Matakazu Furukawa

Evaluation of Cerebral Perfusion parameters measured by Perfusion CT in chronic Cerebral ischemia: Comparison with xenon CT

Purpose The purpose of this work was to evaluate the usefulness of perfusion CT in the evaluation of patients with chronic cerebral ischemia by comparing it with xenon CT (Xe-CT). Method Cerebral blood flow (CBF) of perfusion CT (CBFper) and time to peak (TTP) were compared with the CBF of Xe-CT (CBFxe) in 18 patients. Cerebral blood volume (CBV) was compared with cerebral vascular reserve (CVR) in 10 of 18 patients who underwent pre- and postacetazolamide Xe-CT. Results CBFper and TTP demonstrated a high correlation with CBFxe in relative values by side-to-side comparisons (r = 0.743, p < 0.0001 and r = −0.760, p < 0.0001, respectively). There was a negative correlation between relative CBV and relative CVR (r = −0.637, p = 0.0025). Visually, territories with delayed TTP corresponded well to those of decreased CBFxe, but these territories tended to be larger in TTP maps. Conclusion Perfusion CT is a useful tool to evaluate chronic hemodynamic disturbance and can be an alternative method for those using acetazolamide challenge.

MRI in seven cases of tacrolimus (FK-506) encephalopathy: utility of FLAIR and diffusion-weighted imaging

Abstract We assessed the utility of fluid-attenuated inversion-recovery (FLAIR) and diffusion-weighted (DWI) images in investigation of tacrolimus (FK-506) encephalopathy, and to see whether we could predict its cause from clinical and imaging data. In seven patients with presumed FK-506 toxicity the areas involved on MRI were similar to those in cyclosporin A (CsA) toxicity. The abnormal signal was most evident on FLAIR in all cases. In three of four patients who underwent DWI, no diffusion abnormalities were detected; in the remaining patient, increased diffusion was seen in the deep white matter bilaterally on the apparent diffusion coefficient map, consistent with the findings on T2-weighted spin-echo and FLAIR images. Five of the six patients for whom we had clinical data showed sudden changes in electrolyte or fluid equilibrium due to diarrhoea, a polyuria or oliguria one day before or on the day of onset of the central nervous system disturbances. We speculate that FK-506 encephalopathy is triggered by the disturbance of the electrolyte and/or fluid equilibrium, given a certain serum level of FK-506.

Evaluation of the facial artery on computed tomographic angiography using 64-slice multidetector computed tomography: implications for facial reconstruction in plastic surgery.

Background: Preoperative knowledge of a patients individual variations in facial artery anatomy would benefit plastic surgeons for reconstructive planning. The authors evaluated the feasibility of multislice computed tomographic angiography in vascular mapping of the facial artery. Methods: In total, 187 facial arteries in 94 patients without facial tumor or vascular disease were studied. Anatomical variations of the facial artery were classified into four types: type 1, a short course that terminates proximal to the superior labial artery; type 2, an intermediate course that terminates distal to the superior labial artery near the nasolabial fold; type 3, a classic course that extends to the lateral nasal ala beyond the nasolabial fold with an angular branch; and type 4, duplex with dominant lateral angular branch. Facial artery patterns were compared with dominant patterns of the facial–submental artery bifurcation. The extent of the inferior and superior labial artery was evaluated separately. Results: Sixty-four facial artery branches (34 percent) were classified as type 1, 74 (40 percent) as type 2, and 45 (24 percent) as type 3. Type 4 was seen in only four branches (2 percent). The facial artery was dominant in the facial–submental artery bifurcation in 84 percent of type 3 facial arteries. Three-dimensional volume-rendered images allow detailed visualization of the facial artery and its branches and help preoperative mapping. Conclusion: Facial computed tomographic angiography allows detailed visualization of the facial artery and its branches and is a potential noninvasive imaging tool for preoperative vascular mapping for facial reconstructive operations. CLINICAL QUESTION/LEVEL OF EVIDENCE: Diagnostic, IV.

Distinct and Shared Endophenotypes of Neural Substrates in Bipolar and Major Depressive Disorders.

Little is known about disorder-specific biomarkers of bipolar disorder (BD) and major depressive disorder (MDD). Our aim was to determine a neural substrate that could be used to distinguish BD from MDD. Our study included a BD group (10 patients with BD, 10 first-degree relatives (FDRs) of individuals with BD), MDD group (17 patients with MDD, 17 FDRs of individuals with MDD), and 27 healthy individuals. Structural and functional brain abnormalities were evaluated by voxel-based morphometry and a trail making test (TMT), respectively. The BD group showed a significant main effect of diagnosis in the gray matter (GM) volume of the anterior cingulate cortex (ACC; p = 0.01) and left insula (p < 0.01). FDRs of individuals with BD showed significantly smaller left ACC GM volume than healthy subjects (p < 0.01), and patients with BD showed significantly smaller ACC (p < 0.01) and left insular GM volume (p < 0.01) than healthy subjects. The MDD group showed a tendency toward a main effect of diagnosis in the right and left insular GM volume. The BD group showed a significantly inverse correlation between the left insular GM volume and TMT-A scores (p < 0.05). Our results suggest that the ACC volume could be a distinct endophenotype of BD, while the insular volume could be a shared BD and MDD endophenotype. Moreover, the insula could be associated with cognitive decline and poor outcome in BD.

Superselective Intra-arterial Chemotherapy for Advanced Maxillary Sinus Cancer: An Evaluation of Arterial Perfusion With Computed Tomographic Arteriography and of Tumor Response

Objective: The purpose of our study was to elucidate the relationship between arterial perfusion in advanced maxillary sinus cancer which was opacified by superselective intra-arterial computed tomographic arteriography (IA-CTA) and the tumor response to intra-arterial chemotherapy. Methods: Superselective IA-CTA was performed to identify the feeding arteries and their perfusion in advanced maxillary sinus cancer in 10 patients. Cisplatin was selectively infused into these feeding arteries, except for the internal carotid artery. Results: The results were assessed in 9 of the 10 patients, and a complete response was achieved in 5 patients in whom either the entire tumor, or most of the tumor, was perfused by the branches of the external carotid artery. In 4 patients with a partial response, the residual tumors were seen in the territory of the perfusion defect or in the perfusion territory of the internal carotid artery. Conclusion: Superselective IA-CTA is a useful technique to correctly identify the intratumoral perfusion and to predict tumor response to the intra-arterial chemotherapy of advanced maxillary sinus cancer.

Atypical extraventricular neurocytoma in a 3-year-old girl: case report with radiological-pathological correlation

BackgroundExtraventricular neurocytoma (EVN) is a rare neuronal tumor histologically similar to central neurocytoma but arising in the brain parenchyma outside the ventricles. The minority of EVNs show atypical features including increased proliferative index, microvascular proliferation, or necrosis, and are called atypical EVN. Most of atypical EVNs occur in adults, and the tumors in children are extremely rare. A radiological-pathological correlation and radiological clue to atypical EVNs have not been clarified.Case reportWe report a case of atypical EVN in a 3-year-old girl. Magnetic resonance imaging (MRI) revealed an extraventricular intraparenchymal tumor in the left frontal lobe, which was composed of homogeneous well-demarcated cystic component and peripheral ill-delineated solid component with enhancement. Angiography demonstrated vascular proliferation and arteriovenous shunting in the tumor. Histologically, the resected tumor was diagnosed as atypical EVN. Types of the tumor borders (well-circumscribed or infiltrative) and MRI findings correlated closely. Morphology of the tumor vasculature was remarkable for microvascular proliferation and dilated, thickened veins, which corresponded to the angiographic features.ConclusionAlthough rare, atypical EVN should be included in the differential diagnosis of a cystic mass in the cerebral hemispheres in children. Radiological evaluation of tumor borders and angiographic characteristics might be useful for predicting atypicality of the tumor.

Abstract 132: EVALUATION OF FACIAL ARTERY ON CT ANGIOGRAPHY USING 64 SLICE MDCT

Purpose: Most studies of facial artery (FA) anatomy have been performed in cadaveric specimens and appear to over estimate the presence of the angular branch. In addition, a less invasive in-vivo technique for assessment would be bene cial for use in preoperative evaluation, especially in reconstructive transplantation. Aim of this study is to evaluate the value of CT angiography in assessment of anatomical variations of the FA and its branches and to determine the true incidence of anatomic variations.