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Sastre-Garriga J, Vidal-Jordana A, Toosy AT, Enzinger C, Granziera C, Frederiksen J, Ciccarelli O, Filippi M, Montalban X, Tintore M, Pareto D, Rovira À. Value of Optic Nerve MRI in Multiple Sclerosis Clinical Management: A MAGNIMS Position Paper and Future Perspectives. Neurology 2024; 103:e209677. [PMID: 39018513 PMCID: PMC11271394 DOI: 10.1212/wnl.0000000000209677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Accepted: 05/17/2024] [Indexed: 07/19/2024] Open
Abstract
The optic nerve is frequently involved in multiple sclerosis (MS). However, MRI of the optic nerve is considered optional in the differential diagnosis of optic neuropathy symptoms either at presentation or in established MS. In addition, unlike spinal cord imaging in comparable scenarios, no role is currently recommended for optic nerve MRI in patients presenting with optic neuritis for its confirmation, to plan therapeutic strategy, within the MS diagnostic framework, nor for the detection of subclinical activity in established MS. In this article, evidence related to these 3 aspects will be summarized and gaps in knowledge will be highlighted, including (1) the acquisition challenges and novel sequences that assess pathologic changes within the anterior visual pathways; (2) the clinical implications of quantitative magnetic resonance studies of the optic nerve, focusing on atrophy measures, magnetization transfer, and diffusion tensor imaging; and (3) the relevant clinical studies performed to date. Finally, an algorithm for the application of optic nerve MRI will be proposed to guide future studies aimed at addressing our knowledge gaps.
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Affiliation(s)
- Jaume Sastre-Garriga
- From the Department of Neurology (J.S.-G., A.V.-J., X.M., M.T.), Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; NMR Research Unit (A.T.T.), Queen Square MS Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, University College London, United Kingdom; Department of Neurology and Division of Neuroradiology (C.E.), Vascular and Interventional Radiology, Department of Radiology, Medical University of Graz, Austria; Translational Imaging in Neurology (ThINk) Basel (C.G.), Department of Biomedical Engineering, Faculty of Medicine, University of Basel; Neurology Department and MS Center, University Hospital Basel, Switzerland; Department of Neurology (J.F.), Rigshospitalet-Glostrup, and University of Copenhagen, Glostrup, Denmark; NMR Research Unit (O.C.), Queen Square MS Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, University College London; National Institute for Health Research (NIHR) University College London Hospitals (UCLH) Biomedical Research, United Kingdom; Neuroimaging Research Unit (M.F.), Division of Neuroscience and Neurology Unit, IRCCS San Raffaele Scientific Institute; Vita-Salute San Raffaele University, Milan, Italy; and Section of Neuroradiology and Magnetic Resonance Unit (D.P., A.R.), Department of Radiology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain
| | - Angela Vidal-Jordana
- From the Department of Neurology (J.S.-G., A.V.-J., X.M., M.T.), Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; NMR Research Unit (A.T.T.), Queen Square MS Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, University College London, United Kingdom; Department of Neurology and Division of Neuroradiology (C.E.), Vascular and Interventional Radiology, Department of Radiology, Medical University of Graz, Austria; Translational Imaging in Neurology (ThINk) Basel (C.G.), Department of Biomedical Engineering, Faculty of Medicine, University of Basel; Neurology Department and MS Center, University Hospital Basel, Switzerland; Department of Neurology (J.F.), Rigshospitalet-Glostrup, and University of Copenhagen, Glostrup, Denmark; NMR Research Unit (O.C.), Queen Square MS Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, University College London; National Institute for Health Research (NIHR) University College London Hospitals (UCLH) Biomedical Research, United Kingdom; Neuroimaging Research Unit (M.F.), Division of Neuroscience and Neurology Unit, IRCCS San Raffaele Scientific Institute; Vita-Salute San Raffaele University, Milan, Italy; and Section of Neuroradiology and Magnetic Resonance Unit (D.P., A.R.), Department of Radiology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain
| | - Ahmed T Toosy
- From the Department of Neurology (J.S.-G., A.V.-J., X.M., M.T.), Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; NMR Research Unit (A.T.T.), Queen Square MS Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, University College London, United Kingdom; Department of Neurology and Division of Neuroradiology (C.E.), Vascular and Interventional Radiology, Department of Radiology, Medical University of Graz, Austria; Translational Imaging in Neurology (ThINk) Basel (C.G.), Department of Biomedical Engineering, Faculty of Medicine, University of Basel; Neurology Department and MS Center, University Hospital Basel, Switzerland; Department of Neurology (J.F.), Rigshospitalet-Glostrup, and University of Copenhagen, Glostrup, Denmark; NMR Research Unit (O.C.), Queen Square MS Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, University College London; National Institute for Health Research (NIHR) University College London Hospitals (UCLH) Biomedical Research, United Kingdom; Neuroimaging Research Unit (M.F.), Division of Neuroscience and Neurology Unit, IRCCS San Raffaele Scientific Institute; Vita-Salute San Raffaele University, Milan, Italy; and Section of Neuroradiology and Magnetic Resonance Unit (D.P., A.R.), Department of Radiology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain
| | - Christian Enzinger
- From the Department of Neurology (J.S.-G., A.V.-J., X.M., M.T.), Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; NMR Research Unit (A.T.T.), Queen Square MS Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, University College London, United Kingdom; Department of Neurology and Division of Neuroradiology (C.E.), Vascular and Interventional Radiology, Department of Radiology, Medical University of Graz, Austria; Translational Imaging in Neurology (ThINk) Basel (C.G.), Department of Biomedical Engineering, Faculty of Medicine, University of Basel; Neurology Department and MS Center, University Hospital Basel, Switzerland; Department of Neurology (J.F.), Rigshospitalet-Glostrup, and University of Copenhagen, Glostrup, Denmark; NMR Research Unit (O.C.), Queen Square MS Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, University College London; National Institute for Health Research (NIHR) University College London Hospitals (UCLH) Biomedical Research, United Kingdom; Neuroimaging Research Unit (M.F.), Division of Neuroscience and Neurology Unit, IRCCS San Raffaele Scientific Institute; Vita-Salute San Raffaele University, Milan, Italy; and Section of Neuroradiology and Magnetic Resonance Unit (D.P., A.R.), Department of Radiology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain
| | - Cristina Granziera
- From the Department of Neurology (J.S.-G., A.V.-J., X.M., M.T.), Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; NMR Research Unit (A.T.T.), Queen Square MS Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, University College London, United Kingdom; Department of Neurology and Division of Neuroradiology (C.E.), Vascular and Interventional Radiology, Department of Radiology, Medical University of Graz, Austria; Translational Imaging in Neurology (ThINk) Basel (C.G.), Department of Biomedical Engineering, Faculty of Medicine, University of Basel; Neurology Department and MS Center, University Hospital Basel, Switzerland; Department of Neurology (J.F.), Rigshospitalet-Glostrup, and University of Copenhagen, Glostrup, Denmark; NMR Research Unit (O.C.), Queen Square MS Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, University College London; National Institute for Health Research (NIHR) University College London Hospitals (UCLH) Biomedical Research, United Kingdom; Neuroimaging Research Unit (M.F.), Division of Neuroscience and Neurology Unit, IRCCS San Raffaele Scientific Institute; Vita-Salute San Raffaele University, Milan, Italy; and Section of Neuroradiology and Magnetic Resonance Unit (D.P., A.R.), Department of Radiology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain
| | - Jette Frederiksen
- From the Department of Neurology (J.S.-G., A.V.-J., X.M., M.T.), Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; NMR Research Unit (A.T.T.), Queen Square MS Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, University College London, United Kingdom; Department of Neurology and Division of Neuroradiology (C.E.), Vascular and Interventional Radiology, Department of Radiology, Medical University of Graz, Austria; Translational Imaging in Neurology (ThINk) Basel (C.G.), Department of Biomedical Engineering, Faculty of Medicine, University of Basel; Neurology Department and MS Center, University Hospital Basel, Switzerland; Department of Neurology (J.F.), Rigshospitalet-Glostrup, and University of Copenhagen, Glostrup, Denmark; NMR Research Unit (O.C.), Queen Square MS Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, University College London; National Institute for Health Research (NIHR) University College London Hospitals (UCLH) Biomedical Research, United Kingdom; Neuroimaging Research Unit (M.F.), Division of Neuroscience and Neurology Unit, IRCCS San Raffaele Scientific Institute; Vita-Salute San Raffaele University, Milan, Italy; and Section of Neuroradiology and Magnetic Resonance Unit (D.P., A.R.), Department of Radiology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain
| | - Olga Ciccarelli
- From the Department of Neurology (J.S.-G., A.V.-J., X.M., M.T.), Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; NMR Research Unit (A.T.T.), Queen Square MS Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, University College London, United Kingdom; Department of Neurology and Division of Neuroradiology (C.E.), Vascular and Interventional Radiology, Department of Radiology, Medical University of Graz, Austria; Translational Imaging in Neurology (ThINk) Basel (C.G.), Department of Biomedical Engineering, Faculty of Medicine, University of Basel; Neurology Department and MS Center, University Hospital Basel, Switzerland; Department of Neurology (J.F.), Rigshospitalet-Glostrup, and University of Copenhagen, Glostrup, Denmark; NMR Research Unit (O.C.), Queen Square MS Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, University College London; National Institute for Health Research (NIHR) University College London Hospitals (UCLH) Biomedical Research, United Kingdom; Neuroimaging Research Unit (M.F.), Division of Neuroscience and Neurology Unit, IRCCS San Raffaele Scientific Institute; Vita-Salute San Raffaele University, Milan, Italy; and Section of Neuroradiology and Magnetic Resonance Unit (D.P., A.R.), Department of Radiology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain
| | - Massimo Filippi
- From the Department of Neurology (J.S.-G., A.V.-J., X.M., M.T.), Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; NMR Research Unit (A.T.T.), Queen Square MS Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, University College London, United Kingdom; Department of Neurology and Division of Neuroradiology (C.E.), Vascular and Interventional Radiology, Department of Radiology, Medical University of Graz, Austria; Translational Imaging in Neurology (ThINk) Basel (C.G.), Department of Biomedical Engineering, Faculty of Medicine, University of Basel; Neurology Department and MS Center, University Hospital Basel, Switzerland; Department of Neurology (J.F.), Rigshospitalet-Glostrup, and University of Copenhagen, Glostrup, Denmark; NMR Research Unit (O.C.), Queen Square MS Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, University College London; National Institute for Health Research (NIHR) University College London Hospitals (UCLH) Biomedical Research, United Kingdom; Neuroimaging Research Unit (M.F.), Division of Neuroscience and Neurology Unit, IRCCS San Raffaele Scientific Institute; Vita-Salute San Raffaele University, Milan, Italy; and Section of Neuroradiology and Magnetic Resonance Unit (D.P., A.R.), Department of Radiology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain
| | - Xavier Montalban
- From the Department of Neurology (J.S.-G., A.V.-J., X.M., M.T.), Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; NMR Research Unit (A.T.T.), Queen Square MS Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, University College London, United Kingdom; Department of Neurology and Division of Neuroradiology (C.E.), Vascular and Interventional Radiology, Department of Radiology, Medical University of Graz, Austria; Translational Imaging in Neurology (ThINk) Basel (C.G.), Department of Biomedical Engineering, Faculty of Medicine, University of Basel; Neurology Department and MS Center, University Hospital Basel, Switzerland; Department of Neurology (J.F.), Rigshospitalet-Glostrup, and University of Copenhagen, Glostrup, Denmark; NMR Research Unit (O.C.), Queen Square MS Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, University College London; National Institute for Health Research (NIHR) University College London Hospitals (UCLH) Biomedical Research, United Kingdom; Neuroimaging Research Unit (M.F.), Division of Neuroscience and Neurology Unit, IRCCS San Raffaele Scientific Institute; Vita-Salute San Raffaele University, Milan, Italy; and Section of Neuroradiology and Magnetic Resonance Unit (D.P., A.R.), Department of Radiology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain
| | - Mar Tintore
- From the Department of Neurology (J.S.-G., A.V.-J., X.M., M.T.), Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; NMR Research Unit (A.T.T.), Queen Square MS Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, University College London, United Kingdom; Department of Neurology and Division of Neuroradiology (C.E.), Vascular and Interventional Radiology, Department of Radiology, Medical University of Graz, Austria; Translational Imaging in Neurology (ThINk) Basel (C.G.), Department of Biomedical Engineering, Faculty of Medicine, University of Basel; Neurology Department and MS Center, University Hospital Basel, Switzerland; Department of Neurology (J.F.), Rigshospitalet-Glostrup, and University of Copenhagen, Glostrup, Denmark; NMR Research Unit (O.C.), Queen Square MS Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, University College London; National Institute for Health Research (NIHR) University College London Hospitals (UCLH) Biomedical Research, United Kingdom; Neuroimaging Research Unit (M.F.), Division of Neuroscience and Neurology Unit, IRCCS San Raffaele Scientific Institute; Vita-Salute San Raffaele University, Milan, Italy; and Section of Neuroradiology and Magnetic Resonance Unit (D.P., A.R.), Department of Radiology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain
| | - Deborah Pareto
- From the Department of Neurology (J.S.-G., A.V.-J., X.M., M.T.), Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; NMR Research Unit (A.T.T.), Queen Square MS Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, University College London, United Kingdom; Department of Neurology and Division of Neuroradiology (C.E.), Vascular and Interventional Radiology, Department of Radiology, Medical University of Graz, Austria; Translational Imaging in Neurology (ThINk) Basel (C.G.), Department of Biomedical Engineering, Faculty of Medicine, University of Basel; Neurology Department and MS Center, University Hospital Basel, Switzerland; Department of Neurology (J.F.), Rigshospitalet-Glostrup, and University of Copenhagen, Glostrup, Denmark; NMR Research Unit (O.C.), Queen Square MS Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, University College London; National Institute for Health Research (NIHR) University College London Hospitals (UCLH) Biomedical Research, United Kingdom; Neuroimaging Research Unit (M.F.), Division of Neuroscience and Neurology Unit, IRCCS San Raffaele Scientific Institute; Vita-Salute San Raffaele University, Milan, Italy; and Section of Neuroradiology and Magnetic Resonance Unit (D.P., A.R.), Department of Radiology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain
| | - Àlex Rovira
- From the Department of Neurology (J.S.-G., A.V.-J., X.M., M.T.), Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; NMR Research Unit (A.T.T.), Queen Square MS Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, University College London, United Kingdom; Department of Neurology and Division of Neuroradiology (C.E.), Vascular and Interventional Radiology, Department of Radiology, Medical University of Graz, Austria; Translational Imaging in Neurology (ThINk) Basel (C.G.), Department of Biomedical Engineering, Faculty of Medicine, University of Basel; Neurology Department and MS Center, University Hospital Basel, Switzerland; Department of Neurology (J.F.), Rigshospitalet-Glostrup, and University of Copenhagen, Glostrup, Denmark; NMR Research Unit (O.C.), Queen Square MS Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, University College London; National Institute for Health Research (NIHR) University College London Hospitals (UCLH) Biomedical Research, United Kingdom; Neuroimaging Research Unit (M.F.), Division of Neuroscience and Neurology Unit, IRCCS San Raffaele Scientific Institute; Vita-Salute San Raffaele University, Milan, Italy; and Section of Neuroradiology and Magnetic Resonance Unit (D.P., A.R.), Department of Radiology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain
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Danieli L, Roccatagliata L, Distefano D, Prodi E, Riccitelli GC, Diociasi A, Carmisciano L, Cianfoni A, Bartalena T, Kaelin-Lang A, Gobbi C, Zecca C, Pravatà E. Nonlesional Sources of Contrast Enhancement on Postgadolinium "Black-Blood" 3D T1-SPACE Images in Patients with Multiple Sclerosis. AJNR Am J Neuroradiol 2022; 43:872-880. [PMID: 35618421 DOI: 10.3174/ajnr.a7529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Accepted: 04/08/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE We hypothesized that 3D T1-TSE "black-blood" images may carry an increased risk of contrast-enhancing lesion misdiagnosis in patients with MS because of the misinterpretation of intraparenchymal vein enhancement. Thus, the occurrence of true-positive and false-positive findings was compared between standard MPRAGE and volumetric interpolated brain examination techniques. MATERIALS AND METHODS Sampling perfection with application-optimized contrasts by using different flip-angle evolution (SPACE) images obtained from 232 patients with MS, clinically isolated syndrome, or radiologically isolated syndrome were compared with standard MPRAGE and volumetric interpolated brain examination images. The intraparenchymal vein contrast-to-noise ratio was estimated at the level of the thalami. Contrast-enhancing lesions were blindly detected by 2 expert readers and 1 beginner reader. True- and false-positives were determined by senior readers' consensus. True-positive and false-positive frequency differences and patient-level diagnosis probability were tested with the McNemar test and OR. The contrast-to-noise ratio and morphology were compared using the Mann-Whitney U and χ2 tests. RESULTS The intraparenchymal vein contrast-to-noise ratio was higher in SPACE than in MPRAGE and volumetric interpolated brain examination images (P < .001, both). There were 66 true-positives and 74 false-positives overall. SPACE detected more true-positive and false-positive results (P range < .001-.07) but did not increase the patient's true-positive likelihood (OR = 1 1.29, P = .478-1). However, the false-positive likelihood was increased (OR = 3.03-3.55, P = .008-.027). Venous-origin false-positives (n = 59) with contrast-to-noise ratio and morphology features similar to small-sized (≤14 mm3 P = .544) true-positives occurred more frequently in SPACE images (P < .001). CONCLUSIONS Small intraparenchymal veins may confound the diagnosis of enhancing lesions on postgadolinium black-blood SPACE images.
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Affiliation(s)
- L Danieli
- Form the Department of Neuroradiology (L.D., E. Prodi, A.C., E. Pravatà), Neurocenter of Southern Switzerland, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - L Roccatagliata
- Dipartimento di Scienze della Salute (L.R., A.D.), Università degli Studi di Genova, Genoa, Italy
| | | | - E Prodi
- Form the Department of Neuroradiology (L.D., E. Prodi, A.C., E. Pravatà), Neurocenter of Southern Switzerland, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - G C Riccitelli
- Department of Neurology (G.C.R., A.K.-L., C.G., C.Z., E. Pravatà), Neurocenter of Southern Switzerland, Ente Ospedaliero Cantonale, Lugano, Switzerland.,Faculty of Biomedical Sciences (G.C.R., A.C., A.K.-L., C.G., C,Z., E. Pravatà), Università della Svizzera Italiana, Lugano, Switzerland
| | - A Diociasi
- Dipartimento di Scienze della Salute (L.R., A.D.), Università degli Studi di Genova, Genoa, Italy
| | - L Carmisciano
- Department of Health Sciences, Section of Biostatistics (L.C.), Università degli Studi di Genova, Genoa, Italy
| | - A Cianfoni
- Form the Department of Neuroradiology (L.D., E. Prodi, A.C., E. Pravatà), Neurocenter of Southern Switzerland, Ente Ospedaliero Cantonale, Lugano, Switzerland.,Faculty of Biomedical Sciences (G.C.R., A.C., A.K.-L., C.G., C,Z., E. Pravatà), Università della Svizzera Italiana, Lugano, Switzerland
| | - T Bartalena
- Department of Radiology (T.B.), Pol. Zappi Bartalena, Imola, Italy
| | - A Kaelin-Lang
- Department of Neurology (G.C.R., A.K.-L., C.G., C.Z., E. Pravatà), Neurocenter of Southern Switzerland, Ente Ospedaliero Cantonale, Lugano, Switzerland.,Faculty of Biomedical Sciences (G.C.R., A.C., A.K.-L., C.G., C,Z., E. Pravatà), Università della Svizzera Italiana, Lugano, Switzerland
| | - C Gobbi
- Department of Neurology (G.C.R., A.K.-L., C.G., C.Z., E. Pravatà), Neurocenter of Southern Switzerland, Ente Ospedaliero Cantonale, Lugano, Switzerland.,Faculty of Biomedical Sciences (G.C.R., A.C., A.K.-L., C.G., C,Z., E. Pravatà), Università della Svizzera Italiana, Lugano, Switzerland
| | - C Zecca
- Department of Neurology (G.C.R., A.K.-L., C.G., C.Z., E. Pravatà), Neurocenter of Southern Switzerland, Ente Ospedaliero Cantonale, Lugano, Switzerland.,Faculty of Biomedical Sciences (G.C.R., A.C., A.K.-L., C.G., C,Z., E. Pravatà), Università della Svizzera Italiana, Lugano, Switzerland
| | - E Pravatà
- Form the Department of Neuroradiology (L.D., E. Prodi, A.C., E. Pravatà), Neurocenter of Southern Switzerland, Ente Ospedaliero Cantonale, Lugano, Switzerland .,Faculty of Biomedical Sciences (G.C.R., A.C., A.K.-L., C.G., C,Z., E. Pravatà), Università della Svizzera Italiana, Lugano, Switzerland
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