Functional MRI cortical activations from unilateral tactile-taste stimulations of the tongue.

Functional magnetic resonance imaging (fMRI) was used for revealing activations in the human brain by lateralized tactile-gustatory stimulations of the tongue. Salt, a basic taste stimulus, and water, now recognized as an independent taste modality, were applied to either hemitongues with pads similar to the taste strips test for the clinical psychophysical evaluation of taste. With both stimuli, the observed cortical patterns of activations could be attributed to a combined somatosensory and gustatory stimulation of the tongue, with no significant differences between salt and water. Stimulation of each hemitongue evoked a bilateral activation of the anterior insula-frontal operculum, ascribable to the gustatory component of the stimulation, and a bilateral activation of the inferior part of the postcentral gyrus, ascribable to the tactile component of the stimulation. The results are in line with the notion that the representation of the tongue in the cerebral hemispheres in both the touch and the taste modalities is bilateral. Clinical and brain stimulation findings indicate that this bilaterality depends primarily on a partial crossing of the afferent pathways, perhaps with a predominance of the crossed pathway in the touch modality and the uncrossed pathway in the taste modality. Previous evidence suggests that the corpus callosum is not indispensible for this bilateral representation, but can contribute to it by interhemispheric transfer of information in both modalities.

Recurrent glioblastoma multiforme versus radiation injury: a multiparametric 3-T MR approach.

OBJECTIVE: The discrimination between recurrent glioma and radiation injury is often a challenge on conventional magnetic resonance imaging (MRI). We verified whether adding and combining proton MR spectroscopic imaging ((1)H-MRSI), diffusion-weighted imaging (DWI) and perfusion-weighted imaging (PWI) information at 3 Tesla facilitate such discrimination. MATERIALS AND METHODS: Twenty-nine patients with histologically verified high-grade gliomas, who had undergone surgical resection and radiotherapy, and had developed new contrast-enhancing lesions close to the treated tumour, underwent MRI, (1)H-MRSI, DWI and PWI at regular time intervals. The metabolite ratios choline (Cho)/normal( n )Cho n , N-acetylaspartate (NAA)/NAA n , creatine (Cr)/Cr n , lactate/lipids (LL)/LL n , Cho/Cr n , NAA/Cr n , Cho/NAA, NAA/Cr and Cho/Cr were derived from (1)H-MRSI; the apparent diffusion coefficient (ADC) from DWI; and the relative cerebral blood volume (rCBV) from PWI. RESULTS: In serial MRI, recurrent gliomas showed a progressive enlargement, and radiation injuries showed regression or no modification. Discriminant analysis showed that discrimination accuracy was 79.3 % when considering only the metabolite ratios (predictor, Cho/Cr n ), 86.2 % when considering ratios and ADC (predictors, Cho/Cr n and ADC), 89.7 % when considering ratios and rCBV (predictors, Cho/Cr n , Cho/Cr and rCBV), and 96.6 % when considering ratios, ADC and rCBV (predictors, Cho/Cho n , ADC and rCBV). CONCLUSIONS: The multiparametric 3-T MR assessment based on (1)H-MRSI, DWI and PWI in addition to MRI is a useful tool to discriminate tumour recurrence/progression from radiation effects.

Multislice computed tomography overestimates superior semicircular canal dehiscence syndrome.

OBJECTIVES: We assessed the prevalence of superior semicircular canal dehiscence (SSCD) through examination of ultrahigh-resolution computed tomography (CT) scans of the temporal bone and attempted to verify the correspondence between a radiologic diagnosis of SSCD and clinical signs of SSCD syndrome. METHODS: A prospective study was carried out on 191 consecutive patients who underwent temporal bone ultrahigh-resolution CT scans. Cases that matched the radiologic diagnosis of SSCD were subsequently referred for a comprehensive audiological evaluation that might enable a final diagnosis of SSCD syndrome. RESULTS: Among the 191 patients, 17 had a radiologic diagnosis of SSCD, which was bilateral in 5 cases, for a total of 22 SSCD cases, with a prevalence rate of 5.8%. In 2 of the 17 patients, the audiological examination revealed signs and symptoms indicative of SSCD syndrome, with a total prevalence rate of 0.5%. CONCLUSIONS: Our data confirm that the radiologic diagnosis of SSCD, performed by mean thin-section CT scans reformatted in the plane of the superior semicircular canal, is not necessarily related to the clinical presentation of SSCD syndrome. Our study also showed a prevalence rate of SSCD syndrome that was similar to the prevalence of SSCD reported from studies of histologic specimens.

Automatic detection, localization, and volume estimation of ischemic infarcts in noncontrast computed tomographic scans: method and preliminary results.

OBJECTIVES: Sensitivity of noncontrast computed tomography (NCCT) in detecting hyperacute (< 8 hours) and acute (< 24 hours) cerebral infarction is low. We propose an automatic method to detect and localize ischemic infarct and to assess its volume from a single NCCT scan. MATERIALS AND METHODS: The method automatically determines attenuation value ranges of cerebrospinal fluid and white and gray matter, separates the brain scan into the left and right hemispheres, and by analyzing hemisphere attenuation value distributions using percentile difference ratios, it detects, localizes, and quantifies the infarct without its segmentation. The method performance was evaluated on 576 patients with clinically confirmed stroke through NCCT scans acquired at 4 centers to measure how it matched with that of experts in detection, localization, and assessment of infarct volume. The time from the onset of symptoms ranged from 1.5 to 72 hours for 450 scans and more than 72 hours for 82 scans, most with pathologic findings in addition to cerebral infarction; the time was unavailable for 44 scans. In addition, the method was compared with the novice's (with 52 scans) and experienced readers' infarct detection (with 21 × 2 scans) in early ischemia detection (with the time from the onset of symptoms ranging from 1.5 to 7 hours). RESULTS: The method matches 100% the expert's infarct detection when chronic infarcts, leukoaraiosis cases, and infarct volumes less than 2 cm (determined by detection accuracy simulation) are excluded from the analysis. For all cases excluding infarct volumes less than 2 cm, the method detection accuracy is 95.7%. Overall, the method detection accuracy is 83.2%. The early method detection accuracy (≤ 3 hours) is 78.4%. The novice detection accuracy is 27.8% (≤ 3 hours), 37.5% (3 < to ≤ 8 hours), and 77.8% (> 8 hours), whereas the expert detection accuracy for these cases is 100%. Moreover, the method detected all 21 early infarcts, of which 15 were missed by the stroke experts and 14 of 15 were missed by a general radiologist. The method performs automatic analysis in approximately 7 seconds. CONCLUSIONS: The results demonstrate potential benefits of our method for enhancing expert's performance because it quickly localizes the infarct and detects cases missed by experts, and it is to be considered as an aid in the emergency department because it substantially outperforms novice readers (100% vs 27%) in infarct detection on NCCT.

Unilateral visual loss due to ischaemic injury in the right calcarine region: a functional magnetic resonance imaging and diffusion tension imaging follow-up study.

To study the functional recovery of a patient with cerebrovascular injury using combined functional magnetic resonance imaging (fMRI) and diffusion tensor imaging (DTI). A 24-year-old woman with left hemianopsia underwent fMRI and DTI in a 1.5-tesla machine both in the acute phase and 1 month after an ischaemic stroke involving the right calcarine cortex. Acute-phase fMRI demonstrated that peripheral left visual field stimulation did not activate the right primary visual cortex, whereas stimulation 1 month later activated the visual cortex bilaterally. Analysis of acute-phase DTI data disclosed that a reduction of fractional anisotropy in the right optic radiation had almost resolved after 1 month. Fibre direction was normal at either time point. fMRI and DTI can demonstrate functional damage and recovery in patients with neuro-ophthalmological lesions.

Topographical organization of human corpus callosum: an fMRI mapping study.

The concept of a topographical map of the corpus callosum (CC) has emerged from human lesion studies and from anatomical tracing investigations in other mammals. Over the last few years, a rising number of researchers have been reporting functional magnetic resonance imaging (fMRI) activation in white matter, particularly the CC. In this study, the scope for describing CC topography with fMRI was explored by evoking activation through simple sensory stimulation and motor tasks. We reviewed our published and unpublished fMRI data on the cortical representation of tactile, gustatory, and visual sensitivity and of motor activation, obtained in 36 volunteers. Activation foci were consistently detected in discrete CC regions: anterior (taste stimuli), central (motor tasks), central and posterior (tactile stimuli), and splenium (visual stimuli). These findings demonstrate that the functional topography of the CC can be explored with fMRI.

[Functional topography of the human corpus callosum]. / Organisation topographique du corps calleux chez l'homme. Etude cartographique en imagerie par résonance magnétique fonctionnelle (f-IRM).

The concept of a topographical map of the corpus callosum (CC) has emerged from lesion studies in humans and from anatomical tracing investigations in other mammals. We conducted the first in vivo study aimed at outlining the topographical organization of the normal human CC, using non-invasive functional magnetic resonance imaging (fMRI). We tested cortical and callosal activation by the BOLD effect during simple sensory stimulation (tactile, gustatory and visual) and simple motor tasks in 38 volunteers. The axonal organization of callosal white matter was also studied in 16/38 subjects, using diffusion tensor imaging (DTI) and diffusion tensor tractography (DTT). Activation foci evoked by taste stimuli were detected in most subjects in the anterior part of the CC, those elicited by motor tasks lay in the central portion of the body of the CC, and those elicited by tactile stimulation of different body regions lay in the posterior part of the body. Activation foci evoked by visual stimulation were seen in the splenium of the CC. Callosal fibers interconnecting the primary cortical areas activated by taste stimulation, motor tasks, and tactile and visual stimuli were shown by DTT. Anatomical correlates of the BOLD activation foci were demonstrated in the CC, with fibers crossing it at the level of the genu, anterior and posterior body, and splenium, respectively. This study demonstrates for the first time that the functional topographical organization of the human CC can be explored by fMRI in vivo. Our findings may have clinical implications, especially for neurosurgical planning.

Estudio mediante imagen funcional de resonancia magnética (fMRI) de las activaciones emotivas correlacionadas a la presentación de rostros extraños o del propio rostro en sujetos con personalidad inward y outward / Functional magnetic resonance imaging (fMRI) study of emotional expressions correlated to strange face expressions or of the itself in subjects with inward or outward personality

Introduction: Due to patterns ofreciprocity based on steady and coherent behaviours or, on the contrary, on articúlate and changing behaviours, attachment relationships produce personal meaning organizations respectively centred on inward or outward focus. In inward organizations, emotions are more distinct and reciprocity is more based on physical distance (protection, loneliness); in outward organizations, emotions are more blurred and reciprocity is more based on a semantic sight of relations (approval, rules). Thanks to the modern technologies of neuroimaging (especially functional magnetic resonance, flMR), a scientific, Uve study ofwhat happens when an emotion starts is now possible. Method: We studied in 10 healthy subjects the amygdala and other nervous system structures activations when the subject perceives emotional expressions by seeing an unknown face and his/her own face. Results were also matched with inward/outward organization (studied with clinical approach and MMPI2, QSP, MQOP). Results and Discussion: Our results proved that an unknown face produces higher activation on the subjects than their own face (surprise effect); the anger mostly activates the right amygdala, while the joy activates both the amygdalas or the left one (it produces a semantic decoding). Outward subjects, with respect to the inward ones, respond to the anger with a less intense and univocal pattern, actívate more cortical ßreas, not always respond to their own facial expressions and respond to the joy with an higher involvement ofthe left verbal hemisphere.

Introducción: Patrones de reciprocidad estable y coherente o, al contrario, no unívocos y cambiantes, permiten desarrollar organizaciones de significado personal con enfoque de la experiencia a lo interno (inward) o externo (outward). En los inward las emociones son más definidas y la reciprocidad es primordialmente física (protección, soledad); en los outward las emociones son más difuminadas y la reciprocidad es prevalentemente semántica (confirmación, reglas). Las modernas tecnologías de imágenes funcionales han permitido estudiar en vivo qué sucede cuando se experimenta una emoción. Método: Hemos estudiado, mediante imagen funcional de resonancia magnética (fMRI), las activaciones de la amígdalay de otras estructuras del SNCproducidas, en 10 voluntarios sanos, por estímulos emocionales externos estandarizados, tanto cuando el sujeto percibe expresiones emotivas relativas a un rostro extraño (tercera persona), como relativas al rostro propio (primera persona). Resultados y Discusión: Los resultados obtenidos han sido confrontados con las modalidades de enfoque inward o outward, atribuibles al funcionamiento de base de la personalidad individual. Tales modalidades han sido comprobadas mediante MMPI2, QSPyMQOP asociados a una evaluación clínica realizada por un psicoterapeuta experto. Los resultados indican que un rostro extraño produce activaciones mayores respecto al propio (efecto sorpresa), que la rabia activa mayormente la amígdala derecha, mientras que la alegría activa ambas amígdalas o la izquierda. Los outward, respecto a los inward, responden a la rabia de manera menos intensa y unívoca, activan más áreas corticales, pueden no responder a las emociones propias y tienen una mayor implicación del hemisferio verbal en la alegría.

Proton MR spectroscopy of cerebral gliomas at 3 T: spatial heterogeneity, and tumour grade and extent.

This study aimed to evaluate the usefulness of proton MR spectroscopic imaging ((1)H-MRSI) at 3 T in differentiating high- from low-grade gliomas, and tumour from necrosis, oedema or normal tissue. Forty-four patients with brain gliomas and four with meningiomas were retrospectively reviewed. The normalised metabolites choline (nCho), N-acetylaspartate (nNAA), creatine (nCr) and lactate/lipids (nLL), and the metabolite ratios Cho/NAA, NAA/Cr and Cho/Cr were calculated. Necrotic-appearing areas showed two spectroscopic patterns: "necrosis" with variable nCho and high nLL, and "cystic necrosis" with variable nLL or nonevident peaks. Peri-enhancing oedematous-appearing areas showed three spectroscopic patterns ("tumour" with abnormal Cho/NAA, "oedema" with normal Cho/NAA and "tumour/oedema" with normal nCho and abnormal Cho/NAA) in gliomas, and one ("oedema") in meningiomas. Peri-enhancing or peri-tumour normal-appearing areas showed two patterns ("infiltrated" with abnormal nCho and/or Cho/NAA and "normal" with normal spectra) in gliomas and one ("normal") in meningiomas. Discriminant analysis showed that classification accuracy between high- and low-grade glioma masses was better with normalised metabolites or all parameters together than metabolite ratios and that among peri-enhancing areas was much better with normalised metabolites. The analysis of spatial distribution of normalised metabolites by 3-T (1)H-MRSI helps to discriminate among different tissues, offering information not available with conventional MRI.

Multiparametric 3T MR approach to the assessment of cerebral gliomas: tumor extent and malignancy.

INTRODUCTION: Contrast-enhanced MR imaging is the method of choice for routine assessment of brain tumors, but it has limited sensitivity and specificity. We verified if the addition of metabolic, diffusion and hemodynamic information improved the definition of glioma extent and grade. METHODS: Thirty-one patients with cerebral gliomas (21 high- and 10 low-grade) underwent conventional MR imaging, proton MR spectroscopic imaging ((1)H-MRSI), diffusion weighted imaging (DWI) and perfusion weighted imaging (PWI) at 3 Tesla, before undergoing surgery and histological confirmation. Normalized metabolite signals, including choline (Cho), N-acetylaspartate (NAA), creatine and lactate/lipids, were obtained by (1)H-MRSI; apparent diffusion coefficient (ADC) by DWI; and relative cerebral blood volume (rCBV) by PWI. RESULTS: Perienhancing areas with abnormal MR signal showed 3 multiparametric patterns: "tumor", with abnormal Cho/NAA ratio, lower ADC and higher rCBV; "edema", with normal Cho/NAA ratio, higher ADC and lower rCBV; and "tumor/edema", with abnormal Cho/NAA ratio and intermediate ADC and rCBV. Perienhancing areas with normal MR signal showed 2 multiparametric patterns: "infiltrated", with high Cho and/or abnormal Cho/NAA ratio; and "normal", with normal spectra. Stepwise discriminant analysis showed that the better classification accuracy of perienhancing areas was achieved when regarding all MR variables, while (1)H-MRSI variables and rCBV better differentiated high- from low-grade gliomas. CONCLUSION: Multiparametric MR assessment of gliomas, based on (1)H-MRSI, PWI and DWI, discriminates infiltrating tumor from surrounding vasogenic edema or normal tissues, and high- from low-grade gliomas. This approach may provide useful information for guiding stereotactic biopsies, surgical resection and radiation treatment.

Predicting posttraumatic epilepsy with MRI: prospective longitudinal morphologic study in adults.

PURPOSE: Evaluation of morphologic risk factors for posttraumatic epilepsy (PTE) by using brain magnetic resonance imaging (MRI) in serial assessments

Contribution of posterior corpus callosum to the interhemispheric transfer of tactile information.

Three total and three partial callosotomy patients underwent neuropsychological testing to evaluate interhemispheric transfer of tactile information. Tactile transfer is required to name objects presented to the left hand, to compare objects held in either hand, and to transfer topological information between hands. Tactile Naming, Same-Different Recognition, and Tactile Finger Localization Tests (intra- and intermanual tasks) were administered as specific tools. Results were compared with previous fMRI data from the same subjects and with the performance of a control group (20 age-matched subjects). Total callosotomy patients performed modestly: mean correct responses were 93% and 30% (right and left hand, respectively) in Tactile Naming; 68% in Same-Different Recognition; 84% and 76% (right and left hand stimulation, respectively) in intermanual Tactile Finger Localization, and 100% in the intramanual task. Partial callosotomy patients achieved 93-100% accuracy: all have an intact splenium, and one, and possibly all, also an intact posterior callosal body. Controls scored 99% in Tactile Naming, both hands, and Same-Different Recognition; 100% in intramanual Tactile Finger Localization; and 96% and 95%, with right and left hand stimulation, respectively, in the intermanual task. Differences between the two callosotomy groups were significant, as were those between total callosotomy patients and controls. The partial callosotomy group scored like the control subjects. Neuropsychological data agree with previous functional findings, further demonstrating that interhemispheric tactile transfer requires posterior corpus callosum integrity.

Bilateral cortical representation of the trunk midline in human first somatic sensory area.

The cortical representation of the trunk zone in the human first somatosensory area was studied with functional magnetic resonance imaging (fMRI) to establish whether the cutaneous regions close to the midline are represented in this area of both hemispheres. Cortical activation foci evoked by unilateral tactile stimulation of ventral trunk regions were detected in the postcentral gyrus of the contralateral hemisphere slightly medial to or just behind the omega-shaped region of the central sulcus and in the anterior bank of the postcentral sulcus. These regions probably correspond to the trunk ventral midline representation zones of areas 3a-3b and 1-2, respectively. Stimulation of cutaneous regions adjacent to the midline evoked activation foci also in the ipsilateral postcentral gyrus in regions symmetrical to those activated in the contralateral hemisphere. These data demonstrate that in humans, as in nonhuman primates, the cutaneous regions adjacent to the trunk midline are represented bilaterally in the first somatic sensory cortex. Whether the ipsilateral activation depends on callosal or extracallosal inputs remains to be elucidated.

Karyometric features of low and high grade glial tumors as compared with their MRI appearance.

OBJECTIVE: To compare the results of a magnetic resonance imaging (MRI) grading designed to identify low and high grade gliomas with karyometry used as a tool to grade primary brain tumors. STUDY DESIGN: A consecutive series of 23 primary brain tumors was selected for this study. The neuroradiologist, not knowing the histologic diagnoses, divided the cases into low and high grade categories on the basis of the following 7 features: border sharpness, heterogeneity without contrast, cavitation, contrast enhancement, hypervascularity, mass effect and perifocal T2 hyperintensity. To each feature was given a numerical value, ranging from 1 to 3. All the cases were reviewed and classified by the same pathologist, blinded to the MRI diagnosis. Two hundred nuclei per case were recorded, and 93 karyometric features related to nuclear area, total optical density and chromatin distribution were analyzed for each nucleus. Statistical analysis included discriminant analysis, Kruskal-Wallis test, nonsupervised learning algorithm P-index and Beale statistic. RESULTS: Ten cases were classified as low grade on the basis of their MRI features. The corresponding histopathologic diagnoses were: grade 2 astrocytoma in 2 cases and grade 2 oligodendroglioma in 8 cases. An MRI diagnosis of high grade tumor was made in 13 cases. In 10 cases it was confirmed by the histopathologic diagnosis (3 grade 3 astrocytomas, 1 grade 3 oligodendroglioma and 6 glioblastomas). In the remaining 3 cases the histologic examination revealed a low grade tumor, 1 grade 2 astrocytoma and 2 grade 2 oligodendrogliomas. For the purposes of the karyometric analysis the cases were allocated to the low or high grade category according to their histologic diagnosis (13 cases low grade and 10 cases high grade). Nuclei from low and high grade tumors showed clearly different karyometric characteristics. The oligodendroglioma nuclei had abnormality values close to the low grade standard, while the astrocytoma nuclei were a highly dispersed group with characteristics indicative of a higher degree of nuclear abnormality than the oligodendroglioma nuclei. The results of karyometric analysis showed that grade 2 tumors, corresponding to the low grade group, form a rather distinct category from grade 3 and 4 tumors belonging to the high grade group. CONCLUSION: The results of MRI grading based on a series of features that are routinely assessed by the neuroradiologist to reach a final diagnosis correlate highly with the histopathologic diagnosis. Karyometry can be a useful adjunct to histologic grading.

Correlation between cerebral MRI abnormalities and mental retardation in patients with mucopolysaccharidoses.

Mucopolysaccharidoses (MPSs) are a group of inherited disorders due to lysosomal enzyme deficiencies which lead to multi-organ accumulation of glycosaminoglycans. Some forms of MPS disorders are characterized by various degrees of mental retardation. Magnetic Resonance Imaging (MRI) is the primary imaging technique to detect CNS alterations. The aim of this study is to evaluate the correlation between white matter (WM) alterations and the presence of mental retardation. We analyzed 20 patients with different forms of MPSs, 11 with mental retardation and 9 with a normal cognitive function; all of them underwent brain MRI and received a score on the basis of the alterations (WM alterations; perivascular, subarachnoid, and ventricular space enlargement; abnormalities of the basal ganglia, of the corpus callosum and of the atlanto-axial joint). All patients with mental retardation presented severe WM alterations, while only five out of the nine subjects without mental retardation showed certainly WM abnormalities. As far as the other cerebral abnormalities are concerned, no difference between the two groups has been found. These data seem to show that there is a significant correlation between the presence of WM alterations and mental retardation.

3.0 T magnetic resonance in neuroradiology.

Ever since the introduction of magnetic resonance (MR), imaging with 1.5 T has been considered the gold standard for the study of all body areas. Until not long ago, higher-field MR equipment was exclusively employed for research, not for clinical use. More recently, the introduction of 3.0 T MR machines for new and more sophisticated clinical applications has yielded in important benefits, especially in neuroradiology. Indeed, their high gradient power and field intensity allow adjunctive and more advanced diagnostic methodologies to be applied with excellent resolution in a fraction of the time of acquisition compared with earlier machines. The numerous advantages of these machines in terms of higher signal, increased spatial resolution and greater sensitivity, and their few limitations, which can be overcome and anyway do not adversely affect diagnostic efficacy, will make 3.0 T MR systems the gold standard for morphological and functional studies of the brain.