Papers by Alessandro Cianfoni
American Journal of Neuroradiology, 2007
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Journal of Integrative Neuroscience, Dec 30, 2021
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Frontiers in Neurology, Aug 12, 2021
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Headache, Mar 27, 2013
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Neurology, Apr 6, 2015
OBJECTIVE: To assess the prognostic value of new asymptomatic spinal cord lesions (ASL) in a stab... more OBJECTIVE: To assess the prognostic value of new asymptomatic spinal cord lesions (ASL) in a stable relapsing remitting multiple sclerosis (RRMS) population. BACKGROUND: Theimpact of ASL on disease progression in MS patients is poorly characterized. DESIGN/METHODS: We included all RRMS patients who received serial spinal-MRI (sMRI) with T2-weighted and post-Gadolinium (Gd) T1-weighted images, at baseline (sMRI t1) and within 12 to 36 months (sMRI t2) in condition of clinical stability (no relapses and no disability progression). Last clinical follow-up was defined as t3. Annualized relapse rate (ARR) and disability progression measured by the Expanded Disability Status Scale (EDSS) were evaluated in all patients between t2 and t3. RESULTS: Four-hundred-thirteen MS patients were screened, 308 were excluded [<2 evaluable sMRI (n=219); t1-t2 interval 蠅36 months (n=29); disease subtype other than RRMS (n=26); or clinically unstable (n=34)], resulting in 105 patients finally included. After a median t1 - t2 interval of 17 (IQR 13-26) months, 26 (24.8[percnt]) patients had 蠅1 new ASL, 4 (3.8[percnt]) had Gd enhancement. No differences in ARR and EDSS progression were found between patients with and without new ASL (p=0.22 and p=0.51, respectively). In multivariate analyses, baseline EDSS (β=0.98, p<0.001) and older age (β=0.03, p=0.02) were significant predictors of disability progression at t3, while presence of new ASL (OR 12.3; 95[percnt] CI 1.86-82.2, p=0.009) and male gender (OR 6.0; 95[percnt] CI2.1-15.5 p=0.001) were associated with an increased risk of relapses between t2 andt3. CONCLUSIONS: In our RRMS population, occurrence of new ASL was associated with an increased risk of subsequent relapses.These findings lend support to the employment of combined brain and spinal MRI in the clinical follow up routine of RRMS patients. Study Supported by: No financial support received. Disclosure: Dr. Chiara has received personal compensation for activities with Teva, Merck Serono, Biogen Idec, Bayer Schering, and Novartis as a consultant. Dr. Riccitelli has nothing to disclose. Dr. Pravata has nothing to disclose. Dr. Cianfoni has nothing to disclose. Dr. Staedler has nothing to disclose. Dr. Cereda has nothing to disclose. Dr. Disanto has nothing to disclose. Dr. Panicari has nothing to disclose. Dr. Gobbi has received personal compensation for activities with Teva, Merck Serono, Biogen Idec, Bayer Schering, Novartis, and Genzyme as a consultant.
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Journal of the Neurological Sciences, Oct 1, 2019
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American Journal of Neuroradiology, Mar 25, 2021
Dedicated 3D-T2-STIR-ZOOMit images improved substantially the detection of MS disease disseminati... more Dedicated 3D-T2-STIR-ZOOMit images improved substantially the detection of MS disease dissemination in the anterior visual pathways, particularly in the intracranial segments and in patients without past optic neuritis. BACKGROUND AND PURPOSE: Demyelinating lesions in the anterior visual pathways represent an underestimated marker of disease dissemination in patients with MS. We prospectively investigated whether a dedicated high-resolution MR imaging technique, the 3D-T2-STIR-ZOOMit, improves demyelinating lesion detection compared with the current clinical standard sequence, the 2D-T2-STIR. MATERIALS AND METHODS: 3T MR imaging of the anterior visual pathways (optic nerves, chiasm, and tracts) was performed using 3D-T2-STIR-ZOOMit and 2D-T2-STIR, in patients with MS and healthy controls. Two experienced neuroradiologists assessed, independently, demyelinating lesions using both sequences separately. 3D-T2-STIR-ZOOMit scan-rescan reproducibility was tested in 12 patients. The Cohen κ was used for interrater agreement, and the intraclass correlation coefficient for reproducibility. Between-sequence detection differences and the effects of location and previous acute optic neuritis were assessed using a binomial mixed-effects model. RESULTS: Forty-eight patients with MS with (n = 19) or without (n = 29) past optic neuritis and 19 healthy controls were evaluated. Readers' agreement was strong (3D-T2-STIR-ZOOMit: 0.85; 2D-T2-STIR: 0.90). The 3D-T2-STIR-ZOOMit scan-rescan intraclass correlation coefficient was 0.97 (95% CI, 0.96–0.98; P < .001), indicating excellent reproducibility. Overall, 3D-T2-STIR-ZOOMit detected more than twice the demyelinating lesions (n = 89) than 2D-T2-STIR (n = 43) (OR = 2.7; 95% CI, 1.7–4.1; P < .001). In the intracranial anterior visual pathway segments, 33 of the 36 demyelinating lesions (91.7%) detected by 3D-T2-STIR-ZOOMit were not disclosed by 2D-T2-STIR. 3D-T2-STIR-ZOOMit increased detection of demyelinating lesion probability by 1.8-fold in patients with past optic neuritis (OR = 1.8; 95% CI, 1.2–3.1; P = .01) and 5.9-fold in patients without past optic neuritis (OR = 5.9; 95% CI, 2.5–13.8; P < .001). No false-positive demyelinating lesions were detected in healthy controls. CONCLUSIONS: Dedicated 3D-T2-STIR-ZOOMit images improved substantially the detection of MS disease dissemination in the anterior visual pathways, particularly in the intracranial segments and in patients without past optic neuritis.
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Clinical Neurology and Neurosurgery, Oct 1, 2018
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American Journal of Neuroradiology, Jun 20, 2019
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The Spine Journal, Dec 1, 2014
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European Journal of Radiology, Oct 1, 2013
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Springer eBooks, 2016
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Expert Opinion on Biological Therapy, Apr 3, 2015
We aimed to investigate the influence of natalizumab (NTZ) treatment on multiple sclerosis course... more We aimed to investigate the influence of natalizumab (NTZ) treatment on multiple sclerosis course in patients with and without spinal involvement. Annualized relapse rate (ARR), disability progression and occurrence of new brain and spinal T2 lesions (N2TL) in 68 spinal (S-P) versus 68 non-spinal matched patients (NS-P) were retrospectively collected and compared between before (2 years) and after NTZ treatment using multivariate regression models. Mean duration of NTZ treatment was 31.3 ± 16.3 months in S-P and 32.1 ± 15.1 months in N-SP (p = 0.56). The mean ARR after NTZ treatment was similarly reduced in both S-P (0.07 ± 0.19) and N-SP (0.07 ± 0.16) (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001 for both). Disability progression after NTZ start was similarly low in S-P and NS-P. However, when compared to before NTZ start, disability progression was significantly reduced in S-P (p = 0.017), but not in NS-P (p = 0.68). This was largely mediated by a higher disability progression before NTZ start in S-P than N-SP. The risk of developing N2TL during NTZ was not different between S-P and NS-P (p = 0.10). NTZ similarly reduced the occurrence of relapses and NT2L in S-P and NS-P, whereas the effect on disability progression was particularly evident in the presence of spinal involvement. NTZ appears to be a treatment of high efficacy in both S-P and NS-P.
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Multiple Sclerosis Journal, Jul 11, 2016
To investigate the dynamic temporal changes of brain resting-state functional connectivity (RS-FC... more To investigate the dynamic temporal changes of brain resting-state functional connectivity (RS-FC) following mental effort in multiple sclerosis (MS) patients with cognitive fatigue (CF). Twenty-two MS patients, 11 with (F) and 11 without CF, and 12 healthy controls were included. Separate RS-FC scans were acquired on a 3T MR scanner immediately before (t0), immediately after (t1) and 30 minutes after (t2) execution of the paced auditory serial addition test (PASAT), a cognitively demanding task. Subjectively perceived CF after PASAT execution was also assessed. RS-FC changes were investigated by using a data-driven approach (the Intrinsic Connectivity Contrast-power), complemented by a priori defined regions of interest analyses. The F-group patients experienced stronger RS-FC at t2 between the left superior frontal gyrus (L-SFG) and occipital, frontal and temporal areas, which increased over time after PASAT execution. In the F-group patients, the L-SFG was hyperconnected at t1 with the left caudate nucleus and hypoconnected at t2 with the left anterior thalamus. These variations were correlated with both subjectively perceived and clinically assessed CF, and-for the left thalamus-with PASAT performance. The development of cortico-cortical and cortico-subcortical hyperconnectivity following mental effort is related to CF symptoms in MS patients.
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Multiple Sclerosis Journal, Oct 12, 2015
Background: The impact of new asymptomatic spinal cord lesions (a-SL) in multiple sclerosis (MS) ... more Background: The impact of new asymptomatic spinal cord lesions (a-SL) in multiple sclerosis (MS) course is poorly characterized. Objective: The objective of this research paper is to assess the prognostic value of a-SL in predicting MS course. Methods: Relapsing–remitting MS patients who received serial MRI (brain and spinal) at baseline (t1) and within 12 to 36 months (t2) during clinical stability, and had a follow-up (t2–t3) ⩾24 months were included. Relapses and disability progression were evaluated between t2 and t3. Results: Of 413 consecutive screened MS patients, 103 patients (65 females, median age 43 years) were included. After a median t1–t2 interval of 17 (IQR 13–26) months, 25.2% and 43.7% patients had ⩾1 new a-SL (a-SL+) and asymptomatic brain lesions (a-BL+), respectively. Relapse risk between t2 and t3 (median interval: 42 (IQR 32–57.5) months) was significantly increased in a-SL+ and/or a-BL+ vs a-BL– and a-SL– (HR = 2.31, 95% CI = 1.13–4.72, p = 0.02). No differences in the risk of disability progression were found in a-SL+ and/or a-BL+ vs a-SL- and a-BL–. Conclusion: a-SL occur in one-quarter of clinically stable RRMS, and combined with a-BL contribute significantly in predicting future disease course.
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American Journal of Neuroradiology, May 26, 2022
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Headache, Jul 25, 2012
A 66-year-old man was admitted to our department to investigate a 4-day history of right facial p... more A 66-year-old man was admitted to our department to investigate a 4-day history of right facial pain. Blood pressure was 180/90 mm Hg. Neurological examination and nonenhanced brain–computed tomography (CT) were unremarkable. The pain was confined to right hemiface, involving eye, cheek, and mouth, without a typical trunk nerve distribution.The patient was admitted and an antihypertensive therapy was started. Because of pain persistence, a brain magnetic resonance imaging (MRI) and magnetic resonance (MR) angiography was obtained, revealing bilateral distal cervical nonocclusive internal carotid artery dissection (ICAD) (Figure). The MRI features of the mural hematoma suggested metachronous ICAD, with the right ICAD being more recent (Figure B,C). Extensive laboratory studies proved normal, including screening for systemic autoimmune disorders and thrombophilic conditions. Clinical visit and cardiological evaluation ruled out vascular conditions as fibromuscular dysplasia or Marfan syndrome. No cervical traumas or manipulations were reported. CT angiography of the neck vasculature confirmed the bilateral ICAD and showed the residual patency of the true lumen.Antiplatelet treatment was started, and the patient was discharged 3 days later. Headache resolved progressively in the following weeks.
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Medicina
Vertebral augmentation has been used to treat painful vertebral compression fractures and metasta... more Vertebral augmentation has been used to treat painful vertebral compression fractures and metastatic lesions in millions of patients around the world. An international group of subject matter experts have considered the evidence, including but not limited to mortality. These considerations led them to ask whether it is appropriate to allow the subjective measure of pain to so dominate the clinical decision of whether to proceed with augmentation. The discussions that ensued are related below.
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Journal of Neurosurgery: Spine, 2020
OBJECTIVESevere lytic cancerous lesions of the spine are associated with significant morbidity an... more OBJECTIVESevere lytic cancerous lesions of the spine are associated with significant morbidity and treatment challenges. Stabilization and restoration of the axial load capability of the vertebral body (VB) are important to prevent or arrest vertebral collapse. Percutaneous stent screw–assisted internal fixation (SAIF), which anchors a VB stent/cement complex with pedicular screws to the posterior vertebral elements, is a minimally invasive, image-guided, 360° internal fixation technique that can be utilized in this patient cohort. The purpose of this study was to assess the feasibility, safety, and stabilization efficacy of VB reconstruction via the SAIF technique in a cohort of patients with extensive lytic vertebral lesions, who were considered to have an unstable or potentially unstable spine according to the Spinal Instability Neoplastic Score (SINS).METHODSThis study was a retrospective assessment of a prospectively maintained database of a consecutive series of patients with ...
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Papers by Alessandro Cianfoni