Ichiro Ikushima

Usefulness of diffusion‐weighted MRI with echo‐planar technique in the evaluation of cellularity in gliomas

The purpose of this study was to evaluate the utility of diffusion‐weighted magnetic resonance imaging (MRI) with echo‐planar imaging (EPI) technique in depicting the tumor cellularity and grading of gliomas. Twenty consecutive patients (13 men and 7 women, ranging in age from 13 to 69 years) with histologically proven gliomas were examined using a 1.5 T superconducting imager. Tumor cellularity, analyzed with National Institutes of Health Image 1.60 software on a Macintosh computer, was compared with the minimum apparent diffusion coefficient (ADC) and the signal intensity on the T2‐weighted images. The relationship of the minimum ADC to the tumor grade was also evaluated. Tumor cellularity correlated well with the minimum ADC value of the gliomas (P = 0.007), but not with the signal intensity on the T2‐weighted images. The minimum ADC of the high‐grade gliomas was significantly higher than that of the low‐grade gliomas. Diffusion‐weighted MRI with EPI is a useful technique for assessing the tumor cellularity and grading of gliomas. This information is not obtained with conventional MRI and is useful for the diagnosis and characterization of gliomas. J. Magn. Reson. Imaging 1999;9:53–60

Perfusion-sensitive MRI of cerebral lymphomas: a preliminary report.

PURPOSE To date, there have been no systematic reports examining cerebral lymphomas with perfusion-sensitive MRI. We sought to determine the characteristics of perfusion-sensitive MRI of these tumors. METHOD Five primary and three secondary cerebral lymphomas were analyzed. None of the patients had a history of AIDS. Various areas of relative cerebral blood volume (rCBV) within tumor were analyzed, and maximum CBV ratios (CBV[tumor/contralateral]) were identified for evaluation. RESULTS In three primary and three secondary cerebral lymphomas, maximum CBV ratios were <2.5 (mean 1.50). In others, maximum CBV ratios were markedly higher than those of the white matter (5.38 and 5.42). Mean maximum rCBV ratios of primary and secondary cerebral lymphomas were 2.93 and 1.43, respectively. There was no significant difference between the two groups. CONCLUSION Cerebral lymphomas had a tendency to have low rCBV values. This information may be helpful in diagnosing these tumors.

Contrast-enhanced CISS MRI of vestibular schwannomas: phantom and clinical studies.

PURPOSE The purpose of this work was to assess the changes of signal intensity on constructive interference in steady state (CISS) 3D Fourier transformation (3DFT) MRI after administration of Gd-DTPA and to evaluate the efficacy of contrast-enhanced CISS-3DFT MRI to depict the seventh and eighth cranial nerves affected by vestibular schwannomas. METHOD All scans were carried out on a 1.5 T MR unit. First, an experimental study was conducted to evaluate the changes in signal intensity of the CISS-3DFT sequence in relation to the concentration of contrast medium. Second, nine consecutive patients with 11 vestibular schwannomas underwent CISS-3DFT imaging before and after contrast agent administration. Signal intensities of the tumors and nerves were measured and compared between the pre- and postcontrast images. Visualization of the facial and cochlear nerves was rated on pre- and postcontrast CISS imaging independently. RESULTS On the phantom study, the CISS-3DFT sequence showed a constant increase in signal intensity as the concentration of Gd-DTPA increased. The contrast between the nerves and tumors significantly increased after contrast agent administration (from 0.1 to 9.0 as mean contrast-to-noise ratio). The ability to depict the nerves was also significantly higher for postcontrast CISS-3DFT imaging than for precontrast. CONCLUSION Although the CISS-3DFT sequence offers similar contrast as other heavily T2-weighted sequences, the signal intensity of contrast-enhanced tumors increased on CISS-3DFT imaging. Contrast-enhanced CISS imaging was valuable for evaluating the seventh and eighth cranial nerves affected by vestibular schwannomas.

Dynamic MRI of meningiomas and schwannomas: is differential diagnosis possible?

Abstract We studied 23 patients with meningiomas and 14 with schwannomas using dynamic spin-echo (TR/TE 200/15 ms) MRI. Histologically the meningiomas were classified according to the 1993 WHO classification. Serial images were obtained every 30 s for 210 s after rapid injection of gadopentetate dimeglumine (0.1 mmol/kg). The contrast-enhancement ratio (CER) was divided into three patterns; a sharp rise with a peak within 60 s (A), a relatively rapid increase with a peak between 60 and 210 s (B), a slow increase without a peak (C). The patterns were correlated with the histology of the tumors. The signal intensities of the tumours on T2-weighted images were also analyzed and correlated with the dynamic patterns. Meningiomas had more varied dynamic patterns than schwannomas. Almost half of the meningiomas showed pattern A, and one third pattern C. Of six meningothelial meningiomas showed pattern A; all schwannomas and fibrous meningiomas showed pattern C. Various patterns were observed in transitional meningiomas. Of the 8 meningiomas showing pattern C, only one gave high signal on T2-weighted images, and could not be differentiated from the schwannomas. Thus, one third of meningiomas could not be differentiated from schwannomas by the dynamic contrast enhancement alone. However, when this was combined with the signal intensity on T2-weighted images, most meningiomas could be differentiated from schwannomas.

Evaluation of vascular compression in trigeminal neuralgia by 3D time-of-flight MRA.

Objective Our goal was to assess the usefulness of 3D images in the preoperative evaluation of 16 patients with surgically confirmed trigeminal neuralgia. Materials and Methods The axial source images from 3D TOF MRA were evaluated for a total of 32 sides by two observers in a blinded manner, focusing on the presence of the neurovascular compression and the identiflcation of compressing vessels. All 3D images including coronal orientation and gadolinium-enhanced images were reviewed retrospectively by another two observers together with the surgical findings. Results In the blinded study with axial 3D images, the sensitivity was 75 and 75% with a specificity of 75 and 69% for observers A and B, respectively. By reviewing the coronal images, the relationship between trigeminal nerve and vessels became clearer, especially in sandwich-type compression. With gadolinium-enhanced images, three vessels that were not shown in the nonenhanced images could be identified. On the asymptomatic side, vascular compression could not be excluded retrospectively in five cases. Conclusion Nonenhanced axial images may not display small arteries or veins that are compressing the trigeminal nerve. Gadolinium enhancement will be necessary for those patients without demonstrable compression on nonenhanced examination. Coronal images are also helpful in the evaluation of vascular compression.

Virtual MRI endoscopy of the intracranial cerebrospinal fluid spaces

Abstract We used constructive interference in steady state (CISS) 3D Fourier transform (3DFT) MRI data sets to obtain three-dimensional (3D) virtual MRI endoscopic views of the intracranial cerebrospinal fluid (CSF) spaces, processing them with a commercially available perspective endoscopic algorithm. We investigated the potential of the intracranial virtual MRI endoscopy applied to visualisation of the pathology in 13 patients with surgically confirmed trigeminal neuralgia (3), hemifacial spasm (3), acoustic neuroma (3), suprasellar germinoma (1), Langerhans cell histiocytosis (1), lateral ventricle nodules (1) and pituitary dwarfism (1). All images were acquired using a 1.5-T imager employing a circular polarised head coil. The CISS-3DFT data sets were transferred to a workstation for processing with the perspective endoscopic algorithm. Postprocessing for virtual MRI endoscopy was possible for all data sets. The lesions in 12 patients, and their complex anatomical relationships with the surrounding structures, were well seen on the 3D images. A small acoustic neuroma in the internal auditory meatus was not seen using virtual endoscopy. Although virtual MRI endoscopy has limitations, it provides 3D images which cannot be acquired using any other procedure.

Basilar artery aneurysm treated with coil embolization via persistent primitive trigeminal artery.

AbstractA saccular aneurysm of the right basilar-superior cerebellar artery associated with a persistent primitive trigeminal artery (PPTA) was successfully treated by endovascular occlusion with Guglielmi detachable coils. Since both vertebral arteries and the basilar artery proximal to the junction with the PPTA were hypoplastic, a microcatheter was advanced via the PPTA. To our knowledge, this is the first case report describing the treatment of the aneurysm through the PPTA.

High-resolution constructive interference in a steady state imaging of cervicothoracic adhesive arachnoiditis.

Purpose: To assess the usefulness of constructive interference in a steady state (CISS) sequence for an evaluation of cervicothoracic adhesive arachnoiditis. Methods: Seven patients with arachnoiditis underwent magnetic resonance imaging with T1- and T2-weighted fast spin-echo (FSE) and 3-dimensional CISS sequences. Three observers compared T2-weighted FSE and 3-dimensional CISS images with regard to image quality for spinal adhesive arachnoiditis. Magnetic resonance appearances accompanied with cervicothoracic adhesive arachnoiditis on CISS coupled with T2-weighted FSE sequences were also evaluated. Results: The CISS images were superior to T2-weighted FSE images in the demarcation of spinal cord, dura matter, nerve root, and adhesive point. In our 7 cases with cervicothoracic adhesive arachnoiditis, dural thickening in 2 cases, syringomyelia in 6, arachnoidal cysts in 3, findings of presyrinx in 2, intramedullary microcyst in 2, and deformity of the spinal cord were present. Conclusions: A CISS sequence was more desirable for an evaluation of the cervicothoracic adhesive arachnoiditis than T2-weighted FSE images and could provide useful additional information.

Chordomas of the skull base: dynamic MRI.

OBJECTIVE To investigate the role of dynamic MRI in the diagnosis of chordomas at the skull base. MATERIALS AND METHODS Six patients with surgically proven chordomas of the skull base were examined with spin-echo technique (repetition time/echo time 200 ms/15 ms). Serial imaging was performed every 30 s for 240 s after a rapid injection of gadopenetate dimeglumine (0.1 mmol/kg). The contrast material enhancement ratio (CER) was analyzed. The CER was obtained for each region of interest as follows (Sn - So) x 100/Smax - So, where Sn indicates signal intensity at each dynamic phase; So, signal intensity on the image obtained before administration of contrast material; and Smax, maximum signal intensity of all dynamic imaging. RESULTS All chordomas showed very slow but steady increase of contrast enhancement with no peak within 240 s. The CERs of six cases at 30 s are 13 to 40 (mean value +/- standard deviation: 22.8 +/- 10.2). CONCLUSION Dynamic MRI may be helpful in differentiating between chordomas and other tumors of the skull base.

A better effect of cilostazol for reducing in-stent restenosis after femoropopliteal artery stent placement in comparison with ticlopidine.

Purpose The purpose of this study was to assess the preventive effect of cilostazol on in-stent restenosis in patients after superficial femoral artery (SFA) stent placement. Materials and methods Of 28 patients with peripheral arterial disease, who had successfully undergone stent implantation, 15 received cilostazol and 13 received ticlopidine. Primary patency rates were retrospectively analyzed by means of Kaplan–Meier survival curves, with differences between the two medication groups compared by log-rank test. A multivariate Cox proportional hazards model was applied to assess the effect of cilostazol versus ticlopidine on primary patency. Results The cilostazol group had significantly better primary patency rates than the ticlopidine group. Cumulative primary patency rates at 12 and 24 months after stent placement were, respectively, 100% and 75% in the cilostazol group versus 39% and 30% in the ticlopidine group (P = 0.0073, log-rank test). In a multivariate Cox proportional hazards model with adjustment for potentially confounding factors, including history of diabetes, cumulative stent length, and poor runoff, patients receiving cilostazol had significantly reduced risk of restenosis (hazard ratio 5.4; P = 0.042). Conclusion This retrospective study showed that cilostazol significantly reduces in-stent stenosis after SFA stent placement compared with ticlopidine.