The aim of this study was to examine the hypothesis, if the activation of some cerebral structures due to physiological stimulation is accompanied by deactivations of other structures elsewhere in the brain. A vibratory stimulus was applied to the right hand palm of healthy volunteers and the regional cerebral blood flow (rCBF) and regional cerebral oxygen metabolism (rCMRO2) were measured with positron emission tomography (PET). Regional analysis and voxel-by-voxel plots indicated that the stimulation induced increases and decreases of the rCBF were coupled to increases and decreases of the rCMRO2. The increases were localized in the left primary somatosensory area (SI), the left secondary somatosensory area (SII), the left retroinsular field (RI), the left anterior parietal cortex, the left primary motor area (MI), and the left supplementary motor area (SMA). The decreases occurred bilaterally in the superior parietal cortex, in paralimbic association areas, and the left globus pallidus. The increases and decreases of the rCBF and rCMRO2 were balanced in such a way that the mean global CBF and CMRO2 did not change compared with rest. We conclude that the decreases of the cerebral oxidative metabolism indicated regional depressions of synaptic activity.

Two patients with midline tumours and disturbances of bimanual co-ordination as the presenting symptoms were examined. Both reported difficulties whenever the two hands had to act together simultaneously, whereas they had no problems with unimanual dexterity or the use of both hands sequentially. In the first patient the lesion was confined to the cingulate gyrus; in the second it also invaded the corpus callosum and the supplementary motor area. Kinematic analysis of bimanual in-phase and anti-phase movements revealed an impairment of both the temporal adjustment between the hands and the independence of movements between the two hands. A functional imaging study in six volunteers, who performed the same bimanual in-phase and anti-phase tasks, showed strong activations of midline areas including the cingulate and ventral supplementary motor area. The prominent activation of the ventral medial wall motor areas in the volunteers in conjunction with the bimanual co-ordination disorder in the two patients with lesions compromising their function is evidence for their pivotal role in bimanual co-ordination.

Summary:The computerized brain atlas programme (CBA) provides a powerful tool for the anatomical anal ysis of functional images obtained with positron emission tomography (PET). With a repertoire of simple transfor mations, the data base of the CBA is first adapted to the anatomy of the subject's brain represented as a set of magnetic resonance (MR) or computed tomography (CT) images. After this, it is possible to spatially standardize (reformat) any set of tomographic images related to the subject, PET images, as well as CT and MR images, by applying the inverse atlas transformations. From these reformatted images, statistical images, such as average images and associated error images corresponding to dif ferent groups of subjects, may be produced. In all these images, anatomical structures can be localized using the atlas data base and the functional values can be evaluated quantitatively. The purpose of this study was to deter mine the spatial and quantitative accuracy and precision of the calculated regional mean values. Therefore, the CBA was applied to regional CBF (rCBF) measurements with [ 11 C]fluoromethane and PET on 26 healthy male vol unteers during rest and during three different physiolog ical stimulation tasks. First, the spatial accuracy and pre cision of the reformation process were determined by measuring the spread of defined anatomical structures in the reformatted MR images of the subjects. Second, the mean global CBF and the mean rCBF in the average PET images were compared with the global CBF and rCBF in the original PET images. Our results demonstrate that the reformation process accurately transformed the individReceived July 24, 1989; revised November 24, 1989; accepted November 28, 1989. Address correspondence and reprint requests to Dr. R. J. Seitz at Department of Clinical Neurophysiology, Karolinska Hospital, Box 60500, S-10401 Stockholm, Sweden.Abbreviations used: CBA, computerized brain atlas pro gramme; CT, computed tomography; MR, magnetic resonance; PET, positron emission tomography; rCBF, regional CBF; rCMR, regional CMR; ROl, region of interest. For image types, see Table I. . O wing to this high sampling resolution, it was possible to differentiate the mean rCBF changes in adjacent activated fields such as the left motor hand area from the sensory hand area and the left premotor cortex. (c) By calculating the rela tion of the mean rCBF change to the SEM of the mean rCBF change on a pixel-by-pixel basis, areas with signif icant rCBF changes could be determined. By use of the CBA, it was found that there was a high intersubject con sistency in location of stimulation-induced rCBF changes. Furthermore, the rCBF changes in specifically stimulated areas were of similar magnitude among the subjects. It was shown that the stimulation-induced mean rCBF increases may be accompanied by mean rCBF de creases in other areas. Key Words: Computerized brain atlas-Magnetic resonance imaging-Physiological stim ulation-Positron emission tomography.Positron emission tomography (PET) is a no...

We studied the time course and magnitude of cerebral blood flow velocity (CBFV) changes in the middle cerebral artery (MCA) and the regional cerebral blood flow (rCBF) in the MCA territory during stimulation of the left sensorimotor cortex. Healthy right-handed male subjects were examined during performance of right-hand finger movement sequences, vibratory stimulation, and somatosensory discrimination. In somatosensory discrimination there were significant increases of the mean CBFV (4.8 +/- 9.9 cm/s; P < 0.01) and the mean rCBF (10.2 +/- 4.2 ml.100 g-1.min-1; P < 0.01), whereas no significant changes of the mean CBFV and rCBF occurred in finger movement sequences or vibratory stimulation. During all stimulation sessions the mean CBFV changes increased rapidly and reached a first maximum 3.3 +/- 0.3 s after stimulation onset. Simultaneous measurements of relative mean CBFV changes in both MCAs revealed left-right differences during voluntary finger movement sequences (left MCA, 14.3 +/- 10.6%; right MCA, 0.9 +/- 11.6%; P < 0.001) corresponding to a higher mean rCBF change in the left MCA territory. In the two tasks involving finger movements there was an increase of the respiratory rates (4.3 +/- 3.8 breaths/min; P < 0.05) and the pulse rates (11.6 +/- 5.5 beats/min; P < 0.05), respectively. Our data demonstrate a correspondence of mean CBFV and rCBF changes evoked by sensorimotor activation in the human brain. Furthermore, cerebral hemodynamic changes related to motor activity are accompanied by cardiorespiratory effects.

We compared regional cerebral blood flow (rCBF) and arteriojugular vein differences of glucose, ketones, glycerol, lactate, pyruvate, and O2 in eight subjects with well-controlled insulin-dependent diabetes mellitus (IDDM) and in six healthy volunteers. Duration of diabetes was 19.4 +/- 2.1 yr. Measurements were performed before and after 120 min of insulin infusion and concomitant Biostator-controlled normoglycemia. Net uptake of ketones was seen in IDDM subjects before but not after insulin. Net uptake of glucose did not differ significantly between groups. During normoglycemia the molar ratio of O2 to glucose uptake was lower in IDDM than in nondiabetic subjects (4.68 vs. 5.50; P less than 0.05; Wilcoxon test). Small but significant release of lactate and pyruvate was seen in IDDM but not in nondiabetic subjects. The rCBF was measured by 11CH3F and position emission tomography. Global mean CBF was higher in IDDM subjects (64.9 +/- 5.9 vs. 49.3 +/- 2.7 ml.100 g-1.min-1, means +/- SE in nondiabetic subjects, P less than 0.05). rCBF was enhanced in many cortical and subcortical areas, whereas it was decreased in the head of the caudate nucleus. Neuropsychological testing did not reveal obvious cognitive dysfunction. The results imply that a larger fraction of glucose is nonoxidatively metabolized in the IDDM subjects and furthermore indicate an abnormal rCBF pattern in these subjects.