A Uchino

Saitama Medical University, Saitama, Saitama, Japan

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Publications (176)308.26 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: The aim of our study was to investigate the effects of subclinical brain lesions and cognitive function on gait performance with or without concurrent cognitive task in community-dwelling elderly subjects. Participants without dementia (92 men and 109 women with a mean age of 67.8 years) underwent brain magnetic resonance imaging, neuropsychologic tests, and gait measurements. Impaired gait velocity of the Timed Up and Go test was associated with deep white matter lesions (odds ratio [OR], 2.338; 95% confidence interval [CI], 1.120-4.880) and diabetes mellitus (OR, 2.725; 95% CI, 1.120-6.630) after adjusted for age, sex, education, and cognitive function tests. Impaired gait velocity of dual task walking was associated with age and the score of Rivermead Behavioral Memory Test (OR, .899/1 point higher; 95% CI, .813-.994), whereas deep white matter lesions were not significantly associated with dual task walking. The present study showed that gait represents not only physical functioning but also subclinical cognitive dysfunction particularly memory impairment in healthy elderly subjects.
    Journal of stroke and cerebrovascular diseases: the official journal of National Stroke Association 06/2014;
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    ABSTRACT: Recently, magnetic resonance imaging (MRI) abnormalities of the pulvinar in patients with epilepsy have received greater attention, but their occurrence and features have not been fully elucidated. Therefore, we investigated the clinical and radiological features of patients with epilepsy who presented MRI abnormalities of the pulvinar. We retrospectively investigated 225 consecutive patients who came to our institute because of seizures and underwent an MRI within 24h. The patients who exhibited pulvinar MRI abnormalities, their profile, seizure type, efficacy of medication, and chronological changes of MRI findings were examined. Out of the 225 patients who underwent MRI within 24h of seizure, 17 exhibited MRI abnormalities of the pulvinar. All of these 17 patients presented status epilepticus. Bilateral pulvinar diffusion-weighted imaging (DWI) hyperintensity was observed in 3 patients and unilateral pulvinar DWI hyperintensity in the other 14. Out of these 14 patients, 7 exhibited DWI hyperintensity in the ipsilateral cerebral cortex, and 10 patients presented an old lesion due to stroke or trauma. Our results demonstrated that the involvement of the pulvinar in status epilepticus is more frequent than expected and consisted of unilateral or bilateral DWI hyperintensities that may completely normalize. These pulvinar MRI abnormalities possibly reflect the epileptogenic hyperexcitation of different cortical areas through their connections with the pulvinar.
    Journal of Neuroradiology 01/2014; · 1.24 Impact Factor
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    ABSTRACT: Objective Recently, magnetic resonance imaging (MRI) abnormalities of the pulvinar in patients with epilepsy have received greater attention, but their occurrence and features have not been fully elucidated. Therefore, we investigated the clinical and radiological features of patients with epilepsy who presented MRI abnormalities of the pulvinar. Patients and methods We retrospectively investigated 225 consecutive patients who came to our institute because of seizures and underwent an MRI within 24 h. The patients who exhibited pulvinar MRI abnormalities, their profile, seizure type, efficacy of medication, and chronological changes of MRI findings were examined. Results Out of the 225 patients who underwent MRI within 24 h of seizure, 17 exhibited MRI abnormalities of the pulvinar. All of these 17 patients presented status epilepticus. Bilateral pulvinar diffusion-weighted imaging (DWI) hyperintensity was observed in 3 patients and unilateral pulvinar DWI hyperintensity in the other 14. Out of these 14 patients, 7 exhibited DWI hyperintensity in the ipsilateral cerebral cortex, and 10 patients presented an old lesion due to stroke or trauma. Conclusions Our results demonstrated that the involvement of the pulvinar in status epilepticus is more frequent than expected and consisted of unilateral or bilateral DWI hyperintensities that may completely normalize. These pulvinar MRI abnormalities possibly reflect the epileptogenic hyperexcitation of different cortical areas through their connections with the pulvinar.
    Journal of Neuroradiology. 01/2014;
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    ABSTRACT: A 40-year-old man visited to our hospital due to progressive right hemiparesis. Magnetic resonance imaging demonstrated a heterogeneous contrast-enhanced lesion in the left basal ganglia with compression of the ventricles. A brain biopsy did not demonstrate central nervous system (CNS) lymphoma, although acute demyelination was observed. Despite the administration of steroids, the lesion increased in size, and the patient died three months after admission. An autopsy disclosed perivascular and parenchymal infiltration of lymphoma cells. An immunohistochemical analysis showed that the lesion was a cytotoxic T-cell lymphoma. This case indicates that the development of primary CNS lymphoma of this immunophenotype may be preceded by demyelination with subsequent rapid progression, thus requiring a careful evaluation and meticulous diagnosis.
    Internal medicine (Tokyo, Japan). 01/2014; 53(11):1197-200.
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    ABSTRACT: A 46-year-old man presented with right hemiparesis. Cranial magnetic resonance (MR) imaging revealed both an acute cerebral infarction in the territory of the left anterior cerebral artery (ACA) and a thin subarachnoid hemorrhage in the left superior frontal sulcus. MR angiography revealed stenosis at the A2 segment of the left ACA. MR cisternography was, therefore, performed on day 12 after admission using sagittal, 3-dimensional, heavily T2-weighted images. Fusiform dilatation of the outer contour was confirmed by MR cisternography at the region of narrowing identified by MR angiography. This case indicates that the combination of MR cisternography and angiography can be useful for detecting ACA dissection.
    Journal of stroke and cerebrovascular diseases: the official journal of National Stroke Association 01/2014;
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    ABSTRACT: Our previous study showed that the male predominance of silent brain infarction (SBI) was largely because of higher prevalence of alcohol habit and smoking in men than in women. In the present study, we further conducted an analysis of brain magnetic resonance imaging findings to examine whether early menopause contributes to SBI in community-dwelling subjects. Women were queried as to the age and cause of menopause, the total number of children, and the age at giving birth to her last child. Among 306 female subjects aged 60 years or older, univariate analysis showed that early menopause (total or natural) was significantly associated with SBI but age at natural menopause, number of children, and age at the last parity were not. In the total of 715 subjects (283 men and 432 women with a mean age of 67.2 years), the forward stepwise method of logistic analysis revealed that natural early menopause (odds ratio [OR] 4.28, 95% confidence interval [CI] 1.07-17.11), in addition to age, hypertension, alcohol intake, and smoking, was a significant factor concerning SBI. Also in the subgroup of female subjects aged 60 years or older, natural early menopause was a significant factor concerning SBI (OR 4.35, 95% CI 1.05-18.08) adjusted for covariates. Although the prevalence of natural early menopause was low (3.3% of 306 female subjects), natural menopause before the age of 40 years may be a risk for SBI or small-vessel disease of the brain.
    Journal of stroke and cerebrovascular diseases: the official journal of National Stroke Association 09/2013;
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    ABSTRACT: Purpose: We evaluated the prevalence and imaging characteristics of ring-shaped lateral ventricular nodules (RSLVNs) detected by postcontrast brain magnetic resonance (MR) imaging. Materials and Methods: We retrospectively reviewed cranial MR images of 1,241 patients who underwent contrast-enhanced brain imaging between January 1, 2008 and March 31, 2011, excluded images of inadequate quality of 130 patients, and ultimately analyzed images of 1,111 patients (544 male, 567 female). We assessed location, shape, and signal intensity of RSLVNs on T1-weighted (T1WIs), T2-weighted (T2WIs), fluid-attenuated inversion recovery (FLAIR), and diffusion-weighted (DWIs) images and characteristics of contrast enhancement. Results: In 5 patients, we found 6 RSLVNs (0.45%), four in the frontal horn and two in the roof of the body. Three RSLVNs were round, two were oval, and one was lobular on axial images. All 6 RSLVNs were isointense with adjacent brain parenchyma on T1WI, T2WI, and DWI but slightly hyperintense on FLAIR images; none showed enhancement on postcontrast MR imaging. Five nodules serially examined (range, 8 to 24 months) showed no interval changes. Conclusions: Our MR imaging findings of a 0.45% prevalence of RSLVNs shows they are not so rare as previously reported. Except for configuration, all nodules had similar intensity, and none showed contrast enhancement. Absence of changes during the follow-up period seemed to indicate that the nodules have no clinical significance. However, their clear differentiation avoids unnecessary surgery.
    Magnetic Resonance in Medical Sciences 05/2013; · 0.75 Impact Factor
  • Source
    Akira Uchino
    Neuroradiology 05/2013; · 2.70 Impact Factor
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    ABSTRACT: Abstract Secondary degeneration of the substantia nigra (SN) after damage to the ipsilateral striatum has been widely reported in animal stroke models. Secondary degeneration of the SN frequently occurs in stroke patients with damage to the striatum. Decreased γ-aminobutyric acid in the striatonigral pathway causes disinhibition of the SN pars reticulata, which consequently causes neuronal degeneration there. The SN pars compacta, in constant, degenerates in a retrograde manner. Diffusion-weighted imaging reveals this secondary degeneration as a high-intensity lesion, which may be misdiagnosed as a new infarction. (Received: November 8, 2012, Accepted: November 27, 2012).
    Brain and nerve = Shinkei kenkyū no shinpo 03/2013; 65(3):289-95.
  • Akira Uchino, Kouhei Kamiya, Chihiro Suzuki
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    ABSTRACT: Extremely rarely, a posterior communicating artery (PCoA) of "duplicate origin" occurs when two branches of the PCoA arise separately from the supraclinoid segment of the internal carotid artery (ICA) and quickly fuse to form an arterial ring. Three such cases previously reported were described as "fenestration." We report the case of this rare variation diagnosed by magnetic resonance angiography and discuss the differentiation of PCoA of duplicate origin from PCoA fenestration, supraclinoid ICA fenestration, and hyperplastic anterior choroidal artery.
    Anatomia Clinica 02/2013; · 0.93 Impact Factor
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    ABSTRACT: INTRODUCTION: A persistent dorsal ophthalmic artery (OA) is a rare variation that originates from the cavernous segment of the internal carotid artery (ICA) and enters the orbit via the superior orbital fissure (SOF). Occasionally, the OA also arises from the middle meningeal artery (MMA) and enters the orbit via the SOF. These two major variations of the OA have not been well described by magnetic resonance (MR) angiography. We evaluated their prevalence on MR angiography at 3 T. METHODS: We retrospectively reviewed our database of MR angiographic images obtained using a 3 T imager. Of images of 846 patients, we evaluated those of 826 patients (1,652 OAs) with special attention to OA origin and its course into the orbit. We excluded images of the 20 because quality was insufficient to assess. RESULTS: We found 7 (0.42 %) persistent dorsal OAs among 1,652 OAs (right/left, 6/1; male/female, 3/4). Twenty-four (1.45 %) OAs arose from the MMA (right/left/bilateral, 11/5/4; male/female, 10/10), three of which also demonstrated a small normally branching OA. In one patient, we observed both right persistent dorsal OA and left OA arising from the MMA. CONCLUSIONS: Per OA, the prevalence of persistent dorsal OA was 0.42 % and of OA arising from the MMA, 1.45 %, with a tendency toward right-side predominance. OA arising from the MMA can be seen bilaterally; preprocedural knowledge of this variation is important because of the danger associated with endovascular procedures of the external carotid system when the OA arises from the MMA.
    Anatomia Clinica 02/2013; · 0.93 Impact Factor
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    ABSTRACT: INTRODUCTION: The origin of the vertebral artery (VA) varies, though most VAs enter the transverse foramen (TF) of the sixth cervical vertebra. On computed tomography (CT) angiographic images, we evaluated the prevalence of variations of both VA origin and its level of entry into the TF. METHODS: We retrospectively reviewed CT angiographic images of 2,287 patients obtained using either of two 64-slice multidetector CT scanners. All patients were Japanese and underwent scanning from the aortic arch to the intracranial region; most had or were suspected of having cerebrovascular diseases. RESULTS: The left VA (LVA) arose from the aorta between the left common carotid artery and left subclavian artery in 94 patients (4.1 %) and in other variations in 44 patients (1.9 %). The right VA (RVA) arose from the extreme proximal segment of the right subclavian artery in 72 patients (3.1 %) and in other variations in 14 patients (0.6 %). The LVA entered the sixth TF in 2,127 patients (93.0 %), and the RVA entered the sixth TF in 2,146 patients (93.8 %). Anomalous origin and anomalous entry level into the TF correlated strongly. CONCLUSIONS: The total prevalence of variation in the origin of the LVA was 6.0 % and of the RVA, 3.8 %. The total prevalence of variation in entry level into the TF was 7.0 % for the LVA and 6.2 % for the RVA. Recognition and reporting of these variations is important in interpreting CT angiography to prevent complications during surgery of the aortic arch or lower neck.
    Neuroradiology 01/2013; · 2.70 Impact Factor
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    ABSTRACT: A 72-year-old man was admitted with left homonymous hemianopsia and hemiparesis. Magnetic resonance imaging revealed a heterogeneously enhanced lesion in the right parietal lobe. A brain biopsy showed acute demyelination without malignancy, which led to a diagnosis of tumefactive multiple sclerosis (MS). The patient received corticosteroid therapy and experienced clinical and radiological improvement. Six months later, new lesions appeared, and a second biopsy revealed proliferation of dysplastic lymphocytes. This led to a revised diagnosis of primary central nervous system lymphoma (PCNSL). Because PCNSL mimics MS both clinically and radiologically, PCNSL is difficult to diagnose. Performing repeated brain biopsies may therefore be required when PCNSL is strongly suspected.
    Internal Medicine 01/2013; 52(4):483-8. · 0.97 Impact Factor
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    ABSTRACT: Background and Purpose: Impaired kidney function or chronic kidney disease (CKD), as measured by estimated glomerular filtration rate (eGFR), is associated with incident stroke risk. However, few studies have examined the relationship between CKD and subclinical cerebral abnormalities. Methods: We examined 675 elderly subjects (mean age 69.9 years), who were living independently at home without apparent dementia, using magnetic resonance imaging. Serum creatinine values, measured by the enzymatic method, were used for the Japanese equation of eGFR. Results: Subclinical lacunar infarction, deep white matter lesions, and periventricular hyperintensities were detected in 88 (13.0%), 240 (35.6%) and 158 (23.4%) of the 675 participants, respectively. In the forward stepwise method of logistic analysis, age (OR 2.081/10, 95% CI 1.541-2.810), hypertension (OR 3.656, 95% CI 2.184-6.119), diabetes mellitus (OR 1.961, 95% CI 1.007-3.820), alcohol intake (OR 2.130, 95% CI 1.283-3.535), and eGFR <45 ml/min/1.73 m(2) were significant factors concerning subclinical lacunar infarction. CKD defined as eGFR <60 ml/min/1.73 m(2) was not significantly associated with subclinical lacunar infarction. Decreased eGFR was not a significant factor associated with white matter lesions (WMLs). Age (OR 2.781/10, 95% CI 2.252-3.435), hypertension (OR 1.746, 95% CI 1.231-2.477), diabetes mellitus (OR 1.854, 95% CI 1.070-3.213), but not eGFR were significant factors concerning WMLs. Conclusions: The present study showed that community-dwelling elderly subjects with late stage 3 CKD were at high risk for prevalent subclinical lacunar infarction. The identification of CKD-specific modifiable risk factors for SBI and WMLs is of increased importance for prevention of subclinical brain ischemic lesions.
    Contributions to nephrology 01/2013; 179:24-34. · 1.49 Impact Factor
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    ABSTRACT: INTRODUCTION: The left common carotid artery (LCCA) is usually a second branch of the aortic arch that arises between the brachiocephalic trunk (BCT) and left subclavian artery; relatively frequently, it also arises from or shares a common origin with the BCT. In patients with LCCA of anomalous origin, transfemoral catheterization into the LCCA is sometimes difficult, and transbrachial or transradial approach may be recommended. We evaluated the prevalence of these variations on computed tomography (CT) angiography. METHODS: We retrospectively reviewed CT angiographic images of 2,357 patients obtained using either of two 64-slice multidetector CT scanners. All patients were Japanese and underwent scanning from the aortic arch to the intracranial region; most had or were suspected of having cerebrovascular diseases. RESULTS: We evaluated CT angiographic images of 2,352 patients after excluding four patients with LCCA occluded at its origin. The LCCA arose from the BCT in 141 patients (6.0 %) and had a common origin with the BCT in 130 patients (5.5 %). We found 11 aberrant right subclavian artery (0.47 %), and four of the 11 patients (36 %) had LCCA of common origin with the right common carotid artery, forming a bicarotid trunk (prevalence: 0.17 %). CONCLUSIONS: The total prevalence of variations of LCCA origin diagnosed by CT angiography was 11.7 %.
    Anatomia Clinica 11/2012; · 0.93 Impact Factor
  • R Nakajima, A Uchino, S Sakai
    Clinical neuroradiology. 10/2012;
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    ABSTRACT: PURPOSE: We report a case of type 1 proatlantal intersegmental artery (PIA) associated with multiple anomalies of the aortic arch, and discuss the possible embryonic mechanism and clinical importance of the multiple cerebrovascular variants in this patient. METHODS: A 65-year-old woman with dizziness underwent cerebral magnetic resonance (MR) imaging and head and neck MR angiography using a 3-tesla scanner and computed tomography (CT) angiography using a 64-slice multidetector CT scanner. RESULTS: MR and CT angiography demonstrated an aneurysm of the distal end of the azygos anterior cerebral arteries and hypoplasia of the proximal right vertebral artery (VA) with an anastomotic artery, between the right internal carotid artery (ICA) and distal right VA that passed through the foramen magnum, indicating a type 1 PIA. She also demonstrated an aberrant right subclavian artery (ARSA) with hypoplasia of the right VA, and the left VA arose directly from the aortic arch. CONCLUSION: To our knowledge, this is the first report of a type 1 PIA associated with multiple vascular anomalies of the aortic arch, such as ARSA and origin of the left VA from the arch. In cases of persistent anastomoses between the carotid and vertebrobasilar arteries, such as PIAs, imaging examination should include the aortic arch to identify associated vascular variations.
    Anatomia Clinica 09/2012; · 0.93 Impact Factor
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    ABSTRACT: In patients with head and neck cancer, posttreatment imaging can be complicated and difficult to interpret because of the complexity of the surgical procedures performed and the postirradiation changes, but such imaging is critical for the evaluation of (a) the response to therapy and (b) tumor control. Posttreatment changes are affected by the type of surgery performed, reconstruction, neck dissection, and radiation therapy. Three types of flaps are used for reconstruction in the head and neck region: (a) the local flap, with geometric repositioning of adjacent tissue; (b) the pedicle flap, with rotation of donor tissue and preservation of the original vascular system; and (c) the free flap, with transfer of tissue that is revascularized by using microvascular surgical techniques. The posttreatment imaging findings in patients with head and neck cancer can be divided into four groups: altered anatomy secondary to surgical reconstruction, tumor recurrence, potential postsurgical complications, and possible postirradiation changes. Potential postsurgical complications are wound infection, abscess, fistula, flap necrosis, hematoma, chylous fistula, and serous retention. Possible postirradiation changes include mucosal necrosis, osteoradionecrosis, radiation-induced vasculopathy, radiation pneumonitis, radiation lung fibrosis, radiation-induced brain necrosis, and radiation-induced secondary malignancies. A familiarity with the imaging characteristics of posttreatment changes and of the potential complications caused by surgery and irradiation and an ability to differentiate these findings from tumor recurrence are essential for posttreatment surveillance and follow-up management of patients with head and neck cancer. © RSNA, 2012.
    Radiographics 09/2012; 32(5):1261-82. · 2.79 Impact Factor
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    ABSTRACT: Rarely, the ophthalmic artery (OA) arises from the cavernous segment of the internal carotid artery (ICA) inferolaterally and enters into the orbit via the superior orbital fissure. This anomalous OA that originates from the inferolateral trunk is regarded as a persistent dorsal OA. Extremely rarely, both normal OA and persistent dorsal OA arise from the ICA. We report the first case of such double OAs, one of which arose from the cavernous segment of the ICA superolaterally and we believe that it originated from the meningohypophyseal trunk rather than the inferolateral trunk.
    Anatomia Clinica 08/2012; · 0.93 Impact Factor
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    ABSTRACT: INTRODUCTION: Persistent hypoglossal artery (PHA) is the second most common anastomosis between the carotid and vertebrobasilar systems and demonstrates some variations. We evaluated the prevalence of PHA on computed tomography (CT) angiography. We also evaluated characteristic features of PHA and its variants on magnetic resonance (MR) angiography. METHODS: We retrospectively reviewed our database of 2,074 CT angiographic images obtained using either of two 64-slice multidetector CT scanners. We also reviewed our database of 7,646 MR angiographic images obtained using either of two 1.5-T or one 3.0-T imager. We could not determine the exact number of patients whose MR angiography included the hypoglossal canal. Most patients had or were suspected of having cerebrovascular diseases. RESULTS: We found six usual PHAs arising from the cervical internal carotid artery on CT angiography among 2,074 patients. On MR angiography, we also found six additional usual PHAs (total 12, right/left = 6/6, male/female = 3/9), three right PHAs originating from the external carotid artery (ECA), and two posterior inferior cerebellar arteries (PICAs) arising from the ECA without connection to the vertebral artery. CONCLUSIONS: The prevalence of usual PHA diagnosed by CT angiography was 0.29 %, slightly higher than that reported for angiography and may be due to selection bias in the examined patients. We propose naming usual PHA "type 1 PHA"; PHA originating from the ECA, of which we found three, "type 2 PHA"; and PICA arising from the ECA, of which we found two, "type 2 PHA variant."
    Neuroradiology 07/2012; · 2.70 Impact Factor

Publication Stats

1k Citations
308.26 Total Impact Points

Institutions

  • 2008–2014
    • Saitama Medical University
      • • Department of Neurology
      • • Department of Radiology
      Saitama, Saitama, Japan
  • 2011
    • National Hospital Organization Sagamihara Hospital
      Sagamihara, Kanagawa, Japan
  • 2005–2011
    • Saga University
      • • Division of Radiology
      • • Division of Neurology
      Сага Япония, Saga, Japan
  • 2003–2011
    • Sagamihara National Hospital
      Йокосука, Kanagawa, Japan
  • 1986–2008
    • Kyushu University
      • • Faculty of Medical Sciences
      • • Department of Neurosurgery
      Fukuoka-shi, Fukuoka-ken, Japan
  • 1996–1997
    • Kyushu Kosei Nenkin Hospital
      Kitakyūshū, Fukuoka, Japan
    • University of Southern California
      Los Angeles, California, United States