Brain Imaging in Psychiatry

I. Uses of Neuroimaging
Neuroimaging methodologies allow meas of the structure, func & chemistry of the living human brain.
CT Structural brain lesions, Tumors, Stroke
MRI Distinguish better Gray & White Matter & Better visualization of smaller lesions
PET & SPECT Insights into brain function
Indications for ordering neuroimaging in clinical practice
1. Neurological deficits, suspicion of CNS Disorder, New-onset psychosis, acute changes in MSE.
2. Dementia. Alzheimer's disease is the most common associated with diffuse brain loss.
Normal pressure hydrocephalus is a treatable cause of dementia that requires neuroimaging for D
3. Strokes. Easily seen on MRI scans.
4. Vascular dementia is characterized on MRI scans by patches of increased signal in the WM.
5. Degenerative disorders. Of basal ganglia structures.
Huntington's disease typically produces atrophy on the caudate nucleus
Thalamic degeneration can interrupt the neural links to the cortex.
6. Space-occupying lesions can cause dementia (SDH, Cerberal contusions, Brain Tumors).
7. Chronic infections. Neurosyphilis, TB, Lyme disease charac enhancement of the meninges
HIV infection diffuse loss of brain volume.
Multiple sclerosis plaques on MRI as periventricular patches of increased signal intensity.

II. Brain Imaging Methods

1. Computed tomography (CT)
A. Clinical indications: dementia or depression, general cognitive decline, routine for first psychosis.
B. Research:
a. Differentiating subtypes of Alzheimer's disease.
b. Cerebral atrophy in alcohol & benzodiazepine abusers.
c. Cortical and cerebellar atrophy in schizophrenia.
d. Increased Ventricle size in Schizophrenia

2. Magnetic resonance imaging (MRI) (NMR)

A. Function: Measures structures not functions through measuring radiofrequencies omitted by
different elements in the brain following application of an external magnetic field.
B. Ads: No radiation involved; minimal or no risk to patients from strong magnetic fields.
Provides much higher resolution than CT. particularly in gray matter.
Produces slice images. Can image deep midline structures well.
The ideal tech for evaluating multiple sclerosis and other demyelinating diseases.
C. Disads: A major problem is the time needed to make a scan ( 40 minutes).

3. Positron emission tomography (PET)

A. Function: Positron emitters (eg. Carbon 11, fluorine 18) are used to label glucose aminoacids,
neurotransmitter percursors, & other molecules to measure receptor densities, Br Function
B. Ads: Labeled antipsychotics can map out location and density of dopamine receptors.
Can assess regional brain function and blood flow.
2- Deoxyglucose is absorbed into cells as easily as glucose but is not metabolized.
Can be used to measure regional glucose uptake.
Compares laterality, anteroposterior gradients, and cortical-to-subcortical gradient.
C. Findings reported in schizophrenia.
1) Cortical hypofrontality.
2) Steeper subcortical-to-cortical gradient.
3) Uptake decreased in left compared with right cortex.
4) Higher rate of activity in left temporal lobe.
5) Lower rate of metabolism in left basal ganglia
6) Higher density of Dopamine receptors
7) Greater increase in metabolism in ant brain reg in resp to unpleasant stim (not spec)

4. Brain electrical activity mapping (BEAM)

A. Function: Topographic imaging of EEG and evoked potentials.
B. Ads: Shows areas of varying electrical activity in the brain through scalp electrodes.
Each point on the map is given a numeric value representing its electrical activity.
Each value is computed by linear interpolation among the three nearest electrodes.
C. Findings reported in schizophrenia.
Evoked potentials differ spatially and temporally; beta-wave activity is increased in certain
regions; delta-wave activity is increased, most prominently in the frontal lobes.

5. Regional cerebral blood flow (rCBF)

A. Function: Yields a two-dimensional cortical image representing blood flow to different brain areas.
Blood flow correlate directly with neuronal activity.
Xenon 133 is inhaled. Crosses blood-brain barrier freely but is inert.
Detectors measure rate at which xenon 133 is cleared from specific brain areas and compare with
calculated control to obtain a mean transit time for the tracer. GM clears quickly. WM clears slowly
B. Ads: rCBF have great potential in studying diseases that involve a decrease in the amount of
brain tissue (e.g., dementia, ischemia, atrophy).
Low levels of radiation.
Compared with PET, spatial resolution less, but temporal resolution is better.
C. Findings reported in schizophrenia.
CBF in the dorsolateral frontal lobe may be decreased & CBF in the left hemisphere may be
increased during activation. (WCST) No differences have been found in resting patients.

6. Single photon emission computed tomography (SPECT)

A. Function: Adaptation of rCBF techniques to obtain slice tomograms rather than two-dimensional
surface images of rCBF.

B. Aid in AD Diagnosis. Findings Typically shows

Decrease in bilateral temporoparietal perfusion in AD
Single perfusion defects or multiple areas of hypoperfusion in vascular dementia.

7. Functional MRI (fMRI)

A. Ads: May provide functional brain images with clarity of MRI.
Can be correlated with high-resolution three-dimensional MRI.
B. Findings reported in schizophrenia
Less frontal activation and more left temporal activation during a word fluency task.

8. Magnetic resonance spectroscopy (MRS)

A. Function: Uses powerful magnetic fields to evaluate brain function and metabolism.
B. Ads: Provides information regarding brain intracellular pH, phospholipids, carbohydrate, protein.
Can provide information about lithium and fluorinated psychopharmacological agents.
C. Findings reported in schizophrenia
Decreased adenosine triphosphate and inorganic orthophosphate levels,
suggestive of dorsal prefrontal hypoactivity.

9. Magnetoencephalography
A. Function: Research tool.
Uses conventional and computerized EEG data.
Detects magnetic fields associated with neuronal activity in cortical and deep brain structures.
Noninvasive with no radiation exposure.

Brain Imaging in Schizophrenia

1- CT
Cortical and cerebellar atrophy in schizophrenia.

Increased Ventricle size in Schizophrenia

2- PET
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Cortical hypofrontality.
Steeper subcortical-to-cortical gradient.
Uptake decreased in left compared with right cortex.
Higher rate of activity in left temporal lobe.
Lower rate of metabolism in left basal ganglia
Higher density of Dopamine receptors
Greater increase in metabolism in ant brain reg in resp to unpleasant stim (not spec)

3- BEAM
Evoked potentials differ spatially and temporally; beta-wave activity is increased in certain
regions; delta-wave activity is increased, most prominently in the frontal lobes.
4- rCBF
CBF in the dorsolateral frontal lobe may be decreased & CBF in the left hemisphere may be
increased during activation. (WCST) No differences have been found in resting patients.
5- fMRI
Less frontal activation and more left temporal activation during a word fluency task.
6- MRS
Decreased adenosine triphosphate and inorganic orthophosphate levels,
suggestive of dorsal prefrontal hypoactivity.