引地 智加

Background: Although single-photon emission computerized tomography of the dopamine transporter (DATSPECT) is useful for diagnosing parkinsonian syndrome, its applicability toward the early phase of Parkinson's disease remains unknown. Methods: We enrolled 32 patients showing parkinsonism with normal cardiac I-123-metaiodobenzylguanidine (MIBG) uptake and abnormal DAT-SPECT findings among 84 consecutive patients with parkinsonism. We divided these patients into two groups (group 1: Parkinson's disease, group 2: corticobasal degeneration, progressive supranuclear palsy, multiple system atrophy), and compared their clinical characteristics, specific binding ratios, and striatal asymmetry indexes on DAT-SPECT examinations. Results: The striatal asymmetry indexes were significantly lower in group 1 than in group 2 (p < 0.05), but there were no differences in the specific binding ratios between the two groups. Conclusion: The combined use of striatal asymmetry index on DAT-SPEC' and cardiac MIBG scintigraphy might offer useful clues for the differential diagnosis of the early phase Parkinson's disease from other parkinsonian syndromes. (C) 2017 Elsevier B.V. All rights reserved.

Introduction: To visualize peripheral nerves in patients with chronic inflammatory demyelinating polyneuropathy (CIDP), we used MR imaging. We also quantified the volumes of the brachial and lumbar plexus and their nerve roots. Methods: Thirteen patients with CIDP and 12 healthy volunteers were enrolled. Whole- body MR neurography based on diffusionweighted whole- body imaging with background body signal suppression ( DWIBS) was performed. Peripheral nerve volumes were calculated from serial axial MR images. Results: The peripheral nervous system was visualized with 3-dimensional reconstruction. Volumes ranged from 8.7 to 49.5 cm(3)/m(2) in the brachial plexus and nerve roots and from 10.2 to 53.5 cm(3)/m(2) in the lumbar plexus and nerve roots. Patients with CIDP had significantly larger volumes than controls ( P < 0.05), and volume was positively correlated with disease duration. Conclusions: MR neurography and the measurement of peripheral nerve volume are useful for diagnosing and assessing CIDP.

Objective: Acute multifocal embolic infarction (AMEI) is conventionally caused by etiologies such as cardioembolism due to atrial fibrillation (AO, but can also be caused by serious underlying diseases such as cancer. We characterized cancer-related AMEI and identified useful indicators for cancer-associated strokes. Methods: A retrospective analysis was performed on 35 patients with Af-related AMEI and 35 patients with cancer -related AMEI selected from 1235 consecutive patients with acute infarcts. All patients received diffusion weighted magnetic resonance (MR) imaging. Cerebral MR angiography, carotid and cardiac ultrasonography, electrocardiogram-monitoring and whole body computed tomography were also performed on these patients. D-dimer levels were evaluated on admission, and were measured during the sub-acute phase in 19 of the patients with Af and 27 of the patients with cancer. Results: Acute phase D-dimer levels were significantly higher in patients with cancer than in patients with Af alone. The cut-off D-dimer value to identify cancer-associated infarcts was 2.0 mu g/mL. D-dimer levels during the sub-acute phase remained elevated in the cancer patients. Conclusions: We may differentiate cancer-associated AMEI from Af using a D-dimer level >= 2.0 mu g/mL, which does not decrease during the sub-acute phase. (C) 2016 Elsevier B.V. All rights reserved.

Background: Although most patients with Parkinson's disease (PD) show decreased cardiac I-123-metaiodobenzylguanidine (MIBG) uptake, some exhibit normal uptake. We evaluated the clinical characteristics of such patients. Methods: We enrolled 154 non-demented patients showing parkinsonism with normal cardiac MIBG uptake and had been clinically followed up during 29.9 +/- 27.6 months. We defined the patients who did not fit the exclusion criteria for PD and demonstrated >= 30% reduction in the Unified Parkinson's Disease Rating Scale (UPDRS) motor score after anti-Parkinson agent administration as probable PD. We compared clinical characteristics and the cardiac MIBG heart-to-mediastinum (H/M) ratio between the probable PD group (N = 37) and other groups (N = 117). Results: The probable PD group showed significantly higher UPDRS motor scores and greater incidence of tremor/rigidity than those of other groups. In addition, they showed a significantly lower cardiac MIBG HIM ratio in the delayed phase (delayed, p < 0.0001). Washout-rate (WR) was significantly higher in probable PD cases (p < 0.0001). Among 16 probable PD patients undergoing serial cardiac MIBG scintigraphy, the delayed phase cardiac MIBG H/M ratio showed a significant decrease and WR significantly increased during follow-up periods. Conclusions: An increase in WR and lower delayed phase cardiac MIBG uptake were found to be characteristics of such patients. (C) 2015 Elsevier B.V. All rights reserved.