Goodbye Tsugumi (B. Yoshimoto) is about the coming of age of two cousins, grown up together on the Japanese seaside, and whose ways are about to part. One of the two girls has an undefined illness, which has left her on the verge of dying for most of her life, and which also lets her get away with the most obnoxious and rude behaviour towards the people around her. I was disappointed by this book, having really enjoyed “Amrita” by the same author, but maybe this is due to its translation from Japanese (by M. Emmerich)… the language is rather blunt and crude, while the story is subtle, with a lot of attention for detail of these girls’ lives spending their last summer together. Of course, I’m only speculating, but I really think this subtlety and tenderness, that was so obvious in “Amrita”, got lost in the translation of this book. So, not really recommended; but do read Amrita instead.
Last day of the conference and, amazingly, there are still some people here! Maybe seeking refuge from the warm weather and bright sunshine..
Neurodegenerative and demyelinating diseases were this morning’s topic:
Low dose fluoxetine reduces the NAA-peak on MR spectroscopy in MS patients, according to a study by Sijens et al. (Groningen, NL); unfortunately clinical outcome was not studied. Well, as long as the brain normalises, right?
The combination of triple dose Gd, 3T scanning, 30 min delay after contrast administration, and a fat-saturation sequence increases the detection of active MS plaques (Wolansky et al, Newark, US) - I reckon! A double inversion recovery pulse sequence makes it easier to determine the precise location of MS plaques (within grey matter, adjacent to grey matter, or both in grey and white matter), according to Gavra et al. (Athens, GR). No idea whether this has got any clinical implications, but it does make us, neurotic radiologists, so much happier :-).
Voxel-based morphometry shows early grey matter changes in the hippocampus of asymptomatic subjects with familial Alzheimer’s disease, according to a study by Della Nave et al. (Pisa, IT). Scary..
Anyway, it’s been fun, but I’ve really heard enough German for a while.. time to go home and do some real work again!
Another sunny day in Vienna, but I was actually really grateful to be inside all day, after my little taste of Vienna’s nightlife last night.. didn’t quite make the early morning teaching session on diffusion and perfusion MR imaging of the brain, I’m afraid.
Fortunately, this is the country of extremely good coffee, even allowed to be taken into the lecture rooms, otherwise I would have missed GJ Kasprian’s (Vienna, AT) results from in vivo DTI and fibre tracking of the human fetus, as early as at 25 weeks’ gestation. Very impressive.
My big highlight of the day was going to be prof. Glazer’s (Stanford, US) lecture on new horizons in MR imaging, but unfortunately he couldn’t make it and had sent one of his disciples instead :-(. Still, I’d never heard of Na-imaging of the brain in stroke: not something for the near future I think, since 3T’s really the minimum apparently, and even their 7T images still looked very noisy. Very impressive DTI images as well, showing the small connecting fibres between the internal and external capsule, but without any information on the actual acquisition, I suspect this is not an easy one to reproduce.. Ultra-short TE sequences (in the range of 0.08 ms) are going to be the way to go for solid tissues, such as cartilage, white matter and even bone.. let’s see what the future brings!
Sunday and glorious weather in Vienna… but I went to the image interpretation session, where radiologists from different countries were teamed up to compete with each other. France and England were a team, as were Greece and Turkey.. I don’t think these countries’ relations had gotten any better by working on a case together, although something seemed to have flourished between the Bavarian and the Austrian radiologists, very cute. Anyway, I’ve learned that zebras are colibris in German (to indicate the most unusual diagnoses), which all of the presented cases were, of course.
Very interesting poster by Ojango et al. from Nottingham (UK), who studied the BOLD fMRI response in the motor cortex in patients with stroke and/or carotid stenosis, showing a very strong correlation with vasoreactivity (assessed with hypercapnia), both in the non-affected and in the affected hemisphere, without a substantial effect of changed perfusion.
Kanasaki et al. from Yonago (JP) presented a poster on a new application for SWI (susceptibility weighted imaging): acute ischemic stroke. Not only are the intra-arterial thrombi clearly visible, changes in venous circulation also become apparent.
Very busy day today: presenting “Loss of consciousness in minor head injury” from our CHIP study, my fMRI study of postconcussion syndrome, and “Neuro-applications at 3T” at the GE Healthcare Satellite symposium. Not much time and energy left to follow many other talks or courses..
Still, it was great to hear Dr. Nyhsen present her results from a “mini CHIP study” from Newcastle upon Tyne. Newcastle’s the 2nd most popular place for clubbing - after London - apparently, which provides the Newcastle A&E departments with an abundance of minor head injury patients. Their patients’ characteristics seem to bear a striking resemblance with our Rotterdam population: young, intoxicated men… Fallen Over Pissed (FOP). Anyway, the use of CT in minor head injury remains a topic of much debate, and many questions were asked regarding CT reduction, radiation issues, and cost-effectiveness… all to be addressed in my next CHIP paper!
There was an interesting talk by Lutz et al. who studied fibromyalgia patients’ brains with DTI, and found a significant increase of FA values in these patients’ amygdala, hippocampus and cingulate gyrus compared with healthy controls. Will we find a “somatic” cause for this syndrome after all?
The European Congress of Radiology in Vienna kicked off today, and I started my day with presenting our combined fMRI/DTI study of the arcuate fasciculus. Very happy to say that this paper has just become available online. Flatz et al. compared DTI at 1.5T with 3.0T, and (fortunately - no need to correct my talk for tomorrow!) confirmed that SNR doubles at 3.0T compared to 1.5T; The same SNR of an 8 averages non-isotropic voxel scan (12 mm³) at 1.5T will be achieved with an isotropic scan (8 mm³) of 4 averages at 3.0T: better resolution and a bit faster.
Slightly reassuring was a talk by Kutschbach et al. saying that caffeine was not physically addictive (although withdrawal symptoms do occur!), and therefore not considered a drug legally. Less reassuring was their finding that a dose of 100mg of caffeine was enough to induce T2* changes measurable with SWI.. and to a much lesser extent in the “regular users” than in “non-users”. Should I reduce my coffee consumption (and go into withdrawal)? Now, with still 3 talks to prepare and deliver, it just doesn’t seem the right time..
The talk by Bohner et al. - presenting results on brain activation related to pictures of high-calory food in obese people - just left me wondering… how did they get these BMI>35+ volunteers to fit inside the scanner?
Finally, according to dr. Salomonowitz, we lose up to 10% of our brain fibres per decade as we age.. based on the absolute numbers of fibres that are all beautifully automatically created in DTIstudio.. oh dear. Don’t think I’ll need to start worrying about my brain fibres just yet.
Winter in Madrid (C.J. Sansom) is a historical spy thriller, set in Madrid during World War II against the background of the Spanish Civil war. I have to admit that I don’t know much about that part of modern history, but apparently the book is overall historically correct. The characters, mostly English and all with their own reasons for being in Madrid, are very well described and it is therefore very easy to be dragged into their complicated and tragic lives. Once started, this book wasn’t easy to put down, with its almost cinematographic writing. Much recommended, but no happy endings, alas..
The Inheritance of Loss (K. Desai) centres around Sai, an Indian girl living with her misanthropist grandfather and his cook in a village at the foot of the Himalayas. The book is beautifully written with slowly developing plotlines, extensively elaborating on the characters, the country and their lives in general. The Ghorka uprising therefore seems to come as a surprise, both to the reader and the characters, each of whose lives are upset in very different ways. Much recommended.