Comparison of multiple parameters obtained on 3T pulsed arterial spin-labeling, diffusion tensor imaging, and MRS and the Ki-67 labeling index in evaluating glioma grading.

BACKGROUND AND PURPOSE: Pulsed arterial spin-labeling, DTI, and MR spectroscopy provide useful data for tumor evaluation. We evaluated multiple parameters by using these pulse sequences and the Ki-67 labeling index in newly diagnosed supratentorial gliomas. MATERIALS AND METHODS: All 32 patients, with grade II (3 each of diffuse astrocytoma, oligodendroglioma, and oligoastrocytoma), grade III (3 anaplastic astrocytomas, 4 anaplastic oligodendrogliomas, and 1 anaplastic oligoastrocytoma), and grade IV (14 glioblastomas and 1 glioblastoma with an oligodendroglioma component) cases underwent pulsed arterial spin-labeling, DTI, and MR spectroscopy studies by using 3T MR imaging. The following variables were used to compare the tumors: relative cerebral blood flow, fractional anisotropy; ADC tumor/normal ratios; and the Cho/Cr, NAA/Cho, NAA/Cr, and lactate/Cr ratios. A logistic regression and receiver operating characteristic analysis were used to assess parameters with a high sensitivity and specificity to identify the threshold values for separate grading. We compared the Ki-67 index with various MR imaging parameters in tumor specimens. RESULTS: Significant correlations were observed between the Ki-67 index and the mean, maximum, and minimum ADC, Cho/Cr, and lactate/Cr ratios. The receiver operating characteristic analysis showed that the combination of the minimum ADC and Cho/Cr ratios could differentiate low-grade and high-grade gliomas, with a sensitivity and specificity of 87.0% and 88.9%, respectively. The mean and maximum relative cerebral blood flow ratios were used to classify glioblastomas from other-grade astrocytomas, with a sensitivity and specificity of 92.9% and 83.3%, respectively. CONCLUSIONS: Our findings indicate that pulsed arterial spin-labeling, DTI, and MR spectroscopy are useful for predicting glioma grade. Additionally, the parameters obtained on DTI and MR spectroscopy closely correlated with the proliferative potential of gliomas.

Acute toxicity and mutagenicity study on branched corn syrup and evaluation of its laxative effect in humans.

We developed a branched corn syrup (BCS, average molecular weight: 500, content of indigestible portion: 45%) by heat treatment of indigestible dextrin with hydrochloric acid. To confirm the safety of BCS, we conducted both an acute toxicity test and a mutagenicity test. Moreover, we observed gastroenteric effects of BCS in fifty healthy humans. The results are summarized as follows. 1) There was no death observed after oral administration of BCS in Sprague-Dawley-strain rats. Lethal dose (LD)50, value was estimated to be more than 10 g/kg body weight. 2) No mutagenicity was observed in Salmonella typhimurium TA98, TA100, TA1535, TA1537, or Escherichia coli WP2uvrA. 3) Fifty adults were divided into five groups often (five of each sex) and orally administered BCS at 0.2, 0.3, 0.4. 0.5 and 0.6 g/kg body weight as indigestible portion. Although no diarrhea was observed in females, BCS at 0.6 g/kg as indigestible portion caused diarrhea in two out of five males. The maximum non-effective dose of indigestible portion of BCS was estimated to be 0.5 g/kg in males and more than 0.6 g/kg in females.

The regional cerebral blood flow amelioration of argatroban in the acute stage of cerebral thrombosis.

Cerebral blood flow changes by argatroban in the acute stage of cerebral thrombosis have been investigated with the use of stable xenon computed tomography (Xe/CT). The study group consisted of 14 cases (7 males, 7 females) with the average age of 59 years old (ranging from 21 to 79 years of age). We evaluated the cerebral blood flow change after an intravenous drip infusion of 10 mg of argatroban. After the administration of argatroban, we recognized a significant increase in the blood flow (24.4 +/- 5.0 ml/100 g/min to 28.4 +/- 2.7 ml/100 g/min, p < 0.05) in the blood flow area of lower than 30 ml/100 g/min in the affected vascular territory. As a conclusion, we found that argatroban improves ischemic symptoms through the amelioration of blood flow in the penumbra area.

Malignant meningioma metastasizing through the cerebrospinal pathway.

A case of malignant meningioma metastasizing through the cerebrospinal pathway is presented. The primary tumor was a parasagittal malignant meningioma invading into the brain. The tumor seeded to the cerebellopontine angle cistern and thoracic spine after multiple operations. Although this type of tumor borders the CSF, metastasis through the cerebrospinal pathway is rare, and only 18 such cases have been reported (2, 3, 10, 12).

[Analysis of recurrences of meningiomas following neurosurgical resection].

A clinical and pathological study of 124 surgically treated patients with intracranial meningiomas was carried out to evaluate factors influencing recurrence. The patients ranged in age from 8 years to 75 years. Thirty-five (28.2%) were males and 89 (71.8%) were females. Recurrences occurred in 18 patients, once in eleven, twice in six, four times in one. The period from first surgery to recurrence ranged from 5 months to 84 months (mean 29.9 months). Age, sex, site of tumor, surgical grading, and histology were selected as analytic factors. Simpson's classification was used as surgical grading. All the patients with recurrences were younger than 60 years old, and particularly in the patients who were younger than 40 years the recurrence rate was high. Mean age of the group with recurrence was 41.8 years, which was significantly younger than that of the group without recurrence (52.0 years). In the group with recurrence, ten were males and eight were females. The recurrence rate was 28.6% in males, and was 9.0% in females. Thus the recurrence rate was significantly higher for males than for females (p = 0.016). It also seemed that the period from first surgery to recurrence was earlier for males than for females. The patients with meningiomas at posterior fossa or sphenoid ridge often had recurrences, and the recurrence rate was 29.4% and 21.7%, respectively. But these recurrence rates were not significantly higher than those at other sites. On the contrary, no recurrences occurred at convexity, intraventricle, and olfactory groove.(ABSTRACT TRUNCATED AT 250 WORDS)

[A case of hemorrhage into a brain abscess].

A rare case of hemorrhage into a brain abscess in a 23-year-old man is reported. The patient complained of headache and low-grade fever on February 26, 1986. Two days later, he developed right hemiparesis and right hemisensory disturbance with mild consciousness disturbance and was admitted to a local hospital. Seven days after the onset, he suddenly became semicomatose, developed anisocoria and was consequently transferred to the University Hospital. On admission, his temperature was 37.5 degrees C and neurological examination revealed semicoma, anisocoria and right hemiparesis without nuchal rigidity. Enhanced CT scan showed a high density area within an irregular ring enhancement at the left basal ganglia. At that time, malignant glioma was diagnosed and an emergency operation was performed by left frontotemporal craniectomy. During the operation blood clot was found in the posterior part of the basal ganglia. After operation, a histological examination was made and a brain abscess was diagnosed. Gram staining revealed gram-positive bacillus. By aspiration of the abscess and chemotherapy, recovery was gradually made. He was discharged with motor dysphasia and mild right hemiparesis three months later. Differentiation between abscess and malignant glioma and the cause of the hemorrhage are discussed.

Intrasphenoidal encephalocele: report of a case.

The diagnosis of intrasphenoidal encephalocele may be difficult because of its rarity and its nonspecific signs and symptoms. The authors report a patient with intrasphenoidal encephalocele who was operated on by the transsphenoidal approach with a good result. They also review five reported cases, with discussion of their clinical characteristics and operative indications.

Brain abscess with hemorrhage.

A very rare case of brain abscess with hemorrhage in the basal ganglia is reported. We discuss the difficulties in the differential diagnosis and the mechanism of hemorrhage.