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PubMed2004

Neuro-Behçet's disease with chorea after remission of intestinal Behçet's disease.

Neuro-Behçet's disease shows various neuropsychiatric symptoms, but chorea has rarely been reported. We report a case of neuro-Behçet's disease in a 67-year-old woman with depression and chorea that occurred 22 years after the onset of intestinal Behçet's disease. Brain magnetic resonance imaging (MRI) using a fluid-attenuated inversion-recovery (FLAIR) sequence demonstrated lesions more clearly than did T2-weighted MRI. Some of the lesions appeared as small ring-like foci, i.e. low-intensity spots rimmed with remarkable hyperintense signals, in the periventricular white matter and basal ganglia. A review of the literature revealed that the onset of chorea in cases of Behçet's disease varied from the time of onset of Behçet's disease to 31 years after onset of the disease. Psychiatric manifestations have often been associated with neuro-Behçet's disease. In the present patient, treatment with prednisolone resolved the chorea, suggesting that the chorea was caused by an autoimmune mechanism. It seems likely that the long-term development of vasculitis in patients with Behçet's disease results in the formation of these particular brain lesions on FLAIR MR images. Chorea should be taken into consideration as one of the manifestations of Behçet's disease, even many years after remission of the disease.

Aged↗
PubMedDate not supplied

Visual field damage in normal-tension glaucoma patients with or without ischemic changes in cerebral magnetic resonance imaging.

PURPOSE: To compare the pattern of visual field damage between normal-tension glaucoma (NTG) patients with signs indicative of ischemic changes and those NTG patients without signs of ischemic changes, using brain magnetic resonance imaging (MRI), in a single center, cross-sectional study. METHODS: In 94 consecutive NTG patients who were younger than 61 years old, brain MRI images were obtained using fluid-attenuated inversion recovery pulse sequences. The presence of signs indicative of ischemic changes in brain MRI images was decided separately by two neuroradiologists masked to the diagnosis and stage of glaucoma. Visual field testing was performed using the 30-2 program of the Humphrey Visual Field Analyzer. Between the patients with signs indicative of ischemic changes in brain MRI (ischemic group) and those without MRI signs (nonischemic group), total deviation (TD) at each test point less the average of TDs of the 30-2 program ([TD - TD(mean)])--was compared at each test point. RESULTS: Signs indicative of ischemic changes in brain MRI were found in 32 of the 94 patients (34.0%). Age, blood pressure, refraction, intraocular pressure, the average of TDs, mean deviation, and corrected pattern standard deviation were not significantly different between the ischemic (N = 32) and nonischemic (N = 62) groups (P > 0.2). [TD - TD(mean)] in the ischemic group was significantly smaller than that in the nonischemic group at 6 nonedge contiguous test points in the inferior pericentral to nasal field (P = 0.005-0.047). CONCLUSION: NTG patients with signs indicative of ischemic changes in brain MRI had a relatively deeper depression in the inferior pericentral visual field.

Blood Pressure↗
PubMed2005

Semi-quantification of methionine uptake and flair signal for the evaluation of chemotherapy in low-grade oligodendroglioma.

UNLABELLED: 11C-Methionine (MET) is a useful positron emission tomography (PET) tracer for the evaluation of low-grade gliomas. Among these tumors, a high percentage of low-grade oligodendrogliomas (ODG) are sensitive to chemotherapy with procarbazine, CCNU, and vincristine (PCV). We aimed at: (1) objectively assessing ODG response to PCV by a metabolic index (the Activity Volume Index or AVI) generated from an automated semi-quantification of PET with MET (PET-MET); (2) comparing AVI and quantitative magnetic resonance imaging (MRI) measurements of response to PCV. METHODS: seven patients with ODG were followed for a period of 19.9+/-6.6 months after the completion of PCV chemotherapy. Regions of interest (ROI) were generated by covering all voxels with count values above a threshold level set at 120% of the mean cerebellar activity. On each slice, ROI volume and mean count values were calculated. AVI was calculated as the sum over all ROI of tumor volumex(tumor mean count/cerebellum count). Tumor volume measurements on MRI, were based on signal abnormalities visually detected on fluid-attenuated inversion recovery (FLAIR) sequences. RESULTS: PCV therapy was associated with a drastic decrease in AVI (mean+/-SD, cm3): AVI post-PCV=0.80+/-1.45 vs. AVI prior PCV=12.94+/-11.46 (P=0.03). Likewise, we observed a decrease in tumor volume estimated from the FLAIR signal (31.37+/-11.99 post-PCV vs. 67.95+/-39.96 prior PCV, P=0.03) although AVI decrease after PCV was significantly more pronounced (P=0.015). CONCLUSION: This study, based on limited number of patients and follow-up period indicates that AVI may be a sensitive and observer-independent method applicable to the assessment of ODG responsiveness to PCV treatment and may offer a major added value to both clinical assessment and MRI evaluation of chemotherapeutic outcomes.

Adult↗
PubMed2005

Activation of the WUS gene induces ectopic initiation of floral meristems on mature stem surface in Arabidopsis thaliana.

A gain-of-function Arabidopsis mutant was identified via activation tagging genetic screening. The mutant exhibited clustered ectopic floral buds on the surface of inflorescence stems. The mutant was designated as sef for stem ectopic flowers. Our detailed studies indicate that the ectopic flower meristems are initiated from the differentiated cortex cells. Inverse PCR and sequence analysis indicated that the enhancer-containing T-DNA from the activation tagging construct, SKI015, was inserted upstream of the previously cloned WUS gene encoding a homeodomain protein. Studies from RT-PCR, RNA in situ hybridization and transgenic plant analysis further confirmed that the phenotypes of sef are caused by the overexpression of WUS. Our results suggest that overexpression of WUS could trigger the cell pluripotence and reestablish a new meristem in cortex. The type of new meristems caused by WUS overexpression was dependent upon the developmental and physiological stages of a plant. With the help of some undefined factors in the reproductive organs the new meristems differentiated into floral buds. In a vegetative growth plant, however, only the new vegetative buds can be initiated upon the overexpression of WUS. These studies provide new insights of WUS on flower development.

Arabidopsis↗
PubMed2003

Quantitative characterization of phospholipids in milk fat via 31P NMR using a monophasic solvent mixture.

The phospholipids (PL) occurring in both ewe and cow milk fat globule membrane were identified and quantitatively determined using 31P NMR spectroscopy with inverse gated decoupled sequences, which allowed a rigorous quantitative analysis. A strict relation between amount and distribution of PL and type of feeding was found. The method was calibrated over a mixture of PL standards. A recently introduced solvent constituted by a monophasic dimethylformamide/triethylamine/guanidinium hydrochloride solvent mixture was used. Compared to the traditional chloroform/methanol/water-EDTA solvent, the new solvent mixture shows very similar accuracy and precision from a quantitative point of view. The monophasic solvent overcomes the partition problems related to a biphasic system, and slightly enlarges the range of 31P NMR chemical shifts, thus improving the resolution. In addition, the new solvent apparently displays a lower chemical shift dependence on the various PL concentrations. The limit of the method is mainly determined by the formation of adducts between triethylamine and some PL, namely, PE, monomethylphosphatidylethanolamine, phosphatidylethanolamine plasmalogens, and some lyso-PL. However, the new 31P NMR signals arising from these adducts could be easily quantified in the determination of PE.

Animals↗
PubMed1992

31P NMR analysis of red blood cell UDPGlucose and UDPGalactose: comparison with HPLC and enzymatic methods.

The levels of uridine diphosphogalactose (UDPGal) and uridine diphosphoglucose (UDPGlu) in trichloroacetic acid extracts of human red blood cells (RBC) were measured by 31P NMR spectroscopy. Individual determinations were compared to results obtained by enzymatic and high-pressure liquid chromatographic (HPLC) methods. The characteristic doublet of the P beta resonance signals of both UDPGal and UDPGlu were detected in proton-decoupled spectra of extracts. Quantitative analyses were obtained by employing a standard, methylene diphosphonate, in an external capillary tube during data acquisition for periods of 14 to 24 h using an "inverse-gated" pulse sequence. The ratio of the integrated area of each of the uridine sugar nucleotide doublets to the area of the external reference peak was linear with concentrations between 0.03 and 0.50 mM. There was no difference between the mean value obtained by 31P NMR of 6.6 +/- 1.4 mumol UDPGlu/100 g Hgb or 2.1 +/- 0.6 mumol UDPGal/100 gHgb and the corresponding levels determined enzymatically or by HPLC in identical RBC extracts. When analyzed as paired data, only UDPGlu by NMR was found to be lower than the value obtained by HPLC. As a quantitative analytical tool, NMR spectrometry validated both the enzymatic and HPLC methods used for measurement of uridine sugar nucleotides in our laboratories.

Adult↗
PubMedDate not supplied

Progressive brainstem and white matter lesions in Kearns-Sayre syndrome: a case report.

We performed serial cranial MRI examinations on an 11-year-old boy with Kearns-Sayre syndrome. Proton density (PD)-, T2-weighted and T2-weighted fluid attenuated inversion recovery (FLAIR) sequences revealed progressive high signal intensity areas in the brainstem, globus pallidus, thalamus, and white matter of the cerebrum and cerebellum bilaterally. The probable gliotic lesions in the brainstem may be part of the neurogenic origin of the external ophthalmoplegia in addition to the primary defect of the extraocularmuscle in KSS.

Brain↗
PubMedDate not supplied

MRI in primary bone tumors: therapeutic implications.

The accuracy of preoperative MRI in detecting tumor extent has been evaluated in 35 patients with primary bone neoplasms; intra-osseous extent was measured on MR images and compared with macroslides of surgical specimens in 26 cases. An almost completely accurate prediction of tumor size was obtained with the combined employment of Spin-Echo (SE) and Short Inversion Time Inversion Recovery (STIR) sequences in the various tumors, with the exception of two Ewing's sarcomas. Changes in Signal Intensity (SI) and tumor morphology were identified in those cases which had undergone presurgical chemotherapy; the reduction in SI and in tumor size or the appearance of a more homogeneous signal was correlated with a positive response to cytotoxic therapy. MR imaging fully satisfies surgeon's preoperative requirements in the assessment of therapy-responding neoplasms as well as in local tumor staging in all types of neoplasms, with the exception of Ewing's sarcoma.

Antineoplastic Agents↗
PubMed1994

Precision, accuracy, and image plane uniformity in NMR relaxation time imaging on a 1.5 T whole-body MR imaging system.

In order to evaluate the accuracy, precision and image plane uniformity a phantom study was undertaken on a 1.5 T whole-body MR imaging system (Philips Gyroscan S15 HP). The manufacturers algorithm for obtaining relaxation time images was used. This method uses Ratios and Least Squares (RLSQ-algorithm) on data obtained from a combination of a multi-echo (CPMG) and an inversion recovery pulse sequence, yielding a calculated T1-, T2- and a proton density image simultaneously. T1 and T2 accuracy was measured in phantoms consisting of CuSO4 and MnCl2 in aqueous solution in different concentrations. The results were compared to a reference T1 and T2 obtained by spectroscopy. The accuracy error over the entire relaxation time range was expressed as the root mean square of the modulus of the difference between the reference and the image measurement and was 2.3% for T1 and 4.1% for T2. Precision or reproducibility was measured by 11 double estimations on 11 samples. The precision error was 0.35% for both T1 and T2. Image plane uniformity, i.e., the homogeneity of pixel values throughout the image plane, was measured by 3 consecutive image readings from a phantom of 19 cm in diam. in 8 directions 45 degrees apart and 1, 3, 5, 7, 9 cm from the center. Errors in the imaging plane were expressed as the deviation from the center value. For both T1 and T2 the maximum deviation was less than 5% over the entire image in the transverse plane. It is concluded that when the pulse sequence timings are carefully optimized, the mixed imaging sequence in combination with the RLSQ algorithm used in this MRI system is a reliable and precise means of obtaining relaxation time data.

Algorithms↗
PubMed1994

Comparison of T1 estimation techniques in cardiac MRI.

We have shown that the use of a simple combination of inversion recovery/spin-echo (IR/SE) sequences provides undeniably superior precision in quantitative in vivo myocardium T1 estimation than the standard multiple spin-echo approach. On a group of 25 healthy subjects, the T1 dispersion was, respectively, 3.8% for the IR/SE combination and 19.6% for the best SE pair combination. Moreover, repeated measurements were carried out on seven of the volunteers in order to assess T1 reproducibility. The mean intra-individual T1 precision was found to be 2.8% for the IR/SE pair and 20.0% for the best SE pair. The in vivo imaging work was supported and corroborated by a thorough treatment of the theoretical T1 errors. We also highlight the importance of quality control in quantitative MRI; a correction being required in the SE sequences to bring measured signal intensities into line with those predicted from simple theory.

Adult↗
PubMedDate not supplied

Inflammatory pseudotumor of the liver: appearance on MRI.

Inflammatory pseudotumor of the liver is a rare entity; fewer than 50 cases have been reported in the world literature. Its appearance on both computerized tomography (CT) and ultrasound have been previously described. To our knowledge, this is the first report of its appearance on magnetic resonance imaging (MRI). The lesion demonstrated increased signal intensity on T-1 and T-2 spin-echo and inversion recovery (STIR) sequences in relationship to normal liver. The signal characteristics, however, were nonspecific and diagnosis required biopsy confirmation. There was spontaneous resolution with conservative management, and this was documented on follow-up CT and MRI.

Biopsy↗
PubMed2005

MRI findings of eosinophilic myelomeningoencephalitis due to Angiostrongylus cantonensis.

AIM: To study the imaging characteristics of eosinophilic myelomeningoencephalitis due to Angiostrongylus cantonensis using magnetic resonance imaging (MRI). MATERIALS AND METHODS: Seventeen MRI examinations of the brain and spinal cord in five patients with angiostrongyliasis cantonensis of the central nervous system were performed. The final diagnosis was based on typical clinical symptoms, results of blood and cerebrospinal fluid (CSF) tests, and the presence of nematode larvae in the CSF. The sequential MRI follow-up examinations were carried out at a different stage for every patient from 1 to 28 weeks after the onset of symptoms. The features of the lesions in the brain, spinal cord, meninges and nerve roots on MRI were studied, moreover, the development of the lesions was analysed on follow-up MRI. RESULTS: Abnormalities were demonstrated on MRI in all five cases. They included three cases of meningoencephalitis, one case of encephalitis and one myelomeningitis. The locations and appearances of the lesions were as follows: (1) brain involvement in four cases (including cerebrum in four, cerebellum in two and brain stem in three), and spinal cord involvement in one case. These lesions were diffuse or scattered and appeared as similar or slightly reduced signal intensity on T1-weighted images (T1WI), high signal intensity on T2-weighted images (T2WI) and turbo fluid attenuated inversion recovery pulse sequence (FLAIR) images. After administration of gadolinium chelate (Gd-DTPA), multiple round or oval enhancing nodules, with diameters ranging from 3 to 10 mm, were seen on T1WI, a few lesions appeared as stick-shaped enhancement whose longest measurement was 14 mm. Diffuse or local oedema around the lesion could be seen. (2) Meningeal involvement in four cases, a case of ependymal involvement and a case of nerve root involvement were among them. These lesions appeared as linear or nodular enhancement of the leptomeninges and ependyma, as well as nerve root enhancement. (3) There was a mild ventricular enlargement in two cases. On follow-up MRI lesions were most severe from the 5th week to the 8th week and it took at least 4-8 weeks (1-2 months) for a lesion to resolve completely, the resolution of larger lesion needed more than 22 weeks. CONCLUSION: Multiple enhancing nodules in the brain and linear enhancement in the leptomeninges were the main features; stick-shaped enhancement was the characteristic sign of the disease on Gd-DTPA enhanced-T1 weighted images.

Adult↗
PubMed2005

MR imaging features of foot involvement in ankylosing spondylitis.

OBJECTIVE: To determine alterations of the soft tissue, tendon, cartilage, joint space, and bone of the foot using magnetic resonance (MR) imaging in ankylosing spondylitis (AS) patients. MATERIALS AND METHOD: Clinical and MR examination of the foot was performed in 23 AS patients (46 feet). Ten asymptomatic volunteers (20 feet) were studied on MR imaging, as a control group. MR imaging protocol included; T1-weighted spin-echo, T2-weighted fast-field echo (FFE) and fat-suppressed short tau inversion recovery (STIR) sequences in sagittal, sagittal oblique, and coronal planes using a head coil. Specifically, we examined: bone erosions, tendinitis (acute and chronic), para-articular enthesophyte, joint effusion, plantar fasciitis, joint space narrowing, soft tissue edema, bone marrow edema, enthesopathy in the Achilles tendon and plantar fascia attachment, subchondral signal intensity abnormalities (edema and sclerosis), tenosynovitis, retrocalcaneal bursitis, subchondral cysts, subchondral fissures, and bony ankylosis. Midfoot, hindfoot, and ankle were included in examined anatomic regions. RESULTS: Clinical signs and symptoms (pain and swelling) due to foot involvement were present in 3 (13%) of the patients while frequency of involvement was 21 (91%) with MR imaging assessment. The MR imaging findings were bone erosions (65%), Achilles tendinitis (acute and chronic) (61%), para-articular enthesophyte (48%), joint effusion (43%), plantar fasciitis (40%), joint space narrowing (40%), subchondral sclerosis (35%), soft tissue edema (30%), bone marrow edema (30%), enthesopathy of the Achilles attachment (30%), subchondral edema (26%), enthesopathy in the plantar fascia attachment (22%), retrocalcaneal bursitis (22%), subchondral cysts (17%), subchondral fissures (17%), tendinitis and enthesopathy of the plantar ligament (13%), and bony ankylosis (9%). The most common involved anatomical region was the hindfoot (83%) following by midfoot (69% ) and ankle (22%). CONCLUSION: In our experience, MR imaging may detect inflammatory and/or erosive bone, soft tissue, cartilage, tendon, and joint abnormalities in AS patients, even if AS patients did not have clinical signs and symptoms of foot involvement. If these data prove to be confirmed in further MR studies, MR imaging may be of importance especially in early diagnosis of inflammatory changes in the foot.

Achilles Tendon↗
PubMed2005

Intracranial epidermoid cysts: diffusion-weighted, FLAIR and conventional MR findings.

PURPOSE: To compare diffusion-weighted echo-planar imaging (DW) with spin-echo (SE), and fluid-attenuated inversion recovery (FLAIR) sequences in the evaluation of epidermoid cysts (ECs), and to evaluate T2 shine-through effect. MATERIALS AND METHODS: Fifteen patients were imaged prospectively in two different 1.5 T magnetic resonance (MR) units with standard head coils with SE, FLAIR and DW echo planar imaging sequences. The qualitative and quantitative assessments were performed by two radiologists in consensus. Apparent diffusion coefficient (ADC) values were obtained from all ECs. Exponential DW images are obtained in 11 cases to eliminate T2 shine-through effects. The results are analyzed with variance analysis (ANOVA) and Bonferroni t method. RESULTS: FLAIR sequence was superior to T1- and T2-weighted sequences in showing ECs. In 13 cases, the borders of the lesions could be delineated from the surrounding structures with only DW imaging where ECs were markedly hyperintense. The ADC values of ECs are significantly lower than CSF (P < 0.001), and significantly higher than deep white matter (P < 0.01). On exponential DW images, ECs had similar intensity with brain parenchyma showing that the real cause of the hyperintensity of the lesions on trace images is the enhanced T2 effect of the tissue. CONCLUSION: FLAIR sequence is superior to the conventional MR sequences in demonstrating the ECs and DW imaging is superior to other MR sequences in delineating the borders of the ECs. Exponential DW images had shown that the hyperintensity in the trace images are caused by increased T2 effect of the lesion rather than the decrease in ADC values.

Adult↗
PubMed2005

Signal intensity, clinical activity and cross-sectional areas on MRI scans in thyroid eye disease.

The signal intensity from inflamed extra-ocular muscles on short tau inversion recovery (STIR)-sequence magnetic resonance imaging (MRI) is known to correlate with clinical scores of thyroid eye disease (TED) severity. Twenty-one patients who had undergone repeated MRI scanning for TED were studied retrospectively. Signal intensity of extra-ocular muscles (from STIR-sequence MRI) and cross-sectional area (from STIR and T1 MRI) were correlated with Mourits' clinical activity score (CAS). The area of highest signal intensity within the most inflamed extra-ocular muscle, and the average cross-sectional signal intensity of the most inflamed extra-ocular muscle reliably correlated with CAS, and this was maintained as disease activity changed over time. In contrast, isolated measures of muscle cross-sectional area did not correlate with CAS. The extra-ocular muscle cross-sectional area calculated from STIR-sequence MR images was greater than that measured on T1 images. This suggests that muscle area from STIR-sequence MRI may also detect peri-muscular inflammation. We conclude that the peak signal intensity from the most inflamed extra-ocular muscle remains the most reliable correlate of clinical disease activity obtained from these images. STIR-sequence MRI scans provide a number of useful measures of disease activity in TED.

Anatomy, Cross-Sectional↗
PubMed2005

MRI findings of Wernicke encephalopathy revisited due to hunger strike.

BACKGROUND AND PURPOSE: The purpose of this study was to determine the characteristic magnetic resonance imaging (MRI) findings among a group of patients who presented with Wernicke encephalopathy (WE) due to the neurological complications of a long-term hunger strike (HS). METHODS: MRI studies also including the fluid-attenuated inversion recovery (FLAIR) sequence and diffusion-weighted imaging (DWI) of six male patients with WE aged from 25 to 38 years (mean age 31 years) were evaluated. RESULTS: In all subjects, T2-weighted sequences, FLAIR and DWI revealed a signal hyperintensity within the posteromedial thalami and surrounding the third ventricle. In particular, on coronal images, the hyperintense areas around the third ventricle showed a suggestive "double wing" configuration. We observed an increased signal on proton-density and T2-weighted images in the mamillary bodies of three patients. Four patients demonstrated additional hyperintensities within the periaqueductal region and/or the tectal plate. At least one lesion area in five of six patients demonstrated contrast enhancement. CONCLUSION: The consistent imaging findings of our study suggest that MRI is a reliable means of diagnosing WE. Acute WE is sometimes underdiagnosed, yet early diagnosis and treatment of WE is crucial in order to avoid persistent brain damage. MRI, including postcontrast T1-weighted imaging, DWI beneath standardized T2-weighted imaging, and FLAIR sequences may prove to be a valuable adjunct to clinical diagnosis and to provide additional information in acute and/or subacute WE.

Adult↗
PubMed2004

MR enteroclysis using iron oxide particles (ferristene) as an endoluminal contrast agent: an open phase III trial.

To evaluate efficacy and safety of a superparamagnetic iron oxide contrast agent (ferristene) as an endoluminal contrast medium for magnetic resonance (MR) enteroclysis in a phase III trial. Twenty-three patients with history of known or suspected small bowel Crohn's disease underwent MR imaging of the abdomen at 0.5 T unit. The imaging protocol included two phases: the first one without administration of any contrast agent and the second one, where the small bowel was filled by enteroclysis with 800 ml of the luminal iron oxide contrast medium and Gd-DTPA (0.1 mmol/Kg) was administered intravenously. Axial Spin-Echo (SE) T1-weighted (T1w), proton-density and T2w images, sagittal and coronal SE T1w and Short TI Inversion Recovery (STIR) sequences were subsequently obtained. Three investigators blindly evaluated images to determine small bowel distribution of ferristene, presence of artifacts, delineation of bowel lesion/wall and the diagnostic value of ferristene combined with gadolinium. Pre- and postcontrast signal intensity measurements of bowel lesion/wall, bowel lumen and background noise were also calculated. Three patients withdrew before the procedure, therefore 20 patients were effectively included in the study. No significant difference between the three investigators' evaluations of the improvement of the diagnostic information was found (percentage of improvement of 90% with 95% confidence limits of 68% and 99%). A statistically significant difference between the first and third investigators was found for grading of quality of delineation of bowel lesion/wall. Signal intensity measures showed a significant increase of the bowel lesion/wall and background noise/lesion for the SE T1w images. No serious adverse event was reported in our series. MR enteroclysis using ferristene as an endoluminal contrast agent appears to be a safe and efficient procedure for the study of the small bowel.

Adult↗