MR signal changes in a child with cat scratch disease encephalopathy and status epilepticus.
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Adolescent↗
Biomedical subjects
Masayuki Maeda
Publications and source records attributed to Masayuki Maeda.
Radiofrequency ablation combined with bone cement injection for the treatment of bone malignancies.
PURPOSE: To evaluate the feasibility, safety, and effectiveness of combined treatment with radiofrequency (RF) ablation followed by bone cement injection in patients with malignant bone neoplasms. MATERIALS AND METHODS: Seventeen patients with 23 bone tumors were treated. The tumors, measuring 1.2-15 cm (mean, 4.9 +/- 3.5 cm), were located in the spine (n = 17), iliac bone (n = 3), sacrum (n = 2), and ischial bone (n = 1). All procedures were performed with computed tomographic (CT) fluoroscopic guidance. An electrode with an internally cooled tip was placed in the bone tumor through a biopsy needle and RF energy was applied, followed by cement injection. Pain relief was evaluated with use of the visual analogue scale score (VAS score). Local therapeutic effects were evaluated by contrast-enhanced MR imaging. Lack of tumor enhancement was considered to indicate necrosis. RESULTS: The procedures were technically successful in all patients except for one patient with an osteoblastic ischial lesion (22 of 23 patients; 96%). Pain was relieved within 1 week in all 13 patients who reported pain (13 of 13 patients; 100%), with a significant decrease in the VAS score from 8.4 to 1.1 (P <.001). Tumor necrosis was observed in 71% +/- 24% of the tumor volume (range, 14%-100%). Neural damage occurred in four patients in whom the tumor had invaded the posterior cortex of the vertebral body and pedicle. CONCLUSION: The combined therapy described here is both feasible and useful for the treatment of malignant bone neoplasms. The safety of the procedure depends on the tumor location. When the tumor is adjacent to the spinal cord, there is a risk of nerve injury.
Bone Cements↗
Surrounding muscle edema detected by MRI is valuable for diagnosis of intramuscular myxoma.
We recently experienced 4 cases of intramuscular myxoma and analyzed MRI findings, comparing them with histological ones. Results showed that all tumors were depicted with a homogeneous low signal intensity on T1-weighted images and a markedly high signal intensity on T2-weighted images, findings which are similar to those of cystic lesions like intramuscular ganglions. However, tumors were diffusely and finely enhanced on T1-weighted images with intravenous gadolinium administration. Three cases showed the characteristic fat rim and fat cap. A diffuse edematous lesion demonstrating intermediate signal intensity on T1-weighted images and high signal intensity on T2-weighted images was also found in the adjacent muscle surrounding the tumor in 3 of 4 cases. In this lesion, tumor invasion, diffuse and severe muscle degeneration, blood and lymphatic congestion with exudates, and reactive adipose tissue formation were observed. The present results suggested that for the clinical diagnosis of intramuscular myxoma with MRI examination, the combination of three MRI signs such as homogeneous low signal intensity on T1-weighted mages, markedly high signal intensity on T2-weighted images, and an enhancement effect with contrast medium are important, but the fat rim or fat cap, and the surrounding muscle edema as detected by MRI are also characteristic and allow for a more firm diagnosis. We presume that the diffuse and severe muscle fiber degeneration induced by tumors may cause such specific surrounding muscle edema.
Aged↗
Diffuse leptomeningeal hyperintensity on fluid-attenuated inversion recovery MR images in neurocutaneous melanosis.
Neurocutaneous melanosis (NCM) is a rare neuroectodermal dysplasia characterized by large or multiple cutaneous congenital pigmented nevi and benign or malignant melanocytic tumors of the leptomeninges. Although the MR manifestations of this disease have been reported in a small series of cases, the usefulness of fluid-attenuated inversion recovery (FLAIR) MR findings has not been documented. We present a case of NCM that showed diffuse leptomeningeal hyperintensity on FLAIR images. This FLAIR finding may be a clue to the detection of leptomeningeal abnormalities in NCM.
Abnormalities, Multiple↗
Brain stem hypertensive encephalopathy evaluated by line scan diffusion-weighted imaging.
Hypertensive encephalopathy rarely presents with predominant involvement of the brain stem and relative sparing of the supratentorial regions. We describe the MR imaging features in a patient with reversible brain stem hypertensive encephalopathy. Extensive hyperintensity was predominantly seen in brain stem regions on fluid-attenuated inversion-recovery and T2-weighted images. These lesions showed an increased apparent diffusion coefficient with the use of line scan diffusion-weighted imaging. The clinical findings and MR imaging abnormalities resolved with control of hypertension.
Aged↗
Dermal spindle cell lipoma of the posterior neck: CT and MR findings.
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Aged↗
Abnormal hyperintensity within the subarachnoid space evaluated by fluid-attenuated inversion-recovery MR imaging: a spectrum of central nervous system diseases.
A variety of central nervous system (CNS) diseases are associated with abnormal hyperintensity within the subarachnoid space (SAS) by fluid-attenuated inversion-recovery (FLAIR) MR imaging. Careful attention to the SAS can provide additional useful information that may not be available with conventional MR sequences. The purpose of this article is to provide a pictorial essay about CNS diseases and FLAIR images with abnormal hyperintensity within the SAS. We present several CNS diseases including subarachnoid hemorrhage, meningitis, leptomeningeal metastases, acute infarction, and severe arterial occlusive diseases such as moya-moya disease. We also review miscellaneous diseases or normal conditions that may exhibit cerebrospinal fluid hyperintensity on FLAIR images. Although the detection of abnormal hyperintensity suggests the underlying CNS diseases and narrows differential diagnoses, FLAIR imaging sometimes presents artifactual hyperintensity within the SAS that can cause the misinterpretation of normal SAS as pathologic conditions; therefore, radiologists should be familiar with such artifactual conditions as well as pathologic conditions shown as hyperintensity by FLAIR images. This knowledge is helpful in establishing the correct diagnosis.
Adult↗
Quantitative assessment of diffusion abnormalities in benign and malignant vertebral compression fractures by line scan diffusion-weighted imaging.
OBJECTIVE: Acute vertebral collapse is common, and it is sometimes difficult to determine whether the cause is benign or malignant. Recently, diffusion-weighted imaging has been reported to be useful for differentiating the two types. The purpose of this study was to evaluate diffusion abnormalities quantitatively in benign and malignant compression fractures using line scan diffusion-weighted imaging. SUBJECTS AND METHODS. Line scan diffusion-weighted imaging was prospectively performed in 17 patients with 20 acute vertebral compression fractures caused by osteoporosis or trauma, in 12 patients with 16 vertebral compression fractures caused by malignant tumors, and in 35 patients with 47 metastatic vertebrae without collapse. Images were obtained at b values of 5 and 1,000 sec/mm(2). The apparent diffusion coefficient (ADC) was measured in vertebral compression fractures and metastatic vertebrae without collapse. RESULTS: The ADC (mean +/- SD) was 1.21 +/- 0.17 x 10(-3) mm(2)/sec in benign compression fractures, 0.92 +/- 0.20 x 10(-3) mm(2)/sec in malignant compression fractures, and 0.83 +/- 0.17 x 10(-3) mm(2)/sec in metastatic vertebral lesions without collapse. The ADC was significantly higher in benign compression fractures than in malignant compression fractures (p < 0.01), although the two types showed considerable overlap. CONCLUSION: Although the quantitative assessment of vertebral diffusion provides additional information concerning compressed vertebrae, the benign and malignant compression fracture ADC values overlap considerably. Therefore, even a quantitative vertebral diffusion assessment may not always permit a clear distinction between benign and malignant compression fractures.
Aged↗
Oxidant and antioxidant activities in childhood meningitis.
Animal studies have provided substantial evidence for a key role of reactive oxygen species, nitric oxide and its related compounds in the complex pathophysiology of bacterial meningitis. However, there is little information on changes in the redox status in human meningitis. In the present study, we evaluated the redox status and oxidative stress in the central nervous system of children with meningitis. Oxidant and antioxidant activities were assessed from cerebrospinal fluid levels of acrolein-lysine adducts (a marker of lipid peroxidation), nitrite (a marker of nitric oxide production) and bilirubin derivatives (a marker of antioxidant activity of bilirubin). All these markers were several times higher in children during the early phase of bacterial meningitis compared with those of children without meningitis and patients with aseptic meningitis. In the bacterial meningitis group, the levels of bilirubin derivatives correlated significantly with those of acrolein-lysine adducts and nitrite. Acrolein-lysine adducts and nitrite decreased significantly as the patients started to respond to treatment but bilirubin derivatives remained elevated. In conclusion, our data indicate the enhancement of both oxidant and antioxidant activities in the central nervous system of children with early bacterial meningitis, but not in those with aseptic meningitis. Clinical and laboratory improvement may be associated with a decrease in oxidant activities in the central nervous system.
Adolescent↗
Transient splenial lesion of the corpus callosum associated with antiepileptic drugs: evaluation by diffusion-weighted MR imaging.
Transient focal lesions in the splenium of the corpus callosum have been reported in epileptic patients receiving antiepileptic drugs. The characteristic imaging features included an oval high signal lesion on T2-weighted images in the central part of the splenium, no enhancement on post-contrast MR images, and complete reversibility without specific treatment. We report identical MR imaging findings in a depressive patient who had received antiepileptic drugs. In addition, diffusion-weighted MR imaging findings are described in our case, which is the first report on this unique lesion associated with antiepileptic drugs. Although this lesion has been assumed to be vasogenic edema in the previous reports, diffusion-weighted MR imaging showed markedly restricted diffusion of the lesion in the present case, suggesting that cytotoxic edema was the main pathophysiological abnormality.
Adult↗
Peritumoral brain edema in intracranial meningiomas evaluated by dynamic perfusion-weighted MR imaging: a preliminary study.
Our objective was to semi-quantitatively evaluate the cerebral perfusion in the peritumoral brain edema of meningiomas using dynamic perfusion-weighted MR imaging. Six patients with intracranial meningiomas accompanied by peritumoral brain edema were prospectively examined by perfusion-weighted MR imaging. One patient was examined twice, once before and once 5 months after the surgical resection. The relative regional cerebral blood volume (rrCBV), the relative regional cerebral blood flow (rrCBF), and the relative regional mean transit time (rrMTT) were calculated for peritumoral brain edema and the contralateral white matter. These parameters were compared between peritumoral brain edema and the contralateral white matter. The time-concentration curve of the peritumoral brain edema was less prominent than that of the contralateral white matter, resulting in a significantly lower rrCBV (mean 46%) and rrCBF (mean 45%) in peritumoral brain edema than those of contralateral white matter. The serial perfusion-weighted MR imaging also demonstrated the recovery of these parameters after the removal of meningioma by means of surgical resection. Perfusion-weighted MR imaging can demonstrate significantly decreased rrCBV and rrCBF in peritumoral brain edema compared with those in normal white matter.
Aged↗
Clinical and immunohistochemical study of eight cases with thymic carcinoma.
BACKGROUND: Thymic carcinoma is a rare neoplasm with extremely poor prognosis. To evaluate the biological characteristics of thymic carcinoma, we reviewed 8 patients. METHODS: There were 2 men and 6 women: ages ranged from 19 to 67 years old (mean 54.8 years). None of these patients had concomitant myasthenia gravis and pure red cell aplasia. No patient had stage I disease, 1 stage II, 5 stage III, and 2 stage IV. The pathologic subtypes of thymic carcinoma included 5 squamous cell carcinomas, 1 adenosquamous cell carcinomas, 1 clear cell carcinoma, and 1 small cell carcinoma. Immunohistochemical study was performed using antibodies against p53, bcl-2, Ki-67, carcinoembryonic antigen (CEA), epithelial membrane antigen (EMA), nm23-H1, vascular endothelial growth factor (VEGF), basic fibroblast growth factor (FGF-2) and factor VIII. RESULTS: Curative resection could be done in 4 patients (50%). Our data indicates a trend toward an association between complete resection and patient survival. Expression of p53, bcl-2, CEA, EMA, nm23-H1, VEGF and FGF-2 was detected in 5/8, 3/8, 4/8, 5/8, 6/8, 5/8 and 3/8, respectively. Mean Ki-67 labeling index and microvessel density was 7.01 and 34.36 (per 200x field), respectively. When compared with our previous studies, immunohistochemical staining of these proteins in thymomas, the expression rates of these proteins in thymic carcinomas were higher than those in thymomas. CONCLUSIONS: In this small series, it is suggested that a complete resection suggests a favorable result. Immunohistochemical results reveal that the expression of these proteins might indicate the aggressiveness of thymic carcinoma.
Adult↗
A case of pulmonary metastasis from breast cancer following an 18-year disease-free interval that responded to tamoxifen treatment.
A 61-year-old woman was admitted to our hospital with an abnormal shadow on chest roentgenogram. She had undergone a radical mastectomy for right breast cancer 18 years previously. Since pleural dissemination was noted at the time of thoracotomy, only tumor biopsy was performed. Although a decisive diagnosis could not be obtained histologically, the tumor resembled breast cancer and the estrogen receptor status was positive. She underwent post-operative chemotherapy and tamoxifen treatment. After tamoxifen treatment, complete response was observed. The patient is now doing well without recurrence about 10 years after thoracotomy. Based on the clinical course, we obtained both a definitive diagnosis and complete remission.
Breast Neoplasms↗
Giant cell tumor of the rib.
In a rare case of a giant cell tumor of rib origin, a 25-year-old woman to be evaluated for an abnormal mass shadow in chest radiography was strongly positive in a tuberculin skin test, but showed no evidence of active tuberculosis. Chest computed tomography showed a heterogeneous mass originating in the posterior end of the right fourth rib and containing multiple calcifications and cystic lesions. Magnetic resonance imaging showed a high signal intensity with low signal intensity areas. Bone scintigraphy showed an abnormal marked accumulation at the tumor site. A thoracoscopic examination was conducted prior to complete tumor resection, including the fourth rib and related muscles. The pathological diagnosis returned was a giant cell tumor of the bone. The patient did not undergo chemotherapy or radiotherapy, and remains well, and tumor-free at 6 months after surgery.
Adult↗
Correlation between tumor angiogenesis and invasiveness in thymic epithelial tumors.
OBJECTIVE: Because it is difficult to predict the behavior of thymomas on the basis of morphology alone, other methods for determining tumor aggressiveness must be explored. This study investigated the correlation between angiogenic grade and invasiveness in thymic epithelial tumors. METHODS: Immunohistochemical studies of 46 surgically resected thymic epithelial tumors (18 noninvasive thymomas, 20 invasive thymomas, and 8 thymic carcinomas) were conducted. To highlight the microvessels, we used a specific monoclonal antibody against factor VIII. Expression of vascular endothelial growth factor and basic fibroblast growth factor was determined by using polyclonal antibodies. RESULTS: Mean microvessel density readings for noninvasive thymomas, invasive thymomas, and thymic carcinomas were 4.6 +/- 3.2, 12.4 +/- 7.5, and 34.4 +/- 16.7, respectively. Stages I, II, III, and IV of thymoma had microvessel density readings of 4.6 +/- 3.2, 8.5 +/- 4.3, 13.8 +/- 7.7, and 22.0 +/- 6.8, respectively. These findings suggest a significant correlation between microvessel density and tumor invasiveness. Vascular endothelial growth factor expression in noninvasive thymomas, invasive thymomas, and thymic carcinomas was present in 1 (5.6%) of 18, 11 (55.0%) of 20, and 5 (62.5%) of 8 patients, respectively, thereby indicating a distinct association between vascular endothelial growth factor expression and increased microvessel density. Basic fibroblast growth factor expression was present in only 8 patients. CONCLUSIONS: In patients with thymic epithelial tumors, there appears to be a significant correlation between tumor angiogenesis and invasiveness. Furthermore, our data suggests that this angiogenesis in thymic epithelial tumors might be, at least in part, dependent on vascular endothelial growth factor expression.
Adult↗
Measurement of the vascularity and vascular leakage of gliomas by double-echo dynamic magnetic resonance imaging: a preliminary study.
RATIONALE AND OBJECTIVE: To evaluate the vascularity and vascular leakage of well-enhanced gliomas by double-echo dynamic magnetic resonance (MR) imaging. MATERIALS AND METHODS: Eight patients with glioblastoma multiforme (GBM) and two patients with juvenile pilocytic astrocytoma (JPA) were studied. Double-echo dynamic MR imaging was utilized to separate the T2* shortening effect and the T1 shortening effect. The former was represented by the vascularity index, and the latter was represented by the leakage index. These indexes were compared with histopathologic data. RESULTS: The mean vascularity index of the GBM was higher than that of the JPA (mean +/- SD, 3.48 +/- 1.57 [GBM] versus 0.51 +/- 0.29 [JPA]), and the mean leakage index of the JPA was higher than that of the GBM (1.35 +/- 0.87 [JPA] versus 0.27 +/- 0.15 [GBM]). Abundant vascularity was noted in the tight interstitial space in the pathologic specimen of GBM. Conversely, sparse vasculature was observed in the wide interstitial space in the pathologic specimen of JPA. CONCLUSION: This method may enable better characterization of grade in well-enhanced glioma by providing the information on the vascularity and leakage indexes.
Adult↗
Solitary plasmacytoma of the sacrum. Radiologic findings of three cases.
We report the radiologic findings from three cases of solitary plasmacytoma (SP) of the sacrum. Common findings included lytic changes on computed tomography (CT) and relatively low signal intensity on T2-weighted magnetic resonance (MR) images, with intense enhancement after contrast administration. All cases showed infiltrating and slightly expansive growth, but the sacral structure was generally maintained. These radiologic findings may be of utility when generating a differential diagnosis of a solitary sacral tumor.
Aged↗
Recanalization and reversal of diffusion abnormalities and markedly reduced cerebral blood volume in a patient with transient ischemic attack.
Resolution of diffusion abnormalities is a finding that is rarely seen in hyperacute cerebral ischemia. We report a serial study of diffusion and perfusion magnetic resonance imaging (MRI) in a case of transient ischemic attack (TIA). In the current case, marked decrease of cerebral blood volume (CBV) as well as reduced diffusion in the affected middle cerebral arterial territory was shown by the initial diffusion and perfusion MRI at 1.5 h after onset. The initial MRI findings as well as neurological symptoms recovered probably due to prompt and spontaneous recanalization of thrombosed vessel.
Aged↗