森 墾

Genital arteriovenous malformations are rare and present unique surgical challenges in preserving urogenital function, abdominal wall integrity, and lower limb perfusion. A 32-year-old man with a giant abdominoscrotal arteriovenous malformation presented with recurrent heavy bleeding. Due to the high risk of rebleeding and fatal hemorrhage, surgery with curative intent was proposed and the patient was counseled on the risks of ischemia to the lower limb, testes, and penis. Preoperative embolization of the feeding vessels was performed. Three days later, surgical excision of the mass with the affected scrotum, left rectus muscle, sheath, and overlying abdominal skin followed. The testes were dissected from the malformation and preserved along with the right internal pudendal artery. The left thigh skin was advanced to the scrotal remnants and a neoscrotum created. The resulting large abdominal wall defect was reconstructed in layers with a pedicled anterolateral thigh flap, including innervated vastus lateralis muscle, to prevent herniation. Recovery was uneventful, and a 4-year follow-up revealed no significant clinical or radiological recurrence with recovery of flap sensation, retained erectile function, and no herniation. We report this case due to rarity of giant abdominoscrotal arteriovenous malformations and present preoperative embolization, surgical resection, and functional anterolateral thigh flap reconstruction as a valuable treatment option of this life-threatening illness.

<title>Abstract</title> Accumulated experience supports the efficacy of allogenic haematopoietic stem cell transplantation in arresting the progression of childhood-onset cerebral form of adrenoleukodystrophy in early stages. For adulthood-onset cerebral form of adrenoleukodystrophy, however, there have been only a few reports on haematopoietic stem cell transplantation and the clinical efficacy and safety of that for adulthood-onset cerebral form of adrenoleukodystrophy remain to be established. To evaluate the clinical efficacy and safety of haematopoietic stem cell transplantation, we conducted haematopoietic stem cell transplantation on 12 patients with adolescent-/adult-onset cerebral form/cerebello-brainstem form of adrenoleukodystrophy in a single-institution-based prospective study. Through careful prospective follow-up of 45 male adrenoleukodystrophy patients, we aimed to enrol patients with adolescent-/adult-onset cerebral form/cerebello-brainstem form of adrenoleukodystrophy at early stages. Indications for haematopoietic stem cell transplantation included cerebral form of adrenoleukodystrophy or cerebello-brainstem form of adrenoleukodystrophy with Loes scores up to 13, the presence of progressively enlarging white matter lesions and/or lesions with gadolinium enhancement on brain MRI. Clinical outcomes of haematopoietic stem cell transplantation were evaluated by the survival rate as well as by serial evaluation of clinical rating scale scores and neurological and MRI findings. Clinical courses of eight patients who did not undergo haematopoietic stem cell transplantation were also evaluated for comparison of the survival rate. All the patients who underwent haematopoietic stem cell transplantation survived to date with a median follow-up period of 28.6 months (4.2–125.3 months) without fatality. Neurological findings attributable to cerebral/cerebellar/brainstem lesions became stable or partially improved in all the patients. Gadolinium-enhanced brain lesions disappeared or became obscure within 3.5 months and the white matter lesions of MRI became stable or small. The median Loes scores before haematopoietic stem cell transplantation and at the last follow-up visit were 6.0 and 5.25, respectively. Of the eight patients who did not undergo haematopoietic stem cell transplantation, six patients died 69.1 months (median period; range 16.0–104.1 months) after the onset of the cerebral/cerebellar/brainstem lesions, confirming that the survival probability was significantly higher in patients with haematopoietic stem cell transplantation compared with that in patients without haematopoietic stem cell transplantation (P = 0.0089). The present study showed that haematopoietic stem cell transplantation was conducted safely and arrested the inflammatory demyelination in all the patients with adolescent-/adult-onset cerebral form/cerebello-brainstem form of adrenoleukodystrophy when haematopoietic stem cell transplantation was conducted in the early stages. Further studies are warranted to optimize the procedures of haematopoietic stem cell transplantation for adolescent-/adult-onset cerebral form/cerebello-brainstem form of adrenoleukodystrophy.

PURPOSE: The purpose of this retrospective study was to evaluate the usefulness of serum tumour markers and morphological characteristics in CT/MRI to differentiate between ovarian metastases from colorectal carcinomas (OMCRC) and primary ovarian carcinomas (POC). METHOD: Preoperative radiological images of 41 OMCRCs from 27 patients (mean age ± SD: 52.2 ± 10.7 years) and 46 POCs from 36 patients (52.1 ± 12.7 years) were included. Three blinded gynecological radiologists classified tumour morphology into 'mille-feuille sign', 'solid and cystic', 'multicystic without nodules', and 'multicystic with nodules' groups and analysed using Fisher's exact test. Serum carcinoembryonic antigen (CEA), cancer antigen 125 (CA125), and carbohydrate antigen 19-9 levels were compared by Wilcoxon rank-sum test. RESULTS: 'Mille-feuille sign' indicated OMCRC (OMCRC: 8/41, POC: 1/46, specificity = 0.98, p = 0.011) and had excellent interobserver agreement (Fleiss's kappa value = 0.96). 'Solid and cystic' indicated POC (18/41 vs 41/45, p < 0.001) and 'multicystic without nodules' indicated OMCRC (8/41 vs 2/46, p = 0.041). There was no significant difference in 'multicystic with nodules'. CA125 levels were higher in POCs (292.5 U/mL vs. 41.0 U/mL, p = 0.003). CEA levels were higher in OMCRCs (24.5 ng/mL vs 2 ng/mL, p < 0.001). CEA (< 6.3 ng/mL) AND (CA125 (≥87.0 U/mL) OR 'solid and cystic') indicated POC with high accuracy (3/41 vs 44/46, accuracy = 0.94, p < 0.001). CONCLUSIONS: Our new method with morphological classification and tumour markers were useful for differentiating the two tumours. In particular, the 'mille-feuille sign' frequently indicated OMCRC with high specificity and excellent interobserver agreement.

OBJECTIVES: To understand the sources of variability in diagnostic performance among experienced radiologists. DESIGN: All prostate MRI examinations performed between 2016 and 2018 were retrospectively reviewed. SETTING: University hospital in Japan. PARTICIPANTS: Data derived from 334 pathology-proven cases (male, mean age: 70 years; range: 35-90 years) that were interpreted by 10 experienced radiologists were subjected to the analysis. PRIMARY AND SECONDARY OUTCOME MEASURES: Diagnostic performance measures of the radiologists were compared with candidate factors, including interpretive volume of prostate MRIs, volume of self-directed and assigned total annual interpretive work, and years of experience. The potential influence of fatigue was also evaluated by examining the effect of the report's issue time. RESULTS: There were 186 prostate cancer cases. Performance was based on accuracy, sensitivity and specificity (86%, 85% and 84%, respectively). While performance was not correlated with the volume of prostate MRIs, per se (ρ=-0.15, p=0.69; ρ=-0.01, p=0.99; ρ=-0.33, p=0.36) or the total MRIs assigned for each radiologist (p>0.6) or years of experience (p>0.4), all measures were strongly correlated with voluntary work represented by the interpretive volume of abdominal CTs (r=0.79, p<0.01; r=0.80, p<0.01; r=0.64, p=0.048). The performance did not differ based on the issue time of the report (morning, afternoon and evening) (χ2(2)=3.65, p=0.16). CONCLUSIONS: Greater autonomy, represented as enhanced self-directed interpretive work, was most significantly correlated with the performance of prostate MRI interpretation. The lack of a correlation between the performance and assigned volume confirms the complexity of human learning. Together, these findings support the hypothesis that successful promotion of internal drivers could have a pervasive positive impact on improving diagnostic performance.

BACKGROUND: Intramedullary hyperintense lesions associated with spinal cord edema on T2-weighted MR images (T2WI) are rare findings in patients with cervical spondylosis and are poorly characterized. We investigated the clinical characteristics of spinal cord edema due to cervical spondylosis (SCECS). METHODS: In total, 214 patients with cervical spondylotic myelopathy who underwent surgery between April 2007 and March 2017 were divided into SCECS and non-SCECS groups with SCECS defined as follows: (1) intramedullary signal intensity (ISI) of the cervical spinal cord in sagittal T2WI extending to more than one vertebral body height; (2) "fuzzy" ISI, recognized as a faint intramedullary change with a largely indistinct and hazy border; and (3) a larger sagittal diameter of the spinal cord segment with ISI just above or below the cord compression area compared with areas of the cervical spine without ISI. Radiographic parameters, demographic characteristics, and the Japanese Orthopedic Association (JOA) surgical outcomes score were compared between the groups. RESULTS: Seventeen patients (7.9%) were diagnosed with SCECS. These patients were younger than those in the non-SCECS group [median (interquartile range), 64 (20) vs. 69 (15) years, respectively, p = 0.016], and the disease duration from onset to surgery was significantly shorter in the SCECS group than in the non-SCECS group [6 (7) vs. 20 (48) months, respectively]. No significant difference was observed between groups with respect to sex, radiologic findings, or surgical outcomes. CONCLUSION: The disease showed an earlier onset and more rapid progression in the patients with SCECS than in those without SCECS.

Little is known regarding differences between model-based iterative reconstruction (MBIR) and hybrid iterative reconstruction (HIR) in temporal bone computed tomography (CT). This study compared the ability to depict microstructures in temporal bone in quarter-detector CT (QDCT) between MBIR and HIR.Sixty-two temporal bones in 31 consecutive adult patients who underwent QDCT were included. Reconstruction was performed with Forward projected model-based Iterative Reconstruction SoluTion (FIRST) BONE mild mode and Adaptive Iterative Dose Reduction 3D (AIDR3D) enhanced mild mode. Imaging quality was graded for 3 microstructures (spiral osseous lamina, tympanic membrane, and singular canal).Spiral osseous lamina was significantly well-delineated in the AIDR3D enhanced group, compared with the FIRST group. In nearly all cases with FIRST, spiral osseous lamina was poorly defined. Although there was no significant difference, depiction of the tympanic membrane and singular canal tended to be better with AIDR3D enhanced mode.Routine reconstruction for preoperative temporal bone CT should be performed with HIR, rather than MBIR.

OBJECIVE: To clarify the neuroimaging findings of children with acute flaccid myelitis during an outbreak of EV-D68 infection. METHODS: We performed a detailed review of the spinal and cranial MRI results of 54 children with acute flaccid myelitis. We focused on the range of longitudinal lesions, the localization and appearance of lesions within a horizontal section, Gadolinium-enhancement, and changes over time. RESULTS: All children had longitudinal spinal lesions involving central gray matter. Twenty-six children had lesions spanning the entire spine. Six of them had weakness in all limbs, whereas seven had weakness of only one limb. Thirty-eight children had lesions in both gray and white matter and limb weakness tended to be more severe in these children. During the acute period, spinal lesions showed bilateral ill-defined widespread T2 hyperintensity. During the subacute period, lesions were well defined and confined to the anterior horn. The distribution of limb weakness was correlated with the appearance of lesions during the subacute period. Gadolinium enhancement was performed in 37 children, and enhancement was seen in the cauda equina in 29 children. Enhancement was infrequent within 2 days after onset but was seen in almost all children thereafter. Twenty-two children had brainstem lesions continuous with spinal lesions. CONCLUSION: Extensive longitudinal spinal lesions were characteristic in children with acute flaccid myelitis. Lesions were usually bilateral and widespread during the acute period, whereas localization to the anterior horn could become obvious. Although enhancement of the cauda equina was often observed, its appearance was sometimes delayed.

To compare coronary artery luminal enhancement in coronary computed tomography angiography (CCTA) between ventral and dorsal region-of-interest (ROI) bolus tracking in the descending aorta.The records of 165 consecutive patients who underwent CCTA with non-helical acquisition from July 2017 to March 2018 were retrospectively examined. We performed 320-row CCTA with bolus tracking [scan triggered at 260 HU in the descending aorta] and 133 patients were finally included. ROI was set in the ventral and dorsal halves of the descending aorta in 68 and 65 patients, respectively.Contrast arrival time was significantly shorter in the dorsal group (ventral: 21.8 ± 0.372 s; dorsal: 20.7 ± 0.369; P = .0295). The mean density of the proximal and distal RCA was significantly higher in the ventral group (proximal: ventral, 428.1 ± 6.95 HU; dorsal, 405.5 ± 7.72 HU, P = .0318; distal: ventral, 418.0 ± 9.29 HU; dorsal, 393.2 ± 9.46 HU, P = .0133).Dorsal bolus tracking ROI in the descending thoracic aorta significantly reduced preparation time and RCA CT values.

A 71-year-old woman with a 6-month history of relapsing bilateral anterior scleritis presented with severe right visual impairment due to posterior scleritis. Despite radiological signs of encephalitis, the patient and her family members noticed no cognitive decline. The patient subsequently developed slight auricular pain without any visual changes such as redness or swelling, which, however, showed increased uptake of F-18-fluorodeoxyglucose on positron emission tomography. Auricular cartilage biopsy revealed perichondrial inflammation suggesting relapsing polychondritis. Steroid therapy improved her symptoms and radiological findings. This case illustrates that asymptomatic brain inflammatory lesions can precede clinical signs of chondritis in relapsing polychondritis, and that auricular cartilage biopsy should be considered even with mild auricular pain without apparent clinical findings of inflammation.

PURPOSE: Although advanced MRI techniques are increasingly available, imaging differentiation between glioblastoma and primary central nervous system lymphoma (PCNSL) is sometimes confusing. We aimed to evaluate the performance of image classification by support vector machine, a method of traditional machine learning, using texture features computed from contrast-enhanced T1-weighted images. METHODS: This retrospective study on preoperative brain tumor MRI included 76 consecutives, initially treated patients with glioblastoma (n = 55) or PCNSL (n = 21) from one institution, consisting of independent training group (n = 60: 44 glioblastomas and 16 PCNSLs) and test group (n = 16: 11 glioblastomas and 5 PCNSLs) sequentially separated by time periods. A total set of 67 texture features was computed on routine contrast-enhanced T1-weighted images of the training group, and the top four most discriminating features were selected as input variables to train support vector machine classifiers. These features were then evaluated on the test group with subsequent image classification. RESULTS: The area under the receiver operating characteristic curves on the training data was calculated at 0.99 (95% confidence interval [CI]: 0.96-1.00) for the classifier with a Gaussian kernel and 0.87 (95% CI: 0.77-0.95) for the classifier with a linear kernel. On the test data, both of the classifiers showed prediction accuracy of 75% (12/16) of the test images. CONCLUSIONS: Although further improvement is needed, our preliminary results suggest that machine learning-based image classification may provide complementary diagnostic information on routine brain MRI.

Introduction: Multinodular and vacuolating neuronal tumor (MVNT) had been initially described as an epilepsy-related brain tumor, but recent studies demonstrated it could be found incidentally in non-epilepsy patients. Case report: A 33-year-old woman with intractable post-encephalitis epilepsy presented a cluster of multinodular T2 hyperintensity in the left temporal lobe, which was very similar to the characteristics of MVNT. Long-term video electroencephalogram demonstrated that the habitual seizures were originated from bilateral temporal area and the interictal epileptic discharges were seen multifocally, although the lesions with MVNT appearance were localized in the left temporal lobe. It was presumed that the epilepsy in this patient was due to encephalitis in the past, and the link between the lesions and the epilepsy in this patient seemed weak. Conclusion: Although MVNT had been considered as an epilepsy-related brain tumor, we suggest it is not necessarily preferable to perform surgical resection of MVNT even on patients with epilepsy, unless epileptic foci are highly related to MVNT.

© 2019 The Authors Acute flaccid myelitis (AFM)is a recently defined clinical disease accompanied by the national outbreak of enterovirus D68 (EV-D68)in the United States during the late summer/fall of 2014; 258 cases of EV-D68 and 59 cases of AFM were reported in Japan during the late summer/fall of 2015. Subsequently, there have been no epidemics of AFM or EV-D68. However, we encountered a patient who had AFM associated with EV-D68 in 2017. This is the first case of AFM caused by EV-D68 after the 2015 epidemic, and the only reported case in 2017. This report indicates that AFM caused by EV-D68 can arise even in non-epidemic situations. If a patient presents with paralysis, AFM caused by EV-D68 should be included in the differential diagnosis, regardless of the absence of an epidemic of EV-D68 infection.

Neuronal intranuclear inclusion disease (NIID) is a rare neurodegenerative disease with marked variety in its clinical manifestations. While characteristic neuroimaging and skin biopsy findings are important clues to the diagnosis, autopsy studies are still important for confirming the exact disease features. We herein report the case of a patient who received an antemortem diagnosis of familial NIID with dementia-dominant phenotype that was later confirmed by an autopsy. Our report is the first to document a case of autopsy-confirmed NIID involving both cognitive impairment and sensorimotor neuropathy.

OBJECTIVE: Approximately 5% of cerebral small vessel diseases are hereditary, which include COL4A1/COL4A2-related disorders. COL4A1/COL4A2 encode type IV collagen α1/2 chains in the basement membranes of cerebral vessels. COL4A1/COL4A2 mutations impair the secretion of collagen to the extracellular matrix, thereby resulting in vessel fragility. The diagnostic yield for COL4A1/COL4A2 variants is around 20 to 30%, suggesting other mutated genes might be associated with this disease. This study aimed to identify novel genes that cause COL4A1/COL4A2-related disorders. METHODS: Whole exome sequencing was performed in 2 families with suspected COL4A1/COL4A2-related disorders. We validated the role of COLGALT1 variants by constructing a 3-dimensional structural model, evaluating collagen β (1-O) galactosyltransferase 1 (ColGalT1) protein expression and ColGalT activity by Western blotting and collagen galactosyltransferase assays, and performing in vitro RNA interference and rescue experiments. RESULTS: Exome sequencing demonstrated biallelic variants in COLGALT1 encoding ColGalT1, which was involved in the post-translational modification of type IV collagen in 2 unrelated patients: c.452 T > G (p.Leu151Arg) and c.1096delG (p.Glu366Argfs*15) in Patient 1, and c.460G > C (p.Ala154Pro) and c.1129G > C (p.Gly377Arg) in Patient 2. Three-dimensional model analysis suggested that p.Leu151Arg and p.Ala154Pro destabilized protein folding, which impaired enzymatic activity. ColGalT1 protein expression and ColGalT activity in Patient 1 were undetectable. RNA interference studies demonstrated that reduced ColGalT1 altered COL4A1 secretion, and rescue experiments showed that mutant COLGALT1 insufficiently restored COL4A1 production in cells compared with wild type. INTERPRETATION: Biallelic COLGALT1 variants cause cerebral small vessel abnormalities through a common molecular pathogenesis with COL4A1/COL4A2-related disorders. Ann Neurol 2018;84:843-853.

Here, I review the efficacy of radiological methods in the diagnosis of diplopia/double vision. The simplest technique for achieving a successful diagnosis is to capture a wide field-of-view image. In order to start the process of diagnosis, it is fundamental to first study the image findings. Analysis based on the principle of MECE or mutually exclusive collectively exhaustive is performed using four methods: deductive reasoning, fractionation, longitudinal study, and priority setting. The conventional practical procedure to attain a diagnosis is as follows. First, identify the location of the lesion by imaging, which will shorten the list of differential diagnosis. Second, obtain as much information as possible on the characteristics of the lesion in order to determine the pathology. Third, look for any associated findings, such as tortuous vasculature around the brain. Fourth, refer to all the available information; for example, the main complaint, clinical history, previous history, family history, physical findings, physiological findings, laboratory data, previous images, and other modalities. Finally, if still in doubt, one should consult with colleagues and the attending physician. However, because rationality (statistical analyses, such as posterior probability or positive predictive value with positive findings), predicted utility, and emotions play a factor in a person&#039;s decision making, it seems impossible to completely avoid oversights and misdiagnosis.

© 2018, Springer-Verlag GmbH Germany, part of Springer Nature. Purpose: To evaluate the effects of the single-energy metal artifact reduction (SEMAR) algorithm on image quality of cerebral CT and CT angiography (CTA) for patients who underwent intracranial aneurysm coiling. Methods: Twenty patients underwent cerebral CT and CTA using a 320-detector row CT after intracranial aneurysm coiling. Images with and without application of the SEMAR algorithm (SEMAR CT and standard CT images, respectively) were reconstructed for each patient. The images were qualitatively assessed by two independent radiologists in a blinded manner for the depiction of anatomical structures around the coil, delineation of the arteries around the coil, and the depiction of the status of coiled aneurysms. Artifact strength was quantitatively assessed by measuring the standard deviation of attenuation values around the coil. Results: The strength of artifacts measured in SEMAR CT images was significantly lower than that in standard CT images (25.7 ± 10.2 H.U. vs. 80.4 ± 67.2 H.U., p < 0.01, Student’s paired t test). SEMAR CT images were significantly improved compared with standard CT images in the depiction of anatomical structures around the coil (p < 0.01, the sign test), delineation of the arteries around the coil (p < 0.01), and the depiction of the status of coiled aneurysms (p < 0.01). Conclusion: The SEMAR algorithm significantly reduces metal artifacts from intracranial aneurysm coiling and improves visualization of anatomical structures and arteries around the coil, and depiction of the status of coiled aneurysms on post-interventional cerebral CT.

Major depressive disorder (MDD) is a globally prevalent psychiatric disorder that results from disruption of multiple neural circuits involved in emotional regulation. Although previous studies using diffusion tensor imaging (DTI) found smaller values of fractional anisotropy (FA) in the white matter, predominantly in the frontal lobe, of patients with MDD, studies using diffusion kurtosis imaging (DKI) are scarce. Here, we used DKI whole-brain analysis with tract-based spatial statistics (TBSS) to investigate the brain microstructural abnormalities in MDD. Twenty-six patients with MDD and 42 age- and sex-matched control subjects were enrolled. To investigate the microstructural pathology underlying the observations in DKI, a compartment model analysis was conducted focusing on the corpus callosum. In TBSS, the patients with MDD showed significantly smaller values of FA in the genu and frontal portion of the body of the corpus callosum. The patients also had smaller values of mean kurtosis (MK) and radial kurtosis (RK), but MK and RK abnormalities were distributed more widely compared with FA, predominantly in the frontal lobe but also in the parietal, occipital, and temporal lobes. Within the callosum, the regions with smaller MK and RK were located more posteriorly than the region with smaller FA. Model analysis suggested significantly smaller values of intra-neurite signal fraction in the body of the callosum and greater fiber dispersion in the genu, which were compatible with the existing literature of white matter pathology in MDD. Our results show that DKI is capable of demonstrating microstructural alterations in the brains of patients with MDD that cannot be fully depicted by conventional DTI. Though the issues of model validation and parameter estimation still remain, it is suggested that diffusion MRI combined with a biophysical model is a promising approach for investigation of the pathophysiology of MDD.

Objectives: On computed tomography (CT), sinonasal schwannoma displays as a soft-tissue mass without any distinctive features. Our aim was to define the radiological criteria for distinguishing schwannoma from other sinonasal benign tumours. Methods: We retrospectively identified consecutive patients who were pathologically diagnosed with benign sinonasal tumours between 2007 and 2016. CT attenuation values were compared between benign tumours and the brainstem. The utilities of demographic factors, clinical factors, and CT parameters for predicting the CT attenuation values of the brainstem were analysed by univariate and multivariate regression. Results: Of the 111 identified cases of benign tumours, the CT attenuation values of tumours and the brainstem were analysed in 36 cases (schwannoma, 4 cases inverted papilloma, 26 juvenile nasopharyngeal angiofibroma, 3 cavernous haemangioma, 3). The CT attenuation values of the schwannomas were significantly lower than in the brainstem, while those of the other tumours were significantly higher than in the brainstem. No factors affected the CT attenuation values of the brainstem. Conclusion: Low CT attenuation values of sinonasal benign tumours relative to the brainstem could distinguish schwannomas from other benign tumours.

Background: Acute flaccid myelitis (AFM) is an acute flaccid paralysis syndrome with spinal motor neuron involvement of unknown etiology. We investigated the characteristics and prognostic factors of AFM clusters coincident with an enterovirus D68 (EV-D68) outbreak in Japan during autumn 2015. Methods: An AFM case series study was conducted following a nationwide survey from August to December 2015. Radiographic and neurophysiologic data were subjected to centralized review, and virology studies were conducted for available specimens. Results: Fifty-nine AFM cases (58 definite, 1 probable) were identified, including 55 children and 4 adults (median age, 4.4 years). The AFM epidemic curve showed strong temporal correlation with EV-D68 detection from pathogen surveillance, but not with other pathogens. EV-D68 was detected in 9 patients: 5 in nasopharyngeal, 2 in stool, 1 in cerebrospinal fluid (adult case), and 1 in tracheal aspiration, nasopharyngeal, and serum samples (a pediatric case with preceding steroid usage). Cases exhibited heterogeneous paralysis patterns from 1- to 4-limb involvement, but all definite cases had longitudinal spinal gray matter lesions on magnetic resonance imaging (median, 20 spinal segments). Cerebrospinal fluid pleocytosis was observed in 50 of 59 cases (85%), and 8 of 29 (28%) were positive for antiganglioside antibodies, as frequently observed in Guillain-Barré syndrome. Fifty-two patients showed variable residual weakness at follow-up. Good prognostic factors included a pretreatment manual muscle strength test unit score >3, normal F-wave persistence, and EV-D68-negative status. Conclusions: EV-D68 may be one of the causative agents for AFM, while host susceptibility factors such as immune response could contribute to AFM development.

PURPOSE: To elucidate differences between glioblastoma (GBM) and primary central nervous system lymphoma (PCNSL) with MR image-based texture features. METHODS: This was an Institutional Review Board (IRB)-approved retrospective study. Consecutive, pathologically proven, initially treated 44 patients with GBM and 16 patients with PCNSL were enrolled. We calculated a total of 67 image texture features on the largest contrast-enhancing lesion in each patient on post-contrast T1-weighted images. Texture analyses included first-order features (histogram) and second-order features calculated with gray level co-occurrence matrix, gray level run length matrix (GLRLM), gray level size zone matrix, and multiple gray level size zone matrix. All texture features were measured by two neuroradiologists independently and the intraclass correlation coefficients were calculated. Reproducible features with the intraclass correlation coefficients of greater than 0.7 were used for hierarchical clustering between the cases and the features along with unpaired t statistics-based comparisons under the control of false discovery rate (FDR) < 0.05. Principal component analysis (PCA) was performed to find the predominant features in evaluating the differences between GBM and PCNSL. RESULTS: Twenty-one out of the 67 features satisfied the acceptable intraclass correlation coefficient and the FDR constraints. PCA suggested first-order entropy, median, GLRLM-based run length non-uniformity, and run percentage as the distinguished features. Compared with PCNSL, run percentage and median were significantly lower, and entropy and run length non-uniformity were significantly higher in GBM. CONCLUSIONS: Among MR image-based textures, first-order entropy, median, GLRLM-based run length non-uniformity, and run percentage are considered to enhance differences between GBM and PCNSL.

Focal neuroinflammation is considered one of the hypotheses for the cause of temporal lobe epilepsy (TLE) with amygdala enlargement (AE). Here, we report a case involving an adult female patient with TLE-AE characterized by late-onset seizures and cognitive impairment. Anti-N-methyl-d-aspartate receptor (NMDAR) antibodies were detected in her cerebrospinal fluid. However, administration of appropriate anti-seizure drugs (ASD), without immunotherapy, improved TLE-AE associated with NMDAR antibodies. In the present case, two clinically significant observations were made: 1) anti-NMDAR antibody-mediated autoimmune processes may be associated with TLE-AE, and 2) appropriate administration of ASD alone can improve clinical symptoms in mild cases of autoimmune epilepsy.

The symptoms of idiopathic normal pressure hydrocephalus (iNPH) can be improved by shunt surgery, but prediction of treatment outcome is not established. We investigated changes of the corticospinal tract (CST) in iNPH before and after shunt surgery by using diffusion microstructural imaging, which infers more specific tissue properties than conventional diffusion tensor imaging. Two biophysical models were used: neurite orientation dispersion and density imaging (NODDI) and white matter tract integrity (WMTI). In both methods, the orientational coherence within the CSTs was higher in patients than in controls, and some normalization occurred after the surgery in patients, indicating axon stretching and recovery. The estimated axon density was lower in patients than in controls but remained unchanged after the surgery, suggesting its potential as a marker for irreversible neuronal damage. In a Monte-Carlo simulation that represented model axons as undulating cylinders, both NODDI and WMTI separated the effects of axon density and undulation. Thus, diffusion MRI may distinguish between reversible and irreversible microstructural changes in iNPH. Our findings constitute a step towards a quantitative image biomarker that reflects pathological process and treatment outcomes of iNPH. (C) 2017 The Authors. Published by Elsevier Inc. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

BACKGROUND: Intracranial atherosclerosis (ICAS) involves diverse histologies and several remodeling patterns. Ring finger protein 213 (RNF213) c.14576G>A variant (rs112735431), recently reported to be associated with ICAS, may be linked with negative remodeling (outer diameter - reducing morphological alteration) of intracranial arteries. This study investigated the outer diameter of atherosclerotic middle cerebral artery (MCA). METHODS: Patients with unilateral atherosclerotic MCA stenosis/occlusion were enrolled in this single-hospital-based case-control study at The University of Tokyo Hospital. The patients were divided into two groups by the presence of RNF213 c.14576G>A (variant group and wild-type group) and the outer diameter of the MCA was measured with high-resolution magnetic resonance imaging. RESULTS: Twenty-eight patients with the wild type and 19 patients with the variant type were included. The outer diameter of the stenotic side MCA was smaller in the variant group than in the wild-type group (P = 8.3 × 10-6). The outer diameter of the normal side MCA was also smaller in the variant group than in the wild-type group (P = 5.2 × 10-3). The ratio of stenotic side to normal side was also smaller in the variant group than in the wild-type group (P = 1.5 × 10-5). CONCLUSIONS: This study indicates that RNF213 c.14576G>A is associated with negative remodeling of ICAS.

MRI in a 2-year-old female presenting afebrile seizures and left blepharoptosis revealed multiple well-marginated round-shaped lesions, isointensity to gray matter on T1- and T2-weighted images with homogenously reduced diffusion and diffuse contrast enhancement. MRS revealed elevation of taurine, choline and glutamate, and reduction of N-acetylaspartate. A brain biopsy confirmed a diagnosis of juvenile xanthogranuloma (JXG). JXG should be considered when MR spectroscopy shows elevated taurine and glutamate, which has only previously been reported in medulloblastomas. (C) 2016 The Japanese Society of Child Neurology. Published by Elsevier B.V. All rights reserved.

Meningiomas are common neoplasms that frequently occur in the brain and spine. Among the 15 histological subtypes of meningiomas in the WHO classification, the incidence of meningothelial meningiomas is the highest, followed by fibrous and transitional meningiomas. These three subtypes account for approximately 80 % of all meningiomas, and thus could be regarded as typical meningiomas. For this reason, other uncommon histological subtypes may be considered as imaging variants, and diagnosis is often challenging for radiologists solely based on imaging features of typical meningiomas. In addition to the histological subtypes, meningiomas arising in atypical locations could be easily mistaken for other lesions more commonly observed in those locations. The purpose of this article is to review characteristic clinical and imaging findings of uncommon meningiomas, including histological variants and meningiomas occurring in relatively rare locations.

Background and Purpose: We analyzed the ability of a machine learning approach that uses diffusion tensor imaging (DTI) structural connectomes to determine lateralization of epileptogenicity in temporal lobe epilepsy (TLE). Materials and Methods: We analyzed diffusion tensor and 3-dimensional (3D) T-1-weighted images of 44 patients with TLE (right, 15, left, 29; mean age, 33.0 +/- 11.6 years) and 14 age-matched controls. We constructed a whole brain structural connectome for each subject, calculated graph theoretical network measures, and used a support vector machine (SVM) for classification among 3 groups (right TLE versus controls, left TLE versus controls, and right TLE versus left TLE) following a feature reduction process with sparse linear regression. Results: In left TLE, we found a significant decrease in local efficiency and the clustering coefficient in several brain regions, including the left posterior cingulate gyrus, left cuneus, and both hippocampi. In right TLE, the right hippocampus showed reduced nodal degree, clustering coefficient, and local efficiency. With use of the leave-one-out cross-validation strategy, the SVM classifier achieved accuracy of 75.9 to 89.7% for right TLE versus controls, 74.4 to 86.0% for left TLE versus controls, and 72.7 to 86.4% for left TLE versus right TLE. Conclusion: Machine learning of graph theoretical measures from the DTI structural connectome may give support to lateralization of the TLE focus. The present good discrimination between left and right TLE suggests that, with further refinement, the classifier should improve presurgical diagnostic confidence.

Purpose: Diffusional kurtosis imaging (DKI) is an emerging technique that describes diffusion of water molecules in terms of deviation from Gaussian distribution. This study investigated correlations between DKI metrics and cognitive function in patients with idiopathic normal pressure hydrocephalus (iNPH). Materials and Methods: DKI was performed in 29 iNPH patients and 14 age-matched controls. Mini-mental state examination (MMSE), frontal assessment battery (FAB), and trail making test A (TMT-A) were used as cognitive measures. Tract-based spatial statistics (TBSS) analyses were performed to investigate the between-group differences and correlations with the cognitive measures of the diffusion metrics, including mean kurtosis (MK), fractional anisotropy (FA), apparent diffusion coefficient (ADC), axial diffusivity (AD), and radial diffusivity (RD). Results: In iNPH patients, FA and MK identified positive correlations with cognitive function in similar regions, predominantly in the frontal lobes (P &lt; 0.05, corrected for multiple comparisons). The frontoparietal subcortical white matter showed significant correlations with FAB and TMT-A across more extensive areas in MK analyses than in FA. ADC, AD, and RD analyses showed no significant correlations with MMSE and FAB, while negative correlation with TMT-A was observed in the limited portion of the frontal deep white matter. Conclusion: Both FA and MK correlated well with cognitive impairment in iNPH. The observed differences between FA and MK results suggest DKI may play a complementary role to conventional FA and ADC analyses, especially for evaluation of the subcortical white matter.

OBJECT The authors assessed whether the combined use of diffusion tensor tractography (DTT) and contrast-enhanced (CE) fast imaging employing steady-state acquisition (FIESTA) could improve the accuracy of predicting the courses of the facial and cochlear nerves before surgery. METHODS The population was composed of 22 patients with vestibular schwannoma in whom both the facial and cochlear nerves could be identified during surgery. According to DTT, depicted fibers running from the internal auditory canal to the brainstem were judged to represent the facial or vestibulocochlear nerve. With regard to imaging, the authors investigated multifused CE-FIESTA scans, in which all 3D vessel models were shown simultaneously, from various angles. The low-intensity areas running along the tumor from brainstem to the internal auditory canal were judged to represent the facial or vestibulocochlear nerve. RESULTS For all 22 patients, the rate of fibers depicted by DTT coinciding with the facial nerve was 13.6% (3/22), and that of fibers depicted by DTT coinciding with the cochlear nerve was 63.6% (14/22). The rate of candidates for nerves predicted by multifused CE-FIESTA coinciding with the facial nerve was 59.1% (13/22), and that of candidates for nerves predicted by multifused CE-FIESTA coinciding with the cochlear nerve was 4.5% (1/22). The rate of candidates for nerves predicted by combined DTT and multifused CE-FIESTA coinciding with the facial nerve was 63.6% (14/22), and that of candidates for nerves predicted by combined DTT and multifused CE-FIESTA coinciding with the cochlear nerve was 63.6% (14/22). The rate of candidates predicted by DTT coinciding with both facial and cochlear nerves was 0.0% (0/22), that of candidates predicted by multifused CE-FIESTA coinciding with both facial and cochlear nerves was 4.5% (1/22), and that of candidates predicted by combined DTT and multifused CE-FIESTA coinciding with both the facial and cochlear nerves was 45.5% (10/22). CONCLUSIONS By using a combination of DTT and multifused CE-FIESTA, the-authors were able to increase the number of vestibular schwannoma patients for whom predicted results corresponded with the courses of both the facial and cochlear nerves, a result-that has been considered difficult to achieve by use of a single modality only. Although the 3D image including these prediction results helped with comprehension of the 3D operative anatomy, the reliability of prediction remains to be established.

Dumbbell-shaped tumors consisting of 2 different tumors are extremely rare. Herein, the authors present a case of concurrent spinal schwannoma and meningioma mimicking a single cervical dumbbell-shaped tumor. A 64-year-old man presented with a 5-year history of gradually exacerbating left occipital pain without clinical evidence of neurofibromatosis. Magnetic resonance imaging showed an extradural tumor along the left C-2 nerve root with a small intradural component. The tumor was approached via a C-1 hemilaminectomy. The intradural tumor was resected together with the extradural tumor after opening the dura meter. The intradural tumor was attached to the dura mater around the exit point of the C-2 nerve root. lntraoperative biopsy revealed that the extradural tumor was a schwannoma and that the intradural tumor was a meningioma. The dura mater adjacent to the tumor was then coagulated and resected. Postoperative pathological examination confirmed the same diagnoses with no evidence of continuity between the intra- and extradural components. The patient's postoperative clinical course was uneventful. Clinicians should be aware that cervical dumbbell-shaped tumors can consist of 2 different tumors.

© 2015 The Korean Neurosurgical Society. Chronic lymphocytic inflammation with pontine perivascular enhancement responsive to steroids (CLIPPERS) is a relapsing-remitting disorder for which steroid administration is a key to control the progression. CLIPPERS can exhibit radiological features similar to malignant lymphoma, whose diagnosis is confounded by prior steroid administration. We report a case of CLIPPERS accompanied by abnormal elevation of β-2 microglobulin in the cerebrospinal fluid (CSF). A 62-year-old man started to experience numbness in all fingers of his left hand one year ago, which gradually extended to his body trunk and legs on both sides. Magnetic resonance imaging demonstrated numerous small enhancing spots scattered in his brain and spinal cord. CSF levels of β-2 microglobulin were elevated; although this often indicates central nervous system involvement in leukemia and lymphoma, the lesions were diagnosed as CLIPPERS based on the pathological findings from a biopsy specimen. We emphasize the importance of biopsy to differentiate between CLIPPERS and malignant lymphoma because the temporary radiological response to steroid might be the same in both diseases but the treatment strategies regarding the use of steroid are quite different.

According to recent findings, diffusion tensor tractography (DTT) only allows prediction of facial nerve location in relation to vestibular schwannoma (VS) with high probability. However, previous studies have not mentioned why only the facial nerve was selectively visualized. Our previous report investigated the optimal conditions of DTT for normal facial and vestibulocochlear nerves. In the present study, we applied the optimal conditions of DTT to VS patients to assess the feasibility of DTT for the facial and vestibulocochlear nerves. We investigated 11 patients with VS who underwent tumor resection. Visualized tracts were compared with locations of the facial and cochlear nerves as identified by intraoperative electrophysiological monitoring. With the proposed method, visualized tracts corresponded to pathway area of the facial or cochlear nerves in nine of 11 patients (81.8 %); specifically, to the pathway area of the facial nerve in three of 11 patients (27.3 %), and to the pathway area of the cochlear nerve in six of 11 patients (54.5 %). We visualized facial or vestibulocochlear nerves in nine of 11 patients (81.8 %). For the first time, DTT proved able to visualize not only the facial nerve but also the vestibulocochlear nerve in VS patients. Despite our findings, good methods for distinguishing whether a visualized nerve tract represents facial nerve, vestibulocochlear nerve, or only noise remain unavailable. Close attention should therefore be paid to the interpretation of visualized fibers.

Diffusion tensor tractography (DTT) is not adequately reliable for prediction of facial and vestibulocochlear (VII-VIII) nerve locations, especially relative to a vestibular schwannoma (VS). Furthermore, it is often not possible to visualize normal VII-VIII nerves by DTT (visualization rates were 12.5-63.6 %). Therefore, DTT post-processing was optimized for normal VII-VIII nerve visualization with and without manual noise elimination. DTT examinations of ten patients were evaluated to assess the improvement in performance by modifying seed region of interest (ROI) and fractional anisotropy (FA) threshold. Seed ROI was placed at the porus of the internal auditory meatus, and FA threshold values were either fixed or variable for each patient. DTT visualization of cranial nerves VII-VIII was evaluated and the noise effect was measured. Cranial nerves VII-VIII were visualized in 90 % of patients without using manual noise elimination by modifying the seed ROI and FA threshold. The visualization rate with FA threshold of the upper limit in each patient (100 %) was significantly higher than that with FA threshold of 0.1 (75 %) (). The incidence rate of noise with FA threshold of the upper limit (10 %) was not significantly different than the FA threshold of 0.1 (20 %) (). Seed ROI modification and FA thresholding can improve the visualization of cranial nerve VII-VIII locations in DTT. This technique is promising for its potential to determine the relationship of cranial nerves VII-VIII to VS.

© 2014, Japanese Society of Radiological Technology and Japan Society of Medical Physics. Our aim was to show whether sensitivity for detecting volume changes in regional gray matter in default mode network (DMN) at converted [from mild cognitive impairment to Alzheimer’s disease (from MCI to AD)] phase was improved by use of a standardized volume with global gray-matter volume. T1-weighted MR images (T1WI) of seven normal subjects and seven converted (from MCI to AD) patients were obtained from the Alzheimer’s Disease Neuroimaging Initiative (ADNI) database. Gray-matter images segmented with Statistical Parametric Mapping 5 were measured by the atlas-based method. We focused on five nodes of the DMN. For each phase, region of interest (ROI) volumes in the five nodes were standardized by two methods: (1) the ratio to the screening phase (S_volume) and (2) the ratio to the screening phase after both volumes were standardized by the global gray-matter volume (S_N_volume). Significant group differences between longitudinal gray-matter volume change of the converted (from MCI to AD) group and that of the normal group were found in lateral temporal cortex by S_N_volume, and precuneus by S_N_volume. These findings are useful for improving the understanding of DMN volume changes at the converted (from MCI to AD) phase.

Objectives: To investigate whether reproducibility of gray matter volumetry is influenced by parameter settings for VBM 8 using Diffeomorphic Anatomical Registration Through Exponentiated Lie Algebra (DARTEL) with region-of-interest (ROI) analyses. Methods: We prepared three-dimensional T1-weighted magnetic resonance images (3D-T1 WIs) of 21 healthy subjects. All subjects were imaged with each of five MRI systems. Voxel-based morphometry 8 (VBM 8) and WFU PickAtlas software were used for gray matter volumetry. The bilateral ROI labels used were those provided as default settings with the software: Frontal Lobe, Hippocampus, Occipital Lobe, Orbital Gyrus, Parietal Lobe, Putamen, and Temporal Lobe. All 3D-T1 Wls were segmented to gray matter with six parameters of VBM 8, with each parameter having between three and eight selectable levels. Reproducibility was evaluated as the standard deviation (mm(3)) of measured values for the five MRI systems. Results: Reproducibility was influenced by 'Bias regularization (BiasR)', 'Bias FWHM, and 'De-noising filter' settings, but not by 'MRF weighting', 'Sampling distance', or 'Warping regularization' settings. Reproducibility in BiasR was influenced by ROI. Superior reproducibility was observed in Frontal Lobe with the BiasR1 setting, and in Hippocampus, Parietal Lobe, and Putamen with the BiasR3*, BiasR1, and BiasR5 settings, respectively. Conclusion: Reproducibility of gray matter volumetry was influenced by parameter settings in VBM 8 using DARTEL and ROI. In multi-center studies, the use of appropriate settings in VBM 8 with DARTEL results in reduced scanner effect.

Magnetic resonance imaging findings of the central nervous system in ciliopathy-related disorders were described. The neuroimaging hallmarks of Joubert syndrome and related disorders (JSRD) include vermian hypoplasia and the molar-tooth sign (MTS). The MTS results from a midbrain-hindbrain malformation characterized by thickened and elongated superior cerebellar peduncles and an abnormally deep interpeduncular fossa. Bardet-Biedl syndrome shows little cerebellar malformations but a high rate of hippocampal dysgenesis which is consistent with cognitive impairment. Meckel-Gruber syndrome has not only the triad of occipital encephalocele, bilateral enlarged multicystic kidneys and postaxial Polydactyly, but also wide variety of other malformations. Orofaciodigital syndrome type VI (OFD VI) exhibit a more severe neuroimaging pattern than other JSRD, including brainstem and cerebellar abnormalities, gyration disorder, polymicrogy-ria and/or heterotopia. Leber congenital amaurosis can also show the similar findings of JSRD. When we look at the MTS, therefore, we must search for further complicating disorders of other organs and musculoskeletal system to make a precise diagnosis.

Destructive infiltration of invasive fungal sinusitis can easily occur into the central nervous system (CNS). Cerebral aneurysms associated with fungal infection are highly vulnerable to rupture, and can frequently and rapidly take a serious clinical course. We experienced a patient who twice developed cerebral aneurysm followed by rupture due to invasive fugal sinusitis. This 77-year-old man was admitted for progressive bilateral visual disturbance, which was initially treated as idiopathic hypertrophic pachymeningitis. The patient subsequently suffered subarachnoid hemorrhage (SAH) twice in only 12 days. Both SAH originated from different newly formed cerebral aneurysms. Trapping was performed for both ruptured aneurysms. Pathological examination of the resected aneurysms indicated the presence of fungi determined to be Aspergillus. This Aspergillus infection was also discovered inside the frontal sinus by endoscopic biopsy, so a regimen of antifungal agents was instituted. Prolonged antifungal therapy caused renal impairment, which ultimately led to the patient's death. Autopsy detected no mycotic infiltration of the major cerebral arteries, except for the 2 ruptured cerebral aneurysms. However, prolonged mycosis of the CNS, such as in the deep part in the falx cerebri and in the small veins proximal to the tentorium cerebelli, was observed, indicating that mycosis invading the cranium is refractory even to long-term administration of antifungal agents. The present case strongly suggests that urgent and proactive definitive diagnosis is essential to successfully treat invasive paranasal sinus aspergillosis. If infiltration of the CNS is suspected, early surgical resection and antifungal therapy must be initiated immediately.

Background: Epithelioid hemangioendotheliomas (EHE) is an extremely rare tumor that can arise not only intracranially but also systemically. Its radiological characteristics and the mechanism underlying the multiple organ involvement in EHE are poorly understood. Case Description: A 24-year-old woman with a 7-month history of coughing and blood-stained sputum complained of visual disturbance in the right eye that had persisted for 1-month. Magnetic resonance (MR) imaging revealed multiple intraparenchymal masses with low-intensity on MR susceptibility-weighted images with minimal enhancement with gadolinium. Systemic computed tomography revealed multiple nodules in both lungs and the liver. Because her neurological status rapidly deteriorated, brain biopsy of the right frontal mass was performed. The pathological diagnosis was EHE. Over the following 3 months, the patient gradually developed disturbance of consciousness. She died at 4 months after admission because of significant intracranial hypertension. Conclusion: Although intracranial EHEs are extremely rare, they should be included in the differential diagnoses of multiple small-sized masses with low-intensity on MR susceptibility-weighted images. We also emphasize that the systemic involvement of this tumor was more compatible with multicentric development than metastasis.

Background: To evaluate the sensitivity, specificity, and accuracy of time-of-flight MR angiography (MRA) compared with CT angiography (CTA) for detection of branch vessels arising from the intracranial aneurysm sac, using a 3-tesla MR scanner and an area detector CT scanner. Methods: Fifty patients with an intracranial aneurysm (25 patients with a branch vessel arising from the sac and 25 patients without) underwent rotational intraarterial digital subtraction angiography (rotational DSA), MRA, and CFA. The following six image sets were assessed using a 3-point scale for the existence of a branch vessel; (1) volume rendering with MRA (MRA-VR); (2) CTA-VR; (3) source images with MRA; (4) source images with CTA; (5) VR and source images with MRA ('MRA-VR+source images'); and (6) 'CTA-VR+source images'. Each set comprised the data of all 50 patients. Three radiologists then performed consensus review and calculated the sensitivity, specificity, and accuracy for MRA and CTA; rotational DSA was considered as the gold standard. Results: Higher accuracies were obtained in review using VR+source compared with both VR and source alone. In addition, higher accuracies were obtained in review using MRA compared with CTA. The highest accuracy of 0.96 was obtained for 'MRA-VR+source images'; in contrast, accuracy on 'CTA-VR+source images' was 0.86. Conclusions: The results show that 3-tesla MRA is an ideal non-invasive imaging examination for detection of a branch vessel arising from an intracranial aneurysm sac. Higher accuracy, especially sensitivity, with MRA compared with CTA was found in ICA, but accuracy with MRA was same as that with CTA in MCA. (C) 2014 Elsevier B.V. All rights reserved.

Purpose: To investigate the use of non-Gaussian diffusion-weighted imaging (q-space imaging [QSI]) to estimate diurnal changes in intervertebral disc (IVD) microstructure. Materials and Methods: IVDs of 15 male subjects (mean age, 27.3 years; mean body mass index, 22.50 kg/m(2)) were investigated once in the morning, less than 30 min after rising, and a second time in the evening after at least 10 h of normal physical activity, using 3 Tesla (T) MR imaging. T2 mapping and QSI data values (apparent diffusion coefficient [ADC], root mean square displacement [RMSD], and apparent kurtosis coefficient [AKC]) were calculated and compared between the morning and evening imaging sessions. Results: The T2, ADC, and RMSD values showed a significant decrease in the evening (175.8 +/- 49.5 ms, 1.56 +/- 0.32 10(-3) mm(2)/s and 40.0 +/- 3.0 mu m, respectively; P &lt; 0.05 for all values; paired t-test), when compared with the morning values (226.5 +/- 83.8 ms, 1.69 +/- 0.29 10(-3) mm(2)/s and 45.2 +/- 2.9 mm, respectively). The AKC value showed a significant increase in the evening (0.67 +/- 0.08), when compared with the morning value (0.58 +/- 0.04; P &lt; 0.05). Conclusion: The RMSD and AKC values obtained from QSI analysis may be biomarkers for IVD diurnal microstructural changes.

Previous studies have revealed top-down control during memory retrieval from the prefrontal cortex to the temporal cortex. In the present functional MRI study, we investigated whether the fronto-temporal functional interaction occurs even during fixation periods after memory retrieval trials. During recency judgments, subjects judged the temporal order of two items in a study list. The task used in the present study consisted of memory trials of recency judgments and non-memory trials of counting dots, and post-trial fixation periods. By comparing the brain activity during the fixation periods after the memory trials with that during the fixation periods after the non-memory trials, we detected heightened brain activity in the lateral prefrontal cortex, the lateral temporal cortex and the hippocampus. Functional interactions during the fixation periods after the memory vs. non-memory trials as examined using a psychophysiological interaction revealed a decreased interaction from the lateral prefrontal cortex to the lateral temporal cortex, but not to the hippocampus. The functional interaction between the same frontal and temporal regions was also present during the memory trials. A trial-based functional connectivity analysis further revealed that the fronto-temporal interaction was positive and decreased during the fixation periods after the memory trials, relative to the fixation periods after the non-memory trials. These results suggest that the fronto-temporal interaction existed during the post-trial fixation periods, which had been present during the memory trials and temporally extended into the fixation periods.

Neonatal subgaleal hemorrhage (SGH) is a serious adverse event that is often underestimated and sometimes goes unrecognized. It can cause bleeding complications and jeopardize the patient's life. Early diagnosis and prompt treatment are important in optimizing the outcome in neonates with SGH. Herein we describe the case of a newborn who developed severe SGH and died. We report unenhanced computed tomography (CT) of ongoing SGH, which showed a low-density region in the surrounding area of the head. The density could be explained by unclotted active bleeding and low hematocrit. Even if a patient with clinically suspected SGH has a low-density region on CT, the presence of SGH should not be excluded.

Objective To develop a new method to determine the presence of intracochlear ossification and/or fibrosis in cochlear implantation candidates with bilateral profound deafness following meningitis. Study Design Diagnostic test assessment. Setting A university hospital. Subjects and Methods This study involved 15 ears from 13 patients with profound deafness following meningitis who underwent cochlear implantation. These ears showed normal structures, soft tissue, partial bony occlusion, and complete bony occlusion in 4, 3, 2, and 6 ears, respectively. We measured radiodensity in Hounsfield units (HU) using 0.5-mm-thick axial high-resolution computed tomography image slices at 3 different levels in the basal turn, the fenestration, and inferior and ascending segment sites, located along the electrode-insertion path. Pixel-level analysis on the DICOM viewer yielded actual computed tomography values of intracochlear soft tissues by eliminating the partial volume effect. The values were compared with the intraoperative findings. Results Values for ossification (n = 12) ranged from +547 HU to +1137 HU; for fibrosis (n = 11), from +154 HU to +574 HU; and for fluid (n = 22), from -49 HU to +255 HU. From these values, we developed 2 presets of window width (WW) and window level (WL): (1) WW: 1800, WL: 1100 (200 HU to 2000 HU) and (2) WW: 1500, WL: 1250 (500 HU to 2000 HU). The results using these 2 presets corresponded well to the intraoperative findings. Conclusion Our new method is easy and feasible for preoperative determination of the presence of cochlear ossification and/or fibrosis that develops following meningitis.