Grey matter alterations in patients with Pantothenate Kinase-Associated Neurodegeneration (PKAN).

BACKGROUND: Pantothenate Kinase-Associated Neurodegeneration (PKAN) is a rare heritable disease marked by dystonia and loss of movement control. In contrast to the well-known "Eye-of-the-Tiger" sign affecting the globus pallidus, little is known about other deviations of brain morphology, especially about grey matter changes. METHODS: We investigated 29 patients with PKAN and 29 age-matched healthy controls using Magnet Resonance Imaging and Voxel-Based Morphometry. RESULTS: As compared to controls, children with PKAN showed increased grey matter density in the putamen and nucleus caudatus and adults with PKAN showed increased grey matter density in the ventral part of the anterior cingulate cortex. A multiple regression analysis with dystonia score as predictor showed grey matter reduction in the cerebellum, posterior cingulate cortex, superior parietal lobule, pars triangularis and small frontal and temporal areas and an analysis with age as predictor showed grey matter decreases in the putamen, nucleus caudatus, supplementary motor area and anterior cingulate cortex. CONCLUSIONS: The grey matter increases may be regarded as a secondary phenomenon compensating the increased activity of the motor system due to a reduced inhibitory output of the globus pallidus. With increasing age, the grey matter reduction of cortical midline structures however might contribute to the progression of dystonic symptoms due to loss of this compensatory control.

Spatial resolution of fMRI in the human parasylvian cortex: comparison of somatosensory and auditory activation.

In spite of its outstanding spatial resolution, the biological resolution of functional MRI may be worse because it depends on the vascular architecture of the brain. Here, we compared the activation patterns of the secondary somatosensory and parietal ventral cortex (SII/PV) with that of the primary auditory cortex and adjacent areas (AI/AII). These two brain regions are located immediately adjacent to each other on opposite banks of the Sylvian fissure, and are anatomically and functionally distinct. In 12 healthy subjects, SII/PV was activated by pneumatic tactile stimuli applied to the index finger (0.5 cm2 contact area, 4 bar pressure), and AI/AII by amplitude-modulated tones (800 Hz carrier frequency, modulated at 24-36 Hz). Functional images were obtained with a 1.5-T scanner and were evaluated using SPM99. Sensitivity of fMRI activation in this unselected sample was 71% for tactile and 83% for auditory stimulation. Group analysis showed activation of SII/PV by tactile and activation of three locations in AI/AII by auditory stimuli. Distributions extended to the opposite side of the fissure (19-58% after tactile and 13-14% after auditory stimulation, depending on the side of stimulation/hemisphere). Morphometry of individual sulcal anatomy revealed that the course of the Sylvian fissure varied by 5.3 mm (SD) in vertical direction. Taking this into account, SII/PV was located 5.8 +/- 2.7 mm above the Sylvian fissure, whereas AI/AII was located 6.3 +/- 1.7 mm below the Sylvian fissure. Even in individual analysis, the most significant voxel after tactile stimuli in one subject was found on the "wrong" side of the fissure; this error could be ascribed to the spatial normalization procedure. These data show that fMRI signals may overlap substantially, even if the activated regions are separated by 12 mm across a major sulcus. Spatial normalization to an atlas template can introduce additional variance. Individual sulcal anatomy should be preferred over mean atlas locations.