A large portion of the Italian population is exposed to high air pollution levels exceeding both European and WHO standards. To face this serious environmental risk, several efforts have been ...undertaken at policy-administration level in Italy and a national-regional cooperation act (the Po Basin Agreement, PBA) was adopted in 2013 in Northern Italy. The signatory parties agreed to identify and implement concerted actions contrasting air pollution, in addition to measures already in place. In this paper, a first evaluation of the identified measures has been carried out using the MINNI model, an integrated assessment model that allows the impact evaluation of emission variations. Assuming that PBA measures are applied in the whole Italian territory and focusing on residential heating, road transport and agriculture, the consequent impact on air quality was assessed for the scenario years 2020 and 2030. The Current Legislation scenario for the year 2030 shows that neither the national emission ceilings (NEC) nor the European air quality standards would be reached with the measures already in place and that additional actions are needed. The PBA 2030 scenario shows the attainment of the NEC targets, but non-compliance for daily PM10, daily maxima of 8 h running means of O3 and annual PM2.5 concentrations still remains.
•The integrated assessment model MINNI was applied to study the Po Basin Agreement measures for reducing air pollution.•The 2030 CLE scenario does not allow to reach neither the NEC emission ceilings nor the EU air quality standards.•The 2030 PBA scenario would allow the attainment of the NEC ceilings but not the attainment of the AQ standards.
BACKGROUND AND PURPOSESpine MR imaging plays a pivotal role in the diagnostic work-up of spontaneous intracranial hypotension. The aim of this study was to compare the diagnostic accuracy of ...unenhanced spine MR imaging and intrathecal gadolinium-enhanced spine MR imaging for identification and localization of CSF leaks in patients with spontaneous intracranial hypotension. MATERIALS AND METHODSA retrospective study of patients with spontaneous intracranial hypotension examined from February 2013 to October 2017 was conducted. Their spine MR imaging was reviewed by 3 blinded readers for the presence of epidural CSF using 3 different sequences (T2WI, 3D T2WI fat-saturated, T1WI gadolinium). In patients with leaks, the presumed level of the leak was reported. RESULTSIn total, 103 patients with spontaneous intracranial hypotension (63/103 61% women; mean age, 50 years) were evaluated. Seventy had a confirmed CSF leak (57/70 81% proved intraoperatively), and 33 showed no epidural CSF on multimodal imaging. Intrathecal gadolinium-enhanced spine MR imaging was nonsuperior to unenhanced spine MR imaging for the detection of epidural CSF (P = .24 and .97). All MR imaging sequences had a low accuracy for leak localization. In all patients, only 1 leakage point was present, albeit multiple suspicious lesions were reported in all sequences (mean, 5.0). CONCLUSIONSIntrathecal gadolinium-enhanced spine MR imaging does not improve the diagnostic accuracy for the detection of epidural CSF. Thus, it lacks a rationale to be included in the routine spontaneous intracranial hypotension work-up. Heavily T2-weighted images with fat saturation provide high accuracy for the detection of an epidural CSF collection. Low accuracy for leak localization is due to an extensive CSF collection spanning several vertebrae (false localizing sign), lack of temporal resolution, and a multiplicity of suspicious lesions, albeit only a single leakage site is present. Thus, dynamic examination is mandatory before targeted treatment is initiated.
PDF
