1. ANTERIOR CINGULATE The Anterior Cingulate Cortex (ACC) resembles a collar around the Corpus Collosum. The ACC is an area of profound biological importance and plays a role in many illness conditions. It is active during many brain processes covering a variety of activities. The ACC can be thought of as center for transmitting information to other brain regions for further processing. http://theamazingworldofpsychiatry.wordpress.com/2011/07/18/brodmann-areas-%E2%80%93-part- 3-area-25-the-anterior-cingulate-cortex-%E2%80%93-a-brief-literature-review

2. REFERENCE FOR ANTERIOR CINGULATE TRACING Kathy Jones and Jacquie Marietta Traces are based on: “Anterior Cingulate Cortex: An MRI-Based Parcellation Method” Laurie McCormick, et al 2006. http://www.sciencedirect.com/science/article/pii/S1053811906005350

3. The Cingulate Cortex consists of anterior and posterior cingulate structures. http://en.wikipedia.org/wiki/Cingulate_cortex

4. The following are the Anterior Cingulate structures, excluding the subgenual, that are traced as one structure for the ANN. Blue (Dorsal) Green (Rostral) and Orange (Subcallosal)

5. The Anterior Cingulate structures traced as a single structure for the ANN.

6. Tracing Guidelines Slicer3 Three sections of the Anterior Cingulate are traced as one structure for the ANN, Dorsal, Rostral, and Subcallosal. The Subgenual is traced separately. See slide 14. 1. SLICER3 script: /IPLlinux/ipldev/sharedopt/20110411/RedHatEnterpriseWorkstation_6.0/Slicer 3-3.6.4-beta-2011-04-12-linux-x86_64/Slicer3 *.nii.gz.

7. Tracing Guidelines Plane guidelines 2. Tracing guide using in the Sagittal Plane: Always start with Plane C (Dorsal) using the marginal sulcus as a guide to distinguish the anterior cingulate from the posterior cingulate. The sagittal view is used to indicate where to start tracing in the coronal plane. 3. Tracing labels in the Coronal Plane: Labels are created on every Coronal slice and include all gray matter regions of the anterior cingulate.

8. The Marginal Sulcus in the sagittal view is used to define the endpoint of dorsal cingulate. http://en.wikipedia.org/wiki/Central_sulcus

9. Tracing Guidelines Plane definitions DORSAL (Plane C): Starting point is seen in the sagittal plane as the middle (highest point) of the first gyrus anterior to the ascending marginal sulcus which joins the cingulate sulcus and ends 1 slice in front of the slice where the two sides of the corpus callosum are no longer connected thru the genu. ROSTRAL (Plane A): Starting point is 1 slice in front of the slice where the two sides of the corpus callosum are no longer connected thru the genu. This plane ends when the cingulate ends at most anterior part of brain. SUBCALLOSAL (Plane B): Starting point is the same as the last slice of the Dorsal and ends the slice before the putamen appears in the coronal. Adjacent to this region is the SUBGENUAL.

10. An example of the Anterior Cingulate in Brains2 - Plane A, Plane B, and Plane C http://www.sciencedirect.com/science/article/pii/S1053811906005350

11. Subcallosal Area http://www.innerbody.com/anatomy/nervous/paraterminal-gyrus

12. DORSAL cingulate in coronal view Dorsal cingulate

13. ROSTRAL cingulate in coronal view Rostral cingulate

14. SUBCALLOSAL cingulate in coronal view Subcallosal cingulate Dorsal cingulate

15. The SUBGENUAL CINGULATE Subgenual : The SUBGENUAL area is the lower portion of the SUBCALLOSAL (Area 24) adjacent to the paraterminal gyrus. This area is considered Brodmann’s Area 25. http://photos1.blogger.com/blogger/1782/2187/1600/medial%20frontal%20fig.jpg

16. Subgenual in Subcallosal Area Adjacent to Paraterminal Gyrus http://spinwarp.ucsd.edu/neuroweb/Text/br-800epi.htm

17. Paraterminal Gyrus is indicate in Green http://www.innerbody.com/anatomy/nervous/paraterminal-gyrus

18. Location of the Straight Gyrus http://www.med.harvard.edu/AANLIB/cases/caseNA/pb9.htm

19. SubgenualTracing Guidelines Trace the subgenual cingulate in the Coronal plane using the Sagittal plane to watch for boundaries. a. SUPERIOR boundary is where GM and WM intersect with the Corpus Collosum b. INFERIOR boundary is the tip of the Straight Gyrus (see slide 24) c. ANTERIOR boundary is where the putamen first comes into view one slice behind PLANE B at Rostrum of the Corpus Collosum. d. POSTERIOR boundary is drawn on the Coronal plane adjacent to the Paraterminal Gyrus.

20. Anterior Cingulate including Subgenual

21. Subgenual region

22. Example of Anterior Cingulate including Subgenual region in Brains2

23. Subgenual Tracing Guidelines Useful Guidelines: These guidelines are not always followed depending on the circumstances but are sometimes helpful: a. Watch the SUBCALLOSAL top border. The SUBCALLOSAL goes up into the Corpus Collosum a few slices on the top portion while the lower portion follows the rostral band around. b. Look for the deepest (darkest) sulci for DORSAL. Usually, but not always, go with deepest. c. There is a flowing C shape to the ROSTRAL which you follow around. If the C shape is broken up etc. it is probably not cingulate tissue. d. When the Putamen comes in view, stop the SUBCALLOSAL in the Coronal. e. In Coronal when the CC breaks and is no longer connected, start the ROSTRAL.

24. Determine the inferior boundaries of the Subgenual tissue using the straight gyrus: Axial view: locate the straight gyrus (AXIAL STRAIGHT GYRUS: -16.5 start/-10.5 Stop). Straight gyrus first comes into view decide if 2 or 3rd slice from when we first see it. (see straight gyrus photos) Do guide traces of straight gyrus for help with inferior boundary BUT DON'T SAVE GUIDE TRACES or they will become part of the subgenual label! SAVE ROI then check with guide trace to see if in proper position. Exit without saving guide trace Coronal view: divide white area between caudate and subgenual and split the difference in that region between caudate and subgenual tissue. NOTE: check all views now to trace subgenual as axial will show how far down to come inferior/coronal shows how far out into white area/sagittal shows if you are down far enough superior etc. Subgenual Tracing Guidelines

25. References ADDITIONAL INFORMATION: a. Traces are based on "Anterior Cingulate Cortex: An MRI-Based Parcellation Method" Laurie McCormick, et al 2006. http://www.sciencedirect.com/science/article/pii/S1053811906005350 b. This is a good web site for learning various sulci: http://defiant.ssc.uwo.ca/fmri4newbies/primeroncorticalsulci.html#Precentral%20sulcus c. This is a good web site for learning brain anatomy: http://www.loni.ucla.edu/~esowell/edevel/MedialLinesProtocol.htm