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Dynamic statistical parametric mapping: combining fMRI and MEG for high-resolution imaging of cortical activity.

Functional magnetic resonance imaging (fMRI) can provide maps of brain activation with millimeter spatial resolution but is limited in its temporal resolution to the order of seconds. Here, we describe a technique that combines structural and functional MRI with magnetoencephalography (MEG) to obtain spatiotemporal maps of human brain activity with millisecond temporal resolution. This new technique was used to obtain dynamic statistical parametric maps of cortical activity during semantic processing of visually presented words. An initial wave of activity was found to spread rapidly from occipital visual cortex to temporal, parietal, and frontal areas within 185 ms, with a high degree of temporal overlap between different areas. Repetition effects were observed in many of the same areas following this initial wave of activation, providing evidence for the involvement of feedback mechanisms in repetition priming.

Brain↗

Focal ictal beta discharge on scalp EEG predicts excellent outcome of frontal lobe epilepsy surgery.

PURPOSE: To determine whether a focal beta-frequency discharge at seizure onset on scalp EEG predicts outcome of frontal lobe epilepsy (FLE) surgery. METHODS: We identified 54 consecutive patients with intractable FLE who underwent epilepsy surgery between December 1987 and December 1996. A blind review of EEGs and magnetic resonance images (MRIs) was performed. Lesional epilepsy is defined as presence of an underlying structural abnormality on MRI. RESULTS: Overall, 28 (52%) patients were seizure free, with a mean follow-up of 46.5 months. Presence of a focal beta-frequency discharge at seizure onset on scalp EEG predicted seizure-free outcome in lesional (p = 0.02) and non-lesional (p = 0.01) epilepsy patients. At least 90% of patients who had either lesional or non-lesional epilepsy were seizure free if scalp EEG revealed a focal beta discharge at ictal onset. Moreover, logistic regression analysis showed that focal ictal beta pattern and completeness of lesion resection were independently predictive of seizure-free outcome. Ictal onset with lateralized EEG activity of any kind and postresection electrocorticographic spikes did not predict surgical outcome (p > 0.05). CONCLUSIONS: Only about 25% of FLE surgical patients have a focal beta-frequency discharge at seizure onset on scalp EEG. However, its presence is highly predictive of excellent postsurgical seizure control in either lesional or non-lesional FLE surgical patients.

Child↗

[Diagnosis of uterine vascular malformation using Doppler ultrasound].

We present the case of a 56-year-old woman, who was admitted to our clinic for diagnostic laparoscopy because of a cystic uterine tumour of uncertain dignity. In the patient's history three curettages due to recurrent acyclic premenopausal vaginal bleeding were reported without specific histological findings. The preceding MRI described the structure as a myoma. During preoperative diagnostics an arteriovenous malformation was suspected by transvaginal Doppler sonography. Consequently the procedure was changed and a laparotomy performed. The sonographic findings were confirmed during surgery and by histological examination. This case points out the important role of transvaginal sonography combined with colour-flow-mapping. By confirming the diagnosis preoperatively and changing the management a low-risk procedure could be ensured.

Arteriovenous Malformations↗

Congenital caudal spinal atrophy: a case report.

An infant presented at birth with symmetrical flaccid paraparesis limited to lower legs and feet, and involving the proximal and distal muscle group. Limitation of the ankle joints was noticed. There were no sensory deficits to painful stimuli and no evidence of loss of sphincter control. Muscle CT revealed severe muscle atrophy in the pelvis and lower limbs, and electromyographic study of the bilateral hamstrings showed polyphasic giant potentials. Motor and sensory nerve conduction velocities were within normal limits, and the spinal MRI showed no structural abnormalities in the cord and the lower spine. These features suggest a congenital segmental abnormality at the anterior horn cell level in the lumbosacral spinal cord, which we propose to call "congenital caudal spinal atrophy".

Arthrogryposis↗

Sensitivity of the WAIS-R Verbal-Performance IQ difference and intersubtest scatter to traumatic brain injury. Wechsler Adult Intelligence Scale-Revised.

The Wechsler Adult Intelligence Scale-Revised (WAIS-R) Verbal IQ-Performance IQ (VIQ-PIQ) discrepancy and a number of indices of intersubtest scatter were examined in 25 subjects with a history of traumatic brain injury (TBI) and magnetic resonance imaging (MRI) evidence of structural brain abnormality. Abnormal VIQ-PIQ differences and scatter index values were identified by referring to published normal base rates. Only 16% of the subjects were identified as abnormal on any one of these WAIS-R measures, which suggests these measures are largely insensitive to the presence of structural brain abnormality in TBI.

Adult↗

Imaging of axonal damage in vivo in Rasmussen's syndrome.

We obtained magnetic resonance spectroscopic images (MRSIs) in three patients with Rasmussen's syndrome. The relative resonance intensity of N-acetylaspartate (NAA) to creatine (NAA:Cr), an index of neuronal loss or damage, was determined for various regions within the brain, and the affected:unaffected hemisphere asymmetry ratio was determined. All three patients had decreased relative NAA signal intensity over the entire affected hemisphere. The decrease in NAA:Cr involved cortex and white matter, was most prominent in the anterior periventricular region, and showed a tendency to be worse in patients with longer duration of disease. 1 year follow-up MRSI showed further reduction of the relative NAA signal in all patients, indicating progression of the disease. All patients were free of seizures for at least 48 h before the first MRSI, but two of them had epilepsia partialis continua (EPC) during the follow-up examination. There was no significant increase of the lactate resonance intensity, except in the two MRSIs performed during EPC. This indicates that lactate accumulation results from repetitive seizures rather than from the disease process itself. The spatial distribution of the metabolic abnormality on MRSI was more widespread than that of the structural abnormality on MRI. The relative NAA resonance intensity was not reduced in the contralateral hemisphere. Our findings indicate that MRSI can identify and quantify neuronal damage and loss throughout the affected hemisphere of patients with Rasmussen's syndrome, including areas that appear normal on conventional MRI.

Adolescent↗

Reduced basal ganglia blood flow and volume in pre-symptomatic, gene-tested persons at-risk for Huntington's disease.

The aim of this study was to examine basal ganglia volumes and regional cerebral blood flow in asymptomatic subjects at-risk for Huntington's disease who had undergone genetic testing. We determined which measures were the best 'markers' for the presence of the mutation and for the onset of symptoms. Twenty subjects who were Huntington's disease gene mutation-positive and 24 Huntington's disease gene mutation-negative participants, all of whom had a parent with genetically confirmed Huntington's disease, and were therefore 50% at-risk for inheriting the Huntington's disease gene mutation, were included in the study. To evaluate basal ganglia structure and function, MRI and single photon emission computed tomography (SPECT) were used. Quantitative measures of regional volumes and relative measures of regional perfusion were calculated. SPECT and MRI scans were co-registered so that MRI anatomy could be used accurately to place SPECT regions. Estimated years-to-onset in the mutation-positive subjects was calculated based on a regression formula that included gene (CAG)(n) repeat length and parental age of onset. Changes in imaging measures in relation to estimated years-to-onset were assessed. The imaging measure that was most affected in mutation-positive subjects was putamen volume. This was also the measure that correlated most strongly with approaching onset. In subjects >/=7 years from estimated onset age, the putamen volume measures were similar to those of the mutation-negative subjects. However, in subjects </=6 years from estimated onset age, there were dramatic reductions in putamen volume, resulting in >90% discrimination from both the far-from-onset and the mutation-negative subjects. Caudate volume and bicaudate ratio also showed a significant decline in the close-to-onset subjects, although to a lesser degree than putamen volume reductions. Furthermore, SPECT basal ganglia perfusion deficits were observed in mutation-positive subjects. Imaging markers of neuropathological decline preceding clinical onset are important for assessing the effects of treatments aimed at slowing the course of Huntington's disease. The current study suggests that quantitative assessment of basal ganglia may provide a means to track early signs of decline in individuals with the Huntington's disease gene mutation prior to clinical onset.

Adult↗

Dynamic magnetic resonance imaging of human Rolandic cortex.

Rolandic cortex was imaged with magnetic resonance (MR) in nine subjects while performing a motor activation task. Imaging was performed by a volumetric, T2-weighted pulse sequence in a conventional 1.5 Tesla scanner during both resting conditions and volitional toe flexion and extension of the dominant foot. Significant changes in MR signal intensity of 7.8 +/- 2.3% (mean +/- s.e.m.) were observed in the medial Rolandic cortex contralateral to the active foot. Changes were maximal in the vicinity of the central sulcus, but were also identified anteroposteriorly, across successive coronal planes. No significant changes were found in the ipsilateral Rolandic cortex or in other brain structures. Volumetric functional MRI strategies may provide an important non-invasive tool for assessment of cortical motor function.

Adolescent↗

Color enhancement of multispectral MR images: improving the visualization of subcortical structures.

PURPOSE: The current investigation was undertaken to evaluate a new method for creating MR multispectral color images, which we call "Superimages." They were developed to improve the delineation of small brain structures composed of mixed tissue types, such as the basal ganglia. METHOD: To qualitatively validate the method, visual comparisons were made of six unimodal and multispectral images, including the Superimage. Quantitative validation was undertaken by comparing the reliability values for parcellation of the globus pallidus (GP) using either a gray scale (T1-weighted) image or the Superimage. RESULTS: Qualitative assessment of the Superimage revealed enhanced visualization of the GP, caudate, and putamen. Quantitative assessment resulted in good reliability for Superimage traces. CONCLUSION: The Superimage significantly improves both the visualization and the parcellation of structures visualized by MRI.

Adult↗

Recovery from optic neuritis is associated with a change in the distribution of cerebral response to visual stimulation: a functional magnetic resonance imaging study.

OBJECTIVES: Recovery to normal or near normal visual acuity is usual after acute demyelinating optic neuritis, despite the frequent persistence of conduction abnormalities as evidenced by the visual evoked potential (VEP). This raises the possibility that cortical adaptation to a persistently abnormal input contributes to the recovery process. The objective of this study was to investigate the pattern of cerebral response to a simple visual stimulus in recovered patients in comparison to normal subjects. METHODS: Functional magnetic resonance imaging (fMRI) was used to study the brain activation pattern induced by a periodic monocular 8Hz photic stimulus in seven patients who had recovered from a single episode of acute unilateral optic neuritis, and in seven normal controls. VEPs and structural optic nerve MRI were performed on patients. RESULTS: Stimulation of either eye in controls activated only the occipital visual cortex. However, in patients, stimulation of the recovered eye also induced extensive activation in other areas including the insula-claustrum, lateral temporal and posterior parietal cortices, and thalamus; stimulation of the clinically unaffected eye activated visual cortex and right insula-claustrum only. The volume of extraoccipital activation in patients was strongly correlated with VEP latency (r = 0.71, p = 0.005). CONCLUSIONS: The extraoccipital areas that were activated in patients all have extensive visual connections, and some have been proposed as sites of multimodal sensory integration. The results indicate a functional reorganisation of the cerebral response to simple visual stimuli after optic neuritis that may represent an adaptive response to a persistently abnormal input. Whether this is a necessary part of the recovery process remains to be determined.

Adult↗

High correlation of whole-body red fluorescent protein imaging and magnetic resonance imaging on an orthotopic model of pancreatic cancer.

We have developed genetically fluorescent orthotopic models of human pancreatic cancer. In these models, noninvasive fluorescent protein imaging (FPI) of internal primary tumors and metastatic deposits has been carried out. Whole-body tumor images are easily and inexpensively obtained using FPI, permitting both detection and quantification of tumor load. In this study, we simultaneously compared single mice with a highly fluorescent, red fluorescent protein-expressing orthotopic pancreatic cancer xenografts with both FPI and high-resolution magnetic resonance imaging (MRI). Images were acquired at multiple time points after tumor implantation in the pancreas. Indwelling pancreatic primary tumors and metastatic foci were detected by both FPI and MRI. Moreover, a strong correlation existed between images taken with these two technologies. FPI permitted rapid, high-throughput imaging without the need for either anesthesia or contrast agents. Both FPI and MRI enabled accurate imaging of tumor growth and metastasis, although MRI enabled tissue structure to be visualized as well. FPI has high resolution and is exceedingly rapid with instant image capture. We suggest a complimentary role for these two imaging modalities.

Animals↗

MRI morphometric study and correlation with cognitive functions in young adults shunted for congenital hydrocephalus related to spina bifida.

We studied the morphometric MRI findings and their correlation with cognitive functions in a population of 10 young adults shunted for congenital hydrocephalus related to spina bifida. Morphometric MRI analysis included measurement of the ventricular dilatation index, frontal and occipital parenchymal thickness and the size of the corpus callosum. The neuropsychological status was evaluated, notably to look for a discrepancy between verbal and performance skills, a finding which has previously been described in hydrocephalic children. We also investigated whether there was a correlation between cognitive function and cerebral morphometric indexes. In each case, MRI demonstrated the structural changes associated with the Chiari II malformation. The size of the lateral ventricles varied, ranging from important dilatation to small ventricles. Six patients had only partial development of the corpus callosum. All patients had a normal global IQ. In our population of young adults, we did not observe any discrepancy between verbal and visuospatial performances as has been described in children with hydrocephalus. We found no relationship between cognitive function and ventricle dilatation or parenchymal thickness or between the size of the corpus callosum and callosal transfer.

Adolescent↗

Brain magnetic resonance imaging findings in ECT-induced delirium.

A prolonged (interictal) but reversible delirium was induced by electroconvulsive therapy (ECT) in 10 of 87 (11%) elderly depressed patients. Brain magnetic resonance imaging (MRI) revealed several structural abnormalities, particularly basal ganglia and moderate to severe subcortical white-matter lesions, in the patients who developed delirium. These findings are consistent with several lines of data that have implicated the basal ganglia and subcortical white matter in the development of delirium from other causes and suggest that lesions in these areas may predispose one to developing an interictal delirium during a course of ECT.

Aged↗

Focal right inferotemporal atrophy in AD with disproportionate visual constructive impairment.

OBJECTIVE: To explore the structural neuroimaging correlates of visual constructive impairment in patients with mild to moderate Alzheimer disease (AD). BACKGROUND: There is considerable heterogeneity in the non-memory cognitive deficits associated with AD. Structural neuroimaging with MRI is an important diagnostic tool that is gaining acceptance as a surrogate measure of brain pathology in AD treatment trials. Most MRI measurements have focused on medial temporal lobe or global cortical atrophy, which may not reflect some important clinical features of AD. METHODS: Thirty-two patients with probable AD were stratified into two groups based on their relative performance on a visual constructive task, the copy of a modified Rey-Osterrieth figure (Rey). The two groups did not differ in basic demographic features or in neuropsychological performance, other than on the visual constructive task. MRI measurements of hippocampal volume, cortical gray matter volume, and focal cortical gray matter loss were performed in the patients and a group of 71 age-matched, normal controls. RESULTS: Both groups showed significant, bilateral hippocampal as well as cortical gray matter volume loss relative to controls. The more spatially impaired AD group (SAD) had more right than left cortical gray matter loss, whereas the opposite was true in the less spatially impaired group (NSAD). The SAD group had significantly less gray matter in the right inferior temporal gyrus relative to the NSAD group. Atrophy of this region was correlated with performance on the Rey task in all patients with AD. CONCLUSIONS: Right inferotemporal atrophy may serve as a neuroimaging marker of visual constructive impairment in mild to moderate AD. Heterogeneous cortical atrophy is a common feature of AD.

Aged↗

Relation of education to brain size in normal aging: implications for the reserve hypothesis.

OBJECTIVE: To examine the relations between education and age-related changes in brain structure in a nonclinical sample of elderly adults. BACKGROUND: Education may protect against cognitive decline in late life--an observation that has led to the "reserve" hypothesis of brain aging. Little is known, however, about the effect of education on age-related changes in brain structure. METHODS: Quantitative MRI of the brain was performed in 320 elderly volunteers (age range, 66 to 90 years) living independently in the community (Mini-Mental State Examination scores > or =24), all of whom were participants in the Cardiovascular Health Study. Blinded measurements of global and regional brain size were made from T1-weighted axial images using computer-assisted edge detection and trace methodology. High measurement reliabilities were obtained. RESULTS: Regression analyses (adjusting for the effects of intracranial size, sex, age, age-by-sex interactions, and potential confounders) revealed significant main effects of education on peripheral (sulcal) CSF volume-a marker of cortical atrophy. Each year of education was associated with an increase in peripheral CSF volume of 1.77 mL (p<0.03). As reported previously, main effects of age (but not education) were observed for all of the remaining brain regions examined, including cerebral hemisphere volume, frontal region area, temporoparietal region area, parieto-occipital region area, lateral (Sylvian) fissure volume, lateral ventricular volume, and third ventricle volume. CONCLUSIONS: The authors' findings demonstrate a relation between education and age-related cortical atrophy in a nonclinical sample of elderly persons, and are consistent with the reserve hypothesis as well as with a small number of brain imaging studies in patients with dementia. The neurobiological basis and functional correlates of this education effect require additional investigation.

Aged↗

Application of magnetic resonance imaging to study pathophysiology in brain disease models.

Magnetic resonance imaging (MRI) provides a noninvasive and multimodal tool to study neurological disorders in experimental models. MRI experiments can be sensitized to various contrast parameters and, hence, enable comprehensive assessment of normal and abnormal brain physiology. Different conventional and novel MRI techniques have been developed that supply specific information on lesion location and size (e.g., T2- and diffusion-weighted MRI), alterations in tissue structure (e.g., magnetization transfer imaging and diffusion tensor imaging), perfusion deficits (perfusion MRI), brain activation (functional MRI), cell migration (cellular MRI), gene expression (molecular MRI), and more. The advantages of in vivo, longitudinal, and multiparametric studies with MRI provide unique opportunities for characterizing and delineating experimental models of neurological diseases and pathophysiological mechanisms, as well as spontaneous and treatment-induced recovery mechanisms.

Animals↗

Experimental design--basic considerations.

Experimental design is a critically important tool for improving the performance of a manufacturing process. It has also extensive application in the development of new processes. It is important to investigate all factors that may be of importance and to not be overly influenced by past experience, particularly when we are in the early stages of experimentation or when the process is not very mature.

Journal Article↗

MR imaging and electrophysiological evaluation in carpal tunnel syndrome.

The objective of this study was to compare the MRI findings of wrists in patients diagnosed with CTS with those of the healthy controls, and to evaluate the correlation between the MRI differences and the electrophysiological findings in the patient group. This study involved 55 wrists, 30 of which were clinically and electrophysiologically diagnosed with CTS and 25 healthy controls. These 55 wrists were evaluated electrophysiologically, and in terms of median nerve diameter, ratio of median nerve diameter at psiform bone level to distal radio-ulnar joint level, the flexor retinaculum bulging ratio and the median nerve intensity by MRI. When the patient group, which were clinically and electrophysiologically diagnosed with CTS, and the healthy control group were compared, a significant difference (p < 0.001) was observed between the two in terms of median nerve diameters (at psiform bone level: 8.47 +/- 1.41mm and 2.91 +/- 1.01 mm, distal radio-ulnar joint level: 4.04 +/- 1.06 mm and 2.42 +/- 0.95 mm), ratio of median nerve diameter at psiform bone level to distal radio-ulnar joint level (2.17 +/- 0.54 and 1.25 +/- 0.12), their flexor retinaculum bulging ratios (26.21 +/- 5.98% and 7.27 +/- 4.53%) and their median nerve intensities. In the patient group, no significant correlation between MRI and the electrophysiological findings was found (p > 0.05). According to the data obtained from the study, we believe that the MRI examination of structural changes that occur in the carpal tunnel, neighboring structures and the median nerve would be useful in the diagnosis of CTS, especially in cases with suspected clinical and electrophysiological diagnosis.

Action Potentials↗