Background: Magnetic resonance angiography (MRA) has been acknowledged as a noninvasive diagnostic modality for moyamoya disease. However, in terms of staging of moyamoya disease, conventional angiography is still the gold standard. Therefore, the purpose of this study was to establish MRA grades for moyamoya disease as an alternative to conventional angiography. Methods: Twenty-two patients (44 sides) with moyamoya disease diagnosed by conventional angiography were evaluated by MRA during the past 5 years. MRA scores were assigned based on the severity of occlusive changes of the internal carotid artery, the horizontal portion of the middle cerebral artery, the anterior and the posterior cerebral arteries and the signals of the distal branches of these arteries. Total points ranged from 0 (normal) to 10 (most severe). Results: MRA scores (0–10) were significantly consistent with the conventional angiographic staging. Four grades based on this novel MRA scores correlated well with Suzuki’s stages, with high sensitivity and specificity. Conclusions: These novel MRA grades can be a reliable alternative to conventional staging. By employing these novel MRA grades, the use of conventional angiography can be avoided for the purpose of evaluation of the stages of moyamoya disease.

Purpose: To evaluate whether short-tau inversion-recovery (STIR) fat suppression is worthwhile in non-contrast-enhanced respiration-triggered free-breathing time-spatial labeling inversion pulse (Time-SLIP) renal magnetic resonance angiography (MRA) compared with chemical shift selective (CHESS) fat suppression. Materials and Methods:Simulation-based analyses of inversion time (TI) for spatial-selective inversion-recovery (ssIR) pulse and breathing rate were performed, and confirmed on a phantom and in human subjects using a threedimensional (3D) coherent steady-state free precession (SSFP) sequence on a 1.5T Toshiba scanner. Results:The STIR fat suppression successfully suppressed signals from the intestines and parenchymous organs and provided better contrast between the arteries and the background, although an extension of TI was required for the ssIR pulse when a patient's respiration was extremely slow. Conclusion:STIR fat suppression provides better renal artery contrast than CHESS fat suppression in non-contrast free-breathing Time-SLIP MRA; it is also an effective screening tool for renal artery stenosis because of the lack of interference from intestinal signals. However, close attention is needed if the patient has slow respiration. As the TI for the ssIR pulse decreases, the STIR method requires faster-paced respiration.

MEK/ERK-mediated signals have recently been found to inhibit Fas-mediated cell death through inhibition of caspase-8 activity. It remains unknown whether MEK/ERK-mediated signals affect ionizing radiation (IR)-induced cell death. Here we demonstrate that MEK/ERK-mediated signals selectively inhibit IR-induced loss of mitochondrial membrane potential (DC m ) and subsequent cell death. In Jurkat cells, TPA strongly activated ERK and inhibited the IR-induced caspase-8/Bid cleavage and the loss of DC m . The inhibitory effect of TPA was mostly abrogated by pretreatment of a specific MEK inhibitor PD98059, indicating that the effect depends upon MEK/ERKmediated signals. Moreover, BAF-B03 transfectants expressing IL-2 receptor (IL-2R) bc chain lacking the acidic region, which is responsible for MEK/ERK-mediated signals, revealed higher sensitivity to IR than the transfectants expressing wildtype IL-2R. Interestingly, the signals could neither protect the DC m loss nor cell death in UV-irradiated cells. These data imply that the anti-apoptotic effect of MEK/ERK-mediated signals appears to selectively inhibit the IR-induced cell death through protection of the DC m loss. Our data enlighten an antiapoptotic function of MEK/ERK pathway against IR-induced apoptosis, thereby implying its contribution to radioresistance.

Purpose:To evaluate the efficacy of double-subtraction magnetic resonance angiography (MRA) (subtraction of the subtracted venous phase image from the subtracted arterial dominant phase image) for depicting the artery of Adamkiewicz and differentiating it from the drainage vein. Materials and Methods:A total of 170 patients (123 men, 47 women; aged 17-84 years, mean ϭ 67 years), with a thoracoabdominal vascular lesion underwent MRA for detection of the artery of Adamkiewicz. MRA was performed as a five-phase dynamic-enhanced three-dimensional (3D) fast spoiled gradient recalled acquisition in steady state (GRASS) sequence on a 1.5-T system, with double-dose bolus contrast and saline injection. The levels at which the artery of Adamkiewicz and drainage vein originated were determined. Signal intensities of the two vessels were measured with source images to assess the signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), and necessity of the double-subtraction technique. Results:The artery of Adamkiewicz was detected in 140 patients (82.4%). Branching occurred at levels T8 -T12 on the left and T8 -T11 on the right. An additional anterior radiculomedullary artery was detected in 18 patients. The drainage vein was detected in 133 patients (78.2%). It merged at the T9 -L2 level on both sides. In six of the 133 patients (4.5%), the drainage vein branched upwardly. Neither SNR nor CNR differed significantly between the artery of Adamkiewicz and the drainage vein in the arterial phase; but on the subtraction image, signal intensity of the artery was higher than that of the drainage vein (P Ͻ 0.05).Conclusion: Double-subtraction MRA is useful for detecting the artery of Adamkiewicz when it is necessary to differentiate it from the drainage vein.

Most laryngeal cancers are squamous cell carcinomas, and adenocarcinomas account for < 1% of cancers of the larynx. Among them, mucoepidermoid carcinoma is extremely rare and there is little agreement about the treatment of this carcinoma. We encountered one patient with mucoepidermoid carcinoma of the bilateral vocal cords (T1bN0M0, Stage 1). For this, most investigators recommended a surgical procedure. However, because of his old age, the early stage and low grade of histopathology, we treated this patient with radiotherapy alone, delivered by accelerated hyperfractionation, which is a more effective strategy for treating radioresistant tumors than conventional irradiation. Following radiotherapy, the tumor disappeared and the patient has been alive and well for more than six years. An old patient with mucoepidermoid carcinoma of the larynx was successfully treated with radiotherapy alone.