Neurosyphilis is a rare infection of the brain and spinal cord caused by a spirochete named Treponema pallidum. We describe the magnetic resonance imaging of a 53-year-old man with syphilis who manifested as both meningovascular, and spinal meningomyelitic types, which involved the optic, trigeminal, facial and vestibulocochlear nerves, both middle and left posterior cerebral arteries, thoracic spinal cord and meninges of the lumbar spine. This case report suggests that neurosyphilis should be considered as a possible diagnosis in patients showing complex brain and spinal imaging features. These features include enhancing meningeal lesions with multiple cranial nerve involvement, stenoses in large to medium size cerebral arteries, and intramedullary and meningeal lesions of spine.
Brain ; Cerebral Arteries ; Cerebral Infarction* ; Constriction, Pathologic ; Cranial Nerve Diseases* ; Cranial Nerves ; Diagnosis ; HIV* ; Humans ; Magnetic Resonance Imaging* ; Meninges ; Meningitis ; Middle Aged ; Neurosyphilis* ; Posterior Cerebral Artery ; Spinal Cord ; Spine ; Spirochaetales ; Syphilis ; Tabes Dorsalis ; Treponema pallidum ; Vestibulocochlear Nerve

We present MR diffusion-weighted imaging (DWI) findings of status epilepticus in two patients. DWI showed a focal or diffuse hyperintensity with decreased apparent diffusion coefficient (ADC) value, indicating cytotoxic edema in the cerebral hemispheric cortices. The hyperintensities were located in the bilateral temporoparietooccipital areas and insular cortex in one patient, and unilaterally in the temporal lobe in the other patient.
Diffusion ; Edema ; Humans ; Status Epilepticus* ; Temporal Lobe

PURPOSE: Cortical dysplasia is known to be of variety of MR imaging findings. We attempted to classify MR imaging findings of cortical dysplasia into several types and to correlate those with histopathologic grades and subtypes. MATERIALS AND METHODS: Preoperative MR images of 97 patients with pathologically-proven cortical dysplasia were retrospectively reviewed with knowledge of the diagnosis and operative sites. The patients were divided into MR- positive and MR-negative groups based on the presence or absence of MR imaging abnormalities. In MR-positive group, MR imaging features were arbitrarily classified into four types (atrophic, cortical-band, inward-rounding, and nonspecific types) on the basis of size of the gyrus and adjacent CSF space, cortical thickness, signal intensity of the subcortical white matter, and blurring of the gray-white matter junction. The pathologic findings were also retrospectively reviewed without knowledge of MR imaging findings and divided into three grades (mild, moderate, and severe) and two subtypes (nonballoon-cell and balloon-cell). Pathologic grades and subtypes were compared between MR-positive and MR-negative groups. Four MR types of the MR-positive group were correlated with the pathologic grades and subtypes. RESULTS: MR-positive and MR-negative groups consisted of 39 (40%) and 58 (60%) patients, respectively . Of the MR-positive group, atrophic type was seen in 13 patients (33%), corticalband type in 9 (23%), inward-rounding type in 9 (23%), and nonspecific type in 8 (21%). There was no significant difference in the pathologic grades between MR-positive and MR-negative groups, although MR-positive group tended to have higher pathologic grades than MR-negative group did. Balloon-cell subtype was found significantly higher in MR-positive group than in MRnegative group (p<0.05): 21% (8/39) versus 5% (3/58). The inward-rounding type corresponded to the pathologically severe grade and balloon-cell subtype in 78% (7/9) and 56% (5/9) of the patients, respectively, while the atrophic type to the mild grade and nonballoon-cell subtype in 77% (10/13) and 100% (13/13), respectively. CONCLUSION: A variety of MR imaging abnormalities were found in 40% of the patients with cortical dysplasia and those were classified into four types (atrophic, cortical-band, inwardrounding, and nonspecific types), of which the inward-rounding type correlated well with the pathologically severe grade and balloon-cell subtype, whereas the atrophic type with the mild grade and nonballoon-cell subtype.
Brain* ; Diagnosis ; Humans ; Magnetic Resonance Imaging* ; Malformations of Cortical Development* ; Retrospective Studies

PURPOSE: Early degeneration of articular cartilage is accompanied by a loss of glycosaminoglycan (GAG) and the consequent change of the integrity. The purpose of this study was to biochemically quantify the loss of GAG, and to evaluate the Gd(DTPA)2--enhanced, and T1, T2, rho relaxation map for detection of the early degeneration of cartilage. MATERIALS AND METHODS: A cartilage-bone block in size of 8mmx10 mm was acquired from the patella in each of three pigs. Quantitative analysis of GAG of cartilage was performed at spectrophotometry by use of dimethylmethylene blue. Each of cartilage blocks was cultured in one of three different media: two different culture media (0.2 mg/ml trypsin solution, 1mM Gd (DTPA)2- mixed trypsin solution) and the control media (phosphate buffered saline (PBS)). The cartilage blocks were cultured for 5 hrs, during which MR images of the blocks were obtained at one hour interval (0 hr, 1 hr, 2 hr, 3 hr, 4 hr, 5 hr). And then, additional culture was done for 24 hrs and 48 hrs. Both T1-weighted image (TR/TE, 450/22 ms), and mixed-echo sequence (TR/TE, 760/21-168ms; 8 echoes) were obtained at all times using field of view 50 mm, slice thickness 2 mm, and matrix 256x512. The MRI data were analyzed with pixel-by-pixel comparisons. The cultured cartilage-bone blocks were microscopically observed using hematoxylin & eosin, toluidine blue, alcian blue, and trichrome stains. RESULTS: At quantitation analysis, GAG concentration in the culture solutions was proportional to the culture durations. The T1-signal of the cartilage-bone block cultured in the Gd(DTPA)2- mixed solution was significantly higher (42% in average, p<0.05) than that of the cartilage-bone block cultured in the trypsin solution alone. The T1, T2, rho relaxation times of cultured tissue were not significantly correlated with culture duration (p>0.05). However the focal increase in T1 relaxation time at superficial and transitional layers of cartilage was seen in Gd(DTPA)2- mixed culture. Toluidine blue and alcian blue stains revealed multiple defects in whole thickness of the cartilage cultured in trypsin media. CONCLUSION: The quantitative analysis showed gradual loss of GAG proportional to the culture duration. Microimagings of cartilage with Gd(DTPA)2--enhancement, relaxation maps were available by pixel size of 97.9x195 micrometer. Loss of GAG over time better demonstrated with Gd(DTPA)2--enhanced images than with T1, T2, rho relaxation maps. Therefore Gd(DTPA)2--enhanced T1-weighted image is superior for detection of early degeneration of cartilage.
Alcian Blue ; Cartilage ; Cartilage, Articular* ; Coloring Agents ; Culture Media ; Eosine Yellowish-(YS) ; Hematoxylin ; Magnetic Resonance Imaging* ; Patella ; Relaxation ; Spectrophotometry ; Swine ; Tolonium Chloride ; Trypsin

PURPOSE: To investigate the signal enhancement ratio by NOE effect on in vivo 31P MRS in human heart muscle and liver. we also evaluated the enhancement ratios of different phosphorus metabolites, which are important in 31P MRS for each organ. MATERIALS AND METHODS: Ten normal subjects (M: F = 8: 2, age range = 24-32 yrs) were included for in vivo 31P MRS measurements on a 1.5 T whole-body MRI/MRS system using 1H-31P dual tuned surface coil. Two-dimensional Chemical Shift Imaging (2D CSI) pulse sequence for 31P MRS was employed in all 31P MRS measurements. First, 31P MRS performed without NOE effect and then the same 2D CSI data acquisitions were repeated with NOE effect. After postprocessing the MRS raw data in the time domain, the signal enhancements in percent were estimated from the major metabolites. RESULTS: The calculated NOE enhancement for liver 31P MRS were: alpha-ATP (7%), beta- ATP (9%), gamma-ATP (17%), Pi (1%), PDE (19%), and PME (31%). Because there is no creatine kinase activity in liver, PCr signal is absent. For cardiac 31P MRS, whole body coil gave better scout images and thus better localization than surface coil. In 31P cardiac multi-voxel spectra, DPG signal increased from left to right according to the amount of blood included. The calculated enhancement for cardiac 31P MRS were: alpha -ATP (12%), beta-ATP (19%), gamma-ATP (30%), PCr (34%), Pi (20%), PDE (51%), and DPG (72%). CONCLUSION: Our results revealed that the NOE effect was more pronounced in heart muscle than in liver with different coupling to 1H spin system and thus different heteronuclear cross-relaxation.
Adenosine Triphosphate ; Creatine Kinase ; Heart* ; Humans ; Liver* ; Magnetic Resonance Imaging ; Myocardium ; Phosphorus ; Polymerase Chain Reaction

PURPOSE: We evaluated 1H MR spectroscopy improves the preoperative diagnosis of diffuse infiltrative type of primary central nervous system lymphomas. MATERIALS AND METHODS: After review of conventional MR images and medical records, we retrospectively reviewed proton MR spectra in seven patients with primary central nervous system lymphoma diagnosed by means of biopsy. Relative ratio of choline (Cho), N-acetylaspartate (NAA), and lipid-lactate (Lip- Lac) to creatine (Cr) were measured for quantitative analysis. RESULTS: The average ratio of Cho/Cr was 1.80+/-0.95, NAA/Cr was 1.34+/-0.41, and Lip-Lac/Cr was 1.12+/-0.16. All cases of lymphomas showed increased Lip-Lac peak. Two case of mass forming lymphoma showed decreased NAA/Cr significantly, whereas five cases of lymphoma without mass formation showed preserved NAA/Cr. CONCLUSION: We thought the presence of Lip-Lac peak without significant reduction of NAA on the MR spectroscopy was helpful for diagnosis of diffuse infiltrative type of central nervous system lymphoma.
Biopsy ; Central Nervous System* ; Choline ; Creatine ; Diagnosis ; Humans ; Lymphoma* ; Magnetic Resonance Spectroscopy* ; Medical Records ; Protons ; Retrospective Studies

PURPOSE: To evaluate the usefulness and reproducibility of 1H MRS in different 1.5 T MR machines with different coils to compare the SNR, scan time and the spectral patterns in different brain regions in normal volunteers. MATERIALS AND METHODS: Localized 1H MR spectroscopy (1H MRS) was performed in a total of 10 normal volunteers (age; 20-45 years) with spectral parameters adjusted by the autoprescan routine (PROBE package). In all volunteers, MRS was performed in a three times using conventional MRS (Signa Horizon) with 1 channel coil and upgraded MRS (Echospeed plus with EXCITE) with both 1 channel and 8 channel coil. Using these three different machines and coils, SNRs of the spectra in both phantom and volunteers and (pre)scan time of MRS were compared. Two regions of the human brain (basal ganglia and deep white matter) were examined and relative metabolite ratios (NAA/Cr, Cho/Cr, and mI/Cr ratios) were measured in all volunteers. For all spectra, a STEAM localization sequence with three-pulse CHESS H2O suppression was used, with the following acquisition parameters: TR=3.0/2.0 sec, TE=30 msec, TM=13.7 msec, SW=2500 Hz, SI=2048 pts, AVG=64/128, and NEX=2/8 (Signa/Echospeed). RESULTS: The SNR was about over 30% higher in Echospeed machine and time for prescan and scan was almost same in different machines and coils. Reliable spectra were obtained on both MRS systems and there were no significant differences in spectral patterns and relative metabolite ratios in two brain regions (p>0.05). CONCLUSION: Both conventional and new MRI systems are highly reliable and reproducible for 1H MR spectroscopic examinations in human brains and there are no significant differences in applications for 1H MRS between two different MRI systems.
Brain* ; Ganglia ; Healthy Volunteers ; Humans* ; Magnetic Resonance Imaging ; Magnetic Resonance Spectroscopy* ; Spectrum Analysis ; Steam ; Volunteers

PURPOSE: Our aim was to evaluate the usefulness of fluid-attenuated inversion recovery (FLAIR) MR imaging for detection of acute subarachnoid hemorrhage (SAH) compared with unenhanced CT. MATERIALS AND METHODS: We compared FLAIR MR images with unenhanced CT scans in 28 patients with acute SAH. Findings of SAH on CT and MR images were graded as 0 (absence), 1 (suspicious), 2 (definite) in the cerebral sulci, sylvian fissure, basal cistern, and cisterns of the posterior fossa. We also compared FLAIR MR images of 28 patients with those of 35 normal subjects, and then the sensitivity, specificity, and diagnostic accuracy of FLAIR MR image for detection of acute SAH were calculated. RESULTS: FLAIR MR image was superior to CT in detecting SAH in the posterior fossa (1.41+/-.74 vs 0.78+/-.80; p<0.05) and cortical sulci(1.11+/-.80 vs 0.70+/-.83; p<0.05). There was no significant difference between FLAIR MR image and CT in detecting SAH in the basal cistern and sylvian fissure. The sensitivity, specificity, and diagnostic accuracy of FLAIR MR image for detection of SAH were 100% in all. CONCLUSION: FLAIR MR image is useful in detecting acute SAH, especially in patients with small amount of SAH or SAH in the posterior fossa.
Humans ; Magnetic Resonance Imaging* ; Sensitivity and Specificity ; Subarachnoid Hemorrhage* ; Tomography, X-Ray Computed

PURPOSE: Within a clinically acceptable time frame, we obtained the high resolution MR images of the human brain, knee, foot and wrist from 3T whole-body MRI system which was equipped with the world first 3T active shield magnet. MATERIALS AND METHODS: Spin echo (SE) and Fast Spin Echo (FSE) images were obtained from the human brain, knee, foot and wrist of normal subjects using a homemade birdcage and transverse electromagnetic (TEM) resonators operating in quadrature and tuned to 128 MHz. For acquisition of MR images of knee, foot and wrist, we employed a homemade saddle shaped RF coil. Typical common acquisition parameters were as follows: matrix= 512x512, field of view (FOV) = 20 cm, slice thickness = 3 mm, number of excitations (NEX) = 1. For T1-weighted MR images, we used TR= 500 ms, TE = 10 or 17.4 ms. For T2-weighted MR images, we used TR=4000 ms, TE = 108 ms. RESULTS: Signal to noise ratio (SNR) of 3T system was measured 2.7 times greater than that of prevalent 1.5T system. MR images obtained from 3T system revealed numerous small venous structures throughout the image plane and provided reasonable delineation between gray and white matter. CONCLUSION: The present results demonstrate that the MR images from 3T system could provide better diagnostic quality of resolution and sensitivity than those of 1.5T system. The elevated SNR observed in the 3T high field magnetic resonance imaging can be utilized to acquire images with a level of resolution approaching the microscopic structural level under in vivo conditions. These images represent a significant advance in our ability to examine small anatomical features with noninvasive imaging methods.
Brain ; Foot ; Humans ; Knee ; Magnetic Resonance Imaging* ; Magnets ; Signal-To-Noise Ratio ; Wrist

PURPOSE: Our purpose was to compare maximum relative cerebral blood volume (rCBV) with histologic grade of cerebral gliomas. MATERIALS AND METHODS: First-pass perfusion MR imaging was performed preoperatively in 16 patients with pathologically proven cerebral gliomas (7 glioblastoma, 2 anaplastic astrocytoma, 1 anaplastic oligo-dendroglioma, 5 low-grade astrocytoma, and 1 low-grade oligodendroglioma). Maximum rCBV was com-pared with histologic diagnosis and grade of the tumor. RESULTS: Maximum rCBVs of glioblastomas were in the range of 433%-1330% (average, 790%), as compared with those of contra-lateral normal white matters. Maximum rCBVs of two non-enhancing anaplastic astrocytomas were 66% and 284%, respectively. Maximum rCBV of one well-enhancing anaplastic oligodendroglioma was 502%. Maximum rCBVs of low-grade astrocytomas were in the range of 80%-369% (average, 202%). Maximum rCBV of one low-grade oligodendroglioma was 1450%, even higher than those of glioblastomas. CONCLUSION: Maximum rCBV was higher in glioblastoma than in low-grade astrocytoma without overlap-ping. However, there was no difference of maximum rCBV between non-enhancing anaplastic astrocytoma and low-grade astrocftoma.
Astrocytoma ; Blood Volume ; Diagnosis ; Glioblastoma ; Glioma* ; Humans ; Magnetic Resonance Imaging* ; Oligodendroglioma ; Perfusion*