ASLを用いたうつ病における6週間のエスシタロプラム内服による脳血流変化の検討

広島大学(Hiroshima University)博士(医学)Doctor of Philosophy in Medical Sciencedoctora

Changes over Time in Intracranial Air in Patients with Cerebral Air Embolism: Radiological Study in Two Cases

Cerebral air embolism can be easily identified on computed tomography (CT) scans. However, changes in the distribution and amount of intracranial air are not well known. We report two patients with cerebral air embolism and present imaging findings on the serial changes in the intracranial air. We thought that the embolic source was venous in one patient because CT showed air inflow in cortical veins in the bilateral frontal areas, reflecting air buoyancy. In the other patient, CT showed air inflow into not only the cortical veins but also the bilateral cerebral hemispheres and we thought this to be a paradoxical cerebral air embolism. We found that intracranial air can be promptly absorbed and while cerebral infarcts due to air are clearly visualized on diffusion-weighted images (DWI), the air may rapidly disappear from images. In patients with suspected cerebral air embolism whose CT findings show no intracranial air, DWI should be performed because it may reveal cerebral infarction due to cerebral air embolism

Diagnostic Performance of Positron Emission Tomography for the Presurgical Evaluation of Patients with Non-lesional Intractable Partial Epilepsy : Comparison among 18F-FDG, 11C-Flumazenil, and 11C-Flumazenil Binding Potential Imaging Using Statistical Imaging Analysis

To compare the diagnostic performance of 18F-FDG PET, 11C-FMZ PET, and 11C-FMZ BP imaging for the evaluation of patients with intractable partial epilepsy whose MRI findings are normal by using statistical imaging analysis. Ten patients underwent comprehensive presurgical evaluation, including PET studies, to assess the epileptic foci. The extent of cortical resection was based on the results of intracranial video-electroencephalography (IVEEG) monitoring and brain mapping under stimulation. The images of 10 patients and 30 controls were spatially normalized to templates generated in-house by non-rigid registration and the standardized images of the patients and controls were statistically compared. Epileptic focus candidates were visualized on a color map of axial images of each template and the focus site was identified in candidates for lobar location. In patients with Engel I postoperative seizure outcomes we assessed the sensitivity and specificity of the imaging methods for lobar focus localization. We also compared the concordance scores of patients with Engel I and Engel II-IV postoperative seizures. The sensitivity and specificity for lobar focus localization on 18F-FDG PET scans was 90.0% and 84.8%, respectively; it was 30.0% and 81.4% for 11C-FMZ PET, 40.0% and 66.7% for 11C-FMZ BP images, and 100.0% and 51.4% for 18F-FDG PET/11C-FMZ PET/11C-FMZ BP images. In one patient the epileptic focus not detected on 18F-FDG PET scans was shown on 11C-FMZ BP images. In patients with Engel I post-treatment seizures the concordance scores were significantly higher for 18F-FDG PET than 11C-FMZ PET and 11C-FMZ BP images (p < 0.05). With respect to sensitivity and specificity, 18F-FDG PET was superior to 11C-FMZ PET and 11C-FMZ BP imaging. However, in some patients with normal MRI results, 11C-FMZ BP studies may complement 18F-FDG PET findings in efforts to identify the epileptogenic lobar regions

Cooperative Clinical Trial of Photodynamic Therapy for Early Gastric Cancer With Photofrin Injection® and YAG-OPO Laser

Background and Objective: Photodynamic therapy (PDT) treats malignant tumors using photosensitizers and light. We employed a new pulse laser as the excitation light source for PDT, i.e. an optical parametric oscillator (OPO) system pumped by a Q-switched Nd:YAG laser, because it provides extremely high peak power

A Clinical Study of Photodynamic Therapy for Superficial Esophageal Carcinoma by YAG-OPO Laser

A cooperative clinical study of photodynamic therapy (PDT) for superficial esophageal carcinoma was conducted at 6 medical institution. PHE (2mg/kg) with high tumor affinity was used as the oncotropic compound. The light source was a pulse wave YAG-OPO laser with high penetration into the tissue. Irradiation was performed at an energy density of 60–180 J/cm2 48–72 h after PHE administration. Eight lesions in 6 patients were treated. All were type 0-II superficial carcinomas. The depth of invasion was EP–MM for 6 lesions and SM for 2 lesions. A complete response (CR) was achieved in all patients after one session of PDT. Five adverse events, including anemia and fever, were reported by 4 patients, but all were WHO grade 2 or lower and transient. PDT using PHE and YAG-OPO laser was therefore considered effective as a curative therapy for superficial esophageal carcinoma

Changes over Time in Intracranial Air in Patients with Cerebral Air Embolism: Radiological Study in Two Cases

Cerebral air embolism can be easily identified on computed tomography (CT) scans. However, changes in the distribution and amount of intracranial air are not well known. We report two patients with cerebral air embolism and present imaging findings on the serial changes in the intracranial air. We thought that the embolic source was venous in one patient because CT showed air inflow in cortical veins in the bilateral frontal areas, reflecting air buoyancy. In the other patient, CT showed air inflow into not only the cortical veins but also the bilateral cerebral hemispheres and we thought this to be a paradoxical cerebral air embolism. We found that intracranial air can be promptly absorbed and while cerebral infarcts due to air are clearly visualized on diffusion-weighted images (DWI), the air may rapidly disappear from images. In patients with suspected cerebral air embolism whose CT findings show no intracranial air, DWI should be performed because it may reveal cerebral infarction due to cerebral air embolism

Pituitary Volumes and Functions in Children with Growth Hormone Deficiency: Volumetric Magnetic Resonance Findings

Purpose: The purpose of the study was to compare pituitary volumes calculated from magnetic resonance imaging (MRI) in patients with idiopathic growth hormone deficiency (GHD) without structural abnormalities in the pituitary gland with clinical and biochemical features.Methods: This study was designed as a retrospective review and the need for informed consent was waived. MRI of the head was performed for 39 male and 17 female patients ranging in age from 10 to 14 years. Pituitary volumes were calculated from sectional area and ellipsoid formula. Pituitary volumes were compared between boys and girls. Pituitary volumes were also compared with measurements of pituitary function, age, and standard deviation scores (SDS) for height.Results: Whole pituitary volumes in patients were 405.1 ± 150.6 mm3 for the male group and 348.6 ± 161.1 mm3 for the female group. No significant difference was identified between mean pituitary volumes of the female and male groups. A weak correlation was found between pituitary volume and height SDS for boys (Ï = 0.34, p = .03). For girls, a moderate correlation was identified between pituitary volume and FSH level (Ï = 0.67, p &lt; .01).Conclusion: Pituitary volumes of GHD patients correlated with height SDS in boys and FSH levels in girls. Brain MRI can be used not only to rule out anatomical abnormalities of the pituitary gland in GHD patients, but also to assess pituitary functions in clinical settings

Magnetic resonance evaluation of multiple myeloma at 3.0 Tesla: how do bone marrow plasma cell percentage and selection of protocols affect lesion conspicuity?

PURPOSE: To compare various pulse sequences in terms of percent contrast and contrast-to-noise ratio (CNR) for detection of focal multiple myeloma lesions and to assess the dependence of lesion conspicuity on the bone marrow plasma cell percent (BMPC%). MATERIALS AND METHODS: Sagittal T1-weighted FSE, fat-suppressed T2-weighted FSE (FS- T2 FSE), fast STIR and iterative decomposition of water and fat with echo asymmetry and least-squares estimation (IDEAL) imaging of the lumbar spine were performed (n = 45). Bone marrow (BM)-focal myeloma lesion percent contrast and CNR were calculated. Spearman rank correlation coefficients were obtained between percent contrast, CNR and BMPC%. Percent contrasts and CNRs were compared among the three imaging sequences. RESULTS: BM-focal lesion percent contrasts, CNRs and BMPC% showed significant negative correlations in the three fat-suppression techniques. Percent contrast and CNRs were significantly higher for FS- T2 FSE than for STIR (P<0.01, P<0.05, respectively), but no significant differences were found among the three fat-suppression methods in the low tumor load BM group. CONCLUSION: The higher BMPC% was within BM, the less conspicuous the focal lesion was on fat-suppressed MRI. The most effective protocol for detecting focal lesions was FS- T2 FSE. In the high tumor load BM group, no significant differences in lesion conspicuity were identified among the three fat-suppression techniques

Effect of fatigue on the brain activity of radiologists while reading images

Reading fatigue in radiologists while assessing diagnostic images reduces their performance and increases errors in image interpretation. Such errors impact patient morbidity and mortality rates as diagnostic imaging plays a crucial role in patient management. We conducted functional magnetic resonance imaging (fMRI) scans of experienced and less-experienced radiologists reading images, both before and after fatigue induction, and assessed their brain activity in both states. Computed tomography (CT) images were presented to seven experienced and six less-experienced radiologists. Pre-fatigue, the radiologists underwent fMRI while reading head CT images; subsequently, they interpreted different CT images for 1 hour outside the MRI suite. Then, in the fatigued state, all 13 radiologists underwent fMRI scanning again while reading a different set of images. During the pre-fatigue reading of head CT images, the bilateral lingual gyri and posterior lobes of the cerebellum were activated in the experienced radiologists but not significantly activated in the less-experienced radiologists. No region was significantly activated in either group of fatigued radiologists. We concluded that the bilateral lingual gyri and posterior lobes of the cerebellum have important roles in image-reading tasks, suggesting the possibility of identifying brain regions involved in specific professional skills. The results indicated that fatigue resulted in reduced brain activation, underscoring the serious effect of excessive work on the brain activation of diagnostic radiologists