T1-weighted Brain Magnetic Resonance Research Articles

Measurement of Precuneal and Hippocampal Volumes Using Magnetic Resonance Volumetry in Alzheimer's Disease

Background and PurposeAlzheimer's disease (AD) is associated with structural alterations in the medial temporal lobe (MTL) and functional alterations in the posterior cortical region, especially in the early stages. However, it is unclear what mechanisms underlie these regional discrepancies or whether the posterior cortical hypometabolism reflects disconnection from the MTL lesion or is the result of local pathology. The precuneus, an area of the posteromedial cortex that is involved in the early stages of AD, has recently received a great deal of attention in functional neuroimaging studies. To assess the relationship between the precuneus and hippocampus in AD, we investigated the volumes of these two areas using a magnetic resonance volumetric method.MethodsTwenty-three subjects with AD and 14 healthy age-matched controls underwent T1-weighted three-dimensional volumetric brain magnetic resonance imaging. Volumetric measurements were performed in the precuneus and hippocampus.ResultsCompared to controls, AD patients exhibited a significant reduction in total precuneal volume, which was more prominent on the right side, and significant bilateral reductions in hippocampal volume. No correlation was found between the total volumes of the precuneus and hippocampus in the AD group.ConclusionsThese results suggest that volumetric measurements of both the precuneus and hippocampus are useful radiological indices for the diagnosis of AD. Furthermore, the lack of correlation is attributable to local pathology rather than being a secondary consequence of MTL pathology.

Fast and Accurate Registration Techniques for Affine and Nonrigid Alignment of MR Brain Images

Registration of magnetic resonance brain images is a geometric operation that determines point-wise correspondences between two brains. It remains a difficult task due to the highly convoluted structure of the brain. This paper presents novel methods, Brain Image Registration Tools (BIRT), that can rapidly and accurately register brain images by utilizing the brain structure information estimated from image derivatives. Source and target image spaces are related by affine transformation and non-rigid deformation. The deformation field is modeled by a set of Wendland's radial basis functions hierarchically deployed near the salient brain structures. In general, nonlinear optimization is heavily engaged in the parameter estimation for affine/non-rigid transformation and good initial estimates are thus essential to registration performance. In this work, the affine registration is initialized by a rigid transformation, which can robustly estimate the orientation and position differences of brain images. The parameters of the affine/non-rigid transformation are then hierarchically estimated in a coarse-to-fine manner by maximizing an image similarity measure, the correlation ratio, between the involved images. T1-weighted brain magnetic resonance images were utilized for performance evaluation. Our experimental results using four 3-D image sets demonstrated that BIRT can efficiently align images with high accuracy compared to several other algorithms, and thus is adequate to the applications which apply registration process intensively. Moreover, a voxel-based morphometric study quantitatively indicated that accurate registration can improve both the sensitivity and specificity of the statistical inference results.

Exercise-induced acute kidney injury with reversible posterior leukoencephalopathy syndrome

We report a case of a 17-year-old boy suffering from severe loin pain and oliguric acute kidney injury after strenuous exercise, with slightly elevated serum myoglobin and creatinine phosphokinase. Exercise-induced acute kidney injury (AKI) was diagnosed. We started intermittent hemodialysis thrice a week from the admission day. Four days later, he temporally lost consciousness, followed by visual agnosia and general clonic seizure. T2-weighted brain magnetic resonance images (MRI) showed multiple areas of increased signal intensity in the subcortical white matter, predominantly in the cerebrum of the posterior and parietal lobes and in the cerebellum. Clinical symptoms improved without sequelae. Follow-up MRI 1 month later showed complete resolution of the signals, and he was diagnosed with reversible posterior leukoencephalopathy syndrome (RPLS). This is the first reported case of exercise-induced AKI associated with RPLS. Vasoconstriction and endothelial dysfunction are considered as the common etiology of these diseases.

Gray matter atrophy is related to long‐term disability in multiple sclerosis

To determine the relation of gray matter (GM) and white matter (WM) brain volumes, and WM lesion load, with clinical outcomes 20 years after first presentation with clinically isolated syndrome suggestive of multiple sclerosis (MS). Seventy-three patients were studied a mean of 20 years from first presentation with a clinically isolated syndrome (33 of whom developed relapsing-remitting MS and 11 secondary-progressive MS, with the rest experiencing no further definite neurological events), together with 25 healthy control subjects. GM and WM volumetric measures were obtained from three-dimensional T1-weighted brain magnetic resonance images using Statistical Parametric Mapping 2. Significant GM (p < 0.001) and WM atrophy (p = 0.001) was seen in MS patients compared with control subjects. There was significantly more GM, but not WM atrophy, in secondary-progressive MS versus relapsing-remitting MS (p = 0.003), and relapsing-remitting MS versus clinically isolated syndrome (p < 0.001). GM, but not WM, fraction correlated with expanded disability status scale (r(s) = -0.48; p < 0.001) and MS Functional Composite scores (r(s) = 0.59; p < 0.001). WM lesion load correlated with GM (r(s) = -0.63; p < 0.001), but not with WM fraction. Regression modeling indicated that the GM fraction explained more of the variability in clinical measures than did WM lesion load. In MS patients with a relatively long and homogeneous disease duration, GM atrophy is more marked than WM atrophy, and reflects disease subtype and disability to a greater extent than WM atrophy or lesions.

Periventricular white matter hyperintensities as predictors of suicide attempts in bipolar disorders and unipolar depression

The aim of this study was to evaluate whether deep white matter hyperintensities (DWMH) and periventricular white matter hyperintensities (PVH) are associated with suicidal behavior in patients with major affective disorders. Subjects were 99 consecutively admitted inpatients (42 men; 57 women; mean age: 46.5 years [SD = 15.2; Min./Max. = 19/79]) with a diagnosis of major affective disorder (bipolar disorder type I, bipolar disorder type-II and unipolar major depressive disorder). 44.4% of the participants had made at least one previous suicide attempt. T2-weighted brain magnetic resonance images were rated for the presence and extension of WMH using the modified Fazekas scale. Patients were interviewed for clinical data on average 5 days after admission. Bivariate analyses, corrected for multiple-testing, and logistic regression analysis were used to test the association between suicide attempts and clinical variables. Attempters and nonattempters differed only in the presence of PVH—the former were more likely to have PVH. The logistic regression indicated that the presence of PVH was robustly associated with suicidal behaviors after controlling for age (OR: 8.08). In conclusion, neuroimaging measures may be markers of risk for suicidal attempts in patients with major affective disorders.

Regional Gray Matter Changes in Bipolar Disorder: A Voxel-Based Morphometric Study

To investigate structural abnormalities in bipolar disorder (BD) using optimized voxel-based morphometry (VBM) in closely matched patients and controls, and to examine the relationship of clinical features with regional gray matter (GM) volumes. Twenty-four patients (six male) aged 19-59 years (mean=38.21 years, SD=11.04 years) with DSM-IV bipolar I disorder were compared with 25 control subjects, matched on age, sex, and years of education. VBM analyses were conducted on high-resolution T1-weighted brain magnetic resonance imaging to detect regional GM volume differences between groups, ensuring statistical correlation for age, sex and total intracranial volumes. Within the patient groups, regional GM changes were also investigated. Compared to controls, BD patients had increased GM volume in left parahippocampal gyrus and decreased GM volume in left middle temporal gyrus. Family history, psychotic symptoms and lithium status were associated with regional GM abnormalities in BD patients. This study presents evidence of gray matter volume abnormalities in adults with bipolar I disorder. Regional variation in relation to clinical factors suggests a neurobiological basis for clinical heterogeneity and posits the possibility of trait deficits.

Neuro-Behcets/Neuro-Sweets Disease Presents Simultaneously with Severe Tonsillitis, and Features Mimicking Bacterial Meningitis with Skin Lesions

The patient was hospitalized due to rapidly undulant fever and sore throat. Empirical antibiotic therapy was started, however, headache also occurred. Lumbar puncture disclosed polynuclear leukocyte-predominant pleocytosis indicating that the patient suffered from bacterial meningitis. The antibiotics therapy was increased, however, consciousness became impaired and erythema multiforme-like skin lesions appeared. T2-weighted brain magnetic resonance imaging showed high signal intensity in the brainstem. HLA testing revealed B54 and Cw1. The patient presented futures of Behçets disease at the same time as those of Sweets syndrome and it was difficult to distinguish between the two diseases. Administration of prednisolone showed remarkable effect.

Comparison and validation of tissue modelization and statistical classification methods in T1-weighted MR brain images

This paper presents a validation study on statistical nonsupervised brain tissue classification techniques in magnetic resonance (MR) images. Several image models assuming different hypotheses regarding the intensity distribution model, the spatial model and the number of classes are assessed. The methods are tested on simulated data for which the classification ground truth is known. Different noise and intensity nonuniformities are added to simulate real imaging conditions. No enhancement of the image quality is considered either before or during the classification process. This way, the accuracy of the methods and their robustness against image artifacts are tested. Classification is also performed on real data where a quantitative validation compares the methods' results with an estimated ground truth from manual segmentations by experts. Validity of the various classification methods in the labeling of the image as well as in the tissue volume is estimated with different local and global measures. Results demonstrate that methods relying on both intensity and spatial information are more robust to noise and field inhomogeneities. We also demonstrate that partial volume is not perfectly modeled, even though methods that account for mixture classes outperform methods that only consider pure Gaussian classes. Finally, we show that simulated data results can also be extended to real data.

Response to Interferon Beta-1a Treatment in African American Multiple Sclerosis Patients

African Americans (AAs) with multiple sclerosis (MS) seem to have a more severe disease course than white Americans (WAs). To our knowledge, it is not known to what extent treatment with interferon beta-1a will effect the MS disease course within the AA population. To compare the response to treatment with interferon beta-1a between AA and WA MS patients. This is an exploratory post hoc analysis of the Evidence of Interferon Dose-Response: European North American Comparative Efficacy (EVIDENCE) study. The EVIDENCE study is a randomized controlled trial that compared the efficacy of once weekly, intramuscular, 30-microg interferon beta-1a treatment with thrice weekly, subcutaneous, 44-microg interferon beta-1a therapy in treatment-naïve MS subjects. Thirty-six AA subjects were compared with 616 WA subjects. The number of MS exacerbations, the proportion of exacerbation-free subjects, and the number of new MS lesions present on brain magnetic resonance imaging were compared between AA and WA subjects at 24 and 48 weeks after initiating treatment with interferon beta-1a. The AA subjects experienced more exacerbations and were less likely to remain exacerbation free (statistical trends). The AA subjects developed more new MS lesions on T2-weighted brain magnetic resonance imaging at 48 weeks (P = .04). Despite the small sample size, AA subjects appeared less responsive to treatment than WA subjects on outcome measures, reaching significance only for T2-weighted lesion count at 48 weeks. However, it is difficult to base these differences solely on response to treatment given the potential differing in MS disease course in AA patients.

Magnetization transfer histograms in clinically isolated syndromes suggestive of multiple sclerosis

In established multiple sclerosis, magnetization transfer ratio (MTR) histograms reveal abnormalities of normal-appearing white matter (NAWM) and grey matter (NAGM). The aim of this study was to investigate for such abnormalities in a large cohort of patients presenting with clinically isolated syndromes suggestive of multiple sclerosis. Magnetization transfer imaging was performed on 100 patients (67 women, 33 men, median age 32 years) a mean of 19 weeks (SD 3.8, range 12-33 weeks) after symptom onset with a clinically isolated syndrome and in 50 healthy controls (34 women, 16 men, median age 32.5 years). SPM99 software was used to generate segmented NAWM and NAGM MTR maps. The volumes of T2 lesions, white matter and grey matter were calculated. Eighty-one patients were followed up clinically and with conventional MRI after 3 years (n = 61) or until they developed multiple sclerosis if this occurred sooner (n = 20). Multiple regression analysis was used to investigate differences between patients and controls with age, gender and volume measures as covariates to control for potential confounding effects. The MTR histograms for both NAWM and NAGM showed a reduction in the mean (NAWM, 38.14 versus 38.33, P = 0.001; NAGM 32.29 versus 32.50, P = 0.009; units in pu) and peak location, with a left shift in the histogram. Mean NAWM and NAGM MTR were also reduced in the patients who developed clinically definite multiple sclerosis and multiple sclerosis according to the McDonald criteria but not in the 24 patients with normal T2-weighted brain magnetic resonance imaging (MRI). MTR abnormalities occur in the NAWM and NAGM at the earliest clinical stages of multiple sclerosis.

Brain White Matter Hyperintensities: Relative Importance of Vascular Risk Factors in Nondemented Elderly People

To prospectively determine whether there is an association between brain white matter signal hyperintensities on magnetic resonance (MR) images and potential risk factors for cerebral ischemia in a well-characterized narrow age cohort of nondemented community-dwelling elderly people. The study population consisted of surviving members of the Aberdeen 1921 Birth Cohort, a subsample of participants in the 1932 Scottish Mental Survey who were born in 1921. With the permission of the local ethics committee and with informed written consent, 106 nondemented subjects (62 men, 44 women) aged 78-79 years underwent T2-weighted brain MR imaging. Brain MR images were scored semiquantitatively for deep white matter hyperintensities and periventricular hyperintensities. Vascular risk factors and clinical measures potentially associated with cerebral ischemia included hypertension, diabetes, cerebrovascular disease, smoking, body mass index grade, respiratory function levels (forced expiratory volume in 1 second [FEV1], forced vital capacity [FVC], and peak expiratory flow rate [PEFR]) normalized for subject's height, plasma lipid levels (cholesterol, triglycerides, high-density lipoprotein, and low-density lipoprotein), glycated hemoglobin level, and mean fasting blood glucose level. Pearson correlation coefficients were calculated for correlations between potential vascular risk factors and scores for deep white matter and periventricular hyperintensities, and stepwise multiple linear regression analysis was performed for factors with a statistically significant correlation. Significant Pearson correlations with deep white matter hyperintensities were found for glycated hemoglobin level (r = 0.31), hypertension (r = 0.27), normalized FEV1 (r = -0.27), normalized FVC (r = -0.22), normalized PEFR (r = -0.27), low-density lipoprotein (r = 0.24), and cholesterol (r = 0.20), and with periventricular hyperintensities for glycated hemoglobin level (r = 0.28) and normalized PEFR (r = -0.23). Multiple linear regression analysis showed that glycated hemoglobin level and hypertension were predictive of 16.2% of the variance in deep white matter hyperintensities. When subjects with non-insulin-dependent (type 2) diabetes mellitus (n = 11) were excluded, hypertension and decreased normalized PEFR were predictive of 11.7% of the variance. White matter hyperintensities are associated with elevated levels of glycated hemoglobin in nondemented community-dwelling elderly subjects. Hypertension and decreased normalized PEFR are the principal predictors of deep white matter hyperintensities in nondiabetic subjects.

Adaptive Model Initialization and Deformation for Automatic Segmentation of T1-Weighted Brain MRI Data

A fully automatic, two-step, T1-weighted brain magnetic resonance imaging (MRI) segmentation method is presented. A preliminary mask of parenchyma is first estimated through adaptive image intensity analysis and mathematical morphological operations. It serves as the initial model and probability reference for a level-set algorithm in the second step, which finalizes the segmentation based on both image intensity and geometric information. The Dice coefficient and Euclidean distance between boundaries of automatic results and the corresponding references are reported for both phantom and clinical MR data. For the 28 patient scans acquired at our institution, the average Dice coefficient was 98.2% and the mean Euclidean surface distance measure was 0.074 mm. The entire segmentation for either a simulated or a clinical image volume finishes within 2 min on a modern PC system. The accuracy and speed of this technique allow us to automatically create patient-specific finite element models within the operating room on a timely basis for application in image-guided updating of preoperative scans.

PII: S0022-3999(05)00155-8

The aim of this study was to evaluate whether deep white matter hyperintensities (DWMH) and periventricular white matter hyperintensities (PVH) are associated with suicidal behavior in patients with major affective disorders. Subjects were 99 consecutively admitted inpatients (42 men; 57 women; mean age: 46.5 years [SD = 15.2; Min./Max. = 19/79]) with a diagnosis of major affective disorder (bipolar disorder type I, bipolar disorder type-II and unipolar major depressive disorder). 44.4% of the participants had made at least one previous suicide attempt. T2-weighted brain magnetic resonance images were rated for the presence and extension of WMH using the modified Fazekas scale. Patients were interviewed for clinical data on average 5 days after admission. Bivariate analyses, corrected for multiple-testing, and logistic regression analysis were used to test the association between suicide attempts and clinical variables. Attempters and nonattempters differed only in the presence of PVH—the former were more likely to have PVH. The logistic regression indicated that the presence of PVH was robustly associated with suicidal behaviors after controlling for age (OR: 8.08). In conclusion, neuroimaging measures may be markers of risk for suicidal attempts in patients with major affective disorders.

One-and-a-Half Syndrome With Facial Diplegia: The 15 1/2 Syndrome?

We recently examined a 67-year-old man who demonstrated findings consistent with a unilateral one-and-a-half syndrome and a bilateral lower motor neuron facial palsy (1 1/2 + 7 + 7 = 15 1/2). The patient had the sudden onset of dizziness, nausea, and blurring of vision. He smoked heavily and had a history of diabetes mellitus. Examination disclosed a complete right horizontal conjugate gaze palsy and a right adduction deficit. Oculocephalic stimulation did not improve the defective eye movements. Convergence was relatively spared. Vertical ocular movements and alignment were normal and ptosis was absent. The pupils were equal in size and normally reactive to light and a near stimulus. The remainder of the neurologic examination was normal. One day later, a bilateral lower motor neuron facial palsy abruptly developed, including bilateral flattening of the nasolabial fold and absent forehead wrinkling. Brain computed tomography was normal. FLAIR and T2-weighted brain magnetic resonance imaging disclosed high signal in the lower pontine tegmentum, findings considered typical of stroke (Fig. 1). A facial nerve conduction and blink reflex study confirmed a bilateral lower motor neuron facial palsy.FIG. 1: Axial FLAIR (A), axial T2-weighted (B), sagittal T2- weighted (C), and diffusion-weighted (D) magnetic resonance images show increased signal (arrow) consistent with ischemic stroke in the paramedian dorsal pontine tegmentum bilaterally.When last examined 2 months after the onset of symptoms, the patient showed only a minimal deficit in right horizontal gaze. Horizontal gaze palsy in one-and-a-half syndrome may result from lesions in the abducens nucleus, in the abducens nerve and the medial longitudinal fasciculus, or in the pontine paramedian reticular formation (PPRF) (1,2). Isolated PPRF lesions are associated with retained vestibulo-ocular movement. If the vestibulo-ocular movement is abolished, the lesion lies rostral or caudal to the PPRF (5,6). Because our patient showed limitation of oculocephalic abduction toward the right side, we presume that the lesion lies in the abducens nucleus or fascicle rather than in the PPRF (2-7). More rapid resolution of ipsilateral adduction compared with abduction favors involvement of the abducens fascicle rather than the nucleus. An alternative hypothesis is that these findings reflect the relative vulnerability of abducens motor neurons innervating the lateral rectus (2). The one-and-a-half syndrome is rarely an isolated finding (7), being usually associated with cranial nerve palsies (facial in 75%), hemiplegia (30%), or hemihypesthesia (35%) (3,4). A lower motor neuron facial nerve palsy is the most commonly associated finding, resulting from involvement of the genu of the intraaxial fasciculus of the facial nerve in the pontine tegmentum (2,4). Although the combination of a one-a-a-half syndrome and an ipsilateral seventh nerve palsy has been described ("eight-and-a-half syndrome" (2)), we are unaware of a previous description of a one-and-a-half syndrome with bilateral seventh nerve palsies, as our patient had. We attribute these findings to a bilateral tegmental pontine lesion involving the right abducens nucleus or fasciculus, bilateral or right medial longitudinal fasciculus, and bilateral intraaxial fasciculi of the facial nerve (Fig. 2). The histopathologic studies of Fisher (8) showing terminal bifurcation of a single paramedian artery to supply the dorsal pontine tegmentum bilaterally could explain why occlusion of a single vessel would produce these findings.FIG. 2: Schematic axial section through the caudal pons. The shaded area represents the site of the lesion that involves the right abducens nucleus, both medial longitudinal fasciculi, and both seventh (facial) nerve fasciculi.Jong Seok Bae, MD Hong Ki Song, MD Department of Neurology; Seoul Medical Center and College of Medicine, Hallym University; Seoul, Korea; E-mail: [email protected]

CRUISE: Cortical reconstruction using implicit surface evolution

Segmentation and representation of the human cerebral cortex from magnetic resonance (MR) images play an important role in neuroscience and medicine. A successful segmentation method must be robust to various imaging artifacts and produce anatomically meaningful and consistent cortical representations. A method for the automatic reconstruction of the inner, central, and outer surfaces of the cerebral cortex from T1-weighted MR brain images is presented. The method combines a fuzzy tissue classification method, an efficient topology correction algorithm, and a topology-preserving geometric deformable surface model (TGDM). The algorithm is fast and numerically stable, and yields accurate brain surface reconstructions that are guaranteed to be topologically correct and free from self-intersections. Validation results on real MR data are presented to demonstrate the performance of the method.

Using nine degrees-of-freedom registration to correct for changes in voxel size in serial MRI studies.

Quantitative longitudinal brain magnetic resonance (MR) studies may be confounded by scanner-related drifts in voxel sizes. Total intracranial volume (TIV) normalisation is commonly used to correct serial cerebral volumetric measurements for these drifts. We hypothesised that automated rigid-body registration of whole brain incorporating automatic scaling correction might also correct for such fluctuations, and might be a more practical alternative. Twenty-three subjects (12 patients with Alzheimer's disease [AD] and 11 controls) had at least two serial T1-weighted volumetric brain MR scans. Ten scans from the control subjects were artificially scaled (stretched) by 1.5, 3.0, 4.6 and 6.1%. A 9-degrees-of-freedom (9dof) registration was used to register the scaled scans back onto the original scans and corresponding scaling factors compared to TIV measurements. A further nine 1-year repeat scans from the AD subjects were artificially scaled and registered (9dof) to baseline. The two correction methods were further assessed using multiple serial scans for each of the 23 subjects (resulting in 49 scan pairs). All serial scans were registered (9dof) to baseline. TIV was measured on all scans. It was found that the 9dof registration successfully recovered the artificially generated scaling changes. Scaling correction using 9dof registration did not alter the amount of brain atrophy measured over the 1-year period in the AD subjects. The 9dof volume scaling factors were very similar to the TIV ratios (repeat TIV over baseline TIV), but less variable (p < 0.001), in both artificial and 'real' scenarios. In the latter, the volume scaling factors allowed identification of two time-points in which a 3% change in voxel size had occurred. Both the 9dof brain registration and TIV correction were successfully able to correct for these fluctuations. Significant shifts in voxel size are a problem in longitudinal brain imaging studies. It is important that such changes are adjusted for: 9dof registration, which is automated and computationally inexpensive, may be superior to the more labour-intensive TIV correction for this purpose.

Postcontrast T1-weighted Brain Magnetic Resonance Imaging in Pediatric Patients: Comparison Between Postcontrast Fat-suppression Imaging and Conventional T1-weighted or Magnetization Transfer Imaging

Purpose: We wished to assess the merits and weaknesses of postcontrast fat-suppression (FS) brain MR imaging in children for the evaluation of various enhancing lesions as compared with postcontrast conventional T1- weighted or magnetization transfer (MT) imaging. Materials and Methods: We reviewed the records of those patients with enhancing lesions on brain MR imaging who had undergone both FS imaging and one of the conventional T1-weighted or MT imaging as a postcontrast T1-weighted brain MR imaging. Thirty-one patients (21 male, 10 female; mean age, 8.7 years) with 38 enhancing lesions (18 intra-axial, 16 extra-axial and 4 orbital locations) were included in this study. There were 27 pairs of FS and conventional imagings, and 13 pairs of FS and MT imagings available for evaluation. Two radiologists visually assessed by consensus the lesions’conspicuity, and they also looked for the presence of flow or susceptibility artifacts in a total of 40 pairs of MR imagings. For 19 measurable lesions (14 pairs of FS and conventional T1-weighted imagings, 5 pairs of FS and MT imagings), the contrast ratios between the lesion and the normal brain ([SIlesion-SIwater]/[SInormal brain-SIwater]) were calculated and compared. Results: Compared with conventional imaging, the lesion conspicuity on FS imaging was better in 10 cases (7extra-axial lesions, 2 orbital lesions and 1 fat-containing intra-axial lesion), equal in 16 cases, and worse in one case. Compared with MT imaging, the lesion conspicuity on FS imaging was better in 3 cases (2 extra-axial lesions and 1 intra-axial lesion), equal in 8 cases, and worse in 2 cases. Image quality of FS imaging was compromised by flow or susceptibility artifacts for 7 patients. The contrast ratios for FS imaging were not significantly different from those for conventional imaging (2.20.7 vs. 2.20.6, respectively, p=0.914) and they were significantly lower than those for MT imaging (2.40.8 vs. 4.51.5, respectively, p=0.018). Conclusion: Postcontrast FS brain MR imaging appears to be better than the conventional T1-weighted imaging and comparable to MT imaging for the visual assessment of enhancing lesions. Especially, the FS imaging has the merit to delineate orbital and extra-axial enhancing lesions or fat-containing lesions, whereas it is disadvantageous when flow or susceptibility artifacts occur.

Postcontrast T1-weighted Brain Magnetic Resonance Imaging in Pediatric Patients: Comparison Between Postcontrast Fat-suppression Imaging and Conventional T1-weighted or Magnetization Transfer Imaging

Postcontrast T1-weighted Brain Magnetic Resonance Imaging in Pediatric Patients: Comparison Between Postcontrast Fat-suppression Imaging and Conventional T1-weighted or Magnetization Transfer Imaging

Brain white matter lesions detected by magnetic resosnance imaging are associated with balance and gait speed

Objective: To investigate the relations between premorbid and current mental ability, mood, and white matter signal abnormalities detected by T2 weighted brain magnetic resonance imaging (MRI) and impairment of balance...

Chorea associated with non-ketotic hyperglycemia and hyperintensity basal ganglia lesion on T1-weighted brain MRI study: a meta-analysis of 53 cases including four present cases

Background: Chorea associated with non-ketotic hyperglycemia and high signal intensity lesions on T1-weighted brain magnetic resonance images (C-H-BG) is recognized as a unique syndrome that affects elderly women exclusively. However, its overall clinical features are unclear. Material and Methods: The literature describing patients with C-H-BG from 1985 to 2001 was reviewed using MEDLINE. Their clinical features and those of four patients with C-H-BG at this hospital were analyzed. Results: This study included 49 patients from the literature and four patients at this hospital. Their mean age at the onset was 71.1 years (range=22–92 years). Women were affected more frequently than men (men/women=17:30). The mean serum glucose level measured after the onset of chorea was 481.5 mg/dl (ranging from 169 to 1264), HbA1c level was 14.4% (ranging from 9.9 to 19.2), and the serum osmolarity was 305.9 mmol/kg (ranging from 291 to 335). Forty-seven patients developed hemichorea. Six patients developed bilateral chorea, and magnetic resonance imaging (MRI) showed bilateral basal ganglia lesions. MRI showed that putamen was involved in all cases (isolated putamen=31 patients, additional basal ganglia lesions=22 patients). None had lesions confined to the caudate nucleus or the globus pallidus. In all, except one, the anterior limb of the internal capsule was spared. Follow-up MRI studies were performed in 22 patients. In most, hemichorea improved along with the disappearance of the lesions. In 39 patients, chorea had ameliorated completely. The remaining 14 cases showed some improvement during the follow-up period. The chorea recurred in seven patients. Conclusion: C-H-BG is a benign disorder affecting the elderly. It affects men much more frequently than has been reported. The high signal intensity basal ganglia lesion on the T1-weighted brain MRI study was reversible, and correlated with the clinical improvement in chorea.