Uicheul Yoon

Clinical Significance of Microbleeds in Subcortical Vascular Dementia

Background and Purpose— Despite many studies investigating the association between the ischemic changes and cognitive impairment in subcortical vascular dementia (SVaD), few studies correlated cognitive impairment with microbleeds (MBs) frequently seen in SVaD. Methods— Participants consisted of 86 patients with SVaD who fulfilled the criteria proposed by Erkinjuntti et al. Results— MBs occurred in 73 of 86 (84.9%) patients with SVaD. MBs were most commonly distributed in the cortex, and the cortical MBs were most pronounced in the temporoparietal area. A multiple regression showed that the number of cerebral MB was an independent predictor of cognitive impairment in multiple domains and the severity of dementia even after controlling confounding factors such as age, education, ischemic severity, and number of lacunes. Conclusion— These results indicate that cerebral MB is one of the important factors that cause cognitive impairments in SVaD.

Fractal dimension in human cortical surface: multiple regression analysis with cortical thickness, sulcal depth, and folding area.

Fractal dimension (FD) has been widely used to provide a quantitative description of structural complexity in the cerebral cortex. FD is an extremely compact measure of shape complexity, condensing all details into a single numeric value. We interpreted the variation of the FD in the cortical surface of normal controls through multiple regression analysis with cortical thickness, sulcal depth, and folding area related to cortical complexity. We used a cortical surface showing a reliable representation of folded gyri and manually parcellated it into frontal, parietal, temporal, and occipital regions for regional analysis. In both hemispheres the mean cortical thickness and folding area showed significant combination effects on cortical complexity and accounted for about 50% of its variance. The folding area was significant in accounting for the FD of the cortical surface, with positive coefficients in both hemispheres and several lobe regions, while sulcal depth was significant only in the left temporal region. The results may suggest that human cortex develops a complex structure through the thinning of cortical thickness and by increasing the frequency of folds and the convolution of gyral shape rather than by deepening sulcal regions. Through correlation analysis of FD with IQ and the number of years of education, the results showed that a complex shape of the cortical surface has a significant relationship with intelligence and education. Our findings may indicate the structural characteristics that are revealed in the cerebral cortex when the FD in human brain is increased, and provide important information about brain development. Hum Brain Mapp, 2006.

Pathogenesis of cerebral microbleeds: In vivo imaging of amyloid and subcortical ischemic small vessel disease in 226 individuals with cognitive impairment

Cerebral microbleeds (CMBs) are a neuroimaging marker of small vessel disease (SVD) with relevance for understanding disease mechanisms in cerebrovascular disease, cognitive impairment, and normal aging. It is hypothesized that lobar CMBs are due to cerebral amyloid angiopathy (CAA) and deep CMBs are due to subcortical ischemic SVD. We tested this hypothesis using structural magnetic resonance imaging (MRI) markers of subcortical SVD and in vivo imaging of amyloid in patients with cognitive impairment.

Pattern classification using principal components of cortical thickness and its discriminative pattern in schizophrenia.

We proposed pattern classification based on principal components of cortical thickness between schizophrenic patients and healthy controls, which was trained using a leave-one-out cross-validation. The cortical thickness was measured by calculating the Euclidean distance between linked vertices on the inner and outer cortical surfaces. Principal component analysis was applied to each lobe for practical computational issues and stability of principal components. And, discriminative patterns derived at every vertex in the original feature space with respect to support vector machine were analyzed with definitive findings of brain abnormalities in schizophrenia for establishing practical confidence. It was simulated with 50 randomly selected validation set for the generalization and the average accuracy of classification was reported. This study showed that some principal components might be more useful than others for classification, but not necessarily matching the ordering of the variance amounts they explained. In particular, 40-70 principal components rearranged by a simple two-sample t-test which ranked the effectiveness of features were used for the best mean accuracy of simulated classification (frontal: (left(%)|right(%))=91.07|88.80, parietal: 91.40|91.53, temporal: 93.60|91.47, occipital: 88.80|91.60). And, discriminative power appeared more spatially diffused bilaterally in the several regions, especially precentral, postcentral, superior frontal and temporal, cingulate and parahippocampal gyri. Since our results of discriminative patterns derived from classifier were consistent with a previous morphological analysis of schizophrenia, it can be said that the cortical thickness is a reliable feature for pattern classification and the potential benefits of such diagnostic tools are enhanced by our finding.

Cortical Thinning in Vascular Mild Cognitive Impairment and Vascular Dementia of Subcortical Type

Amnestic mild cognitive impairment (MCI) is known to be a preclinical stage of Alzheimers disease (AD). Similarly, MCI associated with small‐vessel disease (svMCI), might be a forme froste of subcortical vascular dementia (SVaD). Patterns of cortical thinning in addition to the ischemia rating on MRI may further elucidate the clinical characteristics and pathogenesis of SVaD and svMCI. We tried to determine if svMCI differs from SVaD in the distribution of cortical atrophy, which may help understand the hierarchy between svMCI and SVaD and possibly also how svMCI evolves into SVaD.

Neuroanatomy of childhood disruptive behavior disorders

Our aims were to (1) examine possible neuroanatomical abnormalities associated with the Disruptive Behavior Disorders (DBDs) as a group and (2) assess neuroanatomical anomalies specific to each DBD (i.e., conduct disorder [CD] and oppositional defiant disorder). Cortical thickness analysis and voxel-based morphometry were analyzed in 47 8-year-old boys (22 DBDs with and without CD and/or ODD and 25 healthy controls) from Magnetic Resonance Imaging brain scans. DBD symptoms were assessed using the Dominic-R. In DBD subjects relative to controls, we found (1) a decreased overall mean cortical thickness; (2) thinning of the cingulate, prefrontal and insular cortices; and (3) decreased gray matter density (GMd) in the same brain regions. We also found that scores on the Dominic-R were negatively correlated with GMd in the prefrontal and precuneus/superior temporal regions. There was a subdiagnostic main effect for CD, related to thinning of the middle/medial frontal, and for ODD in the left rectal/orbitofrontal. Findings suggest that thinning and decreased GMd of the insula disorganizes prefrontal circuits, diminishing the inhibitory influence of the prefrontal cortex on anger, aggression, cruelty, and impulsivity, and increasing a persons likelihood of aggressive behavior. These findings have implications for pathophysiologic models of the DBDs, their diagnostic classification system, and for designing more effective intervention programs.

Fractal dimension of cerebral cortical surface in schizophrenia and obsessive–compulsive disorder

Schizophrenia and obsessive-compulsive disorder (OCD) are assumed to be neurodevelopmental disorders. To examine the cortical patterns in the two disorders, three-dimensional fractal dimension (FD) of skeletonized cerebral cortical surface was estimated from magnetic resonance (MR) images of 50 patients with schizophrenia, 45 patients with OCD and 26 healthy normal controls. The schizophrenic group had a significantly smaller mean FD than OCD group, and the OCD group than normal controls. The FD revealed a significant interaction effect of group-by-hemisphere, and the FD asymmetry index distinguished the schizophrenic group from normal controls. In logistic regression models, the FD and CSF volume correctly classified 95.6% of the schizophrenics from the controls and 88.0% of the patients with OCD from the controls. In the control and schizophrenic groups, the FD was not associated with any of tissue volume measures. In the OCD group, however, the FD was significantly correlated with gray matter tissue volume and intracranial volume (ICV). The results of the present study suggest that three-dimensional FD of cortical surface may be a sensitive indicator for investigation of the structural brain abnormalities in mental disorders, especially those developmentally disturbed. Further studies to explore regional FD changes in mental disorders and clinical implications of the FD including diagnostic value should be performed in the future.

Evaluation of automated and semi-automated skull-stripping algorithms using similarity index and segmentation error.

The skull-stripping in the MR brain image appears to be a key issue in neuroimage analysis. In this paper, we evaluated the accuracy and efficiency of both automated and semi-automated skull-stripping methods. The evaluation was performed on both simulated and real data with the ground truth in skull-stripping. Although automated method showed better efficient results, it should require additional intervention. In contrast to that, semi-automated method showed better accurate results, but it was time consuming and prone to operator bias. Therefore, it might be practical that the semi-automated method was used as the post-processing of the automated one.

Lateralized Genetic and Environmental Influences on Human Brain Morphology of 8-year-old Twins

It has been increasing rapidly interest in understanding genetic effects on brain structure and function in recent years. In this study, we examined the genetic and environmental influences on the variation in cortical thickness and specific tissue volumes in a large cohort of 8-year-old healthy twins. The present study can provide a better estimation of the genetic and environmental effects by virtue of the homogeneously aged pediatric twin pairs with a similar growing environment. We found that common environmental factors contributed significantly to the variations of the right lateral ventricle (36%) and corpus callosum (36%) volumes while genetic factors accounted for most of the phenotypic variance in other brain tissue volumes. In the case of cortical thickness, several regions in the left hemisphere showed statistically significant additive genetic factors, including the middle and inferior frontal gyri, lateral fronto-orbital and occipitotemporal gyri, pars opercularis, planum temporale, precentral and parahippocampal gyri and the medial region of the primary somatosensory cortex. Relatively high common environmental influence (>50%) was observed in the right anterior cingulate cortex and insula. Our findings indicate that the genetic and common environmental influences on individual human brain structural differences are lateralized, with the language-dominant left cerebral cortex under stronger genetic control than the right.

Analysis of the hemispheric asymmetry using fractal dimension of a skeletonized cerebral surface

We investigated hemispheric asymmetry using the fractal dimension (FD) of the skeletonized cerebral surface. Sixty-two T1-weighted magnetic resonance imaging volumes from normal Korean adults were used. The skeletonization of binary volume data, which corresponded to the union of the gray matter and cerebrospinal flow classified by fuzzy clustering, was performed slice by slice in the sagittal direction, and then skeletonized slices were integrated into the three-dimensional (3-D) hemisphere. Finally, the FD of the 3-D skeletonized cerebral surface was calculated using the box-counting method. We measured the FD of the skeletonized cerebral surface and the volumes of intracranial gray matter and white matter for the whole hemispheres and obtained the hemispheric asymmetries of each measurement. The FD, the gray matter, and the white matter volumes for the whole hemispheres decreased in the old group. The asymmetry of the FD revealed a significant right-greater-than-left asymmetry showed rightward, but did not change according to age and gender. None of the intracranial gray matter or white matter volumes showed any significant asymmetric changes. It could be said that the FD of the skeletonized cerebral surface is a novel measure of cerebral asymmetry.