Purpose To investigate the diagnostic efficacy of MRI diagnostic algorithms with an ascending automatization, in distinguishing between high-grade glioma (HGG) and solitary brain metastases (SBM). Methods 36 patients with histologically proven HGG (n = 18) or SBM (n = 18), matched by size and location were enrolled from a database containing 655 patients. Four different diagnostic algorithms were performed serially to mimic the clinical setting where a radiologist would typically seek out further findings to reach a decision: pure qualitative, analytic qualitative (based on standardized evaluation of tumor features), semi-quantitative (based on perfusion and diffusion cutoffs included in the literature) and a quantitative data-driven algorithm of the perfusion and diffusion parameters. The diagnostic yields of the four algorithms were tested with ROC analysis and Kendall coefficient of concordance. Results Qualitative algorithm yielded sensitivity of 72.2%, specificity of 78.8%, and AUC of 0.75. Analytic qualitative algorithm distinguished HGG from SBM with a sensitivity of 100%, specificity of 77.7%, and an AUC of 0.889. The semi-quantitative algorithm yielded sensitivity of 94.4%, specificity of 83.3%, and AUC = 0.889. The data-driven algorithm yielded sensitivity = 94.4%, specificity = 100%, and AUC = 0.948. The concordance analysis between the four algorithms and the histologic findings showed moderate concordance for the first algorithm, (k = 0.501, P < 0.01), good concordance for the second (k = 0.798, P < 0.01), and third (k = 0.783, P < 0.01), and excellent concordance for fourth (k = 0.901, p < 0.0001). Conclusion When differentiating HGG from SBM, an analytical qualitative algorithm outperformed qualitative algorithm, and obtained similar results compared to the semi-quantitative approach. However, the use of data-driven quantitative algorithm yielded an excellent differentiation.

Purpose The head of the hippocampus (H) is classically described as having two to four digitations both in ex vivo specimens and in vivo MR coronal images. The aim of this study was to develop and evaluate a new MR-based classification of the anatomical variants of the hippocampal head in a large sample population of healthy subjects. Methods MR images of the brain of 238 young healthy subjects (138 men and 100 women; age range 18-39) were analyzed. The head of the H was identified on coronal reformatted 3D T1 weighted MR images. The frequencies were reported for hemisphere and sex. Inter-rater reliability was assessed. Results Eight variants of the hippocampal head were described. Class 0 (11.4%) indicated a total absence of sulci. This class was further subdivided as follows: 0A (one digitation, 10.1%) and 0B (no digitations or "null variant", 1.3%). Class 1 (25.6%) presented a single sulcus and was further subdivided into four types according to the location and the width of the sulcus [1A (8.8%), 1B (12.8%), 1C (1.3%), and 1D (2.7%)]. Class 2 (63.0%, the most frequent and the classical variant) had two symmetrical sulci and three digitations. Statistically significant differences between the two hemispheres were observed only in women and overall. Differences in prevalence between sexes were not observed. Conclusions The large study population allowed the description of a novel morphological classification of the different anatomical variants of normal H in the coronal plane. This classification could reduce the risk of misinterpreting normal anatomical variants as pathological.

Purpose To compare the corneal tissue trauma after the use of an automated preloaded injector and a manual injector and assess scanning electron microscope (SEM) and atomic force microscope (AFM) features of both injector cartridges. Setting Ophthalmology Clinic and Laboratory of Stem Cells and Regenerative Medicine University “G. d'Annunzio” of Chieti-Pescara, Chieti, Italy; Design Prospective randomized clinical study Methods Forty eyes of 40 patients for phacoemulsification were divided into two groups: implantation of intraocular lens was performed with AutonoMe automated delivery system (AutonoMe group: 20 eyes) and Monarch III injector system (Monarch group: 20 eyes). In vivo confocal microscopy (IVCM) and anterior segment optical coherence tomography (AS-OCT) were performed before surgery, at 1 h, 1 day and 1 month post-operatively. In addition, SEM and AFM were performed on cartridges of both injector systems after injection of the IOL. Results A greater increase in central corneal thickness and corneal thickness at the incision site were observed in Monarch group versus AutonoMe group 1 h and 1 day post-operatively ( p < 0.05). Endothelial cell count loss was significantly higher in Monarch group compared with AutonoMe group ( p < 0.05) at 1 and 24 h. AS-OCT showed less endothelial misalignment at 30 days ( p < 0.05), and IVCM showed less tunnel inflammation at all time points ( p < 0.05) in AutonoMe group compared with Monarch group; roughness analysis at AFM of the AutonoMe cartridge was significantly lower compared to Monarch D cartridge ( p < 0.05). Conclusions The AutonoMe injector provided less corneal tissue trauma compared with Monarch III injector. The AutonoMe cartridge showed lower roughness at AFM compared to the Monarch D cartridge.

Objective: To identify the effects of different dietary inositol stereoisomers on insulin resistance and the development of gestational diabetes mellitus (GDM) in women at high risk for this disorder.Design: A preliminary, prospective, randomized, placebo controlled clinical trial.Participants: Nonobese singleton pregnant women with an elevated fasting glucose in the first or early second trimester were studied throughout pregnancy.Intervention: Supplementation with myo-inositol, d-chiro-inositol, combined myo- and d-chiro-inositol or placebo.Main outcome measure: Development of GDM on a 75 grams oral glucose tolerance test at 24-28 weeks' gestation. Secondary outcome measures were increase in BMI, need for maternal insulin therapy, macrosomia, polyhydramnios, neonatal birthweight and hypoglycemia.Results: The group of women allocated to receive myo-inositol alone had a lower incidence of abnormal oral glucose tolerance test (OGTT). Nine women in the control group (C), one of the myo-inositol (MI), five in d-chiro-inositol (DCI), three in the myo-inositol/D-chiro-inositol group (MI/DCI) required insulin (p = .134). Basal, 1-hour, and 2 hours glycemic controls were significantly lower in exposed groups (p < .001, .011, and .037, respectively). The relative risk reduction related to primary outcome was 0.083, 0.559, and 0.621 for MI, DCI, and MI/DCI groups.Conclusions: This study compared the different inositol stereoisomers in pregnancy to prevent GDM. Noninferiority analysis demonstrated the largest benefit in the myo-inositol group. The relevance of our findings is mainly related to the possibility of an effective approach in GDM. Our study confirmed the efficacy of inositol supplementation in pregnant women at risk for GDM.

To evaluate superficial capillary plexus (SCP) changes occurring after internal limiting membrane (ILM) peeling for the treatment of idiopathic epiretinal membrane (ERM).

To investigate modifications of Magnetic Resonance Diffusion Tensor Imaging (DTI) and Diffusion Kurtosis Imaging (DKI) metrics in lateral white matter (WM) bundles of the cervical spinal cord in patients with previous stroke in the vascular territory of the middle cerebral artery (MCA).

Background to assess vessel density of superficial capillary plexus (SCP), deep capillary plexus (DCP) and choriocapillaris (CC) in advanced Stargardt disease (STGD) using optical coherence tomography angiography (OCTA) and correlate these findings with macular function using pattern electroretinogram (PERG) and multifocal electroretinogram (mfERG). Methods Twelve patients (24 eyes) with advanced STGD underwent vessel densities and macular thickness measurements using OCTA. A control group of 24 healthy controls (24 eyes) was chosen for comparison. In the STGD group correlation between vessel density and macular thickness and between macular function and morphologic parameters were evaluated. Results Whole parafoveal vessel density (VD) of SCP was significantly lower in STGD group compared to the control group (p<0.05). Foveal VD and whole parafoveal VD of the DCP were significantly lower in STGD group compared to the controls (p<0.05). CC was significantly decreased in STGD compared to controls (p<0.05). Foveal macular thickness (MT), full parafoveal MT, and inner limiting membrane (ILM)-inner plexiform layer (IPL) parafoveal MT thickness were decreased in STGD eyes compared to controls (p<0.001). PERG and mfERG were both significantly reduced in STGD compared to controls (p<0.001). A direct correlation was found between full parafoveal MT and vessel density in the STGD group. Conclusions Patients with advanced STGD showed a reduction of SCP, DCP and CC compared to healthy eyes related to a reduction of total and ILM-IPL macular thickness. These results suggest that both retinal capillaris plexuses and choriocapillaris reduction occur in STDG along with inner and outer retinal thinning.

The authors present the case of a 59-year-old woman in treatment with interferon alfa-2b for stage IV melanoma and widespread metastases who presented with interferon-associated retinopathy. An ocular examination revealed multiple retinal cotton-wool spots and hard exudates. Interferon treatment was suspended. The patient was followed up for 5 months following the baseline visit by means of en face optical coherence tomography (OCT), spectral-domain OCT, and OCT angiography. Multimodal imaging was useful in the follow-up of this condition, permitting the characterization of all the lesions hallmarking the interferon-retinopathy and showing that this illness was related to a reduction of the retinal vascular perfusion. [ Ophthalmic Surg Lasers Imaging Retina. 2017;48:498–504.]

AIM: To investigate foveal avascular zone (FAZ) and parafoveal vessel densities (PRVD) by means of optical coherence tomography angiography (OCTA) in diabetic patients with or without diabetic retinopathy (DR) and to assess the reproducibility of FAZ and PRVD measurements. METHODS: Sixty diabetic patients (60 eyes) with different stage of DR (graded according to the International Clinical Severity Scale for DR) and 20 healthy subjects underwent FAZ area and PRVD measurements using OCTA by two experienced examiners. FAZ area in all patients was also assessed using fluorescein angiography (FA). RESULTS: In subject with proliferative DR and with moderate-severe non proliferative DR, FAZ area was significantly increased compared to healthy controls (P=0.025 and P=0.050 respectively measured with OCTA and P=0.025 and P= 0.048 respectively measured with FA). OCTA showed significantly less inter-observer variability compared to FA. Concordance correlation coefficient (CCC) for FAZ area measurements was 0.829 (95%CI: 0.736-0.891) P<0.001 with FA and 1.000 (95%CI: 0.999-1.000) P<0.001 with OCTA. CCC was 0.834 (95%CI: 0.746-0.893) P<0.001 and 0.890 (95% CI: 0.828-0.930) P<0.001 for parafoveal superficial and deep vessel density measurements, respectively. CONCLUSION: OCTA shows progressive increase of FAZ area and reduction of PRVD in both superficial and deep plexus at increasing DR severity. FAZ area and PRVD measurements using OCTA are highly reproducible.

Poster: ECR 2017 / B-1353 / Microstructural evaluation of the anterior cruciate ligament (ACL) with MR-diffusion tensor imaging (DTI): correlations with knee stability by: I. P. Voicu , L. Di Clemente, R. Navarra, P. A. Mattei, V. Panara, A. R. Cotroneo, M. Caulo; Chieti/IT

Purpose: Abnormal brain perfusion is a critical mechanism in neonatal brain injury. The aim of the present study was to compare Cerebral Blood Flow (CBF) evaluated with ASL MRI in three groups of neonates: preterms without brain lesions on MRI (PN), preterms with periventricular white matter lesions (PNp) and term neonates with normal MRI (TN). The correlation between CBF and clinical outcome was explored.Materials and methods: The institutional review board approved this prospective study and waived informed consent. The perfusion ASL data from 49 consecutive preterm neonates (PN) studied at term-equivalent age and 15 TN were evaluated. Statistically significant differences in gray matter CBF were evaluated by using a linear mixed-model analysis and Mann-Whitney U test. Logistic regression analysis was used to assess the relation between CBF and neuromotor outcome at 12 months.Results: Comparison of means indicated that the CBF of the whole brain were significantly higher in PN compared to TN (P= 0.011). This difference remained significant when considering the frontal (P= 0.038), parietal (P= 0.002), temporal (P= 0.030), occipital (P= 0.041) and cerebellar (P= 0.010) gray matter. In the PN group, lower CBF in basal ganglia was associated with a worse neuromotor outcome (P= 0.012).Conclusions: ASL MRI demonstrated differences in brain perfusion of the basal ganglia between PN and TN. In PN, a positive correlation between CBF and neuromotor outcome was demonstrated in this area.

PURPOSE:The aim of this prospective study was to determine the feasibility in terms of repeatability and reproducibility of diffusional kurtosis imaging (DKI) for microstructural assessment of the normal cervical spinal cord (cSC) using a phase-sensitive inversion recovery (PSIR) sequence as the anatomical reference for accurately defining white-matter (WM) and gray-matter (GM) regions of interests (ROIs).METHODS:Thirteen young healthy subjects were enrolled to undergo DKI and PSIR sequences in the cSC. The repeatability and reproducibility of kurtosis metrics and fractional anisotropy (FA) were calculated in GM, WM, and cerebral-spinal-fluid (CSF) ROIs drawn by two independent readers on PSIR images of three different levels (C1-C4). The presence of statistically significant differences in DKI metrics for levels, ROIs (GM, WM, and CSF) repeatability, reproducibility, and inter-reader agreement was evaluated.RESULTS:Intra-class correlation coefficients between the two readers ranged from good to excellent (0.75 to 0.90). The inferior level consistently had the highest concordance. The lower values of scan-rescan variability for all DKI parameters were found for the inferior level. Statistically significant differences in kurtosis values were not found in the lateral white-matter bundles of the spinal cord.CONCLUSION:The integration of DKI and PSIR sequences in a clinical MR acquisition to explore the regional microstructure of the cSC in healthy subjects is feasible, and the results obtainable are reproducible. Further investigation will be required to verify the possibility to translate this method to a clinical setting to study patients with SC involvement especially in the absence of MRI abnormalities on standard sequences.

A rotating polarimetric 90°-cross linear-filter interferometry system was used to detect the morphological characteristics and features of interference patterns produced in in-vivo corneal stroma in healthy human corneas of 23 subjects. The characteristic corneal isogyres presenting with an evident cross-shaped pattern, grossly aligned with the fixation axis, were observed in all patients with centers within the pupillary dark area, impeding the exact determination of the center point. During the rotational scan in 78.3% of the eyes the cross-shaped pattern of the isogyre gradually separated to form two distinct hyperbolic arcs in opposite quadrants, reaching their maximal separation at 45 degrees with respect to angle of cross-shaped pattern formation. The corneal cross and hyperbolic-pattern repeated every 90° throughout the 360° rotational scan. While the interpretation of the isogyres presents particular difficulties, two summary parameters can be extracted for each cornea: the presence/orientation of a single or two dark areas in post-processed images and isochromes. However, the development of dedicated software for semi-quantitative analysis of these parameters and enantiomorphism may become available in the near future. The possible application of polarimetric interferometry in the field of both corneal pathologies and corneal surgery may be of great interest for clinical purposes.

PURPOSE:To investigate alterations of superficial and deep retinal vascular densities, as well as of choroidal thickness, in patients affected by adult-onset foveomacular vitelliform dystrophy (AOFVD).METHODS:A total of 22 eyes (15 patients) affected by AOFVD were recruited in the study. Furthermore, 20 eyes of 20 healthy subjects and 20 eyes of 18 patients affected by intermediate dry age-related macular degeneration (AMD) were enrolled. All patients underwent a complete ophthalmologic examination, including optical coherence tomography angiography. Outcome measures were superficial vessel density, deep vessel density, and choroidal thickness.RESULTS:Parafoveal superficial vessel density was increased in patients with AOFVD compared with the AMD group (50.6 ± 4.3% and 46.3 ± 4.3%, respectively, P = 0.016). Parafoveal deep vessel density was 57.9 ± 6.4% in patients with AOFVD, 52.2 ± 3.8% in patients with AMD, and 52.7 ± 6.0% in healthy controls (P = 0.006 and P = 0.035, respectively, after comparison with the AOFVD group).CONCLUSION:We demonstrated that both superficial and deep vessel densities were significantly increased in patients with AOFVD, after the comparison with intermediate patients with AMD. These findings suggest that the pathogenic mechanisms in AOFVD are different from those in AMD and that optical coherence tomography angiography could be useful in differentiate early stages of these two diseases.

The aim of this study was to evaluate corneal tissue trauma after femtosecond laser-assisted cataract surgery (FLACS) and phacoemulsification (femtophaco surgery) compared to FLACS and nanolaser emulsification (all laser surgery). This is a prospective nonrandomized clinical study conducted at the Ophthalmology Clinic, University “G. d’Annunzio” of Chieti-Pescara, Italy, involving forty-two eyes of 42 patients candidates to cataract surgery. Patients were enrolled in two groups: femtophaco surgery (group 1 with 21 eyes) and all laser surgery (group 2 with 21 eyes). Main outcome measures included uncorrected visual acuity and distance corrected visual acuity, corneal endothelial cell count, and corneal thickness at the tunnel site and at the center of the cornea. Best correct visual acuity was not significantly different between the two groups. Postoperatively, a significant decrement of endothelial cell count at the center of the cornea was observed in group 1 compared with preoperative values at 90 days (p < 0.001) while t remained stable in group 2. The central corneal thickness showed a statistically significant increase for both groups that reached a maximum thickness at 7 days and then returned to presurgery levels after 90 days for group 1 and after 60 days for group 2. The tunnel corneal thickness showed a statistically significant increase for both groups that reached a maximum thickness at 7 days, which did not return to presurgery level for group 1 but did return to presurgery levels after 60 days for group 2. All laser surgery induced lower central endothelial cell loss and lower increase of corneal thickness compared to femtophaco surgery.

PURPOSE:To report morphologic features of idiopathic macular telangiectasia (MacTel) type 2 by means of optical coherence tomography angiography (OCTA) and to compare these findings to fundus fluorescein angiography (FFA), fundus autofluorescence (FAF), confocal blue reflectance (CBR), and spectral-domain OCT (SD-OCT). In addition, foveal vessel density and parafoveal vascular density (PFVD), and foveal retinal thickness and parafoveal retinal thickness (PFRT) were compared between MacTel 2 patients and normal aged-matched controls.METHODS:Eight patients (15 eyes) with MacTel 2 and 17 normal controls (17 eyes) underwent retinal multimodal imaging assessment and grading. Results from different imaging techniques were used to compare interimaging modalities. Objective quantification of retinal vessel density and macular thickness was evaluated in MacTel 2 patients (15 eyes).RESULTS:In MacTel 2 eyes a comparison of OCTA to the other imaging techniques showed that the strongest correlations were present with SD-OCT, early FFA, and late FFA. Moderate correlations were found between OCTA and CBR and FAF. Foveal vessel density was significantly lower in MacTel 2 eyes than control eyes both in the superficial plexus (23.74% vs. 33.14%; P = 0.003) and in the deep plexus (24.63% vs. 34.21%; P = 0.005). Superficial PFVD was significantly different in the two groups (47.06% vs. 51.40%; P = 0.005) but not the deep PFVD. Foveal retinal thickness was 214.13 μm in MacTel 2 eyes and 258.18 μm in normal controls, and PFRT was 279.60 and 323.29 μm, respectively (P < 0.0001).CONCLUSIONS:Optical coherence tomography angiography is useful for retinal vasculature characterization in MacTel type 2 patients and showed a high correlation with well-established imaging techniques.

Purpose To assess the reproducibility and repeatability of foveal avascular zone (FAZ) area measurements using swept-source optical coherence tomography angiography (SS-OCTA) in healthy subjects. Methods Sixty-four eyes of 64 healthy volunteers were randomly subjected to FAZ area measurements using SS-OCTA by 2 examiners in 2 different sessions. Results The FAZ areas measured by the first and second observer were 0.269 ± 0.092 mm2 and 0.270 ± 0.090 mm2, respectively. Within subjects, the coefficients of variations were 2.44% (95% confidence interval [CI] 1.95% to 2.93%) and 2.66% (95% CI 2.00% to 3.31%) for the first and second observers, respectively. The coefficient of repeatability average measurements of FAZ area were 0.021 mm2 and 0.024 mm2. The intraclass correlation coefficient values were 0.993 (95% CI 0.989 to 0.996) and 0.991 (95% CI 0.986 to 0.995). Interobserver and intraobserver concordance correlation coefficients ranged from 0.998 (95% CI 0.997 to 0.999) to 0.999 (95% CI 0.998 to 0.999) and from 0.989 (95% CI 0.982 to 0.993) to 0.987 (95% CI 0.979 to 0.992), respectively. Conclusions The FAZ area measurements by means of SS-OCTA showed high reproducibility and repeatability in healthy eyes.

Preterm neonates represent a high-risk population for abnormal neuropsychological development. But presently, an accurate method for identifying those at risk is not available. This study evaluated the association between the microstructural organization measured with Diffusion Tensor Imaging (DTI) in term-corrected preterm neonates and subsequent motor performance. Fractional anisotropy (FA), axial diffusion (AD), mean diffusivity (MD) and radial diffusivity (RD) were determined in two regions of interest (ROIs) corresponding to the posterior limb of the internal capsule (PLIC) and cortico-spinal tract (CST). The Griffiths Mental Developmental Scales (GMDS) were longitudinally administered at 3, 6 and 15 months; and correlations between the metrics of diffusivity and the motor subscale of the GMDS were assessed using the Spearman correlation. A statistically significant negative correlation was observed between the AD of PLIC of the left hemisphere and the 3-month GMDS Locomotor Subscale. These results suggested that AD is a valid indicator of the stage of maturation of the motor pathway in preterm neonates, but not of later motor outcome.

Gestational diabetes mellitus (GDM) is a common complication characterized by increased insulin resistance, and by increased risk for adverse pregnancy outcomes affecting both the mother and the fetus. International guidelines describe optimal ways to recognize it, and the recommended treatment of patients affected to reduce adverse outcomes. Improving insulin resistance could reduce incidence of GDM and its complications. Recently, a few trials have been published on the possible prevention of GDM. Inositol has been proposed as a food supplement that might reduce gestational diabetes incidence in high-risk pregnant women.