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Geraldo AF, Caorsi R, Tortora D, Gandolfo C, Ammendola R, Alessio M, Conti G, Insalaco A, Pastore S, Martino S, Ceccherini I, Signa S, Gattorno M, Rossi A, Severino M. Widening the Neuroimaging Features of Adenosine Deaminase 2 Deficiency. AJNR Am J Neuroradiol 2021; 42:975-979. [PMID: 33632736 DOI: 10.3174/ajnr.a7019] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Accepted: 11/23/2020] [Indexed: 02/06/2023]
Abstract
Adenosine deaminase 2 deficiency (OMIM #615688) is an autosomal recessive disorder characterized by a wide clinical spectrum, including small- and medium-sized vessel vasculopathies, but data focusing on the associated neuroimaging features are still scarce in the literature. Here, we describe the clinical neuroimaging features of 12 patients with genetically proven adenosine deaminase 2 deficiency (6 males; median age at disease onset, 1.3 years; median age at genetic diagnosis, 15.5 years). Our findings expand the neuroimaging phenotype of this condition demonstrating, in addition to multiple, recurrent brain lacunar ischemic and/or hemorrhagic strokes, spinal infarcts, and intracranial aneurysms, also cerebral microbleeds and a peculiar, likely inflammatory, perivascular tissue in the basal and peripontine cisterns. Together with early clinical onset, positive family history, inflammatory flares and systemic abnormalities, these findings should raise the suspicion of adenosine deaminase 2 deficiency, thus prompting genetic evaluation and institution of tumor necrosis factor inhibitors, with a potential great impact on neurologic outcome.
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Affiliation(s)
- A F Geraldo
- Neuroradiology Unit (A.F.G., D.T., R.A., A.R., M.S.), IRCCS Istituto Giannina Gaslini, Genoa, Italy.,Diagnostic Neuroradiology Unit, Imaging Department (A.F.G.), Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - R Caorsi
- Center for Autoinflammatory Diseases and Immunodeficiencies (R.C., S.S., M.G.), IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - D Tortora
- Neuroradiology Unit (A.F.G., D.T., R.A., A.R., M.S.), IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - C Gandolfo
- Interventional Unit (C.G.), IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - R Ammendola
- Neuroradiology Unit (A.F.G., D.T., R.A., A.R., M.S.), IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - M Alessio
- Department of Translational Medical Sciences (M.A.), Federico II University of Naples, Naples, Italy
| | - G Conti
- Pediatric Nephrology and Rheumatology Unit (G.C.), AOU G Martino, Messina, Italy
| | - A Insalaco
- Division of Rheumatology (A.I.), IRCCS Ospedale Pediatrico Bambino Gesù, Roma, Italy
| | - S Pastore
- Department of Pediatrics (S.P.), Institute for Maternal and Child Health - IRCCS "Burlo Garofolo", Trieste, Italy
| | - S Martino
- Division of Pediatric Immunology and Rheumatology, Department of Public Health and Pediatrics (S.M.), Regina Margherita Children Hospital, University of Turin, Turin, Italy
| | - I Ceccherini
- UOSD Genetics and Genomics of Rare Diseases (I.C.), IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - S Signa
- Center for Autoinflammatory Diseases and Immunodeficiencies (R.C., S.S., M.G.), IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - M Gattorno
- Center for Autoinflammatory Diseases and Immunodeficiencies (R.C., S.S., M.G.), IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - A Rossi
- Neuroradiology Unit (A.F.G., D.T., R.A., A.R., M.S.), IRCCS Istituto Giannina Gaslini, Genoa, Italy.,Department of Health Sciences (DISSAL) (A.R.), University of Genoa, Genoa, Italy
| | - M Severino
- Neuroradiology Unit (A.F.G., D.T., R.A., A.R., M.S.), IRCCS Istituto Giannina Gaslini, Genoa, Italy
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Geraldo AF, Parodi A, Bertamino M, Buffelli F, Uccella S, Tortora D, Moretti P, Ramenghi L, Fulcheri E, Rossi A, Severino M. Perinatal Arterial Ischemic Stroke in Fetal Vascular Malperfusion: A Case Series and Literature Review. AJNR Am J Neuroradiol 2020; 41:2377-2383. [PMID: 33122209 DOI: 10.3174/ajnr.a6857] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 07/17/2020] [Indexed: 11/07/2022]
Abstract
Fetal vascular malperfusion includes a continuum of placental histologic abnormalities increasingly associated with perinatal brain injury, namely arterial ischemic stroke. Here, we describe the clinical-neuroimaging features of 5 neonates with arterial ischemic stroke and histologically proved fetal vascular malperfusion. All infarcts involved the anterior territories and were multiple in 2 patients. In 2 neonates, there were additional signs of marked dural sinus congestion, thrombosis, or both. A mixed pattern of chronic hypoxic-ischemic encephalopathy and acute infarcts was noted in 1 patient at birth. Systemic cardiac or thrombotic complications were present in 2 patients. These peculiar clinical-radiologic patterns may suggest fetal vascular malperfusion and should raise the suspicion of this rare, underdiagnosed condition carrying important implications in patient management, medicolegal actions, and future pregnancy counseling.
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Affiliation(s)
- A F Geraldo
- From the Units of Neuroradiology (A.F.G., D.T., A.R., M.S.).,Diagnostic Neuroradiology Unit (A.F.G.), Imaging Department, Centro Hospitalar Vila Nova de Gaia/Espinho, Portugal
| | - A Parodi
- Neonatal Intensive Care (A.P., L.R.)
| | - M Bertamino
- Physical Medicine and Rehabilitation (M.B., P.M.)
| | - F Buffelli
- Gynaecologic and Fetal-Perinatal Pathology (F.B., E.F.)
| | - S Uccella
- Child Neuropsychiatry (S.U.), IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - D Tortora
- From the Units of Neuroradiology (A.F.G., D.T., A.R., M.S.)
| | - P Moretti
- Physical Medicine and Rehabilitation (M.B., P.M.)
| | - L Ramenghi
- Neonatal Intensive Care (A.P., L.R.).,Departments of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI) (L.R.)
| | - E Fulcheri
- Gynaecologic and Fetal-Perinatal Pathology (F.B., E.F.).,Surgical Sciences and Integrated Diagnostics, Pathology Division of Anatomic Pathology (E.F.)
| | - A Rossi
- From the Units of Neuroradiology (A.F.G., D.T., A.R., M.S.).,Health Sciences (DISSAL) (A.R.), University of Genoa, Genoa, Italy
| | - M Severino
- From the Units of Neuroradiology (A.F.G., D.T., A.R., M.S.)
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Geraldo AF, Messina SS, Tortora D, Parodi A, Malova M, Morana G, Gandolfo C, D'Amico A, Herkert E, Govaert P, Ramenghi LA, Rossi A, Severino M. Neonatal Developmental Venous Anomalies: Clinicoradiologic Characterization and Follow-Up. AJNR Am J Neuroradiol 2020; 41:2370-2376. [PMID: 33093132 DOI: 10.3174/ajnr.a6829] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 08/06/2020] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Although developmental venous anomalies have been frequently studied in adults and occasionally in children, data regarding these entities are scarce in neonates. We aimed to characterize clinical and neuroimaging features of neonatal developmental venous anomalies and to evaluate any association between MR imaging abnormalities in their drainage territory and corresponding angioarchitectural features. MATERIALS AND METHODS We reviewed parenchymal abnormalities and angioarchitectural features of 41 neonates with developmental venous anomalies (20 males; mean corrected age, 39.9 weeks) selected through a radiology report text search from 2135 neonates who underwent brain MR imaging between 2008 and 2019. Fetal and longitudinal MR images were also reviewed. Neurologic outcomes were collected. Statistics were performed using χ2, Fisher exact, Mann-Whitney U, or t tests corrected for multiple comparisons. RESULTS Developmental venous anomalies were detected in 1.9% of neonatal scans. These were complicated by parenchymal/ventricular abnormalities in 15/41 cases (36.6%), improving at last follow-up in 8/10 (80%), with normal neurologic outcome in 9/14 (64.2%). Multiple collectors (P = .008) and larger collector caliber (P < .001) were significantly more frequent in complicated developmental venous anomalies. At a patient level, multiplicity (P = .002) was significantly associated with the presence of ≥1 complicated developmental venous anomaly. Retrospective fetal detection was possible in 3/11 subjects (27.2%). CONCLUSIONS One-third of neonatal developmental venous anomalies may be complicated by parenchymal abnormalities, especially with multiple and larger collectors. Neuroimaging and neurologic outcomes were favorable in most cases, suggesting a benign, self-limited nature of these vascular anomalies. A congenital origin could be confirmed in one-quarter of cases with available fetal MR imaging.
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Affiliation(s)
- A F Geraldo
- From the Neuroradiology Unit (A.F.G.), Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal.,Neuroradiology Unit (A.F.G., D.T., G.M., A.R., M.S.)
| | - S S Messina
- Radiology Unit (S.S.M.), Casa di Cura Regina Pacis, Palermo, Italy
| | - D Tortora
- Neuroradiology Unit (A.F.G., D.T., G.M., A.R., M.S.)
| | - A Parodi
- Neonatal Intensive Care Unit (A.P., M.M., L.A.R.)
| | - M Malova
- Neonatal Intensive Care Unit (A.P., M.M., L.A.R.)
| | - G Morana
- Neuroradiology Unit (A.F.G., D.T., G.M., A.R., M.S.)
| | - C Gandolfo
- Interventional Unit (C.G.), IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - A D'Amico
- Dipartimento di Scienze Biomediche Avanzate (A.D.), Universita' Federico II, Napoli, Italy
| | - E Herkert
- Division of Neonatology (E.H., P.G.), Department of Paediatrics, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - P Govaert
- Division of Neonatology (E.H., P.G.), Department of Paediatrics, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - L A Ramenghi
- Neonatal Intensive Care Unit (A.P., M.M., L.A.R.)
| | - A Rossi
- Neuroradiology Unit (A.F.G., D.T., G.M., A.R., M.S.)
| | - M Severino
- Neuroradiology Unit (A.F.G., D.T., G.M., A.R., M.S.)
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Alcaide-Leon P, Dufort P, Geraldo AF, Alshafai L, Maralani PJ, Spears J, Bharatha A. Differentiation of Enhancing Glioma and Primary Central Nervous System Lymphoma by Texture-Based Machine Learning. AJNR Am J Neuroradiol 2017; 38:1145-1150. [PMID: 28450433 DOI: 10.3174/ajnr.a5173] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Accepted: 02/01/2017] [Indexed: 01/13/2023]
Abstract
BACKGROUND AND PURPOSE Accurate preoperative differentiation of primary central nervous system lymphoma and enhancing glioma is essential to avoid unnecessary neurosurgical resection in patients with primary central nervous system lymphoma. The purpose of the study was to evaluate the diagnostic performance of a machine-learning algorithm by using texture analysis of contrast-enhanced T1-weighted images for differentiation of primary central nervous system lymphoma and enhancing glioma. MATERIALS AND METHODS Seventy-one adult patients with enhancing gliomas and 35 adult patients with primary central nervous system lymphomas were included. The tumors were manually contoured on contrast-enhanced T1WI, and the resulting volumes of interest were mined for textural features and subjected to a support vector machine-based machine-learning protocol. Three readers classified the tumors independently on contrast-enhanced T1WI. Areas under the receiver operating characteristic curves were estimated for each reader and for the support vector machine classifier. A noninferiority test for diagnostic accuracy based on paired areas under the receiver operating characteristic curve was performed with a noninferiority margin of 0.15. RESULTS The mean areas under the receiver operating characteristic curve were 0.877 (95% CI, 0.798-0.955) for the support vector machine classifier; 0.878 (95% CI, 0.807-0.949) for reader 1; 0.899 (95% CI, 0.833-0.966) for reader 2; and 0.845 (95% CI, 0.757-0.933) for reader 3. The mean area under the receiver operating characteristic curve of the support vector machine classifier was significantly noninferior to the mean area under the curve of reader 1 (P = .021), reader 2 (P = .035), and reader 3 (P = .007). CONCLUSIONS Support vector machine classification based on textural features of contrast-enhanced T1WI is noninferior to expert human evaluation in the differentiation of primary central nervous system lymphoma and enhancing glioma.
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Affiliation(s)
| | - P Dufort
- Department of Medical Imaging (P.D., A.F.G.) Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - A F Geraldo
- Department of Medical Imaging (P.D., A.F.G.) Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - L Alshafai
- Department of Medical Imaging (L.A.), Mount Sinai Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - P J Maralani
- Department of Medical Imaging (P.J.M.), Sunnybrook Research Institute, University of Toronto, Toronto, Ontario, Canada
| | - J Spears
- Neurosurgery (J.S.), St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - A Bharatha
- From the Departments of Medical Imaging (P.A.-L., A.B.)
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Geraldo AF, Bastos-Carvalho A, Neto LL, Sousa RF, Sequeira PT, Campos J. Leukocoria in a child with sturge-weber syndrome. Neuroradiol J 2012; 25:85-8. [PMID: 24028881 DOI: 10.1177/197140091202500112] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2011] [Accepted: 11/02/2011] [Indexed: 11/16/2022] Open
Abstract
A five-year-old girl with Sturge-Weber syndrome (SWS) presented with unilateral leukocoria. Imaging excluded retinoblastoma and revealed a choroidal hemangioma, a non-traumatic vitreous hemorrhage and a cataract. To the best of our knowledge, this is the first case report in the radiologic literature of these ophthalmologic findings presenting together and conditioning leukocoria in the setting of SWS. We discuss possible mechanisms and review the literature, emphasizing the role of neuroimaging in pediatric patients with SWS and ophthalmologic complaints.
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Affiliation(s)
- A F Geraldo
- Neuroradiology Department, CHLN-Santa Maria Hospital; Lisbon, Portugal -
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