Purpose: This study was performed to determine whether the T1 relaxation time of gadoxetic acid-enhanced liver MR imaging is useful for detecting and staging liver fibrosis in patients with chronic liver disease. Materials and Methods: One hundred and three patients with suspected focal liver lesion underwent MR imaging and Fibroscan. Fibroscan was chosen as the reference standard for classifying liver fibrosis. T1 relaxation times were acquired before (preT1), 20 minutes after (postT1) contrast administration, and reduction rate of T1 relaxation time (rrT1) on transverse 3D VIBE (volumetric interpolated breath-hold examination) sequence using 3T MR imaging. The optimal cut-off values for the fibrosis staging were determined with ROC analysis. Results: PreT1 and postT1 increased and rrT1 decreased constantly with increasing severity of liver fibrosis according to the METAVIR score (F0–F4). There were statistically significant differences between F2 and F3 in preT1 (F2, 836.0 ± 74.7 ms; F3, 888.6 ± 77.5 ms, p < 0.05) and between F3 and F4 in postT1 (F3, 309.0 ± 80.2 ms; F4, 406.6 ± 147.7 ms, p < 0.05) and rrT1 (F3, 65.4 ± 7.7%; F4, 57.3 ± 11.4%, p < 0.05). ROC analysis revealed that combination test (preT1 + postT1) was the best test for predicting liver fibrosis. Conclusion PreT1 and postT1 increased constantly with increasing severity of liver fibrosis. T1 mapping in gadoxetic acid-enhanced liver MR imaging could be a helpful complementary sequence to determine the liver fibrosis stage.

Purpose: This study was performed to determine whether the T1 relaxation time of gadoxetic acid-enhanced liver MR imaging is useful for detecting and staging liver fibrosis in patients with chronic liver disease. Materials and Methods: One hundred and three patients with suspected focal liver lesion underwent MR imaging and Fibroscan. Fibroscan was chosen as the reference standard for classifying liver fibrosis. T1 relaxation times were acquired before (preT1), 20 minutes after (postT1) contrast administration, and reduction rate of T1 relaxation time (rrT1) on transverse 3D VIBE (volumetric interpolated breath-hold examination) sequence using 3T MR imaging. The optimal cut-off values for the fibrosis staging were determined with ROC analysis. Results: PreT1 and postT1 increased and rrT1 decreased constantly with increasing severity of liver fibrosis according to the METAVIR score (F0–F4). There were statistically significant differences between F2 and F3 in preT1 (F2, 836.0 ± 74.7 ms; F3, 888.6 ± 77.5 ms, p < 0.05) and between F3 and F4 in postT1 (F3, 309.0 ± 80.2 ms; F4, 406.6 ± 147.7 ms, p < 0.05) and rrT1 (F3, 65.4 ± 7.7%; F4, 57.3 ± 11.4%, p < 0.05). ROC analysis revealed that combination test (preT1 + postT1) was the best test for predicting liver fibrosis. Conclusion PreT1 and postT1 increased constantly with increasing severity of liver fibrosis. T1 mapping in gadoxetic acid-enhanced liver MR imaging could be a helpful complementary sequence to determine the liver fibrosis stage.

Objective: The aim of this study was to investigate whether a new generic rosuvastatin is non-inferior to a proprietary one in terms of lipid-lowering efficacy. We also evaluated its non-lipid effects including adverse events. Methods: One-hundred and fifty-eight patients with cardiovascular risks requiring pharmacological lipid-lowering therapy were screened. After a 4-week run-in period, 126 individuals who met the lipid criteria for drug therapy were randomly assigned to receive the new generic or proprietary rosuvastatin 10 mg daily for 8 weeks. The primary outcome variables were low-density lipoprotein-cholesterol (LDL-C) reduction and LDL-C target achievement. Hematological and biochemical parameters and adverse events were assessed. Results: After 8 weeks of drug treatment, the mean percentage change in LDL-C was not different between the groups (−45.5%±19.9% and −45.1%±19.0% for generic and proprietary rosuvastatin, respectively; p=0.38). The LDL-C target achievement rate was similar between the groups (75.0% and 77.1% for generic and proprietary rosuvastatin, respectively; p=0.79). The percentage change in the other lipid profiles was not significantly different. Although generic- and proprietary rosuvastatins modestly affected creatine kinase and blood pressure, respectively, the changes were all within normal ranges. Incidence of adverse events did not differ between the receivers of the 2 formulations. Conclusion The new generic rosuvastatin was non-inferior to the proprietary rosuvastatin in terms of lipid-lowering efficacy. The rosuvastatin formulations did not exhibit clinically significant non-lipid effects with good safety profiles. Our study provides comprehensive data regarding 2 rosuvastatin formulations in East Asian subjects.

Most cystic lesions of the liver are found incidentally in imaging studies because they are not symptomatic, and generally do not require treatment. Rarely, however, symptomatic hepatic cysts may develop complications and require treatment. Here, we describe a case of a 77-year-old woman who developed biliary obstruction with abdominal pain due to compression of the bile duct by a simple hepatic cyst. We confirmed the diagnosis based on symptoms and imaging studies. The patient's symptoms improved after simple cyst ablation by sclerotherapy.
Abdominal Pain ; Aged ; Bile Ducts ; Cholestasis ; Diagnosis ; Female ; Humans ; Liver* ; Sclerotherapy

BACKGROUND: Frontotemporal dementia (FTD) has a characteristic pattern of lobar atrophy in frontal and/or temporal lobes. Asymmetry in the lateral ventricle size on brain magnetic resonance image (MRI) in FTD patients may have clinical significance. This study compares the ventricular asymmetry seen on MRI with that of the neuropsychological difference and asymmetric hypoperfusion using statistical parametric mapping (SPM) analysis of brain SPECT in patients with FTD. METHODS: Thirteen FTD patients who underwent Brain MRI, TC-99m ECD SPECT and neuropsychological testing and who had the ventricular asymmetry on brain MRI were retrospectively selected. The patients were divided into two groups (5 right dominant group, 8 left dominant group) according to the ventricular asymmetry on brain MRI. We compared the regional blood flow pattern on TC-99m ECD SPECT images using SPM analysis and the results of neuropsychological tests between the two groups. RESULTS: In the right dominant group, a significant perfusion deficit was identified at the bilateral frontal regions. In the left dominant group, significant hypoperfusion was found at the left frontotemporal regions (uncorrected p<0.001). There was no significant difference of neuropsychological testing in between the two groups. However, the score on the Neuropsychiatric Inventory (NPI) in the right dominant group was higher than that of the left dominant group (p=0.043). CONCLUSIONS: Hemispheric asymmetry on brain MRI was common in patients with FTD and was related with a characteristic pattern of hypoperfusion on brain SPECT images and neuropsychiatric symptoms.
Atrophy ; Brain ; Cysteine ; Frontotemporal Dementia ; Humans ; Lateral Ventricles ; Magnetic Resonance Spectroscopy ; Neuropsychological Tests ; Organotechnetium Compounds ; Perfusion ; Regional Blood Flow ; Retrospective Studies ; Temporal Lobe ; Tomography, Emission-Computed, Single-Photon

BACKGROUND AND OBJECTIVES: The left ventricular ejection fraction (LVEF) and volume (LVV) are important variables in patients with coronary artery disease. Quantitative gated myocardial SPECT (QGS) permits the simultaneous assessment of perfusion, LVEF and LVV. However, the presence of a perfusion defect may influence the LVEF and LVV measured by QGS. SUBJECTS AND METHODS: 67 subjects (M/F=47/20; mean age: 60.2+/-12.4 years) underwent both QGS with Tc-99m MIBI and 2-D echocardiography (Echo) at less than 7 days apart. The LVEF and LVV were measured by Echo, using the modified Simpson's method, and by QGS, using the automatic software, AutoQUANT(TM). The QGS rest images were used to compare with the Echo. RESULTS: The correlations between the QGS and Echo for LVEF, LVEDV and LVESV were good in all 67 subjects (r=0.781, 0.754 and 0.906, respectively, p<0.0001). In patients with no perfusion defect (n=34), the correlations between the QGS and Echo for LVEF, LVEDV and LVESV were good (r=0.689, 0.593 and 0.586, p<0.0001). In patients with a perfusion defect (n=33), the LVEF between the QGS and Echo was well correlated (r=0.777, p<0.0001), but the LVEF was higher by 7.1+/-8.7% from the Echo results. The LVEDV and LVESV by both QGS and Echo were also well correlated (r=0.804 and 0.929, respectively, p<0.0001), but the LVEDV and LVESV were higher from QGS by 17.9+/-34 and 16.9+/-25 mL, respectively. A Bland-Altman analysis showed the agreement between the QGS and Echo in patients without perfusion defect was better than for those with a perfusion defect. CONCLUSION: The perfusion defect from QGS might affect the measurements of the LVEF and LVV; therefore, the QGS and Echo values are not interchangeable.
Coronary Artery Disease ; Echocardiography ; Humans ; Perfusion* ; Stroke Volume* ; Tomography, Emission-Computed, Single-Photon* ; Ventricular Function, Left

A 63-year-old man was admitted with newly developed left hemiparesis. He had experienced left hemiparesis that had resulted from an earlier right thalamic hemorrhage. Diffusion-weighted images showed only high signal intensity lesion in the left internal capsule. Ipsilateral motor evoked potentials were obtained at the affected hand muscles when the unaffected motor cortex was stimulated. This suggests that cortical reorganization in the unaffected hemisphere after the first stroke may be involved in the occurrence of such symptom.
Evoked Potentials, Motor ; Hand ; Hemorrhage ; Humans ; Internal Capsule* ; Middle Aged ; Motor Cortex ; Muscles ; Paresis* ; Stroke*

BACKGROUND: Diffusion tensor MRI (DTI) is a new imaging technique and enables us to analyze the structural damage of fiber pathways and to monitor the time course of Wallerian degeneration of the pyramidal tract in stroke patients. We used DTI to investigate structural changes of the infarct area and the associated descending corticospinal tract in patients with subcortical infarct. METHODS: We examined 24 consecutive patients who presented with acute single cerebral infarct in the subcortical area and who also had undergone an MRI study within 7 days after symptom onset. Clinical outcome was assessed using the National Institutes of Health Stroke Scale (NIHSS) at admission, 7 days, 14 days and 30 days and modified Rankin Scale (mRS) at admission and 30 days. Each of the indices was achieved by post processing the acquired DTI data and correlated with the NIHSS. RESULTS: In infarct region, fractional anisotropy (FA) was significantly decreased compared with matched-contralateral regions (0.39 vs. 0.53, p<0.001). In the distal to the infarct, FA was significantly decreased at internal capsule (0.62 vs. 0.64, p=0.019), not at pons (0.51 vs. 0.53, p=0.103). The decrease of anisotropy at infarct region correlated positively with the NIHSS at 7, 14 and 30 days and mRS at 30 days after stroke, but the decrease of anisotropy at internal capsule did not correlate with the NIHSS. CONCLUSIONS: This study shows the potential of DTI to detect and monitor the structural degeneration of fiber pathways and to establish the prognosis in patients with acute subcortical cerebral infarct.
Anisotropy ; Cerebral Infarction* ; Diffusion* ; Humans ; Internal Capsule ; Magnetic Resonance Imaging* ; National Institutes of Health (U.S.) ; Pons ; Prognosis ; Pyramidal Tracts ; Stroke ; Wallerian Degeneration

BACKGROUND: To investigate the optimal values of transcranial doppler (TCD) index in the evaluation of leptomeningeal collateral circulation (CC) in patients with middle cerebral artery (MCA) stenosis. METHODS: Forty-one patients, with angiographically confirmed single stenosis or occlusion of the M1 segment of the MCA, were studied with TCD and brain MRI. Patients were divided into two groups according to the existence of CC though ipsilateral anterior cerebral artery on transfemoral cerebral angiography (TFCA). Mean flow velocities (mFV) of anterior and middle cerebral arteries (ACA, MCA) were analyzed. We then investigated the optimal values of TCD flow index: 1) ipsilateral mFV ACA/MCA (AMVR), 2) ACA velocity ratio (ACAVR), 3) mFVACA. We then correlated TCD flow index with TFCA results. RESULTS: TFCA revealed single moderate to severe M1 stenosis (n=35) and occlusion (n=6). Presence of CC was found in 11 (27%), absence of CC in 30 (73%). The mean of AMVR, ACAVR and mFVACA differed between the two groups: 1.76 +/- 0.69, 1.43 +/- 36, 86.27 +/- 31.73 cm/s in the presence of CC; 0.48 +/- 0.24, 1.21 +/- 0.39, 65.93 +/- 23.24 in the absence of CC. The optimal cutoff values for detection of CC were found at AMVR>or=0.9, ACAVR>or=1.30 and mFVACA>or=80 cm/s. The combination of individual TCD indexes had improved the specificity and positive predicted value in the detection of CC. CONCLUSIONS: TCD enables detecting the existence of CC in patients with MCA stenoocclusion. These optimal values may provide a noninvasive method for evaluate the pathomechanism of stroke and prospect the prognosis of these patients.
Anterior Cerebral Artery* ; Brain ; Cerebral Angiography ; Collateral Circulation* ; Constriction, Pathologic ; Humans ; Infarction, Middle Cerebral Artery* ; Magnetic Resonance Imaging ; Middle Cerebral Artery* ; Prognosis ; Sensitivity and Specificity ; Stroke

Abnormal motor behaviors caused by ipsilateral hemispheric lesions have not been frequently reported. However, a 76-year-old woman developed left hemiparesis and abnormal movements of the right limb. Upon observation, she would unintentionally rotate her hand continuously on the table in a stereotypical way. A brain CT showed an infarction in the basal ganglia and corona radiata. We report this patient with unilateral hyperkinesia and contralateral hemiparesis due to ipsilateral basal ganglia lesions.
Aged ; Basal Ganglia* ; Brain ; Dyskinesias ; Extremities ; Female ; Hand ; Humans ; Hyperkinesis* ; Infarction* ; Paresis*