Wakoh Takahashi

F-18 FDG uptake in endometrial cancer.

Endometrial cancer, which is one of the most common malignant gynecologic diseases, was detected by F-18 fluorodeoxyglucose (FDG) positron emission tomography (PET) in a 60-year-old woman with abdominal distention. FDG PET revealed heterogeneous and marked accumulation in the endometrium, which was thought to represent endometrial cancer. In addition, focal intense accumulation of FDG in both lungs suggestive of lung metastases were noted. Endometrial cancer and lung metastases were confirmed by endometrial biopsy and computed tomography of the chest, respectively.

Magnetic resonance imaging and 11C-N-methylspiperone/positron emission tomography studies in a patient with the interval form of carbon monoxide poisoning

Magnetic resonance (MR) and (11)C-N-methylspiperone ((11)C-NMSP)/positron emission tomography (PET) imagings were repeatedly performed in a 50-year-old man with the interval form of carbon monoxide (CO) poisoning. In MR images obtained when delayed neuropsychiatric symptoms developed (two months after poisoning), the inner segments of the bilateral globus pallidus appeared as high signal intensities in the T1-weighted and low signal intensities in the T2-weighted images, suggesting prior focal hemorrhage in these areas. A PET study with (11)C-NMSP performed at that time showed an increase in dopamine D2 receptor binding in the caudate and putamen. Treatment with bromocriptine was very effective and five months after the poisoning, MR and (11)C-NMSP/PET images showed improvement, concomitantly with the disappearance of the neuropsychiatric symptoms.

Recommendations for the Management of Intracranial Haemorrhage – Part I: Spontaneous Intracerebral Haemorrhage

This article represents the recommendations for the management of spontaneous intracerebral haemorrhage of the European Stroke Initiative (EUSI). These recommendations are endorsed by the 3 European societies which are represented in the EUSI: the European Stroke Council, the European Neurological Society and the European Federation of Neurological Societies.This article represents the recommendations for the management of spontaneous intracerebral haemorrhage of the European Stroke Initiative (EUSI). These recommendations are endorsed by the 3 European s

Relationship Between Chronic Kidney Disease and White Matter Hyperintensities on Magnetic Resonance Imaging

Renal dysfunction may be related to cerebral small-vessel disease. This study aimed to assess the relationship between mild renal dysfunction and various white matter hyperintensities on magnetic resonance imaging (MRI). A total of 2106 subjects (1368 men and 738 women; mean age, 56 ± 10 years) without a history of stroke were enrolled in the study. Kidney function was evaluated in terms of estimated glomerular filtration rate (eGFR), calculated using the relationship 194Cr(-1.094) × age(-0.287) × 0.739 (if female), where Cr is serum creatinine concentration. White matter hyperintensity on T2-weighted MRI was classified as deep and/or subcortical white matter hyperintensity (DSWMH), periventricular hyperintensity (PVH), or asymptomatic cerebral infarction (ACI). The prevalence of ACI, DSWMH, and PVH was significantly correlated with degree of eGFR reduction; in the subgroups with eGFR ≥ 90, 60∼89, and <60 mL/min/1.73 m(2), the following prevalences were found: ACI, 7%, 6%, and 16%; DSWMH, 18%, 21%, and 37%; PVH: 7%, 10%, and 21%. The odds ratios for ACI, DSWMH, and PVH of eGFR <60 mL/min/1.73 m(2) were significantly increased, to 2.11 (95% confidence interval [CI], 1.23-3.61; P = .006), 2.26 (1.53-3.34; P < .001), and 2.81 (1.67-4.72; P < .001), respectively. Our data indicate that mild renal dysfunction may be associated with an increase in cerebral small-vessel disease independent of hypertension.

Chronic Kidney Disease in Patients with Ischemic Stroke

To examine the significance of renal dysfunction in patients who have sustained ischemic stroke, we examined the relationship between the renal function evaluated in terms of estimated glomerular filtration rate (eGFR) and the subtype of brain infarction (BI) in patients with ischemic stroke. A total of 639 patients with BI were enrolled in this study, with 314 subjects without stroke or transient ischemic attack registered as age-matched controls. eGFR was calculated according to the equation 194 × Cr(-1.094) × Age(-0.287) (-0.739 if female), where Cr is serum creatinine concentration, and was classified into four stages: stage I, eGFR ≥ 90 mL/min/1.73 m(2); stage II, eGFR 60 ~ 89 mL/min/1.73 m(2); stage III, eGFR 30 ~ 59 mL/min/1.73 m(2); and stage IV, eGFR <29 mL/min/1.73 m(2). Stage III-IV was significantly more prevalent in the BI group (38%) than in the control group (22%; P < .001). The odds ratio for stage III-IV was significantly higher in the BI group (1.93; 95% confidence interval [CI], 1.35-2.76). Among the BI subgroups, the odds ratios of stage III-IV for the atherothrombotic type (1.81; 95% CI, 1.23-2.68) and the cardiogenic type (2.25; 95% CI, 1.32-3.83) were significantly higher than that of the control group, but that of stage III-IV for lacunar type was not (1.67; 95% CI, 0.98-2.84). Our results indicate that ischemic stroke is frequently associated with renal dysfunction. Chronic kidney disease might be independent risk factor for infarction, especially for cardiogenic and atherosclerotic types.

Increased FDG uptake in the wall of the right atrium in people who participated in a cancer screening program with whole-body PET

The purpose of this study was to evaluate the characteristics of patients who showed increased FDG uptake in the wall of the right atrium.We have encountered 10 patients with increased activity in the wall of the right atrium among a total of 2,367 examinees who participated in our cancer screening program with whole-body PET. The mean age of these examinees was 62.9 yr, higher than that of the total population. All suffered from cardiac disorders, especially atrial fibrillation. FDG accumulated almost exclusively in the wall of the right atrium, whereas only slight activity was seen in the wall of the left atrium. Although the average size of the right atria was significantly enlarged, left atria were more severely dilated than right ones. Therefore overload does not seem to account for the FDG accumulation in the wall of the right atrium.In conclusion, the increased activity in the wall of the right atrium was a rare finding that was made in older people who suffered from cardiac disease. Although the mechanism of induction of the high metabolic state of glucose in the wall of the right atrium remains unclear, this unusual activity would be another false positive finding in cancer screening with whole-body FDG PET.

Reversible Magnetic Resonance Imaging Lesions in Wilson's Disease: Clinical-Anatomical Correlation

Described herein is a patient with Wilsons disease who had tremor as a prominent neurological manifestation. T2‐weighted magnetic resonance imaging showed abnormal high signal intensities in the bilateral lenticular nuclei, thalami, and red nuclei of the midbrain. Improvement of tremor with copper chelating agents was well correlated with a decrease of the abnormal signals in the thalami and the red nuclei.

Stroke Risk of Asymptomatic Intra- and Extracranial Large-Artery Disease in Apparently Healthy Adults

Background: The predictive value of asymptomatic intracranial artery stenosis for future stroke remains uncertain. The aim of this study is to assess the stroke risk of asymptomatic intracranial artery stenosis and to compare it with that of extracranial artery disease. Methods: The study subjects were 2,924 participants (mean age 55 years) without any history of stroke. We examined the relation between intra- or extracranial large-artery disease and subsequent cerebrovascular events (mean follow-up 63 months). Results: The incidence rate of total cerebrovascular events in persons with intracranial artery stenosis was 1.3% per year. In the group without plaque in the extracranial carotid arteries, the annual rate of total cerebrovascular events was only 0.6%, but in the group with plaque, the rate was 3.6%. Kaplan-Meier analysis of total events showed a significant difference between the 2 groups (p = 0.002). Conclusions: The stroke risk in subjects with asymptomatic extracranial artery disease is markedly increased if intracranial artery stenosis is also present.

Quantitative PET cerebral glucose metabolism estimates using a single non-arterialized venous-blood sample.

The purpose of this study is to develop a method of quantitating the cerebral metabolic rate of glucose (CMRglc) by positron emission tomography using a population-based heated venous curve and one-point sampling from a non-heated vein, i.e. that can avoid arterial puncture.Methods: We conducted this study on 17 subjects with a mean age of 61 ± 9 years. A time-concentration curve as an input function was obtained by sampling 24 blood samples, from the heated left hand vein, one before and the others after intravenous injection of 259 MBq of F-18-fluorodeoxyglucose into the right cubital vein. A non-heated venous sample was also obtained from the right cubital vein.Results: The population-based input function was calculated by averaging time-concentration curves from the first 7 subjects. A single sample obtained from 10 other subjects from 7.5 to 20 minutes and 35 and 40 minutes after injection predicted input function well with an error of less than 4.5%. The radioactivity in the non-heated 40 minutes’ sample was 1.7 ± 2.9% higher than in the heated vein. When we calibrated the population-based curve using the non-heated venous samples at 40 minutes in 10 subjects, the calculated CMRglc values were 1.3 ± 5.4% lower than the actual values.Conclusions: Non-heated venous one-point sampling and the population-based curve can decrease the complexity of the procedures and the manpower required, and also make the FDG study less invasive, without a significant increase in measurement error.

FDG accumulation in aortic walls.

A 65-year-old woman with no symptoms underwent whole-body F-18 fluorodeoxyglucose (FDG) positron emission tomography (PET) for cancer screening. FDG accumulation was detected incidentally in her arterial walls, including the aortic wall. She had no history of inflammatory or cardiovascular disease. Although accumulation of FDG is well recognized in the aortic wall when vasculitis is present, this patient showed no symptoms of active vasculitis during the 22-month follow-up period after the PET study. The aortic wall might be a site where FDG accumulates physiologically in elderly persons.