(1) Background: Dural arteriovenous fistulas (DAVF) represent a rare acquired intracranial vascular malformation, with a variety of clinical signs and symptoms, which make their diagnosis difficult. Intracranial hemorrhage is one of the most serious clinical manifestations. In this paper the authors’ goal was to verify the accuracy and utility of contrast-enhanced brain CT angiography (CTA) for the identification and the characterization of dural arteriovenous fistulas (DAVFs) in patients who presented with brain hemorrhage compared to 3D digital subtraction angiography (3D DSA); (2) a retrospective study of 26 patients with DAVFs who presented with intracranial hemorrhage to our institution was performed. The information reviewed included clinical presentation, location and size of hemorrhage, brain CTA and 3D DSA findings; (3) results: 61% (16/26) of DAVFs were identified by CTA. The vast majority of patients were male (69%, 18/26) and the most common presenting symptom was sudden onset headache. All DAVFs had cortical venous drainage and about one-third were associated with a venous varix. The most common location was tentorial (73%, 19/26); (4) conclusions: CTA can represent a valid alternative diagnostic method to 3D DSA for the study of DAVF in the initial and preliminary diagnostic approach, especially in emergency situations. In fact, it represents a fast, inexpensive, non-invasive and above all, easily accessible and available diagnostic technique, unlike DSA or MRI, allowing to provide information necessary for the identification, classification and treatment planning of DAVFs.

Background: The diagnosis of acute spondylodiscitis can be very difficult because clinical onset symptoms are highly variable. The reference examination is MRI, but very often the first diagnostic investigation performed is CT, given its high availability in the acute setting. CT allows rapid evaluation of other alternative diagnoses (e.g., fractures), but scarce literature is available to evaluate the accuracy of CT, and in particular of multi-detector computed tomography (MDCT), in the diagnosis of suspected spondylodiscitis. The aim of our study was to establish MDCT accuracy and how this diagnostic method could help doctors in the depiction of acute spondylodiscitis in an emergency situation by comparing the diagnostic performance of MDCT with MRI, which is the gold standard. Methods: We searched our radiological archive for all MRI examinations of patients who had been studied for a suspicion of acute spondylodiscitis in the period between January 2017 and January 2021 (n = 162). We included only patients who had undergone MDCT examination prior to MRI examination (n = 25). The overall diagnostic value of MDCT was estimated, using MRI as the gold standard. In particular, the aim of our study was to clarify the effectiveness of CT in radiological cases that require immediate intervention (stage of complications). Therefore, the radiologist, faced with a negative CT finding, can suggest an elective (not urgent) MRI with relative serenity and without therapeutic delays. Results: MDCT allowed identification of the presence of acute spondylodiscitis in 13 of 25 patients. Specificity and positive predictive value were 100% for MDCT, while sensitivity and negative predictive value were 68% and 50%, respectively, achieving an overall accuracy of 76%. In addition, MDCT allowed the identification of paravertebral abscesses (92%), fairly pathognomonic lesions of spondylodiscitis pathology. Conclusions: The MDCT allows identification of the presence of acute spondylodiscitis in the Emergency Department (ED) with a satisfactory accuracy. In the case of a positive CT examination, this allows therapy to be started immediately and reduces complications. However, we suggest performing an elective MRI examination in negative cases in which pathological findings are hard to diagnose with CT alone.

Background and Objectives: Brainstem infarctions remain challenging to identify due to their small size, complex anatomy, and known limitations of conventional axial diffusion-weighted imaging (DWI), particularly in the posterior fossa. Thin-section coronal DWI may improve lesion conspicuity by providing higher spatial resolution and an orthogonal imaging perspective. To evaluate whether 3 mm thin-section coronal DWI improves lesion visualization and delineation compared with standard 4 mm axial DWI in patients with MRI-confirmed acute brainstem infarction. Materials and Methods: In this retrospective single-center study, 125 consecutive patients with isolated brainstem infarction confirmed by MRI (January 2021–January 2024) were included. All patients underwent both axial and coronal DWI acquisitions. Lesions were classified by anatomical location and by the imaging plane providing better visualization (“coronal better” vs. “equal”). Lesion volumes were calculated using manual segmentation. Image interpretation was performed independently by two neuroradiologists. Interobserver agreement was assessed using Cohen’s kappa and intraclass correlation coefficient (ICC). Statistical analysis included both parametric and nonparametric tests, with confidence intervals reported. Results: Coronal DWI provided improved or equivalent lesion visualization in all cases. Improved visualization was most frequent in midbrain infarctions (100%) and in a subset of medullary lesions (26.7%). Lesions better visualized on coronal DWI were significantly smaller than those equally visualized (mean volume ~0.23 mL vs. ~0.55 mL, p < 0.0001). Twelve midbrain and eight medullary lesions were identified only on coronal DWI within the imaging protocol, all showing confirmation on ADC and/or FLAIR correlation. Interobserver agreement was substantial to excellent. Conclusions: Thin-section coronal DWI improves visualization and delineation of small brainstem infarctions, particularly in anatomically compact regions. These findings support its role as a complementary sequence rather than a replacement for standard axial imaging.