Cyclophosphamide-Associated Reversible Cerebral Vasoconstriction Syndrome Presenting as Concurrent Cerebral Infarction and Subarachnoid Hemorrhage

Reversible cerebral vasoconstriction syndrome (RCVS) has several trigger factors, including physical exertion, pregnancy, and the intake of vasoconstrictive agents. These triggers activate the sympathetic nervous system and induce vasoconstriction, thereby leading to an ischemic or hemorrhagic stroke. In this study, we describe case of RCVS in a 73-year-old woman who complained of sudden bilateral leg weakness after taking cyclophosphamide for anti-neutrophil cytoplasmic antibody associated vasculitis. She was diagnosed with concurrent cerebral hemorrhage and cerebral infarction with multiple intracranial vasoconstrictions on imaging analyses.

Cyclophosphamide-Associated Reversible Cerebral Vasoconstriction Syndrome Presenting as Concurrent Cerebral Infarction and Subarachnoid Hemorrhage

Reversible cerebral vasoconstriction syndrome (RCVS) has several trigger factors, including physical exertion, pregnancy, and the intake of vasoconstrictive agents. These triggers activate the sympathetic nervous system and induce vasoconstriction, thereby leading to an ischemic or hemorrhagic stroke. In this study, we describe case of RCVS in a 73-year-old woman who complained of sudden bilateral leg weakness after taking cyclophosphamide for anti-neutrophil cytoplasmic antibody associated vasculitis. She was diagnosed with concurrent cerebral hemorrhage and cerebral infarction with multiple intracranial vasoconstrictions on imaging analyses.

Cerebral Infarction Secondary to Vascular Infiltration of Glioblastoma Confirmed in High-Resolution Vessel Wall MRI

Acute cerebral infarction secondary to glioblastoma is rarely reported, and its mechanism is still controversial. Vascular infiltration of malignant cell, direct mass effect and local procoagulant effect were considered as main pathophysiology. We report a case of glioblastoma-related cerebral infarction documented by high resolution vessel wall magnetic resonance imaging, which reveals concentric enhancement of arterial wall and intraluminal thrombus without direct compression. These findings suggest tumor cell infiltration of intracranial vessels is one of the important mechanisms of glioblastoma-related cerebral infarction.

Impaired Hand Dexterity Function in a Non-human Primate Model with Chronic Parkinson’s Disease

ymptoms of Parkinson’s disease (PD) caused by loss of dopaminergic neurons are accompanied by movement disorders, including tremors, rigidity, bradykinesia, and akinesia. Non-human primate (NHP) models with PD play an essential role in the analysis of PD pathophysiology and behavior symptoms. As impairments of hand dexterity function can affect activities of daily living in patients with PD, research on hand dexterity function in NHP models with chronic PD is essential. Traditional rating scales previously used in the evaluation of animal spontaneous behavior were insufficient due to factors related to subjectivity and passivity. Thus, experimentally designed applications for an appropriate apparatus are necessary. In this study, we aimed to longitudinally assess hand dexterity function using hand dexterity task (HDT) in NHP-PD models. To validate this assessment, we analyzed the alteration in Parkinsonian tremor signs and the functionality of presynaptic dopaminergic neuron using positron emission tomography imaging of dopamine transporters in these models. In addition, a significant inverse correlation between HDT and DAT level was identified, but no local bias was found. The correlation with intention tremor signs was lower than the resting tremor. In conclusion, the evaluation of HDT may reflect behavioral symptoms of NHP-PD models. Furthermore, HDT was effectively used to experimentally distinguish intention tremors from other tremors.

Pylorus-preserving Whipple Pancreaticoduodenectomy: CT Findings of Immediate Postoperative Complications

PURPOSE: To determine the CT findings of immediately postoperative complications including anastomoticleakage, and to evaluate the usefulness of CT scan in the assessment of early postoperative complications ofpylorus preserving Whipple pancreaticoduodenectomy (PPPD) MATERIALS AND METHODS: During the early postoperativeperiod, fluid accomulated in the abdominal cavity of ten of 23 patients who had undergone PPPD. In all cases, thetime interval between the first follow up CT scan and surgery was no more than two weeks. At each leakage site, wecompared CT findings with those of conventional fluoroscopic studies: upper gastrointestinal studies with oralwater-soluble contrast materials, a contrast injection study via drainage catheters in place in the stomach, thesite of choledochojejunostomy during surgery and pancreaticojejunostomy, and nine cases of sinogram viapercutaneous drainage catheters. We also evaluated CT findings of the locations, amounts, and margin of the fluidcollections. If conventional fluoroscopic studies showed no evidence of anastomotic leakage, as was the case withsix patients, the leakage site was determined on the basis of clinical and laboratory data. In four of the six,this was found to be the site of pancreaticojejunostomy, and in the other two, an abscess without anastomoticleakage. RESULTS: Eight patients showed intra-abdominal fluid collections due to leakage at anastomotic sites: infive, this was the site of pancreaticojejunostomy, and in three, that of choledochojejunostomy. One patient showeda right subphrenic abscess, and another, a loculated fluid collection between the jejunal loops, without leakageat the anastomotic site. CT scans in all three cases with leakage at the site of choledochojejunostomy showed thesmall collection of fluid to be relatively well demarcated and confined to the areas of lesser sac or gallbladderbed. In four of five cases of leakage at the site of pancreaticojejunostomy, the large collection of fluid waswidespread; it occupied areas which included the perihepatic and peripancreatic space, as well as the paracolicgutters and pelvic cavity. CONCLUSION: In some cases of suspected complications arising after PPPD, and includinganastomotic leakage and abdominal abscess, leakage is not revealed by conventional fluoroscopic studies; in suchcases, CT scanning may help detect the complications and determine the site of anastomotic leakage.

MR Imaging of Uterine Cervical Carcinoma: Is Contrast-enhanced Imaging Useful in Staging?

PURPOSE: To evaluate the usefulness of contrast-enhanced T1-weighted MR imaging in the diagnosis and stagingof uterine cervical carcinoma. MATERIALS AND METHODS: MR images (T1WI, T2WI and CE-T1WI) of 40 patients withhistologically proven uterine cervical carcinoma were reviewed by three radiologists. Tumor visualization, signalintensity, degree of enhancement, delineation of tumor margin, assessment of parametrial involvement, andevaluation of pelvic lymph node metastasis were analynized on each sequence, retrospectively. We compared theaccuracy of CE-T1WI with that of T2WI in the diagnosis and staging of uterine cervical carcinoma. RESULTS: Tumorswere detected in 35/40 cases (87.5%) on T2WI, and in 34/40 (85.0%) on CE-T1WI. On T2WI, signal intensities of allvisualized tumors were more hyperintense than those of normal cervical stroma. The signal intensities of enhancedtumors were lower(79.4%), similar to (5.9%), or higher than (14.7%) those of well-enhanced normal myometrium. Inthe assessment of parametrial involvement and the evaluation of pelvic lymph node metastasis, accuracy during eachsequence was 85.7% (12/14) and 100% (28/28), respectively. With regard to delineation of tumor margin, nostatistical difference was found between CE-T1WI and T2WI, though in cases of lesions greater than 3 cm in maximalsize, the margin was clearer in 14 cases, and less clear in 4 cases, on CE-T1WI than on T2WI, with a significantstatistical difference. The accuracy of tumor staging was 78.6% (11/14) on T2WI, and 71.4% (10/14) on CE-T1WI. CONCLUSION: There was no significant statistical difference in tumor visualization, accuracy of staging, andevaluation of pelvic lymph node metastasis between T2W1 and CE-T1WI. CE-T1WI was superior to T2WI in delineatingthe margin of tumors more than 3 cm in maximal size. Contrast-enhanced T1WI appears to be useful for evaluatingthe extent of large cervical carcinomas.

CT-Guided Biopsy of Pulmonary Lesions: A Comparison of Diagnostic Accuracy and Complication Rate betweenAutomated Gun Biopsy and Fine Needle Aspiration Biopsy

PURPOSE: To compare the efficacy and safety of CT-guided automated gun biopsy with those of fine needleaspiration biopsy of pulmonary lesions. MATERIALS AND METHODS: Under CT guidance, we performed automated gunbiopsies in 115 cases of 109 patients and fine needle aspiration biopsies in 119 cases of 108 patients withpulmonary lesions. Between the two methods, we compared the diagnostic rate, diagnostic accuracy and frequency ofcomplications according to the depth and diameter of pulmonary lesions. RESULTS: The overall diagnostic rates ofautomated gun biopsy and fine needle aspiration biopsy were 76.5% (88/115) and 64.7% (77/119) respectively. Therewas a significant statistical difference (p=0.048), especially in the case of malignant lesions less than 3 cm(p=0.027) and more than 6 cm (p=0.008) in maximal diameter. The diagnostic accuracy of automated gun biopsy andfine needle aspiration biopsy showed significant statistical difference only in malignant lesions more than 6cm inmaximal diameter (p=0.008), and in the lesions located from 1 cm to less than 3cm from the pleura (p=0.030), asseen on CT. There was no significant statistical difference in the frequency of complications. CONCLUSION:Automated gun biopsy of pulmonary lesions under CT guidance is safe, with complications rate comparable to thoseof fine needle aspiration biopsy. A higher overall diagnostic rate can be achieved by automated gun biopsy than byfine needle aspiration biopsy. For the diagnosis of pulmonary lesions under CT guidance, automated gun biopsy istherefore a more useful procedure than fine needle aspiration biopsy.

Simple Bone Cyst: Radiologic Changes after Injection of Steroid

PURPOSE: To evaluate radiographic changes and clinical effects after the injection of steroid injection into simple bone cyst. MATERIALS AND METHODS: We analyzed plain radiographic and CT findings after the injection of steroid (methylprednisolone acetate, MPA) into simple bone cyst. Twelve patients were involved; eight were males and four were females, and their ages ranged from 6 to 41 years. They were treated from one to seven times with an intracystic injection of MPA, 80-200mgs per injection. All patients were evaluated by plain film, and four by CT, and the mean follow-up period was 20 months. RESULTS: Postinjection plain radiographic findings were as follows: increased internal radiodensity (n=10), smaller cyst (n=8), cortical thickening (n=7), and radiodensity of double ring pattern (n=4). CT findings were as follows: increased internal attenuation (n=4), smaller cyst (n=4) and radiodensity of double ring pattern along the cyst wall (n=4). All patients improved clinically and radiologically, especially those with radiodensity of double ring pattern. CONCLUSION: The injection of steroid into simple bone cyst is an effective treatment. A new radiographic finding after injection is radiodensity of double ring pattern along the cyst wall, and we believe that this indicates progression of the healing process.

A Relationship Between Amount of Joint Effusion, Disk Displacement and Presence of Pain in theTemporomandibular Joint: MR Imaging

PURPOSE: To correlate MR findings of amount of temporomandibular joint effusion with joint pain and disk displacement. MATERIALS AND METHODS: In 57 patients, 114 temporomandibular joints with symptoms of disorder(presence of clinical pain) were imaged. Closed and open mouth sagittal spin echo (SE) T1-weighted images (WI) and fast spin echo (FSE) T2-WI were obtained. We classified the amount of joint effusion into grades. Joint effusion was classified as either Grade I, II or III, as follours : in sagittal FSE T2-WI, a long diameter of joint effusion shorter than 1/3 of the diameter of the convex margin of temporal eminence was grade I; longer than 2/3 was grade III; between grade I and III was grade II. Disk displacement was classified as either with or without reduction in the open mouth position. These findings were correlated with one another and statistically analyzed. RESULTS: In 29 cases with joint pain (37%) and in 34 cases without pain (63%) there was no evidence of joint effusion; there were, however, more grade I joint effusion cases with pain (14 ; 60.9%) than without pain (9 : 39.1%). Cases of joint pain increased in proportion to grade of joint effusion, which was statistically significant (p<0.05). In joints without disk displacement, the largest grouping was that which showed no effusion (39 ; 72.2%) ; no joints showed grade III effusion. Cases of joint effusion decreased in proportion to grade of effusion. In joints with disk displacement, cases of joint effusion tended to increase in proportion to the grade of effusion. CONCLUSION: MR findings of amount of temporomandibular joint effusion correlate with joint pain and anterior disk displacement.