Dokkyo Journal of Medical Sciences37（2）：129 〜 131，2010

129

Case Report

Image Analysis with the Brain Easy Analysis Tool（BEAT）Method in Cases of Encephalomalacia Following
Shaken Baby Syndrome111

2George Imataka , Yoshiyuki Watabe , Keiko Tsukada , Shigeko Kuwashima ,Teisuke Hashimoto 2 and Osamu Arisaka 1
Department of Pediatrics1 and Rediology2 , Dokkyo Medical University School of Medicine

SUMMARY
Brain easy analysis tool（BEAT）is newly released software to calculate composite images both MRI andSPECT on computer graphics. At first, we herein report two cases with shaken baby syndrome associatedwith multicystic encephalomalasia diagnosed based on MRI. Next, we created fusion MRI-SPECT images
using BEAT. The result of composited images was not only well recognized in anatomical visually but alsoeasy to explain data to patients. This report is the second case report with this software called BEAT.
Key Words：Shaken baby syndrome, brain easy analysis tool, encephalomalacia, fusion image

INTRODUCTION
Shaken baby syndrome（SBS）is a battered childand 99m-Tc ECD SPECT for SBS using the computer
software called Brain Easy Analysis Tool（BEAT）,
which was newly developed recently 5）.

syndrome that occurs due to the shaking of the head

CASE REPORTSof an infant. Because it occurs in the daily lives of children, society has become aware of the importance ofCase 1

its prevention. Shaking causes intracranial hemorrhag-

A 2-month-old male infant visited the emergency

ing, which is complicated by fundal hemorrhaging at a

outpatient unit due to eye deviation and local convul-

high rate. In many cases, shaking of the brain results

sion of the limbs. According to our inquiry of the par-in secondary destructive changes detected in brain

ents, the patient exhibited repeated stereotyped move-

MRI examinations, leaving severe neurological seque-ments of moving the limbs up and down for half a day.

1 〜 4）

There was no obvious trigger for the occurrence ofThis article presents two cases that exhibited sec-

these movements. The child had no trauma on theondary encephalomalacia in brain MRI examinations

body surface. Palpation revealed that the limbs had be-following SBS. Furthermore, we herein report that wecome stiff, and the eyes were displaced downward andattempted fusion image analysis of brain MRI images

immobilized. The anterior fontanelle exhibited bulging.

lae.

We diagnosed the child with local convulsive status. In
Received March 16, 2010；accepted May 24, 2010
Reprint requests to：George Imataka, MD.
Department of Pediatrics, Dokkyo Medical
University School of Medicine, Mibu, Tochigi
321-0293 Japanfunduscopy, periretinal hemorrhaging was found. In abrain CT examination, subdural hemorrhaging wasfound. Subsequently, the child quickly developed respiratory failure and underwent artificial respiratory
management. The patient entered the ICU and under-130George Imataka

DJMS

Case 1：
A：MRI T1-weighted image（spin echo；TR＝545.0, TE＝15.0）showed multicyctic encephalomalasia.
B：99 m-Tc ECD SPECT qualitative analysis showed hypo-perfusion area consisted with images ofMRI. C：Fusion images using BEAT with 30 ％ composite image exhibited characteristic both MRI
and SPECT images.
Case 2：
D：Brain MRI T1-weighted image（spin echo；TR＝545.0, TE＝15.0）of axial image revealed
multicyctic encephalomalasia. E：99 m-Tc ECD SPECT qualitative analysis suggested hypo-perfusionarea consisted with catastrophic images of MRI. F：Fusion images employing BEAT with 30 ％composite image showed characteristic both MRI and SPECT images.

went mild brain hypothermia therapy and steroid
pulse therapy.

Case 2
A 3-month-old female child visited the emergency

Several days later, we heard from the parents that

outpatient unit due to local convulsion of the hands.

they had shaken the child hard, and we clinically diag-

The child had been born at 28 weeks gestation with a

nosed the patient with SBS. A brain MRI（Fig. A）ex-

weight below 1,000 g. According to our inquiry of theamination conducted two months after onset showedparents, the child became inactive after excessive

subdural hemorrhaging, atrophic images of the cere-shaking when cradling her at home. Subsequently, lo-brum in the right frontotemporal region, and contralat-

cal convulsion of the eyes and hands were expressed.

eral cystic encephalomalacia. 99 m-Tc ECD SPECTIn a brain CT examination, subdural hemorrhaging

qualitative analysis（Fig. B）showed extensive images

was found. The ocular fundus had hemorrhaged. Fromof inadequate blood flow.

these two findings and the clinical course, we diag-

Two years after onset, the patient still has disorders

nosed the patient with SBS. Steroid pulse therapy andof the visual field and visual acuity as well as talipes

continuous anticonvulsant infusion was performed.

equinus with spastic paralysis, and he is undergoing

However, severe sequelae remained. An MRI examina-rehabilitation.

tion（Fig. D）conducted 6 months after onset showed37（2）（2010）BEAT with Encephalomalacia

131bilateral encephalomalacia. Moreover, in 99 m-Tc ECD

The two cases presented herein both involved ex-

SPECT qualitative analysis（Fig. E）, inadequate blood

tensive cerebral cortical disorder due to encephalomal-flow images matching the MRI findings were found.

acia in the MRI images. In such cases, the fusion images using BEAT were very useful for visually
understanding structural abnormalities in MRI and ab-

BEAT analysis
MR images were analysis to the computer system

normal blood flow in SPECT. This software provides

from the server as DICOM data. Format fusion images

not only a technique for creating fusion images using

was obtained employing the DICOM viewer software

MRI and SPECT but also functions for superimposing5）

licensed by Fujifilm RI farma Co. Ltd .

a difference image, which displays a difference

SPECT was performedusing a triple-head system（amount of change or rate of change）between two（Toshiba GCA-9300A/HG Ⓡ ）equipped with ultra-

SPECT images from the same patient, over an MRI

high-resolution fanbeam collimators and interfaced toimage to display the image. In the future, we would

a dedicated computer. Data were collected for continu-

like to test MRI and SPECT images of the two cases

ous 5 rotations（3 minutes for one rotation）in a 128 ×

presented herein over time and examine the fusion of

128-matrix. Acquired data were reconstructed using

difference images and MRI images as well.

3-dimensional Butterworth-Wiener filter（order, 8.0；
cutoff frequency, 0.13 cycle per pixel）after applying aAcknowledgement.

This study was partially sup-Shepp & Logan back projection filter. For both cases,

ported by the Dokkyo Medical University, Investiga-

we created fusion images of MRI from DICOM data

tor-Investigated Research Grant（No. 2010-01-6）andand qualitative analysis SPECT images obtained

Young Investigator Award.

around the same time using the BEAT method, andREFERENCES

these images are presented herein（Fig. C/F）.

DISCUSSION
In cases involving dynamic reductions in the reflux
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ages on a computer screen, and it has been clinically4）Imataka G, Kuwashima S, Wake K, et al：Three cases

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