All sectors of the human cerebral cortex receive dense cholinergic input. The origin of this projection is located in the Ch4 cell group of the nucleus basalis of Meynert. However, very little is known about the location of the pathways which link the cholinergic neurons of the nucleus basalis to the human cerebral cortex. This question was addressed in whole-hemisphere sections processed for the visualization of multiple cholinergic markers. Two highly organized and discrete bundles of cholinergic fibres extended from the nucleus basalis to the cerebral cortex and amygdala and were designated as the medial and lateral cholinergic pathways. These bundles contained acetylcholinesterase, choline acetyltransferase and nerve growth factor receptors, confirming their cholinergic nature and origin within the basal forebrain. The medial pathway joined the white matter of the gyrus rectus, curved around the rostrum of the corpus callosum to enter the cingulum and merged with fibres of the lateral pathway within the occipital lobe. It supplied the parolfactory, cingulate, pericingulate and retrosplenial cortices. The lateral pathway was subdivided into a capsular division travelling in the white matter of the external capsule and uncinate fasciculus and a perisylvian division travelling within the claustrum. Branches of the perisylvian division supplied the frontoparietal operculum, insula and superior temporal gyrus. Branches of the capsular division innervated the remaining parts of the frontal, parietal and temporal neocortex. Representation of these cholinergic pathways within a 3D MRI volume helped to identify white matter lesion sites that could interfere with the corticopetal flow of cholinergic pathways.
An accurate knowledge of cerebral anatomy is important in order to evaluate the precise location of a cerebral lesion. Cortical structures are identified by knowledge of the adjacent gyri and sulci; however, white matter tracts are difficult to differentiate from one another due to the lack of clear anatomic landmarks. Therefore, even if MRI shows obvious white matter abnormalities, in some cases it is difficult accurately to localize the lesion. The purpose of this study is to evaluate the location of the main white matter tracts by using three-dimensional MR imaging. MRI study was performed by 1.5 Tesla (Signa: General Electric). Computer assisted analysis with Voxtool software (General Electric) was used to generate both surface brain and tomographic images. The exact anatomic basis of white matter signal abnormalities is important when analyzing patients with disconnective syndromes or neuropsychological deficits such as conduction aphasia, visuospatial deficit etc. This preliminary attempt at constructing a three-dimensional MRI white matter atlas of the brain may be helpful for evaluating the anatomico-clinical correlations in these patients, and also as teaching materials for the clinical (neurologic, neurosurgical), anatomic and radiographic disciplines.
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