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BACKGROUND: Although the essential components of pain pathways have been identified, a thorough comprehension of the interactions necessary for creating focused treatments is still lacking. Such include more standardised methods for measuring pain in clinical and preclinical studies and more representative study populations. OBJECTIVE: This review describes the essential neuroanatomy and neurophysiology of pain nociception and its relation with currently available neuroimaging methods focused on health professionals responsible for treating pain. METHODS: Conduct a PubMed search of pain pathways using pain-related search terms, selecting the most relevant and updated information. RESULTS: Current reviews of pain highlight the importance of their study in different areas from the cellular level, pain types, neuronal plasticity, ascending, descending, and integration pathways to their clinical evaluation and neuroimaging. Advanced neuroimaging techniques such as fMRI, PET, and MEG are used to better understand the neural mechanisms underlying pain processing and identify potential targets for pain therapy. CONCLUSIONS: The study of pain pathways and neuroimaging methods allows physicians to evaluate and facilitate decision-making related to the pathologies that cause chronic pain. Some identifiable issues include a better understanding of the relationship between pain and mental health, developing more effective interventions for chronic pain's psychological and emotional aspects, and better integrating data from different neuroimaging modalities for the clinical efficacy of new pain therapies.

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The application of Magnetic Resonance Imaging (MRI) have helped in different modalities for prostate cancer management, from early detection to treatment planning and follow-up, the evolution of MRI techniques allows to obtain not only anatomical but also functional information to take advantage of prostate cancer detection and staging while supplying prognostic and predictive biomarkers. This review presents conventional and advanced MRI techniques (known as multiparametric MRI) that allow functional and quantitative assessment of the normal prostate gland and its correlation with prostate cancer. Additional topics include the epidemiology of prostate cancer following the Global Burden Diseases Cancer Collaboration 2018, the clinical anatomy of the prostate gland, and the lower urinary tract; we also mention some aspects of the diagnosis performance in ultrasound. We end the review with a brief explanation about the anatomical foundation of external-beam planning radiotherapy.

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Imaging of the postoperative spine requires the identification of several critical points by the radiologist to be written in the medical report: condition of the underlying cortical and cancellous bone, intervertebral disc, and musculoskeletal tissues; location and integrity of surgical implants; evaluation of the success of decompression procedures; delineation of fusion status; and identification of complications. This article presents a pictorial narrative review of the most common findings observed in noninstrumented and instrumented postoperative spines. Complications in the noninstrumented spine were grouped in early (hematomas, pseudomeningocele, and postoperative spine infection) and late findings (arachnoiditis, radiculitis, recurrent disc herniation, spinal stenosis, and textiloma). Complications in the instrumented spine were also sorted in early (hardware fractures) and late findings (adjacent segment disease, hardware loosening, and implant migration). This review also includes a short description of the most used diagnostic techniques in postoperative spine imaging: plain radiography, ultrasound (US), computed tomography (CT), magnetic resonance (MR), and nuclear medicine. Imaging of the postoperative spine remained a challenging task in the early identification of complications and abnormal healing process. It is crucial to consider the advantages and disadvantages of the imaging modalities to choose those that provide more accurate spinal status information during the follow-up. Our review is directed to all health professionals dealing with the assessment and care of the postoperative spine.

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BACKGROUND: The two of the most common indications for magnetic resonance (MR) imaging of the cervical spine include acute spine trauma and degenerative disease. OBJECTIVE: We aimed to correlate the measurements of the free area of the spinal canal (FASC), a new approach to the cervical spinal canal compromise, with the Torg´s ratio quantification of the cervical spine. METHODS: A cross-sectional study including 50 cervical-spine MR evaluations of patients with acute cervical trauma or degenerative disease was performed. We used multivariate analysis of covariance (MANCOVA) to identify the type of lesion, intervertebral level and gender differences between FASC and Torg´s ratio quantification of the cervical spine; age was the controlled covariate. Correlates between FASC and Torg´s ratio were obtained at each intervertebral level. RESULTS: There was a non-significant interaction between the type of lesion, gender and intervertebral levels between FASC and Torg´s ratio measurements, F (8, 456) 0.260, p = .978; Wilks' Lambda 0.991; with a small effect size (partial η2 = .005). Among the main effects, only the gender was statistically significant: F (2, 228) = 3.682, p = .027. The age (controlled covariate) was non-significantly related to FASC and Torg´s ratio quantification: F (2, 228) = .098, p = .907. The Pearson´s correlation coefficient depicted a poor, non-significant agreement between FASC and Torg´s ratio. CONCLUSION: FASC provides an integrative evaluation of the cervical spinal canal compromise in acute, cervical spine trauma and degenerative disease. Further observations and correlation with specific neurological symptoms, surgical findings and clinical outcomes are necessary to assess the usefulness of FASC in clinical settings.

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Persistent trigeminal artery (PTA), also called primitive trigeminal artery, represents the most common embryonic remnant of fetal circulation in adulthood, (only after fetal pattern of posterior communicating artery [PComA]) with an estimated incidence of between 0.1% and 0.76%. The permanence of this fetal pattern constitutes an incidental finding in most cases, however, may be associated with aneurysms, arteriovenous malformations, trigeminal neuralgia, and other types of fetal circulation persistency. A patient with giant aneurysm in the communicating segment of the right internal carotid artery, associated with the presence of PTA and fetal pattern of PComA, also on the right side is reported.

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There is a broad community of health sciences professionals interested in the anatomy of the cranial nerves (CNs): specialists in neurology, neurosurgery, radiology, otolaryngology, ophthalmology, maxillofacial surgery, radiation oncology, and emergency medicine, as well as other related fields. Advances in neuroimaging using high-resolution images from computed tomography (CT) and magnetic resonance (MR) have made highly-detailed visualization of brain structures possible, allowing normal findings to be routinely assessed and nervous system pathology to be detected. In this article we present an integrated perspective of the normal anatomy of the CNs established by radiologists and neurosurgeons in order to provide a practical imaging review, which combines 128-slice dual-source multiplanar images from CT cisternography and 3T MR curved reconstructed images. The information about the CNs includes their origin, course (with emphasis on the cisternal segments and location of the orifices at the skull base transmitting them), function, and a brief listing of the most common pathologies affecting them. The scope of the article is clinical anatomy; readers will find specialized texts presenting detailed information about particular topics. Our aim in this article is to provide a helpful reference for understanding the complex anatomy of the cranial nerves.

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Neurocysticercosis is a neurologic parasitic disease caused by the encysted larva of the tapeworm Taenia solium and is the most important parasitic disease of the human central nervous system. It is the most common cause of acquired epilepsy in endemic settings and constitutes a public health challenge for most of the developing world. Nowadays, however, as a result of globalization, neurocysticercosis is being seen more frequently in developed countries as well. Neurocysticercosis is acquired through fecal-oral contamination, and the disease course is complex, with two intermediate hosts (ie, pigs and humans) and a definitive host (humans). Traditionally, it has been classified into active and nonactive forms according to disease location. Radiologists must be aware of its imaging appearance, which is quite variable, as is the differential diagnosis. Imaging findings depend on several factors, including the stage of the life cycle of T solium at presentation; the number and location (ie, subarachnoid, cisternal, or intraventricular) of parasites; and associated complications such as vascular involvement (ie, arteritis with or without infarction), inflammatory response (ie, edema, gliosis, or arachnoiditis), and, in ventricular forms, degree of obstruction. Thus, the diagnostic approach, management, and prognosis for neurocysticercosis differ widely depending on the type of infection.

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Se estima que hasta 70% de los pacientes con epilepsia del lóbulo temporal tienen una alteración morfológica del hipocampo, la esclerosis hipocampal mesial, también llamada esclerosis temporal mesial que se caracteriza por pérdida de neuronas y gliosis responsable del foco epiléptico. En la resonancia magnética convencional la esclerosis temporal mesial se define por la presencia de una atrofia del hipocampo más una señal hiperintensa en las secuencias con tiempo de repetición largo específicas para el hipocampo (FLAIR y T2 coronal). La resonancia magnética 3.0 Tesla permite actualmente estudiar la anatomía y fisiología cerebral o cambiar el mecanismo de adquisición de la imagen y los parámetros posproceso. La volumetría proporciona actualmente un volumen preciso y junto con la espectroscopia hace posible una evaluación cuantitativa del hipocampo. Ambas técnicas se suman a los hallazgos de la resonancia magnética convencional para identificar las lesiones cerebrales que participan en un foco epiléptico. Presentamos un caso de esclerosis temporal mesial con análisis cuantitativo del hipocampo y una breve revisión de la literatura.

Recent studies show that up to 70% of patients with temporal lobe epilepsy (TLE) have a hippocampal deficit known as temporal mesial sclerosis (TME) characterized by neuron loss and gliosis, and considered the main epileptogenic focus among this type of patients. The magnetic resonance imaging (MRI) features of TME include atrophy and hippocampus hyperintensitY in the long TR sequences (Flair and T2). The 3.0 Tesla MRI allows the study of the brain's anatomy and physiology using different sequences and post processing mechanisms. Volumetry can determine the accurate volume and, together with spectroscopy, makes possible a quantitative assessment of the hyppocampus. Both techniques help to locate cerebral areas with epileptogenic activity. We describe the imaging findings from spectroscopy and volumetry in a patient with TLE and briefly review the related literature.

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El síndrome de Wallenberg es una de las entidades clínicas más frecuentemente reconocidas como parte de la patología vascular del tallo cerebral. En la actualidad puede ser identificada con rapidez gracias a las modernas técnicas en neuroimagen. Presentamos un paciente con cuadro clínico de miosis, disfonía, disfagia, seguido de ataxia. Se efectuó evaluación con resonancia magnética utilizando técnicas de difusión, coeficiente aparente de difusión, FLAIR (fast fluid-attenuated inversion recovery) y perfusión. Se describe la correlación clínica de los síntomas con la localización anatómica de la lesión, y se discuten los hallazgos de imagen. La descripción de este caso enfatiza la utilidad de la resonancia magnética para una adecuada evaluación y correlación clínica de los hallazgos en imagen con la exploración neurológica.

Wallenberg's syndrome is one of the most common clinically recognized conditions due to brain stem infarct, which can nowadays be identified by modern neuro-imaging techniques. We describe a patient complaining of miosis, dysphonia, and dysphagia followed by ataxia. An MRI evaluation was performed including diffusion-weighted imaging, apparent diffusion coefficient, T2-weighted images, fluid attenuated inversion recovery (FLAIR) and perfusion. A brief discussion of imaging findings is presented as well as a clinical correlation of the symptoms with the anatomic location of the lesion. This case report emphasizes the importance of imaging findings and their clinical correlation with neurological examination.

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Recent studies show that up to 70% of patients with temporal lobe epilepsy (TLE) have a hippocampal deficit known as temporal mesial sclerosis (TME) characterized by neuron loss and gliosis, and considered the main epileptogenic focus among this type of patients. The magnetic resonance imaging (MRI) features of TME include atrophy and hippocampus hyperintensitY in the long TR sequences (Flair and T2). The 3.0 Tesla MRI allows the study of the brain's anatomy and physiology using different sequences and post processing mechanisms. Volumetry can determine the accurate volume and, together with spectroscopy, makes possible a quantitative assessment of the hyppocampus. Both techniques help to locate cerebral areas with epileptogenic activity. We describe the imaging findings from spectroscopy and volumetry in a patient with TLE and briefly review the related literature.

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Wallenberg's syndrome is one of the most common clinically recognized conditions due to brain stem infarct, which can nowadays be identified by modern neuro-imaging techniques. We describe a patient complaining of miosis, dysphonia, and dysphagia followed by ataxia. An MRI evaluation was performed including diffusion-weighted imaging, apparent diffusion coefficient, T2-weighted images, fluid attenuated inversion recovery (FLAIR) and perfusion. A brief discussion of imaging findings is presented as well as a clinical correlation of the symptoms with the anatomic location of the lesion. This case report emphasizes the importance of imaging findings and their clinical correlation with neurological examination.

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Cervical carotid artery dissections (CCAD) are common in young adults with a mean age of 44 years and may account for as many as 20% of strokes in patients younger than 30 years. Trauma and primary diseases of the arterial wall such as fibromuscular dysplasia are the main predisposing factors. Some CCAD cases are diagnosed solely on clinical history and physical examination, and even imaging tools such as helical/multi-slice computed tomography (CT) and magnetic resonance imaging (MRI) sometimes are not sufficient to reach a diagnosis. We describe the case of an 18-year-old male who presented to our emergency department due to loss of consciousness 18 hours after a car accident. Previously he had been in no acute distress, with fluent speech, and able to follow 3-step commands. Helical CT showed a hypodense lesion in the left-middle cerebral artery territory, as well as hyperdensity of the M1 segment of the middle cerebral artery. Cerebral angiography depicted the left carotid artery dissection in the C1 segment. Physicians should consider this entity in "asymptomatic" patients during their first hours after head injury, among patients who later develop focal neurological symptoms and clinical deficits. Clinical suspicion followed by radiological findings allows early neurovascular treatment, trying to save viable brain tissue in the first hours post injury.

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La disección de la arteria carótida interna (DACI) en su porción extracraneal es más común en adultos jóvenes, con edad de presentación promedio de 44 años y representa hasta 20% de los accidentes vasculares cerebrales en menores de 30. Algunos casos de DACI son de difícil diagnóstico, si se basan únicamente en la clínica y la exploración física; aunado a este hecho, los métodos de imagen como la tomografía computada (TC) helicoidal o multicorte así como la resonancia magnética (RM) pueden no ser suficientes para delinear la patología en cuestión. Presentamos el caso de un paciente masculino de 18 años, quien sufrió accidente automovilístico, sin pérdida del estado de alerta, 18 horas después del accidente presenta deterioro súbito del estado de conciencia, fue trasladado al hospital. La TC identificó una lesión hipodensa en el territorio de la arteria cerebral media izquierda, e hiperdensidad de esta arteria en la fase simple. Se realizó una angiografía cerebral diagnóstica, que mostró DACI izquierda en su segmento C1. Desde el punto de vista clínico-quirúrgico es importante sospechar esta patología en un paciente “asintomático” en las primeras horas postraumatismo y que posteriormente desarrolla déficit neurológico. La sospecha clínica y su comprobación radiológica permiten un tratamiento neuroquirúrgico-vascular para intentar el rescate del tejido cerebral viable en las primeras horas de establecido el daño.

Cervical carotid artery dissections (CCAD) are common in young adults with a mean age of 44 years and may account for as many as 20% of strokes in patients younger than 30 years. Trauma and primary diseases of the arterial wall such as fibromuscular dysplasia are the main predisposing factors. Some CCAD cases are diagnosed solely on clinical history and physical examination, and even imaging tools such as helical/multi-slice computed tomography (CT) and magnetic resonance imaging (MRI) sometimes are not sufficient to reach a diagnosis. We describe the case of an 18-year-old male who presented to our emergency department due to loss of consciousness 18 hours after a car accident. Previously he had been in no acute distress, with fluent speech, and able to follow 3-step commands. Helical CT showed a hypodense lesion in the left-middle cerebral artery territory, as well as hyperdensity of the M1 segment of the middle cerebral artery. Cerebral angiography depicted the left carotid artery dissection in the C1 segment. Physicians should consider this entity in [quot ]asymptomatic[quot ] patients during their first hours after head injury, among patients who later develop focal neurological symptoms and clinical deficits. Clinical suspicion followed by radiological findings allows early neurovascular treatment, trying to save viable brain tissue in the first hours post injury.

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