Takeshi Wada

Nara Medical University, Kashihara, Nara, Japan

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Publications (26)39.54 Total impact

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    ABSTRACT: The objective of this study was to determine long-term outcomes after stent placement for subclavian artery (SA) obstructive lesions assisted by intraoperative intravascular ultrasound (IVUS). The study included 25 lesions in 24 patients who underwent stent placement assisted by intraoperative IVUS for subclavian artery stenosis or obstruction at our hospital between January 2003 and August 2010. Outcome was evaluated based on the results within 30 postoperative days (technical success rate, improvement in upper extremity ischemia, steal syndrome, left-right blood pressure difference, and perioperative complications) and the results after 30 postoperative days (incidence of vertebrobasilar artery territory infarction and restenosis). Stent placement and vessel dilatation were successful in all patients, without perioperative complications. Upper extremity ischemia, steal syndrome, and left-right blood pressure difference disappeared in all cases. During follow-up observation (6-96 months; median 51 months), no restenosis occurred at the stent placement site in any patient. In one case, four years after initial treatment, stenosis was noted proximal to the stent placement site. Satisfactory long-term as well as short-term outcomes were achieved after stent placement for SA obstructive lesions assisted by intraoperative IVUS evaluation.
    The neuroradiology journal. 04/2014; 27(2):213-21.
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    ABSTRACT: Intracranial giant vertebral artery aneurysms are extremely rare in the pediatric population and are associated with significant morbidity and mortality. The present report describes a case of a pediatric patient with giant vertebral artery aneurysm who presented with intracranial mass effect. This patient was successfully treated with endovascular parent artery occlusion and coil embolization.
    Surgical Neurology International 01/2014; 5(Suppl 4):S143-7. · 1.18 Impact Factor
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    ABSTRACT: Periprocedural ischemic stroke is one problem associated with carotid artery stenting (CAS). This study was designed to assess whether preoperative statin therapy reduces the risk of periprocedural ischemic complications with CAS. In this prospective study at 11 centers, patients with carotid artery stenosis (symptomatic ≥50 %, asymptomatic ≥80 %) and a high risk of carotid endarterectomy but without previous statin treatments were divided into two groups by low-density lipoprotein cholesterol (LDL-C) levels. With LDL-C ≥120 mg/dl, the pitavastatin-treated (PS) group received pitavastatin at 4 mg/day. With LDL-C <120 mg/dl, the non-PS group received no statin therapy. After 4 weeks, both groups underwent CAS. Frequencies of new ipsilateral ischemic lesions on diffusion-weighted imaging within 72 h after CAS and cerebrovascular events (transient ischemic attack, stroke, or death) within 30 days were assessed. Among the 80 patients enrolled, 61 patients (PS group, n = 31; non-PS group, n = 30) fulfilled the inclusion criteria. New ipsilateral ischemic lesions were identified in 8 of 31 patients (25.8 %) in the PS group and 16 of 30 patients (53.3 %) in the non-PS group (P = 0.028). Cerebrovascular events occurred in 0 patients in the PS group and in 3 of 30 patients (10.0 %) in the non-PS group (P = 0.071). Multivariate analyses demonstrated the pitavastatin treatment (β = 0.74, 95 % confidence interval 0.070-1.48, P = 0.042) to be an independent factor for decreasing post-CAS ischemic lesions. Pretreatment with pitavastatin significantly reduced the frequency of periprocedural ischemic complications with CAS.
    CardioVascular and Interventional Radiology 12/2013; · 2.09 Impact Factor
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    ABSTRACT: Optimal platelet inhibition is an important therapeutic adjunct in patients with carotid artery stenosis undergoing carotid artery stenting (CAS). Clopidogrel resistance is associated with increased periprocedural thromboembolic complications from neurovascular stent placement procedures. The addition of cilostazol to dual antiplatelet therapy (DAT) has been reported to reduce platelet reactivity and to improve clinical outcomes after percutaneous coronary intervention. This study was undertaken to evaluate the impact of adjunctive cilostazol in patients with CAS. Platelet function was assessed by light transmittance aggregometry using the VerifyNow assay. Sixty-four consecutive patients who underwent CAS received standard DAT, clopidogrel (75 mg daily), and aspirin (100 mg daily) more than 4 weeks before the procedure. From 2010 to 2011 (period I), 28 patients underwent CAS under standard DAT. From 2011 to 2013 (period II), 36 patients prospectively had preoperative assessment of platelet function, and 13 patients with clopidogrel resistance received adjunctive cilostazol (200 mg daily) in addition to standard DAT. The incidence of new ipsilateral ischemic lesions on diffusion-weighted imaging a day after CAS and ischemic or hemorrhagic events within 30 days was assessed. Clopidogrel resistance was indentified in 12 patients (43%) in period I and 13 patients (36%) in period II (P = .615). In period II, the addition of cilostazol significantly decreased P2Y12 reaction units and % inhibition (P = .006 and P = .005, respectively), and there was a significant difference in P2Y12 reaction units between the two periods. New ipsilateral ischemic lesions were significantly decreased in period II (2/36 patients) compared with period I (7/28 patients; P = .034); however, there was no significant difference in hemorrhagic and thromboembolic events between the two periods. Adjunctive cilostazol (triple antiplatelet therapy) in clopidogrel-resistant patients reduces the rate of clopidogrel resistance and suppresses new ischemic lesions without hemorrhagic complications, as compared with standard DAT. Antiplatelet management based on the evaluation of antiplatelet resistance would be required for prevention of perioperative thromboembolic complications in CAS.
    Journal of vascular surgery: official publication, the Society for Vascular Surgery [and] International Society for Cardiovascular Surgery, North American Chapter 11/2013; · 3.52 Impact Factor
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    ABSTRACT: The present study aimed to identify the types of curved lesions that are difficult to place Carotid Wallstent (CWS). The study targeted 31 consecutive carotid artery (CA) stenosis underwent carotid artery stenting using CWS. CWS placement success rate, stenosis location, lesion tortuosity, and relationship with stent placement failures were investigated. Lesion tortuosity was defined as the angle formed by 2 tangential lines between internal CA and common CA from the inflection point (IP) was defined as the center of lesion curvature. Stenosed lesions were classified into type A or B. Type A was defined as if the distal end of the stenosis was located proximal to the IP at a distance ≥0.5 of a vertebral body based on the posterior height of the 3rd vertebral body, otherwise was type B. The stent placement success rate was 93.5% (29/31). The 2 unsuccessfully stented lesions, both lesions were significantly different from other lesions by having a lesion tortuosity less than 90° and by belonging to type B. Since CWS placement is difficult in patients with CA stenosis located close to the IP at a lesion tortuosity ≤90°, open-cell stents should be considered as an alternative.
    SpringerPlus 01/2013; 2:468.
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    ABSTRACT: BACKGROUND:: Retrograde leptomeningeal venous drainage (RLVD) in dural arteriovenous fistulas (DAVFs) is associated with intracerebral hemorrhage and nonhemorrhagic neurological deficits or death. Angiographic evidence of RLVD is a definite indication for treatment, but less-invasive methods of identifying RLVD are required. OBJECTIVE:: To evaluate the efficacy of susceptibility-weighted magnetic resonance imaging (SWI) in detecting RLVD in DAVFs. METHODS:: We retrospectively identified 17 DAVF patients who had angiographic evidence of RLVD and received treatment. Conventional angiography and SWI were assessed at pre- and post-treatment time points. The presence of RLVD on SWI was defined as cortical venous hyperintensity, and the presence of venous congestion on SWI venograms was defined as increased caliber of cortical or medullary veins. RESULTS:: Cortical venous hyperintensity was identified in pre-treatment SWI of 15 patients. Cortical venous hyperintensity was absent in early post-treatment SWI, consistent with the absence of RLVD in post-treatment angiography, in all but one of these patients. In two patients, cortical venous hyperintensity was identified during follow-up, indicating recurrence of RLVD. Cortical venous hyperintensity was not identified in pre-treatment SWI of two patients, despite angiographic evidence of RLVD. Venous congestion was identified in pre-treatment SWI venograms of 11 patients, and was of similar appearance to that identified from angiography. Venous congestive signs improved over the follow-up period. CONCLUSION:: The presence of SWI hyperintensity within the venous structure could be a useful indicator of RLVD in DAVF patients. SWI offers a noninvasive alternative to angiography for identification of RLVD in pre- and post-treated DAVF patients.
    Neurosurgery 10/2012; · 2.53 Impact Factor
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    ABSTRACT: INTRODUCTION: The presence of adhesions between the brain and the meningioma is an important factor that determines the success of total surgical removal. Brain surface motion imaging enables assessment of the dynamics of brain surface motion. A subtraction image of pulse-gated heavily T2-weighted images in different phases of the cardiac cycle provides a stripe pattern on the surface of the pulsating brain. Thus, the lack of a stripe pattern on the surface of extraaxial tumor indicates the presence of tumor-brain adhesion. The purpose of the present experiment was to evaluate the accuracy of predicting tumor-brain adhesion using the original double acquisition method and the improved single acquisition method. METHODS: The subjects were 67 meningioma cases patients who were surgically treated after brain surface motion imaging. Thirty-three cases were evaluated using the double acquisition method and 34 cases were evaluated with the single acquisition method. In the double acquisition method, the two sets of images are acquired as two independent scans, and in the single acquisition method, the images are acquired serially as a single scan. RESULTS: The findings for the double acquisition method agreed with the surgical findings in 23 cases (69.7 %), while findings from the single acquisition method agreed with the surgical findings in 26 cases (76.5 %). CONCLUSION: Pre-surgical evaluation for tumor-brain adhesion by brain surface motion imaging provides helpful information for meningioma surgery, especially when using the single acquisition method.
    Neuroradiology 06/2012; · 2.70 Impact Factor
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    ABSTRACT: INTRODUCTION: The current study evaluated the signal characteristics of susceptibility weighted imaging (SWI) of arteriovenous malformation (AVM), especially for draining veins. For this purpose, we identified the draining veins of the AVM on angiography and evaluated the signal on magnitude image for SWI (SWI-mag) and minimum intensity projection image (SWI-minIP). METHODS: Subjects were 14 cases with angiographically proven AVM. SWI-mag, SWI-minIP, and time-of-flight (TOF) magnetic resonance angiography were acquired. For the draining veins of the AVM identified on angiography, we analyzed signal intensity on the images listed above, and classified it into hyperintensity (hyper), mixed intensity (mixed), hypointensity (hypo), and no visualization. RESULTS: On the analysis of 27 angiographically proven draining veins, 19 draining veins were classified as hyper, 3 as mixed, 0 as hypo, and 6 as no visualization on SWI-mag. On TOF images, 21 draining veins were classified as hyper, 2 as mixed, 0 as hypo, and 4 as no visualization, while 6 draining veins did not show hyperintensity on TOF, and SWI-mag visualized 3 of these 6 veins as hyper. CONCLUSION: SWI-mag depicted most draining veins of AVM as hyperintensity. We speculate that this is mainly due to the higher concentration of oxygenated hemoglobin (oxy-Hb) and inflow effect of the draining vein. SWI-mag seems to be useful in the analysis and follow-up for AVM as the signal on the image may reflect physiological status.
    Neuroradiology 05/2012; · 2.70 Impact Factor
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    ABSTRACT: Intravascular treatment of cavernous dural arteriovenous fistula (dAVF) is usually safe and effective. However, we describe a patient with a rare brainstem hemorrhage during transvenous embolization (TVE). A 79-year-old woman suffered from left chemosis and diplopia. Cerebral angiography revealed a left cavernous dAVF with cortical venous drainage. The patient underwent TVE of the cavernous sinus (CS) via the left inferior petrosal sinus. Superior petrosal sinus (SPS) outflow occlusion was performed to avoid venous congestion, followed by superficial middle cerebral vein outflow occlusion, selective shunt occlusion of the middle meningeal artery, and superior orbital vein outflow occlusion. The patient's condition suddenly deteriorated during CS packing. A CT scan revealed a massive brainstem hemorrhage. Cerebral angiography did not show SPS reopening or redistributed drainage to the posterior fossa. Thus, TVE for cavernous dAVF can result in life-threatening vascular complications. Well-planned treatment strategies could avert this rare complication.
    Journal of Clinical Neuroscience 04/2012; 19(4):589-92. · 1.25 Impact Factor
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    ABSTRACT: We hypothesized that the pattern of branching of the lenticulostriate arteries (LSAs) is involved in the variation of the distribution of the infarction within the LSA region. Our purpose was to evaluate the visibility of LSAs in 3D time-of-flight (TOF) MR angiography (MRA) with a 3.0 T scanner and to investigate the branching patterns of LSAs. We performed 3D TOF MRA at 3.0 T for 100 healthy subjects. We assessed the number of LSAs and the number of branches arising from each LSA by evaluating MRA source images. In 200 hemispheres, 330 LSAs were visualized (mean = 1.65/hemisphere). In 3.5% of all hemispheres, no LSA was depicted; one LSA was depicted in 39%, two in 46.5%, and three in 11%. The maximum number of depicted LSA branches was five in 2% of all subjects, four in 7%, three in 26%, and two in 49% (mean = 2.3/subject). A large LSA trunk with three or more branches was found in 35% of subjects. Visualization of LSAs was possible in 96.5% of subjects by use of 3.0 T MRA. LSA branching patterns were variable, and a large LSA trunk with three or more branches was common.
    Japanese journal of radiology 02/2012; 30(4):331-5. · 0.73 Impact Factor
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    ABSTRACT: Hemifacial spasm is usually caused by compression of the facial nerve at the root exit zone (REZ), whereas fusiform aneurysmal compression is extremely rare. The authors describe symptomatic hemifacial spasm caused by a contralateral fusiform aneurysm of the vertebral artery (VA) that was treated by endovascular coil embolization. A 55-year-old woman developed left hemifacial spasm that had gradually worsened over a period of 2 years before admission to our hospital. Cerebral angiography showed an elongated right VA fusiform aneurysm near the VA union that inclined toward the left side. The cause of the facial spasm was considered to be compression of the left facial nerve REZ by the aneurysm. Endovascular parent artery embolization including the aneurysm was performed. The hemifacial spasm disappeared within 3 months. Hemifacial spasm caused by contralateral VA fusiform aneurysm can be treated by intravascular parent artery occlusion with coil embolization.
    Neurosurgery 09/2011; 69(3):E768-71; discussion E771-2. · 2.53 Impact Factor
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    ABSTRACT: The Carotid WALLSTENT (CWS) and Filter-Wire EZ (FWEZ) embolic protection devices for use in carotid arterial stenting (CAS) were newly approved for national health insurance coverage in Japan in April 2010. This article describes our initial experience of CAS using the CWS and FWEZ. A group of 14 patients (12 men, 2 women; mean age 70.1 years, range 59-83 years) with 15 carotid artery stenoses at high risk for carotid endarterectomy were treated by CAS using the CWS and FWEZ. Of these stenoses, 5 were symptomatic with ≥50% stenosis of the common or internal carotid artery (ICA), and 10 were asymptomatic with ≥80% stenosis. The rates of technical success, ICA flow impairment during filter protection, periprocedural ischemic stroke, 30-day major adverse events (MAEs) (stroke, death, myocardial infarction), and development of new ischemic lesions on diffusion-weighted imaging (DWI) were assessed. CAS was successful in all cases. There was no ICA flow impairment, periprocedural ischemic stroke, or MAEs. DWI showed new ipsilateral ischemic lesions in only one patient (6.7%). Our initial clinical experience using the CWS and FEWZ for CAS was generally excellent, and the incidence of postprocedural ischemic lesions was low.
    Japanese journal of radiology 01/2011; 29(1):51-8. · 0.73 Impact Factor
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    ABSTRACT: We assessed the signal of the globus pallidus (GP) in cases of hepatic insufficiency, especially to evaluate the degree of discrepancy in paramagnetic effects on shortening of T(1) and T(2)* using susceptibility-weighted images (SWI). Seven patients with hepatic insufficiency underwent magnetic resonance (MR) examinations that included T(1)-weighted images (T(1)WI), T(2)-weighted images (T(2)WI), and SWI on a 1.5-tesla MR imager, and we compared their results to those of controls. On T(1)WI and T(2)WI, we measured signal intensity in the GP and posterior segment of the putamen (Put) to obtain a signal ratio (GP/Put ratio), and on SWI, we classified signal intensity into 4 grades: A, higher than the cortex; B, lower than the cortex and higher than the cerebrospinal fluid (CSF); C, lower than the CSF and higher than the red nucleus; and D, lower than the red nucleus. In the 7 patients with hepatic insufficiency, the mean GP/Put ratio was significantly higher on T(1)WI and T(2)WI than those values in controls. On SWI, we classified 2 cases each as Grade A, Grade B, and Grade C, and one as Grade D. Although the signal of the GP was elevated on T(1)WI, there was no decrease in signal on T(2)WI. On SWI, we obtained no low signal intensity. In patients with hepatic insufficiency, the globus pallidus did not show low signal intensity on either T(2)WI or SWI. Hyperintensity of the GP on T(1)WI without hypointensity on T(2)WI, or even SWI, suggests a discrepancy between paramagnetic effect on T(1) and T(2) shortening that reflects the accumulation of manganese and the presence of hepatic insufficiency.
    Magnetic Resonance in Medical Sciences 01/2011; 10(2):79-83. · 0.75 Impact Factor
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    ABSTRACT: The aim of this study was to determine the feasibility and usefulness of contrast-enhanced magnetic resonance angiography (CE-MRA) and 3-dimensional (3D) time-of-flight (TOF) MRA for follow-up of intracranial aneurysms treated using the Enterprise stent. Five aneurysm cases using the Enterprise stent were prospectively analyzed and were followed up with CE-MRA, 3D TOF MRA, and digital subtraction angiography (DSA). Depictions of parent artery lumen and the aneurysm neck with 3D TOF MRA and CE-MRA were compared with those of DSA. In all cases, on 3D TOF MRA, it was difficult to evaluate the parent artery lumen and aneurysm neck owing to the significant artifacts from the stent. Contrast-enhanced MRA sufficiently demonstrated parent artery lumen and aneurysm neck distinctly and as clear as DSA did in all cases. For follow-up after coiling with an Enterprise stent, CE-MRA may be necessary to avoid susceptibility artifacts caused by the stent.
    Journal of computer assisted tomography 01/2011; 35(5):568-72. · 1.38 Impact Factor
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    ABSTRACT: Cerebral salt wasting syndrome (CSWS) in patients with aneurysmal subarachnoid hemorrhage (SAH) is considered to correlate with delayed ischemic neurological deficits (DIND) induced by cerebral vasospasm; however, its exact mechanism is still not well-known. The purpose of the present study is to evaluate the relationship between hyponatremia caused by CSWS and the increase of the urinary sodium excretion in early phase following SAH. Fifty-four patients with SAH were divided into 2 groups, normonatremia group and hyponatremia group which suffered hyponatremia after SAH. The hyponatremia group comprise 14 patients (26%) in whom the hyponatremia developed of the SAH. In this group, the serum level of sodium significantly decreased 7 days after SAH and then gradually normalised. Further, excretion of sodium in the urine tended to increase 3 days after SAH and significantly increased 7 days after SAH. In conclusion, the increased urinary sodium excretion in the early phase of SAH would serve as a predictive factor for CSWS after SAH. We consider that it is important to start sodium and fluid supplementation and inhibit natriuresis by fludrocortisone acetate administration before hyponatremia occurs in order to prevention delayed ischemic neurological deficits in SAH patients.
    Brain and nerve = Shinkei kenkyū no shinpo 12/2009; 61(12):1419-23.
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    ABSTRACT: A 77-year-old man presented with transient motor weakness of the left hand. Cerebral angiography showed 90% stenosis at the origin of the right internal carotid artery. Carotid artery stenting (CAS) was performed 3 weeks later, and a large intraluminal thrombus was found during the procedure. The blood around the thrombus was aspirated using an aspiration catheter under distal protection with a filter wire protection device, and CAS was successfully performed without complications. Although this patient was treated by CAS without complications, carotid stenosis associated with intraluminal thrombus-because it has a high risk of distal embolism-should be carefully diagnosed immediately before CAS.
    Japanese journal of radiology 11/2009; 27(9):367-70. · 0.73 Impact Factor
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    ABSTRACT: The purpose is to investigate the feasibility of magnetic resonance (MR) plaque imaging in predicting the arterial flow impairment (slow-flow phenomenon) during carotid artery stenting (CAS) using a filter-type protection device. Thirty-one carotid artery stenotic lesions in 30 patients (28 men and two women; mean age, 71.8 years) were evaluated by MR plaque imaging with black blood T1- and T2-weighted and time-of-flight sequences before CAS. Main plaque components were classified as vulnerable (intraplaque hemorrhage and lipid-rich/necrotic core) or stable (fibrous tissue and dense calcification) from the signal pattern. The plaque classification was statistically compared with the occurrence of slow-flow phenomenon. The slow-flow phenomenon was observed in ten CAS procedures (five flow arrests and five flow reductions). Flow arrests consisted of four vulnerable and one stable plaque, and flow reductions consisted of four vulnerable and one stable plaque. The slow-flow phenomenon occurred significantly (P<0.01) more frequently in patients with vulnerable plaque. Vulnerable carotid plaques have a significantly higher risk of slow-flow phenomenon than stable plaques. The occurrence of the slow-flow phenomenon can be predicted by MR plaque imaging before CAS.
    Neuroradiology 11/2009; 52(4):275-83. · 2.70 Impact Factor
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    ABSTRACT: No filter protection devices for carotid artery stenting (CAS) have been formally approved for use in Japan; however, as of April 2008, the Angioguard XP (AGXP) was approved. This article describes our initial results using the AGXP during CAS for the treatment of carotid artery stenosis. A group of 15 patients (14 men) with a mean age of 72.3 years (range 53-81 years) were treated by CAS using the AGXP. Among them, 10 were symptomatic with >50% stenosis of the common or internal carotid artery (ICA), and 5 were asymptomatic with >70% stenosis. The rates of technical success, periprocedural stroke, ICA flow impairment, filter movement, and development of new ischemic lesions on diffusion-weighted imaging (DWI) were assessed. CAS using the AGXP was successful in all cases. There was one minor stroke, and flow impairment occurred in six patients. Filter movement averaged 1.9 vertebral bodies. DWI showed new ipsilateral ischemic lesions in eight of the patients. Initial clinical experience using the AGXP for CAS has been generally sufficient. However, attention must be paid to three problems when using the AGXP: the filter may move after placement; the filter may disturb blood flow in the ICA; and debris may pass around the filter.
    Radiation Medicine 07/2008; 26(6):348-54.
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    ABSTRACT: This study discusses prominent signal intensity of T(1)/T(2) prolongation of subcortical white matter within the anterior temporal region in premature infant brains that radiologists may encounter when interpreting conventional screening MRIs. T(1)- and T(2)-weighted images of 69 preterm and term infants with no neurological abnormalities or developmental delays were evaluated retrospectively for areas of prominent signal intensity of T(1)/T(2) prolongation in white matter. We measured signal intensities of anterior temporal white matter, deep temporal white matter, frontopolar white matter and subcortical white matter of the precentral gyrus. We accessed chronological changes in signal intensity in the anterior and deep temporal white matter. We also analyzed variance tests among the signal intensity ratios to the ipsilateral thalamus of white matter areas by gestational age. There was high frequency of prominent signal intensity of T(1)/T(2) prolongation in the temporal tip, particularly at a gestational age of 36-38 weeks. Signal intensity ratio of the anterior temporal white matter was lower on T(1)-weighted images and higher on T(2)-weighted images, and the finding became less prominent with increasing gestational age. The signal intensity ratios of anterior temporal white matter at a gestational age of 36-37 weeks and 38-39 weeks were significantly different from other regions. Prominent signal intensity of T(1)/T(2) prolongation of subcortical white matter of the anterior temporal region is seen in normal premature infants, especially those at 36-39 gestational weeks. Although it is a prominent finding, radiologists should understand that these findings do not represent a pathological condition.
    Magnetic Resonance Imaging 07/2008; 26(10):1374-80. · 2.06 Impact Factor
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    ABSTRACT: The cerebrovascular complications of Takayasu arteritis are primarily related to the presence of occlusive lesions. Cerebral aneurysms rarely occur as complications; only 18 cases have been reported thus far. The use of coil embolization to treat cerebral aneurysms occurring as a complication of Takayasu arteritis has not been previously reported. We report a case of Takayasu arteritis with a basilar tip aneurysm and a P1 segment aneurysm of the left posterior cerebral artery that were successfully treated with coil embolization. Because coil embolization for cerebral aneurysms associated with Takayasu arteritis requires the use of limited access routes that have extremely curved and tortuous courses, catheter navigation was difficult. The guide catheter, microcatheter, and guidewire must be selected and navigated with greater care than is usually required for common aneurysm embolization.
    Radiation Medicine 02/2008; 26(1):33-8.

Publication Stats

85 Citations
39.54 Total Impact Points

Institutions

  • 2001–2014
    • Nara Medical University
      • • Department of Radiology
      • • Department of Neurosurgery
      Kashihara, Nara, Japan
  • 2007–2011
    • Numazu City Hospital
      Sizuoka, Shizuoka, Japan