1,720,973 research outputs found
Structural and functional MRI study in mentally ill persons considered socially dangerous with diminished penal responsibility
Full text linkLa complessa relazione tra malattia mentale e criminalità rappresenta un tema di concreta rilevanza sociale, dibattuto da anni ma sempre di grande attualità. Secondo il codice penale, è considerato “socialmente pericoloso” il soggetto autore di reato, anche se non imputabile per vizio totale o parziale di mente, che abbia una elevata probabilità di recidiva del reato. Per questo motivo la prevenzione delle azioni socialmente pericolose riveste un ruolo di fondamentale importanza giuridica e sociale. In questo contesto la psichiatria forense si occupa delle questioni che sorgono all’interfaccia tra psichiatria e giurisprudenza, con l’obiettivo principale di evidenziare lo stato di salute mentale dei soggetti che commettono un reato attraverso una perizia psichiatrica.
La disciplina neuroradiologica, grazie anche all’utilizzo di tecniche avanzate di analisi delle immagini, si pone oggi come strumento di valido ausilio nella valutazione clinica dei pazienti psichiatrici e può supportare gli sforzi congiunti di psichiatri e giuristi per studiare la relazione tra malattia mentale e criminalità.
L’obiettivo di questo progetto di dottorato è stato quello di effettuare uno studio volumetrico della sostanza grigia cerebrale attraverso un esame di Risonanza Magnetica (RM) su un gruppo di soggetti autori di reato, considerati non imputabili al momento del fatto per vizio totale o parziale di mente, detenuti nella REMS dell’ASL Rm5 e considerati socialmente pericolosi.
I risultati dell’analisi volumetrica sono stati confrontati con un gruppo di controllo, comparabile per età e sesso. E’stata inoltre effettuata un’analisi della connettività funzionale cerebrale a riposo (resting-state functional MRI) con l’intento di indagare i network cerebrali alla base del comportamento morale, dell’attribuzione della salienza e dei processi di ricompensa, confrontando sempre i risultati con un gruppo di controllo.
Nel gruppo sperimentale sono stati inclusi 13 individui destrorsi (età media: 44 ± 7 anni) detenuti nella REMS dell’ASL Rm5 con disturbo dello spettro psicotico (schizofrenia, disturbo bipolare con caratteristiche psicotiche, disturbo schizo-affettivo, disturbi deliranti), che hanno commesso crimini violenti (omicidi, tentati omicidi, aggressioni e violenze domestiche) e che sono stati dichiarati socialmente pericolosi dall’autorità giudiziaria a causa dell’ alto rischio di recidiva criminale. I dati di RM sono stati acquisiti su un magnete 3 Tesla (Verio, Siemens) dotato di una bobina a 12 canali, utilizzando sequenze volumetriche T13D e sequenze BOLD eco-planari (EPI).
Nello studio I abbiamo eseguito un’analisi della volumetria cerebrale con tecnica VBM (Voxel-based morphometry) utilizzando il Computational Anatomy Toolbox (CAT12) del software Statistical Parametric Mapping (SPM12). Abbiamo riscontrato come il volume della sostanza grigia cerebrale del gruppo sperimentale fosse significativamente ridotto, rispetto ai controlli, a livello della corteccia insulare bilaterale, nel giro temporale superiore (STG) dell’emisfero sinistro e nel giro fusiforme dell’emisfero destro. Abbiamo infine eseguito un’analisi di correlazione tra la gravità dei sintomi psichiatrici e le regioni con volume corticale ridotto. I cluster di volume a livello di STG e insula sinistra sono risultati essere significativamente correlati alla gravità dei sintomi espressa dalla scala di valutazione BPRS (Brief Psychiatric Rating Scale).
Nello studio II abbiamo esaminato la connettività cerebrale a riposo nelle 19 regioni selezionate “a priori” sulla base della letteratura che risultassero coinvolte nella morale, nell’ attribuzione della salienza e nei processi di ricompensa. L’analisi è stata effettuata utilizzando il software CONN v. 18a, sulla piattaforma Matlab. Abbiamo documentato una ridotta connettività tra le regioni del sistema limbico, come il nucleo accumbens e l’amigdala, ed aumentata connettività nello striato dorsale, tra il nucleo accumbens e la corteccia cingolata posteriore, tra corteccia fronto-orbitale e gangli della base e tra corteccia cingolata anteriore e amigdala.
Sulla base di questi risultati ipotizziamo che l’alterata connettività in queste specifiche aree possa rappresentare la modificazione del comportamento in senso maladattativo degli individui del gruppo sperimentale, in termini di alterata risposta emotiva circa le proprie violazioni morali o di mancanza di empatia verso gli altri al fine di ottenere vantaggi personali o riguardo al controllo dell’impulsività.
Nonostante la bassa numerosità campionaria non consenta di approdare a conclusioni definitive, questo studio cerca di approfondire i correlati neurali degli individui autori di reato con ridotta responsabilità penale e socialmente pericolosi al fine di fornire un eventuale strumento di ausilio nella valutazione di questa particolare categoria di persone, con importanti risvolti giuridici ed etici oltre che nella pianificazione e nello sviluppo del trattamento di questi pazienti durante la loro permanenza nelle REMS.The relation between mental illness and criminality is a relevant social issue that has been debated over the years. Socially dangerous actions committed by mentally ill patients often have severe consequences, which is why much public attention is directed toward the prevention of these actions by these individuals. Modern neuroimaging investigations support the joint efforts of psychiatrists and lawyers to study the relationship between psychiatric illness and criminality.
The overall aim of this PhD project was to investigate differences in cortical GM volumes of this population, compared to a control group of healthy non-offender participants, using a VBM analysis of structural MRI. We also decided to investigate brain networks underpinning moral behaviour, salience attribution and reward processes performing a functional MRI at resting-state.
Experimental Group (EG) included 13 right-handed individuals (mean age: 44 ± 7 yrs) who committed violent crimes (homicides, attempted homicides, aggressions, and domestic violence), had a diagnosis included in the psychotic spectrum (schizophrenia, bipolar disorder with psychotic features, schizoaffective disorder, delusional disorders) and were declared socially dangerous by the judicial authority due to a high risk of criminal recidivism.
All subjects of the EG were institutionalized in the REMS psychiatric unit of ASL RM5 (Rome, Italy) for no longer than two years. Thirteen healthy right-handed men, who had never received a psychiatric diagnosis, undergone any psychiatric treatment, or been convicted of any crime were included in the control group (CG) (mean age: 38 ± 11yrs).
MRI data were acquired using a 3 Tesla Siemens imaging system (Siemens, Verio, Erlangen, Germany) equipped with a 12-channel head coil. Structural scans of the brain were acquired for each participant using a T1-weighted three dimensionals sagittal magnetization-prepared rapid gradient echo sequence. Resting state functional (rs-fMRI) data were collected while participants lay still and awake, with eyes closed using T2*-weighted gradient-echo echo-planar functional images (EPIs).
In study I we performed a voxel-based morphometry (VBM) analyses on participants’ T1-weighted structural images using Computational Anatomy Toolbox (CAT12), which runs within SPM12. We found that total cerebral GM volume was significantly reduced in EG in specific regions within the bilateral insular cortex compared to controls. We also found a reduced GM volume in the superior temporal gyrus (STG) of left hemisphere and in the fusiform gyrus of the right hemisphere. We finally performed a correlation analyses between psychiatric symptoms and regions with reduced GM volume. The clusters in STG and insula of left hemisphere significantly correlated with the gravity of symptoms expressed by the BPRS (Brief Psychiatric Rating Scale). In study II, temporal correlations of the resting-state BOLD signal time series were examined between nineteen seed regions that we selected “a priori” among those known to be involved in moral judgment salience attribution and reward processes. Analysis was performed using the software CONN v. 18a, running in Matlab. Our results documented reduced connectivity in limbic regions like the nucleus accumbens and the amiygdala and augmented connectivity within the dorsal striatum, between nucleus accumbens and the posterior cingulate cortex, between fronto- orbitalis cortex and basal ganglia and anterior cingulate cortex and amygdala. We suggest that dysregulation in these areas reflects the maladaptive behavior of socially dangerous subjects in terms of an altered emotional response to their own moral violations and a lack of empathy for others when making personal desire-oriented decisions.
While the small sample size does not allow definitive conclusions to be reached, the present study sheds some light on the neural correlates of this specific population, which deserves further attention due to their theoretical and clinical implications.
A further understanding of the neural basis of risk evaluation in mentally ill persons with a history of violence who are judged not criminally responsible could aid in forensic assessment and treatment development
Cerebral venous thrombosis: A case series and a neuroimaging review of the literature
No full textCerebral venous thrombosis (CVT) is a rare condition, difficult to diagnose because of its non specific clinical symptoms. In some cases CVT can mimic other conditions as subarachnoid hemorrhage, ischemia or tumor and for these reasons diagnosis is delayed or missed. CT, DSA and MRI findings help to obtain an early diagnosis and to distinguish it from other diseases. Our cases involved four patients with no signs or symptoms suspected for CVT and without risk factors associated to this disease; furthermore some early imaging findings observed in these patients could mimic other diseases. The aim of presenting these cases is to underline the importance of some findings at imaging techniques in obtaining an early diagnosis of CVT; in particular we describe the usefulness of MRI with gradient echo sequences (GRE) in detecting the venous thrombus, suggesting that GRE sequences should be included in the MRI protocol when a CVT is suspected. We also underline the role of radiologists in helping neurologists to make an early diagnosis of CVT or when in doubt to encourage further investigations in order to begin the anticoagulation therapy as soon as possible avoiding the onset of complications as permanent parenchymal damage, cerebral hemorrhage and venous infarction
Advanced magnetic resonance imaging in the study of primary intracranial brain tumors in adults: a state of art review
No full textIntracranial tumors are an important health problem with an annual incidence of primary and secondary central nervous system neoplasms ranges from 10 to 17 per 100,000 persons. Tumor imaging have as fundamental aims: the initial differential diagnosis with the distinction between newly diagnosed brain tumors and non-neoplastic lesions, ischemia, extra-axial neoplasm and metastasis; the preoperative planning, estimating the tumor grade, guiding the biopsy, resection, local ablative therapy and therapeutic follow-up; the monitoring of disease progression and therapeutic response, including the differentiation of recurrent tumor from delayed radiation necrosis. Imaging plays an integral role in intracranial tumor management. In particular, conventional magnetic resonance imaging (cMRI) has emerged as the imaging modality most frequently used to evaluate intracranial tumors offering important anatomic informations even though sometimes these anatomic informations are not exhaustive in the correct assessment of these tumors. In this review, we are going to investigate the role of the most widely available and practical techniques such as diffusion-weighted imaging (DWI), perfusion-weighted imaging MRI (PMR), diffusion-tensor imaging (DTI), and MR spectroscopy (MRS)
Shaken Baby Syndrome: Magnetic Resonance Imaging Features in Abusive Head Trauma
Full text linkIn the context of child abuse spectrum, abusive head trauma (AHT) represents the leading cause of fatal head injuries in children less than 2 years of age. Immature brain is characterized by high water content, partially myelinated neurons, and prominent subarachnoid space, thus being susceptible of devastating damage as consequence of acceleration–deceleration and rotational forces developed by violent shaking mechanism. Diagnosis of AHT is not straightforward and represents a medical, forensic, and social challenge, based on a multidisciplinary approach. Beside a detailed anamnesis, neuroimaging is essential to identify signs suggestive of AHT, often in absence of external detectable lesions. Magnetic resonance imaging (MRI) represents the radiation-free modality of choice to investigate the most typical findings in AHT, such as subdural hematoma, retinal hemorrhage, and hypoxic-ischemic damage and it also allows to detect more subtle signs as parenchymal lacerations, cranio-cervical junction, and spinal injuries. This paper is intended to review the main MRI findings of AHT in the central nervous system of infants, with a specific focus on both hemorrhagic and non-hemorrhagic injuries caused by the pathological mechanisms of shaking. Furthermore, this review provides a brief overview about the most appropriate and feasible MRI protocol to help neuroradiologists identifying AHT in clinical practice
The choice of gadolinium-based contrast agents: a radiologist’s responsibility between pharmaceutical equivalence and bioethical issues
Full text linkContrast Agents (CA) are among the most commonly prescribed drugs worldwide, and are used, with a variety of techniques, to increase and intensify the differences between body tissues and to help radiologist make diagnoses in a fast and precise way. In recent decades, advancements in research have resulted in significant improvements in their composition, and have made them safer and better-tolerated by patients; this notwithstanding, although the currently available CA are generally considered to be safe, their use is not completely without risk. The use of CA faces the radiologist with economic considerations, bioethical dilemmas, and possible profiles of professional responsibility. In fact, to achieve the best results in diagnostic imaging, radiologists have to focus on making an appropriate choice of CA, in consideration of efficacy, safety and appropriateness. Moreover, besides by cost/benefit models widely introduced in health management, radiologists are also influenced by their responsibility of appropriate use for the various diagnostic tests and, finally, the choice of best CA to utilise for each individual patient. Thus, the dilemma of choosing between the best and the most cost-effective tests and procedures is occurring more frequently every day. Different variables, such as the patient, examinations, and technology available, can affect the choice of CA in terms of obtaining the highest diagnostic quality, minimum impact on higher-risk patients, and optimisation of used volumes and injection flow
Real-time Magnetic Resonance-guided High-intensity Focused Ultrasound Focal Therapy for Localised Prostate Cancer: Preliminary Experience
No full textFive patients with unifocal, biopsy-proven prostate cancer (PCa) evident on multiparametric magnetic resonance imaging (MRI) were treated with magnetic resonance-guided focused ultrasound (MRgFUS) ablation before radical prostatectomy (RP). An endorectal probe featuring a phased-array focused ultrasound transducer was positioned for lesion ablation under MRI guidance. The tissue temperature and accumulation of thermal damage in the target zone was monitored during the procedure by MRI thermometry. Overlap between the ablation area and the devascularisation of the target lesion was evaluated by contrast-enhanced MRI performed immediately after treatment. The procedure was uneventful, and no adverse events were observed. RP was safely performed without significant surgical difficulties in relation to the previous MRgFUS treatment. The histopathology report showed extensive coagulative necrosis, with no residual tumour in the ablated area. Significant bilateral residual tumour, not evident on pretreatment MRI, was observed outside the treated area in two patients. MRgFUS ablation of focal localised PCa is feasible and, if confirmed in appropriate studies, could represent a valid option for the focal treatment of localised PCa. (C) 2012 European Association of Urology. Published by Elsevier B. V. All rights reserved
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
CT angiography and magnetic resonance angiography findings after surgical and interventional radiology treatment of peripheral arterial obstructive disease
No full textIn the last years, technical innovations in the field of CT angiography (CTA) and magnetic resonance angiography (MRA) have allowed accurate and highly detailed evaluation of peripheral vascular pathologies. This has dramatically changed the diagnostic approach in treatment planning of peripheral arterial obstructive disease and also enabling early identification of treatment failure or treatment-related complications after surgical or endovascular procedures. Although Doppler Ultrasound is the first-line imaging modality during follow-up after treatment, its role is currently diminishing in importance mostly because of the proliferation of high-end CT and MR scanners capable of fast, reproducible, and highly reliable vascular imaging. The aim of this study is to review the various surgical and endovascular procedures for peripheral arterial obstructive disease and to provide CTA and MRA samples of common and uncommon complications related to treatmen
- …
