Fluid-Attenuated Inversion Recovery Hypointensity of the Pulvinar Nucleus of Patients with Alzheimer Disease: Its Possible Association with Iron Accumulation as Evidenced by the T2* Map

OBJECTIVE: We hypothesized that prominent pulvinar hypointensity in brain MRI represents the disease process due to iron accumulation in Alzheimer disease (AD). We aimed to determine whether or not the pulvinar signal intensity (SI) on the fluid-attenuated inversion recovery (FLAIR) sequences at 3.0T MRI differs between AD patients and normal subjects, and also whether the pulvinar SI is correlated with the T2* map, an imaging marker for tissue iron, and a cognitive scale. MATERIALS AND METHODS: Twenty one consecutive patients with AD and 21 age-matched control subjects were prospectively included in this study. The pulvinar SI was assessed on the FLAIR image. We measured the relative SI ratio of the pulvinar to the corpus callosum. The T2* values were calculated from the T2* relaxometry map. The differences between the two groups were analyzed, by using a Student t test. The correlation between the measurements was assessed by the Pearson's correlation test. RESULTS: As compared to the normal white matter, the FLAIR signal intensity of the pulvinar nucleus was significantly more hypointense in the AD patients than in the control subjects (p < 0.01). The pulvinar T2* was shorter in the AD patients than in the control subjects (51.5 +/- 4.95 ms vs. 56.5 +/- 5.49 ms, respectively, p = 0.003). The pulvinar SI ratio was strongly correlated with the pulvinar T2* (r = 0.745, p < 0.001). When controlling for age, only the pulvinar-to-CC SI ratio was positively correlated with that of the Mini-Mental State Examination (MMSE) score (r = 0.303, p < 0.050). Conversely, the pulvinar T2* was not correlated with the MMSE score (r = 0.277, p = 0.080). CONCLUSION: The FLAIR hypointensity of the pulvinar nucleus represents an abnormal iron accumulation in AD and may be used as an adjunctive finding for evaluating AD.

Immunocytochemical Study on the Monoaminergic Innervation of Diencephalic Visual Structures in the Squirrel Monkey

This study was for investigating relations between distributions of monoamines-norepinephrine, serotonin, and dopamine-on the visual system and their functions. Distributions of these monoamines in the lateral geniculate body, pulvinar, lateral posterior nucleus, and suprachiasmatic nucleus were investigated. Brain of a squirrel monkey was removed and frozen sectioned. Immunocytochemical study was performed for the tissue of the brain. Results showed that the anterior part of the lateral geniculate body contained more monoamines than the posterior part. More serotonins were distrbuted at the magnocellular part, and more dopamines were found at the parvocellular part. In pulvinar, more norepinephrines were distributed at the medial part, while serotonins were evenly distributed at all parts. In lateral posterior nucleus and suprachiasmatic nucleus, three kinds of monoamines were distributed with high density. Among the three, density of the serotonin showed the highest value. The lateral geniculate body relates with visual perception such as visual acuity, form and color perception, and stereopsis, while the pulvinar relates with visual functions, such as visual attention, sensory integration, and differentiation. Since norepinephrine and serotonine are distributed with high density in the pulvinar than in the lateral geniculate body those two monoamines are expected to playa major role for visual functions. Inferior part of the pulvinar relates with visual imagination, and the lateral posterior nucleus relates with integration of visual sensory. Relatively high distribution of dopamine in these two parts means that dopamine may playa major role for visual imagination and integration. As suprachiasmatic nucleus relates with controlling biorhythm, dense distribution of monoamines in suprachiasmatic nucleus implies that the monoamines may work for controlling biorhythm.