Seung-Koo Lee

Effect of a Novel Free Radical Scavenger, Edaravone (MCI-186), on Acute Brain Infarction

Edaravone, a novel free radical scavenger, demonstrates neuroprotective effects by inhibiting vascular endothelial cell injury and ameliorating neuronal damage in ischemic brain models. The present study was undertaken to verify its therapeutic efficacy following acute ischemic stroke. We performed a multicenter, randomized, placebo-controlled, double-blind study on acute ischemic stroke patients commencing within 72 h of onset. Edaravone was infused at a dose of 30 mg, twice a day, for 14 days. At discharge within 3 months or at 3 months after onset, the functional outcome was evaluated using the modified Rankin Scale. Two hundred and fifty-two patients were initially enrolled. Of these, 125 were allocated to the edaravone group and 125 to the placebo group for analysis. Two patients were excluded because of subarachnoid hemorrhage and disseminated intravascular coagulation. A significant improvement in functional outcome was observed in the edaravone group as evaluated by the modified Rankin Scale (p = 0.0382). Edaravone represents a neuroprotective agent which is potentially useful for treating acute ischemic stroke, since it can exert significant effects on functional outcome as compared with placebo.

Corpus callosal connection mapping using cortical gray matter parcellation and DT-MRI.

Population maps of the corpus callosum (CC) and cortical lobe connections were generated by combining cortical gray matter parcellation with the diffusion tensor fiber tractography of individual subjects. This method is based on the fact that the cortical lobes of both hemispheres are interconnected by the corpus callosal fibers. T1‐weighted structural MRIs and diffusion tensor MRIs (DT‐MRI) of 22 right‐handed, healthy subjects were used. Forty‐seven cortical parcellations in the dorsal prefrontal cortex, ventral prefrontal cortex, sensory‐motor cortex, parietal cortex, temporal cortex, and occipital cortex were semi‐automatically derived from structural MRIs, registered to DT‐MRI, and used to identify callosal fibers. The probabilistic connections to each cortex were mapped on entire mid‐sagittal CC voxels that had anatomical homology between subjects as determined by spatial registration. According to the population maps of the callosal connections, the ventral prefrontal cortex and parts of the dorsal prefrontal cortex both project fibers through the genu and rostrum. The CC regions through which the superior frontal cortex passes extend into the posterior body. Fibers arising from the parietal lobe and occipital lobe run mainly through the splenium, while fibers arising from the sensory‐motor cortex pass through the isthmus. In general, dorsal or medial cortical lobes project fibers through the dorsal region of the CC, while lateral cortical lobes project fibers through the ventral region of the CC. The probabilistic subdivision of the CC by connecting cortical gray matter provides a more precise understanding of the CC. Hum Brain Mapp 2008.

Stent-assisted coil embolization of intracranial wide-necked aneurysms

The endovascular treatment of cerebral aneurysms with coils poses significant technical challenges, particularly with respect to wide-necked aneurysms. We present the results of our initial experiences in using a stent for endovascular treatment of aneurysms, with an emphasis on potential applications, technical aspects, and associated complications. Twenty-three wide-necked aneurysms from 22 patients were treated during the 13-month study period. Seven patients presented with subarachnoid hemorrhage. Aneurysms were located at the internal carotid artery (n=14), the vertebral artery (n=3), the basilar artery (n=5), and the middle cerebral artery (n=1). A Neuroform stent2 was used for stent-assisted procedures. Premedication with antithrombotic agents was available for unruptured cases. Postprocedural antithrombotic medication was prescribed for all patients. Nineteen aneurysms were primarily stented, followed by coil placement. For five of these aneurysms, stenting was performed subsequent to failure of an attempt to frame with an initial coil. Stenting for the remaining four aneurysms was performed as a rescue procedure to prevent the migration of previously placed coils. Complete occlusion was obtained in ten aneurysms, nearly complete occlusion (95% or more occluded) in 11 aneurysms, and partial occlusion (less than 95% occluded) in one aneurysm. In one aneurysm, we failed to navigate the microcatheter into the aneurysmal sac through the interstices of the stent. Stent thrombosis was noted during the procedure in one patient. Hemorrhagic complication on the 25th day after the procedure was noted in one patient. No procedure-related complications were observed during the procedure or during follow-up in the remaining 20 patients, including seven patients who did not receive antithrombotic agents prior to endovascular treatment owing to recent subarachnoid hemorrhage. To overcome the technical limitation in the coiling of wide-necked aneurysms, stent-assisted coil embolization may be a technically feasible and relatively safe method, even though longer periods of follow-up are required.

White matter abnormalities associated with auditory hallucinations in schizophrenia: A combined study of voxel-based analyses of diffusion tensor imaging and structural magnetic resonance imaging

White matter (WM) abnormalities in schizophrenia may offer important clues to a better understanding of the disconnectivity associated with the disorder. The aim of this study was to elucidate a WM basis of auditory hallucinations in schizophrenia through the simultaneous investigation of WM tract integrity and WM density. Diffusion tensor images (DTIs) and structural T1 magnetic resonance images (MRIs) were taken from 15 hallucinating schizophrenic patients, 15 non-hallucinating schizophrenic patients and 22 normal controls. Voxel-based analyses and post-hoc region of interest analyses were obtained to compare the three groups on fractional anisotropy (FA) derived from DTI as well as WM density derived from structural MRIs. In both the hallucinating and non-hallucinating groups, FA of the WM regions was significantly decreased in the left superior longitudinal fasciculus (SLF), whereas WM density was significantly increased in the left inferior longitudinal fasciculus (ILF). The mean FA value of the left frontal part of the SLF was positively correlated with the severity score of auditory hallucinations in the hallucinating patient group. Our findings show that WM changes were mainly observed in the frontal and temporal areas, suggesting that disconnectivity in the left fronto-temporal area may contribute to the pathophysiology of schizophrenia. In addition, pathologic WM changes in this region may be an important step in the development of auditory hallucinations in schizophrenia.

Evidence of slow maturation of the superior longitudinal fasciculus in early childhood by diffusion tensor imaging.

While the majority of axonal organization is established by birth in mammalian brains, axonal wiring and pruning processes, as well as myelination, are known to extend to the postnatal periods, where environmental stimuli often play a major role. Normal axonal and myelin development of individual white matter tracts of human in this period is poorly understood and may have a major role in cognitive development of human. In this study, we applied diffusion tensor imaging and normalization-based population analyses to 44 preteen children and 30 adult images. We observed highly significant changes of fiber orientations at regions that correspond to the superior longitudinal fasciculus during the first 5 years. The result is attributed to slow axonal and/or myelin maturation of this tract, which is believed to be involved in language functions.

Detection of Thrombus in Acute Ischemic Stroke Value of Thin-Section Noncontrast-Computed Tomography

Background and Purpose— Previous studies on the hyperdense middle cerebral artery (MCA) sign were conducted using ≥5-mm thickness noncontrast-computed tomography (NCT). The purpose of this study was to compare thin-section NCT with 5-mm NCT in the detection of thrombus in acute ischemic stroke. Methods— Enrolled were consecutive 51 patients with acute infarction in the anterior or MCA territory. All patients underwent both 5-mm NCT and either 1.25- or 1-mm thin-section helical NCT within 6 hours of symptom onset. Patients were assigned to either the single or multisegmental occlusion group, depending on the thrombus extent on thin-section NCT. Thin-section NCT and 5-mm NCT were compared in the detection of thrombi. Results— Thrombi were identified in 45 patients (88%) on thin-section NCT and 16 on 5-mm NCT (31%; P<0.001). No occlusion was seen in 6 patients. Both sensitivity and specificity of thin-section NCT in detection of thrombus were 100%. Conclusions— Acute thrombus can be detected with higher sensitivity on thin-section NCT than on 5-mm NCT, and its extent is more accurately determined on thin-section NCT.

Volumetric analysis of the substantia innominata in patients with Parkinson's disease according to cognitive status

The cholinergic system arising from the substantia innominata (SI) of the basal forebrain has an important role in the cognitive functions of Parkinsons disease (PD). We performed magnetic resonance imaging based volumetric analysis to evaluate the SI volume in patients with PD-intact cognition (PD-IC), PD-mild cognitive impairment (PD-MCI), and PD dementia (PDD). The mean normalized SI volume was significantly decreased in patients with PD-IC (1.54 ± 0.12, p < 0.001), PD-MCI (1.49 ± 0.12, p < 0.001), and PDD (1.39 ± 0.12, p < 0.001) compared with that of control subjects (1.68 ± 0.11). The normalized SI volume did not differ between patients with PD-IC and PD-MCI; however, the normalized SI volume was significantly decreased in patients with PDD compared with that in those with PD-IC (p < 0.001) or PD-MCI (p = 0.016). The normalized SI volume was significantly correlated with general cognitive status (r = 0.51, p < 0.001) as well as with performance in each cognitive subdomain, with a particularly significant independent association with attention (β = 0.33, p = 0.003) and object naming (β = 0.26, p = 0.017). The present study demonstrated that the SI volume in PD differs depending on cognitive status and is significantly correlated with cognitive performance.

Glioma grading capability: comparisons among parameters from dynamic contrast-enhanced MRI and ADC value on DWI.

Objective Permeability parameters from dynamic contrast-enhanced MRI (DCE-MRI) and apparent diffusion coefficient (ADC) value on diffusion-weighted imaging (DWI) can be quantitative physiologic metrics for gliomas. The transfer constant (Ktrans) has shown efficacy in grading gliomas. Volume fraction of extravascular extracellular space (ve) has been underutilized to grade gliomas. The purpose of this study was to evaluate ve in its ability to grade gliomas and to assess the correlation with other permeability parameters and ADC values. Materials and Methods A total of 33 patients diagnosed with pathologically-confirmed gliomas were examined by 3 T MRI including DCE-MRI and ADC map. A region of interest analyses for permeability parameters from DCE-MRI and ADC were performed on the enhancing solid portion of the tumors. Permeability parameters form DCE-MRI and ADC between low- and high-grade gliomas; the diagnostic performances of presumptive metrics and correlation among those metrics were statistically analyzed. Results High-grade gliomas showed higher Ktrans (0.050 vs. 0.010 in median value, p = 0.002) and higher ve (0.170 vs. 0.015 in median value, p = 0.001) than low-grade gliomas. Receiver operating characteristic curve analysis showed significance in both Ktrans and ve for glioma grading. However, there was no significant difference in diagnostic performance between Ktrans and ve. ADC value did not correlate with any of the permeability parameters from DCE-MRI. Conclusion Extravascular extracellular space (ve) appears to be comparable with transfer constant (Ktrans) in differentiating high-grade gliomas from low-grade gliomas. ADC value does not show correlation with any permeability parameters from DCE-MRI.

Post-transfusion posterior leukoencephalopathy with cytotoxic and vasogenic edema precipitated by vasospasm.

Introduction The syndrome of posterior leukoencephalopathy (PLE) is characterized clinically by headache, vomiting, confusion, seizures, visual abnormalities, and motor signs in association with mainly posterior lesions, which suggest edema on neuroimages [1]. PLE has often been associated with various, usually systemic disorders, such as hypertensive encephalopathy, eclampsia, and the use of immunosuppressive drugs. Ito et al. [2] reported upon a patient with transfusion-related reversible PLE and angiographic evidence of vasoconstriction. It is not certain whether the mechanism of edema formation in PLE is disruption of the blood-brain barrier and fluid extravasation, or an ischemic process induced by vasospasm. Diffusion-weighted magnetic resonance imaging (DWI) can discriminate between cytotoxic and vasogenic edema and provides a clue to the mechanism of PLE [3–6]. We describe a patient with post-transfusion PLE who showed vasospasm and features suggesting cytotoxic and vasogenic edema on DWI.

CT Features of Lobular Capillary Hemangioma of the Nasal Cavity

BACKGROUND AND PURPOSE: Lobular capillary hemangioma is a benign capillary proliferation of unknown etiology. To our knowledge, no comprehensive review of imaging findings of LCHNC has been presented. Thus, we investigated characteristic CT features of LCHNC. MATERIALS AND METHODS: This retrospective study included 6 patients (2 men and 4 women; age range, 30–65 years; mean age, 49.2 years) with histologically proved LCHNC. We evaluated the size, site of origin, attenuation on NECT, degree and pattern of enhancement, and bony changes. RESULTS: The LCHNC lesion was 13.0–45.0 mm (average, 25.0 mm) in diameter. These lesions arose from the inferior turbinate in 5 (83.3%) patients and the anterior nasal septum in 1 (16.7%). Compared with the masticator muscles, the LCHNC lesion was hypoattenuating in 2 (33.3%) and isoattenuating on NECT in 4 (66.7%) patients. In 5 (83.3%) patients, the LCHNC lesion consisted of 2 distinct areas on CECT: a lobular intensely enhancing mass and an iso- or hypoattenuating cap of variable thickness around the intensely enhancing mass. Bony changes included erosion in 3 (50.0%) and displacement in 2 (33.3%) patients. CONCLUSIONS: CT features of LCHNC consist of an intensely enhancing mass and an iso- or hypoattenuating cap on CECT. The inferior turbinate seems to be a common site of origin, and bony changes are not uncommon features of LCHNC. CT is useful not only in identifying the site of origin and assessing the extent but also in suggesting the nature of LCHNC.