Assessment of dissociation symptoms in patients with mental disorders by the Dissociation Questionnaire (DIS-Q).

AIM: Dissociative symptoms are often found in psychiatric patients and have been implicated in psychotic trauma. We aimed to explore dissociative tendencies in psychiatric patients including dissociative disorders (DDs), obsessive-compulsive disorder (OCD), eating disorder (ED), and post-traumatic stress disorder (PTSD) by using the Dissociation Questionnaire Japanese version (DIS-Q-J). METHODS: We evaluated the reliability and the validity of DIS-Q-J by comparing it with the Dissociative Experience Scale (DES). 107 patients (32 DDs, 28 OCDs, 24 PTSDs, 23 EDs) and 83 controls answered both the DIS-Q-J and the DES questionnaires. In addition, OCD patients were assessed by the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), PTSD patients were assessed by the Impact of Event Scale-Revised (IES-R), and ED patients were assessed by the Bulimic Investigatory Test, Edinburgh (BITE). RESULTS: The internal consistency of the total DIS-Q-J and DES scale was high in all groups (Cronbach's alpha coefficients, DIS-Q-J; 0.922-0.975, DES; 0.934-0.957, p<0.01). The correlation between the total scores of the DIS-Q-J and the DES in all groups was significant (Spearman's rank correlation, 0.613-0.777 (p<0.01)). An analysis of variance (ANOVA) showed that the mean total scores of the control and clinical groups were significantly different (p<0.05) for both the DIS-Q-J and DES. CONCLUSION: These results suggest that the DIS-Q-J is a useful tool for the assessment of dissociative symptoms.

Evaluation of the validity of the Autism Spectrum Quotient (AQ) in differentiating high-functioning autistic spectrum disorder from schizophrenia.

The aim of this study is to examine the validity of the Autism Spectrum Quotient (AQ) to differentiate high-functioning autistic spectrum disorder (ASD) from schizophrenia (SCH). The AQ was developed by Baron-Cohen et al. to measure autistic traits. In addition to the original AQ items, we created self-administered questions about psychotic symptoms (S-scale). We administered the modified AQ to 51 ASD patients and 46 SCH patients, and we compared these two groups in terms of total AQ score, AQ subscale scores and S-scale score. We applied receiver operating characteristic (ROC) curves to examine the discriminating power of the AQ. The mean total AQ score of the ASD group (32.6; SD=6.8; range: 8-48) was significantly higher than that of the SCH group (21.8; SD=7.4; range: 10-39) (p<0.001). All AQ subscale scores of the ASD group were significantly higher than those of the SCH group. By using a cut-off score of 29 for the AQ total score, we were able to correctly classify 80% of the subjects. At this cut-off, the positive and negative predictive values were 0.83 and 0.78, respectively. Inclusion of additional questions of the S-scale did not increase the power of differentiation. These results indicate that the usefulness of the AQ in differentiating high-functioning ASD from SCH is limited.

[Simulation study for artifacts on Gd-EOB-DTPA-enhanced liver dynamic MR imaging in arterial dominant phase].

We performed a simulation for artifacts on liver dynamic MR imaging with the contrast agent gadolinium-ethoxybenzyl (Gd-EOB)-DTPA. The signal enhancement of the image by the contrast agent in the arterial dominant phase was assumed, and the time-enhancement curve was numerically generated. The data in k-space was obtained by the Fourier transform of a liver image. By assuming the scan timing and duration in the time-enhancement curve, the data set of each phase-encoding step in k-space was increased in proportion to the corresponding intensity in the time-enhancement curve. We obtained the simulated image by the Fourier transform of the k-space data, and investigated artifacts in the image. Assuming the use of the centric k-space filling scheme, blurring in the image is found when the scan timing is delayed. When the scan is started in an early timing, we observe the effect of edge enhancement in the image. These artifacts of blurring and edge enhancement are decreased by shortening the scan duration. Assuming the use of the sequential k-space filling scheme, those artifacts are not prominent. The use of the sequential scheme would be effective for the purpose of avoiding the artifacts. It is known that the contrast enhancement would not be sufficient without optimal scan timing; in addition, artifacts should be noted. For basic study of the contrast enhancement and artifacts, our simulation technique based on the time-enhancement curve would be useful.

[Study of susceptibility-weighted imaging (SWI) using a simple MR phantom].

We evaluated the visibility of hypointensity regions on susceptibility-weighted (SW) magnetic resonance imaging (MRI). A commercial simple phantom filled uniformly with a gel material was demonstrated to include small regions affected by different magnetic susceptibilities compared to their surroundings. For detection of these regions in the phantom, the three-dimensional SW imaging (SWI) technique is superior to a conventional two-dimensional gradient-recalled-echo (GRE) MRI technique. The mean contrast between the hypointensity regions and their surroundings on GRE images (T2* weighted images) of 4 mm slice thickness is approximately 88% less than that on SWI of 4 mm effective slice thickness. When the effective slice thickness of SWI is increased more than 4 mm, the contrast on SW images is decreased. While the mean contrast on SWI of 7 mm effective slice thickness is approximately 75-65% compared to that of 4 mm effective slice thickness, its contrast of 7 mm is determined to be higher than that on GRE images of 4 mm slice thickness; this suggests that the SWI technique could be applied to whole brain examination by reducing the acquisition time. The quantitative results in this article are considered to be useful for evaluating the visibility of hypointensity regions on SWI, when comparing them with GRE images and varying the effective slice thickness of SWI.

[Optimization of flip angle for 3D-VIBE technique in liver dynamic MRI].

The aim of this study was to determine a moderate flip angle (FA) for dynamic liver MR imaging (MRI) with the three-dimensional volumetric interpolated breath-hold examination (3D-VIBE) technique. Images of phantoms with various T(1) values (44-560 msec) were acquired with the 3D-VIBE sequence (TR/TE=5.2/2.6 msec) using different FA (5-50 degree). We estimated signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR), considered to indicate tumor-to-liver contrast, as a function of FA. In phantoms, in which T(1) values (44-191 msec) were assumed to be shortened by the effect of Gd-DTPA in hepatocellular carcinoma (HCC), the highest SNR in each phantom was observed at FA ranging from 15 to 30 degrees. SNRs in other phantoms, in which T(1) values (298-560 msec) were assumed to be normal liver-tissue pre- or post-enhancement, were high with FA of 10-12 degrees, and were remarkably decreased with FA of more than 30 degrees. CNR increased as FA increased in every phantom, especially in the phantom with shortened T(1) values (44-191 msec), suggesting that enlarging FA improved the tumor-to-liver contrast. Taking both results of SNR and CNR into account, we concluded that a moderate FA was approximately 25 degrees. The advantage with an FA of 25 degrees was confirmed in a clinical study of a patient with hypervascular HCC, in which we could observe coronal enhancement surrounding the lesion in the late phase of the double arterial phase by dynamic MRI using the 3D-VIBE technique.

Relationship between radiographic grading of osteoarthritis and the biochemical markers for arthritis in knee osteoarthritis.

The aim of this study was to investigate the relationship between the biochemical markers of arthritis and the radiographic grading of osteoarthritis (OA) in knees. Seventy-one women aged 49-85 years with knee OA were studied. Anterior-posterior knee radiographs and hand radiographs were taken in all patients. The radiographic grading of OA in the knee was performed by using the Kellgren-Lawrence criteria and the joint space width. The 71 patients with knee OA were divided into two groups: 37 patients exhibiting generalized osteoarthritis (GOA) and 34 non-GOA patients, according to the grading of their hand radiograph. C-reactive protein (CRP), urinary pyridinoline, YKL-40, plasma matrix metalloproteinase (MMP)-3, MMP-9 and tissue inhibitor of metalloproteinases (TIMP)-1 were measured as the biochemical markers of arthritis. The radiographic grading with the Kellgren-Lawrence scale revealed a significant relationship to the joint space width (P = 0.003): the joint space width decreased with increasing Kellgren-Lawrence grade. All biochemical markers had negative correlations with the joint space width, but only urinary pyridinoline had a significant correlation (P = 0.039). Pyridinoline (P = 0.034) and TIMP-1 (P = 0.017) also exhibited a significant relationship to the Kellgren-Lawrence grade. In GOA evaluations, the joint space width did not differ between GOA and non-GOA patients. CRP, pyridinoline, YKL-40 and MMP-3 levels were significantly greater in GOA patients than in non-GOA patients. CRP, pyridinoline, YKL-40, MMP-3 and TIMP-1 levels each related to at least one of the radiographic gradings. Furthermore, pyridinoline related to every type of radiographic grading examined in the present study.

[Evaluation of the increase in signal intensity from applying the fast recovery technique to fast spin echo images].

The aim of the present study was to evaluate the increase in signal intensity caused by applying the fast recovery (FR) technique to fast spin echo (FSE) images, that is, the fast recovery fast spin echo (FR-FSE) method. All images of phantoms, whose T(2) values were different, were acquired with a Signa 1.5 Tesla system (GE Medical Systems) using the three-dimensional (3D) FSE and 3D FR-FSE sequences. We assessed the increased signal intensity as follows: (signal intensity on the FR-FSE image - FSE image) / FSE image (%). Our results showed that the increased signal intensity became high when 1) T(2) of the phantom was prolonged, 2) TR was shortened, and 3) echo train length (ETL) was decreased. By utilizing the results of this study, the increased signal caused by the FR technique could be estimated quantitatively when the TR, ETL, and T(2) of investigated substances were determined. For example, when TR, ETL, and T(2) were 1500 msec, 16-64, and 1500 msec, respectively, the increase in signal intensity was estimated to be approximately 70%. In addition, when T(2) was less than approximately 250 msec, signal intensity was not significantly increased by the FR pulses, that is, the FR-FSE image was the same as the FSE image. Accordingly, the FR-FSE method was confirmed to enhance the signal in substances with longer T(2), while maintaining the same contrast of the image as that obtained by the conventional FSE method. Our results are useful for evaluating the increased signal intensity caused by employing the FR technique.

[Duration of enhancement and scan timing in three-dimensional contrast-enhanced MR angiography using the elliptical centric phase-encoding technique].

In the present study, we quantitatively investigated the relationship between the signal intensity in a vessel and the duration of contrast enhancement as well as scan timing in 3D contrast-enhanced MR angiography using an elliptical centric phase-encoding technique. A tube phantom filled with Gd-DTPA, acting as a vessel, was taken out from the field of view during data acquisition, by using the "pause" function of our MR scanner (GE Signa, 1.5 Tesla), thereby simulating the presence and absence of a vessel. The shortening of the duration of enhancement corresponds to the delay of scan timing from the optimal point in the phase-encoding of the centric-ordering system. The signal intensity in a vessel (1-5 mm in diameter) decreased as the duration of enhancement became shorter and the diameter of the vessel decreased. When the number of partitions was 16 or 32 in a 128-mm-thick slab, the signal intensity obtained by the elliptical centric phase-encoding technique was almost the same as that obtained by the conventional centric phase-encoding technique. However, when the number of partitions was increased (64-124), and if the duration of enhancement was short, the signal intensity obtained by the elliptical centric phase-encoding technique was higher than that obtained by the conventional centric phase-encoding technique. In conclusion, in terms of the duration of enhancement and the delay of scan timing, the elliptical centric phase-encoding technique is superior to the conventional centric phase-encoding technique when the number of partitions in a slab for 3D MR angiography is increased.

[Simulation study of scan timing in three-dimensional contrast-enhanced MR angiography].

In our study of three-dimensional contrast-enhanced MR angiography, we performed a computer simulation to quantitatively investigate vessel visibility according to scan timing. To construct the simulated MR images, we varied the position (scan timing) and range (enhancement-duration) of k-space data assumed to be acquired during contrast enhancement. In the present study, either the sequential or centric phase-encoding order in k(y) and k(z) on k-space was assumed to be used. When scan timing was shifted from the optimal timing, the visibility of thick vessels decreased, and the signal intensity in thin vessels was higher than that in thick vessels. We found that the appropriate setting of scan timing was an important factor in the visibility of thick vessels. Meanwhile, we also noted that extending the enhancement-duration (or shortening the scan time) could increase the visibility of thin vessels. Our results and the simple technique used for simulation are considered to be useful for the study of three-dimensional contrast-enhanced MR angiography.