Left Middle Cingulate Gyrus Research Articles

Altered dynamic regional homogeneity in patients with conduct disorder

Conduct disorder (CD) is a psychiatric condition characterized by severe aggressive and antisocial behaviors. Prior neuroimaging work reported that CD is associated with abnormal resting-state local intrinsic brain activity (IBA). However, few studies detected the time-varying brain activity patterns in CD. In this study, eighteen adolescent patients with CD and 18 typically developing controls underwent resting-state functional magnetic resonance imaging scans. We then compared the dynamic characteristics of IBA by calculating the dynamic regional homogeneity (dReHo) through a sliding-window approach between the two groups, and the correlations between the dReHo variability and clinical symptoms in CD were further examined. Moreover, the statistical between-group differences in dReHo were selected as classification features to help distinguish CD patients from controls by adopting a linear support vector machine (SVM) classifier. CD patients showed increased dReHo variability in the left precuneus, right postcentral gyrus, right precentral gyrus, left middle cingulate gyrus, and left paracentral lobule compared to controls, and dReHo variability in the left precuneus was significantly positively associated with impulsiveness scores in CD patients. Importantly, SVM combined with the leave-one-out cross-validation method results demonstrated that 75% (p < 0.001) subjects were correctly classified with sensitivity of 61% and specificity of 89%. Our results provided the initial evidence that CD is characterized by abnormal dynamic IBA patterns, giving novel insights into the neuropathological mechanisms of CD. Further, our findings exhibited that the dReHo variability may distinguish CD patients from controls with high accuracy.

Neuronal Signatures of Negative and Positive Schemas towards the Self and Others in Patients with Early Stage Schizophrenia.

ObjectiveThe present study investigated the functional neuroanatomy underlying negative and positive schemas towards the self and others in patients with early stage schizophrenia spectrum disorders (SSDs) using a task-based fMRI procedure. MethodsThis study included 50 patients with SSDs and 52 controls. The schema-evoking task consisted of four active conditions and neutral condition. Differences in brain activation were compared between the two groups. Correlation analysis was performed between task-related activation and psychopathology. ResultsThe SSD patients exhibited higher activity of the left middle and inferior frontal gyri under the negative-others minus neutral contrast as well as greater activation of the left superior and middle frontal gyri and right medial superior frontal gyrus under the positive-self minus neutral and positive-others minus neutral contrasts. Under the positive-others minus neutral contrast, negative correlation was observed between activity of the right inferior parietal gyrus and right angular and total score of the Positive and Negative Syndrome Scale (PANSS), whereas positive correlation between activity of the left middle cingulate gyrus and left/right precuneus and positive-others score of the Brief Core Schema Scales (BCSS). Conclusion The present findings suggest that the frontal brain regions of SSD patients are more sensitive to negative and positive schemas towards the self and/or others compared to those of controls.

Changes in the regional homogeneity of resting-state magnetic resonance imaging in perimenopausal women

BackgroundThere is a noticeable lack of systematic researches on evaluating the correlation between serum estrogen levels and changes in brain functional areas of perimenopausal women.The aim of this study is to investigate the regional spontaneous brain activity changes in perimenopausal women.MethodsBased on the resting-state functional magnetic resonance imaging datasets acquired from 25 perimenopausal women and 20 healthy women of reproductive age, a two-sample t-test was performed on individual normalized regional homogeneity (ReHo) maps. Relationships between abnormal ReHo values and the self-rating anxiety scale (SAS), the self-rating depression scale (SDS) were investigated with Pearson correlation analysis. We also investigated the correlation between abnormal ReHo values and serum estrogen level.ResultsIn the perimenopausal group, we found increased ReHo in the right posterior cerebellum (region 2), left middle frontal gyrus and left middle cingulate gyrus (P<0.05). Additionally, the ReHo values in left middle frontal gyrus and leftt middle cingulate gyrus showed positively significant correlation with the SAS, SDS scores. On the contrary, there was no significant correlation between the ReHo value in right posterior cerebellum and SDS, SAS scores. In the perimenopausal group, the ReHo values in the left middle frontal gyrus and left middle cingulate gyrus were negatively correlated with the serum estrogen level (P<0.05).ConclusionThe results of this preliminary study have suggested that abnormal spontaneous activities of multiple brain regions during resting state was already altered in perimenopausal women. Alterative activities might be related to emotional regulation deficits and cognitive impairment, and might potentially represent the neural mechanism underlying perimenopausal period.

Impaired frontal-parietal control network in chronic prostatitis/chronic pelvic pain syndrome revealed by graph theoretical analysis: A DTI study.

Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is characterized by chronic pain in pelvic area and lower urinary tract symptoms (LUTS). Previous neuroimaging studies demonstrated that chronic pain was associated with the altered brain activity. However, the pathological mechanisms associated with altered brain control of CP/CPPS are not well-understood. Therefore, we sought to investigate the topological properties of white matter brain networks in patients with CP/CPPS and whether the topological configuration of frontal-parietal control network was disrupted. We collected 19 patients with CP/CPPS and 32 matched healthy controls (HCs). Diffusion tensor imaging data of all participates were used to map the white matter structural networks. Graph theoretical method was applied to investigate the alterations of topological properties of brain network in patients. Moreover, we also investigated whether the alerted brain regions might be correlated with any clinical features of patients by the method of Pearson correlation analysis. Both CP/CPPS patients and HCs exhibited a 'small-world' behavior or economical small-world architecture of the white matter brain networks. In addition, CP/CPPS had a lower global efficiency in the right middle frontal gyrus (orbital part) and a higher global efficiency in the left middle cingulate and paracingulate gyri. CP/CPPS also showed increased local efficiency in the left middle cingulate and paracingulate gyri and paracentral lobule. Moreover, the local efficiency of the left middle cingulate gyrus was positively correlated with the scores of the influence of symptoms on the quality of life. The local efficiency of the left precuneus and right supplementary motor area were positively correlated with the total scores of NIH-CPSI and the scores of pain and discomfort symptoms, respectively. Together, we found that patients with CP/CPPS had alterations of connections within the frontal-parietal control network, which suggested that the altered connectivity involved in the executive control processing procedures might contribute to the pathogenesis of the pelvic pain and LUTS in CP/CPPS. Thus these results provided new insights into the understanding of CP/CPPS.

Abnormal Regional Spontaneous Neural Activity in Nonarteritic Anterior Ischemic Optic Neuropathy: A Resting-State Functional MRI Study.

Objective To explore altered regional neuronal activity in patients with nonarteritic anterior ischemic optic neuropathy (NAION) and its correlation with clinical performances using the regional homogeneity (ReHo) method, which is based on resting-state functional magnetic resonance imaging (fMRI). Method Thirty-one patients with NAION (20 males, 11 females) and 31 age- and sex-matched normal controls (NCs) (20 males, 11 females) were enrolled in the study. All patients underwent ophthalmic examination, including eyesight, intraocular pressure measurement, optimal coherence tomography (OCT), visual field analysis, and fMRI scans. After ReHo was calculated, we investigated group differences in results between the patients and NCs. We analyzed the relationship between ReHo values for different brain regions in patients with NAION and intraocular pressure, visual field analysis, and OCT. A receiver operating characteristic (ROC) curve was used to assess the diagnostic ability of the ReHo method. Results Compared with NCs, patients with NAION exhibited higher ReHo values in the left middle frontal gyrus, left middle cingulate gyrus, left superior temporal gyrus, and left inferior parietal lobule. Additionally, they exhibited lower ReHo values in the right lingual gyrus, left putamen/lentiform nucleus, and left superior parietal lobule. ReHo values in the left superior parietal lobule were negatively correlated with right retinal nerve fiber layer values (r = −0.462, P = 0.01). The area under the ROC curve for each brain region indicated that the ReHo method is a credible means of diagnosing patient with NAION. Conclusion NAION was primarily associated with dysfunction in the default mode network, which may reflect its underlying neural mechanisms.

Low CSF β-amyloid levels predict early regional grey matter atrophy in multiple sclerosis

Background and purposeGrey matter (GM) atrophy is present from the earliest stages of multiple sclerosis (MS) and occurs largely in a nonrandom manner. However, the biological mechanisms underlying the progression of regional atrophy are still unclear. Aim of this study is to investigate whether amyloid pathology might be involved in determining the pattern of GM atrophy over time. MethodsForty-six subjects were recruited: 31 newly diagnosed relapsing-remitting (RR-) MS patients and 15 age- and sex-matched healthy controls (HC). Aβ levels were determined in CSF samples from all subjects. All participants underwent brain magnetic resonance imaging (MRI) at baseline, and 23 out of 31 patients at one year follow-up. T1-weighted scans were segmented using the Geodesic Information Flows software. Non-parametric statistical tests were used for between-group comparisons and multiple regression analyses. ResultsCSF Aβ concentration was the best predictor of global GM loss over time after age (β = 0.403; p = 0.024), in particular in the left precuneus (p = 0.045), in the left middle cingulate gyrus (p = 0.009), in the left precentral gyrus (p = 0.021) and in the right angular gyrus (p = 0.029). ConclusionsCSF Aβ levels seem to be crucial in MS early brain volume loss as GM atrophy manifests in regions particularly vulnerable to early Aβ deposition.

Different Patterns of Functional Connectivity Alterations Within the Default-Mode Network and Sensorimotor Network in Basal Ganglia and Pontine Stroke.

BackgroundThe aim of this study was to investigate whether patients with basal ganglia stroke and patients with pontine stroke have different types of functional connectivity (FC) alterations in the early chronic phase.Material/MethodsWe included 14 patients with pontine stroke, 17 patients with basal ganglia stroke, and 20 well-matched healthy controls (HCs). All of them underwent resting-state functional magnetic resonance imaging (rs-fMRI) scanning. The independent component analysis (ICA) approach was applied to extract information regarding the default-mode network (DMN), including anterior DMN (aDMN) and posterior DMN (pDMN) components and the sensorimotor network (SMN).ResultsCompared with HCs, patients with basal ganglia stroke exhibited significantly reduced FC in the left precuneus of the pDMN, right supplementary motor area (SMA), and right superior frontal gyrus (SFG) of the SMN. Additionally, FC in the left medial prefrontal gyrus (MFG) of the aDMN, right precuneus and right posterior cingulate cortex (PCC) of the pDMN, and left middle cingulate gyrus (mid-CC) of the SMN decreased in patients with pontine stroke.ConclusionsThe different patterns of FC damage in patients with basal ganglia stroke and patients with pontine stroke in the early chronic phase may provide a new method for investigating lesion-induced network plasticity.

Learning to play badminton altered resting-state activity and functional connectivity of the cerebellar sub-regions in adults.

Previous studies have shown that sport experts are different from novices in functions and structures of the cerebellar sub-regions and the functional connectivity (FC) associated with the cerebellum, suggesting the role of the cerebellum on motor skill learning (MSL). However, the manipulation of individuals with different motor skills fails to exclude the effects of innate talents. In addition, individuals with higher motor skills often start with the MSL in their young ages. It is still unclear whether the effects regarding the cerebellum would be shown at one’s adult age. The present study was to directly alter individuals’ motor skills to investigate whether MSL (taking learning to play badminton as an example) in adulthood influences resting-state activity in the cerebellum. To this end, young adults without ball training experience were recruited as participants and were assigned randomly into the experimental group and the control group. Participants in the experimental group were asked to attend a badminton training course for 12 weeks, while the control group did not regularly attend any ball sports during this period. Resting-state functional magnetic resonance imaging (fMRI) was recorded before and after the training. Results showed that compared to the control group, the experimental group had smaller amplitude of low-frequency fluctuation (ALFF) in right cerebellar hemispheric VI and left VIII after training. For the experimental group, right hemispheric VIII had a stronger FC with left hemispheric IV-V, cerebellar vermal IX, left middle cingulate gyrus and right hippocampus after training. Taken together, these findings suggested that MSL, at least learning to play badminton in adulthood, reduces resting-state activity in different sub-regions in the cerebellum but increases FC between sub-regions of the cerebellum as well as between sub-regions of the cerebellum and cerebral cortices (e.g., middle cingulate cortex and hippocampus).

Functional network connectivity changes in children with attention-deficit hyperactivity disorder: A resting-state fMRI study

The study aimed to investigate the pathologic mechanism of functional brain regions in attention-deficit hyperactivity disorder (ADHD) patients through making comparisons of normal and ADHD children from the perspective of the network nodes of brain network and the intensity of functional connection between bilateral of hemispheres by resting-state functional magnetic resonance imaging (fMRI). Thirty-five ADHD and forty-two children were examined by resting-state functional magnetic resonance imaging (fMRI) scans. Data analysis was done via the degree centrality (DC) and voxel-mirrored homotopic connectivity (VMHC) approaches. Compared with healthy subjects, the ADHD group exhibited significantly decreased DC values in the right posterior cingulate gyrus, left medial superior frontal gyrus, right inferior parietal gyrus, right middle frontal gyrus, left superior frontal gyrus and right superior frontal gyrus. Children with ADHD also exhibited some areas with increased DC values compared with healthy children. These regions included the cerebellar anterior lobe, right middle occipital cortex, left middle cingulate gyrus and right middle cingulate gyrus. VMHC analysis all revealed positive activation in a range of brain regions when comparing ADHD and normal children, suggesting that the VMHC scores of children with ADHD were higher in the bilateral superior frontal lobe, bilateral middle occipital lobe, and bilateral cerebellar anterior lobes. This work provides a new approach for examining the neural mechanisms underlying ADHD, demonstrating that the DC and VMHC methods enabled more comprehensive analysis that can be cross-checked.

CSF glial biomarkers YKL40 and sTREM2 are associated with longitudinal volume and diffusivity changes in cognitively unimpaired individuals.

Cerebrospinal fluid (CSF) YKL40 and sTREM2 are astroglial and microglial activity biomarkers, respectively. We assessed whether CSF YKL40 and sTREM2 baseline levels are associated with longitudinal brain volume and diffusivity changes in cognitively unimpaired adults. Two brain MRI scans of 36 participants (57 to 78-years old, 12 male) were acquired in a 2-year interval. Aβ42, p-tau, YKL40 and sTREM2 concentrations in CSF were determined at baseline. We calculated gray and white matter volume changes per year maps (ΔGM and ΔWM, respectively) by means of longitudinal pairwise registration, and mean diffusivity variation per year (ΔMD) by subtraction. We checked voxel-wise for associations between ΔGM, ΔWM and ΔMD and baseline CSF level of YKL40 and sTREM2 and verified to what extent these associations were modulated by age (YKL40xAGE and sTREM2xAGE interactions). We found a positive association between ΔGM and YKL40 in the left inferior parietal region and no association between sTREM2 and ΔGM. Negative associations were also observed between ΔGM and YKL40xAGE (bilateral frontal areas, left precuneus and left postcentral and supramarginal gyri) and sTREM2xAGE (bilateral temporal and frontal cortex, putamen and left middle cingulate gyrus). We found negative associations between ΔWM and YKL40xAGE (bilateral superior longitudinal fasciculus) and sTREM2xAGE (bilateral superior longitudinal fasciculus, left superior corona radiata, retrolenticular external capsule and forceps minor, among other regions) but none between ΔWM and neither YKL40 nor sTREM2. ΔMD was positively correlated with YKL40 in right orbital region and negatively with sTREM2 in left lingual gyrus and precuneus. In addition, significant associations were found between ΔMD and YKL40xAGE (tail of left hippocampus and surrounding areas and right anterior cingulate gyrus) and sTREM2xAGE (right superior temporal gyrus). Areas showing statistically significant differences were disjoint in analyses involving YKL40 and sTREM2. These results suggest that glial biomarkers exert a relevant and distinct influence in longitudinal brain macro- and microstructural changes in cognitively unimpaired adults, which appears to be modulated by age. In younger subjects increased glial markers (both YKL40 and sTREM2) predict a better outcome, as indicated by a decrease in ΔGM and ΔWM and an increase in ΔMD, whereas in older subjects this association is inverted and higher levels of glial markers are associated with a poorer neuroimaging outcome.

Insight and emotion regulation in schizophrenia: A brain activation and functional connectivity study.

BackgroundInsight is impaired in the majority of schizophrenia patients. The exact neural correlates of impaired insight remain unclear. We assume that the ability to regulate emotions contributes to having good clinical insight, as patients should be able to regulate their emotional state in such a way that they can adapt adequately in order to cope with impaired functioning and negative stigma associated with a diagnosis of schizophrenia. Numerous studies have shown emotional dysregulation in schizophrenia. We investigated the association between insight and brain activation and connectivity during emotion regulation.MethodsBrain activation during emotion regulation was measured with functional MRI in 30 individuals with schizophrenia. Two emotion regulation strategies were examined: cognitive reappraisal and expressive suppression. Clinical insight was measured with the Schedule for the Assessment of Insight – Expanded, and cognitive insight was measured with the Beck Cognitive Insight Scale. Whole brain random effects multiple regression analyses were conducted to assess the relation between brain activation during emotion regulation and insight. Generalized psychophysiological interaction (gPPI) was used to investigate the relation between task-related connectivity and insight.ResultsNo significant associations were found between insight and neural correlates of cognitive reappraisal. For clinical insight and suppression, significant positive associations were found between symptom relabeling and activation in the left striatum, thalamus and insula, right insula and caudate, right pre- and postcentral gyrus, left superior occipital gyrus and cuneus and right middle and superior occipital gyrus and cuneus. Furthermore, reduced clinical insight was associated with more connectivity between midline medial frontal gyrus and right middle occipital gyrus. For cognitive insight and suppression, significant positive associations were found between self-reflectiveness and activation in pre- and postcentral gyrus and left middle cingulate gyrus.ConclusionsOur results suggest an association between the capacity to relabel symptoms and activation of brain systems involved in cognitive-emotional control and visual processing of negative stimuli. Furthermore, poorer self-reflectiveness may be associated with brain systems subserving control and execution.

Spatial&amp;ndash;temporal signature of resting-state BOLD signals in classic trigeminal neuralgia

Resting-state functional magnetic resonance imaging (R-fMRI) signals are spatiotemporally organized. R-fMRI studies in patients with classic trigeminal neuralgia (CTN) have suggested alterations in functional connectivity. However, far less attention has been given to investigations of the local oscillations and their frequency-specific changes in these patients. The objective of this study was to address this issue in patients with CTN. R-fMRI data from 17 patients with CTN and 19 age- and gender-matched healthy controls (HCs) were analyzed using amplitude of low-frequency fluctuation (ALFF). The ALFF was computed across different frequencies (slow-4: 0.027–0.073 Hz; slow-5: 0.01–0.027 Hz; and typical band: 0.01–0.08 Hz) in patients with CTN compared to HCs. In the typical band, patients with CTN showed increases of ALFF in bilateral temporal, occipital, and left middle frontal regions and in the left middle cingulate gyrus, as well as decreases of ALFF in the right inferior temporal region and in regions (medial prefrontal regions) of default mode network. These significant group differences were identified in different sub-bands, with greater brainstem findings in higher frequencies (slow-4) and extensive default mode network and right postparietal results in lower frequencies (slow-5). Furthermore, significant relationships were found between subjective pain ratings and both amplitudes of higher frequency (slow-4) blood oxygen level-dependent (BOLD) signals in pain localization brain regions and lower frequencies (slow-5) in pain signaling/modulating brain regions in the patients, and decreased ALFF within the prefrontal regions was significantly correlated with pain duration in the patients. This result supports our hypothesis that trigeminal pain has a characteristic spatiotemporal distribution of low-frequency BOLD signals. These findings might contribute to a better understanding of the impact of CTN on the brain’s intrinsic architecture. Future studies should take the frequencies into account when measuring brain resting BOLD signals of patients with CTN.

A Cross-Sectional Voxel-Based Morphometric Study of Age- and Sex-Related Changes in Gray Matter Volume in the Normal Aging Brain.

The aim of the study was to carry out a cross-sectional study of 124 cognitively normal Chinese adults using the voxel-based morphometry approach to delineate age-related changes in the gray matter volume of regions of interest (ROI) in the brain and further analyze their correlation with age. One hundred twenty-four cognitively normal adults were divided into the young age group, the middle age group, and the old age group. Conventional magnetic resonance imaging was performed with the Achieva 3.0 T system. Structural images were processed using VBM8 and SPM8. Regions of interest were obtained by WFU PickAtlas and all realigned images were spatially normalized. Females showed significantly greater total gray matter volume than males (t = 4.81, P = 0.0000, false discovery rate corrected). Compared with young subjects, old-aged subjects showed extensive reduction in gray matter volumes in all ROIs examined except the occipital lobe. In young- and middle-aged subjects, female and male subjects showed significant difference in the right middle temporal gyrus, right superior temporal gyrus, left angular gyrus, right middle occipital lobe, left middle cingulate gyrus, and the pars triangularis of the right inferior frontal gyrus, suggesting an interaction between age and sex (P < 0.001, uncorrected). Logistic regression analysis revealed linear negative correlation between the total gray matter volume and age (R = 0.529, P < 0.001). Significant age-related differences are present in gray matter volume across multiple brain regions during aging. The VPM approach may provide an emerging paradigm in the normal aging brain that may help differentiate underlying normal neurobiological aging changes of specific brain regions from neurodegenerative impairments.

Study on fractional amplitude of low-frequency fluctuation in male patients with unipolar and bipolar depression

Objective To explore the characteristic differences of the fractional amplitude of low-frequency fluctuation (fALFF) feature of the spontaneous neural activity between young male unipolar depression and bipolar depression patients, and determine the biological markers to distinguish the two disorders. Methods Twelve male unipolar depression, 12 bipolar depression patients and 11 age and educated-matched healthy males underwent resting-state functional magnetic resonance imaging scanning at 3.0 Tesla. The whole brain's fALFF were calculated and analyzed. Results The differences of the fALFF of the three groups had significant differences (P<0.01, Alphasim) in the right orbital medial frontal gyrus (6, 33, -9; K=29), the left medial frontal gyrus (-6, 60, 3; K=44) and the left paracentral lobule (-3, -27, 51; K=20). The unipolar depression subjects had significantly higher fALFF compared with healthy controls in the left anterior cingulate gyrus. The bipolar depression subjects had significantly higher fALFF compared with healthy controls in the bilateral medial frontal gyrus and the left middle cingulate gyrus. And the unipolar depression subjects had significantly lower fALFF compared with bipolar depression ones in the right orbital medial frontal gyrus, the right anterior cingulate gyrus and the bilateral medial frontal gyrus(all P<0.05). Conclusions Abnormalities exist in the brain regions in male with unipolar or bipolar depression patients in the resting state, and the abnormal regions are different. Key words: Unipolar depression; Bipolar depression; Male; Resting-state; fALFF

Dissociable neural systems for moral judgment of anti- and pro-social lying

Pro-social lying, which serves to benefit listeners, is considered more socially and morally acceptable than anti-social lying, which serves to harm listeners. However, it is still unclear whether the neural mechanisms underlying the moral judgment of pro-social lying differ from those underlying the moral judgment of anti-social lying. We used functional magnetic resonance imaging (fMRI) to examine the neural activities associated with moral judgment in anti- and pro-social lying. During fMRI scanning, subjects were provided with scenarios describing a protagonist׳s anti- and pro-social lying and were then asked to judge whether the protagonist׳s act was morally appropriate. The behavioral data showed that anti-social lying was mostly judged to be morally inappropriate and that pro-social lying was mainly judged to be morally appropriate. The functional imaging data revealed dissociable neural systems for moral judgment in anti- and pro-social lying. The anti-social lying, which was judged to be morally inappropriate, was associated with increased activity in the right ventromedial prefrontal cortex, right middle frontal gyrus, right precuneus/posterior cingulate gyrus, left posterior cingulate gyrus, and bilateral temporoparietal junction when compared with the control condition. The pro-social lying, which was judged to be morally appropriate, was associated with increased activity in the right middle temporal gyrus, right supramarginal gyrus, and the left middle cingulate gyrus when compared with the control condition. No overlapping activity was observed during the moral judgment of anti- and pro-social lying. Our data suggest that cognitive and neural processes for the moral judgment of lying are modulated by whether the lie serves to harm or benefit listeners.

Neural correlates of craving and resisting craving for tobacco in nicotine dependent smokers

Craving is a significant factor which can lead to relapse during smoking quit attempts. Attempts to resist urges to smoke during cue-elicited craving have been shown to activate regions in the brain associated with decision-making, anxiety regulation and visual processing. In this study, 32 treatment-seeking, nicotine-dependent smokers viewed blocks of smoking and neutral cues alternating with rest periods during magnetic resonance imaging scanning in a 3T Siemens scanner (Siemens AG, Erlangen, Bavaria, Germany). While viewing cues or control images, participants were instructed either to 'allow yourself to crave' or 'resist craving.' Data were analyzed with FSL 4.1.5, focused on the smoking cues versus neutral cues contrast, using cluster thresholding (Z > 2.3 and corrected cluster threshold of P = 0.05) at the individual and group levels. During the Crave condition, activation was seen on the left anterior cingulated cortex (LACC), medial prefrontal cortex, left middle cingulate gyrus, bilateral posterior cingulated gyrus and bilateral precuneus, areas associated with attention, decision-making and episodic memory. The LACC and areas of the prefrontal cortex associated with higher executive functioning were activated during the Resist condition. No clear distinctions between group crave and resist analyses as a whole were seen without taking into account specific strategies used to resist the urge to smoke, supporting the idea that craving is associated with some degree of resisting the urge to smoke, and trying to resist is almost always accompanied by some degree of craving. Different strategies for resisting, such as distraction, activated different regions. Understanding the underlying neurobiology of resisting craving to smoke may identify new foci for treatments.