Koshi Ikeda

Effects of Electroconvulsive Therapy on Frontal White Matter in Late-Life Depression: A Diffusion Tensor Imaging Study

This study was conducted to elucidate the effects of electroconvulsive therapy (ECT) on frontal white matter in late-life depressed patients. Diffusion tensor imaging was performed on 8 late-life depressed patients and 12 healthy age-matched controls. The patients were scanned before and after a course of ECT. Fractional anisotropy (FA) was determined in the frontal and temporal regions and the corpus callosum. A significant white matter FA reduction was found in widespread frontal and temporal brain regions in patients with depression before ECT treatment compared with controls. A significant increase in frontal white matter FA was seen following ECT treatment. A course of bilateral ECT ameliorated white matter integrity in frontal brain regions. This suggests a strong relationship with the antidepressant action of ECT.

Corpus Callosum in Patients with Obsessive-Compulsive Disorder: Diffusion-Tensor Imaging Study

PURPOSE To prospectively examine microstructural white matter abnormalities in the corpus callosum (CC) of patients with obsessive-compulsive disorder (OCD), as compared with control subjects, and to investigate the relationship between diffusion-tensor (DT) imaging measures of the CC region and clinical symptoms of OCD. MATERIALS AND METHODS Institutional review board approval was obtained, and each participant--or the participants parent(s)--provided written informed consent. Sixteen patients with OCD (seven male, nine female; mean age, 28.7 years +/- 9.8 [standard deviation]) and 16 matched healthy volunteers (control subjects) (seven male, nine female; mean age, 29.9 years +/- 9.0) were examined. Mean diffusivity and fractional anisotropy (FA) were measured in five subdivisions of the CC. The paired t test was performed to compare the mean diffusivity or the FA in CC regions between the patients with OCD and the control subjects. RESULTS There were no significant differences (rostrum, P = .15; genu, P = .88; rostral body, P = .12; isthmus, P = .77; splenium, P = .88) in mean diffusivity between the patients with OCD and the healthy volunteers. A significant reduction in FA was observed in the rostrum of the CC in patients with OCD compared with the rostral FA in the control subjects (P < .001). Higher FA in only the rostrum correlated significantly with lower Yale-Brown obsessive-compulsive scale score (r = -0.72, P = .002). CONCLUSION Study results support the widely held view that the orbital prefrontal region is involved in the pathophysiology of OCD and indicate that the orbitofrontal circuit influences symptom severity in patients with OCD.

Kimura Disease: Diagnosis and Prognostic Factors

OBJECTIVES: To establish a preoperative diagnostic system and examine prognostic factors for Kimura disease. STUDY DESIGN: Retrospective study. SETTING: Hospital records were reviewed for nine cases of Kimura disease treated in our department. Preoperative eosinophil counts for 74 cases with untreated malignancy in the parotid gland were also examined. RESULTS: Parotid swelling with inhomogeneities and subcutaneous invasion on magnetic resonance imaging and eosinophils > 10.5 percent in Asian patients clearly indicates Kimura disease. Eosinophils > 50 percent, serum IgE levels > 10,000 IU/mL, and multifocal lesions outside salivary glands are prognostic factors suggesting disease recurrence. CONCLUSIONS: A preoperative decision based on our diagnostic criteria and prognostic factors should lead to better therapeutic outcomes for Kimura disease, for which a definitive treatment policy has never been determined.

Diffusion-weighted echo-planar imaging of the head and neck using 3-T MRI: Investigation into the usefulness of liquid perfluorocarbon pads and choice of optimal fat suppression method

PURPOSE To investigate whether image quality can be improved using liquid perfluorocarbon pads (Sat Pad) and clarify the optimal fat-suppression method among chemical shift selective (CHESS), water excitation (WEX), and short TI inversion recovery (STIR) methods in diffusion-weighted imaging (DWI) of the head and neck using 3-T magnetic resonance imaging. Correlations between results of visual inspection and quantitative analysis were also examined. MATERIAL AND METHODS This study was approved by our Institutional Review Board and informed consent was waived. DWI was performed on 25 subjects with/without Sat Pad and using three fat-suppression methods (6 patterns). Image quality was evaluated visually (4-point scales and lesion-depiction capability) and by quantitative analysis (signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR)). Two-way repeated-measures analysis of variance (ANOVA) was used to detect significant differences in scores of visual evaluation, SNR, and CNR. RESULTS Mean visual evaluation scores were significantly higher with Sat Pad using STIR than without Sat Pad for all fat-suppression methods (P<0.05). DWI with Sat Pad using STIR tended to be useful for depicting lesions. DWI using STIR showed reduced W-SNR (W: whole area of depicted structure) and CNR (between semispinalis capitis muscle and subcutaneous fat) due to fewer artifacts and uniform fat suppression. CONCLUSION Combining Sat Pad with STIR provides good image quality for visual inspections. When numerous artifacts are present and fat suppression is insufficient, higher SNR and CNR do not always provide good diagnostic image quality.

Spontaneous rupture of a necrotic hepatic angiosarcoma : findings on dual-phase computed tomography and angiography

We present dual-phase computed tomographic (CT) and angiographic findings of a ruptured hepatic angiosarcoma. These tumors can be divided into two types: those with and those without gross central necrosis with hemorrhage. In our case, the tumor had gross central necrosis, and CT and angiographic findings showed a small number of areas with a centripetal enhancement pattern and the rest of the tumor with avascular areas. We found that dual-phase CT and angiographic findings are able to distinguish angiosarcoma, which mimics a hemangioma, as these lesions show avascular areas that reflect a mass with gross central necrosis.

MR findings of clear cell sarcoma: Two case reports

We report two patients with clear cell sarcomas arising from tendons in the ankle and knee. In the current cases, calcifications, fluid-fluid levels and the marked hypointense areas are not seen within the masses. In the differential diagnosis of the mass developing in the tendons and aponeuroses, when these signs are absent, the probability of clear cell sarcoma is higher.

Apolipoprotein C-II is a potential serum biomarker as a prognostic factor of locally advanced cervical cancer after chemoradiation therapy.

PURPOSE To determine pretreatment serum protein levels for generally applicable measurement to predict chemoradiation treatment outcomes in patients with locally advanced squamous cell cervical carcinoma (CC). METHODS AND MATERIALS In a screening study, measurements were conducted twice. At first, 6 serum samples from CC patients (3 with no evidence of disease [NED] and 3 with cancer-caused death [CD]) and 2 from healthy controls were tested. Next, 12 serum samples from different CC patients (8 NED, 4 CD) and 4 from healthy controls were examined. Subsequently, 28 different CC patients (18 NED, 10 CD) and 9 controls were analyzed in the validation study. Protein chips were treated with the sample sera, and the serum protein pattern was detected by surface-enhanced laser desorption and ionization-time-of-flight mass spectrometry (SELDI-TOF MS). Then, single MS-based peptide mass fingerprinting (PMF) and tandem MS (MS/MS)-based peptide/protein identification methods, were used to identify protein corresponding to the detected peak. And then, turbidimetric assay was used to measure the levels of a protein that indicated the best match with this peptide peak. RESULTS The same peak 8918 m/z was identified in both screening studies. Neither the screening study nor the validation study had significant differences in the appearance of this peak in the controls and NED. However, the intensity of the peak in CD was significantly lower than that of controls and NED in both pilot studies (P=.02, P=.04) and validation study (P=.01, P=.001). The protein indicated the best match with this peptide peak at 8918 m/z was identified as apolipoprotein C-II (ApoC-II) using PMF and MS/MS methods. Turbidimetric assay showed that the mean serum levels of ApoC-II tended to decrease in CD group when compared with NED group (P=.078). CONCLUSION ApoC-II could be used as a biomarker for detection in predicting and estimating the radiation treatment outcome of patients with CC.

Traumatic neuroma of the bile duct.

We present the CT and MRI findings of a traumatic neuroma of the bile duct, which is not a true neoplasm, but a reactive proliferation of pericholangial nerve tissue induced by cholecystectomy. Previous authors have shown a dilatation of the bile duct without a nodule. In our case, a nodule was present, and it was markedly enhanced.

Diffusion-weighted imaging for predicting new compression fractures following percutaneous vertebroplasty

Background: Percutaneous vertebroplasty (PVP) is a technique that structurally stabilizes a fractured vertebral body. However, some patients return to the hospital due to recurrent back pain following PVP, and such pain is sometimes caused by new compression fractures. Purpose: To investigate whether the apparent diffusion coefficient (ADC) of adjacent vertebral bodies as assessed by diffusion-weighted imaging before PVP could predict the onset of new compression fractures following PVP. Material and Methods: 25 patients with osteoporotic compression fractures who underwent PVP were enrolled in this study. ADC was measured for 49 vertebral bodies immediately above and below each vertebral body injected with bone cement before and after PVP. By measuring ADC for each adjacent vertebral body, ADC was compared between vertebral bodies with a new compression fracture within 1 month and those without new compression fractures. In addition, the mean ADC of adjacent vertebral bodies per patient was calculated. Results: Mean preoperative ADC for the six adjacent vertebral bodies with new compression fractures was 0.55×10−3 mm2/s (range 0.36–1.01×10−3 mm2/s), and for the 43 adjacent vertebral bodies without new compression fractures 0.20×10−3 mm2/s (range 0–0.98×10−3 mm2/s) (P<0.001). Mean preoperative ADC for the six patients with new compression fractures was 0.55×10−3 mm2/s (range 0.21–1.01×10−3 mm2/s), and that for the 19 patients without new compression fractures 0.17×10−3 mm2/s (range 0.01–0.43×10−3 mm2/s) (P<0.001). Conclusion: The ADC of adjacent vertebral bodies as assessed by diffusion-weighted imaging before PVP might be one of the predictors for new compression fractures following PVP.

Hourglass-shaped sublingual dermoid cyst: MRI features

Dermoid cysts located in the floor of the mouth are classified as submental or sublingual based on their location with respect to the mylohyoid muscle. The lesion was located in the midline, involved the genioglossus and geniohyoid muscles, and extended down to the area superior to the mylohyoid muscle. An hourglass-shaped cyst of the floor of mouth was seen. Such magnetic resonance imaging findings appear to be characteristic of an extended sublingual dermoid cyst.