Anatomical information of the lenticulostriate arteries on high-resolution 3D-TOF MRA at 3 T: comparison with 3D-DSA.

PURPOSE: As the lenticulostriate arteries (LSAs) perfuse neurologically important areas, it is necessary to accurately assess the origin and number of the LSAs before surgery. Although three-dimensional time-of-flight MR angiography (3D-TOF MRA) is a non-invasive procedure, it requires high-resolution (HR) images to depict the LSAs with a small diameter. Therefore, we performed 3D-TOF MRA with the maximum HR (HR-MRA) using a 3 T scanner to examine whether a good depiction of the LSAs, equivalent to that of digital subtraction angiography (DSA), could be obtained. METHODS: Our study group comprised 16 consecutive patients who underwent HR-MRA and 3D-DSA. In both studies, we evaluated the localization of the origin from M1, M2, or A1 segments, their number of stems, and depiction. RESULTS: There was no significant difference in the visualization of the LSAs between HR-MRA and 3D-DSA (P values; M1, M2, and A1 = 0.39, 0.69, and 0.69, respectively), and both the number of stems and the localization of the origin of the LSAs corresponded between the two examinations. CONCLUSION: HR-MRA at 3 T can depict the LSA well. It reveals the number of the LSA stems and the LSA origin comparatively with DSA.

Magnetic resonance bone imaging: applications to vertebral lesions.

MR bone imaging is a recently introduced technique, that allows visualization of bony structures in good contrast against adjacent structures, like CT. Although CT has long been considered the modality of choice for bone imaging, MR bone imaging allows visualization of the bone without radiation exposure while simultaneously allowing conventional MR images to be obtained. Accordingly, MR bone imaging is expected as a new imaging technique for the diagnosis of miscellaneous spinal diseases. This review presents several sequences used in MR bone imaging including black bone imaging, ultrashort/zero echo time (UTE/ZTE) sequences, and T1-weighted 3D gradient-echo sequence. We also illustrate clinical cases in which spinal lesions could be effectively demonstrated on MR bone imaging, performed in most cases using a 3D gradient-echo sequence at our institution. The lesions presented herein include degenerative diseases, tumors and similar diseases, fractures, infectious diseases, and hemangioma. Finally, we discuss the differences between MR bone imaging and previously reported techniques, and the limitations and future perspectives of MR bone imaging.

Randomized phase III study of high-dose methotrexate and whole-brain radiotherapy with/without temozolomide for newly diagnosed primary CNS lymphoma: JCOG1114C.

BACKGROUND: The goal was to determine whether the addition of temozolomide (TMZ) to the standard treatment of high-dose methotrexate (HD-MTX) and whole-brain radiotherapy (WBRT) for primary central nervous system lymphoma (PCNSL) improves survival. METHODS: An open-label, randomized, phase III trial was conducted in Japan, enrolling immunocompetent patients aged 20-70 years with histologically confirmed, newly diagnosed PCNSL. After administration of HD-MTX, patients were randomly assigned to receive WBRT (30 Gy) ±â€…10 Gy boost (arm A) or WBRT ±â€…boost with concomitant and maintenance TMZ for 2 years (arm B). The primary endpoint was overall survival (OS). RESULTS: Between September 29, 2014 and October 15, 2018, 134 patients were enrolled, of whom 122 were randomly assigned and analyzed. At the planned interim analysis, 2-year OS was 86.8% (95% confidence interval [CI]: 72.5-94.0%) in arm A and 71.4% (56.0-82.2%) in arm B. The hazard ratio was 2.18 (95% CI: 0.95-4.98), with the predicted probability of showing the superiority of arm B at the final analysis estimated to be 1.3%. The study was terminated early due to futility. O6-methylguanine-DNA methyltransferase (MGMT) promoter methylation status was measured in 115 tumors, and it was neither prognostic nor predictive of TMZ response. CONCLUSIONS: This study failed to demonstrate the benefit of concomitant and maintenance TMZ in newly diagnosed PCNSL.

Neurosurgical simulation by interactive computer graphics on iPad.

PURPOSE: Presurgical simulation before complicated neurosurgery is a state-of-the-art technique, and its usefulness has recently become well known. However, simulation requires complex image processing, which hinders its widespread application. We explored handling the results of interactive computer graphics on the iPad tablet, which can easily be controlled anywhere. METHODS: Data from preneurosurgical simulations from 12 patients (4 men, 8 women) who underwent complex brain surgery were loaded onto an iPad. First, DICOM data were loaded using Amira visualization software to create interactive computer graphics, and ParaView, another free visualization software package, was used to convert the results of the simulation to be loaded using the free iPad software KiwiViewer. RESULTS: The interactive computer graphics created prior to neurosurgery were successfully displayed and smoothly controlled on the iPad in all patients. The number of elements ranged from 3 to 13 (mean 7). The mean original data size was 233 MB, which was reduced to 10.4 MB (4.4% of original size) after image processing by ParaView. This was increased to 46.6 MB (19.9%) after decompression in KiwiViewer. Controlling the magnification, transfer, rotation, and selection of translucence in 10 levels of each element were smoothly and easily performed using one or two fingers. The requisite skill to smoothly control the iPad software was acquired within 1.8 trials on average in 12 medical students and 6 neurosurgical residents. CONCLUSIONS: Using an iPad to handle the result of preneurosurgical simulation was extremely useful because it could easily be handled anywhere.