Brain Imaging Pdf

[Rosamunda Froats]

Neuroimaging is the use of quantitative (computational) techniques to study the structure and function of the central nervous system, developed as an objective way of scientifically studying the healthy human brain in a non-invasive manner. Increasingly it is also being used for quantitative research studies of brain disease and psychiatric illness. Neuroimaging is highly multidisciplinary involving neuroscience, computer science, psychology and statistics, and is not a medical specialty. Neuroimaging is sometimes confused with neuroradiology.

Neuroradiology is a medical specialty and uses non-statistical brain imaging in a clinical setting, practiced by radiologists who are medical practitioners. Neuroradiology primarily focuses on recognising brain lesions, such as vascular disease, strokes, tumors and inflammatory disease. In contrast to neuroimaging, neuroradiology is qualitative (based on subjective impressions and extensive clinical training) but sometimes uses basic quantitative methods. Functional brain imaging techniques, such as functional magnetic resonance imaging (fMRI), are common in neuroimaging but rarely used in neuroradiology. Neuroimaging falls into two broad categories:

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.[1]

In 1918, the American neurosurgeon Walter Dandy introduced the technique of ventriculography. X-ray images of the ventricular system within the brain were obtained by injection of filtered air directly into one or both lateral ventricles of the brain. Dandy also observed that air introduced into the subarachnoid space via lumbar spinal puncture could enter the cerebral ventricles and also demonstrate the cerebrospinal fluid compartments around the base of the brain and over its surface. This technique was called pneumoencephalography.[citation needed]

In the early 1970s, Allan McLeod Cormack and Godfrey Newbold Hounsfield introduced computerized axial tomography (CAT or CT scanning), and ever more detailed anatomic images of the brain became available for diagnostic and research purposes. Cormack and Hounsfield won the 1979 Nobel Prize for Physiology or Medicine for their work. Soon after the introduction of CAT in the early 1980s, the development of radioligands allowed single-photon emission computed tomography (SPECT) and positron emission tomography (PET) of the brain.

More or less concurrently, magnetic resonance imaging (MRI or MR scanning) was developed by researchers including Peter Mansfield and Paul Lauterbur, who were awarded the Nobel Prize for Physiology or Medicine in 2003. In the early 1980s MRI was introduced clinically, and during the 1980s a veritable explosion of technical refinements and diagnostic MR applications took place. Scientists soon learned that the large blood flow changes measured by PET could also be imaged by the correct type of MRI. Functional magnetic resonance imaging (fMRI) was born, andsince the 1990s, fMRI has come to dominate the brain mapping field due to its low invasiveness, lack of radiation exposure, and relatively wide availability.

The world record for the spatial resolution of a whole-brain MRI image was a 100-micrometer volume (image) achieved in 2019. The sample acquisition took about 100 hours.[2] The spatial world record of a whole human brain of any method was anX-ray tomography scan performing at the ESRF (European synchrotron radiation facility), which had a resolution of about 25 microns and requiring about 22 hours. This scan was part of the human organ atlas which has X-ray tomography scans of other organs in the human body with the same resolution.[3][4]

A crucial idea for magnetic resonance imaging is that the net magnetization vector can be moved by exposing the spin system to energy of a frequency equal to the energy difference between the spin states (e.g., by a radio frequency pulse). If enough energy is delivered to the system, it is possible to make the net magnetization vector orthogonal to that of the external magnetic field.

Common clinical indications for neuroimaging include head trauma, stroke like symptoms e.g.: sudden weakness/numbness in one half of body, difficulty talking or walking; seizures, sudden onset severe headache, sudden change in level of consciousness for unclear reasons.

Another indication for neuroradiology is CT-, MRI- and PET-guided stereotactic surgery or radiosurgery for treatment of intracranial tumors, arteriovenous malformations and other surgically treatable conditions.[5][6][7]

One of the more common neurological problems which a person may experience is simple syncope.[8][9] In cases of simple syncope in which the patient's history does not suggest other neurological symptoms, the diagnosis includes a neurological examination but routine neurological imaging is not indicated because the likelihood of finding a cause in the central nervous system is extremely low and the patient is unlikely to benefit from the procedure.[9]

Neuroradiology is not indicated for patients with stable headaches which are diagnosed as migraine.[10] Studies indicate that presence of migraine does not increase a patient's risk for intracranial disease.[10] A diagnosis of migraine which notes the absence of other problems, such as papilledema, would not indicate a need for radiological investigations.[10] In the course of conducting a careful diagnosis, the physician should consider whether the headache has a cause other than the migraine and might require radiological investigations.[10][11]

Computed tomography (CT) or Computed Axial Tomography (CAT) scanning uses a series of x-rays of the head taken from many different directions. Typically used for quickly viewing brain injuries, CT scanning uses a computer program that performs a numerical integral calculation (the inverse Radon transform) on the measured x-ray series to estimate how much of an x-ray beam is absorbed in a small volume of the brain. Typically the information is presented as cross-sections of the brain.[12]

Magnetic resonance imaging (MRI) uses magnetic fields and radio waves to produce high quality two- or three-dimensional images of brain structures without the use of ionizing radiation (X-rays) or radioactive tracers.

The record for the highest spatial resolution of a whole intact brain (postmortem) is 100 microns, from Massachusetts General Hospital. The data was published in Scientific Data on 30 October 2019.[13]

PET scanning is also used for diagnosis of brain disease, most notably brain tumors, epilepsy, and neuron-damaging diseases which cause dementia (such as Alzheimer's disease) all cause great changes in brain metabolism, which in turn causes easily detectable changes in PET scans. PET is probably most useful in early cases of certain dementias (with classic examples being Alzheimer's disease and Pick's disease) where the early damage is too diffuse and makes too little difference in brain volume and gross structure to change CT and standard MRI images enough to be able to reliably differentiate it from the "normal" range of cortical atrophy which occurs with aging (in many but not all) persons, and which does not cause clinical dementia.

FDG-PET scanning is also often used in assessment of patients with epilepsy who continue to have seizures despite adequate medical treatment. In focal epilepsy, where seizures begin in a small part of the brain before spreading elsewhere, it is one of the many modalities used to identify the region of brain responsible for seizure onset. Typically, the area of brain where seizures begin is dysfunctional even when patient is not having a seizure and uptakes less glucose, hence less FDG compared to healthy brain regions.[15] This information can help plan for epilepsy surgery as a treatment for drug resistant epilepsy.

Other radiotracers have also been used to identify areas of seizure onset though they are not available commercially for clinical use. These include 11C-flumazenil, 11C-alpha-methyl-L-tryptophan, 11C-methionine, 11C-cerfentanil.[15]

Single-photon emission computed tomography (SPECT) is similar to PET and uses gamma ray-emitting radioisotopes and a gamma camera to record data that a computer uses to construct two- or three-dimensional images of active brain regions.[16] SPECT relies on an injection of radioactive tracer, or "SPECT agent," which is rapidly taken up by the brain but does not redistribute. Uptake of SPECT agent is nearly 100% complete within 30 to 60 seconds, reflecting cerebral blood flow (CBF) at the time of injection. These properties of SPECT make it particularly well-suited for epilepsy imaging, which is usually made difficult by problems with patient movement and variable seizure types. SPECT provides a "snapshot" of cerebral blood flow since scans can be acquired after seizure termination (so long as the radioactive tracer was injected at the time of the seizure). A significant limitation of SPECT is its poor resolution (about 1 cm) compared to that of MRI. Today, SPECT machines with Dual Detector Heads are commonly used, although Triple Detector Head machines are available in the marketplace. Tomographic reconstruction, (mainly used for functional "snapshots" of the brain) requires multiple projections from Detector Heads which rotate around the human skull, so some researchers have developed 6 and 11 Detector Head SPECT machines to cut imaging time and give higher resolution.[17][18]

Like PET, SPECT also can be used to differentiate different kinds of disease processes which produce dementia, and it is increasingly used for this purpose. SPECT scan using Isoflupane labeled with I-123 (also called DaT scan) is useful in differentiating Parkinson's disease from other causes of tremor.[19]

SPECT scan is also used in evaluation of drug resistant epilepsy. This uses Tc99 labeled hexamethyl-propylene amine oxime (Tc99HMPAO) or ethyl cysteinate dimer ( Tc99 ECD) as the tracers. The radiotracer is injected into the patient's vein as soon as the start of a seizure is detected and scanning is done within few hours after the seizure is over. This technique is called ictal SPECT and relies on the increased CBF in areas of seizure onset during the seizure. Interictal SPECT is a scan done using the same tracers but during a time when the patient is not having a seizure. In between seizures, a reduction in CBF is seen in areas of seizure onset and is not as pronounced as the blood flow increase during the seizure.[20]

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