Summary: Quantitative interpretation of functional im ages (PET or SPECT) is hampered by poor spatial reso lution, low counting statistics, and, for many tracers, low contrast between different brain structures of interest. Furthermore, normal tracer distributions can be severely disrupted by such gross pathologies as stroke, tumor, and dementia. Hence, the complementary anatomical infor mation provided by CT or MRI is essential for accurate and reproducible regional analysis of functional data. We have developed methods for the simultaneous three dimensional display and analysis of image volumes from MRI and PET. A general algorithm for defining the affine transformation between two equivalent point ensembles has been adapted for the purpose of registering MRI and PET image volumes by means of a simple fiducial arThe problem of quantitative regional analysis of positron emission tomography (PET) data from the human brain has been discussed at length (Bajcsy et aI. , 1983; Bohm et aI. , 1983 Bohm et aI. , , 1985 Dann et aI. , 1988; Evans et aI. , 1988 Evans et aI. , , 1989 Valentino et aI. , 1988; Marrett et aI. , 1989; Pelizarri et aI. , 1989). PET im ages offer imprecise anatomical information be cause of poor spatial resolution, poor statistics, or because the tracer distribution does not adequately reflect underlying anatomical variation. These problems are often exacerbated when imaging pathological brain, where extensive disruption of normal functional patterns can occur. Hence, accu rate and reproducible analysis of different types of A69rangement. In addition, we have extended previous MRI based computerized atlas methodology to three dimen sions. The native atlas planes were spaced at 2 mm inter vals, sufficient axial sampling to permit the generation of oblique planar sections through the atlas space. This will allow for an infinite number of angulations and axial off sets in two-dimensional region-of-interest (ROI) tem plates, all derived from the same master three-dimen sional volume-of-interest (Val) atlas and therefore main taining topographical consistency throughout. These ROI templates may be selected to match the image orientation for conventional two-dimensional segmentation and data extraction. Key Words: Positron emission tomography Anatomical-functional correlation-Magnetic resonance imaging-Volume-of-interest atlas-Regions of interest.PET image requires additional information from the structural imaging modalities of magnetic resonance imaging (MRI) or computed tomography (CT).In previous work (Evans et aI. , 1988), we devel oped procedures for the registration of MRI and PET image planes using fiducial markers for patient setup. We also implemented a method for transfer ring the MRI anatomical information to the PET analysis via a computerized brain atlas that is mod ified interactively, plane by plane, to fit each sub ject's brain. That methodology required careful planning to obtain matched planes from MRI, PET, and the brain atlas. In this report, we describe our implementation ...

Amnesia is a common sequela following traumatic brain injury (TBI), for which there is no current treatment. Pleiotropic effects of statins have demonstrated faster recovery of spatial memory after TBI in animals. We conducted a double-blind randomized clinical trial add-on of patients with TBI (16-50 years of age), with Glasgow Coma Scale (GCS) scores of 9-13, and intracranial lesions as demonstrated by computed tomography (CT) scan. We excluded those patients with recent head injury or severe disability; administration of known drugs as modifiers of statin metabolism; multisystemic trauma; prior use of mannitol, barbiturate, corticosteroids, indomethacin or calcium antagonists; surgical or isolated lesion in brainstem; allergy to statins; previous hepatopathy or myopathy; previous management in another clinic; or pregnancy. Each patient received the same treatment and was randomly allocated to receive either rosuvastatin (RVS) or placebo over a period of 10 days. The primary outcome measures assessed were amnesia and disorientation times using Galveston Orientation Amnesia Test. Additionally, we evaluated plasma levels of interleukin (IL) 1beta, tumor necrosis factor (TNF) alpha, and IL-6, as well as disability at 3 months. We analyzed eight patients with RVS and 13 controls with similar basal characteristics. Using Cox regression analysis, administration of RVS showed a reduction of amnesia time with a hazard ratio of 53.76 (95% confidence interval [CI], 1.58-1824.64). This was adjusted for early intubation, basal leukocytes, basal Marshall and Fisher score, change of IL-1beta levels, and lesion side. IL-6 values at day 3 were increased in the RVS group (p = 0.04). No difference was detected in disability at 3 months. While statins may reduce amnesia time after TBI, possibly by immunomodulation, further trials are needed in order to confirm this positive association.

The authors postulate that MIFNES is a good alternative for the management of intraventricular and subarachnoid basal cisterns NCC because it allows removal of most of the parasites, rapid recovery of the patients, and removal and placement of shunt under direct vision when necessary. Traditional treatment is a second option where the MIFNES procedure is not available.

The authors' data suggest that statins may induce an antiinflammatory effect and may promote recovery after TBI. The role of statins in TBI therapy should be confirmed in larger clinical trials.