Possible utility of MRI using Gd-EOB-DTPA for estimating liver functional reserve

Preoperative estimation of the liver functional reserve is important in liver surgery. We evaluated the role of dynamic magnetic resonance (MR) imaging with gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid (Gd-EOB-DTPA), i.e., EOB-MRI, for determining liver functional reserve. Fifty patients who underwent EOB-MRI to examine their liver tumors were included in this study. We first performed a pixel-by-pixel comparison of registered MR images and activity images with Tc-99m galactosyl human serum albumin (GSA) on each slice, and the correlation coefficient was calculated for 8 patients. We also determined the correlation coefficient between the relative signal intensity (SI) values of EOB-MRI and preoperative liver function, such as the GSA, indocyanine green dye retention at 15 min (ICGR15), and prothrombin time. The mean of the correlation coefficients for 512 × 512 matrices between the EOB-MRI and the GSA was 0.83 ± 0.05 (ranging from 0.73 to 0.87). The correlation coefficient between the relative SI of the EOB-MRI and the receptor index (LHL15) of GSA was 0.56 (P < 0.01). Better correlation coefficients were observed between the relative SI and the liver function test, including ICGR15 (r = -0.67, P < 0.01) and prothrombin time (r = 0.59, P < 0.01). In a patient with hilar cholangiocarcinoma whose right hepatic duct was obstructed, the relative SI in the right lobe (2.4 ± 0.3) was significantly lower than that in the left lobe (3.1 ± 0.1). EOB-MRI represents a practical and reliable imaging technique that may be used to estimate regional liver functional reserve in the clinical setting.


一過性脳虚血発作患者における拡散強調画像の意義と落とし穴

一過性脳虚血発作患者における拡散強調画像の意義と落とし穴


Usefulness of transcatheter arterial embolization prior to excision of hypervascular musculoskeletal tumors.

The objective of this study was to evaluate the usefulness of transcatheter arterial embolization prior to surgical excision of musculoskeletal tumors. We reviewed the records of nine patients (3 females and 6 males) who received arterial embolization prior to excision of musculoskeletal tumors in our hospital from December 2009 to April 2010. We evaluated tumor region, size, histopathology, feeding artery, embolic material, and blood loss during surgery. We compared the actual amount of intraoperative bleeding with arterial embolization to estimated amounts of bleeding without embolization predicted by three orthopedic surgeons. Arterial embolization was performed on the same day or within 5 days before surgery. Operations were performed as planned in all patients without serious complications. The amount of intraoperative bleeding was 35-4200 mL and there was significantly less bleeding with arterial embolization compared with the estimated amounts (p<0.01). Our results show that arterial embolization prior to resection of hypervascular musculoskeletal tumors reduces the amount of bleeding during surgery and contributes to patient safety.

The Journal of Medical Investigation : JMI


Neuroradiological and neurofunctional examinations for patients with 22q11.2 deletion.

Since the neuroradiological features of patients with 22q11.2 deletion syndrome are not well-understood, examinations using functional imaging were performed in this study. Brain magnetic resonance imaging (MRI) and 1H-magnetic resonance spectroscopy (MRS) were performed using a clinical 3-Tesla MR imager in 4 patients with 22q11.2 deletion syndrome (2 boys and 2 girls; aged 2-6 years.) and 20 age- and sex-matched healthy control subjects. Furthermore, interictal 123I-iomazenil (IMZ) single photon emission computed tomography (SPECT) was examined in 2 of the 4 patients. Among the 4 patients with 22q11.2 deletion syndrome, 2 patients showed polymicrogyria and 1 patient showed agyria. Those patients with brain malformations also showed abnormal brain artery patterns and decreased accumulation of IMZ in 123I-IMZ SPECT. Although all 4 patients showed epileptic discharges in their electroencephalograms (EEG), one patient with polymicrogyria had no seizure episodes. Decreases in γ-aminobutyric acid (GABA) corresponding to the areas of polymicrogyria and/or epileptic discharges in EEG were shown in all patients except for the patient with agyria. Although consistent evidence was not seen in patients with 22q11.2 deletion syndrome in this study, brain malformations and disturbances of the GABAergic nervous system would be underlying mechanisms of the neurodevelopmental abnormalities in this syndrome.


Preliminary observations and clinical value of N-acetyl resonances in ovarian tumours using in-vivo proton MR spectroscopy at 3T.

To retrospectively evaluate the clinical significance of N-acetyl resonances at 2 ppm in in-vivo proton magnetic resonance (MR) spectroscopy for distinguishing mucinous and non-mucinous tumours in patients with ovarian masses. MR spectroscopy was performed in patients with pathologically diagnosed ovarian tumours at 3T-MR imaging. Single-voxel MR spectroscopy data were collected from a single square volume of interest that encompassed the ovarian masses. The metabolite resonance peak areas at 2 ppm were quantified relative to unsuppressed water using a software package (LCModel). A total of 32 ovarian lesions in 32 patients were evaluated in this study. High metabolite peak at 2 ppm was observed in all nine mucinous tumours (9.71 +/- 7.46 mM), whereas low peak was observed in 14 of 23 non-mucinous tumours (3.12 +/- 1.42 mM) (p < 0.001). Using a cut off value of 4.45 mM for mucinous tumours had a sensitivity of 89%, specificity of 86%, PPV of 80%, and NPV of 92%. Proton MR spectroscopy with quantitative evaluation of the metabolite at 2 ppm concentration, which may suggest the presence of mucinous material containing N-acetyl mucinous compounds, can provide helpful information in distinguishing mucinous and non-mucinous ovarian tumours. Key Points MR spectroscopy helps distinguish mucinous from non-mucinous ovarian tumours. High N-acetyl resonance at 2 ppm is observed in ovarian mucinous tumours. Thus MR spectroscopy could improve management of these patients.


Measurement of variation in the human cerebral GABA level by in vivo MEGA-editing proton MR spectroscopy using a clinical 3 T instrument and its dependence on brain region and the female menstrual cycle.

The objectives of this study were to examine the reproducibility of the MEGA-editing J-difference technique and to determine the normal variation in the γ-aminobutyric acid (GABA) level depending on the cerebral region and its fluctuation according to the menstrual cycle as baseline data for clinical application. The participants consisted of 15 normal adult volunteers (eight men and seven women), and all measurements were repeated twice in all participants. The MEGA-editing pulses were incorporated into point-resolved spectroscopy on a 3 T instrument to obtain the J-difference editing spectra from a voxel located in the lentiform nuclei (LN), left frontal lobe (FL), and anterior cingulate cortex (AC). The GABA levels in the gray matter (GM) were compensated by the fraction ratios of the gray and white matters and cerebrospinal fluid in the measurement volume. The extent of the variation in GABA was almost the same as that observed in the major metabolites, and its reproducibility was also maintained (intraclass correlation coefficient > 0.7). GABA level was highest in LN and lowest in AC. A difference in the GABA level between the follicular and luteal phases of the menstrual cycle was found in both LN and FL, but not in AC. This technique showed the differences in the GABA levels in the GM and the region-specific decrease in the GABA levels during the women's luteal phase.


Non-invasive evaluation of the GABAergic/glutamatergic system in autistic patients observed by MEGA-editing proton MR spectroscopy using a clinical 3 tesla instrument.

Amino acids related to neurotransmitters and the GABAergic/glutamatergic system were measured using a 3 T-MRI instrument in 12 patients with autism and 10 normal controls. All measurements were performed in the frontal lobe (FL) and lenticular nuclei (LN) using a conventional sequence for n-acetyl aspartate (NAA) and glutamate (Glu), and the MEGA-editing method for GABA. The GABA level and [GABA]/[NAA] ratio were significantly lower (p < 0.01) in the FL, but not the LN, in patients with autism compared to normal controls. The [GABA]/[Glu] ratio in the FL was also significantly lower (p < 0.05) in the patients than in the normal controls, thus suggesting a possible abnormality in the regulation between GABA and Glu.

Journal of Autism and Developmental Disorders


Differentiation of benign and malignant uterine corpus tumors by using proton MR spectroscopy at 3T: preliminary study.

To retrospectively evaluate the diagnostic ability of magnetic resonance (MR) spectroscopy for distinguishing benign and malignant lesions in patients with uterine corpus tumours at MR imaging. Pelvic MR spectroscopy was performed in patients with pathologically diagnosed benign and malignant uterine corpus tumours at 3T-MR imaging. Single-voxel MR spectroscopy data were collected from a single square volume of interest that encompassed the uterine corpus lesion. The total choline compounds (tCho) resonance peak areas were quantified relative to unsuppressed water using a software package. Patients who fulfilled the criteria for estimates of acceptable reliability were included. A total of 32 patients (age range, 24-76 years) with 32 lesions were evaluated in this study. The median lesion size at MR imaging was 50 mm (range, 19-218 mm). A tCho peak was present in all 32 lesions including 14 malignant lesions (9.21 ± 2.21 mM), and 18 benign lesions (4.59 ± 2.22 mM) (p < 0.0001). Using a cut-off value of 7.00 mM for malignant lesions had a sensitivity of 93%, specificity of 83%, PPV of 81% and NPV of 94%. Proton MR spectroscopy with quantitative evaluation of tCho concentration can provide helpful information in distinguishing benign and malignant uterine corpus tumours.


Temporal evolution of sporadic Creutzfeldt-Jakob disease monitored by 3-Tesla MR spectroscopy.


Temporomandibular joint and 3.0T pseudodynamic magnetic resonance imaging. Part 2: evaluation of articular disc obscurity.

This study examined the relationship between temporomandibular joint (TMJ) dysfunctions and obscurity grades of interpreted anterior and posterior borders of the articular disc (Da and Dp, respectively) by 3.0 T pseudodynamic MRI. Da and Dp were classified into seven obscurity grades, and the Dp contour was classified into three types. The grades, types and TMJ function were compared by 3.0 T pseudodynamic MRI. Unobscured Da images at condylar positions posterior to the articular eminence were associated with normal TMJ function (P = 0.046 < 0.05). Unobscured Dp images at condylar positions anterior to the articular eminence were associated with normal TMJ function (P = 0.033 < 0.05). In addition, unobscured Dp images following flap insertion were associated with normal TMJ function (P = 0.043 < 0.05). There was no statistical relationship between Dp contour types and TMJ movement, but any change observed in the Dp contour during mouth opening was associated with abnormal TMJ function (P = 0.040 < 0.05). Grading of Da and Dp obscurity based on how well the areas were defined in the images, identifying the condylar positions in relation to the glenoid fossa and articular eminences, and observing the changes in Dp contour types were useful for diagnosing TMJ abnormalities.


Temporomandibular joint and 3.0T pseudodynamic magnetic resonance imaging. Part 1: evaluation of condylar and disc dysfunction.

This study describes an improved method for examining and diagnosing temporomandibular joint (TMJ) dynamics by 3.0 T pseudodynamic MRI. Clinical observation and conventional static MRI of volunteers (one without and eight with TMJ arthrosis) were followed by 3.0 T pseudodynamic MRI in positions ranging from the mouth closed to mouth fully opened. Condylar head (Cd), articular disc anterior border (Da) and articular disc posterior border (Dp) were digitized on sagittal images to determine trajectory and velocity patterns. Patients were divided into three groups based on the presence or absence of dysfunction: Group 1, no dysfunction on the right or left side of the TMJ; Group 2, dysfunction on the right or left side of the TMJ; and Group 3, dysfunction on both the right and left sides of the TMJs. In 75% of patients (12 of 16 joints), pseudodynamic TMJ analysis was useful for determining a functional abnormality. Using a points system based on three trajectory and seven velocity patterns, discs with adhesion and perforation had significantly fewer points than discs with anterior displacement (with and without reduction) and discs with no abnormality (P = 0.019 < 0.05). Trajectory and velocity patterns based on 3.0 T pseudodynamic MRI identified the affected side and determined the extent of morbidity in the Cd as well as the Da and Dp. The typical abnormal movement pattern of discs with anterior displacement (with and without reduction) and pathological structural changes of the articular disc (such as adhesion and perforation) could be identified.


Images in cardiovascular medicine. Cardiac magnetic resonance imaging and 2-dimensional speckle tracking echocardiography in secondary cardiac amyloidosis.


Incidence and clinical correlation of intracranial hemorrhages observed by 3-tesla gradient echo T2*-weighted images following intravenous thrombolysis with recombinant tissue plasminogen activator

The purpose of this study was to determine the incidence and clinical correlation of intracranial hemorrhages (ICHs) detected by 3-tesla gradient echo T(2)*-weighted images after intravenous recombinant tissue plasminogen activator (rt-PA) administration. We included 43 consecutive patients with anterior-circulation ischemia who underwent MRI studies before and after thrombolysis. Each hemorrhage was classified as a hemorrhagic infarction (HI) or parenchymal hemorrhage (PH) according to the European Cooperative Acute Stroke Study definition. The clinical outcome was defined as an improvement (> or =4-point reduction) or deterioration (> or =4-point increase) based on a comparison between the initial and the 30-day NIHSS scores. The incidence of ICHs was 58%, and the HI rate was 52%; both were higher than the rates reported in the literature. Most of the patients with HI improved clinically, and these patients had second MRAs that showed recanalization. None of the patients with PH demonstrated improvement. Three-tesla MRI may reveal a higher frequency of HI type hemorrhages than lower-field MRIs, and HI may be a predictor of good recovery by reflecting the presence of recanalization. The rate of PH in our study was low compared to other studies, probably due to the lower dosage of rt-PA.


GABA concentration in schizophrenia patients and the effects of antipsychotic medication: a proton magnetic resonance spectroscopy study.

Gamma-amino butyric acid (GABA) is thought to play a role in the pathophysiology of schizophrenia. High magnetic field proton magnetic resonance spectroscopy ((1)H-MRS) provides a reliable measurement of GABA in specific regions of the brain. This study measured GABA concentration in the anterior cingulate cortex (ACC) and in the left basal ganglia (ltBG) in 38 patients with chronic schizophrenia and 29 healthy control subjects. There was no significant difference in GABA concentration between the schizophrenia patients and the healthy controls in either the ACC (1.36+/-0.45 mmol/l in schizophrenia patients and 1.52+/-0.54 mmol/l in control subjects) or the ltBG (1.13+/-0.26 mmol/l in schizophrenia patients and 1.18+/-0.20 mmol/l in control subjects). Among the right handed schizophrenia patients, the GABA concentration in the ltBG was significantly higher in patients taking typical antipsychotics (1.25+/-0.24 mmol/l) than in those taking atypical antipsychotics (1.03+/-0.24 mmol/l, p=0.026). In the ACC, the GABA concentration was negatively correlated with the dose of the antipsychotics (rs=-0.347, p=0.035). In the ltBG, the GABA concentration was positively correlated with the dose of the anticholinergics (rs=0.403, p=0.015). To the best of our knowledge, this is the first study to have directly measured GABA concentrations in schizophrenia patients using (1)H-MRS. Our results suggest that there are no differences in GABA concentrations in the ACC or the ltBG of schizophrenia patients compared to healthy controls. Antipsychotic medication may cause changes in GABA concentration, and atypical and typical antipsychotics may have differing effects. It is possible that medication effects conceal inherent differences in GABA concentrations between schizophrenia patients and healthy controls.


Selection of endogenous 13C substrates for observation of intracellilar metabolism using the dynamic nuclear polarization technique

The aim of this study was to select a suitable substrate candidate for dynamic nuclear polarization (DNP) studies and demonstrate its utility for evaluating intracellular metabolism. Hyperpolarized substances included 1-(13)C-pyruvate (Pyr), 1-(13)C-glucose (Glc), and 1-(13)C-acetate. A DNP polarizer and a 600-MHz vertical small-bore scanner were used for (13)C-MR spectroscopic measurements. After polarization for 1 h, the dissolved solution was injected via a capillary line into the nuclear magnetic resonance tube in the scanner. The sequential spectra of the hyperpolarized (13)C-labeled substrates were acquired in durations of more than 120 s, and a thermal spectrum was obtained more than 1 h thereafter. FM3A cancer cells of mammary tumors were cultured for intracellular detection of the hyperpolarized (13)C-substances. The greatest sensitivity was found using Pyr with the longest T1 decay (51.5 s); and remarkably, the least sensitivity was observed using Glc with a signal decay of less than 2 s. An effective increase in sensitivity was shown using the other substances. The hyperpolarized intracellular study using (13)C-Pyr showed distinct elevation of lactate levels. The DNP technique is useful for evaluating intracellular metabolism. However, Glc is not suitable for use with the DNP technique.


How to manage RI venography in pre-orthopedic surgery patients

The preoperative evaluation of venous thromboembolism (VTE) is important to avoid complications, because VTE is often induced by orthopedic surgery. We focused on radioisotope venography (RIV) using 99mTc-macroaggregated human serum albumin, examining orthopedic patients. We conducted 34 examinations in 33 patients who were referred for RIV and lung perfusion scintigraphy for the pre-orthopedic operative evaluation of VTE. Two board-certified (one nuclear medicine board-certified) radiologists interpreted the images based on the following: (1) flow defect of the lower extremities; (2) interruption of flow; (3) irregular or asymmetric filling of the deep vein (low flow); (4) presence of collateral vessels; and (5) abnormal RI retention on delayed-phase images. Scoring was based on a 5-point scale, and more than 2 points was considered VTE positive. Abnormal findings were noted in 27 of the 34 examinations performed in the 33 patients and normal findings in the other 7 examinations. According to the RI score, 21 patients were classified into the VTE-positive group and 12 into the VTE-negative group. Surgery was canceled because of advanced age and respiratory dysfunction in 2 of the 21 patients in the VTE-positive group. Of the 19 patients who underwent surgery, an IVH filter was placed before surgery in 2 and anticoagulant treatment with heparin and warfarin was initiated on the day of surgery in 12 to prevent postoperative VTE, and only one of the patients receiving anticoagulant treatment developed PTE after surgery. Surgery was canceled due to advanced age and at patient's request in 2 of 12 patients in the VTE-negative group. Anticoagulant treatment with heparin/ warfarin was performed to prevent postoperative VTE in only 3 patients: one with a past medical history of pulmonary infarction, one with atrial fibrillation, and one suspected of having antiphospholipid antibody syndrome. No patient in the VTE-negative group developed VTE after surgery. The preoperative identification of patients with VTE by RIV might be useful for perioperative management and the evaluation of preventive measures against postoperative VTE.


Reversibility of ischemic findings on 3-T T2*-weighted imaging after emergency superficial temporal artery-middle cerebral artery anastomosis in patients with progressive ischemic stroke.

Vascular ischemic signs, i.e. multiple hypointense vessels in the ischemic territory, were identified by gradient echo-type 3-T T(2)*-weighted magnetic resonance (MR) imaging in 3 patients with acute ischemia due to major vessel occlusion. Emergency superficial temporal artery-middle cerebral artery (STA-MCA) anastomosis was performed in 2 patients with progressive stroke caused by bleeding-type moyamoya disease or severe MCA stenosis. Both patients were initially treated conservatively, but their neurological signs deteriorated. 3-T T(2)*-weighted MR imaging detected funicular low signals in both patients indicating enhancement of cortical vessels or medullary veins. The area of the vascular ischemic signs was almost the same or smaller than the hypoperfusion area on perfusion-weighted MR imaging or single-photon emission computed tomography. Postoperatively, the vascular ischemic signs disappeared in both patients, suggesting a relationship with severe ischemia due to high-risk misery perfusion. Their postoperative course was uneventful, and MR imaging revealed no new cerebral ischemic lesions or cerebral hyperperfusion. The patient without surgery developed cerebral infarction in the area of the vascular ischemic signs. Vascular ischemic signs detected by 3-T T(2)*-weighted MR imaging may represent a new predictor of high-risk misery perfusion, and may disappear after STA-MCA anastomosis performed in the subacute stage.


Diagnostic utility of cardiac magnetic resonance for detection of cardiac involvement in female carriers of Duchenne muscular dystrophy.


Thallium-201 chloride scintigraphy in soft tissue tumors.

We report the findings of Thallium-201 chloride ((201)TlCl) scintigraphy and consider how to use this technique to evaluate the character of soft tissue lesions. We enrolled 91 consecutive patients (45 males and 46 females, age range 8-91-years-old). Nineteen patients were malignant and 72 were benign. Patients were scanned 15 minutes (early phase) and 3 hours (delayed phase) after (201)TlCl injection. More intense uptake in the lesion compared to the normal side was considered as 'high', the same degree of uptake was considered 'iso', and decreased uptake was 'low'. The retention index (RI) was calculated in 9 patients in the malignant group and in 16 patients in the benign group. In malignant tumors, 15 of 19 patients showed high uptake in both the early and delayed phases. One malignant fibrous histiocytoma patient was high only in the delayed phase and 1 liposarcoma patient was high only in the early phase. Two liposarcoma patients showed an iso uptake in both phases. One of these patients was pathologically diagnosed as a myxoid type. In benign lesions, no lipoma showed increased uptake. All neurogenic tumors except for 2 demonstrated high uptake. All 3 ganglions of the lower extremities showed iso uptake. Most inflammatory diseases showed increased uptake. Clinically-considered benign patients consisted of tumorous lesions or inflammatory disease. Only 2 patients were considered 'low', and these were diagnosed as intramuscular hematoma and cyst. RI was variable in both malignant and benign lesions and no statistically significant difference was seen between malignant and benign lesions by t-test (p=0.72). A high (201)TlCl uptake lesion is more frequently seen in malignant tumors, but regardless of whether the tumor is benign or malignant, according to the histopathological variety, the (201)TlCl uptake pattern can not be the only indicator to differentiate malignant from benign tumors. We ultimately need to evaluate the nature of tumors by a combination of several imaging techniques.

The Journal of Medical Investigation : JMI


A case of von Recklinghausen's disease with coincident malignant peripheral nerve sheath tumor and gastrointestinal stromal tumor.

(18)F-fluorodeoxyglucose positron emission tomography ((18)F-FDG PET/CT) was performed to evaluate a left femoral subcutaneous mass in a patient with von Recklinghausen's disease (vRd) that gradually enlarged, causing pain and numbness. The left femoral mass showed intense FDG uptake with the maximum standardized uptake value (SUVmax) of 9.0. Other subcutaneous masses considered benign and neurogenic in nature also showed FDG uptake (SUVmax around 3 or less), but the degree of FDG uptake differed considerably from the left femoral mass. This observation suggested that the degree of FDG uptake may be a useful indicator of malignant transformation. Incidentally, PET/CT also showed an asymptomatic large abdominal mass with intense FDG uptake (SUVmax 8.8). The abdominal mass was resected and confirmed as gastrointestinal stromal tumor (GIST) of the small intestine. Three months later, the left femoral mass was operated on and pathologically diagnosed as a malignant peripheral nerve sheath tumor (MPNST). Various malignant diseases are known to occur with high frequency in vRd. Therefore, vRd patients need to have periodical examinations including PET/CT. We present a rare case of a patient with vRd with a MPNST of the left femur and coincidental GIST of the small intestine. February, 2009.


3T-MRIによる脳血管疾患の画像診断

3T-MRIによる脳血管疾患の画像診断


Evaluation of Initial Diffusion-weighted Image Findings in Acute Stroke Patients using a Semiquantitative Score.

We evaluated the usefulness of rating diffusion-weighted images (DWI) using a semiquantitative score modified from the Alberta Stroke Programme Early CT Score (ASPECTS) to predict deterioration of neurological symptoms in patients with hyperacute ischemic stroke who had undergone thrombolytic therapy with recombinant tissue plasminogen activator (rt-PA). We examined 22 patients with acute stroke (14 men, 8 women, mean age 72.5 years) treated with intravenous rt-PA. All were assessed using the National Institutes of Health Stroke Scale (NIHSS) and underwent emergent magnetic resonance (MR) imaging within 3 hours and 24 hours of stroke onset. Patients were divided into a deteriorated group (16 patients), in which NIHSS scores were increased after thrombolysis, and a non-deteriorated group (6 patients). We compared the DWI score, ASPECTS, and volume of hyperintense ischemic lesion on DWI (DWI volume) of the 2 groups and examined correlations between these scores and initial NIHSS score or DWI volume. The DWI score and ASPECTS tended to be lower in the deteriorated group than the non-deteriorated group. In addition, with a cutoff value<or=7, the DWI score could discriminate the deteriorated group from the non-deteriorated group with a sensitivity of 50% and specificity of 87.5%, whereas for ASPECTS, sensitivity was 50% and specificity, 81.2%. The DWI score, ASPECTS, and DWI volume had no correlation with NIHSS score but weak negative correlations with the DWI volume (P<0.01; Spearman's test). Comparing initial NIHSS score with each DWI score and DWI volume, the non-deteriorated group tended to have higher DWI scores and smaller DWI volumes than the deteriorated group, but there was no statistical difference between initial NIHSS and DWI scores. Though the DWI score was not statistically different, the threshold would be set to 6 points or above. Comparing initial DWI score with volume, patients with low DWI scores tended to show large variation in DWI volume and patients with small DWI volume showed large variation in DWI scores. There was no relation between hemorrhagic change and symptoms in either group. The semiquantitative DWI score easily evaluated extent of acute ischemic lesion on DWI and might be used to predict patient outcome after thrombolytic therapy more accurately than ASPECTS or DWI volume.


Metabolite changes and gender differences in schizophrenia using 3-Tesla proton magnetic resonance spectroscopy (1H-MRS).

A change in the glutamatergic system is thought to play an important role in the pathophysiology of schizophrenia. The aim of this study was to investigate the changes in metabolites, including glutamate (Glu), in the anterior cingulate cortex (ACC) and the left basal ganglia (ltBG) of patients with chronic schizophrenia using proton magnetic resonance spectroscopy ((1)H-MRS). In addition, since gender differences in this illness were known, we examined the effects of gender on these metabolites. The (1)H-MRS was performed on the ACC and ltBG of 30 patients with schizophrenia and 25 healthy individuals who acted as the control group. The levels of Glu, glutamine (Gln), creatine plus phosphocreatine (Cre), myo-inositol (mI), N-acetylaspartate (NAA), and choline-containing compounds (Cho) were measured. Two-way analysis of variance revealed that the illness significantly affected the levels of Glu and mI in the ACC; both metabolites were lower in the patients with schizophrenia as compared to the control subjects. The results also revealed that gender significantly affected the level of Gln in the ACC and the levels of Cre and NAA in the ltBG; the level of Gln in the ACC were higher in male subjects versus female subjects, whereas Cre and NAA levels in the ltBG were lower in male subjects as compared to female subjects. These results confirmed a change in the glutamatergic system and suggested an involvement of mI in the pathophysiology of schizophrenia.


[Comparison of 3 Tesla whole heart coronary MRA (WHCA) with 1.5 Tesla]

1.5Tと比較した3TにおけるWhole Heart Coronary MRA(WHCA)の検討

Whole heart coronary MRA (WHCA) is a noninvasive method used to image all coronary arteries with cardiac and real-time respiratory gating. We compared the coronary depiction ability of 3T WHCA with that of 1.5T using healthy volunteers. In addition, we compared the study performance rate, which might differ at 3T and 1.5T due to the difference in specific absorption rate (SAR) limits. The coronary artery was classified into nine segments, based on the classification of the American Heart Association (AHA). Each observer was asked to evaluate WHCA with the three-point scale rating for each segment, and to measure the visible length of each coronary artery utilizing reconstructed CPR and VR images. Depiction at 3T was superior to that at 1.5T. The completion rate of study was 100% at 1.5T, but just 63% at 3T owing to SAR limits. Thus it was suggested that 3T WHCA might be feasible with the advantage of high depiction ability, if adequate SAR reduction techniques were developed.

Japanese Journal of Radiological Technology


Ischemic Findings of T2*-Weighted 3-Tesla MRI in Acute Stroke Patients.

We compared ischemic findings on gradient echo-type T(2)*-weighted images at 3-tesla MRI (T(2)*WI) in patients with acute ischemia and major vessel occlusion, and stroke patients with lacunar infarction or branch atheromatous disease. Our study population consisted of 45 patients with acute stroke. They underwent 3-tesla MRI within 12 h of stroke onset. Included were 24 patients (13 men and 11 women, mean age 68 years) with major vessel occlusion and 21 patients (11 men and 10 women, mean age 69 years) with minor infarction such as lacunar infarcts or branch atheromatous disease. We classified vascular ischemic findings of T(2)*WI into 3 sign categories, i.e. artery susceptibility sign, cortical vessel sign (hypointensity and enlargement of the cortical vessels) and brush sign (hypointensity of vessels in the deep white matter). Decreased intensity in the ischemic parenchyma was designated ischemic tissue sign. We compared regions of interest in the hypoperfused area on flow-sensitive alternating inversion recovery (FAIR) images with our vascular ischemic findings. None of the vascular ischemic signs nor the ischemic tissue sign were found in patients with minor vessel disease. All 24 patients with major vessel occlusion manifested the cortical vessel sign, 23 the brush sign. The area with ischemic vessel signs on T(2)*WI was almost as large or somewhat smaller than the hypoperfused area on FAIR images. Compared to the contralateral side, 14 of 24 patients (58.3%) with major vessel occlusion showed decreased intensity in the ischemic parenchyma (ischemic tissue sign). Region of interest measurements on FAIR images demonstrated greater hypoperfusion in the area classified as ischemic tissue sign on T(2)*WI. Ischemic vessel signs and the ischemic tissue sign on T(2)*WI at 3 T would be useful to evaluate the extensive ischemia due to major vessel occlusion and may be correlated with the blood-oxygen-level-dependent effect due to increased deoxyhemoglobin. The ischemic tissue sign may be reflective of severe ischemia.


Can Kampo Therapy prolong the life of cancer patients?

Our policy regarding the performance of radiotherapy to squamous cell carcinoma of the uterine cervix has not changed since 1969. We have already reported the treatment results which were as good as those from other institutions. Since 1978, Kampo therapy was first introduced in the treatment of cancer patients in dealing with problems such as the side effects of radiotherapy and chemotherapy and various types of general malaise. We analyzed our treatment results in order to re-evaluate the chemo-radiotherapy in combination with Kampo. Survival rates for 5, 10 and 15 years, respectively, were 90.9%, 71.6% and 71.6% for Stage IB, 78.9%, 61.8% and 41.8% for Stage II, 62.3%, 49.1% and 41.2% for Stage III and 53.1%, 36.5% and 16.7% for Stage IV. The Kampo significantly extended the survival of patients with uterine cervical cancer. We intend to perform further research with more patients to explore how this therapy contributes to the prolonging of patients survival.


Comparison of 3.0-and 1.5-tesla diffusion-weighted imaging in the visibility of breast cancer.

PURPOSE: The aim of this study was to compare diffusion-weighted imaging (DWI) at 3.0 T and 1.5 T by evaluating the apparent diffusion coefficient (ADC) value and visibility of breast cancer in the same patients. MATERIALS AND METHODS: A total of 13 patients (16 lesions) with breast cancer underwent DWI at 3.0 T and 1.5 T. Tumors were classified into two groups based on the lesion size. The ADC values were measured, and visibility of the tumors was scored blindly. RESULTS: No significant difference was found for ADC values between 3.0 T and 1.5 T in either group (P > 0.05). All of the large lesions were visible clearly at both magnetic field strengths, and image scores were not different (P > 0.05). In contrast, small lesions were more clearly visible and had better image scores at 3.0 T than at 1.5 T (P < 0.001). CONCLUSION: Small cancers were more clearly visible on DWI at 3.0 T than 1.5 T.


Diagnosis and Treatment in Stroke Center of Tokushima University Hospital : Efficacy of 3 Tesla Stroke MRI(<Topic> Stroke Care Unit, Stroke Center)

徳島大学病院stroke centerでの脳卒中医療の現状 -特にstroke MRIの有用性-

After the stroke care unit of Tokushima University hospital was established in November 1999, stroke MRI (diffusion-, perfusion-weighted image, MRA) was performed to initially evaluate stroke patients, except for SAH. Since April 2004, 3 tesla MRI has been used for stroke MRI, and T2^* weighted image was added to routine study of stroke MRI. 3 tesla stroke MRI can reduce examination time and also take functional MR images, which yield important information for diagnosis and treatment decisions. The combination of our stroke center and rehabilitation hospital is a key factor in improving patients' outcomes for acute rehabilitation and improving quality of life.


Diagnosis of acute stroke patients: using MRI as the first selected modality

MRIを第一選択とした急性期脳血管障害の画像診断法


3T-MRIによるStroke MRIの現状と問題点 脳梗塞急性期治療の最前線ー血栓溶解療法の新たな展開ー


The usefulness and problem for MR I examination by using clinical 3T-MRI


Change of Diffusion Anisotropy in Patients with Acute Cerebral Infarction Using Statistical Parametric Analysis

We conducted statistical parametric comparison of fractional anisotropy (FA) images and quantified FA values to determine whether significant change occurs in the ischemic region. The subjects were 20 patients seen within 24 h after onset of ischemia. For statistical comparison of FA images, a sample FA image was coordinated by the Talairach template, and each FA map was normalized. Statistical comparison was conducted using SPM99. Regions of interest were set in the same region on apparent diffusion coefficient (ADC) and FA maps, the region being consistent with the hyperintense region on diffusion-weighted images (DWIs). The contralateral region was also measured to obtain asymmetry ratios of ADC and FA. Regions with areas of statistical significance on FA images were found only in the white matter of three patients, although the regions were smaller than hyperintense regions on DWIs. The mean ADC and FA ratios were 0.64 +/- 0.16 and 0.93 +/- 0.09, respectively, and the degree of FA change was less than that of the ADC change. Significant change in diffusion anisotropy was limited to the severely infarcted core of the white matter. We believe statistical comparison of FA maps to be useful for detecting different regions of diffusion anisotropy.


Effect of repetitive transcranial magnetic stimulation applied over the premotor cortex on somatosensory-evoked potentials and regional cerebral blood flow.

Somatosensory-evoked potentials (SEPs) are attenuated by movement. This phenomenon of 'gating' reflects sensorimotor integration for motor control. The frontal N30 component after median nerve stimulation was shown to be reduced in amplitude prior to hand movement. To investigate the mechanism of this sensory gating, we recorded median SEPs immediately before and after application of monophasic very low-frequency (0.2 Hz) repetitive transcranial magnetic stimulation (rTMS) of 250 stimuli over motor cortex (MC), premotor cortex (PMC), or supplementary motor area (SMA) in 9 healthy volunteers. The stimulus intensity for MC or PMC was set 85% of the resting motor threshold for the hand muscle, and that for SMA was at the active motor threshold for the leg muscle. SEPs showed significant increases in amplitudes of the frontal N30 component after PMC stimulation, but not after SMA or MC stimulation. Low-frequency (1 Hz) biphasic stimulation over PMC showed no significant N30 changes in 6 out of 9 subjects tested, indicating the effect being specific for 0.2 Hz monophasic stimulation. To examine the functional anatomy of the N30 change, single photon emission computed tomography was performed immediately before and after monophasic 0.2 Hz rTMS over PMC in all the 9 subjects. Regional cerebral blood flow showed significant increases mainly in PMC and prefrontal cortex, indicating the involvement of these cortical areas in sensory input gating for motor control.


Cerebral hyperperfusion in a patient with eclampsia with perfusion-weighted magnetic resonance imaging

The patient was a 25-year-old Japanese woman with postpartum eclampsia, in whom magnetic resonance imaging (MRI) was performed ten hours after convulsion. The patient improved within three days. Diffusion-weighted images showed a high apparent diffusion coefficient (ADC), and perfusion-weighted images obtained by the multi-slice flow-sensitive alternating inversion recovery (FAIR) method showed hyperperfusion, which was suggestive of vasogenic edema, on the parietal and occipital subcortical white matter, corresponding with transient hyperintensities on T2-weighted images. MR angiography (MRA) revealed no signs of vasospasm. These findings suggested hyperperfusion-induced vasogenic edema without cerebrovascular spastic change in the early stage of eclampsia. The FAIR method is considered a useful technique for perfusion-weighted MRI, especially useful to evaluate the cerebral perfusion of emergency patients such as those with eclampsia.


Regional changes of fractional anisotropy with normal aging using statistical parametric mapping (SPM).

There has been reports on the usefulness of diffusion tensor imaging (DTI) about age-or disease-related degradation. DTI is generally evaluated by the region of interest (ROI) methodology. In this study, we applied a statistical way using Statistical Parametric Mapping (SPM) to assess normal aging by DTI and compared results of these two methods. Ten young and ten senior normal volunteers were examined. On SPM, tensor images were changed into normalized tensor images. They were compared between the two groups by t-test. In the senior group, fractional anisotropy (FA) values were higher on the basal ganglia, cingulated gyrus and other cortical gray matter, lower in the corona radiata, internal capsule, centrum semiovale and corpus callosum by using SPM. In the ROI method, the results were almost compatible except in the brain periphery. Aging changes on water diffusion anisotropy was clearly shown by SPM method which would be useful to evaluate change of water diffusion anisotropy without operator bias even in clinical setting instead of ROI measurement.

The Journal of Medical Investigation : JMI


Diagnosis and treatment of patients with acute cerebral ischemia using stroke MRI

Stroke MRIによる急性期脳虚血の診断と治療

Between November 1999 and September 2002, 175 patients with acute cerebral infarction were admitted to our Stroke Care Unit. Stroke MRI (Diffusion-, perfusion- and T2-weighted imaging and MR angiography) was performed for these patients, and we used diffusion/perfusion mismatch for indication of cardiovascular reconstruction. Of 175 patients, 44 were diagnosed as atherothrombotic infarction, 70 as cardioembolic infarction and 57 as lacunar infarction. In 19 patients (27.1%) of cardioembolic infarction and 17 (38.6%) of atherothrombotic infarction, cerebrovascular reconstructions were performed. Although outcome after treatment was good in only 3 of these 19 patients (15.8%) with cardioembolism, out,come was good in 13 of 17 (76.5%) with atherothrombotic infarction. Outcomes of patients with cardioembolic internal carotid occlusion were very poor even if stroke MRI indicated acute thrombolysis, because almost all thrombolysis were failed. In conclusion, stroke MRI accurately diagnosed acute cerebrai infarction, and acute and subacute cerebrovascular reconstruction induced good outcome in patients with atherothrombotic infarction.

米国では脳卒中は心臓発作と同様にbrain attackとして認識され, 発症からできるだけ早く脳卒中専門の施設に搬送することを国民に啓蒙し, かつ国をあげてのキャンペーンを展開している. 本邦では必ずしも脳卒中の診断から治療までがスムーズに施行されているとはいえず, 急性期治療の遅れが指摘されてきた. われわれは脳卒中急性期の診断と治療を迅速かつ正確に行うために1999年11月よりstroke care unit(SCU)を開設した. 今回SCUに入院した急性期脳卒中患者に対して, 24時間体制でstroke MRIを施行し, 脳卒中, 特に脳梗塞の診断と治療成績について分析したので報告する. 対象と方法 1999年11月より2002年9月までに当院のSCUに入院した急性期脳卒中患者295例のうち, 脳虚血と診断した175例(59.3%)を対象とした. 175例の脳梗塞の病態別症例数はアテローム血栓性脳梗塞44例(25.1%), 心原性脳梗塞70例(40%), ラクナ梗塞57例(32.6%), その他4例(2.3%)であった.


Difference of signal change by a language task on autistic patients using functional MRI

OBJECTIVE: Cerebral function with a language task was evaluated by functional magnetic resonance imaging (MRI), and the differences of activated pattern and signal changes were compared between autistic patients and normal controls. METHODS: Ten autistic and ten normal subjects were tested by fMRI with a language task requiring the attribution of complex mental states. Activation maps analyzed between two groups were generated and the asymmetry indexes calculated by the quotient of activated pixels of the right frontal lobe divided by those of the left frontal lobe were statistically compared by unpaired t-test. RESULTS: Both the autistic and the normal subjects showed activation at the bilateral prefrontal cortical areas and the ventral occipito-temporal regions. However, the autistic patients demonstrated more activation at the right frontal lobe than the normal controls. Thus it was considered that in the autistic patients the right-hemisphere was more dominant for the language task than that of the normal controls. The result is consist to the theory that autism is related to early left-hemisphere dysfunction. CONCLUSIONS: We considered that fMRI may be a useful non-invasive method to evaluate the cerebral functional abnormality in autistic patients.


Detection of coronary arterial microvascular discorders using 99mTc-tetrofosm in uptake increase during exercise and coronary blood flow velocity patterns obtained by magnetic resonance imaging.

This study reports an evaluation of coronary arterial blood flow patterns in patients with diabetes mellitus and healthy subjects using magnetic resonance coronary angiography (MRCA). Twenty patients with diabetes mellitus (DM group) and 20 healthy subjects (N group) were studied using MRCA and myocardial SPECT images using (99m)Tc-tetrofosmin (TF). The rate of change in myocardial TF uptake was measured during a 1-day protocol of exercise and rest. Initial and delayed exercise single photon emission computed tomography (SPECT) images were acquired 30 min and 3 h after injection (370 MBq of TF) (TF1 and TF2, respectively). Thereafter, 740 MBq of TF was administered intravenously, again, and resting SPECT images (TF3) were acquired 30 min later. The myocardial counts of these three points of acquisition were defined, and the rate of change of myocardial TF uptake between exercise and rest was determined. The % increase in uptake was significantly lower in the DM group than in the N group in all myocardial segments. The average coronary arterial diastolic velocity determined using MRCA was slightly lower in the DM group than in the N group, and the average systolic peak velocity (ASPV) was slightly greater in the DM group than in the N group, although these values were not statistically significant. The diastolic/systolic velocity ratio (DSVR) in the DM group was significantly lower than that in the N group ( P < 0.05). There was a significant correlation between DSVR and % uptake increase ( r = 0.605, P < 0.05). These results indicate that the measurements made using MRCA and the % uptake increase measured using TF myocardial scintigraphy represent a potentially useful noninvasive method for diagnosing microvascular dysfunction in diabetic patients.


Stroke MRIにおける急性期脳虚血の診断と治療

Stroke MRIにおける急性期脳虚血の診断と治療


Comparison of FAIR technique with different inversion times and post contrast dynamic perfusion MRI in chronic occlusive cerebrovascular disease

The purpose of this study was to examine the signal change occurring with different inversion times (TIs) of the flow-sensitive alternating inversion recovery (FAIR) technique and to compare with the perfusion image obtained with Gd-DTPA injection. The subjects were 11 patients with unilateral occlusive cerebrovascular disease. Two FAIR images with different TIs (800 ms and 1600 ms) were measured for each patient and dynamic perfusion MRI was performed to produce four kinds of parameter maps: mean transit time (MTT), time to peak (TTP), relative cerebral blood flow (rCBF) and relative cerebral blood volume (rCBV) maps. Asymmetry ratios (ARs) between the affected and contra-lateral vascular sides were measured in both FAIR images and the four dynamic parameter maps. The AR of the MTT map of the four parameters showed the highest correlation with that of the FAIR images, especially with that of TI = 1600 ms (r = 0.829), and the AR of the rCBV map revealed the worst correlation with the FAIR images. The AR of the FAIR image with TI = 800 ms was less correlated with that of MTT than that with TI = 1600 ms. These results suggested that the signal intensity of the FAIR image was influenced by flow transition time and the change in TI could be used to select the flow with a different transition time. Our study suggested that a longer TI in the FAIR technique might be more useful than a shorter TI for evaluating chronic occlusive cerebrovascular disease in the clinical setting.


Magnetic resonance imaging and proton MR spectroscopy of the brain in a patient with carbohydrate-deficient glycoprotein syndrome type I.

This is a report on a case of carbohydrate-deficient glycoprotein syndrome (CDGS) with neurological deficits. Magnetic resonance (MR) images showed remarkable atrophy of the cerebellum and brainstem, and hypointensity was seen in the pallidum on diffusion-weighted images (DWI), suggesting deposits of metal substances. In the cerebellum, proton MR spectroscopy (MRS) showed decreased concentrations of N-acetylaspartate and a complex of glutamine and glutamate (Glx) while the concentration of myo-inositol was increased, indicating neuronal impairment and gliosis. In the parietal lobe, there was an increased concentration of Glx, possibly reflecting dysfunction caused by liver injury.

Journal of Magnetic Resonance Imaging : JMRI


Diagnosis of acute brain-stem infarcts using diffusion-weighed MRI

There are many reports on acute cerebral infarcts diagnosed by diffusion-weighted MRI (DWI), but few describe brain-stem infarcts diagnosed by this method. Using the apparent diffusion coefficient (ADC), we studied 18 consecutive patients with brain-stem infarcts who underwent DWI during the acute phase. We calculated and compared the ADC ratio (lesion ADC/contralateral ADC) in 10 patients with brain-stem and 23 with supratentorial cortical infarcts examined within 24 h of the onset of stroke. Ischaemic brain-stem lesions were detected in all 15 patients who underwent DWI more than 3 h after the onset, but not in two who had DWI within 3 h of the onset; their ADC ratio was more than 0.95. ADC ratios in patients with brain-stem infarcts decreased as the interval between onset and DWI increased; the decrease was slower than in patients with supratentorial cortical infarcts.


Myocardial perfusion magnetic resonance imaging for diagnosing coronary arterial stenosis:evaluation by signal-intensity time curves

It has been reported that myocardial perfusion MRI is a useful method for evaluating the severity of myocardial ischemia. We evaluated whether the severity of coronary arterial stenosis could be assessed by the signal-intensity time curve (SITC) obtained by myocardial perfusion MRI.br The subjects consisted of 10 patients who showed no abnormalities on coronary angiographies (CAG) (A group), 12 with single-vessel disease of 75-90% stenosis on CAG (B group), and 15 with single-vessel disease of 90% or more stenosis (C group). After infusion of dipyridamole for 4 minutes, gadolinium-diethylenetriamine pentaacetic acid was administered intravenously, followed by serial acquisition of T1-weighted left ventricular short-axis MR images. These images were evaluated after dividing them into the following 3 myocardial segments: anterior wall, lateral wall, and inferior wall. Mean values of the slope of SITC (1.4 ± 0.2 vs 1.1 ± 0.2, iP /i 0.01), and increases to the peak corrected SI (ΔSI) (47.5 ± 1.9 % vs 33.7 ± 2.4%, iP/i 0.01) in normal myocardial segments were significantly greater than in ischemic segments in the C group, while there was no significant distinction between normal and ischemic segments in the B group. The mean values of time to the peak SI were not significantly different between normal and ischemic regions in the B and C groups.br The results suggest that myocardial segments exhibiting 30% decreases in both the slope and ΔSI of SITC can be diagnosed as having 90% or more severe coronary stenosis. The present study shows that visual and SITC evaluations of myocardial perfusion MR images may be useful for clinically evaluating the severity of coronary stenosis.br


Magnetic resonance imaging and spectroscopy in a patient with treated methylmalonic acidemia.

Magnetic resonance imaging (MRI) and proton magnetic resonance spectroscopy (proton MRS) findings before and after carnitine therapy in a patient with methylmalonic acidemia (MMA) are evaluated. The hyperintensity on T2-weighted image and diffusion-weighted image and the decreased apparent diffusion coefficient of bilateral basal ganglia were normalized in parallel with normalization of the elevated lactate levels and the decreased N-acetyl-aspartate levels, corresponding to improvement of clinical symptoms. MRI and proton MRS may serve as a suitable, noninvasive modality for monitoring treated MMA.


Reproducibility of Metabolite Concentration Evaluated by Intraclass Correlation Coefficient Using Clinical MR Apparatus.

The purpose of this study was to evaluate the reproducibility of in vivo quantitative proton MR spectroscopy (MRS) by repeated-measure analysis of variance and intraclass correlation coefficient (ICC) including assessment of both inter- and intrasubject variation. The concentration of metabolites was quantified using long-TR and short-TE stimulated-echo acquisition mode sequences with a quadrature head coil. All preparation procedures for MRS measurement except volume of interest determination were done by an automatic preparation scanning system equivalent to a clinical setting. Analyses were conducted by an LCModel running based on our original basis set by two different reference methods. The ICC showed a good correlation (r = 0.61-0.99) in any metabolite and almost the same value between the two different reference methods, but the concentration of myoinositol had a large intersubject variation. Our results suggest that the reproducibility of quantified metabolite concentration is acceptable in the clinical setting regardless of the reference method, although quantified values may have different intersubject variations.


A characteristic feature of acute haematomas in the brain on echo-planar diffusion-weighted imaging

Diffusion-weighted MRI (DWI) is used in the diagnosis of acute ischaemic disease of the brain, but it is not clear whether or not it can be used to differentiate an acute haematoma from an infarct. Our purpose was to identify any characteristic feature of acute haematomas which can be recognised on DWI and to evaluate the usefulness of DWI in acute cerebral stroke. We examined nine patients with acute haemorrhage using CT and MRI including DWI. We measured the volume and apparent diffusion coefficient (ADC) of the haematomas. All showed heterogeneous signal on DWI, and the centre of the large (>20 ml) haematomas especially a mixed pattern with high and low signal. The characteristic feature of acute haematomas was a peripheral low-signal region, found in all subjects regardless of the size of the haematoma; acute infarcts did not show this. This low-signal rim on DWI may be useful for differentiating an acute haematoma from an infarct.


Twisted atrioventricular valves in double inlet left ventricle

Twisted atrioventricular connections usually occur in hearts with biventricular artioventricular connections. Here, we describe a case of twisted atrioventricular valves associated with double inlet left ventricle and discordant ventriculo-arterial connections. Color Doppler echocardiography, and cine magnetic resonance imaging, clearly demonstrated that the right atrioventricular valve was located anterior and superior to the left atrioventricular valve, and that the axes of the two atrioventricular valves crossed each other within the dominant left ventricle.


Diffusion-weighted in vivo localized proton MR spectroscopy of human cerebral ischemia and tumor

The apparent diffusion coefficients (ADCs) of water and brain metabolites were determined by proton MR spectroscopy on a clinical MR scanner for healthy volunteers and for pathological changes in cases of acute cerebral infarction and brain tumor. The ADCs of N-acetyl aspartate (NAA) and creatines in tissue involved in acute infarction were decreased compared to normal control values, while in tumors they showed increased values. Since NAA is a neuronal marker, these findings suggest that neuronal cell viscosity changes according to the pathological status of the tissue. The lactate ADC was significantly larger than the values for other major metabolites in cases of ischemia and tumor, suggesting that lactate is present in a different compartment. These results indicate that metabolite diffusion data can be used to reveal changes in the intracellular environment depending on the pathological status.


Can Diffusion- and Perfusion-weighted Magnetic Resonance Imaging Evaluate the Efficacy of Acute Thrombolysis in Patients with Internal Carotid Artery or Middle Cerebral Artery Occlusion?

The value of combined diffusion-weighted imaging (DWI) and perfusion-weighted imaging (PWI) for detecting ischemic lesions of patients with acute ischemic injury was analyzed. Combined pre- and posttreatment DWI and PWI studies were used to assess the efficacy of intra-arterial thrombolysis. Intra-arterial thrombolysis was performed within 6 hours of onset in 10 patients who presented with acute middle cerebral artery or internal carotid artery occlusion. DWI and PWI obtained before and after treatment were studied. The final T2-weighted magnetic resonance scans were obtained 1 month after onset. Thrombolysis resulted in recanalization in seven patients. The mismatch ratio percentage ([initial PWI-initial DWI/initial PWI] x 100) and the rescued ratio percentage ([initial PWI-final T2/initial PWI] x 100) were calculated. The National Institutes of Health Stroke Scale (NIHSS) was used for neurological assessment of stroke severity at admission and at 1 month after onset. In all patients, the mismatch ratio was greater than 60% (mean +/- standard deviation, 81.7 +/- 16.7%) and was significantly correlated with initial NIHSS score (-0.74; P = 0.03), and the rescued ratio was significantly correlated with the NIHSS score 1 month after the insult (r = -0.83; P = 0.01). In patients who exhibited recanalization of the occluded artery (n = 7), the mean rescued ratio was 89.6 +/- 12.8% (range, 63-100%). In addition, the lesion volume on posttreatment DWI scans and final T2-weighted magnetic resonance images was not enlarged; on posttreatment PWI scans, it was significantly decreased. The NHISS score at 1 month after the insult (2.3 +/- 2.1) was markedly improved as compared with the initial NHISS score (10.7 +/- 3.9). In a small number of patients who presented with internal carotid artery or middle cerebral artery occlusion, the DWI/PWI mismatch ratio correlated with the initial neurological severity. The rescued ratio may be an objective indicator of the efficacy of treatment.


強迫性障害におけるproton MRSによる評価 --- 特にグルタミン酸とグルタミン代謝に対して

Japanese Journal of Magnetic Resonance in Medicine


Quantitative evaluation of cerebral metabolites and cerebral blood flow in patients with carotid stenosis

We examined the metabolic and hemodynamic status of patients with severe carotid stenosis and evaluated the effectiveness of carotid endarterectomy (CEA) by comparing pre- and post-operative results of quantitative proton magnetic resonance spectroscopy (1H-MRS) and single-photon emission computed tomography (SPECT). Quantitative 1H-MRS and SPECT were performed in 17 patients with severe carotid stenosis before CEA; in 10 patients the examinations were repeated after CEA. There was a significant correlation between the degree of internal carotid artery (ICA) stenosis and the N-acetyl-aspartate (NAA) concentration, and between CBFand NAA in the basal ganglia. In 10 of the 17 patients (58.8%) we noted a decrease of NAA on 1H-MRS. After CEA in these patients, NAA was significantly increased, and in 7 of 8 patients whose pre-operative SPECT had indicated impairment of cerebral vasoreactivity, it was improved. Quantitative 1H-MRS and CBF measurements can indicate the severity of metabolic and hemodynamic impairment in patients with severe carotid stenosis, and can help to assess the effectiveness of CEA.


Multivariate analysis of regional metabolic differences in normal ageing on localised quantitative proton MR spectroscopy


Evaluation of female intrapelvic tumors by clinical proton MR spectroscopy.

We measured metabolites in large tumors of the female pelvis (23 cases total: 6 malignant cases, 17 benign cases) using single-voxel proton magnetic resonance (MR) spectroscopy and evaluated the clinical significance of this method in the differential diagnosis of female pelvic tumors. The characteristically obtained signal was lactate, which was detected not only in all the malignant tumors but also in some of the benign tumors. However, the lactate signals of the malignant tumors tended to form higher peaks than those of benign tumors, which was a finding consistent with the result of the earlier in vitro study reported in ovarian tumors. The signal of choline-containing compounds (Cho) was found only in solid tumors, and the signal intensity varied among different histological types of tumors, possibly reflecting metabolic activity of the cell membrane. We considered that proton MR spectroscopy (MRS) of intrapelvic tumors would be useful for the diagnosis of the nature of female intrapelvic tumors. J. Magn. Reson. Imaging 2001;13:912-917.

Journal of Magnetic Resonance Imaging : JMRI


Relationship among gastric motility,autonomic activity,and portal hemodynamics in patients with liver cirrhosis

We examined the effects of the autonomic nervous function and the volume of portal blood flow to clarify the mechanism of the abnormal gastric motility in patients with liver cirrhosis. Heart rate variability, electrogastrogram (EGG), and volume of portal blood flow were measured before and after a meal in 27 patients with liver cirrhosis (LC group) and in 20 normal subjects (N group). Autonomic nervous function was evaluated by using spectral analysis of heart rate variability. We used the cine phase-contrast (PC) method, using magnetic resonance imaging (MRI) to measure the portal flow, while the peak frequency and spectral power of the EGG were measured at pre- and postprandial change. The ratio of low frequency power to high frequency power (LF/HF) was significantly higher, and the HF power was significantly lower in the LC group than in the N group both before and after a meal. In both groups, the electrogastrographic peak power ratio before and after a meal showed a positive correlation with the HF ratio, and an inverse correlation with the LF/HF ratio. In addition, portal blood flow volume was significantly decreased in the LC group than in the N group. However, the increased rate of portal blood flow after a meal correlated positively with the increased rate of electrogastrographic peak power. Moreover, gastric motility was positively correlated with esophageal varices and coma scale with the use of multivariate analysis. Parasympathetic hypofunction, sympathetic hyperfunction and portal hemodynamics were closely related with gastric motility in cirrhotic patients. In addition, gastric motility was decreased, at least in part, by the ingestion of food in cirrhotic patients because of abnormalities in autonomic functions and portal blood flow following a meal.

Journal of Gastroenterology and Hepatology


拡散強調画像で過小評価された急性期脳梗塞の2例

拡散強調画像で過小評価された急性期脳梗塞の2例


摂食による冠動脈血流速度の変化，胃電図および冠動脈シネMRAを用いた検討

摂食による冠動脈血流速度の変化，胃電図および冠動脈シネMRAを用いた検討


99mTc-MIBIによる運動負荷時冠血流増加率と冠動脈血流速波形との関連 --- -冠動脈MR coronary angiographyを用いた検討-


脳卒中急性期における画像診断プロトコール

脳卒中急性期における画像診断プロトコール


Magnetic Resonance Coronary Angiography in Patients with Ischemic Heart Disease Analysis of Coronary Arterial Blood Flow Velocity Pattern

Only a few reports evaluating coronary arterial blood flow velocity patterns using magnetic resonance (MR) coronary angiography have appeared to date. This study reports an evaluation of coronary arterial blood flow velocity patterns in patients with ischemic heart disease and in healthy subjects using MR coronary angiography. The subjects consisted of 20 patients with ischemic heart disease (IHD group) and 20 normal healthy subjects (N group). Using the fCARD PC method, ECG-gated MR coronary angiography was performed using an anteroposterior opposing phased array coil. Regions of interest were placed on bilateral coronary arteries to measure coronary arterial blood flow velocity patterns. The IHD group was divided into two subgroups, based on the presence (MI group) or absence (AP group) of infarcted myocardium using 99m Tc-methoxyisobutylisonitrile (MIBI) myocardial scintigraphy. Average diastolic peak velocity (ADPV) was lower in the IHD group than in the N group. In addition, the diastolic / systolic velocity ratio (DSVR) was significantly lower in the MI group. Moreover, in the AP group, both the ADPV and DSVR values were significantly increased in those who had undergone percutaneous transluminal coronary angioplasty postoperatively. Different from the Doppler guidewire method, MR coronary angiography facilitates noninvasive evaluation of coronary arterial blood flow velocity. Therefore, these results indicate that MR coronary angiography represents a potentially useful technique for diagnosing lesions of coronary arteries and evaluating their functions. This noninvasive method can be expected to replace the invasive Doppler guidewire method in the near future with development of MR coronary angiography technology.


Neuronal impairment of adult moyamoya disease detected by quantified proton MRS and comarison with cerebral perfusion by SPECT with Tc-99m HM-PAO: A trial of clinical quantification of metabolites

We evaluated neuronal impairment of adult moyamoya patients by proton magnetic resonance spectroscopy (MRS) and cerebral perfusion scintigraphy. After evaluating two methods for compensating relaxation times, we selected a long TR, short TE sequence to achieve better reproducibility. The cerebral blood flow (CBF) value was measured by scintigraphy following the method of quantification reported in the previous literature. N-acetyl aspartate (NAA) concentrations and CBFs value were decreased statistically (P < 0. 05) compared with those of the age-matched normal controls. However, the decreased rate of NAA concentration was changed more than the CBF value, and no linear correlation was found between the two values. We considered that the NAA concentration was not always correlated with that of the present cerebral perfusion. The NAA concentration showed a more dispersive distribution in patients than in controls, indicating a large individual variation in neuronal impairment. We concluded that proton MRS may provide useful information about neuronal impairment in individual patients. J. Magn. Reson Imaging 1999;10:124-129.


Brain metabolites in the hippocampus-amygdala region and cerebellum in autism: an 1H-MR spectroscopy study.

Histological abnormalities of the brain in autism have been investigated extensively. We studied metabolites in the hippocampus-amygdala (HA) region and cerebellum. We examined the right HA region and left cerebellar hemisphere of 27 autistic patients 2-18 years old, 21 boys and 6 girls and 10 normal children 6-14 years old, 4 boys and 6 girls, using the STEAM sequence. This sequence was used to minimise the influence of relaxation times. The N-acetyl aspartate (NAA) concentration was significantly lower (P = 0.042) in autistic patients than in normal children (9.37 and 10.95 mM, respectively). There was no significant difference in other metabolites. The correlation coefficient (r value) of NAA between the HA region and cerebellum was 0.616. The decreased NAA concentration may be due to neuronal hypofunction or immature neurons. The NAA concentration in the HA region and cerebellum may be related, because of neuronal circuits or networks.


Effects of hepatic impairment on the metabolism of fructose and 5-fluorouracil, as studied in fatty liver models using in vivo 31P-MRS and 19F-MRS.

The purpose of this study was to observe the effects of hepatic impairment on the metabolism of fructose and 5-fluorouracil (5-FU) in fatty liver models using in vivo 31P-MRS and 19F-MRS and to compare the results. In addition, we compared the results to those of other conventional tests such as laboratory examinations, imaging and pathology. Male SIc:Wistar rats were examined on BEM170/200 (4.7 T, Otsuka Electronics, USA) with 17-mm diameter surface coil. Fatty liver was induced by a choline deficient diet (CD diet) for 2 weeks. 31P-MRS were obtained for 90 min after intravenous (i.v.) injection of 1 g/kg of fructose and 19F-MRS were measured for 100 min after i.v. injection of 100 mg/kg of 5-FU. 1H-MRS and 1H-MRI were also performed. On 31P-MRS, there was no statistical difference in the time course of phosphomonoester (PME), adenosine triphosphate (ATP), and inorganic phosphate (Pi) between CD diet group and control group. On 19F-MRS, we detected high peak of fluoronucleotide (Fnct) and suppressed peak of alpha-fluoro-beta-alanine (FBAL) in CD diet group. We showed the metabolism of fructose and 5-FU by 31P-MRS and 19F-MRS, respectively. There was no difference in fructose metabolism but we observed increased fluoronucleotide and decreased a-fluoro-b-alanine in 5-FU metabolism of fatty liver. We speculate that the effects of hepatic impairment in fatty liver may be more severe on 5-FU metabolism and the increased fluoronucleotide may reflect cell proliferation.


Radioimmunodetection of human myeloma xenografts with a monoclonal antibody directed against a plasma cell specific antigen, HM1.24


頚動脈狭窄症に対するSPECTおよび1H-MRSによる脳血流，脳代謝の評価

頚動脈狭窄症に対するSPECTおよび1H-MRSによる脳血流，脳代謝の評価


MRIによる冠動脈血流速度

MRIによる冠動脈血流速度


Coronary-Pulmonary Artery Fistulae Depicted by Multiplanar Reconstruction Using Magnetic Resonance Imaging


Proton MR SPectroscopyの定量化における基礎的検討と慢性脳虚血性疾患に対する応用


Proton MRSにおける脳内代謝物の横緩和時間について-定量化に関わる要因として-


Proton magnetic resonance spectroscopy on childhood-onset dentatorubral-pallidoluysian atrophy(DRPLA)


Therpeutic Efficacy of A Case of Pyruvate Dehydrogenase Complex Deficiency Monitored by Localized Proton Magnetic Resonance Imaging


下肢疲労防止に対する弾性ストッキングの着用効果-ヒ腹筋の運動における32-PMRS-


Non-invasive Characterization of Brain Tumor by in-vivo Proton Magnetic Resonance Spectroscopy


先天性筋緊張性ジストロフィー症の脳プロトン磁気共鳴スぺクトロスコピー

先天性筋緊張性ジストロフィー症の脳プロトン磁気共鳴スぺクトロスコピー


Brain Asbcess Observed by Localized Proton Magnetic Resonance Spectroscopy


Clinical trial of UFT against carcinoma of the Uterine Cervix

子宮頸癌におけるUFTの臨床治験


Accuracy of the results measured by in vivo 1H-MRS using model solution

The Tokushima Journal of Experimental Medicine


A study of skeletal metastasis of Carcinoma of the Uterine Cervix

子宮頸癌の骨転移例の検討

The Official Jpurnal of The Japanese Society for Therapeutic Radiology and Oncology


Eight Cases of Intracranial Arteriovenous Malformations Conducted Conventional Radiation Therapy

放射線療法を行った頭蓋内動静脈奇形について


Multidisciplinary treatment of carcinoma of the alveolus and gingiva


Characterization of Movement Disorders Using Multimodal Neuroimaging


Endogenous/exogenous tracers in CEST for pH measurement at 3T MRI


Evaluation of Blood Flow and Plaque Vulnerability in Carotid Artery Stenosis Focusing on Morphological and Component Characteristics

Proceedings of the 2022 ISMRM & SMRT ANNUAL MEETING & EXHIBITION, No.3783, 2022


Brain Tumor Characterization and Assessment using Automatic Detection of Extracellular pH Change

Proceedings of the 2021 ISMRM & SMRT ANNUAL MEETING & EXHIBITION


Role of Central Hypo-enhancement in the Hepatic Arterial Phase of Dynamic Computed Tomography in Patients with Mass-Forming Intrahepatic Cholangiocarcinoma.

The enhancement pattern in the hepatic arterial phase (HAP) of dynamic computed tomography (CT) is reportedly a prognostic marker in patients with intrahepatic cholangiocarcinoma (IHCC). This study was performed to clarify the significance of central hypo-enhancement in the HAP in patients with mass-forming IHCC. Forty patients who had undergone initial surgical resection for mass-forming IHCC were enrolled. The dynamic CT was scanned 40 s after contrast agent injection as the HAP. A radiologist classified the patients into three groups based on the vascular pattern: the hyper-enhancement group (Hyper group), rim-enhancement group (Rim group), and hypo-enhancement group (Hypo group). The surgical specimens were immunohistochemically stained for hypoxia-inducible factor 1 (HIF-1). The correlation with clinicopathological findings and HIF-1 expression was investigated. The Hyper, Rim, and Hypo groups comprised 8, 7, and 25 patients, respectively. There were no significant correlations between the groups and clinicopathological factors. Overall survival (OS) was significantly worse in the Hypo than in the Hyper group (p = 0.03). OS was also significantly worse in the Rim +ypo group (i.e., hypo-enhancement in the central tumor) than in the Hyper group (p = 0.04). Furthermore, inclusion in the Rim +ypo group was a prognostic factor for OS (hazard ratio 6.68). High HIF-1 expression in the central part of the tumor was correlated with central hypo-enhancement (Hyper group: 25% and Rim +ypo group: 72%). Central hypo-enhancement was a prognostic factor in patients with IHCC. The high malignant potential of tumors with central hypo-enhancement might be associated with HIF-1 upregulation.


Calculation of Concentration of Contrast Media, Relaxivity, Extracellular pH and Oxygen Extraction Fraction for Brain Tumor Characterization

Proceedings of the 28th Annual Meeting of ISMRM


Calculation of molar relaxivity and concentration map of Gd-DTPA map using quantitative parameter map before and after injection for brain metastasis

Proceedings of the 27th Annual Meeting of ISMRM


Chemical exchange saturation transfer imaging depending on several neurodegenerative diseases at 3T


Which number of b-value is better for accurate calculation of virtual MR elastography?


Why are shear stiffness and estimated intravoxel incoherent motion map correlated in the liver?


Chemical exchange saturation transfer imaging for neurodegenerative diseases

Proceedings of the 26th Annual Meeting of ISMRM


T2*強調画像における脳実質・脳表の低信号

T2*強調画像における脳実質・脳表の低信号


脳室周囲および延髄背側の病変

脳室周囲および延髄背側の病変


Function of the frontal lobe in autistic individuals: a proton magnetic resonance spectroscopic study

In this investigation, we studied differences in chemical metabolites in certain brain regions between autistic patients and normal control subjects. Proton magnetic resonance spectroscopy ((1)H-MRS) was used to evaluate functional activity in these regions. Specific regions studied were right and left dorsolateral prefrontal cortex(DLPFC) and the anterior cingulated cortex(ACC). In the ACC, the N-acetylaspartate(NAA)/creatine/phosphocreatine(Cr) ratio in autistic patients (n=31) was significantly lower than that in control subjects (n=28). The decrease in the NAA/Cr ratio for the ACC was much greater in the group with worst social ability. NAA/Cr for the left DLPFC and social ability of autistic patients also correlated well. Furthermore, NAA/Cr for the left DLPFC in the group with intelligence quotient (IQ) below 50 was significantly less than in controls. NAA/Cr for the right DLPFC in autistic patients was not decreased compared to controls, and did not correlate with IQ or social ability. These findings suggest neuronal dysfunction in the ACC and left DLPFC in autism, and also a relationship between social disability and metabolic dysfunction in these regions. Dysfunction in the ACC and the left DLPFC may contribute to the pathogenesis of autism.

The Journal of Medical Investigation : JMI


機能性磁気共鳴画像(FMRI)法を用いた視覚神経系の賦活に関する基礎的検討

機能性磁気共鳴画像(FMRI)法を用いた視覚神経系の賦活に関する基礎的検討

Bulletin of School of Medical Sciences, the University of Tokushima

徳島大学医療技術短期大学部紀要


Clinical results of radiotherapy and B-M therapy for advanced cervical cancer

進行子宮頸癌に対する放射線+化学療法(B-M療法)併用における成績

徳島大学医療技術短期大学部紀要


水溶性高分子で構造化した水に溶解した代謝物質の緩和時間変化

水溶性高分子で構造化した水に溶解した代謝物質の緩和時間変化

徳島大学医療技術短期大学部紀要


1H-MRSによる脳内代謝物質の内部標準としての水の有用性

1H-MRSによる脳内代謝物質の内部標準としての水の有用性

徳島大学医療技術短期大学部紀要


モデル溶液中の脳内代謝物質と水の緩和時間の基礎的検討

モデル溶液中の脳内代謝物質と水の緩和時間の基礎的検討

徳島大学医療技術短期大学部紀要


脳運動野における機能性MRIの基礎的検討

脳運動野における機能性MRIの基礎的検討

徳島大学医療技術短期大学部紀要


1H-MRスペクトロスコピーによる脳内代謝物質の検討

1H-MRスペクトロスコピーによる脳内代謝物質の検討

徳島大学医療技術短期大学部紀要


Proton MRSにおける脳内代謝物の横緩和時間について-定量化に関わる要因として-