Hironobu Nakamura

Movement-Related Desynchronization of the Cerebral Cortex Studied with Spatially Filtered Magnetoencephalography

Event-related desynchronization (ERD) within the alpha and beta bands on unilateral index finger extension and hand grasping was investigated on six normal volunteers with magnetoencephalography (MEG). A novel spatial filtering technique for imaging cortical source power, synthetic aperture magnetometry (SAM), was employed for the tomographic demonstration of ERD. SAM source image results were transformed into statistical parametric images. On the same hand grasping task, a functional MRI (fMRI) study was conducted on two subjects and compared with the ERD result. When the MEG data were analyzed with the fast Fourier transformation, power attenuation within the alpha and beta bands was evident on the contralateral sensorimotor area just prior to movement onset. The tomographic distribution of ERD was clearly obtained with SAM statistical imaging analysis. The equivalent current dipole (ECD) for the signal-averaged motor field was localized to the hemisphere contralateral to the hand movement, roughly at the center of the region displaying beta-band ERD. The signal increase on fMRI roughly colocalized with the ERD on the contralateral sensorimotor area. In conclusion, with the novel spatial filtering technique for the brain magnetic field, SAM, cortical regions contributing to ERD on finger movement were successfully demonstrated in a tomographic manner. The relative colocalization of the contralateral SAM ERD with ECD as well as the fMRI activation suggests that SAM is a practically useful technique to extract event-related signals from brain noise.

MRI of the brain in diabetes mellitus

We studied the MRI appearances of the brain in 159 patients with diabetes mellitus (DM) and 2566 agematched individuals without DM (controls). The images were reviewed for cerebral infarcts, hemorrhage, atrophy and subcortical arteriosclerotic encephalopathy. Cerebral atrophy was significantly more frequent in patients with DM than in controls (P>0.005) from the sixth to the eighth decade. The frequency of atrophy was 41.2% in the 6th decade, 60.0% in the 7th and 92.3% in the 8th decade in DM, and 19.8%, 38.9% and 56.8% respectively in controls. Unexpectedly, there was no statistically significant difference in the incidences of cerebrovascular diseases at any age.

High-resolution CT findings of lung disease in patients with polymyositis and dermatomyositis.

The purpose of this study was to determine the type and distribution of interstitial lung disease seen in patients with polymyositis and dermatomyositis, using high-resolution computed tomography (HRCT). The presence and distribution of high-resolution CT findings were retrospectively evaluated in 25 patients with polymyositis/dermatomyositis. In 14 patients, a pathological diagnosis of pulmonary disease was obtained. Three lung specimens were also studied. Results showed that 23 patients had abnormal HRCT showing the following abnormalities: ground glass opacities (92%), linear opacities (92%), irregular interfaces (88%), airspace consolidation (52%), parenchymal micronodules (28%), and honeycombing (16%). A relatively high prevalence of airspace consolidation (52%) and a low prevalence of honeycombing (16%) were observed. Two patients with extensive consolidation proved to have diffuse alveolar damage; eight patients with either subpleural band-like opacities (n = 5) and/or airspace consolidation (n = 7) had bronchiolitis obliterans organizing pneumonia; four patients with honeycombing had usual interstitial pneumonitis. We conclude that HRCT findings in patients with polymyositis/dermatomyositis are nonspecific. However, a high prevalence of airspace consolidation and a low prevalence of honeycombing were observed. Predominant HRCT patterns are suggestive of the pathologic processes occurring in polymyositis/dermatomyositis.

Phase II study of hepatic arterial infusion of a fine-powder formulation of cisplatin for advanced hepatocellular carcinoma

Aim:  Intra‐arterial cisplatin appears to have high therapeutic efficacy, but this has not been studied in detail. Accordingly, we developed a fine‐powder cisplatin formulation and tested it in advanced hepatocellular carcinoma (HCC) patients in an open‐label, uncontrolled study in which 27 institutions participated.

Pulmonary involvement in primary Sjögren's syndrome: spectrum of pulmonary abnormalities and computed tomography findings in 60 patients.

The purpose of this study was to describe the high-resolution computed tomography (HRCT) findings of pulmonary involvement in primary Sjögrens syndrome. The study included 60 patients who met the diagnostic criteria for primary Sjögrens syndrome. The authors retrospectively reviewed the presence, extent, and distribution of various HRCT findings. Results showed that the most common HRCT findings were areas with ground-glass attenuation (92%), followed by subpleural small nodules (78%), non-septal linear opacity (75%), interlobular septal thickening (55%), bronchiectasis (38%), and cysts (30%).

Nonpalpable lymph nodes of the neck: Assessment with US and US-guided fine-needle aspiration biopsy

Ultrasound (US) and US‐guided fine‐needle aspiration biopsy (FNA) were performed in 91 nonpalpable neck nodes of 70 patients, 93% of which had known malignancy. Various sonographic findings were evaluated for predicting malignancy. The accuracy of US‐guided FNA for detecting malignancy was 88%, with 96% sensitivity and 94% specificity. The ratio of minimal to maximal axial diameters of a node was most valid for predicting malignancy with US. A ratio of more than 0.55 yielded the highest accuracy (80%) (92% sensitivity, 63% specificity). Addition of any other factors to this criterion did not improve its accuracy. US and US‐guided FNA are accurate for the assessment of nonpalpable neck nodes. Lymph nodes with a round configuration should be biopsied in patients with known malignancy.

Construction of Hierarchical Multi-Organ Statistical Atlases and Their Application to Multi-Organ Segmentation from CT Images

Hierarchical multi-organ statistical atlases are constructed with the aim of achieving fully automated segmentation of the liver and related organs from computed tomography images. Constraints on inter-relations among organs are embedded in hierarchical organization of probabilistic atlases (PAs) and statistical shape models (SSMs). Hierarchical PAs are constructed based on the hierarchical nature of inter-organ relationships. Multi-organ SSMs (MO-SSMs) are combined with previously proposed single-organ multi-level SSMs (ML-SSMs). A hierarchical segmentation procedure is then formulated using the constructed hierarchical atlases. The basic approach consists of hierarchical recursive processes of initial region extraction using PAs and subsequent refinement using ML/MO-SSMs. The experimental results show that segmentation accuracy of the liver was improved by incorporating constraints on inter-organ relationships.

Automated segmentation of the liver from 3D CT images using probabilistic atlas and multi-level statistical shape model

An atlas-based automated liver segmentation method from 3D CT images is described. The method utilizes two types of atlases, that is, the probabilistic atlas (PA) and statistical shape model (SSM). Voxel-based segmentation with PA is firstly performed to obtain a liver region, and then the obtained region is used as the initial region for subsequent SSM fitting to 3D CT images. To improve reconstruction accuracy especially for largely deformed livers, we utilize a multi-level SSM (ML-SSM). In ML-SSM, the whole shape is divided into patches, and principal component analysis is applied to each patches. To avoid the inconsistency among patches, we introduce a new constraint called the adhesiveness constraint for overlap regions among patches. In experiments, we demonstrate that segmentation accuracy improved by using the initial region obtained with PA and the introduced constraint for ML-SSM.

Embolization of High Flow Arteriovenous Malformations: Experience with Use of Superabsorbent Polymer Microspheres

PURPOSE To determine efficacy, safety, and requirements for adjunctive embolization or surgery in the treatment of symptomatic arteriovenous malformations (AVMs) with superabsorbent polymer microsphere (SAP-MS) particles. MATERIALS AND METHODS SAP-MS particles (sodium acrylate and vinyl alcohol copolymer) are nonbiodegradable spheres with a precisely calibrated diameter. SAP-MS particles swell by absorbing fluids and become soft and deformable. Twenty-five patients (16 men, nine women; mean age, 32 y; range 12-66 y) with symptomatic facial (n = 5), upper- (n = 8) and lower- (n = 12) extremity AVMs were treated primarily (n = 23) or preoperatively (n = 2) by transarterial embolization (TAE) treatment with use of SAP-MS particles. Direct puncture embolization (DPE; n = 4) and/or surgical intervention (n = 5; ie, skin graft, resection, or amputation) were required. Surgical specimens from the resected (n = 2) and the amputated (n = 2) patients were evaluated histologically. Follow-up study, including clinical findings and imaging studies, was performed at intervals ranging from 3 months to 1 year. Clinical outcome was evaluated retrospectively, depending on the subjective improvement of symptoms and signs, according to the medical records. RESULTS Seventy-two TAEs (range, 1-11; mean, 2.8) and 12 DPEs (range, 1-3; mean, 2.4) were performed during the mean follow-up period of 38 months (range, 7-110 mo). Twenty patients (80%) experienced symptom improvement by embolotherapy alone (n = 17) or in combination with surgery (n = 3). One lip and two finger AVMs were totally removed by surgical excision or amputation after TAE treatment. In diffuse upper- (n = 1) and lower- (n = 1) extremity AVMs, the symptoms were uncontrolled. No nerve injury or skin necrosis was observed after TAE treatment with SAP-MS particles. Mucosal necrosis was induced by DPE with ethanol in one patient. Histologically, SAP-MS particles penetrated intralesional vessels and conformed to the vessel lumen, resulting in tight vessel occlusion. Minimal perivascular reaction was observed. CONCLUSION SAP-MS particles were used safely in TAE treatment of AVM. TAE treatment with use of SAP-MS particles was suitable for certain symptomatic AVMs, but diffuse AVMs remain a challenge and a combination of alternative methods will be necessary for further strategy.

Invasive and noninvasive thymoma: distinctive CT features.

Purpose The purpose of this work was to evaluate the CT features of thymoma and to determine the most helpful findings in differentiating invasive from noninvasive thymoma. Method The CT scans from 27 patients with invasive thymoma and 23 with noninvasive thymoma were independently assessed by two observers without knowledge of their invasiveness. The presence and distribution of various CT findings were independently analyzed. Results Invasive thymomas were more likely to have lobulated (16/27, 59%) or irregular (6/27, 22%) contours than noninvasive thymomas (8/23, 35% and 1.5/23, 6%, respectively) (p < 0.05). Invasive thymomas had a higher prevalence of low attenuation areas within the tumor (16/27, 60%) than noninvasive thymomas (5/23, 22%) (p < 0.001) as well as foci of calcification (14.5/27, 54% vs. 6/23, 26%; p < 0.01). Conclusion The presence of lobulated or irregular contour, areas of low attenuation, and multifocal calcification is suggestive of invasive thymoma.