|
Results
In table IV and V we present the results observed in each Brodmann area for each group studied. We include also the results of statistical analyses expressed by means of p value.
Cortical structures.
Analyses of these results demonstrate the following:
1) Presence of increased perfusion in both groups of the study in subregions of areas 8, 9 and 10 of Brodmann (executive area), also in area 7 of Brodmann, (posterior parietal lobe). All these areas presented a maximal uptake > 2 standard deviations above the mean of the normal controls. Fig 2, 3, 4, 6 and 7.
2) Presence of relative hypoperfusion in areas 24 and 32 (internal frontal lobe), area: 25, (affective area) and area 21, 22, and 38, (temporal lobe). Fig 6 and 7
3) There were statistically significant differences among the two groups of this study in the following subregions of interest for the maximal uptake: area 24 left, area 25 right, area 11 right, 22 left, 38 left. In all these areas, the group of long lasting evolution of disease presented hypoperfusion significantly more marked than the group of short evolution (p < 0.005). Only in subregion 32 right maximal uptake was significantly increased in the group of long lasting evolution versus the short evolution. Fig 7
Subcortical Structures
Analyses of all results demonstrate the following:
1) The three sub-cortical structures analysed (thalamus, caudate and lentiform nucleus) demonstrated increased perfusion in both groups studied with values larger than 3 standard deviations above the normal control (Fig 5).
2) There were no statistical differences among the different areas in the two groups studied (Table V).
Table IV.
Comparison of values of cortical perfusion between early onset group
and late onset group expressed by means of maximum SD
|
Area
|
Area of Brodmann
|
Early Onset Group
|
Late Onset Group
|
P Value
|
|
Executive Area
Anterior
Frontal
Lobe
|
8L
8R
|
2.56
2.57
|
1.99
2.22
|
0.15
0.4
|
|
9L
9R
|
3.41
2.85
|
2.83
2.7
|
0.1
0.7
|
|
10L
10R
|
2.69
3.13
|
2.83
3.00
|
0.7
0.7
|
|
Internal
Frontal
Lobe
|
24L
24R
|
-1.61
-1.20
|
-2.32
-1.70
|
0.03
0.9
|
|
32L
32R
|
1.36
0.25
|
0.86
1.29
|
0.1
0.04
|
|
Affective
Area
|
25L
25R
|
-0.47
-0.90
|
-1.18
-1.44
|
0.09
0.03
|
|
11L
11R
|
2.15
2.22
|
1.38
1.19
|
0.07
0.005
|
|
Temporal
Lobe
|
21L
21R
|
0.74
1.05
|
0.40
1.76
|
0.3
0.07
|
|
22L
22R
|
1.11
1.43
|
0.27
1.66
|
0.02
0.5
|
|
38L
38R
|
0.94
0.77
|
0.21
0.74
|
0.01
0.9
|
|
Posterior
Parietal Lobe
|
7L
7R
|
3.11
3.01
|
2.72
3.45
|
0.2
0.2
|
Table V.
Comparison of values of sub-cortical perfusion between early onset group and
late onset group expressed by means of maximum SD
|
Region of Interest
(ROI)
|
Means of Max SD.
Early onset group
|
Means of Max SD
Late onset group
|
p Value
|
|
Left Caudate Nucleus
|
4.04
|
3.62
|
0.41
|
|
Right Caudate Nucleus
|
4.10
|
3.75
|
0.33
|
|
Left Lentiform Nucleus
|
4.09
|
4.49
|
0.16
|
|
Right Lentiform Nucleus
|
4.49
|
4.34
|
0.84
|
|
Left Thalamus
|
4.48
|
4.17
|
0.41
|
|
Right Thalamus
|
4.58
|
4.30
|
0.38
|
|
|
|
Figure 2. NeuroSPECT Tc99m HMPAO normal. Proyections of 3D images of distribution of normal cortical HMPAO uptake; anterior, right lateral, right parasaggital, posterior, left lateral, and left parasaggital images (from left to right and upper row followed by lower row). Color scale in standard deviations above and below normal mean. Color silver = > 2 standard deviations. Above normal mean. Color blue = > -2 standard deviations below normal mean.
|
|
|
|
Figure 3. Bipolar Disorder Disorder Early Onset. We observe markedly increased perfusion in bilateral frontal and posterior parietal lobes. There is also hypoperfusion of both orbito-frontal areas, anterior and mesial temporal areas.
|
|
|
|
Figure 4. Bipolar Disorder Early Onset. Increased perfusion in frontal areas 9 and 10 of Brodmann, executive cortex. There is also increased perfusion in area 40 and 22 of Brodmann. Furthermore there is hypoperfusion in areas 11, 12, 38, 24, 25 and 32 of Brodmann (color blue).
|
|
|
|
Figure 5. Bipolar Disorder. Basal Ganglia. We observe increased perfusion in ventral and left lateral aspect of the head of the left caudate nucleus and left lentiform nucleus.
|
|
|
|
Figure 6. Bipolar disorders Early Onset Group. Statistical analysis of comparison of Maximum Uptake in different functional Brodmann areas demonstrate increased perfusion in executive function areas 8,9 and 10 of Brodmann , statistical significant with maximal values above 2.5 St Dev of the normal mean. There is also increased perfusion in posterior parietal region, Brodmann area 7. There are signs of hypoperfusion marked in affective area, 24 and 25 with maximums –0.5 St Dev below the normal mean and hypoperfusion also in internal frontal and temporal regions.
|
|
|
|
Figure 7. Bipolar disorders Late Onset Group. Statistical analysis of comparison of Maximum Uptake in different functional Brodmann in comparison with normal database demonstrates increased perfusion in executive frontal areas 8,9 and 10 of Brodmann and also in area 7 of Brodmann. There are signs of hypoperfusion marked in affective area, 24 and 25 with maximums –0.5 St Dev below the normal mean and hypoperfusion also in internal frontal and temporal regions in area 32. In comparison with early onset group there are statistically significant differences in areas 24L, 32 R, 11 R, 25 R, 22 L and 38 L Please see table 4. The differences are in direction of more impaired perfusion in late onset group.
|
|
|
