The Role of the Ventromedial Prefrontal Cortex in Preferential Decisions for Own- and Other-Age Faces.

Own-age bias is a well-known bias reflecting the effects of age, and its role has been demonstrated, particularly, in face recognition. However, it remains unclear whether an own-age bias exists in facial impression formation. In the present study, we used three datasets from two published and one unpublished functional magnetic resonance imaging (fMRI) study that employed the same pleasantness rating task with fMRI scanning and preferential choice task after the fMRI to investigate whether healthy young and older participants showed own-age effects in face preference. Specifically, we employed a drift-diffusion model to elaborate the existence of own-age bias in the processes of preferential choice. The behavioral results showed higher rating scores and higher drift rate for young faces than for older faces, regardless of the ages of participants. We identified a young-age effect, but not an own-age effect. Neuroimaging results from aggregation analysis of the three datasets suggest a possibility that the ventromedial prefrontal cortex (vmPFC) was associated with evidence accumulation of own-age faces; however, no clear evidence was provided. Importantly, we found no age-related decline in the responsiveness of the vmPFC to subjective pleasantness of faces, and both young and older participants showed a contribution of the vmPFC to the parametric representation of the subjective value of face and functional coupling between the vmPFC and ventral visual area, which reflects face preference. These results suggest that the preferential choice of face is less susceptible to the own-age bias across the lifespan of individuals.

Thrombosis of a basilar perforator aneurysm associated with pontine infarction in a patient with systemic lupus erythematosus.

Systemic lupus erythematosus (SLE) is an autoimmune disease that can affect multiple organ systems. Cerebral aneurysm formation is a rare central nervous system manifestation of SLE and tends to present as subarachnoid hemorrhage. Here, we report a 34-year-old woman with SLE complicated by a thrombosed aneurysm that had arose at the origin of a perforating artery, thereby causing obstruction of the artery and subsequent development of pontine infarction. Detailed examination of thin-slice CT and magnetic resonance imaging scans led to the correct diagnosis of uncommon cause of stroke.

Relationship between decreased cerebral blood flow and amnesia after microsurgery for anterior communicating artery aneurysm.

OBJECTIVE: Postoperative amnesia after surgery for anterior communicating artery aneurysm might be associated with the damage of the basal forebrain. Our purpose was to verify whether decreased regional cerebral blood flow (rCBF) in basal forebrain could be related to the degree of postoperative amnesia. METHODS: Regional voxel rCBF data analyzed using three-dimensional stereotactic surface projection on 123I-IMP-SPECT were compared between ten patients with postoperative amnesia and 13 normal subjects. The Severity (average Z score of the voxels with a Z score that exceeds a threshold value of 2) was calculated. The cerebral lobes with rCBF exhibiting Severity > 2 in all patients were identified. In these lobes, we then examined whether there was a gyrus exhibiting Severity that was negatively related to memory quotients (MQs). RESULTS: In the right subcallosal gyrus, there was a significant negative correlation between Severity and visual MQ (ρ= - 0.884, p = 0.0007) or general MQ (ρ =- 0.853, p = 0.0017). In the right anterior cingulate gyrus, there was a significant negative correlation between Severity and verbal MQ (ρ = - 0.769, p = 0.0092). In the right rectal gyrus, there was a significant negative correlation between Severity and general MQ (ρ = - 0.811, p = 0.0044). No significant correlations were found between Severity in other brain regions and verbal, visual, or general MQ. CONCLUSIONS: The decreased rCBF in the subcallosal gyrus included in the basal forebrain, anterior cingulate gyrus, and the rectal gyrus in the right hemisphere was related to postoperative amnesia.

Perfusion contrast-enhanced ultrasound to predict early lymph-node metastasis in breast cancer.

PURPOSE: To evaluate whether quantitative analysis of perfusion contrast-enhanced ultrasound (CE-US) could predict early lymph-node (LN) metastasis in clinically node-negative breast cancer. MATERIALS AND METHODS: In this prospective study, 64 breast cancer patients were selected for perfusion CE-US imaging. Regions of interest were placed where the strongest and weakest signal increases were found to obtain peak intensities (PIs; PImax and PImin, respectively) for time-intensity curve analyzes. The PI difference and PI ratio were calculated as follows: PI difference = PImax-PImin; PI ratio = PImax/PImin. RESULTS: Forty-seven cases were histologically diagnosed as negative for LN metastasis and 17 were positive. There was a significant difference in PImin and the PI ratio between the LN-negative and -positive metastasis groups (p = 0.0053 and 0.0082, respectively). Receiver-operating curve analysis revealed that the area under the curve of PImin and the PI ratio were 0.73 and 0.72, respectively. The most effective threshold for the PI ratio was 1.52, and the sensitivity, specificity, positive predictive value, and negative predictive value were 59% (10/17), 87% (41/47), 63% (10/16), and 85% (41/48), respectively. CONCLUSIONS: Parameters from the quantitative analysis of perfusion CE-US imaging showed significant differences between the LN-negative and -positive metastasis groups in clinically node-negative breast cancer.

Ultrafast Dynamic Contrast-Enhanced Breast MRI: Kinetic Curve Assessment Using Empirical Mathematical Model Validated with Histological Microvessel Density.

RATIONALE AND OBJECTIVES: To evaluate whether parameters from empirical mathematical model (EMM) for ultrafast dynamic contrast-enhanced (DCE) magnetic resonance imaging (MRI) correlate with histological microvessel density (MVD) in invasive breast cancer. MATERIALS AND METHODS: Ninety-eight consecutive patients with invasive breast cancer underwent an institutional review board-approved ultrafast DCE-MRI including a pre- and 18 postcontrast whole breast ultrafast scans (3 seconds) followed by four standard scans (60 seconds) using a 3T system. Region of interest was placed within each lesion where the highest signal increase was observed on ultrafast DCE-MRI, and the increase rate of enhancement was calculated as follows: ΔS = (SIpost - SIpre)/SIpre. The kinetic curve obtained from ultrafast DCE-MRI was analyzed using a truncated EMM: ΔS(t) = A(1 - e-αt), where A is the upper limit of the signal intensity, α (min-1) is the rate of signal increase. The initial slope of the kinetic curve is given by Aα. Initial area under curve (AUC30) and time of initial enhancement was calculated. From the standard DCE-MRI, the initial enhancement rate (IER) and the signal enhancement ratio (SER) were calculated as follows: IER = (SIearly - SIpre)/SIpre, SER = (SIearly - SIpre)/(SIdelayed - SIpre). The parameters were compared to MVD obtained from surgical specimens. RESULTS: A, α, Aα, AUC30, and time of initial enhancement significantly correlated with MVD (r = 0.29, 0.40, 0.51, 0.43, and -0.32 with p = 0.0027, p < 0.0001, p < 0.0001, p < 0.0001, and p = 0.0012, respectively), whereas IER and SER from standard DCE-MRI did not. CONCLUSION: The parameters of the EMM, especially the initial slope or Aα, for ultrafast DCE-MRI correlated with MVD in invasive breast cancer.

Fast Temporal Resolution Dynamic Contrast-Enhanced MRI: Histogram Analysis Versus Visual Analysis for Differentiating Benign and Malignant Breast Lesions.

OBJECTIVE: The purpose of this study was to validate a kinetic assessment based on visually identified peak enhancement, which is routinely used in clinical practice, for differentiating benign from malignant lesions during fast dynamic contrast-enhanced MRI. MATERIALS AND METHODS: Between January 2015 and December 2016, 90 consecutively registered patients with 105 breast lesions (40 benign, 65 malignant) underwent dynamic contrast-enhanced 1.5-T MRI that included one unenhanced and eight contrast-enhanced fast temporal resolution (10 seconds) whole-breast acquisitions. Histogram analysis was performed to measure the voxel-based enhancement of the entire lesion to obtain 90th, 75th, and 50th percentile values at each time point and to generate kinetic curves. Two observers selected visually identified peak enhancement within the lesions to generate the kinetic curves. The kinetic curves from histogram and visually identified peak enhancement analyses were fitted by means of an empiric mathematic model (EMM): ΔS(t) = A × (1 - e-αt), where A is the upper limit of signal intensity, e indicates the exponential function, and α (min-1) is the rate of increase in signal intensity. The initial slope of the kinetic curve (A × α) and the initial AUC (AUC30) were calculated. These parameters were compared between benign and malignant lesions, and results from visually identified peak enhancement analysis were compared with those from histogram analysis. RESULTS: Benign lesions were successfully differentiated from malignant lesions in both visually identified peak enhancement and histogram analyses (90th and 75th percentile values) on the basis of α, A × α, and AUC30 from the EMM. There was no significant difference in ROC AUC in these EMM parameters between visually identified peak enhancement and histogram analyses (p = 0.21). CONCLUSION: Kinetic assessment with visually identified peak enhancement was acceptable for differentiating benign from malignant lesions.

Traumatic midline subarachnoid hemorrhage on initial computed tomography as a marker of severe diffuse axonal injury.

OBJECTIVEThe objective of this study was to test the hypothesis that midline (interhemispheric or perimesencephalic) traumatic subarachnoid hemorrhage (tSAH) on initial CT may implicate the same shearing mechanism that underlies severe diffuse axonal injury (DAI).METHODSThe authors enrolled 270 consecutive patients (mean age [± SD] 43 ± 23.3 years) with a history of head trauma who had undergone initial CT within 24 hours and brain MRI within 30 days. Six initial CT findings, including intraventricular hemorrhage (IVH) and tSAH, were used as candidate predictors of DAI. The presence of tSAH was determined at the cerebral convexities, sylvian fissures, sylvian vallecula, cerebellar folia, interhemispheric fissure, and perimesencephalic cisterns. Following MRI, patients were divided into negative and positive DAI groups, and were assigned to a DAI stage: 1) stage 0, negative DAI; 2) stage 1, DAI in lobar white matter or cerebellum; 3) stage 2, DAI involving the corpus callosum; and 4) stage 3, DAI involving the brainstem. Glasgow Outcome Scale-Extended (GOSE) scores were obtained in 232 patients.RESULTSOf 270 patients, 77 (28.5%) had DAI; tSAH and IVH were independently associated with DAI (p < 0.05). Of tSAH locations, midline tSAH was independently associated with both overall DAI and DAI stage 2 or 3 (severe DAI; p < 0.05). The midline tSAH on initial CT had sensitivity of 60.8%, specificity of 81.7%, and positive and negative predictive values of 43.7% and 89.9%, respectively, for severe DAI. When adjusted for admission Glasgow Coma Score, the midline tSAH independently predicted poor GOSE score at both hospital discharge and after 6 months.CONCLUSIONSMidline tSAH could implicate the same shearing mechanism that underlies severe DAI, for which midline tSAH on initial CT is a probable surrogate.

Subcallosal and Heubner artery infarcts following surgical repair of an anterior communicating artery aneurysm: a causal relationship with postoperative amnesia and long-term outcome.

Since the 1950s, amnesia or memory impairment has been repeatedly reported in patients following surgical repair of anterior communicating artery (ACoA) aneurysms. Postoperative infarctions following surgical repair of ACoA aneurysms are classified as involvement of the subcallosal artery (the largest unpaired perforator of the ACoA), the recurrent artery of Heubner (RAH), or a combination of both. Postoperative amnesia can seriously affect the patient's quality of life, thus prompting physicians to discuss the symptomatology of the three infarction patterns. We made the following speculations regarding the causal relationship between the infarction pattern and postoperative amnesia. First, postoperative amnesia is most likely caused by an infarction in the territory of the subcallosal artery, particularly in the column of the fornix, a constituent of the Papez neuronal circuit. Second, infarction in the RAH territory alone is unlikely to cause significant amnesia. Third, infarcted foci in the RAH territory, when associated with a subcallosal artery infarction, can cause considerable frontal dysfunction due to impaired frontostriatal circuits in patients with postoperative amnesia, with resultant worsening of the long-term outcome or quality of life.

Ischemic White Matter Lesions Associated With Medullary Arteries: Classification of MRI Findings Based on the Anatomic Arterial Distributions.

OBJECTIVE: The purposes of this article are to describe the important role of the medullary arteries in the pathogenesis of cerebral vascular disease and to present a classification of MRI findings of ischemic white matter lesions for use in elucidating pathogenesis. CONCLUSION: From the viewpoint of the anatomy of the medullary arteries, the pattern of medullary artery-related ischemic changes and infarcts can be classified into four types: 1, ischemic leukoaraiosis; 2, infarcts involving individual medullary arteries; 3, watershed infarcts; and 4, territorial infarcts.

A change in brain white matter after shunt surgery in idiopathic normal pressure hydrocephalus: a tract-based spatial statistics study.

BACKGROUND: The aim of this study was to elucidate changes in cerebral white matter after shunt surgery in idiopathic normal pressure hydrocephalus (INPH) using diffusion tensor imaging (DTI). METHODS: Twenty-eight consecutive INPH patients whose symptoms were followed for 1 year after shunt placement and 10 healthy control (HC) subjects were enrolled. Twenty of the initial 28 INPH patients were shunt-responsive (SR) and the other 8 patients were non-responsive (SNR). The cerebral white matter integrity was detected by assessing fractional anisotropy (FA) and mean diffusivity (MD). The mean hemispheric DTI indices and the ventricular sizes were calculated, and a map of these DTI indices was created for each subject. The DTI maps were analysed to compare preshunt INPH with HC and preshunt INPH with 1 year after shunt placement in each INPH group, using tract-based spatial statistics. We restricted analyses to the left hemisphere because of shunt valve artefacts. RESULTS: The ventricles became significantly smaller after shunt placement both in the SR and SNR groups. In addition, there was a significant interaction between clinical improvement after shunt and decrease in ventricular size. Although the hemispheric DTI indices were not significantly changed after shunt placement, there was a significant interaction between clinical improvement and increase in hemispheric MD. Compared with the HC group, FA in the corpus callosum and in the subcortical white matter of the convexity and the occipital cortex was significantly lower in SR at baseline, whereas MD in the periventricular and peri-Sylvian white matter was significantly higher in the SR group. Compared with the pre-operative images, the post-operative FA was only decreased in the corona radiata and only in the SR group. There were no significant regions in which DTI indices were altered after shunt placement in the SNR group. CONCLUSIONS: Brain white matter regions in which FA was decreased after shunt placement were in the corona radiata between the lateral ventricles and the Sylvian fissures. This finding was observed only in shunt-responsive INPH patients and might reflect the plasticity of the brain for mechanical pressure changes from the cerebrospinal fluid system.

Quantitative Analysis of Contrast-Enhanced Ultrasound Imaging in Invasive Breast Cancer: A Novel Technique to Obtain Histopathologic Information of Microvessel Density.

We examined whether enhancement area ratios obtained by the new bubble detection method correlate with histologic microvessel density in invasive breast cancer. Forty consecutive patients with invasive breast cancer lesions underwent contrast-enhanced ultrasound. The ratio of enhanced area to manually segmented tumor area (enhancement area ratio) was obtained with the new method at peak and delayed phases (50-54, 55-59, 60-64 and 65-69 s). We also analyzed time-intensity curves to obtain peak intensity and area under curve. Enhancement area ratios in both peak and delayed phases (50-54, 55-59, 60-64 and 65-69 s) were significantly correlated with microvessel density (r = 0.57, 0.62, 0.68, 0.61 and 0.58; p = 0.0001, <0.0001, <.0001, <.0001 and 0.0001, respectively). In time-intensity curve analysis, peak intensity was significantly correlated (r = 0.43, p = 0.0073), whereas area under the curve was not (r = 0.29, p = 0.0769). Enhancement area ratios obtained by the new method were correlated with microvessel density in invasive breast cancer.

T2 relaxometry improves detection of non-sclerotic epileptogenic hippocampus.

OBJECT: The use of T2 relaxometry was investigated to detect non-sclerotic epileptogenic abnormality of the hippocampus in presurgical evaluation of temporal lobe epilepsy (TLE). METHODS: This prospective study included 30 patients who underwent hippocampectomy as part of surgical treatment of refractory TLE. Ten patients had structural epileptogenic lesions in the extra-hippocampal temporal lobe. Twelve patients underwent intracranial electroencephalography (iEEG) study before surgery. Visual assessment of atrophy and increased T2 signal intensity, volumetry, and T2 relaxometry of hippocampus were performed pre-operatively using 3T magnetic resonance imaging, and compared with the neuropathological findings and iEEG findings. Magnetic resonance imaging of 30 age- and sex-matched healthy controls was used to establish normal values, which were defined as z score within 2. RESULTS: Visual assessment, volumetry, and T2 relaxometry detected hippocampal abnormalities on the surgical side in 16 (53%), 16 (53%), and 26 (87%) patients, respectively. Hippocampal volume loss was always associated with prolonged T2 relaxation time, and supported by histopathological diagnosis of HS in all cases except one. Hippocampal abnormality was detected only by T2 relaxometry in nine patients (30%). Pathological diagnosis of these cases included mild HS in one, microdysgenesis in one, and granule cell pathology in three. Four patients with normal hippocampal volume and T2 relaxation time had no HS or granule cell pathology. Prolonged T2 relaxation time was associated with medial temporal seizure onset in iEEG (p<0.05). CONCLUSIONS: T2 relaxometry improves the detection of non-sclerotic epileptogenic abnormality of the hippocampus.

Gender differences in ventromedial prefrontal cortex activity associated with valuation of faces.

Psychological studies have indicated that males exhibit stronger preferences for physical attributes in the opposite gender, such as facial attractiveness, than females. However, whether gender differences in mate preference originate from differential brain activity remains unclear. Using functional magnetic resonance imaging (fMRI), we investigated the patterns of brain activity in the ventromedial prefrontal cortex (vmPFC), a region critical for the valuation of faces, in response to elderly male, elderly female, young male, and young female faces. During fMRI, male and female subjects were presented with a face and asked to rate its pleasantness. Following fMRI, the subjects were presented with pairs of faces and asked to select the face that they preferred. We analyzed the vmPFC activity during the pleasantness-rating task according to the gender of the face stimulus (male and female) and the age of the face stimulus (elderly and young). Consistent with the results of previous studies, the vmPFC activity parametrically coded the subjective value of faces. Importantly, the vmPFC activity was sensitive to physical attributes, such as the youthfulness and gender of the faces, only in the male subjects. These findings provide a possible neural explanation for gender differences in mate preference.