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Ecstasy (3,4-methylenedioxymethamphetamine [MDMA]) is a psychostimulant that is popular among adolescents and young adults. Whether MDMA causes lasting cognitive impairment or brain injury has been difficult to determine because of a lack of baseline (i.e., pre-drug use) assessment. In this study, 188 nonusers (mean age, 21.7 years) with high probability of future ecstasy use underwent several baseline neuroimaging studies: SPECT to measure serotonin transporter densities, MR spectroscopy to identify neuronal damage, diffusion tensor imaging to measure axonal integrity, and perfusion-weighted imaging to measure blood flow. Between 12 and 36 months later, studies were repeated in 59 subjects who had begun using ecstasy (in low doses) and in …