Clinical significance of corrected relative flow reserve derived from 13N-ammonia positron emission tomography combined with coronary computed tomography angiography.

BACKGROUND: This study evaluated corrected relative flow reserve (RFR) derived from 13N-ammonia positron emission tomography (PET) combined with coronary computed tomography angiography (CTA). METHODS: We analyzed 61 patients who underwent coronary CTA, 13N-ammonia PET, and invasive coronary angiography. Triple-vessel disease were excluded. Conventional RFRs were calculated as the ratio of hyperemic myocardial blood flow (hMBF) of hypoperfusion areas to those of non-ischemic lesions. Corrected RFRs were calculated using PET and coronary CTA to adjust coronary territories to their feeding vessels. Diagnostic performance was compared to detect obstructive coronary lesions. RESULTS: Of the 180 vessels analyzed, 50 were diagnosed as obstructive lesions (≥ 70% stenosis and/or fractional flow reserve value ≤ 0.8). The coronary flow reserve (CFR), hMBF, conventional RFR, and corrected RFR of obstructive lesions were significantly lower than those of non-obstructive lesions. In receiver operating characteristic curve analysis, these quantitative PET measurements had area under the curve of 0.67, 0.71, 0.89, and 0.92, respectively. Diagnostic performance differences between corrected and conventional RFR were not statistically significant. CONCLUSION: In patients with single or double vessel disease, indices of RFR, with or without coronary angiographic guidance of the reference coronary territory, are better discriminators of flow-limiting stenoses than hMBF and CFR.

Successful treatment of mixed (mainly cancer) pain by tramadol preparations.

The patient, a 70-year-old Japanese woman diagnosed with parotid gland cancer, underwent wide excision and reconstruction (facial nerve ablation, nerve transposition). At 1 month after the surgery, she was brought to our hospital's pain medicine department because her postoperative pain and cancer-related pain were poorly controlled. She had already been prescribed a tramadol (37.5 mg)/acetaminophen (325 mg) combination tablet (5 tablets/day). However, in addition to the continuous pain in her face and lower limbs, she was troubled by a trigeminal neuralgia-like prominence ache. Because this pain could not be controlled by an increase to eight combination tablets per day, we switched her medication to a tramadol capsule. At 11 months post-surgery, we then switched her medication to an orally disintegrating tramadol tablet to improve medication adherence of the drug. From 14 months post-surgery, the patient also used a sustained-release tramadol preparation, and she was then able to sleep well. Her current regimen is an orally disintegrating sustained-release tablet combination (total 300 mg tramadol) per day, and she achieved sufficient pain relief. Because tramadol is not classified as a medical narcotic drug, it widely available and was shown here to be extremely useful for the treatment of our patient's mixed (mainly cancer) pain. J. Med. Invest. 64: 311-312, August, 2017.

Blood supply during Japan's 1995 Hanshin-Awaji Earthquake.

On January 17, 1995, a magnitude 7.3 earthquake occurred in southern Hyogo Prefecture, a substantially urban area of Japan's main island, Honshu. Now known as the Hanshin-Awaji Earthquake, this disaster damaged or destroyed 639 686 houses and took 6434 lives. Within the disaster area, the Japanese Red Cross (JRC) Hyogo Blood Center had regional responsibilities for collecting, testing, processing, storing, and distributing blood components, including red blood cells (RBCs), fresh frozen plasma (FFP) and platelet concentrates (PLTs). Platelet shakers collapsed, forcing the discard of 103 PLT bags (1125 units) that could not be temperature-controlled or agitated. RBCs and FFP in refrigerated and frozen storage, respectively, remained in temperature control with the help of dry ice imported from non-affected areas. Local blood collection was suspended and replaced by products from other blood centers. Local demand for blood components decreased to 66% of comparable pre-quake demand. Emergent supplies rather than reserved supplies of blood components were markedly increased after the earthquake. Communication infrastructure damage prompted JRC Hyogo Blood Center to send blood delivery vehicles loaded with RBCs and FFP on a circuit of main hospitals in the affected area. Local blood donation and processing resumed 20 days after the quake. In retrospect, a nationally coordinated system of production and distribution demonstrated JRC's ability to meet transfusion demand after the 1995 Hanshin-Awaji Earthquake, and prompted changes in anticipation of subsequent disasters.

Radiological features of cerebellar glioblastoma.

BACKGROUND AND PROPOSE: Glioblastoma (GBM) is the most common type of malignant primary central nervous system tumor in adults; however, the prevalence of GBM arising in the cerebellum is extremely low. This study aimed to demonstrate the radiological features of cerebellar GBMs, including computed tomography (CT), magnetic resonance imaging (MRI), diffusion-weighted imaging (DWI), and (18)F-fluorodeoxyglucose (FDG)- and (11)C methionine (MET)-positron emission tomography (PET) findings. MATERIALS AND METHODS: We retrospectively reviewed seven patients with cerebellar GBM (six men and one woman: mean age: 56 years, range: 18-73 years). We reviewed medical records and radiological data, including preoperative CT, MRI and PET. All patients underwent CT and MRI. DWI data were acquired in four patients. Three patients underwent FDG- and MET-PET examinations. All patients underwent total or subtotal tumor resection and received pathological diagnoses. RESULTS: Four patients had imaging findings consistent with GBM and received preoperative cerebellar GBM diagnoses. Two patients exhibited homogeneous patchy and nodular enhancement without necrosis on MRI, which resembled malignant lymphoma and metastasis. One case exhibited Lhermitte-Duclos disease-like parallel linear striations (i.e.,"tiger-striped" appearance). Although the imaging findings of these three patients were inconsistent with GBM, pathological diagnosis confirmed cerebellar GMB. CONCLUSIONS: Some evaluated cases of cerebellar GBM did not exhibit the common CT, MRI, and PET findings of supratentrial GBM, leading to considerable difficulty with preoperative differential diagnosis.

Quantitative analysis of myocardial 18F-fluorodeoxyglucose uptake by PET/CT for detection of cardiac sarcoidosis.

BACKGROUND: Imaging with fluorodeoxyglucose (FDG) PET/CT is used to diagnose patients with cardiac sarcoidosis (CS). However, its specificity is relatively low. We aimed to demonstrate that higher diagnostic specificity for CS can be obtained using quantitative methodology to analyze PET/CT. METHODS: A total of 125 consecutive patients with suspected CS were enrolled in the study. After clinical assessment and cardiac imaging studies, the patients underwent FDG PET/CT imaging after eating a low-carbohydrate diet followed by an overnight fast lasting ≥ 18 h. For visual analysis, fusion and maximum intensity projection images were reviewed. For quantitative analysis, the maximum standardized uptake value (SUV max) within the myocardium was obtained. RESULTS: Of the 92 patients who met study inclusion criteria, 37 were diagnosed with CS. Myocardial SUV max was significantly higher in patients with CS compared with non-CS patients (9.5 ± 4.8 vs. 3.0 ± 1.7, p < 0.0001). The area under the curve by receiver operating characteristic analysis was 0.960 for SUV max. Using a cut-off value of 4.0, the sensitivity was 97.3% and specificity was 83.6% for diagnosing CS, which is more accurate than visual analysis. Moreover, SUV max was the only significant predictor of CS among 10 clinical and imaging variables. In 18 patients who received steroid therapy with a mean follow-up duration of 6.4 ± 5.2 months, SUV max significantly decreased from 9.8 ± 4.2 to 5.5 ± 3.5 (p = 0.003). CONCLUSION: When evaluated by quantification of myocardial SUV max, FDG PET/CT imaging provides high sensitivity and specificity for diagnosing CS.

Detection of influenza vaccine effectiveness among nursery school children: Lesson from a season with cocirculating respiratory syncytial virus.

In the winter influenza epidemic season, patients with respiratory illnesses including respiratory syncytial virus (RSV) infections increase among young children. Therefore, we evaluated the effectiveness of influenza vaccine against influenza-like illness (ILI) using a technique to identify outbreaks of RSV infection and to distinguish those patients from ILI patients. The study subjects were 101 children aged 12 to 84 months attending nursery school. We classified the cases into 6 levels based on the definitions of ILI for outcomes. We established observation periods according to information obtained from regional surveillance and rapid diagnostic tests among children. Multivariate odds ratios (ORs) for each case classification were obtained using a logistic regression model for each observation period. For the entire observation period, ORs for cases with fever plus respiratory symptoms were reduced marginally significantly. For the local influenza epidemic period, only the OR for the most serious cases was significantly decreased (0.20 [95%CI: 0.04-0.94]). During the influenza outbreak among the nursery school children, multivariate ORs for fever plus respiratory symptoms decreased significantly (≥ 38.0°C plus ≥ one symptoms: 0.23 [0.06-0.91), ≥ 38.0°C plus ≥ 2 symptoms: 0.21 [0.05-0.85], ≥ 39.0°C plus ≥ one symptoms: 0.18 [0.04-0.93] and ≥ 39.0°C plus ≥ 2 symptoms: 0.16 [0.03-0.87]). These results suggest that confining observation to the peak influenza epidemic period and adoption of a strict case classification system can minimize outcome misclassification when evaluating the effectiveness of influenza vaccine against ILI, even if influenza and RSV cocirculate in the same season.

Variation in avian brain shape: relationship with size and orbital shape.

There is wide variation in brain shape among birds. Differences in brain dimensions reflect species-specific sensory capacities and behavioral repertoires that are shaped by environmental and biological factors during evolution. Most previous studies aimed at defining factors impacting brain shape have used volumetric or linear measurements. However, few have explored the quantitative indices of three-dimensional (3D) brain geometry that are absolutely imperative to understanding avian evolutionary history. This study aimed: (i) to explore the relationship between brain shape and overall brain size; and (ii) to assess the relationship between brain shape and orbital shape. Avian brain endocasts were reconstructed from computed tomography images and analyzed using 3D geometric morphometrics. Principal component analysis revealed dominant regional variations in avian brain shape and shape correlations between the telencephalon and cerebellum, between the cerebellum and myelencephalon, and between the diencephalon and optic tectum. Brain shape changes relative to total brain size were determined by multivariate regression analysis. Larger brain size was associated with a relatively slender telencephalon and differences in brain orientation. The correlation between brain shape and orbital shape was assessed by two-block partial least-squares analysis. Relatively round brains with a ventrally flexed brain base were associated with rounder orbits, while narrower brains with a flat brain base were associated with more elongated orbits. The shapes of functionally associated avian brain regions are correlated, and orbital size and shape are dominant factors influencing the overall shape of the avian brain.

Optimization of scan parameters for T1-FLAIR imaging at 1.5 and 3T using computer simulation.

PURPOSE: We attempted to optimize scan parameters for T1-weighted fluid-attenuated inversion recovery (T1-FLAIR) sequence at 3 and 1.5 tesla (T) using computer simulation. METHODS: We measured the T1 and T2 relaxation time values (T1v and T2v) of gray (GM) and white matter (WM) at 3 and 1.5T, generated computer-simulated T1-FLAIR (CS-T1-FLAIR) images using those values, and compared the simulated and actual T1-FLAIR images to verify the contrast reliability of our computer simulation. We mathematically and visually evaluated CS-T1-FLAIR images at various repetition times (TR) and echo times (TE). RESULTS: At 3T, the measured relaxation values for GM were T1v, 1524 ms, and T2v, 85 ms, and for WM, T1v, 750 ms, and T2v, 65 ms. At 1.5T, the measured relaxation values for GM were T1v, 1251 ms, and T2v, 99 ms, and for WM, T1v, 623 ms, and T2v, 75 ms. Contrast of CS-T1-FLAIR and actual T1-FLAIR images was identical. An optimal TR of 3140 ms was determined for T1-FLAIR at 3T and 2440 ms at 1.5T based on mathematical evaluation. The optimal TR ranges were 2400 to 3900 ms at 3T and 1800 to 3200 ms at 1.5T based on visual assessment of CS-T1-FLAIR. A shorter TE provided better T1 contrast. CONCLUSION: We optimized T1-FLAIR by focusing on its most important scan parameters using computer simulations and determined that a longer TR was suitable at 3T than at 1.5T. Our computer simulation was useful for determining the optimal scan parameters.

Accuracy of diffusion tensor magnetic resonance imaging-based tractography for surgery of gliomas near the pyramidal tract: a significant correlation between subcortical electrical stimulation and postoperative tractography.

BACKGROUND: Diffusion tensor (DT) imaging-based fiber tracking is a noninvasive magnetic resonance technique that can delineate the course of white matter fibers. OBJECTIVE: To evaluate the accuracy and usefulness of this DT imaging-based fiber tracking for surgery in patients with gliomas near the pyramidal tract (PT). METHODS: Subjects comprised 32 patients with gliomas near the PT. DT imaging-based fiber tracks of the PT were generated before and within 3 days after surgery in all patients. A tractography-integrated navigation system was used during the operation. Cortical and subcortical motor-evoked potentials (MEPs) were also monitored during resection to maximize the preservation of motor function. The threshold intensity for subcortical MEPs was examined by searching the stimulus points and changing the stimulus intensity. Minimum distance between the resection border and the illustrated PT was measured on postoperative tractography. RESULTS: In all subjects, DT imaging-based tractography of the PT was successfully performed, preoperatively demonstrating the relationship between tumors and the PT. With the use of the tractography-integrated navigation system and intraoperative MEPs, motor function was preserved postoperatively in all patients. A significant correlation was seen between threshold intensity for subcortical MEPs and the distance between the resection border and PT on postoperative DT imaging. CONCLUSION: DT imaging-based fiber tracking is a reliable and accurate method for mapping the course of subcortical PTs. Fiber tracking and intraoperative MEPs were useful for preserving motor function in patients with gliomas near the PT.

Evaluation of intraoperative brain shift using an ultrasound-linked navigation system for brain tumor surgery.

Image-guided neurosurgery using navigation systems is an essential tool to increase accuracy in brain tumor surgery. However, brain shift during surgery has remained problematic. The present study evaluated the utility of a new ultrasound (US)-linked navigation system for brain tumor surgery in 64 patients with intracranial tumors. The navigation system consisted of a StealthStation navigation system, a SonoNav system, and a standard US scanner. This system determines the orientation of the US images and reformats the images from preoperative computed tomography (CT) or magnetic resonance (MR) imaging to match the US images. The system was used intraoperatively to measure brain shift several times, using the results to guide tumor resection. US-linked navigation provided information regarding brain shift, and extent of tumor resection during surgery. Evaluation of brain shift was easily achieved in all patients, without using intraoperative CT or MR imaging. Accurate information regarding the true anatomical configuration of the patient could be obtained in all phases of the operation. Magnitude of brain shift increased progressively from pre- to post-resection and depended on the type of cranial structure. Integration of the US scanner with the navigation system allowed comparisons between the intraoperative US and preoperative images, thus improving interpretation of US images. The system also improved the rate of tumor resection by facilitating the detection of remnant tumor tissue. This US-linked navigation system provides information on brain shift, and improves the accuracy and utility of image-guided surgery.

[Pitfalls in diagnosing cerebrovascular diseases using magnetic resonance angiography].

Magnetic resonance angiography (MRA) is one of the important methods for neurological imaging. Currently, time-of-flight (TOF) MRA, phase contrast (PC) MRA, and contrast-enhanced MRA are being studied for their potential for diagnosing cerebrorascular diseases. Many specific flow signal patterns and artifacts are observed on MRI. MRA has recently been developed on the basis of the studies on the MR flow phenomenon. However, flow artifacts are observed even in MRA, and most of the pitfalls associated with MRA have arisen due to the MR flow phenomenon. To avoid false-negative and false-positive results in MRA, it is very important to understand the MR flow phenomenon and flow artifacts. The purpose of this paper is to explain the MR flow phenomenon, flow artifacts, and the principle of MRA. Furthermore, the technical development of TOF MRA and the pitfalls observed while evaluating clinical cases have been discussed. This paper also clarifies MR flow artifacts and the current status of cerebral 3D TOF MRA, and explains how to avoid false negative and false positive results in MRA.

A simple and accurate method for estimating the brain volume of birds: possible application in paleoneurology.

Brain volume provides useful information for a discussion of the behavior and cognition of animals. Obtaining accurate brain volume from extinct species is difficult, however, because fossils are often partly or largely broken. The purpose of this study was to estimate the brain volumes of birds using scant osteological information. Brain volumes were calculated from magnetic resonance or computed tomography images of bird heads from 27 species representing 12 orders. Correlations between brain volume and maximum brain width, length, and height were assessed using multiple regression analysis and correlation analysis. Brain volume and maximum brain width show a strong linear correlation. Thus, in the extant Neornithes (modern birds), it is possible to estimate brain volume accurately from the maximum brain width using a standard line. We also used this method to calculate the brain volumes of fossil species to assess whether it can be used for extinct species. The brain volume values estimated by this method fit satisfactorily with the reported values in extinct Neornithes, suggesting that the method is applicable not only for extant, but also for extinct Neornithes and might be a powerful tool to obtain information not previously available from fossil specimens.

Diagnosis of unruptured intracranial aneurysms: 3T MR angiography versus 64-channel multi-detector row CT angiography.

BACKGROUND AND PURPOSE: We compared 3-dimensional time-of-flight magnetic resonance angiography (3D TOF MRA) using a 3-tesla (T) MR unit with 64-channel multi-detector row computed tomographic angiography (64-MDCTA) for detection and characterization of angiographically proven unruptured intracranial aneurysms. METHODS: Thirty-eight patients with 47 aneurysms and 8 patients without aneurysms underwent 3T, 3D TOF MRA; 64-MDCTA; and intra-arterial angiography. As a first study, 3 radiologists blinded to pertinent clinical information independently reviewed MRA and CTA images. We evaluated diagnostic accuracy using an alternative free-response receiver operating characteristic (AFROC) analysis and evaluated the sensitivity and specificity of each technique. Next, 2 radiologists used volume-rendering images generated from MRA or CTA data to evaluate the morphology of the 47 aneurysms detected, and MRA and CTA results were compared. Three-dimensional digital angiography (DA) images were used as the standard of reference. RESULTS: On the AFROC analysis, the value of the mean area under the AFROC curve (A(1)) was 0.91 for both modalities. Mean sensitivity of 89% and specificity of 76% for MRA were not significantly different from sensitivity of 87% and specificity of 79% for CTA. Therefore, when used to evaluate aneurysmal morphology, both modalities appear satisfactory for determining these vascular anomalies. CONCLUSION: Three-tesla, 3D TOF MRA and 64-MDCTA are excellent modalities with high diagnostic accuracy for evaluating unruptured intracranial aneurysms and no significant difference between them in diagnostic performance.

Visualization of treatment response in tumors by use of dynamic contrast-enhanced magnetic resonance imaging.

Our goal in this study was to present a method for generating functional parametric maps of hemodynamic parameters in tumors and a visualization method for assessing treatment response by use of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI). A total of 13 patients with musculoskeletal tumors were included in this study. First, tumor blood flow (F(T)) maps were generated from DCE-MRI data by use of deconvolution analysis, and K(1), k(2), and f were obtained from a two-compartment model, where K(1) and k(2) denote the rate constant for the transfer of contrast agent from blood to tissue and from tissue to blood, respectively, and f is the fraction of the blood volume. Images were generated by application of the linear least squares method pixel by pixel. Furthermore, the images of the distribution volume (V(d)) and permeability-surface area product (PS) were obtained from the relations V(d) = K(1)/k(2) and PS = -F(T) x ln(1 - K(1)/(F(T)), respectively. Second, two-dimensional (2D) plots were generated with V(d) and K(1) placed on the x- and y-axes, and three-dimensional (3D) plots were generated by the addition of PS on the z-axis. In the case of good responders whose biopsied specimens revealed tumor necrosis greater than 90%, both 2D and 3D plots gradually approached the origin after an increasing number of treatments. On the other hand, in the case of non-responders whose biopsied specimens showed little chemotherapeutic effect, large changes were not observed in either plot. In conclusion, our method will be promising for evaluating the treatment response in tumors visually.

Sensitivity of an eight-element phased array coil in 3 Tesla MR imaging: a basic analysis.

PURPOSE: To evaluate the performance advantages of an 8-element phased array head coil (8 ch coil) over a conventional quadrature-type birdcage head coil (QD coil) with regard to the signal-to-noise ratio (SNR) and image uniformity in 3 Tesla magnetic resonance (MR) imaging. MATERIALS AND METHODS: We scanned a phantom filled with silicon oil using an 8 ch coil and a QD coil in a 3T MR imaging system and compared the SNR and image uniformity obtained from T(1)-weighted spin echo (SE) images and T(2)-weighted fast SE images between the 2 coils. We also visually evaluated images from 4 healthy volunteers. RESULTS: The SNR with the 8 ch coil was approximately twice that with the QD coil in the region of interest (ROI), which was set as 75% of the area in the center of the phantom images. With regard to the spatial variation of sensitivity, the SNR with the 8 ch coil was lower at the center of the images than at the periphery, whereas the SNR with the QD coil exhibited an inverse pattern. At the center of the images with the 8 ch coil, the SNR was somewhat lower, and that distribution was relatively flat compared to that in the periphery. Image uniformity varied less with the 8 ch coil than with the QD coil on both imaging sequences. CONCLUSION: The 8 ch phased array coil was useful for obtaining high quality 3T images because of its higher SNR and improved image uniformity than those obtained with conventional quadrature-type birdcage head coil.

Measurement of tumor blood flow using dynamic contrast-enhanced magnetic resonance imaging and deconvolution analysis: a preliminary study in musculoskeletal tumors.

OBJECTIVE: To measure tumor blood flow (TBF) using dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI). METHODS: A DCE-MRI was performed using inversion recovery-preparation fast-field echo sequences. Dynamic data were obtained every 3.2 seconds for 2 minutes, immediately after gadolinium injection. In 14 patients with malignant musculoskeletal tumors, TBF maps were generated pixel-by-pixel by deconvolution analysis. For preclinical studies, muscle blood flow in 5 volunteers and signal intensities of different gadolinium concentrations were measured. RESULTS: There was a good linear relationship between signal intensities and gadolinium concentrations (r = 0.989, P < 0.001, at gadolinium concentrations

Subcutaneous fibrolipoma in the back.

A 65-year-old man presented with a subcutaneous giant mass in his upper back. The tumor had a massive fatty and non-adipose component that enhanced heterogeneously on contrast-enhanced computed tomography and magnetic resonance imaging. Therefore, the lesion was initially thought to be a liposarcoma or spindle cell lipoma. After surgery, the tumor was histologically diagnosed as a fibrolipoma. Subcutaneous fibrolipoma is a rare neoplasm that is defined as a subtype of lipoma.

Assessment of left ventricular wall motion using 16-channel multislice computed tomography: comparison with left ventriculography.

PURPOSE: Using the raw data from coronary computed tomography (CT) angiography, multislice CT (MSCT) can be used to evaluate cardiac function. However, the accuracy of left ventricular (LV) wall motion assessment by MSCT has not been thoroughly investigated. We investigated whether 16-channel MSCT could accurately assess LV wall motion by comparing its results with those of conventional biplane left ventriculography (LVG). MATERIALS AND METHODS: The study included 20 patients with various kinds of heart disease. All patients underwent both contrast-enhanced MSCT and biplane LVG. Using a retrospective electrocardiography-gating technique, 10 phases over one cardiac cycle were extracted. The left ventricle was divided into seven segments according to the American Heart Association classification. Wall motion was scored as follows: 1, normal; 2, mild to moderate hypokinesis; 3, severe hypokinesis; 4, akinesis; 5, dyskinesis; and 6, aneurysm. The scores obtained by MSCT were compared with those obtained by LVG. The wall motion scores were analyzed using the chi-squared independence test (6 x 6 contingency table). RESULTS: Wall motion could be assessed in all segments of the 20 patients using interactive multiplanar animation. Among a total of 140 segments in 20 patients, scores in 118 were concordant between MSCT and LVG (118/140, 84.3%). CONCLUSION: The 16-MSCT can accurately assess LV wall motion.

Heterogeneity of posterior limbic perfusion in very early Alzheimer's disease.

PURPOSE: This study was designed to quantify the heterogeneity of cerebral perfusion on SPECT images in elderly controls and Alzheimer's disease (AD) patients in mild stage using a three-dimensional fractal analysis (3D-FA). MATERIAL AND METHOD: Seventy-five patients with possible and probable AD based on the NINCDS/ADRDA criteria, and thirty-one elderly controls underwent 99mTc-HMPAO SPECT scanning. Dementia severity was assessed using the clinical dementia rating (CDR). Patients with CDR scores of 0.5 (n=33) were classified as "very early" and those with CDR 1 (n=42) as "early". We delineated the SPECT images using 2 cutoffs (35% and 50% cutoffs of the maximal voxel radioactivity) and measured the number of voxels in the areas included by the contours obtained with each cutoff level. The fractal dimension (FD) was calculated by relating the logarithms of cutoff level and the number of voxels. Posterior limbic images were reconstructed at 30 degrees positive to the coronal plane, and posterior limbic FD was calculated. RESULT: Posterior limbic FD for early AD, very early AD, and control groups were 1.03+/-0.16, 1.02+/-0.17, and 0.87+/-0.14 (P=0.001 versus early AD group, P=0.001 versus very early AD). Use of the posterior limbic FD and the ratio of posterior limbic FD to total FD separated very early AD patients from controls with a sensitivity of 76% and a specificity of 81%. CONCLUSION: 3D-FA indicated significant differences in the heterogeneity of CBF distribution between patients with AD in mild stage and elderly controls. Posterior limbic FD may be useful for easily and objectively distinguishing patients with very early AD from aging people.

Image fusion of coronary tree and regional cardiac function image using multislice computed tomography.

BACKGROUND: Although trials of image fusion, such as positron emission computed tomography and multislice spiral computed tomography (MSCT), have already demonstrated clinical usefulness, fusion of the coronary artery image and functional image by MSCT alone has not been reported yet. Here, a new idea of data analysis is proposed in which both regional cardiac function and the responsible coronary arteries can be assessed by a fused image. METHODS AND RESULTS: The study group comprised 5 patients with coronary artery disease. At the first procedure, 3 dimensional (D) volume rendering coronary artery (3D-CTA) was extracted. At the second procedure, the systolic regional wall thickening was calculated and the color 3D functional surface map of systolic wall thickening (3D-SWT) was generated. At the final procedure, 3D-SWT was superimposed on the left ventricular surface with 3D-CTA using a transparency. In all 5 patients, image fusion of the coronary tree and cardiac function was correctly generated. Image fusion can be displayed as clear 3D images, offering better orientation to help assess both the coronary artery and regional function. CONCLUSIONS: Image fusion of coronary computed tomography angiography and the functional map by MSCT is potentially a new method of assessing both the coronary artery and cardiac function.