Significance of Brain imaging in Psychiatry. Most of the major Psychiatric disorders are associated with statistically significant differences on various Neuroimaging measures, when comparing groups of patients and controls.
Brief description of various neuroimaging modalities used in psychiatry which help in early detection, diagnosis and treatment of various neuropsychiatric disorders.
Brief description of various neuroimaging modalities used in psychiatry which help in early detection, diagnosis and treatment of various neuropsychiatric disorders.
Hallucination definition, explanation. Difference between true perception and hallucinations. Mental images. Pseudo-hallucinations. Causes of hallucinations. Types of hallucinations.
Hallucination definition, explanation. Difference between true perception and hallucinations. Mental images. Pseudo-hallucinations. Causes of hallucinations. Types of hallucinations.
Image Processing Technique for Brain Abnormality DetectionCSCJournals
Medical imaging is expensive and very much sophisticated because of proprietary software and expert personalities. This paper introduces an inexpensive, user friendly general-purpose image processing tool and visualization program specifically designed in MATLAB to detect much of the brain disorders as early as possible. The application provides clinical and quantitative analysis of medical images. Minute structural difference of brain gradually results in major disorders such as schizophrenia, Epilepsy, inherited speech and language disorder, Alzheimer's dementia etc. Here the main focusing is given to diagnose the disease related to the brain and its psychic nature (Alzheimer’s disease).
Micro-Neuro-Sensor Recording of STN Neurons of the Human BrainMangaiK4
Abstract-What cause to the neurons of the human brain cells when they are damaged. They become inactive. So damage to subthalamiuc ucleus (STN) neurons of the human brain causing larger involuntary movements and thereby attacking the Parkinson’s disease (PD). Deep brain stimulation (DBS) of bilateral sub thalamic nuclei (STN) is an efficient method of rehabilitation technique in subjects with advanced idiopathic Parkinson’s (or Parkinson) disease. Accurate targeting of STN neurons and placement of microelectrodes/ (neurosensors) are paramount importance for optimal results after STN-DBS method.In this paper, microminiaturized electrode recordings (MER) of STN neurons were detected in a mean of 3.5 ±1.1 channels on right hemisphere and 3.6 ±1.04 on left hemisphere.Final channel selected were most commonly central seen in 42.3% followed by anterior in 33.7%. When a high current is delivered to STN or GPi neurons of basal ganglia (a component of human brain), causing their inhibition and improved indication of symptoms. It is now known that there is a significant change in the firing pattern and a reorganization of the entire basal ganglia circuit with DBS. The MER of STN neurons has identified a specific high frequency irregular larger amplitude firing patterns seen only in disease states and hence used to detect the neurons of ST nucleus during functional surgery. Micro electrode recording is so useful to confirm the right path but has to be taken in consideration with effects on macro stimulation.
Brain tissue segmentation from MR images Tanmay Patil
This presentation was made for an engineering technical seminar in Biomedical engineering branch.
The presentation consist of working of MRI and method for segmenting the brain tissue..
The content was taken from various papers which are given as references at the end of ppt.
According to WHO , there were 8,17,000 suicides globally in 2016, which is 1 person in every 40 seconds.
In the last 45 years suicide rates have increased by 60% worldwide. Suicide is now among the second leading cause of death among those aged 15-29 years (both sexes).
Suicide attempts up to 20 times more frequent than completed suicide.
Neuro electrophysiology is the study of the electrical properties of biological cells and tissues in the nervous system. The electroencephalogram (EEG) is the recording of electrical activity of brain.
The DSM-5 organizes 10 personality disorders into 3 groups, or clusters, based on shared key features. Cluster C Personality disorders includes 3 disorders sharing anxious and fearful features. Avoidant, Dependent, and Obsessive-Compulsive.
The association of neuropsychiatric disorders with cerebrovascular disease has been recognized by clinicians for over 100 years. Disease of the vascular system contribute greatly to the sum total of psychiatric disability, chiefly in the elderly population, mainly as a result of stroke, cerebrovascular accidents & subarachnoid haemorrhage.
History about Malingering, Concept and nosology, Symptom presentation, Interview and observation, Psychological assessment, Diagnostic difficulty and Differential diagnosis.
Culture bound syndrome, culture related specific disorders, culture specific disorders/ syndromes, exotic psychiatric syndromes or Rare atypical unclassifiable disorders.
ABDOMINAL TRAUMA in pediatrics part one.drhasanrajab
Abdominal trauma in pediatrics refers to injuries or damage to the abdominal organs in children. It can occur due to various causes such as falls, motor vehicle accidents, sports-related injuries, and physical abuse. Children are more vulnerable to abdominal trauma due to their unique anatomical and physiological characteristics. Signs and symptoms include abdominal pain, tenderness, distension, vomiting, and signs of shock. Diagnosis involves physical examination, imaging studies, and laboratory tests. Management depends on the severity and may involve conservative treatment or surgical intervention. Prevention is crucial in reducing the incidence of abdominal trauma in children.
Integrating Ayurveda into Parkinson’s Management: A Holistic ApproachAyurveda ForAll
Explore the benefits of combining Ayurveda with conventional Parkinson's treatments. Learn how a holistic approach can manage symptoms, enhance well-being, and balance body energies. Discover the steps to safely integrate Ayurvedic practices into your Parkinson’s care plan, including expert guidance on diet, herbal remedies, and lifestyle modifications.
Adv. biopharm. APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMSAkankshaAshtankar
MIP 201T & MPH 202T
ADVANCED BIOPHARMACEUTICS & PHARMACOKINETICS : UNIT 5
APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMS By - AKANKSHA ASHTANKAR
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
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Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
2. INTRODUCTION
HISTORICAL MILESTONES
TYPES OF NEUROIMAGING
BASIC PRINCIPLES
NEUROIMAGING IN SOME SPECIFIC PSYCHIATRIC DISORDERS
CONCLUSION
3. The factors determining human behavior have fascinated
man from times immemorial.
There has been constant endeavor to localize areas of the
brain responsible for various aspects of behavior & especially
to map out changes responsible for abnormal behavior.
4. Brain imaging methodologies allow measurement of the
structure, function and 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.
5. The first chapter of the history of neuroimaging
traces back to the Italian Neuroscientist Angelo
Mosso who invented the ‘Human Circulation
Balance', in 1882 which could non-invasively
measure the redistribution of blood during
emotional and intellectual activity.
6. 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.
In 1927 Egas Moniz, a Portuguese Neurologist
introduced Cerebral Angiography, whereby both
normal and abnormal blood vessels in and around
the brain could be visualized with great precision.
7. 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
1994 – Hyperpolarized 129 Xe imaging
8. Structural study - provides
noninvasive visualization of the
morphology of the brain
Functional study - provides a
visualization of the spatial
distribution of specific bio-chemical
processes
CT SCAN FMRI
MRI PET
PLAIN SKULL RADIOGRAPHY SPECT
PNEUMO-ENCEPHALOGRAPHY MRS
DTI
BRAIN ELECTRICAL ACTIVITY
MAPPING (BEAM)
9.
10. 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
When viewed in sequence, the
images allow mental
reconstruction of the structure
of the brain
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
11. 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.
13. Criteria for contrast CT
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 ( ionic/ non-ionic ) Contrast Medium
Diagnostic Accuracy 92%
14.
15. CT offers excellent spatial resolution (<1 mm) and is effective at
distinguishing tissues with markedly different X-ray attenuation
properties (e.g., bone vs. Soft tissue vs. fluid vs. gas).
CT is an excellent modality for imaging bone.
CT is the imaging modality of choice for acute trauma or when an
acute bleed or ischemia is suspected.
CT is not helpful in visualizing subtle white matter lesions due to
CT’s poor ability to distinguish between the X-ray attenuation
properties of different soft tissue densities.
16. CT uses ionizing radiation and thus is strongly
contraindicated in pregnancy.
Patient anxiety is usually less during a CT scan than during
an MRI scan because the scanning environment is
traditionally more open, quieter, and scanning time is brief.
CT is best for patients with ferro-metallic implants (e.g.,
foreign bodies, some aneurysm clips, pacemakers, etc.) as
MRI is contraindicated in this patient population.
17. 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
Prolonged catatonia
Co existence of seizure with psychiatric symptoms
Movement disorders of unknown etiology
Focal neurological signs accompanying psychiatric symptoms
Weinberg 1984; Beresford et al 1986
18.
19. 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
20. 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
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
21. 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, DTI etc.
22. 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
23. T1 is the only sequence that
allows contrast enhancement
with GADOLINIUM.
Contrast enhanced structures
on T1 appears white
24. 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
25.
26. 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.
27. MRI can detect the movement of water molecules within
tissues, and forms the basis for diffusion weighted imaging
(DWI) and diffusion tensor imaging (DTI).
DWI is well suited to detecting recent infarction in the brain,
and may be used to rule out such strokes in patients with
new mental status changes (Albers 1998 ).
DTI is of great interest to psychiatric research because it
allows remarkably detailed assessments of white matter
tracts, extending researchers’ ability to test hypotheses
concerning circuit abnormalities (Mori and Zhang 2006 )
30. 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
31. 1. CT is still the modality of choice for patients with suspected acute
bleeds or acute trauma.
2. MRI is superior to CT for the differentiation of white from gray matter
and the identification of white matter lesions.
3. MRI is superior to CT for the detection of posterior fossa and
brainstem pathology.
4. CT is recommended if MRI is contraindicated (i.e., paramagnetic
protheses; inability to tolerate scanner time, noise, or confinement).
5. MRI is recommended if radiation exposure is contraindicated (i.e.,
young children or women of childbearing potential).
32. PLAIN SKULL RADIOGRAPHY
Plain films of the skull are of little value in studying psychiatric
disorders, as it gives very little information.
PNEUMO-ENCEPHALOGRAPHY
PEG is a process in which air is introduced in the ventricular cavities to
visualize any changes.
Results of PEG in psychiatric patients have been reviewed by
Weinberger and Wyatt.
Cerebral atrophy found in psychiatric patients.
33.
34.
35.
36.
37.
38. PRINCIPLE
Basic principle similar to MRI
Except MRS can detect several odd-numbered nuclei
MRS permits study of many metabolic processes
Nuclei align themselves in the strong magnetic 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.
39. 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.)
40. 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.
It has shown elevated brain Lactate levels during panic
attacks in pts with panic disorder.
41.
42. 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, 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
43. ADVANTAGE LIMITATIONS
Possible to study both cerebral anatomy & functional
neurophysiology using a single technique (Bullmore &
Fletcher 2003)
fMRI asseses neuronal activity indirectly by measuring
blood flow (or tissue perfusion), which limits its
resolution.
No radio active exposure Two tasks that activates clusters of neurons 5 mm
apart will yield overlapping signals on fMRI & thus are
indistinguishable by this technique.
Used in criminal psychiatry or federal investigations
as a lie detector
Sensitivity & resolution can be improved by using ultra-
small non toxic iron oxide particles.
fMRI produces maps of resting cerebral blood flow
(Wintermark et al. 2005 ).
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.
47. 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.
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
48. Estimate 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
50. g-ray
detector
+
-
Radioactive
nucleus
• 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 & concentration
of radio-isotope.
Most Commonly Used Isotopes
• F 18
• N 13
• O 15
51. 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
52. SPECT PET
Single photon Positron
99mTc , XE133 or I 123 13 N, 15 O or 18F
Short half life Longer half life
Less sensitive Highly sensitive (100 times more than SPECT)
SPECT is limited to one study per day Multiple PET scans may sometimes be done
within a day
Low spatial resolution Superior spatial resolution
Cheaper and easily available than PET Costly, not easily available
57. The use of clinical neuroimaging by psychiatrists has traditionally been
limited to structural studies (CT, MRI) to detect neurological lesions or
diseases that may produce psychiatric symptoms.
For Dementia the clinical imaging applications provide solid affirmative
diagnostic evidence.
When using the various currently available neuroimaging modalities a
number of factors must be considered including the indications, risks,
costs, advantages, and limitations.
58. There have been numerous studies, dating back to 1978, assessing the
utility of CT imaging in psychiatric populations.
Across these studies, which represent a diverse population totaling
1346 patients, 29.5% of patients exhibited diffuse cortical atrophy while
12% of patients exhibited focal abnormalities (Renshaw and Rauch
1999 ).
When MRI became available in the 1980s, changes in the
neuroimaging literature reflected a shift away from CT and toward the
use of MRI in psychiatric populations.
59. The largest study of the use of MRI in psychiatric populations was
conducted at McLean Hospital over a 5-year period and included all
6200 patients who received an MRI during that time (Rauch and
Renshaw 1995).
The study found that 99 patients (1.6%) had unexpected and potentially
treatable findings including hemorrhage, temporal lobe cysts, tumors,
vascular malformations, and hydrocephalus.
Multiple sclerosis was newly diagnosed in 0.8% of the subjects, a rate
that is approximately 13 times higher than the prevalence of multiple
sclerosis in the general population (Lyoo et al. 1996).
60. Psychiatric patients with newly diagnosed multiple sclerosis in the study
had been diagnosed with refractory affective illness.
A number of studies have found an increased incidence of white matter
lesions, more easily detected with MRI than CT, in psychiatric
populations.
Subsequent studies also revealed that as many as 30% of healthy
control subjects over age 60 have white matter abnormalities of no
apparent clinical significance.
61. Subsequent evidence was presented which suggested that subcortical
and white matter lesions are more prevalent in patients with late life
onset depression and psychosis (Becker et al. 1995 ).
62. Criteria for appropriate structural brain imaging (Dougherty and Rauch
2001):
1. Patients with acute changes in mental status (including changes in
affect, behavior, or personality) plus at least one of three additional
criteria:
Age greater than 50 years
Abnormal neurological exam (especially focal abnormalities)
History of signifi cant head trauma
2. New onset psychosis.
3. New onset delirium or dementia of unknown cause.
4. Possibly for treatment refractory patients.
5. Possibly prior to an initial course of electroconvulsive therapy
63. Adherence to the criteria listed above yield positive findings in 10–45%
of cases.
However, only 1–5% will produce findings that lead to specific medical
intervention.
Lastly, if structural neuroimaging is indicated, one should use MRI
unless the problem is an acute trauma or an acute bleed is suspected.
64. Functional neuroimaging modalities include PET, SPECT, and
functional MRI, and are now used in clinical situations as aids for the
diagnosis of psychiatric conditions.
Most applications of functional neuroimaging in psychiatry occur in the
field of research.
Clinical role for functional neuroimaging in dementia, traumatic brain
injury (TBI), seizures, and possibly other conditions are evolving and
showing promise.
65. As characteristic functional neuroimaging profi les emerge for various forms of
dementia, the role of PET, SPECT, and MRI in the evaluation of dementia is
expanding.
Alzheimer’s disease is
associated with characteristic
hypoperfusion and reduced
glucose metabolism in bilateral
temporo-parietal regions.
66. Some studies have indicated that SPECT and PET neuroimaging can
offer better than 90% sensitivity and specificity in distinguishing
Alzheimer’s disease from other kinds of dementia (Silverman et al.
2001 , Bonte et al. 2001)
Other dementias such as frontotemporal dementias (e.g., Pick’s
disease) and multi-infarct dementia may also be diagnosed by
combining clinical evidence with functional imaging findings.
In frontotemporal dementia Structural imaging reveals severe sharply
localised atrophy – bilaterally symmetric “KNIFE-BLADE ATROPHY”
Functional imaging reveals Fronto-temporal hypometabolism.
67.
68.
69.
70. EEG measures cortical surface electrical activity but is less efficacious if the
seizure focus is deeper in the brain.
PET and SPECT images typically demonstrate ictal hypermetabolism and
interictal hypometabolism (Krausz et al. 1996 , Theodore and Gaillard
2000).
This allows for the detection of seizure foci during the predominant interictal
period.
71. PET imaging showing right temporo-parietal interictal hypometabolism (a) that during seizure
demonstrates hypermetabolism (b). Note the mildly increased metabolism in bilateral thalamus and
basal ganglia with widespread hypometabolism diffusely in the ictal PET.
72. Psychiatrists often examine and treat patients with psychiatric
symptoms who have suffered a potentially etiologic head injury.
In the 80% of cases that are classified as mild TBI based upon loss of
consciousness < 30 min, Glascow Coma Scores of 13–15, and
posttraumatic amnesia < 24 hr, the causal relationship between the
head trauma and subsequent psychiatric problems may be less
obvious.
In such cases, functional imaging may offer more useful information
than that provided by a structural imaging study alone.
73. Injured brain tissue, after the acute stage, may show metabolic
depression and reduced perfusion on FDG PET and SPECT,
respectively, although research findings have been thus far inconsistent
(Belanger et al. 2007).
In terms of structural imaging, DTI show greater diagnostic sensitivity
than the more typically ordered T1- or T2-weighted sequences.
Expert testimony concerning neuroimaging evidence and TBI has now
become a fairly common phenomenon in forensic psychiatric practice.
74. Figure: Positron emission tomography after concussion. PET scan after concussion (mild head injury,
left ), compared with severe head injury ( middle ) and normal, uninjured brain ( right ). Red ( light
shading ) indicates high brain metabolism, which is a sign of high brain activity, whereas blue ( dark
shading ) indicates low brain metabolism or low activity. Note that concussion and severe head-injury
patients both displayed low levels of brain metabolism.
75. Neuroimaging technology has evolved considerably during the last few
decades.
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.
There are still substantial limitations on the amount of information that
neuroimaging provides in the clinical setting.
The continued evolution of neuroimaging technology offers great
promise for the future.
76. REFERENCES
Kaplan and Sadock's Comprehensive Textbook of Psychiatry, 9th Edition
Psychiatry, Third Edition, Allan Tasman
Diagnostic Imaging Brain, Osborn
http://med.stanford.edu/neuroimaging/research.html
https://www.researchgate.net/Positron-emission-tomography-after-concussion-
PET-scan-after-concussion-mild
www.google.com (images)