Central Nervous System Magnetic Resonance Imaging Research Articles

Post-COVID-19 vaccination and the brain: A critical analysis of CNS MRI findings

The coronavirus disease 2019 (COVID-19) pandemic has led to an urgent need for vaccine development and global distribution. Recent research suggests that there may be potential impacts on the central nervous system (CNS), as evidenced by findings from magnetic resonance imaging (MRI). This article aims to provide feedback on the current evidence regarding the associations between COVID-19 vaccination and neurological complications. It is essential to conduct further research to enhance our scientific understanding of how vaccines interact with the central nervous system. This knowledge can significantly support public health efforts in controlling the spread of new viral variants through widespread vaccination.

Assessment of Safety and Biodistribution of AAVrh.10hCLN2 Following Intracisternal Administration in Nonhuman Primates for the Treatment of CLN2 Batten Disease.

CLN2 disease is a fatal, childhood autosomal recessive disorder caused by mutations in ceroid lipofuscinosis type 2 (CLN2) gene, encoding tripeptidyl peptidase 1 (TPP-1). Loss of TPP-1 activity leads to accumulation of storage material in lysosomes and resultant neuronal cell death with neurodegeneration. Genotype/phenotype comparisons suggest that the phenotype should be ameliorated with increase of TPP-1 levels to 5-10% of normal with wide central nervous system (CNS) distribution. Our previous clinical study showed that intraparenchymal (IPC) administration of AAVrh.10hCLN2, an adeno-associated vector serotype rh.10 encoding human CLN2, slowed, but did not stop disease progression, suggesting that this may be insufficient to distribute the therapy throughout the CNS (Sondhi 2020). In this study, we assessed whether the less invasive intracisternal delivery route would be safe and provide a wider distribution of TPP-1. A study was conducted in nonhuman primates (NHPs) with intracisternal delivery to cerebrospinal fluid (CSF) of AAVrh.10hCLN2 (5 × 1013 genome copies) or phosphate buffered saline (PBS). No abnormal behavior was noted. CNS magnetic resonance imaging and clinical chemistry data were all unremarkable. Histopathology of major organs had no abnormal finding attributable to the intervention or the vector, except that in one out of two animals treated with AAVrh.10hCLN2, dorsal root ganglia showed mild-to-moderate mononuclear cell infiltrates and neuronal degeneration. In contrast to our previous NHP study (Sondhi 2012) with IPC administration where TPP-1 activity was >2 × above controls in 30% of treated brains, in the two intracisternal treated NHPs, the TPP-1 activity was >2 × above controls in 50% and 41% of treated brains, and 52% and 84% of brain had >1,000 vector genomes/μg DNA, compared to 0% in the two PBS NHP. CSF TPP1 levels in treated animals were 43-62% of normal human levels. Collectively, these data indicate that AAVrh.10hCLN2 delivered by intracisternal route is safe and widely distributes TPP-1 in brain and CSF at levels that are potentially therapeutic. Clinical Trial Registration: NCT02893826, NCT04669535, NCT04273269, NCT03580083, NCT04408625, NCT04127578, and NCT04792944.

Post-COVID-19 Vaccination CNS Magnetic Resonance Imaging Findings: A Systematic Review.

This systematic review aims to synthesize and analyze the available literature on central nervous system (CNS) magnetic resonance imaging (MRI) findings in individuals who have received COVID-19 vaccinations. Our objective is to enhance understanding of potential neurological side effects, inform clinical practice, and guide future research on the neurological implications of COVID-19 vaccination. In this systematic review, we conducted a comprehensive search in PubMed, Scopus, and Web of Science from January 2020 to April 2023, using terms related to COVID-19 vaccination and CNS MRI findings. We evaluated the quality of the study, extracted relevant data, and included 89 eligible studies that covered various vaccines, demographics of patients, symptoms, and MRI findings to provide a thorough understanding of SARS-CoV-2 vaccination-related CNS problems. We investigated CNS MRI findings following COVID-19 vaccination across various vaccine types. Common diseases associated with post-vaccination CNS MRI findings included cerebral venous sinus thrombosis (CVST), vaccine-induced immune thrombotic thrombocytopenia (VITT), acute disseminated encephalomyelitis (ADEM), acute myelitis, autoimmune encephalitis (AE), and others. Patients presented with diverse onset symptoms and neurological manifestations. Abnormalities identified in CNS MRI findings included white matter (WM) hyperintensity. Our analysis offers a comprehensive overview of the current literature on post-vaccination CNS MRI findings. Discussion. We highlight a range of post-COVID-19 vaccination CNS MRI findings, including CVST, with a higher incidence in individuals receiving the ChAdOx1 (AstraZeneca) vaccine. Other notable observations include cases of ADEM, myelitis or transverse myelitis (TM), Guillain-Barré syndrome (GBS), and acute encephalopathy following COVID-19 vaccination. The incidence of these neurological complications is extremely rare, and the benefits of vaccination outweigh the risks. The reviewed studies were primarily case reports or case series, and thus large-scale epidemiological studies and controlled clinical trials are needed to better understand the underlying mechanisms and risk factors associated with these neurological complications following COVID-19 vaccination.

Extremely high levels of central nervous system involvement in miliary tuberculosis

BackgroundMiliary tuberculosis (TB) is one of the severest manifestations of TB that can be lethal when concomitant with the central nervous system (CNS) involvement. Bacteriological, biochemical and radiological methods for find CNS comorbidity in miliary TB was evaluated in this study.MethodsConsecutive miliary TB adults were retrospectively enrolled from two designated TB hospitals in China. The capacities of examinations of cerebrospinal fluid (CSF), cerebral computed tomography (CT) and magnetic resonance imaging (MRI) for diagnosis of CNS involvement were assessed.ResultsAssessment of CNS involvement with a lumbar puncture and/or neuroimaging was undertaken in 282 out of 392 of acute miliary TB. Of these 282 patients, 87.59% (247/282) had CNS involvement. Cerebral contrast-enhanced MRI (96.05%, 170/177) and MRI (93.15%, 204/219) yielded significantly higher sensitivities over CSF examination (71.92%, 146/203, P < 0.001) and CT (34.69%, 17/49, P < 0.001). The sensitivity of CSF examination was superior to CT scan (P < 0.001). Although 59.65% (134/225) miliary TB patients acquired bacteriological evidence with sputum examination, the positivity was only 8.82% (21/238) for CSF examination by conventional and molecular tests.ConclusionAlmost all miliary TB had CNS involvement and MRI demonstrated outstanding potential over other methods. Therefore, a routinely screening of CNS TB should be strongly suggested in miliary TB and MRI could be used as the initial approach in resources rich settings.

Acute Visual Loss in Young Boy

Abstract: Objective: Multiple sclerosis is immune mediated disorder of central nervous system (CNS). Diagnosis of multiple sclerosis is based on clinical findings and investigations, like MRI of CNS. Herein, we presents a 13-year old boy who presented with sudden loss of vision in both eyes for two days duration. The concurrent phenomenon of optic neuritis and multiple sclerosis is less common in children and rarely reported. Keywords: Multiple sclerosis (MS), Optic neuritis (ON), Child, Steroids, Visual loss, Magnetic resonance imaging (MRI) brain, Fundoscopy.

Classification and Prognosis of Central Nervous System Involvement in Erdheim-Chester Disease

Background: Erdheim-Chester disease (ECD) is a non-Langerhans cell histiocytosis, characterized by the infiltration of tissues by foamy CD68+CD1a- histiocytes, with 1500 known-cases since 90 years. Mutations activating the MAPK pathway are found in more than 80% of ECD patients, mainly the BRAFV600E in 57 to 70%. Central nervous system (CNS) involvement during ECD lead to significant morbidity and mortality. We assessed CNS manifestations in a French cohort of 253 ECD patients. Since 2012, close to 200 patients worldwide with multi-systemic and refractory ECD (e.g. heart and/or CNS involvements) have benefited from BRAF and MEK inhibitors, which have proven highly beneficial. Methods: CNS manifestations were determined by clinical examination and brain and/or spine magnetic resonance imaging (MRI). Targeted therapy efficacy was assessed using physician and radiologist global assessment. Results: Ninety-seven (38%) among the 253 of the whole cohort of ECD patients had CNS involvement. CNS involvement was significantly associated with a younger age at diagnosis (mean 55.5 years) and at symptoms onset (mean 50.5 years), and also with the presence of the BRAFV600E mutation (in 77% of cases), xanthelasma (34%), and diabetes insipidus (36%). Median survival among patients with CNS involvement was significantly lower than in ECD patients without CNS involvement (124 months versus 146 months, p=0.03). Seventy-four CNS MRI were centrally reviewed, corresponding to 3 patterns: tumoral in 66%, degenerative in 50%, and vascular in 18%. Targeted therapy (BRAF and/or MEK inhibitors) was associated with improvement of symptoms in 43% of patients, and MRI improvement in 45%. Conclusions: CNS manifestations are typically associated with a poor prognosis in ECD. Three distinct patterns may be recognized: tumoral, degenerative, and vascular. Targeted therapy leads to clinical and/or imaging improvement in almost 50% of patients. OffLabel Disclosure: Targeted therapies such as BRAF inhibitor (vemurafenib) and MEK inhibitor (cobimetinib) are used in severe histiocytosis in EU but are off label

Impact of airway management strategies on magnetic resonance image quality

BackgroundUse of general anaesthesia or deep sedation during magnetic resonance imaging (MRI) studies leads to pharyngeal muscle relaxation, often resulting in snoring and subsequent vibrations with head micromotion. Given that MRI is very susceptible to motion, this causes artifacts and image quality degradation. The purpose of our study was to determine the effectiveness of different airway management techniques in overcoming micromotion-induced MRI artifacts. MethodsAfter obtaining institutional review board approval, we conducted a retrospective study on the image quality of central nervous system MRI studies in nine patients who had serial MRIs under general anaesthesia. All data were obtained from electronic records. We evaluated the following airway techniques: use of no airway device (NAD); oral, nasal, or supraglottic airway (SGA); or tracheal tube. To assess MRI quality, we developed a scoring system with a combined score ranging from 6 to 30. We used the linear mixed model to account for patient-dependent confounders. ResultsWe assessed 85 MRI studies from nine patients: 48 NAD, 27 SGA, four oral, four nasal, and two tracheal tube. Arithmetical mean combined scores were 21.6, 27.6, 20.3, 15.3, and 29.5, respectively. The estimated mean combined scores for the NAD and SGA cohorts were 22.0 and 27.3, respectively, showing that SGA use improved the combined score by 5.3 (P<0.0001). ConclusionsThe use of an SGA during MRI studies under general anaesthesia or deep sedation significantly improves image quality.

Prenatal diagnosis of bowel malposition using T2-weighted fetal MRI sequences.

The goal of this study was to investigate the capability of T2-weighted magnetic resonance imaging (MRI) in revealing fetal bowel malposition. All fetal MRI examinations (excluding central nervous system MRI examinations) performed in our department from January 2005 to January 2014 were retrospectively studied by 2 independent observers for situs, stomach and jejunum location on T2-weighted images. Patients data were also reviewed for results of ultrasound examinations, MRI indication, and gestational age. Abnormally positioned jejunums were classified into 3 groups: intrathoracic (A), extra-fetal (B) and abnormal intra-fetal (C). Prenatal data were compared to postnatal imaging, surgery or autopsy findings that served as standard of reference. A total of 709 fetal MRI examinations were analyzed. In 64 fetus (9%), the jejunum was not present in the left subgastric area on T2-weighted MR images. In these 64 fetuses, proximal jejunum was intrathoracic (41/64, 64%, group A), extra-fetal (11/64, 17%, group B), or intra-abdominal but abnormally positioned (12/64, 19%, group C). Interobserver agreement was 100%. All diagnoses for fetuses in groups A and B (52 cases) were confirmed postnatally (41 cases) or at autopsy (11 cases). In group C, bowel malposition was suspected after ultrasound in only 2/12 fetuses (16.6%); it was confirmed postnatally in 1 fetus but not confirmed in the remaining one. In the 10 remaining fetuses (83%), malposition was confirmed postnatally although not initially suspected. T2-weighted fetal MR images are useful for the prenatal diagnosis of bowel malposition, even when they are unsuspected on ultrasound examination.

Zmiany niedotlenieniowo-niedokrwienne w badaniu MR ośrodkowego układu nerwowego u noworodków donoszonych i urodzonych przedwcześnie - obrazy typowe i rzadziej spotykane

Hypoxic-ischemic brain injury occurring in antenatal, perinatal or early postnatal period constitutes an important diagnostic problem in both term and prematurely born neonates. Over the past several years magnetic resonance imaging (MRI) has become relatively easily accessible in Poland. On the basis of the central nervous system MRI, the experienced radiologist are able to determine the location of the hypoxic-ischemic lesions, their extent and evolution. Therefore he can help clinicians to answer the question whether the brain damage of the newborn is responsible for its clinical condition and he can contribute to determining the prognosis of the infant's future development. The aim of this study is to present the current knowledge of different types of hypoxic-ischemic brain lesions based on our personal experience and MR images from the archives of the Department of Diagnostic Imaging at the Institute of Mother and Child.

Incidence and pattern of radiological central nervous system Langerhans cell histiocytosis in children: A population based study

Patients with Langerhans cell histiocytosis (LCH) may develop neurodegeneration and other central nervous system (CNS) dysfunctions revealed by brain magnetic resonance imaging (MRI). We estimated the incidence and pattern of pathological brain MRI findings in a well-defined, population-based cohort of children with LCH. Among children under 15 years of age diagnosed with LCH in the Stockholm County during 1992-2001, brain MRI was performed at a single center in children with clinical and/or laboratory signs of CNS involvement, including endocrine dysfunction. Out of the 29 children (16 males, 13 females) diagnosed with LCH, brain MRI was performed based on clinical indications in 16 children (55%) with either abnormal endocrine findings (n = 6), such as diabetes insipidus (n = 5), low IGF-1 (n = 1), or panhypopituitarism (n = 1), or clinical CNS symptoms (n = 10). CNS MRI abnormalities were demonstrated in eight children (28%), at a median time of 3.5 years after LCH diagnosis (range 1-11.4 years). Altogether 7 of the 29 children (24%) had MRI findings associated with neurodegeneration, corresponding to a minimal incidence of 2.1/10(6) children per year. Neurodegenerative abnormalities tended to be more frequent in patients with craniofacial involvement (P = 0.12). The minimal annual incidence rate of neurodegenerative associated radiographic findings in LCH is estimated at 2.1/10(6) children (24% of all children with LCH). An important question is whether all patients with LCH, or certain forms of LCH, should be recommended for a late follow-up examination including MRI. In patients with CNS-LCH, neurological, neuropsychological, neurophysiological, neurochemical and neuroradiological follow-up assessment is suggested.

Ultrasmall superparamagnetic iron oxides (USPIOs): a future alternative magnetic resonance (MR) contrast agent for patients at risk for nephrogenic systemic fibrosis (NSF)?

Gadolinium (Gd) based contrast agents (GBCAs) in magnetic resonance imaging (MRI) are used in daily clinical practice and appear safe in most patients; however, nephrogenic systemic fibrosis (NSF) is a recently recognized severe complication associated with GBCAs. It affects primarily patients with renal disease, such as stage 4 or 5 chronic kidney disease (CKD; glomerular filtration rate <30 ml/min per 1.73 m(2)), acute kidney injury, or kidney and liver transplant recipients with kidney dysfunction. Contrast-enhanced MRI and computed tomography (CT) scans provide important clinical information and influence patient management. An alternative contrast agent is needed to obtain adequate imaging results while avoiding the risk of NSF in this vulnerable patient group. One potential alternative is ultrasmall superparamagnetic iron oxide (USPIO) nanoparticles, which provide enhancement characteristics similar to GBCAs. We review our experience in approximately 150 patients on the potential benefits of the USPIOs ferumoxtran-10 and ferumoxytol. We focus on central nervous system (CNS) MRI but also review imaging of other vascular beds. Safety studies, including USPIO administration (ferumoxytol) as iron supplement therapy in CKD patients on and not on dialysis, suggest that decreased kidney function does not alter the safety profile. We conclude that for both CNS MR imaging and MR angiography, USPIO agents like ferumoxytol are a viable option for patients at risk for NSF.

Central Nervous System Abnormalities in Dyskeratosis Congenita and Fanconi Anemia: Correlation with Clinical Phenotype and Aplastic Anemia.

Fanconi anemia (FA) and dyskeratosis congenita (DC) are characterized by bone marrow failure (BMF) and an increased risk of acute myeloid leukemia, myelodysplastic syndrome and epithelial cancers. While cerebellar hypoplasia has been reported in some patients with DC, and small pituitary size and midline brain anomalies in FA, systematic central nervous system (CNS) magnetic resonance imaging (MRI) and correlation with clinical phenotype and aplastic anemia (AA) are lacking. To investigate these associations we evaluated patients with DC and FA enrolled in the National Cancer Institute's Inherited Bone Marrow Failure Syndrome study. DC: 16 patients, ages 1–23 yrs (median 9 yrs), had CNS MRI as a part of their evaluation. All had peripheral cytopenias; 11 with severe AA were on treatment with androgens or transfusions. 13/16 had at least 2 of the 3 features of the diagnostic triad (dystrophic nails, oral leukoplakia and reticulated skin pigmentation). Among 10 patients with microcephaly, 8 had developmental delay, 7 truncal ataxia and 6 had a severe phenotype with the Hoyeraal-Hreidarsson variant. 7/16 patients had moderate to severe cerebellar hypoplasia. Patients with cerebellar hypoplasia were significantly younger than those without (median age 6 yrs vs. 14 yrs respectively; p=0.01). All patients with cerebellar hypoplasia had truncal ataxia, developmental delay and microcephaly, whereas amongst those without hypoplasia 3 had microcephaly (p=0.01), none had ataxia and one had developmental delay (p=0.001). There was no correlation between the severity of AA and cerebellar hypoplasia (p=0.5). FA: 11 patients, ages 6–42 yrs (median 22 yrs) who were not on current treatment and 13 age and sex-matched controls underwent CNS MRI. 9 patients had cytopenias; 5 with severe AA had received prior treatment (3 bone marrow transplant, 2 transfusions). Pituitary height, width and area in patients with FA were compared with the NIH controls and pituitary heights were compared with published normal values. The mean pituitary height in the FA patients tended to be lower then the NIH or published controls (p=0.06 and p=0.09 respectively). However, the mean pituitary width and the mean pituitary area were significantly lower in patients with FA compared with the NIH controls (p=0.003). In all, 7/11 patients had small pituitary glands; one of these had pituitary stalk interruption and another had an absent septum pellucidum. 7 patients had one or more endocrine abnormalities: 4 growth hormone deficiency, 6 hypothyroidism, 7 hypogenitalia/hypogonadism and 6 short stature. An equal proportion of patients with a small pituitary had short stature, hypothyroidism and growth hormone deficiency when compared with those who had a normal pituitary gland (p=1.0). There was no correlation between small pituitary size and age (p=0.2), any endocrine abnormality (p=0.5) or severe AA (p=0.6). CNS abnormalities were detected by MRI in ∼ 50% of patients with DC or FA. In an age-dependent analysis, the cumulative incidence of AA was the same in those with or without cerebellar hypoplasia in DC and in those with or without a small pituitary in FA. We currently recommend that all patients with DC and FA undergo MRI of the brain and pituitary to more completely characterize the spectrum of CNS anomalies, and to determine whether there is an association with hematologic severity in a larger data set.

Contrast Enhancement of Central Nervous System Lesions: Multicenter Intraindividual Crossover Comparative Study of Two MR Contrast Agents

To prospectively compare gadobenate dimeglumine with gadopentetate dimeglumine (0.1 mmol per kilogram body weight) for enhanced magnetic resonance (MR) imaging of central nervous system (CNS) lesions. This study was HIPAA-compliant at U.S. centers and was conducted at all centers according to the Good Clinical Practice standard. Institutional review board and regulatory approval were granted; written informed consent was obtained. Seventy-nine men and 78 women (mean age, 50.5 years +/- 14.4 [standard deviation]) were randomized to group A (n = 78) or B (n = 79). Patients underwent two temporally separated 1.5-T MR imaging examinations. In randomized order, gadobenate followed by gadopentetate was administered in group A; order of administration was reversed in group B. Contrast agent administration (volume, speed of injection), imaging parameters before and after injection, and time between injections and postinjection acquisitions were identical for both examinations. Three blinded neuroradiologists evaluated images by using objective image interpretation criteria for diagnostic information end points (lesion border delineation, definition of disease extent, visualization of internal morphologic features of the lesion, enhancement of the lesion) and quantitative parameters (percentage of lesion enhancement, contrast-to-noise ratio [CNR]). Overall diagnostic preference in terms of lesion conspicuity, detectability, and diagnostic confidence was assessed. Between-group comparisons were performed with Wilcoxon signed rank test. Readers 1, 2, and 3 demonstrated overall preference for gadobenate in 75, 89, and 103 patients, compared with that for gadopentetate in seven, 10, and six patients, respectively (P < .0001). Significant (P < .0001) preference for gadobenate was demonstrated for diagnostic information end points, percentage of lesion enhancement, and CNR. Superiority of gadobenate was significant (P < .001) in patients with intraaxial and extraaxial lesions. Gadobenate compared with gadopentetate at an equivalent dose provides significantly better enhancement and diagnostic information for CNS MR imaging.

Endovascular treatment of spinal arteriovenous fistula in a young child with hereditary hemorrhagic telangiectasia

Hereditary hemorrhagic telangiectasia ([HHT] or Osler-Weber-Rendu syndrome) can manifest as sudden onset of epistaxis or neurological deficit in a child with characteristic mucocutaneous telangiectasias or as an asymptomatic bruit with or without overlying cutaneous vascular lesions. The authors present a case study of a pediatric patient with HHT in whom a screening computerized tomography (CT) scan of the chest revealed an asymptomatic arteriovenous malformation (AVM) of the spine. An 18-month-old child with a strong family history of HHT, including fatal central nervous system (CNS) hemorrhage and pulmonary AVMs, presented with a cutaneous telangiectasia of the pinna. The child was subsequently screened for potentially morbid pulmonary and CNS AVMs by using chest CT scanning and brain magnetic resonance (MR) imaging. A spinal MR image revealed a perimedullary macro-AVF (MAVF) resulting in a large venous varix within the parenchyma of the thoracic spinal cord. A transarterial embolization of the fistula was performed using N-butyl cyanoacrylate and ethiodol. Postembolization angiography confirmed obliteration of the fistula, and MR imaging revealed thrombosis and reduction in size of the venous varix. There were no neurological sequelae due to the treatment. In families with HHT and a high risk of sudden severe morbidity or death from undisclosed pulmonary or CNS AVMs, screening chest CT scanning and CNS MR imaging should be considered. Interdisciplinary teams of neurosurgery and interventional radiology specialists should evaluate and treat such patients by using diagnostic and therapeutic angiography and, if necessary, surgery.

MRI of Central Nervous System under General Anaesthesia with Laryngeal Mask Airway in Childhood

Our anaesthetic experience and outcomes in children undergoing magnetic resonance imaging (MRI) scanning are presented. unpremedicated 417 children were included in this study. Heart rate (HR), noninvasive blood pressure (BP) and peripheral oxygen saturation (SpO2) were monitored by MRI-compatible equipment during MRI scanning in all children. Induction of anaesthesia was performed with 4–8% sevoflurane inhalation in 50% nitrous oxide-oxygen mixture using Mapleson D breathing circuit by an MRI-compatible anaesthesia machine. After providing regular spontaneous ventilation, an appropriate sized classic laryngeal mask airway (LMA) was positioned. Then anaesthesia and ventilation were maintained with approximately 1–1.5% sevoflurane inhalation in 50% nitrous oxide oxygen mixture using the circle system. MRI studies of all the children were completed successfully with satisfactory image quality. HR, BP and SpO2 remained within safe limits throughout MRI scanning. Vomiting was observed in 22 children out of 417 which resolved spontaneously without any antiemetic therapy. Oral intake was established within 20 minutes of anaesthesia completion in children. All of the children were discharged within 1 hour after admission to the postanaesthesia care unit. In conclusion, LMA used under general anaesthesia in children undergoing MRI scanning was uneventful allowing satisfactory image quality and prompt discharge of children with far fewer complications resulting from general anaesthesia.

In Vitro and In Vivo Study of Solid Lipid Nanoparticles Loaded with Superparamagnetic Iron Oxide

Solid Lipid Nanoparticles (SLN) are already under investigation as a pharmaceutical tool able to change the pharmacokinetic and biodistribution of carried molecules. SLN are able to target drugs to lymph after duodenal administration and to overcome the Blood Brain Barrier (BBB). In this study, superparamagnetic SLN have been prepared, have colloidal size, in vitro analysis showed relaxometric properties similar to Endorem®. In vivo Magnetic Resonance Imaging (MRI) of the central nervous system (CNS) with both SLN and Endorem® showed that superparamagnetic SLN have slower blood clearance than Endorem®. MRI data are consistent with CNS uptake of SLN lasting up to the end of the experiment (135 min). These findings confirm the ability of SLN to overcome the BBB; SLN might be used as a CNS MRI contrast agent.

Severe persistent neuropsychiatric toxicity after a human leucocyte antigen‐non‐identical peripheral blood stem cell transplantation (total body irradiation, etoposide, thiotepa) and interleukin 2‐based experimental therapy for poor prognosis relapse acute lymphoblastic leukaemia

Severe persistent neuropsychiatric toxicity after a human leucocyte antigen‐non‐identical peripheral blood stem cell transplantation (total body irradiation, etoposide, thiotepa) and interleukin 2‐based experimental therapy for poor prognosis relapse acute lymphoblastic leukaemia

Magnetic Resonance in Dermatology

Magnetic resonance imaging (MRI), a technique that has had a truly revolutionary impact on many areas of clinical medicine, 1 is starting to be appreciated by the dermatologic community. In this issue of theArchives, Truhan and Filipek 2 describe central nervous system MRI findings in patients with neurofibromatosis, tuberosclerosis, and Sturge-Weber syndrome. This is a comprehensive and well-written review on the subject. However, as the authors point out, in the majority of neurocutaneous syndromes, consistent characteristic CNS findings by MRI have not yet been described. 2 For example, central nervous system MRI findings in patients with hypomelanosis of Ito are still poorly characterized and are inconsistent. 3,4 The use of MRI surface coils permits direct evaluation and characterization of dermatologic conditions by MR techniques. The evaluation of cutaneous diseases by MR techniques can be subdivided into three areas: (1) the evaluation of skin tumors by MRI using standard commercially