This document provides an overview of neuroimaging in psychiatry. It discusses the historical milestones of neuroimaging techniques such as CT, MRI, PET and SPECT. It explains the basic principles and types of structural and functional neuroimaging. The document summarizes the significance of neuroimaging in understanding specific psychiatric disorders and its role in diagnosis, prognosis and treatment development. Neuroimaging techniques can help identify neural abnormalities in psychiatry and aid in better classification of mental illnesses.

1. NEUROIMAGING IN
PSYCHIATRY
Dr. Subrata Naskar
Email :
nsubrata09@gmail.com

2. PLAN OF PRESENTATION
• INTRODUCTION
• HISTORICAL MILESTONES
• WHY NEUROIMAGING IN PSYCHIATRY ?
• TYPES OF NEUROIMAGING
• BASIC PRINCIPLES
• NEUROIMAGING IN SOME SPECIFIC PSYCHIATRIC DISORDERS
• CONCLUSION
• BIBLIOGRAPHY

3. INTRODUCTION
• RADIOIMAGING ARE METHODOLOGIES THAT ALLOW
MEASUREMENT OF THE STRUCTURE, FUNCTION, & CHEMISTRY
OF THE LIVING HUMAN BRAIN
• IT HAS PROVIDED NEW INFORMATION ABOUT THE
PATHOPHYSIOLOGY OF PSYCHIATRIC DISORDERS
• IT CAN BE USEFUL FOR DIAGNOSING ILLNESS, PREDICTING
PROGNOSIS & FOR DEVELOPING NEW TREATMENTS

4. HISTORY
• THE FIRST CHAPTER OF THE HISTORY OF NEUROIMAGING TRACES BACK TO THE ITALIAN NEUROSCIENTIST
ANGELO MOSSO WHO INVENTED THE 'HUMAN CIRCULATION BALANCE', WHICH COULD NON-INVASIVELY
MEASURE THE REDISTRIBUTION OF BLOOD DURING EMOTIONAL AND INTELLECTUAL ACTIVITY.
• IN 1918 THE AMERICAN NEUROSURGEON WALTER DANDY INTRODUCED THE TECHNIQUE OF
VENTRICULOGRAPHY. X-RAYIMAGES OF THE VENTRICULAR SYSTEM WITHIN THE BRAIN WERE OBTAINED
BY INJECTION OF FILTERED AIR DIRECTLY INTO ONE OR BOTH LATERAL VENTRICLES OF THE BRAIN.
• IN 1927 EGAS MONIZ INTRODUCED CEREBRAL ANGIOGRAPHY, WHEREBY BOTH NORMAL AND
ABNORMAL BLOOD VESSELS IN AND AROUND THE BRAIN COULD BE VISUALIZED WITH GREAT PRECISION.

5. ANGELO MOSSOWALTER DANDY EGAS MONIZ

6. HISTORY
1946 – MR PHENOMENON EXPLAINED BY BLOCH & PURCELL [1952 – NOBEL PRIZE]
1950 – 1970 – NMR DEVELOPED AS AN ANALYTICAL TOOL
1963 – 1ST INSTANCE OF SPECT USING ANGER CAMERA – KUHN & EDWARDS
1972 – COMPUTERIZED TOMOGRAPHY [GODFREY HOUNSFIELD, ALAN MCLEOD
CORMACK, 1979 – NOBEL PRIZE]
1973 – BACKPROJECTION MRI – LAUTERBUR
1983 – COMPTON CAMERA FOR SPECT – MANBIR SINGH & DAVID DORIA
1985 – DTI – LE BIHAN D & BRETON E
1986 – GRADIENT ECHO IMAGING, NMR MICROSCOPE
1987 – MR ANGIOGRAPHY – DUMOULIN
1992 – FUNCTIONAL MRI BY RICHARD .R. ERNST

7. WHY NEUROIMAGING IN PSYCHIATRY ?
TO HELP US IDENTIFY NEURAL SYSTEM ABNORMALITIES THAT ARE MORE
ACCURATE THAN TRADITIONAL CLINICAL MEASURES
FUNCTIONAL NEUROIMAGING TECHNIQUES CURRENTLY HAVE AN
ADJUNCTIVE ROLE IN THE EVALUATION OF DEMENTIA AND SEIZURE
DISORDERS
BETTER CLASSIFICATION SYSTEM OF PSYCHIATRIC ILLNESS

8. TYPES OF NEUROIMAGING
STRUCTURAL FUNCTIONAL
CT SCAN FMRI
MRI PET
PLAIN SKULL RADIOGRAPHY SPECT
PNEUMO-ENCEPHALOGRAPHY MRS
DTI
BRAIN ELECTRICAL ACTIVITY
MAPPING (BEAM)

9. COMPUTED TOMOGRAPHY

10. COMPUTED TOMOGRAPHY
CT SCANNERS TAKE A SERIES OF
HEAD X-RAY PICTURES FROM
ALL VANTAGE POINTS
360º AROUND A PATIENT'S
HEAD
THE AMOUNT OF RADIATION
THAT PASSES THROUGH, OR IS
NOT ABSORBED FROM, EACH
ANGLE IS DIGITIZED &
ENTERED INTO A COMPUTER
THE COMPUTER USES MATRIX
ALGEBRA CALCULATIONS TO
ASSIGN A SPECIFIC DENSITY TO
EACH POINT WITHIN THE HEAD
& DISPLAYS THESE DATA AS A
SET OF 2-D IMAGES
WHEN VIEWED IN SEQUENCE,
THE IMAGES ALLOW MENTAL
RECONSTRUCTION OF THE
STRUCTURE OF THE BRAIN

11. CT SCAN
TISSUE APPEARANCE
BONE WHITE
CALCIFIED TISSUE WHITE
CLOTTED BLOOD WHITE
GREY MATTER LIGHT GREY
WHITE MATTER MEDIUM GREY
CSF NEARLY BLACK
WATER NEARLY BLACK
AIR BLACK

12. • CT IMAGE IS DETERMINED ONLY BY DEGREE TO WHICH TISSUES ABSORB X-RAY
• BONY TISSUE ABSORB LARGE AMOUNT OF X-RAYS AND TEND TO OBSCURE THE DETAILS
OF NEIGHBORING STRUCTURES POOR VISIBILITY IN BRAINSTEM.
• POOR DIFFERENTIATION OF GREY-WHITE PATTERN THAN COMPARED TO MRI.
• CERTAIN TUMORS MAY BE INVISIBLE ON CT BECAUSE THEY ABSORB AS MUCH
IRRADIATION THAN THE SURROUNDING BRAIN VISIBLE ON CONTRAST CT.
• BONE, CLOTTED BLOOD, CALCIFIED TISSUE, CONTRAST MATERIAL ALL APPEAR WHITE &
CSF BLACK
• THE ONLY COMPONENT OF BRAIN BETTER SEEN ON CT SCAN IS CALCIFICATION, WHICH
MAY BE INVISIBLE ON MRI

13. NORMAL CT SCAN OF BRAIN

14. SOME IMPORTANT STRUCTURES THAT WE
SHOULD KNOW

16. • CRITERIA FOR CONTRAST-
– PATIENTS WITH H/O SEIZURE
– PATIENTS WITH H/O CEREBRO-VASCULAR ACCIDENT
– SUSPICION OF INTRACRANIAL SOLS INCLUDING GRANULOMAS, CNS
TUMOURS, METASTATIC LESIONS
• PLAIN CT
– DIAGNOSTIC ACCURACY 82%
• CONTRAST CT
– IV IODINATED CONTRAST MEDIUM
– DIAGNOSTIC ACCURACY 92%

17. IMAGE SHOWING ENHANCEMENT AFTER CONTRAST ADMINISTRATION

18. • ADVANTAGES
– SIMPLER, CHEAPER, MORE
ACCESSIBLE
– TOLERATED BY CLAUSTROPHOBICS
– NO ABSOLUTE
CONTRAINDICATIONS
– BETTER THAN MR FOR BONE
DETAIL & CALCIFICATION
• DISADVANTAGES
₋ IONIZING RADIATION
₋ IV CONTRAST
COMPLICATIONS
₋ LIMITED RANGE OF
TISSUE CONTRASTS

19. CLNICAL INDICATIONS OF CT BRAIN IN PSYCHIATRY
• CONFUSION &/OR DEMENTIAS OF UNKNOWN CAUSE
• FIRST EPISODE OF PSYCHOSIS
• FIRST EPISODE OF MAJOR AFFECTIVE DISORDER AFTER 50 YEARS OF
AGE
• PERSONALITY CHANGES AFTER 50 YEARS OF AGE
• PSYCHIATRIC SYMPTOMS FOLLOWING HEAD INJURY
• TO RULE OUT COMPLICATIONS DUE TO POSSIBLE HEAD TRAUMA

20. CLNICAL INDICATIONS OF CT BRAIN IN PSYCHIATRY
• PROLONGED CATATONIA
• CO EXISTENCE OF SEIZURE WITH PSYCHIATRIC SYMPTOMS
• MOVEMENT DISORDERS OF UNKNOWN ETIOLOGY
• FOCAL NEUROLOGICAL SIGNS ACCOMPANYING PSYCHIATRIC
SYMPTOMS

21. MAGNETIC RESONANCE IMAGING

22. MAGNETIC RESONANCE IMAGING
NUCLEI OF ALL ATOMS ARE
THOUGHT TO SPIN ABOUT AN
AXIS RANDOMLY ORIENTED IN
SPACE
PLACED IN MAGNETIC FIELD 
AXIS OF ALL ODD-NUMBERED
NUCLEI (MAINLY HYDROGEN)
ALIGN WITH THE MAGNETIC
FIELD
WHEN EXPOSED TO A PULSE OF
RADIOFREQUENCY WAVES -
AXIS OF NUCLEUS DEVIATES
AWAY FROM THE MAGNETIC
FIELD
WHEN THE PULSE TERMINATES,
THE AXIS OF THE SPINNING
NUCLEUS REALIGNS ITSELF WITH
THE MAGNETIC FIELD
DURING THIS REALIGNMENT, IT
EMITS ITS OWN
RADIOFREQUENCY SIGNAL
MRI SCANNERS COLLECT THE
EMISSIONS OF INDIVIDUAL
REALIGNING NUCLEI & USE
COMPUTER ANALYSIS TO
GENERATE A SERIES OF 2-D
IMAGES THAT REPRESENT THE
BRAIN

23. • RADIOFREQUENCY AND MAGNETIC
FIELD PULSES MANIPULATED TO CREATE
DIFFERENT PULSE SEQUENCES.
• BASED ON THE DURATION OF RF PULSE
& THE LENGTH OF TIME - DIFFERENT
PULSE SEQUENCES ARE OBTAINED.
• EXAMPLES: T1, T2, FLAIR, DWI ETC.

24. SOME IMPORTANT POINTS TO REMEMBER
• MAGNETIC FIELD STRENGH IS THE MEASURED INTENSITY OF
MAGNETIC FIELD
• MAGNETIC FIELD STRENGTH IS MEASURED IN Tesla (T) OR
Gauss (G)
• FDA APPROVED MRI SCANNER ≤ 3T
• 3T = 50,000 EARTH’S MAGNETIC FIELD

25. SOME IMPORTANT POINTS TO REMEMBER
• AN MRI IMAGE IS A SLICE OF A PART OF HUMAN BODY
• EACH SLICE HAS A THICKNESS
• VOXELS ARE VOLUME ELEMENTS
• SEVERAL VOLUME ELEMENTS IS PRESENT IN A SLICE
• VOXEL = 3mm
• PIXEL – PICTURE ELEMENTS OF AN MRI IMAGE

26. T1 WEIGHTED MRI
• BEST FOR VISUALIZING NORMAL NEUROANATOMY
• SHARP BOUNDARIES BETWEEN GREY MATTER, WHITE MATTER,
AND CSF
• USEFUL IN EVALUATION OF CEREBRO-PONTINE ANGLE, CISTERN
& PITUITARY FOSSA
• BONE WHITE
• WHITE MATTER LIGHT GREY
• GREY MATTER MEDIUM GREY
• WATER/CSF/AIR BLACK

27. T1 WEIGHTED MRI
T1 IS THE ONLY SEQUENCE THAT
ALLOWS CONTRAST ENHANCEMENT
WITH GADOLINIUM.
CONTRAST ENHANCED STRUCTURES
ON T1 APPEARS WHITE

28. T2 WEIGHTED MRI
• LESS DISTINCT BOUNDARIES BETWEEN WHITE AND GREY
MATTER
• BEST FOR DISPLAYING PATHOLOGY
• USEFUL IN DEMYELINATION, EDEMA & TUMOUR INFILTRATION
– GRAY MATTER MEDIUM GRAY
– WHITE MATTER DARK GREY
– CSF AND WATER WHITE

29. T1 WEIGHTED MRI T2 WEIGHTED MRI

30. FLUID ATTENUATED INVERSION RECOVERY
(FLAIR)
• SPECIAL TYPE OF MRI SCAN
• T1 IMAGE IS INVERTED & ADDED TO THE T2 IMAGE
• CONTRAST BETWEEN GREY & WHITE MATTER IS DOUBLED &
THE NORMAL CSF SIGNAL IS SUPPRESSED.
• SPECIAL INDICATIONS
– TO DETECT SCLEROSIS OF HIPPOCAMPUS IN TEMPORAL LOBE
EPILEPSY.
– TO LOCALIZE THE AREAS OF ABNORMAL METABOLISM IN
DEGENERATIVE NEUROLOGICAL DISEASES.

31. FLUID ATTENUATED INVERSION RECOVERY
(FLAIR)

32. DIFFUSION WEIGHTED IMAGING (DWI)
• SENSITIVE TO SPEED OF WATER DIFFUSION
• VISUALIZES AREA OF ISCHEMIC STROKE IN 1ST FEW HOURS- EARLIEST TO DETECT
ISCHEMIA.
• MRI TECHNIQUE THAT ENABLES THE MEASUREMENT OF THE RESTRICTED DIFFUSION OF
WATER IN TISSUE
• PRINCIPLE APPLICATION IS IN THE IMAGING OF WHITE MATTERWHERE THE LOCATION,
ORIENTATION, AND ANISOTROPY OF THE TRACT S CAN BE MEASURED
• THE ARCHITECHTURE OF THE AXONS IN PARALLEL BUNDLES, AND THEIR MYELIN
SHEATHS, FACILITATE THE DIFFUSION OF THE WATER MOLECULES PREFERENTIALLY
ALONG THEIR MAIN DIRECTION. SUCH PREFERENTIALLY ORIENTED DIFFUSION IS CALLED
ANISOTROPHIC DIFFUSION

33. THREE-DIMENSIONAL RECONSTRUCTION BASED ON DIFFUSION DATA

34. IMPORTANT POINTS
• MRI MAGNETS USED IN CLINICAL PRACTICE RANGES FROM 0.3 TO 2.0 TESLA STRENGTH.
• HIGHER FIELD-STRENGTH SCANNERS PRODUCE IMAGE OF HIGHER RESOLUTION.
INDICATION ADVANTAGES DISADVANTAGES
TO RULE OUT ORGANIC CAUSE
OF PSYCHIATRIC ILLNESS
DOES NOT EXPOSE THE
PATIENT TO IONIZING
RADIATIONS
AVOIDED IN PATIENTS
WEARING METALLIC DEVICES
ABRUPT CHANGE IN MENTAL
STATE
DEMYELINATING DISEASE
CAN BE ASSESSED RELIABLY
CLAUSTROPHOBIA
NEW ONSET MEMORY LOSS
OR DEMENTIA
BETTER STUDY OF POSTERIOR
FOSSA STRUCTURES
DOES NOT PICK UP BONY
ABNORMALITIES
DIFFICULT IN
UNCOOPERATIVE PATIENTS

35. IV CONTRAST IN NEURO-IMAGING
• CT → IODINE BASED
– IODINE IS HIGHLY ATTENUATING OF X-RAY BEAM (BRIGHT ON CT)
• MRI → GADOLINIUM BASED (GADOLINIUM DTPA)
– GADOLINIUM IS A PARAMAGNETIC METAL THAT HASTENS T1 RELAXATION OF NEARBY WATER
PROTONS (BRIGHT ON T1-WEIGHTED IMAGES)
• TISSUE THAT GETS BRIGHTER WITH IV CONTRAST IS SAID TO BE “ENHANCED”
• ENHANCEMENT REFLECTS THE VASCULARITY OF TISSUE,
• THE BLOOD-BRAIN BARRIER KEEPS IV CONTRAST OUT OF THE BRAIN
• ENHANCEMENT IMPLIES BBB IS ABSENT OR DYSFUNCTIONAL

36. LOCATION OF
SOME IMPORTANT BRAIN STRUCTURES

37. AMYGDALA

38. HIPPOCAMPUS

39. CAUDATE HEAD

40. PUTAMEN

41. GLOBUS PALLIDUS

42. MAGNETIC RESONANCE SPECTROSCOPY
(MRS)
• BASIC PRINCIPLE:

43. MAGNETIC RESONANCE SPECTROSCOPY
(MRS)
• NUCLEI ALIGN THEMSELVES IN THE STRONG MAG. FIELD
• A RADIOFREQUENCY PULSE CAUSES THE NUCLEI OF INTEREST
TO ABSORB & THEN EMIT ENERGY
• READOUT ON MRS IS IN THE FORM OF A SPECTRUM
• CAN BE CONVERTED INTO A PICTORIAL IMAGE OF THE BRAIN

45. NUCLEI USED IN MRS & THEIR USES IN PSYCHIATRY
NUCLEI USES
H¹ DECREASED ASPARTATE (NAA) IN DEMENTIA & OTHER NEUROLOGICAL CONDITIONS
LI 7 PHARMACOKINETICS OF LITHIUM
C¹³ STUDY OF METABOLIC PATHWAY
F 19  PHARMACOKINETICS OF CERTAIN DRUGS LIKE SSRIS (FLUOXETINE, FLUOXAMINE)
 ANALYSIS OF GLUCOSE METABOLISM
P³¹ TISSUE METABOLISM (COMPOUND CONTAINING HIGH ENERGY PHOSPHATES LIKE ATP,
ADP ETC.)

46. SIGNIFICANCE OF MRS IN PSYCHIATRY
• MRS HAS REVEALED DECREASED NAA CONC. IN TEMPORAL
LOBES & INCREASED CONC. OF INOSITOL IN OCCIPITAL LOBES
OF PTS WITH ALZHEIMER DEMENTIA.
• MRS HAS REVEALED DECREASED NAA CONC. IN TEMPORAL &
FRONTAL LOBES OF PTS WITH SCHIZOPHRENIA.
• ALSO IT HAS SHOWN ELEVATED BRAIN LACTATE LEVELS DURING
PANIC ATTACKS IN PTS WITH PANIC DISORDER.

47. FUNCTIONAL MAGNETIC RESONANCE IMAGING
(fMRI)

48. PRINCIPLE
• A SUB-TYPE OF MRI SCAN
• USES THE NEW T2 OR THE BLOOD-OXYGEN LEVEL DEPENDENT (BOLD)
SEQUENCE
• DETECTS LEVELS OF OXYGENATED HB IN THE BLOOD
• MAPS BRAIN FUNCTION
• DETECTS NOT THE BRAIN ACTIVITY PER SE, BUT THE BLOOD FLOW
NEURONAL
ACTIVITY WITHIN
THE BRAIN
LOCAL INCREASE IN
BLOOD FLOW
INCREASES THE
LOCAL HB CONC
WHICH REFLECTS
THE FUNC.
ACTIVITY OF BRAIN
ON T2 SEQUENCE

49. ADVANTAGES
• POSSIBLE TO STUDY BOTH CEREBRAL ANATOMY & FUNCTIONAL
NEUROPHYSIOLOGY USING A SINGLE TECHNIQUE (BULLMORE &
FLETCHER 2003)
• NO RADIO ACTIVE EXPOSURE
• USED IN CRIMINAL PSYCHIATRY OR FEDERAL INVESTIGATIONS AS
A LIE DETECTOR

50. LIMITATIONS OF fMRI
• FMRI ASSESES NEURONAL ACTIVITY INDIRECTLY BY MEASURING BLOOD
FLOW (OR TISSUE PERFUSION). THIS LIMITS ITS RESOLUTION.
• TWO TASKS THAT ACTIVATES CLUSTERS OF NEURONS 5 MM APART WILL
YIELD OVERLAPPING SIGNALS ON FMRI & THUS ARE INDISTINGUISHABLE
BY THIS TECHNIQUE.
• SENSITIVITY & RESOLUTION CAN BE IMPROVED BY USING ULTRA-SMALL
NON TOXIC IRON OXIDE PARTICLES.
• ACQUISITION OF SUFFICIENT IMAGES FOR STUDY CAN REQUIRE 20
MINUTES TO 3 HOURS, DURING WHICH THE SUBJECT’S HEAD MUST
REMAIN IN EXACTLY THE SAME POSITION.

51. DEPRESSION

52. SCHIZOPHRENIA

53. SINGLE PHOTON EMISSION COMPUTERIZED
TOMOGRAPHY (SPECT)

54. BASIC PRINCIPLE
• A TYPE OF NUCLEAR IMAGING THAT SHOWS HOW BLOOD
FLOWS TO TISSUES & ORGANS
• INTEGRATES : CT + RADIOACTIVE MATERIAL (TRACER)
• SPECT USES COMPOUNDS LABELED WITH SINGLE PHOTON-
EMITTING ISOTOPES: IODINE-123, TECHNETIUM-99M, AND
XENON-133

55. PRINCIPLE
INJECT WITH
RADIO-LABELLED
MATERIAL
GAMMA RAYS
EMITTED
DETECTED BY
SCANNER
TRANSLATED
INTO 2-D IMAGE
THESE IMAGES
ADDED
TOGETHER TO
GET A 3-D IMAGE

56. WHERE USED ?
• REGIONAL CEREBRAL BLOOD FLOW
• TC99 IS MOST COMMONLY USED FOR DEEPER STRUCTURES OF BRAIN
• XE133 FOR SUPERFICIAL STRUCTURES OF BRAIN (RCBF TECHNIQUE)
• MUSCARINIC CHOLINERGIC SYSTEM USING I123
• DOPAMINERGIC SYSTEM
• RADIOLABELLED RECEPTOR BINDING AGENTS I123, IBZM (IODOBENZAMIDE) FOR D2
RECEPTORS
• ADRENERGIC SYSTEM
• EARLY DIAGNOSIS OF ALZHEIMER'S DISEASE
*RCBF – REGIONAL CEREBRAL BLOOD FLOW

57. POSITRON EMISSION TOMOGRAPHY
(PET)
• A RADIOACTIVE ISOTOPE IS INJECTED
& DECAYS, EMITTING A Β + PARTICLE.
• WITHIN A SHORT DISTANCE, THE Β +
PARTICLE BUMPS INTO AN ELECTRON
& THE TWO ANNIHILATE,
PRODUCING A PAIR OF G - RAYS.
• BY DETECTING & RECONSTRUCTING
WHERE THE G - RAYS COME FROM,
WE CAN MEASURE THE LOCATION &
CONC OF RADIO-ISOTOPE.

58. POSITRON EMISSION TOMOGRAPHY
• MOST COMMONLY USED ISOTOPES
– F 18
– N 13
– O 15
• APPLICATIONS:
• TO ESTIMATE REGIONAL CEREBRAL BLOOD FLOW
• TO ESTIMATE REGIONAL CEREBRAL GLUCOSE METABOLISM (REGIONAL CEREBRAL METABOLIC
RATE FOR GLUCOSE - RCMRGLU)
• FOR RECEPTOR IMAGING
• TO STUDY NORMAL BRAIN DEVELOPMENT

59. SPECT PET
SINGLE PHOTON POSITRON
99MTC OR I 123 11C OR 18F
SHORT HALF LIFE LONGER HALF LIFE
LESS SENSITIVE HIGHLY SENSITIVE (100 TIMES MORE THAN SPECT)
LOW SPATIAL RESOLUTION SUPERIOR SPATIAL RESOLUTION
CHEAPER AND EASILY AVAILABLE THAN PET COSTLY, NOT EASILY AVAILABLE

61. PET SCAN CHANGES IN DEPRESSION

62. PET CHANGES IN ADHD

63. SOME OTHER MODALITIES
• BRAIN MAPPING
– CONNECTOGRAM
• FUNCTIONAL NEAR INFRARED SPECTROSCOPY (fNIRS)
• ALL NEUROIMAGING CAN BE CONSIDERED PART OF BRAIN MAPPING.
• BRAIN MAPPING CAN BE CONCEIVED AS A HIGHER FORM OF NEUROIMAGING,
PRODUCING BRAIN IMAGES SUPPLEMENTED BY THE RESULT OF ADDITIONAL
(IMAGING OR NON-IMAGING) DATA PROCESSING OR ANALYSIS, SUCH AS MAPS
PROJECTING (MEASURES OF) BEHAVIOR ONTO BRAIN REGIONS (FMRI).
• ONE SUCH MAP, CALLED A CONNECTOGRAM, DEPICTS CORTICAL REGIONS
AROUND A CIRCLE, ORGANIZED BY LOBES.

64. CONNECTOGRAMS
• ON AN INDIVIDUAL LEVEL, CONNECTOGRAMS CAN BE USED TO
INFORM THE TREATMENT OF PATIENTS WITH NEUROANATOMICAL
ABNORMALITIES.
• CONNECTOGRAMS HAVE BEEN USED TO MONITOR THE
PROGRESSION OF NEUROLOGICAL RECOVERY OF PATIENTS WHO
SUFFERED A TRAUMATIC BRAIN INJURY

66. FUNCTIONAL NEAR-INFRARED IMAGING
• FUNCTIONAL NEAR-INFRARED SPECTROSCOPY (FNIR OR FNIRS), IS THE USE OF NIRS
(NEAR-INFRARED SPECTROSCOPY) FOR THE PURPOSE OF FUNCTIONAL
NEUROIMAGING.
• USING FNIR, BRAIN ACTIVITY IS MEASURED THROUGH HEMODYNAMIC RESPONSES
ASSOCIATED WITH NEURON BEHAVIOR.
• THE USE OF FNIR AS A FUNCTIONAL IMAGING METHOD RELIES ON THE PRINCIPLE OF
NEURO-VASCULAR COUPLING ALSO KNOWN AS THE HAEMODYNAMIC RESPONSE OR
BOLD (BLOOD-OXYGENATION-LEVEL-DEPENDENT) RESPONSE.

67. IMAGING IN SPECIFIC PSYCHIATRIC DISORDERS

68. DEMENTIA
• PURPOSE
– DIAGNOSING THE CAUSE
– MONITORING DISEASE PROGRESSION
– STAGING OF DISEASE

69. ALZHEIMER’S DEMENTIA
STRUCTURING IMAGING FINDINGS

70. CT SCAN
CEREBRAL ATROPHY (TYPICAL
DILATATION OF LATERAL
VENTRICLES & WIDENING OF
CORTICAL SULCI) PARTICULARLY
IN POSTERIOR TEMPORAL &
PARIETAL REGIONS
SPECIFIC BRAIN REGIONS LIKE
HIPPOCAMPUS AND MEDIAL
TEMPORAL LOBE.

71. MRI
VOLUMETRIC MRI REVEALS SHRINKAGE IN
VULNERABLE BRAIN REGIONS, PARTICULARLY
THE MEDIAL TEMPORAL LOBE &
HIPPOCAMPUS.

72. FUNCTIONAL IMAGING
• EARLY STUDIES USING PET OR SPECT REVEALED A CHARACTERISTIC
PATTERN OF HYPOMETABOLISM IN THE POSTERIOR PARIETAL
LOBES.
• MRS IN AD REVEALED- DECREASED CONC OF NAA IN THE
TEMPORAL LOBES & INCREASED CONC OF INOSITOL IN THE
OCCIPITAL LOBES

73. SPECT
HYPOMETABOLISM IN THE POSTERIOR PARIETAL LOBES.

74. PET OF GLUCOSE
METABOLISM IN NORMAL
VS. ALZHEIMER’S DISEASE

75. • MOST RECENT DEVELOPMENT IN BRAIN IMAGING IN AD IS THE
DEVELOPMENT OF RADIO-LABELLED LIGANDS THAT CAN BIND
WITH AMYLOID, AND THEN CAN BE VISUALISED WITH PET.
• THIS TECHNIQUE IS CURRENTLY UNDER INVESTIGATION.

76. FRONTO-TEMPORAL DEMENTIA
• STRUCTURAL IMAGING REVEALS-
– SEVERE SHARPLY LOCALISED ATROPHY – BILATERALLY SYMMETRIC
“KNIFE-BLADE ATROPHY”
– HYPER-INTENSE SIGNAL IN THE CORTEX & UNDERLYING WHITE MATTER
OF THE AFFECTED AREAS
• AREAS INVOLVED- DORSOLATERAL PREFRONTAL CORTEX & MEDIAL TEMPORAL
LOBES
• AREAS SPARED- POSTERIOR PARIETAL AND OCCIPITAL CORTICES.
• FUNCTIONAL IMAGING REVEALS-
– FRONTO-TEMPORAL HYPOMETABOLISM

77. SEVERE SHARPLY LOCALISED ATROPHY – BILATERALLY SYMMETRIC “KNIFE-BLADE ATROPHY”

78. KNIFE-BLADE ATROPHY
SEVERE SHARPLY
LOCALISED ATROPHY –
BILATERALLY SYMMETRIC
“KNIFE-BLADE ATROPHY”

79. BI-LATERAL TEMPORO-
PARIETAL DEFICITS
BI-LATERAL FRONTAL LOBE
DEFICITS
ALZHEIMER’S DISEASE FRONTAL LOBE DEMENTIA
FRONTAL LOBE DEMENTIA
FRONTAL HYPO-PERFUSION SOMETIMES INCLUDING TEMPORAL LOBES

80. LEWY BODY DEMENTIA
• TO DATE, NO MRI FEATURES HAVE BEEN IDENTIFIED TO
CHARACTERIZE LEWY BODY DEMENTIA.
• THE ABSENCE OF SIGNIFICANT MEDIAL TEMPORAL LOBE
ATROPHY IN AN ELDERLY DEMENTED PATIENT SUGGESTS LEWY
BODY DEMENTIA ETIOLOGY RATHER THAN AD.
• PET OR SPECT MAY REVEAL REDUCED OCCIPITAL FUNCTION
WITH GENERALIZED REDUCTION OF CORTICAL ACTIVITY.

81. VASCULAR DEMENTIA
• DEMENTIA DUE TO CHRONIC CEREBROVASCULAR DISEASE IS
2ND MOST COMMON CAUSE OF DEMENTIA IN ELDERLY
• 3 MAIN FORMS ARE RECOGNIZED
– MULTI-INFARCT DEMENTIA
– SUB CORTICAL VASCULAR DEMENTIA/ BINSWANGER’S DISEASE
– CEREBRAL AMYLOID ANGIOPATHY

83. SPECT FINDINGS IN VASCULAR DEMENTIA
• 99MTC – HMPAO SPECT OF THE BRAIN IN VASCULAR DEMENTIA
SHOWS MULTIPLE PATCHY PERFUSION DEFECTS

84. MULTIPLE REGIONS OF FOCALLY REDUCED PERFUSION

85. NORMAL PRESSURE HYDROCEPHALUS
• TRIAD:
– DEMENTIA
– GAIT DISTURBANCES
– URINARY INCONTINENCE
• AGE : USUALLY AFTER 60 YEARS
• THEORIES:
– IMPAIRED EXTRAVENTRICULAR CSF ABSORPTION, DUE TO PRIOR SUB-ARACHNOID
HEMORRHAGE/ MENINGITIS.
– DECREASED WHITE MATTER TENSILE STRENGTH DUE TO DEEP WHITE MATTER
INFARCTION/ ISCHEMIC CHANGES

86. VENTRICULAR ENLARGEMENT OUT OF PROPORTION TO SULCAL ATROPHY.

87. • PRIMARY MRI FINDINGS IN NPH
– VENTRICULAR ENLARGEMENT OUT OF PROPORTION TO SULCAL ATROPHY.
– PROMINENT PERIVENTRICULAR HYPERINTENSITY (HALO).
– PROMINENT FLOW VOID IN THE AQUEDUCT AND THIRD VENTRICLE, THE SO-
CALLED JET SIGN, (PRESENTS AS A DARK AQUEDUCT AND THIRD VENTRICLE ON A
T2-WEIGHTED IMAGE WHERE REMAINDER OF CSF IS BRIGHT)
– THINNING AND ELEVATION OF CORPUS CALLOSUM ON SAGITTAL IMAGES

88. IMAGING IN OBCESSIVE COMPULSIVE DISORDER
• STRUCTURAL FINDINGS: (MRI & CT)
– BILATERALLY SMALLER CAUDATE IN OCD
PTS.
– SIGNIFICANTLY MORE CEREBRAL GREY
MATTER & LESS WHITE MATTER VOLUME
THAN NORMAL CONTROLS.
– DECREASED VOLUME OF LEFT ORBITAL
FRONTAL CORTEX.
– ABNORMALITY IN LENGTH OF CORPUS
CALLOSUM.
– ABNORMALITY IN PITUITARY VOLUME
MAY ALSO BE NOTED.
– LARGER ANTERIOR CINGULATE VOLUMES
(ACV) A/W INCREASED OCD SYMPTOMS
SEVERITY BUT NOT DURATION OF ILLNESS

89. • MAIN INCREASED (A) AND DECREASED (B) GREY MATTER
REGIONS IN INDIVIDUALS WITH OBSESSIVE–COMPULSIVE
DISORDER COMPARED WITH HEALTHY CONTROLS
• (A) INCREASED GREY MATTER IN LENTICULAR NUCLEI
• (B) DECREASED GREY MATTER IN DORSAL
MEDIOFRONTAL/ANTERIOR CINGULATE GYRI

90. MRS IN OCD
• OCD PATIENTS WERE DIVIDED INTO THREE GROUPS
– RESPONDERS TO A SSRI
– RESPONDERS TO A SSRI + AN ATYPICAL ANTIPSYCHOTIC
– NON-RESPONDERS TO EITHER SSRI OR SSRI + AN ATYPICAL
ANTIPSYCHOTIC
• MRS WAS USED TO MEASURE NAA CONCENTRATIONS
IN THE ANTERIOR CINGULATE, THE LEFT BASAL
GANGLIA & THE LEFT PREFRONTAL LOBE OF THE
SUBJECTS
• SIGNIFICANTLY LOWER NAA CONCENTRATIONS IN
RESPONDERS TO SSRI + AAP IN ANTERIOR CINGULATE
GYRUS
GREATER GLUTAMATERGIC
CONC. IN CAUDATE, AS
MEASURED BY ¹H-MRS IN
COMPARISON TO
CONTROLS
N-acetyl-aspartate (NAA)

91. SPECT & PET IN OCD
• IN A RESTING SPECT STUDY, OCD PTS HAS INCREASED MESIAL FRONTAL PERFUSION,
WHICH NORMALISES WITH FLUOXETINE RX.
• PET HAVE SHOWN
– INCREASED ACTIVITY (EG. METABOLISM & BLOOD FLOW) IN THE FRONTAL LOBES, BASAL GANGLIA
(SP. CAUDATE), AND THE CINGULATE GYRUS IN OCD PTS. (FINDINGS CONSISTENT WITH THE MRI
FINDINGS)
• HEAD OF THE CAUDATE
– PET : GREATER ACTIVITY
– SPECT : DECREASED ACTIVITY
• PHARMALCOLOGICAL AND BEHAVIORAL RX REPORTEDLY REVERSE THESE
ABNORMALITIES.

92. IMAGING IN DEPRESSION & BIPOLAR DISORDER

93. CT & MRI IN DEPRESSION
• SMALLER VOLUMES OF FRONTAL CORTEX, CEREBELLUM, CAUDATE & PUTAMEN.
• VENTRICULAR ENLARGEMENT, CORTICAL ATROPHY, AND SULCAL WIDENING ALSO
HAVE BEEN REPORTED IN SOME STUDIES.
• THE MOST CONSISTENT ABNORMALITY OBSERVED IN DEPRESSION IS
– INCREASED FREQUENCY OF ABNORMAL HYPERINTENSITIES IN SUBCORTICAL REGIONS INCLUDING
PERIVENTRICULAR REGIONS, BASAL GANGLIA, AND THALAMUS.
• THESE HYPERINTENSITIES MAY REFLECT THE DELETERIOUS EFFECTS OF RECURRENT
AFFECTIVE EPISODES. (SPECIALLY IN BIPOLAR I DISORDER AND AMONG ELDERLY)

94. • SOME DEPRESSED PTS MAY ALSO HAVE SPECIFICALLY REDUCED
HIPPOCAMPAL OR CAUDATE NUCLEUS VOLUMES, SUGGESTING
PRESENCE OF MORE FOCAL DEFECTS.
• FOCAL AREAS OF ATROPHY HAVE BEEN ASSOCIATED WITH
INCREASED ILLNESS SEVERITY, BIPOLARITY AND INCREASED
CORTISOL LEVELS.

95. fMRI IN DEPRESSION
• BILATERAL ANTERIOR CINGULATE CORTEX & RIGHT AMYGDALA
SIGNIFICANTLY SMALLER IN SIZE.
• INACTIVATION OF LEFT PREFRONTAL CORTEX IN DEPRESSED
INACTIVATION OF RIGHT PREFRONTAL CORTEX IN MANIA

96. fMRI
INACTIVATION OF LEFT PREFRONTAL CORTEX IN DEPRESSED

97. SPECT IN DEPRESSION
• BASELINE CEREBRAL BLOOD
FLOW (CBF) WAS LOWER IN
DEPRESSED PATIENTS – IN
FRONTAL CORTEX &
SUBCORTICAL NUCLEI
BILATERALLY
• MEDICATION RESPONSE –
NORMALIZATION OF CBF
DEFICIT.

98. PET IN DEPRESSION
• THE MOST WIDELY REPLICATED PET FINDING IN
DEPRESSION IS
– DECREASED ANTERIOR BRAIN (FRONTAL / PREFRONTAL
CORTEX) METABOLISM SPECIALLY ON DOMINANT
HEMISPHERE (LEFT SIDE).
– REVERSAL OF THIS HYPOFRONTALITY OCCURS WHEN PT.
SHIFTS FROM DEPRESSION INTO MANIA (I.E. DECREASE
RIGHT FRONTAL LOBE FUNCTION SEEN IN MANIA)
– IT HAS BEEN SEEN THAT ANTIDEPRESSANTS AT LEAST
PARTIALLY NORMALISES THESE CHANGES.

99. PET SCANS OF A 45 YEAR OLD WOMAN WITH RECURRENT
DEPRESSION PRE AND POST TREATMENT

100. BIPOLAR DISORDER
• PET STUDIES IN DEPRESSED BP-I, BIPOLAR II, AND MANIC
INDIVIDUALS HAVE SHOWN INCREASED AMYGDALA AND
VENTRAL STRIATAL LIMBIC SUBCORTICAL ACTIVITY
COMPARED WITH HEALTHY CONTROLS
• IN ADULTS, THERE ARE FINDINGS OF ENLARGED (OR
SHRUNKEN) AMYGDALA, DECREASED DORSAL AND VENTRAL
PREFRONTAL CORTICES, AND SMALLER OR NO CHANGE IN
HIPPOCAMPUS.

101. BIPOLAR DISORDER EARLY ONSET.
STUDIES SHOW
• MARKEDLY INCREASED
PERFUSION IN BILATERAL
FRONTAL AND POSTERIOR
PARIETAL LOBES.
• THERE IS ALSO HYPOPERFUSION
OF BOTH ORBITO-FRONTAL
AREAS, ANTERIOR AND MESIAL
TEMPORAL AREAS.

102. CT/MRI IN SCHIZOPHRENIA
• ENLARGEMENT OF LATERAL & THIRD VENTRICLES MAY BE
STATIC OR PROGRESSIVE.
• FRONTAL LOBE ABNORMALITIES, PARTICULARLY
PREFRONTAL GRAY MATTER AND ORBITOFRONTAL
REGIONS.
• PARIETAL LOBE ABNORMALITIES, PARTICULARLY OF THE
INFERIOR PARIETAL LOBULE WHICH INCLUDES BOTH
SUPRAMARGINAL AND ANGULAR GYRI.
• SUBCORTICAL ABNORMALITIES I.E. CAVUM SEPTI
PELLUCIDUM, BASAL GANGLIA, CORPUS CALLOSUM, AND
THALAMUS.
• ALL THESE STRUCTURAL ABNORMALITIES MAY BE STATIC
OR PROGRESSIVE.

103. • DECREASED SIZE OF MEDIAL TEMPORAL LOBE STRUCTURES (WHICH INCLUDE THE
AMYGDALA, HIPPOCAMPUS, AND PARAHIPPOCAMPAL GYRUS), AND ABNORMALITIES
OF NEOCORTICAL TEMPORAL LOBE REGIONS (SUPERIOR TEMPORAL GYRUS).
• HIPPOCAMPUS IS NOT ONLY SMALLER IN SIZE BUT ALSO FUNCTIONALLY ABNORMAL
(DISTURBED GLUTAMATE TRANSMISSION IN FUNCTIONAL SCANS)
• REDUCED SYMMETRY IN VARIOUS BRAIN AREAS MAY BE INDICATIVE OF DISRUPTION OF
BRAIN LATERALISATION DURING NEURODEVELOPMENT.
• ANATOMICAL & FUNCTIONAL DEFICITS IN PREFRONTAL CORTEX.
• VOLUME SHRINKAGE OR NEURONAL LOSS IN MEDIAL DORSAL NUCLEUS OF THALAMUS.

104. • POSITIVE SYMPTOMS - DECREASED VOLUME OF SUPERIOR
TEMPORAL GYRUS
• NEGATIVE SYMPTOMS - ENLARGED LATERAL VENTRICLE &
DECREASED VOLUME OF MEDIAL TEMPORAL LOBE STRUCTURES
• TYPICAL ANTI-PSYCHOTICS INCREASES THE SIZE OF THE BASAL
GANGLIA

105. CORONAL MR SCANS FROM
A CHRONIC SCHIZOPHRENIC
(RIGHT) AND NORMAL
COMPARISON SUBJECT
(LEFT). NOTE INCREASE IN
CSF IN LEFT AMYGDALA-
HIPPOCAMPAL COMPLEX
(SMALLER AMYGDALA ON
LEFT)
NORMAL CHRONIC SCHIZOPHRENIA

106. FUNCTIONAL IMAGING
• HYPOFRONTALITY
• FUNCTIONAL SCANS HAVE ALSO REVEALED
LOWER LEVELS OF PHOSPHOMONOESTER &
INORGANIC PHOSPHATE AND HIGHER LEVELS
OF PHOPHODIESTER IN SCHIZ PTS.
• NAA LEVELS WERE ALSO LOWER IN
HIPPOCAMPUS AND FRONTAL LOBES IN PTS
WITH SCHIZOPHRENIA.

109. IMAGING IN ANXIETY DISORDERS

110. • STRUCTURAL IMAGING (CT & MRI)-
– OCCASIONAL INCREASE IN SIZE OF VENTRICLES.
– ABNORMALITIES IN RIGHT HEMISPHERE BUT NOT IN THE LEFT
HEMISPHERE.
– THIS FINDING SUGGESTS THAT SOME TYPE OF CEREBRAL ASYMMETRY
MAY BE IMPORTANT IN THE DEVELOPMENT OF ANXIETY DISORDER.
• FUNCTIONAL IMAGING (FMRI, SPECT, PET)-
– ABNORMALITIES IN FRONTAL CORTEX, OCCIPITAL & TEMPORAL AREAS
IN PTS. WITH ANXIETY DISORDER & ABNORMALITIES IN
PARAHIPPOCAMPAL GYRUS IN PTS WITH PANIC DISORDER.

111. MRS
• IN PANIC D/O USED TO RECORD THE LEVELS OF LACTATE,
WHOSE IV INFUSION CAN PPT. PANIC EPISODES IN ~ 3/4TH OF
THE PTS. WITH EITHER PANIC D/O OR MAJOR DEPRESSION
• BRAIN LACTATE CONC. WERE FOUND TO BE ELEVATED DURING
PANIC ATTACKS, EVEN WITHOUT PROVOCATIVE INFUSION IN
PANIC DISORDER PTS.

112. IMAGING IN PTSD
• STUDIES IN PTSD VIETNAM COMBAT
VETERANS REVEALED:
– REDUCED LEFT AND RIGHT
HIPPOCAMPAL VOLUME
– VOLUME REDUCTIONS WERE
ASSOCIATED WITH SEVERITY OF
COMBAT EXPOSURE.
– A SIMILAR STUDY WAS UNDERTAKEN
WITH GULF WAR VETERANS IN ISRAEL,
AND THESE DATA ARE HAVE SHOWN
SIMILAR FINDINGS
HIPPOCAMPUS (GREEN), FORNIX (BLUE)
AND MAMMILARY BODIES (GRAY) ARE
SHOWN IN 3D.

113. • SMALLER HIPPOCAMPAL VOLUME IS NOT A NECESSARY RISK
FACTOR FOR DEVELOPING PTSD AND DOES NOT OCCUR
WITHIN 6 MONTHS OF EXPRESSING THE DISORDER
• THIS BRAIN ABNORMALITY MIGHT OCCUR IN INDIVIDUALS
WITH CHRONIC OR COMPLICATED PTSD.

114. TWIN STUDY IN PTSD
• A STUDY REPORTED IN NATURE-NEUROSCIENCE EVALUATED MR BRAIN
MORPHOMETRY OF THE HIPPOCAMPUS IN MONOZYGOTIC TWINS DISCORDANT FOR
PTSD. THE PTSD TWIN WAS DIAGNOSED WITH PTSD AS A RESULT OF COMBAT
EXPOSURE IN THE VIETNAM WAR.
• THE TWIN ASPECT OF THIS STUDY WAS IMPORTANT AS IT SHOWED THAT INDIVIDUALS
DISCORDANT FOR PTSD SHOWED REDUCED HIPPOCAMPAL VOLUME COMPARED
WITH TWINS WHERE PTSD WAS PRESENT IN NEITHER TWIN.
• THIS FINDING SUGGESTS THAT THERE MAY BE A PREDISPOSITION OR VULNERABILITY
FACTOR INVOLVED IN THE GENESIS OF PTSD

115. FUNCTIONAL IMAGING IN PTSD
• fMRI STUDIES HAVE FOUND INCREASED
ACTIVITY IN AMYGDALA, A BRAIN
REGION ASSOCIATED WITH FEAR.

116. IMAGING IN ADHD (CT & MRI)
• SHOWS NO CONSISTENT FINDINGS.
• INCREASED CORTICAL GREY & WHITE MATTER VOLUMES FROM 5 YRS OF AGE WITH
PEAK AT 12-15 YRS OF AGE.
• EARLY ONSET ADHD MAY BE ASSOCIATED WITH SMALLER TOTAL BRAIN VOLUME IN-
4% CASES.
• DECREASE IN THE VOLUME OF POSTERIOR INFERIOR CEREBELLAR VERMIS MAY BE
NOTED.(REGION INVOLVED IN ATTENTION PROCESSING)

117. FUNCTIONAL IMAGING (fMRI, SPECT, PET)
• PET HAS SHOWN THAT ADOLESCENT FEMALES WITH ADHD HAVE GLOBALLY LOWER
GLUCOSE METABOLISM THAT BOTH NORMAL CONTROLS & MALES WITH ADHD.
• PET SCAN HAS ALSO SHOWN LOWER CBF AND METABOLIC RATES IN THE FRONTAL
LOBES OF CHILDREN WITH ADHD.
• THIS MAY BE BECAUSE FRONTAL LOBES IN CHILDREN WITH ADHD ARE NOT ADEQUATELY
PERFORMING THEIR INHIBITORY MECHANISM ON LOWER STRUCTURES, LEADING TO
DISINHIBITION.
• LESS STRIATAL ACTIVATION DURING COGNITION INHIBITION TASKS.

118. fMRI LOWER CBF AND METABOLIC RATES IN THE FRONTAL LOBES

119. PET SCAN IN ADHD VS NORMAL
WHITE, RED, ORANGE =
HIGHER GLUCOSE
METABOLISM
BLUE, GREEN, PURPLE =
LOWER GLUCOSE
METABOLISM
GLOBALLY LOWER GLUCOSE METABOLISM

120. IMAGING IN AUTISM
• SIGNIFICANT DECREASE OF GREY MATTER CONCENTRATION IN SUPERIOR TEMPORAL
SULCUS BILATERALLY, AN AREA WHICH IS CRITICAL FOR PERCEPTION OF KEY SOCIAL
STIMULI.
• ALSO A DECREASE OF WHITE MATTER CONCENTRATION IN THE RIGHT TEMPORAL POLE
AND IN CEREBELLUM COMPARED TO NORMAL CHILDREN.
• INCREASE IN TOTAL CEREBRAL VOLUME, BOTH IN GREY AND WHITE MATTER, MOSTLY IN
THE OCCIPITAL, TEMPORAL AND PARIETAL LOBES.
• BRAIN ENLARGEMENT HAS BEEN CONSIDERED AS A POSSIBLE BIOMARKER FOR AUTISTIC
DISORDER.

121. BRAIN ENLARGEMENT IN AUTISM

122. FUNCTIONAL IMAGING
• BILATERAL HYPOPERFUSION OF THE TEMPORAL LOBES IN
AUTISTIC CHILDREN.
• IN ADDITION, ACTIVATION ABNORMALITIES MAY BE OBSERVED
IN THE TEMPORAL LOBES AND AMYGDALA, WHICH ARE
INVOLVED IN LANGUAGE AND SOCIAL COGNITION.
• AN INCREASE IN VISUAL CORTEX ACTIVITY WAS ALSO REPORTED

123. BILATERAL HYPOPERFUSION OF THE
TEMPORAL LOBES IN AUTISTIC CHILDREN
A - NORMAL CHILD
B - AUTISTIC CHILD

124. ALCOHOL DEPENDENCE
• CT SCAN:
– ALCOHOLIC PATIENTS TEND TO HAVE LARGER VENTRICLES AND WIDER CEREBRAL SULCI AND FISSURES
THAN CONTROL.
– CORTICAL ATROPHY IS ALSO REPORTED FREQUENTLY
– ABSTINENT PATIENTS MAY SHOW A REDUCTION IN VENTRICULAR SIZE
• MRI
– PRONOUNCED AND LASTING REDUCTION IN CORTICAL VOLUME –DISRUPTION OF
NEURODEVELOPMENTAL PROCESS
• DTI
– DISRUPTION IN THE INTEGRITY OF WHITE MATTER TRACKS. THE VOLUMETRIC CHANGES ARE
PARTICULARLY SEVERE IN PATIENTS WITH WERNICKE-KORSAKOFF SYNDROME

125. • MRS
– DURING ACUTE WITHDRAWAL CORTICAL GABA LEVELS APPEAR TO BE
NORMAL
– WITH RECOVERY FROM ALCOHOL DEPENDENCE, CORTICAL GABA
LEVELS APPEAR TO DECLINE AND MAY BE SIGNIFICANTLY BELOW THE
LEVEL SEEN IN NORMAL HEALTHY SUBJECTS
• fMRI
– ABNORMAL ACTIVATION PATTERNS IN FRONTAL CORTEX, THALAMUS,
STRIATUM, CEREBELLUM AND HIPPOCAMPUS
– INCREASED LIMBIC AND ORBITO-FRONTAL CORTEX ACTIVATION WHEN
EXPOSED TO ALCOHOL RELATED CUES THAT ELICIT CRAVING

126. • PET & SPECT IN ADS:
– DOPAMINE: IMAGING SHOWS DA SYNTHESIS IS REDUCED IN THE STRIATAL REWARD AREAS OF SOME
ALCOHOL DEPENDENT SUBJECTS
– THE POST-SYNAPTIC DOPAMINE D2/D3 RECEPTORS, PREDOMINANTLY LOCALIZED ON GABA TERMINALS
IN THE STRIATAL REWARD AREAS IS ALSO REDUCED IN LIMBIC STRIATUM AND SENSORIMOTOR
STRIATUM IN ALCOHOL DEPENDENT SUBJECTS IN ACUTE AND PROLONGED ABSTINENCE.
– SEROTONIN: 5HT TRANSPORTER AVAILABILITY IS REDUCED IN THE BRAINSTEM OF ALCOHOL
DEPENDENT SUBJECTS WITH IMPULSIVE AGGRESSION AND VIOLENCE, SUGGESTING THAT ALCOHOL
AND AGGRESSION ARE ASSOCIATED WITH LOWER 5HT TRANSMISSION
– GABA: INITIAL IMAGING STUDIES EVALUATED GABA-A BZD RECEPTOR AVAILABILITY ---RECEPTOR
LEVELS ARE FOUND TO BE LOWER IN FRONTAL, PARIETAL AND TEMPORAL CORTICES OF ADS PATIENTS

127. OTHERS SUBSTANCE RELATED DISORDERS
• COCAINE DEPENDENCE:
– PET SCANS OF BRAINS OF PATIENTS BEING TREATED FOR COCAINE ADDICTION
SHOW HIGH ACTIVATION OF THE MESOLIMBIC DA SYSTEM WHEN ADDICTS
PROFOUNDLY CRAVE A DRUG
– PATIENTS DESCRIBE FEELINGS OF INTENSE CRAVING FOR THE DRUG WHILE PET
SCAN SHOWED ACTIVATION IN AREA FROM THE AMYGDALA AND ANTERIOR
CINGULATE TO THE TIP OF BOTH TEMPORAL LOBES
• OPIOID DEPENDENCE:
– FEW STUDIES USING PET HAVE SUGGESTED THAT ONE EFFECT OF ALL OPIOIDS IS
DECREASED BLOOD FLOW IN SELECTED REGIONS OF BRAIN IN PERSONS WITH
OPIOID DEPENDENCE

128. • TOBACCO SMOKING:
– NICOTINE’S ACTIONS AT B2-N ACH RECEPTOR INITIATES A CASCADE OF
EFFECTS THROUGHOUT MOST MAJOR NEUROTRANSMITTER SYSTEMS IN
THE BRAIN INCLUDING
– THE DOPAMINERGIC
– GABAERGIC
– GLUTAMINERGIC
– NORADRENERGIC
– SEROTONERGIC SYSTEMS
– SUGGESTING THAT THE ADDICTIVE PROPERTIES OF TOBACCO SMOKING
ARE LIKELY MEDIATED BY MULTIPLE NEUROTRANSMITTER SYSTEMS
– SMOKERS HAVE LOWER LEVELS OF MAO ENZYMES AS DEMONSTRATED
USING PET.

129. SUMMARY
• NEUROIMAGING CAN BE STRUCTURAL / FUNCTIONAL
• FUNCTIONAL IMAGING MORE USEFUL THAN STRUCTURAL IN
PSYCHIATRY
• NEUROIMAGING IN PSYCHIATRY IS PRESENTLY USED MAINLY TO RULE
OUT NEUROLOGICAL CAUSES, AND IN EVALULATION OF DEMENTIA
• SENSITIVIY & SPECIFITY OF IMAGING IN PSYCHIATRY IS NOT MUCH
• STILL VARIOUS STUDIES AND THEIR FINDINGS AND NEWER
DEVELOPMENTS HOLDS A PROMISING FUTURE FOR NEUROIMAGING IN
PSYCHIATRIC DIAGNOSIS & MANAGEMENTS.

130. THANK YOU