Anatomy-guided multi-resolution image reconstruction in PET

Objective. In this paper, we propose positron emission tomography image reconstruction using a multi-resolution triangular mesh. The mesh can be adapted based on patient specific anatomical information that can be in the form of a computed tomography or magnetic resonance imaging image in the hybrid imaging systems. The triangular mesh can be adapted to high resolution in localized anatomical regions of interest (ROI) and made coarser in other regions, leading to an imaging model with high resolution in the ROI with clearly reduced number of degrees of freedom compared to a conventional uniformly dense imaging model.Approach.We compare maximum likelihood expectation maximization reconstructions with the multi-resolution model to reconstructions using a uniformly dense mesh, a sparse mesh and regular rectangular pixel mesh. Two simulated cases are used in the comparison, with the first one using the NEMA image quality phantom and the second the XCAT human phantom.Main results.When compared to the results with the uniform imaging models, the locally refined multi-resolution mesh retains the accuracy of the dense mesh reconstruction in the ROI while being faster to compute than the reconstructions with the uniformly dense mesh. The locally dense multi-resolution model leads also to more accurate reconstruction than the pixel-based mesh or the sparse triangular mesh.Significance.The findings suggest that triangular multi-resolution mesh, which can be made patient and application specific, is a potential alternative for pixel-based reconstruction.

Single-stage approach for estimating optical parameters in spectral quantitative photoacoustic tomography

In quantitative photoacoustic tomography, the optical parameters of a target, most importantly the concentrations of chromophores such as deoxygenated and oxygenated hemoglobin, are estimated from photoacoustic data measured on the boundary of the target. In this work, a numerical approximation of a forward model for spectral quantitative photoacoustic tomography is constructed by utilizing the diffusion approximation for light propagation, the acoustic wave equation for ultrasound propagation, and spectral models of optical absorption and scattering to describe the wavelength dependence of the optical parameters. The related inverse problem is approached in the framework of Bayesian inverse problems. Concentrations of four chromophores (deoxygenated and oxygenated hemoglobin, water, and lipid), two scattering parameters (reference scattering and scattering power), and the Grüneisen parameter are estimated in a single-stage from photoacoustic data. The methodology is evaluated using numerical simulations in different full-view and limited-view imaging settings. The results show that, utilizing spectral data and models, the spectral optical parameters and the Grüneisen parameter can be simultaneously estimated. Furthermore, the approach can also be utilized in limited-view imaging situations.

Persistence of Structural Distortion and Bulk Band Rashba Splitting in SnTe above Its Ferroelectric Critical Temperature

The ferroelectric semiconductor α-SnTe has been regarded as a topological crystalline insulator, and the dispersion of its surface states has been intensively measured with angle-resolved photoemission spectroscopy (ARPES) over the past decade. However, much less attention has been given to the impact of the ferroelectric transition on its electronic structure, and in particular on its bulk states. Here, we investigate the low-energy electronic structure of α-SnTe with ARPES and follow the evolution of the bulk-state Rashba splitting as a function of temperature, across its ferroelectric critical temperature of about Tc ≈ 110 K. Unexpectedly, we observe a persistent band splitting up to room temperature, which is consistent with an order-disorder contribution of local dipoles to the phase transition that requires the presence of fluctuating dipoles above Tc. We conclude that no topological surface state can occur under these conditions at the (111) surface of SnTe, at odds with recent literature.

Carrier-Density Control of the Quantum-Confined 1T-TiSe_{2} Charge Density Wave

Using angle-resolved photoemission spectroscopy, combined with first principle and coupled self-consistent Poisson-Schrödinger calculations, we demonstrate that potassium (K) atoms adsorbed on the low-temperature phase of 1T-TiSe_{2} induce the creation of a two-dimensional electron gas (2DEG) and quantum confinement of its charge-density wave (CDW) at the surface. By further changing the K coverage, we tune the carrier density within the 2DEG that allows us to nullify, at the surface, the electronic energy gain due to exciton condensation in the CDW phase while preserving a long-range structural order. Our Letter constitutes a prime example of a controlled exciton-related many-body quantum state in reduced dimensionality by alkali-metal dosing.

Benchmark problems for transcranial ultrasound simulation: Intercomparison of compressional wave models

Computational models of acoustic wave propagation are frequently used in transcranial ultrasound therapy, for example, to calculate the intracranial pressure field or to calculate phase delays to correct for skull distortions. To allow intercomparison between the different modeling tools and techniques used by the community, an international working group was convened to formulate a set of numerical benchmarks. Here, these benchmarks are presented, along with intercomparison results. Nine different benchmarks of increasing geometric complexity are defined. These include a single-layer planar bone immersed in water, a multi-layer bone, and a whole skull. Two transducer configurations are considered (a focused bowl and a plane piston operating at 500 kHz), giving a total of 18 permutations of the benchmarks. Eleven different modeling tools are used to compute the benchmark results. The models span a wide range of numerical techniques, including the finite-difference time-domain method, angular spectrum method, pseudospectral method, boundary-element method, and spectral-element method. Good agreement is found between the models, particularly for the position, size, and magnitude of the acoustic focus within the skull. When comparing results for each model with every other model in a cross-comparison, the median values for each benchmark for the difference in focal pressure and position are less than 10% and 1 mm, respectively. The benchmark definitions, model results, and intercomparison codes are freely available to facilitate further comparisons.

Benchmark problems for transcranial ultrasound simulation: Intercomparison of compressional wave models

Computational models of acoustic wave propagation are frequently used in transcranial ultrasound therapy, for example, to calculate the intracranial pressure field or to calculate phase delays to correct for skull distortions. To allow intercomparison between the different modeling tools and techniques used by the community, an international working group was convened to formulate a set of numerical benchmarks. Here, these benchmarks are presented, along with intercomparison results. Nine different benchmarks of increasing geometric complexity are defined. These include a single-layer planar bone immersed in water, a multi-layer bone, and a whole skull. Two transducer configurations are considered (a focused bowl and a plane piston operating at 500 kHz), giving a total of 18 permutations of the benchmarks. Eleven different modeling tools are used to compute the benchmark results. The models span a wide range of numerical techniques, including the finite-difference time-domain method, angular spectrum method, pseudospectral method, boundary-element method, and spectral-element method. Good agreement is found between the models, particularly for the position, size, and magnitude of the acoustic focus within the skull. When comparing results for each model with every other model in a cross-comparison, the median values for each benchmark for the difference in focal pressure and position are less than 10% and 1 mm, respectively. The benchmark definitions, model results, and intercomparison codes are freely available to facilitate further comparisons.

Nonlinear estimation of pressure projection of ultrasound fields in background-oriented schlieren imaging

Background-oriented schlieren imaging is a recently proposed method for measuring projections of ultrasound fields. The method is based on observing deflection of light in a heterogeneous refractive index field that is induced by ultrasound via an acousto-optic effect. The deflection of light manifests as apparent perturbations in an imaged target, forming a potential flow estimation problem. In this work, the potential flow approach is formulated as a nonlinear regularized least-squares approach to alleviate limitations of approaches that linearize the problem. The nonlinear approach is shown to outperform the linear one when estimating projections of medically relevant ultrasound fields.

Adaptive stochastic Gauss-Newton method with optical Monte Carlo for quantitative photoacoustic tomography

SIGNIFICANCE

The image reconstruction problem in quantitative photoacoustic tomography (QPAT) is an ill-posed inverse problem. Monte Carlo method for light transport can be utilized in solving this image reconstruction problem.

AIM

The aim was to develop an adaptive image reconstruction method where the number of photon packets in Monte Carlo simulation is varied to achieve a sufficient accuracy with reduced computational burden.

APPROACH

The image reconstruction problem was formulated as a minimization problem. An adaptive stochastic Gauss-Newton (A-SGN) method combined with Monte Carlo method for light transport was developed. In the algorithm, the number of photon packets used on Gauss-Newton (GN) iteration was varied utilizing a so-called norm test.

RESULTS

The approach was evaluated with numerical simulations. With the proposed approach, the number of photon packets needed for solving the inverse problem was significantly smaller than in a conventional approach where the number of photon packets was fixed for each GN iteration.

CONCLUSIONS

The A-SGN method with a norm test can be utilized in QPAT to provide accurate and computationally efficient solutions.

Break of symmetry at the surface of IrTe2upon phase transition measured by x-ray photoelectron diffraction

IrTe₂undergoes a series of charge-ordered phase transitions below room temperature that are characterized by the formation of stripes of Ir dimers of different periodicities. Full hemispherical x-ray photoelectron diffraction (XPD) experiments have been performed to investigate the atomic position changes undergone near the surface of 1T-IrTe₂in the first-order phase transition, from the (1 × 1) phase to the (5 × 1) phase. Comparison between experiment and simulation allows us to identify the consequence of the dimerization on the Ir atoms local environment. We report that XPD permits to unveil the break of symmetry of IrTe₂trigonal to a monoclinic unit cell and confirm the occurrence of the (5 × 1) reconstruction within the first few layers below the surface with a staircase-like stacking of dimers.

Computationally Efficient Forward Operator for Photoacoustic Tomography Based on Coordinate Transformations

Photoacoustic tomography (PAT) is an imaging modality that utilizes the photoacoustic effect. In PAT, a photoacoustic image is computed from measured data by modeling ultrasound propagation in the imaged domain and solving an inverse problem utilizing a discrete forward operator. However, in realistic measurement geometries with several ultrasound transducers and relatively large imaging volume, an explicit formation and use of the forward operator can be computationally prohibitively expensive. In this work, we propose a transformation-based approach for efficient modeling of photoacoustic signals and reconstruction of photoacoustic images. In the approach, the forward operator is constructed for a reference ultrasound transducer and expanded into a general measurement geometry using transformations that map the formulated forward operator in local coordinates to the global coordinates of the measurement geometry. The inverse problem is solved using a Bayesian framework. The approach is evaluated with numerical simulations and experimental data. The results show that the proposed approach produces accurate 3-D photoacoustic images with a significantly reduced computational cost both in memory requirements and time. In the studied cases, depending on the computational factors, such as discretization, over the 30-fold reduction in memory consumption was achieved without a reduction in image quality compared to a conventional approach.

Perturbation Monte Carlo Method for Quantitative Photoacoustic Tomography

Quantitative photoacoustic tomography aims at estimating optical parameters from photoacoustic images that are formed utilizing the photoacoustic effect caused by the absorption of an externally introduced light pulse. This optical parameter estimation is an ill-posed inverse problem, and thus it is sensitive to measurement and modeling errors. In this work, we propose a novel way to solve the inverse problem of quantitative photoacoustic tomography based on the perturbation Monte Carlo method. Monte Carlo method for light propagation is a stochastic approach for simulating photon trajectories in a medium with scattering particles. It is widely accepted as an accurate method to simulate light propagation in tissues. Furthermore, it is numerically robust and easy to implement. Perturbation Monte Carlo maintains this robustness and enables forming gradients for the solution of the inverse problem. We validate the method and apply it in the framework of Bayesian inverse problems. The simulations show that the perturbation Monte Carlo method can be used to estimate spatial distributions of both absorption and scattering parameters simultaneously. These estimates are qualitatively good and quantitatively accurate also in parameter scales that are realistic for biological tissues.

Modeling of Errors Due to Uncertainties in Ultrasound Sensor Locations in Photoacoustic Tomography

Photoacoustic tomography is an imaging modality based on the photoacoustic effect caused by the absorption of an externally introduced light pulse. In the inverse problem of photoacoustic tomography, the initial pressure generated through the photoacoustic effect is estimated from a measured photoacoustic time-series utilizing a forward model for ultrasound propagation. Due to the ill-posedness of the inverse problem, errors in the forward model or measurements can result in significant errors in the solution of the inverse problem. In this work, we study modeling of errors caused by uncertainties in ultrasound sensor locations in photoacoustic tomography using a Bayesian framework. The approach is evaluated with simulated and experimental data. The results indicate that the inverse problem of photoacoustic tomography is sensitive even to small uncertainties in sensor locations. Furthermore, these uncertainties can lead to significant errors in the estimates and reduction of the quality of the photoacoustic images. In this work, we show that the errors due to uncertainties in ultrasound sensor locations can be modeled and compensated using Bayesian approximation error modeling.

Modelling of errors due to speed of sound variations in photoacoustic tomography using a Bayesian framework

Inverse problem of estimating initial pressure in photoacoustic tomography is ill-posed and thus sensitive to errors in modelling and measurements. In practical experiments, accurate knowledge of the speed of sound of the imaged target is commonly not available, and therefore an approximate speed of sound is used in the computational model. This can result in errors in the solution of the inverse problem that can appear as artefacts in the reconstructed images. In this paper, the inverse problem of photoacoustic tomography is approached in a Bayesian framework. Errors due to uncertainties in the speed of sound are modelled using Bayesian approximation error modelling. Estimation of the initial pressure distribution together with information on the reliability of these estimates are considered. The approach was studied using numerical simulations. The results show that uncertainties in the speed of sound can cause significant errors in the solution of the inverse problem. However, modelling of these uncertainties improves the accuracy of the solution.

Acoustic pressure field estimation methods for synthetic schlieren tomography

Synthetic schlieren tomography is a recently proposed three-dimensional (3D) optical imaging technique for studying ultrasound fields. The imaging setup is composed of an imaged target, a water tank, a camera, and a pulsed light source, which is stroboscopically synchronized with an ultrasound transducer to achieve tomographically stationary imaging of an ultrasound field. In this technique, ultrasound waves change the propagation of light rays by inducing a change in refractive index via the acousto-optic effect. The change manifests as optical flow in the imaged target. By performing the imaging in a tomographic fashion, the two-dimensional tomographic dataset of the optical flow can be transformed into a 3D ultrasound field. In this work, two approaches for acoustic pressure field estimation are introduced. The approaches are based on optical and potential flow regularized least square optimizations where regularization based on the Helmholtz equation is introduced. The methods are validated via simulations in a telecentric setup and are compared quantitatively and qualitatively to a previously introduced method. Cases of a focused, an obliquely propagating, and a standing wave ultrasound field are considered. The simulations demonstrate the efficiency of the introduced methods also in situations in which the previously applied method has weaknesses.

Three dimensional photoacoustic tomography in Bayesian framework

The image reconstruction problem (or inverse problem) in photoacoustic tomography is to resolve the initial pressure distribution from detected ultrasound waves generated within an object due to an illumination by a short light pulse. Recently, a Bayesian approach to photoacoustic image reconstruction with uncertainty quantification was proposed and studied with two dimensional numerical simulations. In this paper, the approach is extended to three spatial dimensions and, in addition to numerical simulations, experimental data are considered. The solution of the inverse problem is obtained by computing point estimates, i.e., maximum a posteriori estimate and posterior covariance. These are computed iteratively in a matrix-free form using a biconjugate gradient stabilized method utilizing the adjoint of the acoustic forward operator. The results show that the Bayesian approach can produce accurate estimates of the initial pressure distribution in realistic measurement geometries and that the reliability of these estimates can be assessed.

Quantitative photoacoustic tomography augmented with surface light measurements

Quantitative photoacoustic tomography is an imaging modality in which distributions of optical parameters inside tissue are estimated from photoacoustic images. This optical parameter estimation is an ill-posed problem and it needs to be approached in the framework of inverse problems. In this work, utilising surface light measurements in quantitative photoacoustic tomography is studied. Estimation of absorption and scattering is formulated as a minimisation problem utilising both internal quantitative photoacoustic data and surface light data. The image reconstruction problem is studied with two-dimensional numerical simulations in various imaging situations using the diffusion approximation as the model for light propagation. The results show that quantitative photoacoustic tomography augmented with surface light data can improve both absorption and scattering estimates when compared to the conventional quantitative photoacoustic tomography.

Ultrasound field characterization using synthetic schlieren tomography

Synthetic schlieren imaging, also known as background oriented schlieren imaging, is used to determine the acoustical field of a focused ultrasound transducer operating at 1.01 MHz frequency with peak pressure amplitude of 0.97 MPa. The measurement setup is composed of a commercial off-the-shelf digital single-lens reflex (DSLR) camera with an ordinary objective, a high power light-emitting diode driven in pulsating mode, water tank, ultrasound transducer, rotation stage, and driving electronics. Measurements are performed in tomographic fashion by rotating the ultrasound transducer within the water tank and photographing an imaged target behind the ultrasound field. The photographs are processed with a Horn-Schunck-type algorithm, commonly used in optical flow analysis, in order to determine the deflection of light rays as caused by ultrasound field induced acousto-optic effect. Inverse Radon transform is then used, with the deflection data, to obtain three-dimensional spatial distribution of the pressure field gradient, from which an approximation of the ultrasonic pressure field is computed. The pressure field obtained with synthetic schlieren tomography is then compared to hydrophone measurements mainly qualitatively.

A numerical study on the oblique focus in MR-guided transcranial focused ultrasound

Recent clinical data showing thermal lesions from treatments of essential tremor using MR-guided transcranial focused ultrasound shows that in many cases the focus is oblique to the main axis of the phased array. The potential for this obliquity to extend the focus into lateral regions of the brain has led to speculation as to the cause of the oblique focus, and whether it is possible to realign the focus. Numerical simulations were performed on clinical export data to analyze the causes of the oblique focus and determine methods for its correction. It was found that the focal obliquity could be replicated with the numerical simulations to within [Formula: see text] of the clinical cases. It was then found that a major cause of the focal obliquity was the presence of sidelobes, caused by an unequal deposition of power from the different transducer elements in the array at the focus. In addition, it was found that a 65% reduction in focal obliquity was possible using phase and amplitude corrections. Potential drawbacks include the higher levels of skull heating required when modifying the distribution of power among the transducer elements, and the difficulty at present in obtaining ideal phase corrections from CT information alone. These techniques for the reduction of focal obliquity can be applied to other applications of transcranial focused ultrasound involving lower total energy deposition, such as blood-brain barrier opening, where the issue of skull heating is minimal.

Direct Estimation of Optical Parameters From Photoacoustic Time Series in Quantitative Photoacoustic Tomography

Estimation of optical absorption and scattering of a target is an inverse problem associated with quantitative photoacoustic tomography. Conventionally, the problem is expressed as two folded. First, images of initial pressure distribution created by absorption of a light pulse are formed based on acoustic boundary measurements. Then, the optical properties are determined based on these photoacoustic images. The optical stage of the inverse problem can thus suffer from, for example, artefacts caused by the acoustic stage. These could be caused by imperfections in the acoustic measurement setting, of which an example is a limited view acoustic measurement geometry. In this work, the forward model of quantitative photoacoustic tomography is treated as a coupled acoustic and optical model and the inverse problem is solved by using a Bayesian approach. Spatial distribution of the optical properties of the imaged target are estimated directly from the photoacoustic time series in varying acoustic detection and optical illumination configurations. It is numerically demonstrated, that estimation of optical properties of the imaged target is feasible in limited view acoustic detection setting.

Image reconstruction with uncertainty quantification in photoacoustic tomography

Photoacoustic tomography is a hybrid imaging method that combines optical contrast and ultrasound resolution. The goal of photoacoustic tomography is to resolve an initial pressure distribution from detected ultrasound waves generated within an object due to an illumination of a short light pulse. In this work, a Bayesian approach to photoacoustic tomography is described. The solution of the inverse problem is derived and computation of the point estimates for image reconstruction and uncertainty quantification is described. The approach is investigated with simulations in different detector geometries, including limited view setup, and with different detector properties such as ideal point-like detectors, finite size detectors, and detectors with a finite bandwidth. The results show that the Bayesian approach can be used to provide accurate estimates of the initial pressure distribution, as well as information about the uncertainty of the estimates.

Quantitative photoacoustic tomography using illuminations from a single direction

Quantitative photoacoustic tomography is an emerging imaging technique aimed at estimating optical parameters inside tissues from photoacoustic images, which are formed by combining optical information and ultrasonic propagation. This optical parameter estimation problem is ill-posed and needs to be approached within the framework of inverse problems. It has been shown that, in general, estimating the spatial distribution of more than one optical parameter is a nonunique problem unless more than one illumination pattern is used. Generally, this is overcome by illuminating the target from various directions. However, in some cases, for example when thick samples are investigated, illuminating the target from different directions may not be possible. In this work, the use of spatially modulated illumination patterns at one side of the target is investigated with simulations. The results show that the spatially modulated illumination patterns from a single direction could be used to provide multiple illuminations for quantitative photoacoustic tomography. Furthermore, the results show that the approach can be used to distinguish absorption and scattering inclusions located near the surface of the target. However, when compared to a full multidirection illumination setup, the approach cannot be used to image as deep inside tissues.

Numerical simulations of clinical focused ultrasound functional neurosurgery

A computational model utilizing grid and finite difference methods were developed to simulate focused ultrasound functional neurosurgery interventions. The model couples the propagation of ultrasound in fluids (soft tissues) and solids (skull) with acoustic and visco-elastic wave equations. The computational model was applied to simulate clinical focused ultrasound functional neurosurgery treatments performed in patients suffering from therapy resistant chronic neuropathic pain. Datasets of five patients were used to derive the treatment geometry. Eight sonications performed in the treatments were then simulated with the developed model. Computations were performed by driving the simulated phased array ultrasound transducer with the acoustic parameters used in the treatments. Resulting focal temperatures and size of the thermal foci were compared quantitatively, in addition to qualitative inspection of the simulated pressure and temperature fields. This study found that the computational model and the simulation parameters predicted an average of 24 ± 13% lower focal temperature elevations than observed in the treatments. The size of the simulated thermal focus was found to be 40 ± 13% smaller in the anterior-posterior direction and 22 ± 14% smaller in the inferior-superior direction than in the treatments. The location of the simulated thermal focus was off from the prescribed target by 0.3 ± 0.1 mm, while the peak focal temperature elevation observed in the measurements was off by 1.6 ± 0.6 mm. Although the results of the simulations suggest that there could be some inaccuracies in either the tissue parameters used, or in the simulation methods, the simulations were able to predict the focal spot locations and temperature elevations adequately for initial treatment planning performed to assess, for example, the feasibility of sonication. The accuracy of the simulations could be improved if more precise ultrasound tissue properties (especially of the skull bone) could be obtained.

Bayesian Image Reconstruction in Quantitative Photoacoustic Tomography

Quantitative photoacoustic tomography is an emerging imaging technique aimed at estimating chromophore concentrations inside tissues from photoacoustic images, which are formed by combining optical information and ultrasonic propagation. This is a hybrid imaging problem in which the solution of one inverse problem acts as the data for another ill-posed inverse problem. In the optical reconstruction of quantitative photoacoustic tomography, the data is obtained as a solution of an acoustic inverse initial value problem. Thus, both the data and the noise are affected by the method applied to solve the acoustic inverse problem. In this paper, the noise of optical data is modelled as Gaussian distributed with mean and covariance approximated by solving several acoustic inverse initial value problems using acoustic noise samples as data. Furthermore, Bayesian approximation error modelling is applied to compensate for the modelling errors in the optical data caused by the acoustic solver. The results show that modelling of the noise statistics and the approximation errors can improve the optical reconstructions.

Truncated Fourier-series approximation of the time-domain radiative transfer equation using finite elements

The radiative transfer equation (RTE) is widely accepted to accurately describe light transport in a medium with scattering particles, and it has been successfully applied as a light-transport model, for example, in diffuse optical tomography. Due to the computationally expensive nature of the RTE, most of these applications have been in the frequency domain. In this paper, an efficient solution method for the time-domain RTE is proposed. The method is based on solving the frequency-domain RTE at multiple modulation frequencies and using the Fourier-series representation of the radiance to obtain approximation of the time-domain solution. The approach is tested with simulations. The results show that the method can be used to obtain the solution of the time-domain RTE with good accuracy and with significantly fewer computational resources than are needed in the direct time-domain solution.

Investigation of standing-wave formation in a human skull for a clinical prototype of a large-aperture, transcranial MR-guided focused ultrasound (MRgFUS) phased array: an experimental and simulation study

Standing-wave formation in an ex vivo human skull was investigated using a clinical prototype of a 30-cm diameter with 15-cm radius of curvature, low-frequency (230 kHz), hemispherical transcranial magnetic resonance-guided focused ultrasound phased array. Experimental and simulation studies were conducted with changing aperture size and f -number configurations of the phased array and qualitatively and quantitatively examined the acoustic pressure variation at the focus due to standing waves. The results demonstrated that the nodes and antinodes of standing wave produced by the small-aperture array were clearly seen at approximately every 3 mm. The effect of the standing wave became more pronounced as the focus was moved closer to skull base. However, a sharp focus was seen for the full array, and there was no such standing-wave pattern in the acoustic plane or near the skull base. This study showed that the fluctuation pressure amplitude would be greatly reduced by using a large-scale, hemispherical phased array with a low f-number.

Simulations and measurements of transcranial low-frequency ultrasound therapy: skull-base heating and effective area of treatment

Measurements of temperature elevations induced by sonications in a single intact cadaver skull filled with soft-tissue mimicking phantom material were performed using magnetic resonance thermometry. The sonications were done using a clinical transcranial ultrasound therapy device operating at 230 kHz and the measurements were compared with simulations done using a model incorporating both the longitudinal and shear wave propagation. Both the measurements and simulations showed that in some situations the temperature increase could be higher in the phantom material adjacent to the skull-base than at the focus, which could lead to undesired soft-tissue damage in treatment situations. On average the measurements of the sonicated locations, as well as the comparative simulations, showed 32 ± 64% and 49 ± 32% higher temperature elevations adjacent to the skull-base than at the focus, respectively. The simulation model was used to extend the measurements by simulating multiple sonications of brain tissue in five different skulls with and without correcting the aberrations caused by the skull on the ultrasound. Without aberration correction the closest sonications to the skulls that were treatable in any brain location without undesired tissue damage were at a distance of 19.1 ± 2.6 mm. None of the sonications beyond a distance of 41.2 ± 5.3 mm were found to cause undesired tissue damage. When using the aberration correction closest treatable, safe distances for sonications were found to be 16.0 ± 1.6  and 38.8 ± 3.8 mm, respectively. New active cooling of the skull-base through the nasal cavities was introduced and the treatment area was investigated. The closest treatable distance without aberration correction reduced to 17.4 ± 1.9 mm with the new cooling method. All sonications beyond a distance of 39.7 ± 6.6 mm were found treatable. With the aberration correction no difference in the closest treatable or the safety distance was found in comparison to sonications without nasal cavity cooling. To counteract undesired skull-base heating a new anti-focus within solid media was developed along with a new regularized phasing method. Mathematical bases for both the methods and simulations utilizing them were presented. It was found that utilizing the anti-focus in solid media and regularized phasing, the fraction of temperature increase of the brain tissue at the focus and the peak temperature increase adjacent to the skull-base can be increased from 1.00 to 1.95. This improves the efficiency of the sonication by reducing the energy transfer to the skull-base.

Intron 4 polymorphism of the endothelial nitric oxide synthase gene is associated with elevated blood pressure in type 2 diabetic patients with coronary heart disease

The endothelial nitric oxide synthase (eNOS) gene is responsible for constitutive nitric oxide synthesis and arterial vasodilatation. Recently two polymorphisms, the 27-bp repeat sequence in intron 4 and the Glu298Asp substitution in exon 7 of the eNOS gene have been reported to be related to coronary heart disease (CHD). We screened these polymorphisms of the eNOS gene in 308 unrelated nondiabetic subjects with CHD, in 251 unrelated patients with type 2 diabetes with CHD, and in 110 randomly selected healthy subjects without CHD. The 4a and Asp298 allele frequencies of the eNOS gene were 0.19 and 0.36 in nondiabetic patients with CHD, 0.21 and 0.27 in type 2 diabetic patients with CHD, and 0.16 and 0.31 in nondiabetic subjects without CHD (n.s. between the groups). The Asp298 allele in exon 7 of the eNOS gene was not associated with elevated blood pressure in any of the study groups. Among type 2 diabetic patients with CHD the 4a allele in intron 4 of the eNOS gene was associated with elevated levels of systolic (P=0.035) and mean arterial blood pressure (P=0.040). In nondiabetic subjects these associations were not statistically significant. When all study groups were pooled in statistical analysis the 4a allele of the eNOS gene was associated with elevated diastolic (P=0.032) and mean (P=0.030) arterial blood pressure even after adjustment for confounding factors. We conclude that the 4a allele of the eNOS gene is not associated with CHD or type 2 diabetes, but that it is related to elevated blood pressure levels particularly among type 2 diabetic patients with CHD.

MspI polymorphism at +83 bp in intron 1 of the human apolipoprotein A1 gene is associated with elevated levels of HDL cholesterol and apolipoprotein A1 in nondiabetic subjects but not in type 2 diabetic patients with coronary heart disease

OBJECTIVE

Elevated HDL cholesterol and its principal carrier protein apolipoprotein a1 [apo(a1)] are associated with reduced risk of coronary heart disease (CHD). No studies are available on the impact of the -75-bp and/or +83-bp polymorphisms of the apo(a1) gene on HDL cholesterol and apo(a1) levels in patients with type 2 diabetes.

RESEARCH DESIGN AND METHODS

We determined the prevalence of the: -75-bp and +83-bp polymorphisms of the apo(a1) gene by restriction fragment length polymorphism analysis among 308 unrelated nondiabetic subjects with CHD and among 251 unrelated patients with type 2 diabetes with CHD and in randomly selected 82 healthy men (CHD-).

RESULTS

The rare M1- and M2- allele frequencies of the apo(a1) gene were 23 and 1.8%, respectively, among control subjects; 20 and 1.5%, respectively, among nondiabetic subjects with CHD; and 22 and 2.6%, respectively, among patients with type 2 diabetes and CHD (NS). Nonsmoking nondiabetic subjects with CHD having the M2+- genotype had higher HDL cholesterol (1.48 +/- 0.19 vs. 1.23 +/- 0.02 mmol/l, P < 0.01) and apo(a1) (1.43 +/- 0.10 vs. 1.36 +/- 0.02 g/l, P < 0.05) levels than subjects with the M2++ genotype, even after adjustment for confounding factors. This association was not found among patients with type 2 diabetes and CHD.

CONCLUSIONS

We conclude that the +83-bp polymorphism of the apo(a1) gene is associated with elevated HDL cholesterol and apo(a1) levels in Finnish nondiabetic subjects but not in patients with type 2 diabetes.

The codon 64 polymorphism of the beta3-adrenergic receptor gene is not associated with coronary heart disease or insulin resistance in nondiabetic subjects and non-insulin-dependent diabetic patients

Hyperinsulinemia has been shown to predict coronary heart disease (CHD) events in both nondiabetic subjects and patients with non-insulin-dependent diabetes mellitus (NIDDM). Therefore, defects in genes that regulate insulin action could be responsible for an increased risk of CHD. The Trp64Arg polymorphism of the beta3-adrenergic receptor gene has been linked with abdominal obesity, insulin resistance, and early-onset NIDDM. Therefore, we screened for this polymorphism among 185 unrelated nondiabetic subjects (101 men and 84 women; age, 56+/-1 years [mean +/- SEM]; body mass index [BMI], 27.8+/-0.3 kg/m2) with angiographically confirmed CHD (stenosis > 50% in > or = two coronary arteries), among 119 unrelated patients with NIDDM (90 men and 29 women; age, 62+/-1 years; BMI, 28.7+/-0.4 kg/m2; 95 had CHD by the same criteria and 24 had definite myocardial infarction [MI]), and among 82 healthy men (age, 54+/-1 years; BMI, 26.3+/-0.4 kg/m2) from our previous study. The frequency of the Trp64Arg allele of the beta3-adrenergic receptor gene was similar in nondiabetic patients with CHD (8%), NIDDM patients with CHD (7%), and nondiabetic subjects without CHD (7%). No association was found between cardiovascular risk factors and the codon 64 polymorphism of the beta3-adrenergic receptor gene in patients with CHD. Similarly, this polymorphism was not significantly related to insulin resistance in nondiabetic and NIDDM subjects with CHD evaluated by the euglycemic clamp technique. These results indicate that the Trp64Arg allele of the beta3-adrenergic receptor gene does not contribute to the risk of CHD in nondiabetic subjects and NIDDM patients.

Variants of the fatty acid-binding protein 2 gene are not associated with coronary heart disease in nondiabetic subjects and in patients with NIDDM

OBJECTIVE

To investigate the association of variants of the fatty acid-binding protein (FABP) 2 gene with coronary heart disease (CHD) in nondiabetic subjects and in patients with NIDDM.

RESEARCH DESIGN AND METHODS

Cross-sectional study included 135 nondiabetic and 79 NIDDM subjects with stenosis (> 50%) in at least two coronary arteries. A group of 81 healthy nondiabetic men without CHD served as a control population. All exons and intron-exon junctions of the FABP2 gene were amplified with the polymerase chain reaction, and variants were screened with the single-strand conformation polymorphism analysis.

RESULTS

The allele frequency of an amino acid polymorphism (alanine-->threonine) in codon 54 of exon 2 of the FABP2 gene was 0.26 in nondiabetic subjects with CHD and 0.27 in NIDDM subjects with CHD. Other variants (GTA 118 GTC, GCGCA-->GCACA in the 3'-noncoding region, and the number of ATT repeats in intron 2) also did not associate with CHD.

CONCLUSIONS

The variants of the FABP2 gene are not likely to contribute to the risk of CHD in Finnish nondiabetic and NIDDM subjects.

Second-trimester diurnal variation of maternal serum alpha-fetoprotein, human chorionic gonadotropin, and unconjugated oestriol: is it present and does it affect the prediction of a patient's risk for fetal Down syndrome?

Both a cross-sectional and a longitudinal study were performed to investigate whether or not the collection time should be taken into consideration when generating a patient's risk for fetal Down syndrome with multiple marker screening. Diurnal variations of third-trimester alpha-fetoprotein (AFP) levels and first-trimester human chorionic gonadotropin (hCG) levels have been previously reported. In addition, large episodic fluctuations of conjugated and unconjugated oestriol (uE3) as well as a diurnal variation have also been reported in the third trimester. If the levels of these analytes routinely fluctuate during the day, they could affect a patient's risk calculation for fetal Down syndrome. The longitudinal study evaluated ten non-diabetic women who underwent sequential sampling for AFP, hCG, and uE3. The cross-sectional study evaluated 1953 patients for these three markers whose time of sampling was recorded between 8.00 a.m. and 5.59 p.m. Using either study design, no significant effect was seen in the median MOM levels of the screening analytes as a function of the time of day.

Simultaneous fetal and maternal cotinine levels in pregnant women smokers

OBJECTIVE

Our purpose was to determine the simultaneous concentrations of serum cotinine in both fetal and maternal blood.

STUDY DESIGN

Serum cotinine levels were measured in 11 maternal-fetal pairs at percutaneous umbilical blood sampling. Statistical analysis was performed by means of a one-group t test to determine whether the ratio of fetal-to-maternal cotinine was significantly different from 1.

RESULTS

Fetal cotinine levels ranged from 75% to 110% of maternal values (mean ratio 0.90, 95% confidence interval 0.83 to 0.97). Fetal levels were significantly lower than maternal concentrations (p = 0.02).

CONCLUSIONS

Cotinine, a metabolite of nicotine used to quantify exposure to tobacco smoke, readily gains access to the fetal circulation. Fetal cotinine concentrations in pregnant women smokers are, on average, 90% of maternal values throughout gestation.

Prenatal screening for Down's syndrome with use of maternal serum markers

BACKGROUND

Approximately 35 percent of all cases of Down's syndrome in fetuses can be detected by measuring maternal serum alpha-fetoprotein during the second trimester in the general population of pregnant women. Recent case-control studies indicate that this detection rate could be approximately doubled by measuring serum levels of unconjugated estriol and chorionic gonadotropin, which are abnormally low and abnormally high, respectively, in women carrying fetuses affected by Down's syndrome.

METHODS

We prospectively screened 25,207 women and adolescents in the second trimester of pregnancy and assigned each a risk of fetal Down's syndrome with an algorithm that took into account measurements of all three serum markers in combination with maternal age. On this basis, 1661 subjects (6.6 percent) were initially assigned a second-trimester risk of fetal Down's syndrome of at least 1 in 190, and 962 (3.8 percent) were offered amniocentesis for chromosomal analysis after verification of gestational age. Gestational age was determined on the basis of the first day of the last menstrual period or, when available, by ultrasonography.

RESULTS

Among the 760 women and adolescents who chose amniocentesis, 20 cases of fetal Down's syndrome were detected, along with 7 other chromosomal disorders. There was 1 additional case of fetal Down's syndrome among the 202 women who chose not to have amniocentesis. The rate of detection of Down's syndrome was thus 58 percent (21 of 36 expected cases), and the frequency of identifying a fetus with Down's syndrome in women undergoing amniocentesis was 1 per 38 amniocenteses (95 percent confidence interval, 1 in 25 to 1 in 62).

CONCLUSIONS

Measuring serum alpha-fetoprotein, chorionic gonadotropin, and estriol is more effective in screening for fetal Down's syndrome than measuring maternal serum alpha-fetoprotein alone. Such an expanded protocol can readily be incorporated into existing prenatal screening programs.

Diet in infancy and bronchial hyperreactivity later in childhood

Sixty-seven atopy-prone children (atopic family group, AFG) and 52 children with no family history of atopy (NAFG) were followed for 10 years. During infancy, the mothers of the newborn AFG children were advised to adjust their infants' diet, with a view toward minimizing the risk of atopy, and not to keep pets. Pulmonary function tests, methacholine inhalation challenge (MIC), and skin prick tests (SPT) were done in order to evaluate the bronchial reactivity and skin reactivity in the two groups. A pathological result in MIC was found in 20 (30%) of the AFG children and in 10 (19%) of the NAFG children. Such results of MIC were more common in the children with positive SPT results than in those without (67% vs. 24%). In regard to the diet consumed in infancy, MIC was pathological in 23% of children with and in 36% without prophylactic diet in infancy. For MIC, using the new, Spira electro 2 dosimeter equipment, the sensitivity was 75% and specificity 97%, but the predictive value for diagnosing bronchial asthma was only 25%. The important advantage of our method is that the degree of bronchial reactivity can be estimated by responses to increasing provocative doses. Our observations confirm that the new method is suitable for detecting bronchial asthma in clinical practice but it seems not to be optimal for epidemiological studies. We concluded that later bronchial hyperreactivity can not be diminished by avoiding home pets or providing a hypoallergenic diet during infancy.

Prevalence of thyroid deficiency in pregnant women

OBJECTIVE

The present study was designed to determine the current prevalence of gestational hypothyroidism, since maternal thyroxine deficiency is associated with poor obstetric outcomes and mental retardation in the surviving offspring.

DESIGN

TSH concentrations were measured in the sera of women at 15-18 weeks of gestation. Those sera with TSH concentrations above 6 mU/l and the two sera closest in order with TSH concentrations below 6 mU/l were further analysed for T4, FT4, TBG, and antithyroid antibodies. Study criteria for hypothyroidism were sera with elevated concentrations of TSH plus both a free T4 concentration and a total T4 concentration and/or T4/TBG ratio more than two standard deviations below the mean for the control pregnant women.

PATIENTS

The sera were from 2000 consecutive women in Maine being tested for alpha-fetoprotein concentration at 15-18 weeks of gestation.

RESULTS

TSH concentrations above 6 mU/l were found in the sera of 49 women, 2.5% of the pregnant women. Six women with elevated TSH concentrations (range 6.9-54 mU/l) had both a FT4 concentration and a T4/TBG ratio and/or a T4 concentration more than two standard deviations below the respective control means, meeting the study criteria for thyroid deficiency, and thus giving a prevalence of 0.3%. The remaining 43 women with elevated TSH concentrations were classified as having compensated thyroid disease although some may have been hypothyroid. Fifty-eight per cent of women with TSH concentrations above 6 mU/l and 90% of the women with elevated TSH concentrations and at least one thyroxine index more than two standard deviations below the control means had positive titres of antithyroid antibodies as opposed to 11% of the controls.

CONCLUSIONS

Although it is not known what severity of maternal thyroid deficiency is necessary to cause fetal brain damage, the present data indicate a sufficiently high prevalence of thyroid dysfunction to demand investigation of the mental development of the offspring of women with thyroid dysfunction and of the effect of replacement therapy.

Insulin receptor binding in obesity: a reassessment

A defect in the binding of insulin to circulating monocytes occurs when obese patients are hospitalized and fed a liberal carbohydrate diet. Under ordinary circumstances, most obese patients have normal insulin binding despite very high concentrations of serum insulin. These results show that insulin does not necessarily regulate its own receptor in vivo--as it does in vitro.