森 墾

PURPOSE: The aim of this study was to develop ex vivo diffusion tensor (DT) flexible phantoms. MATERIALS AND METHODS: Materials were bundles of textile threads of cotton, monofilament nylon, rayon, and polyester bunched with spiral wrapping bands and immersed in water. DT images were acquired on a 1.5-Tesla clinical magnetic resonance scanner using echo planar imaging sequences with 15 motion probing gradient directions. DT tractography with seeding and a line-tracking method was carried out by software originally developed on a PC-based workstation. RESULTS: We observed relatively high fractional anisotropy on the polyester phantom and were able to reconstruct tractography. Straight tracts along the bundle were displayed when it was arranged linearly. It was easy to bend arcuately or bifurcate at one end; and tracts followed the course of the bundle, whether it was curved or branched and had good agreement with direct visual observation. Tractography with the other fibers was unsuccessful. CONCLUSION: The polyester phantom revealed a diffusion anisotropic structure according to its shape and would be utilizable repeatedly under the same conditions, differently from living central neuronal system. It would be useful to validate DT sequences and to optimize an algorithm or parameters of DT tractography software. Additionally, the flexibility of the phantom would enable us to model human axonal projections.

Brachial plexus injury (BPI) is a severe neurologic injury that causes functional impairment of the affected upper limb. Imaging studies play an essential role in differentiating between preganglionic and postganglionic injuries, a distinction that is crucial for optimal treatment planning. Findings at standard myelography, computed tomographic (CT) myelography, and conventional magnetic resonance (MR) imaging help determine the location and severity of injuries. MR imaging sometimes demonstrates signal intensity changes in the spinal cord, and enhancement of nerve roots and paraspinal muscles at MR imaging indicates the presence of root avulsion injuries. New techniques including MR myelography, diffusion-weighted neurography, and Bezier surface reformation can also be useful in the evaluation and management of BPI. MR myelography with state-of-the-art technology yields remarkably high-quality images, although it cannot replace CT myelography entirely. Diffusion-weighted neurography is a cutting-edge technique for visualizing postganglionic nerve roots. Bezier surface reformation allows the depiction of entire intradural nerve roots on a single image. CT myelography appears to be the preferred initial imaging modality, with standard myelography and contrast material - enhanced MR imaging being recommended as additional studies. Work-up will vary depending on the equipment used, the management policy of peripheral nerve surgeons, and, most important, the individual patient.

Objective: To visualize the corticospinal tract (CST) in patients with arteriovenous malformations (AVMs) by using diffusion tensor tractography (DTT) and to confirm the clinical reliability of DTT in patients with AVMs. Methods: We performed DTT in 24 patients who had their AVMs near the CST. Tracts and AVMs were shown simultaneously, providing information on their spatial relationships. We also counted numbers of voxels in the DTT-CST at the level of the AVM. Results: DTT was visualized in 23 patients. In all 9 patients with hemiparesis, their DTT-CSTs were involved in the AVM or its surrounding lesion. Their volume of DTT-CST at the affected side was significantly decreased when compared with the contralateral side (P= 0.0469). All 14 patients whose DTT-CSTs were free from lesion had no hemiparesis. Conclusions: DTT was safe and clinically applicable in patients with AVMs. DTT is recommended when an AVM is located near the corticospinal tract.

PURPOSE: Diffusion tensor imaging can evaluate the cerebral white matter quantitatively using fractional anisotropy (FA) and also can extract a certain tract by tractography, but these two have been used separately and not combined. The purpose of this study was to assess the clinical feasibility of ROI analysis using diffusion tensor tractography (DTT) in patients with amyotrophic lateral sclerosis (ALS). MATERIALS AND METHODS: Sixteen patients with ALS (9 limb-onset type, 7 bulbar-onset type) and nine age-matched volunteers were studied. DTT of the corticobulbar tract (DTT-CBT) and corticospinal tract (DTT-CST) were visualized by free software (dTV/VOLUME-ONE). Regions-of-interest (ROIs) were semi-automatically placed on the tracts defined by DTT methods, and FA values within the ROIs were measured. RESULTS: Mean FA values of ALS patients in the ROIs along the DTT-CST (bulbar-onset: 0.574, limb-onset: 0.594) were significantly lower than those of controls (DTT-CST: 0.629) (p<0.05). The mean FA of DTT-CBT of the bulbar-onset type (0.509) was significantly lower than that of the limb-onset type (0.558) and that of volunteers (0.561). CONCLUSION: DTT could segmentate certain white matter tracts and evaluate them quantitatively. It could depict the subtle changes between subtypes of ALS as well as the changes between the patients and volunteers.

In previous reports, tracts obtained by diffusion tensor (DT) fiber tracking were terminated or deviated by the brain tumors or surrounding edema. There has been no report showing diffusion tensor tractography penetrating through the tumor. A case of glioma is reported, whose DT fiber tract passing through the tumor was observed by changing the threshold of fractional anisotropy.

The diffusion tensor tractography has drawbacks such as low objectivity by interactive ROI setting and fiber-crossing. For coping with such problems, we are constructing a statistical atlas of white matter fiber tracts, in which probability density maps of tract structures are stored with diffusion tensor parameters on spatially normalized brain data. In building the atlas, our fiber tract modeling method plays a key role, which is based on a novel approach of vector/tensor field reconstruction avoiding fiber-crossings. In this abstract, we describe the modeling method, our statistical atlas, and the preliminary results.

Diffusion-tensor imaging (DTI), a unique magnetic resonance technique for analysis of diffusion-anisotropy of the brain, can identify subtle white matter changes in vivo. To investigate changes of truncated neurofibers, DTI was conducted prior to and following functional hemispherectomy in a female infant for refractory epilepsy associated with hemimegalencephaly. Anisotropy of the amputated pyramidal tract decreased relative to the unaffected side after surgery, which reflects secondary degeneration in neurofibers. In DTI applied to infants, differentiation between developmental changes and changes associated with the current phenomenon must be evaluated cautiously. Standardization of diffusion-tensor analysis of developmental change is desirable.

We present here an unusual case of papillary neuroepithelial tumor of the pineal region. The patient was a 29-year-old female who presented with headaches. A computed tomography scan revealed a tumorous lesion at the pineal region and hydrocephalus. The resected tumor was composed of columnar and cuboidal cells showing characteristics of papillary growth. The tumor cells exhibited diffuse and intense immunoreactivity to cytokeratins and neural cell adhesion molecule. The tumor expressed abundant levels of transthyretin (prealbumin) and appeared ependymal in nature, with numerous microlumens delineated by punctate and ring-like patterns in epithelial membrane antigen staining. Reactivity to synaptophysin and glial fibrillary acidic protein was observed only in the infiltrated non-neoplastic pineal parenchyma. These histological characteristics matched the description of the recently reported papillary tumor of the pineal region thought to originate from the specialized ependyma of the subcommissural organ (SCO). Transthyretin expression of the present case further supports the likelihood of SCO origin, as transthyretin is one of the proteins presumed to be secreted by human SCO.

The purpose of this study is to investigate whether the diffusional anisotropy of water molecules is disrupted in the pyramidal and extra-pyramidal regions in patients with amyotrophic lateral sclerosis (ALS). We studied seven patients with probable ALS (four women, mean age+/-SD, 57.3+/-6.2 years old) according to the criteria of the World Federation of Neurology. A control group consisted of 11 age- and sex-matched volunteers (six women, 57.1+/- 4.5) without disorders affecting the central nervous system. Voxel-based diffusion tensor analysis was made with statistical parametric mapping (SPM99). We also created the normalized corticospinal tractography from the diffusion tensor data. The significant fractional anisotropy (FA) decrease in the ALS group was found in the right frontal subgyral white matter and left frontal precentral white matter. These clusters with significant FA decrease corresponded well to the average group map of the corticospinal tract in a standard reference frame. These results suggested that the combination of voxel-based diffusion tensor analysis and diffusion tensor tractography might help determine the location of the affected neuronal tissues among ALS patients in a non-invasive manner. Copyright (C) 2004 John Wiley Sons, Ltd.

Objective: To evaluate diffusion tensor imaging (DTI) based on periodically rotated overlapping parallel lines with enhanced reconstruction (PROPELLER) compared with DTI based on single-shot echo planar imaging (EPI). Methods: Diffusion tensor data were acquired with PROPELLER (PROPELLER-DTI, 3 NEX), EPI (EPI-DT12,16 NEX) with the same acquisition time (11.4 minutes) and with EPI (EPI-DTI I, number of excitations = 4) with a shorter acquisition time (2.8 minutes). Regions of interest were set in the genu and splenium of the corpus callosurn, as determined on T2-weighted fast spin echo images and fractional anisotropy (FA) maps, separately. Two neuroradiologists visually evaluated image distortion and quality in the supra- and infratentorial structures. Results: in the genu, standard deviation determined by respective FA maps was decreased in order of PROPELLER-DTI, EPI-DTI 1, and EPI-DT12. Both EPI-DTI sequences were quantitatively superior in the splenium, but PROPELLER-DTI was less distorted. Conclusion: Periodically rotated overlapping parallel lines with enhanced reconstruction-DTI could become a complementary tool when qualitatively evaluating seriously distorted structures.

Objective: To evaluate the crossing fiber trajectory through the corpus callosum using distortion-corrected diffusion tensor tractography in the human brain. Methods: After correcting distortion associated with large-diffusion gradients, T2-weighted echo planar images (EPIs) acquired from 10 right-handed healthy men were coregistered into T2-weighted fast spin echo images using linear through sixth-order nonlinear, 3-dimensional, polynomial warping functions. The optimal transformation parameters were also applied to the distortion-corrected diffusion-weighted EPIs. Diffusion tensor tractography through the corpus callosum was reconstructed, employing the "1 or 2 regions of interest" method. Results: Compared with the lines through the genu, those through the rostrum ran more inferiorly and seemed to enter the orbital gyrus. Those lines entering posterior temporal white matter (tapetum) crossed through the ventral portion of the splenium and were clearly distinguished from lines that reached parieto-occipital white matter (forceps major). Conclusion: Diffusion tensor tractography is a feasible noninvasive tool to evaluate commissural fiber trajectory.

Diffusion tensor imaging (DTI) is a magnetic resonance (MR) technique used to analyze diffusion anisotropy of the central nervous system (CNS) and can demonstrate subtle white matter anatomy. In particular, tractography is expected to be a unique, non-invasive tool to provide more pertinent insights into brain structure and orientation not accessible with conventional MRI. Data collection was performed in a normal volunteer on a 1.5-T MRI system using several techniques including six axis single-shot echo planar imaging (EPI), over six axis EPI, and periodically rotated overlapping parallel lines with enhanced reconstruction techniques. Tractography was generated by a continuous tracking method with our original software, Volume-One (for viewing volumetric image data) and VizDT-II (for analysis of DTI data). Using these data, estimated tracts were generated in arcuate fibers of cerebrum, cingulum, superior longitudinal fasciculus, uncinate fasciculus, inferior longitudinal fasciculus, corpus callosum, fornix, anterior thalamic radiation, central thalamic radiation, thalamo-parietal fibers, optic radiation, superior cerebellar peduncle, middle cerebellar peduncle, inferior cerebellar peduncle and intrinsic commissure paths of the hipoccampous. DTI including tractography allows differentiation between complex white matter tracts. The information regarding the detailed relationship may be useful for diagnosis of the location and extent of brain lesions, and preoperative planning.

Periodically Rotated Overlapping Parallel Lines with Enhanced Reconstruction (PROPELLER) is one of the newer magnetic resonance imaging (MRI) methods developed to correct motion artifacts. PROPELLER uses a radial scan variation of the fast spin-echo sequence and spatial inconsistencies to be corrected using self navigation and an averaging effect for low spatial frequencies. We report and assess the imaging findings in a restless patient with Creutzfeldt-Jakob disease with a point mutation at codon 180 in prion protein DNA using PROPELLER diffusion-weighted MRI.

T2-weighted MR imaging (T2WI) in patients presenting with variant Creutzfeldt-Jakob disease (vCJD) can demonstrate high signal intensity lesions in both pulvinars and/or medial side of thalami (the pulvinar sign) at a high rate. Nevertheless, since patients with dementia are frequently uncooperative and restless, the T2WI sequence may often fail. This article presents a clinically effective case involving application of PROPELLER MRI with correction of reduced motion artifacts to exclude the pulvinar sign.

PURPOSE: To evaluate the ability of periodically rotated overlapping parallel lines with enhanced reconstruction diffusion-weighted imaging (PROPELLER DWI) to distinguish between vessel occlusion and slow flow. MATERIALS AND METHODS: Using a flow phantom with various velocities (1.37 to 11.1 cm/s), the signal-intensity ratios of the phantom, with the intensity of no flow as baseline, were measured using the following imaging sequences: PROPELLER DWI, spin-echo T1-weighted imaging (SE T1WI), fast-spin-echo T2-weighted imaging (FSE T2WI), two-dimensional phase-contrast imaging (2D PC), and two-dimensional time-of-flight imaging (2D TOF). The b-factor of PROPELLER DWI was varied from 0 to 1000 s/mm(2). The velocity encoding of 2D PC was varied from 2 to 30 cm/s. RESULTS: At the lowest flow velocity (1.37 cm/s) , the signal-intensity ratio was 0.0075 for PROPELLER DWI (b-factor=1000 s/mm(2)), 1.8 for SE T1WI, 0.67 for FSE T2WI, 11 for 2D PC (velocity encoding=2 cm/s), and 1.4 for 2D TOF. The signal-intensity ratio was smallest for PROPELLER DWI, even when the reciprocals of the signal-intensity ratio of 2D PC or 2D TOF were considered. CONCLUSION: The results indicate that PROPELLER DWI provides the best signal intensity-ratio between vessel occlusion and slow flow. Although DWI with single-shot echo-planar imaging (EPI) or multi-shot EPI may have similarly high sensitivity for slow flow, these sequences do not have high spatial resolution or robustness to susceptibility artifacts. PROPELLER DWI would be a better choice for distinguishing between occluded and low-velocity arteries in the skull base or parasellar regions.

As the PROPELLER sequence is a combination of the radial scan and fast-spin-echo (FSE) sequence, it can be considered an FSE sequence with a motion correlation. However, there are some differences between PROPELLER and FSE owing to differences in k-space trajectory. We clarified the imaging characteristics of PROPELLER T2-weighted imaging (T2WI) for different parameters in comparison with usual FSE T2WI. When the same parameters were used, PROPELLER T2WI showed a higher signal-to-noise ratio (SNR) and lower spatial resolution than usual FSE. Effective echo time (TE) changed with different echo train lengths (ETL) or different bandwidths on PROPELLER, and imaging contrast changed accordingly to be more effective.

Purpose: In order to ensure that three-dimensional diffusion tensor tractography (3D-DTT) of the corticospinal tract (CST), is performed accurately and efficiently, we set out to find the optimal lower threshold of fractional anisotropy (FA) below which tract elongation is terminated (trackability threshold). Methods: Thirteen patients with acute or early subacute ischemic stroke causing motor deficits were enrolled in this study. We performed 3D-DTT of the CST with diffusion tensor MR (magnetic resonance) imaging. We segmented the CST and established a cross-section of the CST in a transaxial plane as a region of interest. Thus, we selectively measured the FA values of the right and left corticospinal tracts at the level of the cerebral peduncle, the posterior limb of the internal capsule, and the centrum semiovale. The FA values of the CST were also measured on the affected side at the level where the clinically relevant infarction was present in isotropic diffusion-weighted imaging. Results: 3D-DTT allowed us to selectively measure the FA values of the CST. Among the 267 regions of interest we measured, the minimum FA value was 0.22. The FA values of the CST were smaller and more variable in the centrum semiovale than in the other regions. The mean minus twice the standard deviation of the FA values of the CST in the centrum semiovale was calculated at 0.22 on the normal unaffected side and 0.16 on the affected side. Conclusion: An FA value of about 0.20 was found to be the optimal trackability threshold. © 2004 by Japanese Society for Magnetic Resonance in Medicine.

The evident advantage of high-field MR (magnetic resonance) scanners is their higher signal-to-noise ratio, which results in improved imaging. While no reliable efficacy studies exist that compare the diagnostic capabilities of low- versus high-field scanners, the adoption and acceptance of low-field MRI (magnetic resonance imaging) is subject to biases. On the other hand, the cost savings associated with low-field MRI hardware are obvious. The running costs of a non-superconductive low-field scanner show even greater differences in favor of low-field scanners. Patient anxiety and safety issues also reflect the advantages of low-field scanners. Recent technological developments in the realm of low-field MR scanners will lead to higher image quality, shorter scan times, and refined imaging protocols. Interventional and intraoperative use also supports the installation of low-field MR scanners. Utilization of low-field systems has the potential to enhance overall cost reductions with little or no loss of diagnostic performance. © 2004 by Japanese Society for Magnetic Resonance in Medicine.

Diffusion tensor MR imaging (DTI) provides information on diffusion anisotropy, which can be expressed with three-dimensional (3D) white matter tractography. We used 3D white matter tractography to show the corticospinal tract in eight patients with acute or early subacute ischaemic stroke involving the posterior limb of the internal capsule or corona radiata and to assess involvement of the tract. Infarcts and the tract were shown simultaneously, providing information on their spatial relationships. In five of the eight patients, 3D fibre tract maps showed the corticospinal tract in close proximity to the infarct but not to pass through it. All these patients recovered well, with maximum improvement from the lowest score on manual muscle testing (MMT) up to the full score through rehabilitation. In the other three patients the corticospinal tract was shown running through the infarct; reduction in MMT did not necessarily improve favourably or last longer, other than in one patient. As 3D white matter tractography can show spatial relationships between the corticospinal tract and an infarct, it might be helpful in prognosis of gross motor function.

Little is known about the diffusion properties of brain lesions in neuro-Behçet&#039;s disease (NBD). We looked at 19 NBD lesions (13 active, six chronic) in six patients, using diffusion-weighted MRI (DWI). We calculated the apparent diffusion coefficients (ADC) of the lesions and compared them with normal contralateral brain, expressing this ratio as relative ADC (rADC). The rADC was 1.29 ± 0.33 in active and 1.44 ± 0.47 in chronic lesions, i.e., significantly higher than in the control regions. Increased diffusivity in both active and chronic phases in NBD is different from the pattern in fischaemic infarcts, so that ADC analysis might be helpful for differentiating between these conditions.

Many central nervous system disorders have been genetically analyzed, and now, many degenerative, metabolic as well as vascular diseases have become diagnosed by genetic abnormalities. Relationship between genetic diagnosis and imaging studies will be discussed.

The goal of this study was to investigate apparent diffusion coefficient (ADC) and T-2 relaxation time (T-2) in the substantia nigra and thalamus after middle cerebral artery occlusion in rats. In the substantia nigra ipsilateral to infarct, ADC was significantly lower and T-2 was significantly higher on the third and fourth days, but they did not change significantly on the first, second, eighth and 15th days. In the ipsilateral thalamus, ADC and T-2 did not change significantly between the first and fourth days, but were significantly lower on the eighth and 15th days. This combination of MR findings suggested that secondary degeneration in the thalamus was different from that in the substantia nigra. Copyright (C) 2003 John Wiley Sons, Ltd.

Cerebral ischemic stroke is one of the most fatal diseases despite current advances in medical science. Recent demonstration of efficacy using intravenous and intra-arterial thrombolysis demands therapeutic intervention tailored to the physiologic state of the individual tissue and stratification of patients according to the potential risks for therapies. In such an era, the role of the neuroimaging becomes increasingly important to evaluate the extent and location of tissues at risk of infarction (ischemic penumbra), to distinguish it from unsalvageable infarcted tissues or doomed hemorrhagic parenchyma. In this review, we present briefly the current role and limitation of computed tomography and conventional magnetic resonance imaging (MRI). We also present the possible applications of advanced MR techniques, such as diffusion and perfusion imaging, concentrating on the delineation or detection of ischemic penumbra. (C) 2002 Elsevier Science Ireland Ltd. All rights reserved.

Assessment of intracranial arteriovenous malformations (AVMs) by conventional catheter angiography carries risks; moreover, this invasive procedure is often repeated for follow-up. We investigated the clinical applicability of two-dimensional thick-slice, contrast-enhanced magnetic resonance digital subtraction angiography (2D MRDSA) with high temporal resolution in the assessment of AVMs. We performed 78 2D MRDSA studies of treated or untreated small to medium-size AVMs on a 1.5 tesla imager. Two observers independently evaluated demonstration of nidus flow void on T2-weighted images and each component of the AVM on 2D MRDSA employing a three-point grading scale. In 55 patients with AVMs, the mean ratings of nidus flow voids, feeding vessels, nidi, draining vessels and early venous filling on MRI were 2.8, 2.4, 2.6, 2.8 and 2.8, respectively. sensitivity, specificity, positive and negative predictive values for an AVM using 2D MRDSA were 87, 100, 100 and 78%, respectively and for nidus flow voids on T2-weighted images 80, 91, 96 and 66%, respectively. 2D MRDSA can thus demonstrate haemodynamic features of AVMs. It can be employed as a less invasive, dynamic angiographic tool for follow-up of AVMs previously delineated by catheter angiography.

Purpose: To assess the feasibility of a curvature-based enhanced display system for detecting cerebral aneurysms in MR angiography. Methods: MR angiography studies of 18 patients (eight male and 10 female, average age 65.7, age range 50 to 75 years old) with 23 known aneurysms were evaluated with a curvature-based display system. The two curvature features-the volumetric shape index and curvedness values-were calculated at each voxel. These were displayed independently on a workstation, overlaid on volume-rendered images. Two neuroradiologists evaluated the images for visibility and diagnosis of the cerebral aneurysms. The diagnostic results were compared with the original reports. Results: The calculation time for each curvature index was 30 to 40 s for 120 to 140 slices of original MR angiography data. Shape index images emphasized smooth and round aneurysms more than aneurysms with irregular surfaces. Curvedness images revealed aneurysms well when the aneurysms had diameters that differed from those of the surrounding vessels. The computer-assisted-detection method detected 24 aneurysms, three of which were not pointed out in the initial report. Conclusion: Our results show that the curvature-based display system we have developed is feasible and that it may help to detect small aneurysms that are prone to be overlooked in routine readings.

Purpose: The purpose of this study was to develop a new technique for a high temporal resolution two-dimensional MR digital subtraction angiography (2D MRDSA) sequence under intraarterial injection of contrast material to permit the visualization of vascular anatomy and hemodynamics. Methods: 2D MRDSA was imaged on a 0.3T open MR scanner with a T1-weighted fast gradient echo sequence. The phantom study examined vials containing gadolinium (Gd) solutions ranging in concentration from 0.5 mmol/L to 100 mmol/L. Repetition time and echo time were fixed at minimal values in order to achieve high temporal resolution, and only the flip angle was changed in 10-degree increments between 10 and 90 degrees. The in vivo study examined a brachial artery of a human volunteer. MRDSA images were acquired continuously during intraarterial injections of Gd solutions ranging in concentration from 0.5 mmol/L to 100 mmol/L. The subtracted images were displayed on the monitor in real time at a frame rate of one frame per second and evaluated to determine the optimal concentration of contrast material. Results: In the phantom study, a 10-mmol/L Gd concentration with a flip angle of 50°-90° and a 25-mmol/L Gd concentration with a flip angle of 60°-90° showed high signal-to-noise ratios. In the human brachial artery experiment, the forearm arteries were well visualized when solutions of 5-50 mmol/L Gd concentration were used. The 10- and 25-mmol/L Gd concentrations were considered optimal. The palmar digital arteries were also visualized. Higher Gd concentrations showed a paradoxical signal increase when diluted by blood. Conclusion: We successfully developed an intraarterial contrast-enhanced 2D MRDSA sequence. With appropriate settings of imaging parameters and Gd concentrations, we obtained acceptable vessel visualization in the human study. The low Gd concentration for optimal visualization permits repeated intraarterial injections. This technique can be a useful tool for investigating the vascular anatomy and hemodynamics required for MR-guided vascular interventions.

We present the contrast-enhanced dynamic MR imaging appearance of cerebral arteriovenous malformations (AVM) following gamma knife radiosurgery and discuss the implications of this finding with respect to treatment. Dynamic MR images obtained in our three AVM patients following radiosurgery revealed slowly enhancing lesions. This pattern is not observed in all cases involving AVMs following gamma knife radiosurgery. When it is present, a haemangioma-like lesion should be considered.

We describe the clinical features and MRI findings of a patient with hypereosinophilia-induced encephalopathy associated with human T-cell lymphotropic virus type 1. Initial diffusion-weighted images revealed hyperintense spots in the border zone, and the apparent diffusion coefficient of the lesions increased over a three-week follow-up period. MRI findings, particularly those of the diffusion-weighted images, are of diagnostic value and are helpful in terms of understanding the pathophysiology of this disease.

We describe a patient with a rare association of a parietal arteriovenous malformation (AVM) and an ipsilateral persistent primitive hypoglossal artery (PPHA). A 27-year-old woman was treated by surgical removal, followed by gamma-knife radiosurgery. Only seven cases of intracranial AVM associated with PPHA have been reported in the literature. Although AVM associated with persistent carotid-basilar anastomosis has no distinguishing features compared with ordinary AVM, early recognition of the association is of significance to minimize neurological deficits during diagnostic angiography, interventional radiology (embolization) and surgery. The present report adds to the growing literature regarding AVMs associated with carotid-basilar anastomoses.

A case of complex regional pain syndrome (CRPS ) secondary to peripheral nerve injury occurring during venipuncture for post-contrast CT examination is presented. The puncture site was in the left antecubital fossa. Anatomically, cutaneous nerves lie close to cutaneous veins, making them vulnerable to injury during the procedure. This syndrome is characterized by continuing pain, allodynia, or hyperalgesia that is disproportionate to any inciting event in severity, and may lead to loss of the involved limb. The syndrome is poorly understood by radiologists and is often misdiagnosed. Early recognition and appropriate therapy are most important in treating this disorder.

Diffusion-weighted MR imaging has been applicable to the differential diagnosis of abscesses and necrotic or cystic brain tumors. However, restricted water diffusion is not necessarily specific for brain abscess. We describe ring-enhancing metastases of lung carcinoma characterized by high signal intensity on diffusion-weighted MR images. The signal pattern probably reflected intralesional hemorrhage. The present report adds to the growing literature regarding the differential diagnosis of ring-enhancing brain lesions.

Objective: Array spatial sensitivity encoding techniques (ASSET) were employed to improve the temporal resolution of two-dimensional (2D) thick-slice contrast-enhanced magnetic resonance digital subtraction angiography (MRDSA). Methods: 2D MRDSA using ASSET was performed in 28 patients via fast spoiled gradientecho sequence (TR/TE 5.4/1.5 ms FA 60 FOV 24x24 cm matrix size 256x256 slice thickness 50-70 mm), followed by a bolus injection of gadolinium chelate and subsequent saline flush, for 40 seconds on a sagittal plane. Images were evaluated for visualization of normal intracranial vessels and brain lesions utilizing a three-point scale additionally, in 10 of the 28 patients, results were compared with those of conventional 2D MRDSA. Results: 2D MRDSA using ASSET, which improved temporal resolution from 1.45 to 0.77 seconds, displayed image quality comparable to that of conventional 2D MRDSA. Moreover, this technique afforded superior detectability with respect to early venous filling in patients with arteriovenous malformations (AVMs). Conclusion: ASSET improves the temporal resolution of 2D MRDSA without compromising spatial resolution.

Magnetic resonance imaging (MRI) is useful to diagnose dural sinus thrombosis. However, the representative appearance of dural sinus thrombosis on diffusion-weighted MRI has not been established. This study was aimed at determining whether cytotoxic or vasogenic edema is more predominant in the affected cerebral parenchyma and assessing the time courses and prognosis of dural sinus thrombosis lesion. The studies on sixteen patients with dural sinus thrombosis who underwent diffusion-weighted MRI were retrospectively reviewed. The diagnosis was confirmed by digital subtraction angiography in 11 patients and magnetic resonance angiography in five patients. Diffusion-weighted images with echo-planar imaging were obtained using two or three b values, with the highest b value of up to 1,000 s/mm(2). A region of interest was placed on an area of abnormal signal intensity to calculate apparent diffusion coefficients (ADCs). Nine of the 16 patients had lesions with an increased ADC, whereas, three of these nine patients also had lesions with a decreased ADC. Among 11 patients who underwent initial MRI within 7 days of their last episode, eight had lesions with an increased ADC, of whom three had lesions mixed with both decreased and increased ADC areas. Follow-up studies of these three patients revealed the development of hemorrhagic infarction in two and subcortical hemorrhage in one. Vasogenic edema develops more predominantly and earlier in dural sinus thrombosis, though cytotoxic edema was also associated with the pathological changes in the early phase. Decrease of ADC value is presumed to reflect severe pathological conditions and indicate possible future development of infarction or hemorrhage.

We surveyed to assess for the incidence of clinically silent brain infarction after cerebral catheter angiography. Diffusion-weighted images were performed shortly after 33 cerebral catheter angiographies. We found totally 11 abnormally high intensity spots in 5 of 33 patients on diffusion-weighted images and, therefore, the incidence was calculated as 15.2%. This incidence is higher than has been estimated based on the incidence of neurological deficits (about 0.5%) after cerebral angiography. Diffusion-weighted MR imaging is suitable to monitor the safety of angiographic procedures and material.

We performed selective intraarterial infusion chemotherapy using a combined MRI-angiography system for head and neck cancers. In three patients, three or five infusions of CDDP (100 mg/body) were administered to the feeding arteries selectively. For the evaluation of drug distribution, MRI during arteriography through the infusion pump was performed before CDDP administration. When a distribution mismatch was found, arterial selection was attempted again under a mechanically unstable C-arm system, and further evaluation under an MR system was carried out. Thus, more ideal treatment could be provided. We consider MRI during arteriography to be useful in assessing for distribution during intraarterial chemotherapy.

Periodically Rotated Overlapping ParallEL Lines with Enhanced Reconstruction (PROPELLER) is one of newer magnetic resonance imaging (MRI) methods that are developed to correct motion artifacts. PROPELLER uses a radial scan variation of the fast spin-echo sequence and allows one to correct spatial inconsistencies using self navigation and an averaging effect for low spatial frequencies. We report a case of restless patient with a variety of progressive neurological symptoms whose PROPELLER T2-weighted images were high quality enough for the evaluation of a pulvinar sign.

The purpose of this study is to elucidate changes in mean diffusivity (ADC) and fractional anisotropy (FA) using MR diffusion tensor imaging (DTI) in the central nervous system during normal aging. We studied 50 normal volunteers (30 men, 20 women; mean age 44.8 ± 14.0; age range, 21-69 years) without disorders affecting the central nervous system. The frontal, parietal white matter, lentiform nucleus, posterior limb of internal capsule, thalamus, genu and splenium of the corpus callosum were selected for investigation. There was no significant difference in ADC or FA between male and female or between the right and left hemisphere. A significant ADC increase with advancing age was observed in frontal white matter (P = 0.010) and lentiform nucleus (P = 0.022). A significant FA decline was found only in the genu of the corpus callosum (P < 0.001) with advancing age. Quantitative diffusion tensor analysis correlate with normal aging and may help in assessing normal age-related changes and serve as a standard for comparison with neurodegenerative disorders. © 2002 Elsevier Science Inc. All rights reserved.

Purpose: Although it is documented that radiation can cause density or intensity changes on computed tomography or MR imaging in the irradiated hepatic parenchyma, few researchers have reported or understood the MR presentation of changes in hepatic parenchyma following radiotherapy in the patient with Budd-Chiari syndrome. The purpose of this study was to investigate the MR appearance of hepatic radiation injury in Budd-Chiari syndrome and to consider the underlying pathophysiology. Materials and Methods: The MR examinations of two patients with Budd-Chiari syndrome were compared with those of 11 patients without Budd-Chiari syndrome. The two groups, both of which suffered from hepatocellular carcinoma, underwent 50-72 Gy of proton-beam irradiation during a period of 14-43 days. Examinations including T1- and T2-weighted imaging, superparamagnetic iron oxide-enhanced imaging, and dynamic study were performed 3-10 weeks after the end of irradiation. Results: Radiation-induced hepatic injury was observed as a low-intensity area on T2-weighted images and on delayed phase images of dynamic study in the Budd-Chiari patients, and as iso- or high-intensity areas on both images in the patients without Budd-Chiari syndrome. US-guided needle biopsy from the irradiated area in one patient with Budd-Chiari syndrome revealed mostly necrotic tissue and fibrous tissue. Conclusion: These MR features of hepatic radiation injury in Budd-Chiari syndrome were considered to be due to severe hepatic fibrosis.

Though diffusion-weighted MRI has been applied to various intracranial lesions, few reports had been presented about cerebral hamartomatous lesions in patients with neurofibromatosis type 1 (NF1). In this study, we report the interval changes of apparent diffusion coefficient (ADC) in a presumed hamartomatous lesion. In our case, the ADC increased slightly over a 3 year period. This diffusion property may provide specific insight into the etiology of cerebral hamartomatous lesions observed in NF1.

OBJECTIVE. The study objective was to distinguish between the features of tumorous and nontumorous arterioportal shunts on superparamagnetic iron oxide - enhanced MR imaging in patients with cirrhosis. SUBJECTS AND METHODS. Ten arterioportal shunts in eight patients, including four tumorous and six nontumorous arterioportal shunts, were evaluated on T2-weighted turbo spin-echo and T2(*)-weighted gradient-echo sequences before and after administration of superparamagnetic iron oxide. Qualitatively, the relative signal intensity of the arterioportal shunt compared with that of the surrounding liver parenchyma was categorized into three grades: high, slightly high, and not detected. Quantitatively, signal-to-noise ratio, contrast-tonoise ratio, lesion-to-liver contrast, and percentage enhancement were calculated and compared between tumorous and nontumorous arterioportal shunts by a nonparametric statistical test (Mann-Whitney test). RESULTS. Qualitatively, all four tumorous arterioportal shunts appeared as areas of slightly high or high intensity without and with superparamagnetic iron oxide on T2-weighted turbo spin-echo images and changed from isointensity to high intensity after the administration of superparamagnetic iron oxide on T2(*)-weighted gradient-echo images. All nontumorous arterioportal shunts except one could not be recognized without or with superparamagnetic iron oxide on either sequence. Quantitatively, with superparamagnetic iron oxide the contrast-to-noise ratio and the lesion-to-liver contrast of the tumorous arterioportal shunts were significantly higher than those of the nontumorous arterioportal shunts. CONCLUSION. Tumorous arterioportal shunts are seen as areas of reduced signal loss, whereas most nontumorous arterioportal shunts are seen as areas of normal signal loss, like the normal liver parenchyma. The difference is more marked on T2(*)-weighted gradient-echo images than on T2-weighted turbo spin-echo images.

We devised a simple &quot;pumping&quot; method to make gelatin sponge particles for transcatheter arterial embolization. As the frequency of pumping increased, the number of particles 0.2-1.6 mm in diameter increased, whereas no particles of more than 3.2 mm in diameter were present after 20 pumpings. After passing through the microcatheter, particles of less than 0.2 mm in diameter were relatively increased by about 10 points in both the pumping and cutting methods. It was histologically demonstrated that the size of embolized arteries corresponded well to the size of particles. These results suggest that our &quot;pumping&quot; method offers sufficient quality for transcatheter arterial embolization.

Early radiation-induced liver injury during radiotherapy detected by a particulate reticuloendothelial MR contrast agent (superparamagnetic iron oxide SPIO) is described in a patient with cholangiocarcinoma. The irradiated hepatic parenchyma appeared as a heterogeneous, less decreased signal intensity area than the nonirradiated area on MR images after SPIO administration. Resultant differences in signal intensity were better visualized on SPIO-enhanced T1-weighted images than SPIO-enhanced T2-weighted images, although SPIO-enhanced T2*-weighted fast field echo imaging was the most sensitive.

Superparamagnetic iron oxide (SPIO)-enhanced MRI was performed in twenty-one patients undergoing proton-beam radiotherapy for hepatocellular carcinomas. Patients were divided into two groups: early and late phase hepatic injuries. Each group was investigated 3 to 9 weeks and 4 to 65 months after the start of irradiation, respectively. T1-weighted, T2-weighted, and T2*-weighted images were obtained before and after SPIO administration. In all postcontrast sequences in the early phase, irradiated livers demonstrated relatively higher intensity than nonirradiated livers and the radiation-to-liver contrast-to-noise ratio (C/N) was improved. Postcontrast T2*-weighted images showed the highest C/N. In the late phase, the irradiated areas showed high intensity on T2-weighted images and low intensity on T1-weighted images without SPIO, while high intensity on T1-weighted images with SPIO. The C/N increased with SPIO in all sequences and postcontrast T2-weighted images showed the highest C/N in the late phase. SPIO-enhanced MRI is useful to evaluate this entity both in the early and late phase of clinical studies. (C) 2000 Elsevier Science Inc.

We report an immunohistochemical study on manganese superoxide dismutase (Mn SOD) in Parkinson's disease (PD) patients and age-matched control subjects. Overall appearance of immunostaining intensity of nigral neurons did not differ significantly between the PD patients and the control subjects. However, when the immunostaining intensity of each neuron was semiquantitatively analyzed, both very intensely stained (more than normal) neurons as well as neurons stained only weakly were more frequently detected in the lateral part than in the medial and the central parts of the substantia nigra in PD patients. As a result, the proportion of normally stained neurons was significantly smaller in the lateral part of the substantia nigra in PD patients; however, the overall distribution of the neurons among the three rating grades for immunostaining did not differ significantly. The immunostaining intensity of the neuropils in the medial and the central part of the substantia nigra tended to be more intense in PD patients than in the control subjects. Our results suggest up-regulation of Mn SOD mainly in the dendritic processes of the less involved nigral neurons. (C) 1997 Elsevier Science B.V.