Volume 362, Issue 9397, Pages 1699-1707 (November 2003) Cortical abnormalities in children and adolescents with attention-deficit hyperactivity disorder  Dr Elizabeth R Sowell, PhD, Paul M Thompson, PhD, Suzanne E Welcome, BS, Amy L Henkenius, BS, Prof Arthur W Toga, PhD, Bradley S Peterson, MD  The Lancet  Volume 362, Issue 9397, Pages 1699-1707 (November 2003) DOI: 10.1016/S0140-6736(03)14842-8 Copyright © 2003 Elsevier Ltd Terms and Conditions

Figure 1 Sample fully processed images Sample original T1-weighted image (A), skull stripped tissue segmented image (B), and surface rendering (C), with Sylvian fissure, superior and inferior temporal sulci, central, precentral, and postcentral sulci, superior and inferior frontal sulci, and olfactory sulci all drawn in blue. The midline landmark curves bordering the interhemispheric fissure, which are necessary as limiters for the cortical surface matching algorithms, are also shown in blue. The surface rendering from one representative subject mapped with the five regions of interest is also shown (D). Dorsal frontal lobe is shown in yellow, ventral frontal lobe in pink, temporal lobe in green, occipital lobe in red, and parietal lobe in blue. The Lancet 2003 362, 1699-1707DOI: (10.1016/S0140-6736(03)14842-8) Copyright © 2003 Elsevier Ltd Terms and Conditions

Figure 2 Distance from centre difference maps (A) and statistical maps (B) Group-difference maps (A) show differences in brain surface extent or local brain shape (in mm), and group-difference statistical maps (B) show the significance of these differences, between patients and controls, according to the colour bar on the right (Pearson's correlation coefficients ranging from -0·5 to 0·5). (A) Note brain size reductions up to 3 mm in anterior temporal, and ventrolateral frontal regions bilaterally. (B) Regions overlaid in yellow correspond to correlation coefficients that show significant reductions in distance from centre in patients at a threshold of p=0·05, and those in red correspond to a decrease at a threshold of p=0·01. Positive correlations—ie, increased difference from centre in patients versus controls—were significant only in left parietal cortices, shown in white. The Lancet 2003 362, 1699-1707DOI: (10.1016/S0140-6736(03)14842-8) Copyright © 2003 Elsevier Ltd Terms and Conditions

Figure 3 Grey matter difference maps (A) and statistical maps (B) Group-difference maps (A) show differences in grey-matter density (% difference), and group-difference statistical maps (B) show the significance of these differences, between patients and controls, according to the colour bar on the right (Pearson's correlation coefficients ranging from -0·5 to 0·5). (A) Warmer colours (above O on the colour bar) are regions in which grey-matter density is greater in patients than controls, and cooler colours (below O) are regions in which controls have greater grey-matter density than patients. Note the roughly 20–30% increase in grey-matter density in temporal and inferior parietal regions bilaterally. (B) Regions overlaid in yellow correspond to correlation coefficients that show a significant increase in grey-matter density in patients at a threshold of p=0·05, and those in red correspond to a significant increase at a threshold of p=0·01. Negative correlations—ie, reduced grey-matter density in patients versus controls—are shown in white. The Lancet 2003 362, 1699-1707DOI: (10.1016/S0140-6736(03)14842-8) Copyright © 2003 Elsevier Ltd Terms and Conditions

Figure 4 Distance from centre and hyperactivity map ADHD=attention-deficit hyperactivity disorder. Correlation maps between distance from centre and hyperactivity scores within the patients' group (front view), showing the significance of these correlations according to the colour bar on the right (Pearson's correlation coefficients ranging from-0·5 to 0·5). Regions overlaid in yellow correspond to correlation coefficients that show significant positive correlation between distance from centre and hyperactivity at a threshold of p=0·05, and those in red correspond to significant positive correlations at a threshold of p=0·01. The scatterplot shows the correlation between hyperactivity scores and distance from centre at one representative significant surface point within the frontal region of interest. The Lancet 2003 362, 1699-1707DOI: (10.1016/S0140-6736(03)14842-8) Copyright © 2003 Elsevier Ltd Terms and Conditions