1. © Copyright 2004 Cardinal Health, Inc. or one of its subsidiaries. All rights reserved. Brain Anatomy and Function

2. © Copyright 2004 Cardinal Health, Inc. or one of its subsidiaries. All rights reserved. Anatomy of the Brain Separated into right and left halves by the Interhemispheric Fissure The Central Sulcus runs down & forward The Lateral Fissure runs backward & up

3. © Copyright 2004 Cardinal Health, Inc. or one of its subsidiaries. All rights reserved. Thought Voluntary movement Speech motor Covers 1/3 rd of area of the brain Frontal and Temporal Lobes Memory Auditory function FrontalTemporal

4. © Copyright 2004 Cardinal Health, Inc. or one of its subsidiaries. All rights reserved. Sensation Touch Pressure Pain Temperature Texture Position/spatial orientation Parietal and Occipital Lobes Vision Visual processes Reading ParietalOccipital

5. © Copyright 2004 Cardinal Health, Inc. or one of its subsidiaries. All rights reserved. Large Muscle Coordination Balance  Walking, Writing Medulla Oblongata, Cerebellum, and Pons Relay between the cerebral hemispheres and the cerebellum Respiration Heart rate Continuous with the spinal cord (2.5 cm) CerebellumMedulla Oblongata Pons

6. © Copyright 2004 Cardinal Health, Inc. or one of its subsidiaries. All rights reserved. Basal Ganglia and Thalamus “The Brakes” Modifies movement on a minute-to- minute basis Inhibits Movement Coordination Cortical relay

7. © Copyright 2004 Cardinal Health, Inc. or one of its subsidiaries. All rights reserved. Attention Sensory gateway Memory processing Rage Aggression Sexuality Appetite/Thirst Limbic System

8. © Copyright 2004 Cardinal Health, Inc. or one of its subsidiaries. All rights reserved. The Nerve Cell Synaptic junction

9. © Copyright 2004 Cardinal Health, Inc. or one of its subsidiaries. All rights reserved. Neurotransmitters Serotonin – major – emotions, judgment, eating and sleep disorders (associated with frontotemporal disorder) Glutamate/GABA - Widespread, anxiety, sleep, (Valium targets this) Dopamine – memory, mood, movement, Parkinson's Disease, psychiatric problems Endorphins – relief of pain, (Morphine targets this) Lichtman, J., et al Washington University 2002

10. © Copyright 2004 Cardinal Health, Inc. or one of its subsidiaries. All rights reserved. Serotonin Normal functions  Emotions  Judgment  Sleep Imbalances  Depression  Suicidal behavior  Anxiety  Impulsive behavior  Eating disorders Glutamate/GABA Normal functions Involved in most facets of brain function Imbalances  Memory disturbances  Sleep disturbances  Anxiety

11. © Copyright 2004 Cardinal Health, Inc. or one of its subsidiaries. All rights reserved. Dopamine Normal functions  Mood  Movement  Memory Imbalances  Movement disorders  Schizophrenia  Addiction Endorphins Normal functions Relieve pain Induce euphoria

12. © Copyright 2004 Cardinal Health, Inc. or one of its subsidiaries. All rights reserved. Normal Aging Brain Brain weight and volume decrease Grooves widen Surface smoothes Neurofibrillary tangles increase Understanding normal variation is key to interpretation

13. © Copyright 2004 Cardinal Health, Inc. or one of its subsidiaries. All rights reserved. Brain Glucose Metabolism – Normal Normal brain tissue actively metabolizes glucose and its analogue (F-18 FDG) Glucose metabolism provides 95% of the energy required for brain function FDG is irreversibly trapped within brain cells in proportion to its use because it cannot be broken down or stored unlike glucose

14. © Copyright 2004 Cardinal Health, Inc. or one of its subsidiaries. All rights reserved. FDG-PET Normal Brain Metabolism

15. © Copyright 2004 Cardinal Health, Inc. or one of its subsidiaries. All rights reserved. FDG-PET Abnormal Brain Imaging Dementia  Memory loss  Cognitive Decline Epilepsy  Localization of a seizure focus Tumor Assessment  Radiation Necrosis vs Tumor  Grade Objective Imaging Diagnosis of Movement Disorders  Huntington’s Disease  Parkinson’s Disease

16. © Copyright 2004 Cardinal Health, Inc. or one of its subsidiaries. All rights reserved. Dementia Diagnosis: Current Methods History and physical examination  Neurologist (Sens. = 50-80%)  Neuropsychologist / Neuropsychiatrist Neuropsychological testing MRI / CT Blood testing Functional Neuroimaging (SPECT/ PET/MR) Sens.=80-90%

17. © Copyright 2004 Cardinal Health, Inc. or one of its subsidiaries. All rights reserved. Summary Normal Brain Anatomy Normal Brain Function Current PET Brain Applications:  Diagnosis of Dementia  Seizure Localization  Tumor Assessment  Objective Imaging Diagnosis of Movement Disorders (not CMS approved)

18. © Copyright 2004 Cardinal Health, Inc. or one of its subsidiaries. All rights reserved. Contributors Rebecca Trunnell Hyman Coordinator of PET Services Clinical PET of West County - Creve Coeur, MO Kevin L. Berger, M.D. Assistant Professor of Radiology Director of PET Imaging Michigan State University – East Lansing, MI