Rehabilitation technique facilitates association cortices in hemiparetic patients: functional MRI study.

We used fMRI to study brain activation with facilitative rehabilitation techniques (passive hand movements and visual feedback) in two patients with subcortical lesions. Two tasks were given in a sequence. The first task (trial 1) was repetitive hand grasping by the paretic hand at a rate of 0.5 Hz with the eyes closed. The second task (trial 2), the facilitative rehabilitation technique, included task 1 plus support by a trainer to move the paretic hand with the eyes open to get visual feedback of the movement. The data were analyzed by a subtractive method. When task 1 was subtracted from task 2, it was found that the bilateral visual cortex, contralateral premotor cortex and posterior parietal cortex were involved with the passive hand movement and visual feedback. These facilitative rehabilitation techniques may integrate networks between sensory information and motor commands, and lead to functional reorganization.

Serial diffusion-weighted imaging in MELAS.

Clinical features of mitochondrial myopathy, encephalopathy, lactic acidosis and stroke-like episodes (MELAS) resemble those of cerebral infarcts, but the pathogenesis of infarct-like lesions is not fully understood. To characterise these infarct-like lesions, we studied two patients with MELAS using diffusion-weighted (DWI) MRI before and after stroke-like episodes and measured the apparent diffusion coefficient (ADC) in the new infarct-like lesions. These gave high signal on DWI and had much higher ADC than normal-appearing regions. The ADC remained high even 30 days after a stroke-like episode then decreased in lesions, with or without abnormality as shown by conventional MRI. We speculate that early elevation of ADC in the acute or subacute phase reflects vasogenic rather than cytotoxic edema. The ADC of the lesions, which disappeared almost completely with clinical improvement, returned to normal levels, which may reflect tissue recovery without severe damage. To our knowledge, this is the first study of DWI in MELAS.

Breath-hold gadolinium-enhanced three-dimensional MR thoracic aortography: higher spatial resolution imaging with phased-array coil and three-dimensional surface display.

The aim of this study was to examine signal intensities of data sets from MR thoracic aortography and to evaluate three-dimensional surface display (3DSD) for postprocessing. Twenty-five patients were imaged with gadolinium-enhanced 3D fast gradient echo sequence. The intensity at the aortic arch was significantly higher than that at the mediastinal fat (p<0.0001). The signal-to-noise ratio was lower at the aortic arch than at the ascending and descending aorta, whereas the contrast-to-noise ratio was fairly high at the aortic arch. Although in one case (4%) the intensity at the arch was smaller than that at the mediastinal fat, 3DSD was successfully performed in all cases. Superiority of 3DSD over maximum intensity projection was obtained in 67% of the cases. 3DSD was evaluated to be superior to maximum intensity projection in all cases of thoracic aortic aneurysm and coarctation of aorta. Higher resolution MR thoracic aortography could be successfully performed with phased-array coil and 3DSD.

A decrease in cerebral cortex intensity on T2-weighted with ageing images of normal subjects.

To determine the change in intensity in the cerebral cortex on T2-weighted MRI with ageing, we reviewed the T2-weighted images of 83 normal subjects and measured the signal intensity in the cerebral cortex in 30 subjects randomly selected from them. Low-intensity areas were more common in the cerebral cortex of the aged. The intensity of different cortical regions varied, and the intensity in the temporal and parietal to be decreased with ageing. Presumably, this change of the intensity reflects senile changes, although low intensity is not evident in the temporal cortex because of its high basal intensity level.

Preoperative Diagnosis of Breast Diseases by Dynamic MR Mammography:Cut-off Point Establishment for Signal Intensity Ratio.

We have demonstrated that the dynamic study for breast lesions by magnetic resonance imaging(MRI)can differentiate benign from malignant lesions objectively.The cases were 57 histopathologically appraised breast lesions, including 20 cases of breast cancer, 28 cases of mastopathy, 8 cases of fibroadenoma and 1 caseof intraductal papillomatosis. We plotted time-signal intensity ratio curves and then determined 95% confidence intervals, plotting the signal intensity ratio for both breast cancer and mastopathy every 30 seconds during dynamic magnetic resonance mammography(MRM)after gadolinium-diethylenetriamine pentaacetic acid(Gd-DTPA)administration, and further established cut-off points to differentiate between them. We then tried of estimate objectively the benign-malignant differentiation to breast lesions by confirming their signal intensity ratio to be more or less than the cut-off points. We advocate this procedure, and call it the " dynamic ratio method. " As a result, we found highly significant differences between breast cancer and mastopathy at 30 and 60 seconds after Gd-DTPA administration(P < 0.0001). We also confirmed that the cut-off point for the dynamic ratio method was equivalent to 1.4 and 1.8 times the precontrast signal intensity value at30 and 60 seconds after administration of Gd-DTPA respectively. By performing this dynamic ratio method preoperatively we can assess objectively not only the malignancy of breast lesions, but also neighboring infiltration, extending intraductal component, and lymph node metastasis. Furthermore, the dynamic ratio method provides detailed information for selecting the appropriate region for breast conserving surgery preoperatively, and can be expected to reduce unnecessary biopsies of benign cases. The dynamic ratio method had a sensitivity of 95.0%, a specificity of 81.1% and a positive predictive value of 73.1%. Also, for detectinginvasive ductal carcinoma, the sensitivity of the dynamic ratio method was 100.0%.

An improved assay method for fibroblast gelatinolytic enzyme.

A useful gelatinolytic enzyme assay for fibroblasts, utilizing a novel sample preparation method for collagenase with dithiothreitol (DTT) treatment to inactivate endogenous collagenase inhibitors, was developed using soluble fluorescein isothiocyanate (FITC)-labeled gelatin. The substrate, gelatin was prepared by heating commercially available FITC-labeled type I collagen. The denatured collagen was cleaved with purified trypsin and partially purified fibroblast gelatinase, and the digested FITC-fragments were measured fluorometrically. The intensity of the fluorescence was in proportion to the reaction time and enzyme concentration. Both enzyme activities were measurable within the nanogram range of enzyme preparations. The enzyme activity was detected after 4-aminophenylmercuric acetate (APMA) treatment which was completely inhibited by metalloproteinase inhibitors, but not by serine- and cysteine-proteinases' inhibitors. Conditioned media of human periodontal ligament fibroblasts (PLF) and gingival fibroblasts (GF) were separately treated with DTT prior to the enzyme assay, and then the assay was performed in the presence of APMA. The enzyme activities of PLF and GF were 106- and 55-fold higher than those of the conventional gelatinase assay which was carried out without DTT treatment. This assay method allowed the measurement of gelatinolytic enzyme activity when tissue inhibitors of metalloproteinases were present in the fibroblast culture medium.

Low intensity areas observed on T2-weighted magnetic resonance imaging of the cerebral cortex in various neurological diseases.

The cerebral cortex of patients with Alzheimer's disease (AD) or amyotrophic lateral sclerosis (ALS) may show low signal intensity on T2-weighted magnetic resonance images (MRI). Since these low intensity areas (LIA) are also often observed in aged patients with other diseases, we suspected that they might be a non-specific finding. We conducted a retrospective study of LIA in 139 patients with various diseases of the central and peripheral nervous systems, and evaluated their relationship to age and other MRI findings. Brain atrophy, ventricular dilatation, white matter lesions, and LIA were visually evaluated on axial images of the spin echo sequences obtained with a 1.5 tesla (T) system. We found that LIA appeared after age 50 and became more common with advancing age. Their presence correlated with brain atrophy and white matter lesions. They were most frequent in the motor cortex, followed by the occipital and sensory cortices. Their incidence in the motor cortex was significantly higher in patients with central nervous system diseases than in those with peripheral neuropathy. We conclude that LIA are common in old patients with various neurological diseases and suggest that the deposition of iron in the cerebral cortices causes their development.

[Intratumoral LPD deposition within hepatocellular carcinoma without arterial tumor staining].

The dissociation of intratumoral LPD deposition and arterial tumor staining was investigated in 20 cases of hepatocellular carcinoma (HCC) without arterial tumor staining. The intratumoral deposition of LPD injected from the hepatic artery was observed in nine cases of HCC and coincided with the decrease in tumor vascular bed evaluated by photomicroscopic study and arterial portography. LPD deposition was not observed within the 11 other tumors, which were diagnosed as well differentiated HCC. Infusion angiographic CT revealed that the arterial and portal vascular beds were separated from each other. Therefore, arterial tumor staining was insufficient for accurate evaluation of the tumor vascular bed. The vascular bed in cancerous and noncancerous tissue was accurately evaluated by the addition of the contrast enhancements from the hepatic artery and the portal vein.

[Experimental study on early detection of alloxan-induced pulmonary injury by magnetic resonance imaging].

We studied the early detection of alloxan-induced pulmonary injury by magnetic resonance imaging in vivo. Permeability edema was induced in ten rats by intravenous injection of alloxan at 100 mg/kg. T1-and T2-weighted images were acquired in five rats every 30 min for 120 min after alloxan injection. Five rats served as controls. The rats were sacrificed immediately after imaging and examined microscopically. CT images were also acquired in five rats every 30 min for 120 min after alloxan injection. Five rats served as controls. The rats were sacrificed immediately after imaging, and the wet-to-dry ratio of the lung was measured. In T1-weighted images, relative signal intensity from the lung with permeability edema rose from 30 min to 120 min, and was greater than that from normal lung every time. In T2-weighted images, there was no statistically significant difference in relative signal intensity of the lung between permeability edema and the control during 120 min. In CT images, there was also no statistically significant difference in lung density between permeability edema and the control during 120 min. There was no statistically significant difference in the wet-to-dry lung ratio between edematous lung and normal lung. In histological study, mild congestion and interstitial edema were observed in edematous lung. These results suggest the potential capability of MR imaging in detecting the early phase of permeability pulmonary edema.

Diffusion anisotropy of cerebral ischaemia.

Focal cerebral ischemia was produced by occlusion of the middle cerebral artery with a silicone cylinder in Wistar rats. Diffusion-weighted echo-planar images (DW-EPIs) using the motion-probing gradient (MPG) method were acquired at 1-3 hours and 24-48 hours after occlusion. Apparent diffusion coefficients (ADCs) were calculated from these images in ischemic lesions and in normal unoccluded regions. Results were as follows. 1. Ischemic lesions could be detected on the DW-EPIs at 1 hour after occlusion. 2. The ADC of water in the brain tissue was smaller than that of free water as a result of restricted diffusion. 3. Anisotropic diffusion that probably can be attributed to the myelin sheath was observed in the normal deep white matter. 4. In the ischemic lesions, the ADC decreased rapidly within 1-3 hours after occlusion and then slightly further declined after 24-48 hours. In the ischemic deep white matter, diffusion anisotropy disappeared at 24-48 hours after occlusion. Diffusion-weighted imaging may have applications in the examination of pathophysiological mechanisms in cerebral ischemia by means of evaluation of ADC and diffusion anisotropy.

Column-switching high-performance liquid chromatography for on-line simultaneous determination and resolution of enantiomers of verapamil and its metabolites.

An on-line simultaneous assay for the enantiomers of verapamil (VA) and its three metabolites in plasma was developed with column-switching HPLC. This system consists of an ovomucoid protein chiral stationary phase coupled to an achiral reversed-phase column via a dilution tube and a trapping column. The reversed-phase column was used to separate and quantitate VA, its metabolites, and internal standard, without interference from plasma components. Then each of the eluates containing VA and its metabolites was selectively switched into a sampling loop, and the samples were transferred successively to the trapping column after dilution with a new mobile phase. After concentration on the trapping column, each sample was passed to the ovomucoid column, where the enantiomers were resolved and quantitated. The mobile phases for both HPLC columns were independently optimized and the diffusion of the sample during column switching was minimized. This method was shown to be efficient and reliable.

Interstitial deletion of the long arm of chromosome 6 associated with absent pulmonary valve.

We report on a newborn infant with a deletion of 6q and absent pulmonary valve. His chromosome constitution was 46,XY,del (6) (q15q21). To our knowledge this is the first case with such combination. Some of his clinical features were found in common in 2 previous 6q- cases with the same breakpoints.

[A case of arachnoid cyst in the posterior fossa with lower cranial nerve palsy].

We experienced a rare case of arachnoid cyst in the right cerebellomedullary cistern. A 59-year-old female was admitted to our clinic because of lower cranial nerve palsy (deviation of uvula to the left side, swallowing disturbance, curtain sign, hoarseness, atrophy of the right sternocleidomastoid muscle, and deviation of the tongue to the right side). MRI demonstrated a mass lesion compressed towards the medulla oblongata in the right cerebellomedullary cistern. MRI was very helpful as a diagnostic tool, since there is no bone object in the posterior fossa. Although by CT cisternography, the arachnoid cyst was thought to have a communication with the surrounding subarachnoid spaces, the cyst wall was removed because of its compressive symptoms on the lower cranial nerves. After the operation, the cyst shrank, and the clinical symptoms were reduced.

Magnetic resonance imaging of Chiari malformations.

The authors describe the features of magnetic resonance (MR) images of Chiari type I and II malformations and present four illustrative cases. Downward displacement of the posterior fossa was more pronounced with type II than type I. A variety of intracranial anomalies were associated with the Chiari type II malformation, whereas type I was mainly associated with syringomyelia and craniovertebral changes. MR imaging is useful in the diagnosis of intracranial anomalies and those situated at the craniovertebral junction, including Chiari malformations.

[Lymphocytic adenohypophysitis: MRI findings of a suspected case].

We report a case of a 26-year-old woman who had developed decrease of visual acuity, and restriction of the temporal visual field of the left eye in the 30th week of gestation. A skull roentgenogram showed no abnormality, but a pituitary mass was visualized by plain computed tomographic scan. Magnetic resonance imaging (MRI) demonstrated a symmetric sellar mass which had homogeneous signal intensity in all pulse sequences. T1 relaxation time of the mass was elongated as compared with that of a normal pituitary gland. The height of the mass was 11mm, and optic chiasm appeared compressed by the mass. Her visual disturbance improved before delivery, and the size of the pituitary mass regressed spontaneously. Although no histological examination was carried out, the most likely explanation for this phenomenon is lymphocytic adenohypophysitis. Early surgical intervention is not required for lymphocytic adenohypophysitis, because this disorder may be self-limiting, and may resolve itself. Most of these cases have been reported in women, often coincident with pregnancy. So we consider that MRI is the most useful and safest method for diagnosis and follow-up of this disease.

Pituitary enlargement, hypertrichosis and blunted growth hormone secretion in primary hypothyroidism.

Pituitary hyperplasia, hypertrichosis and blunted growth hormone (GH) secretion were observed in three children with untreated primary hypothyroidism. These abnormalities disappeared and improved after thyroid hormone therapy. The recognition of these associations may eliminate unnecessary surgery and GH therapy and lead to the choice of thyroid hormone replacement therapy.

[Magnetic resonance imaging of hypothalamic hamartoma].

Magnetic resonance (MR) findings of two patients with a hypothalamic hamartoma are discussed. The two girls showed clinical symptoms and endocrinological signs of precocious puberty. MR imaging was of diagnostic value superior to that of CT in the demonstration of the characteristic location of this tumor and relationships to the neighboring structures because of its multi-dimensional utility. Although it has been reported that CT showed this lesion as isodense to the grey matter with and without injection of contrast medium, MR imaging depicted the lesion as a high signal intensity area on T 2-weighted images in both patients. MR imaging is a useful method for the evaluation of the hypothalamic hamartoma.

[Clinical study on serum immunosuppressive factors in gastric cancer patients--with special reference to preoperative ferritin levels and influence of surgical stress].

Serum ferritin values were measured preoperatively in 83 patients with gastric cancer and were found to be significantly higher than in normal subjects and mammary cancer patients. They were also significantly higher in healthy men than in women and in gastric cancer patients at stages I and IV than in those at stage III. There was no significant correlation between the serum ferritin value and various immunologic parameters. OK-432 serially administered pre- and postoperatively (A) and only postoperatively (B). The ferritin value increased markedly at one week postoperatively, reaching a peak at two weeks; at four weeks, it was reduced toward the value at one week. However, these changes in ferritin value showed no significant difference between groups A and B.