Regional Cerebral Blood Flow Patterns Research Articles

Regional hyperperfusion in older adults with objectively-defined subtle cognitive decline

Although cerebral blood flow (CBF) alterations are associated with Alzheimer’s disease (AD), CBF patterns across prodromal stages of AD remain unclear. Therefore, we investigated patterns of regional CBF in 162 Alzheimer’s Disease Neuroimaging Initiative participants characterized as cognitively unimpaired (CU; n = 80), objectively-defined subtle cognitive decline (Obj-SCD; n = 31), or mild cognitive impairment (MCI; n = 51). Arterial spin labeling MRI quantified regional CBF in a priori regions of interest: hippocampus, inferior temporal gyrus, inferior parietal lobe, medial orbitofrontal cortex, and rostral middle frontal gyrus. Obj-SCD participants had increased hippocampal and inferior parietal CBF relative to CU and MCI participants and increased inferior temporal CBF relative to MCI participants. CU and MCI groups did not differ in hippocampal or inferior parietal CBF, but CU participants had increased inferior temporal CBF relative to MCI participants. There were no CBF group differences in the two frontal regions. Thus, we found an inverted-U pattern of CBF signal across prodromal AD stages in regions susceptible to early AD pathology. Hippocampal and inferior parietal hyperperfusion in Obj-SCD may reflect early neurovascular dysregulation, whereby higher CBF is needed to maintain cognitive functioning relative to MCI participants, yet is also reflective of early cognitive inefficiencies that distinguish Obj-SCD from CU participants.

Cerebral blood flow in children with syndromic craniosynostosis: cohort arterial spin labeling studies.

In comparison with the general population, children with syndromic craniosynostosis (sCS) have abnormal cerebral venous anatomy and are more likely to develop intracranial hypertension. To date, little is known about the postnatal development change in cerebral blood flow (CBF) in sCS. The aim of this study was to determine CBF in patients with sCS, and compare findings with control subjects. A prospective cohort study of patients with sCS using MRI and arterial spin labeling (ASL) determined regional CBF patterns in comparison with a convenience sample of control subjects with identical MRI/ASL assessments in whom the imaging showed no cerebral/neurological pathology. Patients with SCS and control subjects were stratified into four age categories and compared using CBF measurements from four brain lobes, the cerebellum, supratentorial cortex, and white matter. In a subgroup of patients with sCS the authors also compared longitudinal pre- to postoperative CBF changes. Seventy-six patients with sCS (35 female [46.1%] and 41 male [53.9%]), with a mean age of 4.5 years (range 0.2-19.2 years), were compared with 86 control subjects (38 female [44.2%] and 48 male [55.8%]), with a mean age of 6.4 years (range 0.1-17.8 years). Untreated sCS patients < 1 year old had lower CBF than control subjects. In older age categories, CBF normalized to values observed in controls. Graphical analyses of CBF by age showed that the normally expected peak in CBF during childhood, noted at 4 years of age in control subjects, occurred at 5-6 years of age in patients with sCS. Patients with longitudinal pre- to postoperative CBF measurements showed significant increases in CBF after surgery. Untreated patients with sCS < 1 year old have lower CBF than control subjects. Following vault expansion, and with age, CBF in these patients normalizes to that of control subjects, but the usual physiological peak in CBF in childhood occurs later than expected.

S8A-15 SESSION 8A: METOPIC SYNOSTOSIS CEREBRAL BLOOD FLOW OF THE FRONTAL LOBE IN UNTREATED CHILDREN WITH TRIGONOCEPHALY VERSUS HEALTHY CONTROLS: AN ARTERIAL SPIN LABELING STUDY

Introduction: There is an international tendency to be more selective in the indication for surgical correction of trigonocephaly. The choice for surgery is mainly based on the severity of phenotype, with little consensus for the moderate presentation. To date, little is known about cerebral blood flow (CBF) in children with unoperated trigonocephaly. The aim of this study is to determine CBF of the frontal lobe of patients with trigonocephaly to determine whether or not an abnormal CBF can serve as a threshold for surgery. Methods: A prospective cohort study of untreated patients with trigonocephaly using magnetic resonance imaging (MRI) and arterial spin labeling (ASL), determining regional CBF patterns in comparison with a sample of control subjects. These controls showed no cerebral/neurological pathology. Both subjects and controls are at the age of <1 years and sedated using CBF measurements on 3 levels of the frontal lobe bilaterally. Results: Five untreated patients with trigonocephaly and eight control patients with a mean age <1 yearswere included. There was a no difference in CBF between the frontal lobe of untreated patients with trigonocephaly (mean CBF 68.70ml/100g/min; SE 5.42) and the control group (mean CBF 67.34ml/100g/min; SE 4.42; p> 0.10). Conclusion: There is no difference in CBF of the frontal lobe between untreated patients with trigonocephaly and control subjects under the age of 1. As such, a reduced CBF is an unlikely indicator for surgery. Prospectively future studies will be conducted to include more patients with a range of phenotypic severity to further explore the impact of trigonocephaly on CBF.

Quantitative cerebral blood flow using xenon-enhanced CT after decompressive craniectomy in traumatic brain injury.

OBJECTIVE Few studies have reported on changes in quantitative cerebral blood flow (CBF) after decompressive craniectomy and the impact of these measures on clinical outcome. The aim of the present study was to evaluate global and regional CBF patterns in relation to cerebral hemodynamic parameters in patients after decompressive craniectomy for traumatic brain injury (TBI). METHODS The authors studied clinical and imaging data of patients who underwent xenon-enhanced CT (XeCT) CBF studies after decompressive craniectomy for evacuation of a mass lesion and/or to relieve intractable intracranial hypertension. Cerebral hemodynamic parameters prior to decompressive craniectomy and at the time of the XeCT CBF study were recorded. Global and regional CBF after decompressive craniectomy was measured using XeCT. Regional cortical CBF was measured under the craniectomy defect as well as for each cerebral hemisphere. Associations between CBF, cerebral hemodynamics, and early clinical outcome were assessed. RESULTS Twenty-seven patients were included in this study. The majority of patients (88.9%) had an initial Glasgow Coma Scale score ≤ 8. The median time between injury and decompressive surgery was 9 hours. Primary decompressive surgery (within 24 hours) was performed in the majority of patients (n = 18, 66.7%). Six patients had died by the time of discharge. XeCT CBF studies were performed a median of 51 hours after decompressive surgery. The mean global CBF after decompressive craniectomy was 49.9 ± 21.3 ml/100 g/min. The mean cortical CBF under the craniectomy defect was 46.0 ± 21.7 ml/100 g/min. Patients who were dead at discharge had significantly lower postcraniectomy CBF under the craniectomy defect (30.1 ± 22.9 vs 50.6 ± 19.6 ml/100 g/min; p = 0.039). These patients also had lower global CBF (36.7 ± 23.4 vs 53.7 ± 19.7 ml/100 g/min; p = 0.09), as well as lower CBF for the ipsilateral (33.3 ± 27.2 vs 51.8 ± 19.7 ml/100 g/min; p = 0.07) and contralateral (36.7 ± 19.2 vs 55.2 ± 21.9 ml/100 g/min; p = 0.08) hemispheres, but these differences were not statistically significant. The patients who died also had significantly lower cerebral perfusion pressure (52 ± 17.4 vs 75.3 ± 10.9 mm Hg; p = 0.001). CONCLUSIONS In the presence of global hypoperfusion, regional cerebral hypoperfusion under the craniectomy defect is associated with early mortality in patients with TBI. Further study is needed to determine the value of incorporating CBF studies into clinical decision making for severe traumatic brain injury.

Regional cerebral blood flow patterns associated with apathy in amnestic mild cognitive impairment

Background: Apathy is one of the most common neuropsychiatric symptoms in early Alzheimer disease (AD).

Arterial spin labeling in patients with schizophrenia: a systematic review

euroimaging studies are an invaluable source of information about the physiopathology of schizophrenia. Arterial spin labeling (ASL) is a new magnetic resonance technique (MRI) that is able to effectively evaluate brain function without the use of radiation. Objective: To make a systematic review of studies using ASL to compare resting-state regional cerebral blood flow (rCBF) patterns in patients with schizophrenia and healthy controls. Methods: Original articles were searched for on PubMed, Scopus, Web of Science and PsycINFO electronic databases. The search terms used were ‘arterial’, ‘spin’, ‘labeling’, and ‘schizophrenia’. Only studies comparing resting-state rCBF were included, a qualitative synthesis was then performed. Results: Ten articles were included in the review among a total of 22. Decreased rCBF in schizophrenia patients was described in the anterior cingulate, cuneus, fusiform gyrus, frontal lobe, left middle frontal gyrus, inferior frontal gyrus, lingual gyrus, middle occipital gyrus, and parietal lobe. The putamen was the only region with increased rCBF in schizophrenia. Discussion: The evidence of the studies reviewed lends support to the concept of hipofrontality in schizophrenia. rCBF alterations were found in regions classically associated with schizophrenia. ASL seems to be valid, and reliable tool to assess schizophrenia

How far is arterial spin labeling MRI from a clinical reality? Insights from arterial spin labeling comparative studies in Alzheimer's disease and other neurological disorders.

How far is arterial spin labeling MRI from a clinical reality? Insights from arterial spin labeling comparative studies in Alzheimer's disease and other neurological disorders.

Angiogenesis in the Pathophisiology of Schizophrenia – a Comprehensive Review and a Conceptual Hypotesis

Introduction Schizophrenia (SZ) is a severe mental disorder poor elucidated from the etiopathogenesis prism. Recently, several micro andmacro vascular abnormalities have been consistently implicated in SZ´spathophysiology. The relationship between Angiogenesis and SZ can putatively influence brain hemodynamics, pathophysiology and symptomatology due to its involvement in embryogenesis and neurogenesis. Angiogenesis can provide a framework in which some etiological factors and susceptibility genes for SZ can be linked together. Aims To explore the link between SZ and angiogenesis, taking into account new insights fromgenetic, molecular, neurochemical, animal, and neuroimaging functional studies. Methods A non-systematic review of the literature was performed to summarize current knowledge regarding Angiogenesis and SZ usingthe PubMed database. Results Recent molecular and neuroimaging studies indicate that angiogenesis could be involved in SZ etiopathogenesis through its role in neurogenesis during neurodevelopment, or by angiomodulation of cerebral blood flow (CBF). A complex multivariate interplay between angiogenic factors, dopamine, neurotrophins, brain angiogenic inhibitors molecules (BAI1-3) and patterns of regional blood flow mayyield to a biological effect. Conclusions The role of Angiogenesis in angiomodulation and angioregulation of regional CBF patterns may have direct implications in theclinical heterogeneity of SZ. Studying the effect of antipsychotics on brain microvasculature and on CBF in different stages of the disease, focusing on brain Angiogenesis activation through VEGF or by neurotrophic-based mechanisms, and by complementing the analysis determining related Angiogenesis abnormalities, could reveal more cues behind the crosstalk's between Angiogenesis, CNS development and SZ.

The effect of morphine on regional cerebral blood flow measured by 99mTc-ECD SPECT in dogs.

To gain insights into the working mechanism of morphine, regional cerebral blood flow (rCBF) patterns after morphine administration were assessed in dogs. In a randomized cross-over experimental study, rCBF was estimated with 99mTc-Ethylcysteinate Dimer single photon emission computed tomography in 8 dogs at baseline, at 30 minutes and at 120 minutes after a single bolus of morphine. Perfusion indices (PI) in the frontal, parietal, temporal and occipital cortex and in the subcortical and cerebellar region were calculated. PI was significantly decreased 30 min after morphine compared to baseline in the right frontal cortex. The left parietal cortex and subcortical region showed a significantly increased PI 30 min after morphine compared to baseline. No significant differences were noted for the other regions or at other time points. In conclusion, a single bolus of morphine generated a changing rCBF pattern at different time points.

Neural basis of three dimensions of agitated behaviors in patients with Alzheimer disease

BackgroundAgitated behaviors are frequently observed in patients with Alzheimer disease (AD). The neural substrate underlying the agitated behaviors in dementia is unclear. We hypothesized that different dimensions of agitated behaviors are mediated by distinct neural systems.MethodsAll the patients (n=32) underwent single photon emission computed tomography (SPECT). Using the Agitated Behavior in Dementia scale, we identified the relationships between regional cerebral blood flow (rCBF) patterns and the presence of each of three dimensions of agitated behavior (physically agitated behavior, verbally agitated behavior, and psychosis symptoms) in AD patients. Statistical parametric mapping (SPM) software was used to explore these neural correlations.ResultsPhysically agitated behavior was significantly correlated with lower rCBF values in the right superior temporal gyrus (Brodmann 22) and the right inferior frontal gyrus (Brodmann 47). Verbally agitated behavior was significantly associated with lower rCBF values in the left inferior frontal gyrus (Brodmann 46, 44) and the left insula (Brodmann 13). The psychosis symptoms were significantly correlated with lower rCBF values in the right angular gyrus (Brodmann 39) and the right occipital lobe (Brodmann 19).ConclusionOur results support the hypothesis that three different agitated behaviors may represent distinct neural networks in AD patients.

Differential brain activity in subjects with painful trigeminal neuropathy and painful temporomandibular disorder

Human brain imaging investigations have revealed that acute pain is associated with coactivation of numerous brain regions, including the thalamus, somatosensory, insular, and cingulate cortices. Surprisingly, a similar set of brain structures is not activated in all chronic pain conditions, particularly chronic neuropathic pain, which is associated with almost exclusively decreased thalamic activity. These inconsistencies may reflect technical issues or fundamental differences in the processing of acute compared with chronic pain. The appreciation of any differences is important because better treatment development will depend on understanding the underlying mechanisms of different forms of pain. In this investigation, we used quantitative arterial spin labeling to compare and contrast regional cerebral blood flow (CBF) patterns in individuals with chronic neuropathic orofacial pain (painful trigeminal neuropathy) and chronic nonneuropathic orofacial pain (painful temporomandibular disorder). Neuropathic pain was associated with CBF decreases in a number of regions, including the thalamus and primary somatosensory and cerebellar cortices. In contrast, chronic nonneuropathic pain was associated with significant CBF increases in regions commonly associated with higher-order cognitive and emotional functions, such as the anterior cingulate and dorsolateral prefrontal cortices and the precuneus. Furthermore, in subjects with nonneuropathic pain, blood flow increased in motor-related regions as well as within the spinal trigeminal nucleus.

Autistic traits, ADHD symptoms, neurological soft signs and regional cerebral blood flow in adults with autism spectrum disorders

The resting regional cerebral blood flow (rCBF) patterns related to co-occurring symptoms such as inattention, hyperactivity, neurological soft signs and motor problems have not yet been disclosed in autism spectrum disorders (ASD).In this study thirteen adults with ASD and ten matched neurotypical controls underwent PET. The scores of rating scales for autistic traits, attention deficit hyperactivity disorder (ADHD) and neurological soft signs were included in a factorial analysis and correlated with rCBF. Factors corresponding to “autistic/ADHD traits”, “sensory-motor integration” and “Intelligence/Motor sequencing” were identified. In the ASD group, positive correlations with CBF were found for “autistic/ADHD traits” in caudate bilaterally and the inferior parietal lobule, for “sensory-motor integration” in parieto-occipital cortex and for “Intelligence/Motor sequencing” in the right temporal cortex. Notably, CBF in the left thalamus correlated negatively with all three factors. Autistic traits and ADHD symptoms were associated with shared neural substrates. The correlation between “autistic/ADHD traits” and rCBF in the caudate is possibly associated with the executive impairments and ritualistic/stereotyped behaviors apparent in ASD. Furthermore, sensory-motor deficits were correlated with rCBF in the occipital visual cortex, involved in atypical visual perception in ASD. Various behavioral and neurological symptoms are suggested to converge into the ASD phenotype.

Effects of Fructose vs Glucose on Regional Cerebral Blood Flow in Brain Regions Involved With Appetite and Reward Pathways

Increases in fructose consumption have paralleled the increasing prevalence of obesity, and high-fructose diets are thought to promote weight gain and insulin resistance. Fructose ingestion produces smaller increases in circulating satiety hormones compared with glucose ingestion, and central administration of fructose provokes feeding in rodents, whereas centrally administered glucose promotes satiety. To study neurophysiological factors that might underlie associations between fructose consumption and weight gain. Twenty healthy adult volunteers underwent 2 magnetic resonance imaging sessions at Yale University in conjunction with fructose or glucose drink ingestion in a blinded, random-order, crossover design. Relative changes in hypothalamic regional cerebral blood flow (CBF) after glucose or fructose ingestion. Secondary outcomes included whole-brain analyses to explore regional CBF changes, functional connectivity analysis to investigate correlations between the hypothalamus and other brain region responses, and hormone responses to fructose and glucose ingestion. There was a significantly greater reduction in hypothalamic CBF after glucose vs fructose ingestion (-5.45 vs 2.84 mL/g per minute, respectively; mean difference, 8.3 mL/g per minute [95% CI of mean difference, 1.87-14.70]; P = .01). Glucose ingestion (compared with baseline) increased functional connectivity between the hypothalamus and the thalamus and striatum. Fructose increased connectivity between the hypothalamus and thalamus but not the striatum. Regional CBF within the hypothalamus, thalamus, insula, anterior cingulate, and striatum (appetite and reward regions) was reduced after glucose ingestion compared with baseline (P < .05 significance threshold, family-wise error [FWE] whole-brain corrected). In contrast, fructose reduced regional CBF in the thalamus, hippocampus, posterior cingulate cortex, fusiform, and visual cortex (P < .05 significance threshold, FWE whole-brain corrected). In whole-brain voxel-level analyses, there were no significant differences between direct comparisons of fructose vs glucose sessions following correction for multiple comparisons. Fructose vs glucose ingestion resulted in lower peak levels of serum glucose (mean difference, 41.0 mg/dL [95% CI, 27.7-54.5]; P < .001), insulin (mean difference, 49.6 μU/mL [95% CI, 38.2-61.1]; P < .001), and glucagon-like polypeptide 1 (mean difference, 2.1 pmol/L [95% CI, 0.9-3.2]; P = .01). In a series of exploratory analyses, consumption of fructose compared with glucose resulted in a distinct pattern of regional CBF and a smaller increase in systemic glucose, insulin, and glucagon-like polypeptide 1 levels.

P4‐370: Imaging features of early stage of dementia with Lewy bodies

The neuroimaging findings in patients with mild cognitive impairment (MCI) associated with Alzheimer 's disease (AD) or early stage of AD were well documented, as medial temporal atrophy on MRI, and temporoparietal and posterior cingulate hypometabolism on PET. In patients with Dementia with Lewy Bodies (DLB), the characteristic occipital cortical hypometabolism on PET was recognized. But it is still unclear the neuroimaging difference between AD and DLB in the early stages.The objective of this paper is to assess the neuroimaging characteristic on MRI and SPECT in early stages in DLB patients. We performed MRI examination (Siemens, MAGNETOM Harmony 1.5 T) in 17 cases of clinically probable DLB patients（M:F= 7：10, age 77.8 ± 9.5 years, MMSE 24± 3.36). Volumetric studies were performed to measure the hippocampal volumes. Visual rating was performed to measure the other areas including the midbrain. We examined single-photon emission computed tomography (SPECT) technetium-99m cysteinate dimmer (99m Tc-ECD) （Toshiba, 7200Ａ−DI）and evaluated regional cerebral blood flow patterns using easy Z-score imaging system (eZIS) analysis. Atrophy in medial temporal was relatively smaller than that of Alzheimer 's disease. Atrophy in the midbrain was prominent in DLB patients. Less than half DLB patients showed hypoperfusion in occipital cortex on SPECT. We suggest that relatively small atrophy in medial temporal cortex, atrophy in the midbrain, hypoperfusion in the occipital cortex may be helpful in the diagnosis in the early stage of DLB.

Regional Cerebral Blood Flow Patterns in Patients With Freezing of Gait Due to Lacunar Infarction: SPECT Study Using Three-Dimensional Stereotactic Surface Projections

ABSTRACTBackground: Although freezing of gait (FOG) is reportedly caused by cerebrovascular disease, few studies have examined its pathology. We examined regional cerebral blood flow (rCBF) patterns in patients with FOG resulting from chronic lacunar infarction using single-photon emission computed tomography (SPECT). Methods: Among patients with chronic lacunar infarction treated at our outpatient unit, we performed N-isopropyl-p-[123I]-iodoamphetamine SPECT in seven patients with FOG (FOG group) and in 20 patients without FOG (non-FOG group). We analyzed and compared the SPECT data using three-dimensional stereotactic surface projections of the two groups. Results: On z-score maps, the FOG group showed a significant reduction in rCBF in the bilateral anterior cingulate cortices compared with the non-FOG group. The mean z-score for the bilateral cingulate gyri was significantly higher in the FOG group than in the non-FOG group (p < .01). When the cingulate gyrus data of the anterior and posterior subregions were analyzed on a region-by-region basis, the mean z-score for the left anterior cingulate gyrus was significantly higher than that for the right cingulate gyrus (p < .05). Conclusion: These results suggest that anterior cingulate cortex dysfunction may be involved in the pathology of FOG in patients with chronic lacunar infarction.

A Longitudinal SPECT Study of Different Patterns of Regional Cerebral Blood Flow in Alzheimer’s Disease with or without Diabetes

Aims: To determine the effect of diabetes mellitus (DM) on regional cerebral blood flow (rCBF) patterns in patients with Alzheimer’s disease (AD). Methods: We investigated the initial rCBF of 71 AD patients (36 without DM and 35 with DM) and the final rCBF of 23 AD patients (12 without DM and 11 with DM) after an average of 32 months. Single-photon emission computed tomography (SPECT) data were analyzed by statistical brain imaging. Results: The initial SPECT showed that AD patients without DM had lower rCBF in the left and right inferior temporal gyri than AD patients with DM. A follow-up SPECT demonstrated that rCBF decreased in more widespread regions, including the parietal, temporal, frontal, and limbic lobes, in AD patients without than with DM. Conclusion: This study suggests that functional brain abnormalities in AD differ depending on the DM status at baseline and during follow-up, reflecting neuropathologic differences.

Regional Cerebral Blood Flow Patterns Detected by SPECT With Easy Z-score Imaging System Analysis in Early-stage Alzheimer's Disease

The objective of this study is to investigate the characteristic patterns of regional cerebral blood flow reduction in early Alzheimer's disease (AD). Twenty patients were recruited in this study. We performed MRI(Siemens, MAGNETOM Harmony 1.0T,) and single-photon emission computed tomography (SPECT) technetium-99m cysteinate dimmer (99m Tc-ECD) (Toshiba, 7200A−DI), simultaneously, and corrected using voxel-based morphometry as to reduce the atrophic influence. We evaluated regional cerebral blood flow patterns using easy Z-score imaging system (eZIS) analysis, and we calculated the extent of each regions using voxel-based Stereotactic Extraction Estimation (vb SEE)(Level 3 classification). In 8 subjects, MRI and SPECT were reevaluated one or two years after and the comparative study was performed. There was prominent decrease in the bilateral posterior cingulated gyrus, parietal cortex, temporal cortex, and frontal cortex. The eZIS analysis with vb SEE is useful in highlighting the changes in the hypoperfusional regions. These results were in agreement with those of 3D-SSP study with SEE analysis.

The progression of cognitive deterioration and regional cerebral blood flow patterns in Alzheimer's disease: A longitudinal SPECT study

Background and purpose The progression of cognitive deterioration in patients with Alzheimer's disease (AD) is considerably variable. The ability to predict the progression rate is important for clinicians to treat and manage patients with AD. We examined the possible relationship between the rate of cognitive deterioration and regional cerebral blood flow (rCBF) patterns in patients with AD. Methods We followed 48 patients with AD for an average of 37 months. They were subsequently divided into the rapidly progressing group ( n = 24) and slowly progressing group ( n = 24) based on an annual Mini-Mental State Examination (MMSE) score change. Initial and follow-up rCBF were assessed using single photon emission CT (SPECT) and the SPECT data were analyzed by 3D-stereotactic surface projections. Results At initial evaluation, the rapidly progressing group had greater rCBF deficits mainly in the parietotemporal and frontal regions, and left posterior cingulate than did the slowly progressing group. When compared with initial SPECT, follow-up SPECT showed a significant rCBF reduction in widespread regions, including parietotemporal and frontal lobes, of the rapidly progressing group, while showed in the scattered and small regions of hemispheres of the slowly progressing group. Conclusion Our longitudinal SPECT study suggests a significant association between rCBF deficits in the parietotemporal, posterior cingulate, and frontal regions and subsequent rapid cognitive and rCBF deterioration.

Modulation of limbic circuitry predicts treatment response to antipsychotic medication: a functional imaging study in schizophrenia.

The regional neuronal changes taking place in the early and late stages of antipsychotic treatment are still not well characterized in humans. In addition, it is not known whether these regional changes are predictive or correlated with treatment response. Using PET with 15O, we evaluated the time course of regional cerebral blood flow (rCBF) patterns generated by a first (haloperidol) and a second (olanzapine) generation antipsychotic drug (APD) in patients with schizophrenia during a 6 week treatment trial.Patients were initially scanned after withdrawal of all psychotropic medication (two weeks), and then blindly randomized to treatment with haloperidol (n=12) or olanzapine (n=17) for a period of 6 weeks. Patients were scanned again after 1 and 6 weeks of treatment. All assessments, including scanning sessions, were obtained in a double-blind manner.As hypothesized, we observed rCBF changes that were common to both drugs, implicating cortico-subcortical and limbic neuronal networks in antipsychotic action. In addition, in these regions, some patterns seen at week 1 and 6 were distinctive, indexing neuronal changes related to an early (ventral striatum, hippocampus) and consolidated [anterior cingulate/medial frontal cortex (ACC/MFC)] stage of drug response. Finally, both after 1 and 6 weeks of treatment, we observe differential patterns of rCBF activation between good and poor responders. After one week of treatment, greater rCBF increase in ventral striatum and greater decrease in hippocampus were associated with good response.

Regional cerebral blood flow patterns of change following the own body image exposure in eating disorders: A longitudinal study

Objective The aim of the present study is to see if the changes in the regional cerebral blood flow (rCBF) experienced by restrictive anorexia nervosa (AR) and bulimia nervosa (BN) patients, following the exposure to their own body image, persist at follow-up. Methods Three single photon emission computed tomography (SPECT) were performed on nine patients with a DSM-IV diagnosis of AR, 13 with BP, and 12 controls: at rest, following a neutral stimulus, and after exposure to their previously filmed whole body image. Body dissatisfaction was measured by means of the Body Dissatisfaction Questionnaire (BSQ). One year later the same assessment was repeated. Results Following the exposure to their own body image, BN showed an increase in body dissatisfaction, which was associated with the increase in the rCBF of the Right Temporal Area. Those changes persisted at follow-up. Discussion More specific long term therapies are needed for the treatment of the averse response showed by ED patients to their own body image exposure that is associated with the hyperactivation of the right temporal area when they are confronted with their whole body image.