Ana Filipa Geraldo da Silva Couceiro

All Publications

• Response assessment in pediatric neurooncology (RAPNO) criteria revisited: a practical navigation guide for neuroradiologists. Neuroradiology Geraldo, A. F., Maldonado, F., Severino, M., Mankad, K., Dahmoush, H., Soares, B., Rugilo, C., Rossi, A. 2024

  Abstract

  The Response Assessment in Pediatric Neuro-Oncology (RAPNO) Working Group is an international, collaborative network of experts dedicated to pediatric central nervous system (CNS) tumors that was created in 2011. Since then, six RAPNO articles with imaging guidelines for response assessment in diverse pediatric tumor subgroups have been published, namely: 1) medulloblastomas and leptomeningeal seeding tumors (2018), 2) pediatric high-grade gliomas (2020), 3) pediatric low-grade gliomas (2020), 4) diffuse intrinsic pontine gliomas (2020), 5) pediatric intracranial ependymomas (2022) and 6) pediatric craniopharyngiomas (2023). The purpose of this article is to review all current available RAPNO criteria using a systematized and comparative approach centered on the role of neuroradiologists and supported by neuroimaging examples. Special emphasis will be placed on clarification of core concepts as well as practical adoption aspects of the RAPNO guidelines, namely how and when to image the brain and/or the spine; how to interpret the imaging findings; which other clinical, therapeutic and laboratory variables to consider; and finally how to apply the information to attribute the final appropriate response assessment classification.

  View details for DOI 10.1007/s00234-024-03493-x

  View details for PubMedID 39446196

• Central nervous system embryonal tumor with PLAGL1 amplification: a case report of a novel entity focusing on imaging findings. Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery Maldonado, F., Geraldo, A. F., Guarnizo, A., Fernández-Ponce, N., Baroni, L., Rugilo, C. 2024; 40 (8): 2603-2607

  Abstract

  The embryonal central nervous system (CNS) tumor with PLAGL1 (pleomorphic adenoma gene-like) amplification is a novel type of pediatric neoplasm with a distinct methylation profile, described for the first time in 2022. It may be located anywhere in the neuroaxis and, as its name implies, it is driven by the amplification and overexpression of one of the PLAG family genes. Although the associated clinical, immunohistopathological, and molecular characteristics are well characterized in the seminal report of this entity, data on the radiological features is still lacking. Here, we present a case report of a 4-year-old girl with a biopsy-proven PLAGL1-amplified brainstem tumor and provide a detailed description of the corresponding conventional neuroimaging characteristics, aiming to better delineate this entity and to increase the awareness of this pathology in the radiological community.

  View details for DOI 10.1007/s00381-024-06422-8

  View details for PubMedID 38642111

  View details for PubMedCentralID 8598784

• Go Green in Neuroradiology: towards reducing the environmental impact of its practice. Neuroradiology Rovira, À., Ben Salem, D., Geraldo, A. F., Cappelle, S., Del Poggio, A., Cocozza, S., Saatci, I., Zlatareva, D., Lojo, S., Quattrocchi, C. C., Morales, Á., Yousry, T. 2024; 66 (4): 463-476

  Abstract

  Raising public awareness about the relevance of supporting sustainable practices is required owing to the phenomena of global warming caused by the rising production of greenhouse gases. The healthcare sector generates a relevant proportion of the total carbon emissions in developed countries, and radiology is estimated to be a major contributor to this carbon footprint. Neuroradiology markedly contributes to this negative environmental effect, as this radiological subspecialty generates a high proportion of diagnostic and interventional imaging procedures, the majority of them requiring high energy-intensive equipment. Therefore, neuroradiologists and neuroradiological departments are especially responsible for implementing decisions and initiatives able to reduce the unfavourable environmental effects of their activities, by focusing on four strategic pillars-reducing energy, water, and helium use; properly recycling and/or disposing of waste and residues (including contrast media); encouraging environmentally friendly behaviour; and reducing the effects of ionizing radiation on the environment. The purpose of this article is to alert neuroradiologists about their environmental responsibilities and to analyse the most productive strategic axes, goals, and lines of action that contribute to reducing the environmental impact associated with their professional activities.

  View details for DOI 10.1007/s00234-024-03305-2

  View details for PubMedID 38353699

  View details for PubMedCentralID 4900601

• Recommendations for neuroradiological examinations in children living with achondroplasia: a European Society of Pediatric Radiology and European Society of Neuroradiology opinion paper. Pediatric radiology Wright, J., Cheung, M., Siddiqui, A., Lucas, J., Calder, A., Argyropoulou, M. I., Arthurs, O. J., Caro-Dominguez, P., Thompson, D., Severino, M., D'Arco, F. 2023; 53 (12): 2323-2344

  Abstract

  Children living with achondroplasia are at an increased risk of developing neurological complications, which may be associated with acute and life-altering events. To remediate this risk, the timely acquisition of effective neuroimaging that can help to guide clinical management is essential. We propose imaging protocols and follow-up strategies for evaluating the neuroanatomy of these children and to effectively identify potential neurological complications, including compression at the cervicomedullary junction secondary to foramen magnum stenosis, spinal deformity and spinal canal stenosis. When compiling these recommendations, emphasis has been placed on reducing scan times and avoiding unnecessary radiation exposure. Standardized imaging protocols are important to ensure that clinically useful neuroimaging is performed in children living with achondroplasia and to ensure reproducibility in future clinical trials. The members of the European Society of Pediatric Radiology (ESPR) Neuroradiology Taskforce and European Society of Neuroradiology pediatric subcommittee, together with clinicians and surgeons with specific expertise in achondroplasia, wrote this opinion paper. The research committee of the ESPR also endorsed the final draft. The rationale for these recommendations is based on currently available literature, supplemented by best practice opinion from radiologists and clinicians with subject-specific expertise.

  View details for DOI 10.1007/s00247-023-05728-0

  View details for PubMedID 37674051

  View details for PubMedCentralID 6318916

• Neuroimaging of pediatric tumors of the sellar region-A review in light of the 2021 WHO classification of tumors of the central nervous system. Frontiers in pediatrics Maia, R., Miranda, A., Geraldo, A. F., Sampaio, L., Ramaglia, A., Tortora, D., Severino, M., Rossi, A. 2023; 11: 1162654

  Abstract

  Sellar/suprasellar tumors comprise about 10% of all pediatric Central Nervous System (CNS) tumors and include a wide variety of entities, with different cellular origins and distinctive histological and radiological findings, demanding customized neuroimaging protocols for appropriate diagnosis and management. The 5th edition of the World Health Organization (WHO) classification of CNS tumors unprecedently incorporated both histologic and molecular alterations into a common diagnostic framework, with a great impact in tumor classification and grading. Based on the current understanding of the clinical, molecular, and morphological features of CNS neoplasms, there have been additions of new tumor types and modifications of existing ones in the latest WHO tumor classification. In the specific case of sellar/suprasellar tumors, changes include for example separation of adamantinomatous and papillary craniopharyngiomas, now classified as distinct tumor types. Nevertheless, although the current molecular landscape is the fundamental driving force to the new WHO CNS tumor classification, the imaging profile of sellar/suprasellar tumors remains largely unexplored, particularly in the pediatric population. In this review, we aim to provide an essential pathological update to better understand the way sellar/suprasellar tumors are currently classified, with a focus on the pediatric population. Furthermore, we intend to present the neuroimaging features that may assist in the differential diagnosis, surgical planning, adjuvant/neoadjuvant therapy, and follow-up of this group of tumors in children.

  View details for DOI 10.3389/fped.2023.1162654

  View details for PubMedID 37416813

  View details for PubMedCentralID PMC10320298

• Feingold syndrome type 1: a rare cause of fetal microcephaly (prenatal diagnosis). BMJ case reports Gouveia, I., Geraldo, A. F., Godinho, C., Castedo, S. 2023; 16 (3)

  Abstract

  We report a case of fetal microcephaly found during the second trimester ultrasound and confirmed by further ultrasound scans and fetal MRI. The array comparative genomic hybridisation analysis of the fetus and the male parent showed a 1.5 Mb deletion overlapping the Feingold syndrome region, an autosomal dominant syndrome that can cause microcephaly, facial/hand abnormalities, mild neurodevelopmental delay and others. This case illustrates the need for a detailed investigation by a multidisciplinary team to provide prenatal counselling regarding a postnatal outcome to the parents and orient their decision towards the continuation or termination of pregnancy.

  View details for DOI 10.1136/bcr-2022-254366

  View details for PubMedID 36889805

  View details for PubMedCentralID PMC10008251

• Torcular pseudomass is frequently detected on fetal magnetic resonance imaging and reduces with gestational age. Pediatric radiology Miranda, A. M., Bem, P., Araújo, A., Brito, C., Nunes, J., Geraldo, A. F. 2023; 53 (3): 470-478

  Abstract

  The torcular pseudomass is an incidental extra-axial midline mass located between the venous sinuses and the occipital squama in the pediatric population. Although this structure is presumed to be a developmental feature, it has not been characterized on fetal MRI.To determine the frequency, imaging features and longitudinal in utero evolution of torcular pseudomass using fetal MRI.We present a single-center retrospective study of fetal MRI performed at a tertiary hospital. Two independent reviewers first ordinally scored torcular pseudomass as absent, focal, crescentic or bulky based on morphology. We reviewed available follow-up fetal and postnatal MRI and further classified torcular pseudomass as stable, involuted or progressive. We also collected clinical and demographic data from electronic charts and compared them among categories, corrected for multiple comparisons.This study included a total of 219 fetuses with median gestational age of 28 weeks (interquartile range [IQR]: 23-32 weeks). Torcular pseudomass was absent in 8% (n=17) and present as a focal mass in 15% (n=33), crescentic in 45% (n=98) and bulky in 32% (n=71) of the cases. Median gestational age was statistically different among torcular pseudomass categories and inversely associated with size. Follow-up fetal MRI was available in 9.6% (n=21) of cases (median interval 4 weeks; IQR: 2-9 weeks) and torcular pseudomass in these cases was classified as stable in 67% (n=14), involuted in 29% (n=6) and progressive in 5% (n=1). Postnatal MRI was available in 5% (n=12) of fetuses (median interval 11.5 months, IQR: 3-17 months), and among these cases torcular pseudomass was classified as stable in 33% (n=4) and involuted in 67% (n=8).Torcular pseudomass is highly prevalent in the fetal population and shows a natural tendency to involute, even in utero, although it sometimes persists during early infanthood.

  View details for DOI 10.1007/s00247-022-05549-7

  View details for PubMedID 36437371

  View details for PubMedCentralID 3682118

• Natural history of familial cerebral cavernous malformation syndrome in children: a multicenter cohort study. Neuroradiology Geraldo, A. F., Alves, C. A., Luis, A., Tortora, D., Guimarães, J., Abreu, D., Reimão, S., Pavanello, M., de Marco, P., Scala, M., Capra, V., Vaz, R., Rossi, A., Schwartz, E. S., Mankad, K., Severino, M. 2023; 65 (2): 401-414

  Abstract

  There is limited data concerning neuroimaging findings and longitudinal evaluation of familial cerebral cavernous malformations (FCCM) in children. Our aim was to study the natural history of pediatric FCCM, with an emphasis on symptomatic hemorrhagic events and associated clinical and imaging risk factors.We retrospectively reviewed all children diagnosed with FCCM in four tertiary pediatric hospitals between January 2010 and March 2022. Subjects with first available brain MRI and [Formula: see text] 3 months of clinical follow-up were included. Neuroimaging studies were reviewed, and clinical data collected. Annual symptomatic hemorrhage risk rates and cumulative risks were calculated using survival analysis and predictors of symptomatic hemorrhagic identified using regression analysis.Forty-one children (53.7% males) were included, of whom 15 (36.3%) presenting with symptomatic hemorrhage. Seven symptomatic hemorrhages occurred during 140.5 person-years of follow-up, yielding a 5-year annual hemorrhage rate of 5.0% per person-year. The 1-, 2-, and 5-year cumulative risks of symptomatic hemorrhage were 7.3%, 14.6%, and 17.1%, respectively. The latter was higher in children with prior symptomatic hemorrhage (33.3%), CCM2 genotype (33.3%), and positive family history (20.7%). Number of brainstem (adjusted hazard ratio [HR] = 1.37, P = 0.005) and posterior fossa (adjusted HR = 1.64, P = 0.004) CCM at first brain MRI were significant independent predictors of prospective symptomatic hemorrhage.The 5-year annual and cumulative symptomatic hemorrhagic risk in our pediatric FCCM cohort equals the overall risk described in children and adults with all types of CCM. Imaging features at first brain MRI may help to predict potential symptomatic hemorrhage at 5-year follow-up.

  View details for DOI 10.1007/s00234-022-03056-y

  View details for PubMedID 36198887

  View details for PubMedCentralID PMC9859903

• Spinal involvement in pediatric familial cavernous malformation syndrome. Neuroradiology Geraldo, A. F., Luis, A., Alves, C. A., Tortora, D., Guimarães, J., Reimão, S., Pavanello, M., de Marco, P., Scala, M., Capra, V., Rossi, A., Schwartz, E. S., Mankad, K., Severino, M. 2022; 64 (8): 1671-1679

  Abstract

  The aim of the study was to assess the prevalence and characteristics of spinal cord cavernous malformations (SCCM) and intraosseous spinal vascular malformations (ISVM) in a pediatric familial cerebral cavernous malformation (FCCM) cohort and evaluate clinico-radiological differences between children with (SCCM +) and without (SCCM-) SCCM.All patients with a pediatric diagnosis of FCCM evaluated at three tertiary pediatric hospitals between January 2010 and August 2021 with [Formula: see text] 1 whole spine MR available were included. Brain and spine MR studies were retrospectively evaluated, and clinical and genetic data collected. Comparisons between SCCM + and SCCM- groups were performed using student-t/Mann-Whitney or Fisher exact tests, as appropriate.Thirty-one children (55% boys) were included. Baseline spine MR was performed (mean age = 9.7 years) following clinical manifestations in one subject (3%) and as a screening strategy in the remainder. Six SCCM were detected in five patients (16%), in the cervico-medullary junction (n = 1), cervical (n = 3), and high thoracic (n = 2) regions, with one appearing during follow-up. A tendency towards an older age at first spine MR (P = 0.14) and [Formula: see text] 1 posterior fossa lesion (P = 0.13) was observed in SCCM + patients, lacking statistical significance. No subject demonstrated ISVM.Although rarely symptomatic, SCCM can be detected in up to 16% of pediatric FCCM patients using diverse spine MR protocols and may appear de novo. ISVM were instead absent in our cohort. Given the relative commonality of asymptomatic SCCM, serial screening spine MR should be considered in FCCM starting in childhood.

  View details for DOI 10.1007/s00234-022-02958-1

  View details for PubMedID 35451625

• Malformations of Cortical Development Pediatric Neuroradiology Geraldo, A., Rossi, A., Severino, M. Springer. 2022
• IgG4-related disease with renal and orbital involvement: a clinical case. Acta reumatologica portuguesa Oliveira, P. M., Geraldo, A. F., Pereira, T., Barbedo, M. 2021; 46 (3): 272-276

  Abstract

  IgG4-related disease (IgG4-RD) is characterized by the growth of pseudotumors, which can affect almost every organ. Elevated serum IgG4 levels are present in only two-thirds of the patients and are not specific. Diagnosis is difficult and is usually based on a biopsy.A 39-year-old man presented complaints of low back pain and fever. A renal computed tomography (CT) scan revealed a voluminous mass next to the right kidney and a biopsy showed an inflammatory process and excluded a neoplasm. A follow-up CT scan at four months revealed total regression without any treatment. Three years later, the patient presented with diplopia and right proptosis. MRI of the orbits revealed a retro-ocular mass; biopsy excluded a malignant process. Infectious, autoimmune or paraneoplastic diseases were also excluded. Although the patient's IgG4 serum levels were normal, histopathological reobservation of the renal biopsy revealed IgG4-positive plasma cells, thus confirming the diagnosis. The patient was prescribed a daily dose of 40 mg of prednisolone and regression of the right orbital lesion was observed.IgG4-RD is a rare and recently described condition. Most anatomic pathology laboratories do not routinely test for it. Spontaneous pseudotumor remission is possible, even when associated with the renal phenotype, although this has not been described until now.

  View details for PubMedID 34628455

• Widening the Neuroimaging Features of Adenosine Deaminase 2 Deficiency. AJNR. American journal of neuroradiology Geraldo, A. F., Caorsi, R., Tortora, D., Gandolfo, C., Ammendola, R., Alessio, M., Conti, G., Insalaco, A., Pastore, S., Martino, S., Ceccherini, I., Signa, S., Gattorno, M., Rossi, A., Severino, M. 2021; 42 (5): 975-979

  Abstract

  Adenosine deaminase 2 deficiency (OMIM #615688) is an autosomal recessive disorder characterized by a wide clinical spectrum, including small- and medium-sized vessel vasculopathies, but data focusing on the associated neuroimaging features are still scarce in the literature. Here, we describe the clinical neuroimaging features of 12 patients with genetically proven adenosine deaminase 2 deficiency (6 males; median age at disease onset, 1.3 years; median age at genetic diagnosis, 15.5 years). Our findings expand the neuroimaging phenotype of this condition demonstrating, in addition to multiple, recurrent brain lacunar ischemic and/or hemorrhagic strokes, spinal infarcts, and intracranial aneurysms, also cerebral microbleeds and a peculiar, likely inflammatory, perivascular tissue in the basal and peripontine cisterns. Together with early clinical onset, positive family history, inflammatory flares and systemic abnormalities, these findings should raise the suspicion of adenosine deaminase 2 deficiency, thus prompting genetic evaluation and institution of tumor necrosis factor inhibitors, with a potential great impact on neurologic outcome.

  View details for DOI 10.3174/ajnr.A7019

  View details for PubMedID 33632736

  View details for PubMedCentralID PMC8115359

• Diagnostic Approach to Macrocephaly in Children. Frontiers in pediatrics Accogli, A., Geraldo, A. F., Piccolo, G., Riva, A., Scala, M., Balagura, G., Salpietro, V., Madia, F., Maghnie, M., Zara, F., Striano, P., Tortora, D., Severino, M., Capra, V. 2021; 9: 794069

  Abstract

  Macrocephaly affects up to 5% of the pediatric population and is defined as an abnormally large head with an occipitofrontal circumference (OFC) >2 standard deviations (SD) above the mean for a given age and sex. Taking into account that about 2-3% of the healthy population has an OFC between 2 and 3 SD, macrocephaly is considered as "clinically relevant" when OFC is above 3 SD. This implies the urgent need for a diagnostic workflow to use in the clinical setting to dissect the several causes of increased OFC, from the benign form of familial macrocephaly and the Benign enlargement of subarachnoid spaces (BESS) to many pathological conditions, including genetic disorders. Moreover, macrocephaly should be differentiated by megalencephaly (MEG), which refers exclusively to brain overgrowth, exceeding twice the SD (3SD-"clinically relevant" megalencephaly). While macrocephaly can be isolated and benign or may be the first indication of an underlying congenital, genetic, or acquired disorder, megalencephaly is most likely due to a genetic cause. Apart from the head size evaluation, a detailed family and personal history, neuroimaging, and a careful clinical evaluation are crucial to reach the correct diagnosis. In this review, we seek to underline the clinical aspects of macrocephaly and megalencephaly, emphasizing the main differential diagnosis with a major focus on common genetic disorders. We thus provide a clinico-radiological algorithm to guide pediatricians in the assessment of children with macrocephaly.

  View details for DOI 10.3389/fped.2021.794069

  View details for PubMedID 35096710

  View details for PubMedCentralID PMC8795981

• Neonatal Developmental Venous Anomalies: Clinicoradiologic Characterization and Follow-Up. AJNR. American journal of neuroradiology Geraldo, A. F., Messina, S. S., Tortora, D., Parodi, A., Malova, M., Morana, G., Gandolfo, C., D'Amico, A., Herkert, E., Govaert, P., Ramenghi, L. A., Rossi, A., Severino, M. 2020; 41 (12): 2370-2376

  Abstract

  Although developmental venous anomalies have been frequently studied in adults and occasionally in children, data regarding these entities are scarce in neonates. We aimed to characterize clinical and neuroimaging features of neonatal developmental venous anomalies and to evaluate any association between MR imaging abnormalities in their drainage territory and corresponding angioarchitectural features.We reviewed parenchymal abnormalities and angioarchitectural features of 41 neonates with developmental venous anomalies (20 males; mean corrected age, 39.9 weeks) selected through a radiology report text search from 2135 neonates who underwent brain MR imaging between 2008 and 2019. Fetal and longitudinal MR images were also reviewed. Neurologic outcomes were collected. Statistics were performed using χ2, Fisher exact, Mann-Whitney U, or t tests corrected for multiple comparisons.Developmental venous anomalies were detected in 1.9% of neonatal scans. These were complicated by parenchymal/ventricular abnormalities in 15/41 cases (36.6%), improving at last follow-up in 8/10 (80%), with normal neurologic outcome in 9/14 (64.2%). Multiple collectors (P = .008) and larger collector caliber (P < .001) were significantly more frequent in complicated developmental venous anomalies. At a patient level, multiplicity (P = .002) was significantly associated with the presence of ≥1 complicated developmental venous anomaly. Retrospective fetal detection was possible in 3/11 subjects (27.2%).One-third of neonatal developmental venous anomalies may be complicated by parenchymal abnormalities, especially with multiple and larger collectors. Neuroimaging and neurologic outcomes were favorable in most cases, suggesting a benign, self-limited nature of these vascular anomalies. A congenital origin could be confirmed in one-quarter of cases with available fetal MR imaging.

  View details for DOI 10.3174/ajnr.A6829

  View details for PubMedID 33093132

  View details for PubMedCentralID PMC7963246

• Definitions and classification of malformations of cortical development: practical guidelines (vol 143, awaa174, 2020) BRAIN Severino, M., Geraldo, A., Utz, N., Tortora, D., Pogledic, I., Klonowski, W., Triulzi, F., Arrigoni, F., Mankad, K., Leventer, R. J., Mancini, G. M. S., Barkovich, J. A., Lequin, M. H., Rossi, A., European Network Brain 2020; 143

  View details for DOI 10.1093/brain/awaa298

  View details for Web of Science ID 000615920000010

• Perinatal Arterial Ischemic Stroke in Fetal Vascular Malperfusion: A Case Series and Literature Review. AJNR. American journal of neuroradiology Geraldo, A. F., Parodi, A., Bertamino, M., Buffelli, F., Uccella, S., Tortora, D., Moretti, P., Ramenghi, L., Fulcheri, E., Rossi, A., Severino, M. 2020; 41 (12): 2377-2383

  Abstract

  Fetal vascular malperfusion includes a continuum of placental histologic abnormalities increasingly associated with perinatal brain injury, namely arterial ischemic stroke. Here, we describe the clinical-neuroimaging features of 5 neonates with arterial ischemic stroke and histologically proved fetal vascular malperfusion. All infarcts involved the anterior territories and were multiple in 2 patients. In 2 neonates, there were additional signs of marked dural sinus congestion, thrombosis, or both. A mixed pattern of chronic hypoxic-ischemic encephalopathy and acute infarcts was noted in 1 patient at birth. Systemic cardiac or thrombotic complications were present in 2 patients. These peculiar clinical-radiologic patterns may suggest fetal vascular malperfusion and should raise the suspicion of this rare, underdiagnosed condition carrying important implications in patient management, medicolegal actions, and future pregnancy counseling.

  View details for DOI 10.3174/ajnr.A6857

  View details for PubMedID 33122209

  View details for PubMedCentralID PMC7963247

• Partially reversible confluent white matter lesions in a Caucasian child with moyamoya disease. Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery Geraldo, A. F., Leitão, C., Nunes, J., Vila-Real, M. 2020; 36 (11): 2605-2608

  View details for DOI 10.1007/s00381-020-04854-6

  View details for PubMedID 32754868

• Definitions and classification of malformations of cortical development: practical guidelines. Brain : a journal of neurology Severino, M., Geraldo, A. F., Utz, N., Tortora, D., Pogledic, I., Klonowski, W., Triulzi, F., Arrigoni, F., Mankad, K., Leventer, R. J., Mancini, G. M., Barkovich, J. A., Lequin, M. H., Rossi, A. 2020; 143 (10): 2874-2894

  Abstract

  Malformations of cortical development are a group of rare disorders commonly manifesting with developmental delay, cerebral palsy or seizures. The neurological outcome is extremely variable depending on the type, extent and severity of the malformation and the involved genetic pathways of brain development. Neuroimaging plays an essential role in the diagnosis of these malformations, but several issues regarding malformations of cortical development definitions and classification remain unclear. The purpose of this consensus statement is to provide standardized malformations of cortical development terminology and classification for neuroradiological pattern interpretation. A committee of international experts in paediatric neuroradiology prepared systematic literature reviews and formulated neuroimaging recommendations in collaboration with geneticists, paediatric neurologists and pathologists during consensus meetings in the context of the European Network Neuro-MIG initiative on Brain Malformations (https://www.neuro-mig.org/). Malformations of cortical development neuroimaging features and practical recommendations are provided to aid both expert and non-expert radiologists and neurologists who may encounter patients with malformations of cortical development in their practice, with the aim of improving malformations of cortical development diagnosis and imaging interpretation worldwide.

  View details for DOI 10.1093/brain/awaa174

  View details for PubMedID 32779696

  View details for PubMedCentralID PMC7586092

• Neuroimaging assessment in Down syndrome: a pictorial review. Insights into imaging Rodrigues, M., Nunes, J., Figueiredo, S., Martins de Campos, A., Geraldo, A. F. 2019; 10 (1): 52

  Abstract

  Down syndrome (DS), or trisomy 21, is the leading genetic cause of intellectual incapacity worldwide, with a reported incidence of about 1 in 1,000 to 1 in 1,100 live births. Besides the several commonly known physical features characteristic of this syndrome present at birth, DS may additionally affect every organ system. In addition, despite the large number of published papers concerning this syndrome, there is scarce literature focusing specifically in the typical neuroimaging features associated with this condition. The aim of this paper is to review and systematize the distinctive characteristics and abnormalities of the central nervous system, head and neck, and spine present in DS patients that should actively be searched for and evaluated by radiologists and/or neuroradiologists.

  View details for DOI 10.1186/s13244-019-0729-3

  View details for PubMedID 31111268

  View details for PubMedCentralID PMC6527671

• Reply: "Developmental venous anomaly depicted incidentally in fetal MRI and confirmed in post-natal MRI". Neuroradiology Geraldo, A. F., Melo, M., Monteiro, D., Valente, F., Nunes, J. 2019; 61 (1): 11-12

  View details for DOI 10.1007/s00234-018-2132-z

  View details for PubMedID 30426145

• Developmental venous anomaly depicted incidentally in fetal MRI and confirmed in post-natal MRI. Neuroradiology Geraldo, A. F., Melo, M., Monteiro, D., Valente, F., Nunes, J. 2018; 60 (10): 993-994

  View details for DOI 10.1007/s00234-018-2089-y

  View details for PubMedID 30155642

• Posterior fossa lipoma without T1 hyperintensity in foetal magnetic resonance imaging performed in the third trimester. Pediatric radiology Geraldo, A. F., Valente, F., Almeida, N., Nunes, J. 2018; 48 (8): 1178-1179

  View details for DOI 10.1007/s00247-018-4168-y

  View details for PubMedID 29876683

• Beyond fractional anisotropy in amyotrophic lateral sclerosis: the value of mean, axial, and radial diffusivity and its correlation with electrophysiological conductivity changes. Neuroradiology Geraldo, A. F., Pereira, J., Nunes, P., Reimão, S., Sousa, R., Castelo-Branco, M., Pinto, S., Campos, J. G., de Carvalho, M. 2018; 60 (5): 505-515

  Abstract

  This paper aims to analyze the contribution of mean diffusivity (MD), axial diffusivity (AD), and radial diffusivity (RD) in the detection of microstructural abnormalities in amyotrophic lateral sclerosis (ALS) and to evaluate the degree of agreement between structural and functional changes through concomitant diffusion tensor imaging (DTI), transcranial magnetic stimulation (TMS), and clinical assessment.Fourteen patients with ALS and 11 healthy, age- and gender-matched controls were included. All participants underwent magnetic resonance imaging including DTI. TMS was additionally performed in ALS patients. Differences in the distribution of DTI-derived measures were assessed using tract-based spatial statistical (TBSS) and volume of interest (VOI) analyses. Correlations between clinical, imaging, and neurophysiological findings were also assessed through TBSS.ALS patients showed a significant increase in AD and MD involving the corticospinal tract (CST) and the pre-frontal white matter in the right posterior limb of the internal capsule (p < 0.05) when compared to the control group using TBSS, confirmed by VOI analyses. VOI analyses also showed increased AD in the corpus callosum (p < 0.05) in ALS patients. Fractional anisotropy (FA) in the right CST correlated significantly with upper motor neuron (UMN) score (r = - 0.79, p < 0.05), and right abductor digiti minimi central motor conduction time was highly correlated with RD in the left posterior internal capsule (r = - 0.81, p < 0.05). No other significant correlation was found.MD, AD, and RD, besides FA, are able to further detect and characterize neurodegeneration in ALS. Furthermore, TMS and DTI appear to have a role as complementary diagnostic biomarkers of UMN dysfunction.

  View details for DOI 10.1007/s00234-018-2012-6

  View details for PubMedID 29564498

• Differentiation of Enhancing Glioma and Primary Central Nervous System Lymphoma by Texture-Based Machine Learning. AJNR. American journal of neuroradiology Alcaide-Leon, P., Dufort, P., Geraldo, A. F., Alshafai, L., Maralani, P. J., Spears, J., Bharatha, A. 2017; 38 (6): 1145-1150

  Abstract

  Accurate preoperative differentiation of primary central nervous system lymphoma and enhancing glioma is essential to avoid unnecessary neurosurgical resection in patients with primary central nervous system lymphoma. The purpose of the study was to evaluate the diagnostic performance of a machine-learning algorithm by using texture analysis of contrast-enhanced T1-weighted images for differentiation of primary central nervous system lymphoma and enhancing glioma.Seventy-one adult patients with enhancing gliomas and 35 adult patients with primary central nervous system lymphomas were included. The tumors were manually contoured on contrast-enhanced T1WI, and the resulting volumes of interest were mined for textural features and subjected to a support vector machine-based machine-learning protocol. Three readers classified the tumors independently on contrast-enhanced T1WI. Areas under the receiver operating characteristic curves were estimated for each reader and for the support vector machine classifier. A noninferiority test for diagnostic accuracy based on paired areas under the receiver operating characteristic curve was performed with a noninferiority margin of 0.15.The mean areas under the receiver operating characteristic curve were 0.877 (95% CI, 0.798-0.955) for the support vector machine classifier; 0.878 (95% CI, 0.807-0.949) for reader 1; 0.899 (95% CI, 0.833-0.966) for reader 2; and 0.845 (95% CI, 0.757-0.933) for reader 3. The mean area under the receiver operating characteristic curve of the support vector machine classifier was significantly noninferior to the mean area under the curve of reader 1 (P = .021), reader 2 (P = .035), and reader 3 (P = .007).Support vector machine classification based on textural features of contrast-enhanced T1WI is noninferior to expert human evaluation in the differentiation of primary central nervous system lymphoma and enhancing glioma.

  View details for DOI 10.3174/ajnr.A5173

  View details for PubMedID 28450433

  View details for PubMedCentralID PMC7960089

• Impact of leukoaraiosis on parenchymal hemorrhage in elderly patients treated with thrombolysis. Neuroradiology Nighoghossian, N., Abbas, F., Cho, T. H., Geraldo, A. F., Cottaz, V., Janecek, E., Mechtouff, L., Bischoff, M., El Khoury, C., Schott, A. M., Derex, L., Hermier, M., Tisserand, L. G., Amelie, R., Chamard, L., Berthezene, Y. 2016; 58 (10): 961-967

  Abstract

  Severity of vascular damage of white matter may predict hemorrhagic transformation (HT). We assess the relationship between leukoaraiosis (LA) severity and the type of hemorrhagic transformation in elderly patients treated with thrombolysis.We retrospectively analyzed the clinical data and pretreatment magnetic resonance imaging (MRI) of 180 consecutive ischemic stroke patients aged over 75 years. LA severity was graded according to the Fazekas scale, and acute diffusion-weighted-imaging (DWI) lesion volumes were semi-automatically outlined. Predictors of hemorrhagic infarction (HI) and parenchymal hemorrhage (PH) were identified using logistic regression analysis and exact multinomial logistic analysis.HT occurred in 31 patients (17 %). Baseline National Institute of Health Stroke Score (NIHSS; p = 0.008), severe LA (p = 0.02), and diffusion lesion volume (p = 0.02) were predictors of HT in univariable logistic regression. Adjusted to lesion volume and baseline NIHSS score, exact multinomial logistic analysis showed that severe LA was the only independent predictor of parenchymal hemorrhage (p = 0.03).In elderly patients, LA severity better predicts parenchymal hemorrhage than infarct size.

  View details for DOI 10.1007/s00234-016-1725-7

  View details for PubMedID 27447872

• Pseudotumoral presentation of cerebral amyloid angiopathy-related inflammation. Neurology Ronsin, S., Deiana, G., Geraldo, A. F., Durand-Dubief, F., Thomas-Maisonneuve, L., Formaglio, M., Desestret, V., Meyronet, D., Nighoghossian, N., Berthezène, Y., Honnorat, J., Ducray, F. 2016; 86 (10): 912-9

  Abstract

  To identify the clinical and radiologic features that should raise suspicion for the pseudotumoral presentation of cerebral amyloid angiopathy-related inflammation (CAA-I).We retrospectively reviewed the characteristics of 5 newly diagnosed and 23 previously reported patients in whom the CAA-I imaging findings were initially interpreted as CNS neoplasms.Most cases (85%) occurred in patients >60 years old. The clinical characteristics at presentation included subacute cognitive decline (50%), confusion (32%), focal deficits (32%), seizures (25%), and headaches (21%). Brain MRI demonstrated infiltrative white matter lesions that exhibited a loco-regional mass effect without parenchymal enhancement (93%). In general, these findings were interpreted as low-grade glioma or lymphoma. Eighteen patients (64%) underwent a biopsy, which was nondiagnostic in 4 patients (14%), and 6 patients (21%) underwent a surgical resection. The primary reason for the misinterpretation of the imaging findings was the absence of T2*-weighted gradient recalled echo (T2*-GRE) sequences on initial imaging (89%). When subsequently performed (39%), the T2*-GRE sequences demonstrated multiple characteristic cortical and subcortical microhemorrhages in all cases. Perfusion MRI and magnetic resonance spectroscopy (MRS), which were performed on a subset of patients, indicated markedly reduced relative cerebral blood flow and a normal metabolic ratio.The identification of one or several nonenhancing space-occupying lesions, especially in elderly patients presenting with cognitive impairment, should raise suspicion for the pseudotumoral presentation of CAA-I and lead to T2*-GRE sequences. Perfusion MRI and MRS appear to be useful techniques for the differential diagnosis of this entity.

  View details for DOI 10.1212/WNL.0000000000002444

  View details for PubMedID 26850981

  View details for PubMedCentralID PMC4782113

• Does b1000-b0 Mismatch Challenge Diffusion-Weighted Imaging-Fluid Attenuated Inversion Recovery Mismatch in Stroke? Stroke Geraldo, A. F., Berner, L. P., Haesebaert, J., Chabrol, A., Cho, T. H., Derex, L., Hermier, M., Louis-Tisserand, G., Chamard, L., Klaerke Mikkelsen, I., Ribe, L., Østergaard, L., Hjort, N., Pedraza, S., Thomalla, G., Baron, J. C., Nighoghossian, N., Berthèzene, Y. 2016; 47 (3): 877-81

  Abstract

  Our aim was to explore whether the mismatch in lesion visibility between b1000 and b0 images is an alternative to mismatch between diffusion-weighted imaging and fluid-attenuated inversion recovery imaging as a surrogate marker of stroke age.We analyzed patients from the European multicenter I-KNOW database. Independent readers assessed the visibility of ischemic lesions of the anterior circulation on b0 and fluid-attenuated inversion recovery imaging images. The signal-intensity ratio for b0 and fluid-attenuated inversion recovery imaging images was also measured from the segmented stroke lesion volume on b1000 images.This study included 112 patients (68 men; mean age, 67.4 years) with stroke onset within (n=85) or longer than (n=27) 4.5 hours. b1000-b0 mismatch identified patients within 4.5 hours of stroke onset with moderate sensitivity (72.9%; 95% confidence interval [CI], 63.5-82.4) and specificity (70.4%; 95% CI, 53.2-87.6), high positive predictive value (88.6%; 95% CI, 81.1-96.0), and low negative predictive value (45.2%; 95% CI, 30.2-60.3). Global comparison of b1000-b0 mismatch with diffusion-weighted imaging-fluid-attenuated inversion recovery imaging mismatch (considered the imaging gold standard) indicated high sensitivity (85.9%; 95% CI, 78.2-93.6), specificity (91.2%; 95% CI, 76.3-98.1), and positive predictive value (96.7%; 95% CI, 88.0-99.1) and moderate negative predictive value (73.8%; 95% CI, 60.5-87.1) of this new approach. b0 signal-intensity ratio (r=0.251; 95% CI, 0.069-0.417; P=0.008) was significantly although weakly correlated with delay between stroke onset and magnetic resonance imaging.b1000-b0 mismatch may identify patients with ischemic stroke of the within 4.5 hours of onset with high positive predictive value, perhaps constituting an alternative imaging tissue clock.

  View details for DOI 10.1161/STROKEAHA.115.011501

  View details for PubMedID 26757750

• Delayed leukoencephalopathy after acute carbon monoxide intoxication. Journal of radiology case reports Geraldo, A. F., Silva, C., Neutel, D., Neto, L. L., Albuquerque, L. 2014; 8 (5): 1-8

  Abstract

  Delayed leukoencephalopathy is an uncommon complication of hypoxic-ischemic events of different etiologies, including carbon monoxide intoxication. We present a case of a 40-year-old male patient who was admitted with rapidly progressive neurocognitive and behavioral deficits. There was a history of accidental carbon monoxide intoxication one month before, presenting with loss of consciousness and short hospitalization, followed by a complete clinical recovery. The imaging studies in the delayed phase depicted confluent, symmetric supra-tentorial white matter lesions in keeping with diffuse demyelinization. Restricted diffusion and metabolite abnormalities in magnetic resonance proton spectroscopy were also seen. The diagnosis of CO-mediated delayed post-hypoxic leukoencephalopathy was assumed after exclusion of other mimickers. Hyperbaric oxygen therapy was tentatively performed and the patient had a favorable clinical and radiological evolution.

  View details for DOI 10.3941/jrcr.v8i5.1721

  View details for PubMedID 25426224

  View details for PubMedCentralID PMC4242060

• Preterm cerebellum at term age: ultrasound measurements are not different from infants born at term. Pediatric research Graça, A. M., Geraldo, A. F., Cardoso, K., Cowan, F. M. 2013; 74 (6): 698-704

  Abstract

  Reduced supratentorial brain growth has been shown in preterm-born infants at term-equivalent age (TEA), but cerebellar growth may be preserved in the absence of supratentorial injury. Our study aims to compare cerebellar size assessed using cerebral ultrasound (cUS) at TEA between preterm infants and term-born controls.Cerebellar dimensions (including transverse cerebellar diameter (TCD), cerebellar vermis height, anteroposterior vermis diameter (APVD), and cerebellar vermis area (CVA)) were measured using Image Arena software (TomTec Imaging Systems, Unterschleissheim, Germany) in 71 infants <32-wk gestation without significant scan abnormality at TEA and in 58 term-born control infants. Intra- and interobserver agreement were evaluated.In comparison with controls, preterms at TEA had smaller TCDs (4.9 vs. 5.2 cm; P < 0.001) but larger CVAs (4.7 vs. 4.3 cm(2); P < 0.005) and APVDs (2.4 vs. 2.2 cm; P < 0.001); however, these differences were no longer seen after accounting for head shape. In <28-wk gestational age infants, CVA was statistically similar to controls, as were for small-for-gestational-age infants.Our data support neonatal sparing of preterm cerebellar growth that is measureable using cUS, and this includes the most immature and small-for-gestational-age infants. We suggest cUS can be used to assess cerebellar size at TEA, with measures of both width and height being taken into account, and thus may be a useful tool for detecting infants with poorer cerebellar growth who are at increased risk of disability.

  View details for DOI 10.1038/pr.2013.154

  View details for PubMedID 24002327

• Recovery after copper-deficiency myeloneuropathy in Wilson's disease. Journal of neurology Teodoro, T., Neutel, D., Lobo, P., Geraldo, A. F., Conceição, I., Rosa, M. M., Albuquerque, L., Ferreira, J. J. 2013; 260 (7): 1917-8

  View details for DOI 10.1007/s00415-013-6963-6

  View details for PubMedID 23712800

• Leukocoria in a child with sturge-weber syndrome. The neuroradiology journal Geraldo, A. F., Bastos-Carvalho, A., Neto, L. L., Sousa, R. F., Sequeira, P. T., Campos, J. 2012; 25 (1): 85-8

  Abstract

  A five-year-old girl with Sturge-Weber syndrome (SWS) presented with unilateral leukocoria. Imaging excluded retinoblastoma and revealed a choroidal hemangioma, a non-traumatic vitreous hemorrhage and a cataract. To the best of our knowledge, this is the first case report in the radiologic literature of these ophthalmologic findings presenting together and conditioning leukocoria in the setting of SWS. We discuss possible mechanisms and review the literature, emphasizing the role of neuroimaging in pediatric patients with SWS and ophthalmologic complaints.

  View details for DOI 10.1177/197140091202500112

  View details for PubMedID 24028881

• Neurosyphilis versus Herpes Encephalitis in a Patient with Confusion, Memory Loss, and T2-Weighted Mesiotemporal Hyperintensity CASE REPORTS IN INFECTIOUS DISEASES Vedes, E., Geraldo, A., Rodrigues, R., Reimao, S., Ribeiro, A., Antunes, F. 2012; 2012

  View details for DOI 10.1155/2012/154863

  View details for Web of Science ID 000215174200002