[Resting state functional MRI of the brain]. / Funktionelle MRT des Gehirns im Ruhezustand.

The article presents an introduction to studies of the brain using functional magnetic resonance imaging during rest (rsfMRI). These studies are based on the fact that the resting brain exhibits a certain level of constant background activity. These spontaneous rsfMRT activities are characterized by fluctuations of the blood oxygenation level-dependent (BOLD) signal (typically in the low frequency part of the power spectrum < 0.1 Hz), which correlate with the local neuronal activity and can be seen as a result of neuronal coupling of monosynaptic and polysynaptic connections. The first network, described in detail is the so-called default mode network (DMN). This includes the medial prefrontal cortex (MPC), the posterior cingulate cortex (PCC), the precuneus (PrC), parts of the medial temporal lobe and the lateral inferior parietal lobe. In addition, a number of other resting state networks (RSNs), such as a motor, somatosensory, visual, auditory and cognitive system has been described, which partly process long-term connections from the cerebral cortex to the diencephalon, brain stem and cerebellum.

Neural correlates of irony comprehension: the role of schizotypal personality traits.

To detect that a conversational turn is intended to be ironic is a difficult challenge in everyday language comprehension. Most authors suggested a theory of mind deficit is crucial for irony comprehension deficits in psychiatric disorders like schizophrenia; however, the underlying pathophysiology and neurobiology are unknown and recent research highlights the possible role of language comprehension abnormalities. Fifteen female right-handed subjects completed personality testing as well as functional magnetic resonance imaging (fMRI) and neuropsychology. Subjects were recruited from the general population. No subject had a lifetime history of relevant psychiatric disorder; however, subjects differed in their score on the German version of the schizotypal personality questionnaire (SPQ). During fMRI scans, the subjects silently read 44 short text vignettes that ended in either an ironic or a literal statement. Imaging was performed using a 3 T Siemens scanner. The influence of schizotypy on brain activation was investigated by using an SPM5 regression analysis with the SPQ total score and the SPQ cognitive-perceptual score as regressors. Reading ironic in contrast to literal sentences activated a bilateral network including left medial prefrontal and left inferior parietal gyri. During reading of ironic sentences, brain activation in the middle temporal gyrus of both hemispheres showed a significant negative association with the SPQ total score and the SPQ cognitive-perceptual score. Significant positive correlation with the SPQ total score was present in the left inferior frontal gyrus. We conclude schizotypal personality traits are associated with a dysfunctional lateral temporal language rather than a theory of mind network.

Metachromatic leukodystrophy: a scoring system for brain MR imaging observations.

BACKGROUND AND PURPOSE: Metachromatic leukodystrophy (MLD) is a devastating demyelinating disease for which novel therapies are being tested. We hypothesized that MR imaging of brain lesion involvement in MLD could be quantified along a scale. MATERIALS AND METHODS: Thirty-four brain MR images in 28 patients with proved biochemical and genetic defects for MLD were reviewed: 10 patients with late infantile, 16 patients with juvenile, and 2 patients with adult MLD. All MR images were reviewed by experienced neuroradiologists and neurologists (2 readers in Germany, 2 readers in the United States) for global disease burden, as seen on the T2 and fluid-attenuated inversion recovery images. A visual scoring method was based on a point system (range, 0-34) derived from the location of white matter involvement and the presence of global atrophy, analogous to the scoring system developed for adrenoleukodystrophy. The readers were blinded to the neurologic findings. RESULTS: Thirty-three of 34 MR images showed confluent T2 hyperintensities of white matter. The inter-rater reliability coefficient was 0.988. Scores between readers were within 2 points of each other. Serial MR imaging studies in 6 patients showed significant progressive disease in 3 patients (initial score average, 4; mean follow-up, 24.3) and no change or 1 point progression in 3 patients (initial score average, 12; mean follow-up, 12.66). Projection fibers and the cerebellum tended to be involved only in advanced stages of disease. CONCLUSIONS: The MLD MR severity scoring method can be used to provide a measure of brain MR imaging involvement in MLD patients.

Cortical processing of residual ano-rectal sensation in patients with spinal cord injury: an fMRI study.

Eleven paraplegic patients with complete traumatic spinal cord injuries (SCI) [according to American Spinal Injury Association (ASIA) criteria] at different levels (Th3-L3) were investigated during non-painful stimulation of the distal rectum and anal canal, using event related functional magnetic resonance imaging. Although a complete lesion was clinically diagnosed in all, four of them experienced reproducible sensations during anal and/or rectal stimulation. In six patients, individual data analysis revealed significant activation in the right secondary somatosensory cortex SII, the posterior cingular gyrus, the prefrontal cortex, and the left posterior cerebellar lobe during either anal or rectal stimulation or both. A Region of interest analysis using a data mask from healthy controls confirmed that SCI patients demonstrate cortical activation in areas similar to those activated in healthy volunteers, but to a less extensive degree. This supports the notion that the diagnosis of complete spinal cord transsection by ASIA criteria alone may be insufficient for assessment of 'completeness' of cord lesions, and that visceral sensitivity testing may be required in addition.

Reorganization of the cerebro-cerebellar network of language production in patients with congenital left-hemispheric brain lesions.

Patients with congenital lesions of the left cerebral hemisphere may reorganize language functions into the right hemisphere. In these patients, language production is represented homotopically to the left-hemispheric language areas. We studied cerebellar activation in five patients with congenital lesions of the left cerebral hemisphere to assess if the language network is reorganized completely in these patients, i.e. including also cerebellar language functions. As compared to a group of controls matched for age, sex, and verbal IQ, the patients recruited an area not in the right but in the left cerebellar hemisphere. The extent of laterality of the cerebellar activation correlated significantly with the laterality of the frontal activation. We suggest that the developing brain reacts to early focal lesions in the left hemisphere with a mirror-image organization of the entire cerebro-cerebellar network engaged in speech production.

(Re-)organization of basal ganglia in congenital hemiparesis with ipsilateral cortico-spinal projections.

In congenital hemiparesis after pre- or perinatally acquired unilateral brain lesions, many patients control their paretic hand via ipsilateral cortico-spinal projections from the contralesional hemisphere. In order to clarify the pattern of basal ganglia activation in case of such a shift of the primary motor cortical representation (M1) of the paretic hand to the contralesional hemisphere, fMRI was performed in eight patients with congenital hemiparesis due to unilateral periventricular white matter lesions and ipsilateral corticospinal projections to the paretic hand (as determined by focal transcranial magnetic stimulation). FMRI during active movements of the paretic hand yielded basal ganglia activation in the ipsilateral (=contralesional) hemisphere, but not in the contralateral (lesioned) hemisphere. Thus, (re-)organization in congenital hemiparesis with ipsilateral cortico-spinal projections includes, in addition to the ipsilateral primary motor cortex (M1), also the ipsilateral basal ganglia - in contrast to the primary somatosensory cortex (S1), which is typically preserved in the affected hemisphere.

Developing somatosensory projections bypass periventricular brain lesions.

The authors studied four hemiparetic patients with large unilateral periventricular brain lesions acquired during the early third trimester of pregnancy. fMRI and magnetoencephalography demonstrated that the primary somatosensory representation of their paretic hands was nevertheless located in the contralateral rolandic cortex. Thus, outgrowing thalamocortical somatosensory projections had apparently bypassed the lesion to reach their original cortical destination. Such somatosensory projections curving around the lesion were effectively visualized by magnetic resonance diffusion tractography.

Humor and smiling: cortical regions selective for cognitive, affective, and volitional components.

BACKGROUND: The interrelationships among humor, smiling, and grinning have fascinated philosophers for millennia and neurologists for over a century. A functional dissociation between emotional facial expressions and those under voluntary control was suggested decades ago. Recent functional imaging studies, however, have been somewhat at odds with older studies with respect to the role of the right frontal cortex in the perception of humor. METHODS: Blood oxygen level-dependent (BOLD) activity was measured in 13 subjects during the presentation of "funny" vs "nonfunny" versions of essentially the same cartoons and compared with BOLD activity associated with "merely grinning" at similar nonfunny cartoons via fMRI. RESULTS: Humor perception was correlated with BOLD activity in the left temporo-occipitoparietal junction and left prefrontal cortex and humor-associated smiling (recorded with an MR-compatible video camera) with bilateral activity in the basal temporal lobes. Unexpectedly, both conditions were also accompanied by a decrease in BOLD activity in the right orbitofrontal cortex. Voluntary "grinning" in the absence of humorous stimuli was accompanied by bilateral activity in the facial motor regions. CONCLUSIONS: These results confirm the clinically derived hypothesis of separate cortical regions responsible for the production of emotionally driven vs voluntary facial expressions. The right orbitofrontal decrease reconciles inconsistencies between clinical and functional imaging findings and may reflect a disinhibition of facial emotional expression.

Neuroimaging patterns associated with motor control in traumatic brain injury.

OBJECTIVE: To determine if patients with traumatic brain injury (TBI) and motor deficits show differences in functional activation maps during repetitive hand movements relative to healthy controls. Are there predictors for motor outcome in the functional maps of these patients? METHODS: In an exploratory cross-sectional study, functional magnetic resonance imaging (fMRI) was used to study the blood-oxygenation-level-dependent (BOLD) response in cortical motor areas of 34 patients suffering from moderate motor deficits after TBI as they performed unilateral fist-clenching motions. Twelve of these patients with unilateral motor deficits were studied 3 months after TBI and a 2nd time approximately 4 months later. RESULTS: Compared to age-matched, healthy controls performing the same task, TBI patients showed diminished fMRI-signal change in the primary sensorimotor cortex contralateral to the moving hand (cSM1), the contralateral dorsal premotor cortex, and bilaterally in the supplementary motor areas (SMAs). Clinical impairment and the magnitude of the fMRI-signal change in cSM1 and SMA were negatively correlated. Patients with poor and good motor recovery showed comparable motor impairment at baseline. Only patients who evolved to "poor clinical outcome" had decreased fMRI-signal change in the cSM1 during baseline. CONCLUSIONS: These observations raise the hypothesis that the magnitude of the fMRI-signal change in the cSM1 region could have prognostic value in the evaluation of patients with TBI.

Error images for spectroscopic imaging by LCModel using Cramer-Rao bounds.

The results of spectroscopic imaging (SI) measurements are often presented as metabolic images. If the spectra quality is not sufficient, the calculated concentrations are biased and the metabolic images show an incorrect metabolite distribution. To simplify the quality analysis of spectra measured by SI, an error image, reflecting the accuracy of the computed concentrations, can be displayed along with the metabolite image. In this paper the relevance of Cramer-Rao bounds (CRBs) calculated by the LCModel program to describe errors in estimated concentrations is validated using spectra simulations. The relation between the average CRBs and standard deviations (STD) of metabolite concentrations from 100 simulated spectra for various signal to noise ratio and line broadening conditions is evaluated. A parameter for calculating error images for metabolite ratios is proposed and an effective way to display error images is shown. The results suggest that the average CRBs are strongly correlated with the standard deviations and hence that CRB values reflect the relative uncertainty of the calculated concentrations. The error information can be integrated directly into a metabolite image by displaying only those areas of the metabolite image with corresponding CRBs below a selected threshold or by mapping CRBs as a transparency of the metabolite image. The concept of error images avoids extensive examination of each SI spectrum and helps to reject low quality spectra.

Functional imaging of stress urinary incontinence.

Stress urinary incontinence (SUI) is defined as an involuntary loss of urine during increases in intraabdominal pressure such as coughing or laughing. It is often a consequence of weakness of the pelvic floor. Treatment of SUI consists of pelvic floor muscle training with EMG-biofeedback (PFMT) or contraction-exercises, with voluntary pelvic contractions in order to strengthen the pelvic floor. We investigated neuroplastic changes comparing PFMT with EMG-biofeedback before and after training in ten female patients with SUI using event-related functional Magnetic Resonance Imaging (fMRI). After a 12-week training a more focused activation in the primary motor and somatosensory cortical representation sites of the lower urogenital tract was found. In addition, reductions in brain activation in the insula, right frontal operculum and the anterior cingulate cortex suggest changes in emotional arousal in micturition after treatment. These changes are related to clinical improvement documented by decreased number of incontinence episodes and increased EMG-activity of the pelvic floor muscles after training. The changes in EMG-activity were correlated with heightened BOLD responses in the primary motor and primary sensory cortical representation sites of the lower urogenital tract.

MRI and proton MR spectroscopy in acute disseminated encephalomyelitis.

INTRODUCTION: Acute disseminated encephalomyelitis (ADEM) is one of a group of demyelinating disorders of the central nervous system (CNS). It is said to be attributed to an overshooting immunologic response following an infection or vaccination. The clinical course and type of manifestation is heterogeneous. The early application of corticosteroids has been shown to be beneficial to outcome; thus, an early diagnosis is highly desirable. METHODS: The potential diagnostic value of advanced MR techniques such as proton MR spectroscopy and diffusion-weighted imaging (DWI) was investigated in two paediatric patients with ADEM, one of whom had a remitting and relapsing clinical course and presented with additional cranial nerve involvement. Proton MR spectroscopy revealed typical signs of acute demyelination, such as increased macromolecules, not found in other forms of non-necrotising pathology. CONCLUSION: The addition of proton MR spectroscopy and DWI adds to the diagnostic power of MRI in the setting of post-infectious demyelinating disorders of the CNS or ADEM and may obviate the need for biopsy.

fMRI reveals two distinct cerebral networks subserving speech motor control.

BACKGROUND: There are few data on the cerebral organization of motor aspects of speech production and the pathomechanisms of dysarthric deficits subsequent to brain lesions and diseases. The authors used fMRI to further examine the neural basis of speech motor control. METHODS AND RESULTS: In eight healthy volunteers, fMRI was performed during syllable repetitions synchronized to click trains (2 to 6 Hz; vs a passive listening task). Bilateral hemodynamic responses emerged at the level of the mesiofrontal and sensorimotor cortex, putamen/pallidum, thalamus, and cerebellum (two distinct activation spots at either side). In contrast, dorsolateral premotor cortex and anterior insula showed left-sided activation. Calculation of rate/response functions revealed a negative linear relationship between repetition frequency and blood oxygen level-dependent (BOLD) signal change within the striatum, whereas both cerebellar hemispheres exhibited a step-wise increase of activation at approximately 3 Hz. Analysis of the temporal dynamics of the BOLD effect found the various cortical and subcortical brain regions engaged in speech motor control to be organized into two separate networks (medial and dorsolateral premotor cortex, anterior insula, and superior cerebellum vs sensorimotor cortex, basal ganglia, and inferior cerebellum). CONCLUSION: These data provide evidence for two levels of speech motor control bound, most presumably, to motor preparation and execution processes. They also help to explain clinical observations such as an unimpaired or even accelerated speaking rate in Parkinson disease and slowed speech tempo, which does not fall below a rate of 3 Hz, in cerebellar disorders.

Identification of emotional intonation evaluated by fMRI.

During acoustic communication among human beings, emotional information can be expressed both by the propositional content of verbal utterances and by the modulation of speech melody (affective prosody). It is well established that linguistic processing is bound predominantly to the left hemisphere of the brain. By contrast, the encoding of emotional intonation has been assumed to depend specifically upon right-sided cerebral structures. However, prior clinical and functional imaging studies yielded discrepant data with respect to interhemispheric lateralization and intrahemispheric localization of brain regions contributing to processing of affective prosody. In order to delineate the cerebral network engaged in the perception of emotional tone, functional magnetic resonance imaging (fMRI) was performed during recognition of prosodic expressions of five different basic emotions (happy, sad, angry, fearful, and disgusted) and during phonetic monitoring of the same stimuli. As compared to baseline at rest, both tasks yielded widespread bilateral hemodynamic responses within frontal, temporal, and parietal areas, the thalamus, and the cerebellum. A comparison of the respective activation maps, however, revealed comprehension of affective prosody to be bound to a distinct right-hemisphere pattern of activation, encompassing posterior superior temporal sulcus (Brodmann Area [BA] 22), dorsolateral (BA 44/45), and orbitobasal (BA 47) frontal areas. Activation within left-sided speech areas, in contrast, was observed during the phonetic task. These findings indicate that partially distinct cerebral networks subserve processing of phonetic and intonational information during speech perception.

Directional correlation in white matter tracks of the human brain.

PURPOSE: To describe a technique for the detection of distinct brain fibers in sets of magnetic resonance (MR) diffusion tensor imaging (DTI) data. MATERIALS AND METHODS: MR-DTI can be used for a tractography of brain fibers presuming a data set of high spatial resolution and high signal to noise. A less demanding technique for the visualization of discrete brain fiber bundles involves segmentation. By using a region-growing algorithm, those voxels that have a direction similar to that of the major eigenvector in neighboring voxels of a data set can be marked. It has been shown recently by Mori et al (1) that this technique can be successfully applied to data from a single slice of a mouse brain. In this study, the segmentation technique was applied with modifications to multislice DTI data from the human brain. RESULTS: A distinct segmentation of various brain fiber bundles could be achieved by the use of a two-step algorithm. In the first step, voxels within large fiber tracts-such as corticofugal tracts (e.g., corticospinal tract) and the optic radiation-were segmented by starting the region-growing algorithm in the corpus callosum (CC) and erasing this major structure from the data set. In the second step, remaining voxels were segmented by the same algorithm; this revealed a good assignment of the similarly oriented fibers derived by segmentation to the anatomically given brain lobes. This two-step procedure was successfully applied to DTI data of six healthy volunteers. CONCLUSION: The segmentation technique for DTI data proposed by Mori et al (1) for data from mouse brains can be applied to multislice data from the human brain by using a two-step algorithm including a masking of the major fiber tracts.

Distinct frontal regions subserve evaluation of linguistic and emotional aspects of speech intonation.

In addition to the propositional content of verbal utterances, significant linguistic and emotional information is conveyed by the tone of speech. To differentiate brain regions subserving processing of linguistic and affective aspects of intonation, discrimination of sentences differing in linguistic accentuation and emotional expressiveness was evaluated by functional magnetic resonance imaging. Both tasks yielded rightward lateralization of hemodynamic responses at the level of the dorsolateral frontal cortex as well as bilateral thalamic and temporal activation. Processing of linguistic and affective intonation, thus, seems to be supported by overlapping neural networks comprising partially right-sided brain regions. Comparison of hemodynamic activation during the two different tasks, however, revealed bilateral orbito-frontal responses restricted to the affective condition as opposed to activation of the left lateral inferior frontal gyrus confined to evaluation of linguistic intonation. These findings indicate that distinct frontal regions contribute to higher level processing of intonational information depending on its communicational function. In line with other components of language processing, discrimination of linguistic accentuation seems to be lateralized to the left inferior-lateral frontal region whereas bilateral orbito-frontal areas subserve evaluation of emotional expressiveness.

Proton MR spectroscopy in succinic semialdehyde dehydrogenase deficiency.

Succinic semialdehyde dehydrogenase (SSADH) deficiency is a rare hereditary disorder of the CNS catabolism of gamma-aminobutyric acid (GABA), leading to accumulation of the metabolite 4-hydroxybutyrate (GHB). Here the authors report on 1.5 and 3.0 T proton MR spectroscopy in a patient with SSADH deficiency. A characteristic pattern with clearly elevated GABA levels and traces of GHB was found in both the white and the gray matter of the brain. In vivo spectroscopy may be useful for diagnosis and monitoring SSADH deficiency.

Pyramidal tract damage correlates with motor dysfunction in bilateral periventricular leukomalacia (PVL).

In children with periventricular leukomalacia (PVL), motor dysfunction is thought to be related to involvement of pyramidal tract fibres in the periventricular white matter. The purpose of the present study was to test this hypothesis. Thirteen former preterm adolescents with PVL, ten of whom were suffering from bilateral spastic cerebral palsy, were studied by MRI. The severity of pyramidal tract damage was assessed on semicoronal MRI reconstructions along anatomical landmarks of somatotopy in the precentral gyrus and the internal capsule; for comparison, the overall volume of cerebral white matter (determined by automated volumetry) served as a global measure of lesion severity. The motor dysfunction of each of the four extremities correlated much more strongly with the severity of pyramidal tract damage assessed on the respective MRI reconstruction (range of correlation coefficients, 0.647 to 0.922) than with the total volume of white matter (range of correlation coefficients, - 0.458 to - 0.212; Spearman). These findings corroborate the notion that an involvement of pyramidal tract fibres in the periventricular white matter is indeed a relevant factor for motor dysfunction in children with PVL.