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A 52-year-old woman complained of upper respiratory symptoms and subsequently developed Wallenberg syndrome. Chest CT and brain MRI revealed multiple nodular lesions in the lungs and brain. She was pathologically diagnosed with low-grade lymphomatoid granulomatosis by lung biopsy. Brain PET examinations using 11C-methionine, 18F-FDG, and 18F-THK5351 were performed. Uptake of 11C-methionine and 18F-FDG was slightly increased in some lesions, likely reflecting the degree of inflammatory cell infiltration. 18F-THK5351 uptake was significantly increased in all lesions, likely reflecting the degree of reactive astrogliosis. This case illustrates the utility of PET studies for diagnosing lymphomatoid granulomatosis and provides insight into its pathophysiology.

Voxel-based morphometry (VBM) analysis of nuclear Magnetic Resonance Imaging (MRI) data allows the identification of medial temporal lobe (MTL) atrophy and is widely used to assist the diagnosis of Alzheimer’s disease (AD). However, its reliability in the clinical environment has not yet been confirmed. To determine the credibility of VBM, amyloid positron emission tomography (PET) and VBM studies were compared retrospectively. Patients who underwent Pittsburgh Compound B (PiB) PET were retrospectively recruited. Ninety-seven patients were found to be amyloid negative and 116 were amyloid positive. MTL atrophy in the PiB positive group, as quantified by thin sliced 3D MRI and VBM software, was significantly more severe (p =0.0039) than in the PiB negative group. However, data histogram showed a vast overlap between the two groups. The area under the ROC curve (AUC) was 0.646. MMSE scores of patients in the amyloid negative and positive groups were also significantly different (p = 0.0028), and the AUC was 0.672. Thus, MTL atrophy could not reliably differentiate between amyloid positive and negative patients in a clinical setting, possibly due to the wide array of dementia-type diseases that exist other than AD.

Aims/Introduction Older adults with diabetes mellitus are susceptible to sarcopenia. Diffusion tensor imaging studies have also shown that patients with diabetes have altered white matter integrity. However, the relationship between these structural changes in white matter and sarcopenia remains poorly understood. Materials and Methods The study included 284 older patients (aged ≥65 years) who visited the Tokyo Metropolitan Geriatric Hospital Frailty Clinic. We used diffusion tensor imaging to measure fractional anisotropy (FA) and mean diffusivity (MD) to evaluate changes in white matter integrity. We investigated the associations between sarcopenia, or its diagnostic components, and FA or MD in seven white matter tracts considered to be associated with sarcopenia according to the patients’ diabetes status. Results We found significantly low FA or high MD values in the bilateral anterior thalamic radiations (ATR) and right inferior fronto‐occipital fasciculus (IFOF) of patients with Asian Working Group for Sarcopenia 2019‐defined sarcopenia, in all patients and those with diabetes. Using binominal regression analyses, we associated low FA values in the left ATR and right IFOF with sarcopenia in all patients and those with diabetes, after adjusting for age, gender, HbA1c, blood pressure, cognitive function, physical activity, depression, nutritional status, and inflammation. Conclusions White matter alterations in left ATR and right IFOF are associated with the prevalence of sarcopenia in patients with diabetes. Specific changes to the left ATR and right IFOF tracts could play critical roles in the occurrence of sarcopenia in patients with diabetes., Older adults with diabetes mellitus are susceptible to sarcopenia and altered white matter integrity. Using diffusion tensor imaging technique, we found alterations in left anterior thalamic radiation and right inferior fronto‐occipital fasciculus are associated with sarcopenia in patients with diabetes.

White matter abnormalities may reflect cerebral microvessel disease. Diffusion tensor imaging (DTI) can help detect early changes in white matter integrity in each tract. However, studies investigating the relationship between subclinical atherosclerosis markers and white matter alterations in DTI findings are limited. This study aimed to examine associations between cardiovascular risk factors and indices of subclinical atherosclerosis—ankle brachial index (ABI), brachial-ankle pulse wave velocity (baPWV), and carotid artery intima-media thickness (IMT)—and altered white matter integrity in older patients. A total of 224 patients (aged ≥65 years) with cardiometabolic disease who underwent magnetic resonance imaging (MRI) and either plethysmography or cervical ultrasound at the start of the 3-year observational study period were included in this study. We measured fractional anisotropy (FA) and mean diffusivity (MD), which are indices of white matter integrity in seven white matter tracts. In a univariate analysis, lower ABI and higher baPWV values were associated with FA or MD abnormalities in several tracts, whereas IMT was scarcely associated with such change. In addition, high blood pressure and glycoalbumin/glycohemoglobin ratio (GA/HbA1c) and low body mass index (BMI) and triglyceride (TG) levels were associated with FA or MD abnormalities. In a multivariate analysis adjusted for age, sex, BMI, diastolic blood pressure, TG, and GA/HbA1c, the associations between ABI and FA or MD remained in all of either side of the following tracts: anterior thalamic radiation, forceps minor, inferior frontooccipital fasciculus (p < 0.001 for all) and superior longitudinal fasciculus (SLF; p < 0.05), whereas most of those between baPWV and FA or MD disappeared except for SLF (p < 0.05). These results indicate that low ABI could be an indicator of white matter abnormalities.

Two patients with different amyotrophic lateral sclerosis (ALS) phenotypes underwent 18F-THK5351 PET to visualize lesions undergoing astrogliosis by measuring monoamine oxidase B activity. Patient 1 was a 57-year-old man with flail leg syndrome. Elevated uptake was observed inside the motor cortex, corresponding to the leg area in a cortical homunculus. Patient 2 was a 64-year-old man with ALS-frontotemporal dementia semantic variant. Elevated uptake was observed around the left anterior temporal lobe. Both core lesions were consistent with their respective neurological features. Hence, 18F-THK5351 PET is a useful technique to assess ALS pathophysiology by visualizing the core lesions.

AIM Gait impairment implies subtle cognitive impairment (CI) and is associated with severity of white matter hyperintensities (WMHs). However, cognitive differences in such an association are not yet fully understood. This study examined the association between WMHs and gait performance among three cognitively different older groups. METHODS Gait performance and WMHs were assessed in 150 community-dwelling older adults, comprising 53 with CI (Mini-Mental State Examination [MMSE] score

Objective To evaluate the imaging characteristics and diagnostic utility of the “Dinosaur tail sign” in the diagnosis of cerebrospinal fluid (CSF) leakage. Background The authors propose the “Dinosaur tail sign,” defined as a combination of the dorsal epidural hyperintensities, fat tissue, spinal cord, and cauda equine on lumbosacral sagittal fat-suppressed T2-weighted image (FST2WI), as a sensitive indicator for diagnosing CSF leakage. Methods Imaging characteristics of the “Dinosaur tail sign” was evaluated in seven spontaneous intracranial hypotension (SIH) and 23 iatrogenic CSF leakage (ICSFL) patients. Additionally, the diagnostic index was compared between the “Dinosaur tail sign” and other previously reported useful magnetic resonance imaging (MRI) and magnetic resonance myelography (MRM) findings. Results In contrast to other imaging findings including the epidural expansion, floating dural sac sign, and distension of the spinal epidural veins on MRI, and paraspinal fluid collections (PFC) on MRM, the “Dinosaur tail sign” was found equally in both SIH and ICSFL patients (6 SIH and 19 ICSFL; 83% of all patients with CSF leakage). The “Dinosaur tail sign” showed sufficient diagnostic utility (sensitivity 83%, specificity 94%, accuracy 89%) that was comparable to that of PFC. Conclusion The “Dinosaur tail sign” is a useful imaging finding suggestive of CSF leakage. Evaluation of subtle interspinous arched hyperintensities on spinal MRI is mandatory for the diagnosis of SIH and ICSFL.

This short report clarifies the heterogeneity of structural magnetic resonance imaging (MRI) findings in seven demented patients due to pathologically accumulated TAR DNA-binding protein-43 (TDP-43) protein using visual analyses including visual rating scales (i.e., global cortical atrophy and medial temporal atrophy scales). In addition to the well-known frontotemporal lobar atrophy, structural MRI has revealed multifaceted imaging findings including asymmetric atrophy of the frontoparietal lobe and cerebral peduncle, midbrain atrophy, and localized or diffuse white matter T2 hyperintensity. Understanding of these multifaceted neuroimaging findings is important for the precise antemortem diagnosis of TDP-43 proteinopathy.

Adult-onset neuronal intranuclear inclusion disease (NIID) is a rare neurodegenerative disorder described mainly in the Japanese population, with characteristic DWI abnormalities at the junction between gray and white matter. We identify possible cases of NIID in the picture archive and communication system (PACS) of a tertiary neurological referral hospital in Singapore and describe their radiological features. The neuroradiology imaging database was reviewed using keyword search of radiological reports to identify patients who had “subcortical U fibre” abnormalities on DWI. MRI were retrospectively reviewed, and those fulfilling inclusion criteria were invited for skin biopsy to detect nuclear inclusions by light and electron microscopy. Twelve Chinese patients (nine female; median age 70.5 years) were enrolled. Seven patients were being assessed for dementia and five for other neurological indications. In all patients, DWI showed distinctive subcortical high signal with increased average apparent diffusion coefficient (ADC), involving frontal, parietal, and temporal more than occipital lobes; the corpus callosum and external capsule were affected in some patients. On T2-weighted images, cerebral and cerebellar atrophy and white matter hyperintensity of Fazekas grade 2 and above were seen in all patients. Three patients underwent skin biopsy; all were positive for intranuclear hyaline inclusion bodies on either p62 staining or electron microscopy, which are pathognomonic for NIID. Previously undiagnosed patients with NIID can be identified by searching for abnormalities at the junction between gray and white matter on DWI in PACS and subsequently confirmed by skin biopsy. Radiologists should recognize the distinctive neuroimaging pattern of this dementing disease.

The purpose of this study is to clarify the characteristic structural magnetic resonance imaging (MRI) findings in demented patients with pathologically confirmed argyrophilic grain disease (AGD). Nine pathologically confirmed AGD patients with cerebral three-dimensional T1-weighted MRI were evaluated in this study. In addition to visual rating scales of atrophic and asymmetric changes in the limbic and temporal lobes, voxel-based morphometry (VBM) was performed to assess group difference between pathologically confirmed AGD and Alzheimer’s disease (AD) patients. On visual analyses of AGD patients, the medial temporal, anterior temporal, and posterior temporal atrophy scores were 3.3 ± 0.7, 1.7 ± 0.5, and 1.0 ± 0.7, respectively. Asymmetric scores of the hippocampus and parahippocampal gyrus, amygdala and ambient gyrus, anterior temporal, and posterior temporal lobes were rated as 1.1 ± 0.7, 1.6 ± 0.5, 1.3 ± 0.8, and 0.4 ± 0.7, respectively. In spite of no statistical differences in atrophic scores, AGD patients showed the higher score and proportion of anterior temporal asymmetric score than AD (p = 0.03 and 0.02). Compared with controls, VBM analysis revealed left dominant asymmetric atrophy predominantly in the limbic and anterior temporal lobe in AGD patients. By contrast, there was no significant gray matter reduction between AGD and AD patients. Asymmetric atrophy relatively localized to the anterior temporal and limbic lobes including the amygdala and ambient gyrus is a characteristic MRI finding of AGD. For the precise antemortem diagnosis, especially to differentiation from AD, it is important to pay attention to this asymmetric change.

Purpose Various magnetic resonance imaging (MRI) techniques including T2*-weighted imaging, susceptibility-weighted imaging, and MR relaxometry had been performed to evaluate different patterns of brain iron depositions in Parkinsonian syndrome. The aim of the present study was to evaluate the diagnostic value of a volume of interest (VOI) analysis on the principles of echo shifting with a train of observations (PRESTO) imaging using the statistical parametric mapping (SPM) 8 and the WFU PickAtlas program for the diagnosis of Parkinsonian syndrome.,Methods: Fifty subjects, including 13 with the Parkinsonian variant of multiple system atrophy (MSA-P), 12 with progressive supranuclear palsy (PSP), 12 with Parkinson's disease (PD) and 13 controls were evaluated in this study. After the spatial normalization of PRESTO images on SPM8, the WFU PickAtlas program was performed to create target VOIs in the putamen, red nucleus, substantia nigra, subthalamic nucleus, and dentate nucleus. The signal intensity ratio (SIR) was calculated by normalizing the signal of each VOI to that of the cerebrospinal fluid space. These SIRs were used as determinants in receiver operating characteristic (ROC) analyses. Results SIR of the putamen was significantly lower in MSA-P than in PSP (P = 0.0051) and controls (P = 0.0004). In contrast, SIR of the red nucleus was significantly lower in PSP than in MSA-P (P = 0.0003), PD (P = 0.0029), and controls (P = 0.0011). In ROC analyses, SIR of the putamen exhibited the highest areas under the curves (AUCs) of 0.83 (vs. PSP) and 0.91 (vs. controls) in the diagnosis of MSA-P. On the other hand, SIR of the red nucleus exhibited the highest AUCs of 0.87 (vs. MSA-P), 0.90 (vs. PD), and 0.89 (vs. controls) in the diagnosis of PSP. Conclusions The VOI analysis based on spatially normalized PRESTO images may be useful for depicting hypointensity, indicative of abnormal iron depositions, of the putamen and red nucleus in the diagnosis of MSA-P and PSP.

Magnetic resonance imaging (MRI) is a non-invasive and useful imaging modality with a high contrast resolution to diagnose craniocervical artery dissections. However, to avoid misinterpretations and misdiagnosis, it is mandatory to understand not only the pathological condition of craniocervical artery dissection, but also the principles of MRI techniques. In this manuscript, the details of MRI findings, especially when using high-resolution vessel wall imaging, are discussed.

The remarkable progress of imaging diagnostic technology has nearly reached the point of determining the causative agent of neurodegenerative diseases, and it is becoming possible to capture detailed images that can reflect macro pathology. However, images are just images. In order to accomplish accurate image diagnosis in accordance with the chief complaint encountered in clinical practice, we must leave the chief complaint as the chief complaint, reevaluate the image on its own merits, and approach the disease condition from this new perspective. In this special feature, I would like to select the appropriate image examination based on the chief complaint of each patient, and furthermore to make use the imaging diagnostic technology to approach the disease condition, from the perspective of the experts of the neuroradiology whom I admire from the bottom of my heart.

Background It has recently become clear that glaucoma is not only an ocular disease, but involves central visual pathways as well. The purpose of this study was to examine functional and structural alterations in the brains of glaucoma patients. Design Case–control study in a hospital. Participants A total of 32 glaucoma patients and 19 healthy controls. Methods All participants underwent positron emission tomography with 18F-fluorodeoxyglucose, diffusion-tensor magnetic resonance imaging, and the 30-2 program of the Humphrey Visual Field Analyzer. Main Outcome Measures Fractional anisotropy values of the optic radiation were compared between the two groups by defining regions of interests. Cerebral glucose metabolism was compared using statistical parametric mapping software. The correlation coefficients were calculated between the average of the total deviation of hemivisual fields of both eyes, fractional anisotropy values of the contralateral optic radiation and glucose metabolism in the contralateral striate cortex. Results Fractional anisotropy values in the bilateral optic radiations were significantly lower in patients with glaucoma. A significant glucose hypometabolism in the bilateral striate cortex was also observed in the glaucoma group. Regression analyses for glaucoma patients demonstrated that the average of the total deviation of hemivisual fields significantly correlated with both fractional anisotropy value of the contralateral optic radiation and glucose metabolism in the contralateral striate cortex. Moreover, there were significant correlations between fractional anisotropy values of the optic radiation and ipsilateral striatal glucose metabolism. Conclusion We observed structural alterations in the bilateral optic radiations and glucose hypometabolism in the bilateral striate cortex of glaucoma patients.

Purpose To evaluate alteration of the optic radiation (OR) in patients with retinitis pigmentosa (RP) using fractional anisotropy (FA) measured by diffusion tensor MRI. Methods We performed MRI and evaluated alteration of the ORs in 17 patients with RP and 27 healthy controls. Regions of interest were placed over the bilateral anterior and posterior areas of the ORs, and we measured the FA value of each region. Visual field (VF) tests were examined in all subjects, and we corrected the residual VF area according to the projection area to the striate cortex. Differences between the FA values of patients and healthy controls were tested. We performed regression analyses between the sum of the corrected VF areas and FA values in the anterior or posterior contralateral ORs in patients with RP. Moreover, we performed regression analyses between the average of FA values of ORs and the average of both eyes of visual acuity in patients with RP. Results FA values of the bilateral anterior and posterior ORs were lower in patients with RP (anterior right, p=0.012; posterior right, p=0.0004; anterior left, p=0.0008; and posterior left, p=0.0004) compared with those of healthy controls. In patients with RP, significant correlations were observed between average FA values of anterior ORs and average visual acuity (correlation coefficient (r)=−0.54; p=0.025). Conclusions In patients with RP, alterations may occur not only in the retina but also in the brain.

Purpose Diagnosing corticobasal degeneration (CBD) and progressive supranuclear palsy (PSP) is often difficult due to the wide variety of symptoms and overlaps in the similar clinical courses and neurological findings. The purpose of this study was to evaluate the utility of white matter (WM) atrophy for the diagnosis of patients with clinically diagnosed CBD (corticobasal syndrome, CBS) and PSP (Richardson’s syndrome, RS). Methods We randomly divided the 3D T1-weighted MR images of 18 CBS patients, 33 RS patients, and 32 age-matched controls into two groups. We obtained segmented WM images in the first group using Voxel-based specific regional analysis system for Alzheimer’s disease (VSRAD) based on statistical parametric mapping (SPM) 8 plus diffeomorphic anatomical registration through exponentiated Lie algebra. A target volume of interest (VOI) for disease-specific atrophy was subsequently determined in this group using SPM8 group analyses of WM atrophy between patients groups and controls. We then evaluated the utility of these VOIs for diagnosing CBS and RS patients in the second group. Z score values in these VOIs were used as the determinant in receiver operating characteristic (ROC) analyses. Results Specific target VOIs were determined in the bilateral frontal subcortical WM for CBS and in the midbrain tegmentum for RS. In ROC analyses, the target VOIs of CBS and RS compared to those of controls exhibited an area under curve (AUC) of 0.99 and 0.84, respectively, which indicated an adequate diagnostic power. The VOI of CBS revealed a higher AUC than that of RS for differentiating between CBS and RS (AUC, 0.75 vs 0.53). Conclusions Bilateral frontal WM volume reduction demonstrated a higher power for differentiating CBS from RS. This VOI analysis is useful for clinically diagnosing CBS and RS., Highlights ・We evaluate the utility of white matter (WM) atrophy for the diagnosis of patients with corticobasal syndrome (CBS) and Richardson’s syndrome (RS). ・We obtained segmented WM images using Voxel-based specific regional analysis system for Alzheimer’ s disease based on statistical parametric mapping 8 plus diffeomorphic anatomical registration through exponentiated Lie algebra. ・The most significant areas of atrophy observed in CBS patients compared to the controls were in the bilateral frontal subcortical WM. ・The most significant areas of atrophy observed in RS patients compared to the controls were in the midbrain. ・The volume of interest analysis using bilateral frontal WM volume reduction demonstrated a higher power for differentiating CBS from RS.

Aims Although evidence has accumulated that white matter hyperintensity (WMH) is associated with the deterioration of cognitive function and impairment of activities of daily living (ADL), the clinical relevance of WMH in elderly patients with diabetes mellitus is not still clear. The aim of this study was to examine whether WMH volume is associated with ADL and cognitive function and whether glucose control and glucose variability can affect WMH volume in these patients. Methods This cross-sectional study investigated the associations of WMH with cognitive function and instrumental ADL (IADL), as well as metabolic and vascular risk factors in a total of 178 elderly patients with diabetes. The study assessed WMH volumes and the functional status of cognition and IADL. WMH volumes were evaluated by obtaining axial T2-weighted and fluid-attenuated inversion recovery sequence images on brain magnetic resonance imaging and assessing the images using Software for Neuro-Image Processing in Experimental Research. Results We found a significant association between WMH volumes and Mini-Mental State Examination (MMSE) scores (p = 0.039) and between WMH and IADL status (p = 0.006). Furthermore, we found significant relations of large WMH volumes with a high glycoalbumin/glycohemoglobin ratio (GA/HbA1c) (p < 0.001). Large WMH volumes were also found to be associated with a low body mass index (p = 0.014) and a low diastolic blood pressure (p = 0.024), but not with HbA1c. Multiple regression analysis showed that high GA/HbA1c, which reflects high glucose variability, was a significant determining factor for large WMH volumes. We also found that GA/HbA1c was negatively associated with both MMSE (p = 0.036) and IADL (p < 0.001). Conclusions GA/HbA1c, which is a marker of glucose variability, was independently associated with WMH volumes, which could lead to the decline of cognition and IADL in elderly patients with diabetes mellitus.

The role of neuroradiologists in the diagnosis of dementia is to identify the wide range of disorders causing dementia through diagnostic imaging in patients clinically exhibiting cognitive impairments, and provide information that directly contributes to their treatment, care, and nursing to clinical workers. The diseases included in dementia are diverse and include degenerative dementia, cerebrovascular dementia, idiopathic normal pressure hydrocephalus, metabolic disorders, poisoning, encephalitis, and encephalopathy, and the diagnostic process markedly differs according to the disease. It is important to diagnose diseases that can be cured and to evaluate images independently of the clinical diagnosis. Images need to be evaluated from multiple viewpoints by taking clinical information from the patient, physicians at clinical departments, local doctors, nurses, care staff, and family as well as information obtained by multiple modalities into consideration.

We herein report that the clinical, laboratory, and radiographic features and positron emission tomography (PET) imaging may provide valuable clues to the pathogenesis of cerebral amyloid angiopathy (CAA)-associated encephalopathy, which currently remains unclear. We herein describe two cases of encephalopathy with CAA, with an emphasis on PET imaging with (11)C-Pittsburgh compound B ((11)C-PiB) and (18)F-fluorodeoxyglucose ((18)F-FDG). One case of Alzheimer's disease for which a brain biopsy was performed showed CAA-related inflammation. Another case that had developed sudden sensory aphasia presented with posterior reversible encephalopathy syndrome-like vasogenic edema in the left temporal region with (11)C-PiB uptake and microhemorrhages. (11)C-PiB and (18)F-FDG PET are useful for detecting CAA-associated encephalopathy, including atypical CAA cases.

We evaluated optic radiation (OR) damage in patients with glaucoma by using fractional anisotropy (FA) of diffusion-tensor magnetic resonance imaging. We studied 29 patients with glaucoma and 19 healthy controls. Regions of interest were placed over the bilateral anterior and posterior ORs on the FA maps, and the FA value of each region was measured. FA values of the bilateral anterior and posterior ORs were significantly lower in patients with glaucoma (anterior right, P = 0.0002; anterior left, P = 0.00028; posterior right, P = 0.0004; and posterior left, P = 0.0001) than in the healthy controls. In glaucoma patients, significant correlations were observed between the FA values and the average of the total deviation of the contralateral hemifields of both eyes (left hemifield and anterior right OR, correlation coefficient [r] = 0.46 [P = 0.013]; right hemifield and anterior left OR, r = 0.43 [P = 0.021]; left hemifield and posterior right OR, r = 0.54 [P = 0.0027]; and right hemifield and posterior left OR, r = 0.46 [P = 0.012]). FA values of the entire OR were decreased in glaucoma patients and correlated with the degree of visual field defect.

Recently, it has been recognized that pathologically proven progressive supranuclear palsy (PSP) cases are classified into various clinical subtypes with non-uniform symptoms and imaging findings. This article reviews essential imaging findings, general information, and advanced magnetic resonance imaging (MRI) techniques for PSP and presents these MRI findings of pathologically proven typical and atypical PSP cases for educational purposes. With the review of literatures, notably including atypical pathologically proven PSP cases, MRI and clinical information of 15 pathologically proven typical and atypical PSP cases were retrospectively evaluated. In addition to typical symptoms, PSP patients can exhibit atypical symptoms including levodopa-responsive parkinsonism, pure akinesia, non-fluent aphasia, corticobasal syndrome, and predominant cerebellar ataxia. As well as clinical symptoms, the degree of midbrain atrophy, a well-known imaging hallmark, is not consistent in atypical PSP cases. This fact has important implications for the limitation of midbrain atrophy as a diagnostic imaging biomarker of PSP pathology. Additional evaluation of other imaging findings including various regional atrophies of the globus pallidus, frontal lobe, cerebral peduncle, and superior cerebellar peduncle is essential for the diagnosis of atypical PSP cases. It is necessary for radiologists to recognize the wide clinical and radiological spectra of typical and atypical PSP cases.

Aim: The Montreal Cognitive Assessment (MoCA), developed by Dr Nasreddine (Nasreddine et al. 2005), is a brief cognitive screening tool for detecting older people with mild cognitive impairment (MCI). We examined the reliability and validity of the Japanese version of the MoCA (MoCA-J) in older Japanese subjects. Methods: Subjects were recruited from the outpatient memory clinic of Tokyo Metropolitan Geriatric Hospital or community-based medical health check-ups in 2008. The MoCA-J, the Mini-Mental State Examination (MMSE), the revised version of Hasegawa's Dementia Scale (HDS-R), Clinical Dementia Rating (CDR) scale, and routine neuropsychological batteries were conducted on 96 older subjects. Mild Alzheimer's disease (AD) was found in 30 subjects and MCI in 30, with 36 normal controls. Results: The Cronbach's alpha of MoCA-J as an index of internal consistency was 0.74. The test–retest reliability of MoCA, using intraclass correlation coefficient between the scores at baseline survey and follow-up survey 8 weeks later was 0.88 (P

BACKGROUND AND PURPOSE: The clinical diagnosis of corticobasal degeneration (CBD) is often difficult due to varied clinical manifestations. In 4 patients with neuropathologically confirmed CBD, characteristic imaging findings and correlations with neuropathologic features were evaluated. Furthermore, imaging findings in CBD were compared with neuropathologically confirmed progressive supranuclear palsy (PSP) for a differential diagnosis. MATERIALS AND METHODS: Four patients with neuropathologically confirmed CBD were studied. We evaluated the area of the tegmentum in the midsagittal plane, subcortical white matter (SCWM) abnormality, asymmetric cerebral atrophy, and signal-intensity abnormality in the subthalamic nuclei on MR imaging and compared them with histopathologic findings. Then, MR imaging findings in CBD were compared with those in 13 patients with PSP. RESULTS: On MR imaging, 3 patients had asymmetric cerebral atrophy extending to the central sulcus. On midsagittal sections, the mean midbrain tegmentum area was 66 mm 2 , being markedly smaller than normal, but there was no significant difference between PSP and CBD. All patients had signal-intensity abnormalities of the SCWM, constituting primary degeneration neuropathologically; however, no diffuse signal-intensity abnormality in the SCWM existed in the 13 patients with PSP. In 3 patients, T1-weighted images showed symmetric high signal intensity in the subthalamic nuclei. Neuropathologically, these areas showed characteristic CBD. MR imaging signal-intensity changes also existed in 4 patients with PSP; however, subthalamic nucleus degeneration was more severe in PSP than in CBD. CONCLUSIONS: In cases with midbrain tegmentum atrophy and signal-intensity changes in the subthalamic nuclei, the differential diagnosis distinguishing CBD from PSP based on MR imaging alone was difficult. White matter lesions and asymmetric atrophy can be useful for a differential diagnosis.

Background and Objective Narrow-band ultraviolet-B light (NBUVB) (313 nm) is known to have anti-proliferative effects, implying a potential treatment for intimal hyperplasia, but it remains to be ascertained. We assessed the effects of NBUVB irradiation for prevention of intimal hyperplasia. Study Design/Materials and Methods The rat carotid arteries were irradiated with NBUVB after balloon injury (BI), and the degree of intimal hyperplasia was histopathologically assessed. The anti-proliferative effects using cultured human smooth muscle cells were evaluated by flow cytometry and immunoblot analysis. Results NBUVB (0.3–4.5 J/cm2) irradiation immediately after BI reduced the degree of intimal hyperplasia at 14 and 28 days after BI (P

An octogenarian with Lewy body dementia presented to our hospital in cardiac arrest and was successfully resuscitated. Although he had abdominal pain the previous day, small bowel wall oedema and ascites were the only abnormalities noted on abdominal CT. Despite treatment with catecholamines and antimicrobials, he died of recurrent cardiopulmonary arrest later the same day. An autopsy showed that the patient's death was the result of a small bowel perforation caused by accidental ingestion of a press-through package (PTP). Precautions regarding PTP use and improved packaging design are necessary to prevent PTP ingestion, especially in elderly patients with dementia.

OBJECTIVES We evaluated factors associated with increased radiation exposure dose in nursing staff who assisted patients with (18)F-fluorodeoxyglucose ((18)F-FDG) positron emission tomography (PET)/computed tomography (CT) examinations. METHODS The Barthel Index and Mini-Mental State Examination (MMSE) score were obtained before PET/CT examinations in 193 patients (mean age ± SD, 77.7 ± 8.0 yr). Three nurses self-measured their radiation exposure dose while assisting patients during each PET examination. Disturbance factors during PET examinations (use of a stretcher or wheelchair, use of lines or tubes connected to the patient, use of diapers or urethral catheterization, patient age), (18)F-FDG injection dose, and previous PET/CT experience in the patients and outpatient or inpatient status were evaluated as factors possibly associated with increased radiation exposure. Principle component analysis, univariate analysis, and multivariate regression analysis were used for assessing associations between radiation exposure dose and factors. RESULTS The mean radiation exposure dose of the nursing staff was 6.07 ± 5.71 µSv per examination. Statistically significant factors associated with increased radiation exposure (

Magnetic resonance diffusion tensor imaging (DTI) is a noninvasive technique that can identify and quantify white matter tracts by evaluating the diffusion of water in biological tissues. While association fibers are bundles of axons within the brain that unite different parts of the same cerebral hemisphere, projection fibers are bundles of axons that unite the cortex with lower parts of the brain and the spinal cord. The commissural fibers are axon bundles that connect the two hemispheres of the brain. Quantitative analysis of DTI can be roughly classified into three types: region of interest analysis, tract-specific analysis, and fully automated hypothesis free whole brain analysis.

A 20-year-old woman presented unconscious due to hypoglycemia after a self-administered insulin injection. Diffusion-weighted MRI (DWI), performed 5 days after admission, demonstrated heterogeneous high-intensity signal areas in both the cortex and subcortex but sparing the motor and sensory centers. On the 11th day after admission, she began making incomprehensible verbal sounds, eye opening spontaneously and moving her extremities with pyramidal tract signs. Three months later, she had aphasia, agnosia and apraxia but a normal gait without pyramidal tract signs or ataxia. DWI is thus considered useful to predict the functional outcome of patients with severe hypoglycemia.

We report the MRI findings of a 2-year-old boy with recurrent herpes simplex encephalitis (HSE). At the age of 14 months, the patient developed a high fever that lasted over 1 week and he did not receive appropriate treatment. At 6 months after the fever, MRI showed marked atrophic changes in both deep temporal lobes with hyperintensity in the hippocampi and parahippocampal gyri. Thirteen months after the first episode of the fever, the patient was diagnosed with recurrent HSE by polymerase chain reaction assay of the CSF; MRI at this time revealed diffuse cortical swelling. Hyperintensity on T2-weighted images was noted in the occipito-parietal cortex bilaterally, the left thalamus, the subcortical white matter and the splenium of the corpus callosum. Recurrence of HSE may be more common in infants than previously thought. It is important to consider the possibility of recurrent HSE and to understand that MRI findings in HSV1 encephalitis in infants and young children appear to differ from those observed in neonates, older children and adults.

Vascular endothelial growth factor (VEGF) is known to be a mediator of angiogenesis and vascular permeability. A cystic component and haemorrhage are often found in pituitary adenomas. We assessed the VEGF expression based on immunohistochemical examinations in 48 pituitary adenomas. All the adenomas showed some VEGF immunoreactivity mainly in the cytoplasm of tumour cells. Of the 48 adenoma-cases, 16 cases had a strong VEGF immunoreactivity, 26 cases had a moderate one, and 6 cases had a weak one. On the MR images, a cystic component was found in 16 cases (33.3%), and a haemorrhage was found in 18 cases (37.5%). The VEGF immunoreactivity had a significant relationship with the cystic component but not the haemorrhage, size, recurrence, or HE classification. These findings suggest that VEGF plays any potential role in the pathogenesis of cystic formation in pituitary adenomas.

We describe a 67-year-old Japanese man with probable sporadic Creutzfeldt-Jakob disease (CJD) who had valine homozygosity at codon 129, a rarity in the Japanese. T2-weighted magnetic resonance imaging (MRI) detected high-intensity lesions in the bilateral middle cerebellar peduncles and basal ganglia as well as cerebellar and cortical atrophy. He developed cerebellar ataxia and subsequent mental deterioration, myoclonus, and periodic synchronous discharge as shown in an electroencephalogram. Cerebrospinal fluid examination showed a high level of neuron-specific enolase and a positive immunoassay for the 14-3-3 protein. He died of pneumonia 10 months after the initial symptoms appeared. Whether or not the genetic polymorphism increased his susceptibility to sporadic CJD is not clear because valine homozygosity at codon 129 is less than 1% in the normal Japanese population. Although there is no convincing evidence in the present case, the MRI findings of cerebellar peduncle changes, which are rare in CJD, suggest a kind of degeneration, demyelination, or both.

We herein describe the MRI findings in a patient clinically diagnosed with primary Sjögren's syndrome (SjS) initially manifested by retrobulbar optic neuritis. A 63-year-old woman suddenly had left ocular pain and progressive visual disturbance. MR T2-weighted images revealed hyperintensity in the left optic nerve, with swelling. Contrast-enhanced T1-weighted images showed no abnormal enhancement. Follow-up MRI 6 months after admission revealed no significant changes in the affected optic nerve. To our knowledge, optic neuritis as a complication of SjS has been reported in ten patients [1, 2, 3, 4, 5, 6] and MRI findings in only one of them [6]. We thought MR images were useful for visualizing optic nerve involvement in SjS and observing its course.

Two elderly female patients with carotid-cavernous fistulas (CCFs) were treated by transvenous embolization through a transfemoral superior ophthalmic vein approach via the facial vein. Complete occlusion of CCFs was not achieved with this technique exclusively, but the technique was effective in these cases. This technique provides an alternative to other transvenous approaches for the treatment of CCFs.