The effect of age on odor-stimulated functional MR imaging.

BACKGROUND AND PURPOSE: The effects of age, sex, and handedness on olfaction have not been adequately addressed with odor-stimulated functional MR imaging studies. We sought to determine the effect of age on functional MR imaging experiments performed with odor stimulation. METHODS: Five right-handed subjects with a mean age of 73 years and five right-handed subjects with a mean age of 24 years underwent gradient-echo echo-planar functional MR imaging using binasal olfactory stimulation. Imaging parameters included 3000/30 (TR/TE) and a 5-mm section thickness in a 6-minute sequence with 30 seconds of pulsed odorants alternating with 30 seconds of room air. The data were normalized to a standard atlas, and individual and group statistical parametric maps (SPMs) were generated for each task. The SPMs were thresholded for a P < .01, and the volumes of activation and distribution of cluster maxima were compared for the two groups. RESULTS: Analysis of the group SPMs revealed activated voxels in the frontal lobes, perisylvian regions, and cingulate gyri, with greater volume in the younger group than in the older group. The right inferior frontal, right perisylvian, and right and left cingulum had the largest number of voxels activated. The most common sites of activation on individual maps in both groups were the right inferior frontal regions and the right and left superior frontal and perisylvian zones. CONCLUSION: Given similar olfactory task paradigms, younger subjects showed a greater number of activated voxels than did older subjects. One must be cognizant of this effect when designing studies of odor-stimulated functional MR imaging.

Posttraumatic smell loss: relationship of psychophysical tests and volumes of the olfactory bulbs and tracts and the temporal lobes.

RATIONALE AND OBJECTIVES: The purpose of this study was to define the primary sites of injury in patients with posttraumatic anosmia and hyposmia with magnetic resonance (MR) imaging and to determine if these sites correlated with the results of psychophysical olfactory tests. MATERIALS AND METHODS: Thirty-six patients with subjective loss in olfaction after head trauma underwent volumetric MR studies of the olfactory bulbs and tracts and temporal lobes. Pearson correlations were computed between olfactory bulb and tract and temporal lobe volumes and the patients' scores on tests of odor identification (including the University of Pennsylvania Smell Identification Test [UPSIT]), detection, and memory. Analysis of variance was used to compare volumes of the control subjects and the posttraumatic patients. RESULTS: The olfactory bulbs and tracts (32 [89%] of 36 patients), the subfrontal lobes (22 [61%] of 36 patients), and the temporal lobes (11 [31%] of 36 patients) showed the highest incidence of posttraumatic encephalomalacia. Left olfactory bulb and tract volumes showed a statistically significant correlation with left and total UPSIT scores. A statistically significant difference (P < .001) was found in the right and left olfactory bulb and tract volumes between anosmic and hyposmic patients and between posttraumatic patients and control subjects. CONCLUSION: Olfactory bulb and tract damage may correlate with deficits in odor identification. Olfactory bulb and tract and frontal lobe encephalomalacia coexist in many patients.

Gender effects on odor-stimulated functional magnetic resonance imaging.

On standardized tests of odor identification and odor detection, women tend to score better than men at nearly all age groups. We sought to determine if these findings would translate to differences between the sexes in the volume of activated brain when odors are presented to subjects as the stimulants for functional magnetic resonance imaging (FMRI) experiments. The activation maps of eight right-handed women (mean age 25.3 years old, range 20-44, S.D. 8.3 years) were compared with those of 8 right-handed men (mean age 30.5, range 18-37, S.D. 6.5 years) given the same olfactory nerve stimuli in an FMRI experiment at 1.5 T. Olfactory stimuli were delivered to the patients in a passive fashion using a Burghart OM4-B olfactometer with a nose piece inserted into the patients' nostrils. We used agents (eugenol, phenyl ethyl alcohol, or phenyl ethyl alcohol alternating with hydrogen sulfide) that were selective for olfactory nerve stimulation in the nose. The odorants were delivered to both nostrils for 1 s every 4 s during a 30 s 'on-period'. During the 30 s 'off-period', the patient received room air at the same flow rate. The women's group-averaged activation maps showed up to eight times more activated voxels than men for specific regions of the brain (frontal and perisylvian regions). The left and right inferior frontal regions showed a statistically significant increase in activation in women at p<0.01. In general, more women showed activation than men. The results suggest that (1) FMRI activation maps in subject groups can demonstrate correlates to psychophysical tests of olfaction, and (2) one must control for gender when performing odor-stimulated FMRI experiments.

Olfactory bulb and tract and temporal lobe volumes. Normative data across decades.

The sense of smell shows a diminution with age as measured by the University of Pennsylvania Smell Identification Test (UPSIT). To ascertain whether the volumes of the olfactory bulbs and tracts (OBTs) and the temporal lobes (TL) declined in parallel to smell function, we examined 36 individuals from ages 22 to 78 who did not complain of any loss of the sense of smell using magnetic resonance (MR) imaging. The OBT volumes showed an initial increase to the 4th decade of life and then a decrease with increasing age, while the trend in TL volume was not as dramatic. There was no correlation between OBT or TL volumes with unilateral or total UPSIT scores. The normative data by decades can be used to assess the OBTs of cohorts of patients with neurodegenerative disorders that affect olfaction.

Adenoidal width and HIV factors.

PURPOSE: To determine the factors that correspond to adenoidal hypertrophy, often prominent in human immunodeficiency virus (HIV)-positive patients. METHODS: The sagittal T1-weighted MR images of 21 HIV-positive patients (age range, 25 to 50 years; mean, 37 years) and 21 healthy control subjects (age range, 24 to 55 years; mean, 35 years) were reviewed blindly and independently by two radiologists who measured the maximal dimension of the nasopharyngeal lymphoid tissue. Twenty-six additional HIV-positive patients were combined with the original 21 HIV-positive patients, and the hematologic studies of these 47 patients were compared with the adenoidal measurements to assess whether a relationship existed between nasopharyngeal prominence and hematocrit, white blood cell count, and CD4 count. RESULTS: Mean adenoidal width was 6.76 mm (SD, 5.82) in the HIV-positive population, but was only 3.36 mm (SD, 2.48) in the age-matched control group. Age and HIV status correlated with nasopharyngeal width measurements. No relationship between adenoidal width and hematocrit, CD4 count, or white blood cell count was evident. CONCLUSION: After correcting for age, we found that adenoidal lymphoid tissue is more abundant in HIV-positive persons than in control subjects. The hematologic ramifications of this finding remain uncertain.

Functional MR imaging during odor stimulation: preliminary data.

PURPOSE: To determine the locations and extent of activation in areas of the brain at functional magnetic resonance (MR) imaging with olfactory stimulation and to determine whether accommodation or amplification of brain activation occurs with sequential olfactory stimulation. MATERIALS AND METHODS: Five adult men with normal senses of smell underwent multisection, gradient-echo, echo-planar imaging according to a blood-oxygen-level-dependent experimental paradigm. Odorants that nearly exclusively stimulate the olfactory system and odorants that stimulate the olfactory and trigeminal nerves were compared by using repetitive imaging procedures. RESULTS: Activation with olfactory nerve-mediated odorants was demonstrated in the orbitofrontal cortex (Brodmann area 11) with a right-sided predominance. Mild cerebellar stimulation was also observed. With repeated testing, overall activation with olfactory nerve-mediated odorants declined. Odorants that also stimulated the trigeminal nerve produced additional cingulate, temporal, cerebellar, and occipital activation. Activation with combined trigeminal and olfactory system odors increased more than sixfold with repeated testing. CONCLUSION: Olfactory nerve-mediated and combined olfactory and trigeminal nerve-mediated odorants activate different regions of the brain. Orbitofrontal stimulation spreads to all parts of the brain when a trigeminal component is added. Habituation (deactivation) occurs with repeated testing of olfactory nerve-mediated odorants, while, paradoxically, activation increases with repeated exposure to odors that also stimulate the trigeminal nerve.

Reproducibility and reliability of volumetric measurements of olfactory eloquent structures.

RATIONALE AND OBJECTIVES: The authors assessed the reliability and reproducibility of volumetric measurements of olfactory bulbs and tracts (OBTs) and temporal lobes (TLs) with magnetic resonance (MR) imaging. METHODS: Repetitive MR imaging of two phantoms and OBTs and TLs of patients was performed. Regions of interest were manually drawn around the relevant structures, and their volumes were measured at workstations. Intra- and interobserver variability for the two readers were measured. Intraclass and Pearson correlation coefficients and mean percentage differences were calculated. RESULTS: The measured phantom volumes were within 1.9%-12% of the true volumes with a variability of < or = 5%. Intraclass and Pearson correlation coefficients were > or = 0.919 for measurements by a single reader and > or = 0.924 for measurements by different readers. The inter- and intraobserver variabilities were < or = 4.2% for TL and 11.3%-14.6% for OBTs. CONCLUSION: Volumetric measurements of the olfactory apparatus can be reliably and accurately reproduced from MR images.

Posttraumatic olfactory dysfunction: MR and clinical evaluation.

PURPOSE: To evaluate the sites of injury in patients with posttraumatic olfactory deficits and to compare damage with findings on clinical olfactory tests. METHODS: Twenty-five patients with posttraumatic olfactory dysfunction were examined by means of olfactory testing, endoscopy, and MR imaging. MR surface-coil scans through the olfactory bulbs and tracts and head-coil scans of the temporal lobes were evaluated. Quantitative and qualitative gradings of damage to the olfactory bulbs, tracts, subfrontal region, hippocampus, and temporal lobes were compared with results on tests of odor identification, detection, memory, and discrimination. RESULTS: Twelve patients were anosmic, eight had severe impairment, and five were mildly impaired. Injuries to the olfactory bulbs and tracts (88% of patients), subfrontal region (60%), and temporal lobes (32%) were found, but these did not correlate well with individual olfactory test scores. Volumetric analysis showed that patients without smell function had greater volume loss in olfactory bulbs and tracts than did those posttraumatic patients who retained some sense of smell. Qualitative and quantitative assessments of damage showed few significant correlations with olfactory tests, probably because of multifocal injuries, primary olfactory nerve damage, and the constraints of a small sample size on the detection of clinically significant differences. CONCLUSION: MR imaging shows abnormalities in patients with posttraumatic olfactory dysfunction at a very high rate (88%), predominantly in the olfactory bulbs and tracts and the inferior frontal lobes.

MR evaluation of patients with congenital hyposmia or anosmia.

OBJECTIVE: The purpose of this study was to evaluate patients with reduced or no sense of smell since birth for sites of abnormality by MR imaging. MATERIALS AND METHODS: Twenty-five patients who reported no olfactory function since birth were evaluated by olfactory testing, sinonasal endoscopy, and MR imaging. Surface coil and head coil images of the olfactory bulbs, olfactory tracts, subfrontal cortex, and temporal lobes in contiguous 3-mm sections were obtained. Two reviewers determined unilateral olfactory bulb and tract volumes and temporal lobe volumes in two separate sessions. Qualitative grading for olfactory bulb, olfactory tract, olfactory sulcus, subfrontal region, hippocampus, and temporal lobe damage also was performed. RESULTS: The absence of olfactory bulbs and tracts (68-84%) or the presence of hypoplasia (16-32%) was noted in all cases. Eight individuals had Kallmann's syndrome (hypogonadotropic hypogonadism with anosmia). Temporal and/or frontal lobe volume loss was noted in five individuals and was mild in all but one individual. CONCLUSION: Congenital anosmia or hyposmia appears to be an olfactory bulb-olfactory tract phenomenon rather than a cerebral process.