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I. Uses of Neuroimaging
Neuroimaging methodologies allow meas of the structure, func & chemistry of the living human brain.
CT Structural brain lesions, Tumors, Stroke
MRI Distinguish better Gray & White Matter & Better visualization of smaller lesions
PET & SPECT Insights into brain function
Indications for ordering neuroimaging in clinical practice
1. Neurological deficits, suspicion of CNS Disorder, New-onset psychosis, acute changes in MSE.
2. Dementia. Alzheimer's disease is the most common associated with diffuse brain loss.
Normal pressure hydrocephalus is a treatable cause of dementia that requires neuroimaging for D
3. Strokes. Easily seen on MRI scans.
4. Vascular dementia is characterized on MRI scans by patches of increased signal in the WM.
5. Degenerative disorders. Of basal ganglia structures.
Huntington's disease typically produces atrophy on the caudate nucleus
Thalamic degeneration can interrupt the neural links to the cortex.
6. Space-occupying lesions can cause dementia (SDH, Cerberal contusions, Brain Tumors).
7. Chronic infections. Neurosyphilis, TB, Lyme disease charac enhancement of the meninges
HIV infection diffuse loss of brain volume.
Multiple sclerosis plaques on MRI as periventricular patches of increased signal intensity.
A. Function: Positron emitters (eg. Carbon 11, fluorine 18) are used to label glucose aminoacids,
neurotransmitter percursors, & other molecules to measure receptor densities, Br Function
B. Ads: Labeled antipsychotics can map out location and density of dopamine receptors.
Can assess regional brain function and blood flow.
2- Deoxyglucose is absorbed into cells as easily as glucose but is not metabolized.
Can be used to measure regional glucose uptake.
Compares laterality, anteroposterior gradients, and cortical-to-subcortical gradient.
C. Findings reported in schizophrenia.
1) Cortical hypofrontality.
2) Steeper subcortical-to-cortical gradient.
3) Uptake decreased in left compared with right cortex.
4) Higher rate of activity in left temporal lobe.
5) Lower rate of metabolism in left basal ganglia
6) Higher density of Dopamine receptors
7) Greater increase in metabolism in ant brain reg in resp to unpleasant stim (not spec)
9. Magnetoencephalography
A. Function: Research tool.
Uses conventional and computerized EEG data.
Detects magnetic fields associated with neuronal activity in cortical and deep brain structures.
Noninvasive with no radiation exposure.
Cortical hypofrontality.
Steeper subcortical-to-cortical gradient.
Uptake decreased in left compared with right cortex.
Higher rate of activity in left temporal lobe.
Lower rate of metabolism in left basal ganglia
Higher density of Dopamine receptors
Greater increase in metabolism in ant brain reg in resp to unpleasant stim (not spec)
3- BEAM
Evoked potentials differ spatially and temporally; beta-wave activity is increased in certain
regions; delta-wave activity is increased, most prominently in the frontal lobes.
4- rCBF
CBF in the dorsolateral frontal lobe may be decreased & CBF in the left hemisphere may be
increased during activation. (WCST) No differences have been found in resting patients.
5- fMRI
Less frontal activation and more left temporal activation during a word fluency task.
6- MRS
Decreased adenosine triphosphate and inorganic orthophosphate levels,
suggestive of dorsal prefrontal hypoactivity.