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Neuroimaging in Neurological Diseases
Seung Bong Hong, MD, PhD
Department of Neurology, Samsung Medical CenterSungkyunkwan University School of Medicine
Decade of Brain
Century of Brain
Techniques
• Volumetry, voxel-based morphometry
• SPECT, PET subtraction
• SPM analysis of SPECT, PET
• Multi-modality image processing
Volumetry
• Hippocampal volumetry
• Frontal lobe volume
• Temporal lobe volume
• The area of corpus callosum
Hippocampal volumetry
• Epilepsy: temporal lobe epilepsy
• Dementia
• Memory dysfunction
• Status epilepticus
측정하는 구조물• Hippocampus, dentate gyrus• Subiculum, Alveus
Autopsy Brain MRI
Amygdala-hippocampus border
Hippocampal Volume in Normal Subjects
Reported normal hippocampal volume values(Reported normal hippocampal volume values(unnormalizedunnormalized))
RightRight
LeftLeft
Radiology Radiology ‘‘8989Jack et al.Jack et al.
AJNR AJNR ‘‘9191AshtariAshtari et al.et al.
Brain Brain ‘‘9292Cook et al.Cook et al.
Neurology Neurology ‘‘9292Watson et al.Watson et al.
Neurology Neurology ‘‘9393CendesCendes et al.et al.
Neurology Neurology ‘‘9393BhatiaBhatia et al.et al.
28002800
2500250025982598
2727272731853185
3229322952655265
4903490347114711
4591459137703770
37803780
RightRight
LeftLeft
Hong, et al., KoreaHong, et al., Korea
3350.8 ± 368.43104.3 ± 365.7
Summary of hippocampal volumetry
(n=72)• Right HV was significantly larger than left HV
(right: 3350.8 ± 368.4 mm3, left: 3104.3 ± 365.7 mm3, p<0.01).
• Corrected HV by ICV was larger in female than in male (p<0.01) and maintains significant right/left difference (p<0.01).
• ICV, WBV and hippocampal volume were negatively correlated with age (ICV: r=-0.43, p<0.01, WBV: r=-0.61, p<0.01).
hand knob
The measurement of frontal lobe volume on SPGR axial MRI. Centralsulcus was identified with the hand knob(solid arrow) in precentral gyrus. The posterior margin of the frontal lobe is delineated by the central sulcus. Other detailed boundary criteria was adopted from Aylward EH’s study.
3D Whole brain & 3D Frontal lobe
Temporal lobe volumetry
After reconstruction of longitudinal axis of hippocampus, temporal lobe was segmented with the boundary of CSF, hippocampus, and posterior end of splenium.
Posterior end of splenium
• Witelson’s criteria .
1. Rostrum Caudal/orbital prefrontal, inf. premotor2. Genu Prefrontal3. Rostral body Premotor, supplementory motor4. Anterior midbody Motor5. Posterior midbody Somaesthetic, post. parietal6. Isthmus Superior temporal, posterior parietal7. Splenium Occipital, inferior temporal
Anatomical divisions of Corpus Callosum
정확한 mid-sagittal image 획득
Corpus callosum Mid-sagittal area
* * Scion Image 4.02(Window version of NIH image)Scion Image 4.02(Window version of NIH image)
Voxel-based morphometry: juvenile myoclonic epilepsy
Normal : JME = 19 : 19 cases
The 3D view of voxel-based morphometry
The Abnormality of Frontal Lobe and Basal Banglia in Juvenile Myoclonic
Epilepsy
• Rostrum and rostral body of CC and left hippocampus were significantly smaller while the left frontal lobe was significantly larger in JME than in normal subjects.
• Decreased gray matter concentration (GMC) was found in left dorsolateral-prefrontal lobe, bilateral medial prefrontal lobe, and left temporalgyrus while increased GMC was found in bilateral putamen and globus pallidus, and right caudate nucleus.
SPECT subtraction
Interictal SPECT Ictal SPECT
Ictal SPECT
Interictal SPECT
Right SMA epilepsy
Brain MRI, FDG-PET: normal, EEG: non-lateralized
KKH: Right mesial TLE
Brain MRI: normal, EEG: Rt. fronto-central
Longitudinal PET subtraction
MMSE 변화
0
5
10
15
20
25
30
97/12 98/06 98/12 99/06 99/12 00/06 00/12 01/06 01/12 02/06
Date
MM
SE S
core
Shunt Operation
PET 1 2 3
SDH Operation
MMSE 변화
NPH + Alzheimer’s disease
Pre-opFDG-PET
PETsubtraction(Post –Pre-opFDG-PET)
1999PET – 2002PET
Alzheimer’s disease process
SPM analysis of SPECT
With dystonia : without dystonia = 10:11 patients
Ictal hyperperfusion of dystonia group of R-MTLE: in comparison with the group without dystonia
TLE : normal = 29 : 15 casesFDR corrected p < 0.001
Lt. Lt. mesialmesial Temporal Lobe EpilepsyTemporal Lobe EpilepsyInterictal hypoperfusion Ictal hyperperfusion
SPM analysis of FDG-PET
Front Rear
RL
Basal
L
R
-34 -24 -14
-4 4 14 24
34 44 54 64
-44
L R
SPM analysis of FDG-PET between Normal group and Frontotemporal dementia
Multi-modality image processing
• SPECT-MRI, PET-MRI
• MRI-CT
• MRI(SPGR)-MRI(FLAIR)
• MRI-SPECT-lesion
• MRI-SPECT-lesion-brain stimulation
불명확한뇌 MRI 병변
Fused ImageMRI-PET-gridco-registration
Central sulcus
KHJ
Registered PET
Fused MRI and PET
Transform Matrix
Source image
Binary image
Registration
Segmented image
Localization of intracranial electrodes(MRI-CT co-registration)
Interictal SPECT
Ictal SPECT
SubtractedSPECT
Concordant to epileptogenic zone
SMY: normal brain MRI and FDG-PET
MRI lesion Subtracted SPECT
Subdural grid electrodes
Intracranial Recording and Resection of Epileptic Focus
2nd – 5th finger motor
Thumb motor
Tonguemotor
Toe motorNegative motor
Interictal spikes Ictal onset zone
Neurological diseases
Neuro-imaging
Clinicalsymptoms
Neuro
logica
l
signs
Electro
-
diagno
stic
studies
Biochemical
Studies
Genetic studies