Tatsuo Banno

Surgical treatment of chronic subdural hematoma based on intrahematomal membrane structure on MRI.

Summary Background. To determine the optimal surgical management of chronic subdural hematoma (CSDH), we assessed which operative procedure, burr holes or small craniotomy, was more effective on 49 consecutive patients. Method. We retrospectively classified all cases into two groups according to the intrahematomal membrane structure of CSDH on T*2-weighted magnetic resonance (MR) imaging. The first group, labeled type B, included hematomas which had no intrahematomal membrane and/or were monolayer multilobule. The second group, labeled type C, consisted of hematomas which were divided into multiple layers by the intrahematomal membrane. Findings. The outcome of type C patients treated with burr holes was significantly inferior to that of those who underwent a small craniotomy in terms of the relative outcome of neurological grading, re-operation ratio, and postoperative hospital stay (p<0.05). Type C hematomas treated with burr holes also had inferior outcome compared with a small craniotomy in terms of the duration of hematoma until disappearance on postoperative CT (p<0.05). Interpretation. We concluded that a considerable number of cases appeared to need craniotomy and resection of intrahematomal membrane for complete recovery in CSDH, and that T*2-weighted MR imaging could be used as a basis for selecting the operative procedure for CSDH.

Quantitative Analysis of CSF Flow Dynamics using MRI in Normal Pressure Hydrocephalus

In order to clarify the flow dynamics of cerebrospinal fluid (CSF) in normal pressure hydrocephalus (NPH), a phase-contrast cine magnetic resonance (MR) imaging technique with retrospective cardiac gating was used to measure the quantitative flow velocity of CSF in the aqueduct in patients with NPH after subarachnoid hemorrhage (SAH-NPH group, n = 17), idiopathic NPH (1-NPH group, n = 2), asymptomatic ventricular dilatation or brain atrophy (VD group, n = 7) and healthy volunteers (control group, n = 19). Intracranial pressure (ICP) and pressure volume response (PVR) were also measured during the shunt operation in six of the SAH- NPH group. The maximum CSF flow velocity (Vmax) in the aqueduct was significantly larger in the SAH-NPH group (9.21 +/- 4.12 cm/sec, mean +/- SD) than in the control group (5.27 +/- 1.77, p < 0.001) and the VD group (4.06 +/- 1.81, p < 0.005). Vmax was not different between the control and VD groups. There was a positive correlation between the PVR and the peak CSF flow velocity in the SAH-NPH group. These findings suggest that the changes of CSF flow velocity in the SAH-NPH group might be caused by a moderate decrease of intracranial compliance. The CSF flow study using MRI is useful to differentiate NPH from brain atrophy or asymptomatic ventricular dilatation and also to estimate the intracranial compliance.

Endovascular stent placement for multiple aneurysms of the extracranial internal carotid artery: technical case report.

A patient with multiple extracranial internal carotid artery aneurysms that caused cerebral infarction was treated by endovascular placement of a metallic stent. Complete disappearance of the aneurysms was angiographically confirmed within 15 weeks. Endovascular observation 6 months after the stent placement revealed that the endoluminal surface was totally covered by normal endothelium. The patient returned to his regular work routine and had no complication or neurological deterioration during the 17-month follow-up period.

Deterioration of ocular motor dysfunction after transvenous embolization of dural arteriovenous fistula involving the cavernous sinus.

Summary We treated 9 patients with the dural arteriovenous fistula involving the cavernous sinus by transvenous embolization. Two patients experienced deterioration of oculo-motor dysfunction after transvenous embolization. We can speculate about two different kind of causes by which patients symptoms deteriorated according to the result of intrasinus pressure recorded during the embolization [1]: high intrasinus pressure caused by the obliteration of the drainage pathway resulted in cranial nerve palsy in one case [2]; implanted coils directly compressed the cranial nerve in another case. Fortunately our cases recovered, but some kind of preventative measures may be needed in similar cases.

Frequency analyses of CSF flow on cine MRI in normal pressure hydrocephalus

Abstract. Our objective was to clarify intracranial cerebrospinal fluid (CSF) flow dynamics in normal-pressure hydrocephalus (NPH). Frequency analyses of CSF flow measured with phase-contrast cine MRI were performed. The CSF flow spectra in the aqueduct were determined in patients (n=51) with NPH, brain atrophy or asymptomatic ventricular dilation (VD), and in healthy volunteers (control group; n=25). The changes in CSF flow spectra were also analyzed after intravenous injection of acetazolamide. Moreover, a phase transfer function (PTF) calculated from the spectra of the driving vascular pulsation and CSF flow in the aqueduct were assessed. These values were compared with the pressure volume response (PVR). The amplitude in the NPH group was significantly larger than that in the VD or control group because of a decrease in compliance. The phase in the NPH group was significantly different from that in either the VD or the control group, but no difference was found between the VD and control groups. The amplitude increased in all groups after acetazolamide injection. The PTF in the NPH group was significantly larger than in the control group, and a positive correlation was noted between PTF and PVR. Frequency analyses of CSF flow measured by cine MRI make it possible to noninvasively obtain a more detailed picture of the pathophysiology of NPH.

Endovascular Stent Placement for Multiple Aneurysms of the Extracranial Internal Carotid Artery

ABSTRACTA PATIENT WITH multiple extracranial internal carotid artery aneurysms that caused cerebral infarction was treated by endovascular placement of a metallic stent. Complete disappearance of the aneurysms was angiographically confirmed within 15 weeks. Endovascular observation 6 months after th

Quantitative assessment of regional myocardial blood flow using oxygen-15-labelled water and positron emission tomography: a multicentre evaluation in Japan.

Abstract.Recently, a method has been proposed for the quantitative measurement of regional myocardial blood flow (MBF) using oxygen-15-labelled water and positron emission tomography (PET). A multicentre project was organized with the intention of evaluating the accuracy of this method, particularly as a multicentre clinical investigative tool. Each of seven institutions performed PET studies on more than five normal volunteers following a specified protocol. The PET study included a transmission scan, a 15O-carbon monoxide static scan and a 15O-water dynamic scan, thereby yielding MBF values which should have been independent of the spatial resolution of the PET scanner employed. Fifty-three subjects (aged 20–63 years, mean±SD 36±12 years) were studied at rest, and 31 of these subjects were also studied after dipyridamole in five institutions. Inter-institution consistency and intra-subject variation in MBF values were then evaluated. MBF averaged for all subjects was 0.93±0.34 ml min–1 g–1 at rest and 3.40±1.73 ml min–1 g–1 after the administration of dipyridamole, and the flow reserve (defined as the ratio of the two MBF values) was 3.82±2.12; these values are consistent with previous reports. Resting MBF values were significantly correlated with the heart rate–blood pressure product (RPP) (y=0.31+6.56E-5x, P<0.010), and RPP was in resting MBF observed in all institutions was well explained by the age-dependent RPP. No significant difference was observed in resting MBF among the institutions. Except in one institution, no significant difference was seen in dipyridamole MBF or myocardial flow reserve. No significant difference was found among the myocardial segments. Regional variation was reasonably small in five institutions, but was not acceptable in two institutions, which was attributed to the scanner performance. These observations suggest that the 15O-water PET technique is useful for a multicentre clinical study if the PET scanner can provide time-activity data with good count statistics.

Acoustic noise analysis in echo planar imaging: multicenter trial and comparison with other pulse sequences

The purpose of this study was to evaluate acoustic noise in echo planar imaging (EPI) at various magnetic resonance imaging (MRI) centers and to compare EPI acoustic noise with that in other fast pulse sequences. The authors measured A-weighted root-mean-square sound pressure levels and peak impulse sound pressure levels for EPI, under the same conditions, in eleven clinical super-conducting MRI systems. They also compared sound pressure levels for the EPI and six different pulse sequences and analyzed the acoustic noise spectra. Sound pressure levels during the use of the EPI differed greatly among institutions. Moreover, sound pressure levels of the EPI were not significantly different from those of other fast pulse sequences and were within permissible noise exposure levels. In comparison to other fast sequences, the EPI had significantly greater acoustic noise in the high-octave band frequency.

Measurements of MTF and SNR( f ) using a subtraction method in MRI

A method was developed for accurate measurement of the modulation transfer function (MTF) and signal-to-noise ratio in the spatial frequency domain (SNR(f)) of magnetic resonance images (MRI). The MTF was calculated from the complex images of a line object which were obtained by the subtraction of two separately acquired data sets of a specially designed phantom with a sliding sheet. Moreover, the SNR(f) was calculated from the MTF and Wiener spectrum, both of which were determined using the same phantom configuration. The MTFs and SNR(f)s in the conventional spin-echo (SE) and turbo SE, in which the effective echo time was set to the first echo, were evaluated by changing the T2 of the phantom and the echo train length. The MTFs in the positive and negative frequencies indicated the effect of the k-space trajectory for each pulse sequence. SNR(f)s gave spatial frequency information that was not obtained with conventional methods. In this method, the influence of image nonuniformity and unwanted artefacts (edge and ghost) could be eliminated. An analysis of the MTF and the SNR in the spatial frequency domain provides additional information for the assessment of image quality in MRI.

Characteristics of acoustic noise in echo-planar imaging

Characteristics of the acoustic noise generated by magnetic resonance imagers of different systems and performance levels were studied when operating in echo-planar imaging (EPI) sequence. Continuous equivalent A-weighted sound pressure levels (Leq) and peak impulse sound pressure levels (Lpeak) during EPI were measured in 12 clinical super-conducting MRI systems (0.5-1.5 T). Sound pressure levels and frequency spectra of EPI were compared with those of nine different pulse sequences. EPI sound pressure levels differed among institutions (Leq = 94.2 +/- 2.7 dBA. Lpeak = 109.1 +/- 3.5 dB), but these were within permissible noise exposure levels. Sound pressure levels during EPI were not significantly different from those during other pulse sequences. However, compared to other pulse sequences. EPI had a significantly greater proportion of acoustic noise in the high octave-frequency band. Single-shot EPI had relatively higher frequency noise and greater Leq than multishot EPI, but the difference in Leq decreased when the number of slices in multishot EPI was increased.