Rank-order versus mean based statistics for neuroimaging

Detecting Suicide Ideation in the Era of Social Media: The Population Neuroscience Perspective

Social media platforms are increasingly used across many population groups not only to communicate and consume information, but also to express symptoms of psychological distress and suicidal thoughts. The detection of suicidal ideation (SI) can contribute to suicide prevention. Twitter data suggesting SI have been associated with negative emotions (e.g., shame, sadness) and a number of geographical and ecological variables (e.g., geographic location, environmental stress). Other important research contributions on SI come from studies in neuroscience. To date, very few research studies have been conducted that combine different disciplines (epidemiology, health geography, neurosciences, psychology, and social media big data science), to build innovative research directions on this topic. This article aims to offer a new interdisciplinary perspective, that is, a Population Neuroscience perspective on SI in order to highlight new ways in which multiple scientific fields interact to successfully investigate emotions and stress in social media to detect SI in the population. We argue that a Population Neuroscience perspective may help to better understand the mechanisms underpinning SI and to promote more effective strategies to prevent suicide timely and at scale.

The Developing Brain in the Digital Era: A Scoping Review of Structural and Functional Correlates of Screen Time in Adolescence

The widespread diffusion of screen-based devices in adolescence has fueled a debate about the beneficial and detrimental effects on adolescents’ well-being and development. With the aim of summarizing the existing literature on the associations between screen time (including Internet-related addictions) and adolescent brain development, the present scoping review summarized evidence from 16 task-unrelated and task-related neuroimaging studies, published between 2010 and 2020. Results highlight three important key messages: (i) a frequent and longer duration of screen-based media consumption (including Internet-related addictive behaviors) is related to a less efficient cognitive control system in adolescence, including areas of the Default Mode Network and the Central Executive Network; (ii) online activities act as strong rewards to the brain and repeated screen time augments the tendency to seek short-term gratifications; and (iii) neuroscientific research on the correlates between screen time and adolescent brain development is still at the beginning and in urgent need for further evidence, especially on the underlying causality mechanisms. Methodological, theoretical, and conceptual implications are discussed.

A semiautomated measurement of muscle fiber size using the Imaris software

The size and shape of skeletal muscle fibers are affected by various physiological and pathological conditions, such as muscle atrophy, hypertrophy, regeneration, and dystrophies. Hence, muscle fiber cross-sectional area (CSA) is an important determinant of muscle health and plasticity. We adapted the Imaris software to automatically segment muscle fibers based on fluorescent labeling of the plasma membrane and measure muscle fiber CSA. Analysis of muscle cross sections by the Imaris semiautomated and manual approaches demonstrated a similar decrease in CSA of atrophying muscles from fasted mice compared with fed controls. In addition, we previously demonstrated that downregulation of the Ca2+-specific protease calpain-1 attenuates muscle atrophy. Accordingly, both the Imaris semiautomated and manual approaches showed a similar increase in CSA of fibers expressing calpain-1 shRNA compared with adjacent nontransfected fibers in the same muscle cross section. Although both approaches seem valid for measurements of muscle fiber size, the manual marking method is less preferable because it is highly time-consuming, subjective, and limits the number of cells that can be analyzed. The Imaris semiautomated approach is user-friendly, requires little training or optimization, and can be used to efficiently and accurately mark thousands of fibers in a short period. As a novel addition to the commonly used statistics, we also describe statistical tests that quantify the strength of an effect on fiber size, enabling detection of significant differences between skewed distributions that would otherwise not be detected using typical methods.

Not All Lesioned Tissue Is Equal: Identifying Pericavitational Areas in Chronic Stroke With Tissue Integrity Gradation via T2w T1w Ratio

Stroke-related tissue damage within lesioned brain areas is topologically non-uniform and has underlying tissue composition changes that may have important implications for rehabilitation. However, we know of no uniformly accepted, objective non-invasive methodology to identify pericavitational areas within the chronic stroke lesion. To fill this gap, we propose a novel magnetic resonance imaging (MRI) methodology to objectively quantify the lesion core and surrounding pericavitational perimeter, which we call tissue integrity gradation via T2w T1w ratio (TIGR). TIGR uses standard T1-weighted (T1w) and T2-weighted (T2w) anatomical images routinely collected in the clinical setting. TIGR maps are analyzed with relation to subject-specific gray matter and cerebrospinal fluid thresholds and binned to create a false colormap of tissue damage within the stroke lesion, and these are further categorized into low-, medium-, and high-damage areas. We validate TIGR by showing that the cerebral blood flow within the lesion reduces with greater tissue damage (p = 0.005). We further show that a significant task activity can be detected in pericavitational areas and that medium-damage areas contain a significantly lower magnitude of hemodynamic response function than the adjacent damaged areas (p < 0.0001). We also demonstrate the feasibility of using TIGR maps to extract multivariate brain-behavior relationships (p < 0.05) and show general agreement in location compared to binary lesion, T1w-only, and T2w-only maps but that the extent of brain behavior maps may depend on signal sensitivity as denoted by the sparseness coefficient (p < 0.0001). Finally, we show the feasibility of quantifying TIGR in early and late subacute stroke phases, where higher-damage areas were smaller in size (p = 0.002) and that lesioned voxels transition from lower to higher damage with increasing time post-stroke (p = 0.004). We conclude that TIGR is able to (1) identify tissue damage gradient within the stroke lesion across different post-stroke timepoints and (2) more objectively delineate lesion core from pericavitational areas wherein such areas demonstrate reasonable and expected physiological and functional impairments. Importantly, because T1w and T2w scans are routinely collected in the clinic, TIGR maps can be readily incorporated in clinical settings without additional imaging costs or patient burden to facilitate decision processes related to rehabilitation planning.

Sensorimotor, Attentional, and Neuroanatomical Predictors of Upper Limb Motor Deficits and Rehabilitation Outcome after Stroke

The rehabilitation of motor deficits following stroke relies on both sensorimotor and cognitive abilities, thereby involving large-scale brain networks. However, few studies have investigated the integration between motor and cognitive domains, as well as its neuroanatomical basis. In this retrospective study, upper limb motor responsiveness to technology-based rehabilitation was examined in a sample of 29 stroke patients (18 with right and 11 with left brain damage). Pretreatment sensorimotor and attentional abilities were found to influence motor recovery. Training responsiveness increased as a function of the severity of motor deficits, whereas spared attentional abilities, especially visuospatial attention, supported motor improvements. Neuroanatomical analysis of structural lesions and white matter disconnections showed that the poststroke motor performance was associated with putamen, insula, corticospinal tract, and frontoparietal connectivity. Motor rehabilitation outcome was mainly associated with the superior longitudinal fasciculus and partial involvement of the corpus callosum. The latter findings support the hypothesis that motor recovery engages large-scale brain networks that involve cognitive abilities and provides insight into stroke rehabilitation strategies.

Convergence of heteromodal lexical retrieval in the lateral prefrontal cortex

Lexical retrieval requires selecting and retrieving the most appropriate word from the lexicon to express a desired concept. Few studies have probed lexical retrieval with tasks other than picture naming, and when non-picture naming lexical retrieval tasks have been applied, both convergent and divergent results emerged. The presence of a single construct for auditory and visual processes of lexical retrieval would influence cognitive rehabilitation strategies for patients with aphasia. In this study, we perform support vector regression lesion-symptom mapping using a brain tumor model to test the hypothesis that brain regions specifically involved in lexical retrieval from visual and auditory stimuli represent overlapping neural systems. We find that principal components analysis of language tasks revealed multicollinearity between picture naming, auditory naming, and a validated measure of word finding, implying the existence of redundant cognitive constructs. Nonparametric, multivariate lesion-symptom mapping across participants was used to model accuracies on each of the four language tasks. Lesions within overlapping clusters of 8,333 voxels and 21,512 voxels in the left lateral prefrontal cortex (PFC) were predictive of impaired picture naming and auditory naming, respectively. These data indicate a convergence of heteromodal lexical retrieval within the PFC.

Comparing VBM and ROI analyses for detection of gray matter abnormalities in patients with bipolar disorder using MRI

Background

With the increasing efforts to a better understanding of psychiatric diseases, detection of brain morphological alterations is necessary. This study compared two methods—voxel-based morphometry (VBM) and region of interest (ROI) analyses—to identify significant gray matter changes of patients with bipolar disorder type I (BP I).

Results

The VBM findings suggested gray matter reductions in the left precentral gyrus and right precuneus of the patients compared to healthy subjects (α = 0.0005, uncorrected). However, no regions reached the level of significance in ROI analysis using the three atlases, i.e., hammers, lpba40, and neuromorphometrics atlases (α = 0.0005).

Conclusion

It can be concluded that VBM analysis seems to be more sensitive to partial changes in this study. If ROI analysis is employed in studies to detect structural brain alterations between groups, it is highly recommended to use VBM analysis besides.

Revaluing the Role of vmPFC in the Acquisition of Pavlovian Threat Conditioning in Humans

The role of the ventromedial prefrontal cortex (vmPFC) in human pavlovian threat conditioning has been relegated largely to the extinction or reversal of previously acquired stimulus-outcome associations. However, recent neuroimaging evidence questions this view by also showing activity in the vmPFC during threat acquisition. Here we investigate the casual role of vmPFC in the acquisition of pavlovian threat conditioning by assessing skin conductance response (SCR) and declarative memory of stimulus-outcome contingencies during a differential pavlovian threat-conditioning paradigm in eight patients with a bilateral vmPFC lesion, 10 with a lesion outside PFC and 10 healthy participants (each group included both females and males). Results showed that patients with vmPFC lesion failed to produce a conditioned SCR during threat acquisition, despite no evidence of compromised SCR to unconditioned stimulus or compromised declarative memory for stimulus-outcome contingencies. These results suggest that the vmPFC plays a causal role in the acquisition of new learning and not just in the extinction or reversal of previously acquired learning, as previously thought. Given the role of the vmPFC in schema-related processing and latent structure learning, the vmPFC may be required to construct a detailed representation of the task, which is needed to produce a sustained conditioned physiological response in anticipation of the unconditioned stimulus during threat acquisition.SIGNIFICANCE STATEMENT Pavlovian threat conditioning is an adaptive mechanism through which organisms learn to avoid potential threats, thus increasing their chances of survival. Understanding what brain regions contribute to such a process is crucial to understand the mechanisms underlying adaptive as well as maladaptive learning, and has the potential to inform the treatment of anxiety disorders. Importantly, the role of the ventromedial prefrontal cortex (vmPFC) in the acquisition of pavlovian threat conditioning has been relegated largely to the inhibition of previously acquired learning. Here, we show that the vmPFC actually plays a causal role in the acquisition of pavlovian threat conditioning.

Brain responsivity provides an individual readout for motor recovery after stroke

Promoting the recovery of motor function and optimizing rehabilitation strategies for stroke patients is closely associated with the challenge of individual prediction. To date, stroke research has identified critical pathophysiological neural underpinnings at the cellular level as well as with regard to network reorganization. However, in order to generate reliable readouts at the level of individual patients and thereby realize translation from bench to bedside, we are still in a need for innovative methods. The combined use of transcranial magnetic stimulation (TMS) and EEG has proven powerful to record both local and network responses at an individual's level. To elucidate the potential of TMS-EEG to assess motor recovery after stroke, we used neuronavigated TMS-EEG over ipsilesional primary motor cortex (M1) in 28 stroke patients in the first days after stroke. Twenty-five of these patients were reassessed after >3 months post-stroke. In the early post-stroke phase (6.7 ± 2.5 days), the TMS-evoked EEG responses featured two markedly different response morphologies upon TMS to ipsilesional M1. In the first group of patients, TMS elicited a differentiated and sustained EEG response with a series of deflections sequentially involving both hemispheres. This response type resembled the patterns of bilateral activation as observed in the healthy comparison group. By contrast, in a subgroup of severely affected patients, TMS evoked a slow and simplified local response. Quantifying the TMS-EEG responses in the time and time-frequency domain revealed that stroke patients exhibited slower and simple responses with higher amplitudes compared to healthy controls. Importantly, these patterns of activity changes after stroke were not only linked to the initial motor deficit, but also to motor recovery after >3 months post-stroke. Thus, the data revealed a substantial impairment of local effects as well as causal interactions within the motor network early after stroke. Additionally, for severely affected patients with absent motor evoked potentials and identical clinical phenotype, TMS-EEG provided differential response patterns indicative of the individual potential for recovery of function. Thereby, TMS-EEG extends the methodological repertoire in stroke research by allowing the assessment of individual response profiles.

Suicidal Ideation in Adolescence: A Perspective View on the Role of the Ventromedial Prefrontal Cortex

Suicide in adolescence is a worldwide issue, and it continues to present a serious problem in terms of its prevention. Among the various aspects of suicide, a very interesting area of research is represented by suicidal ideation. Recently, neuroimaging-based methods have made it possible to study the cognitive processes involved in several social situations and clinical conditions. This theoretical perspective article with an interdisciplinary approach integrates evidence from developmental psychology and social neuroscience with the aim of investigating the role of the brain area responsible for regulating negative emotions during the cognitive processes of suicidal ideation: the ventromedial prefrontal cortex. By highlighting the role of brain areas in the few studies published so far, it is possible to develop perspectives of considerable impact. Studying and understanding the role of brain areas involved in suicidal thoughts in adolescents could facilitate the creation of new perspectives on prevention programs and interventions.

The differential roles of contralesional frontoparietal areas in cortical reorganization after stroke

BACKGROUND

Studies examining the contribution of contralesional brain regions to motor recovery after stroke have revealed conflicting results comprising both supporting and disturbing influences. Especially the relevance of contralesional brain regions beyond primary motor cortex (M1) has rarely been studied, particularly concerning the temporal dynamics post-stroke.

METHODS

We, therefore, used online transcranial magnetic stimulation (TMS) interference to longitudinally assess the role of contralesional (right) frontoparietal areas for recovery of hand motor function after left hemispheric stroke: contralesional M1, contralesional dorsal premotor cortex (dPMC), and contralesional anterior intraparietal sulcus (IPS). Fourteen stroke patients and sixteen age-matched healthy subjects performed motor tasks of varying complexity with their (paretic) right hand. Motor performance was quantified using three-dimensional kinematic data. All patients were assessed twice, (i) in the first week, and (ii) after more than three months post-stroke.

RESULTS

While we did not observe a significant effect of TMS interference on movement kinematics following the stimulation of contralesional M1 and dPMC in the first week post-stroke, we found improvements of motor performance upon interference with contralesional IPS across motor tasks early after stroke, an effect that persisted into the later phase. By contrast, for dPMC, TMS-induced deterioration of motor performance was only evident three months post-stroke, suggesting that a supportive role of contralesional premotor cortex might evolve with reorganization.

CONCLUSION

We here highlight time-sensitive and region-specific effects of contralesional frontoparietal areas after left hemisphere stroke, which may influence on neuromodulation regimes aiming at supporting recovery of motor function post-stroke.

Social support modulates the neural correlates underlying social exclusion

Ostracism threatens the human need for social interactions, with negative consequences on cognition, affect and behavior. Understanding the mechanisms that can alleviate these consequences has therefore become an important research agenda. In this study, we used behavioral and fMRI measures to advance our understanding how social support can buffer the negative effects of social exclusion. We focused on two different types of support from a friend: emotional support, conveyed by gentle touch and appraisal support, implemented as informative text messages. Seventy-one female participants underwent fMRI scanning while playing a virtual ball-tossing game in the course of which they were excluded. Two consecutive runs of the game were separated according to the participant’s experimental condition (appraisal support, emotional support and no support). Results showed that the experience of social exclusion is modulated by the type of support received. Specifically, emotional support decreased negative emotions and anterior insula activity, while appraisal support increased negative emotions, with concomitant increase of subgenual anterior cingulate cortex and decrease of temporal-parietal junction activity. These divergent effects of social support point to the necessity to characterize whether and under which conditions it represents an effective and positive resource to alleviate the negative consequences of social exclusion.

Using machine learning-based lesion behavior mapping to identify anatomical networks of cognitive dysfunction: Spatial neglect and attention

Previous lesion behavior studies primarily used univariate lesion behavior mapping techniques to map the anatomical basis of spatial neglect after right brain damage. These studies led to inconsistent results and lively controversies. Given these inconsistencies, the idea of a wide-spread network that might underlie spatial orientation and neglect has been pushed forward. In such case, univariate lesion behavior mapping methods might have been inherently limited in detecting the presumed network due to limited statistical power. By comparing various univariate analyses with multivariate lesion-mapping based on support vector regression, we aimed to validate the network hypothesis directly in a large sample of 203 newly recruited right brain damaged patients. If the exact same correction factors and parameter combinations (FDR correction and dTLVC for lesion size control) were used, both univariate as well as multivariate approaches uncovered the same complex network pattern underlying spatial neglect. At the cortical level, lesion location dominantly affected the temporal cortex and its borders into inferior parietal and occipital cortices. Beyond, frontal and subcortical gray matter regions as well as white matter tracts connecting these regions were affected. Our findings underline the importance of a right network in spatial exploration and attention and specifically in the emergence of the core symptoms of spatial neglect.

Inter-individual differences in human brain structure and morphology link to variation in demographics and behavior

We perform a comprehensive integrative analysis of multiple structural MR-based brain features and find for the first-time strong evidence relating inter-individual brain structural variations to a wide range of demographic and behavioral variates across a large cohort of young healthy human volunteers. Our analyses reveal that a robust 'positive-negative' spectrum of behavioral and demographic variates, recently associated to covariation in brain function, can already be identified using only structural features, highlighting the importance of careful integration of structural features in any analysis of inter-individual differences in functional connectivity and downstream associations with behavioral/demographic variates.

Lesion mapping in acute stroke aphasia and its implications for recovery

Patients with stroke offer a unique window into understanding human brain function. Mapping stroke lesions poses several challenges due to the complexity of the lesion anatomy and the mechanisms causing local and remote disruption on brain networks. In this prospective longitudinal study, we compare standard and advanced approaches to white matter lesion mapping applied to acute stroke patients with aphasia. Eighteen patients with acute left hemisphere stroke were recruited and scanned within two weeks from symptom onset. Aphasia assessment was performed at baseline and six-month follow-up. Structural and diffusion MRI contrasts indicated an area of maximum overlap in the anterior external/extreme capsule with diffusion images showing a larger overlap extending into posterior perisylvian regions. Anatomical predictors of recovery included damage to ipsilesional tracts (as shown by both structural and diffusion images) and contralesional tracts (as shown by diffusion images only). These findings indicate converging results from structural and diffusion lesion mapping methods but also clear differences between the two approaches in their ability to identify predictors of recovery outside the lesioned regions.

Peripersonal and extrapersonal visuospatial neglect in different frames of reference: A brain lesion-symptom mapping study

INTRODUCTION

Visuospatial neglect can occur in peripersonal and extrapersonal space. The dorsal visual pathway is hypothesized to be associated with peripersonal, and the ventral pathway with extrapersonal neglect. We aimed to evaluate neural substrates of peripersonal versus extrapersonal neglect, separately for egocentric and allocentric frames of reference.

METHODS

This was a retrospective study, including stroke patients admitted for inpatient rehabilitation. Approximately 1 month post-stroke onset, computerized cancellation (egocentric) and bisection tasks (egocentric and allocentric) were administered at 30 cm and 120 cm. We collected CT or MRI scans and performed voxel-based lesion-symptom mapping for the cancellation, and subtraction analyses for the line bisection task.

RESULTS

We included 98 patients for the cancellation and 129 for the bisection analyses. The right parahippocampal gyrus, hippocampus, and thalamus were associated with egocentric peripersonal neglect as measured with cancellation. These areas were also associated with extrapersonal neglect, together with the right superior parietal lobule, angular gyrus, supramarginal gyrus, lateral occipital cortex, planum temporale and superior temporal gyrus. Lesions in the right parietal, temporal and frontal areas were associated with both peripersonal and extrapersonal egocentric neglect as measured with bisection. For allocentric neglect no clear pattern of associated brain regions was observed.

DISCUSSION

We found right hemispheric anatomical correlates for peripersonal and extrapersonal neglect. However, no brain areas were uniquely associated with peripersonal neglect, meaning we could not conclusively verify the ventral/dorsal hypothesis. Several areas were uniquely associated with egocentric extrapersonal neglect, suggesting that these brain areas can be specifically involved in extrapersonal, but not in peripersonal, attention processes.

Come together: human-avatar on-line interactions boost joint-action performance in apraxic patients

Limb apraxia (LA) is a high-order motor disorder linked to left-hemisphere damage. It is characterized by defective execution of purposeful actions upon delayed imitation, or verbal command when the actions are performed in isolated, non-naturalistic, conditions. Whether interpersonal interactions provide social affordances that activate neural resources different from those requested by individual action execution, which may improve LA performance, is unknown. To fill this gap, we measured interaction performance, behavioral and kinematic indexes of left-brain damaged patients with/without LA in a social reach-to-grasp task involving two different degrees of spatio-temporal interactivity with an avatar. We found that LA patients' impairment in coordinating with the virtual partner was abolished in highly interactive conditions (where patients selected their actions on-line based on the behavior of the virtual partner) with respect to low interactive conditions (where actions were selected beforehand based on abstract instructions). Voxel-based-Lesion-Symptom-Mapping indicated that impairments in low-interactive conditions were underpinned by lesions of premotor, motor and insular areas, and of the basal ganglia. Our approach expands current understanding of the behavioral and neural correlates of interactive motor performance by highlighting the important role of social affordances, and provides novel, potentially important, views on rehabilitation of higher-order motor cognition disorders.

Regional structural impairments outside lesions are associated with verbal short-term memory deficits in chronic subcortical stroke

Background and Purpose

We aimed to explore the neural mechanisms of verbal short-term memory (VSTM) impairment in subcortical stroke by evaluating the contributions of lesion and remote grey matter volume (GMV) reduction.

Results

There was no significant correlation between lesions and VSTM. In stroke patients with left lesions, GMV reductions in the right middle frontal gyrus and in the left inferior frontal gyrus were positively correlated with VSTM impairment. In patients with right lesions, GMV reduction in the right dorsal posterior cingulate cortex was positively correlated with VSTM impairment.

Materials and Methods

Ninety-seven patients with chronic subcortical ischemic stroke and seventy-nine healthy controls underwent VSTM and structural MRI examinations. Voxel-based lesion symptom mapping was used to identify correlations between lesions and VSTM. Voxel-wise comparisons were used to identify brain regions with significant GMV reduction in patients with left and right lesions. These regions were used in correlation analyses between GMV and VSTM in each patient subgroup.

Conclusions

These findings suggest that VSTM impairment in subcortical stroke is associated with secondary regional structural damage in non-lesion regions, rather than with the lesion itself. Moreover, different neural substrates may underlie VSTM impairment in stroke patients with left and right lesions.

Lesion Characteristics of Chronic Dysphagia in Patients With Supratentorial Stroke

Objective

To analyze the relationship between brain lesion location and type of chronic dysphagia in patients with supratentorial stroke.

Methods

Data from 82 chronic stroke patients who underwent videofluoroscopic swallowing studies at >6 months after an initial stroke event were retrospectively analyzed. Delayed oral transit time, delayed pharyngeal transit time, and the presence of aspiration were extracted. A voxel-based lesion symptom mapping (VLSM) analysis was used to correlate types of dysphagia with specific brain lesions.

Results

VLSM identified several clusters of voxels that significantly correlated with type of dysphagia. Delayed oral transit time mainly correlated with lesions in the left inferior frontal lobe and precentral gyrus; delayed pharyngeal time mainly correlated with lesions in the right basal ganglia and corona radiate; and aspiration was mainly correlated with lesions in the putamen.

Conclusion

Understanding the association between lesion location and dysphagia in chronic stroke patients is an important first step towards predicting permanent dysphagia after stroke. Improved understanding of the neural correlates of dysphagia will inform the utility of interventions for its treatment and prevention after stroke.

Lesion symptom map of cognitive-postural interference in multiple sclerosis

Objective:

To investigate the disease-altered structure–function relationship underlying the cognitive–postural interference (CPI) phenomenon in multiple sclerosis (MS).

Methods:

We measured postural sway of 96 patients and 48 sex-/age-matched healthy controls by force platform in quiet standing (single-task (ST)) while performing the Stroop test (dual-task (DT)) to estimate the dual-task cost (DTC) of balance. In patient group, binary T2 and T1 lesion masks and their corresponding lesion volumes were obtained from magnetic resonance imaging (MRI) of brain. Normalized brain volume (NBV) was also estimated by SIENAX. Correlations between DTC and lesion location were determined by voxel-based lesion symptom mapping (VLSM) analyses.

Results:

Patients had greater DTC than controls (p < 0.001). Among whole brain MRI metrics, only T1 lesion volume correlated with DTC (r = −0.27; p < 0.01). However, VLSM analysis did not reveal any association with DTC using T1 lesion masks. By contrast, we found clusters of T2 lesions in distinct anatomical regions (anterior and superior corona radiata, bilaterally) to be correlated with DTC (p < 0.01 false discovery rate (FDR)-corrected). A multivariable stepwise regression model confirmed findings from VLSM analysis. NBV did not contribute to fit the model.

Conclusion:

Our findings suggest that the CPI phenomenon in MS can be explained by disconnection along specific areas implicated in task-switching abilities and divided attention.

CerebroMatic: A Versatile Toolbox for Spline-Based MRI Template Creation

Brain image spatial normalization and tissue segmentation rely on prior tissue probability maps. Appropriately selecting these tissue maps becomes particularly important when investigating "unusual" populations, such as young children or elderly subjects. When creating such priors, the disadvantage of applying more deformation must be weighed against the benefit of achieving a crisper image. We have previously suggested that statistically modeling demographic variables, instead of simply averaging images, is advantageous. Both aspects (more vs. less deformation and modeling vs. averaging) were explored here. We used imaging data from 1914 subjects, aged 13 months to 75 years, and employed multivariate adaptive regression splines to model the effects of age, field strength, gender, and data quality. Within the spm/cat12 framework, we compared an affine-only with a low- and a high-dimensional warping approach. As expected, more deformation on the individual level results in lower group dissimilarity. Consequently, effects of age in particular are less apparent in the resulting tissue maps when using a more extensive deformation scheme. Using statistically-described parameters, high-quality tissue probability maps could be generated for the whole age range; they are consistently closer to a gold standard than conventionally-generated priors based on 25, 50, or 100 subjects. Distinct effects of field strength, gender, and data quality were seen. We conclude that an extensive matching for generating tissue priors may model much of the variability inherent in the dataset which is then not contained in the resulting priors. Further, the statistical description of relevant parameters (using regression splines) allows for the generation of high-quality tissue probability maps while controlling for known confounds. The resulting CerebroMatic toolbox is available for download at http://irc.cchmc.org/software/cerebromatic.php.

Whole Brain Magnetic Resonance Image Atlases: A Systematic Review of Existing Atlases and Caveats for Use in Population Imaging

Brain MRI atlases may be used to characterize brain structural changes across the life course. Atlases have important applications in research, e.g., as registration and segmentation targets to underpin image analysis in population imaging studies, and potentially in future in clinical practice, e.g., as templates for identifying brain structural changes out with normal limits, and increasingly for use in surgical planning. However, there are several caveats and limitations which must be considered before successfully applying brain MRI atlases to research and clinical problems. For example, the influential Talairach and Tournoux atlas was derived from a single fixed cadaveric brain from an elderly female with limited clinical information, yet is the basis of many modern atlases and is often used to report locations of functional activation. We systematically review currently available whole brain structural MRI atlases with particular reference to the implications for population imaging through to emerging clinical practice. We found 66 whole brain structural MRI atlases world-wide. The vast majority were based on T1, T2, and/or proton density (PD) structural sequences, had been derived using parametric statistics (inappropriate for brain volume distributions), had limited supporting clinical or cognitive data, and included few younger (>5 and <18 years) or older (>60 years) subjects. To successfully characterize brain structural features and their changes across different stages of life, we conclude that whole brain structural MRI atlases should include: more subjects at the upper and lower extremes of age; additional structural sequences, including fluid attenuation inversion recovery (FLAIR) and T2* sequences; a range of appropriate statistics, e.g., rank-based or non-parametric; and detailed cognitive and clinical profiles of the included subjects in order to increase the relevance and utility of these atlases.

Reconfiguration of brain network architecture to support executive control in aging

Aging is accompanied by declines in executive control abilities and changes in underlying brain network architecture. Here, we examined brain networks in young and older adults during a task-free resting state and an N-back task and investigated age-related changes in the modular network organization of the brain. Compared with young adults, older adults showed larger changes in network organization between resting state and task. Although young adults exhibited increased connectivity between lateral frontal regions and other network modules during the most difficult task condition, older adults also exhibited this pattern of increased connectivity during less-demanding task conditions. Moreover, the increase in between-module connectivity in older adults was related to faster task performance and greater fractional anisotropy of the superior longitudinal fasciculus. These results demonstrate that older adults who exhibit more pronounced network changes between a resting state and task have better executive control performance and greater structural connectivity of a core frontal-posterior white matter pathway.

The right hemisphere is dominant in organization of visual search-A study in stroke patients

Cancellation tasks are widely used for diagnosis of lateralized attentional deficits in stroke patients. A disorganized fashion of target cancellation has been hypothesized to reflect disturbed spatial exploration. In the current study we aimed to examine which lesion locations result in disorganized visual search during cancellation tasks, in order to determine which brain areas are involved in search organization. A computerized shape cancellation task was administered in 78 stroke patients. As an index for search organization, the amount of intersections of paths between consecutive crossed targets was computed (i.e., intersections rate). This measure is known to accurately depict disorganized visual search in a stroke population. Ischemic lesions were delineated on CT or MRI images. Assumption-free voxel-based lesion-symptom mapping and region of interest-based analyses were used to determine the grey and white matter anatomical correlates of the intersections rate as a continuous measure. The right lateral occipital cortex, superior parietal lobule, postcentral gyrus, superior temporal gyrus, middle temporal gyrus, supramarginal gyrus, inferior longitudinal fasciculus, first branch of the superior longitudinal fasciculus (SLF I), and the inferior fronto-occipital fasciculus, were related to search organization. To conclude, a clear right hemispheric dominance for search organization was revealed. Further, the correlates of disorganized search overlap with regions that have previously been associated with conjunctive search and spatial working memory. This suggests that disorganized visual search is caused by disturbed spatial processes, rather than deficits in high level executive function or planning, which would be expected to be more related to frontal regions.

Reduced Sensitivity to Sooner Reward During Intertemporal Decision-Making Following Insula Damage in Humans

During intertemporal choice, humans tend to prefer small-sooner rewards over larger-delayed rewards, reflecting temporal discounting (TD) of delayed outcomes. Functional neuroimaging (fMRI) evidence has implicated the insular cortex in time-sensitive decisions, yet it is not clear whether activity in this brain region is crucial for, or merely associated with, TD behavior. Here, patients with damage to the insula (Insular patients), control patients with lesions outside the insula, and healthy individuals chose between smaller-sooner and larger-later monetary rewards. Insular patients were less sensitive to sooner rewards than were the control groups, exhibiting reduced TD. A Voxel-based Lesion-Symptom Mapping (VLSM) analysis confirmed a statistically significant association between insular damage and reduced TD. These results indicate that the insular cortex is crucial for intertemporal choice. We suggest that he insula may be necessary to anticipate the bodily/emotional effects of receiving rewards at different delays, influencing the computation of their incentive value. Devoid of such input, insular patients' choices would be governed by a heuristic of quantity, allowing patients to wait for larger options.

The t test and beyond: Recommendations for testing the central tendencies of two independent samples in research on speech, language and hearing pathology

PURPOSE

In this Tutorial we compare current practice of the analysis of data obtained in designs involving two independent samples with new developments in statistics and evidence on the behavior of conventional statistics. We included t tests, non-parametric alternatives, such as the Wilcoxon-Mann-Whitney test, and recently developed approaches, known as bootstrapping and randomization tests. The relative use of the different statistics is illustrated on the basis of counts carried out in three journals on disordered communication in the time interval 2005-2013: Clinical Linguistics & Phonetics, Journal of Communication Disorders and Journal of Speech, Language and Hearing Research. A number of recommendations are given to guide the researcher in the presentation and analysis of her/his data.

CONCLUSIONS

The main messages are (a) that researchers should present more relevant features of their data (means, medians, SD, skewness, tailedness, outliers etc.), (b) not routinely use conventional non-parametric tests like Wilcoxon-Mann-Whitney test in case one or more of the assumptions of t tests are not met, and (c) should consider using less conventional, but robust statistics which have been developed and tested in the last decades.

Permutation and parametric tests for effect sizes in voxel-based morphometry of gray matter volume in brain structural MRI

Permutation testing has been widely implemented in voxel-based morphometry (VBM) tools. However, this type of non-parametric inference has yet to be thoroughly compared with traditional parametric inference in VBM studies of brain structure. Here we compare both types of inference and investigate what influence the number of permutations in permutation testing has on results in an exemplar study of how gray matter proportion changes with age in a group of working age adults. High resolution T1-weighted volume scans were acquired from 80 healthy adults aged 25-64years. Using a validated VBM procedure and voxel-based permutation testing for Pearson product-moment coefficient, the effect sizes of changes in gray matter proportion with age were assessed using traditional parametric and permutation testing inference with 100, 500, 1000, 5000, 10000 and 20000 permutations. The statistical significance was set at P<0.05 and false discovery rate (FDR) was used to correct for multiple comparisons. Clusters of voxels with statistically significant (PFDR<0.05) declines in gray matter proportion with age identified with permutation testing inference (N≈6000) were approximately twice the size of those identified with parametric inference (N=3221voxels). Permutation testing with 10000 (N=6251voxels) and 20000 (N=6233voxels) permutations produced clusters that were generally consistent with each other. However, with 1000 permutations there were approximately 20% more statistically significant voxels (N=7117voxels) than with ≥10000 permutations. Permutation testing inference may provide a more sensitive method than traditional parametric inference for identifying age-related differences in gray matter proportion. Based on the results reported here, at least 10000 permutations should be used in future univariate VBM studies investigating age related changes in gray matter to avoid potential false findings. Additional studies using permutation testing in large imaging databanks are required to address the impact of model complexity, multivariate analysis, number of observations, sampling bias and data quality on the accuracy with which subtle differences in brain structure associated with normal aging can be identified.

Use of brain MRI atlases to determine boundaries of age-related pathology: the importance of statistical method

Introduction

Neurodegenerative disease diagnoses may be supported by the comparison of an individual patient’s brain magnetic resonance image (MRI) with a voxel-based atlas of normal brain MRI. Most current brain MRI atlases are of young to middle-aged adults and parametric, e.g., mean ±standard deviation (SD); these atlases require data to be Gaussian. Brain MRI data, e.g., grey matter (GM) proportion images, from normal older subjects are apparently not Gaussian. We created a nonparametric and a parametric atlas of the normal limits of GM proportions in older subjects and compared their classifications of GM proportions in Alzheimer’s disease (AD) patients.

Methods

Using publicly available brain MRI from 138 normal subjects and 138 subjects diagnosed with AD (all 55–90 years), we created: a mean ±SD atlas to estimate parametrically the percentile ranks and limits of normal ageing GM; and, separately, a nonparametric, rank order-based GM atlas from the same normal ageing subjects. GM images from AD patients were then classified with respect to each atlas to determine the effect statistical distributions had on classifications of proportions of GM in AD patients.

Results

The parametric atlas often defined the lower normal limit of the proportion of GM to be negative (which does not make sense physiologically as the lowest possible proportion is zero). Because of this, for approximately half of the AD subjects, 25–45% of voxels were classified as normal when compared to the parametric atlas; but were classified as abnormal when compared to the nonparametric atlas. These voxels were mainly concentrated in the frontal and occipital lobes.

Discussion

To our knowledge, we have presented the first nonparametric brain MRI atlas. In conditions where there is increasing variability in brain structure, such as in old age, nonparametric brain MRI atlases may represent the limits of normal brain structure more accurately than parametric approaches. Therefore, we conclude that the statistical method used for construction of brain MRI atlases should be selected taking into account the population and aim under study. Parametric methods are generally robust for defining central tendencies, e.g., means, of brain structure. Nonparametric methods are advisable when studying the limits of brain structure in ageing and neurodegenerative disease.

Distinct anatomical correlates of discriminability and criterion setting in verbal recognition memory revealed by lesion-symptom mapping

Recognition memory, that is, the ability to judge whether an item has been previously encountered in a particular context, depends on two factors: discriminability and criterion setting. Discriminability draws on memory processes while criterion setting (i.e., the application of a threshold resulting in a yes/no response) is regarded as a process of cognitive control. Discriminability and criterion setting are assumed to draw on distinct anatomical structures, but definite evidence for this assumption is lacking. We applied voxel-based and region of interest-based lesion-symptom mapping to 83 patients in the acute phase of ischemic stroke to determine the anatomical correlates of discriminability and criterion setting in verbal recognition memory. Recognition memory was measured with the Rey Auditory Verbal Learning Test. Signal-detection theory was used to calculate measures for discriminability and criterion setting. Lesion-symptom mapping revealed that discriminability draws on left medial temporal and temporo-occipital structures, both thalami and the right hippocampus, while criterion setting draws on the right inferior frontal gyrus. Lesions in the right inferior frontal gyrus were associated with liberal response bias. These findings indicate that discriminability and criterion setting indeed depend on distinct anatomical structures and provide new insights in the anatomical correlates of these cognitive processes that underlie verbal recognition memory.

Statistical inferences under the Null hypothesis: common mistakes and pitfalls in neuroimaging studies

Published studies using functional and structural MRI include many errors in the way data are analyzed and conclusions reported. This was observed when working on a comprehensive review of the neural bases of synesthesia, but these errors are probably endemic to neuroimaging studies. All studies reviewed had based their conclusions using Null Hypothesis Significance Tests (NHST). NHST have yet been criticized since their inception because they are more appropriate for taking decisions related to a Null hypothesis (like in manufacturing) than for making inferences about behavioral and neuronal processes. Here I focus on a few key problems of NHST related to brain imaging techniques, and explain why or when we should not rely on "significance" tests. I also observed that, often, the ill-posed logic of NHST was even not correctly applied, and describe what I identified as common mistakes or at least problematic practices in published papers, in light of what could be considered as the very basics of statistical inference. MRI statistics also involve much more complex issues than standard statistical inference. Analysis pipelines vary a lot between studies, even for those using the same software, and there is no consensus which pipeline is the best. I propose a synthetic view of the logic behind the possible methodological choices, and warn against the usage and interpretation of two statistical methods popular in brain imaging studies, the false discovery rate (FDR) procedure and permutation tests. I suggest that current models for the analysis of brain imaging data suffer from serious limitations and call for a revision taking into account the "new statistics" (confidence intervals) logic.

Altered microstructure in temporal lobe epilepsy: a diffusional kurtosis imaging study

BACKGROUND AND PURPOSE

Temporal lobe epilepsy is associated with regional abnormalities in tissue microstructure, as demonstrated by DTI. However, the full extent of these abnormalities has not yet been defined because DTI conveys only a fraction of the information potentially accessible with diffusion MR imaging. In this study, we assessed the added value of diffusional kurtosis imaging, an extension of DTI, to evaluate microstructural abnormalities in patients with temporal lobe epilepsy.

MATERIALS AND METHODS

Thirty-two patients with left temporal lobe epilepsy and 36 matched healthy subjects underwent diffusion MR imaging. To evaluate abnormalities in patients, we performed voxelwise analyses, assessing DTI-derived mean diffusivity, fractional anisotropy, and diffusional kurtosis imaging-derived mean diffusional kurtosis, as well as diffusional kurtosis imaging and DTI-derived axial and radial components, comparing patients with controls.

RESULTS

We replicated findings from previous studies demonstrating a reduction in fractional anisotropy and an increase in mean diffusivity preferentially affecting, but not restricted to, the temporal lobe ipsilateral to seizure onset. We also noted a pronounced pattern of diffusional kurtosis imaging abnormalities in gray and white matter tissues, often extending into regions that were not detected as abnormal by DTI measures.

CONCLUSIONS

Diffusional kurtosis is a sensitive and complementary measure of microstructural compromise in patients with temporal lobe epilepsy. It provides additional information regarding the anatomic distribution and degree of damage in this condition. Diffusional kurtosis imaging may be used as a biomarker for disease severity, clinical phenotypes, and treatment monitoring in epilepsy.

Anosognosia for hemiplegia: The contributory role of right inferior frontal gyrus

OBJECTIVE

Awareness of motor functioning is most likely a complex process that requires integration of sensory-motor feedback to constantly update the system on the functioning of the limb during motor behavior. Using lesion mapping procedures and behavioral measures, the current study aimed to evaluate neural correlates of anosognosia for hemiplegia (AHP) in the acute stage (first 48 hr) of right hemisphere stroke.

METHOD

Thirty-five individuals with right hemisphere stroke who presented to an urban medical center within 24 hr of symptom onset were included in the study. All 35 individuals had hemiplegia, and 8 of these individuals exhibited AHP.

RESULTS

Fisher's exact test statistical map of lesion-deficit association (range is between-log(p) 4 to 11) found maximal value of 10.9 located in pars orbitalis (Brodmann's Area 47; BA). In this selected location, 6 out of 8 patients with AHP had tissue abnormality, whereas none of the unaffected subjects had tissue abnormality in BA 47. Right BA 44/45 was also found to be lesioned more frequently in individuals with AHP (75%) than without AHP (11%).

CONCLUSIONS

The current study findings provide preliminary support for unique involvement of the right inferior frontal gyrus (IFG), pars orbitalis (BA 47) in AHP. The current data suggest that frontal operculum may play a key role in awareness of limb functioning.

The anatomy of visuospatial construction revealed by lesion-symptom mapping

Visuospatial construction is a complex cognitive operation that is composed of a purely constructional component (visuoconstruction proper), and visuoperceptive, attentional, and decision-making components. The anatomical correlates of visuospatial construction and its cognitive subcomponents are poorly understood. The purpose of the present study was to determine the anatomical correlates of visuospatial construction by applying lesion-symptom mapping in a cohort of 111 patients with first-ever ischemic stroke. We employed the Rey-Osterrieth Complex Figure (ROCF) copy test and the Judgment of Line Orientation (JLO); both tests measure visuoperception, while only the ROCF has a constructional component. We first performed assumption-free voxel-based lesion-symptom mapping, which revealed large shared right hemispheric correlates for the ROCF and JLO in the frontal lobe, superior temporal lobe, and supramarginal gyrus. These shared anatomical correlates reflect the visuoperceptive component of the ROCF and JLO. Anatomical correlates were discordant in the right superior parietal lobule, and angular and middle occipital gyri: lesions in these regions were associated with poor performance on the ROCF, but not the JLO. Secondly, these findings were reproduced with a region of interest-based analysis that yielded a statistically significant correlation between infarct volume in the right inferior and superior parietal, angular and middle occipital cortices, and poor performance on the ROCF, but not the JLO. This discordance in anatomical correlates of the ROCF and JLO reflects the visuoconstructive component of the ROCF. These findings provide new insights in the anatomical correlates of the visuoperceptive and visuoconstructive components of the ROCF and provide evidence for a crucial role of the right inferior and superior parietal, angular and middle occipital gyri in visuoconstruction proper.

Permutation inference for the general linear model

Permutation methods can provide exact control of false positives and allow the use of non-standard statistics, making only weak assumptions about the data. With the availability of fast and inexpensive computing, their main limitation would be some lack of flexibility to work with arbitrary experimental designs. In this paper we report on results on approximate permutation methods that are more flexible with respect to the experimental design and nuisance variables, and conduct detailed simulations to identify the best method for settings that are typical for imaging research scenarios. We present a generic framework for permutation inference for complex general linear models (GLMS) when the errors are exchangeable and/or have a symmetric distribution, and show that, even in the presence of nuisance effects, these permutation inferences are powerful while providing excellent control of false positives in a wide range of common and relevant imaging research scenarios. We also demonstrate how the inference on GLM parameters, originally intended for independent data, can be used in certain special but useful cases in which independence is violated. Detailed examples of common neuroimaging applications are provided, as well as a complete algorithm - the "randomise" algorithm - for permutation inference with the GLM.

Strategic white matter tracts for processing speed deficits in age-related small vessel disease

OBJECTIVE

Cerebral small vessel disease is the most common cause of vascular cognitive impairment and typically manifests with slowed processing speed. We investigated the impact of lesion location on processing speed in age-related small vessel disease.

METHODS

A total of 584 community-dwelling elderly underwent brain MRI followed by segmentation of white matter hyperintensities. Processing speed was determined by the timed measure of the Trail Making Test part B. The impact of the location of white matter hyperintensities was assessed by voxel-based lesion-symptom mapping and graph-based statistical models on regional lesion volumes in major white matter tracts.

RESULTS

Voxel-based lesion-symptom mapping identified multiple voxel clusters where the presence of white matter hyperintensities was associated with slower performance on the Trail Making Test part B. Clusters were located bilaterally in the forceps minor and anterior thalamic radiation. Region of interest-based Bayesian network analyses on lesion volumes within major white matter tracts depicted the same tracts as direct predictors for an impaired Trail Making Test part B performance.

CONCLUSIONS

Our findings highlight damage to frontal interhemispheric and thalamic projection fiber tracts harboring frontal-subcortical neuronal circuits as a predictor for processing speed performance in age-related small vessel disease.

Association between subcortical vascular lesion location and cognition: a voxel-based and tract-based lesion-symptom mapping study. The SMART-MR study

Introduction

Lacunar lesions (LLs) and white matter lesions (WMLs) affect cognition. We assessed whether lesions located in specific white matter tracts were associated with cognitive performance taking into account total lesion burden.

Methods

Within the Second Manifestations of ARTerial disease Magnetic Resonance (SMART-MR) study, cross-sectional analyses were performed on 516 patients with manifest arterial disease. We applied an assumption-free voxel-based lesion-symptom mapping approach to investigate the relation between LL and WML locations on 1.5 Tesla brain MRI and compound scores of executive functioning, memory and processing speed. Secondly, a multivariable linear regression model was used to relate the regional volume of LLs and WMLs within specific white matter tracts to cognitive functioning.

Results

Voxel-based lesion-symptom mapping identified several clusters of voxels with a significant correlation between WMLs and executive functioning, mostly located within the superior longitudinal fasciculus and anterior thalamic radiation. In the multivariable linear regression model, a statistically significant association was found between regional LL volume within the superior longitudinal fasciculus and anterior thalamic radiation and executive functioning after adjustment for total LL and WML burden.

Conclusion

These findings identify the superior longitudinal fasciculus and anterior thalamic radiation as key anatomical structures in executive functioning and emphasize the role of strategically located vascular lesions in vascular cognitive impairment.

Influence of hematoma location on acute mortality after intracerebral hemorrhage

BACKGROUND AND PURPOSE

This study aimed to identify predictors of acute mortality after intracerebral hemorrhage (ICH), including voxel-wise analysis of hematoma location.

METHODS

In 282 consecutive patients with acute ICH, clinical and radiological predictors of acute mortality were identified. Voxel-based lesion-symptom mapping examined spatial correlates of acute mortality, contrasting results in basal ganglia ICH and lobar ICH.

RESULTS

Acute mortality was 47.9%. In bivariate analyses, one clinical (serum glucose) and two radiological (hematoma volume and intraventricular extension) measures significantly predicted mortality. The relationship was strongest for hematoma volume. Multivariable modeling identified four significant predictors of mortality (ICH volume, intraventricular extension, serum glucose, and serum hemoglobin), although this model only minimally improved the predictive value provided by ICH volume alone. Voxel-wise analysis found that for patients with lobar ICH, brain regions where acute hematoma was significantly associated with higher acute mortality included inferior parietal lobule and posterior insula; for patients with basal ganglia ICH, a large region extending from cortex to brainstem.

CONCLUSIONS

For patients with lobar ICH, acute mortality is related to both hematoma size and location, with findings potentially useful for therapeutic decision making. The current findings also underscore differences between the syndromes of acute deep and lobar ICH.

Damage to white matter pathways in subacute and chronic spatial neglect: a group study and 2 single-case studies with complete virtual "in vivo" tractography dissection

The exact anatomical localization of right hemisphere lesions that lead to left spatial neglect is still debated. The effect of confounding factors such as acute diaschisis and hypoperfusion, visual field defects, and lesion size may account for conflicting results that have been reported in the literature. Here, we present a comprehensive anatomical investigation of the gray- and white matter lesion correlates of left spatial neglect, which was run in a sample 58 patients with subacute or chronic vascular strokes in the territory of the right middle cerebral artery. Standard voxel-based correlates confirmed the role played by lesions in the posterior parietal cortex (supramarginal gyrus, angular gyrus, and temporal-parietal junction), in the frontal cortex (frontal eye field, middle and inferior frontal gyrus), and in the underlying parietal-frontal white matter. Using a new diffusion tensor imaging-based atlas of the human brain, we were able to run, for the first time, a detailed analysis of the lesion involvement of subcortical white matter pathways. The results of this analysis revealed that, among the different pathways linking parietal with frontal areas, damage to the second branch of the superior longitudinal fasciculus (SLF II) was the best predictor of left spatial neglect. The group study also revealed a subsample of patients with neglect due to focal lesion in the lateral-dorsal portion of the thalamus, which connects the premotor cortex with the inferior parietal lobule. The relevance of fronto-parietal disconnection was further supported by complete in vivo tractography dissection of white matter pathways in 2 patients, one with and the other without signs of neglect. These 2 patients were studied both in the acute phase and 1 year after stroke and were perfectly matched for age, handedness, stroke onset, lesion size, and for cortical lesion involvement. Taken together, the results of the present study support the hypothesis that anatomical disconnections leading to a functional breakdown of parietal-frontal networks are an important pathophysiological factor leading to chronic left spatial neglect. Here, we propose that different loci of SLF disconnection on the rostro-caudal axis can also be associated with disconnection of short-range white matter pathways within the frontal or parietal areas. Such different local disconnection patterns can play a role in the important clinical variability of the neglect syndrome.

Logical circularity in voxel-based analysis: normalization strategy may induce statistical bias

Recent discussions within the neuroimaging community have highlighted the problematic presence of selection bias in experimental design. Although initially centering on the selection of voxels during the course of fMRI studies, we demonstrate how this bias can potentially corrupt voxel-based analyses. For such studies, template-based registration plays a critical role in which a representative template serves as the normalized space for group alignment. A standard approach maps each subject's image to a representative template before performing statistical comparisons between different groups. We analytically demonstrate that in these scenarios the popular sum of squared difference (SSD) intensity metric, implicitly surrogating as a quantification of anatomical alignment, instead explicitly maximizes effect size--an experimental design flaw referred to as "circularity bias." We illustrate how this selection bias varies in strength with the similarity metric used during registration under the hypothesis that while SSD-related metrics, such as Demons, will manifest similar effects, other metrics which are not formulated based on absolute intensity differences will produce less of an effect. Consequently, given the variability in voxel-based analysis outcomes with similarity metric choice, we caution researchers specifically in the use of SSD and SSD-related measures where normalization and statistical analysis involve the same image set. Instead, we advocate a more cautious approach where normalization of the individual subject images to the reference space occurs through corresponding image sets which are independent of statistical testing. Alternatively, one can use similarity terms that are less sensitive to this bias.

Neuroanatomical Dissections of Unilateral Visual Neglect Symptoms: ALE Meta-Analysis of Lesion-Symptom Mapping

Unilateral visual neglect is commonly defined as impaired ability to attend to stimuli presented on the side of visual space contralateral to the brain lesion. However, behavioral analyses indicate that different neglect symptoms can dissociate. The neuroanatomy of the syndrome has been hotly debated. Some groups have argued that the syndrome is linked to posterior parietal cortex lesions, while others report damage within regions including the superior temporal gyrus, insula, and basal ganglia. Several recent neuroimaging studies provide evidence that heterogeneity in the behavioral symptoms of neglect can be matched by variations in the brain lesions, and that some of the discrepancies across earlier findings might have resulted from the use of different neuropsychological tests and/or varied measures within the same task for diagnosing neglect. In this paper, we review the evidence for dissociations between both the symptoms and the neural substrates of unilateral visual neglect, drawing on ALE (anatomic likelihood estimation) meta-analyses of lesion-symptom mapping studies. Specifically, we examine dissociations between neglect symptoms associated with impaired control of attention across space (in an egocentric frame of reference) and within objects (in an allocentric frame of reference). Results of ALE meta-analyses indicated that, while egocentric symptoms are associated with damage within perisylvian network (pre- and postcentral, supramarginal, and superior temporal gyri) and damage within sub-cortical structures, more posterior lesions including the angular, middle temporal, and middle occipital gyri are associated with allocentric symptoms. Furthermore, there was high concurrence in deficits associated with white matter lesions within long association (superior longitudinal, inferior fronto-occipital, and inferior longitudinal fasciculi) and projection (corona radiata and thalamic radiation) pathways, supporting a disconnection account of the syndrome. Using this evidence we argue that different forms of neglect link to both distinct and common patterns of gray and white matter lesions. The findings are discussed in terms of functional accounts of neglect and theoretical models based on computational studies of both normal and impaired attention functions.

Fluorodeoxyglucose positron emission tomography in anti-N-methyl-D-aspartate receptor encephalitis: distinct pattern of disease

BACKGROUND

Patients with encephalitis associated with antibodies against N-methyl-D-aspartate-receptor antibody (NMDAR-ab) encephalitis frequently show psychotic symptoms, amnesia, seizures and movement disorders. While brain MRI in NMDAR-ab encephalitis is often normal, abnormalities of cerebral glucose metabolism have been demonstrated by positron emission tomography (PET) with 18F-fluorodeoxyglucose(FDG) in a few usually isolated case reports. However, a common pattern of FDG-PET abnormalities has not been reported.

METHODS

The authors retrospectively identified six patients with NMDAR-ab encephalitis in two large German centres who underwent at least one whole-body FDG-PET for tumour screening between January 2007 and July 2010. They analysed the pattern of cerebral uptake derived from whole-body PET data for characteristic changes of glucose metabolism compared with controls, and the changes of this pattern during the course of the disease.

RESULTS

Groupwise analysis revealed that patients with NMDAR-ab encephalitis showed relative frontal and temporal glucose hypermetabolism associated with occipital hypometabolism. Cross-sectional analysis of the group demonstrated that the extent of these changes is positively associated with clinical disease severity. Longitudinal analysis of two cases showed normalisation of the pattern of cerebral glucose metabolism with recovery.

CONCLUSIONS

A characteristic change in cerebral glucose metabolism during NMDAR-ab encephalitis is an increased frontotemporal-to-occipital gradient. This pattern correlates with disease severity. Similar changes have been observed in psychosis induced by NMDAR antagonists. Thus, this pattern might be a consequence of impaired NMDAR function.

Advances in longitudinal MRI diagnostic tests

INTRODUCTION

The past decade has seen an explosion of functional magnetic resonance imaging (MRI) studies in neuroscience. As the technology progresses, it is now possible to carry out longitudinal studies using functional MRI. Such studies can be used to understand the progression of mental and neurological disorders and the effectiveness of different treatments by obtaining direct measures of brain activity as well as markers of tissue health and connectivity.

AREAS COVERED

We review six popular neuroimaging tools that can be used for longitudinal studies: blood oxygen level-dependent (BOLD)-weighted imaging, BOLD-based functional connectivity, arterial spin labeling, dynamic R2* imaging, voxel-based morphometry, and diffusion tensor imaging.

EXPERT OPINION

Each of these techniques is targeted to probe a specific feature of brain function or brain structure and can reveal important information about the progression of a pathological condition. We anticipate that in the near future, the MRI techniques discussed here may become standard tools in clinical use and will not be used for research purposes only.

Hippocampal atrophy in temporal lobe epilepsy: the 'generator' and 'receiver'

OBJECTIVE

Some patients with unilateral medial temporal lobe epilepsy (MTLE) display bilateral hippocampal atrophy on MRI, even though seizures originate in only one hippocampus. The correct identification of the epileptogenic hippocampus (the 'generator') vs the non-epileptogenic (the 'receiver') may lead to better surgical planning and results.

MATERIALS AND METHODS

We studied 14 patients with MTLE (eight left and six right) who became seizure free after unilateral hippocampal resection, with hippocampal sclerosis confirmed by histology. Hippocampal tridimensional morphometry was performed comparing patients and healthy controls employing a voxel-wise Wilcoxon test. Results were corrected for multiple comparisons with the application of a False Discovery Rate (FDR)-corrected threshold for q < 0.05.

RESULTS

Patients with MTLE showed atrophy involving the ipsilateral hippocampus and the contralateral hippocampus, more pronouncedly within the ipsilateral hippocampus in the anterior-inferior aspect of the hippocampal head (left MTLE, left hippocampus x = -28, y = -16, z = -24, Z = 3.6; right MTLE, right hippocampus x = 22, y = -11, z = -27, Z = 2.9). On the contralateral hippocampus, the atrophy was more noticeable in the posterior head and body areas.

CONCLUSION

The epileptogenic hippocampal atrophy has an anatomically distinct pattern compared with the contralateral hippocampus. This information may help guide the presurgical assessment of MTLE.

Neural correlates of inter-trial priming and role-reversal in visual search

Studies of priming of visual perception demonstrate that observers respond more quickly to targets in a field of distractors when relevant features are repeated versus novel or role-reversed. In a recent brain imaging study by Kristjánsson et al. (2007), participants were presented with two items of one color and a single item in a different color with the task of reporting the orientation of the uniquely colored item. Consistent with previous behavioral reports, they found that observers were faster to respond when the target and distractor colors were identical to the previous trial than when they were reversed. They found reduced BOLD activity in brain areas linked with attentional control on trials where the target and distractor colors were repeated relative to reversed, which they interpreted as reflecting response suppression (decreased BOLD signal for repeated stimuli). However, since their design only compared repeated versus reversed task demands, it is logically possible that this pattern reflects increased BOLD signal for role-reversed stimuli: activity required to inhibit previously facilitated information and select previously inhibited information. We explored this possibility with a task where we contrasted the signal generated by repeated, reversed, and novel features. Our data suggest that the majority of the change in neural signal elicited by priming of pop-out reflects increased activation when selection criteria are reversed.

Neurological imaging: statistics behind the pictures

Neurological imaging represents a powerful paradigm for investigation of brain structure, physiology and function across different scales. The diverse phenotypes and significant normal and pathological brain variability demand reliable and efficient statistical methodologies to model, analyze and interpret raw neurological images and derived geometric information from these images. The validity, reproducibility and power of any statistical brain map require appropriate inference on large cohorts, significant community validation, and multidisciplinary collaborations between physicians, engineers and statisticians.