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Captopril challenge test (CCT) is a simple and safe confirmatory test for primary aldosteronism (PA). We investigated the effectiveness of the indices after captopril administration for prediction of unilateral hyperaldosteronism (UHA) on adrenal vein sampling (AVS). We studied 238 patients with PA who had CCT and successful AVS between July 2007 and December 2019 in Sapporo City General Hospital. Receiver operating characteristic (ROC) curve analysis showed that the diagnostic performance for prediction of UHA on AVS in regard to the reduction rate of plasma aldosterone concentration (PAC) after captopril administration was inferior to aldosterone to renin ratio (ARR) and PAC (area under the ROC curve 0.72 vs. 0.84, 0.72 vs. 0.89, respectively, both p < 0.01). Based on the optimal cut-off values in ARR (897 pg/mL/ng/mL/h, sensitivity 64.6%, specificity 93.0%) and PAC (203 pg/mL, sensitivity 73.9%, specificity 93.0%) after captopril administration, the patients were divided into three groups: (1) both positive, (2) one positive, and (3) both negative. The prevalence of UHA on AVS in the three groups were 90.0%, 52.9%, and 7.3%, respectively. In the first group, 31 of 32 patients with unilateral nodular lesion on CT had an ipsilateral unilateral AVS. In conclusion, the combination of post-captopril ARR and PAC is useful for prediction of laterality diagnosis on AVS. AVS is strongly recommended in patients with both positive or one positive results for the optimal cut-off values of post-captopril ARR and PAC and is weakly recommended in patients with both negative results.

A 61-year-old woman was diagnosed with rheumatoid arthritis 12 years ago and received multiple treatment regimens before achieving symptomatic stability with methotrexate plus tocilizumab, a humanized monoclonal antibody against the IL-6 receptor, about 2 years prior to the current presentation. Sixteen months after tocilizumab initiation, she exhibited dysarthria and disorientation; five months later, she was hospitalized with movement difficulties. Her neurological symptoms deteriorated thereafter, accompanied by enlarged cerebral white matter lesions on magnetic resonance imaging. A biopsy of the right frontal lesion confirmed progressive multifocal leukoencephalopathy (PML). While several therapeutic monoclonal antibodies have been linked to PML, this is the first case associated with tocilizumab.

Summary A 31-year-old man with Williams syndrome (WS) was referred to our hospital because of a 9-year history of hypertension, hypokalemia, and high plasma aldosterone concentration to renin activity ratio. A diagnosis of primary aldosteronism (PA) was clinically confirmed but an abdominal CT scan showed no abnormal findings in his adrenal glands. However, a 13-mm hypervascular tumor in the posterosuperior segment of the right hepatic lobe was detected. Adrenal venous sampling (AVS) subsequently revealed the presence of an extended tributary of the right adrenal vein to the liver surrounding the tumor. Segmental AVS further demonstrated a high plasma aldosterone concentration (PAC) in the right superior tributary vein draining the tumor. Laparoscopic partial hepatectomy was performed. The resected tumor histologically separated from the liver was composed of clear cells, immunohistochemically positive for aldesterone synthase (CYP11B2), and subsequently diagnosed as aldosterone-producing adrenal adenoma. After surgery, his blood pressure, serum potassium level, plasma renin activity and PAC were normalized. To the best of our knowledge, this is the first report of WS associated with PA. WS harbors a high prevalence of hypertension and therefore PA should be considered when managing the patients with WS and hypertension. In this case, the CT findings alone could not differentiate the adrenal rest tumor. Our case, therefore, highlights the usefulness of segmental AVS to distinguish adrenal tumors from hepatic adrenal rest tumors. Learning points: Williams syndrome (WS) is a rare genetic disorder, characterized by a constellation of medical and cognitive findings, with a hallmark feature of generalized arteriopathy presenting as stenoses of elastic arteries and hypertension. WS is a disease with a high frequency of hypertension but the renin-aldosterone system in WS cases has not been studied at all. If a patient with WS had hypertension and severe hypokalemia, low PRA and high ARR, the coexistence of primary aldosteronism (PA) should be considered. Adrenal rest tumors are thought to arise from aberrant adrenal tissues and are a rare cause of PA. Hepatic adrenal rest tumor (HART) should be considered in the differential diagnosis when detecting a mass in the right hepatic lobe. Segmental adrenal venous sampling could contribute to distinguish adrenal tumors from HART.

Context: Adrenal glands locate at the retroperitoneal space and could be affected their positions by some factors. Adrenal glands being surrounded by visceral adipose tissue (VAT), we have hypothesized that the VAT amount influences the position of adrenal glands in cranial-caudal direction. In patients with primary aldosteronism (PA), comprehending the position of adrenal glands in cranial-caudal direction might be useful to predict the position of adrenal veins before performing adrenal venous sampling. Objectives: To clarify the influence of VAT amount on the position of adrenal glands, we investigated the correlation of visceral fat parameters with the position difference of adrenal glands in cranial-caudal direction in patients with PA. Materials and methods: This retrospective observational study included patients with PA according to the guidelines of both the Japan Endocrine Society and the Japan Society of Hypertension. Those with adrenal tumors more than 10 mm in diameter in computed tomography (CT) were excluded. We measured the position difference of the adrenal glands in cranial-caudal direction, from the top of right adrenal gland to the top of left adrenal gland by CT. We correlated visceral fat percentage (VF%), visceral fat area (VFA), and subcutaneous fat area (SCFA) evaluated by CT studies with the position difference of adrenal glands in cranial-caudal direction. Results: We analyzed 150 patients [male (n = 50), female (n = 100)]. Patients’ characteristics: Age was 54.8 ± 11.4, body mass index 24.9 ± 3.8 kg/m2, plasma aldosterone concentration 133.5 [101–176] pg/ml, plasma renin activity 0.3 [0.2–0.5] ng/ml/h, VF% 25.8 [19.8–33.6] %, VFA 88.3 [60.9–125.0] cm2, and SCFA was 147.4 [105.6–193.4] cm2 (mean ± SD, or median [interquartile range]). The position difference of adrenal glands in cranial-caudal direction was 9.7 ± 10.0 mm. In 120 patients (80.0%), left adrenal glands locate at the upper position comparing to right adrenal glands. In 19 patients (12.7%), right adrenal glands were positioned at the upper comparing to left adrenal glands. A positive correlation of VF%, VFA with the position difference of adrenal glands in cranial-caudal direction were shown (r = 0.451, p < 0.001, r = 0.426, p < 0.001, respectively). No significant correlation of SCFA with the position difference of adrenal glands in cranial-caudal direction was shown (r = 0.122, p = 0.139). In patients with more VAT amount, right adrenal glands locate at the upper position comparing to left adrenal glands. In patients with less VAT amount, left adrenal glands locate at the upper position comparing to right adrenal glands. Conclusions: Regardless of the variation of the position of adrenal gland on each side, the correlation was found between VAT and the position difference of adrenal glands in cranial-caudal direction in PA.

Patients with primary aldosteronism (PA) are complicated by metabolic syndrome more frequently than those without PA. Hyperaldosteronism has been reported to be associated with a higher prevalence of non-alcoholic fatty liver disease (NAFLD). We aimed to clarify the risk factors for hepatic steatosis in the two subtypes of PA, comparing the status of hepatic steatosis in each of these subtypes. This was a retrospective observational study. We enrolled patients with an aldosterone producing adenoma (APA) (n = 33) or idiopathic hyperaldosteronism (IHA) (n = 56). Hepatic fat content was evaluated using the ratio of liver to spleen (L/S) X-ray attenuation on unenhanced computed tomography. L/S ratio

Context The involvement of visceral fat in aldosterone secretion has not been reported in patients with primary aldosteronism (PA). Patients with PA are complicated by metabolic syndrome more frequently than those without PA. An excess of visceral fat has been hypothesized to cause an elevation of aldosterone secretion in patients with PA. Objectives To clarify the role of visceral fat in the pathophysiology of PA, we investigated the correlation between plasma aldosterone concentration (PAC) and visceral fat parameters in patients with PA. Design This retrospective observational study comprised 131 patients diagnosed with PA between April 2007 and April 2017 at Sapporo City General Hospital. We divided participants into two PA subtypes, aldosterone-producing adenoma (APA; n = 47) and idiopathic hyperaldosteronism (IHA, n = 84), utilizing adrenal venous sampling. We analyzed the correlations of PAC with visceral fat percentage (VF%), visceral fat area (VFA), and subcutaneous fat area, by evaluating computed tomography studies in each subtype group. Results Patients with IHA showed a positive correlation of PAC with VF% (r = 0.377, P < 0.001) and VFA (r = 0.443, P < 0.001). The correlation was not evident in patients with APA. Conclusions This study revealed a relationship between visceral adipose tissue and aldosterone production only in patients with IHA.

Objectives The aim of the present study was to determine the relation of urinary dysfunction with motor symptoms and nigrostriatal neuron loss in drug-naive patients with Parkinson's disease (PD). We therefore examined the relation of overactive bladder (OAB) symptoms with motor symptoms and striatal dopamine transporter (DAT) binding measured by [123-Iodine]-fluoropropyl-2beta-carbomethoxy-3beta-(4-iodophenylnortropane) dopamine transporter single-photon emission computed tomography (123I-FP-CIT SPECT). Patients and methods Thirty-one untreated PD patients (12 men and 19 women with a mean age of 71.2 ± 6.7 years) were included in this study. Patients were evaluated with overactive bladder symptom score (OABSS) and divided into an OAB group and Non-OAB group. They underwent clinical assessments and 123I-FP-CIT SPECT imaging. Motor symptoms were assessed using Unified Parkinson's Disease Rating Scale (UPDRS). Results The results showed that UPDRS motor score (p = 0.01) and akinetic-rigid score (p = 0.002) were higher and that striatal DAT availability (p = 0.01) was lower in the OAB group than in the Non-OAB group. However, tremor score, age, and duration of PD showed no significant differences between the OAB group and Non-OAB group. Conclusions Urinary dysfunction in untreated PD is related with increase in motor symptoms (especially bradykinesia and axial symptoms) and reduction of striatal DAT availability.

In adrenal venous sampling (AVS) for patients with primary aldosteronism (PA), adrenocorticotropic hormone (ACTH) stimulation generally increased the success rate. The effect of ACTH stimulation on the left-right differences of laterality diagnosis in AVS remains unclear. A total of 167 patients with PA underwent successful AVS were examined. Patients with autonomous cortisol secretion were excluded. The proportion of dominant side in AVS was compared before and after ACTH stimulation. Unilateral disease on AVS was defined as a lateralization index of more than 4, both before and after ACTH stimulation. Before ACTH stimulation, unilateral disease was more frequently observed on the right side than the left side (right 33.5% vs. left 13.8%, p < 0.01). After ACTH stimulation, unilateral disease was more frequently observed on the left side than the right side, without statistical significance (left 15.6% vs. right 10.8%, p = 0.20). Among the 56 patients who had right unilateral disease before ACTH stimulation, 17 patients (30.0%) also had right unilateral disease after ACTH stimulation. The affected side of AVS was changed from right unilateral to bilateral after ACTH stimulation in 34 (60.7%) out of 56 patients. These patients had milder PA and CT scans showed no nodular lesions on the right side. In AVS, ACTH stimulation not only decreased unilateral results but also shifted to the dominant side. Overestimation should be carefully considered when the surgical indication for the right adrenal gland was decided based on AVS results without ACTH stimulation.

Context: A strong association between excess visceral fat and the presence of metabolic factors, hypertension and type 2 diabetes have been demonstrated. Patients with primary aldosteronism (PA) are complicated by metabolic syndrome more frequently than those without PA. Aldosterone-induced mineralocorticoid receptor activation has been reported to impair insulin sensitivity in adipocytes and skeletal muscle. An excess of visceral fat has been hypothesized to cause an elevation of aldosterone secretion, and to cause insulin resistance in patients with PA. Objectives: To clarify the role of visceral fat in the pathophysiology of PA, we investigated the correlation of visceral fat parameters with plasma aldosterone concentration (PAC), and the correlation of visceral fat parameters with homeostasis model assessment insulin resistance (HOMA-R) in patients with PA. Materials and methods: This retrospective observational study comprised 131 patients diagnosed with PA between 2007 and 2017 at Sapporo City General Hospital. We divided participants into two subtypes, aldosterone producing adenoma (APA, n = 47) and idiopathic hyperaldosteronism (IHA, n = 84), utilizing adrenal venous sampling. We excluded patients with suspected autonomous cortisol secretion, defined as serum cortisol levels ≧ 3 μg/dL after a 1-mg dexamethasone suppression test. We analyzed the correlations of visceral fat percentage (VF%), visceral fat area (VFA) evaluated by computed tomography studies and PAC, and the correlations of VF% and VFA with HOMA-R in each subtype group. Results: Age and sex distribution was not different between patients with APA and patients with IHA (p = 0.85, p = 0.18, respectively). PAC was significantly higher in patients with APA than patients with IHA (p < 0.001). Serum potassium levels were significantly lower in patients with APA than patients with IHA (p < 0.001). Body mass index was not different between these two subtypes (p = 0.87). VF% was significantly higher in patients with IHA than in those with APA (p = 0.02). The number of patients treated as type 2 diabetes mellitus with oral medicine, HbA1c, and HOMA-R were not different between these two subtypes (p =0.76, p =0.22, p = 0.12, respectively). Patients with IHA showed a positive correlation of VF% with PAC (r = 0.377, p < 0.001), and VFA with PAC (r = 0.443, p < 0.001). In contrast, patients with APA showed no significant correlation of VF% and VFA with PAC. Patients with APA and patients with IHA showed a positive correlation of VF% and VFA with HOMA-R. Conclusions: Between two subtypes of PA, the association of visceral fat on insulin resistance was not different. The association of visceral fat on PAC was different in two subtypes of PA. Only in patients with IHA, visceral fat may play a role in regulation of aldosterone secretion.

Background: Williams syndrome (WS) is a microdeletion disorder caused by heterozygous loss of approximately 1.5-Mb pairs of DNA from chromosome 7. Patients with WS have a characteristic constellation of medical and cognitive findings, with a hallmark feature of generalized arteriopathy presenting as stenoses of elastic arteries and hypertension. We present here a case of WS associated with primary aldosteronism (PA), whose source of aldosterone excess was difficult to locate. Clinical case: A 31-year-old man suspected having PA was referred to our Hospital. He was diagnosed as having Williams syndrome at 2 months of age. He had been hypertensive for 9 years. At the age of 31 years old, low serum potassium (K) and high aldosterone to renin ratio were pointed out. His plasma renin activity (PRA) was 0.2 ng/ml/h, plasma aldosterone concentration (PAC) was 456 pg/ml, serum K level was 3.1 mEq/l at admission. Diagnosis of PA was confirmed according to positive captopril challenge test. CT scan revealed a 13mm tumor with low density in posterosuperior segment of right hepatic lobe, but adrenal tumor was not detected. Venography of adrenal vein sampling (AVS) showed an extended tributary of the right adrenal vein to the liver that surrounded the tumor. Segmental AVS was performed for right adrenal vein and showed a high value of PAC (377000 pg/ml) in superior tributary which was drained from the tumor. PAC in other tributaries of right adrenal vein and left adrenal vein was suppressed. Laparoscopic partial hepatectomy was performed as a liver tumor. After surgery, serum K level was normalized, PAC decreased to 67 pg/ml. Pathological examination revealed a golden-yellow tumor separated from the liver by fibrous septum. The tumor was attached to an adrenal cortex embedded in the liver. The tumor was composed of clear cells, positive for 3βHSD2 and CYP11B2 using immunohistochemistry, diagnosed as aldosterone producing adrenal adenoma. Conclusion: To the best of our knowledge, this is the first report of WS associated with PA. Since WS is a disease with high prevalence of hypertension, measurement of PRA and PAC for screening of PA is recommended for patients with WS associated with hypertension. According to CT findings, hepatic adrenal rest tumor was suspected because the tumor was not continuous with the right adrenal gland, but pathological findings demonstrated that an adrenal adenoma was originated from right adrenal cortex rather embedded in the liver. Segmental AVS was useful to distinguish adrenal tumor from hepatic adrenal rest tumor.

Background: In adrenal vein sampling (AVS) for primary aldosteronism (PA), cortisol concentration is used to determine successful AVS, and laterality diagnosis is performed using a combination of aldosterone and cortisol concentrations. In this study, we examined the comparison with the conventional method when AVS was determined by aldosterone alone. Subjects and methods: We studied the data from 277 patients with PA who underwent AVS in Sapporo City General Hospital from July 2007 to April 2020. The patients with autonomous cortisol production were excluded. Using the blood samples from adrenal veins and inferior vena cava (IVC) after ACTH stimulation, the predicting ability of the left and right ratio of aldosterone concentration (aldosterone ratio, AR) for lateralization Index (LI) was examined by Receiver operating characteristic (ROC) analysis. The predicting abilities of the ratio of aldosterone concentration between adrenal vein and IVC (aldosterone index, AI) and aldosterone concentration for selectivity index (SI) and contralateral ratio (CR) were also examined by ROC analysis. Results: Six samples (0.01%) with SI 5 was 0.998, 0.990, respectively, p=0.39. The optimal cut-off values of aldosterone concentration and AI for prediction successful AVS were 1700 pg/ml (sensitivity 99.5%, specificity 100%), 7.44 (sensitivity 94.0%, specificity 100%), respectively. Seventy-two patients (27.3%) had LI >4 who were diagnosed as unilateral aldosterone excess. AR had 0.94 of AUC for prediction of LR >4. The optimal cut-off value of AR was 3.53 (sensitivity 86.1%, specificity 94.8%). Eighty-two patients (31.1%) had unilateral CR

Objective This study examined whether the application of magnetoencephalography (MEG) to interpret magnetic resonance imaging (MRI) findings can aid the diagnosis of intractable epilepsy caused by organic brain lesions. Methods This study included 51 patients with epilepsy who had MEG clusters but whose initial MRI findings were interpreted as being negative for organic lesions. Three board-certified radiologists reinterpreted the MRI findings, utilizing the MEG findings as a guide. The degree to which the reinterpretation of the imaging results identified an organic lesion was rated on a 5-point scale. Results Reinterpretation of the MRI data with MEG guidance helped detect an abnormality by at least one radiologist in 18 of the 51 patients (35.2%) with symptomatic localization-related epilepsy. A surgery was performed in 7 of the 51 patients, and histopathological analysis results identified focal cortical dysplasia in 5 patients (Ia: 1, IIa: 2, unknown: 2), hippocampal sclerosis in 1 patient, and dysplastic neurons/gliosis in 1 patient. Conclusions The results of this study highlight the potential diagnostic applications of MEG to detect organic epileptogenic lesions, particularly when radiological visualization is difficult with MRI alone.

Objectives The aim of the present study was to determine the relations of clinical symptoms with nigrostriatal neuron loss in drug-naive patients with Parkinson’s disease (PD). We examined the severity of motor symptoms and freezing of gait (FOG), falls and overactive bladder (OAB) in PD patients and their relations with striatal dopamine transporter (DAT) binding. Patients and Methods: Thirty-two untreated PD patients (14 men and 18 women with a mean age of 71.4 ± 7.2 years) were included in this study. Clinical assessments were performed by using Unified Parkinson’s Disease Rating Scale (UPDRS) and overactive bladder symptom score (OABSS), and striatal dopamine transporter (DAT) binding was measured by123I-FP-CIT SPECT. Results: The results showed that striatal DAT availability was significantly lower in the high UPDRS motor score group, high akinetic-rigid score group, FOG group, and OAB group than in the low UPDRS motor score group, low akinetic-rigid score group, non-FOG group, and non-OAB group. However, the results also showed that there was no significant difference in striatal DAT availability between the high tremor score group and low tremor score group or between the faller group and non-faller group. Conclusions: The severity of bradykinesia and axial symptoms and the existence of FOG and OAB in untreated PD patients are related to a decrease in striatal DAT availability. Severity of tremors and occurrence of falls are not related to a decrease in striatal DAT availability. The mechanisms underlying the clinical symptoms of PD involve not only dopaminergic pathways but also non-dopaminergic pathways.

Objectives The aim of the present study was to determine the relationships of drooling with motor symptoms and nigrostriatal neuron loss in drug-naive patients with Parkinson’s disease (PD). We therefore examined the relationships of drooling with motor symptoms and striatal dopamine transporter (DAT) binding measured by [123-Iodine]-fluoropropyl-2beta-carbomethoxy-3beta-(4-iodophenylnortropane) dopamine transporter single-photon emission computed tomography(123I-FP-CIT SPECT). Patients and Methods Thirty-five untreated PD patients (14 men and 21 women with a mean age of 71.9 ± 7.2 years) were included in this study. The patients were divided into a drooler group and non-drooler group. They underwent clinical assessments and 123I-FP-CIT SPECT imaging. Motor symptoms were assessed using Unified Parkinson’s Disease Rating Scale (UPDRS). Results The results showed that UPDRS motor score (p = 0.002) and akinetic-rigid score (p = 0.008) were higher and that striatal DAT availability (p = 0.03) was lower in the drooler group than in the non-drooler group. However, tremor score, age, and duration of PD showed no significant differences between the drooler group and non-drooler group. Conclusions Drooling in untreated PD is related to an increase in motor symptoms (especially bradykinesia and axial symptoms) and to reduction of striatal DAT availability.

Objective:Hyperaldosteronism have been reported to be associated with higher prevalence of nonalcoholic fatty liver disease (NAFLD). To clarify prevalence of NAFLD in two subtypes of primary aldosteronism (PA), we compared hepatic fat content evaluated by computed tomography (CT).Design and method:T

Purpose To evaluate the feasibility of arterial spin-labeling (ASL) in head and neck cancer for noninvasive measurement of tumor blood flow (TBF), by comparing 1) the TBF change before and after the treatment, and 2) posttreatment TBF and its reduction rate between residual and nonresidual tumors after treatment. Materials and Methods Twenty-two patients with head and neck cancer were evaluated using ASL on 3.0-T magnetic resonance imaging (MRI) before and after nonsurgical treatment. A pulsed ASL sequence with Look–Locker readout was used to calculate quantitative TBF. TBF reduction rates between pre- and posttreatment values were also calculated. Residual tumors were confirmed when present with either histopathologically or clinical follow-up. Results Pre- and posttreatment mean TBF values were 121.4 ± 27.8 (standard deviation) and 24.9 ± 14.9 mL/100g/min, respectively. Pre- and posttreatment TBF differed significantly. Posttreatment TBF was significantly higher in patients with residual tumors (five patients, 46.9 ± 7.1 mL/100g/min) than in those without (17 patients, 18.4 ± 9.2 mL/100g/min). The TBF reduction rate was significantly lower in patients with residual tumors (0.540.55 ± 0.120.12) than in those without (0.85 ± 0.06). Conclusion ASL allows quantitative assessment of TBF in head and neck cancer. ASL may be useful for noninvasive assessment of tumor viability in head and neck cancer. J. Magn. Reson. Imaging 2014;40:920–928. © 2013 Wiley Periodicals, Inc.

Diffusion tensor imaging (DTI) is considered to be able to non-invasively quantify white matter integrity. This study aimed to use DTI to evaluate white matter integrity in non-geriatric patients with major depressive disorder (MDD) who were free of antidepressant medication. DTI was performed on 19 non-geriatric patients with MDD, free of antidepressant medication, and 19 age-matched healthy subjects. Voxel-based and histogram analyses were used to compare fractional anisotropy (FA) and mean diffusivity (MD) values between the two groups, using two-sample t tests. The abnormal DTI indices, if any, were tested for correlation with disease duration and severity, using Pearson product-moment correlation analysis. Voxel-based analysis showed clusters with FA decrease at the bilateral frontal white matter, anterior limbs of internal capsule, cerebellum, left putamen and right thalamus of the patients. Histogram analysis revealed lower peak position of FA histograms in the patients. FA values of the abnormal clusters and peak positions of FA histograms of the patients exhibited moderate correlation with disease duration and severity. These results suggest the implication of frontal-subcortical circuits and cerebellum in MDD, and the potential utility of FA in evaluation of brain parenchymal integrity. (C) 2012 Elsevier Ireland Ltd. All rights reserved.

Background: Vulnerable and inflamed plaques in the carotid artery are at high risk of ischemic stroke, suggesting the importance of diagnostic modalities to detect them in patients with carotid stenosis with high sensitivity and specificity. Although many investigators have reported that magnetic resonance imaging (MRI) is a useful tool to predict the vulnerable components of carotid plaque, its validity is not established. On the other hand, 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET) may be an alternative modality to directly identify the inflamed plaque in carotid artery stenosis. Therefore, this study aimed at evaluating the validity of MRI and FDG-PET to predict vulnerable and inflamed carotid plaque. Methods: This prospective study totally included 25 patients who underwent carotid endarterectomy (CEA) for carotid artery stenosis at our institute between January 2009 and January 2012. Prior to CEA, FDG-PET, black-blood T1-weighted imaging (BB-T1WI), and 3-dimensional time-of-flight (TOF) imaging were performed. The specimens were stained with hematoxylin-eosin to assess the different plaque components (lipid, hemorrhage, calcification, and fibrous tissue). In addition, they were stained with primary antibodies against CD68 (activated macrophages) and matrix metalloproteinase (MMP)-9. Results: High FDG uptake was detected in 13 (52.0%) of 25 patients. All of them had lipid-rich plaque. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) to identify the lipid-rich plaques were all 100% for FDG-PET. More importantly, all of the FDG-positive plaques had strong immunoreactivity against both CD68 and MMP-9. There was a significant correlation between the findings on FDG-PET and those on immunohistochemistry against CD68 and MMP-9 (p = 0.006 and 0.004, respectively). On the other hand, 16 (64.0%) of 25 patients had high signal intensity plaque on BB-T1WI. In 7 of these 16 patients, the lesions also showed high signal intensity on TOF imaging. All of them had a large intraplaque hemorrhage. The sensitivity, specificity, PPV, and NPV to identify a large intraplaque hemorrhage were 70, 100, 100, and 83%, respectively, for MRI. Conclusions: These findings suggest that FDG-PET and MRI are complementary to predict high-risk carotid plaque, such as lipid-rich or hemorrhagic plaque. FDG-PET can accurately predict the lipid-rich and inflamed plaque. MRI is valuable to identify unstable plaque with a large intraplaque hemorrhage. The combination of these two modalities may play an important role in predicting carotid plaque at high risk of ischemic stroke.

We investigate the diagnostic reliability of differentiating between lipid-poor adrenal adenomas and metastatic adrenal tumors originating from hepatocellular carcinoma (HCC) using a routine dynamic CT protocol for liver imaging. Eighteen metastatic adrenal tumors originating from HCC and 13 lipid-poor adrenal adenomas were identified. Dynamic CT data were analyzed for CT attenuation of adrenal lesions before and after contrast administration. When a cutoff of 36 HU was set for adrenal lesions at pre-contrast attenuation, the sensitivity and specificity for the diagnosis of metastatic lesions were 94.4%and 92.3%, respectively. Attenuation criteria on pre-contrast CT may help optimize the differentiation between these lesions.

Spinal cord sarcoidosis is a rare manifestation of sarcoidosis. Magnetic resonance imaging (MRI) of spinal cord sarcoidosis sometimes resembles that of the non-inflammatory spinal cord lesion. 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) is an effective method to detect both systemic and central nervous system lesions in sarcoidosis. This study compared the standard uptake value (SUV) of FDG-PET between spinal cord sarcoidosis and non-inflammatory spinal cord lesions. We retrospectively reviewed the records of patients who underwent both spinal MRI and FDG-PET scans. We used SUV to evaluate the FDG-PET uptake of the lesion. The region of interest was the center of high-intensity areas on T2-weighted MR images. We included three patients with spinal cord sarcoidosis, five with myelomalacia caused by cervical spondylosis or ossification of the posterior longitudinal ligament, one with spinal cord edema associated with cervical spondylosis, and one with spinal cord edema associated with dural arteriovenous fistula. The spinal cord sarcoidosis group had a significantly higher SUV (mean = 4.38, range 3.30-4.93) than patients with the other diseases (mean = 1.87, range 1.42-2.74). The SUV of FDG-PET thus may be able to distinguish spinal cord sarcoidosis from other non-inflammatory lesions. FDG-PET can play an important role in the diagnosis of spinal cord sarcoidosis because the gadolinium enhancement in MRI is sometimes seen in spondylotic myelopathy or vascular malformation. FDG-PET is informative for the accurate diagnosis of spinal cord sarcoidosis and may enable clinicians to start treatment at an earlier stage.

A 62-year-old man was referred to us after unsuccessful treatment of bilateral weakness in his upper and lower extremities with paresthesia in both lower extremities. Computed tomography (CT) revealed soft tissue masses in the left kidney along the capsule and paraaortic region that were of relatively low attenuation with accompanying granular calcifications. Pathological diagnosis of the biopsy specimen was extramedullary plasmacytoma accompanied by extramedullary hematopoiesis and amyloid deposition. Although the CT findings correlated well with the pathological results, the case was extremely atypical for extramedullary plasmacytoma in respect to location and the accompaniment with extramedullary hematopoiesis.

To determine whether diffusion-tensor (DT) imaging can demonstrate microstructural white matter abnormalities of multiple system atrophy (MSA) and to correlate these imaging findings with clinical signs and symptoms.Institutional review board approval and written informed consent were obtained. DT imaging was performed in 16 patients with MSA with predominant cerebellar symptoms (MSA-C) (mean age, 60.0 years + or - 5.1 [standard deviation]; range, 51-69 years) and 16 age-matched healthy subjects. Fractional anisotropy (FA) and mean diffusivity (MD) were compared voxel-by-voxel between the two groups by using a two-sample t test. Overlap maps were created to illustrate areas with FA and MD alterations. Correlation between DT imaging indexes and Barthel index score, scale for assessment and rating of ataxia (SARA) score, severity of orthostatic hypotension, age of disease onset, and disease duration was tested by using Spearman rank or Pearson product-moment correlation analysis. T2-weighted and proton density-weighted images of the patients were visually assessed.Widespread areas of FA reduction and MD elevation were observed in supra- and infratentorial white matter structures in patients with MSA (P.05, false discovery rate corrected). Significant correlation (P.01) between DT imaging indexes and Barthel index score, SARA score, severity of orthostatic hypotension, and disease duration was observed for multiple areas with FA and/or MD alterations. T2-weighted and proton density-weighted images showed no significant abnormality in supratentorial white matter.DT imaging may help identify the microstructural white matter abnormalities of MSA-C. DT imaging may be useful for severity assessment of MSA-C.

Cerebral fat embolism (CFE) causes microinfarcts, vasogenic edema, and petechiae in the brain. Conventional magnetic resonance imaging has been reported to effectively visualize microinfarcts and vasogenic edema in CFE, but not petechiae. We report 3 cases of CFE in which susceptibility-weighted imaging distinctly demonstrated multiple minute hypointense foci in the brain, which were interpreted as petechiae, susceptibility-weighted imaging is a useful adjunct to conventional magnetic resonance imaging for the evaluation of CFE.

To evaluate diffusion-weighted magnetic resonance (DW-MR) imaging for detection of metastases in lymph nodes by using quantitative analysis.Seventy patients with non-small cell lung cancer were examined with DW and short inversion time inversion recovery (STIR) turbo-spin-echo MR imaging. Apparent diffusion coefficient of each lung cancer and lymph node was calculated from DW-MR images. Difference of the apparent diffusion coefficient in a lung cancer and a lymph node was calculated (D1). From STIR turbo-spin-echo MR images, ratios of signal intensity in a lymph node to that in a 0.9% saline phantom was calculated (lymph node-saline ratio [LSR1]). For quantitative analysis, the threshold value for a positive test was determined on a per node basis and tested for ability to enable a correct diagnosis on a per patient basis. Results of quantitative analyses of DW- and STIR-MR images were compared on a per patient basis with McNemar testing.Mean D1 in the lymph node group with metastases was lower than that in the group without metastases (P0.001). When an D1 of 0.24 x 10(-3) mm2/s was used as the positive test threshold, sensitivity, specificity, and accuracy were 69.2%, 100%, and 94.0%, respectively, on a per patient basis. There was no significant difference (P0.05) between quantitative analyses of DW-MR images and STIR-MR images.Quantitative analysis of DW-MR images enables differentiation of lymph nodes with metastasis from those without.

To determine the timing for follow-up study of power Doppler ultrasonography (PDUS) by evaluating the response of finger joint synovitis in patients with rheumatoid arthritis (RA) to treatment including infliximab, an antitumor necrosis factor alpha agent. Bilateral second/third metacarpo-phalangeal (MCP) joints and second proximal inter-phalangeal (PIP) joints (total of six joints) in 21 patients (18 women and three men; median age 53 years) with chronic active RA were assessed by PDUS before and after 2 weeks, 6 weeks, 14 weeks, 30 weeks, 38 weeks, 46 weeks, and 54 weeks of infliximab infusion. Pulse Doppler settings were standardized for each patient and optimized for the detection of synovial blood flow by adjustment of color gain, pulse repetition, and flow optimization. Power Doppler signal was graded for each joint [joint grade for power Doppler (JGPD) signals], and the sum of the grades of six joints was defined as the PDUS index [joint index for power Doppler signals (JIPD)] at each visit. PDUS and clinical parameters [28-joint disease activity score (DAS28), health assessment questionnaire, and C-reactive protein (CRP) level] were independently assessed and compared with baseline values. The American College of Rheumatology (ACR) core set responders and non-responders at week 54 were compared for clinical parameters and PDUS index at each visit. Fourteen patients completed the planned treatment for 1 year, while six patients dropped out for various reasons and one died suddenly. PDUS was performed a total of 146 times on 467 joints. DAS28 was assessed 127 times. Both DAS28 and JIPD had decreased at the follow-up. Comparative analysis between DAS28 and PDUS was available 125 times. The transverse correlation between the PDUS index and DAS28 was not significant throughout the follow-up period. When responders and non-responders were discriminated at week 54, a logistic regression model for the binary endpoint of responder vs non-responder, with PDUS index as explanatory variable at time point 0, and follow-up revealed statistical significance from week 38 and on. PDUS reflected infliximab’s effect on pannus vascular signals; this effect was observed as early as 2 weeks after treatment had begun. Also, the responders to treatment at 54 weeks tended to have fewer JIPD than non-responders in the follow-up period. PDUS may be performed at week 38 or later to foresee the response to the treatment at week 54.

In most cases of systemic lupus erythematosus (SLE), glomerular lesions are the main renal complication. Although tubulointerstitial lesions are often associated with severe glomerular lesions, predominant or isolated tubulointerstitial injury in the presence of minimal glomerular abnormalities with SLE, so-called predominant tubulointerstitial lupus nephritis, is rare and there is no report on CT and MR imaging findings of predominant tubulointerstitial lupus nephritis. Herein, we describe the case of a 48-year-old woman with SLE who presented with acute renal deterioration attributable to acute tubulointerstitial nephritis with an emphasis on CT and MR imaging findings. CT demonstrated multiple wedge-shaped areas or streaky zones of lesser enhancement that extend from the papilla to the renal cortex. MR images revealed relatively clear corticomedullary junction with slightly irregular cortex on T1-weighted images, and wed-shaped areas of decreased signal intensity corresponding CT findings increased signal intensity in the central parenchyma on T2-weighted image. The enhancement effect was weak and delayed in the central parenchyma on dynamic MR images after bolus administration of contrast. These imaging features seemed to reflect the tubulointerstitial dysfunction and infiltration in this case.

Intravenous pyogenic granuloma is a rare solitary form of lobular capillary hemangioma that usually occurs in the veins of the neck and upper extremities. We report two cases of intravenous pyogenic granuloma localized in the finger, giving details of the magnetic resonance imaging (MRI) findings. These two cases had similar locations in fingers and identical MRI findings. The differential diagnoses of this rare entity are also discussed.

An 11-year-old female receiving treatment for acute lymphoblastic leukemia presented with superior sagittal sinus (SSS) thrombosis. T(1)-weighted, T(2)-weighted, and fluid-attenuated inversion recovery magnetic resonance (MR) imaging, and MR venography showed that the SSS was totally occluded by thrombus. Susceptibility-weighted MR imaging showed hypointense thrombus in the SSS and markedly dilated cortical veins over the bilateral cerebral hemispheres. Two days later, her symptoms had slightly resolved. Iodine-123 N-isopropyl-p-iodoamphetamine single photon emission computed tomography showed marked decrease of cerebral blood flow in the bilateral frontal lobes, indicating that venous congestion had disturbed the cerebral hemodynamics. MR venography showed that the SSS was still mostly occluded, but susceptibility-weighted imaging showed that the dilation of the cortical veins was less marked, suggesting that collateral venous routes had gradually developed. The finding of dilated cortical veins had almost disappeared at 28 days after the onset. Susceptibility-weighted imaging can be used as a non-invasive method to monitor the severity of venous congestion caused by cerebral venous sinus thrombosis.

Echinococcosis is a parasitic infection of humans caused by the larval stage of the tapeworm Echinococcus. Primary alveolar echinococcosis of the adrenal gland is rare. We report a case of alveolar hydatid disease of the adrenal gland that presented as a multiloculated cystic mass without calcification. The lesion was purely cystic in nature, suggesting that it was at an early stage of development.

A 47-year-old male underwent stereotactic radiosurgery (25 Gy) for a cerebral arteriovenous malformation located in the right caudate nucleus, using a linear accelerator. Complete obliteration of nidus was confirmed 20 months after radiosurgery. However, a hypointense mass on T2-weighted magnetic resonance imaging developed in the area adjacent to the nidus after approximately 80 months. The mass gradually increased in size and induced severe perifocal edema over 2 years. The mass was successfully excised. Histological examination revealed that the mass consisted of dilated sinusoid vessels attached to the hematoma capsule, and the hematoma included clots in various stages of organization encapsulated by dense collagenous tissue. The histological diagnosis was cavernoma. De novo formation of cavernoma is well known to occur after radiation surgery for intracranial tumor, especially in pediatric patients, but is rare in adults. Based on the radiological and histological findings in the present case, the radiation-induced cavernoma underwent repeated bleedings resulting in chronic encapsulated expanding hematoma.

われわれは糖尿病性腎症による腎不全症例に生じた急性可逆性パーキンソニズムの2症例を経験したので報告する. 【症例1】56歳, 男性症例で, 突然構音障害・動作緩慢・歩行困難が出現したが, 約8か月で寛解した. 発症時脳magnetic resonance imaging (MRI) 上T2強調画像で大脳基底核に対称性異常高信号を認めたが, 2か月後異常信号はほぼ消失していた. 【症例2】66歳, 男性症例で, 突然脱力, 構音・嚥下障害, 歩行障害が出現したが, 約7か月で寛解した. 発症時MRI上大脳基底核にT2強調で対称性異常高信号を認めたが, 5か月後異常陰影はほぼ消失していた. 文献的にはアジア人の糖尿病性末期腎不全症例での報告が多く, 病因は大脳基底核の血流障害や尿毒症物質, 代謝異常の影響などが推察されるが詳細は不明である. 病像は橋外髄鞘融解症にも類似点が多く, 関連性について今後の検討が必要と思われる. 予後は良好なことが多いが, 合併症による死亡例もあり注意を要する.

A 55-year-old woman underwent radiosurgery for a left cerebral hemisphere arteriovenous malformation (AVM) and developed radiation-induced necrosis causing a massive edema in the surrounding brain tissues. Despite various therapies, the edema expanded to the ipsilateral hemisphere and induced neurological symptoms. The radiation-induced necrotic lesion was surgically removed 4 years after radiosurgery. While the preoperative FDG PET revealed severe hypometabolism in the left cerebrum, the necrotomy significantly ameliorated the brain edema, glucose metabolism (postoperative FDG PET), and symptoms. This case indicates that radiation necrosis-induced neurological deficits may be associated with brain edema and hypometabolism, which could be reversed by appropriate necrotomy.

Primary intramedullary spinal cord germinoma is a rare neoplasm and sensitive to radiotherapy and chemotherapy. In this report, a 16-year-old girl presented with pain and numbness of both thighs, difficulty in walking, followed by urinary disturbance. Neurological examination revealed motor weakness, hypotonicity, reduced deep tendon reflexes of both lower limbs, and decrease in sensation below Th12 level. MR examination demonstrated intramedullary mass lesion of the lower thoracic spinal cord. On T2-weighted images, the lesion was heterogeneous but mostly slightly hyperintense. There were small cysts within the tumor. On T1-weighted images, the lesion was mostly hypointense. Mild and heterogeneous enhancement was observed on postcontrast T1-weighted images. No other neoplastic lesion has been found inside and outside the central nervous system. The patient underwent surgery, and the intramedullary lesion was almost totally resected. The lesion was diagnosed as germinoma histologically. Analysis of cerebrospinal fluid (CSF) obtained during operation revealed elevated level of beta-subunit of human chorionic gonadotrophin (beta-hCG). Literature review revealed that MRI findings of intramedullary spinal cord germinomas are frequently nonspecific, but these tumors sometimes have small intratumoral cysts. Germinomas should be included in the differential diagnosis, especially when an intramedullary spinal cord tumor is found in the thoracic or thoraco-lumbar region in a young adult patient. Elevated level of beta-hCG in CSF strongly suggests germinoma.

Objective : Traumatic brain injury causes cognitive disturbances in many cases. Some patients have moderate–severe brain dysfunction despite slight or no abnormality in MRI. The purpose of this study is to investigate whether the loss of neuronal integrity exists in the patients with traumatic brain injury using C-11 flumazenil PET (FMZ-PET) without MRI abnormality. Method : This study included 11 patients with traumatic brain injury and posttraumatic cognitive disturbances. All of the studies were examined at least 6 months later after injury. The dynamic flumazenil PET was studied in all patients. The binding potential of flumazenil (BP) was calculated by reference method. Axial T1WI, T2WI and FLAIR images were obtained with 1.5-T scanner. Coronal images were added in some cases. The BP images were visually interpreted by at least two experienced nuclear physicians by consensus. The lesions were determined as positive if a definite localized area of decreased distribution with respect to the surrounding normal tissue was present except for physiological distribution. Results : All of the patients had normal T1, T2 and FLAIR MRI. Nine patients had memory impairment. The low uptakes of BP images were shown in seven patients (63%). The low uptakes of BP were shown in the medial temporal lobe, the lateral temporal lobe, the temporal base and the frontal lobe in five, one, one and two patients, respectively. There were no patients that had low uptake in the cerebellum. Six of the nine patients who had memory impairment showed low uptakes in BP in the temporal lobe. Conclusion : These results indicated that the loss of the neuronal integrity, which was not able to be detected with MRI, was one of the causes of the cognitive disturbances in patients with traumatic brain injury.

There are many non-neoplastic intramedullary lesions that mimic intramedullary neoplasm. They are consisted of infections, demyelination, granulomatous disease, radiation myelopathy, vascular lesions, and syringomyelia. In this report, the authors described its differential diagnosis in clinical and neuroradiological findings. Furthermore, we mentioned its surgical approach for several non-neoplastic lesions. Syringomyelia and spinal AV fistula are both good candidate for surgical treatments. We would like to stress that good cooperation between neurologist, neuroradiologist, and neurosurgeon is important to differentiate non-neoplastic lesions and surgical biopsy is final procedure to confirm their pathology.

We report a case of 5-fluorouracil (5-FU)-induced leukoencephalopathy in which magnetic resonance imaging (MRI) of the brain, including diffusion-weighted imaging (DWI), was performed serially. The initial T2-weighted and FLAIR images showed diffuse mild hyperintensity in bilateral deep cerebral white matter and corpus callosum, which on T1WI appeared as non-enhanced faint hypointensity. Isotropic DWI disclosed the abnormality as well-conspicuous diffuse hyperintensity with decreased ADC. Serial studies revealed that majority of the abnormal signal intensity on these sequences resolved, and the decreased ADC values approached normal. Some hyperintensity remained in the deep cerebral white matter and the splenium, but no further significant ADC change after normalization was noted. Measurement of ADC along the three orthogonal directions showed the presence of directional dependence of diffusion throughout the length of study. These findings suggest that early stage of 5-FU-induced leukoencephalopathy is associated with reversible restricted diffusion and preservation of anisotropy. Diffusion-weighted imaging may be useful for the diagnosis.

We report magnetic resonance findings in the intramedullary schwannoma of the cervical spinal cord in two patients. In both cases, the solid portions of the tumours enhanced intensely after administration of Gd-DTPA and the enhanced border was sharply delineated from the adjacent spinal cord. Schwannomas should be considered in the differential diagnosis of intramedullary tumours when magnetic resonance images show a strongly enhancing mass with sharply delineated borders.

Electrocardiographic-gated 64-slice multidetector computed tomography (MDCT) was performed on a 30-year-old man who presented with a complete endocardial cushion defect (ECD) and severe pulmonary hypertension diagnosed when he was 3 years old. Multiplanar reconstruction image showed the common atrium without an atrial septum, a large ventricular septum defect, and a small right ventricle due to a complete atrioventricular canal defect. Three-dimensional CT volume-rending imaging showed a patent ductus arteriosus, dilation of the ascending aorta, and an anomalous-origin right coronary artery. This patient also had heterotaxy syndrome with polysplenia and azygos continuation. MDCT proved to be a good noninvasive imaging method for the evaluation of ECD associated with cardiac as well as extracardiac abnormalities.

Epidural hematoma associated with osteoporotic vertebral collapse has not been reported yet in the literature. We report a case of myelopathy caused by chronic epidural hematoma associated with L1 osteoporotic vertebral collapse and review the relevant literature.

Hokkaido university picture archiving and communication system (HU-PACS) began clinical service in the Hokkaido university hospital in 1989. For the first 5 years the service was limited to the radiology department and the outpatient clinics. This paper describes the outline of the HU-PACS, how we have extended the service to all wards and managed the increasing image data accompanied by the installation of new CTs and MRI since 1994. A plan of future HU-PACS is also described.

We retrospectively reviewed 15 gadolinium-enhanced magnetic resonance imaging examinations of the cervical spine in eight patients who had spinal cord injury. Enhancement was demonstrated at the periphery of the intramedullary lesion in three patients at 1 to 14 weeks after injury. The enhancement might reflect vascularized granulation in a reparative phase. Spinal cord injury should be considered in the differential diagnosis of enhanced intramedullary spinal cord lesions.

Breast MRI protocols have been improved by using a combination of dynamic scans for bilateral breasts and high-resolution imaging for a single breast which can be obtained during dynamic scans by recent technological advances. The purpose of this study was to compare high-resolution imaging during dynamic scans (HR-intra) with high-resolution imaging obtained post dynamic scans (HR-post). Fifty-five women with pathologically proven breast cancer who underwent breast dynamic scans at 3-T MRI from February to September 2009 were enrolled in this study. Tumoral contrasts to the background breast tissue were compared by three radiologists independently in a blinded fashion. Results of visual assessment were categorized into three groups as follows: HR-intra being better (IB), equal (E), and HR-post being better (PB). The contrast to noise ratio (CNR) of the tumor and the signal to noise ratio of the normal breast gland (SNR) were compared between HR-intra and HR-post. Two patients were excluded because of poor MR imaging quality. Three radiologists separately categorized 64.2, 79.2, and 77.4 % of lesions as IB. The CNR of the tumor of HR-intra (mean ± SD = 6.9 ± 4.0) was significantly higher than that of HR-post (6.0 ± 3.7, p

Posterior reversible encephalopathy syndrome (PRES) is characterized by reversible vasogenic edema affecting the subcortical white matter of bilateral occipital and parietal lobes. We describe a case of isolated posterior fossa involvement of PRES which occurred during remission induction chemotherapy for T-cell acute lymphoblastic leukemia. Both the brainstem and cerebellum were extensively involved, but the supratentorial structures were completely spared. The follow-up magnetic resonance images revealed reversibility of most lesions. The knowledge of atypical radiological features of PRES is essential for prompt diagnosis.

To investigate the specific imaging findings of multidetector row CT (MDCT) and PET/CT with18F-FDG in cardiac dominant diffuse large B-cell lymphoma (DLBCL) in comparison with other cardiac tumours. Five patients with DLBCL and 12 patients with other cardiac tumours including pericardial tumours were retrospectively reviewed. Among the patients with other cardiac tumours, seven had metastatic tumours, three had benign tumours, and two had other malignant cardiac tumours. The location of the cardiac mass, the encasement of the coronary artery surrounded by the mass, and pericardial effusion were evaluated using MDCT. The disease activity of the cardiac tumour was also evaluated by PET/CT. Four of the five DLBCL patients had primarily right-sided cardiac lesions, which was seen significantly more frequently in DLBCL than in other cardiac tumours (p = 0.028). All cardiac DLBCL lesions were located around the atrioventricular groove and encased the coronary arteries. ECG-gated cardiac MDCT showed that there was no apparent stenosis of the coronary arteries. Large amounts of pericardial effusion were seen in all DLBCL patients. PET/CT revealed significantly higher FDG uptake in DLBCL than in other cardiac malignant tumours, with no overlap (p = 0.0007). The combination of a right-sided cardiac mass with a large pericardial effusion and no apparent stenosis of the encased coronary artery revealed by MDCT and a high maximum standard uptake value were the specific findings in cardiac dominant DLBCL.

Neuromelanin-sensitive MRI has been reported to be used in the diagnosis of Parkinson's disease (PD), which results from loss of dopamine-producing cells in the substantia nigra pars compacta (SNc). In this study, we aimed to apply a 3D turbo field echo (TFE) sequence for neuromelanin-sensitive MRI and to evaluate the diagnostic performance of semi-automated method for measurement of SNc volume in patients with PD. We examined 18 PD patients and 27 healthy volunteers (control subjects). A 3D TFE technique with off-resonance magnetization transfer pulse was used for neuromelanin-sensitive MRI on a 3T scanner. The SNc volume was semi-automatically measured using a region-growing technique at various thresholds (ranging from 1.66 to 2.48), with the signals measured relative to that for the superior cerebellar peduncle. Receiver operating characteristic (ROC) analysis was performed at all thresholds. Intra-rater reproducibility was evaluated by intraclass correlation coefficient (ICC). The average SNc volume in the PD group was significantly smaller than that in the control group at all the thresholds (P < 0.01, student t test). At higher thresholds (> 2.0), the area under the curve of ROC (Az) increased (0.88). In addition, we observed balanced sensitivity and specificity (0.83 and 0.85, respectively). At lower thresholds, sensitivity tended to increase but specificity reduced in comparison with that at higher thresholds. ICC was larger than 0.9 when the threshold was over 1.86. Our method can distinguish the PD group from the control group with high sensitivity and specificity, especially for early stage of PD.

Background Hyperintense putaminal rim (HPR) is an important magnetic resonance imaging (MRI) sign for multiple system atrophy (MSA). Recent studies have suggested that it can also be observed in normal subjects at 3 T. Whether it can be observed in normal subjects at 1.5 T is not known. This study aimed to determine whether HPR could be observed in normal subjects at 1.5 T; and if so, to establish its prevalence, the MRI characteristics, and the features which distinguish from HPR in MSA patients. Methods Axial T2-weighted images of 130 normal subjects were evaluated for the prevalence of HPR, its age and gender distribution, laterality, maximum dimension, association with hypointensity of nearby putamen, and presence of discontinuity. To distinguish from that observed in MSA, axial T2-weighted images of 6 MSA patients with predominant parkinsonism (MSA-P) and 15 MSA patients with predominant cerebellar symptoms (MSA-C) were also evaluated. The characteristics of HPR were compared between these patients and age-matched normal subjects. The mean diffusivity (MD) values of putamen were also compared. Fisher’s exact test, t-test, and one way analysis of variance were used to determine significance at corrected p Results HPR was observed in 38.5% of normal subjects. Age and gender predilection and laterality were not observed. In most cases, it occupied the full length or anterior half of the lateral margin of putamen, and was continuous throughout its length. Maximum transverse dimension was 2 mm. There was no association with hypointensity of nearby putamen. However, in MSA-P, HPR was located predominantly at the posterolateral aspect of putamen, and associated with putaminal atrophy. Discontinuity of HPR was more frequently observed in MSA-P. On visual analysis, the characteristics of HPR were similar between MSA-C patients and normal subjects. Patients with MSA of either type had significantly higher MD values of putamen than normal subjects. Conclusions HPR can be observed in 38.5% of normal subjects at 1.5 T. Thin linear hyperintensity without discontinuity, occupying the full length or anterior half of the lateral margin of the putamen, is suggestive of “normal.” In doubtful cases, measurement of the MD values of nearby putamen may be valuable.

The aim of this study was to explore whether the regional peak longitudinal (LS) and circumferential strains (CS) at the right ventricular (RV) free wall could be used to identify global RV dysfunction in relation to RV ejection fraction (RVEF) and plasma concentration of brain natriuretic peptide (BNP) in pulmonary hypertension (PH). A total of 37 consecutive patients diagnosed with PH and 13 healthy control subjects were included. Fast strain encoded and routine cine MRI was performed. The LS and CS at three RV levels were quantified and their relations with RVEF and BNP were investigated. Receiver operating characteristic (ROC) analysis was employed to assess the diagnostic utility of strain encoded MRI for the detection of low RVEF. Significant correlations with LS were observed for RVEF and BNP. Compared to CS, LS showed better correlation with RVEF. The mid-ventricular level of RV was the most sensitive site for evaluation of RV dysfunction. According to our ROC analysis, LS showed higher sensitivity and specificity to detect low RVEF. Compared to CS, LS showed stronger correlations with RVEF and BNP and could be a good detector of RV dysfunction in PH.

We report 2 rare cases of primary cardiac paraganglioma demonstrated with multimodality imaging. Both a 46-year-old woman who presented with hypertension (case 1) and a 46-year-old woman without any symptoms (case 2) had mediastinal tumors depicted by CT and MRI. Both cases showed intense focal uptakes in the tumors with iodine-123-meta-iodobenzylguanidine SPECT. Case 2 also underwent 18F-FDG PET/CT and revealed a focal uptake. CT angiography detected the arterial feeder and venous drainages, information that was useful for the operation. After surgical removal, pathology confirmed primary cardiac paraganglioma in both cases. 18F-FDG PET/CT was also useful in ruling out residual or recurrent tumors.

Background and Purpose - Recent studies have disclosed that inflamed and vulnerable plaques in the carotid artery are at high risk for subsequent ischemic stroke, suggesting the importance of non-invasive diagnostic modalities with high sensitivity and specificity to detect them in patients with carotid artery stenosis. Although many investigators have reported that MR imaging is a useful tool to predict the components of carotid plaque, its validity is not established. On the other hand, 18 F-fluorodeoxyglucose (FDG) positron emission tomography (PET) may be an alternative modality to directly identify the inflamed plaque in carotid artery stenosis. Therefore, this study was aimed to evaluate the validity of MR imaging and 18 F-FDG PET to predict the components of carotid plaques. Methods - Totally 19 patients were included in this study. Prior to carotid endarterectomy (CEA), 18 F-FDG PET, black-blood fat-suppressed T1-weighted (FS-T1) imaging, and 3-dimensional time-of-flight (TOF) imaging were performed in all of them. During CEA, macroscopic observation of carotid plaque was performed under surgical microscope. The specimens were stained with primary antibodies against CD68 and MMP9. Results - 18 F-FDG PET revealed that 11 of 19 patients had the carotid plaque with significantly high 18 F-FDG uptake (SUVmax >2.0). All of them had lipid-rich soft plaque with strong immunoreactivity against CD68 and MMP9. Its sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) to identify lipid-rich soft plaque were all 100%. On the other hands, 6 out of 19 patients had the carotid plaque with high signal intensity on both FS-T1 and TOF imaging. Carotid plaque had a large intraplaque hematoma in these 6 patients. Their sensitivity, specificity, PPV, and NPV to identify intraplaque hematoma were 86%, 100%, 100%, and 92%, respectively. Conclusions - These findings strongly suggest that MRI and 18 F-FDG PET are complementary to predict the components of carotid plaque. The former would be useful to detect vulnerable plaque with subintimal hemorrhage, and the latter would be sensitive to identify vulnerable plaque with lipid-rich component. Therefore, combination of these two modalities may be quite valuable to non-invasively predict the carotid plaque at higher risk for subsequent ischemic stroke.