[Evaluation of gamma camera collimator for regional cerebral blood flow measurements using a 133Xe inhalation method]

In the measurements of regional cerebral blood flow (rCBF) using inhalation of 133Xe gas, the activity present is generally limited in lower levels than those of usual brain scintigraphy. Measurements with low count-rate are usually resulted in diminishing the accuracies of results obtained. Therefore, it is necessary to make measurements using a high sensitive collimator for getting as much count-rate as possible when a gamma camera is used. The relationships among sensitivity and structures of multi-parallel collimator were mathematically analyzed. The results of analysis suggested that sensitivity usually increased by using a collimator with holes of reduced height and diameter. A prototype multi-parallel collimator with holes of low height and small diameter was made in our laboratory for testing sensitivity and resolution. The collimator possessing 1141 holes of 6 mm phi in hole diameter, 1.5 cm is hole height and septal thickness of 1 mm lead showed 24 times more sensitive than those of a general all purpose collimator supplied by the manufacturer. However, resolution measured in FWHM was of 9 to 14 mm at the collimator face and of 29 to 38 mm at 5 cm from the face. The results indicated that this collimator was useful enough in rCBF measurements with 133Xe inhalation using a gamma camera. The mathematical analysis however, suggested that optimum collimator for rCBF measurements was approximate 4.5 mm phi in hole diameter and 1.0 cm in hole height.

Electrocorticography: information derived from intraoperative recordings during seizure surgery

The findings of 100 consecutive electrocorticographies in 94 epileptic patients were reviewed. Most of these patients underwent temporal lobectomies. A well defined and circumscript cortical spike focus was found in only 28 tracings whereas multiple sub-foci of spike activity or dissipated areas of spiking were demonstrated in 46 recordings. Cortical spike activity was minimal in 14 and absent in 12 tracings. Additional one-lead depth electrodes (inserted mainly into amygdala and hippocampus) yielded rather little information in contrast to the wealth of information derived from chronic multiple-leads depth implants prior to surgery. The frequent occurrence of dissipated spike foci suggests that, in partial epilepsies (and especially in temporal lobe epilepsy), epileptogenic zones are more widespread than one would expect from the scalp EEG recordings. These findings lend support to the use of en-bloc removal of large portions of an affected lobe.

[The indication of hepatic resection from medical imaging technique for hepatocellular carcinoma]

Recently small hepatocellular carcinoma are frequently diagnosed due to the improvement of medical imaging techniques. Main tumors including one with diameter of 1 cm were definitely diagnosed by the combined use of US and CT. US and angiographic examination were useful in definitely detecting tumor emboli in the main trunk even to the subsegmental level of the portal vein. All of the 12 daughter nodules of diameter over 1 cm could be definitely diagnosed by any examinations. However, diagnostic accuracy was in detecting 11 daughter nodules of diameter below 1 cm as the following data shown; one was positive using US, six were positive using CT, and three were positive using angiography. Sequential moving scan technique during the late phase could make definite preoperative diagnosis of small daughter nodule of diameter below 1 cm. Owing to the improvement of the imaging diagnostic technique, we can obtain accurate preoperative information concerning the presence or absence of daughter nodule and tumor emboli in the portal vein. Therefore, we can select suitable candidates for surgical excision or other combined therapy.

Measurement of carotid blood flow in man and its clinical application

With the use of a new ultrasonic volume flow meter (VFM), over 8000 measurements of common carotid blood flow were made in 120 normal control subjects and 550 patients with various neurological disease. The accuracy of the flow meter in measuring blood flow on an experimental model ranged from 93 to 97%. In normal subjects, common carotid blood flow varies with age. It increased from newborn to age 20 and gradually decreased thereafter. In normal healthy subjects, the flow varies within +/- 6.7% (2SD) at one sitting (intrasession) and +/- 21.2% (2SD) from week to week (intersession study). Carotid blood flow varies linearly with PaCO2 and increased markedly in response to endotracheal intubation. In healthy adults, the flow ratio between the two common carotid arteries is 1.07 +/- 0.052. This ratio increases in patients with transient ischemic attacks to 1.28 +/- 0.23 (p less than 0.05) and in patients with intracranial space occupying lesions to 1.46 +/- 0.39, (p less than 0.01). In 26 consecutive cases of carotid endarterectomies, the preoperative common carotid blood volume flow was 5.1 +/- 1.0 cc/sec. All cases preoperatively had at least 30% stenosis and ranged from 30 to 100% stenosis. The carotid blood volume was significantly increased post-operatively (p less than 0.001). The overall accuracy in detecting carotid and cerebral arterial disease is 89% with sensitivity of 96% and the specificity of 71%. Our clinical experience indicates that this device is not only a valuable noninvasive diagnostic tool for evaluation of carotid disease but also appears to be useful in assessing cerebral blood flow.

Sleep spindles recorded from deep cerebral structures in man

The depth and scalp EEG findings in 73 patients with intractable epileptic seizure disorder and in 14 patients with intractable pain were reviewed; stress was laid on the area of earliest spindle activity. It was found that sleep spindles frequently occurred first in frontal depth leads and especially in the superior frontal region (supplementary motor region). In some cases, spindles in frontal depth leads occurred while the patient showed early drowsy activity or even waking activity (with posterior basic rhythm) in the scalp leads. In patients with thalamic implants, spindles tended to appear on the thalamus before appearance on the scalp. The general rule that sleep onset (NREM) is characterized by the appearance of spindles is valid for the scalp EEG only. Deep spindle activity occurs much earlier and probably requires a certain degree of synchronization before spindle activity is noticeable in scalp leads. The superior frontal region is likely to be the starting point of spindle activity.