Chapter 19 : Functional Magnetic Resonance Imaging in HIV-Associated Dementia

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Functional Magnetic Resonance Imaging in HIV-Associated Dementia, Page 1 of 2

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Neuroimaging studies can aid in the diagnosis of HIV-related brain diseases, as well as improve our understanding of the pathophysiology of HIV dementia. The ultimate goal of "functional" neuroimaging studies is to improve the understanding of common cognitive deficits in HIV patients, such as decreased sustained attention, mental flexibility, general motor speed, and short-term and working memory. To date, only three studies have used perfusion magnetic resonance imagery (pMRI) to evaluate cerebral perfusion in patients with HIV dementia. This chapter reviews some of the technical aspects of pMRI and blood oxygenation level-dependent (BOLD) functional MRI (fMRI), as well as the results of published studies of patients with HIV. Few fMRI or pMRI studies in patients with HIV brain injury have been published. The major findings from pMRI include frontal hypoperfusion, as well as subcortical gray-matter and parietal white-matter hyperperfusion. These regional perfusion abnormalities may reflect neuronal dysfunction or inflammatory changes. Finally, due to the highly reproducible intrasubject patterns of brain activation, fMRI holds great promise, not only for evaluating the extent of brain injury, but also for longitudinal clinical trials to monitor treatment effects in HIV-associated brain injury.

Citation: Ernst T, Tomasi D, Chang L. 2009. Functional Magnetic Resonance Imaging in HIV-Associated Dementia, p 273-280. In Goodkin K, Shapshak P, Verma A (ed), The Spectrum of Neuro-AIDS Disorders. ASM Press, Washington, DC. doi: 10.1128/9781555815691.ch19

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Image of FIGURE 1

Chain of events that link neuronal activation with BOLD signal changes on fMRI. Neuronal stimulation increases neuronal firing, which in turn leads to increased metabolism (glycolysis and oxygen consumption). These cellular events cause hemodynamic changes (increased transport of oxygenated blood to the activated regions), which alter the magnetic properties of the brain regions involved. The altered magnetic properties of the activated brain can be detected with susceptibility-weighted MR pulse sequences and analyzed to generate brain activation maps.

Citation: Ernst T, Tomasi D, Chang L. 2009. Functional Magnetic Resonance Imaging in HIV-Associated Dementia, p 273-280. In Goodkin K, Shapshak P, Verma A (ed), The Spectrum of Neuro-AIDS Disorders. ASM Press, Washington, DC. doi: 10.1128/9781555815691.ch19
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Image of FIGURE 2

Activated brain volume on fMRI in HIV patients and control subjects who performed several cognitive tasks. The control subjects showed increasing activated brain volume with task difficulty for simpler tasks (e.g., from zero-back [0B] and one-back [1B]) but saturation of activated volume with more complex tasks (two-back [2B] and one- and two-increment [1+ and 2+]). The HIV patients showed marked increases in activated brain volume for the simpler tasks (0B and 1B) but a saturation volume on the more difficult tasks similar to that of the control subjects. As a result, the “dynamic range” () in activated brain volume (the ratio of largest to smallest activated volume) was markedly reduced in HIV patients ( = 5) compared to control subjects ( = 20). This reduced dynamic range in HIV may be interpreted as reduced “brain reserve” as a result of injury to the neural substrate due the HIV infection.

Citation: Ernst T, Tomasi D, Chang L. 2009. Functional Magnetic Resonance Imaging in HIV-Associated Dementia, p 273-280. In Goodkin K, Shapshak P, Verma A (ed), The Spectrum of Neuro-AIDS Disorders. ASM Press, Washington, DC. doi: 10.1128/9781555815691.ch19
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1. Axel, L. 1980. Cerebral blood flow determination by rapid-sequence computed tomography. Radiology 137:679686.
2. Bandettini, P. A.,, E. C. Wong,, R. S. Hinks,, R. S. Tikofky, and, J. S. Hyde. 1992. Time course EPI of human brain function during task activation. Magn. Reson. Med. 25:390397.
3. Barker, P. B.,, R. R. Lee, and, J. C. McArthur. 1995. AIDS dementia complex: evaluation with proton MR spectroscopic imaging. Radiology 195:5864.
4. Becker, J. T.,, S. Juengst,, H. J. Aizenstein,, J. Cochran, and, O. L. Lopez. 2005. fMRI evidence of synergistic effects of AIDS and age on brain function. 64:A245.
5. Berger, J. R.,, M. Kumar,, A. Kumar,, J. Fernandez, and, B. Levin. 1994. Cerebrospinal fluid dopamine in HIV-1 infection. AIDS 8:6771.
6. Buxton, R.,, L. Frank,, E. Wong,, B. Siewert,, S. Warach, and, R. Edelman. 1998. A general kinetic model for quantitative perfusion imaging with arterial spin labeling. Magn. Reson. Med. 40:383396.
7. Caparelli, E. C.,, D. Tomasi,, S. Arnold,, L. Chang, and, T. Ernst. 2003. k-Space based summary motion detection for functional magnetic resonance imaging. Neuroimage 20:14111418.
8. Chang, L.,, T. Ernst,, M. Leonido-Yee, and, O. Speck. 2000. Perfusion MRI detects rCBF abnormalities in early stages of HIV-cognitive motor complex. Neurology 54:389396.
9. Chang, L.,, O. Speck,, E. Miller,, A. Braun,, J. Jovicich,, C. Koch,, L. Itti, and, T. Ernst. 2001. Neural correlates of attention and working memory deficits in HIV patients. Neurology 57:10011007.
10. Chang, L.,, D. Tomasi,, R. Yakupov,, C. Lozar,, S. Arnold,, E. Caparelli, and, T. Ernst. 2004. Adaptation of the attention network in human immunodeficiency virus brain injury. Ann. Neurol. 56:259272.
11. Courtney, S. M.,, L. G. Ungerleider,, K. Keil, and, J. V. Haxby. 1997. Transient and sustained activity in a distributed neural system for human working memory. Nature 386:608611.
12. Cox, R. W. 1996. AFNI: software for analysis and visualization of functional magnetic resonance neuroimages. Comp. Biomed. Res. 29:162173.
13. Detre, J. A.,, J. S. Leigh,, D. S. Williams, and, A. P. Koretsky. 1992. Perfusion imaging. Magn. Reson. Med. 23:3745.
14. Ernst, T.,, L. Chang, and, S. Arnold. 2003. Increased glial markers predict increased working memory network activation in HIV patients. Neuroimage 19:16861693.
15. Ernst, T.,, L. Chang,, J. Jovicich,, N. Ames, and, S. Arnold. 2002. Abnormal brain activation on functional MRI in cognitively asymptomatic HIV patients. Neurology 59:13431349.
16. Frackowiak, R. S. J.,, K. J. Friston,, C. D. Frith,, R. J. Dolan, and, J. C. Mazziotta. 1997. Human Brain Function. Academic Press, San Diego, CA.
17. Frahm, J.,, K. D. Merboldt, and, W. Hanicke. 1993. Functional MRI of human brain activation at high spatial resolution. Magn. Reson. Med. 29:139144.
18. Friston, K. J.,, J. Ashburner,, J. B. Poline,, C. D. Frith, and, R. S. J. Frackowiak. 1995a. Spatial realignment and normalization of images. Hum. Brain Mapp. 2:165189.
19. Friston, K. J.,, A. P. Holmes,, K. J. Worsley,, J. B. Poline,, C. D. Frith, and, R. S. J. Franckowiak. 1995b. Statistical parametric maps in functional imaging: a general approach. Hum. Brain Mapp. 2:189210.
20. Gati, J. S.,, R. S. Menon,, K. Ugurbil, and, B. K. Rutt. 1997. Experimental determination of the BOLD field strength dependence in vessels and tissue. Magn. Reson. Med. 38:296302.
21. Glover, G. H.,, and S. Lai. 1998. Self-navigated spiral fMRI: interleaved versus single-shot. Magn. Reson. Med. 39:361368.
22. Goldman-Rakic, P. 1996. Regional and cellular fractionation of working memory. Proc. Natl. Acad. Sci. USA 93:1347313480.
23. Grassi, B.,, G. Graghentini,, A. Campana,, E. Grassi,, S. Bertelli,, P. Cinque,, M. Epifani,, A. Lazzarin, and, S. Scarone. 1999. Spatial working memory in asymptomatic HIV-infected subjects. J. Neuropsychiatry Clin. Neurosci. 11:387391.
24. Hall, D. A.,, M. P. Haggard,, M. A. Akeroyd,, A. Q. Summerfield,, A. R. Palmer,, M. R. Elliott, and, R. Bowtell. 2000. Modulation and task effects in auditory processing measured using fMRI. Hum. Brain Mapp. 10:107119.
25. Harrington, G. S.,, C. T. Wright, and, J. Downs III. 2000. A new vibrotactile stimulator for functional MRI. Hum. Brain Mapp. 10:140145.
26. Harris, G. J.,, G. D. Pearlson,, J. C. McArthur,, S. Zeger, and, N. D. LaFrance. 1994. Altered cortical blood flow in HIV-seropositive individuals with and without dementia: a single photon emission computed tomography study. AIDS 8:495499.
27. Hinkin, C. H.,, W. G. van Gorp,, P. Satz,, T. Marcotte,, R. S. Durvasula,, S. Wood,, L. Campbell, and, M. R. Baluda. 1996. Actual versus self-reported cognitive dysfunction in HIV-1 infection: memory-metamemory dissociations. J. Clin. Exp. Neuropsychol. 18:431443.
28. Holman, B. L.,, B. Garada,, K. A. Johnson,, J. Mendelson,, E. Hallgring,, S. K. Teoh,, J. Worth, and, B. Navia. 1992. A comparison of brain perfusion SPECT in cocaine abuse and AIDS dementia complex. J. Nucl. Med. 33:13121315.
29. Honey, G.,, E. Bullmore,, W. Soni,, M. Varatheesan,, S. Williams, and, T. Sharma. 1999. Differences in frontal cortical activation by a working memory task after substitution of risperidone for typical antispsychotic drugs in patients with schizophrenia. Proc. Natl. Acad. Sci. USA 96:1343213437.
30. Iidaka, T.,, T. Okada,, T. Murata,, M. Omori,, H. Kosaka,, N. Sadato, and, Y. Yonekura. 2002. Age-related differences in the medial temporal lobe responses to emotional faces as revealed by fMRI. Hippocampus 12:352362.
31. Jovicich, J.,, R. J. Peters,, C. Koch,, J. Braun,, L. Chang, and, T. Ernst. 2001. Brain areas specific for attentional load in a motion tracking task. J. Cogn. Neurosci. 13:10481058.
32. Katanoda, K.,, K. Yoshikawa, and, M. Sugishita. 2001. A functional MRI study on the neural substrates for writing. Hum. Brain Mapp. 13:3442.
33. Kawashima, R.,, B. T. O’Sullivan, and, P. E. Roland. 1995. Positron-emission tomography studies of cross-modality inhibition in selective attentional tasks: closing the “mind’s eye”. Proc. Natl. Acad. Sci. USA 92:59695972.
34. Kennan, R. P.,, J. Zhong, and, J. C. Gore. 1994. Intravascular susceptibility contrast mechanisms in tissues. Magn. Reson. Med. 31:921.
35. Kim, S. G.,, J. Ashe,, K. Hendrich,, J. M. Ellermann,, H. Merkle,, K. Ugurbil, and, A. P. Georgopoulos. 1993. Functional magnetic resonance imaging of motor cortex: hemispheric asymmetry and handedness. Science 261:615617.
36. Kure, K.,, K. M. Weidenheim,, W. D. Lyman, and, D. W. Dickson. 1990. Morphology and distribution of HIV-1 gp41-positive microglia in subacute AIDS encephalitis. Acta Neuropathol. (Berlin) 80:393400.
37. Kwong, K. K.,, J. W. Belliveau,, D. A. Chesler,, I. E. Goldberg,, R. M. Weisskoff,, B. P. Poncelet,, D. N. Kennedy,, B. E. Hoppel,, M. S. Cohen,, R. Turner,, H. M. Cheng,, T. J. Brady, and, B. R. Rosen. 1992. Dynamic magnetic resonance imaging of human brain activity during primary sensory stimulation. Proc. Natl. Acad. Sci. USA 89:56755679.
38. Law, W. A.,, A. Martin,, R. L. Mapou,, T. L. Roller,, A. M. Salazar,, L. R. Temoshok, and, J. R. Rundell. 1994. Working memory in individuals with HIV infection. J. Clin. Exp. Neuropsychol. 16:173182.
39. Lopez, O.,, G. Smith,, C. Meltzer, and, J. Becker. 1999. Dopamine systems in human immunodeficiency virus-associated dementia. Neuropsychiatry Neuropsychol. Behav. Neurol. 12:184192.
40. Mangun, G. R.,, S. A. Hillyard, and, S. J. Luck. 1993. Electro-cortical substrates of visual selective attention, p. 219–243. In D. E. Meyer, and, S. Kornblum (ed.), Attention and Performance XIV. MIT Press, Cambridge, MA.
41. Mansfield, P.,, and A. A. Maudsley. 1977. Planar spin imaging by NMR. J. Magn. Reson. 27:101119.
42. Martin, E.,, D. Pitrak,, K. Pursell,, K. Mullane, and, R. Novak. 1995. Delayed recognition memory span in HIV-1 infection. J. Int. Neuropsychol. Soc. 1:575580.
43. Masdeu, J. C.,, A. Yudd,, R. L. Van Heertun,, M. Grundman,, E. Hriso,, R. A. O’Connell,, D. Luck,, U. Camli, and, L. N. King. 1991. Single photon emission computed tomography in human immunodeficiency virus encephalopathy: a preliminary report. J. Nucl. Med. 32:14711475.
44. Mattay, V.,, A. Tessitore,, J. Callicott,, A. Bertolino,, T. Goldberg,, T. Chase,, T. Hyde, and, D. Weinberger. 2002. Dopaminergic modulation of cortical function in patients with Parkinson’s disease. Ann. Neurol. 51:156164.
45. Miller, E. N.,, O. A. Selnes,, J. C. McArthur,, P. Satz,, J. T. Becker,, B. A. Cohen,, K. Sheridan,, A. M. Machado,, W. G. Van Gorp, and, B. Visscher. 1990. Neuropsychological performance in HIV-1 infected homosexual men: the Multicenter AIDS Cohort Study (MACS). Neurology 40:197203.
46. Moran, J.,, and R. Desimone. 1985. Selective attention gates visual processing in the extrastriate cortex. Science 229:782784.
47. Newman, S. D.,, and D. Twieg. 2001. Differences in auditory processing of words and pseudo words: An fMRI study. Hum. Brain Mapp. 14:3947.
48. Ogawa, S.,, T. M. Lee,, A. R. Kay, and, D. W. Tank. 1990. Brain magnetic resonance imaging with contrast dependent on blood oxygenation. Proc. Natl. Acad. Sci. USA 87:98689872.
49. Ogawa, S.,, R. S. Menon,, D. W. Tank,, S. G. Kim,, H. Merkle,, J. M. Ellermann, and, K. Ugurbil. 1993. Functional brain mapping by blood oxygenation level-dependent contrast magnetic resonance imaging. A comparison of signal characteristics with a biophysical model. Biophys. J. 64:803812.
50. Peres, M.,, P. F. Van De Moortele,, C. Pierard,, S. Lehericy,, P. Satabin,, D. Le Bihan, and, C. Y. Guezennec. 2000. Functional magnetic resonance imaging of mental strategy in a simulated aviation performance task. Aviat. Space Environ. Med. 71:12181231.
51. Peterson, B. S.,, M. J. Kane,, G. M. Alexander,, C. Lacadie,, P. Skudlarski,, H. C. Leung,, J. May, and, J. C. Gore. 2002. An event-related functional MRI study comparing interference effects in the Simon and Stroop tasks. Cogn. Brain Res. 13:427440.
52. Pohl, P.,, G. Vogl,, H. Fill,, H. Rossler,, R. Zangerle, and, F. Gerstenbrand. 1988. Single photon emission computed tomography in AIDS dementia complex. J. Nucl. Med. 29:13821386.
53. Power, C.,, P. A. Kong,, T. O. Crawford,, S. Wesselingh,, J. D. Glass,, J. C. McArthur, and, B. D. Trapp. 1993. Cerebral white matter changes in acquired immunodeficiency syndrome dementia: alterations of the blood-brain barrier. Ann. Neurol. 34:339350.
54. Raichle, M. 1987. Circulatory and metabolic correlates of brain function in normal humans, p. 643–674. In V. Mountcastle,, F. Plum, and, S. Geiger (ed.), Handbook of Physiology—the Nervous System. American Physiological Society, Bethesda, Md.
55. Roberts, D.,, J. Detre,, L. Bolinger,, E. Insko, and, J. S. Leigh, Jr. 1994. Quantitative magnetic resonance imaging of human brain perfusion at 1.5 T using steady-state inversion of arterial water. Proc. Natl. Acad. Sci. USA 91:3337.
56. Rosci, M. A.,, F. Pignorini,, A. Bernabei,, F. M. Pau,, V. Volpini,, D. E. Merigliano, and, M. F. Meligrana. 1996. Methods for detecting early signs of AIDS dementia complex in asymptomatic subjects: a quantitative tomography study of 18 cases. AIDS 6:13091316.
57. Rosen, B. R.,, J. W. Belliveau, and, D. Chien. 1989. Perfusion imaging by nuclear magnetic resonance. Magn. Reson. Q. 5:263281.
58. Ross, M. H.,, D. A. Yurgelun-Todd,, P. F. Renshaw,, L. C. Maas,, J. H. Mendelson,, N. K. Mello,, B. M. Cohen, and, J. M. Levin. 1997. Age-related reduction in functional MRI response to photic stimulation. Neurology 48:173176.
59. Rottenberg, D. A.,, J. R. Moeller,, S. C. Strother,, J. J. Sidtris,, B. A. Navia,, V. Dhawan,, J. Z. Ginos, and, R. W. Price. 1987. The metabolic pathology of the AIDS dementia complex. Ann. Neurol. 22:700706.
60. Rottenberg, D. A.,, J. J. Sidtis,, S. C. Strother,, K. A. Schaper,, J. R. Anderson,, M. J. Nelson, and, R. W. Price. 1996. Abnormal cerebral glucose metabolism in HIV-1 seropositive subjects with and without dementia. J. Nucl. Med. 37:11331141.
61. Schwartz, R. B.,, A. L. Komaroff,, B. M. Garada,, M. Gleit,, T. H. Doolittle,, D. W. Bates,, R. G. Vasile, and, B. L. Holman. 1994. SPECT imaging of the brain: comparison of findings in patients with chronic fatigue syndrome, AIDS dementia complex, and major unipolar depression. Am. J. Roentgenol. 162:943951.
62. Selnes, O. A.,, and E. N. Miller. 1994. Development of a screening battery for the HIV-related cognitive impairment: the MACS experience, p. 176–187. In I. Grant, and, A. Martin (ed.), Neuropsychology of HIV Infection. Oxford University Press, New York, NY.
63. Sobel, N.,, V. Prabhakaran,, J. E. Desmond,, G. H. Glover,, E. V. Sullivan, and, J. D. E. Gabrieli. 1997. A method for functional magnetic resonance imaging of olfaction. J. Neurosci. Methods 78:115123.
64. Speck, O.,, T. Ernst,, J. Braun,, C. Koch,, E. Miller, and, L. Chang. 2000. Gender differences in the functional organization of the brain for working memory. Neuroreport 11:15.
65. Talairach, P.,, and J. Tournoux. 1988. A Stereotactic Coplanar Atlas of the Human Brain. Thieme, Stuttgart, Germany.
66. Tomasi, D.,, E. C. Caparelli,, L. Chang, and, T. Ernst. 2005. fMRI-acoustic noise alters brain activation during working memory tasks. Neuroimage 27:377386.
67. Tomasi, D.,, T. Ernst,, E. C. Caparelli, and, L. Chang. 2004. Practice-induced changes of brain function during visual attention: a parametric fMRI study at 4 Tesla. Neuroimage 23:14141421.
68. Tracey, I.,, L. M. Hamberg,, A. R. Guimaraes,, G. Hunter,, I. Chang,, B. A. Navia, and, R. G. Gonzales. 1998. Increased cerebral blood volume in HIV-positive patients detected by functional MRI. Neurology 50:18211826.
69. Turner, R.,, A. Howseman,, G. E. Rees,, O. Josephs, and, K. J. Friston. 1998. Functional magnetic resonance imaging of the human brain: data acquisition and analysis. Exp. Brain Res. 123:512.
70. Turner, R.,, P. Jezzard,, H. Wen,, K. K. Kwong,, D. LeBihan,, T. Zeffiro, and, R. S. Balaban. 1993. Functional mapping of the human visual cortex at 4 and 1.5 Tesla using deoxygenation contrast EPI. Magn. Reson. Med. 29:277279.
71. Wang, G.,, L. Chang,, N. Volkow,, F. Telang,, J. Logan,, T. Ernst, and, J. Fowler. 2004. Decreased brain dopaminergic transporters in HIV-associated dementia patients. Brain 127:24522458.
72. Weisskoff, R. M.,, C. S. Zuo,, J. L. Boxerman, and, B. R. Rosen. 1994. Microscopic susceptibility variation and transverse relaxation: theory and experiment. Magn. Reson. Med. 31:601610.
73. Wenserski, F.,, H. von Giesen,, H. Wittsack,, A. Aulich, and, G. Arendt. 2003. Human immunodeficiency virus 1-associated minor motor disorders: perfusion-weighted MR imaging and H MR spectroscopy. Radiology 228:185192.
74. Williams, D. S.,, J. A. Detre,, J. S. Leigh, and, A. P. Koretsky. 1992. Magnetic resonance imaging of perfusion using spin inversion of arterial water. Proc. Natl. Acad. Sci. USA 89:212216.

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