Tacrolimus is effective for lupus nephritis patients with persistent proteinuria.

OBJECTIVES: To evaluate the safety and potential efficacy of tacrolimus for the treatment of patients with lupus nephritis and persistent proteinuria. METHODS: A total of 23 Japanese patients with lupus nephritis (21 females/2 males) were enrolled in this study. Patients were administered tacrolimus at a dose of 2-3 mg once daily after the evening meal for 6 months. The dose of tacrolimus was unchanged throughout the study period. Concomitant prednisolone therapy was unchanged or gradually tapered, while other immunosuppressants were stopped at the start of tacrolimus treatment. RESULTS: Tacrolimus was well tolerated, and none of the patients developed adverse drug reactions that required discontinuation of the study. Daily urinary protein loss, the U-prot/U-creat ratio, and serum albumin were significantly improved after 4 months, 3 months, and 1 month of treatment with tacrolimus (p<0.05), respectively, and the improvement persisted until 6 months. The serum complement hemolytic activity (CH50), complement C3 level, and CRP level were also significantly improved after treatment with tacrolimus (p<0.05). Improvement of the U-prot/U-creat ratio was most prominent for patients who were in WHO class IV. CONCLUSIONS: Tacrolimus is safe and effective as maintenance therapy for patients with lupus nephritis, at least for 6 months. A larger randomised, controlled trial over a longer period is needed to confirm these results.

Solitary choroid plexus lipomas: CT and MR appearance.

Using MR imaging, the authors detected 23 cases of intracranial lipomas, among which were three cases of solitary choroid plexus lipomas. All the lipomas were located in the choroid plexus at the trigone. One of the three solitary choroid plexus lipomas was very small and could not be detected using CT. The authors believe that solitary choroid plexus lipomas are not as rare as was previously thought.

Giant cell reparative granuloma of the cranial vault.

We describe a case of giant cell reparative granuloma in the cranial vault, which is an extremely rare location for this entity. CT scans showed an enhancing skull tumor with no surrounding sclerosis in the frontal bone. MR images showed a mass isointense with gray matter on both T1- and T2-weighted images.

Cranial MR imaging of sequelae of prefrontal lobotomy.

BACKGROUND AND PURPOSE: Although prefrontal lobotomy is an obsolete treatment for schizophrenia, we still encounter patients who have undergone this procedure. The purpose of this study was to describe the MR imaging findings of sequelae of prefrontal lobotomy. METHODS: We retrospectively reviewed cranial MR images of eight patients with schizophrenia who underwent prefrontal lobotomy approximately 50 years previously. RESULTS: In all patients, a bilateral cavitary lesion with a thick wall was found in the frontal white matter. The genu of the corpus callosum was mildly to markedly atrophic. The size and location of the cavity and the degree of callosal atrophy were correlated. CONCLUSION: MR imaging is useful for the diagnosis of sequelae of prefrontal lobotomy, including cavitary lesions with dense walls of gliosis and secondary degeneration of the genu of the corpus callosum.

Blood blisterlike aneurysms of the internal carotid artery.

OBJECT: An aneurysm arising from the anterior wall of the internal carotid artery (ICA) is a poorly understood entity. A small hemispherical bulge from the anterior wall of the ICA, which is called a "blood blisterlike aneurysm" (BBA), may be confused with a tiny berry aneurysm although the clinical features are distinctly different. This paper summarizes the clinical course of patients with this lesion to clarify the nature of the BBA. METHODS: Six patients with BBAs who presented with subarachnoid hemorrhage (SAH) are described. In all patients, the initial angiogram obtained soon after SAH showed only a small bulge from the anterior wall of the ICA. In three of the six patients this bulge had progressed to a saccular appearance within a few weeks. The wall of the lesion was so thin and fragile that the aneurysm ruptured at the base during clipping or within a few hours after clipping in two patients. CONCLUSIONS: From the authors' experience, as well as a review of the literature, which includes an autopsy study of similar cases, it is inferred that these lesions are focal wall defects covered only with thin fibrous tissue and that they are therefore not true aneurysms. Direct clipping often causes laceration of the lesion, whereas complete wrapping or clipping after wrapping is effective, but may fail to prevent growth of the aneurysm. Endovascular occlusion of the cervical ICA with or without bypass surgery, which is less risky than direct surgery, is another option.

Comparison of adjuvants with respect to serum IgG antibody response in orally immunized chickens.

We have previously shown that oral immunization with non-replicating antigens hardly induced serum IgG antibody response in chickens and addition of sodium fluoride (NaF) to the immunogen markedly improved their immunological states. In the present study, taurine, lithium and Quillaja saponin (Q-SAP) were compared with NaF with respect to their enhancement of serum IgG antibody response in chickens after oral immunization. The antibody titer of chickens which received Q-SAP as the mucosal adjuvant tended to be higher than that of chickens which received antigen plus NaF. Simultaneous administration of antigen with lithium or taurine elicited a higher antibody titer in chickens compared to those of chickens orally immunized with antigen alone, but the effect of these two adjuvants was less efficient compared with that of NaF. These results suggested that Q-SAP as well as NaF is useful as an oral adjuvant for chickens.

Uptake of orally administered polystyrene latex and poly(D,L-lactic/glycolic acid) microspheres into intestinal lymphoid tissues in chickens.

Fluorescein-labeled microspheres were orally administered to chickens and their distribution in intestinal lymphoid tissues was investigated. Polystyrene latex microspheres were observed in Peyer's patches, and also in the Meckel's diverticulum and the jejunum. Their density, however, seemed to be lower than that in Peyer's patches. Microspheres were rarely observed in the other intestinal tissues examined, including the bursa of Fabricius. Of note is that, although microspheres were present in the lumen, few, if any, were observed in the lamina propria of the caecal tonsil and caecum. Polystyrene latex microspheres of diameter 2.0 microm or 4.5 microm were also observed in Peyer's patches, but their density seemed to be lower as compared with the 0.75 microm microspheres. Poly(D,L-lactic/glycolic acid) (PLGA) microspheres were prepared using PLGAs of various molecular weights (MW) and their uptake into Peyer's patches was compared. Microspheres prepared with PLGA of average MW of 20000 were not taken up into Peyer's patches, but those prepared with PLGA of average MW of 61000 or 99 800 were taken up into Peyer's patches.

Posttranscatheter embolization computed tomography in hepatocellular carcinoma. Evaluation of embolization effects.

The postcontrast CT scans and angiography of 26 lesions in 23 patients with hepatomas who underwent transcatheter arterial embolization therapy were reviewed. Newly developed low density and high density areas and gas were noted on CT scans of the tumors after embolization in 100, 8 and 58% of the lesions, respectively. The CT findings of residual tumors correlated well with those of follow-up angiography. When discrete smooth round low density zones were observed on CT, there was no residual neovascularity on follow-up arteriography. When there were nodular or thick septum-like structures in low density lesions, arteriography revealed residual tumor vascularity in the lesions. CT proved useful not only in evaluating the effects of embolization, but also in providing important information about residual tumors.

MR imaging of middle cerebral artery occlusion without cerebral infarction.

Magnetic resonance (MR) images of 12 patients with angiographically proven middle cerebral artery (MCA) occlusion were analyzed, retrospectively. In three of the 12 patients, cerebral infarctions related to the MCA occlusions were not evident. Two of the three patients were cases of atherosclerotic occlusion and the remaining patient had an acute thromboembolism. In all of the occluded M1 portions of the MCA the flow void was absent and there were isointense linear structures, with or without a hyperintense component in the Sylvian vallecula, on T1-weighted images. For nine of the 12 patients, the absence of flow void in the ipsilateral Sylvian fissure was evident on the T2-weighted images. Therefore, even in cases with no evidence of a cerebral infarction, the presence of flow void in the Sylvian vallecula and Sylvian fissure must be searched for in routine reviews of MR images. If MR imaging can be obtained on an emergency basis, appropriate interventional therapy may be immediately initiated.

Magnetic resonance imaging of intracranial venous angiomas.

Magnetic resonance imagings (MRI) were made of intracranial venous angioma (six angiographically proved, four presumed). All draining veins were identified as a linear or a small round structure with a flow void. The stellate configuration was observed in seven of the ten patients. In two of the ten, the associated intraparenchymal hematoma was evident. Increased intensity of adjacent parenchyma on T2-weighted images was detected in four of ten patients, and a decreased intensity on the T1-weighted images was noted in three of eight. Thus, MRI is a pertinent diagnostic modality for evaluating intracranial venous angioma. Angiography does not seem to be required for confirmation in patients with typical MR findings.

Cerebral magnetic resonance imaging of liver cirrhosis patients.

Thirty-two patients with liver cirrhosis underwent cerebral magnetic resonance imaging (MRI) to evaluate clinical and subclinical portal-systemic encephalopathy (PSE). Symmetrically hyperintense globus pallidi were observed on T1-weighted images in all 11 patients with PSE and in 15 of the 21 patients with PSE. This abnormality was classified as grade I (bilateral globus pallidi with mild to moderate hyperintensity relative to white matter), and grade II (marked hyperintensity bilaterally in the globus pallidi with mildly increased signal intensities in the surrounding structures). Portal-systemic collateral vessels were demonstrated in 23 of 24 patients who underwent abdominal angiography. In 18 of the 19 patients with abnormal MRI, collateral vessels were supplied by the superior mesenteric vein with or without the splenic vein, including four patients with collaterals which were less than 10 mm in diameter. We concluded that hyperintense globus pallidi on T1-weighted images are significant manifestations of clinical PSE. When portal-systemic collaterals supplied by the superior mesenteric vein are observed, even if they are of small diameter, cerebral MRI should be performed to evaluate for subclinical PSE.

MRI of dorsal mesencephalic lipomas.

We detected 23 intracranial lipomas using MRI. Among them were nine pericallosal lipomas, six lipomas at the dorsal surface of the midbrain, and eight in other locations. In this paper, six lipomas at the dorsal surface of the midbrain were analyzed. Five of these lipomas were in the quadrigeminal cistern and one in the left-sided quadrigeminal cistern. Excluding the smallest lipoma, five of the six lipomas had irregular margins and were broadly based on the surface of the midbrain. In these five cases, deformities of the brain parenchyma were observed adjacent to the lipomas. A mildly dilated ventricular system was observed in one of the largest lipomas in a quadrigeminal cistern. Based on their characteristic shapes and locations, we termed them "dorsal mesencephalic lipomas." Thus, the two preferential sites of intracranial lipomas were pericallosal and dorsal mesencephalic.

MRI of dural carotid-cavernous fistulas. Comparisons with postcontrast CT.

Ten patients with dural carotid-cavernous fistulas (CCFs) who presented with ophthalmic manifestations were studied using postcontrast computed tomography (CT), magnetic resonance imaging (MRI), and selective cerebral arteriography. The lesions of two patients were bilateral. An enlarged cavernous sinus (CS) was diagnosed in 6 of the 12 involved sides using postcontrast CT. An abnormal flow void in the CS was detectable in 11 of the 12 using MRI. A dilated superior ophthalmic vein (SOV) was demonstrated in all of the involved sides by postcontrast CT, and in 9 of the 12 by axial MRI. Thus, both postcontrast CT and MRI are relatively useful and complementary in the diagnosis of dural CCFs. Patients should be followed with selective cerebral arteriography for definitive diagnoses and for therapeutic planning.

MR imaging and MR angiography of persistent trigeminal artery and its variant.

Six patients with persistent trigeminal artery (PTA) and one patient with its variant (PTAV) were studied using a 1.0-T magnetic resonance unit. With both magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA), four of the six PTAs were detected as abnormal connecting arteries between the cavernous internal carotids and the basilar arteries. The remaining two PTAs and one PTAV were not detected using MRI, but were imaged by MRA. It was concluded that relatively large PTAs can be detected using MRI, but small PTAs and PTAVs may be missed using MRI.

Persistent primitive olfactory artery: diagnosis with MR angiography.

We present a case of persistent primitive olfactory artery (PPOA) diagnosed with the aid of magnetic resonance (MR) angiography. The proximal right anterior cerebral artery (ACA) had an extremely long anteroinferomedial course along the ipsilateral olfactory tract, made a hairpin turn posterosuperiorly, and became a normal distal ACA. After reviewing the literature, we considered the proximal segment of this anomalous ACA to be a PPOA. To our knowledge, this is the first report of a patient with this anomalous ACA diagnosed with MR angiography.

Superficial siderosis of the central nervous system. Its MRI manifestations.

Three cases of superficial siderosis of the central nervous system are reported here. Using a 1.0-T magnetic resonance (MR) unit, typical hypointense rims were observed under the brain surface on T2-weighted images. In one patient, marked atrophy of the superior cerebellar vermis and cerebellar parenchymal hyperintensity were also detected. The spinal cord was involved in two of the three patients. On T1-weighted images, hyperintense rims were demonstrated over the brain surface in two of the three patients. This finding has not been previously reported.

Cerebral hemiatrophy caused by multiple developmental venous anomalies involving nearly the entire cerebral hemisphere.

The authors present a case of multiple developmental venous anomalies (DVAs) that involved nearly the entire cerebral hemisphere and that were diagnosed by magnetic resonance (MR) imaging and selective cerebral angiography. The ipsilateral cerebral hemisphere was mildly atrophic, and there were focal white matter lesions on the MR images. Angiography showed multiple DVAs involving nearly the entire right cerebral hemisphere. We suggest that longstanding venous congestion caused the atrophy and white matter lesions.

MRI of intradural-extramedullary spinal neurinomas and meningiomas.

The magnetic resonance images of 16 patients with intradural-extramedullary spinal tumors, consisting of 11 neurinomas and five meningiomas were reviewed. The neurinomas appeared hypointense compared to the spinal cord on unenhanced T1-weighted images (T1WI) in nine of 11 patients, and hyperintense on T2-weighted images (T2WI) in nine of 11 patients. Neural foraminal extension was present in two cases. All 10 neurinomas were markedly enhanced; six of them exhibited ring-like enhancement on Gadolinium-DTPA (Gd-DTPA)-enhanced T1WI. The meningiomas appeared isointense on unenhanced T1WI in four of five patients and on T2WI in three of four patients. Three meningiomas showed moderate homogeneous contrast enhancement after the intravenous administration of Gd-DTPA. It is concluded that careful scrutiny of magnetic resonance images facilitates the differential diagnosis of spinal neurinomas and meningiomas.

Cerebral venous angiomas associated with hemorrhagic lesions. Their MRI manifestations.

Using two 1.5-T magnetic resonance (MR) scanners, 82 venous angiomas (VAs) were imaged. There were 13 (16%) VAs associated with hemorrhagic lesions. Ten of the 13 hemorrhagic lesions were considered hematomas in the subacute or chronic stage, caused by VAs or coexisting cavernous hemangiomas. Two of the 13 were subacute intracerebral hematomas; the remaining one was a sequela of a hemorrhagic venous infarct. After analysis of our data, it was concluded that infratentorial VAs and deeply draining supratentorial VAs in relatively young adults, especially females, are relatively frequently associated with intracerebral hemorrhagic lesions. MR imaging proved useful for diagnosing VAs and associated hemorrhagic lesions.

Supraclinoid carotid dissection in a pediatric patient.

The authors present the case of a 13-year-old boy with a left temporal lobe infarction that developed during a 400-m run. Magnetic resonance (MR) angiography showed segmental narrowing of the left supraclinoid internal carotid artery (ICA) and a duplicated left middle cerebral artery (MCA). MR angiographic source images revealed a crescent-shaped left carotid lumen, indicative of a supraclinoid carotid dissection.