RESUMO
We explore the nonlinear interactions of an optomechanical microresonator driven by two external optical signals. Optical whispering-gallery waves are coupled to acoustic surface waves of a fused silica medium in the equatorial plane of a generic microresonator. The system exhibits coexisting attractors whose behaviors include limit cycles, steady states, tori, quasi-chaos, and fully developed chaos with ghost orbits of a known attractor. Bifurcation diagrams demonstrate the existence of self-similarity, periodic windows, and coexisting attractors and show high-density lines within chaos that suggests a potential ghost orbit. In addition, the Lyapunov spectral components as a function of control parameter illuminate the dynamic nature of attractors and periodic windows with symmetric and asymmetric formations, their domains of existence, their bifurcations, and other nonlinear effects. We show that the power-shift method can access accurately and efficiently attractors in the optomechanical system as it does in other nonlinear systems. To test whether the ghost orbit is the link between two attractors interrupted by chaos, we examine the elements of the bifurcation diagrams as a function of control parameter. We also use detuning as a second control parameter to avoid the chaotic region and clarify that the two attractors are one.
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Coexisting attractors are studied in a single-mode coherent model of a laser with an injected signal. We report that every attractor has a unique Lyapunov exponent (LE) pattern that is choreographed by the subtle variations in the attractor's dynamics and circumscribed by a common Lyapunov spectral pattern that begins and ends with two-zero LEs. Lyapunov spectra form symmetric-like and asymmetric bubbles; the former foreshadows an attractor's proximity to the cusp of an eminent change in dynamics and the latter indicates the presence of a bifurcation. We show that the peak values of the asymmetric bubbles are always associated with two-zero LEs; in fact, they are allied inseparably in forecasting period-doubling episodes. The two-zero LEs' predictor of torus dynamics is refined to include the convergence of three LEs to a triplet of zeros as a precursor to the two-zero spectra. We report that the long-standing two-zero LEs' signature is a necessary but not sufficient condition for predicting attractors and their dynamic conditions. The evolution of the attractor volume as a function of the injected signal is compared to the spectral formation of the attractor; we report slope changes and points of inflections in the volume trajectory where spectral changes indicate dynamic changes. Attractor viability is tested preliminarily by including random low-level noise in the frequency of the injected signal.
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Technology has been developed which permits continuous production of annual crops in some of the acid, infertile soils of the Amazon Basin. Studies in Yurimaguas, Peru, show that three grain crops can be produced annually with appropriate fertilizer inputs. Twenty-one crops have been harvested during the past 8(1/2) years in the same field, with an average annual production of 7.8 tons of grain per hectare. Soil properties are improving with continuous cultivation. The technology has been validated by local farmers, who normally practice shifting cultivation. Economic interpretations indicate large increases in annual family farm income and a high return on the investment of chemical inputs. Other promising land use alternatives include low-input crop production systems, paddy rice production in fertile alluvial soils, and pastures or agroforestry in rolling areas. Stable, continuous food crop production is an attractive alternative to shifting cultivation in humid tropical regions experiencing severe demographic pressures. For each hectare of land managed in a highly productive manner, there may be less need for clearing additional tropical forests to meet food demands.
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Memory distortions and illusions have been thoroughly documented in psychological studies, but little is known about the neuroanatomical correlates of true and false memories. Vivid but illusory memories can be induced by asking people whether they recall or recognize words that were not previously presented, but are semantically related to other previously presented words. We used positron emission tomography to compare brain regions involved in veridical recognition of printed words that were heard several minutes earlier and illusory recognition of printed words that had not been heard earlier. Veridical and illusory recognition were each associated with blood flow increases in a left medial temporal region previously implicated in episodic memory; veridical recognition was distinguished by additional blood flow increases in a left temporoparietal region previously implicated in the retention of auditory/phonological information. This study reveals similarities and differences in the way the brain processes accurate and illusory memories.
Assuntos
Rememoração Mental/fisiologia , Estimulação Acústica , Adulto , Comportamento/fisiologia , Feminino , Humanos , Lobo Temporal/anatomia & histologia , Lobo Temporal/fisiologia , Tomografia Computadorizada de EmissãoRESUMO
Temperature sensation is regarded as a submodality of touch, but evidence suggests involvement of insular cortex rather than parietal somatosensory cortices. Using positron emission tomography (PET), we found contralateral activity correlated with graded cooling stimuli only in the dorsal margin of the middle/posterior insula in humans. This corresponds to the thermoreceptive- and nociceptive-specific lamina I spinothalamocortical pathway in monkeys, and can be considered an enteroceptive area within limbic sensory cortex. Because lesions at this site can produce the post-stroke central pain syndrome, this finding supports the proposal that central pain results from loss of the normal inhibition of pain by cold. Notably, perceived thermal intensity was well correlated with activation in the right (ipsilateral) anterior insular and orbitofrontal cortices.
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Córtex Cerebral/diagnóstico por imagem , Córtex Cerebral/fisiologia , Temperatura Baixa , Sensação Térmica/fisiologia , Adulto , Mapeamento Encefálico , Córtex Cerebral/irrigação sanguínea , Circulação Cerebrovascular/fisiologia , Limiar Diferencial/fisiologia , Feminino , Mãos/inervação , Mãos/fisiologia , Humanos , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Medição da Dor , Estimulação Física , Prosencéfalo/irrigação sanguínea , Prosencéfalo/diagnóstico por imagem , Prosencéfalo/fisiologia , Tomografia Computadorizada de EmissãoRESUMO
We previously developed a noninvasive technique for the quantification of fluorodeoxyglucose (FDG) positron emission tomography (PET) images using an image-derived input function obtained from a manually drawn carotid artery region. Here, we investigate the use of independent component analysis (ICA) for more objective identification of the carotid artery and surrounding tissue regions. Using FDG PET data from 22 subjects, ICA was applied to an easily defined cubical region including the carotid artery and neighboring tissue. Carotid artery and tissue time activity curves and three venous samples were used to generate spillover and partial volume-corrected input functions and to calculate the parametric images of the cerebral metabolic rate for glucose (CMRgl). Different from a blood-sampling-free ICA approach, the results from our ICA approach are numerically well matched to those based on the arterial blood sampled input function. In fact, the ICA-derived input functions and CMRgl measurements were not only highly correlated (correlation coefficients >0.99) to, but also highly comparable (regression slopes between 0.92 and 1.09), with those generated using arterial blood sampling. Moreover, the reliability of the ICA-derived input function remained high despite variations in the location and size of the cubical region. The ICA procedure makes it possible to quantify FDG PET images in an objective and reproducible manner.
Assuntos
Encéfalo/diagnóstico por imagem , Encéfalo/metabolismo , Artérias Carótidas/metabolismo , Fluordesoxiglucose F18/farmacocinética , Interpretação de Imagem Assistida por Computador/métodos , Tomografia por Emissão de Pósitrons/métodos , Adulto , Encéfalo/irrigação sanguínea , Artérias Carótidas/diagnóstico por imagem , Simulação por Computador , Feminino , Humanos , Masculino , Modelos Neurológicos , Modelos Estatísticos , Análise de Componente Principal , Compostos Radiofarmacêuticos/farmacocinéticaRESUMO
Knowledge of how the brain contributes to the regulation of food intake in humans is limited. We used positron emission tomography and measures of regional cerebral blood flow (rCBF) (a marker of neuronal activity) to describe the functional anatomy of satiation (i.e., the response to a liquid meal) in the context of extreme hunger (36-h fast) in 11 obese (BMI > or =35 kg/m2, age 27+/-5 years, weight 115+/-11 kg, 38+/-7% body fat; mean +/- SD) and 11 lean (BMI < or =25 kg/m2, age 35+/-8 years, weight 73+/-9 kg, 19+/-6% body fat) men. As in lean men, satiation in obese men produced significant increases in rCBF in the vicinity of the ventromedial and dorsolateral prefrontal cortex and significant decreases in rCBF in the vicinity of the limbic/paralimbic areas (i.e., hippocampal formation, temporal pole), striatum (i.e., caudate, putamen), precuneus, and cerebellum. However, rCBF increases in the prefrontal cortex were significantly greater in obese men than in lean men (P < 0.005). rCBF decreases in limbic/paralimbic areas, temporal and occipital cortex, and cerebellum were also significantly greater in obese men than in lean men (P < 0.005), whereas rCBF decreases in the hypothalamus and thalamus were attenuated in obese men compared with lean men (P < 0.05). This study raises the possibility that the brain responses to a meal in the prefrontal areas (which may be involved in the inhibition of inappropriate response tendencies) and limbic/paralimbic areas (commonly associated with the regulation of emotion) may be different in obese and lean men. Additional studies are required to investigate how these differential responses are related to the pathophysiology of obesity.
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Encéfalo/fisiologia , Encéfalo/fisiopatologia , Obesidade/fisiopatologia , Resposta de Saciedade/fisiologia , Adulto , Encéfalo/diagnóstico por imagem , Encéfalo/metabolismo , Mapeamento Encefálico , Circulação Cerebrovascular/fisiologia , Ingestão de Alimentos/fisiologia , Hormônios/metabolismo , Humanos , Masculino , Valores de Referência , Autoimagem , Tomografia Computadorizada de EmissãoRESUMO
The authors developed and tested a method for the noninvasive quantification of the cerebral metabolic rate for glucose (CMRglc) using positron emission tomography (PET), 18F-fluoro-2-deoxyglucose, the Patlak method, and an image-derived input function. Dynamic PET data acquired 12 to 48 seconds after rapid tracer injection were summed to identify carotid artery regions of interest (ROIs). The input function then was generated from the carotid artery ROIs. To correct spillover, the early summed image was superimposed over the last PET frame, a tissue ROI was drawn around the carotid arteries, and a tissue time activity curve (TAC) was generated. Three venous samples were drawn from the tracer injection site at a later time and used for the spillover and partial volume correction by non-negative least squares method. Twenty-six patient data sets were studied. It was found that the image-derived input function was comparable in shape and magnitude to the one obtained by arterial blood sampling. Moreover, no significant difference was found between CMRglc estimated by the Patlak method using either the arterial blood sampling data or the image-derived input function.
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Encéfalo/metabolismo , Circulação Cerebrovascular , Fluordesoxiglucose F18/farmacocinética , Tomografia Computadorizada de Emissão/métodos , Artérias Carótidas/diagnóstico por imagem , Artérias Carótidas/fisiologia , Artérias Cerebrais/diagnóstico por imagem , Artérias Cerebrais/fisiologia , Fluordesoxiglucose F18/sangue , Humanos , Cinética , Análise dos Mínimos Quadrados , Compostos Radiofarmacêuticos/sangue , Compostos Radiofarmacêuticos/farmacocinética , Análise de Regressão , Fatores de TempoRESUMO
BACKGROUND: The sensation of taste provides reinforcement for eating and is of possible relevance to the clinical problem of obesity. OBJECTIVE: Positron emission tomography (PET) was used to explore regions of the brain that were preferentially affected during the taste perception of a liquid meal by 11 right-handed, lean men in the fasting state. DESIGN: After subjects had fasted for 36 h, 2 measurements of regional cerebral blood flow (rCBF) obtained immediately after subjects retained and swallowed 2 mL of a flavored liquid meal (the taste condition) were compared with 2 measurements of rCBF obtained immediately after subjects retained and swallowed 2 mL of water (the baseline condition). RESULTS: Compared with the baseline condition, taste was associated with increased rCBF (P < 0.005) in the left dorsolateral prefrontal cortex and superior temporal gyrus; the right ventrolateral prefrontal cortex, supramarginal gyrus, and anterior thalamus; and bilaterally in the hippocampal formation, posterior cingulate, midbrain, occipital cortex, and cerebellum. Taste was also associated with decreased rCBF (P < 0.005) in the right dorsolateral prefrontal cortex, superior temporal gyrus, and supplementary motor area, and bilaterally in the medial prefrontal cortex and inferior parietal lobule. CONCLUSIONS: This exploratory study provides additional evidence that the temporal cortex, thalamus, cingulate cortex, caudate, and hippocampal formation are preferentially affected by taste stimulation. The asymmetric pattern of activity in the dorsolateral prefrontal cortex and superior temporal gyrus may contribute to the taste perception of a liquid meal perceived as pleasant. Additional studies are required to determine how these regions are affected in patients with obesity or anorexia.
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Encéfalo/irrigação sanguínea , Encéfalo/fisiologia , Jejum/fisiologia , Alimentos , Paladar/fisiologia , Adulto , Algoritmos , Humanos , Masculino , Medição da Dor , Fluxo Sanguíneo Regional , Tomografia Computadorizada de EmissãoRESUMO
To determine whether physical match between studied and tested items influences blood flow increases in the hippocampal formation associated with recognition memory, positron emission tomography (PET) was used to measure changes in regional cerebral blood flow while healthy volunteers made old/new judgements about line drawings of objects. Some objects were tested in the same size and orientation as they had appeared earlier during the study phase of the experiment; other objects were tested in a different size or orientation than when they were studied. Blood flow increases in the vicinity of the hippocampal formation were observed in the same object condition compared with the size change and the orientation change conditions, even though recognition accuracy was affected significantly only by orientation change. Results add to previous findings suggesting that physical similarity between studied items and test cues may contribute to hippocampal activation during episodic retrieval.
Assuntos
Circulação Cerebrovascular/fisiologia , Hipocampo/fisiologia , Rememoração Mental , Orientação/fisiologia , Percepção de Tamanho/fisiologia , Tomografia Computadorizada de Emissão , Adulto , Feminino , Humanos , Projetos Piloto , Valores de ReferênciaRESUMO
OBJECT: The purpose of this report is to demonstrate the value of functional brain mapping using the positron emission tomography (PET) method for preoperative neurosurgical planning in children with brain tumors. Brain maps were used to characterize the relationship between potentially resectable tumors and functionally eloquent brain areas. METHODS: Five children, ranging in age from 3 to 13 years, with hemispheric brain tumors adjacent to eloquent cortex were studied. Magnetic resonance (MR) imaging was used to identify the brain tumors; PET imaging after injection of [18F] fluorodeoxyglucose (FDG), [11C]L-methionine (CMET), or a combination of the two was performed to grade the tumors; and a [15O] H2O uptake study was used to characterize the anatomical relationships of the tumors to functional cortex. The cortical activation maps were obtained during control periods and during behavioral tasks and were used to document motor, visual, and speech and language organizational areas. Wada tests were performed in two patients. Language and speech activation was concordant with the results of Wada testing. CONCLUSIONS: Functional brain mapping using PET scans and coregistered MR images provided the neurosurgeon with precise definitions of structural and functional cortical areas; this altered surgical management in some cases and/or was used to predict outcome. The combination of PET imaging with FDG and/or CMET and measurements of [15O] water uptake was useful in characterizing and grading tumors and instrumental in achieving effective neurosurgical planning. Postoperative results in the five cases suggest that preoperative functional brain mapping has the potential to improve outcome by defining a surgical plan to maximize resection and minimize the risk of neurological sequelae.
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Mapeamento Encefálico , Neoplasias Encefálicas/diagnóstico por imagem , Neoplasias Encefálicas/cirurgia , Tomografia Computadorizada de Emissão , Adolescente , Córtex Cerebral/diagnóstico por imagem , Córtex Cerebral/cirurgia , Criança , Pré-Escolar , Feminino , Fluordesoxiglucose F18 , Humanos , Processamento de Imagem Assistida por Computador , Masculino , Metionina , Valor Preditivo dos Testes , Cuidados Pré-Operatórios , Compostos RadiofarmacêuticosRESUMO
In this paper, we developed and tested strategies for estimating myocardial blood flow (MBF) and generating MBF parametric images using positron emission tomography (PET), N-13 ammonia, and the generalized linear least square (GLLS) method. GLLS was generalized to the general linear compartment model, modified for the correction of spillover, validated using simulated N-13 ammonia data, and examined using PET data from several patient studies. In comparison to the standard model-fitting procedure, the GLLS method provided similar accuracy and superior computational speed.
Assuntos
Amônia , Circulação Coronária/fisiologia , Coração/diagnóstico por imagem , Radioisótopos de Nitrogênio , Compostos Radiofarmacêuticos , Tomografia Computadorizada de Emissão , Idoso , Algoritmos , Simulação por Computador , Doença das Coronárias/fisiopatologia , Doença das Coronárias/cirurgia , Humanos , Aumento da Imagem/métodos , Anastomose de Artéria Torácica Interna-Coronária , Análise dos Mínimos Quadrados , Modelos Lineares , Masculino , Modelos Cardiovasculares , Reprodutibilidade dos Testes , Fatores de Tempo , Tomografia Computadorizada de Emissão/métodos , Tomografia Computadorizada de Emissão/estatística & dados numéricosRESUMO
Dysembryoplastic neuroepithelial tumors are unique and benign congenital tumors occurring frequently in children and adolescents. Differentiation from other low-grade tumors is important for management. Five patients with confirmed dysembryoplastic neuroepithelial tumors were studied with positron emission tomography using glucose and protein metabolic uptake in an attempt to categorize these tumors metabolically. Functional brain mapping also was obtained to aid in operative management. Results of the study conclude that dysembryoplastic neuroepithelial tumors, although having similar neuroimgaing characteristics to other low-grade tumors, are distinguished by a unique metabolic profile. They are inactive tumors with no significant glucose or protein metabolic activity. The combination of preoperative positron emission tomographic metabolic studies with functional brain mapping allowed for prediction of tumor type, defined eloquent areas of cortical function, and improved approach and resection of the tumors with minimal risk of neurologic impairment.
Assuntos
Glicemia/metabolismo , Neoplasias Encefálicas/diagnóstico por imagem , Metabolismo Energético/fisiologia , Neoplasias Neuroepiteliomatosas/diagnóstico por imagem , Proteínas do Tecido Nervoso/metabolismo , Adolescente , Encéfalo/diagnóstico por imagem , Mapeamento Encefálico , Neoplasias Encefálicas/cirurgia , Córtex Cerebral/diagnóstico por imagem , Córtex Cerebral/cirurgia , Criança , Feminino , Fluordesoxiglucose F18 , Humanos , Masculino , Metionina , Neoplasias Neuroepiteliomatosas/cirurgia , Prognóstico , CintilografiaRESUMO
An unusual complication of naso-endotracheal tube obstruction by the inferior turbinate is reported. The delay of onset of signs and symptoms of endotracheal tube obstruction, and the lack of hemorrhage, made a difficult diagnosis.
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Obstrução das Vias Respiratórias/etiologia , Intubação Intratraqueal/efeitos adversos , Conchas Nasais/lesões , Adulto , Humanos , MasculinoRESUMO
Cross-sectional positron emission tomography (PET) studies find that cognitively normal carriers of the apolipoprotein E (APOE) epsilon4 allele, a common Alzheimer's susceptibility gene, have abnormally low measurements of the cerebral metabolic rate for glucose (CMRgl) in the same regions as patients with Alzheimer's dementia. In this article, we characterize longitudinal CMRgl declines in cognitively normal epsilon4 heterozygotes, estimate the power of PET to test the efficacy of treatments to attenuate these declines in 2 years, and consider how this paradigm could be used to efficiently test the potential of candidate therapies for the prevention of Alzheimer's disease. We studied 10 cognitively normal epsilon4 heterozygotes and 15 epsilon4 noncarriers 50-63 years of age with a reported family history of Alzheimer's dementia before and after an interval of approximately 2 years. The epsilon4 heterozygotes had significant CMRgl declines in the vicinity of temporal, posterior cingulate, and prefrontal cortex, basal forebrain, parahippocampal gyrus, and thalamus, and these declines were significantly greater than those in the epsilon4 noncarriers. In testing candidate primary prevention therapies, we estimate that between 50 and 115 cognitively normal epsilon4 heterozygotes are needed per active and placebo treatment group to detect a 25% attenuation in these CMRgl declines with 80% power and P = 0.005 in 2 years. Assuming these CMRgl declines are related to the predisposition to Alzheimer's dementia, this study provides a paradigm for testing the potential of treatments to prevent the disorder without having to study thousands of research subjects or wait many years to determine whether or when treated individuals develop symptoms.
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Doença de Alzheimer/genética , Apolipoproteínas E/genética , Encéfalo/fisiopatologia , Cognição/fisiologia , Heterozigoto , Tomografia Computadorizada de Emissão/métodos , Idoso , Doença de Alzheimer/metabolismo , Apolipoproteína E4 , Encéfalo/metabolismo , Feminino , Glucose/metabolismo , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
Recent neuroimaging studies have obtained evidence of activation in the medial temporal lobe (MTL) during episodic encoding and retrieval. On the basis of a meta-analysis of MTL activations in studies that used positron emission tomography (PET), Lepage et al. (Hippocampus 1998;8:313-322) suggested that episodic encoding tends to involve the anterior MTL, whereas episodic retrieval tends to involve the posterior MTL. In a meta-analysis of studies that used PET and functional magnetic resonance imaging, Schacter and Wagner (Hippocampus 1999;9:7-24) reported weaker evidence for such a rostrocaudal distribution of encoding and retrieval activations. However, these meta-analyses were based largely on studies that examined encoding or retrieval separately. Here, we report a direct, within-subjects comparison of MTL activation during episodic encoding and retrieval by using PET. Results indicated that both encoding and retrieval were associated with blood flow increases in similar MTL regions with little indication that encoding and retrieval are preferentially associated with activity in the anterior versus the posterior MTL. Direct comparisons revealed greater blood flow increases in posterior MTL during encoding than retrieval.
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Mapeamento Encefálico , Hipocampo/fisiologia , Aprendizagem/fisiologia , Memória/fisiologia , Lobo Temporal/fisiologia , Adulto , Feminino , Hipocampo/irrigação sanguínea , Hipocampo/diagnóstico por imagem , Humanos , Radioisótopos de Oxigênio/farmacocinética , Fluxo Sanguíneo Regional , Lobo Temporal/irrigação sanguínea , Lobo Temporal/diagnóstico por imagem , Tomografia Computadorizada de Emissão/métodosRESUMO
OBJECTIVE: Because studies have shown some positive effects of the dopaminergic agent bromocriptine for improving verbal production in patients with nonfluent aphasia, we examined its effect in a patient with an atypical form of crossed nonfluent aphasia from a right hemisphere lesion. DESIGN: Open-label single-subject experimental ABAB withdrawal design. PATIENT: A right-handed man who, after a right frontal stroke, developed nonfluent aphasia, emotional aprosodia, and limb apraxia. INTERVENTION: Escalating doses up to 20mg of bromocriptine in 2 separate phases. MAIN OUTCOME MEASURES: We measured verbal fluency (words/min in discourse, Thurstone letter fluency), expression of emotional prosody, and gesture production. RESULTS: The patient showed substantial improvement in both verbal fluency measures and no significant improvement in gesture or emotional prosody. Verbal fluency improvements continued in withdrawal phases. CONCLUSIONS: Our results are less likely caused by practice or spontaneous recovery because we observed little improvement in emotional prosody and gesture tasks. Verbal fluency improvements during treatment and withdrawal phases suggest that the effects of bromocriptine may be long-lasting in its influence on the neural networks subserving verbal initiation.
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Afasia/tratamento farmacológico , Bromocriptina/uso terapêutico , Agonistas de Dopamina/uso terapêutico , Afasia/etiologia , Infarto Cerebral/complicações , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
OBJECTIVE: To investigate the response of the brains of women to the ingestion of a meal. RESEARCH METHODS AND PROCEDURES: We used measures of regional cerebral blood flow (rCBF), a marker of neuronal activity, by positron emission tomography to describe the functional anatomy of satiation, i.e., the response to a liquid meal in the context of extreme hunger (36-hour fast) in 10 lean (BMI < or = 25 kg/m(2); 32 +/- 10 years old, 61 +/- 7 kg; mean +/- SD) and 12 obese (BMI > or = 35 kg/m(2); 30 +/- 7 years old, 110 +/- 14 kg) women. RESULTS: In lean and obese women, satiation produced significant increases in rCBF in the vicinity of the prefrontal cortex (p < 0.005). Satiation also produced significant decreases in rCBF in several regions including the thalamus, insular cortex, parahippocampal gyrus, temporal cortex, and cerebellum (in lean and obese women), and hypothalamus, cingulate, nucleus accumbens, and amygdala (in obese women only; all p < 0.005). Compared with lean women, obese women had significantly greater increases in rCBF in the ventral prefrontal cortex and had significantly greater decreases in the paralimbic areas and in areas of the frontal and temporal cortex. DISCUSSION: This study indicates that satiation elicits differential brain responses in obese and lean women. It also lends additional support to the hypothesis that the paralimbic areas participate in a central orexigenic network modulated by the prefrontal cortex through feedback loops.
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Encéfalo/irrigação sanguínea , Encéfalo/fisiologia , Obesidade/patologia , Saciação/fisiologia , Adulto , Índice de Massa Corporal , Núcleo Caudado/irrigação sanguínea , Ácidos Graxos não Esterificados/sangue , Feminino , Alimentos , Lobo Frontal/irrigação sanguínea , Hipocampo/irrigação sanguínea , Humanos , Insulina/sangue , Leptina/análise , Sistema Límbico/irrigação sanguínea , Córtex Pré-Frontal/irrigação sanguínea , Lobo Temporal/irrigação sanguíneaRESUMO
Successful surgical management of a neoplastic or nonneoplastic seizure focus in close proximity to or within eloquent brain areas relies on precise delineation of the relationship between the lesion and functional brain areas. The aim of this series was to validate the usefulness and test the efficacy of noninvasive presurgical PET mapping of eloquent brain areas to predict surgical morbidity and outcome in children with seizures. To identify eloquent brain areas in 15 children (6 female and 9 male; mean age 11 years) with epileptogenic lesions PET images of regional cerebral blood flow were performed following the administration of [(15)O]water during motor, visual, articulation, and receptive language tasks. These images with coregistered magnetic resonance (MR) images were then used to delineate the anatomic relationship of a seizure focus to eloquent brain areas. Additional PET images using [18F]fluoro-2-deoxy-D-glucose (FDG) and [11C]methionine (CMET) were acquired to help localize the seizure focus, as well as characterize the lesion. Patient surgical management decisions were based on PET mapping in combination with coregistered MR images, PET-FDG findings, and the anatomic characteristics of the lesion. At follow-up 1-26 months after surgery, all patients that underwent temporal lobectomy (9 patients) and extratemporal resection (4 patients) for a neoplastic or nonneoplastic seizure focus are seizure-free with minimal postoperative morbidity. Of prime importance, no child sustained a postoperative speech or language deficit. PET imaging was also well tolerated without procedural complications. Based on PET mapping, a nonoperative approach was used for 2 children and a biopsy only was used in one child. When cortical injury involved prenatally determined eloquent cortex, PET demonstrated reorganization of language areas to new adjacent areas or even to the contralateral hemisphere. Integration of anatomical and functional data enhanced the surgical safety, defined optimal surgical approach, delineated the seizure focus from eloquent brain areas, facilitated maximum resection and optimized the timing of surgery, thereby minimizing surgical morbidity while maximizing surgical goals. PET measurements of FDG and CMET uptake were also helpful in localizing the seizure focus and grading the tumors. PET used for brain mapping in children provides the surgeon with strategic preoperative information not readily attainable with traditional invasive Wada testing or intraoperative cortical stimulation. PET mapping may also improve the outcome of extratemporal resections by allowing aggressive seizure focus resection. In addition, serial brain maps may optimize timing for surgical intervention by demonstrating reorganization of eloquent cortex often seen in younger children after cortical injury. Our results suggest that noninvasive presurgical brain mapping has the potential to reduce risk and improve neurologic outcome.
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Encéfalo/diagnóstico por imagem , Epilepsia/diagnóstico por imagem , Epilepsia/cirurgia , Tomografia Computadorizada de Emissão , Adolescente , Adulto , Encéfalo/metabolismo , Encefalopatias/diagnóstico por imagem , Mapeamento Encefálico/métodos , Neoplasias Encefálicas/diagnóstico por imagem , Criança , Pré-Escolar , Processamento Eletrônico de Dados , Feminino , Fluordesoxiglucose F18/farmacocinética , Seguimentos , Humanos , Masculino , Metionina/farmacocinética , Cuidados Pré-Operatórios , Compostos Radiofarmacêuticos/farmacocinéticaRESUMO
BACKGROUND: Variants of the apolipoprotein E allele appear to account for most cases of late-onset Alzheimer's disease, and persons with two copies of the epsilon 4 allele appear to have an especially high risk of dementia. Positron-emission tomography (PET) has identified specific regions of the brain in which the rate of glucose metabolism declines progressively in patients with probable Alzheimer's disease. We used PET to investigate whether these same regions of the brain are affected in subjects homozygous for the epsilon 4 allele before the onset of cognitive impairment. METHODS: Apolipoprotein E genotypes were established in 235 volunteers 50 to 65 years of age who reported a family history of probable Alzheimer's disease. Neurologic and psychiatric evaluations, a battery of neuropsychological tests, magnetic resonance imaging, and PET were performed in 11 epsilon 4 homozygotes and 22 controls without the epsilon 4 allele who were matched for sex, age, and level of education. An automated method was used to generate an aggregate surface-projection map that compared regional rates of glucose metabolism in the two groups. RESULTS: The epsilon 4 homozygotes were cognitively normal. They had significantly reduced rates of glucose metabolism in the same posterior cingulate, parietal, temporal, and prefrontal regions as in previously studied patients with probable Alzheimer's disease. They also had reduced rates of glucose metabolism in additional prefrontal regions, which may be preferentially affected during normal aging. CONCLUSIONS: In late middle age, cognitively normal subjects who are homozygous for the epsilon 4 allele for apolipoprotein E have reduced glucose metabolism in the same regions of the brain as in patients with probable Alzheimer's disease. These findings provide preclinical evidence that the presence of the epsilon 4 allele is a risk factor for Alzheimer's disease. PET may offer a relatively rapid way of testing future treatments to prevent Alzheimer's disease.