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We report a 70-year-old male patient with the sero-negative neuromyelitis optica spectrum disorders (NMOSD) associated with atopic disease (AD). He was diagnosed with allergic rhinitis at the age of 20. When he was 61 years old, he subacutely developed orthostatic hypotension, bilateral optic neuritis, quadriparesis, urinary retention, and constipation. The laboratory results revealed allergen-specific IgE positivity for cryptomeria japonica and hinoki, hyperIgEemia, and Th (helper T cell) 1 dominance. The serological tests for autoantibodies revealed negative anti-aquaporine 4 antibody, and high concentration of anti-IgE autoantibody (anti-IgE AAb). Cerebrospinal fluid was negative for anti-myelin-oligodendrocyte glycoprotein antibody and glial fibrillary acidic protein antibody. Fluid-attenuated inversion recovery on brain magnetic resonance imaging (MRI) showed high signal intensities in bilateral cerebral deep white matter. T2 weighted image on spine MRI showed longitudinally extensive high signal intensities in the spinal cord, specifically involving C1 vertebral level to conus medullaris. Intravenous methylprednisolone (IVMP) and plasma exchange resulted in partial improvement. Following the onset of NMOSD, he had relapse of NMOSD four times. In each episode, IVMP was to be partially effective with anti-IgE AAb reduction. Anti-IgE AAb may be a reasonable clinical indicator of increased disease activity in the sero-negative NMOSD associated with AD.

Confirmation of patient information is required to ensure the safety of radiation therapy. The purpose of this study was to construct a system that facilitates radiation therapy operations by linking a radiation therapy information system to a smartphone. By linking a smartphone to a radiation therapy operation support system, without using a PC terminal, we were able to input information about the patient's position and fixation into images taken with a smartphone. In addition, patient information could be directly linked into the radiation therapy information system. In addition, patient information could be verified in the irradiation room by synchronizing the smartphone with the radiation therapy support system. The questionnaire was highly evaluated in terms of radio reception, usability, visibility and barcode reading. In this study, by linking a smartphone to a radiotherapy information system, it was possible to construct a system that facilitates radiotherapy operations by checking and registering patient information at hand.

We report the case of a 51-year-old woman who developed neuromyelitis optica spectrum disorders (NMOSD) associated with primary biliary cholangitis (PBC). When she was 38 years old, she subacutely developed headache and urinary retention. A diffusion weighted image (DWI) on brain MRI showed high signal intensity in the left temporal white matter, and T 2 weighted image (T 2 WI) on spine MRI showed high signal intensities in the spinal cord. After the initial event, follow-ups at 2, 6 and 9 months revealed that she developed neurological symptoms, and T 2 WI on spine MRI showed high signal intensities in the cervical and thoracic regions of the spinal cord. On each episode, she was treated a course of intravenous methylprednisolone which resulted in improvement of her symptoms. At the age of 39 years, the serum levels of biliary enzymes began to elevate, and the serum levels were markedly elevated after the age of 40 years. When she was 40 years old, she developed optic neuritis of the right eye. At the age of 41 years, spine MRI again showed the cervical and thoracic spinal cord lesions. At the age of 51 years, she subacutely developed dizziness and urinary retention. DWI on brain MRI showed high signal intensities in the pons and medulla oblongata, and T 2 WI on spine MRI showed longitudinally extensive high signal intensities in the spinal cord, specifically between the C3 and C5 vertebral levels. The serological tests for autoantibodies revealed positive anti-aquaporine 4 antibody (AQP4-Ab), positive anti-mitochondrial antibody subtype M2 (AM2-Ab) and positive anti-nuclear antibody, and the interleukin-6 (IL-6) level was elevated in the cerebrospinal fluid. Simultaneous occurrence of AQP4-Ab-positive NMOSD and AM2-Ab-positive PBC is extremely rare, and has never been reported in Japan. The present case is the first case with simultaneous occurrence of AQP4-Ab-positive NMOSD and AM2-Ab-positive PBC in Japan. We suspect that IL-6, plasmablast and cytotoxic T lymphocyte were involved with the occurrence of NMOSD with PBC in the present case.

We herein report the case of a 54-year-old man who abused toluene for 25 years and gradually developed gait disturbance. Neurological findings showed mild cognitive impairment, hearing impairment, dysarthria, marked hyperreflexia of the limbs, spastic paraplegia, slight impairment of deep sensation, and urinary disturbance; however, there was no muscular atrophy. Serum antibodies against human T-lymphocytic virus 1 and aquaporin 4 were negative. Biochemical analysis did not show an increase in very-long-chain fatty acids. The cerebrospinal fluid was normal for the cell number and protein level but positive for oligoclonal IgG band, with a mildly increased IgG index. Brain MRI showed marked high intensity in the bilateral periventricular, deep cerebral and subcortical white matter as well as atrophy of the cerebrum, cerebellum and brainstem, and thinning of the corpus callosum. Spinal MRI showed marked atrophy of the lower cervical spinal cord, thoracic spinal cord, and conus medullaris. Spinal cord lesions are extremely rare in chronic toluene intoxications, and there are no reports of spinal cord atrophy. Lateral and ventral columns of the spinal cord are responsible for pyramidal tract signs, and insidious ongoing inflammation related to chronic toluene intoxication in the central nervous system is predicted to underlie the pathogenesis.

We present a case of a 73-year-old female who developed subacute memory disturbance, reduced consciousness and quadriparesis following pernicious anemia. Brain magnetic resonance imagings (MRI) in diffusion weighted, T2 weighted and fluid attenuated inversion recovery (FLAIR) images revealed hyperintensities in bilateral frontal, parietal, temporal and occipital cortices, left thalamus, bilateral splenium of corpus callosum, and bilateral subcortical white matters. Brain gadolinium enhanced T 1 weighted MRI revealed very slight post-contrast enhancement lesions in the right posterior temporal region and bilateral parietal regions. Serum was negative for anti- aquaporin (AQP) 4 antibody, anti-glutamic acid decarboxylase (GAD) antibody and anti-voltage-gated potassium channel (VGKC) antibody, and cerebrospinal fluid (CSF) was negative for anti- N-methyl-D-aspartate (NMDA) receptor antibody. CSF analysis showed slight protein elevation with normal cellular content. No evidence of neoplasm was observed using whole-body 18 F -fluorodeoxyglucose- positron emission tomography/computed tomography. Pathological findings of the left frontal lesion revealed perivascular and scattered parechymal T-lymphocytic infiltration, and astrogliosis without vascular hyalinization. Patient achieved partial recovery during two intraveneous pulse methylprednisolone treatments, and exacerbation afterwards. After the third intraveneous pulse methylprednisolone treatment, remission is sustained for six years. This case can be regarded as autoantibody-negative but probable autoimmune encephalitis with the features of nonparaneoplastic panencephalitis and treatable dementia. Nonparaneoplastic autoimmune panencephalitis with widespread multifocal brain lesions on brain MRI is extremely rare, with exception of anti- NMDA receptor antibody encephalitis.

We investigated the diffusion weighted magnetic resonance imaging (DWI) features of 76 very elderly patients aged 90 years or above with acute ischemic stroke. Stroke subtypes were classified into five types according to the Trial of Org 10172 in Acute Stroke Treatment (TOAST) and the Japanese Stroke Databank. The incidence rates of atherothrombotic brain infarction (ATBI), atherothrombotic brain embolism (ATBE), lacunar infarction (LI), cardiogenic brain embolism (CBE) and undetermined type of brain infarction (UTBI) were 2.6%, 17.1%, 10.5%, 50.0% and 19.8%, respectively. We estimated that the incidence of acute ischemic stroke in women was 3.5-fold higher than that in men. This is likely because survival rate of females is higher than that of males in populations aged 90 years or above. The prevalence of atrial fibrillation (AF) was 46.1% in patients with brain infarctions, and 92.1% in patients with CBE. The frequency of multiple infarctions is 52.6% and that of single infarction is 47.4%. In DWI of lesions, the frequencies of territorial infarction in the cerebral hemisphere, borderzone infarction, and vertebrobasilar infarction were 85.5%, 13.2% and 17.1%, respectively. The frequencies of massive territorial infarction and cerebellar infarction were 23.7% and 13.2%, respectively. With regard to the relationship between DWI lesion topography and stroke subtypes, superficial infarctions in the cerebral hemisphere were seen in patients with ATBE, CBE and UTBI. Single infarctions deep in the cerebral hemisphere were seen in all patients with any of the five stroke subtypes. Massive territorial infarctions with infarctions in other sites of the cerebral hemisphere or vertebrobasilar region were seen only in patients with CBE, and single pontine infarction was seen only in patients with LI. (Received November 19, 2015; Accepted July 3, 2017; Published November 1, 2017).

We report a 28-year-old woman with the overlap of Fisher syndrome and pharyngeal-cervical-brachial variant of Guillain-Barré syndrome associated with urinary retention and constipation. She showed total ophthalmoplegia, dysphagia, dysarthria, upper extremity weakness, cerebellar ataxia, slightly diminished superficial sensations in her hands and feet, urinary retention and constipation 14 days after preceding infection. Laboratory data showed elevations of antiganglioside antibodies to GT1b, GD1b, GQ1b, GD3 and GT1a in the IgG subclass. There was slight elevation of protein with no pleocytosis in cerebrospinal fluid. After administration of intravenous immunoglobulin (IVIg), only the titer of antiganglioside antibody to GQ1b was decreased, and she showed rapid improvement in dysphagia, urinary retention and constipation, and slow recovery in ophthalmoplegia and cerebellar ataxia. The elevations of antiganglioside antibodies to GQ1b may be pathologically related to autonomic involvement such as urinary retention and constipation in that IVIg seems to be effective. The present case suggests that GQ1b may also locate in the autonomic nerve that plays bladder and defecation functions, and that incidence of neurological symptoms and the response of treatment may differ according to each GQ1b localization.

Cancer is known to be a genetic disease, which is caused by abnormalities of oncogenes and/or tumor-suppressor genes. Genetic abnormalities include mutation, deletion or amplification of DNA sequences. Based on the findings of the genetic abnormalities in malignant tumors, many molecular-targeting agents, e.g. Bcr-Abl kinase inhibitors and EGFR kinase inhibitors, have been developed and approved. In addition to genetic abnormalities, epigenetic abnormalities, e.g. DNA methylation, histone methylation and histone acetylation, are also involved in carcinogenesis and tumor development. Based on the findings of the epigenetic abnormalities in malignant tumors, the novel epigenetic molecular-targeting agents, e.g. DNA(DNMT) methyltransferase inhibitors and histone deacetylase (HDAC) inhibitors, have also been developed and approved. Moreover, histone methyltransferase(HMT) inhibitors and histone demethylase(HDM) inhibitors have been also discovered and some agents are in clinical trials.

We report a 72-year-old woman with complex partial status epilepticus who showed recurrent episodes of complex visual hallucinations (CVH). Brain diffusion-weighted magnetic resonance images revealed gyriform cortical hyperintensity in the right parietal, occipital and temporal lobes, and brain magnetic resonance angiograhy revealed a hyperintensity in the right dilated middle cerebral artery during ictal period. Ictal N-isopropyl-p-(iodine-123)-iodoamphetamine single photon emission computed tomography (123I-IMP-SPECT) with three-dimensional stereotactic surface projection (3D-SSP) 14 days after the onset of the first CVH revealed hyperperfusion in the right latero-inferior occipito-temporal region with relation to motion. CVH spontaneously subsided 17 days after the onset of the first CVH. CVH recurred one year after the first CVH. Ictal 123I-IMP-SPECT with 3D-SSP revealed marked hyperperfusion in the right lateral parietal region probably with relation to face and figure hallucinations. Ictal scalp EEGs revealed rhythmic polyspikes at 12 Hz with high amplitude (100-200 μV) in bilateral posterior occipital and temporal region with the right side dominance for 20 seconds and more in several occasions. Interictal 123I-IMP-SPECT with 3D-SSP 28 days after recurrence of CVH revealed marked hypoperfusion in the right lateral parietal region, and recovery of hypoperfusion in the right latero-inferior occipito-temporal region. These findings suggest that ictal CVH might be induced by the spread of epileptic discharges from the right parieto-occipito-temporal region with the old brain contusion (epileptogenic region) to the right latero-inferior occipito-temporal region and the right lateral parietal region (symptomatogenic regions).

We report a patient of 32-year-old female with central IgG4-related disease. She developed headache and visual disturbance. On examination, she revealed diabetes insipidus, retrobulbar neuritis, hyperreflexia and limb weakness. Her laboratory findings showed serum IgG4 elevation, pleocytosis and protein elevation in cerebrospinal fluid. Chest CT showed a nodular lesion in the S8 of the left lung. Cranial and spinal magnetic resonance images with gadolinium contrast material showed cranial, cervical and lumbosacral hypertrophic pachymeningitis associated with infundibulo-hypophysitis. Pathological findings of the left frontal dura mater revealed lymphoplasmacytic inflammatory cell infiltrate with dense fibrosis. IgG4 immunohistochemistry showed no IgG4 + plasma cells within the inflammatory infiltrate. During treatment with intravenous pulse methylprednisolone followed by oral prednisolone, she revealed recovery of visual acuity with improvement of hypertrophic pachymeningitis and normalization of serum IgG4. This is a first report of IgG4-related hypertrophic pachymeningitis which involved cranial, cervical and lumbosacral regions as well as infundibulo-hypophysitis in a young female.

We present a 46-year-old man with central pontine myelinolysis (CPM). He had been diagnosed with diabetes mellitus and chronic pancreatitis. He had drunk more than 1.2 l of Japanese sake daily for 20 years and more. He developed slight reduction of consciousness, dysarthria and truncal ataxia 7 days after he stopped drinking. The laboratory data on admission showed hyperosmolar hyperglycemic state, according to the following findings; glucose 1,058 mg/dl, serum osmolality 328 mOsm/l and serum sodium 119 mEq/l. According as administration of acetic Ringer's solution and insulin injection, the laboratory data 14 hours after admission showed glucose 235 mg/dl, serum osmolality 290 mOsm/l and serum sodium 131 mEq/l. The initial diffusion weighted images (DWI) on MRI revealed a small high signal intensity spot in the pons. The second DWI after 14 days revealed a trident-shaped hyperintensity in the pons that was compatible with CPM. His symptoms showed no remarkable changes, but susceptibility weighted images of MRI after 4 months revealed low signal intensity area in the CPM lesion that indicated pontine hemorrhage. We speculate that marked fluctuation of serum osmotic pressure associated with the rapid change of the serum glucose had a significant role in the pathogenesis of the present case. Therefore, we recommend gradual correction of serum glucose and serum osmolality to maintain less than 12 mEq/l/day as correction of chronic hyponatremia in to prevent and ameliorate pathologic condition of CPM.

We present a 39-year-old woman with transient global amnesia (TGA) who showed sudden onset amnesia immediately following sexual intercourse after taking a bath. Her amnesia resolved within 6 hours. Three-Tesla (3T) diffusion weighted magnetic resonance imaging (DWI) taken 80 hours after the onset revealed hyperintense spots in the CA1 subfields of the bilateral hippocampi. No abnormalities were noted in 3T DWI, T(2) weighted imaging (T(2) WI) and fluid attenuated inversion recovery (FLAIR) at 3 weeks after the onset. She had no cardiovascular diseases. Magnetic resonance venography (MRV) revealed hypoplasia of the right transverse sinus and stenosis of the bilateral brachiocephalic veins. Ultrasound sonographic studies revealed a prolonged retrograde flow component of the right internal jugular vein during a Valsalva maneuver. The vast majority of TGA attacks occur between the ages of 50 and 80, and very rarely under the age of 40 years, which is mostly not exposed to vascular risks. We therefore speculate that in conjunction with a decreased vascular beds from the brain, a Valsalva-like maneuver might have precipitated cerebral venous ischemia in the bilateral hippocampi, which are the most vulnerable to ischemic insults.

We have evaluated relationship between planning CT slice thickness and the accuracy of automatic target registration using cone-beam CT (CBCT). Planning CT images were acquired with reconstructed slice thickness of 1, 2, 3, 5, and 10mm for three different phantoms: Penta-Guide phantom, acrylic ball phantom, and pelvic phantom. After correctly placing the phantom at the isocenter using an in-room laser, we purposely displaced it by moving the treatment couch and then obtained CBCT images. Registration between the planning CT and the CBCT was performed using automatic target registration software, and the registration errors were recorded for each planning CT data set with different slice thickness. The respective average and standard deviation of errors for 10 mm slice thickness CT in the lateral, longitudinal, and vertical directions (n=15 data sets) were: 0.7 +/- 0.2mm, 0.8 +/- 0.2mm, and 0.2 +/- 0.2mm for the Penta-Guide phantom; 0.5 +/- 0.4 mm, 0.6 +/- 0.3 mm, and 0.4 +/- 0.3 mm for the acrylic ball phantom; and 0.6 +/- 0.2 mm, 0.9 +/- 0.2 mm, and 0.2 +/- 0.2 mm for the pelvic phantom. We found that the mean registration errors were always less than 1 mm regardless of the slice thickness tested. The results suggest that there is no obvious correlation between the planning CT slice thickness and the registration errors.

In previous prevention studies, molecular targets were not intended. We then proposed the concept termed "molecular-targeting prevention" and applied it to cancer prevention. In most malignant tumors, tumor-suppressor genes, the retinoblastoma gene (RB) and/or the p53 gene are considered to be inactivated. We therefore hypothesized that RB and/or p53 might be good candidates for the molecular-targeting prevention of cancer. Interestingly, many cancer-preventive food factors were found to reactivate the lost functions of RB and/or p53 by a "gene-regulating chemoprevention" strategy. We next proposed the concept termed "combination-oriented molecular-targeting prevention", in which only the preventive effects are synergistically enhanced. We then investigated the TNF-related apoptosis-inducing ligand (TRAIL)-death receptor 5 (DR5) pathway as a candidate of the target, and found that many cancer-preventive food factors could enhance the pathway resulting in the synergistic apoptosis of various cancer cells. We hope that these strategies will contribute to the prevention of cancer.

We present 3 patients with transient global amnesia (TGA). Patient 1 was a 67-year-old man who had developed TGA 5 years ago. He showed sudden onset amnesia immediately after he quarreled with his wife loudly during driving. Three-Tesla (3T) diffusion-weighted magnetic resonance imaging (DWI) taken 18 hours after onset revealed a small hyperintense signal area in the right CA1 subfield of the hippocampus. Patient 2 was a 66-year-old woman who showed sudden onset amnesia immediately after she walked for about 20 minutes holding a heavy luggage with her arms. 3T DWI taken 64 hours after onset revealed a small hyperintense signal area in the left CA1 subfield of the hippocampus. Patient 3 was a 68-year-old woman who showed sudden onset amnesia immediately after she hurriedly cleaned up her house with a cleaner. 3T DWI taken 48 hours after onset revealed small hyperintense signal areas in the left CA1 subfield and the right subiculum proper of the hippocampus. She developed TGA recurrence 6 months after the first episode of TGA. All these 3 patients had no cardiovascular diseases. Their amnesia resolved within 5-6 hours. Magnetic resonance venography (MRV) revealed hypoplasia of the left transverse sinus in Patient 1 and Patient 3, and aplasia of the left transverse sinus in Patient 2. Ultrasound studies revealed a retrograde flow component of internal jugular vein during Valsalva maneuver in Patient 2. We speculate that an increased venous pressure might have precipitated cerebral venous ischemia in the hippocampus, which is most vulnerable to ischemic insults.

We report diffusion-weighted magnetic resonance imagings (DWI) at the acute stage of two patients with spectacular shrinking deficit (SSD) due to cardioembolic stroke. Patient 1 was a 74-year-old woman with atrial fibrillation (Af) who had been admitted for acute cholecystitis. She abruptly developed consciousness disturbance, global aphasia and right hemiparesis. Her neurological symptoms rapidly improved 30 minutes after onset, and completely disappeared in four hours. Patient 2 was a 84-year-old woman with Af who had been on medication of warfarin potassium for three years. She abruptly developed consciousness disturbance and left hemiplegia. Her neurological symptoms rapidly improved 90 minutes after onset, and almost completely disappeared in ten hours. Their conditions were consistent with SSD in acute cardioembolic stroke. DWI of Patient 1 taken 27 hours after onset showed hyperintense signal areas in the insular and temporal cortices of the left middle cerebral artery territory, and in the parietal cortex corresponding to the border zone between the territories of the left middle cerebral artery and posterior cerebral artery. DWI of Patient 2 taken 39 hours after onset showed hyperintense signal areas in the insular and frontal cortices of the right middle cerebral artery territory, and in the parietal cortex corresponding to the border zone between the territories of the right middle cerebral artery and posterior cerebral artery. They indicated multifocal ischemic injuries at the acute stage. The T2-weighted MRI of Patient 2 showed a slight hyperintense signal area only in the right parietal cortex, but the fluid-attenuated inversion recovery (FLAIR) in both patients showed no abnormal signals in the corresponding areas. To our knowledge, ischemic lesions in DWI of SSD at the acute stage after rapid recovery have not been reported previously. DWI is useful in SSD for detecting ischemic injuries of cardioembolic origin at the early stage.

Objective: To investigate the correlation of the cognitive function and the duration of the illness with the regional cerebral blood flow (rCBF) in patients with Parkinson's disease (PD), by means of an objective diagnostic index of brain imaging, stereotactic extraction estimation (SEE) of 123I-IMP SPECT., Patients and Methods: We examined 123I-IMP SPECT in 24 patients with PD (age = 71.79 +/- 5.18 years; the Mini-Mental State Examination: MMSE score = 21.46 +/- 7.62 points; the duration of the illness = 6.63 +/- 3.91 years; Yahr scale = 3.29 +/- 0.74). A contrast database was created by averaging extracted database sets of the contrast group (numbers = 14 cases; age = 74.64 +/- 5.99 years, the MMSE score > or = 29 points). We applied SEE for Z-score images of three-dimensional stereotactic surface projection analysis (3D-SSP) for 123I-IMP SPECT, and calculated Z*extent ratio by taking advantage of severity of Z-score (the mean value) with extent ratio (%) in the frontal, occipital, temporal, parietal and posterior cingulate cortices, and precuneus, respectively. We investigated the correlation coefficient between the MMSE score and Z*extent ratio, and between the duration of the illness and Z*extent ratio in the six regions. In addition, we compared Z*extent ratio in the six regions between the non-demented group (numbers = 12 patients; MMSE > or = 24 points) and the demented group (numbers =12 patients; E score < or = 23 points)., Results: There were negative correlations between the MMSE score and Z*extent ratio in the temporal (p < 0.05) and posterior cingulate cortices (p < 0.05), and positive correlations between the duration of the illness and Z*extent ratio in the frontal (p < 0.01), temporal (p < 0.01), parietal (p < 0.05) and posterior cingulate cortices (p < 0.01). Z*extent ratio was significantly high only in the posterior cingulate cortex(p < 0.05) in the demented group., Conclusions: SEE for Z-score images of 3D-SSP revealed a close relationship between the decline of the MMSE score and the duration of the illness, and the perfusion reduction of the posterior cingulate cortex in patients with PD. These findings suggest that the perfusion reduction of the posterior cingulate cortex reflects the decline of cognitive impairment of patients with PD.

Recent progress in molecular biology and genetics has improved understanding of the mechanisms of carcinogenesis. However, there are few effective methods for prevention or therapies against cancer based on such elucidated molecular mechanisms of carcinogenesis. We therefore tried to develop novel methods of cancer prevention and therapy based on them. For example, the tumor-suppressor gene p53 is mutated in about 50% of human malignancies or in a cancer-prone family with Li-Fraumeni syndrome. It is known that p53 stimulates the promoter activities of p21/WAF1, gadd45 and bax genes to enhance their expression as a transcriptional factor, resulting in cell cycle arrest, DNA repair and apoptosis, respectively. Therefore, chemical compounds or food factors that can stimulate these genes might compensate for part of the p53 function. As a model of our hypothesis, we found that histone deacetylase inhibitors such as butyrate and trichostatin A dramatically stimulate the p21/WAF1 gene promoter through the Sp1 sites, resulting in cell cycle arrest. We therefore hypothesized that a strategy for up-regulating p53-target genes such as p21/WAF1, gadd45 and bax might be useful for cancer prevention or therapy, and termed this method "Gene-regulating chemoprevention" or "Gene-regulating chemotherapy" against cancer. In fact, butyrate, a short chain fatty acid, exists in colon lumen as a metabolite of dietary fiber, and is believed to be preventive against colon cancer. In conclusion, we proposed that "Gene-regulating chemoprevention" and "Gene-regulating chemotherapy" may be new promising strategies for cancer prevention or therapy, and histone deacetylase inhibitors are good candidates for these strategies. "Gene-regulating chemoprevention" is a particularly suitable model for "Molecular-targeting prevention", which we have proposed recently. We believe that "Molecular-targeting prevention" will become one of the most important concepts in the 21st century for general prevention of a variety of common hereditary or non-hereditary common diseases.

We investigated the regional cerebral blood flow (rCBF) in 8 patients with Parkinson disease (PD) with cognitive impairment (age; 64-82 years, Mini-Mental State Examination score = MMSE score; 22-6 points, Yahr stage; III-V), with the standard transaxial images and the Z-score images using the three-dimensional stereotactic surface projections (3D-SSP) of 123I-IMP SPECT. A contrast database was created by averaging extracted database sets of the contrast group (numbers; 14 cases, age; 64-82 years, MMSE score; > or = 29 points). The regions of the perfusion reduction shown on the standard transaxial images were similarly demonstrated on the Z-score images in 6 of the 8 patients, and only the Z-score images demonstrated definite regions of perfusion reduction in remaining 2 patients. Both the standard transaxial and Z-score images demonstrated the perfusion reduction in the temporo-parietal regions in all of the patients, and the Z-score images but not the standard transaxial ones detected the reduction in the posterior cingulate gyrus and precuneus in 3 patients. 3D-SSP images of 123I-IMP SPECT are thus more sensitive in detecting rCBF of the medial aspect of the parietal cortex than the standard transaxial images, and can be used as a diagnostic tool to objectively evaluate the cognitive function of PD patients.

In multi-slice CT, the scanning center of each line multiple-row detector array is shifted in the Y-axis direction by the tilting of the gantry. Correction of this effect is necessary when CT images are reconstructed. Correction of table feed is necessary as well. These corrections are possible with the Somatom Plus4 Volume Zoom. The use of multi-planar reconstruction (MPR) images has been increasing rapidly in the area of clinical diagnosis. Therefore, we examined the influence of MPR images according to gantry tilt. For each gantry tilt, the spatial resolution of MPR images was almost the same even though scanning pitch was changed. When the gantry was tilted, the full width at half maximum (FWHM) of the section sensitivity profile (SSP) was about 10% to 20% wider than that when the gantry was not tilted. The spatial resolution of MPR images is more affected by whether or not the gantry is tilted than by the angle of tilt. Gantry tilt correction is useful to obtain images without artifact for metal and artificial teeth; however, deterioration in spiral resolution cannot be avoided.