Pre- and post-operative diffusion tensor imaging of the median nerve in carpal tunnel syndrome.

OBJECTIVES: To use pre- and post-operative diffusion tensor imaging (DTI) to monitor median nerve integrity in patients suffering from carpal tunnel syndrome (CTS). METHODS: Diffusivity and anisotropy images along the median nerve were compared among 12 patients, 12 age-matched and 12 young control subjects and correlated with electrophysiological neurography results. Slice-wise DTI parameter values were calculated to focus on local changes. RESULTS: Results of pre-operative patients and age-matched control subjects differed only in the distal nerve. Moreover, pre-operative patients differed significantly from young controls and post-operative patients. The main abnormalities were increased diffusivity and decreased anisotropy in the carpal tunnel and distal median nerve. Post-operative clinical improvement was reflected in diffusivity, but not in anisotropy. Slice-wise analysis showed high pre-operative diffusivity at the distal nerve. All groups had relatively large inter-subject variation in both diffusivity and anisotropy. CONCLUSIONS: DTI can provide information complementary to clinical examination, electrophysiological recordings and anatomical MRI of diseases and injuries of peripheral nerves. However, similar age-related changes in diffusivity and anisotropy may weaken DTI specificity. Slice-wise analysis is necessary for detection of local changes in nerve integrity. KEY POINTS: • Diffusion tensor magnetic resonance imaging provides information complementary to conventional diagnostic methods. • Age caused similar changes to diffusivity and anisotropy as carpal tunnel syndrome. • Post-operative clinical improvement was reflected in diffusivity, but not in anisotropy. • Inter-subject variation in diffusivity and anisotropy was considerable.

Increasing top-down suppression from prefrontal cortex facilitates tactile working memory.

Navigated transcranial magnetic stimulation (TMS) combined with diffusion-weighted magnetic resonance imaging (DW-MRI) and tractography allows investigating functional anatomy of the human brain with high precision. Here we demonstrate that working memory (WM) processing of tactile temporal information is facilitated by delivering a single TMS pulse to the middle frontal gyrus (MFG) during memory maintenance. Facilitation was obtained only with a TMS pulse applied to a location of the MFG with anatomical connectivity to the primary somatosensory cortex (S1). TMS improved tactile WM also when distractive tactile stimuli interfered with memory maintenance. Moreover, TMS to the same MFG site attenuated somatosensory evoked responses (SEPs). The results suggest that the TMS-induced memory improvement is explained by increased top-down suppression of interfering sensory processing in S1 via the MFG-S1 link. These results demonstrate an anatomical and functional network that is involved in maintenance of tactile temporal WM.

Strength of prefrontal activation predicts intensity of suggestion-induced pain.

Suggestion, a powerful factor in everyday social interaction, is most effective during hypnosis. Subjective evaluations and brain-imaging findings converge to propose that hypnotic suggestion strongly modulates sensory processing. To reveal the brain regions that mediate such a modulation, we analyzed data from a functional-magnetic-resonance-imaging study on hypnotic-suggestion-induced pain on 14 suggestible subjects. Activation strengths in the right dorsolateral prefrontal cortex (DLPFC) during initiation of suggestion for pain correlated positively with the subjective intensity of the subsequent suggestion-induced pain, as well as with the strengths of the maximum pain-related activation in the in the secondary somatosensory (SII) cortex. Furthermore, activation of the insula and the anterior cingulate cortex predicted the pain-related SII activation. The right DLPFC, as an area important for executive functions, likely contributes to functional modulation in the modality-specific target areas of given suggestions.

Applicability of a field portable X-ray fluorescence for analyzing elemental concentration of waste samples.

Determining the chemical properties of waste is crucial to ensure the most effective utilization of waste. The standard laboratory measurements can produce accurate results, but analysis is labor- and time-consuming. The variety of elements that field portable X-ray fluorescence spectrometry (FPXRF) can detect from selected waste materials was studied, including how the results compared with those of inductively coupled plasma mass spectrometry (ICP-MS) measurements. The selected materials were fine fraction reject from solid recovered fuel production, fly ash, biowaste, and compost. Based on the results, FPXRF is reported to be best suited for waste samples, such as ash and compost, because of their physical properties, as follows: not too moist, quite small particle size, and not too heterogeneous. The results obtained from FPXRF showed the lowest relative standard deviation for ash material. The analysis of the limits of agreement between FPXRF and ICP-MS showed that FPXRF was mainly suitable for qualitative assessment. Furthermore, regression analysis showed a linear correlation between FPXRF and ICP-MS results for calcium and zinc in the selected materials. Keeping the limitations in mind, FPXRF could be used for qualitative analysis in waste treatment processes, such as first quality control of waste materials.

Brain function during multi-trial learning in mild cognitive impairment: a PET activation study.

We explored functional brain changes with positron emission tomography (PET) in mild cognitive impairment (MCI) patients and elderly normal controls by employing an episodic memory task that included two successive encoding trials of semantically related word-pairs and final retrieval. Both groups demonstrated significant learning across the two trials. The control group showed predominantly left frontal activity during encoding, and right frontal plus left temporal activity during retrieval. However, the MCI patients recruited partly different brain regions. They failed to activate right frontal and left temporal areas during retrieval, and failed to show any different activation for encoding on the first and second trials, whereas the controls activated a region of posterior cingulate. There was indication of compensatory increases in rCBF of the occipital cortex during incremental learning and the left frontal lobe during retrieval in the patients. These results suggest different episodic memory processing in the MCI group, and a possible over-reliance on semantic processing. Subtle functional changes occur in the pre-Alzheimer brain before there are marked structural or behavioural abnormalities.

Functional brain imaging, clinical and neurophysiological outcome of visual rehabilitation in a chronic stroke patient.

PURPOSE: To study rehabilitation outcome in a chronic visual field defect patient using positron emission tomography (PET) imaging, clinical, and neurophysiological measures. METHODS: A patient with chronic visual field defect was rehabilitated using a computer program over a three-month period. Evaluations of rehabilitation effects were done before and after training, and after a three-month follow-up with perimetry, visual evoked potentials (VEP), subjective questionnaire, and PET activation studies of regional cerebral blood flow (rCBF). RESULTS: In perimetry, the visual field increased during the training, and the patient also experienced subjective improvement. In VEP, a previously absent P100 component was identified after the training. In PET, increases in rCBF were diffuse immediately after the training, and more occipital after the late follow-up. A significant positive correlation between the increase in rCBF and improvement in clinical measures was found in the lingual gyrus in the contralesional hemisphere. CONCLUSIONS: All clinical measures showed improvement after rehabilitation, and this was maintained during the follow-up. In PET, a more generalized effect, found at the beginning, later concentrated in the occipital cortex. The results suggest that visual training may cause plastic changes in the brain, and that these changes can be detected both with clinical measures and with functional imaging.

Diffusion tensor imaging and tractography of distal peripheral nerves at 3 T.

OBJECTIVE: We studied whether distal peripheral nerves could be imaged using quantitative diffusion tensor imaging (DTI) with a 3-T MRI scanner, and visualized using tractography. METHODS: Altogether 6 healthy subjects were studied. The diffusion was quantified with apparent diffusion coefficient (ADC) and fractional anisotropy (FA) maps, and the direction of main diffusivity was visualized with color-coded orientation maps and tractography. RESULTS: We present the first DTI and tractography results of human distal peripheral nerves. The courses of median, ulnar, and radial nerves in the upper limb and of tibial and peroneal nerves in the lower limb were first analyzed quantifying ADC and FA, and then visualized in 3D with tractography. Tractography illustrated nicely the 3D courses of both upper and lower limb nerves which were reliably distinguished from the surrounding muscle tissue and ligaments. CONCLUSIONS: Quantitative DTI and tractography can be used to image and visualize distal peripheral nerves. SIGNIFICANCE: DTI is a quantitative method that could provide useful information for the diagnosis and follow-up of nerve lesions, entrapments, and regeneration. Peripheral nerves as well-delineated structures also containing abundant branching into bundles of different diameters, could be used as 'living phantoms' for testing and validating different tractography methods.

Regression analysis utilizing subjective evaluation of emotional experience in PET studies on emotions.

A methodological study on subject-specific regression analysis (SSRA) exploring the correlation between the neural response and the subjective evaluation of emotional experience in eleven healthy females is presented. The target emotions, i.e., amusement and sadness, were induced using validated film clips, regional cerebral blood flow (rCBF) was measured using positron emission tomography (PET), and the subjective intensity of the emotional experience during the PET scanning was measured using a category ratio (CR-10) scale. Reliability analysis of the rating data indicated that the subjects rated the intensity of their emotional experience fairly consistently on the CR-10 scale (Cronbach alphas 0.70-0.97). A two-phase random-effects analysis was performed to ensure the generalizability and inter-study comparability of the SSRA results. Random-effects SSRAs using Statistical non-Parametric Mapping 99 (SnPM99) showed that rCBF correlated with the self-rated intensity of the emotional experience mainly in the brain regions that were identified in the random-effects subtraction analyses using the same imaging data. Our results give preliminary evidence of a linear association between the neural responses related to amusement and sadness and the self-evaluated intensity of the emotional experience in several regions involved in the emotional response. SSRA utilizing subjective evaluation of emotional experience turned out a feasible and promising method of analysis. It allows versatile exploration of the neurobiology of emotions and the neural correlates of actual and individual emotional experience. Thus, SSRA might be able to catch the idiosyncratic aspects of the emotional response better than traditional subtraction analysis.

Different brain activation patterns during production of animals versus artefacts: a PET activation study on category-specific processing.

To study neural correlates of category-specific processing, we measured relative cerebral blood flow changes by PET (oxygen-15) in young healthy subjects while they produced exemplars of animals or artefacts to written subcategory prompts. In comparison to a baseline (word reading), production of animal names elicited increased rCBF in the right inferior temporal region. This fits to recent lesion data on semantic impairment with animals, as well as imaging data on object recognition and semantic retrieval. In our study, it may represent an involvement of visual imagery in generation of animal names. In contrast, production of artefact names elicited increased rCBF in frontoparietal regions previously related to attention and mental effort.

Estimation of nonstationary EEG with Kalman smoother approach: an application to event-related synchronization (ERS).

An adaptive spectrum estimation method for nonstationary electroencephalogram by means of time-varying autoregressive moving average modeling is presented. The time-varying parameter estimation problem is solved by Kalman filtering along with a fixed-interval smoothing procedure. Kalman filter is an optimal filter in the mean square sense and it is a generalization of other adaptive filters such as recursive least squares or least mean square. Furthermore, by using the smoother the unavoidable tracking lag of adaptive filters can be avoided. Due to the properties of Kalman filter and benefits of the smoothing the time-frequency resolution of the presented Kalman smoother spectra is extremely high. The presented approach is applied to estimation of event-related synchronization/desynchronization (ERS/ERD) dynamics of occipital alpha rhythm measured from three healthy subjects. With the Kalman smoother approach detailed spectral information can be extracted from single ERS/ERD samples.

Obesity is associated with white matter atrophy: a combined diffusion tensor imaging and voxel-based morphometric study.

OBJECTIVE: Little is known about the mechanisms by which obesity influences brain structure. In this study, the obesity-related changes in brain white and gray matter integrity were examined. DESIGN AND METHODS: 23 morbidly obese subjects and 22 nonobese volunteers were studied using voxel-based analysis of diffusion tensor imaging and of T1-weighted MRI images. Full-volume statistical parametric mapping analysis was used to compare fractional anisotropy (FA) and mean diffusivity (MD) values as well as gray (GM) and white matter (WM) density between these groups. RESULTS: Obese subjects had lower FA and MD values and lower focal and global GM and WM volumes than control subjects did. The focal structural changes were observed in brain regions governing reward seeking, inhibitory control, and appetite. Regression analysis showed that FA and MD values as well as GM and WM density were negatively associated with body fat percentage. Moreover, the volume of abdominal subcutaneous fat was negatively associated with GM density in most regions. CONCLUSION: These findings imply that changes in GM and WM in obesity may be due to metabolic factors. Atrophy in regions involved in reward processing and appetite control may further promote abnormal reward seeking and eating behavior.

Evaluation of voxel-based group-level analysis of diffusion tensor images using simulated brain lesions.

We simulated brain lesions in mean diffusivity (MD) and fractional anisotropy (FA) images of healthy subjects to evaluate the performance of voxel-based analysis (VBA) with SPM2. We increased MD and decreased FA, simulating the most typical abnormalities in brain pathologies, in the superior longitudinal fasciculus (SLF), corticospinal tract (CST), and corpus callosum (CC). Lesion sizes varied from 10 to 400 voxels (10.5 mm³ each) and intensity changes from 10 to 100%. The VBA contained eddy current correction, spatial normalization, smoothing, and statistical analysis. The preprocessing steps changed the intensities of MD and FA lesions from the original values, and many lesions remained undetected. The detection thresholds varied between the three brain areas, and between MD and FA images. Although spatial smoothing often improved the sensitivity, it also markedly enlarged the estimated lesion sizes. Since conventional VBA preprocessing significantly affected the outcome and sensitivity of the method itself, the impact of analysis steps should be verified and considered before interpreting the findings. Our results provide insight into the sizes and intensity changes of lesions that can be detected with VBA applied to diffusion tensor imaging (DTI) data.

Facilitation of tactile working memory by top-down suppression from prefrontal to primary somatosensory cortex during sensory interference.

Tactile working memory (WM) is improved by increasing top-down suppression of interfering sensory processing in S1 via a link from the middle frontal gyrus (MFG) to S1. Here we studied in healthy subjects whether the efficacy of top-down suppression varies with submodality of sensory interference. Navigated stimulation of the MFG-S1 link significantly improved tactile WM performance when accompanied by tactile but not visual interference of memory maintenance.

Central executive function in mild cognitive impairment: a PET activation study.

Using positron emission tomography (PET), we explored the neural correlates of an executive function, dual tasking, in patients with amnestic mild cognitive impairment (aMCI) and in elderly controls. The experiment employed simple auditory and visual tasks that were presented both in isolation and simultaneously to create a task condition requiring enhanced attentional control. Behaviorally, both groups performed well, albeit the patients made more errors on the visual task. The PET analysis focused at prefrontal regions where group differences in task-related activation patterns were expected. During dual task performance, the patients showed attenuated activity in the left inferior frontal region when compared to the controls. This suggests abnormalities in the neural processes underlying attentional control in aMCI.

Phantom-based evaluation of geometric distortions in functional magnetic resonance and diffusion tensor imaging.

Phantom-based evaluation of geometric distortions in functional MRI and diffusion tensor imaging (DTI) was investigated. An acrylic water-filled phantom with a grid structure was designed and manufactured to provide accurate geometric information over the volume measured in human brain imaging. The grid structures were well detected in data acquired using a 3-T MRI scanner with echo-planar imaging (EPI) sequences commonly applied in functional MRI and DTI. A method for quantifying distortions in the phantom data was presented and applied for the images. The validity of the phantom for EPI was evaluated by quantitatively comparing the distortions present in and induced by the phantom and a human brain when imaged under identical conditions. The results suggest that the new phantom can reveal geometric distortions easily undermined by standard MRI phantoms. For example, prominent variability in the distortions was found as a function of the orientation of the diffusion-sensitizing gradient. Possible future applications for this type of phantom include quality assurance and calibration of the hardware and software used in EPI-based functional MRI and DTI.

Quantification of mechanical vibration during diffusion tensor imaging at 3 T.

Subjects sense clear mechanical vibrations during diffusion tensor imaging (DTI). These vibrations, likely resulting from diffusion-sensitizing gradients, have been assumed to be of the same strength and phase in all parts of the magnetic resonance imaging (MRI) scanner so that they could be ignored. However, our measurements, carried out from several parts of the MRI scanner and its surroundings using an optical laser-based interferometer, demonstrate an uneven distribution of mechanical vibrations within the scanner. The measurements were performed during DT scanning at 3 T, with various diffusion-weighting parameters, by positioning a phantom in the head coil and/or a human subject on the patient bed. The vibration-related movement was caused by the diffusion-sensitizing gradients and was maximally 0.5 mm with typical settings used in brain imaging. The compensation for eddy currents, done with gradients in our DTI sequence, increased the vibration level by a factor of 1.5 or more with diffusion-weighting parameter b = 1000 s/mm(2) and by a factor of 3 or more with b = 3000 s/mm(2). Mechanical vibrations stayed at an acceptable level with b < or = 1000 s/mm(2), resulting in additional signal losses of 5-17%. Vibration levels might be reduced by adjusting imaging parameters, by modifying the gradient waveforms in the DTI sequence, and by redesigning the mechanics of patient bed to effectively dampen the movements.

Brain correlates of subjective reality of physically and psychologically induced pain.

Meaningful behavior requires successful differentiation of events surfacing from one's mind from those arising from the external world. Such judgements may be especially demanding during pain because of the strong contribution from psychological factors to this experience. It is unknown how the subjective reality of pain (SRP) is constructed in the human brain, and neuronal mechanisms of the subjective reality are poorly understood in general. To address these questions, 14 suggestion-prone healthy subjects rated reality of pain that was induced either by laser pulses to the skin or by hypnotic suggestion during functional MRI. Both pain states were associated with activation of the brain's pain circuitry. During laser stimulation, the sensory parts of this circuitry were activated more strongly, and their activation strengths correlated positively with the SRP. During suggestion-induced pain, the reality estimates were lower and correlated positively with activation strengths in the rostral and perigenual anterior cingulate cortex and in the pericingulate regions of the medial prefrontal cortex; a similar trend was evident during laser-induced pain. These findings support the view that information about sensory-discriminative characteristics of pain contributes to the SRP. Differences in such information between physically and psychologically induced pain, however, could be quantitative rather than qualitative and therefore insufficient for judging the reality of pain without knowledge about the source of this information. The medial prefrontal cortex is a likely area to contribute to such source monitoring.

Naming multiple objects: neural correlates as measured by positron emission tomography.

The aim of this study was to examine the neural substrates of multi-object naming by positron emission tomography in normals. Multi-object naming is used in a technique called contextual priming (CP) to elicit contextual effects on picture naming through systematic manipulation of the relatedness of to-be-named pictures in an array. Inhibitory and facilitatory effects of CP on naming have been used both to highlight the inner dynamics of the normal word retrieval system and to treat naming difficulties caused by acquired anomia. Because of the complexity of the CP technique, it is unclear whether it merely reflects lexical retrieval or whether it also recruits general cognitive resources such as attentional control and response selection to a significant degree. When compared with a baseline situation in which colored circles were named, multi-object naming elicited increased blood flow in the occipital lobe and in the left inferior temporal and fusiform gyri. These areas have been related to visual pattern recognition and semantic access, and the pattern of activation is in line with previous functional imaging studies on single picture naming. In conclusion, multi-object naming does not appear to activate brain regions beyond those needed for single object naming. These findings thus provide independent evidence for the claim that CP is a valid paradigm for the study of word production proper.

Cortical activation during a spatiotemporal tactile comparison task.

Tactile sensory memory is needed to infer shape or motion from the spatiotemporal pattern of sensory input during manual exploration. Here we applied triplets of pressure pulses to the fingertips of subjects who were asked to respond when successive triplets were the same (COMPARE task) or when a particular stimulus was included in a triplet (CONTROL task). Stimulus sequences (30 s) alternated with rest blocks (30 s) and functional magnetic resonance images (fMRIs) were acquired in a 1.5-T scanner. During the COMPARE task, we found enhanced activation in inferior parietal cortex, supplementary motor area (SMA), and right dorsolateral prefrontal cortex (DLPFC). Activation of DLPFC is likely to be related to the attempt to memorize the stimulus sequences and activations of SMA and inferior parietal cortex to the analysis of temporospatial tactile patterns and, more generally, to guidance of haptic exploration. In addition, task-specific activation was seen in anterior cingulate gyrus, possibly related to the high mental effort required by the comparison task. Our rhythmic tactile stimulus as such, without any task-specific enhancement, activated also left cerebellum and (mainly left) putamen, supporting the idea that these structures are related to perception of temporal order of tactile stimuli.