Cerebral amyloid-ß-related angiitis without cerebral microbleeds in a patient with subarachnoid hemorrhage.

Amyloid-ß-related angiitis (ABRA), a subtype of cerebral amyloid angiopathy (CAA), is vasculitis occurring in relation to amyloid-ß (Aß) deposition in the walls of intracranial blood vessels. ABRA is presumed to be caused by some immune response to the deposited Aß. An 81-year-old man on oral anticoagulant therapy complained of headache, nausea, and difficulty with standing after a head injury. Head computed tomography revealed subcortical bleeding in the right temporoparietal lobe, and 3 days after admission, magnetic resonance imaging (MRI) showed subarachnoid hemorrhage (SAH) around the hematoma. Cerebral microbleeds, a characteristic of CAA, were not detected on MRI. On worsening of his symptoms, intracranial brain biopsy and hematoma removal were performed. Intraoperative rapid diagnosis with a frozen section suspected vasculitis, which enabled the prompt initiation of steroid therapy. He was pathologically diagnosed with ABRA (granulomatous angiitis) using a formalin-fixed paraffin-embedded section. Vasculitis was prominent around blood vessels in the pia matter covering the cerebrum. In this case, the inflammatory cells seemed to appear via the subarachnoid space following cerebral hemorrhage and SAH. ABRA seemed to be developed by intracranial hemorrhage in this case.

Fishbone migration to bile ducts after pancreaticoduodenectomy: a case series.

We reviewed six cases suspected of having fish bones in the bile ducts on follow-up CT following pancreaticoduodenectomy. The period from surgery to CT examination in which fishbone migration was first suspected ranged from 282 to 1157 days with a median of 517 days. The fish bone in the bile duct disappeared in five out of six cases on subsequent CT. One case was complicated by hepatolithiasis, and the other five cases showed no biliary complications. In two cases, wandering of fish bones in the jejunal limb was observed on CT images before their migration into the bile ducts. Asymptomatic migration of fish bones to the bile ducts following pancreaticoduodenectomy is not rare, but serious complications can occasionally occur. Indications of intervention may be controversial in asymptomatic cases, but once fish bones are observed in the biliary tree or the jejunal limb, dietary instructions advising not to swallow fish bones may be a good option to prevent complications.

Disconnection Surgery for Intractable Epilepsy with a Structural Abnormality in the Medial Posterior Cortex.

BACKGROUND: The lesionectomy is a general surgical procedure for treating focal epilepsy resulting from a structural abnormality, but a favorable outcome cannot be achieved in some patients, especially patients whose symptomatogenic zone is located in remote regions. Herein we propose the surgical disconnection of the seizure propagation pathway, which consists of short and long associating fibers linking the epileptogenic zone to the remote symptomatogenic zone, as an effective method of achieving favorable seizure outcomes in patients with posterior cortex epilepsy. METHODS: Three patients with intractable epilepsy showing a structural abnormality in the medial posterior cortex participated in this study. Their habitual seizures were complex partial seizures stemming from remote symptomatogenic zones. Seizure propagation-related fibers were assumed by non-invasive examination and semiology. RESULTS: Cingulum and superior/inferior longitudinal fasciculus were considered to form main seizure propagation pathway. Based on the preoperative assumption and the intraoperative intracranial electroencephalogram findings, a lesionectomy and corticectomy were performed for 2 patients while a clusterectomy and corticectomy were performed for the remaining patient. The resection area was extended in the direction of the association fibers to disconnect the remote symptomatogenic zone completely from the epileptogenic zone. Engel class I was achieved in all the patients. CONCLUSION: The current study suggested that assuming the presence of association fibers was an important factor for achieving a favorable outcome in the surgical treatment of posterior cortex epilepsy. Though further study is required, disconnection surgery is recommended as a treatment option for cases in which the epileptogenic zone is located in an eloquent area.

Data for behavioral results and brain regions showing a time effect during pair-association retrieval.

The current data article provides behavioral and neuroimaging data for the research article "Relatedness-dependent rapid development of brain activity in anterior temporal cortex during pair-association retrieval" (Jimura et al., 2016) [1]. Behavioral performance is provided in a table. Fig. 2 of the article is based on this table. Brain regions showing time effect are provided in a table. A statistical activation map for the time effect is shown in Fig. 3C of the article.

Lateral-Medial Dissociation in Orbitofrontal Cortex-Hypothalamus Connectivity.

The orbitofrontal cortex (OFC) is involved in cognitive functions, and is also closely related to autonomic functions. The OFC is densely connected with the hypothalamus, a heterogeneous structure controlling autonomic functions that can be divided into two major parts: the lateral and the medial. Resting-state functional connectivity has allowed us to parcellate the cerebral cortex into putative functional areas based on the changes in the spatial pattern of connectivity in the cerebral cortex when a seed point is moved from one voxel to another. In the present high spatial-resolution fMRI study, we investigate the connectivity-based organization of the OFC with reference to the hypothalamus. The OFC was parcellated using resting-state functional connectivity in an individual subject approach, and then the functional connectivity was examined between the parcellated areas in the OFC and the lateral/medial hypothalamus. We found a functional double dissociation in the OFC: the lateral OFC (the lateral orbital gyrus) was more likely connected with the lateral hypothalamus, whereas the medial OFC (the medial orbital and rectal gyri) was more likely connected with the medial hypothalamus. These results demonstrate the fundamental heterogeneity of the OFC, and suggest a potential neural basis of the OFC-hypothalamic functional interaction.

Relatedness-dependent rapid development of brain activity in anterior temporal cortex during pair-association retrieval.

Functional MRI studies have revealed that the brain activity in the anterior temporal cortex during memory retrieval increases over months after memory encoding. Behavioral evidence has demonstrated that long-term memory can sometimes be consolidated more rapidly in one or two days. In the present functional MRI study, we manipulated the relatedness between paired faces to be retrieved in a pair-association task. The brain activity in the anterior temporal cortex during retrieval of paired associates increased rapidly in one day, as shown in previous studies. We found that the speed of the brain activity development was dependent on the level of semantic relatedness of paired faces. The results suggest that the semantic relatedness enhances the speed of formation of memory representation in the anterior temporal cortex.

Energy landscapes of resting-state brain networks.

During rest, the human brain performs essential functions such as memory maintenance, which are associated with resting-state brain networks (RSNs) including the default-mode network (DMN) and frontoparietal network (FPN). Previous studies based on spiking-neuron network models and their reduced models, as well as those based on imaging data, suggest that resting-state network activity can be captured as attractor dynamics, i.e., dynamics of the brain state toward an attractive state and transitions between different attractors. Here, we analyze the energy landscapes of the RSNs by applying the maximum entropy model, or equivalently the Ising spin model, to human RSN data. We use the previously estimated parameter values to define the energy landscape, and the disconnectivity graph method to estimate the number of local energy minima (equivalent to attractors in attractor dynamics), the basin size, and hierarchical relationships among the different local minima. In both of the DMN and FPN, low-energy local minima tended to have large basins. A majority of the network states belonged to a basin of one of a few local minima. Therefore, a small number of local minima constituted the backbone of each RSN. In the DMN, the energy landscape consisted of two groups of low-energy local minima that are separated by a relatively high energy barrier. Within each group, the activity patterns of the local minima were similar, and different minima were connected by relatively low energy barriers. In the FPN, all dominant local minima were separated by relatively low energy barriers such that they formed a single coarse-grained global minimum. Our results indicate that multistable attractor dynamics may underlie the DMN, but not the FPN, and assist memory maintenance with different memory states.

A pairwise maximum entropy model accurately describes resting-state human brain networks.

The resting-state human brain networks underlie fundamental cognitive functions and consist of complex interactions among brain regions. However, the level of complexity of the resting-state networks has not been quantified, which has prevented comprehensive descriptions of the brain activity as an integrative system. Here, we address this issue by demonstrating that a pairwise maximum entropy model, which takes into account region-specific activity rates and pairwise interactions, can be robustly and accurately fitted to resting-state human brain activities obtained by functional magnetic resonance imaging. Furthermore, to validate the approximation of the resting-state networks by the pairwise maximum entropy model, we show that the functional interactions estimated by the pairwise maximum entropy model reflect anatomical connexions more accurately than the conventional functional connectivity method. These findings indicate that a relatively simple statistical model not only captures the structure of the resting-state networks but also provides a possible method to derive physiological information about various large-scale brain networks.

Functional relevance of micromodules in the human association cortex delineated with high-resolution FMRI.

Recent advancement of resting-state functional connectivity magnetic resonance imaging (MRI) has provided a method for drawing boundaries of brain areas. However, it remains to be elucidated how the parcellated areas in the association cortex relate to the spatial extent of the brain activation which ought to reflect a functional unit in the neural network supporting that particular function. To address this issue, in the present study, we first mapped boundaries and 2 adjacent activations in the human inferior frontal cortex, and then examined the spatial relationship between the boundaries and the 2 activations. The boundaries mapped with high-resolution functional magnetic resonance imaging revealed a collection of micromodules, the size of which was approximately only 12 mm on average, much smaller than the Brodmann areas. Each of the 2 activations associated with 2 functions, response inhibition and feedback processing, was smaller in size than the micromodules. By comparing the spatial patterns between the boundaries and the 2 activations, it was revealed that the brain activations were less likely to be located on the boundaries. These results suggest the functional relevance of the areas in the association cortex delineated by the boundary mapping method based on resting-state functional connectivity MRI.

Functional dissociation between anterior and posterior temporal cortical regions during retrieval of remote memory.

Retrieval of remote memory is considered to differentially involve the anterior and posterior temporal neocortices. Previous neuropsychological studies suggest that the different posterior temporal cortical regions are involved in the retrieval of remote memory of different categories of stimuli, whereas the anterior region is involved more generally in remote memory retrieval. In the present study, using functional magnetic resonance imaging of human brains, we tested this dissociation by examining the more precise characteristics of the anterior and posterior temporal cortical regions. Two categories of stimuli, faces and scenes, were used for paired stimuli to be retrieved, and the brain activity during retrieval of paired stimuli that were learned immediately before the scanning was compared with that during retrieval of paired stimuli that were learned ∼8 weeks earlier. We found that the different posterior temporal cortical regions were activated during retrieval of different categories of remote memory in a category-specific manner, whereas the anterior temporal cortical region was activated during retrieval of remote memory in a category-general manner. Furthermore, by applying a multivariate pattern analysis to psychophysiological interactions during retrieval of remote memory relative to recent memory, we revealed the significant interaction from the category-specific posterior temporal cortical regions to the category-general anterior temporal region. These results suggest that the posterior temporal cortical regions are involved in representation and retrieval of category-specific remote memory, whereas the anterior cortical temporal region is involved in category-general retrieval process of remote memory.

Preoperative evaluation of unruptured cerebral aneurysms by fast imaging employing steady-state acquisition image.

BACKGROUND: In aneurysm surgery, understanding the microanatomy around the aneurysm such as perforating arteries and cranial nerves is mandatory. OBJECTIVE: To assess the usefulness in determining the microanatomy around the cerebral aneurysms by the use of fast imaging employing steady-state acquisition (FIESTA) images of magnetic resonance imaging preoperatively, in addition to computed tomography and digital subtraction angiography. METHODS: Between October 2006 and June 2009, 123 patients with 140 unruptured cerebral aneurysms were treated in our institution. Eighty-two patients were assessed with FIESTA by the operators on the workstation of the magnetic resonance image before surgical clipping of the aneurysms. The small vessels and cranial nerves were confirmed intraoperatively before or after obliteration of the aneurysms. RESULTS: Sensitivities and specificities of FIESTA imaging were 100% in detecting hypothalamic artery around anterior communicating artery aneurysms, oculomotor nerve attachment to the posterior communicating artery aneurysm domes, and anterior choroidal artery adhesion to the posterior communicating artery aneurysms. This technique was also useful for predicting adhesion between the aneurysm and adjacent main trunks or perforators. Although the specificity was 100%, sensitivity was 56% in detecting vessel adhesion around the middle cerebral aneurysms. This technique can provide limited information in large aneurysms or aneurysms located in minimal cerebrospinal fluid space. The overall outcomes of the patients included 120 excellent recoveries, 1 moderate deficit, 1 severe deficit, and 1 persistent vegetative state according to the Glasgow Outcome Scale. CONCLUSION: By giving information on the minute anatomical structure around the aneurysm, FIESTA can contribute to thorough preoperative evaluations of cerebral aneurysms.

Prediction of subsequent recognition performance using brain activity in the medial temporal lobe.

Application of multivoxel pattern analysis (MVPA) to functional magnetic resonance imaging (fMRI) data enables reconstruction and classification of cognitive status from brain activity. However, previous studies using MVPA have extracted information about cognitive status that is experienced simultaneously with fMRI scanning, but not one that will be observed after the scanning. In this study, by focusing on activity in the medial temporal lobe (MTL), we demonstrate that MVPA on fMRI data is capable of predicting subsequent recognition performance. In this experiment, six runs of fMRI signals were acquired during encoding of phonogram stimuli. In the analysis, using data acquired in runs 1-3, we first conducted MVPA-based voxel-wise search for the clusters in the MTL whose signals contained the most information about subsequent recognition performance. Next, using the fMRI signals acquired in runs 1-3 from the selected clusters, we trained a classifier function in MVPA. Finally, the trained classifier function was applied to fMRI signals acquired in runs 4-6. Consequently, we succeeded in predicting the subsequent recognition performance for stimuli studied in runs 4-6 with significant accuracy. This accurate prediction suggests that MVPA can extract information that is associated not only with concurrent cognitive status, but also with behavior in the near future.

Role of the bloodstream impacting force and the local pressure elevation in the rupture of cerebral aneurysms.

BACKGROUND AND PURPOSE: Inertial force of the bloodstream results in the local elevation of intravascular pressure secondary to flow impact. Previous studies suggest that this "impacting force" and the local pressure elevation at the aneurysm may have a large contribution to the development of cerebral aneurysms. The goal of the present study is to evaluate how the bloodstream impacting force and the local pressure elevation at the aneurysm influences the rupture of cerebral aneurysms. METHODS: A total of 29 aneurysms were created in 26 patient-specific vessel models, and computer simulations were used to calculate pressure distributions around the vessel branching points and the aneurysms. RESULTS: Direct impact of the parent artery bloodstream resulted in local elevation in pressure at branch points, and bends in arteries (231.2+/-198.1 Pa; 100 Pa=0.75 mm Hg). The bloodstream entered into the aneurysm with a decreased velocity after it impacted on the branching points or bends. Thus, the flow impact at the aneurysm occurred usually weakly. At the top or the rupture point of the aneurysm, the flow velocity was always delayed. The local pressure elevation at the aneurysm was 119.3+/-91.2 Pa. CONCLUSIONS: The pressure elevation at the area of flow impact and at the aneurysm constituted only 1% to 2% of the peak intravascular pressure. The results suggest that the bloodstream impacting force and the local pressure elevation at the aneurysm may have less contribution to the rupture of cerebral aneurysms than was expected previously.

Parahippocampal activation evoked by masked traumatic images in posttraumatic stress disorder: a functional MRI study.

Posttraumatic stress disorder (PTSD) has been widely studied, but its neural mechanism is still unclear. The purpose of this study is to identify dysfunctional areas in PTSD throughout the whole brain to help to elucidate the neural mechanisms of PTSD. Sixteen patients with PTSD and sixteen healthy controls participated in this study. Traumatic images under perceptual threshold including scenes of earthquakes, traffic accidents, ambulances, emergency rooms, and crimes were presented to the participants, and brain activation was measured using functional MRI. Functional brain images of both groups were evaluated with random effect analysis for the whole brain. In the control group, activation in the ventral frontoparietal areas correlated significantly with presentation of the masked traumatic stimuli. In the PTSD group, activation was not observed in these areas, but significant activation correlated with the masked traumatic stimuli in the parahippocampal region including the left parahippocampal gyrus and tail of the left hippocampus. These results suggest that in PTSD patients activation in the ventral frontoparietal network associated with visual attention processing is attenuated, while the left hippocampal area associated with episodic and autobiographical memory is abnormally easily activated. This pattern of activation corresponds well to the clinical characteristics of PTSD, in which even slight traumatic stimuli tend to induce intrusive recollection or flashbacks, despite a general decrease in attention and ability to concentrate.

Collimator choice in cardiac SPECT with I-123-labeled tracers.

BACKGROUND: Septal penetration of high-energy photons may degrade the quality of single photon emission computed tomography (SPECT) of the heart with iodine 123-labeled tracers. We investigated the impact of collimator choice on cardiac SPECT with I-123. METHODS AND RESULTS: SPECT of a thoracic phantom containing I-123 solution was performed with a low-energy high-resolution (LEHR) collimator, special LEHR (SLEHR) collimator, and medium-energy (ME) collimator, and the cavity-to-myocardium contrast, wall thickness, and defect contrast were compared among the collimators. For all indices, use of the SLEHR collimator yielded the best results. Comparison between the LEHR and ME collimators revealed that the cavity-to-myocardium contrast and contrast for large defects were better with the ME collimator, whereas wall thickness and contrast for small defects were similar. Scatter correction by the triple-energy window method improved the indices examined; however, the superiority of the SLEHR collimator was still observed after correction. CONCLUSIONS: Collimator choice substantially influences the quality of cardiac SPECT with I-123-labeled agents, and an appropriate collimator needs to be selected in consideration of septal penetration and spatial resolution.

Effect of collimator choice on quantitative assessment of cardiac iodine 123 MIBG uptake.

BACKGROUND: Quantitative accuracy in iodine 123 studies may be impaired by septal penetration. We evaluated the effect of collimator choice on estimation of the heart-to-mediastinum (H/M) ratio in cardiac I-123 metaiodobenzylguanidine (MIBG) imaging. METHODS AND RESULTS: A low-energy high-resolution (LEHR) collimator, special LEHR (SLEHR) collimator, and medium-energy (ME) collimator were used. In experiments in which a phantom of simple geometry was used, the use of the LEHR collimator provided the lowest contrast accuracy, suggesting the effect of septal penetration. Thoracic phantom studies demonstrated contamination of heart and mediastinum counts by lung and liver activities, which was greatest with the LEHR collimator and least with the ME collimator. In 8 patients anterior chest views were acquired successively with the three collimators after I-123 MIBG injection. H/M ratios were significantly higher with the SLEHR collimator than with the LEHR collimator and were still higher with the ME collimator. The difference in H/M ratios between the LEHR and ME collimators showed a high positive correlation with the lung-to-mediastinum ratio. CONCLUSIONS: Collimator choice substantially influences estimation of the H/M ratios in cardiac I-123 MIBG imaging. The use of an ME collimator provides high quantitative accuracy and may enhance reliability in the evaluation of cardiac sympathetic nerve function.

[Study of elliptical centric view ordering technique with spectrally selected inversion recovery pulse (spec-IR pulse)].

Among several techniques for contrast-enhanced MRA, the elliptical centric view ordering method, originally developed at the Mayo Clinic, is a promising one. It has been difficult to apply a fat-suppression prepulse, mainly because the conventional fat suppression method requires a longer acquisition time during sampling of the low-frequency domain in k-space, and it causes severe image distortion due to the great change in longitudinal magnetization derived from fat tissue. We developed a novel method to append fat saturation to the elliptical centric view ordering technique, and assessed the feasibility of its use. Our method is to apply fat-saturation pulses only at selected sampling points when any gradient is applied in the slice-encoding direction. In this way, we achieved efficient suppression of fat-derived signal within a relatively short time, comparable to that of the conventional fat-saturation method, and succeeded in minimizing artifacts.

MR imaging of ischemic penumbra.

Cerebral ischemic stroke is one of the most fatal diseases despite current advances in medical science. Recent demonstration of efficacy using intravenous and intra-arterial thrombolysis demands therapeutic intervention tailored to the physiologic state of the individual tissue and stratification of patients according to the potential risks for therapies. In such an era, the role of the neuroimaging becomes increasingly important to evaluate the extent and location of tissues at risk of infarction (ischemic penumbra), to distinguish it from unsalvageable infarcted tissues or doomed hemorrhagic parenchyma. In this review, we present briefly the current role and limitation of computed tomography and conventional magnetic resonance imaging (MRI). We also present the possible applications of advanced MR techniques, such as diffusion and perfusion imaging, concentrating on the delineation or detection of ischemic penumbra.

Neural correlates of recency judgment.

The prefrontal cortex plays a critical role in recollecting the temporal context of past events. The present study used event-related functional magnetic resonance imaging (fMRI) and explored the neural correlates of temporal-order retrieval during a recency judgment paradigm. In this paradigm, after study of a list of words presented sequentially, subjects were presented with two of the studied words simultaneously and were asked which of the two words was studied more recently. Two types of such retrieval trials with varied (high and low) levels of demand for temporal-order retrieval were intermixed and compared using event-related fMRI. The intraparadigm comparison of high versus low demand trials revealed brain regions with activation that was modulated on the basis of demand for temporal-order retrieval. Multiple lateral prefrontal regions including the middle and inferior lateral prefrontal cortex were prominently activated. Activation was also observed in the anterior prefrontal cortex and the medial temporal cortex, regions well documented to be related to memory retrieval in general. The modulation of brain activity in these regions suggests a detailed pathway that is engaged during recency judgment.

Radiation-induced arteritis: thickened wall with prominent enhancement on cranial MR images report of five cases and comparison with 18 cases of Moyamoya disease.

PURPOSE: To evaluate magnetic resonance (MR) imaging findings of radiation-induced cranial arteritis regarding arterial wall thickening and degree of enhancement, as well as to compare the findings with those of idiopathic moyamoya disease. MATERIALS AND METHODS: We reviewed cerebral MR images in five patients with radiation-induced large cerebral arteritis. All patients had undergone irradiation 2-25 years prior to this study. Conventional nonenhanced MR, MR angiographic, and contrast material-enhanced MR images were evaluated. Special attention was paid to wall enhancement of the affected arteries (distal internal carotid artery). Wall enhancement was staged in three levels by two neuroradiologists. We also reviewed MR images in 18 patients with primary moyamoya disease for comparison and analyzed them statistically (Fisher exact test). RESULTS: Wall thickening and prominent ring enhancement of the wall of the affected large cerebral arteries were observed in all (five of five) patients with radiation-induced arteritis. In contrast, wall thickening and prominent ring enhancement of the wall of the occluded arteries either were not seen (13 of 18 patients) or were faint (five of 18 patients) in patients with moyamoya disease. Contrast enhancement of the arterial walls in patients with radiation-induced arteritis was significantly more prominent than in patients with moyamoya disease (P =.003). CONCLUSION: MR images of wall thickening and prominent ring enhancement of the wall of affected large cerebral arteries may be a diagnostic clue in differentiating radiation-induced arteritis from moyamoya disease.