Citations
(1) To present the magnetic resonance imaging (MRI) findings of congenital muscular torticollis (CMT) of subjects who underwent surgical release and subjects who showed a good prognosis with stretching exercises and (2) to correlate the MRI findings with the histopathologic findings of CMT for subjects who underwent surgical release in order to examine the hypothesis that the MRI findings of CMT can be used as a determinant to perform surgical release of CMT.
The neck MRI findings of 33 subjects who underwent surgical release for CMT were compared with those of 18 subjects who were successfully managed only with conservative management. The MRI findings were correlated with the histopathologic sections of the CMT mass.
All 33 subjects (100%) who underwent surgical release showed one or more low signal intensities within the involved sternocleidomastoid muscle (SCM) on the T1- and T2-weighted images of neck MRI. The eighteen non-surgical candidates showed only enlargement of the SCM without low signal intensity within the SCM. The histopathologic findings showed interstitial fibrosis and/or the presence of aberrant tendon-like excessive dense connective tissue that was either well-arranged or disorganized.
The histopathologic findings and MRI findings showed good correlation in terms of the amount of fibrosis and aberrant dense connective tissue within the SCM. If multiple or large low signal intensities within the SCM are noted, we think that surgical release should be considered.
Citations
after a traumatic brain injury. Conventional brain MRI presented no specific abnormality in case 1 and 2, a focal encephalomalacia in the left anterior thalamus in case 3, and contusional hemorrhages in the left temporal and parietal lobes in case 4. But DTI disclosed microstructural abnormalities on descending motor pathway including the posterior limb of the internal capsule or the cerebral peduncle of the midbrain in all cases. (J Korean Acad Rehab Med 2003; 27: 446-450)
Method: Seven patients were studied. DTI was peformed using 1.5T MR scanner (Vision Plus, Siemens, Erlangen, Germany) and fractional anisotropies of corona radiata, posterior limbs of internal capsules, and cerebral peduncles of midbrain in both hemisphere were calculated.
Results: The fractional anisotropy was significantly decreased in all corona radiata, posterior limbs of internal capsules, cerebral peduncles of midbrain in six patients except one hemiplegic patient, compared with that of control group. In in the hemiplegic patient, the fractional anisotropy was reduced only in affected hemisphere. In addition, the fractional anisotropy tended to be also increased as gross motor function measure (GMFM) score was increased.
Conclusion: We believe that DTI may be efficient in evaluating microstructural abnormality on the motor pathway of brain and helpful in providing prognosis of clinical findings in cerebral palsied children with periventricular leukomalacia. (J Korean Acad Rehab Med 2003; 27: 340-343)
Objective: To estimate the probable cause and the time of cerebral insult in cerebral palsy (CP) based on MRI findings and risk factors.
Method: The subjects comprised all sixty-seven patients with CP showing abnormal MRI findings between March 1999 and September 2001 at the Catholic University of Korea, St. Mary's Hospital. A detailed medical history was available for all patients including those not born in our hospital. They ranged in age from two months to five years. We analyzed the brain magnetic resonance (MR) findings of patients with CP to correlate the probable cause and the time of cerebral insult through the consideration of medical histories including prenatal, perinatal and postnatal histories.
Results: Of the 67 MRIs, abnormalities were the followings; periventricular leukomalacias (PVLs) in 49 cases, cortical or subcortical infarction in 4 cases, brain atrophy in 7 cases, neuronal migration disorder in 4 cases, and delayed myelination in 3 cases. Among the patients with PVL, perinatal risk factors were responsible for cerebral insult in preterm, but pre- and perinatal contribution were similar in patients born at full term. Among the patients with cerebral infarction, only one case with meningitis at 11 months was suspected for cerebral insult. These patients had no risk factor as a peri- or post-natal etiology. Four patients with neuronal migration disorder had no risk factor for peri- or postnatal etiology except for the one who was a twin.
Conclusion: Review of brain MRI findings such as PVL, infarct, neuronal migration disorder and a detailed medical history including prenatal and perinatal etiology would be a useful method to estimate the probable cause and the time of cerebral insult in CP. (Korean Acad Rehab Med 2002; 26: 508-513)
Hypertrophic olivary degeneration is usually caused by a lesion in the triangle of Guillain and Mollaret. The inciting pathology includes ischemic, inflammatory, degenerative or, less frequently, traumatic lesions. Clinically, it is usually accompanied by palatal myoclonus or other forms of segmental myoclonus. We present four patients with hypertrophic olivary degeneration studied with MRI after severe head trauma. MRI was performed between 5 and 18 months respectively after trauma. Although post-traumatic tremor was observed in three patients, none of patients showed palatal myoclonus. MRI showed multiple post-traumatic lesions within the dentato-rubro-olivary pathway associated with enlargement and increased signal intensity of the inferior olives. (J Korean Acad Rehab Med 2002; 26: 480-484)
Objective: MRI findings of adhesive capsulitis (AC) have been rarely documented even though the disease is a rather common disorder. To find reliable MRI parameters, we studied MRI findings of the patients with arthrographically-proven AC.
Method: Eighteen patients with AC (patient group) and eight subjects without AC (control group) were enrolled. Mean age of the former was 55.1 years and that of the latter was 41.4 years. Mean duration of the diseases in patient group was 5.9 months. Oblique coronal and axial MRI images of the shoulder were measured for the thickness of capsule and synovium around the axillary fold (TAF), volume of axillary recess (VAR), and volume of biceps tendon sheath (VBTS), which were com-
pared in both groups using unpaired t-test.
Results: TAF was significantly increased in patient group (p＜0.0001), and the thickened axillary fold greater than 5.1 mm was a useful MRI criterion for the diagnosis of AC with sensitivity of 93% and with specificity of 100%. VBTS was also significantly diminished in patient group (p＜0.05), whereas there was no significant difference in VAR between two groups.
Conclusion: TAF, especially greater than 5.1 mm, and decreased VBTS are useful MRI parameters for the diagnosis of AC of shoulder. (J Korean Acad Rehab Med 2002; 26: 177-181)
Objective: To investigate cortical reorganization of the brain during voluntary activities of the hand in patients with subcortical cerebral infarction.
Method: Twelve patients with first-ever subcortical brain lesion causing hemiparesis had been evaluated with functional MRI. Bilateral hand clenching was done to test voluntary hand activities. Recovery period ranged from 2 to 36 months.
Results: During the unaffected hand movement, activation of contralateral primary sensorimotor cortex (SMC) were recorded in all cases and supplmentary motor area (SMA) in 1 case. The affected hand movement showed activation of the cotralateral SMC in all cases, ipsilateral SMC in 4 cases, SMA in 4 cases and contralateral prefrontal area in 2 cases. As for the contralateral SMC, affected hand movement showed more increased activation than the unaffected. For the bilateral SMC activation during movement of the affected hand, contralateral SMC activation was greater than the ipsilateral.
Conclusion: Ipsilateral activation of the SMC, SMA, prefrontal area and increased activation of the contralateral SMC during affected hand movement suggest that these may play an important role in the reorganization of sensory and motor system in stroke patients with subcortical lesion. Functional MRI studies of patients who recovered from subcortical stroke provide evidence for several process that may be related to restoration of neurologic function.
This 32 year-old man sustained crush injury and resultant in paraplegia. Lumbar MRI was taken and revealed fracture and dislocation between L2 and L3 vertebrae bodies. On the day of the injury, he underwent a surgical intervention of posterolateral fixation and bone graft from L1 to L4 vertebrae. He was transferred to Rehabilitation Medicine Department of Asan Medical Center where patient was subsequently found to have an unexpected neurologic finding of decreased sensation below T5 dermatome on right and below T6 on left. Accordingly we took a thoracic MRI which showed features consistent with arachnoiditis at thoracic and lumbar cord segment. A dermatomal somatosensory evoked potential study was performed with finding of abnormal somatosensory pathway below mid thoracic dermatome. We reported an unusual case of thoracic arachnoiditis occurred after the surgical fixation of the lumbar vertebral fracture and dislocation.
Objective: To determine the changes of posterior bulging of the lumbar intervertebral discs with flexion and extension movement of the spine in patients with central disc bulges or disc degeneration.
Method: Twenty patients with low back pain were studied. Nine patients had central type disc bulging and eleven patients had disc degeneration only. The spines were scanned in neutral, flexion, and extension positions in a vertically open 0.5T MR scanner. Degree of posterior bulging of the lumbar intervertebral disc of the pathological level was measured.
Results: In the patients with disc bulge, posterior bulging of the disc decreased in all of the patients by 0.8⁑0.6 mm with flexion of the spine and increased in 77.8% of the patients by 1.0⁑0.8 mm with extension of the spine. In the patients with disc degeneration, posterior bulging decreased with flexion in 36.7% of the patients. With extension, posterior bulging increased in 55.6% of the patients.
Conclusion: This study found that patients with low back pain and central disc bulges have consistent and marked discrepancies in posterior bulging with flexion-extension in comparison with our previous study with asymptomatic patients with normal MRIs.
The aim of this study is to investigate the mechanism of motor recovery using both functional Magnetic Resonance Imaging (fMRI) and Transcranial Magnetic Stimulation (TMS) in a patient with hemorrhagic contusion on the right basal ganglia area. Functional MRI showed that the left primary sensorimotor cortex and the supplementary motor area were activated when the right fingers performed the flexion-extension exercise. On the other hand, the bilateral primary sensorimotor cortex and the left premotor area were activated with the excerise of left hand. Brain mapping for both abductor pollicis brevis muscles (APB) using TMS revealed that ipsilateral motor evoked potentials (MEPs) were obtained at left APB. Ipsilateral MEPs of left APB showed delayed latency and lower amplitude compared to that of right APB when stimulated at the left motor cortex. We concluded that ipsilateral motor pathway from undamaged motor cortex seems to contribute to the motor recovery in this patient and combining TMS with fMRI may provide a powerful tool for investigating the mechanism of motor recovery.
Objective: The present study was undertaken to determine the value of developmental assessment, multimodality evoked potentials, brain magnetic resonance image (MRI) and electroencephalography (EEG) and to identify correlations between each evaluation.
Method: Developmental assessments such as Bayley scales of infant development and Vineland social maturity scale, brain MRI, EEG and evoked potentials findings were evaluated in 45 children with spastic cerebral palsy to assess the developmental level and abnormalities of the anatomical structure of the brain and to elucidate the relationship between the test methods.
Results: 1) Mean mental developmental index (MDI) and psychomotor developmental index (PDI) were 69.6 and 68.6, respectively and mean Vineland social maturity quotient (SQ) was 76.1 and there was a significant correlation between the MDI, PDI, and SQ in cerebral palsied children. 2) Abnormal findings of brain MRI and EEG were found in 73.3% and 44.4% of the cases, respectively. 3) There was significant correlation between findings of brain MRI, auditory evoked potentials, visual evoked potentials, median somatosensory evoked potentials and social quotient.
Conclusion: Developmental assessment, multimodality evoked potentials, EEG, and brain MRI would be a useful method to evaluate the maturity of brain and estimate the level of development.
Objective: This study involves an experiment using functional magnetic resonance imaging (fMRI) to delineate neural network and laterality of language related brain activation for spoken and written Korean words in normal adults.
Method: Eight normal right-handed Korean males, aged 20∼33 years, were investigated. Language tasks consisted of auditory and visual verb generation tasks. In fMRI, twenty slices were obtained for each functional volume using single shot echoplanar image sequences. Data were motion corrected, coregistered, normalized, and statistically analyzed using SPM-96 software. The number of activated voxels were counted in each hemisphere to calculate the laterality index according to each language task.
Results: In auditory verb generation task, inferior frontal gyrus and superior temporal region were activated in the left side. Right temporal lobe was also activated in the superior and middle temporal areas. Other activated area included medial frontal lobe. Lateralization index of auditory verb generation task was 78.6⁑30.7. In visual verb generation task, inferior frontal gyrus was activated in the left side. Medial frontal lobe, both lateral occipital lobe, and left parietal lobe were also activated. The laterality index was 87.6⁑10.1.
Conclusion: We could delineate cortical regions subserved for spoken and written Korean language and laterality of language related brain activation using fMRI. These results can contribute to understand underlying mechanism of language disorders in brain injury patients and to investigate the pattern of reorganization of language network after rehabilitation.
The higher cognitive functions of human brain are hypothesized to be selectively distributed across large-scale neural networks interconnected cortical and subcortical areas. Recently, advances in functional imaging made it possible to visualize the brain areas activated by certain cognitive function in vivo. Out of several technologies currently available for brain activation study, functional magnetic resonance imaging (fMRI) is increasingly being used because of its superior time resolution and finer spatial resolution. The technique is non-invasive without radiation hazard, which allow to take repeated multiple scans within the same individual. The most common approach to fMRI of brain is the one using 'blood-oxygen level dependent (BOLD)' contrast, which based on the localized hemodynamic changes following neural activities in the certain areas of brain.
With functional imaging techniques including fMRI, neural networks subserving for higher cognitive functions such as language, memory, attention, and visuospatial functions could be visualized. Neural substrates of human emotion and motivation behaviors also begin to be unveiled. Brain mapping with functional imaging is a very useful method for detecting eloquent areas in a neurosurgical setting to prevent the residual disabilities. One of the issues recently having attention in the field of functional imaging is the reorganization of neural network following brain injuries. Much research results using fMRI identified intra- and/or interhemispheric reorganization of neural networks accompanied with functional recovery after brain injury. Effects of learning and rehabilitation on the extent and pattern of neural reorganization was also delineated. fMRI will be a very useful tool for developing of various rehabilitation treatments, which promote successful functional recovery by maximizing the plasticity of brain.
Objectives: To report the results of functional magnetic resonance imaging (fMRI) experiment to delineate brain network for auditory language tasks in normal Korean adults.
Method: Five normal right-handed Korean males, aged 20∼33 years, were investigated using fMRI technique. Language tasks consisted of auditory listening and verb generation tasks. In fMRI, twenty slices were obtained for each functional volume using single shot echoplanar image sequences. Eighty-four volumes were obtained for each functional run. Data were motion corrected, coregistered, normalized, and statistically analyzed using SPM-96 software (Wellcom Department of Cognitive Neurology, Oxford, UK).
Results: Functional activation were detected in superior temporal region (coordinates: x=64, y=42, z=2) in the left side and superior to middle temporal lobe (coordinates: x=50, y=20, z=2) in the right side for auditory listening task. Auditory verb generation task activated inferior frontal gyrus (coordinates: x=56, y=16, z=14), superior temporal region, and medial frontal region in the left side. Right temporal lobe was also activated in the superior to middle temporal areas. Activation was more extensive in the left side for both language tasks.
Conclusion: Our results can remarkably delineate cortical and subcortical regions subserved for auditory language processing. These results can be contributing to understand the underlying mechanism of language disorders in brain-injured patients and to investigate the pattern of reorganization of language network after rehabilitation.
Mirror writing is script that runs in the direction opposite to normal, with individual letters also reversed. A Right handed woman suddenly developed mirror-writing. After traumatic brain injury without definitive lesions on MRI, she could not discriminate between right and left by herself. Several theories, including motor, visual dominance, spatial disorientation and supplementary motor hypotheses, have been proposed to explain such. We believe that availability of mirror engrams induce reversal of normal left-to-right writing pattern including mirror-writings.
Objective: The purposes of this study were to observe the radiographic changes of lumbar facet joints by magnetic resonance imaging (MRI) in conservatively and operatively treated groups of patients with herniated intervertebral disc, and to compare the biomechanical effects to lumbar facet joints according to the treatment methods
Method: The patients composed of 20 conservatively treated control group and 40 operatively treated group who had disc herniation at lower lumbar spine. Follow-up MRIs were performed in order to assess the radiographic changes of intervertebral disc and lumbar facet joints, such as disc degeneration, lumbar facet joint angle and tropism in either treatment groups individually.
Results: There are significant increase in lumbar facet joint angle in operatvely treated group at the level of both L4/5, right L5/S1 compared to that of conservately treated group, but the disc degeneration and facet joint tropism were not changed after treatment in both groups. There's no relationship between treatment period and each parameters.
Conclusion: The radiographic biomechanical lumbar facet joint changes on MRI seems to be related to degenerative change of lumbar facet joint in operatively treated group with a lumbar disc herniation. Therefore, careful selection of optimal operation time and criteria would be important.
Objective: To investigate the correlation between magnetic resonance imaging (MRI) findings for children with cerebral palsy (CP) and the severity of their developmental disability.
Method: MRI and Münchener Funktionelle Entwicklungs Diagnostik (MFED) were used for the evaluation of 52 children with CP. MFED quotient (MFED age/corrected age⁓100) was compared to the MRI findings.
Results: Of the 52 MRIs, no abnormalities were found in 7 cases (13%), periventricular leukomalacias (PVLs) in 37 cases (71.2%), corpus callosum abnormalities in 33 cases (63.5%), delayed myelinations in 8 cases (15.4%), congenital brain abnormalities in 6 cases (11.5%), and central sulcus abnormalities in 3 cases (5.8%). Among 27 patients who were born preterm, the major MRI finding was PVL (100%), indicative of a hypoxic brain injury. All patients with a normal MRI were born at term. There were significant correlations between the MFED quotient and the severity of PVL. The ratio of corpus callosum length/brain anteroposterior diameter was correlated with a developmental disability.
Conclusion: MRI findings for the patients with CP are well correlated with the developmental disabilities and the timing of brain insult.
Objective: The present study was undertaken to evaluate the findings of multimodality evoked potentials, brain MRI and EEG in cerebral palsy children and to identify the correlations between these findings.
Method: We examined Brain MRI, EEG and evoked potentials including visual evoked potentials(VEPs), brainstem auditory evoked potentials(BAEPs) and somatosensory evoked potentials(SSEPs) in 80 cerebral palsy children.
Results: 1) Abnormal findings of brain MRI and EEG were 79.4% and 81% respectively.
2) Abnormal responses of VEPs and BAEPs were 28.1% and 18.8%.
3) In the median and tibial nerve SSEPs, abnormal responses were 14.6% and 28.6%. Abnormal findings of the tibial nerve SSEPs were more frequent than the median nerve SSEPs.
4) In children with spastic hemiplegia, the abnormal SSEPs were much greater in the affected limb than unaffected limbs.
5) There was a significant correlation between the SSEP abnormalities and brain MRI or EEG abnormalities in cerebral palsy children.
Conclusion: The data obtained in this study would be helpful for identifying and assessing the central nervous system deficits of cerebral palsy children.
Magnetic resonance imaging(MRI) is clearly more reliable than computer tomography and myelography in radiological diagnosis of lumbar herniated intervertebral disc. Moreover, MRI can also detect degenerative changes of intervertebral discs. The purpose of this study was to determine the utility and accuracy of MRI in conjuntion with the diagnosis of lumbar herniated intervertebral disc and to compare findings with operative findings.
Comparisons of operative findings and MRI were done in 133 cases. Each patients had been diagnosed by MRI as having lumbar herniated intervertebral disc. MRI findings included those of spin echo T1-weighted images and T2-weighted images, gradient echo T1-weighted images and T2-weighted images, and gadolinium-DTPA enhancement when needed.
In 32 protrusion disc cases diagnosed by MRI, 28 cases were confirmed by operation and four were actually extrusion disc. In 77 cases diagnosed by MRI as extrusion disc, 72 cases were confirmed by operative findings, while 5 cases were found to be protrusion disc. 4 cases of sequestration disc diagnosed by MRI were confirmed by operative findings. Specific dimensions of MRI use yielded the following results: protrusion disc indicated 84.8% in sensitivity, 95% specificity, 87.5% in accuracy; extrusion disc showed 94.7%, 86.5%, 93.5%, respectively; and sequestration disc revealed 100% in all categories. In this study, the average accuracy of lumbar herniated intervertebral disc diagnosed by MRI was 93.6% on average.
Accordingly, MRI has shown itself to be a good diagnostic tool for determining anatomical and biological change in lumbar herniated intervertebral disc.
The authors studied 60 children (aged 4 months to 9 years) with cerebral palsy by means of magnetic resonance imaging (MRI) and single photon emission computed tomography (SPECT) of the brain. MRI showed normal in 15 cases (25.0%) and deep white matter pathology in 37 cases (61.7%), corpus callosum abnormality in 29 cases (48.3%). In addition, abnormal intensity of thalamus or basal ganglia and delayed myelination were found in minor cases. In all of the patients except for 1 case, SPECT showed the abnormal findings SPECT demonstrated hypoperfusion of thalamus in 58 cases (96.7%), cerebellum in 27 cases (45.0%), frontal and parietal lobe in 26 cases (43.3%), basal ganglia in 23 cases (38.3%) and temporal lobe in 22 cases (36.7%). There was no significant correlation between the severity of motor developmental impairment and the radiologic findings. The results of this study suggest that MRI of the brain provides the anatomical information such as deep white matter and corpus callosum pathologies resulted from the hypoxic-ischemic insult and SPECT of the brain is a very sensitive tool for the assessment of the functional abnormalities in cerebral palsy.
The evaluation of peripheral nerve disorders has traditionally relied on clinical history, physical examination and electrodiagnostic studies. The electrodiagnostic study is currently the most popular procedure to analyse the nerve lesion, but it is painful and its result is operator dependent. The purpose of this study is to evaluate the significance of MRI signal change of denervated muscle in peripheral nerve as an adjuvant study of electrodiagnostic study. After the compression of sciatic nerves in 20 rabbits and severance of scitic nerve in 10 rabbits, the signal change of both T1WI(TR; 450 msec, TE; 15 msec) and T2WI(TR; 3,000 msec TE; 90 msec) of calf muscles were compared with EMG findings of the same muscles. Signal intensity ratio(SIR) of calf muscles was measured and compaired with the grade of abnormal spontaneous activity in the same muscles in needle EMG study. Serial studies were done on 4th day, 1 week, 2 weeks, 3 weeks, 4 weeks, 6 weeks, 8 weeks, 10 weeks after sciatic nerve injury. Among 25 rabbits showing abnormal spontaneous activity in needle EMG, the signal intensity of both T1WI and T2WI was increased in 13 rabbits. The signal intensity began to increase at 1 week in 10 rabbits and 2 weeks in 3 rabbits following nerve injury which was about 1 week later than appearance of abnormal spontaneous activity in needle EMG study. There were no signal intensity increase in rabbits which showed no abnormal spontaneous activity in needle EMG study. The signal intensity ratio and grade of abnormal spontaneous activity had a good correlation(Spearman's correlation coefficiency : 0.635). The signal intensity of 3 rabbits which showed regeneration evidence in needle EMG study returned to normal. These findings suggest that MRI study of denervated muscle can be used as an evaluation method for severe peripheral nerve injury, howeverits value is doubtful in mild peripheral nerve injury.
Chronic progressive radiation myelopathy(CPRM) is a rare but serious complication of radiation therapy. It's exact cause is unknown and the diagnosis is usually made based on the exclusion of other causes of myelopathy. Magnetic resonance imaging(MRI) with gadolinium- diethylenetriamine pentaacetic acid(DTPA) enhancement seems to be useful for the diagnosis of CPRM. There is no known effective treatment and the complication is irreversible.
We report a case of CPRM after radiation therapy for subglottic cancer which was not respond to high-dose steroid therapy with review of literature.
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