Posterior cingulate hypoperfusion in Alzheimer's disease, senile dementia of Alzheimer type, and other dementias evaluated by three-dimensional stereotactic surface projections using Tc-99m HMPAO SPECT

Hypoperfusion in the posterior cingulate cortex is thought to be useful for the early diagnosis of dementia of Alzheimer type (DAT). In the present study, we compared the incidence of posterior cingulate hypoperfusion in patients with Alzheimer's disease (AD), patients with senile dementia of Alzheimer type (SDAT), and patients with other types of dementia, as evaluated by three-dimensional stereotactic surface projection (3D-SSP) imaging. The subjects were 20 AD patients, 20 SDAT patients, 13 frontotemporal dementia patients, and 3 other types of dementia patients. A SPECT study was performed 5 minutes after the injection of 740 MBq technetium-99m hexamethylpropylene amine oxime. 3D-SSP images were obtained with global normalization to perform the statistical analysis. The normal database of 3D-SSP consisted of 15 healthy volunteers. Hypoperfusion was considered to be significant when the Z-score was over 2.5. Posterior cingulate hypoperfusion was observed in 13 of 20 AD patients (65%), in 5 of 20 SDAT patients (25%), but in none of other type of dementia patients. Posterior cingulate hypoperfusion was considered to be a finding specific to DAT, and this finding was thought to be useful to diagnose DAT patients, especially for AD patients. However, it was considered to be difficult to diagnose early-stage SDAT patients.     

Reduction of reconstruction time and data volume of sinogram by angular compression for clinical three-dimensional whole body FDG-PET

In positron emission tomography (PET), the large number of lines of responses in three-dimensional (3D) acquisition mode creates a high volume of sinogram data and increases reconstruction time in iterative reconstruction. We tried to decrease sinogram data volume by reducing the number of views using angular compression and then evaluated the accuracy of this mashed mode. Three methods were compared, conventional mode (CONV), X2 mashed mode (X2: two adjacent projection angles are added together), and X4 mashed mode (X4: four adjacent angles added). A point source of (18)F was used to measure spatial resolution. A hot spot phantom made of 6 hot spheres (10-38 mm in diameter) within water of 20 cm in diameter was scanned to evaluate the recovery coefficient (RC). A lung-heart-liver phantom made of homogeneous radioactive myocardium, a spherical hot mass in the lung (10 mm in diameter), and background activity in the liver was scanned to evaluate the homogeneity of the myocardial wall. The quality of the reconstructed images was evaluated in terms of the normalized mean square error (NMSE), Bull's eye map, profile curve, and peak value of the spherical hot mass. The reconstruction times of X2 and X4 were one-half and one-quarter, respectively, of that of CONV. In terms of spatial resolution, FWHM of CONV, X2, and X4 were, 4.26, 4.33, and 4.48 (mm) at the center, 4.81, 5.68, and 8.73 tangentially, and 8.01, 8.19, and 8.27 radially at R=200 mm, respectively. RC was similar for all methods. The NMSE values of X2 and X4 compared with CONV were 0.0003 and 0.0014, respectively. In the hot mass, these methods showed almost the same profile curves, although the peak value of X4 was only -1.95% less than that of CONV. Although the result of spatial resolution of X4 was slightly degraded, image quality and physical performance were good. Therefore, the X4 mashed mode used with angular compression was considered clinically useful.     

Reduction of radiation exposure in CT perfusion study using a quantum de-noising filter

CT perfusion study requires repeatedly scanning the same part of the patient's head, resulting in an increase of local radiation exposure. The purpose of this study was to assess the feasibility of the ultra-low-dose technique with a quantum de-noising filter. The newly developed quantum de-noising filter selectively reduced noise by two-thirds, while maintaining spatial resolution. The low-dose protocol using the quantum de-noising filter and slow rotation speed accomplished a 68% reduction in the local radiation dose compared with the previous standard protocol. The quantum de-noising filter is considered to be useful to reduce radiation exposure and to improve image quality in CT perfusion study.     

External iliac venous aneurysm in a pregnant woman: a case report

We report an external iliac venous aneurysm in a young pregnant woman who was diagnosed incidentally by ultrasound scanning. The aneurysm was successfully treated by tangential aneurysmectomy and lateral venorrhaphy. Primary iliac venous aneurysm is a rare vascular abnormality. The clinical significance of the disease is unknown. However, embolism, rupture, and thrombosis might occur as they can occur with popliteal venous aneurysm. In fact, three of four reported patients with iliac venous aneurysms had a thromboembolic event. For those reasons, prophylactic treatment is indicated. This is the first patient with an iliac venous aneurysm to be diagnosed without complication.     

Denervation and Reinnervation of the Heart After Aortic Surgery,Estimated by <Superscript>123</Superscript>I-Metaiodobenzylguanidine Scintigraphy

Purpose To investigate whether sympathetic nerve injury occurs during aortic surgery and how reinnervation takes place afterward.Methods Imaging with ¹²³I-metaiodobenzylguanidine (MIBG) was performed in 12 patients (aortic group) who underwent aortic surgery (ascending replacement 3, ascending-arch replacement 9) before and 3 weeks after surgery. In 8 of 12 patients, MIBG scintigraphy was performed 1 and 2 years after surgery. Twelve patients (control group) who underwent open-heart surgery (mitral valve repair: 11; tricuspid valve replacement: 1) were studied using MIBG scintigraphy. The heart-to-mediastinum (H/M) activity ratio was obtained from planar images. The myocardial single-photon-emission computed tomography image was divided into five segments and the regional tracer uptake was scored from 0 = absent to 3 = normal uptake.Results No significant difference in the H/M ratio in either early and delayed planar scans was observed between both groups before surgery. The H/M ratios significantly decreased 3 weeks after surgery in the aortic group, whereas there was no significant change in the control group. The H/M ratio did not recover to the preoperative level within 2 years. In these 8 patients, the regional uptake of MIBG improved in the anterior and septal regions 1 year after surgery.Conclusion During ascending or ascending-arch replacement, the sympathetic nerve was globally denervated and slight reinnervation was observed within 2 years. The anterior and septal regions showed a rapid reinnervation, whereas other regions did not.     

Intraoperative ultrasonography is useful for diagnosing pancreatic duct injury and adjacent tissue damage in a patient with penetrating pancreas trauma

We report a case of pancreatic injury, caused by a stab wound, in which ductal injury and wound depth were clearly identified by intraoperative ultrasonography. A 65-year-old woman was emergently admitted to our hospital after stabbing herself in the abdomen in a suicide attempt. Preoperative computed tomography (CT) and laboratory examination revealed liver and pancreatic injury with massive abdominal bleeding and free air. Operative findings included injuries of the stomach, small bowel, colon, liver, and pancreas. The pancreatic lacerations were 1cm in length, in the body. Intraoperative ultrasonography enabled the diagnosis of a lacerated main pancreatic duct with no damage to the major vessels posterior to the pancreas. Distal pancreatectomy; simple repairs of the liver, small bowel, and stomach; exteriorization of the injured colon; cholecystostomy; gastrostomy; and jejunostomy were performed. The patient recovered and was transferred to a psychiatric hospital 87 days after surgery. In this patient, intraoperative ultrasonography was successfully used to identify the degree of injury to the pancreatic duct, as well as the depth of the stab wound. In conclusion, intraoperative ultrasonography should be routinely performed to detect main pancreatic duct injury in penetrating pancreatic trauma.     

Architecture of binocular disparity processing in monkey inferior temporal cortex

Neurons in the inferior temporal (IT) cortex respond not only to the shape, color or texture of objects, but to the horizontal positional disparity of visual features in the right and left retinal images. IT neurons with similar shape selectivity cluster in columns. In this study, we examined how IT neurons are spatially arranged in the IT according to their selectivity for binocular disparity. With a single electrode, we simultaneously recorded extracellular action potentials from a single neuron and those from background multiple neurons at the same sites or recorded multineuronal responses at successive sites along electrode penetrations, while monkeys performed a fixation task. For neurons at each recording site, effective shapes were first determined from a set of 20 shapes presented at the zero-disparity plane. The most effective shape was then presented with varying amounts of disparity. Single neuron responses and background multiunit responses recorded at the same sites showed a similar ability of disparity discrimination and tended to share the preferred disparity, suggesting that neurons with similar disparity selectivity are clustered in the IT. We estimated from sequential recordings along electrode penetrations that the size of the neuronal clusters with similar disparity selectivity was smaller than the size of clusters with similar shape selectivity.