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Papers by Rosalinda Calandrelli

Research paper thumbnail of Posterior Fossa Morphometry and Volumetric Analysis in Three Different Groups of Pediatric Patients: Congenital Chiari Type 1 Malformation, Posterior Craniosynostosis and Costello Syndrome

PURPOSE Cerebellar tonsils herniation is caused by heterogeneous group of disorders with differen... more PURPOSE Cerebellar tonsils herniation is caused by heterogeneous group of disorders with different pathogenic origins and it may occur early or late in childhood. In order to better evaluate the mechanism of herniation we performed a morphometric and volumetric analysis of the posterior cranial fossa in three different groups of pediatric patients in which cerebellar tonsil herniation occurs: children with congenital Chiari I malformation, children with posterior craniosynostosis and children with Costello Syndrome. METHOD AND MATERIALS Volumes of the posterior cranial fossa (PCFV) and cerebellum (CV) were assessed on axial T2-weighted MR images in 26 children with congenital Chiari I malformation (average 60 + 24 months), 6 children with Costello Syndrome (average 32+ 22 months) and 10 children with posterior craniosynostosis (average 12+ 11 months). The ratio of PCFV and CV was calculated to obtain the proportion of the PCFV occupied by the CV and to reduce the variability among t...

Research paper thumbnail of Radiological assessment of skull base changes in children with syndromic craniosynostosis: role of “minor” sutures

Neuroradiology, 2014

This study aims to identify the premature synostosis of &... more This study aims to identify the premature synostosis of "major" and "minor" sutures of the four "sutural arches" of the skull and to perform a morphometric analysis in children with syndromic craniosynostosis in order to evaluate changes in the skull base linked with premature suture synostosis. We reviewed multiplanar high-resolution CT images, implemented with 3D reconstructions, from 18 patients with complex syndromic craniosynostosis and compared them with 18 age-matched healthy subjects. We assessed the calvarial sutures and their extension to the skull base, and then we correlated specific types of synostosis with the size, shape and symmetry of the cranial fossae. We found a marked asymmetry of the skull base growth in all patients. The synostotic involvement around the coronal ring caused a reduction in the growth of the anterior and middle fossae. The size of the posterior cranial fossa was related not only to "major" but also to "minor" suture synostosis of the lambdoid and parieto-squamosal arches. Changes in the skull base and craniofacial axis symmetry are due to structural and functional relationships between "major" and "minor" skull sutures, suggesting a structural and functional relationship between the neurocranium and basicranium. The early recognition of prematurely closed skull base sutures may help clinicians and neurosurgeons to establish correct therapeutic approaches.

Research paper thumbnail of Identification of skull base sutures and craniofacial anomalies in children with craniosynostosis: utility of multidetector CT

La radiologia medica, 2014

Craniosynostosis is a condition characterised by the premature fusion of one or more of the crani... more Craniosynostosis is a condition characterised by the premature fusion of one or more of the cranial sutures. The aim of the study was to identify, by multidetector computed tomography (CT), the involvement of vault sutures as well as of the skull base sutures (named "minor" sutures). The latter ones are involved in development of craniofacial and skull base deformities. We retrospectively reviewed 27 children with complex synostosis (n = 21) and anterior synostotic plagiocephaly (n = 6). High-resolution CT images with bone definition algorithm and tridimensional volume rendering reconstructions were assessed. In 27 children we found different sutures involved in the synostotic process, including both major and minor skull suture synostosis, and synostosis of synchondroses. Superior orbital rim deformity, nasal root deviation, anterior endocranial axis deviation (ethmoidal axis) are found in children with coronal arch synostosis, while reduced size of the posterior fossa and Chiari 1 malformation are noted in children with lambdoid arch synostosis. High-resolution CT allows an accurate identification of both "major" and "minor" skull base suture synostosis and it represents the gold standard for the diagnosis of craniostenosis and for planning the proper surgical approach.

Research paper thumbnail of Relevance of bleeding pattern on clinical appearance and outcome in patients with hemorrhagic brain arteriovenous malformations

Journal of the Neurological Sciences, 2013

Although several descriptions of the angioarchitectural features of brain arteriovenous malformat... more Although several descriptions of the angioarchitectural features of brain arteriovenous malformations (AVMs) associated with higher hemorrhagic risk have been reported, the prognostic value of the different bleeding patterns still needs to be elucidated. This study evaluated the influence on clinical appearance and outcome of the parenchymal and non-parenchymal (subarachnoid hemorrhage-SAH-and intraventricular hemorrhage-IVH) bleedings associated with ruptured AVMs. Clinical records and neuroradiological examinations of 30 patients with hemorrhagic AVMs were reviewed in order to identify their angioarchitectural features and the associated bleeding pattern. These data along with demographic characteristics and treatment modality were dichotomized and their relationship with clinical status at admission and follow-up was tested. IVH as well as parenchymal hematomas larger than 20 cm(3) appeared associated with a severe clinical status at admission, whereas SAH involving basal cisterns was significantly associated with unfavorable outcome. Age, sex and angioarchitectural features did not show significant association with the severity of the prognosis. However, none of these bleeding patterns appeared as an independent risk factor of poor outcome at multivariate analysis. In conclusion, our data emphasized the possibility that non-parenchymal bleeding may worsen the outcome of patients with hemorrhagic AVMs.

Research paper thumbnail of Thrombosis of a Developmental Venous Anomaly in Inflammatory Bowel Disease: Case Report and Radiologic Follow-up

Journal of Stroke and Cerebrovascular Diseases, 2013

Developmental venous anomalies (DVAs) are benign embryologic vascular variants, and before the ad... more Developmental venous anomalies (DVAs) are benign embryologic vascular variants, and before the advent of computed tomography and magnetic resonance imaging were supposed to be rare conditions. Usually, DVAs are asymptomatic and accidentally discovered during routine brain imaging studies, but sometimes they can be the cause of disabling neurologic symptoms. We describe the clinical and neuroradiologic follow-up of a 62-year-old man with a history of inflammatory bowel disease (IBD) presenting with new onset epilepsy and intracranial hemorrhage caused by thrombosis of a DVA who fully recovered after treatment with oral anticoagulant therapy. Patients with IBD have an increased risk of thrombosis because of inflammatory activity and the hypercoagulable state. Here we describe the first case of DVA thrombosis in a patient with IBD, and we show clinical and neuroradiologic follow-up after anticoagulant therapy.

Research paper thumbnail of Pulmonary Embolism in a Stroke Patient after Systemic Thrombolysis: Clinical Decisions and Literature Review

Journal of Stroke and Cerebrovascular Diseases, 2013

Pulmonary embolism can be a catastrophic event that can result in early death or serious hemodyna... more Pulmonary embolism can be a catastrophic event that can result in early death or serious hemodynamic dysfunction. The dehydration, immobility, and infections occurring in acute stroke patients puts these patients at risk of developing deep vein thrombosis and pulmonary embolism. Recombinant tissue-type plasminogen activator (rt-PA) is the established therapy for acute ischemic stroke, and its prompt administration results in a better outcome in stroke patients. We describe a 73-year-old man who arrived at the emergency room within 2 hours of acute onset of left hemiparesis who was treated with rt-PA and suffered a pulmonary embolism 3 days after acute stroke therapy. rt-PA is also a current therapy for pulmonary embolism, but an ischemic stroke in the previous 3 months is an absolute contraindication to thrombolysis because of the high risk of intracranial hemorrhage. We discuss clinical and therapeutic decisions and review the current literature.

Research paper thumbnail of Nocardia brain abscess mimicking high-grade necrotic tumor on perfusion MRI

Journal of Clinical Neuroscience, 2010

Differentiating a pyogenic cerebral abscess from a cystic brain tumor can be a challenge when usi... more Differentiating a pyogenic cerebral abscess from a cystic brain tumor can be a challenge when using morphological and functional imaging techniques. Several studies on MRI perfusion-weighted imaging (PWI) have demonstrated that enhancing abscess capsules have lower cerebral blood volume ratios (rCBV) than the enhancing rims of necrotic tumors. We report a 67-year-old male with a Nocardia cerebral abscess showing restricted diffusion in the necrotic center, but high values for rCBV in the enhancing capsule on PWI, therefore mimicking a high-grade necrotic tumor. Differential diagnosis between cerebral abscesses and necrotic tumors is greatly improved by the adjunct of diffusion-weighted imaging (DWI) and PWI to the morphological magnetic resonance findings; yet there is still overlap. That an abscess may show increased rCBV along the capsule, therefore mimicking a hypervascular brain tumor on PWI, should be considered when attempting a radiological diagnosis of a ring-enhancing brain lesion.

Research paper thumbnail of Uveal melanoma: evaluation of extrascleral extension using thin-section MR of the eye with surface coils

La radiologia medica, 2014

Purpose This study was done to evaluate the role of highresolution magnetic resonance (MR) imagin... more Purpose This study was done to evaluate the role of highresolution magnetic resonance (MR) imaging with special surface coils in selecting the correct therapeutic approach (eye enucleation or follow-up) in patients with suspected extrascleral extension of uveal melanoma. Materials and methods This prospective study involved 12 patients with suspected extrascleral extension of uveal melanoma on orbital ultrasonography. All patients were studied with thin-section MR imaging of the eye using surface coils. Results High-resolution MR imaging of the eye excluded extrascleral extension of disease in 8/12 patients: in 4/8 cases it revealed vascular ectasia and in the other 4/8 cases the linear hypointensity of the sclera was unbroken. Seven of these eight patients were followed up by ultrasound, which showed stability of melanoma for at least 2 years, while the last patient underwent enucleation, and the histological examination confirmed the MR diagnosis. In 4/12 patients, high-resolution MR suggested a diagnosis of extrascleral extension of melanoma, which was confirmed at histological examination after enucleation. Conclusion High-resolution MR imaging of the eye with surface coils allowed us to evaluate extrascleral extension of uveal melanoma and choose the correct therapeutic approach, avoiding unnecessary enucleation in 7/12 patients.

Research paper thumbnail of Posterior Fossa Morphometry and Volumetric Analysis in Three Different Groups of Pediatric Patients: Congenital Chiari Type 1 Malformation, Posterior Craniosynostosis and Costello Syndrome

PURPOSE Cerebellar tonsils herniation is caused by heterogeneous group of disorders with differen... more PURPOSE Cerebellar tonsils herniation is caused by heterogeneous group of disorders with different pathogenic origins and it may occur early or late in childhood. In order to better evaluate the mechanism of herniation we performed a morphometric and volumetric analysis of the posterior cranial fossa in three different groups of pediatric patients in which cerebellar tonsil herniation occurs: children with congenital Chiari I malformation, children with posterior craniosynostosis and children with Costello Syndrome. METHOD AND MATERIALS Volumes of the posterior cranial fossa (PCFV) and cerebellum (CV) were assessed on axial T2-weighted MR images in 26 children with congenital Chiari I malformation (average 60 + 24 months), 6 children with Costello Syndrome (average 32+ 22 months) and 10 children with posterior craniosynostosis (average 12+ 11 months). The ratio of PCFV and CV was calculated to obtain the proportion of the PCFV occupied by the CV and to reduce the variability among t...

Research paper thumbnail of Radiological assessment of skull base changes in children with syndromic craniosynostosis: role of “minor” sutures

Neuroradiology, 2014

This study aims to identify the premature synostosis of &... more This study aims to identify the premature synostosis of "major" and "minor" sutures of the four "sutural arches" of the skull and to perform a morphometric analysis in children with syndromic craniosynostosis in order to evaluate changes in the skull base linked with premature suture synostosis. We reviewed multiplanar high-resolution CT images, implemented with 3D reconstructions, from 18 patients with complex syndromic craniosynostosis and compared them with 18 age-matched healthy subjects. We assessed the calvarial sutures and their extension to the skull base, and then we correlated specific types of synostosis with the size, shape and symmetry of the cranial fossae. We found a marked asymmetry of the skull base growth in all patients. The synostotic involvement around the coronal ring caused a reduction in the growth of the anterior and middle fossae. The size of the posterior cranial fossa was related not only to "major" but also to "minor" suture synostosis of the lambdoid and parieto-squamosal arches. Changes in the skull base and craniofacial axis symmetry are due to structural and functional relationships between "major" and "minor" skull sutures, suggesting a structural and functional relationship between the neurocranium and basicranium. The early recognition of prematurely closed skull base sutures may help clinicians and neurosurgeons to establish correct therapeutic approaches.

Research paper thumbnail of Identification of skull base sutures and craniofacial anomalies in children with craniosynostosis: utility of multidetector CT

La radiologia medica, 2014

Craniosynostosis is a condition characterised by the premature fusion of one or more of the crani... more Craniosynostosis is a condition characterised by the premature fusion of one or more of the cranial sutures. The aim of the study was to identify, by multidetector computed tomography (CT), the involvement of vault sutures as well as of the skull base sutures (named "minor" sutures). The latter ones are involved in development of craniofacial and skull base deformities. We retrospectively reviewed 27 children with complex synostosis (n = 21) and anterior synostotic plagiocephaly (n = 6). High-resolution CT images with bone definition algorithm and tridimensional volume rendering reconstructions were assessed. In 27 children we found different sutures involved in the synostotic process, including both major and minor skull suture synostosis, and synostosis of synchondroses. Superior orbital rim deformity, nasal root deviation, anterior endocranial axis deviation (ethmoidal axis) are found in children with coronal arch synostosis, while reduced size of the posterior fossa and Chiari 1 malformation are noted in children with lambdoid arch synostosis. High-resolution CT allows an accurate identification of both "major" and "minor" skull base suture synostosis and it represents the gold standard for the diagnosis of craniostenosis and for planning the proper surgical approach.

Research paper thumbnail of Relevance of bleeding pattern on clinical appearance and outcome in patients with hemorrhagic brain arteriovenous malformations

Journal of the Neurological Sciences, 2013

Although several descriptions of the angioarchitectural features of brain arteriovenous malformat... more Although several descriptions of the angioarchitectural features of brain arteriovenous malformations (AVMs) associated with higher hemorrhagic risk have been reported, the prognostic value of the different bleeding patterns still needs to be elucidated. This study evaluated the influence on clinical appearance and outcome of the parenchymal and non-parenchymal (subarachnoid hemorrhage-SAH-and intraventricular hemorrhage-IVH) bleedings associated with ruptured AVMs. Clinical records and neuroradiological examinations of 30 patients with hemorrhagic AVMs were reviewed in order to identify their angioarchitectural features and the associated bleeding pattern. These data along with demographic characteristics and treatment modality were dichotomized and their relationship with clinical status at admission and follow-up was tested. IVH as well as parenchymal hematomas larger than 20 cm(3) appeared associated with a severe clinical status at admission, whereas SAH involving basal cisterns was significantly associated with unfavorable outcome. Age, sex and angioarchitectural features did not show significant association with the severity of the prognosis. However, none of these bleeding patterns appeared as an independent risk factor of poor outcome at multivariate analysis. In conclusion, our data emphasized the possibility that non-parenchymal bleeding may worsen the outcome of patients with hemorrhagic AVMs.

Research paper thumbnail of Thrombosis of a Developmental Venous Anomaly in Inflammatory Bowel Disease: Case Report and Radiologic Follow-up

Journal of Stroke and Cerebrovascular Diseases, 2013

Developmental venous anomalies (DVAs) are benign embryologic vascular variants, and before the ad... more Developmental venous anomalies (DVAs) are benign embryologic vascular variants, and before the advent of computed tomography and magnetic resonance imaging were supposed to be rare conditions. Usually, DVAs are asymptomatic and accidentally discovered during routine brain imaging studies, but sometimes they can be the cause of disabling neurologic symptoms. We describe the clinical and neuroradiologic follow-up of a 62-year-old man with a history of inflammatory bowel disease (IBD) presenting with new onset epilepsy and intracranial hemorrhage caused by thrombosis of a DVA who fully recovered after treatment with oral anticoagulant therapy. Patients with IBD have an increased risk of thrombosis because of inflammatory activity and the hypercoagulable state. Here we describe the first case of DVA thrombosis in a patient with IBD, and we show clinical and neuroradiologic follow-up after anticoagulant therapy.

Research paper thumbnail of Pulmonary Embolism in a Stroke Patient after Systemic Thrombolysis: Clinical Decisions and Literature Review

Journal of Stroke and Cerebrovascular Diseases, 2013

Pulmonary embolism can be a catastrophic event that can result in early death or serious hemodyna... more Pulmonary embolism can be a catastrophic event that can result in early death or serious hemodynamic dysfunction. The dehydration, immobility, and infections occurring in acute stroke patients puts these patients at risk of developing deep vein thrombosis and pulmonary embolism. Recombinant tissue-type plasminogen activator (rt-PA) is the established therapy for acute ischemic stroke, and its prompt administration results in a better outcome in stroke patients. We describe a 73-year-old man who arrived at the emergency room within 2 hours of acute onset of left hemiparesis who was treated with rt-PA and suffered a pulmonary embolism 3 days after acute stroke therapy. rt-PA is also a current therapy for pulmonary embolism, but an ischemic stroke in the previous 3 months is an absolute contraindication to thrombolysis because of the high risk of intracranial hemorrhage. We discuss clinical and therapeutic decisions and review the current literature.

Research paper thumbnail of Nocardia brain abscess mimicking high-grade necrotic tumor on perfusion MRI

Journal of Clinical Neuroscience, 2010

Differentiating a pyogenic cerebral abscess from a cystic brain tumor can be a challenge when usi... more Differentiating a pyogenic cerebral abscess from a cystic brain tumor can be a challenge when using morphological and functional imaging techniques. Several studies on MRI perfusion-weighted imaging (PWI) have demonstrated that enhancing abscess capsules have lower cerebral blood volume ratios (rCBV) than the enhancing rims of necrotic tumors. We report a 67-year-old male with a Nocardia cerebral abscess showing restricted diffusion in the necrotic center, but high values for rCBV in the enhancing capsule on PWI, therefore mimicking a high-grade necrotic tumor. Differential diagnosis between cerebral abscesses and necrotic tumors is greatly improved by the adjunct of diffusion-weighted imaging (DWI) and PWI to the morphological magnetic resonance findings; yet there is still overlap. That an abscess may show increased rCBV along the capsule, therefore mimicking a hypervascular brain tumor on PWI, should be considered when attempting a radiological diagnosis of a ring-enhancing brain lesion.

Research paper thumbnail of Uveal melanoma: evaluation of extrascleral extension using thin-section MR of the eye with surface coils

La radiologia medica, 2014

Purpose This study was done to evaluate the role of highresolution magnetic resonance (MR) imagin... more Purpose This study was done to evaluate the role of highresolution magnetic resonance (MR) imaging with special surface coils in selecting the correct therapeutic approach (eye enucleation or follow-up) in patients with suspected extrascleral extension of uveal melanoma. Materials and methods This prospective study involved 12 patients with suspected extrascleral extension of uveal melanoma on orbital ultrasonography. All patients were studied with thin-section MR imaging of the eye using surface coils. Results High-resolution MR imaging of the eye excluded extrascleral extension of disease in 8/12 patients: in 4/8 cases it revealed vascular ectasia and in the other 4/8 cases the linear hypointensity of the sclera was unbroken. Seven of these eight patients were followed up by ultrasound, which showed stability of melanoma for at least 2 years, while the last patient underwent enucleation, and the histological examination confirmed the MR diagnosis. In 4/12 patients, high-resolution MR suggested a diagnosis of extrascleral extension of melanoma, which was confirmed at histological examination after enucleation. Conclusion High-resolution MR imaging of the eye with surface coils allowed us to evaluate extrascleral extension of uveal melanoma and choose the correct therapeutic approach, avoiding unnecessary enucleation in 7/12 patients.