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Biomedical subjects

A Bozzao

Publications and source records attributed to A Bozzao.

At least 37 records · Page 2Linked to original sources
PubMed1995

Human recombinant interferon beta in the treatment of relapsing-remitting multiple sclerosis: preliminary observations.

An open comparative, randomized trial with recombinant human interferon beta (r-hIFN-beta) involving 72 patients with clinically definite and/or laboratory-supported relapsing-remitting MS is in progress at the University 'La Sapienza' and at the S. Camillo Hospital of Rome. After a 6 month period of clinical and magnetic resonance imaging (MRI) observation (baseline findings), patients are randomly assigned to one of two treatment groups receiving 3 or 9 MIU of recombinant human IFN-beta (r-hIFN-beta) self-administered by subcutaneous injection three times a week for 6 months. All patients are examined by MRI with and without gadolinium (Gd-DTPA) every 4 weeks for the entire duration of the study (12 months). The main aim of the study is to test the hypothesis that r-hIFN-beta may halt or slow the progression of the disease by showing a significant reduction in MRI activity. This will be achieved by comparing pre and post-treatment periods. As an additional clinical end point, the exacerbation rate during these two periods will be compared. This study began in June 1993 and the final analysis of MRI data is planned for the spring of 1995.

Adjuvants, Immunologic↗
PubMed1994

A controlled trial of mitoxantrone in multiple sclerosis: serial MRI evaluation at one year.

We present the results of a randomized double-blinded placebo controlled, multicenter trial, of low-dose mitoxantrone (MX), after one year, in 25 patients with relapsing-remitting multiple sclerosis, who had serial enhanced magnetic resonance imaging (MRI). Treatment groups were balanced for age, gender, duration of illness and neurological disability. Five of the 13 MX patients and 10 of the 12 placebo patients had exacerbations during treatment (p < 0.02). The mean change in the extended disability status scale was not significantly different between the MX and placebo treatment groups. Serial Gadolinium-DTPA enhanced MRI detected no significant difference between the MX treated and placebo groups in the mean total number of new, enlarging, or Gadolinium-DTPA enhancing lesions; there was a trend toward a reduction of new, enlarging and Gadolinium-DTPA enhancing lesions in MX patients. Despite this ameliorating effect, the results indicate that serial Gadolinium-DTPA enhanced MRI, performed over one year in a limited number of patients, could not provide conclusive evidence for a role of MX therapy in relapsing-remitting multiple sclerosis.

Adolescent↗
PubMed1994

No differences in corpus callosum size by sex and aging. A quantitative study using magnetic resonance imaging.

To identify normal variations in the magnetic resonance imaging appearances of the corpus callosum with regard to sex and age, a prospective study was performed in 130 normal subjects. Callosal measurements were calculated by morphometric analysis. There were no significant sex differences in corpus callosum area or the callosal subregions. The absolute area did not decrease significantly with aging in normal males or females. However, age-related changes of callosal configuration were shown by a decrease in the ratio of the rostrum and genu to the splenium.

Adolescent↗
PubMed1992

Planum temporale in schizophrenia: a magnetic resonance study.

Magnetic resonance imaging (MRI) scans were used to examine the size and asymmetry of the planum temporale (PT) in 20 schizophrenic patients and 12 strictly matched healthy volunteers. PT lengths from coronal sections were measured and then summed to obtain an estimate of their areas. Schizophrenics showed the lack of the physiological PT area asymmetry evidenced in the control sample and a statistically significant diagnosis by side interaction was observed (F = 4.96; p less than 0.05). The study of PT asymmetry could permit us to better analyse the role of laterality in the pathophysiology of schizophrenia.

Adult↗
PubMed1992

Lumbar disk herniation: MR imaging assessment of natural history in patients treated without surgery.

The aim of this study was to evaluate the evolution of lumbar disk herniation in patients treated without surgery. Sixty-nine patients with a lumbar disk herniation proved at magnetic resonance (MR) imaging underwent a follow-up MR imaging study. The disk herniations evaluated during both MR imaging examinations were measured and classified into four categories according to the change in size that occurred. The patients were also divided into three clinical classes on the basis of the clinical outcome. Sixty-three percent of the patients showed a reduction of disk herniation of more than 30% (48% had a reduction of more than 70%), while only 8% demonstrated worsening of the clinical picture. These findings suggest that lumbar disk herniation may be primarily a medical (nonsurgical) disease and that MR imaging could play an important role in management of and research into the disorder.

Adult↗
PubMed1991

[Magnetic resonance in condylo-meniscal incoordination pathology of the temporomandibular joint. Indications, diagnostic accuracy and optimization of study techniques].

Up to 28% of the population is affected with pathologic conditions involving the temporo-mandibular joint (TMJ), most of them related to uncoordinated disk motion. To date, these pathologies have been evaluated by means of different diagnostic tools, the latest of which is MR imaging. The authors examined with low-field (0.2 T) MR imaging 15 normal volunteers and 20 patients suffering from temporo-mandibular joint disk dysfunction. The study was aimed at comparing the results obtained with low-field MR imaging with literature data on the subject. A standard technique employing low-field MR imaging was also assessed on normal subjects for the management of the patients with TMJ pathologies. The pathological TMJs were then evaluated, each of them examined with arthroscopy and/or surgery. MR imaging was capable of identifying the meniscus in all cases, together with its morphology, signal, location, and movements during opening and closure of the mouth. Disk dislocation were always correctly identified. The point of re-capture in the cases with spontaneous reduction was easily ascertained. The simultaneous imaging of both the right and the left TMJs allowed the joints to be compared at the same degree of mouth opening, so that motion asymmetries were easily detected. High agreement was observed between MR, arthroscopic and surgical findings. Our experience points to MR imaging as the examination of choice in the evaluation of TMJ diseases. The best results are obtained when both joints are simultaneously imaged, on the sagittal and coronal planes, during opening and closure of the mouth, and possibly in a cine-animation display format.

Arthroscopy↗
PubMed1990

MR imaging of degenerative disorders of brainstem and cerebellum.

In pathologies such as progressive ataxias, clinical criteria are often not enough to provide the correct diagnosis. Therefore, we studied by means of MRI 30 normal volunteers and 19 patients affected by different progressive ataxias, diagnosed by typical standards. On all the subjects measurements were performed in order to identify normal and pathological ranges. Our experience confirms that typical involvement can be detected in the different kinds of progressive ataxias. Peculiar compromissions were found in spinocerebellar diseases, able to differentiate them from the forms mostly involving the cerebellum and brainstem. The differentiation between typical Friedreich and non-Friedreich diseases can also be suggested in most cases.

Adolescent↗
PubMed1990

Wernicke encephalopathy: MR findings in five patients.

Wernicke encephalopathy is a disease usually related to chronic alcoholism. The clinical diagnosis is often difficult to establish, and CT is unable to provide specific findings. MR follow-up studies in five patients affected by Wernicke encephalopathy were performed with the aim of establishing the sensitivity of MR in depicting the typical diencephalic/mesencephalic lesions. All subjects had MR imaging in the acute phase of the disease and were reexamined 6-12 months later, at which time they were in good health. Three of them also had CT scanning. On MR, hyperintense areas seen surrounding the third ventricle and aqueduct during the acute phase of the disease had disappeared or diminished on follow-up evaluations. The third ventricle and aqueduct were dilated. We suggest that these findings reflect the natural evolution of Wernicke encephalopathy. The MR findings in Wernicke encephalopathy enable early diagnosis of the disease, which has a positive effect on both treatment and prognosis.

Adult↗
PubMed1990

[Clinically manifest or silent primary and secondary syringomyelia. The magnetic resonance findings].

The MR scans were retrospectively reviewed of 40 patients who had been diagnosed as having syringomyelia. Our results demonstrate that syringomyelia can be found in asymptomatic patients as well as in many with atypical symptomatology. Our study stresses MR efficacy in investigating this pathologic condition. As a matter of fact, MR allowed us to visualize the cavity, its extension, the eventual association with Arnold Chiari type-I malformation and/or syringobulbia. In all cases cord enlargement and the presence of septations could also be demonstrated. In most cases the possible pathogenesis of syringomyelia could also be supposed.

Adolescent↗
PubMed1989

Ischaemic supratentorial stroke: angiographic findings in patients examined in the very early phase.

Eighty patients were studied by angiography within 6 h of an ischaemic stroke. Angiography was carried out with digital equipment and was usually limited to the vascular territory responsible for the neurological deficits. In 12 of 19 patients with internal carotid occlusion, the contralateral side was also studied. The angiographic abnormalities were classified as extracranial, intracranial, and combined extra and intracranial. The data show a high incidence (66%) of occlusive pathology of intracranial arteries, either isolated or associated with a significant presence of a potential embolic source (85%), and a high incidence of carotid occlusions located at the cervical segment (8 of 19). These observations suggest that most strokes are occlusive in origin.

Aged↗
PubMed1989

Occlusion of the extracranial internal carotid artery in the acute stroke; angiographic findings within 6 hours.

We studied by angiography 80 patients within 6 hours from the onset of symptoms of supratentorial ischaemic stroke. Occlusion of the internal carotid artery in the extracranial segment was found in 19 patients, at the bifurcation in 11 and at the cervical level in 8. While in the chronic phase of stroke, internal carotid artery occlusion in the cervical segment is an uncommon angiographic finding, we found a high frequency of occlusion at this level (8 out of 19) in our patients. Cervical segment occlusion may be due to a dissecting aneurysm or to an intracranial carotid artery occlusion (embolic or atherothrombotic) with subsequent migration of the clot down to this level. A direct embolic occlusion may be postulated as well.

Aged↗
PubMed1989

Early collateral blood supply and late parenchymal brain damage in patients with middle cerebral artery occlusion.

We angiographically studied 80 patients within 6 hours after the onset of ischemic supratentorial infarction. From this group we selected 36 patients with middle cerebral artery occlusion who survived. In these 36 patients, we compared the presence of a collateral blood supply during the early phase with the extent of final parenchymal brain damage obtained by computed tomography 3 months after the event. The presence of a collateral circulation during the first few hours after the stroke reduced the size of the final parenchymal brain damage in patients with middle cerebral artery stem-trunk occlusion. The collateral blood supply was more efficient in patients who had no significant stenosing lesions of the extracranial internal carotid artery. Our data confirm that the lenticulostriate arteries are end arteries not supplied by collateral blood vessels and suggest that lesions formerly thought to be caused by hemodynamic mechanisms (watershed infarcts) or arteriolar lesions (lacunar infarcts) may be due to middle cerebral artery occlusions.

Aged↗
PubMedDate not supplied

Follow-up MR studies in Hallervorden-Spatz disease.

Follow-up magnetic resonance (MR) studies of a child affected by Hallervorden-Spatz disease were performed over a period of 3 years. The hyperintense pallidi shown in the first examination changed to a mixed intensity target-like appearance. All the patterns observed in our patient have been described in the literature but in different subjects. Our data show these findings to be different manifestations of the same disease during its evolution.

Basal Ganglia Diseases↗
PubMedDate not supplied

Does postcontrast MR enhancement in lumbar disk herniation have prognostic value?

OBJECTIVE: The aim of our study was to evaluate the prognostic value, if any, of Gd-enhanced MR in patients with lumbar disk herniation. MATERIALS AND METHODS: Fifteen patients undergoing conservative treatment for acute lumbar disk herniation were included in a prospective Gd-DTPA follow-up MR study. In each patient, the size of the herniation was measured, and, according to the changes in pathology that occurred, patients were divided into four categories. In addition, on the basis of the clinical outcome patients were divided into three classes. RESULTS: In 11 of 15 patients, MR performed in the acute phase of the disease showed Gd-DTPA enhancement around the herniated disk; in all cases, disk herniation was markedly reduced at follow-up MRIs. The clinical outcome was good. In the remaining four cases, no enhancement was evident in the acute phase or at follow-up MRIs; no modification in the size of disk herniation was demonstrated at follow-up in two. Symptoms were unchanged in two patients and mildly improved in one. CONCLUSION: Epidural enhancement, which is likely related to an inflammatory process, seems to play a role in the modification of the size of disk herniation.

Acute Disease↗
PubMedDate not supplied

[Non-invasive assessment of epiaortic vessels. Comparison of magnetic resonance angiography with gadolinium, spiral computerized tomography angiography, and digital angiography].

PURPOSE: The aim of the study was to compare gadolinium-enhanced MRA (Gd-MRA), Computed Tomography angiography (CTA) and digital subtraction angiography (DSA) in the evaluation of carotid stenosis. MATERIAL AND METHODS: Thirty patients with US-proven internal carotid artery stenosis over 50%, underwent Gd-MRA, CTA and DSA. Gd-MRA was acquired using the keyhole technique. RESULTS: The overall agreement was 90% for Gd-MRA and 93% for CTA. Gd-MRA and CTA overestimated 5 and 4 cases of mild stenosis and 1 case each of moderate stenosis, respectively. Gd-MRA better delineated ulcerated plaques, tandem lesions and pseudo-occlusions. DISCUSSION AND CONCLUSIONS: Because of the high speed acquisition breath-hold is no longer necessary for Gd-MRA and more delayed phases were analysed when necessary. The main limitation of Gd-MRA was represented by insufficient volume coverage that allowed the visualisation of supraaortic vessels from the arch only in 57% of the cases. Calcified plaques were very well detected by CTA and not by Gd-MRA. In our experience Gd-MRA represents the second step non invasive tool in patients with US-proven carotid stenosis. This leads to avoid conventional angiography in most cases.

Angiography, Digital Subtraction↗
PubMedDate not supplied

Diffusion and perfusion MR imaging in cases of Alzheimer's disease: correlations with cortical atrophy and lesion load.

BACKGROUND AND PURPOSE: Perfusion and diffusion-weighted MR imaging are powerful new imaging techniques for evaluating tissue pathophysiology in association with many neurologic disorders, such as neurodegenerative diseases. The purpose of our study was to evaluate the sensitivity and specificity of dynamic susceptibility contrast-enhanced MR imaging and diffusion-weighted MR imaging in cases of Alzheimer's disease and to assess the role of atrophy in the quantification of cortical perfusion. METHODS: Thirty-nine participants were studied: 18 patients with moderate cognitive impairment with probable Alzheimer's disease, 16 patients with mild impairment with possible or probable Alzheimer's disease, and 15 group-matched elderly healthy comparison volunteers. Relative values of temporoparietal, sensorimotor, and hippocampal regional cerebral blood volume (rCBV) were measured as a percentage of cerebellar rCBV, and group classification was assessed with logistic regression. Brain atrophy was used as a covariate to assess its role in rCBV quantification. Regions of interest placed on orientation-independent apparent diffusion coefficient maps allowed the calculation of apparent diffusion coefficient values and relative anisotropic indices of the head of the caudate nuclei, thalamus, parietal, frontal, and hippocampal cortices bilaterally, genu and splenium of corpus callosum, and anterior and posterior white matter in patients with Alzheimer's disease and in control volunteers. RESULTS: Temporoparietal rCBV ratios were reduced bilaterally in the patients with Alzheimer's disease. Sensitivity was 91% in moderately affected patients with Alzheimer's disease and 90% in patients with mild cases. Specificity was 87% in healthy comparison volunteers. Lower values of sensitivity and specificity were obtained for sensorimotor (73%, 50%, and 67%, respectively) and hippocampal cortices (80%, 80%, and 65%, respectively). Using brain atrophy as a covariate, patients with Alzheimer's disease still showed a statistically significant reduction of rCBV compared with control volunteers. Diffusion-weighted MR imaging analysis only showed a trend, with no statistic significance, of reduction of anisotropy in posterior white matter. CONCLUSION: Dynamic susceptibility contrast-enhanced MR imaging of rCBV may be an alternative to nuclear medicine imaging for the evaluation of patients with Alzheimer's disease. When brain atrophy is used as a covariate, differences in rCBV still persist between patients with Alzheimer's disease and control volunteers, suggesting that perfusion impairment is unrelated to atrophy. No significant results for either white or gray matter were obtained using diffusion-weighted MR imaging.

Aged↗
PubMedDate not supplied

Cerebral hemodynamics in asymptomatic patients with internal carotid artery occlusion: a dynamic susceptibility contrast MR and transcranial Doppler study.

BACKGROUND AND PURPOSE: Perfusion imaging with dynamic susceptibility contrast MR imaging (DSC-MRI) has been used to evaluate hemodynamic status in patients with symptomatic occlusive cerebrovascular disease. The aim of the present study was to determine the hemodynamic changes occurring in asymptomatic patients with unilateral internal carotid artery (ICA) occlusion by use of DSC-MRI with transcranial Doppler (TCD) measurement of the breath-holding index (BHI). METHODS: Nine patients with asymptomatic unilateral ICA occlusion underwent DSC-MRI and TCD examination. One patient was excluded from final analysis because of severe movement artifacts. On a separate workstation, regional cerebral blood volume (rCBV), regional cerebral blood flow (rCBF), and regional mean time to peak (rMTT) were calculated on the basis of signal decay rate during the passage of gadolinium bolus through the sampled volume in the territory of the middle cerebral artery. TCD-BHI was calculated in all patients. Six healthy subjects underwent the same MR protocol as the patients. RESULTS: Compared with control subjects, patients with unilateral ICA occlusions had hemodynamic changes in the ipsilateral hemisphere: rCBF was significantly lower than in controls (P <.01), and r MTT was significantly increased in both white (WM) and gray matter (GM) in the affected side (WM: P <.01; GM: P <.05). No statistically significant difference in rCBV was found in the group of patients (occluded versus contralateral, P <.1) or between the patient and control groups (occluded side versus controls, P <.1). The correlation of rCBV and BHI showed a strong relation of the two variables, showing a decrease of the latter when the former increased. CONCLUSION: DSC-MRI is a valuable tool for measuring hemodynamic changes in the presence of carotid disease with hemodynamic impairment. In our opinion, hemodynamic changes and efficiency of collateral pathways can be evaluated in occlusive carotid disease by using paired measurement of BHI and DSC-MRI. In the patient group, MR-determined rCBV and TCD-determined BHI showed a significant inverse correlation, suggesting similar significance of the two indices.

Angiography, Digital Subtraction↗