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Purpose : The purpose of this study was to determine the optimalcomputationaloptions in voxel-based morphometry (VBM) for discrimination between Alzheimer's disease (AD) patients and healthy control (HC) subjects. Materials and Methods : Structuralmagnetic resonance images of 24 AD patients and 26 HC subjects were analyzed using VBM to determine brain regions with significant gray matter (GM) loss due to AD. The VBM analyses were performed with 4 different computationaloptions : gray matter concentration (GMC) analysis with and without global normalization, and gray matter volume (GMV) analysis, with and without global normalization. Statistical maps calculated with the 4 computational options were obtained at 3 different P-value thresholds (P < 0. 001, P < 0. 0005, and P < 0. 0001, uncorrected for multiple comparisons), yielding a total of 12 sets of maps, from which regions-of-interest (ROI) were generated for subsequent analyses of performance in terms of discrimination between AD patients and HC subjects as based on the mean value of either the GMC or GMV within the ROI for each of the 12 maps. Discrimination performance was evaluated by means of comparing the area-under-the-curve derived from the receiver-operating characteristic analysis as well as on the accuracy of the discrimination. Results : Discrimination based on GMC analysis resulted in better performance than that based on GMV analysis. The best discrimination performance was achieved with GMC analysis either with or without proportionalgl obalnormal ization. Conclusion : The findings suggested that GMC-based VBM is better suited than GMV-based VBM for discrimination between AD patients and HC subjects.

We report a rare case of giant cell glioblastoma that was difficult to distinguish from cerebral metastasis. The MRI finding was a ring-enhancing well-circumscribed solitary brain tumor that was very similar to cerebral metastasis. Even when MRI results were considered together with the findings by magnet resonance spectroscopy and perfusion-weighted MRI, it was hard to distinguish between giant cell glioblastoma and cerebral metastasis before surgery. When we find a solitary ring-enhancing intracranial mass with little tendency of invasion, we need to consider the possibility of giant cell GBM as a differential diagnosis., 緒言：画像所見上，転移性脳腫瘍との鑑別が困難であった巨細胞膠芽腫の症例を報告する．症例：失行を主訴とする64 歳の女性が当院脳外科に紹介された．CT およびMRI で左頭頂葉にリング状増強を示す境界明瞭な腫瘤がみとめられ．MRI 灌流画像では，増強腫瘤周囲のT2延長域において局所血液量の増加をみとめず，MRスペクトロスコピーでは，同部にコリン/クレアチン比の増加をみとめなかった．これらの画像所見から，転移性腫瘍が疑われた．開頭腫瘍摘出術が行われ，病理組織学的に巨細胞膠芽腫と診断された．考察：巨細胞膠芽腫は膠芽腫の一亜型であるが，その画像診断所見についての報告は少ない．本症例では増強腫瘤の境界が明瞭だったことに加え，増強腫瘤周囲のT2 延長域において，局所血液量の増加やコリン/クレアチン比の増加などの腫瘍の浸潤を示唆する所見がみられなかったことから，転移性脳腫瘍との鑑別が困難であった．結語：画像上浸潤傾向に乏しいリング状増強腫瘤がみとめられた場合，巨細胞膠芽腫は鑑別診断として考慮すべきである．

Background : Intraarterial therapy (IAT) for acute cerebral infarction has been proven to be profitable. However,the criteria for the indications,the choice of the thrombolytic agents, and the use of adjunctive agents are controversial. We retrospectively analyzed the prognostic factors of IAT. Materials and methods: From 1994 to 2003, 28 patients underwent IAT due to middle cerebral artery occlusion (17 women and 11 men ; median age,69 years old). We evaluated the following prognostic parameters: institution of treatment, degree of paralysis at visit, size of high-intensity area on diffusion-weighted images, dose of intraarterial urokinase administration, elapsed time from symptom onset to completion of IAT, presence of penetration of embolus by microcatheter and microguidewire, recanalization after IAT, intracranial hemorrhage (ICH) within 24 hours after IAT, and intravenous heparin administration after IAT. The outcome was evaluated at discharge and was classified into the following categories according to the modified Rankin Scale: independence (0 to 2), dependence (3 to 5), and death (6). Results: Seven patients were judged to be independent, 16 patients were judged to be dependent, and five patients died. Patients with recanalization after IAT had a better outcome than those without (p＜0.05); patients with intracranial hemorrhage had a worse outcome than those without (p＜0.05); and patients with intravenous heparin administration after IAT had a better outcome in activities of daily living than those without (p＜ 0.05). Conclusion :In addition to ICH and recanalization,our results suggested that intravenous heparin administration after IAT had a favorable effect on patient outcome.