Demonstration of cerebral venous variations in the region of the third ventricle on phase-sensitive imaging.

BACKGROUND AND PURPOSE: Susceptibility-weighted (SW) MR imaging has enabled noninvasive visualization of the cerebral veins and has shed light on the nature of venous architecture. For successful surgery of the third ventricle, understanding of the anatomy of the subependymal veins of the lateral ventricle and their relationships to the foramen of Monro is required preoperatively. The purpose of this study was to evaluate the anatomic variations of the subependymal veins around the third ventricle by use of phase-sensitive imaging (PSI) on the basis of principles similar to those of SW MR imaging. MATERIALS AND METHODS: Included in this study were 642 sides in 321 patients. The courses of the anterior septal vein (ASV), thalamostriate vein, and internal cerebral vein (ICV) were evaluated. We classified these into 4 types (IA, IB, IIA, IIB) on the basis of standard classic angiographic criteria. The classification is based on their relationship with the ASV-ICV junction and the presence of a venous angle or a false venous angle, according to the method in a previous study. Other venous variations were classified as type III. RESULTS: A venous angle was formed in 519 (80.9%), whereas a false venous angle was formed in 123 (19.1%). The ASV-ICV junction was located at the venous angle (type IA) in 407 (63.4%) of 642 sides. In 235 sides (36.6%), the ASV-ICV junction was located posteriorly beyond the foramen of Monro (types IB, IIA, IIB, and III). CONCLUSIONS: PSI is useful for understanding normal variations of the subependymal veins in the region of the third ventricle.

Cerebellar lesions in multiple system atrophy: postmortem MR imaging-pathologic correlations.

BACKGROUND AND PURPOSE: Cerebellar atrophy and white matter T2-hyperintensities have been characterized as cerebellar lesions of multiple system atrophy (MSA). The aim of the study was to correlate MR images with histologic findings in cerebellar lesions of MSA. MATERIALS AND METHODS: Postmortem T2-weighted images using 1.5T were compared with histologic findings in 7 postmortem-proved cases with MSA. The MR imaging findings in the cerebellar cortices and deep white matter dentate nucleus regions were compared with their histologic findings in each case. RESULTS: We detected 3 types of cerebellar changes: type 1, no apparent atrophy or signal-intensity changes; type 2, cerebellar atrophy and inhomogeneous (patchy and/or confluent) cerebellar white matter hyperintensities; and type 3, cerebellar atrophy and diffuse white matter hyperintensities. Hypointensities were seen in the dentate nucleus regions. Atrophy of the cerebellar white matter was more severe than that of cerebellar cortices, and this anatomy was well depicted on coronal images. Histologically, degeneration was more severe in the cerebellar white matter than in the cerebellar cortices. Hyperintensities in the cerebellar white matter showed loss of myelinated fibers and gliosis. Hypointensities in the dentate nucleus regions revealed diffuse ferritin deposition in preserved dentate nuclei and white matter both around and within the nuclei. CONCLUSIONS: Hyperintensities in the cerebellar white matter reflect degenerated white matter associated with loss of myelinated fibers and gliosis, whereas hypointensities in the dentate nucleus regions reflect diffuse ferritin deposition in preserved dentate nuclei and white matter around and within the nuclei. Degeneration is more severe in the cerebellar white matter than in the cerebellar cortices.

Cerebral cortical and white matter lesions in amyotrophic lateral sclerosis with dementia: correlation with MR and pathologic examinations.

BACKGROUND AND PURPOSE: Amyotrophic lateral sclerosis with dementia (ALSD) is a progressive neurodegenerative disorder, characterized clinically by motor neuron symptoms and dementia, and pathologically by degeneration of the motor neurons of the brain and spinal cord as well as atrophy of the frontal and/or temporal lobes. So far, there has been no study on the correlation of MR images with histologic findings in ALSD. We studied the correlation of antemortem and postmortem T2-weighted MR images with histologic findings in autopsy-proved cases of ALSD. MATERIALS AND METHODS: Antemortem and postmortem T2-weighted images were compared with histologic findings in 3 autopsy-proved cases of ALSD. RESULTS: Antemortem MR images showed atrophy of the frontal and temporal lobes, which were asymmetric in the medial-ventral part of the temporal lobe. Faint linear T2-hyperintensity was seen in the medial-ventral part of the temporal subcortical white matter in 1 case. Postmortem T2-weighted images showed linear subcortical hyperintensity in the ventral-medial temporal lobe in each case. Histologically, cortical atrophy on MR images showed spongiform change with neuronal loss and gliosis especially in the superficial layers and linear subcortical hyperintensity on T2-weighted images showed degeneration and gliosis in each case. These findings are characteristic histologic changes of ALSD. CONCLUSION: MR imaging of atrophy of the frontal and temporal lobes with linear subcortical hyperintensities in the anteromedial temporal lobe is useful for diagnosis of ALSD.

Wallerian degeneration of the corticospinal tracts: postmortem MR-pathologic correlations.

Postmortem magnetic resonance (MR) images were correlated with the histological findings in two autopsy-proven cases of Wallerian degeneration of the corticospinal and corticopontine tracts associated with cerebral embolic infarction. T2 hyperintensities seen in Wallerian degeneration showed vacuolation of myelin in the early stage, and marked loss of myelin and axons with macrophages in the subacute and chronic stages. Similar T2 hyperintensities seen in the different stages of Wallerian degeneration reflect different histological findings.

Hyperintense putaminal rim at 3T reflects fewer ferritin deposits in the lateral marginal area of the putamen.

BACKGROUND AND PURPOSE: The aim of this study was to clarify the cause of hyperintense putaminal rim (HPR) on the basis of 3T MR imaging-pathologic correlations. MATERIALS AND METHODS: We evaluated brain MR images from 75 subjects 13 to 85 years of age on T2-weighted fast spin-echo (FSE) images at 3T. We also assessed HPR on postmortem T2-weighted FSE images from 4 postmortem cases 1, 12, 63, and 83 years of age. To clarify the cause of HPR, we used 3 staining methods: the Klüver-Barrera method to observe the myelin sheath, the Berlin blue method to observe hemosiderin, and ferritin immunohistochemistry to observe ferritin. The postmortem MR images were compared with the histologic findings in each case. RESULTS: HPR was absent or vague in subjects under 30 years of age but present in subjects in their 30s-60s and again became vague in those subjects older than 70 years of age. The postmortem MR imaging-pathologic correlations revealed that ferritin deposits were slight in the lateral marginal area of the putamen in the 63-year-old subject showing present HPR, but in the 83-year-old subject with no HPR, ferritin deposits were prominent in the lateral marginal area of the putamen as well as in other areas. CONCLUSION: Age-related disproportion in ferritin deposits between the lateral marginal area and the remainder of the putamen causes hypointensity of the latter and the relative hyperintensity of the former, which is depicted as HPR with 3T MR imaging.

Usefulness of diffusion tensor imaging of white matter in Alzheimer disease and vascular dementia.

PURPOSE: To evaluate the usefulness of diffusion tensor imaging in detecting the water diffusivity caused by neuropathological change in Alzheimer disease and vascular dementia. MATERIAL AND METHODS: Twenty patients with Alzheimer disease, 20 with vascular dementia, and 10 control subjects were examined. Diffusion tensor imaging applied diffusion gradient encoding in six non-collinear directions. Fractional anisotropy values were compared in the genu and splenium of the corpus callosum, and anterior and posterior white matter among the three groups. RESULTS: In the patients with Alzheimer disease, fractional anisotropy values of the posterior white matter were significantly lower than those of controls. In patients with vascular dementia, fractional anisotropy values of the anterior white matter tended to be lower than those of the posterior white matter (P=0.07). CONCLUSION: Diffusion tensor imaging reflects the neuropathological changes in the white matter, and may be useful in the diagnosis of Alzheimer disease and vascular dementia.

[Transcatheter arterial embolization with SMANCS and epiADM for hepatocellular carcinoma].

We have attempted transcatheter arterial embolization (TAE) with SMANCS and epiADM for 40 patients with hepatocellular carcinoma and evaluated its therapeutic effects and side effects. There were 7 cases of stage I disease, 10 cases of stage II disease, 10 cases of stage III disease and 13 cases of stage IV disease. Patients underwent TAE superselectively following infusion of w/o emulsion of epiADM and SMANCS-lipiodol. No severe side effect was observed compared with conventional Lp-TAE except in one case with hepatic biloma after treatment. The overall response rate was 70%, and 54.5% in the patients with recurrent tumor after Lp-TAE. The serum AFP value decreased in 16 patients out of 20 patients. Hepatic resection was performed in 2 patients after treatment, and no viable tumor cell was recognized in the specimen. Our result suggested that TAE with SMANCS and epiADM will contribute to improved therapeutic efficacy for hepatocellular carcinoma.