Longitudinal analysis of olfactory deficits in HIV infection

The presence and degree of odor identification deficits in 55 HIV-infected (30 asymptomatic, 25 symptomatic) and 29 HIV-negative at-risk control volunteers were examined longitudinally using the University of Pennsylvania Smell Identification Test (UPSIT). Factors other than HIV infection that could account for olfactory loss (i.e., sinusitis or upper respiratory infection) were also considered by obtaining MRI scans of the nasal passages and information from an olfaction questionnaire. No differences were found among groups at the first administration of the UPSIT, with significant differences among groups emerging at the 1-year and 2-year follow-ups. The symptomatic group showed a significant decline in odor identification scores across time, while means for the asymptomatic and control groups remained stable. The presence of sinusitis or an upper respiratory infection appeared to have no effect on odor identification. The implications for these findings in relationship to cognitive decline in neurodegenerative diseases are discussed.

Practice effects with the NIMH AIDS abbreviated neuropsychological battery

The degree of practice effects with the Brief NIMH Neuropsychological Battery for HIV Infection and AIDS is reported using a 7-10 day test-retest interval. The patient groups were asymptomatic and symptomatic of HIV while the control group was made up of "at risk" volunteers. Statistically significant practice effects were obtained on the California Verbal Learning Test, the Paced Auditory Serial Addition Task and the Visual Search Test among the infected individuals. The controls subjects demonstrated statistically significant practice effects on all of the neuropsychological tests. The implications of these findings in prospective studies are discussed.

Fat-suppressed spoiled GRASS imaging of knee hyaline cartilage: technique optimization and comparison with conventional MR imaging

OBJECTIVE

We studied healthy volunteers with fat-suppressed three-dimensional (3D) spoiled gradient-recalled acquisition in the steady state (SPGR) to determine parameters that maximize positive contrast between knee articular cartilage and fluid, marrow fat, and muscle; and we compared the technique with conventional MR imaging sequences. The purpose was to determine if fat-suppressed 3D SPGR imaging is useful for detecting abnormalities of the articular cartilages.

SUBJECTS AND METHODS

The knees of 10 healthy volunteers were imaged in the axial plane. Fat-suppressed 3D SPGR imaging was performed with a TR of 60 msec, a TE ranging from 5 to 15 msec, and a flip angle ranging from 20 degrees to 80 degrees. This was followed by a similar set of fat-suppressed two-dimensional (2D) SPGR images, and conventional T1- and T2-weighted spin-echo and multiplanar gradient studies. Contrast-to-noise (C/N) ratios were determined for cartilage versus a saline fluid phantom, marrow fat, and muscle. Optimal parameters were determined both quantitatively and by a blinded subjective analysis.

RESULTS

A TE of 5 msec and a flip angle of 40 degrees demonstrated the greatest C/N ratio between the signals for cartilage and for fluid, marrow, and muscle. C/N ratios in the 3D sequences were higher than in the 2D, spin-echo, and gradient series, although the absolute C/N ratio values for the T2-weighted spin-echo sequence were higher than those for the 3D fat-suppressed SPGR sequence. Subjective analysis showed articular cartilage to have a consistent trilaminar appearance, and independent interpreters favored a 3D fat-suppressed SPGR sequence with a TE of 5 msec and a flip angle of 40 degrees. Three subjects with incidental joint fluid had C/N ratios within a 95% confidence range for cartilage versus the fluid phantom.

CONCLUSION

When a fat-suppressed 3D SPGR sequence of 60/5/40 degrees (TR/TE/flip angle) is used, MR images can show high positive contrast between articular hyaline cartilage and adjacent structures. This convenient technique is different from standard MR imaging sequences because it demonstrates greater signal intensity in cartilage than in fluid, marrow fat, and muscle, and because it consistently shows an organized internal architecture of hyaline cartilage. Fat-suppressed 3D SPGR imaging therefore has promise for detecting abnormalities of the articular cartilage.

Development of object vision in infants with permanent cortical visual impairment

We examined 30 infants in whom cortical visual impairment was diagnosed during their first year of life to ascertain prognostic factors for the development of object vision, defined as the ability to recognize faces or hand-held toys. All patients were followed up for a minimum of 12 months. The most common causes of cortical visual impairment in the 30 infants were hydrocephalus in nine infants (30.0%), birth asphyxia or neonatal hypoxia in eight infants (26.7%), intracranial hemorrhage with or without hydrocephalus in seven infants (23.3%), and meningitis in five infants (16.7%). Lack of development of object vision was associated only with hypoxia (P = .013). Findings on ophthalmic examination, an abnormality in the visual pathway on computed tomographic or magnetic resonance scan, and seizures, hydrocephalus, intracranial hemorrhage, meningitis, cerebral palsy, developmental delay, prematurity, microcephaly, and hearing deficit, did not appear to be risk factors for the lack of development of object vision.

Alzheimer dementia: quantification of energy metabolism and mobile phosphoesters with P-31 NMR spectroscopy

To determine whether high-energy phosphate metabolism and mobile phosphoester indexes of membrane metabolism are altered in Alzheimer disease and to help resolve some inconsistencies in the literature, brain phosphate metabolite concentrations and ratios were measured in 11 patients with mild to severe dementia of the probable Alzheimer type and 14 healthy subjects. Fully relaxed, spatially localized, phosphorus-31 nuclear magnetic resonance (NMR) spectroscopy and proton (hydrogen-1) MR imaging were performed. No significant differences were found in the concentrations and relative ratios of phosphocreatine, nucleoside triphosphate, inorganic phosphate, phosphomonoester, and phosphodiesters in whole axial sections through the lateral cerebral ventricles of the brain that could not be accounted for by atrophy. There was no correlation between P-31 NMR indexes and the severity of dementia as assessed with neuropsychologic testing. High-energy phosphate and membrane metabolism, as detected in vivo with P-31 NMR spectroscopy in whole-brain sections, do not appear to play a major role in the disease process, except as a direct consequence of atrophy quantified with H-1 MR imaging.

Magnetic resonance imaging of fourth ventricular epidermoid tumors

Two pathologically proved cases of epidermoid tumor of the fourth ventricle are presented; clinical history and computed tomographic, magnetic resonance imaging, and histopathologic findings are included.

AIDS dementia complex: brain high-energy phosphate metabolite deficits

To test whether compromised high-energy phosphate metabolism is implicated in the neurologic impairment of acquired immunodeficiency syndrome dementia complex (ADC), brain phosphate metabolite concentrations and ratios were measured noninvasively in 12 patients with mild to moderate ADC and 29 healthy volunteers by use of localized phosphorus-31 nuclear magnetic resonance (NMR) spectroscopy and proton (hydrogen-1) magnetic resonance (MR) imaging. In patients, brain phosphocreatine (PCr) and nucleoside triphosphate (NTP) concentrations in sections through the centrum semiovale that were seen with NMR spectroscopy were reduced significantly from normal values of 4.92 mmol/kg wet weight +/- .13 (standard error of the mean) and 2.79 mmol/kg +/- .11, respectively, to 3.33 mmol/kg +/- .26 and 1.99 mmol/kg +/- .13 (P less than .0001). The ratios of metabolites detectable with P-31 NMR spectroscopy did not differ significantly from those of control subjects. The magnitude of the PCr and NTP deficits in ADC was not explicable by focal abnormalities or cerebral atrophy quantified in images of the same regions. These results are consistent with the hypothesis of a generalized virus-associated toxic process affecting brain cell function in ADC. Noninvasive measurement of metabolite concentrations with NMR spectroscopy provides new functional information that may help quantify disease progression and response to therapy.

Three-dimensional time-of-flight magnetic resonance angiography using spin saturation

A three-dimensional Fourier transform magnetic resonance imaging technique is presented. This procedure can be used to selectively detect flowing material such as blood in arteries and veins. Since flow is detected in a manner in which velocity-induced phase shifts are compensated, signal loss arising from complex flow and turbulence is minimized. The flow image is sensitive to all velocity components of flow. Applications of this technique are limited, however, to relatively straight vessels having appreciable flow. Examples of application of this technique to healthy and diseased carotid arteries are shown.

3DFT MR angiography of carotid and basilar arteries

Three-dimensional Fourier transform (3DFT) time-of-flight and two-dimensional Fourier transform (2DFT) projection phase-contrast MR angiography was performed in eight healthy volunteers and in 14 patients with known carotid artery or basilar artery occlusion, stenosis, or dissection. Comparative angiography was available in 13 cases (although in some cases the studies were separated by a number of months) and duplex sonography in one case. After localization of the carotid artery bifurcations by using 2DFT projection phase-contrast angiography, multiple 1.25-mm contiguous images were obtained with the 3DFT technique. In all cases, the lesions were identified on MR angiography. Because flow is detected in a manner that is independent of flow-induced phase shifts in the 3DFT time-of-flight technique, signal loss arising from complex flow and turbulence is minimized, yet the flow image remains sensitive to all velocity components of flow. Applications of this technique are ideal for relatively straight vessels where flow is laminar, but it can also be used to evaluate the carotid artery bifurcations where flow becomes complex.

Intradural extramedullary ependymoma: MR-pathologic correlation

An encapsulated, intradural, extramedullary ependymoma of the midthoracic spinal cord appeared hyperintense relative to normal spinal cord on long repetition time (TR)/long echo time (TE) images and nearly isointense to cord on short TR/short TE images. Clinical history, myelography, magnetic resonance of the tumor in vivo and of the fresh intact specimen, and histopathology are presented.

Intracerebral hemorrhage caused by cerebral amyloid angiopathy: radiographic-pathologic correlation

Seven cases of nontraumatic intracerebral hemorrhage due to histologically confirmed cerebral amyloid angiopathy were observed over a period of 2 1/2 years. Initial computed tomographic (CT) scans demonstrated lobar hemorrhages in all but one patient, who had presented with corpus callosum hemorrhage. Superficial location, irregular borders, and surrounding edema were characteristic features. Angiography was performed in three cases. Findings included mass effect (three cases), opercular branch occlusion (one case), and pericallosal irregularity (one case), all in the areas of the hemorrhage. Clinically, none of the patients had a history of prior cerebrovascular disease. Mild hypertension had been present in three patients and dementia in two. These findings suggest that cerebral amyloid angiopathy is not a rare cause of atraumatic lobar hemorrhage, particularly in a normotensive, elderly population.