Histologic examination of dislocated lenses.

PURPOSE: To examine histological changes resulting from dislocated and subluxated lenses. CASES: The subjects consisted of 16 patients (aged 52-89 years) who underwent total lens extraction for lens dislocation or subluxation in the Department of Ophthalmology at Fukui Medical University during the period between April 1991 and June 1998. There were 5 patients (6 eyes) with traumatic dislocation and 11 patients (11 eyes) with idiopathic dislocation. RESULT: Rupture of the cortical fibers and migration of the epithelial cells toward the posterior pole of the lens were more frequently noted in patients with traumatic dislocation than in the idiopathic group, and both findings were often simultaneously observed. Rupture of the cortical fibers was considered attributable to external pressure transmitted to the lens. CONCLUSION: We speculate that the concurrent migration and dislocation of the equatorial bow architecture toward the posterior pole was caused by inhibition of differentiation of the epithelial cells to fiber cells by external pressure on the equatorial region.

Intracranial cerebrospinal fluid distribution and its postoperative changes in normal pressure hydrocephalus.

BACKGROUND: This study was conducted to investigate the usefulness of intracranial cerebrospinal fluid (CSF) volume measurement using MR-based methods in the management of patients with normal pressure hydrocephalus (NPH). METHODS: The study group comprised 19 patients with NPH who showed a favorable outcome after ventricular shunting, 15 normal volunteers (NV), and 15 patients with cerebrovascular disease (CVD). A 3D-fast asymmetric spin echo MR imaging sequence and the region-growing method were used to extract the CSF space from MR images. Ventricular volume (VV) and intracranial CSF volume (ICV) were measured and the VV/ICV ratio was calculated in each case. In NPH patients, the CSF volume was measured again after shunting. FINDINGS: The mean VV and VV/ICV ratio in the NPH group (91.1 mL and 45.2%, respectively) were significantly (p < 0.01) higher than those in the NV group (26.5 mL and 13.7%) and in the CVD group (44.5 mL and 17.8%). On the other hand, mean ICV values were not significantly different among the three groups. The VV was markedly decreased postoperatively (mean -40.7%), whereas the ICV was unchanged, resulting in a marked reduction in the VV/ICV ratio (mean -39.3%). INTERPRETATION: These results suggest that patients with NPH have a unique intracranial CSF distribution, with an enlarged VV and a slightly increased ICV, resulting in a high VV/ICV ratio. Shunting led to dramatic improvement in our patients. It is likely that CSF measurement can provide valuable information in the management of patients with NPH.

Microanatomy of the cerebellopontine angle and internal auditory canal: study with new magnetic resonance imaging technique using three-dimensional fast spin echo.

OBJECTIVE: We report a new magnetic resonance imaging technique that uses three-dimensional fast spin echo and the minimum intensity projection method. Using this technique, detailed images of the cerebellopontine angle (CPA) and internal auditory canal (IAC) were obtained in normal volunteers and in patients with acoustic neuromas or hemifacial spasm. METHODS: Ten normal volunteers, 44 patients with acoustic neuromas, and 31 patients with hemifacial spasm were studied using the three-dimensional fast spin echo magnetic resonance imaging protocol. The CPA and IAC were scanned by using a 1-mm slice thickness in the axial and parasagittal planes. RESULTS: Normal anatomy was as follows. 1) The vestibulocochlear nerve was ovoid near the brain stem and changed to a slightly crescentic configuration (C shape) as it traveled laterally. 2) Separation of the cochlear and vestibular nerves was observed near the central part of the IAC. 3) Discrimination between the superior and inferior vestibular nerves was also possible near the fundus of the IAC. 4) The facial nerve was easily identifiable as a discrete nerve at the anterior aspect of the vestibulocochlear nerve. 5) The meatal loop of the cerebellar artery was located medial to the porus in 44% of 95 CPAs and reached the porus or protruded into the porus in 56%. Acoustic neuromas were as follows. 1) In a patient with a very small intracanalicular tumor, the nerve on which the tumor was located could be identified. 2) In 22 of 44 acoustic neuromas, cerebrospinal fluid was present between the tumor and the fundus of the IAC. Hemifacial spasm was as follows. The relationship between the responsible artery and the facial nerve could be precisely observed. CONCLUSION: The three-dimensional fast spin echo method offers ultrahigh-resolution images, which are extremely useful in understanding the surgical anatomy of the CPA and IAC.

Delineation of small nerves and blood vessels with three-dimensional fast spin-echo MR imaging: comparison of presurgical and surgical findings in patients with hemifacial spasm.

BACKGROUND AND PURPOSE: We applied a 3D fast spin-echo (3D-FSE) MR imaging technique to the preoperative and postoperative evaluation of patients with hemifacial spasm. METHODS: The study group comprised 20 patients. All images were acquired on a 1.5-T MR system with a 3D-FSE sequence. RESULTS: In all 20 patients, the courses of the seventh and eighth cranial nerves were depicted separately, and the arteries presumed to be responsible for the hemifacial spasm were seen to be in contact with the facial nerves at the root exit zone (REZ). Eight patients underwent neurovascular decompression. In all patients, the presumed responsible blood vessels depicted by 3D-FSE MR imaging corresponded to intraoperative findings. In addition, postoperative 3D-FSE images confirmed the separation of the facial nerve from a contiguous vessel at the REZ. DISCUSSION: The 3D-FSE technique makes it possible to obtain extremely high-quality images of microstructures in the cerebellopontine cistern, and it has several advantages over conventional angiography: it is noninvasive and able to depict the cranial nerves and surrounding vessels in the same image without contrast material, and it may be useful for postoperative evaluation of the decompression procedure. This imaging technique is expected to prove useful for the clinical evaluation of hemifacial spasm.

[2D-FASE MRCP for pediatrics with congenital biliary dilatation: usefulness of non-breath-hold one-shot MRCP].

The usefulness of magnetic resonance cholangiopancreatography (MRCP) using the non-breath-hold one-shot technique was evaluated. Ten children suffering from congenital biliary dilatation (CBD) were included. Four of them were preoperative cases, and the remaining six postoperative. All MR images taken were compared with endoscopic retrograde cholangiopancreatography or intraoperative cholangiography. MR images using the non-breath-hold one-shot technique clearly showed the confluence of the common bile duct and the main pancreatic duct in seven of the cases. The confluence of the common bile duct and main pancreatic duct was obscure in the other three cases, mainly due to motion artifact. These results show that this non-breath-hold one-shot technique is useful for diagnosis and postoperative follow-up of congenital biliary dilatation in children.

[Applicability of the dual interval echo train (DIET) method for female pelvic diseases].

Dual interval echo train fast SE (DIET-FSE) is a modified fast SE technique. It attenuates fat signals by applying a time interval between an excitation pulse and the first echo, which is the odd-number of the following echo interval, and by decreasing the number of high frequency refocusing pulses before collecting echoes in the center of the k space, which determines the contrast. Unlike many other fat-suppression methods, this technique is less affected by susceptibility effects. In this study, we compared DIET-FSE with FSE and conventional SE of the female pelvis. The results of DIET-FSE showed a stable, obvious fat suppression effect which resulted in the easy detection of pelvic organs such as the intestines and ovaries, as compared with FSE. The reductions in imaging time and motion artifacts also permitted more precise differentiation between the normal pelvic organs and lesions than conventional T2-weighted SE. These results imply that the DIET-FSE is useful for the diagnosis of female pelvic disorders.

[Functional imaging of the sensorimotor cortex using an ultra-fast MR imaging method].

UNLABELLED: The aim of this study was to assess changes in brain activity during a motor task and variable sensory stimulation using echo planar imaging, which represents the fastest clinically usefull imaging technique available. MATERIALS AND METHODS: The subjects of this study were 11 healthy-volunteers, 4 males and 11 females, with an average of 26.4 years. The subjects were instructed to tap the fingers of one hand as the motor task. Compressed air was applied 5 times a second as "simple" sensory stimulation. Simple figures were drawn on the subjects palm as "complex" sensory stimulation. In all cases, functional imaging was performed by T2*-weighted echo planar imaging (TE = 53 msec, TR = 3000 msec, flip angle = 90 degrees, matrix 64 x 64, FOV = 205 mm, slice thickness = 8 mm) alternately at rest and during the task (intervals: 30 sec). A total of 60 images was collected in 3 minutes. Images obtained by subtracting images at rest and during the task were analyzed. RESULTS AND DISCUSSION: Almost all subjects showed a transient signal increase in the contralateral paracentral region during simple sensory stimulation. Continuous signal increases in the contra- and/or ipsi-lateral para-central region were observed during complex sensory stimulation. Some exhibited signal increases in the parietal or frontal association cortex, but they disappeared when subject's attention was distracted during stimulation. All subjects displayed signal increases in the contralateral para-central region during the motor task. Some of them exhibited signal increases in the medial frontal area (supplementary motor area) and ipsilateral para-central region. These results suggest that the signal increases of functional MRI reflect not only simple reactions to stimulation but higher cerebral function as well.

[A case report of cervical agenesis combined with vaginal agenesis diagnosed by MRI].

This disease was reported 46-cases in the world literature. We stressed that the diagnosis of a cervicovaginal atresia by MRI offer this advantage of diagnosis in a noninvasive manner prior to surgical intervention.

[A case report of intrahepatic portal vein aneurysm; diagnostic usefulness of MRI].

A very rare case of portal vein aneurysm in 62 year old female was revealed by various modern imaging modalities including MRI. Diagnostic usefulness of MRI was first demonstrated because of it's high sensitivity to the blood flow as compared with other conventional imaging modalities.