The arteriovenous malformations(AVMs) of the corpus callosum are distinct anatomical and surgical entities. The AVMs of the corpus callosum are supplied by the pericallosal arteries if the malformations are located in the anterior and middle portion of the callosum and the AVMs of the splenium are usually fed by the pericallosal and posterior cerebral arteries. Radical excision of the callosal AVMs became successful with microsurgical techniques since a few years ago. The authors report a case of the callosal AVM, who had subarachnoid hemorrhage twice prior to this admission, and the studies with angiography and computed tomography revealed an AVM involing the middle portions of the corpus callosum. Radical excision of the AVM was accomplished by microsurgical techniques without neurologic sequela.
Angiography ; Arteries ; Corpus Callosum* ; Posterior Cerebral Artery ; Subarachnoid Hemorrhage

Aneurysms of the great vein of Galen are rare and the authors report a case of primary type aneurysm of the great vein of Galen. Clinicaly aneurysm of great vein of Galen give rise to different symptoms and signs at different age. New born infants have intractable heart failure, infancy have hydrocephalus, and adolescents have headache and syncope. The diagnosis rests upon angiography, especially four-vessel angiography is mandatary to delineate all of the feeding arteries. The posterior cerebral arteries supply most of the blood to the aneurysm. The only effective treatment is ligation of the feeding vessels at the point of entry into the vein of Galen.
Adolescent ; Aneurysm* ; Angiography ; Arteries ; Cerebral Veins* ; Diagnosis ; Headache ; Heart Failure ; Humans ; Hydrocephalus ; Infant ; Ligation ; Posterior Cerebral Artery ; Syncope ; Veins*

No abstract available.
Peripheral Nerves*

OBJECTIVE: We wanted to assess the role of the popliteal lymph nodes for differentiating rheumatoid arthritis (RA) from osteoarthritis (OA), and we also wanted to investigate the relationship between the popliteal lymph nodes and the inflamed synovial volume (ISV) by using contrast enhanced (CE), fat suppressed, three dimensional-fast spoiled gradient echo (3D-FSPGR) MR imaging. MATERIALS AND METHODS: Contrast enhanced 3D-FSGPR MR imaging of 94 knees (21 with RA and 73 with OA) was analyzed. A lymph node was defined as being 'observed' if it could be seen in at least two planes of the three orthogonal reformatted planes. The number of observed lymph nodes, the mean of the smallest dimension of each lymph node and the existence of central fatty change were recorded. The OA group was graded according to the ISV calculated by a segmentation method: grade I was < 20 cm3; grade II ranged from 20 cm3 to 40 cm3; and grade III was > 40 cm3. Statistical analysis of the number and the mean size of the popliteal lymph nodes among the four groups (the RA group and the grade I-III OA groups) was performed. RESULTS: The prevalence of the observed popliteal lymph nodes was significantly different between all the OA groups or between the grade III OA group and the RA group (p < 0.0001, 0.0001, respectively). The popliteal lymph node was observed in 32 out of 73 OA cases, whereas it was visible in all of the 21 RA cases. The number (mean+/-standard deviation) of lymph nodes in the grade I OA group, the grade II OA group, the grade III OA group and the RA group was 1.2+/-0.4, 1.2+/-0.4, 1.3+/-0.5, and 2.7+/-1.1, respectively. The mean size (mean+/-standard deviation) of the lymph nodes was 3.8+/-1.0 mm, 3.6+/-1.1 mm, 4.1+/-0.8 mm, and 5.4+/-1.3 mm, respectively. The incidence of central fatty changes was significantly lower in the RA group than in all the OA groups and the grade III OA group. When differentiating RA from OA, and when the differentiation was confined to the RA group and grade III OA group, respectively, the criteria of the number of lymph nodes, their size, their central fatty change and a combination of all these three criteria showed statistical significance (Az values for the former were 0.869, 0.847, 0.776, and 0.942; Az values for the latter were 0.855, 0.799, 0.712, and 0.916). The number and mean size of the lymph nodes correlated with the ISVs (r = 0.49, p < 0.001; 0.50, 0.001, respectively). CONCLUSION: The number, size and central fatty changes in the popliteal lymph nodes observed on the MR images might serve as simple and useful markers in differentiating RA disease from OA disease. These markers would be particular helpful in cases of severe synovial enhancement where the ISVs of both RA and OA overlap. The number and mean size of the lymph nodes also correlated well with the ISV.
Adult ; Aged ; Arthritis, Rheumatoid/*diagnosis ; Diagnosis, Differential ; Female ; Humans ; Inflammation ; Knee ; *Lymph Nodes ; Magnetic Resonance Imaging/*methods ; Male ; Middle Aged ; Osteoarthritis/*diagnosis ; Research Support, Non-U.S. Gov't ; Retrospective Studies ; Synovial Membrane/*pathology

PURPOSE: To evaluate the changes and remission of disease activity with changes in inflamed synivial volumes of rheumatoid joints after therapy. MATERIALS AND METHODS: Seven rheumatoid arthritis patients who had been treated with antiinflammatory drugs were followed up. Using NIH imaging and a segmentation technique, pre- and post-enhanced images were measured in subtracted images. Intra- and interobserver variation were evaluated by two radiologists(A and B), using two independent measurements. For comparison, the cases were assigned to one of two groups : remission and non-remission. Changes in ESR and total joint counts(TJC) after therapy were compared with inflamed synovial volumes. RESULTS: Intraobserver variations were 3.2% and 2.7% in A and B, respectively, interobserver variation between A and B was 7.1%. Changes in inflamed synovial volumes correlated well with those in ESR (r=0.88, p<0.009) and TJC (r=0.78, p<0.037) after therapy. Changes between the remission and non-remission group were insignificant, however. CONCLUSION: Changes in inflamed synovial volumes reflect those in the activity of rheumatoid arthritis between pre- and post- treatment. This technique may be used as a tool for predicting therapeutic response in rheumatoid arthritis cases. Changes in inflamed synovial volumes are of limited value, however, in predicting the remission of rheumatoid arthritis after therapy.
Arthritis, Rheumatoid ; Humans ; Joints ; Observer Variation ; Synovial Membrane* ; Synovitis* ; Wrist Joint* ; Wrist*

PURPOSE: To evaluate the changes and remission of disease activity with changes in inflamed synivial volumes of rheumatoid joints after therapy. MATERIALS AND METHODS: Seven rheumatoid arthritis patients who had been treated with antiinflammatory drugs were followed up. Using NIH imaging and a segmentation technique, pre- and post-enhanced images were measured in subtracted images. Intra- and interobserver variation were evaluated by two radiologists(A and B), using two independent measurements. For comparison, the cases were assigned to one of two groups : remission and non-remission. Changes in ESR and total joint counts(TJC) after therapy were compared with inflamed synovial volumes. RESULTS: Intraobserver variations were 3.2% and 2.7% in A and B, respectively, interobserver variation between A and B was 7.1%. Changes in inflamed synovial volumes correlated well with those in ESR (r=0.88, p<0.009) and TJC (r=0.78, p<0.037) after therapy. Changes between the remission and non-remission group were insignificant, however. CONCLUSION: Changes in inflamed synovial volumes reflect those in the activity of rheumatoid arthritis between pre- and post- treatment. This technique may be used as a tool for predicting therapeutic response in rheumatoid arthritis cases. Changes in inflamed synovial volumes are of limited value, however, in predicting the remission of rheumatoid arthritis after therapy.
Arthritis, Rheumatoid ; Humans ; Joints ; Observer Variation ; Synovial Membrane* ; Synovitis* ; Wrist Joint* ; Wrist*

OBJECTIVE: To validate the use of contrast-enhanced (CE) fat-suppressed three-dimensional (3D) fast gradient-recalled acquisition in the steady state with radiofrequency spoiling (FSPGR) magnetic resonance imaging (MRI) for the diagnosis of anterolateral soft tissue impingement of the ankle, as compared to the use of routine ankle MRI. MATERIALS AND METHODS: Contrast-enhanced fat-suppressed 3D-FSPGR MRI and routine MRI scans were retrospectively reviewed for 45 patients with arthroscopically proven anterolateral impingement. In addition, scans were reviewed in 45 control subjects with diagnoses other than impingement. Two radiologists independently reviewed the two sets of images in random order. Using areas (Az) under the receiver operating characteristic curve (ROC), we compared the depiction of anterolateral soft tissue impingement in the two sets of images. RESULTS: The overall accuracy for lesion characterization was significantly higher (p < 0.05) using the CE fat-suppressed 3D-FSPGR MR images (Az = 0.892 and 0.881 for reader 1 and 2, respectively) than using the routine MR images (Az = 0.763 and 0.745). The use of CE fat-suppressed 3D-FSPGR MRI enhanced impingement depiction in most cases. However, in cases with a thickened non-enhancing scar or joint effusion, the routine images better depicted a soft tissue mass that intruded into anterolateral gutter than the CE images. CONCLUSION: The use of CE fat-suppressed 3D-FSPGR MRI of the ankle allows a more accurate assessment of anterolateral soft tissue impingement of the ankle, as compared to the use of routine MRI.
Adolescent ; Adult ; Aged ; Ankle Joint/*pathology ; Contrast Media ; Female ; Gadolinium DTPA/diagnostic use ; Humans ; Image Interpretation, Computer-Assisted ; Imaging, Three-Dimensional ; Joint Diseases/*diagnosis ; Magnetic Resonance Imaging/*methods ; Male ; Middle Aged ; ROC Curve ; Retrospective Studies ; Sensitivity and Specificity ; Statistics, Nonparametric

BACKGROUND: The mortality from acute respiratory distress syndrome(ARDS) in the late stage, which is characterized by progressive pulmonary fibroproliferation, is >or=80%. Although previous prospective trials failed to show a survival benefit of steroid therapy in early ARDS, recently, a few of reports have described the survival benefit of the long-term use of steroid in patients with late ARDS. In this study, we analyzed the effect of steroid therapy on patietns with late ARDS. In this study, we analyzed the effect of steroid therapy on patients with late ARDS retrospectively in a single. Medral intensive care unit. METHODS: Over a 3-year period, the medical records of 48 ARDS patients who had veen on mechanical ventilation more than 8 days were reviewed. 14 patients were treated by the long-term use of methylprednisolone and another 34 patients served as a control. Both groups were comparable regarding clinical and physiologic data lung injury score(LIS), multiple organ failure score, APACHE III and SAPS II score. Because steroid was instituted after 8 days of advanced mechanical ventilatory support in average, we arbitrarily defined the 8th day of ARDS as first day of the study. RESULTS: Initially, the group had similar PF(PaO2/FiO2)ratio, LIS, APA CHE III and SAPS II score. By 7th day after the start of steroid therapy, there were significant improvements in PF ratio, LIS, APACHE III and SAPS II score. The mortality in the steroid treated group was significantly lower(42.9% vs 73.5%, p<0.05). CONCLUSIONS: Although the data of this study was retrospective and was not randomized, in order to improve the patients's outcomes, steroid therapy should be considered in late ARDS patients. However, prospective trials are needed to define the indication and the effect of steroid therapy in late ARDS.
APACHE ; Humans ; Intensive Care Units ; Lung Injury ; Medical Records ; Methylprednisolone ; Mortality ; Multiple Organ Failure ; Prospective Studies ; Respiration, Artificial ; Retrospective Studies

PURPOSE: To assess the values of parametric "maximum slope(MS) and blood volume(BV)" images as indicators of tissue vascularization and perfusion in distinguishing benign from malignant musculoskeletal tumors. MATERIAL AND METHODS: Dynamic inversion recovery spin-echo echo-planar imaging (TR/TE/TI/NEX: 1 5 0 0 / 2 4 / 5 00 ms/1; matrix 128 x 128; slice thickeness 5 mm, interleaved) at 1.5-second intervals(200 phases) was performed after intravenous bolus injection of Gd-DTPA. A total of 32 pathologically proven muscu-loskeletal masses(benign 9, malignant 23) were included in this study. MS was derived by fitting a time-intensity curve using a polynomial model. BV was determined by integration until maximum slope was reached. On a pixel-by-pixel basis, MS and BV images were generated and displayed by gray-scale. We selected a region of interest(ROI, more than 6 x 6 pixels) including the highest value of the tumors and calculated mean values of MS and BV. Wilcoxon's signed rank test was used to compare benign tumors with malignant pre- and postchemotherapy tumors. RESULT: The mean values of ROIs selected on MS images were significantly different (p=.008) between benign (mean 3.33, range 0.01 -16.47 ) and prechemotherapy malignant(mean 8.54, range 1.61 -16.90) tumors, as were the mean values of ROIs on BV images(p=.005; benign tumors: mean 162.17, range 91.17 -2 8 3 . 7 ; prechemotherapy malignant tumors: mean 330.18, range 117.5 -845.1). MS and BV values of benign and malignant tumors overlapped but tended to be separated. CONCLUSION: BV and MS images may help distinguish benign from malignant musculoskeletal tumors.
Blood Volume* ; Echo-Planar Imaging ; Gadolinium DTPA ; Models, Statistical ; Perfusion

PURPOSE: To assess the values of parametric "maximum slope(MS) and blood volume(BV)" images as indicators of tissue vascularization and perfusion in distinguishing benign from malignant musculoskeletal tumors. MATERIAL AND METHODS: Dynamic inversion recovery spin-echo echo-planar imaging (TR/TE/TI/NEX: 1 5 0 0 / 2 4 / 5 00 ms/1; matrix 128 x 128; slice thickeness 5 mm, interleaved) at 1.5-second intervals(200 phases) was performed after intravenous bolus injection of Gd-DTPA. A total of 32 pathologically proven muscu-loskeletal masses(benign 9, malignant 23) were included in this study. MS was derived by fitting a time-intensity curve using a polynomial model. BV was determined by integration until maximum slope was reached. On a pixel-by-pixel basis, MS and BV images were generated and displayed by gray-scale. We selected a region of interest(ROI, more than 6 x 6 pixels) including the highest value of the tumors and calculated mean values of MS and BV. Wilcoxon's signed rank test was used to compare benign tumors with malignant pre- and postchemotherapy tumors. RESULT: The mean values of ROIs selected on MS images were significantly different (p=.008) between benign (mean 3.33, range 0.01 -16.47 ) and prechemotherapy malignant(mean 8.54, range 1.61 -16.90) tumors, as were the mean values of ROIs on BV images(p=.005; benign tumors: mean 162.17, range 91.17 -2 8 3 . 7 ; prechemotherapy malignant tumors: mean 330.18, range 117.5 -845.1). MS and BV values of benign and malignant tumors overlapped but tended to be separated. CONCLUSION: BV and MS images may help distinguish benign from malignant musculoskeletal tumors.
Blood Volume* ; Echo-Planar Imaging ; Gadolinium DTPA ; Models, Statistical ; Perfusion