Temporoparietal White Matter Research Articles

Visual and Motor Anosognosia: shared Modality-specific Damage and convergent Disconnections in Temporo-parietal Cortex (P4-12.001)

<h3>Objective:</h3> To assess if different forms of anosognosia share different or common neural mechanisms. <h3>Background:</h3> Anosognosia, the unawareness of a neurological deficit, is a syndrome whose neural correlates are still unclear. Most theories posit that awareness deficits are encapsulated in modality-specific systems. To date, studies of anosognosia have focused on the locus of damage. However, focal lesions cause network effects far beyond the local damage. <h3>Design/Methods:</h3> We characterize and compare lesions and related structural (SDC) and functional disconnection (FDC) in a group of post-stroke Anton syndrome patients (AS) with those suffering anosognosia for hemiplegia (AHP). Sixteen AS lesions were retrieved from the literature and drawn on a standard brain template. Sixteen hemianopic visual controls (VC) were selected and their unilateral lesions were duplicated in the other hemisphere to generate synthetic bilateral lesions. The two groups were compared in terms of lesions, SDC and FDC computed using a connectome derived from a large sample of healthy controls. The resulting disconnection maps were then compared using the same approach to a group of AHP patients (n=28) and hemiplegic controls without anosognosia (HC=35). <h3>Results:</h3> Lesions in AS were cortical involving both primary and extra-striate visual cortex. In contrast, VC lesions clustered in the occipital white matter and/or the primary visual cortex. AS exhibited greater SDC of temporo-parietal and insular regions. The distribution of SDC matched the FDC of dorsal frontoparietal regions. The comparison between AS vs. AHP showed the extensive involvement of modality-specific regions (i.e., visual vs motor), but also convergent SDC of right temporo-parietal white matter and bilateral FDC of dorsal frontoparietal regions involved in attention and multi-sensory integration. <h3>Conclusions:</h3> AS depends on bilateral striate and extra-striate occipital damage, and disconnection of ventral and dorsal frontoparietal regions involved in attention control. Visual and motor anosognosia share the unique combination of modality-specific and supra-modal mechanisms over temporo-parietal cortices. <b>Disclosure:</b> Dr. Monai has nothing to disclose. Miss Palacino has nothing to disclose. Dr. Bisio has nothing to disclose. Dr. Pini has nothing to disclose. Alessandro Salvalaggio has nothing to disclose. Dr. Corbetta has nothing to disclose.

Fiber-specific structural properties relate to reading skills in children and adolescents.

Recent studies suggest that the cross-sectional relationship between reading skills and white matter microstructure, as indexed by fractional anisotropy, is not as robust as previously thought. Fixel-based analyses yield fiber-specific micro- and macrostructural measures, overcoming several shortcomings of the traditional diffusion tensor model. We ran a whole-brain analysis investigating whether the product of fiber density and cross-section (FDC) related to single-word reading skills in a large, open, quality-controlled dataset of 983 children and adolescents ages 6-18. We also compared FDC between participants with (n = 102) and without (n = 570) reading disabilities. We found that FDC positively related to reading skills throughout the brain, especially in left temporoparietal and cerebellar white matter, but did not differ between reading proficiency groups. Exploratory analyses revealed that among metrics from other diffusion models - diffusion tensor imaging, diffusion kurtosis imaging, and neurite orientation dispersion and density imaging - only the orientation dispersion and neurite density indexes from NODDI were associated (inversely) with reading skills. The present findings further support the importance of left-hemisphere dorsal temporoparietal white matter tracts in reading. Additionally, these results suggest that future DWI studies of reading and dyslexia should be designed to benefit from advanced diffusion models, include cerebellar coverage, and consider continuous analyses that account for individual differences in reading skill.

White matter abnormalities of right hemisphere attention networks contribute to visual hallucinations in dementia with Lewy bodies

ObjectiveFunctional alterations of the visual attention networks in a setting of impaired visual information processing have a role in the genesis of visual hallucinations (VH) in dementia with Lewy bodies (DLB). This multimodal MRI study aims at exploring structural and functional basis of VH. Methods23 DLB patients (10 with and 13 without VH) and 13 healthy controls were studied. They underwent MRI with T1-w sequences to measure cortical thickness, DTI for whole-brain and single tract microstructural properties and rs-fMRI of the default mode, dorsal and ventral attention, and visual networks. ResultsIn DLB with VH, whole-brain DTI revealed a lower fractional anisotropy and a greater mean diffusivity in the right frontal and temporo-parietal white matter tracts. Tracts dissection showed lower fractional anisotropy in the right inferior and superior (ventral part) longitudinal fasciculi (ILF and SLF) (p < .05, corrected), and greater mean diffusivity (p < .05). The extent of white matter microstructural alterations involving the right ILF and SLF correlated with the severity of VH (r = .55, p < .01; r = .42, p < .05, respectively), and with performance in the visual attention task (r = −.56 and r = −.61; p < .01, respectively). Cortical thickness in the projection areas of the right SLF was significantly reduced (p < .05). Patients with VH also showed an altered functional connectivity in the ventral attention network, connected by the ventral portion of the SLF (p < .05). ConclusionsOur findings suggest that a combination of microstructural and functional alterations involving the attention networks in the right hemisphere may be important in the genesis of VH.

Exploratory examination of lexical and neuroanatomic correlates of neglect dyslexia.

This study examined lexical and neuroanatomic correlates of reading errors in individuals with spatial neglect, defined as a failure to respond to stimuli in the side of space opposite a brain lesion, causing functional disability. One-hundred and ten participants with left spatial neglect after right-hemisphere stroke read aloud a list of 36 words. Reading errors were scored as "contralesional" (error in the left half of the word) or as "other." The influence of lexical processing on neglect dyslexia was studied with a stepwise regression using word frequency, orthographic neighborhood (number of same length neighbors that differ by 1 letter), bigram and trigram counts (number of words with the same 2- and 3-letter combinations), length, concreteness, and imageability as predictors. MRI/CT images of 92 patients were studied in a voxelwise lesion-symptom analysis (VLSM). Longer length and more trigram neighbors increased, while higher concreteness reduced, the rate of contralesional errors. VLSM revealed lesions in the inferior temporal sulcus, middle temporal and angular gyri, precuneus, temporal pole, and temporo-parietal white matter associated with the rate of contralesional errors. Orthographic competitors may decrease word salience, while semantic concreteness may help constrain the selection of available word options when it is based on degraded information from the left side of the word. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Patterns of Brain Injury in Newborns Treated with Extracorporeal Membrane Oxygenation.

Neonates treated with extracorporeal membrane oxygenation are at risk for brain injury and subsequent neurodevelopmental compromise. Advances in MR imaging and improved accessibility have led to the increased use of routine MR imaging after extracorporeal membrane oxygenation. Our objective was to describe the frequency and patterns of extracorporeal membrane oxygenation-related brain injury based on MR imaging findings in a large contemporary cohort of neonates treated with extracorporeal membrane oxygenation. This was a retrospective study of neonatal patients treated with extracorporeal membrane oxygenation from 2005-2015 who underwent MR imaging before discharge. MR imaging and ultrasound studies were reviewed for location and type of parenchymal injury, ventricular abnormalities, and increased subarachnoid spaces. Parenchymal injury frequencies between patients treated with venoarterial and venovenous extracorporeal membrane oxygenation were compared by χ2 tests. Of 81 neonates studied, 46% demonstrated parenchymal injury; 6% showed infarction, mostly in vascular territories (5% anterior cerebral artery, 5% MCA, 1% posterior cerebral artery); and 20% had hemorrhagic lesions. The highest frequency of injury occurred in the frontal (right, 24%; left, 25%) and temporoparietal (right, 14%; left, 19%) white matter. Sonography had low sensitivity for these lesions. Other MR imaging findings included volume loss (35%), increased subarachnoid spaces (44%), and ventriculomegaly (17% mild, 5% moderate, 1% severe). There were more parenchymal injuries in neonates treated with venoarterial (49%) versus venovenous extracorporeal membrane oxygenation (29%, P = .13), but the pattern of injury was consistent between both modes. MR imaging identifies brain injury in nearly half of neonates after treatment with extracorporeal membrane oxygenation. The frontal and temporoparietal white matter are most commonly affected, without statistically significant laterality. This pattern of injury is similar between venovenous and venoarterial extracorporeal membrane oxygenation, though the frequency of injury may be higher after venoarterial extracorporeal membrane oxygenation.

DCDC2 polymorphism is associated with left temporoparietal gray and white matter structures during development.

Three genes, DYX1C1, DCDC2, and KIAA0319, have been previously associated with dyslexia, neuronal migration, and ciliary function. Three polymorphisms within these genes, rs3743204 (DYX1C1), rs793842 (DCDC2), and rs6935076 (KIAA0319) have also been linked to normal variability of left temporoparietal white matter volume connecting the middle temporal cortex to the angular and supramarginal gyri. Here, we assessed whether these polymorphisms are also related to the cortical thickness of the associated regions during childhood development using a longitudinal dataset of 76 randomly selected children and young adults who were scanned up to three times each, 2 years apart. rs793842 in DCDC2 was significantly associated with the thickness of left angular and supramarginal gyri as well as the left lateral occipital cortex. The cortex was significantly thicker for T-allele carriers, who also had lower white matter volume and lower reading comprehension scores. There was a negative correlation between white matter volume and cortical thickness, but only white matter volume predicted reading comprehension 2 years after scanning. These results show how normal variability in reading comprehension is related to gene, white matter volume, and cortical thickness in the inferior parietal lobe. Possibly, the variability of gray and white matter structures could both be related to the role of DCDC2 in ciliary function, which affects both neuronal migration and axonal outgrowth.

White Matter Morphometric Changes Uniquely Predict Children’s Reading Acquisition

This study examined whether variations in brain development between kindergarten and Grade 3 predicted individual differences in reading ability at Grade 3. Structural MRI measurements indicated that increases in the volume of two left temporo-parietal white matter clusters are unique predictors of reading outcomes above and beyond family history, socioeconomic status, and cognitive and preliteracy measures at baseline. Using diffusion MRI, we identified the left arcuate fasciculus and superior corona radiata as key fibers within the two clusters. Bias-free regression analyses using regions of interest from prior literature revealed that volume changes in temporo-parietal white matter, together with preliteracy measures, predicted 56% of the variance in reading outcomes. Our findings demonstrate the important contribution of developmental differences in areas of left dorsal white matter, often implicated in phonological processing, as a sensitive early biomarker for later reading abilities, and by extension, reading difficulties.

Mirtazapine treatment ceased the progression of progressive multifocal leukoencephalopathy associated with systemic sarcoidosis

Progressive multifocal leukoencephalopathy occurs almost exclusively in immunosuppressed individuals. Mirtazapine, a 5-hydroxytryptamine-2A antagonist, has been used empirically against progressive multifocal leukoencephalopathy. A 60-year-old man who was diagnosed with sarcoidosis at 20 years-of-age and had not taken immunosuppressive therapies developed dysarthria, left hemiparesis and dressing apraxia. Cranial ?uid-attenuated inversion-recovery magnetic resonance imaging showed hyperintense areas in the right frontal and temporoparietal white matter. The initial diagnosis was neurosarcoidosis, based on non-caseating granuloma in a lymph node biopsy. Immunosuppressive therapy was initiated; however, this aggravated his neurological symptoms. Immunohistochemistry of the brain biopsy showed John Cunningham virus infected large ballooned oligodendrocytes, leading to a diagnosis of progressive multifocal leukoencephalopathy. Treatment with mirtazapine improved the neurological symptoms, and the magnetic resonance imaging abnormality did not progress. We stress the diagnostic difficulties of distinguishing progressive multifocal leukoencephalopathy from neurosarcoidosis, and suggest that mirtazapine treatment is effective against progressive multifocal leukoencephalopathy associated with sarcoidosis.

Decoding the superior parietal lobule connections of the superior longitudinal fasciculus/arcuate fasciculus in the human brain

The temporo-parietal (TP) white matter connections between the inferior parietal lobule and superior temporal gyrus as part of the superior longitudinal fasciculus/arcuate fasciculus (SLF/AF) or middle longitudinal fasciculus (MdLF) have been studied in prior diffusion tensor tractography (DTT) studies. However, few studies have been focusing on the higher TP connections of the superior parietal lobule with the temporal lobe. These higher TP connections have been shown to have a role in core processes such as attention, memory, emotions, and language. Our most recent study, for the first time, hinted to the possibility of a long white matter connection interconnecting the superior parietal lobule (SPL) with the posterior temporal lobe in human brain which we call the SLF/AF TP-SPL and for a shorter abbreviation, the TP-SPL. We decided to further investigate this white matter connection using fiber assignment by continuous tracking deterministic tractography and high spatial resolution diffusion tensor imaging on 3T. Five healthy right-handed men (age range 24–37years) were studied. We delineated the SPL connections of the SLF/AF TP bilaterally in five normal adult human brains. Using a high resolution DTT technique, we demonstrate for the first time, the trajectory of a long fiber bundle connectivity between the SPL and posterior temporal lobe, called the SLF/AF TP-SPL (or the TP-SPL), bilaterally in five healthy adult human brains. We also demonstrate the trajectory of the vertically oriented posterior TP connections, interconnecting the inferior parietal lobule (IPL) with the posterior temporal lobe (TP-IPL) in relation to the TP-SPL, arcuate fasciculus and other major language pathways. In the current study, for the first time, we categorized the TP connections into the anterior and posterior connectivity groups and subcategorized each one into the SPL or IPL connections.

White matter integrity in older females is altered by increased body fat.

ObjectiveTo assess whether the pattern of diffusion changes among a cohort of individuals showing BMI-related increases in white matter volume reflects healthy expansion of myelin or damaged white matter.Design and MethodsDiffusion MRI measures (axial, radial, and fractional anisotropy) were obtained from 94 females, ages 52–92. Relationships between BMI and diffusion measures were assessed controlling for age, hypertension, and diabetes status using general linear modelling. Associations between diffusion measures and cognitive status (memory, executive functions, and visuomotor speed) were assessed using multiple regressions, controlling for age, education, hypertension, and diabetes status.ResultsHigher levels of BMI were associated with lower axial diffusion in frontal, temporal, parietal, internal capsule, and cerebellar white matter. Lower fractional anisotropy was observed in bilateral temporal white matter and the right corticospinal tract, with high radial diffusion in temporal and temporoparietal white matter. Importantly, diffusion measures predicted reductions in executive functioning, memory, and visuomotor speed.ConclusionsThe pattern of diffusion changes in regions of white matter showing BMI-related volume increases are not due to expansion of normal myelin, but instead suggest damage to white matter that has important consequences for cognitive functioning.

Voxel-based analysis of white matter during adolescence and young adulthood

Purpose: To evaluate differences in age-related brain white matter by voxel-based analysis of healthy adolescents and young adults. Materials and methods: Echo-planar diffusion-tensor magnetic resonance (MR) imaging was performed in healthy subjects of 3 groups (aged 11–13, 16–18 and 23–25, respectively). Linear correlative analyses were applied to determining age-related fractional anisotropy (FA) and mean diffusivity (MD), and t-test was performed to compare FA and mean diffusion maps between different age groups. Results: Significant positive correlation of FA with age was found in the internal capsule, the external capsule, the frontal white matter, and the body and genu of the corpus callosum. Compared with the 11–13 age group, FA in the 16–18 age group increased in the internal capsule, the frontal white matter, the body and the splenium of the corpus callosum. Compared to the 16–18 age group, FA in the 23–25 age group increased in the frontal white matter, the posterior limb of internal capsule, and the genu of the corpus callosum. Statistically significant negative correlation of the mean diffusion with age was found in the frontal and parietal white matter. Compared with the 11–13 age group, MD in the 16–18 age group decreased in the prefrontal and the temporo-parietal white matter. Compared with the 16–18 age group, MD in the 23–25 age group decreased in the frontal white matter. Conclusion: Diffusion-tensor MR imaging results indicate that white matter maturation assessed at different ages involves increases in FA and decreases in mean diffusion of the white matter during adolescence and young adulthood. FA and mean diffusion may reflect different physiologic processes in healthy adolescents and young adults. Taken together, these data show that maturation of white matter is an important part of brain maturation during adolescence and young adulthood.

White matter microstructural differences linked to left perisylvian language network in children with dyslexia

Studies of dyslexia using diffusion tensor imaging (DTI) have reported fractional anisotropy (FA) differences in left inferior frontal gyrus (LIFG) and left temporo-parietal white matter, suggesting that impaired reading is associated with atypical white matter microstructure in these regions. These anomalies might reflect abnormalities in the left perisylvian language network, long implicated in dyslexia. While DTI investigations frequently report analyses on multiple tensor-derived measures (e.g., FA, orientation, tractography), it is uncommon to integrate analyses to examine the relationships between atypical findings. For the present study, semi-automated techniques were applied to DTI data in an integrated fashion to examine white matter microstructure in 14 children with dyslexia and 17 typically developing readers (ages 7–16 years). Correlations of DTI metrics (FA and fiber orientation) to reading skill (accuracy and speed) and to probabilistic tractography maps of the left perisylvian language tracts were examined. Consistent with previous reports, our findings suggest FA decreases in dyslexia in LIFG and left temporo-parietal white matter. The LIFG FA finding overlaps an area showing differences in fiber orientation in an anterior left perisylvian language pathway. Additionally, a positive correlation of FA to reading speed was found in a posterior circuit previously associated with activation on functional imaging during reading tasks. Overall, integrating results from several complementary semi-automated analyses reveals evidence linking atypical white matter microstructure in dyslexia to atypical fiber orientation in circuits implicated in reading including the left perisylvian language network.

The contribution of white and gray matter differences to developmental dyslexia: Insights from DTI and VBM at 3.0 T

Developmental dyslexia is one of the most common neuropsychological disorders in children and adults. Only few data are available on the pathomechanisms of this specific dysfunction, assuming – among others – that dyslexia might be a disconnection syndrome of anterior and posterior brain regions involved in phonological and orthographic aspects of the reading process, as well as in the integration of phonemes and graphemes. Therefore, diffusion tensor imaging (DTI) and voxel-based morphometry (VBM) were used to verify the hypothesis of altered white and gray matter structure in German dyslexic adults. DTI revealed decreased fractional anisotropy (FA) in bilateral fronto-temporal and left temporo-parietal white matter regions (inferior and superior longitudinal fasciculus). Significant correlations between white matter anisotropy and speed of pseudoword reading were found. In dyslexics, gray matter volumes (as measured by VBM) were reduced in the superior temporal gyrus of both hemispheres. So far, our results, based on a combined analysis of white and gray matter abnormalities, provide exceedingly strong evidence for a disconnection syndrome or dysfunction of cortical areas relevant for reading and spelling. Thus, we suggest that this imbalance of neuronal communication between the respective brain areas might be the crucial point for the development of dyslexia.

The contribution of white and grey matter differences to developmental dyslexia – Insights from VBM and DTI at 3.0 Tesla

Developmental dyslexia or specific reading disability is a developmental disorder with a biological origin attributable to specific disorders in brain function. Over the last few years, important insights on the neuroanatomical basis of developmental dyslexia have been gained via new structural brain imaging techniques. In the current study, diffusion tensor imaging (DTI) and voxel-based morphometry (VBM) were used to investigate neuroanatomical correlates of dyslexia in German adults. Eight dyslexic adults and healthy controls participated in the study. DTI revealed decreased fractional anisotropy in bilateral fronto-temporal as well as left temporo-parietal white matter in dyslexic participants. In both dyslexics and controls, white matter fibers were predominantly oriented in the anterior-posterior direction, but this orientation was less distinct in dyslexics. Correlational analyses revealed associations between white matter anisotropy and speed of pseudoword reading in both groups. Grey matter density (as measured by VBM) was reduced bilaterally in the superior temporal gyrus in dyslexics.

Left lateralized white matter microstructure accounts for individual differences in reading ability and disability

Diffusion tensor imaging (DTI) was used to investigate the association between variation in white matter microstructure and individual differences in reading skill within children. Unlike previous DTI studies of reading, our sample examined children in both the average reading range as well as several children in the performance range of reading disability (RD). Results replicate previous findings of a strong correlation between fractional anisotropy (FA) values in a left temporo-parietal white matter region and standardized reading scores of typically developing children. Furthermore, FA values in this same region accounted for differences between children scoring in the average range and children scoring in the RD range, suggesting that the role of white matter tract microstructure is best characterized as an extreme range on a continuum of typical variation. Furthermore, significant correlations between working memory and frontal white matter tract regions were present in this same population, yet were demonstrated to be independent of the relationships found between reading and more posterior regions. Results form a “correlational double dissociation” that demonstrates domain specificity in the influence of white matter tract structures to individual differences in cognitive performance.

Imaging brain connectivity in children with diverse reading ability

Reading is a complex cognitive skill that requires the coordination of multiple brain regions. Although functional neuroimaging studies highlight the cortical brain regions associated with a specific cognitive task like reading, they do not directly address the underlying neural connections necessary for efficient performance of this task. Adults with reading disability have demonstrated lower regional white matter connectivity, but it is not known whether this relationship between neuronal wiring and reading performance also holds in younger readers. Using diffusion tensor magnetic resonance imaging (DTI) that highlights the structural integrity of the brain wiring, we show that regional brain connectivity in the left temporo-parietal white matter correlates with a wide range of reading ability in children as young as 8–12 years old. Diffusion tensor tractography suggests that the posterior limb of the internal capsule is consistent with the location of the largest cluster of correlation between reading ability (Word Identification subtest) and fractional anisotropy. The maturation of the white matter may play a key role in the development of cognitive processes such as reading.

Microstructure of temporo-parietal white matter as a basis for reading ability: evidence from DTI

Microstructure of temporo-parietal white matter as a basis for reading ability: evidence from DTI

Perfusion MRI and computerized cognitive test abnormalities in abstinent methamphetamine users

This study aims to determine possible persistent abnormalities in regional cerebral blood flow (relative rCBF) and cognitive function in abstinent methamphetamine (METH) users. Twenty METH-dependent subjects (abstinent for 8±2 months) and 20 age- and gender-matched controls were evaluated with perfusion magnetic resonance imaging (pMRI) and neuropsychological tests. METH users showed decreased relative rCBF bilaterally in putamen/insular cortices (right: −12%; left: −10%) and the right lateral parietal brain region (−11%), but increased relative rCBF bilaterally in the left temporoparietal white matter (+13%), the left occipital brain region: (+10%) and the right posterior parietal region (+24%). Interaction effects were observed between METH and gender in the right occipital cortex and a midline brain region; female METH users showed increased relative rCBF (+15% both regions) whereas the male METH users had decreased relative rCBF (−10% and −18%, respectively). METH users performed within normal ranges on standard neuropsychological tests; however, they were slower on several tasks on the California Computerized Assessment Package (CalCAP), especially tasks that required working memory. These findings suggest that METH abuse is associated with persistent physiologic changes in the brain, and these changes are accompanied by slower reaction times on computerized measures of cognitive function.

Microstructure of Temporo-Parietal White Matter as a Basis for Reading Ability: Evidence from Diffusion Tensor Magnetic Resonance Imaging

Diffusion tensor magnetic resonance imaging (MRI) was used to study the microstructural integrity of white matter in adults with poor or normal reading ability. Subjects with reading difficulty exhibited decreased diffusion anisotropy bilaterally in temporo-parietal white matter. Axons in these regions were predominantly anterior–posterior in direction. No differences in T1-weighted MRI signal were found between poor readers and control subjects, demonstrating specificity of the group difference to the microstructural characteristics measured by diffusion tensor imaging (DTI). White matter diffusion anisotropy in the temporo-parietal region of the left hemisphere was significantly correlated with reading scores within the reading-impaired adults and within the control group. The anisotropy reflects microstructure of white matter tracts, which may contribute to reading ability by determining the strength of communication between cortical areas involved in visual, auditory, and language processing.

Changes in cerebral metabolism are detected prior to perfusion changes in early HIV-CMC: A coregistered (1)H MRS and SPECT study.

Human immunodeficiency virus-cognitive motor complex (HIV-CMC), a common complication of the acquired immunodeficiency syndrome (AIDS), is characterized by progressive cognitive impairment and motor dysfunction. Functional imaging methods, such as single-photon emission computed tomography (SPECT) and proton magnetic resonance spectroscopy ((1)H-MRS), have been applied to assess the severity of brain injury. However, it is unclear which of these two methods is more sensitive in detecting brain abnormalities in patients with early HIV-CMC. Twenty-four HIV-CMC patients were compared with 34 healthy subjects; each had quantitative SPECT ((133)Xenon-calibrated (99m)Tc-HMPAO) and quantitative (1)H-MRS. Both modalities were co-registered in order to assess regional cerebral blood flow (rCBF) and metabolite concentrations within the same voxel of interest in four brain regions (midfrontal and midparietal gray matter, temporoparietal white matter, and basal ganglia). On SPECT, only the temporoparietal white matter showed a trend for decreased rCBF in HIV-CMC patients (-13%, P = 0.06). On MRS, HIV-CMC patients showed significantly reduced creatine concentration in the basal ganglia (-8%, P = 0.008), as well as increased myoinositol concentrations in the basal ganglia (+25%, P = 0.01) and the temporoparietal white matter (+18%, P = 0.08). There was no significant correlation between SPECT and MRS variables in the patients in any region. (1)H MRS showed abnormal neurochemistry in the basal ganglia, whereas rCBF on SPECT was normal in the same region. This finding suggests that metabolite concentrations on (1)H MRS are better surrogate markers than rCBF measurements with SPECT for the evaluation of brain injury in early HIV-CMC. J. Magn. Reson. Imaging 2000;12:859-865.