Intraventricular hemorrhage (IVH) on initial computed tomography (CT) was reported to predict lesions of diffuse axonal injury (DAI) in the corpus callosum (CC) on subsequent magnetic resonance imaging (MRI). We aimed to examine the relationship between initial CT findings and DAI lesions detected on MRI as well as the relationship between the severity of IVH (IVH score) and severity of DAI (DAI staging). A consecutive 140 patients with traumatic brain injury (TBI) who underwent MRI within 30 days after onset were revisited. We reviewed their initial CT for the following six findings: Status of basal cistern, status of mid-line shift, epidural hematoma, IVH, subarachnoid hemorrhage, and volume of hemorrhagic mass and IVH score were assigned in each patient. Based on MRI findings, patients were divided into DAI and non-DAI groups and were assigned a DAI staging. Then, to confirm that the IVH on initial CT predicts DAI lesions on MRI, we used multi-variate analysis of the six CT findings, including IVH, and examined the relationship between IVH score and DAI staging. The IVH detected on CT was the only predictor of DAI (p=0.0139). The IVH score and DAI staging showed significant positive correlation (p<0.0003). IVH score in DAI stage 3 (with DAI involving the brain stem; p=0.0025) or stage 2 (with DAI involving CC; p=0.0042) was significantly higher than that of DAI stage 0 (no DAI lesions). In conclusion, IVH on initial CT is the only marker of DAI on subsequent MRI, specifically severe DAI (stage 2 or 3).

We compared Canadian computed tomography (CT) head rule (CCHR) and New Orleans Criteria (NOC) in predicting important CT findings in patients with mild traumatic brain injury (TBI). We included 142 consecutive patients with mild TBI [Glasgow coma scale (GCS) 13–15] who showed at least one of the risk factors stated in the CCHR or the NOC. We introduced two scores: a Canadian from the CCHR and a New Orleans from the NOC. A patient’s score represented a sum of the number of positive items. We examined the relationship between scores or items and the presence of important CT findings. Only the Canadian was significantly associated with important CT findings in multivariate analyses and showed higher area under the receiver operating characteristic curve (AUC) either in all 142 patients (GCS 13–15: P = 0.0130; AUC = 0.69) or in the 67 with a GCS = 15 (P = 0.0128, AUC = 0.73). Of items, “>60 years” or “≥65 years” included in either guideline was the strongest predictor of important CT finding, followed by “GCS < 15 after 2 h” included only in the CCHR. In a tertiary referral hospital in Japan, CCHR had higher performance than the NOC in predicting important CT findings.Electronic supplementary materialThe online version of this article (doi:10.1186/s40064-016-1781-9) contains supplementary material, which is available to authorized users.

Optic nerve magnetic resonance imaging parameters were significantly correlated to glaucomatous damage. Magnetic resonance imaging analysis of the optic nerve may, thus, have value as an objective instrument to assess glaucomatous degeneration, including the function of the macula.

ABSTRACT. Reports on the MRI findings of cerebral corticosubcortical lesions in osmotic myelinolysis (OM) are rare despite several pathological descriptions of this involvement. We report two patients with subcortical lesions associated with OM that were characteristically distributed along the crowns and sides of the cerebral gyri on T 2 weighted or fluid-attenuated inversion-recovery MRI. We also discuss the MRI characteristics of corticosubcortical lesions in OM. Osmotic myelinolysis (OM) is a demyelinating disorder characterised by acutely evolving corticospinal and bulbar dysfunction following the rapid correction of hyponatraemia [1]. In the literature, MRI findings of OM consist primarily of hyperintensity on T 2 weighted images (T 2 WI) or fluid-attenuated inversion-recovery (FLAIR) images in the central pons (central-pontine myelinolysis), midbrain, bilateral thalami and/or basal ganglia (extrapontine myelinolysis), or a combination of these [1]. Although cerebral corticosubcortical involvements have been described in pathological studies [1][2][3], a description of the MRI findings has been mostly limited to case reports [4][5][6][7][8].We report serial MRI findings in two patients with corticosubcortical lesions associated with OM. One patient's lesions were disclosed on MRI that included diffusion-weighted imaging (DWI) and T 1 weighted imaging (T 1 WI) with contrast enhancement that were obtained 8 days (late acute phase) and 26 days (subacute phase) after the onset of neurological symptoms. The other patient's lesions appeared on MRI 14 months (chronic phase) after symptom onset. Case 1Following 1 month of chemotherapy, a 28-year-old female with advanced colon cancer developed coma and myoclonus-like involuntary movement as a result of hyponatraemia of 110 mEq l -1 . This was presumably caused by water toxicosis derived from vasopressin therapy for diabetes insipidus. The clinicians tried to control the serum sodium level gradually, but it unexpectedly rapidly elevated to 178 mEq l -1 within 4 days. The patient remained comatose after returning to normonatraemia and underwent an MRI of the brain 8 days after the onset of neurological symptoms (late acute phase). DWI showed multiple hyperintense lesions in the striatum (putamen and caudate nucleus) and almost symmetrically distributed in the corticosubcortical regions (Figure 1a,b). These lesions also appeared hyperintense on T 2 WI and FLAIR imaging. Some of the corticosubcortical lesions showed contrast enhancement, especially those subjacent to the top (crown) of the cerebral gyri (Figure 1c). The clinical presentation and MRI findings led to a diagnosis of OM with extrapontine involvement. In the subacute phase (26 days after the onset of symptoms), the cortico-subcortical lesions became more evident on T 2 WI and FLAIR images (Figure 1d,e) but appeared hypointense on T 1 WI. The patient remains comatose. Case 2A 65-year-old female was admitted to the hospital with loss of consciousness and convulsion half a day after she drank a large amount of...

Surgical resection failed to achieve CA19-9 normalization in the high PET group and distant recurrence was frequent. This suggests the potential for residual cancer at distant sites, even after curative resection. Stronger preoperative systemic chemotherapy is preferred for the high PET group patients.