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.

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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

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diagno

stic

studies

Biochemical

Studies

Genetic studies