Utility of combining multiple parameters of 123I-IMP SPECT and voxel-based morphometry MRI using a multiparametric scoring system for differentiating dementia with Lewy bodies from Alzheimer's disease.

BACKGROUND: Brain magnetic resonance imaging voxel-based morphometry (VBM) and perfusion single-photon emission computed tomography (SPECT) are useful for differentiating dementia with Lewy bodies (DLB) from Alzheimer's disease (AD). PURPOSE: To determine whether combining multiple parameters of VBM and SPECT using a multiparametric scoring system (MSS) improves diagnostic accuracy in differentiating DLB from AD. MATERIAL AND METHODS: In total, 23 patients with DLB and 57 patients with AD underwent imaging using a voxel-based specific regional analysis system for AD (VSRAD), an easy Z-score imaging system, and a Z-Graph using three-dimensional stereotactic surface projection. The cutoff values were determined using the receiver operating characteristic curve to differentiate DLB from AD for all parameters. Patients were scored 1 (DLB) or 0 (AD) for each statistically significant parameter, according to a threshold. The total score was determined for each case to obtain a cutoff value for the MSS. RESULTS: The mean Z-scores in the medial temporal lobes using the VSRAD were significantly lower in patients with DLB than in those with AD. Each Z-score of the summed Z-scores in all four segmented regions of the occipital lobes using the Z-Graph was significantly higher in patients with DLB than in those with AD. Among the five parameters, the highest accuracy was 80% for the Z-score of the summed Z-scores in the left medial occipital lobe. For the MSS, a cutoff value of four improved the diagnostic accuracy to 82%. CONCLUSION: MSS was more accurate than any single parameter of VBM or SPECT in differentiating DLB from AD.

MR imaging findings of primary ovarian carcinoid: A novel finding of T1 hyperintense solid tissue.

Ovarian carcinoid is a rare well-differentiated neuroendocrine tumor resembling those arising in the gastrointestinal tract. We present a case of ovarian carcinoid with magnetic resonance imaging (MRI) findings. A 50-year-old woman with genital bleeding and severe constipation was referred to our hospital. On MR imaging, a left ovarian tumor showed iso to high signal intensity on T1-weighted images (T1WI), relatively low signal intensity on T2WI, and slightly high signal intensity on diffusion-weighted images. Additionally, the tumor demonstrated early and delayed strong contrast enhancement on dynamic contrast-enhanced images. The tumor was pathologically diagnosed with ovarian strumal carcinoid. High signal intensity on T1WI should be recognized as the MRI findings in ovarian carcinoids.

High Signal Intensity of the Cochlear Modiolus on Unenhanced T1-Weighted Images in Classical Infratentorial Superficial Siderosis.

Background: Superficial siderosis (SS) results from chronic bleeding in the subarachnoid space. SS can be classified as infratentorial SS (i-SS) and supratentorial SS (s-SS). The cochlear modiolus (CM) normally shows low signal intensity (SI) on Tl-weighted images (T1WI). We noticed persistently high SI of the CM on unenhanced thin-sliced T1WI in patients with i-SS. The purpose of this study was to evaluate the correlation between SS and high SI of the CM on unenhanced T1WI. Methods: This retrospective study analyzed three cases with i-SS, eight cases with s-SS, and 23 normal controls (NC) evaluated on unenhanced thin-sliced T1WI with a three-dimensional spoiled gradient-recalled echo sequence. CM-T1SI scores of 0, 1, and 2 indicated low, iso, and high SI, respectively. In cases with scores of 2 evaluated several times, all scores were reviewed for each case. The CM-T1SI ratio was defined as the contrast ratio between the CM and the cerebellum. Differences between the three groups were statistically analyzed based on the CM-T1SI score and ratio. Receiver operative curve (ROC) analysis was used to determine the cut-off values for differentiating the i-SS group from the NC group based on the CM-T1SI ratio. Results: Two patients with i-SS had a score of 2 on all evaluations. The CM-T1SI score and ratio differed significantly between the i-SS and NC groups. The accuracy of the CM-T1SI ratio for discriminating i-SS from NC was 98.9% at a cutoff value of 0.628. Conclusion: High SI of the CM on unenhanced TIWI can be an additional characteristic finding of i-SS.

Advanced magnetic resonance imaging findings of cerebellar hemangioblastomas: A report of three cases and a literature review.

On conventional magnetic resonance imaging (MRI), hemangioblastomas typically appear as mural nodules with an adjacent surrounding cyst or a solid mass in the cerebellum. However, hemangioblastomas sometimes cannot be reliably distinguished using this imaging technique from other tumors, especially pilocytic astrocytomas and metastatic tumors, because of their similar imaging findings and locations. Herein, we report three cases of cerebellar hemangioblastomas and review their findings on conventional and advanced MRI, including diffusion-weighted imaging (DWI), dynamic susceptibility-weighted contrast-enhanced perfusion-weighted imaging (DSC-PWI), and magnetic resonance spectroscopy (MRS). Solid contrast-enhanced lesions of hemangioblastomas showed increased apparent diffusion coefficient values on DWI, increased relative cerebral blood volume ratio on DSC-PWI, and high lipid/lactate peak on MRS. Therefore, advanced MRI techniques can be helpful in understanding the pathological and metabolic changes of hemangioblastomas and may be useful for their characterization.

Anti-Glomerular Basement Membrane Nephritis Potentially Induced by Nebulized Tobramycin Inhalation.

Objective: To describe a case of anti-glomerular basement membrane (GBM) nephritis that occurred shortly after initiation of nebulized tobramycin (TOB) therapy using intravenous solution, suggesting an association with the inhalation therapy and the disease onset. Background: With the emergence of antimicrobial resistance, clinical importance of aminoglycosides that usually remain susceptibility against gram-negative organisms is increasingly acknowledged. Despite the growing number of evidence supporting the effectiveness of aminoglycoside inhalation therapy for respiratory tract infections, its clinical application has yet to be widely approved by Japanese health insurance. Case Presentation: A 79-year-old Japanese woman had developed amyotrophic lateral sclerosis and experienced recurrent pneumonia mainly caused by Pseudomonas aeruginosa, which required monthly treatments with broad-spectrum antibiotics. Owing to the limited approval, we had no choice but to use intravenous TOB solution for inhalation therapy as an off-label use under an endorsement of the Institutional Review Board of the hospital. Although the repeated pneumonia subsided, the patient subsequently needed immunosuppressive therapy along with plasma exchanges for the treatment of anti-GBM nephritis. Conclusion: Although this off-label use of intravenous solutions is common in both clinical and research purposes, our case raised an issue that its safety needs to be re-evaluated.

Utility of 3T single-voxel proton MR spectroscopy for differentiating intracranial meningiomas from intracranial enhanced mass lesions.

BACKGROUND: Proton magnetic resonance spectroscopy (MRS) provides structural and metabolic information that is useful for the diagnosis of meningiomas with atypical radiological appearance. However, the metabolite that should be prioritized for the diagnosis of meningiomas has not been established. PURPOSE: To evaluate the differences between the metabolic peaks of meningiomas and other intracranial enhanced mass lesions (non-meningiomas) using MR spectroscopy in short echo time (TE) spectra and the most useful metabolic peak for discriminating between the groups. MATERIAL AND METHODS: The study involved 9 meningiomas, 22 non-meningiomas, intracranial enhancing tumors and abscesses, and 15 normal controls. The ranking of the peak at 3.8 ppm, peak at 3.8 ppm/Creatine (Cr), ß-γ Glutamine-Glutamate (bgGlx)/Cr, N-acetyl compounds (NACs)/Cr, choline (Cho)/Cr, lipid and/or lactate (Lip-Lac) at 1.3 ppm/Cr, and the presence of alanine (Ala) were derived. The metabolic peaks were compared using the Mann-Whitney U test. ROC analysis was used to determine the cut-off values for differentiating meningiomas from non-meningiomas using statistically significant metabolic peaks. RESULTS: The ranking of the peak at 3.8 ppm among all the peaks, peak at 3.8 ppm/Cr, bgGlx/Cr, Lip-Lac/Cr, and the presence of Ala discriminated meningiomas from non-meningiomas with moderate to high accuracy. The highest accuracy was 96.9% at a threshold value of 3 for the rank of the peak at 3.8 ppm. CONCLUSION: A distinct elevated peak at 3.8 ppm, ranked among the top three highest peaks, allowed the detection of meningiomas.

Magnetic resonance imaging findings of endosalpingiosis: a case report.

Endosalpingiosis is characterized by the presence of glands lined by benign tubal-type epithelium outside the fallopian tube. It is usually an incidental finding and rarely occurs as a tumor-like mass lesion. Here, we describe the magnetic resonance imaging findings of endosalpingiosis that presented as a paraovarian multicystic lesion. It exhibited iso to low intensity on T1-weighted images and inhomogeneous high intensity on T2-weighted images. The septa presented relatively iso to slight high intensity on T2-weighted images and strong contrast enhancement on dynamic contrast-enhanced imaging. Endosalpingiosis should be considered as a differential diagnosis in cases of paraovarian multicystic lesions along the uterine serosa.

Computed Tomography-guided Lung Biopsy: A Review of Techniques for Reducing the Incidence of Complications.

Computed tomography-guided lung biopsy is a well-established method for the histological diagnosis of pulmonary lesions. There is abundant literature regarding the diagnostic yield of and complications associated with computed tomography-guided lung biopsy. Many studies have investigated the risk factors influencing pneumothorax. Conversely, there are a limited number of reports detailing techniques for reducing the incidence of pneumothorax or other complications. This study reviews the indications, diagnostic accuracy, and complications of computed tomography-guided lung biopsy. In addition, techniques for reducing the incidence of these complications were reviewed.

High Humidity Causes Abnormalities in the Process of Appressorial Formation of Blumeria graminis f. sp. hordei.

High humidity decreases the penetration rate of barley powdery mildew Blumeria graminis f. sp. hordei. However, the mechanism is not well understood. In this study, the morphological and cytochemical analyses revealed that substances containing proteins leaked from the tip of the appressorial germ tube of conidia without the formation of appressorium under a high humidity condition. In addition, exposure to high humidity prior to the formation of appressorium caused the aberrant formation of the appressorial germ tube without appressorium formation, resulting in failure to penetrate the host cell. These findings suggest that the formation and maturation of the appressorium requires a low humidity condition, and will be clues to improve the disease management by humidity control.

Bilateral Ovarian Tumors on MRI: How Should We Differentiate the Lesions?

BACKGROUND: We investigated the distinguishing pathological features of bilateral ovarian tumors using magnetic resonance (MR) imaging. METHODS: Eighty-six patients with bilateral ovarian tumors on MR imaging were evaluated. The pathological diagnosis was investigated, and the results were subjected to statistical analysis using Mann-Whitney U test, Fisher's exact test, Chi-squared test and receiver operating characteristic (ROC) curve to determine the features useful for the differentiation of distinct types of lesions. RESULTS: The diagnosis of bilateral ovarian tumors was confirmed in eighty-one patients and the majority of the lesions were further classified into serous carcinoma (n = 36), mature teratoma (n = 20) and metastasis (n = 12). We assessed the existence of factors useful for the MR imaging differentiation between metastasis and serous carcinoma or primary malignant ovarian tumors. Cancer antigen (CA) 125 serum level and maximum tumor diameter were significantly different between metastasis and serous carcinoma and similarly, between metastasis and primary malignant ovarian tumors. MR imaging morphology, ascites and peritoneal implants did not show any significant difference between the different types of lesions. CONCLUSION: Within our patient cohort, most bilateral ovarian tumor lesions were determined to be serous carcinoma, mature teratoma or metastasis. CA 125 serum level and maximum tumor diameter are useful markers for the differentiation between metastasis and serous carcinoma or primary malignant ovarian tumors.

The spectrum of imaging appearances of müllerian duct anomalies: focus on MR imaging.

Müllerian duct anomalies (MDAs) are the result of incomplete development, vertical or lateral fusion, or absorption of the müllerian ducts. The range of anomalies includes uterovaginal agenesis or hypoplasia, unicornuate uterus, uterus didelphys, bicornuate uterus, septate uterus, and arcuate uterus. Correct diagnosis and classification of these anomalies are essential because pregnancy outcomes and treatment options vary between the types of anomaly. Furthermore, early identification of MDAs helps to avoid prolonged symptomatic periods and the complications that may subsequently arise, such as infertility, endometriosis, and neoplasm. Although many of these abnormalities are initially diagnosed by ultrasound or hysterosalpingography, MR imaging is the most accurate noninvasive modality available for classification of the various anomalies because of its better anatomic assessment compared with other diagnostic modalities. Familiarity with the wide variety of MDA presentations can help in the planning of appropriate treatment.

Volume Measurement by Diffusion-Weighted Imaging in Cervical Cancer.

BACKGROUND: The aim of this paper was to evaluate the validity of tumor volume measurement using diffusion-weighted (DW) imaging in cervical cancer. METHODS: In this retrospective study, 22 patients, who underwent preoperative 3.0 T MR examinations with DW imaging were evaluated. Tumor volume measurement by oblique axial (short axis to the uterine cervix) T2-weighted imaging was performed by manually outlining the tumor on the monitor. The area of tumor in each slice was multiplied by the slice profile (slice thickness plus intersection gap), and the total tumor volume was calculated by summation of these obtained volumes. Meanwhile, one experienced radiological technologist generated three-dimensional DW images of cervical cancer using a volume-rendering algorithm at a computer workstation, and tumor volume was automatically calculated in the workstation. Analysis via the intraclass correlation coefficient (ICC) and Bland-Altman plots were used to assess the validity and reliability of these methods. RESULTS: Between tumor volumes measured by T2-weighted imaging methods and DW imaging methods, the ICC was excellent (0.962). The 95% limits of agreement of volume measurement were -52.7 and 35.7 mL (mean difference, -8.5 mL). In regards to intra-observer variability, the ICC was excellent (0.963). The 95% limits of agreement of volume measurement were -42.2 and 47.4 mL (mean difference, 2.6 mL). CONCLUSION: DW imaging can be used to measure cervical cancer volume.

The Mechanism Causing High-signal Intensity on Diffusion-weighted Imaging in Adnexal Torsion: Two Case Reports.

We report two cases with adnexal torsion to assess the mechanism of very strong signal intensity in ovarian lesions on DW imaging using MR imaging such as T2*-weighted imaging. MR imaging findings of the cases suggest that the very strong signal intensity on DW imaging is contributed to cytotoxic edema with or without vasogenic edema, as well as oxyhemoglobin or extracellular methemoglobin.

Evaluation of Fetal Thyroid with 3D Gradient Echo T1-weighted MR Imaging.

PURPOSE: The characteristics of fetal thyroid on magnetic resonance (MR) imaging, including normal thyroid and disorders other than goiter have not been fully evaluated. Our aim was to assess fetal thyroid using three dimensional (3D) gradient echo (GRE) T1-weighted MR imaging and to examine the usefulness of this modality. MATERIALS AND METHODS: The study included 27 3D GRE T1-weighted images from 26 fetuses. The largest possible region of interest (ROI) within the thyroid at the slice level depicting the thyroid was manually defined and three circular ROIs on neck muscle were manually defined on the image slices showing the highest signal intensity (SI) of the thyroid. Maximum and mean thyroid-to-muscle SI ratios (SIRs) were then calculated as SIR = maximum or mean thyroid SI/muscle SI. RESULTS: The thyroid could not be identified in two cases. Fetal thyroid function was normal in 17 cases, and there were 7 cases of hypothyroidism (6 transient and 1 thyroid dysgenesis). There was no linear relationship between mean and maximum SIR and gestational age. The mean and maximum SIR in the cases of normal fetal thyroid were 1.85 ± 0.20 and 2.61 ± 0.39, and the mean and maximum SIR in fetal hypothyroidism were 1.58 ± 0.20 and 2.13 ± 0.37. Mean (P = 0.0088) and maximum (P = 0.0221) SIR values were significantly different between euthyroid and hypothyroid fetuses. CONCLUSION: Thyroid SIR measurement provided useful information regarding fetal thyroid function.

Apparent diffusion coefficient (ADC) measurement in ovarian tumor: Effect of region-of-interest methods on ADC values and diagnostic ability.

PURPOSE: To investigate the difference in apparent diffusion coefficient (ADC) measurements of differently shaped regions of interest (ROIs) in ovarian tumors, and to investigate the diagnostic ability of differently shaped ROIs in differentiating benign from malignant ovarian tumors. MATERIALS AND METHODS: Fifty-four patients with ovarian tumors with a solid component were evaluated. The patients underwent magnetic resonance (MR) examinations including diffusion-weighted imaging using a 3.0T MR system. Two readers measured ADCs using four ROI methods: freehand, square, round, and five small round ROIs. The interclass correlation coefficient (ICC) and repeated-measures analysis of variance were used to assess their measurement reliability and to compare ADCs for each ROI method. Receiver operating characteristic curve analysis and unpaired t-test on each ROI were used to differentiate benign and malignant ovarian tumors and assess the diagnostic ability. RESULTS: All ROI methods except the square ROI (0.56) showed good or excellent correlations (0.70-0.91). Minimum and mean ADC values differed significantly between the ROIs (P < 0.05). When using the freehand ROI, the minimum and mean ADC values were the lowest and highest, respectively. The optimal cutoff minimum and mean ADC values of each ROI for differentiating benign and malignant tumors were 0.81-1.06 × 10(-3) mm(2) /s and 1.15-1.52 × 10(-3) mm(2) /s, respectively. The areas under the curve showed no significant differences among the ADCs in the different ROI methods (P > 0.05). Minimum and mean ADCs from all ROIs showed significant differences between benign and malignant tumors (P < 0.05). CONCLUSION: The ROI shape influences ADC values and the optimal cutoff ADC values for differentiating benign from malignant ovarian tumors.

The profile of persons with alcohol and drug problems in Spain From "Proyecto Hombre Observatory Report 2014".

This article is an extension of a presentation with the same title given at the Japanese Alcohol, Nicotine & Drug Addiction Conference in Kobe on October 13th 2015: Firstly, a brief overview of support activities and services within Proyecto Hombre is given outlining the advanced assistance programs for supporting and treating addiction. problems. Secondly, it lays out the profile of persons with alcohol and drug problems as taken from "Proyecto Hombre Observatory Report 2014" vhich has informed the reality of adult users' life situation based on a series of indicators from the EuropASI, while they were being treated at Proyecto Hombre 27 Centers in Spain between 1 January, 2014 and 31 December, 2014. The sample consists of 1941 people treated during 2014 after application of the criteria for validation of the questionnaire. The profiles so obtained enable the design of treatment programs according to their specific situation in Proyecto Hombre. In order to allow some guidance to Japanese investigators and social workers regarding the design of treatments programs based on current user situation, this article draws attention to general sociodemographic data as well as data notable for its variation by gender and also by substance, and draws limited conclusions based on these.

Accuracy of semiquantitative dynamic contrast-enhanced MRI for differentiating type II from type I endometrial carcinoma.

PURPOSE: To investigate type II endometrial carcinoma characterization using dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) and evaluate the diagnostic accuracy of semiquantitative DCE-MRI in differentiating type II from type I tumors. MATERIALS AND METHODS: Seventy-seven patients with endometrial carcinoma were retrospectively evaluated using 3T DCE-MRI. The maximum absolute enhancement of signal intensity (SImax), maximum relative enhancement (SIrel), wash-in rate (WIR), and the SImax/SI (piriformis) ratio were analyzed. To differentiate type I from type II tumors, optimal threshold criteria were established. The Mann-Whitney U-test was used for statistical comparison and receiver operating characteristic curve analysis was used to determine optimal cutoff values. RESULTS: The SIrel (P < 0.001), WIR (P < 0.0001), and SImax/SI (piriformis) ratio (P < 0.0001), but not SImax, differed significantly between type I and type II carcinomas. Cutoff values of SIrel ≥58.8, WIR ≥37.0, and SImax/SI (piriformis) ratio ≥1.55 had sensitivities of 93%, 93%, and 67%, specificities of 60%, 60%, and 79%, accuracies of 66%, 66%, and 67%, respectively, for predicting type II endometrial carcinoma. CONCLUSION: Endometrial carcinoma with strong (high level) enhancement on DCE-MRI is suggestive of type II endometrial carcinoma. Semiquantitative evaluation of DCE-MRI may be useful for differentiating type II from type I tumors.