Transient hyperintensity in the subthalamic nucleus and globus pallidus of newborns on T1-weighted images.

BACKGROUND AND PURPOSE: In the brains of newborns, changes in signal intensity in most structures can be explained by the development of myelination. However, there are some structures for which signal intensity changes cannot be accounted for by myelination alone. We examined the STN and globus pallidus signal intensities and tried to determine whether a relationship exists between the signal intensity and the postnatal age or the gestational age at the examination. MATERIALS AND METHODS: We examined T1WI and T2WI obtained from 79 neonates who showed normal development at their 2-year follow-up examinations. We performed both qualitative and quantitative (signal intensity ratio to the thalamus) evaluation of the STN and globus pallidus signals, and we examined the correlation between signal intensity changes and the age of neonates. RESULTS: With increasing postnatal age at examination, the high signal intensity on the T1WI for both STN and globus pallidus diminished. Although the disappearance of this hyperintensity was well correlated with the postnatal age at examination for both the qualitative and quantitative studies, there was no correlation with gestational age at examination. For the T2WI, there was no correlation with either the postnatal age or the gestational age at examination. CONCLUSIONS: Signal intensity on T1WI in the STN and globus pallidus is not related to the gestational age at examination; instead, signal intensities on T1WI seem to be more dependent upon the postnatal age at examination.

[Elderly-onset anticentromere antibody-positive pulmonary-renal syndrome: report of an autopsy case].

We report an autopsy case of elderly-onset anticentromere antibody-positive pulmonary-renal syndrome. An 84-year-old woman was admitted to our hospital with complaints of leg edema and general malaise. Neither skin rush nor arthritis was seen. Because of hematuria, proteinuria with various casts, renal dysfunction and anemia, a clinically diagnosis of rapidly progressive glomerulonephritis was made. Slight pulmonary hypertension was observed in ultrasonic cardiography. Hypocomplementemia was not seen. Tests for MPO- and PR 3-anti-neutrophil cytoplasmic antibodies and anti-glomerular basement membrane antibody were negative, but a high titer of antinuclear antibody with a discrete speckled pattern on immunofluorescent staining was disclosed. Results for anticentromere antibody and anti-Ki antibody were positive, but for anti-Sm antibody and anti-double stranded DNA antibody were both negative. She did not present any clinical features of systemic sclerosis or CREST syndrome. Subsequently, prednisolone was administered, but pulmonary alveolar hemorrhage occurred and the patient died of acute respiratory failure caused by massive pulmonary hemorrhage. Autopsy revealed crescentic glomerulonephritis including glomerular capillaritis and pulmonary capillaritis with positive granular deposits of immunoglobulins and compliment on the glomerular and pulmonary capillary walls. Immunologically mediated crescentic glomerulonephritis and pulmonary capillaritis was then diagnosed histopathologically. The main pathological feature of the case was small-vessel vasculitis with immune-complex deposition. Although this case did not fulfill the clinical criteria for systemic lupus erythematosus (SLE), its histological features resembled those of lupus nephritis and acute lupus pneumonitis. We speculated that anticentromere antibody-positive pulmonary-renal syndrome without any other symptoms or signs of connective tissue disease, such as our case, is a clinical entity distinct from typical SLE or CREST syndrome.

[A case of neurofibromatosis with intrathoracic meningocele presenting respiratory failure caused by pleural effusion].

We reported a 58-year-old man with neurofibromatosis and an intrathoracic meningocele. He was admitted to our hospital because of left-sided chest pain and dyspnea on exertion. He presented with severe kyphoscoliosis and showed a round, well circumscribed mass lesion in the paravertebral region of the left upper lung on a chest roentgenogram. Just before admission, pleural effusion accumulated in the left thoracic cavity, which had caused the respiratory symptoms. The mass was diagnosed as an intrathoracic meningocele by MRI and iotrolan CT myelography. The pleural effusion was transudate fluid and no leakage from the meningocele to pleural cavity was demonstrated. Posterolateral extradural approach with laminectomy was done and dural plasty to close the connection between the meningocele and the subarachnoidal space was carried out. After the operation, both the intrathoracic meningocele and the pleural effusion disappeared with remarkable improvement in the respiratory function. Intrathoracic meningocele is known to be seen in association with neurofibromatosis and scoliosis, but it is very rare to see an intrathoracic meningocele which causes respiratory failure due to massive pleural effusion like this report.

[Ability of subtraction and dynamic MR imaging to detect breast tumors: comparison with ultrasonography and mammography].

We evaluated the ability of subtraction and dynamic MR imaging to accurately detect breast tumors. Sixty-five breast carcinomas and 24 fibroadenomas were examined by an SE pulse sequence using a 0.2 Tesla unit. Subtraction MR images were obtained every minute during dynamic study with Gd-DTPA. Almost all breast tumors were seen as very bright masses, and the margin of the mass was clearly demonstrated on subtraction MR images. Breast carcinomas and fibroadenomas showed characteristic time-intensity curves on dynamic study, Time-intensity curves of the early peak type and plateau type were seen in 97% of breast carcinomas, while the gradually increasing type was seen in 92% of fibroadenomas. The detectability of breast carcinoma was 98% by MRI, 98% by ultrasonography, and 87% by mammography. That of fibroadenoma was 95% by MRI, 91% by ultrasonography and 60% by mammography. Sensitivity and specificity for breast carcinoma were 98% and 92% for MRI and 97% and 71% for ultrasonography. For fibroadenoma, they were 96% and 98% for MRI and 89% and 92% for ultrasonography.

Establishment of the human BSMZ breast cancer cell line, which overexpresses the erbB-2 and c-myc genes.

A new cell line, designated BSMZ, was established from a malignant pleural effusion from a woman with breast cancer. This line has a doubling time of 27 h and has now been cultured for over 120 passages. The large, rounded BSMZ cells grow as both a monolayer and as aggregations in suspension. Intracytoplasmic lumen, a finding consistent with results from cells derived from mammary tissue, was detected on ultrastructural analysis. Injection of BSMZ cells into nude mice resulted in the growth of solid tumors 4 weeks after inoculation. The solid tumor was identical to the original BSMZ cells in microscopic and electron microscopic studies. These cells possess an average of 80 chromosomes. Expression of erbB-2 and c-myc genes was increased by 10-fold, while there was no detectable overexpression of the N-ras and c-myb genes. Southern analysis has revealed amplification of the erbB-2 and c-myc loci. The BSMZ cell line may therefore provide a useful model for the study of human breast cancer and overexpression of the erbB-2 gene.

[A comparative study of myocardial scintigraphy with 99mTc-SQ-30,217 and 201Tl in cases with myocardial infarction].

A comparative study of myocardial scintigraphy with 99mTc-SQ-30217 (SQ) and 201Tl was performed in 6 patients having ischemic heart diseases which were confirmed by the coronary angiography. The SQ study was done 1 week after the 201Tl study. Both studies were performed in exercise and resting state. Degree of perfusion defect was compared between SQ and 201Tl SPECT by means of scoring 0-2 (0: no defect, 1: equivocal, 2: definite defect) by five doctors (two physicians and three radiologists). Ability of this agent to detect the ischemic lesions was similar to that of 201Tl except for two regions. Effect of the liver image on the evaluation of the inferior wall of the left ventricle was small on this study, although the hepatic accumulation of the tracer was prominent. This agent is a promising tracer for the evaluation of myocardial perfusion in the cases with myocardial infarction.

[Acute myocardial infarction due to blunt chest trauma: a case report].

A 32-year-old man who suffered from acute myocardial infarction due to blunt chest trauma was admitted to our hospital. The first coronary angiography was performed on the 38th day after admission. We found aneurysmal dilatation, intimal flap and subintimal hematoma, so coronary dissection of the left anterior descending branch was suspected. When the second coronary angiography was performed 11 months later, those findings had disappeared.

[Kinetics and clinical application of 99mTc-technegas].

Biological characteristics and clinical utilization of 99mTc-technegas were evaluated in three normal volunteers and 10 patients with various pulmonary diseases. 99mTc-pertechnetate (296 MBq (8 mCi] was injected in the crusible of 99mTc-technegas generator, and about 37 MBq (1 mCi) of 99mTc-technegas was inhaled in the lung by three times of deep inspiration. Blood activity was appeared immediately after inhalation of 99mTc-technegas and it was 0.2% of the inhaled dose/liter of blood after 2 hours. Urine activity was also increased after inhalation and cumulative dose was 4.96% of the inhaled dose after 24 hours. The tracer dose to distribution to the lung was about 95% of the total dose in whole body. Biological half time of 99mTc-technegas in the lung was 135 hours and pulmonary image was stable even after 24 hours. Radiation dose to the lung was 0.004 Gy/37 MBq (1 mCi). In patients with pulmonary disease, distribution of 99mTc-technegas was similar to that of 81mKr gas, although defect on 99mTc-technegas image was larger in severe obstructive disease. 99mTc-technegas study was superior over 133Xe gas study to identify the areas of ventilation abnormality more clearly, although quantitative evaluation was difficult in 99mTc-technegas study. On comparative study with 99mTc-aerosol, 99mTc-technegas distributed in more peripheral sites and both methods were cooperative for evaluation of ventilatory disturbance. These results suggest that 99mTc-technegas inhalation study is safe and useful method for ventilation study.

[Pulmonary clearance of 99mTc-HMPAO aerosol].

The clearance rate of inhaled aerosols of a lipophilic substance, 99mTc-HMPAO (Hexamethyl propylene amine oxime) was studied and compared to that of hydrophilic substances in 6 normal volunteers and 18 patients with lung diseases. The subject in sitting position inhaled a single deep breath of 99mTc-HMPAO aerosols, and held his breath about 30 sec. Then he continued to breath aerosols again for about 3 min. Radioactivity rapidly falls down during breath holding, to about 60% of the peak value (fast phase), with T 1/2 of 3.75 +/- 2.22 sec in 6 normal volunteers. This rapid phase was not appeared in hydrophilic aerosols with 99mTc-DTPA and 99mTc-pertechnetate and in lipophilic aerosol with 123I-IMP aerosol. The clearance of residual activity of 99mTc-HMPAO was slow with T 1/2 of 17.4 +/- 4.0 min. The T 1/2 of 99mTc-DTPA, 99mTc-pertechnetate and 123I-IMP were 50.2 +/- 20.9 min, 11.4 +/- 4.3, and 62.5 +/- 20.8 min respectively. 99mTc-HMPAO may cross transcellularly using the whole alveolar surface. The clearance of aerosols in the fast phase is rapid and depend on the regional perfusion. On the other hand, hydrophilic aerosol pass by an intercellular pathway and the clearance will be diffusion limited. As conclusion, inhalation study of 99mTc-HMPAO might be a new method to evaluate perfusion following ventilation study.