Anterior prostatic tumours are difficult to diagnose without MRI

It is often uncertain whether a repeat biopsy is necessary in patients with at least one previous negative prostate biopsy but persistent suspicion of prostate cancer. Here we present the use of multi-parametric magnetic resonance imaging (mp-MRI) to successfully detect and localize a prostate cancer and we suggest that MRI can be useful in optimising repeat biopsy procedures of the prostate in patients with clinically significant carcinoma.

Scale Invariant Feature Transform as feature tracking method in 4D imaging: a feasibility study

We propose the use of Scale Invariant Feature Transform (SIFT) as a method able to extract stable landmarks from 4D images and to quantify internal motion. We present a preliminary validation of the SIFT method relying on expert user identification of landmarks and then apply it to 4D lung CT and liver MRI data. Results demonstrate SIFT capabilities as an operator-independent feature tracking method.

Ultrafast bold fMRI using single-shot spin-echo echo planar imaging

The choice of imaging parameters for functional MRI can have an impact on the accuracy of functional localization by affecting the image quality and the degree of blood oxygenation-dependent (BOLD) contrast achieved. By improving sampling efficiency, parallel acquisition techniques such as sensitivity encoding (SENSE) have been used to shorten readout trains in single-shot (SS) echo planar imaging (EPI). This has been applied to susceptibility artifact reduction and improving spatial resolution. SENSE together with single-shot spin-echo (SS-SE) imaging may also reduce off-resonance artifacts. The goal of this work was to investigate the BOLD response of a SENSE-adapted SE-EPI on a three Tesla scanner. Whole-brain fMRI studies of seven healthy right hand-dominant volunteers were carried out in a three Tesla scanner. fMRI was performed using an SS-SE EPI sequence with SENSE. The data was processed using statistical parametric mapping. Both, group and individual subject data analyses were performed. Individual average percentage and maximal percentage signal changes attributed to the BOLD effect in M1 were calculated for all the subjects as a function of echo time. Corresponding activation maps and the sizes of the activated clusters were also calculated. Our results show that susceptibility artifacts were reduced with the use of SENSE; and the acquired BOLD images were free of the typical quadrature artifacts of SS-EPI. Such measures are crucial at high field strengths. SS SE-EPI with SENSE offers further benefits in this regard and is more specific for oxygenation changes in the microvasculature bed. Functional brain activity can be investigated with the help of single-shot spin echo EPI using SENSE at high magnetic fields.

Breast MR with special focus on DW-MRI and DCE-MRI

The use of magnetic resonance imaging (MRI) for the assessment of breast lesions was first described in the 1970s; however, its wide application in clinical routine is relatively recent. The basic principles for diagnosis of a breast lesion rely on the evaluation of signal intensity in T2-weighted sequences, on morphologic assessment and on the evaluation of contrast enhancement behaviour. The quantification of dynamic contrast behaviour by dynamic contrast-enhanced (DCE) MRI and evaluation of the diffusivity of water molecules by means of diffusion-weighted MRI (DW-MRI) have shown promise in the work-up of breast lesions. Therefore, breast MRI has gained a role for all indications that could benefit from its high sensitivity, such as detection of multifocal lesions, detection of contralateral carcinoma and in patients with familial disposition. Breast MRI has been shown to have a role in monitoring of neoadjuvant chemotherapy, for the evaluation of therapeutic results during the course of therapy. Breast MRI can improve the determination of the remaining tumour size at the end of therapy in patients with a minor response. DCE-MRI and DW-MRI have shown potential for improving the early assessment of tumour response to therapy and the assessment of residual tumour after the end of therapy. Breast MRI is important in the postoperative work-up of breast cancers. High sensitivity and specificity have been reported for the diagnosis of recurrence; however, pitfalls such as liponecrosis and changes after radiation therapy have to be carefully considered.

Towards treatment planning for the embolization of arteriovenous malformations of the brain: intranidal hemodynamics modeling

This paper presents a patient-derived model for the simulation of the hemodynamics of arteriovenous malformations of the brain (BAVM). This new approach is a step toward the simulation of the outcome of the embolization of the BAVM during treatment planning. More specifically, two aspects of the planning are pursued: simulation of the change of blood flow in the brain vasculature after the blocking of the malformation and simulation of the transport of the embolic liquid. The method we propose is tested on 3 BAVM cases of varying complexity. Twenty two out of 24 main BAVM flow paths have been identified well by simulation.

Intraobserver and interobserver variability in the calculation of apparent diffusion coefficient (ADC) from diffusion-weighted magnetic resonance imaging (DW-MRI) of breast tumours

PURPOSE

This study evaluated intraobserver and interobserver variability in the measurement of apparent diffusion coefficient (ADC) values in breast carcinomas.

MATERIALS AND METHODS

Twenty-eight patients with solid breast lesions >10 mm underwent conventional contrast-enhanced magnetic resonance imaging (MRI) and diffusion-weighted MRI (DW-MRI). Two observers (expert and trainee) segmented the lesion from the surrounding breast tissue on DW images with high b-value (1,000 s/mm(2)). This analysis was repeated by the expert reader after 6 months. Volumes were analysed to obtain mean, median and standard deviation (SD) of the ADC values. Interobserver and intraobserver variation was analysed using the Bland-Altman graph.

RESULTS

All lesions were breast carcinomas, with a mean ADC value of 1.07 × 10(-3) mm(2)/s. The mean of the differences was 0.012 × 10(-3) mm(2)/s, corresponding to an intraobserver variability of 1.1% (limits of agreement: -5%/+8%). The mean interobserver difference was 0.022 × 10(-3) mm(2)/s, corresponding to an interobserver variability of 2% (limits of agreement: -9%/+14%).

CONCLUSIONS

We found a low intraobserver and interobserver variability in calculating ADC in breast carcinomas, which supports its potential use in routine clinical practice.

Strategies for health data exchange for secondary, cross-institutional clinical research

Secondary use of health data has a vital role in improving and advancing medical knowledge. While digital health records offer scope for facilitating the flow of data to secondary uses, it remains essential that steps are taken to respect wishes of the patient regarding secondary usage, and to ensure the privacy of the patient during secondary use scenarios. Consent, together with depersonalisation and its related concepts of anonymisation, pseudonymisation, and data minimisation are key methods used to provide this protection. This paper gives an overview of technical, practical, legal, and ethical aspects of secondary data use and discusses their implementation in the multi-institutional @neurIST research project.

Genome-wide association study of intracranial aneurysm identifies three new risk loci

Saccular intracranial aneurysms (IAs) are balloon-like dilations of the intracranial arterial wall; their hemorrhage commonly results in severe neurologic impairment and death. We report a second genome-wide association study with discovery and replication cohorts from Europe and Japan comprising 5,891 cases and 14,181 controls with ∼832,000 genotyped and imputed SNPs across discovery cohorts. We identified three new loci showing strong evidence for association with IA in the combined data set, including intervals near RBBP8 on 18q11.2 (OR=1.22, P=1.1×10^-12), STARD13/KL on 13q13.1 (OR=1.20, P=2.5×10^-9) and a gene-rich region on 10q24.32 (OR=1.29, P=1.2×10^-9). We also confirmed prior associations near SOX17 (8q11.23-q12.1; OR=1.28, P=1.3×10^-12) and CDKN2A/B (9p21.3; OR=1.31, P=1.5×10^-22). It is noteworthy that several putative risk genes play a role in cell-cycle progression, potentially affecting proliferation and senescence of progenitor cell populations that are responsible for vascular formation and repair.

Tuning of the visual word processing system: distinct developmental ERP and fMRI effects

Visual tuning for words vs. symbol strings yields complementary increases of fast occipito-temporal activity (N1 or N170) in the event-related potential (ERP), and posterior-anterior gradients of increasing word-specific activity with functional magnetic resonance imaging (fMRI) in the visual word form system (VWFS). However, correlation of these coarse ERP and fMRI tuning responses seems limited to the most anterior part of the VWFS in adult and adolescent readers (Brem et al. [ 2006]: Neuroimage 29:822-837). We thus focused on fMRI tuning gradients of young readers with their more pronounced ERP print tuning, and compared developmental aspects of ERP and fMRI response tuning in the VWFS. Children (10.3 y, n = 19), adolescents (16.2 y, n = 13) and adults (25.2 y, n = 18) were tested with the same implicit reading paradigm using counterbalanced ERP and fMRI imaging. The word-specific occipito-temporal N1 specialization, its corresponding source activity, as well as the integrated source activity (0-700 ms) were most prominent in children and showed a marked decrease with age. The posterior-anterior fMRI gradient of word-specific activity instead which was fully established in children did not develop further, but exhibited a dependence on reading skills independent of age. To conclude, prominent developmental dissociation of the ERP and fMRI tuning patterns emerged despite convergent VWFS localization. The ERP response may selectively reflect fast visual aspects of print specialization, which become less important with age, while the fMRI response seems dominated by integrated task- and reading-related activations in the same regions.

Intra- and interobserver agreement and impact of arterial input selection in perfusion CT measurements performed in squamous cell carcinoma of the upper aerodigestive tract

BACKGROUND AND PURPOSE

CT Perfusion (CTP) has shown potential for assessing head and neck tumors. Our purposes were to assess the inter- and intraobserver agreement of CTP measurements and to investigate whether the selection of arterial input, ipsilateral versus contralateral to the tumor or left-versus-right external carotid artery (ECA), may affect CTP measurements in patients with squamous cell carcinoma (SCCA) of the upper aerodigestive tract.

MATERIALS AND METHODS

Twenty-six patients with SCCA were enrolled in this prospective study and underwent CTP. Data were analyzed by 2 expert readers and by an inexperienced reader for interobserver agreement and by the 2 expert readers for intraobserver agreement assessment, by using the ECA ipsilateral to tumor site as arterial input. All 3 readers repeated their analysis by using the ECA contralateral to tumor site as arterial input. Inter- and intraobserver agreement was assessed by using the Bland-Altman approach; CTP measurements by using ipsilateral-versus-contralateral or left-versus-right ECA were compared by using the Wilcoxon signed rank test.

RESULTS

The geometric mean of the ratios (95% limits of agreement) for inter- and intraobserver agreement ranged from 0.96 (0.75-1.23) to 1.00 (0.92-1.10) for blood flow (BF), from 0.88 (0.63-1.21) to 1.00 (0.88-1.14) for blood volume (BV), from 0.96 (0.64-1.44) to 0.98 (0.76-1.27) for mean transit time (MTT), and from 0.85 (0.41-1.76) to 1.14 (0.70-1.86) for permeability surface area product (PS). Significantly higher tumor PS and MTT for 2 readers and lower tumor BF for 1 of 3 readers were observed when the arterial input was placed in the left ECA.

CONCLUSIONS

BF, BV, and MTT demonstrated higher inter- and intraobserver agreement than PS. The selection of arterial input, right-versus-left ECA, may determine changes in CTP measurements in patients with SCCA of the upper aerodigestive tract.

The role of vulvar skin biopsy in the evaluation of chronic vulvar pain

Sixty-one percent of refractory vulvodynia patients evaluated in a tertiary care vulvovaginal clinic had clinically relevant dermatoses based on dermatopathologist-analyzed vulvar biopsy including: lichen sclerosus, allergic/irritant dermatitis, lichen planus, and other inflammatory or neoplastic dermatoses. Given the frequency of dermatologic disease, vulvar biopsy and analysis by a dermatopathologist are recommended in patients with vulvodynia.

T2' imaging predicts infarct growth beyond the acute diffusion-weighted imaging lesion in acute stroke

PURPOSE

To show that measurement of the transverse relaxation time that characterizes signal loss caused by local susceptibilities (T2') is sensitive to an increased deoxyhemoglobin concentration in the brain, indicating tissue at risk for infarction.

MATERIALS AND METHODS

The study was approved by the local institutional review board; patients or their guardians provided informed consent. Magnetic resonance (MR) imaging was performed within 6 hours of symptom onset and again 1-11 days thereafter in 100 consecutive stroke patients, all of whom received intravenous thrombolytic therapy (mean age, 67 years). The MR imaging protocol included diffusion- and perfusion-weighted imaging for determination of apparent diffusion coefficient (ADC) and time to peak (TTP), along with quantitative T2 and T2* imaging. T2' maps were calculated and visually compared with ADC and TTP lesions by two independent observers.

RESULTS

A T2'>ADC mismatch was observed by reader 1 in 73 (73%) of 100 patients, and by reader 2 in 65 (65%) patients. Respective sensitivities of T2'>ADC and of TTP>ADC mismatches for later infarct growth were 0.87 and 0.98 for reader 1 and 0.78 and 0.98 for reader 2, with respective specificities of 0.42 and 0.04 for reader 1 and 0.46 and 0.04 for reader 2. The odds ratios for infarct growth in the presence of a T2'>ADC mismatch were 4.59 (reader 1 P = .002) and 3.10 (reader 2 P = .012), while the odds ratios for TTP>ADC mismatch were 2.22 (reader 1 P = .606) and 1.73 (reader 2 P > .999).

CONCLUSION

The presence of a T2'>ADC mismatch is a more specific predictor of infarct growth than is TTP>ADC mismatch and hence may be of clinical value in patient selection for acute stroke therapies in the future.

@neurIST - chronic disease management through integration of heterogeneous data and computer-interpretable guideline services

This paper presents an overview of computerised decision support for clinical practice. The concept of computer-interpretable guidelines is introduced in the context of the @neurIST project, which aims at supporting the research and treatment of asymptomatic unruptured cerebral aneurysms by bringing together heterogeneous data, computing and complex processing services. The architecture is generic enough to adapt it to the treatment of other diseases beyond cerebral aneurysms. The paper reviews the generic requirements of the @neurIST system and presents the innovative work in distributing executable clinical guidelines.

Mixing and modes of mass transfer in the third cerebral ventricle: a computational analysis

Anatomic, velocimetric, and brain motion MRI scans were combined with a computational fluid dynamics model to investigate cerebrospinal fluid (CSF) mixing in the third cerebral ventricle of a healthy male adult. It was found that advection dominates over diffusion in most of the third ventricle. Three zones where diffusion plays an important role in the mixing process were identified. One of these zones, consisting of recessus infundibulus, recessus opticus and the adjacent regions up to commissura anterior, is likely to exist in the general population. We hypothesize that this zone may act as a buffer to flatten concentration peaks of pituitary gland hormones released into the CSF of the third ventricle. We further hypothesize that this zone may facilitate the communication between hypothalamus and the pituitary gland through the third ventricle cerebrospinal fluid by prolonging residence times of the communicated hormones.

Electrophysiological and hemodynamic evidence for late maturation of hand power grip and force control under visual feedback

Several human imaging studies have described the neural network involved in power grip under visual control and the subset of cortical areas within this network that are sensitive to force modulation. As there is behavioral evidence for late maturation in even simple hand motor tasks involving visual feedback, we aimed at identifying the neural correlates of these developmental changes. Subjects from three developmental age groups (9-11, 15-17, and adults) performed the same power grip task in both a functional magnetic resonance imaging and an event-related potential (ERP) session. Trials started with a visual target indicating whether to squeeze at 20%, 40%, or 75% of their maximum and online visual feedback on the actual amount of force was provided. Longer reaction times and more shallow slopes of the force curve characterized the behavior of the younger age groups, especially the children. Both neurophysiological methods detected both general as well as force modulation-specific maturational changes. General development was characterized by decreasing ERP amplitudes and increasing deactivation of an extended network, closely resembling the so-called "default" network. The most pronounced developmental changes specific for force control were observed in an ERP component and brain regions involved in feedback processing. In contrast to adult subjects, we found evidence for a stronger dependency on visual feedback information in the younger age groups. Our results also suggest that the ability to deactivate task-irrelevant networks might be a late developmental achievement.

A preliminary study of the effects of trigger timing on diffusion tensor imaging of the human spinal cord

BACKGROUND AND PURPOSE

Diffusion tensor and diffusion-weighted spinal cord imaging remain relatively unexplored techniques despite demonstrations that such images can be obtained and may yield clinically relevant findings. In this study, we examined the temporal dynamics of spinal cord motion and their impact on diffusion tensor image quality.

METHODS

Four healthy volunteers underwent phase contrast-based velocity mapping and segmented echo-planar diffusion tensor scans of the cervical spinal cord. Regions of interest in the cord were used to identify the temporal patterns of motion. The delay of data acquisition after the cardiac trigger was varied to correspond to either quiescence or motion of the cord.

RESULTS

The cervical spinal cord consistently displayed maximal velocities in the range of 0.5 cm/s and accelerations of up to 25 cm/s(2). In both these respects, the cervical cord values were greater than those of the medulla. Despite this pronounced motion, approximately 40% of the cardiac cycle can be described as relatively calm, with absolute velocities and accelerations less than 20% of the maximum values. Confining image acquisition to this window reduced ghosting artifacts and increased the consistency with which the dominant direction of diffusion was along the rostral-caudal axis in both gray and white matter of the spine. Preliminary clinical application and fiber tracking in pathologic cases was feasible, and alterations of the diffusion properties by multiple sclerosis lesions, tumor, and syringomyelia were seen.

CONCLUSIONS

Acquiring DTI data during the quiescent phase of spinal cord motion can reduce ghosting artifacts and improve fiber tracking.

Computational investigation of subject-specific cerebrospinal fluid flow in the third ventricle and aqueduct of Sylvius

The cerebrospinal fluid flow in the third ventricle of the brain and the aqueduct of Sylvius was studied using computational fluid dynamics (CFD) based on subject-specific boundary conditions derived from magnetic resonance imaging (MRI) scans. The flow domain geometry was reconstructed from anatomical MRI scans by manual image segmentation. The movement of the domain boundary was derived from MRI brain motion scans. Velocimetric MRI scans were used to reconstruct the velocity field at the inferior end of the aqueduct of Sylvius based on the theory of pulsatile flow in pipes. A constant pressure boundary condition was assigned at the foramina of Monro. Three main flow features were observed: a fluid jet emerging from the aqueduct of Sylvius, a moderately mobile recirculation zone above the jet and a mobile recirculation below the jet. The flow in the entire domain was laminar with a maximum Reynolds number of 340 in the aqueduct. The findings demonstrate that by combining MRI scans and CFD simulations, subject-specific detailed quantitative information of the flow field in the third ventricle and the aqueduct of Sylvius can be obtained.

Maturation of luminance- and motion-defined form perception beyond adolescence: a combined ERP and fMRI study

Abilities to discriminate forms defined by motion continue to develop throughout childhood. To investigate late development of the visual motion system, we measured brain activity with event-related EEG potentials (ERPs) and functional magnetic resonance imaging (fMRI) in groups of adolescents (15-17 years) and adults (20-30 years) during a visual form discrimination task--with forms being either defined by motion or luminance contrast. We further explored whether possible developmental changes varied with the degree of motion coherence reflecting maturation specific to global motion processing. Both the fMRI activation patterns and ERP topographies were very similar between adolescents and adults, suggesting that the basic visual networks for processing motion and form are established by the age of 15-17. The ERP response to luminance- and motion-defined forms was dominated by a posterior negativity (N1: 120-270 ms). The N1 of the motion contrast was delayed in adolescents, whereas the N1 of the static condition did not differ between groups. Since the motion-evoked N1 is thought to arise in the middle temporal area MT/V5, our results indicate that visual motion processing in MT continues to get faster, becoming still more efficient during late development. Neither the ERP nor the fMRI results revealed maturation effects specific to motion coherence. This indicates that the specific mechanisms to process global dot motion are already mature in adolescence. The present findings support the view that static perception matures earlier than dynamic perception, and that these visual systems have different developmental courses.

Relevance of postmortem radiology to the diagnosis of fatal cerebral gas embolism from compressed air diving

AIMS

To test the hypothesis that artefact caused by postmortem off-gassing is at least partly responsible for the presence of gas within the vascular system and tissues of the cadaver following death associated with compressed air diving.

METHODS

Controlled experiment sacrificing sheep after a period of simulated diving in a hyperbaric chamber and carrying out sequential postmortem computed tomography (CT) on the cadavers.

RESULTS

All the subject sheep developed significant quantities of gas in the vascular system within 24 hours, as demonstrated by CT and necropsy, while the control animals did not.

CONCLUSIONS

The presence of gas in the vascular system of human cadavers following diving associated fatalities is to be expected, and is not necessarily connected with gas embolism following pulmonary barotrauma, as has previously been claimed.