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Almairac F, Parker D, Mondot L, Isan P, Onno M, Papadopoulo T, Fontaine D, Verma R. Improvement of diffusion tensor imaging-based tractography by free-water correction in nonedematous gliomas: assessment with brain mapping. J Neurosurg 2024:1-11. [PMID: 38626474 DOI: 10.3171/2024.1.jns23568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 01/29/2024] [Indexed: 04/18/2024]
Abstract
OBJECTIVE The free-water correction algorithm (Freewater Estimator Using Interpolated Initialization [FERNET]) can be applied to standard diffusion tensor imaging (DTI) tractography to improve visualization of subcortical bundles in the peritumoral area of highly edematous brain tumors. Interest in its use for presurgical planning in purely infiltrative gliomas without peritumoral edema has never been evaluated. Using subcortical maps obtained with direct electrostimulation (DES) in awake surgery as a reference standard, the authors sought to 1) assess the accuracy of preoperative DTI-based tractography with FERNET in a series of nonedematous glioma patients, and 2) determine its potential usefulness in presurgical planning. METHODS Based on DES-induced functional disturbances and tumor topography, the authors retrospectively reconstructed the putatively stimulated bundles and the peritumoral tracts of interest (various associative and projection pathways) of 12 patients. The tractography data obtained with and without FERNET were compared. RESULTS The authors identified 21 putative tracts from 24 stimulation sites and reconstituted 49 tracts of interest. The number of streamlines of the putative tracts crossing the DES area was 26.8% higher (96.04 vs 75.75, p = 0.016) and their volume 20.4% higher (13.99 cm3 vs 11.62 cm3, p < 0.0001) with FERNET than with standard DTI. Additionally, the volume of the tracts of interest was 22.1% higher (9.69 cm3 vs 7.93 cm3, p < 0.0001). CONCLUSIONS Free-water correction significantly increased the anatomical plausibility of the stimulated fascicles and the volume of tracts of interest in the peritumoral area of purely infiltrative nonedematous gliomas. Because of the functional importance of the peritumoral zone, applying FERNET to DTI could have potential implications on surgical planning and the safety of glioma resection.
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Affiliation(s)
- Fabien Almairac
- 1Department of Neurosurgery, Pasteur 2 Hospital, University Hospital of Nice, France
- 2Clinical Research Unit UR2CA team PIN, French Riviera University, Nice, France
| | - Drew Parker
- 3Department of Radiology, Diffusion and Connectomics in Precision Healthcare Research Lab, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Lydiane Mondot
- 4Department of Neuroradiology, Pasteur 2 Hospital, University Hospital of Nice, France
- 5Clinical Research Unit UR2CA team URRIS, French Riviera University, Nice, France; and
| | - Petru Isan
- 1Department of Neurosurgery, Pasteur 2 Hospital, University Hospital of Nice, France
- 2Clinical Research Unit UR2CA team PIN, French Riviera University, Nice, France
| | - Marie Onno
- 1Department of Neurosurgery, Pasteur 2 Hospital, University Hospital of Nice, France
| | | | - Denys Fontaine
- 1Department of Neurosurgery, Pasteur 2 Hospital, University Hospital of Nice, France
- 2Clinical Research Unit UR2CA team PIN, French Riviera University, Nice, France
| | - Ragini Verma
- 3Department of Radiology, Diffusion and Connectomics in Precision Healthcare Research Lab, University of Pennsylvania, Philadelphia, Pennsylvania
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Golkar E, Parker D, Brem S, Almairac F, Verma R. CrOssing fiber Modeling in the Peritumoral Area using dMRI (COMPARI). bioRxiv 2023:2023.05.07.539770. [PMID: 37215003 PMCID: PMC10197585 DOI: 10.1101/2023.05.07.539770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Visualization of fiber tracts around the tumor is critical for neurosurgical planning and preservation of crucial structural connectivity during tumor resection. Biophysical modeling approaches estimate fiber tract orientations from differential water diffusivity information of diffusion MRI. However, the presence of edema and tumor infiltration presents a challenge to visualize crossing fiber tracts in the peritumoral region. Previous approaches proposed free water modeling to compensate for the effect of water diffusivity in edema, but those methods were limited in estimating complex crossing fiber tracts. We propose a new cascaded multi-compartment model to estimate tissue microstructure in the presence of edema and pathological contaminants in the area surrounding brain tumors. In our model (COMPARI), the isotropic components of diffusion signal, including free water and hindered water, were eliminated, and the fiber orientation distribution (FOD) of the remaining signal was estimated. In simulated data, COMPARI accurately recovered fiber orientations in the presence of extracellular water. In a dataset of 23 patients with highly edematous brain tumors, the amplitudes of FOD and anisotropic index distribution within the peritumoral region were higher with COMPARI than with a recently proposed multi-compartment constrained deconvolution model. In a selected patient with metastatic brain tumor, we demonstrated COMPARI's ability to effectively model and eliminate water from the peritumoral region. The white matter bundles reconstructed with our model were qualitatively improved compared to those of other models, and allowed the identification of crossing fibers. In conclusion, the removal of isotropic components as proposed with COMPARI improved the bio-physical modeling of dMRI in edema, thus providing information on crossing fibers, thereby enabling improved tractography in a highly edematous brain tumor. This model may improve surgical planning tools to help achieve maximal safe resection of brain tumors.
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Affiliation(s)
- Ehsan Golkar
- DiCIPHR (Diffusion and Connectomics in Precision Healthcare Research) Lab, Perelman School of Medicine,University of Pennsylvania, Philadelphia, PA, USA
| | - Drew Parker
- DiCIPHR (Diffusion and Connectomics in Precision Healthcare Research) Lab, Perelman School of Medicine,University of Pennsylvania, Philadelphia, PA, USA
| | - Steven Brem
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania,Philadelphia, PA
| | - Fabien Almairac
- Neurosurgery department, Pasteur 2 Hospital, University Hospital of Nice, France
- UR2CA PIN, Université Côte d’Azur, France
| | - Ragini Verma
- DiCIPHR (Diffusion and Connectomics in Precision Healthcare Research) Lab, Perelman School of Medicine,University of Pennsylvania, Philadelphia, PA, USA
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Almairac F, Parker D, Mondot L, Isan P, Onno M, Papadopoulo T, Filipiak P, Fontaine D, Verma R. Free-water correction DTI-based tractography in brain tumor surgery: assessment with functional and electrophysiological mapping of the white matter. Acta Neurochir (Wien) 2023; 165:1675-1681. [PMID: 37129683 DOI: 10.1007/s00701-023-05608-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 04/20/2023] [Indexed: 05/03/2023]
Abstract
Peritumoral edema prevents fiber tracking from diffusion tensor imaging (DTI). A free-water correction may overcome this drawback, as illustrated in the case of a patient undergoing awake surgery for brain metastasis. The anatomical plausibility and accuracy of tractography with and without free-water correction were assessed with functional mapping and axono-cortical evoked-potentials (ACEPs) as reference methods. The results suggest a potential synergy between corrected DTI-based tractography and ACEPs to reliably identify and preserve white matter tracts during brain tumor surgery.
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Affiliation(s)
- Fabien Almairac
- Neurosurgery Department, Pasteur 2 Hospital, University Hospital of Nice, 06000, Nice, France.
- UR2CA PIN, Université Côte d'Azur, Nice, France.
| | - Drew Parker
- Diffusion and Connectomics in Precision Healthcare Research Lab, Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA
| | - Lydiane Mondot
- Neuroradiology department, Pasteur 2 Hospital, University Hospital of Nice, 06000, Nice, France
- UR2CA URRIS, Université Côte d'Azur, Nice, France
| | - Petru Isan
- Neurosurgery Department, Pasteur 2 Hospital, University Hospital of Nice, 06000, Nice, France
- UR2CA PIN, Université Côte d'Azur, Nice, France
| | - Marie Onno
- Neurosurgery Department, Pasteur 2 Hospital, University Hospital of Nice, 06000, Nice, France
| | | | | | - Denys Fontaine
- Neurosurgery Department, Pasteur 2 Hospital, University Hospital of Nice, 06000, Nice, France
- UR2CA PIN, Université Côte d'Azur, Nice, France
| | - Ragini Verma
- Diffusion and Connectomics in Precision Healthcare Research Lab, Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA
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Gugger JJ, Walter AE, Parker D, Sinha N, Morrison J, Ware J, Schneider AL, Petrov D, Sandsmark DK, Verma R, Diaz-Arrastia R. Longitudinal Abnormalities in White Matter Extracellular Free Water Volume Fraction and Neuropsychological Functioning in Patients with Traumatic Brain Injury. J Neurotrauma 2023; 40:683-692. [PMID: 36448583 PMCID: PMC10061336 DOI: 10.1089/neu.2022.0259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Traumatic brain injury is a global public health problem associated with chronic neurological complications and long-term disability. Biomarkers that map onto the underlying brain pathology driving these complications are urgently needed to identify individuals at risk for poor recovery and to inform design of clinical trials of neuroprotective therapies. Neuroinflammation and neurodegeneration are two endophenotypes potentially associated with increases in brain extracellular water content, but the nature of extracellular free water abnormalities after neurotrauma and its relationship to measures typically thought to reflect traumatic axonal injury are not well characterized. The objective of this study was to describe the relationship between a neuroimaging biomarker of extracellular free water content and the clinical features of a cohort with primarily complicated mild traumatic brain injury. We analyzed a cohort of 59 adult patients requiring hospitalization for non-penetrating traumatic brain injury of all severities as well as 36 healthy controls. Patients underwent brain magnetic resonance imaging (MRI) at 2 weeks (n = 59) and 6 months (n = 29) post-injury, and controls underwent a single MRI. Of the participants with TBI, 50 underwent clinical neuropsychological assessment at 2 weeks and 28 at 6 months. For each subject, we derived a summary score representing deviations in whole brain white matter extracellular free water volume fraction (VF) and free water-corrected fractional anisotropy (fw-FA). The summary specific anomaly score (SAS) for VF was significantly higher in TBI patients at 2 weeks and 6 months post-injury relative to controls. SAS for VF exhibited moderate correlation with neuropsychological functioning, particularly on measures of executive function. These findings indicate abnormalities in whole brain white matter extracellular water fraction in patients with TBI and are an important step toward identifying and validating noninvasive biomarkers that map onto the pathology driving disability after TBI.
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Affiliation(s)
- James J. Gugger
- Department of Neurology, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Alexa E. Walter
- Department of Neurology, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Drew Parker
- Department of Radiology, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
- Department of Neurosurgery, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
- Diffusion and Connectomics in Precision Healthcare Research Lab, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Nishant Sinha
- Department of Neurology, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Justin Morrison
- Department of Neurology, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Jeffrey Ware
- Department of Radiology, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Andrea L.C. Schneider
- Department of Neurology, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
- Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Dmitriy Petrov
- Department of Neurosurgery, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Danielle K. Sandsmark
- Department of Neurology, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Ragini Verma
- Department of Radiology, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
- Department of Neurosurgery, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
- Diffusion and Connectomics in Precision Healthcare Research Lab, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Ramon Diaz-Arrastia
- Department of Neurology, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
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Riahi Samani Z, Parker D, Akbari H, Wolf RL, Brem S, Bakas S, Verma R. Artificial intelligence-based locoregional markers of brain peritumoral microenvironment. Sci Rep 2023; 13:963. [PMID: 36653382 PMCID: PMC9849348 DOI: 10.1038/s41598-022-26448-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 12/14/2022] [Indexed: 01/19/2023] Open
Abstract
In malignant primary brain tumors, cancer cells infiltrate into the peritumoral brain structures which results in inevitable recurrence. Quantitative assessment of infiltrative heterogeneity in the peritumoral region, the area where biopsy or resection can be hazardous, is important for clinical decision making. Here, we derive a novel set of Artificial intelligence (AI)-based markers capturing the heterogeneity of tumor infiltration, by characterizing free water movement restriction in the peritumoral region using Diffusion Tensor Imaging (DTI)-based free water volume fraction maps. We leverage the differences in the peritumoral region of metastasis and glioblastomas, the former consisting of vasogenic versus the latter containing infiltrative edema, to extract a voxel-wise deep learning-based peritumoral microenvironment index (PMI). Descriptive characteristics of locoregional hubs of uniformly high PMI values are then extracted as AI-based markers to capture distinct aspects of infiltrative heterogeneity. The proposed markers are utilized to stratify patients' survival and IDH1 mutation status on a population of 275 adult-type diffuse gliomas (CNS WHO grade 4). Our results show significant differences in the proposed markers between patients with different overall survival and IDH1 mutation status (t test, Wilcoxon rank sum test, linear regression; p < 0.01). Clustering of patients using the proposed markers reveals distinct survival groups (logrank; p < 10-5, Cox hazard ratio = 1.82; p < 0.005). Our findings provide a panel of markers as surrogates of infiltration that might capture novel insight about underlying biology of peritumoral microstructural heterogeneity, providing potential biomarkers of prognosis pertaining to survival and molecular stratification, with applicability in clinical decision making.
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Affiliation(s)
- Zahra Riahi Samani
- Diffusion & Connectomics In Precision Healthcare Research (DiCIPHR) Lab, University of Pennsylvania, Philadelphia, PA, 19104, USA.
- Center for Biomedical Image Computing and Analytics (CBICA), University of Pennsylvania, Philadelphia, PA, 19104, USA.
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA.
| | - Drew Parker
- Diffusion & Connectomics In Precision Healthcare Research (DiCIPHR) Lab, University of Pennsylvania, Philadelphia, PA, 19104, USA
- Center for Biomedical Image Computing and Analytics (CBICA), University of Pennsylvania, Philadelphia, PA, 19104, USA
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Hamed Akbari
- Center for Biomedical Image Computing and Analytics (CBICA), University of Pennsylvania, Philadelphia, PA, 19104, USA
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Ronald L Wolf
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Steven Brem
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Spyridon Bakas
- Center for Biomedical Image Computing and Analytics (CBICA), University of Pennsylvania, Philadelphia, PA, 19104, USA
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
- Department of Pathology & Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Ragini Verma
- Diffusion & Connectomics In Precision Healthcare Research (DiCIPHR) Lab, University of Pennsylvania, Philadelphia, PA, 19104, USA
- Center for Biomedical Image Computing and Analytics (CBICA), University of Pennsylvania, Philadelphia, PA, 19104, USA
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
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Ahmad A, Parker D, Dheer S, Samani ZR, Verma R. 3D-QCNet - A pipeline for automated artifact detection in diffusion MRI images. Comput Med Imaging Graph 2023; 103:102151. [PMID: 36502764 PMCID: PMC10494975 DOI: 10.1016/j.compmedimag.2022.102151] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 10/27/2022] [Accepted: 11/27/2022] [Indexed: 12/03/2022]
Abstract
Artifacts are a common occurrence in Diffusion MRI (dMRI) scans. Identifying and removing them is essential to ensure the accuracy and viability of any post-processing carried out on these scans. This makes quality control (QC) a crucial first step prior to any analysis of dMRI data. Several QC methods for artifact detection exist, however they suffer from problems like requiring manual intervention and the inability to generalize across different artifacts and datasets. In this paper, we propose an automated deep learning (DL) pipeline that utilizes a 3D-Densenet architecture to train a model on diffusion volumes for automatic artifact detection. Our method is validated on 9000 volumes sourced from 7 large clinical datasets spanning different acquisition protocols (with different gradient directions, high and low b-values, single-shell and multi-shell acquisitions) from multiple scanners. Additionally, they represent diverse subject demographics including age, sex and the presence or absence of pathologies. Our QC method is found to accurately generalize across this heterogenous data by correctly detecting 92% artifacts on average across our test set. This consistent performance over diverse datasets underlines the generalizability of our method, which currently is a significant barrier hindering the widespread adoption of automated QC techniques. Thus, 3D-QCNet can be integrated into diffusion pipelines to effectively automate the arduous and time-intensive process of artifact detection.
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Affiliation(s)
- Adnan Ahmad
- Diffusion and Connectomics in Precision Healthcare Research Lab (DiCIPHR), Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA
| | - Drew Parker
- Diffusion and Connectomics in Precision Healthcare Research Lab (DiCIPHR), Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA
| | - Suhani Dheer
- Diffusion and Connectomics in Precision Healthcare Research Lab (DiCIPHR), Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA
| | - Zahra Riahi Samani
- Diffusion and Connectomics in Precision Healthcare Research Lab (DiCIPHR), Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA
| | - Ragini Verma
- Diffusion and Connectomics in Precision Healthcare Research Lab (DiCIPHR), Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA.
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Culleton S, Baradaran H, Kim SE, Stoddard G, Roberts J, Treiman G, Parker D, Duff K, McNally JS. MRI Detection of Carotid Intraplaque Hemorrhage and Postintervention Cognition. AJNR Am J Neuroradiol 2022; 43:1762-1769. [PMID: 36357151 DOI: 10.3174/ajnr.a7701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 10/01/2022] [Indexed: 11/12/2022]
Abstract
BACKGROUND AND PURPOSE Cognitive improvement has been reported after carotid revascularization and attributed to treating stenosis and correcting hypoperfusion. This study investigated the effect of carotid intraplaque hemorrhage on postintervention cognition. MATERIALS AND METHODS In this institutional review board-approved single-center study, consecutive patients scheduled for carotid surgery were recruited for preoperative carotid MR imaging (MPRAGE) and pre- and postintervention cognitive testing using the Repeatable Battery for the Assessment of Neuropsychological Status. Pre- and postintervention scores were compared using t tests and multivariable linear regression. RESULTS Twenty-three participants were included, with endarterectomy performed in 20 (87%) and angioplasty/stent placement, in 3 (13%). Overall, statistically significant improvements occurred in the pre- versus postintervention mean Total Scale score (92.1 [SD, 15.5] versus 96.1 [SD, 15.8], P = .04), immediate memory index (89.4 [SD, 18.2] versus 97.7 [SD, 14.9], P < .001), and verbal index (96.1 [SD, 14.1] versus 103.0 [SD, 12.0], P = .002). Intraplaque hemorrhage (+) participants (n = 11) had no significant improvement in any category, and the attention index significantly decreased (99.4 [SD, 18.0] versus 93.5 [SD, 19.4], P = .045). Intraplaque hemorrhage (-) participants (n = 12) significantly improved in the Total Scale score (86.4 [SD, 11.8] versus 95.5 [SD, 12.4], P = .004), immediate memory index (82.3 [SD, 14.6] versus 96.2 [SD, 14.1], P = .002), delayed memory index (94.3 [SD, 14.9] versus 102.4 [SD, 8.0], P = .03), and verbal index (94.3 [SD, 13.2] versus 101.5 [SD, 107.4], P = .009). Postintervention minus preintervention scores for intraplaque hemorrhage (+) versus (-) groups showed statistically significant differences in the Total Scale score (-0.4 [SD, 6.8] versus 8.0 [SD, 8.5], P = .02), attention index (-5.9 [SD, 8.5] versus 4.3 [SD, 11.9], P = .03), and immediate memory index (4.2 [SD, 6.7] versus 12.2 [SD, 10.2], P = .04). CONCLUSIONS Cognitive improvement was observed after carotid intervention, and this was attributable to intraplaque hemorrhage (-) plaque. MR imaging detection of intraplaque hemorrhage status may be an important determinant of cognitive change after intervention.
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Affiliation(s)
- S Culleton
- From the Department of Radiology (S.C., H.B., S.-E.K., J.R., D.P., J.S.M.)
| | - H Baradaran
- From the Department of Radiology (S.C., H.B., S.-E.K., J.R., D.P., J.S.M.)
| | - S-E Kim
- From the Department of Radiology (S.C., H.B., S.-E.K., J.R., D.P., J.S.M.)
| | - G Stoddard
- Utah Center for Advanced Imaging Research, Division of Epidemiology (G.S.)
| | - J Roberts
- From the Department of Radiology (S.C., H.B., S.-E.K., J.R., D.P., J.S.M.)
| | - G Treiman
- Department of Internal Medicine, Department of Surgery (G.T.)
| | - D Parker
- From the Department of Radiology (S.C., H.B., S.-E.K., J.R., D.P., J.S.M.)
| | - K Duff
- Center for Alzheimer's Care, Imaging and Research (K.D.), University of Utah, Salt Lake City, Utah
| | - J S McNally
- From the Department of Radiology (S.C., H.B., S.-E.K., J.R., D.P., J.S.M.)
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Samani ZR, Parker D, Akbari H, Wolf RL, Brem S, Bakas S, Verma R. NIMG-23. AI-BASED CONNECTED COMPONENT MARKERS OF BRAIN PERITUMORAL MICROENVIRONMENT USING WATER RESTRICTION INFORMATION. Neuro Oncol 2022. [PMCID: PMC9660744 DOI: 10.1093/neuonc/noac209.641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract
PURPOSE
Glioblastoma is the most aggressive adult brain tumor, with heterogeneous neoplastic cell peritumoral infiltration. Characterization of this infiltrative peritumoral heterogeneity is an unmet clinical need that could contribute to strengthening our understanding of this disease. We propose novel AI-based markers of infiltration using deep-learning (DL) based on water restriction caused by infiltration, identified by diffusion tensor imaging (DTI). These markers could contribute to precision/personalized medicine, towards influencing clinical decision-making, including planning for biopsies, surgery, and radiation. METHOD: We automatically extracted peritumoral patches from free water volume fraction maps (FW-VF) of a retrospective cohort of 44 brain metastases and 66 glioblastomata patients and labelled them as high- and low- free water, respectively. An AI/DL model was then trained on these patches to distinguish differences in water restriction. Our trained AI/DL model was then applied on FW-VF of 264 hold-out glioblastoma patients (survival:0.43-76.9 months, age:21-88, 104 females) to generate a peritumoral microenvironment index (PMI) map quantifying infiltrative heterogeneity. Connected components (CCs) of high PMI values were calculated and their descriptive characteristics of size, number, shape, directionality, and spatial location, were extracted as AI-based markers. Gaussian mixture model clustering was then applied on these markers to determine if their representative infiltrative peritumoral heterogeneity can capture overall survival differences, by partitioning the patients into three clusters: low, moderate, and high risk.
RESULTS
The log-rank test yielded significant differences (p< 10-5) between low- and high-risk patients, (HR= 0.47, 95% CI:0.34-0.65; P< 0.005). Average PMI values were significantly greater in high-risk patients (P< 0.05).
CONCLUSION
We introduced novel AI-based markers of infiltration in the peritumoral microenvironment, using information of water restriction extracted from DTI. Our proposed markers can capture overall survival differences, based on the patterns of infiltration using DTI-based characterization of the water restriction, that show promise as clinically relevant prognostic biomarkers.
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Affiliation(s)
- Zahra Riahi Samani
- DiCIPHR (Diffusion and Connectomics in Precision Healthcare Research) Lab, Department of Radiology, Perelman School of Medicine, University of Pennsylvania , Philadelphia , USA
| | - Drew Parker
- DiCIPHR (Diffusion and Connectomics in Precision Healthcare Research) Lab, Department of Radiology, Perelman School of Medicine, University of Pennsylvania , Philadelphia , USA
| | - Hamed Akbari
- University of Pennsylvania , Philadelphia, PA , USA
| | - Ronald L Wolf
- Hospital of the University of Pennsylvania , Philadelphia , USA
| | - Steven Brem
- Hospital of the University of Pennsylvania , Philadelphia , USA
| | - Spyridon Bakas
- Center for Biomedical Image Computing and Analytics, Department of Radiology, and Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania , Philadelphia, PA , USA
| | - Ragini Verma
- DiCIPHR (Diffusion and Connectomics in Precision Healthcare Research) Lab, Department of Radiology, Perelman School of Medicine, University of Pennsylvania , Philadelphia , USA
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Golkar E, Parker D, Brem S, Verma R. MODL-39. CHARACTERIZING NON-ENHANCING TUMOR USING MULTI-SHELL DIFFUSION MRI. Neuro Oncol 2022. [PMCID: PMC9661284 DOI: 10.1093/neuonc/noac209.1166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract
Characterizing infiltration in the non-enhancing tumor (NET) is clinically crucial as infiltration leads to progression, and a reduction in survival times. As voxel-wise biopsy of these regions is infeasible, a non-invasive MRI-based identification of infiltration would be a significant contribution. Diffusion MRI (dMRI), with its ability to model different levels of water restriction, as is caused by infiltration and edema, is well positioned to model the NET. This is achieved via multicomparment modeling (MCM) of the dMRI where infiltration, vasogenic edema and healthy tissue (with complex fibers) form the different compartments. Current MCM approaches are either not designed for NET or rely on advanced MRI scans currently not feasible in the clinic. The simplest ball-tensor models, including Hoy 2014 using multi-shell data and FERNET 2020 for single-shell data, consists of a free water compartment that models vasogenic edema and a tensor modeling underlying tissue. These single-tensor methods cannot model complex WM fibers. Our proposed model consists of two steps. First, two bundles are fit: an isotropic bundle with two balls that model isotropic free diffusivity and restricted diffusivity, and a bundle containing stick and zeppelin, corresponding to intra-cellular and extra-cellular diffusion of axons, respectively. Next, a fiber orientation distribution (FOD) is estimated from the fitted parameters. We applied our modeling to multi-shell data from eight patients with glioblastoma, and one patient with a metastatic brain tumor. Our method produces maps corresponding to free water (CSF), restricted diffusion, intra-cellular, and extra-cellular volume fractions. Preliminary results show that restricted diffusivity map of NET comprises 46% of vasogenic metastatic edema compare to 15% of infiltrated GBM edema. In conclusion, we demonstrate that our proposed model shows promise to characterize the NET region of various brain tumors, and distinguishing tumor types. These compartments will provide invaluable radiomic features that no other modality can capture.
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Affiliation(s)
- Ehsan Golkar
- DiCIPHR (Diffusion and Connectomics in Precision Healthcare Research) Lab, Department of Radiology, Perelman School of Medicine, University of Pennsylvania , Philadelphia , USA
| | - Drew Parker
- DiCIPHR (Diffusion and Connectomics in Precision Healthcare Research) Lab, Department of Radiology, Perelman School of Medicine, University of Pennsylvania , Philadelphia , USA
| | - Steven Brem
- Hospital of the University of Pennsylvania , Philadelphia , USA
| | - Ragini Verma
- DiCIPHR (Diffusion and Connectomics in Precision Healthcare Research) Lab, Department of Radiology, Perelman School of Medicine, University of Pennsylvania , Philadelphia , USA
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10
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Kadagi NI, Wambiji N, Mann B, Parker D, Daly R, Thoya P, Rato DAM, Halafo J, Gaspare L, Sweke EA, Ahmed S, Raseta SB, Osore M, Maina J, Glaser S, Ahrens R, Sumaila UR. Status and challenges for sustainable billfish fisheries in the Western Indian Ocean. Rev Fish Biol Fish 2022; 32:1035-1061. [PMID: 36187439 PMCID: PMC9510346 DOI: 10.1007/s11160-022-09725-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Accepted: 07/12/2022] [Indexed: 06/16/2023]
Abstract
UNLABELLED Billfish species (families Istiophoridae and Xiphiidae) are caught in artisanal, recreational, and commercial fisheries throughout the Western Indian Ocean region. However, data and information on the interactions among these fisheries and the ecology of billfish in the WIO are not well understood. Using an in-depth analysis of peer-reviewed articles, grey literature, observation studies, and authors' insider knowledge, we summarize the current state of knowledge on billfish fisheries in 10 countries. To describe historical and current trends, we examined fisheries statistics from governmental and non-governmental agencies, sportfishing clubs' reports, diaries of sportfishing captains, and the catch and effort databases of the Indian Ocean Tuna Commission. We highlight two key points. First, billfish fisheries in the Western Indian Ocean are highly diverse, comprising two distinct segments-coastal and oceanic. However, data are poor for most countries with significant gaps in information especially for sport and artisanal fisheries. Second, the evidence assembled showed that billfish species have immense social, cultural, and economic value. Swordfish are targeted by both large-scale and semi-industrial fisheries, while other billfish species, particularly marlin, are highly sought after by sport fisheries in most countries. Our paper provides a comprehensive review of billfish fisheries and available information in the context of the WIO underscoring the need to strengthen data collection and reporting, citizen science, and collaborative sustainable development and management of billfish. SUPPLEMENTARY INFORMATION The online version contains supplementary material available at 10.1007/s11160-022-09725-8.
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Affiliation(s)
| | - N. Wambiji
- Kenya Marine and Fisheries Research Institute, Mombasa, Kenya
| | - B. Mann
- Oceanographic Research Institute and South African Association for Marine Biological Research, Durban, South Africa
| | - D. Parker
- Department of Agriculture, Forestry and Fisheries, Pretoria, South Africa
| | - R. Daly
- Oceanographic Research Institute and South African Association for Marine Biological Research, Durban, South Africa
| | - P. Thoya
- Kenya Marine and Fisheries Research Institute, Mombasa, Kenya
- Department of Earth and Environmental Sciences, Macquarie University, Sydney, Australia
- Institute for Marine Ecosystem and Fisheries Science, Center for Earth System Research and Sustainability (CEN), University of Hamburg, Hamburg, Germany
- Leibniz Institute for Baltic Sea Research Warnemuende (IOW), Rostock, Germany
| | | | - J. Halafo
- Mozambique Oceanographic Institute (InOM), Maputo, Mozambique
| | - L. Gaspare
- University of Dar es Salaam, Dar es Salaam, Tanzania
| | - E. A. Sweke
- Deep Sea Fisheries Authority, Zanzibar, Tanzania
| | - S. Ahmed
- University of Dodoma, Dodoma, Tanzania
| | | | - M. Osore
- Kenya Marine and Fisheries Research Institute, Mombasa, Kenya
| | - J. Maina
- Department of Earth and Environmental Sciences, Macquarie University, Sydney, Australia
| | - S. Glaser
- World Wildlife Fund, Washington, DC, USA
| | - R. Ahrens
- Pacific Islands Fisheries Science Center, National Marine Fisheries Service, 1845 Wasp Blvd., Building 176, Honolulu, HI 96818 USA
| | - U. R. Sumaila
- Institute for the Oceans and Fisheries, University of British Columbia, Vancouver, Canada
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11
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Osmanlıoğlu Y, Parker D, Alappatt JA, Gugger JJ, Diaz-Arrastia RR, Whyte J, Kim JJ, Verma R. Connectomic assessment of injury burden and longitudinal structural network alterations in moderate-to-severe traumatic brain injury. Hum Brain Mapp 2022; 43:3944-3957. [PMID: 35486024 PMCID: PMC9374876 DOI: 10.1002/hbm.25894] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 04/08/2022] [Accepted: 04/14/2022] [Indexed: 11/14/2022] Open
Abstract
Traumatic brain injury (TBI) is a major public health problem. Caused by external mechanical forces, a major characteristic of TBI is the shearing of axons across the white matter, which causes structural connectivity disruptions between brain regions. This diffuse injury leads to cognitive deficits, frequently requiring rehabilitation. Heterogeneity is another characteristic of TBI as severity and cognitive sequelae of the disease have a wide variation across patients, posing a big challenge for treatment. Thus, measures assessing network-wide structural connectivity disruptions in TBI are necessary to quantify injury burden of individuals, which would help in achieving personalized treatment, patient monitoring, and rehabilitation planning. Despite TBI being a disconnectivity syndrome, connectomic assessment of structural disconnectivity has been relatively limited. In this study, we propose a novel connectomic measure that we call network normality score (NNS) to capture the integrity of structural connectivity in TBI patients by leveraging two major characteristics of the disease: diffuseness of axonal injury and heterogeneity of the disease. Over a longitudinal cohort of moderate-to-severe TBI patients, we demonstrate that structural network topology of patients is more heterogeneous and significantly different than that of healthy controls at 3 months postinjury, where dissimilarity further increases up to 12 months. We also show that NNS captures injury burden as quantified by posttraumatic amnesia and that alterations in the structural brain network is not related to cognitive recovery. Finally, we compare NNS to major graph theory measures used in TBI literature and demonstrate the superiority of NNS in characterizing the disease.
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Affiliation(s)
- Yusuf Osmanlıoğlu
- Department of Computer Science, College of Computing and Informatics, Drexel University, Philadelphia, Pennsylvania, USA
| | - Drew Parker
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jacob A Alappatt
- Speech and hearing, bioscience and technology program, Harvard Medical School, Harvard University, Boston, MA, USA
| | - James J Gugger
- Department of Neurology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ramon R Diaz-Arrastia
- Department of Neurology, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Center for Brain Injury and Repair, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - John Whyte
- Moss Rehabilitation Research Institute, TBI Rehabilitation Research LaboratoryEinstein Medical Center, Elkins Park, Pennsylvania, USA
| | - Junghoon J Kim
- Department of Molecular, Cellular, and Biomedical Sciences, CUNY School of Medicine, The City College of New York, New York, New York, USA
| | - Ragini Verma
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Center for Brain Injury and Repair, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Department of Neurosurgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, USA
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12
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Hitti FL, Parker D, Yang AI, Brem S, Verma R. Laterality and Sex Differences of Human Lateral Habenula Afferent and Efferent Fiber Tracts. Front Neurosci 2022; 16:837624. [PMID: 35784832 PMCID: PMC9243380 DOI: 10.3389/fnins.2022.837624] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 05/27/2022] [Indexed: 11/26/2022] Open
Abstract
Introduction The lateral habenula (LHb) is an epithalamic nucleus associated with negative valence and affective disorders. It receives input via the stria medullaris (SM) and sends output via the fasciculus retroflexus (FR). Here, we use tractography to reconstruct and characterize this pathway. Methods Multi-shell human diffusion magnetic resonance imaging (dMRI) data was obtained from the human connectome project (HCP) (n = 20, 10 males) and from healthy controls (n = 10, 6 males) scanned at our institution. We generated LHb afferents and efferents using probabilistic tractography by selecting the pallidum as the seed region and the ventral tegmental area as the output target. Results We were able to reconstruct the intended streamlines in all individuals from the HCP dataset and our dataset. Our technique also aided in identification of the LHb. In right-handed individuals, the streamlines were significantly more numerous in the left hemisphere (mean ratio 1.59 ± 0.09, p = 0.04). In left-handed individuals, there was no hemispheric asymmetry on average (mean ratio 1.00 ± 0.09, p = 1.0). Additionally, these streamlines were significantly more numerous in females than in males (619.9 ± 159.7 vs. 225.9 ± 66.03, p = 0.04). Conclusion We developed a method to reconstruct the SM and FR without manual identification of the LHb. This technique enables targeting of these fiber tracts as well as the LHb. Furthermore, we have demonstrated that there are sex and hemispheric differences in streamline number. These findings may have therapeutic implications and warrant further investigation.
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Affiliation(s)
- Frederick L. Hitti
- Department of Neurosurgery, University of Pennsylvania, Philadelphia, PA, United States
- *Correspondence: Frederick L. Hitti,
| | - Drew Parker
- Diffusion and Connectomics in Precision Healthcare Research Lab, Department of Radiology, University of Pennsylvania, Philadelphia, PA, United States
| | - Andrew I. Yang
- Department of Neurosurgery, University of Pennsylvania, Philadelphia, PA, United States
| | - Steven Brem
- Department of Neurosurgery, University of Pennsylvania, Philadelphia, PA, United States
| | - Ragini Verma
- Department of Neurosurgery, University of Pennsylvania, Philadelphia, PA, United States
- Diffusion and Connectomics in Precision Healthcare Research Lab, Department of Radiology, University of Pennsylvania, Philadelphia, PA, United States
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13
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Yang AI, Parker D, Vijayakumari AA, Ramayya AG, Donley-Fletcher MP, Aunapu D, Wolf RL, Baltuch GH, Verma R. Tractography-Based Surgical Targeting for Thalamic Deep Brain Stimulation: A Comparison of Probabilistic vs Deterministic Fiber Tracking of the Dentato-Rubro-Thalamic Tract. Neurosurgery 2022; 90:419-425. [PMID: 35044356 PMCID: PMC9514748 DOI: 10.1227/neu.0000000000001840] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 10/25/2021] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND The ventral intermediate (VIM) thalamic nucleus is the main target for the surgical treatment of refractory tremor. Initial targeting traditionally relies on atlas-based stereotactic targeting formulas, which only minimally account for individual anatomy. Alternative approaches have been proposed, including direct targeting of the dentato-rubro-thalamic tract (DRTT), which, in clinical settings, is generally reconstructed with deterministic tracking. Whether more advanced probabilistic techniques are feasible on clinical-grade magnetic resonance acquisitions and lead to enhanced reconstructions is poorly understood. OBJECTIVE To compare DRTT reconstructed with deterministic vs probabilistic tracking. METHODS This is a retrospective study of 19 patients with essential tremor who underwent deep brain stimulation (DBS) with intraoperative neurophysiology and stimulation testing. We assessed the proximity of the DRTT to the DBS lead and to the active contact chosen based on clinical response. RESULTS In the commissural plane, the deterministic DRTT was anterior (P < 10-4) and lateral (P < 10-4) to the DBS lead. By contrast, although the probabilistic DRTT was also anterior to the lead (P < 10-4), there was no difference in the mediolateral dimension (P = .5). Moreover, the 3-dimensional Euclidean distance from the active contact to the probabilistic DRTT was smaller vs the distance to the deterministic DRTT (3.32 ± 1.70 mm vs 5.01 ± 2.12 mm; P < 10-4). CONCLUSION DRTT reconstructed with probabilistic fiber tracking was superior in spatial proximity to the physiology-guided DBS lead and to the empirically chosen active contact. These data inform strategies for surgical targeting of the VIM.
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Affiliation(s)
- Andrew I. Yang
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA;
| | - Drew Parker
- DiCIPHR (Diffusion and Connectomics in Precision Healthcare Research) Lab, Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA;
| | - Anupa A. Vijayakumari
- DiCIPHR (Diffusion and Connectomics in Precision Healthcare Research) Lab, Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA;
| | - Ashwin G. Ramayya
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA;
| | | | - Darien Aunapu
- DiCIPHR (Diffusion and Connectomics in Precision Healthcare Research) Lab, Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA;
| | - Ronald L. Wolf
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Gordon H. Baltuch
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA;
| | - Ragini Verma
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA;
- DiCIPHR (Diffusion and Connectomics in Precision Healthcare Research) Lab, Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA;
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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14
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Parker D, Hudson P, Tieman J, Thomas K, Saward D, Ivynian S. Evaluation of an online toolkit for carers of people with a life-limiting illness at the end-of-life: health professionals' perspectives. Aust J Prim Health 2021; 27:473-478. [PMID: 34802508 DOI: 10.1071/py21019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 06/03/2021] [Indexed: 11/23/2022]
Abstract
Carers of people with a life-limiting illness report unmet information, practical, and emotional support needs, and are often unaware of services available to help improve preparedness, wellbeing, and reduce strain. CarerHelp is the first e-health toolkit that focuses on the information and support needs of carers of people with a life-limiting illness at the end-of-life, using a pathway approach. This study investigated the usefulness of CarerHelp, from the perspective of health professionals who care for these people. Through a 10-min online survey, health professionals provided feedback about their user experience and perceived usefulness of the website. Their expert opinion was sought to ascertain whether CarerHelp could increase carers' preparedness and confidence to support the person for whom they are caring and thereby improve carers' own psychological wellbeing. Health professionals also evaluated whether CarerHelp adequately raised awareness of support services available. CarerHelp was perceived as a useful resource for increasing preparedness for the caring role, including physical tasks and emotional support. Health professionals reported that CarerHelp would increase carers' knowledge of services, confidence to care and ability for self-care. Health professionals endorsed CarerHelp as a useful information source, guide for support, and would promote CarerHelp to clients and their families.
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Affiliation(s)
- D Parker
- Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - P Hudson
- Centre for Palliative Care, St Vincent's Hospital Melbourne, Melbourne, Vic., Australia; and Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Vic., Australia; and Vrije University, Brussels, Belgium
| | - J Tieman
- Research Centre for Palliative Care, Death and Dying, Flinders University, Adelaide, SA, Australia
| | - K Thomas
- Centre for Palliative Care, St Vincent's Hospital Melbourne, Melbourne, Vic., Australia
| | - D Saward
- Centre for Palliative Care, St Vincent's Hospital Melbourne, Melbourne, Vic., Australia
| | - S Ivynian
- Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia; and Corresponding author.
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15
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Samani ZR, Parker D, Wolf R, Brem S, Verma R. BRMP-04. AI-based biomarker of the peritumoral region using tissue microstructure. Neuro Oncol 2021. [DOI: 10.1093/neuonc/noab196.897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
PURPOSE
Glioblastomas, the most common malignant brain tumor [BS1], infiltrate into peritumoral brain structures, making clinical management challenging. An unmet need is to develop a biomarker that reliably characterize infiltration in the peritumoral region, where surgical biopsy or resection may be hazardous. Diffusion tensor imaging (DTI) with multicompartment modeling can characterize extracellular free water, providing unique information of the tissue microstructure that is able to capture this heterogeneity. We propose a novel biomarker based on peritumoral tissue microstructure, using deep-learning on DTI-based free water map.
METHOD
Peritumoral regions were automatically segmented for 136 patients with brain tumors (86 glioblastomas and 50 metastases, ages 23–87 years, 65 females). We trained a Convolutional Neural Network (CNN) on free-water maps using automatically defined patches in the peritumoral area from glioblastomas and metastases, labeled as low free-water and high free-water to extract a microstructural index for each voxel. To extract the biomarker, we grouped peritumoral voxels into connected components (CCs) where adjacent voxels have high (>0.9) microstructural index values. Two independent test sets related to two clinically significant problems were evaluated: i) metastases vs. glioblastomas; ii) glioma patients categorized into short and long survival groups and the number of CCs were statistically compared.
RESULT
Two-sample t-tests showed significant group difference in the number of CCs between metastases and glioblastomas (p< 0.05), and short and long-survivals (p<0.05) with higher number of CCs in metastases and long-survivals, which suggests smaller number of voxels in CCs.
CONCLUSION
The proposed biomarker based on CCs of microstructural index captures the differences in infiltration of the peritumoral region, showing larger CCs in glioblastomas and short-survivals corresponding to higher infiltration.
CLINICAL IMPORTANCE
The proposed biomarker provides a novel insight into the peritumoral microenvironment and can be derived from clinically feasible DTI data, providing new possibilities for the diagnosis and treatment of glioblastoma.
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Affiliation(s)
| | - Drew Parker
- University of Pennsylvania, Philadelphia, PA, USA
| | - Ronald Wolf
- University of Pennsylvania, Philadelphia, PA, USA
| | - Steven Brem
- University of Pennsylvania, Philadelphia, PA, USA
| | - Ragini Verma
- University of Pennsylvania, Philadelphia, PA, USA
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16
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Schilling KG, Rheault F, Petit L, Hansen CB, Nath V, Yeh FC, Girard G, Barakovic M, Rafael-Patino J, Yu T, Fischi-Gomez E, Pizzolato M, Ocampo-Pineda M, Schiavi S, Canales-Rodríguez EJ, Daducci A, Granziera C, Innocenti G, Thiran JP, Mancini L, Wastling S, Cocozza S, Petracca M, Pontillo G, Mancini M, Vos SB, Vakharia VN, Duncan JS, Melero H, Manzanedo L, Sanz-Morales E, Peña-Melián Á, Calamante F, Attyé A, Cabeen RP, Korobova L, Toga AW, Vijayakumari AA, Parker D, Verma R, Radwan A, Sunaert S, Emsell L, De Luca A, Leemans A, Bajada CJ, Haroon H, Azadbakht H, Chamberland M, Genc S, Tax CMW, Yeh PH, Srikanchana R, Mcknight CD, Yang JYM, Chen J, Kelly CE, Yeh CH, Cochereau J, Maller JJ, Welton T, Almairac F, Seunarine KK, Clark CA, Zhang F, Makris N, Golby A, Rathi Y, O'Donnell LJ, Xia Y, Aydogan DB, Shi Y, Fernandes FG, Raemaekers M, Warrington S, Michielse S, Ramírez-Manzanares A, Concha L, Aranda R, Meraz MR, Lerma-Usabiaga G, Roitman L, Fekonja LS, Calarco N, Joseph M, Nakua H, Voineskos AN, Karan P, Grenier G, Legarreta JH, Adluru N, Nair VA, Prabhakaran V, Alexander AL, Kamagata K, Saito Y, Uchida W, Andica C, Abe M, Bayrak RG, Wheeler-Kingshott CAMG, D'Angelo E, Palesi F, Savini G, Rolandi N, Guevara P, Houenou J, López-López N, Mangin JF, Poupon C, Román C, Vázquez A, Maffei C, Arantes M, Andrade JP, Silva SM, Calhoun VD, Caverzasi E, Sacco S, Lauricella M, Pestilli F, Bullock D, Zhan Y, Brignoni-Perez E, Lebel C, Reynolds JE, Nestrasil I, Labounek R, Lenglet C, Paulson A, Aulicka S, Heilbronner SR, Heuer K, Chandio BQ, Guaje J, Tang W, Garyfallidis E, Raja R, Anderson AW, Landman BA, Descoteaux M. Tractography dissection variability: What happens when 42 groups dissect 14 white matter bundles on the same dataset? Neuroimage 2021; 243:118502. [PMID: 34433094 PMCID: PMC8855321 DOI: 10.1016/j.neuroimage.2021.118502] [Citation(s) in RCA: 53] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 08/10/2021] [Accepted: 08/21/2021] [Indexed: 10/20/2022] Open
Abstract
White matter bundle segmentation using diffusion MRI fiber tractography has become the method of choice to identify white matter fiber pathways in vivo in human brains. However, like other analyses of complex data, there is considerable variability in segmentation protocols and techniques. This can result in different reconstructions of the same intended white matter pathways, which directly affects tractography results, quantification, and interpretation. In this study, we aim to evaluate and quantify the variability that arises from different protocols for bundle segmentation. Through an open call to users of fiber tractography, including anatomists, clinicians, and algorithm developers, 42 independent teams were given processed sets of human whole-brain streamlines and asked to segment 14 white matter fascicles on six subjects. In total, we received 57 different bundle segmentation protocols, which enabled detailed volume-based and streamline-based analyses of agreement and disagreement among protocols for each fiber pathway. Results show that even when given the exact same sets of underlying streamlines, the variability across protocols for bundle segmentation is greater than all other sources of variability in the virtual dissection process, including variability within protocols and variability across subjects. In order to foster the use of tractography bundle dissection in routine clinical settings, and as a fundamental analytical tool, future endeavors must aim to resolve and reduce this heterogeneity. Although external validation is needed to verify the anatomical accuracy of bundle dissections, reducing heterogeneity is a step towards reproducible research and may be achieved through the use of standard nomenclature and definitions of white matter bundles and well-chosen constraints and decisions in the dissection process.
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Affiliation(s)
- Kurt G Schilling
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN, United States.
| | | | - Laurent Petit
- Groupe dImagerie Neurofonctionnelle, Institut Des Maladies Neurodegeneratives, CNRS, CEA University of Bordeaux, Bordeaux, France
| | - Colin B Hansen
- Department of Electrical Engineering and Computer Science, Vanderbilt University, Nashville, TN, United States
| | - Vishwesh Nath
- Department of Electrical Engineering and Computer Science, Vanderbilt University, Nashville, TN, United States
| | - Fang-Cheng Yeh
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA, United States
| | - Gabriel Girard
- CIBM Center for BioMedical Imaging, Lausanne, Switzerland
| | - Muhamed Barakovic
- Translational Imaging in Neurology (ThINK), Department of Medicine and Biomedical Engineering, University Hospital and University of Basel, Basel, Switzerland
| | - Jonathan Rafael-Patino
- Signal Processing Lab (LTS5), École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Thomas Yu
- Signal Processing Lab (LTS5), École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Elda Fischi-Gomez
- Signal Processing Lab (LTS5), École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Marco Pizzolato
- Department of Applied Mathematics and Computer Science, Technical University of Denmark, Kongens Lyngby, Denmark
| | | | - Simona Schiavi
- Department of Computer Science, University of Verona, Italy
| | | | | | - Cristina Granziera
- Translational Imaging in Neurology (ThINK), Department of Medicine and Biomedical Engineering, University Hospital and University of Basel, Basel, Switzerland
| | - Giorgio Innocenti
- Department of Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Jean-Philippe Thiran
- Signal Processing Lab (LTS5), École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Laura Mancini
- Lysholm Department of Neuroradiology, National Hospital for Neurology & Neurosurgery, UCL Hospitals NHS Foundation Trust, London, United Kingdom
| | - Stephen Wastling
- Lysholm Department of Neuroradiology, National Hospital for Neurology & Neurosurgery, UCL Hospitals NHS Foundation Trust, London, United Kingdom
| | - Sirio Cocozza
- Department of Advanced Biomedical Sciences, University "Federico II", Naples, Italy
| | - Maria Petracca
- Department of Neurosciences and Reproductive and Odontostomatological Sciences, University "Federico II", Naples, Italy
| | - Giuseppe Pontillo
- Department of Advanced Biomedical Sciences, University "Federico II", Naples, Italy
| | - Matteo Mancini
- Department of Neuroscience, Brighton and Sussex Medical School, University of Sussex, Brighton, United Kingdom
| | - Sjoerd B Vos
- Centre for Medical Image Computing, University College London, London, United Kingdom
| | - Vejay N Vakharia
- Department of Clinical and Experimental Epilepsy, University College London, London, United Kingdom
| | - John S Duncan
- Epilepsy Society MRI Unit, Chalfont St Peter, United Kingdom
| | - Helena Melero
- Departamento de Psicobiología y Metodología en Ciencias del Comportamiento - Universidad Complutense de Madrid, Spain Laboratorio de Análisis de Imagen Médica y Biometría (LAIMBIO), Universidad Rey Juan Carlos, Madrid, Spain
| | - Lidia Manzanedo
- Facultad de Ciencias de la Salud, Universidad Rey Juan Carlos, Madrid, Spain
| | - Emilio Sanz-Morales
- Laboratorio de Análisis de Imagen Médica y Biometría (LAIMBIO), Universidad Rey Juan Carlos, Madrid, Spain
| | - Ángel Peña-Melián
- Departamento de Anatomía, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - Fernando Calamante
- Sydney Imaging and School of Biomedical Engineering, The University of Sydney, Sydney, Australia
| | - Arnaud Attyé
- School of Biomedical Engineering, The University of Sydney, Sydney, Australia
| | - Ryan P Cabeen
- Laboratory of Neuro Imaging, Stevens Neuroimaging and Informatics Institute, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA, United States
| | - Laura Korobova
- Center for Integrative Connectomics, Stevens Neuroimaging and Informatics Institute, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA, United States
| | - Arthur W Toga
- Laboratory of Neuro Imaging, Stevens Neuroimaging and Informatics Institute, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA, United States
| | | | - Drew Parker
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, United States
| | - Ragini Verma
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, United States
| | - Ahmed Radwan
- KU Leuven, Department of Imaging and Pathology, Translational MRI, B-3000, Leuven, Belgium
| | - Stefan Sunaert
- KU Leuven, Department of Imaging and Pathology, Translational MRI, B-3000, Leuven, Belgium
| | - Louise Emsell
- KU Leuven, Department of Imaging and Pathology, Translational MRI, B-3000, Leuven, Belgium
| | | | | | - Claude J Bajada
- Department of Physiology and Biochemistry, Faculty of Medicine and Surgery, University of Malta, Malta
| | - Hamied Haroon
- Division of Neuroscience & Experimental Psychology, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | | | - Maxime Chamberland
- Cardiff University Brain Research Imaging Centre (CUBRIC), Cardiff University, Cardiff, United Kingdom
| | - Sila Genc
- Cardiff University Brain Research Imaging Centre (CUBRIC), Cardiff University, Cardiff, United Kingdom
| | - Chantal M W Tax
- Cardiff University Brain Research Imaging Centre (CUBRIC), Cardiff University, Cardiff, United Kingdom
| | - Ping-Hong Yeh
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Rujirutana Srikanchana
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Colin D Mcknight
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Joseph Yuan-Mou Yang
- Department of Neurosurgery, Neuroscience Advanced Clinical Imaging Suite (NACIS), Royal Children's Hospital, Parkville, Melbourne, Australia
| | - Jian Chen
- Developmental Imaging, Murdoch Children's Research Institute, Melbourne, Australia
| | - Claire E Kelly
- Victorian Infant Brain Studies, Murdoch Children's Research Institute, Melbourne, Australia
| | - Chun-Hung Yeh
- Institute for Radiological Research, Chang Gung University & Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | | | - Jerome J Maller
- MRI Clinical Science Specialist, General Electric Healthcare, Australia
| | | | - Fabien Almairac
- Neurosurgery department, Hôpital Pasteur, University Hospital of Nice, Côte d'Azur University, France
| | - Kiran K Seunarine
- Developmental Imaging and Biophysics Section, UCL GOS Institute of Child Health, London
| | - Chris A Clark
- Developmental Imaging and Biophysics Section, UCL GOS Institute of Child Health, London
| | - Fan Zhang
- Brigham & Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Nikos Makris
- Brigham & Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Alexandra Golby
- Brigham & Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Yogesh Rathi
- Brigham & Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Lauren J O'Donnell
- Brigham & Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Yihao Xia
- University of Southern California, Keck School of Medicine, Neuroimaging and Informatics Institute, Los Angeles, California, United States
| | - Dogu Baran Aydogan
- Department of Neuroscience and Biomedical Engineering, Aalto University School of Science, Espoo, Finland
| | - Yonggang Shi
- University of Southern California, Keck School of Medicine, Neuroimaging and Informatics Institute, Los Angeles, California, United States
| | | | - Mathijs Raemaekers
- UMC Utrecht Brain Center, Department of Neurology&Neurosurgery, Utrecht, the Netherlands
| | - Shaun Warrington
- Sir Peter Mansfield Imaging Centre, School of Medicine, University of Nottingham, UK
| | - Stijn Michielse
- Department of Neurosurgery, School for Mental Health and Neuroscience, Maastricht University
| | | | - Luis Concha
- Universidad Nacional Autonoma de Mexico, Institute of Neurobiology, Mexico City, Mexico
| | - Ramón Aranda
- Centro de Investigación Científica y de Educación Superior de Ensenada (CICESE-UT3), Cátedras-CONACyT, Ensenada, Mexico
| | | | | | - Lucas Roitman
- Department of Psychology, Stanford University, Stanford, California, USA
| | - Lucius S Fekonja
- Department of Neurosurgery, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Navona Calarco
- Kimel Family Translational Imaging-Genetics Laboratory, Research Imaging Centre, Centre for Addiction and Mental Health, Toronto, Ontario
| | - Michael Joseph
- Kimel Family Translational Imaging-Genetics Laboratory, Research Imaging Centre, Centre for Addiction and Mental Health, Toronto, Ontario
| | - Hajer Nakua
- Kimel Family Translational Imaging-Genetics Laboratory, Research Imaging Centre, Centre for Addiction and Mental Health, Toronto, Ontario
| | - Aristotle N Voineskos
- Kimel Family Translational Imaging-Genetics Laboratory, Research Imaging Centre, Centre for Addiction and Mental Health, Toronto, Ontario
| | | | | | | | | | - Veena A Nair
- University of Wisconsin-Madison, Madison, WI, USA
| | | | | | - Koji Kamagata
- Department of Radiology, Juntendo University Graduate School of Medicine, Tokyo Japan
| | - Yuya Saito
- Department of Radiology, Juntendo University Graduate School of Medicine, Tokyo Japan
| | - Wataru Uchida
- Department of Radiology, Juntendo University Graduate School of Medicine, Tokyo Japan
| | - Christina Andica
- Department of Radiology, Juntendo University Graduate School of Medicine, Tokyo Japan
| | - Masahiro Abe
- Department of Radiology, Juntendo University Graduate School of Medicine, Tokyo Japan
| | - Roza G Bayrak
- Department of Electrical Engineering and Computer Science, Vanderbilt University, Nashville, TN, United States
| | - Claudia A M Gandini Wheeler-Kingshott
- NMR Research Unit, Queen Square MS Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, United Kingdom
| | - Egidio D'Angelo
- Department of Brain and Behavioral Sciences, University of Pavia, Italy
| | - Fulvia Palesi
- Department of Brain and Behavioral Sciences, University of Pavia, Italy
| | - Giovanni Savini
- Brain MRI 3T Research Center, IRCCS Mondino Foundation, Pavia, Italy
| | - Nicolò Rolandi
- Department of Brain and Behavioral Sciences, University of Pavia, Italy
| | - Pamela Guevara
- Universidad de Concepción, Faculty of Engineering, Concepción, Chile
| | - Josselin Houenou
- Université Paris-Saclay, CEA, CNRS, Neurospin, Gif-sur-Yvette, France
| | | | | | - Cyril Poupon
- Université Paris-Saclay, CEA, CNRS, Neurospin, Gif-sur-Yvette, France
| | - Claudio Román
- Universidad de Concepción, Faculty of Engineering, Concepción, Chile
| | - Andrea Vázquez
- Universidad de Concepción, Faculty of Engineering, Concepción, Chile
| | - Chiara Maffei
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Mavilde Arantes
- Department of Biomedicine, Unit of Anatomy, Faculty of Medicine of the University of Porto, Al. Professor Hernâni Monteiro, Porto, Portugal
| | - José Paulo Andrade
- Department of Biomedicine, Unit of Anatomy, Faculty of Medicine of the University of Porto, Al. Professor Hernâni Monteiro, Porto, Portugal
| | - Susana Maria Silva
- Department of Biomedicine, Unit of Anatomy, Faculty of Medicine of the University of Porto, Al. Professor Hernâni Monteiro, Porto, Portugal
| | - Vince D Calhoun
- Tri-institutional Center for Translational Research in Neuroimaging and Data Science (TReNDS), Georgia State University, Georgia Institute of Technology, Emory University, Atlanta, GA 30303, United States
| | - Eduardo Caverzasi
- Neurology Department UCSF Weill Institute for Neurosciences, University of California, San Francisco
| | - Simone Sacco
- Neurology Department UCSF Weill Institute for Neurosciences, University of California, San Francisco
| | - Michael Lauricella
- Memory and Aging Center. UCSF Weill Institute for Neurosciences, University of California, San Francisco, USA
| | - Franco Pestilli
- Department of Psychology, The University of Texas at Austin, TX 78731, USA
| | - Daniel Bullock
- Department of Psychology, The University of Texas at Austin, TX 78731, USA
| | - Yang Zhan
- Brain Cognition and Brain Disease Institute, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, 518055, China
| | - Edith Brignoni-Perez
- Developmental-Behavioral Pediatrics Division, Department of Pediatrics, Stanford School of Medicine, Stanford, CA, United States
| | - Catherine Lebel
- Department of Radiology, University of Calgary, 2500 University Drive NW, Calgary, AB, Canada, T2N 1N4
| | - Jess E Reynolds
- Department of Radiology, University of Calgary, 2500 University Drive NW, Calgary, AB, Canada, T2N 1N4
| | - Igor Nestrasil
- Division of Clinical Behavioral Neuroscience, Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA
| | - René Labounek
- Division of Clinical Behavioral Neuroscience, Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA
| | - Christophe Lenglet
- Center for Magnetic Resonance Research, Department of Radiology, University of Minnesota, Minneapolis, MN, USA
| | - Amy Paulson
- Division of Clinical Behavioral Neuroscience, Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA
| | - Stefania Aulicka
- Department of Paediatric Neurology, University Hospital and Medicine Faculty, Masaryk University, Brno, Czech Republic
| | | | - Katja Heuer
- Center for Research and Interdisciplinarity (CRI), INSERM U1284, Université de Paris, Paris, France
| | - Bramsh Qamar Chandio
- Department of Intelligent Systems Engineering, Indiana University, Bloomington, IN, USA
| | - Javier Guaje
- Department of Intelligent Systems Engineering, Indiana University, Bloomington, IN, USA
| | - Wei Tang
- Department of Computer Science, Indiana University, Bloomington, IN, USA
| | | | - Rajikha Raja
- University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Adam W Anderson
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Bennett A Landman
- Department of Electrical Engineering and Computer Science, Vanderbilt University, Nashville, TN, United States
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Vijayakumari AA, Parker D, Osmanlioglu Y, Alappatt JA, Whyte J, Diaz-Arrastia R, Kim JJ, Verma R. Free Water Volume Fraction: An Imaging Biomarker to Characterize Moderate-to-Severe Traumatic Brain Injury. J Neurotrauma 2021; 38:2698-2705. [PMID: 33913750 PMCID: PMC8590145 DOI: 10.1089/neu.2021.0057] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Traumatic brain injury (TBI) is a major clinical and public health problem with few therapeutic interventions successfully translated to the clinic. Identifying imaging-based biomarkers characterizing injury severity and predicting long-term functional and cognitive outcomes in TBI patients is crucial for treatment. TBI results in white matter (WM) injuries, which can be detected using diffusion tensor imaging (DTI). Trauma-induced pathologies lead to accumulation of free water (FW) in brain tissue, and standard DTI is susceptible to the confounding effects of FW. In this study, we applied FW DTI to estimate free water volume fraction (FW-VF) in patients with moderate-to-severe TBI and demonstrated its association with injury severity and long-term outcomes. DTI scans and neuropsychological assessments were obtained longitudinally at 3, 6, and 12 months post-injury for 34 patients and once in 35 matched healthy controls. We observed significantly elevated FW-VF in 85 of 90 WM regions in patients compared to healthy controls (p < 0.05). We then presented a patient-specific summary score of WM regions derived using Mahalanobis distance. We observed that MVF at 3 months significantly predicted functional outcome (p = 0.008), executive function (p = 0.005), and processing speed (p = 0.01) measured at 12 months and was significantly correlated with injury severity (p < 0.001). Our findings are an important step toward implementing MVF as a biomarker for personalized therapy and rehabilitation planning for TBI patients.
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Affiliation(s)
- Anupa Ambili Vijayakumari
- DiCIPHR (Diffusion and Connectomics in Precision Healthcare Research) Lab, Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Drew Parker
- DiCIPHR (Diffusion and Connectomics in Precision Healthcare Research) Lab, Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Yusuf Osmanlioglu
- DiCIPHR (Diffusion and Connectomics in Precision Healthcare Research) Lab, Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jacob A. Alappatt
- DiCIPHR (Diffusion and Connectomics in Precision Healthcare Research) Lab, Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - John Whyte
- Moss Rehabilitation Research Institute, TBI Rehabilitation Research Laboratory, Einstein Medical Center Elkins Park, Philadelphia, Pennsylvania, USA
| | - Ramon Diaz-Arrastia
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Center for Brain Injury and Repair, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Junghoon J. Kim
- Department of Molecular, Cellular, and Biomedical Sciences, CUNY School of Medicine, The City College of New York, New York, New York, USA
| | - Ragini Verma
- DiCIPHR (Diffusion and Connectomics in Precision Healthcare Research) Lab, Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Center for Brain Injury and Repair, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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18
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Samani ZR, Parker D, Wolf R, Hodges W, Brem S, Verma R. Distinct tumor signatures using deep learning-based characterization of the peritumoral microenvironment in glioblastomas and brain metastases. Sci Rep 2021; 11:14469. [PMID: 34262079 PMCID: PMC8280204 DOI: 10.1038/s41598-021-93804-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 06/30/2021] [Indexed: 11/25/2022] Open
Abstract
Tumor types are classically distinguished based on biopsies of the tumor itself, as well as a radiological interpretation using diverse MRI modalities. In the current study, the overarching goal is to demonstrate that primary (glioblastomas) and secondary (brain metastases) malignancies can be differentiated based on the microstructure of the peritumoral region. This is achieved by exploiting the extracellular water differences between vasogenic edema and infiltrative tissue and training a convolutional neural network (CNN) on the Diffusion Tensor Imaging (DTI)-derived free water volume fraction. We obtained 85% accuracy in discriminating extracellular water differences between local patches in the peritumoral area of 66 glioblastomas and 40 metastatic patients in a cross-validation setting. On an independent test cohort consisting of 20 glioblastomas and 10 metastases, we got 93% accuracy in discriminating metastases from glioblastomas using majority voting on patches. This level of accuracy surpasses CNNs trained on other conventional DTI-based measures such as fractional anisotropy (FA) and mean diffusivity (MD), that have been used in other studies. Additionally, the CNN captures the peritumoral heterogeneity better than conventional texture features, including Gabor and radiomic features. Our results demonstrate that the extracellular water content of the peritumoral tissue, as captured by the free water volume fraction, is best able to characterize the differences between infiltrative and vasogenic peritumoral regions, paving the way for its use in classifying and benchmarking peritumoral tissue with varying degrees of infiltration.
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Affiliation(s)
- Zahra Riahi Samani
- Diffusion and Connectomics in Precision Healthcare Research Lab (DiCIPHR), Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA
| | - Drew Parker
- Diffusion and Connectomics in Precision Healthcare Research Lab (DiCIPHR), Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA
| | - Ronald Wolf
- Department of Radiology, Department of Neurosurgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Wes Hodges
- Founder at Synaptive Medical, Toronto, ON, Canada
| | - Steven Brem
- Department of Radiology, Department of Neurosurgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Ragini Verma
- Diffusion and Connectomics in Precision Healthcare Research Lab (DiCIPHR), Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA.
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19
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Henderson F, Parker D, Vijayakumari AA, Elliott M, Lucas T, McGarvey ML, Karpf L, Desiderio L, Harsch J, Levy S, Maloney-Wilensky E, Wolf RL, Hodges WB, Brem S, Verma R. Enhanced Fiber Tractography Using Edema Correction: Application and Evaluation in High-Grade Gliomas. Neurosurgery 2021; 89:246-256. [PMID: 33913502 DOI: 10.1093/neuros/nyab129] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 02/14/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND A limitation of diffusion tensor imaging (DTI)-based tractography is peritumoral edema that confounds traditional diffusion-based magnetic resonance metrics. OBJECTIVE To augment fiber-tracking through peritumoral regions by performing novel edema correction on clinically feasible DTI acquisitions and assess the accuracy of the fiber-tracks using intraoperative stimulation mapping (ISM), task-based functional magnetic resonance imaging (fMRI) activation maps, and postoperative follow-up as reference standards. METHODS Edema correction, using our bi-compartment free water modeling algorithm (FERNET), was performed on clinically acquired DTI data from a cohort of 10 patients presenting with suspected high-grade glioma and peritumoral edema in proximity to and/or infiltrating language or motor pathways. Deterministic fiber-tracking was then performed on the corrected and uncorrected DTI to identify tracts pertaining to the eloquent region involved (language or motor). Tracking results were compared visually and quantitatively using mean fiber count, voxel count, and mean fiber length. The tracts through the edematous region were verified based on overlay with the corresponding motor or language task-based fMRI activation maps and intraoperative ISM points, as well as at time points after surgery when peritumoral edema had subsided. RESULTS Volume and number of fibers increased with application of edema correction; concordantly, mean fractional anisotropy decreased. Overlay with functional activation maps and ISM-verified eloquence of the increased fibers. Comparison with postsurgical follow-up scans with lower edema further confirmed the accuracy of the tracts. CONCLUSION This method of edema correction can be applied to standard clinical DTI to improve visualization of motor and language tracts in patients with glioma-associated peritumoral edema.
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Affiliation(s)
- Fraser Henderson
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Department of Neurosurgery, The Medical University of South Carolina, Charleston, South Carolina, USA
| | - Drew Parker
- DiCIPHR (Diffusion and Connectomics in Precision Healthcare Research) Lab, Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Anupa A Vijayakumari
- DiCIPHR (Diffusion and Connectomics in Precision Healthcare Research) Lab, Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Mark Elliott
- Center for Magnetic Resonance and Optical Imaging, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Timothy Lucas
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Michael L McGarvey
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Lauren Karpf
- Neuroradiology Clinical Research Division, Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Lisa Desiderio
- Neuroradiology Clinical Research Division, Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jessica Harsch
- Neurosurgery Clinical Research Division, Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Scott Levy
- Neurosurgery Clinical Research Division, Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Eileen Maloney-Wilensky
- Neurosurgery Clinical Research Division, Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ronald L Wolf
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | - Steven Brem
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ragini Verma
- DiCIPHR (Diffusion and Connectomics in Precision Healthcare Research) Lab, Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Departments of Neurosurgery and Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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20
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Agusto M, Salman A, Parker D, Choi D, Schincaglia GP. Root Coverage Predictability in the Treatment of Gingival Recessions on Mandibular Anterior Teeth. JDR Clin Trans Res 2021; 7:224-233. [PMID: 33899565 DOI: 10.1177/23800844211009437] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION Mandibular anterior teeth are most frequently affected by gingival recession. However, data regarding mucogingival treatment aimed at root coverage in this specific location are limited. OBJECTIVE The purpose of this study was to systematically review the scientific literature and to use the meta-analytic approach to address the following focused question: "What is the effectiveness of different surgical approaches on clinical and patient-related outcomes in the treatment of buccal gingival recessions on mandibular anterior teeth?" METHODS Studies were located by searching 3 electronic databases (Medline, Scopus, and Cochrane databases) and cross-referencing. Randomized and nonrandomized studies including at least 1 arm involving the use of pedicle flaps and/or free soft tissue grafts in the treatment of gingival recessions (recession type [RT] 1 and RT2) located on the buccal aspects of mandibular centrals, laterals and canines, were included in the analysis. Primary outcome was mean root coverage (mRC), expressed in percentage, based on a 3- to 12-mo follow-up observation. A Bayesian single-arm network meta-analysis was performed to identify a treatment hierarchy of the different surgical techniques. RESULTS Sixteen studies, with a total of 23 arms, were included in the quantitative analysis. The greatest mRC is associated with laterally positioned flap (LPF) + connective tissue graft (CTG) (91.2%) and tunnel (TUN) + CTG (89.4%), whereas LPF alone, coronally advanced flap (CAF) + CTG, and free gingival graft (FGG) showed lower mRC (79.1%, 78.9%, and 68.5% respectively). TUN + CTG provides significantly greater mRC compared to CAF+CTG. No difference among the procedures could be observed in terms of keratinized tissue width gain. CONCLUSIONS Treatment hierarchy generated by an arm-based network meta-analysis model suggested that tunnel and laterally positioned flap, both in combination with connective tissue graft, may provide the greatest mean root coverage in the treatment of mandibular anterior recessions. KNOWLEDGE TRANSFER STATEMENT The results of the present systematic review can be used by clinicians when deciding which approach to adopt when treating buccal gingival recessions on mandibular anterior teeth. In particular, procedures based on a laterally positioned flap or a tunneling technique, both in combination with connective tissue graft, seem to be the most predictable therapeutic decision.
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Affiliation(s)
- M Agusto
- Department of Periodontics, School of Dentistry, West Virginia University, Morgantown, WV, USA
| | - A Salman
- Department of Periodontics, School of Dentistry, West Virginia University, Morgantown, WV, USA
| | - D Parker
- Division of Population Health Sciences, University of Alaska Anchorage, Anchorage, AK, USA
| | - D Choi
- Department of Periodontics, School of Dentistry, West Virginia University, Morgantown, WV, USA
| | - G P Schincaglia
- Department of Periodontics, School of Dentistry, West Virginia University, Morgantown, WV, USA.,School of Dentistry, University of Ferrara, Ferrara, Italy
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21
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Henderson F, Parker D, Wolf R, Hodges W, Elliott M, Lucas T, McGarvey M, Vijayakumari A, Harsch J, Maloney-Wilensky E, Brem S, Verma R. Enhanced Fiber Tractography in Glioblastoma Using a Novel Edema Correction Algorithm Correlated With Direct Intraoperative Electrical Stimulation and fMRI. Neurosurgery 2020. [DOI: 10.1093/neuros/nyaa447_802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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22
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Samani ZR, Parker D, Alappatt JA, Brem S, Verma R. NIMG-21. DIFFERENTIATING TUMOR TYPES BASED ON THE PERITUMORAL MICROENVIRONMENT USING CONVOLUTIONAL NEURAL NETWORKS. Neuro Oncol 2020. [DOI: 10.1093/neuonc/noaa215.634] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
PURPOSE
The differential diagnosis of glioblastoma (GBM) versus single brain metastasis (Met) is clinically important, and is undertaken with a clinical reading of MR images and/or tumor biopsy. We investigate whether Mets and GBMs can be differentiated based on the microstructure of the FLAIR-hyperintense peritumoral region measured by diffusion tensor imaging (DTI). We hypothesize that the peritumoral microstructure differs in extracellular water content, based on whether it is vasogenic edema or infiltrative. We use deep learning trained on DTI-based free-water volume fraction maps to discriminate between the peritumoral regions of Met and GBM neoplasms. Our results are also compared with mean diffusivity (MD), the most commonly used DTI metric.
METHOD
dMRI data of 143 patients with brain tumors (89 glioblastomas and 54 metastases, ages 19-87 years, 77 females and 66 males) were included. Free-water volume fraction maps were computed for the peritumoral regions (demarcated automatically). We developed a 7-layer convolutional neural network (CNN) architecture to distinguish microstructural patterns of Met and GBM tumors using 32 x 32 mm patches placed at random in the peritumoral area. The CNN was trained on patches from a training set of 113 patients and tested on the remaining 30 patients, where majority voting was applied to predict the tumor type for each patient. Although MD has been previously used in both tumor and peritumoral area for discriminating tumor type, we replicated the same process with MD only in the peritumoral area to provide a stronger comparison.
RESULT
We predicted tumor type with 93% accuracy, outperforming MD with 84% accuracy.
CONCLUSION
Our results demonstrate that deep learning with CNN on DTI-based free-water volume fraction map can be a promising tool for automatic distinction of tumor types, and has potential as a tumor biomarker.
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Affiliation(s)
| | - Drew Parker
- University of Pennsylvania, Philadelphia, PA, USA
| | | | - Steven Brem
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Ragini Verma
- University of Pennsylvania, Philadelphia, PA, USA
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23
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Osmanlioglu Y, Parker D, Brem S, Shokoufandeh A, Verma R. NIMG-69. PERSONALIZED CONNECTOMIC SIGNATURES: BRIDGING THE GAP BETWEEN NEURO-ONCOLOGY AND CONNECTOMICS. Neuro Oncol 2020. [DOI: 10.1093/neuonc/noaa215.682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
PURPOSE
Connectomics has led to significant neuroscientific findings within the last two decades, eventually making impact in the clinics. Neuro-oncology can benefit immensely from connectomics in evaluating structural connectivity of brains with tumor for pre- and post-treatment planning, as a tumor connectome along with derived network measures will make it possible to determine the cognitive effects of treatment and quantify the effect of surgery on quality of life. However, generating connectomes in the presence of tumor is a challenging task. Specifically, registration of an atlas to the brain, which is essential in parcellating the brain into regions of interest, fails around the tumor due to mass effect and infiltration related distortions which are not present in the atlas that comes from a healthy brain. We aim to tackle this problem by introducing a novel atlas registration method.
METHOD
Although tumor deforms the geometrical shape of its surrounding regions, it does not violate the connectivity of displaced cortical voxels to the rest of the brain. Leveraging this fact, we represent the brain as an annotated graph with nodes representing ROIs encoding geometric features of regions and weighted edges representing the connectivity between regions. In encoding the surroundings of the tumor into the graph, we subsample the region into smaller patches to represent the area with multiple nodes. We then calculate many-to-one graph matching between the graphs of a tumor patient and a healthy control to associate surroundings of tumor with healthy ROIs.
OUTCOME
A tumor connectome showing how the connectivity is morphed around the tumor, which can further be extended to creating connectomes of recurrence. CLINICAL
IMPLICATIONS
Use of connectomes can revolutionize neuro-oncology by helping surgeons in estimating structural, functional, and behavioral outcomes of resection prior to surgery and in predicting recovery after the surgery, potentially suggesting subject specific treatment plans.
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Affiliation(s)
| | - Drew Parker
- University of Pennsylvania, Philadelphia, PA, USA
| | - Steven Brem
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | | | - Ragini Verma
- University of Pennsylvania, Philadelphia, PA, USA
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24
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Frigo M, Deslauriers-Gauthier S, Parker D, Ould Ismail AA, Kim JJ, Verma R, Deriche R. Diffusion MRI tractography filtering techniques change the topology of structural connectomes. J Neural Eng 2020; 17. [PMID: 33075758 DOI: 10.1088/1741-2552/abc29b] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Accepted: 10/19/2020] [Indexed: 12/21/2022]
Abstract
OBJECTIVE The use of non-invasive techniques for the estimation of structural brain networks (i.e. connectomes) opened the door to large-scale investigations on the functioning and the architecture of the brain, unveiling the link between neurological disorders and topological changes of the brain network. This study aims at assessing if and how the topology of structural connectomes estimated non-invasively with diffusion MRI is affected by the employment of tractography filtering techniques in structural connectomic pipelines. Additionally, this work investigates the robustness of topological descriptors of filtered connectomes to the common practice of density-based thresholding. APPROACH We investigate the changes in global efficiency, characteristic path length, modularity and clustering coefficient on filtered connectomes obtained with the spherical deconvolution informed filtering of tractograms and using the convex optimization modelling for microstructure informed tractography. The analysis is performed on both healthy subjects and patients affected by traumatic brain injury and with an assessment of the robustness of the computed graph-theoretical measures with respect to density-based thresholding of the connectome. MAIN RESULT Our results demonstrate that tractography filtering techniques change the topology of brain networks, and thus alter network metrics both in the pathological and the healthy cases. Moreover, the measures are shown to be robust to density-based thresholding. SIGNIFICANCE The present work highlights how the inclusion of tractography filtering techniques in connectomic pipelines requires extra caution as they systematically change the network topology both in healthy subjects and patients affected by traumatic brain injury. Finally, the practice of low-to-moderate density-based thresholding of the connectomes is confirmed to have negligible effects on the topological analysis.
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Affiliation(s)
- Matteo Frigo
- Athena Project Team, Université Cote D'Azur, Inria Sophia Antipolis Mediterranean Research Centre, Sophia Antipolis, FRANCE
| | - Samuel Deslauriers-Gauthier
- Athena Project Team, Université Cote D'Azur, Inria Sophia Antipolis Mediterranean Research Centre, Sophia Antipolis, FRANCE
| | - Drew Parker
- Penn Applied Connectomics and Imaging Group, Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania, UNITED STATES
| | - Abdol Aziz Ould Ismail
- Penn Applied Connectomics and Imaging Group, Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania, UNITED STATES
| | - Junghoon John Kim
- Department of Molecular, Cellular, and Biomedical Sciences, CUNY School of Medicine, New York, New York, UNITED STATES
| | - Ragini Verma
- Penn Applied Connectomics and Imaging Group, Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania, UNITED STATES
| | - Rachid Deriche
- Athena Project Team, Université Cote D'Azur, Inria Sophia Antipolis Mediterranean Research Centre, Sophia Antipolis, FRANCE
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Shen RS, Alappatt JA, Parker D, Kim J, Verma R, Osmanlıoğlu Y. Graph Matching Based Connectomic Biomarker with Learning for Brain Disorders. Uncertain Safe Util Mach Learn Med Imaging Graph Biomed Image Anal (2020) 2020; 12443:131-141. [PMID: 34350428 PMCID: PMC8329857 DOI: 10.1007/978-3-030-60365-6_13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
Advances in neuroimaging techniques such as diffusion MRI and functional MRI enabled evaluation of the brain as an information processing network that is called connectome. Connectomic analysis has led to numerous findings on the organization of the brain its pathological changes with diseases, providing imaging-based biomarkers that help in diagnosis and prognosis. A large majority of connectomic biomarkers benefit either from graph-theoretical measures that evaluate brain's network structure, or use standard metrics such as Euclidean distance or Pearson's correlation to show between-connectomes relations. However, such methods are limited in diagnostic evaluation of diseases, because they do not simultaneously measure the difference between individual connectomes, incorporate disease-specific patterns, and utilize network structure information. To address these limitations, we propose a graph matching based method to quantify connectomic similarity, which can be trained for diseases at functional systems level to provide a subject-specific biomarker assessing the disease. We validate our measure on a dataset of patients with traumatic brain injury and demonstrate that our measure achieves better separation between patients and controls compared to commonly used connectomic similarity measures. We further evaluate the vulnerability of the functional systems to the disease by utilizing the parameter tuning aspect of our method. We finally show that our similarity score correlates with clinical scores, highlighting its potential as a subject-specific biomarker for the disease.
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Affiliation(s)
- Rui Sherry Shen
- Diffusion and Connectomics in Precision Healthcare Research Lab, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
| | - Jacob A Alappatt
- Diffusion and Connectomics in Precision Healthcare Research Lab, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
| | - Drew Parker
- Diffusion and Connectomics in Precision Healthcare Research Lab, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
| | - Junghoon Kim
- Department of Molecular, Cellular, and Biomedical Sciences, CUNY School of Medicine, City College of New York, New York City, USA
| | - Ragini Verma
- Diffusion and Connectomics in Precision Healthcare Research Lab, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
| | - Yusuf Osmanlıoğlu
- Diffusion and Connectomics in Precision Healthcare Research Lab, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
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Abstract
OBJECTIVE Connectomics, the study of brain connectivity, has become an indispensable tool in neuroscientific research as it provides insights into brain organization. Connectomes are generated using different modalities such as diffusion MRI to capture structural organization of the brain or functional MRI to elaborate brain's functional organization. Understanding links between structural and functional organizations is crucial in explaining how observed behavior emerges from the underlying neurobiological mechanisms. Many studies have investigated how these two organizations relate to each other; however, we still lack a comparative understanding on how much variation should be expected in the two modalities, both between people and within a single person across scans. APPROACH In this study, we systematically analyzed the consistency of connectomes, that is the similarity between connectomes in terms of individual connections between brain regions and in terms of overall network topology. We present a comprehensive study of consistency in connectomes for a single subject examined longitudinally and across a large cohort of subjects cross-sectionally, in structure and function separately. Within structural connectomes, we compared connectomes generated by different tracking algorithms, parcellations, edge weighting schemes, and edge pruning techniques. In functional connectomes, we compared full, positive, and negative connectivity separately along with thresholding of weak edges. We evaluated consistency using correlation (incorporating information at the level of individual edges) and graph matching accuracy (evaluating connectivity at the level of network topology). We also examined the consistency of connectomes that are generated using different communication schemes. MAIN RESULTS Our results demonstrate varying degrees of consistency for the two modalities, with structural connectomes showing higher consistency than functional connectomes. Moreover, we observed a wide variation in consistency depending on how connectomes are generated. SIGNIFICANCE Our study sets a reference point for consistency of connectome types, which is especially important for structure-function coupling studies in evaluating mismatches between modalities.
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Affiliation(s)
- Yusuf Osmanlıoğlu
- Diffusion and Connectomics in Precision Healthcare Research Lab, Department of Radiology, University of Pennsylvania, Philadelphia, United States of America
| | - Jacob A Alappatt
- Diffusion and Connectomics in Precision Healthcare Research Lab, Department of Radiology, University of Pennsylvania, Philadelphia, United States of America
| | - Drew Parker
- Diffusion and Connectomics in Precision Healthcare Research Lab, Department of Radiology, University of Pennsylvania, Philadelphia, United States of America
| | - Ragini Verma
- Diffusion and Connectomics in Precision Healthcare Research Lab, Department of Radiology, University of Pennsylvania, Philadelphia, United States of America
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Parker D, Ould Ismail AA, Wolf R, Brem S, Alexander S, Hodges W, Pasternak O, Caruyer E, Verma R. Freewater estimatoR using iNtErpolated iniTialization (FERNET): Characterizing peritumoral edema using clinically feasible diffusion MRI data. PLoS One 2020; 15:e0233645. [PMID: 32469944 PMCID: PMC7259683 DOI: 10.1371/journal.pone.0233645] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 05/10/2020] [Indexed: 12/19/2022] Open
Abstract
Characterization of healthy versus pathological tissue in the peritumoral area is confounded by the presence of edema, making free water estimation the key concern in modeling tissue microstructure. Most methods that model tissue microstructure are either based on advanced acquisition schemes not readily available in the clinic or are not designed to address the challenge of edema. This underscores the need for a robust free water elimination (FWE) method that estimates free water in pathological tissue but can be used with clinically prevalent single-shell diffusion tensor imaging data. FWE in single-shell data requires the fitting of a bi-compartment model, which is an ill-posed problem. Its solution requires optimization, which relies on an initialization step. We propose a novel initialization approach for FWE, FERNET, which improves the estimation of free water in edematous and infiltrated peritumoral regions, using single-shell diffusion MRI data. The method has been extensively investigated on simulated data and healthy dataset. Additionally, it has been applied to clinically acquired data from brain tumor patients to characterize the peritumoral region and improve tractography in it.
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Affiliation(s)
- Drew Parker
- DiCIPHR (Diffusion and Connectomics in Precision Healthcare Research) Lab, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States of America
- Center for Biomedical Image Computing and Analytics (CBICA), Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States of America
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States of America
| | - Abdol Aziz Ould Ismail
- DiCIPHR (Diffusion and Connectomics in Precision Healthcare Research) Lab, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States of America
- Center for Biomedical Image Computing and Analytics (CBICA), Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States of America
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States of America
| | - Ronald Wolf
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States of America
| | - Steven Brem
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States of America
| | | | - Wes Hodges
- Synaptive Medical Inc., Toronto, ON, Canada
| | - Ofer Pasternak
- Departments of Psychiatry & Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States of America
| | | | - Ragini Verma
- DiCIPHR (Diffusion and Connectomics in Precision Healthcare Research) Lab, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States of America
- Center for Biomedical Image Computing and Analytics (CBICA), Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States of America
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States of America
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States of America
- * E-mail: ,
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Osmanlıoğlu Y, Alappatt JA, Parker D, Verma R. Analysis of Consistency in Structural and Functional Connectivity of Human Brain. Proc IEEE Int Symp Biomed Imaging 2020; 2020:1694-1697. [PMID: 33324470 PMCID: PMC7734450 DOI: 10.1109/isbi45749.2020.9098412] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Analysis of structural and functional connectivity of brain has become a fundamental approach in neuroscientific research. Despite several studies reporting consistent similarities as well as differences for structural and resting state (rs) functional connectomes, a comparative investigation of connectomic consistency between the two modalities is still lacking. Nonetheless, connectomic analysis comprising both connectivity types necessitate extra attention as consistency of connectivity differs across modalities, possibly affecting the interpretation of the results. In this study, we present a comprehensive analysis of consistency in structural and rs-functional connectomes obtained from longitudinal diffusion MRI and rs-fMRI data of a single healthy subject. We contrast consistency of deterministic and probabilistic tracking with that of full, positive, and negative functional connectivities across various connectome generation schemes, using correlation as a measure of consistency.
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Affiliation(s)
- Yusuf Osmanlıoğlu
- Diffusion and Connectomics in Precision Healthcare Research Lab, Department of Radiology, University of Pennsylvania, Philadelphia, USA
| | - Jacob A Alappatt
- Diffusion and Connectomics in Precision Healthcare Research Lab, Department of Radiology, University of Pennsylvania, Philadelphia, USA
| | - Drew Parker
- Diffusion and Connectomics in Precision Healthcare Research Lab, Department of Radiology, University of Pennsylvania, Philadelphia, USA
| | - Ragini Verma
- Diffusion and Connectomics in Precision Healthcare Research Lab, Department of Radiology, University of Pennsylvania, Philadelphia, USA
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Shinohara RT, Shou H, Carone M, Schultz R, Tunc B, Parker D, Martin ML, Verma R. Distance-based analysis of variance for brain connectivity. Biometrics 2020; 76:257-269. [PMID: 31350904 PMCID: PMC7653688 DOI: 10.1111/biom.13123] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 07/12/2019] [Indexed: 01/07/2023]
Abstract
The field of neuroimaging dedicated to mapping connections in the brain is increasingly being recognized as key for understanding neurodevelopment and pathology. Networks of these connections are quantitatively represented using complex structures, including matrices, functions, and graphs, which require specialized statistical techniques for estimation and inference about developmental and disorder-related changes. Unfortunately, classical statistical testing procedures are not well suited to high-dimensional testing problems. In the context of global or regional tests for differences in neuroimaging data, traditional analysis of variance (ANOVA) is not directly applicable without first summarizing the data into univariate or low-dimensional features, a process that might mask the salient features of high-dimensional distributions. In this work, we consider a general framework for two-sample testing of complex structures by studying generalized within-group and between-group variances based on distances between complex and potentially high-dimensional observations. We derive an asymptotic approximation to the null distribution of the ANOVA test statistic, and conduct simulation studies with scalar and graph outcomes to study finite sample properties of the test. Finally, we apply our test to our motivating study of structural connectivity in autism spectrum disorder.
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Affiliation(s)
- Russell T. Shinohara
- Department of Biostatistics, Epidemiology, and Informatics, Penn Statistics in Imaging and Visualization Center, University of Pennsylvania, Philadelphia, Pennsylvania
- Department of Radiology, Center for Biomedical Image Computing and Analytics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Haochang Shou
- Department of Biostatistics, Epidemiology, and Informatics, Penn Statistics in Imaging and Visualization Center, University of Pennsylvania, Philadelphia, Pennsylvania
- Department of Radiology, Center for Biomedical Image Computing and Analytics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Marco Carone
- Department of Biostatistics, University of Washington, Seattle, Washington
| | - Robert Schultz
- Center for Autism Research, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Birkan Tunc
- Department of Radiology, Center for Biomedical Image Computing and Analytics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Drew Parker
- Department of Radiology, Center for Biomedical Image Computing and Analytics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Melissa Lynne Martin
- Department of Biostatistics, Epidemiology, and Informatics, Penn Statistics in Imaging and Visualization Center, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Ragini Verma
- Department of Radiology, Center for Biomedical Image Computing and Analytics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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Samani ZR, Alappatt JA, Parker D, Ismail AAO, Verma R. QC-Automator: Deep Learning-Based Automated Quality Control for Diffusion MR Images. Front Neurosci 2020; 13:1456. [PMID: 32038150 PMCID: PMC6987246 DOI: 10.3389/fnins.2019.01456] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Accepted: 12/31/2019] [Indexed: 12/04/2022] Open
Abstract
Quality assessment of diffusion MRI (dMRI) data is essential prior to any analysis, so that appropriate pre-processing can be used to improve data quality and ensure that the presence of MRI artifacts do not affect the results of subsequent image analysis. Manual quality assessment of the data is subjective, possibly error-prone, and infeasible, especially considering the growing number of consortium-like studies, underlining the need for automation of the process. In this paper, we have developed a deep-learning-based automated quality control (QC) tool, QC-Automator, for dMRI data, that can handle a variety of artifacts such as motion, multiband interleaving, ghosting, susceptibility, herringbone, and chemical shifts. QC-Automator uses convolutional neural networks along with transfer learning to train the automated artifact detection on a labeled dataset of ∼332,000 slices of dMRI data, from 155 unique subjects and 5 scanners with different dMRI acquisitions, achieving a 98% accuracy in detecting artifacts. The method is fast and paves the way for efficient and effective artifact detection in large datasets. It is also demonstrated to be replicable on other datasets with different acquisition parameters.
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Affiliation(s)
- Zahra Riahi Samani
- Diffusion and Connectomics in Precision Healthcare Research Lab, Department of Radiology, University of Pennsylvania, Philadelphia, PA, United States
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Shen RS, Alappatt JA, Parker D, Kim J, Verma R, Osmanlıoğlu Y. Correction to: Graph Matching Based Connectomic Biomarker with Learning for Brain Disorders. Uncertainty for Safe Utilization of Machine Learning in Medical Imaging, and Graphs in Biomedical Image Analysis 2020. [PMCID: PMC7722458 DOI: 10.1007/978-3-030-60365-6_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Tunç B, Yankowitz LD, Parker D, Alappatt JA, Pandey J, Schultz RT, Verma R. Deviation from normative brain development is associated with symptom severity in autism spectrum disorder. Mol Autism 2019; 10:46. [PMID: 31867092 PMCID: PMC6907209 DOI: 10.1186/s13229-019-0301-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 11/29/2019] [Indexed: 12/13/2022] Open
Abstract
Background Autism spectrum disorder (ASD) is a heterogeneous neurodevelopmental condition. The degree to which the brain development in ASD deviates from typical brain development, and how this deviation relates to observed behavioral outcomes at the individual level are not well-studied. We hypothesize that the degree of deviation from typical brain development of an individual with ASD would relate to observed symptom severity. Methods The developmental changes in anatomical (cortical thickness, surface area, and volume) and diffusion metrics (fractional anisotropy and apparent diffusion coefficient) were compared between a sample of ASD (n = 247) and typically developing children (TDC) (n = 220) aged 6–25. Machine learning was used to predict age (brain age) from these metrics in the TDC sample, to define a normative model of brain development. This model was then used to compute brain age in the ASD sample. The difference between chronological age and brain age was considered a developmental deviation index (DDI), which was then correlated with ASD symptom severity. Results Machine learning model trained on all five metrics accurately predicted age in the TDC (r = 0.88) and the ASD (r = 0.85) samples, with dominant contributions to the model from the diffusion metrics. Within the ASD group, the DDI derived from fractional anisotropy was correlated with ASD symptom severity (r = − 0.2), such that individuals with the most advanced brain age showing the lowest severity, and individuals with the most delayed brain age showing the highest severity. Limitations This work investigated only linear relationships between five specific brain metrics and only one measure of ASD symptom severity in a limited age range. Reported effect sizes are moderate. Further work is needed to investigate developmental differences in other age ranges, other aspects of behavior, other neurobiological measures, and in an independent sample before results can be clinically applicable. Conclusions Findings demonstrate that the degree of deviation from typical brain development relates to ASD symptom severity, partially accounting for the observed heterogeneity in ASD. Our approach enables characterization of each individual with reference to normative brain development and identification of distinct developmental subtypes, facilitating a better understanding of developmental heterogeneity in ASD.
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Affiliation(s)
- Birkan Tunç
- 1Center for Autism Research, The Children's Hospital of Philadelphia, Philadelphia, PA 19104 USA.,2Department of Biomedical and Health Informatics, The Children's Hospital of Philadelphia, Philadelphia, PA 19104 USA.,3Department of Psychiatry, University of Pennsylvania, Philadelphia, PA 19104 USA.,4Center for Biomedical Image Computing and Analytics, University of Pennsylvania, Philadelphia, PA 19104 USA
| | - Lisa D Yankowitz
- 1Center for Autism Research, The Children's Hospital of Philadelphia, Philadelphia, PA 19104 USA.,5Department of Psychology, University of Pennsylvania, Philadelphia, PA 19104 USA
| | - Drew Parker
- 6DiCIPHR (Diffusion and Connectomics in Precision Healthcare Research) Lab, Department of Radiology, University of Pennsylvania, Philadelphia, PA 19104 USA
| | - Jacob A Alappatt
- 6DiCIPHR (Diffusion and Connectomics in Precision Healthcare Research) Lab, Department of Radiology, University of Pennsylvania, Philadelphia, PA 19104 USA
| | - Juhi Pandey
- 1Center for Autism Research, The Children's Hospital of Philadelphia, Philadelphia, PA 19104 USA.,3Department of Psychiatry, University of Pennsylvania, Philadelphia, PA 19104 USA
| | - Robert T Schultz
- 1Center for Autism Research, The Children's Hospital of Philadelphia, Philadelphia, PA 19104 USA.,3Department of Psychiatry, University of Pennsylvania, Philadelphia, PA 19104 USA.,7Department of Pediatrics, University of Pennsylvania, Philadelphia, PA 19104 USA
| | - Ragini Verma
- 4Center for Biomedical Image Computing and Analytics, University of Pennsylvania, Philadelphia, PA 19104 USA.,6DiCIPHR (Diffusion and Connectomics in Precision Healthcare Research) Lab, Department of Radiology, University of Pennsylvania, Philadelphia, PA 19104 USA
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Verma R, Swanson RL, Parker D, Ould Ismail AA, Shinohara RT, Alappatt JA, Doshi J, Davatzikos C, Gallaway M, Duda D, Chen HI, Kim JJ, Gur RC, Wolf RL, Grady MS, Hampton S, Diaz-Arrastia R, Smith DH. Neuroimaging Findings in US Government Personnel With Possible Exposure to Directional Phenomena in Havana, Cuba. JAMA 2019; 322:336-347. [PMID: 31334794 PMCID: PMC6652163 DOI: 10.1001/jama.2019.9269] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE United States government personnel experienced potential exposures to uncharacterized directional phenomena while serving in Havana, Cuba, from late 2016 through May 2018. The underlying neuroanatomical findings have not been described. OBJECTIVE To examine potential differences in brain tissue volume, microstructure, and functional connectivity in government personnel compared with individuals not exposed to directional phenomena. DESIGN, SETTING, AND PARTICIPANTS Forty government personnel (patients) who were potentially exposed and experienced neurological symptoms underwent evaluation at a US academic medical center from August 21, 2017, to June 8, 2018, including advanced structural and functional magnetic resonance imaging analytics. Findings were compared with imaging findings of 48 demographically similar healthy controls. EXPOSURES Potential exposure to uncharacterized directional phenomena of unknown etiology, manifesting as pressure, vibration, or sound. MAIN OUTCOMES AND MEASURES Potential imaging-based differences between patients and controls with regard to (1) white matter and gray matter total and regional brain volumes, (2) cerebellar tissue microstructure metrics (eg, mean diffusivity), and (3) functional connectivity in the visuospatial, auditory, and executive control subnetworks. RESULTS Imaging studies were completed for 40 patients (mean age, 40.4 years; 23 [57.5%] men; imaging performed a median of 188 [range, 4-403] days after initial exposure) and 48 controls (mean age, 37.6 years; 33 [68.8%] men). Mean whole brain white matter volume was significantly smaller in patients compared with controls (patients: 542.22 cm3; controls: 569.61 cm3; difference, -27.39 [95% CI, -37.93 to -16.84] cm3; P < .001), with no significant difference in the whole brain gray matter volume (patients: 698.55 cm3; controls: 691.83 cm3; difference, 6.72 [95% CI, -4.83 to 18.27] cm3; P = .25). Among patients compared with controls, there were significantly greater ventral diencephalon and cerebellar gray matter volumes and significantly smaller frontal, occipital, and parietal lobe white matter volumes; significantly lower mean diffusivity in the inferior vermis of the cerebellum (patients: 7.71 × 10-4 mm2/s; controls: 8.98 × 10-4 mm2/s; difference, -1.27 × 10-4 [95% CI, -1.93 × 10-4 to -6.17 × 10-5] mm2/s; P < .001); and significantly lower mean functional connectivity in the auditory subnetwork (patients: 0.45; controls: 0.61; difference, -0.16 [95% CI, -0.26 to -0.05]; P = .003) and visuospatial subnetwork (patients: 0.30; controls: 0.40; difference, -0.10 [95% CI, -0.16 to -0.04]; P = .002) but not in the executive control subnetwork (patients: 0.24; controls: 0.25; difference: -0.016 [95% CI, -0.04 to 0.01]; P = .23). CONCLUSIONS AND RELEVANCE Among US government personnel in Havana, Cuba, with potential exposure to directional phenomena, compared with healthy controls, advanced brain magnetic resonance imaging revealed significant differences in whole brain white matter volume, regional gray and white matter volumes, cerebellar tissue microstructural integrity, and functional connectivity in the auditory and visuospatial subnetworks but not in the executive control subnetwork. The clinical importance of these differences is uncertain and may require further study.
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Affiliation(s)
- Ragini Verma
- DiCIPHR (Diffusion and Connectomics in Precision Healthcare Research) Lab, Philadelphia, Pennsylvania
- Department of Radiology, University of Pennsylvania, Perelman School of Medicine, Philadelphia
- Department of Neurosurgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia
- Center for Biomedical Image Computing and Analytics, University of Pennsylvania, Philadelphia
- Center for Brain Injury and Repair, University of Pennsylvania, Philadelphia
| | - Randel L. Swanson
- Center for Brain Injury and Repair, University of Pennsylvania, Philadelphia
- Department of Physical Medicine and Rehabilitation, University of Pennsylvania, Perelman School of Medicine, Philadelphia
- Center for Neurotrauma, Neurodegeneration, and Restoration, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania
- Rehabilitation Medicine Service, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania
| | - Drew Parker
- DiCIPHR (Diffusion and Connectomics in Precision Healthcare Research) Lab, Philadelphia, Pennsylvania
- Department of Radiology, University of Pennsylvania, Perelman School of Medicine, Philadelphia
- Center for Biomedical Image Computing and Analytics, University of Pennsylvania, Philadelphia
| | - Abdol Aziz Ould Ismail
- DiCIPHR (Diffusion and Connectomics in Precision Healthcare Research) Lab, Philadelphia, Pennsylvania
- Department of Radiology, University of Pennsylvania, Perelman School of Medicine, Philadelphia
- Center for Biomedical Image Computing and Analytics, University of Pennsylvania, Philadelphia
| | - Russell T. Shinohara
- Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Perelman School of Medicine, Philadelphia
| | - Jacob A. Alappatt
- DiCIPHR (Diffusion and Connectomics in Precision Healthcare Research) Lab, Philadelphia, Pennsylvania
- Department of Radiology, University of Pennsylvania, Perelman School of Medicine, Philadelphia
- Center for Biomedical Image Computing and Analytics, University of Pennsylvania, Philadelphia
| | - Jimit Doshi
- Department of Radiology, University of Pennsylvania, Perelman School of Medicine, Philadelphia
- Center for Biomedical Image Computing and Analytics, University of Pennsylvania, Philadelphia
- Section for Biomedical Image Analysis, Department of Radiology, University of Pennsylvania, Philadelphia
| | - Christos Davatzikos
- Department of Radiology, University of Pennsylvania, Perelman School of Medicine, Philadelphia
- Center for Biomedical Image Computing and Analytics, University of Pennsylvania, Philadelphia
- Section for Biomedical Image Analysis, Department of Radiology, University of Pennsylvania, Philadelphia
| | - Michael Gallaway
- Department of Optometry, Salus University, Elkins Park, Pennsylvania
| | - Diana Duda
- Good Shepherd Penn Partners, University of Pennsylvania, Philadelphia
| | - H. Isaac Chen
- Department of Neurosurgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia
- Center for Neurotrauma, Neurodegeneration, and Restoration, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania
| | - Junghoon J. Kim
- Department of Molecular, Cellular, and Biomedical Sciences, CUNY School of Medicine, City College of New York, New York
| | - Ruben C. Gur
- Department of Psychiatry, University of Pennsylvania, Perelman School of Medicine, Philadelphia
| | - Ronald L. Wolf
- Department of Radiology, University of Pennsylvania, Perelman School of Medicine, Philadelphia
- Center for Brain Injury and Repair, University of Pennsylvania, Philadelphia
| | - M. Sean Grady
- Department of Neurosurgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia
- Center for Brain Injury and Repair, University of Pennsylvania, Philadelphia
| | - Stephen Hampton
- Center for Brain Injury and Repair, University of Pennsylvania, Philadelphia
- Department of Physical Medicine and Rehabilitation, University of Pennsylvania, Perelman School of Medicine, Philadelphia
| | - Ramon Diaz-Arrastia
- Center for Brain Injury and Repair, University of Pennsylvania, Philadelphia
- Department of Neurology, University of Pennsylvania, Perelman School of Medicine, Philadelphia
| | - Douglas H. Smith
- Department of Neurosurgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia
- Center for Brain Injury and Repair, University of Pennsylvania, Philadelphia
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34
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Xu X, Parker D, Inglis S. The Longitudinal Association Between Food Groups, Memory Loss and Comorbidity of Heart Disease in Older People: Results from the 45 and Up Study. Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.06.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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35
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Parker D, Desiderios L, Brem S, Verma R. COMP-01. TRACKING THROUGH EDEMA: ENHANCED NEUROSURGICAL PLANNING USING ADVANCED DIFFUSION MODELING OF THE PERITUMORAL TISSUE MICROSTRUCTURE. Neuro Oncol 2018. [DOI: 10.1093/neuonc/noy148.257] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Drew Parker
- University of Pennsylvania, Philadelphia, PA, USA
| | | | - Steven Brem
- University of Pennsylvania, Philadelphia, PA, USA
| | - Ragini Verma
- University of Pennsylvania, Philadelphia, PA, USA
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36
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Parker D, Alappatt J, Elliott M, Brem S, Verma R. COMP-03. TUMOR CONNECTOME: INSIGHT INTO THE IMPACT OF CNS NEOPLASIA AND THERAPY ON THE BRAIN NETWORK. Neuro Oncol 2018. [DOI: 10.1093/neuonc/noy148.258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Drew Parker
- University of Pennsylvania, Philadelphia, PA, USA
| | | | - Mark Elliott
- University of Pennsylvania, Philadelphia, PA, USA
| | - Steven Brem
- University of Pennsylvania, Philadelphia, PA, USA
| | - Ragini Verma
- University of Pennsylvania, Philadelphia, PA, USA
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McDougall JR, Fleming IR, Thiel R, Dewaele P, Parker D, Kelly D. Estimating degradation-related settlement in two landfill-reclaimed soils by sand-salt analogues. Waste Manag 2018; 77:294-303. [PMID: 29705046 DOI: 10.1016/j.wasman.2018.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Revised: 03/11/2018] [Accepted: 04/10/2018] [Indexed: 06/08/2023]
Abstract
Landfill reclaimed soil here refers to largely degraded materials excavated from old landfill sites, which after processing can be reinstated as more competent fill, thereby restoring the former landfill space. The success of the process depends on the presence of remaining degradable particles and their influence on settlement. Tests on salt-sand mixtures, from which the salt is removed, have been used to quantify the impact of particle loss on settlement. Where the amount of particle loss is small, say 10% by mass or less, settlements are small and apparently independent of lost particle size. A conceptual model is presented to explain this behaviour in terms of nestling particles and strong force chains. At higher percentages of lost particles, greater rates of settlement together with some sensitivity to particle size were observed. The conceptual model was then applied to two landfill reclaimed soils, the long-term settlements of which were found to be consistent with the conceptual model suggesting that knowledge of particle content and relative size are sufficient to estimate the influence of degradable particles in landfill reclaimed soils.
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Affiliation(s)
| | - I R Fleming
- University of Saskatchewan, Saskatoon, Canada
| | - R Thiel
- R.Thiel, Thiel Engineering, Oregon House, United States
| | | | - D Parker
- University of Saskatchewan, Saskatoon, Canada
| | - D Kelly
- SWECO, Edinburgh, United Kingdom
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38
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Cragg J, Lowry D, Hopkins J, Parker D, Kay M, Duddy M. Safety and Outcomes of Ipsilateral Antegrade Angioplasty for Femoropopliteal Disease. J Vasc Surg 2018. [DOI: 10.1016/j.jvs.2018.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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39
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Affiliation(s)
- J Cox
- Oncology Unit, Bradford Royal Infirmary
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40
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Abstract
CA 125 is an epithelial membrane marker which can be detected in the serum of patients with ovarian cancer and which may reflect tumour burden. In a group of 42 patients, the level of this marker has also been shown to be significantly related to survival.
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Affiliation(s)
- D Parker
- Oncology Unit, Bradford Royal Infirmary
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41
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Affiliation(s)
- C Ade
- Oncology Unit, Bradford Royal Infirmary
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42
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Deslauriers-Gauthier S, Parker D, Rheault F, Deriche R, Brem S, Descoteaux M, Verma R. Edema-Informed Anatomically Constrained Particle Filter Tractography. Medical Image Computing and Computer Assisted Intervention – MICCAI 2018 2018. [DOI: 10.1007/978-3-030-00931-1_43] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
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43
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Hickman L, Parker D, Ferguson C, Allida S, Davidson P, Agar M. A Systematic Review of Successful Elements of Interventions for Heart Failure Patients With Mild Cognitive Impairment. Heart Lung Circ 2018. [DOI: 10.1016/j.hlc.2018.06.762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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44
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Davatzikos C, Rathore S, Bakas S, Pati S, Bergman M, Kalarot R, Sridharan P, Gastounioti A, Jahani N, Cohen E, Akbari H, Tunc B, Doshi J, Parker D, Hsieh M, Sotiras A, Li H, Ou Y, Doot RK, Bilello M, Fan Y, Shinohara RT, Yushkevich P, Verma R, Kontos D. Cancer imaging phenomics toolkit: quantitative imaging analytics for precision diagnostics and predictive modeling of clinical outcome. J Med Imaging (Bellingham) 2018; 5:011018. [PMID: 29340286 PMCID: PMC5764116 DOI: 10.1117/1.jmi.5.1.011018] [Citation(s) in RCA: 92] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Accepted: 12/05/2017] [Indexed: 12/26/2022] Open
Abstract
The growth of multiparametric imaging protocols has paved the way for quantitative imaging phenotypes that predict treatment response and clinical outcome, reflect underlying cancer molecular characteristics and spatiotemporal heterogeneity, and can guide personalized treatment planning. This growth has underlined the need for efficient quantitative analytics to derive high-dimensional imaging signatures of diagnostic and predictive value in this emerging era of integrated precision diagnostics. This paper presents cancer imaging phenomics toolkit (CaPTk), a new and dynamically growing software platform for analysis of radiographic images of cancer, currently focusing on brain, breast, and lung cancer. CaPTk leverages the value of quantitative imaging analytics along with machine learning to derive phenotypic imaging signatures, based on two-level functionality. First, image analysis algorithms are used to extract comprehensive panels of diverse and complementary features, such as multiparametric intensity histogram distributions, texture, shape, kinetics, connectomics, and spatial patterns. At the second level, these quantitative imaging signatures are fed into multivariate machine learning models to produce diagnostic, prognostic, and predictive biomarkers. Results from clinical studies in three areas are shown: (i) computational neuro-oncology of brain gliomas for precision diagnostics, prediction of outcome, and treatment planning; (ii) prediction of treatment response for breast and lung cancer, and (iii) risk assessment for breast cancer.
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Affiliation(s)
- Christos Davatzikos
- Center for Biomedical Image Computing and Analytics (CBICA), Philadelphia, Pennsylvania, United States
| | - Saima Rathore
- Center for Biomedical Image Computing and Analytics (CBICA), Philadelphia, Pennsylvania, United States
| | - Spyridon Bakas
- Center for Biomedical Image Computing and Analytics (CBICA), Philadelphia, Pennsylvania, United States
| | - Sarthak Pati
- Center for Biomedical Image Computing and Analytics (CBICA), Philadelphia, Pennsylvania, United States
| | - Mark Bergman
- Center for Biomedical Image Computing and Analytics (CBICA), Philadelphia, Pennsylvania, United States
| | - Ratheesh Kalarot
- Center for Biomedical Image Computing and Analytics (CBICA), Philadelphia, Pennsylvania, United States
| | - Patmaa Sridharan
- Center for Biomedical Image Computing and Analytics (CBICA), Philadelphia, Pennsylvania, United States
| | - Aimilia Gastounioti
- Center for Biomedical Image Computing and Analytics (CBICA), Philadelphia, Pennsylvania, United States
| | - Nariman Jahani
- Center for Biomedical Image Computing and Analytics (CBICA), Philadelphia, Pennsylvania, United States
| | - Eric Cohen
- Center for Biomedical Image Computing and Analytics (CBICA), Philadelphia, Pennsylvania, United States
| | - Hamed Akbari
- Center for Biomedical Image Computing and Analytics (CBICA), Philadelphia, Pennsylvania, United States
| | - Birkan Tunc
- Center for Biomedical Image Computing and Analytics (CBICA), Philadelphia, Pennsylvania, United States
| | - Jimit Doshi
- Center for Biomedical Image Computing and Analytics (CBICA), Philadelphia, Pennsylvania, United States
| | - Drew Parker
- Center for Biomedical Image Computing and Analytics (CBICA), Philadelphia, Pennsylvania, United States
| | - Michael Hsieh
- Center for Biomedical Image Computing and Analytics (CBICA), Philadelphia, Pennsylvania, United States
| | - Aristeidis Sotiras
- Center for Biomedical Image Computing and Analytics (CBICA), Philadelphia, Pennsylvania, United States
| | - Hongming Li
- Center for Biomedical Image Computing and Analytics (CBICA), Philadelphia, Pennsylvania, United States
| | - Yangming Ou
- Massachusetts General Hospital, Martinos Center for Biomedical Imaging, Boston, Massachusetts, United States
| | - Robert K. Doot
- Center for Biomedical Image Computing and Analytics (CBICA), Philadelphia, Pennsylvania, United States
| | - Michel Bilello
- Center for Biomedical Image Computing and Analytics (CBICA), Philadelphia, Pennsylvania, United States
| | - Yong Fan
- Center for Biomedical Image Computing and Analytics (CBICA), Philadelphia, Pennsylvania, United States
| | - Russell T. Shinohara
- Center for Biomedical Image Computing and Analytics (CBICA), Philadelphia, Pennsylvania, United States
- University of Pennsylvania, Perelman School of Medicine, Center for Clinical Epidemiology and Biostatistics (CCEB), Department of Biostatistics, Epidemiology, and Informatics, Philadelphia, Pennsylvania, United States
| | - Paul Yushkevich
- Center for Biomedical Image Computing and Analytics (CBICA), Philadelphia, Pennsylvania, United States
| | - Ragini Verma
- Center for Biomedical Image Computing and Analytics (CBICA), Philadelphia, Pennsylvania, United States
| | - Despina Kontos
- Center for Biomedical Image Computing and Analytics (CBICA), Philadelphia, Pennsylvania, United States
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45
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Thawani JP, Singh N, Pisapia JM, Abdullah KG, Parker D, Pukenas BA, Zager EL, Verma R, Brem S. Three-Dimensional Printed Modeling of Diffuse Low-Grade Gliomas and Associated White Matter Tract Anatomy. Neurosurgery 2017; 80:635-645. [PMID: 28362934 DOI: 10.1093/neuros/nyx009] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Accepted: 02/23/2017] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Diffuse low-grade gliomas (DLGGs) represent several pathological entities that infiltrate and invade cortical and subcortical structures in the brain. OBJECTIVE To describe methods for rapid prototyping of DLGGs and surgically relevant anatomy. METHODS Using high-definition imaging data and rapid prototyping technologies, we were able to generate 3 patient DLGGs to scale and represent the associated white matter tracts in 3 dimensions using advanced diffusion tensor imaging techniques. RESULTS This report represents a novel application of 3-dimensional (3-D) printing in neurosurgery and a means to model individualized tumors in 3-D space with respect to subcortical white matter tract anatomy. Faculty and resident evaluations of this technology were favorable at our institution. CONCLUSION Developing an understanding of the anatomic relationships existing within individuals is fundamental to successful neurosurgical therapy. Imaging-based rapid prototyping may improve on our ability to plan for and treat complex neuro-oncologic pathology.
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Affiliation(s)
- Jayesh P Thawani
- Department of Neurosurgery, Univer-sity of Pennsylvania, Philadelphia, Pennsylvania.,School of Engineering and Applied Sciences, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Nickpreet Singh
- Department of Neurosurgery, Univer-sity of Pennsylvania, Philadelphia, Pennsylvania.,Section of Biomedical Image Analysis, Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jared M Pisapia
- Department of Neurosurgery, Univer-sity of Pennsylvania, Philadelphia, Pennsylvania.,Section of Biomedical Image Analysis, Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Kalil G Abdullah
- School of Engineering and Applied Sciences, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Drew Parker
- Section of Biomedical Image Analysis, Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Bryan A Pukenas
- Department of Neurosurgery, Univer-sity of Pennsylvania, Philadelphia, Pennsylvania.,Department of Radiology, Division of Neuroradiology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Eric L Zager
- Department of Neurosurgery, Univer-sity of Pennsylvania, Philadelphia, Pennsylvania
| | - Ragini Verma
- Section of Biomedical Image Analysis, Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Steven Brem
- Department of Neurosurgery, Univer-sity of Pennsylvania, Philadelphia, Pennsylvania
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46
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Zhang F, Savadjiev P, Cai W, Song Y, Rathi Y, Tunç B, Parker D, Kapur T, Schultz RT, Makris N, Verma R, O'Donnell LJ. Whole brain white matter connectivity analysis using machine learning: An application to autism. Neuroimage 2017; 172:826-837. [PMID: 29079524 DOI: 10.1016/j.neuroimage.2017.10.029] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Revised: 09/26/2017] [Accepted: 10/14/2017] [Indexed: 01/15/2023] Open
Abstract
In this paper, we propose an automated white matter connectivity analysis method for machine learning classification and characterization of white matter abnormality via identification of discriminative fiber tracts. The proposed method uses diffusion MRI tractography and a data-driven approach to find fiber clusters corresponding to subdivisions of the white matter anatomy. Features extracted from each fiber cluster describe its diffusion properties and are used for machine learning. The method is demonstrated by application to a pediatric neuroimaging dataset from 149 individuals, including 70 children with autism spectrum disorder (ASD) and 79 typically developing controls (TDC). A classification accuracy of 78.33% is achieved in this cross-validation study. We investigate the discriminative diffusion features based on a two-tensor fiber tracking model. We observe that the mean fractional anisotropy from the second tensor (associated with crossing fibers) is most affected in ASD. We also find that local along-tract (central cores and endpoint regions) differences between ASD and TDC are helpful in differentiating the two groups. These altered diffusion properties in ASD are associated with multiple robustly discriminative fiber clusters, which belong to several major white matter tracts including the corpus callosum, arcuate fasciculus, uncinate fasciculus and aslant tract; and the white matter structures related to the cerebellum, brain stem, and ventral diencephalon. These discriminative fiber clusters, a small part of the whole brain tractography, represent the white matter connections that could be most affected in ASD. Our results indicate the potential of a machine learning pipeline based on white matter fiber clustering.
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Affiliation(s)
- Fan Zhang
- Harvard Medical School, Boston MA, USA.
| | | | | | - Yang Song
- University of Sydney, Sydney NSW, Australia
| | | | - Birkan Tunç
- University of Pennsylvania, Philadelphia PA, USA
| | - Drew Parker
- University of Pennsylvania, Philadelphia PA, USA
| | | | - Robert T Schultz
- University of Pennsylvania, Philadelphia PA, USA; Department of Radiology, Children's Hospital of Philadelphia, Philadelphia PA, USA
| | | | - Ragini Verma
- University of Pennsylvania, Philadelphia PA, USA
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47
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Fortin JP, Parker D, Tunç B, Watanabe T, Elliott MA, Ruparel K, Roalf DR, Satterthwaite TD, Gur RC, Gur RE, Schultz RT, Verma R, Shinohara RT. Harmonization of multi-site diffusion tensor imaging data. Neuroimage 2017; 161:149-170. [PMID: 28826946 DOI: 10.1016/j.neuroimage.2017.08.047] [Citation(s) in RCA: 563] [Impact Index Per Article: 80.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Revised: 07/03/2017] [Accepted: 08/15/2017] [Indexed: 12/18/2022] Open
Abstract
Diffusion tensor imaging (DTI) is a well-established magnetic resonance imaging (MRI) technique used for studying microstructural changes in the white matter. As with many other imaging modalities, DTI images suffer from technical between-scanner variation that hinders comparisons of images across imaging sites, scanners and over time. Using fractional anisotropy (FA) and mean diffusivity (MD) maps of 205 healthy participants acquired on two different scanners, we show that the DTI measurements are highly site-specific, highlighting the need of correcting for site effects before performing downstream statistical analyses. We first show evidence that combining DTI data from multiple sites, without harmonization, may be counter-productive and negatively impacts the inference. Then, we propose and compare several harmonization approaches for DTI data, and show that ComBat, a popular batch-effect correction tool used in genomics, performs best at modeling and removing the unwanted inter-site variability in FA and MD maps. Using age as a biological phenotype of interest, we show that ComBat both preserves biological variability and removes the unwanted variation introduced by site. Finally, we assess the different harmonization methods in the presence of different levels of confounding between site and age, in addition to test robustness to small sample size studies.
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Affiliation(s)
- Jean-Philippe Fortin
- Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, USA
| | - Drew Parker
- Center for Biomedical Image Computing and Analytics, Department of Radiology, Perelman School of Medicine, University of Pennsylvania, USA
| | - Birkan Tunç
- Center for Biomedical Image Computing and Analytics, Department of Radiology, Perelman School of Medicine, University of Pennsylvania, USA
| | - Takanori Watanabe
- Center for Biomedical Image Computing and Analytics, Department of Radiology, Perelman School of Medicine, University of Pennsylvania, USA
| | - Mark A Elliott
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, USA
| | - Kosha Ruparel
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, USA
| | - David R Roalf
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, USA
| | | | - Ruben C Gur
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, USA; Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, USA
| | - Raquel E Gur
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, USA; Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, USA
| | - Robert T Schultz
- Center for Autism Research, The Children's Hospital of Philadelphia, USA
| | - Ragini Verma
- Center for Biomedical Image Computing and Analytics, Department of Radiology, Perelman School of Medicine, University of Pennsylvania, USA
| | - Russell T Shinohara
- Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, USA.
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48
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Durepos P, Tamara S, Kaasalainen S, Ploeg J, Parker D, Thompson G. CHARACTERISTICS OF RESIDENTS IN NEED AND FAMILY PERCEPTIONS OF FAMILY CARE CONFERENCES IN LTC. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.1593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- P.M. Durepos
- School of Nursing, McMaster Universtiy, Hamilton, Ontario, Canada,
| | - S. Tamara
- McGill University, Montreal, Quebec, Canada,
| | - S. Kaasalainen
- School of Nursing, McMaster Universtiy, Hamilton, Ontario, Canada,
| | - J. Ploeg
- School of Nursing, McMaster Universtiy, Hamilton, Ontario, Canada,
| | - D. Parker
- University of Technology Sydney, Sydney, Western Australia, Australia,
| | - G. Thompson
- University of Manitoba, Winnipeg, Manitoba, Canada
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49
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Durepos P, Kaasalainen S, Tamara S, Ploeg J, Parker D, Brazil K, Papaioannou A. ASSESSING FAMILY CARE CONFERENCES IN LONG-TERM CARE: LESSONS LEARNED FROM CONTENT ANALYSIS. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- P.M. Durepos
- McMaster Universtiy, Hamilton, Ontario, Canada,
- Hamilton Health Sciences Corporation, Hamilton, Ontario, Canada,
| | | | - S. Tamara
- McGill University, Montreal, Quebec, Canada,
| | - J. Ploeg
- McMaster Universtiy, Hamilton, Ontario, Canada,
| | - D. Parker
- University of Technology Sydney, Sydney, Ontario, Canada
| | - K. Brazil
- Queen’s University, Belfast, Ireland,
| | - A. Papaioannou
- McMaster Universtiy, Hamilton, Ontario, Canada,
- Hamilton Health Sciences Corporation, Hamilton, Ontario, Canada,
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50
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Parker D. KNOWLEDGE INTO PRACTICE: IMPROVING ADVANCE CARE PLANNING FOR OLDER PEOPLE IN AUSTRALIA. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.4611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- D. Parker
- Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia,
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