Intrasylvian hematoma caused by ruptured middle cerebral artery aneurysms predicts recovery from poor-grade subarachnoid hemorrhage.

OBJECT: Intrasylvian hematoma (ISH) is a subtype of intracranial hematoma caused by aneurysmal rupture and often presents with a poor initial neurological grade; it is not well studied. The aim of this study was to elucidate outcomes of aneurysmal subarachnoid hemorrhage (SAH) with ISH. METHODS: Data for 97 patients with poor-grade SAH (World Federation of Neurosurgical Societies Grade IV or V) were retrospectively analyzed from a single-center, prospective, observational cohort database. Ultra-early surgical clipping, removal of hematoma, external decompression for brain swelling, and prevention of vasospasm by cisternal irrigation with milrinone were combined as an aggressive treatment. Characteristics and clinical courses of SAH with ISH were identified. The authors also evaluated any correlations between poor admission-grade SAH and ISH with good functional outcome. RESULTS: Patients with poor admission-grade SAH and with ISH were more likely to have initial cerebral edema (p < 0.001, Mann-Whitney U-test), which significantly resolved overtime (p < 0.001, Mann-Whitney U-test). These patients had a better chance of functional survival (modified Rankin Scale scores of 1-3; OR 5.75; 95% CI 1.36-24.3; p = 0.017) at 6 months after hospital discharge, after adjustment for potential confounders such as younger age and better initial neurological grade by multivariable analysis. CONCLUSIONS: ISH predicted good functional recovery from poor-grade aneurysmal SAH.

Evaluation of Fibrous Cap Rupture of Atherosclerotic Carotid Plaque with Thin-Slice Source Images of Time-of-Flight MR Angiography.

OBJECTIVE: To investigate the ability of source image of time-of-flight magnetic resonance angiography (TOF-MRA) in the detection of fibrous cap rupture of atherosclerotic carotid plaques. MATERIALS AND METHODS: From the database of radiological information in our hospital, 35 patients who underwent carotid MR imaging and subsequent carotid endoarterectomy within 2 weeks were included in this retrospective study. MR imaging included thin-slice time-of-flight MR angiography, black-blood T1- and T2-weighted imaging. Sensitivity, specificity and accuracy were calculated for the detection of fibrous cap rupture with source image of TOF-MRA. The Cohen k coefficient was also calculated to quantify the degree of concordance of source image of TOF-MRA with histopathological data. RESULTS: Sensitivity, specificity and accuracy in the detection of fibrous cap rupture were 90% (95%CI: 81-98), 69% (95%CI: 56-82) and 79% (95%CI: 71-87) with a k value of 0.59. The false positives (n = 15) were caused by partial-volume averaging between fibrous cap and lumen at the shoulder of carotid plaque. The false negatives (n = 5) were underestimated as partial thinning of fibrous cap. CONCLUSION: Source image of TOF-MRA can be useful in the detection of fibrous cap rupture with high sensitivity, but further technical improvement should be necessary to overcome shortcomings causing image degradation.

Targeted biopsy based on ADC map in the detection and localization of prostate cancer: a feasibility study.

PURPOSE: To investigate the feasibility of targeted biopsy based on an apparent diffusion coefficient (ADC) map in the detection and localization of prostate cancer. MATERIALS AND METHODS: This study included 288 consecutive patients with high or increasing serum prostate-specific antigen (PSA) levels who underwent prostatic magnetic resonance imaging (MRI) examination with an ADC map. Four core-targeted biopsies of low ADC lesions were performed under transrectal-ultrasound guidance with reference to ADC map. The positive predictive values (PPVs) of low ADC lesions were calculated and compared for the peripheral zone (PZ), transition zone (TZ), and anterior portion, respectively. Comparisons of ADC values and sizes between malignant and nonmalignant lesions were also performed. RESULTS: A total of 313 low ADC lesions were detected in 195 patients and sampled by targeted biopsies. The PPVs were 55.3% (95% confidence interval [CI]: 50-61) in total, 61.0% (95% CI: 53-69) for PZ, 50.6% (95% CI: 43-58) for TZ, and 90.9% (95% CI: 81-100) for the anterior portion. The most common nonmalignant pathology of low ADC lesions was hyperplasia, followed by chronic prostatitis. There were significant differences in ADC values and sizes between malignant and nonmalignant low ADC lesions. CONCLUSION: Targeted biopsies could be capable of detecting cancers well wherever they may be in the prostate, although the PPVs varied depending on the location of low ADC lesions.

Detection and localization of prostate cancer with the targeted biopsy strategy based on ADC map: a prospective large-scale cohort study.

PURPOSE: To investigate the usefulness of targeted biopsy strategy based on apparent diffusion coefficient (ADC) maps in the detection and localization of prostate cancer. MATERIALS AND METHODS: Institutional review board approval and informed consent from all participants were obtained. This study included 1448 consecutive patients suspected of having prostate cancer based on PSA level, who were divided into two groups: Group A included 890 patients with low-ADC lesions who underwent targeted and systematic biopsies; Group B included 558 patients with no low-ADC lesions who underwent only systematic biopsies. The cancer detection rates (CDR) of each group, positive predictive value (PPV), and negative predictive value (NPV) of ADC maps were calculated. RESULTS: The CDR was 70.1% for Group A, higher than those for overall patients (48.1%) and for Group B (13.1%) with significant difference (P < 0.001). In the serum, PSA range from 4 to 20 ng/mL, the CDR was higher for the Group A than for the Group B and overall patients with significant differences. PPV and NPV of MR findings were 70.1% and 86.9%, respectively. Especially, the PPV of the MR findings for the anterior portion was as high as 90.1%. Among the false negatives of MR findings, Gleason score proved 6 or smaller in 79.5%, and positive core number was merely one or two in 80.8%. CONCLUSION: The targeted biopsy strategy based on ADC maps can be useful in the detection and localization of prostate cancer with high PPV.

Diffusion-weighted magnetic resonance imaging in the detection of testicular torsion: feasibility study.

PURPOSE: To investigate the feasibility and usefulness of diffusion-weighted magnetic resonance imaging in the detection of testicular torsion. MATERIALS AND METHODS: Institutional Review Board approval and informed consent from all participants were obtained. Consecutive 28 patients with acute scrotal symptoms were included in this study. Fat-suppressed T2-weighted, dynamic subtraction contrast-enhanced, and diffusion-weighted images were obtained in the coronal plane with a 1.5 T MR unit. An apparent diffusion coefficient (ADC) map was reconstructed from the diffusion-weighted images obtained with b-factor of 0 and 800 s/mm(2). Comparisons of ADC values between the affected and nonaffected testes were performed with Mann-Whitney's U-test. RESULTS: Diffusion-weighted and ADC images with diagnostic quality were obtained in 23 out of the 28 patients (82%). In testicular torsion (n = 9), the mean ADC value of the twisted testes was significantly lower than that of the nonaffected testes (0.750 ± 0.297 vs. 1.017 ± 0.165 × 10(-3) mm(2)/sec, P < 0.05). In other scrotal disorders (n = 14), there was no significant difference in the mean ADC value of the testes between the affected and nonaffected side (P = 0.655). The affected-to-nonaffected ratio of ADC value was significantly lower in testicular torsion than that in other scrotal disorders (P < 0.05). CONCLUSION: Diffusion-weighted imaging of the scrotum with testicular ADC measurement can allow for the detection of testicular torsion without any use of contrast media.

Determination of the cutoff level of apparent diffusion coefficient values for detection of prostate cancer.

PURPOSE: The aim of this study was to determine the cutoff level of apparent diffusion coefficient (ADC) values for diagnosing prostate cancer. MATERIALS AND METHODS: A total of 45 consecutive patients with prostate cancer who underwent diffusion-weighted magnetic resonance imaging (MRI) with ADC maps before radical prostatectomy were included in this retrospective study. MRI findings were correlated retrospectively with histopathological results of surgical specimens. Comparisons of ADC values between cancer and noncancer areas were performed with the two-tailed unequal variance t-test. The cutoff ADC level was determined in a way to achieve the best accuracy for detecting prostate cancer. RESULTS: The mean ADC value of all the cancer lesions (n =60) was 1.04 ± 0.31 (×10(-3) mm(2)/s). In the peripheral zone, the mean ADC values of cancer lesions and noncancer areas were 1.07 ± 0.35 and 1.94 ± 0.31, respectively (P < 0.001). In the transition zone, the mean ADC values of cancer lesions and noncancer areas were 1.00 ± 0.22 and 1.56 ± 0.14, respectively (P<0.001). The cutoff level for the ADC value was determined to be 1.35×10(-3) mm(2)/s. It provided sensitivity, specificity, and accuracy of 88%, 96%, and 93%, respectively. CONCLUSION: The cutoff ADC level determined on the basis of the results obtained from radical prostatectomy specimens can help differentiate malignant from nonmalignant lesions.

Neural correlates of the judgment of lying: A functional magnetic resonance imaging study.

Lie judgment is an estimation of the speaker's intention to deceive inevitably accompanied by moral judgment. To depict their neural substrates, we conducted a functional magnetic resonance imaging study. Eighteen subjects read short stories and made judgments in three different tasks: a control gender judgment task, a moral judgment task, and a lie judgment task. Compared with the control task, both the moral and lie judgment tasks activated the left temporal lobe, the medial prefrontal cortex, the lateral orbitofrontal cortex extending to the dorsolateral prefrontal cortex, the caudate nucleus, the left temporo-parietal junction (TPJ), and the right cerebellum. Neural activations were greater in the left middle frontal gyrus, the bilateral TPJ, and the right superior temporal sulcus in the lie judgment condition than in the moral judgment condition. In addition, the left TPJ showed greater activation when a protagonist told lies for anti-social rather than pro-social purposes. These data suggest that the judgment of lies is mediated by the neural substrates of moral judgment (conventionality) and those involved in detecting the intent to deceive (intentionality), and that the left TPJ might play a key role in processing both the conventional and the intentional information involved in the judgment of lying.

Characterization of atherosclerotic plaque of carotid arteries with histopathological correlation: vascular wall MR imaging vs. color Doppler ultrasonography (US).

PURPOSE: To investigate whether the vessel wall MRI of carotid arteries would differentiate at-risk soft plaque from solid fibrous plaque by identifying liquid components more accurately than color Doppler ultrasonography (US). MATERIALS AND METHODS: This study included 54 carotid arteries in 54 consecutive patients who underwent carotid endarterectomy. MRI was performed using black-blood fat-suppressed (FS) T1-and FS T2-weighted TSE sequences. A total of 68 major segments of the 54 carotid plaques were grouped into four MR categories based on signal intensity index (SII). MR criteria used for the diagnosis of plaque vulnerability were: at-risk soft plaque including a segment of liquid component (category A or B), solid fibrous plaque (category C or D). The MR and US findings were compared with histopathological findings of endarterectomy specimens. RESULTS: Intraoperative findings and microscopic examination of endarterectomy specimens revealed 24 at-risk soft plaques and 30 solid fibrous plaques. The sensitivity, specificity, and accuracy for diagnosing at-risk soft plaque are 96%, 93%, and 94% for MR, and 75%, 63%, and 69% for color Doppler US, respectively. The slice-by-slice MR evaluation of carotid wall also revealed detailed information of plaque segments and correlated well with the features of corresponding histologic sections. CONCLUSION: Vessel wall MRI with MRI category could have a potential to more accurately diagnose an at-risk soft plaque predominantly composed of liquid components in comparison with color Doppler US.

Tactile-visual integration in the posterior parietal cortex: a functional magnetic resonance imaging study.

To explore the neural substrates of visual-tactile crossmodal integration during motion direction discrimination, we conducted functional magnetic resonance imaging with 15 subjects. We initially performed independent unimodal visual and tactile experiments involving motion direction matching tasks. Visual motion discrimination activated the occipital cortex bilaterally, extending to the posterior portion of the superior parietal lobule, and the dorsal and ventral premotor cortex. Tactile motion direction discrimination activated the bilateral parieto-premotor cortices. The left superior parietal lobule, intraparietal sulcus, bilateral premotor cortices and right cerebellum were activated during both visual and tactile motion discrimination. Tactile discrimination deactivated the visual cortex including the middle temporal/V5 area. To identify the crossmodal interference of the neural activities in both the unimodal and the multimodal areas, tactile and visual crossmodal experiments with event-related designs were also performed by the same subjects who performed crossmodal tactile-visual tasks or intramodal tactile-tactile and visual-visual matching tasks within the same session. The activities detected during intramodal tasks in the visual regions (including the middle temporal/V5 area) and the tactile regions were suppressed during crossmodal conditions compared with intramodal conditions. Within the polymodal areas, the left superior parietal lobule and the premotor areas were activated by crossmodal tasks. The left superior parietal lobule was more prominently activated under congruent event conditions than under incongruent conditions. These findings suggest that a reciprocal and competitive association between the unimodal and polymodal areas underlies the interaction between motion direction-related signals received simultaneously from different sensory modalities.

Source of nonlinearity of the BOLD response revealed by simultaneous fMRI and NIRS.

The nonlinearity of the blood oxygenation level-dependent (BOLD) response to stimuli of different duration, particularly those of short duration, has been well studied by functional magnetic resonance imaging (fMRI). This nonlinearity is assumed to be due to neural adaptation and the nonlinearity of the response in the oxygen extraction fraction (OEF); the latter has not been examined quantitatively in humans. To evaluate how the OEF response contributes to the nonlinearity of the BOLD response to neural activity, we used simultaneous fMRI and near-infrared spectroscopy (NIRS). The responses to visual stimuli of four different durations were measured as changes in the BOLD signal and the NIRS-derived hemoglobin concentrations. The hemodynamic response nonlinearity was quantified using an impulse response function model with saturation nonlinearity scaling in the response amplitude, assuming that the unknown neural adaptation parameters varied within a physiologically feasible range. Independent of the degree of neural adaptation, the BOLD response consistently showed saturation nonlinearity similar to that of the OEF response estimated from the NIRS measures, the nonlinearity of which was greater than that of the response in the total hemoglobin concentration representing the cerebral blood volume (CBV). We also found that the contribution of the OEF response to the BOLD response was four to seven times greater than the contribution of the CBV response. Thus, we conclude that the nonlinearity of the BOLD response to neural activity originates mainly from that of the OEF response.

Fast MR imaging in obstetrics.

Ultrasonography (US) is the initial imaging modality of choice for evaluation of patients in obstetrics. However, the results of US are not always sufficient. Magnetic resonance (MR) imaging, which uses no ionizing radiation, may be an ideal method for further evaluation. Although MR imaging is not recommended during the first trimester and use of contrast material is not recommended in pregnant patients, fast MR imaging is useful in various obstetric settings and can provide more specific information with excellent tissue contrast and multiplanar views. In pregnant patients with acute conditions, various diseases (eg, red degeneration of a uterine leiomyoma) may be diagnosed. MR imaging allows characterization of pelvic masses discovered during pregnancy and diagnosis of postpartum complications (eg, abscess, hematoma, ovarian vein thrombosis). In pregnant patients with hydronephrosis, MR urography can demonstrate the site of obstruction and the cause (eg, a ureteral stone). MR pelvimetry may be beneficial in cases of breech presentation. Contrast material-enhanced dynamic MR imaging allows one to evaluate the vascularity of a placental polyp, detect the viable component of a gestational trophoblastic tumor, and diagnose a uterine arteriovenous malformation. MR imaging enables diagnosis of rare forms of ectopic pregnancy and early diagnosis of ectopic pregnancy.