Voxel-Based Morphometry-from Hype to Hope. A Study on Hippocampal Atrophy in Mesial Temporal Lobe Epilepsy.

BACKGROUND AND PURPOSE: Automated volumetry of the hippocampus is considered useful to assist the diagnosis of hippocampal sclerosis in temporal lobe epilepsy. However, voxel-based morphometry is rarely used for individual subjects because of high rates of false-positives. We investigated whether an approach with high dimensional warping to the template and nonparametric statistics would be useful to detect hippocampal atrophy in patients with hippocampal sclerosis. MATERIALS AND METHODS: We performed single-subject voxel-based morphometry with nonparametric statistics within the framework of Statistical Parametric Mapping to compare MRI from 26 well-characterized patients with temporal lobe epilepsy individually against a group of 110 healthy controls. The following statistical threshold was used: P < .05 corrected for multiple comparisons with family-wise error over the region of interest right and left hippocampus. RESULTS: The sensitivity for the detection of atrophy related to hippocampal sclerosis was 0.92 (95% CI, 0.67-0.99) for the right hippocampus and 0.60 (0.31-0.83) for the left, and the specificity for volume changes was 0.98 (0.93-0.99). All clusters of decreased hippocampal volumes were correctly lateralized to the seizure focus. Hippocampal volume decrease was in accordance with neuronal cell loss on histology reports. CONCLUSIONS: Nonparametric voxel-based morphometry is sensitive and specific for hippocampal atrophy in patients with mesial temporal lobe epilepsy and may be useful in clinical practice.

Relation of dopamine receptor 2 binding to pain perception in female fibromyalgia patients with and without depression--A [¹¹C] raclopride PET-study.

Dopamine D2/D3 receptor availability at rest and its association with individual pain perception was investigated using the [(11)C] raclopride PET-method in 24 female Fibromyalgia (FMS) participants with (FMS+, N=11) and without (FMS-, N=13) comorbid depression and in 17 healthy women. Thermal pain thresholds (TPT) and pain responses were assessed outside the scanner. We compared the discriminative capacity, i.e. the individual׳s capacity to discriminate between lower and higher pain intensities and the response criterion, i.e. the subject׳s tendency to report pain during noxious stimulation due to psychological factors. [(11)C] raclopride binding potential (BP), defined as the ratio of specifically bound non-displaceable radioligand at equilibrium (BP(ND)) was used as measure of D2/D3 receptor availability. We found significant group effects of BP(ND) in striatal regions (left ventral striatum, left caudate nucleus and left nucleus accumbens) between FMS+ and FMS- compared to healthy subjects. Correlational analysis showed negative associations between TPT and D2/D3 receptor availability in the left caudate nucleus in FMS-, between TPT and D2/D3 receptor availability in the right caudate nucleus in FMS + and positive associations between TPT and D2/D3 receptor availability in the left putamen and right caudate nucleus in healthy controls. The response criterion was positively associated with D2/D3 receptor availability in the right nucleus accumbens in FMS - and negatively with D2/D3 receptor availability in the left caudate nucleus in healthy controls. Finally, no significant associations between D2/D3 receptor availability and discriminative capacity in any of the groups or regions were determined. These findings provide further support for a disruption of dopaminergic neurotransmission in FMS and implicate DA as important neurochemical moderator of differences in pain perception in FMS patients with and without co-morbid depression.

Abdominal compartment syndrome (ACS) in a severely burned patient.

Abdominal compartment syndrome (ACS) occurs when increasing intra abdominal-pressure (IAP) reduces blood flow to abdominal organs. This results in impairment of pulmonary, cardiovascular, renal, hepatic, central nervous system and gastro-intestinal (gi) function, causing multiple organ dysfunction syndrome and death. The significant prognostic value of elevated intra-abdominal pressure has prompted many intensive care units to adopt measurement of this physiologic parameter as a routine vital sign in patients at risk. ACS generally occurs in patients who are critically ill due to any of a wide variety of medical and surgical conditions. it has been recently described as a rare complication of burn injury. it is fundamental to: 1) recognize IAP and ACS; 2) resuscitate effectively; and 3) prevent the development IAP-induced end-organ dysfunction and failure. We present our recent experience with one patient suffering from ACS secondary to burn injury and the physiologic results of abdominal wall escharotomy.

Le syndrome du compartiment abdominal (SCA) se produit lorsque l'augmente de la pression intra-abdominale (PIA) réduit le flux sanguin vers les organes abdominaux. Il en résulte une dépréciation de pulmonaires, cardiovasculaires, rénales, hépatiques, système nerveux central et la fonction (GI) gastro-intestinale, causant le syndrome de défaillance multiviscérale et la mort. La valeur pronostique de la pression intra-abdominale élevée a incité de nombreuses unités de soins intensifs à adopter la mesure de ce paramètre physiologique comme un signe vital de routine chez les patients à risque. Le SCA se produit généralement chez des patients gravement malades en raison d'une grande variété de conditions médicales et chirurgicales. Il a récemment été décrit comme une complication rare associée aux brûlures. Il est fondamental de: 1) reconnaître la PIA et le SCA; 2) ressusciter efficacement; et 3) prévenir le développement de la dysfonction et la défaillance des organes cibles induites par la PIA. Nous présentons notre expérience récente d'un patient souffrant du SCA suite aux brûlures et les résultats physiologiques d'une escarrotomie de la paroi abdominale.

Genome- and transcriptome-assisted development of nuclear insertion/deletion markers for Calanus species (Copepoda: Calanoida) identification.

Copepods of the genus Calanus are key zooplankton species in temperate to arctic marine ecosystems. Despite their ecological importance, species identification remains challenging. Furthermore, the recent report of hybrids among Calanus species highlights the need for diagnostic nuclear markers to efficiently identify parental species and hybrids. Using next-generation sequencing analysis of both the genome and transcriptome from two sibling species, Calanus finmarchicus and Calanus glacialis, we developed a panel of 12 nuclear insertion/deletion markers. All the markers showed species-specific amplicon length. Furthermore, most of the markers were successfully amplified in other Calanus species, allowing the molecular identification of Calanus helgolandicus, Calanus hyperboreus and Calanus marshallae.

The current state-of-the-art of spinal cord imaging: applications.

A first-ever spinal cord imaging meeting was sponsored by the International Spinal Research Trust and the Wings for Life Foundation with the aim of identifying the current state-of-the-art of spinal cord imaging, the current greatest challenges, and greatest needs for future development. This meeting was attended by a small group of invited experts spanning all aspects of spinal cord imaging from basic research to clinical practice. The greatest current challenges for spinal cord imaging were identified as arising from the imaging environment itself; difficult imaging environment created by the bone surrounding the spinal canal, physiological motion of the cord and adjacent tissues, and small crosssectional dimensions of the spinal cord, exacerbated by metallic implants often present in injured patients. Challenges were also identified as a result of a lack of "critical mass" of researchers taking on the development of spinal cord imaging, affecting both the rate of progress in the field, and the demand for equipment and software to manufacturers to produce the necessary tools. Here we define the current state-of-the-art of spinal cord imaging, discuss the underlying theory and challenges, and present the evidence for the current and potential power of these methods. In two review papers (part I and part II), we propose that the challenges can be overcome with advances in methods, improving availability and effectiveness of methods, and linking existing researchers to create the necessary scientific and clinical network to advance the rate of progress and impact of the research.

The current state-of-the-art of spinal cord imaging: methods.

A first-ever spinal cord imaging meeting was sponsored by the International Spinal Research Trust and the Wings for Life Foundation with the aim of identifying the current state-of-the-art of spinal cord imaging, the current greatest challenges, and greatest needs for future development. This meeting was attended by a small group of invited experts spanning all aspects of spinal cord imaging from basic research to clinical practice. The greatest current challenges for spinal cord imaging were identified as arising from the imaging environment itself; difficult imaging environment created by the bone surrounding the spinal canal, physiological motion of the cord and adjacent tissues, and small cross-sectional dimensions of the spinal cord, exacerbated by metallic implants often present in injured patients. Challenges were also identified as a result of a lack of "critical mass" of researchers taking on the development of spinal cord imaging, affecting both the rate of progress in the field, and the demand for equipment and software to manufacturers to produce the necessary tools. Here we define the current state-of-the-art of spinal cord imaging, discuss the underlying theory and challenges, and present the evidence for the current and potential power of these methods. In two review papers (part I and part II), we propose that the challenges can be overcome with advances in methods, improving availability and effectiveness of methods, and linking existing researchers to create the necessary scientific and clinical network to advance the rate of progress and impact of the research.

(1)H-MR spectroscopy in the human spinal cord.

SUMMARY: MR spectroscopy allows insight into the chemical composition of human tissue noninvasively. Thereby it can help to better characterize pathologic processes affecting the spinal cord and may provide important clinical markers for differential diagnosis. However, due to technical challenges, it has been rarely applied to the spinal cord. The aim of this review was to summarize the technical development and clinical studies using MR spectroscopy in the spinal cord. Main challenges of applying MR spectroscopy in the spinal cord are discussed, and a description of a state-of-the-art scan protocol is given. In conclusion, MR spectroscopy is a promising tool for research and diagnosis of the spinal cord because it can provide additional information complementary to other noninvasive imaging methods. However, the application of MR spectroscopy in the spinal cord is not straightforward, and great care is required to attain optimal spectral quality.

Non parametric, self organizing, scalable modeling of spatiotemporal inputs: the sign language paradigm.

Modeling and recognizing spatiotemporal, as opposed to static input, is a challenging task since it incorporates input dynamics as part of the problem. The vast majority of existing methods tackle the problem as an extension of the static counterpart, using dynamics, such as input derivatives, at feature level and adopting artificial intelligence and machine learning techniques originally designed for solving problems that do not specifically address the temporal aspect. The proposed approach deals with temporal and spatial aspects of the spatiotemporal domain in a discriminative as well as coupling manner. Self Organizing Maps (SOM) model the spatial aspect of the problem and Markov models its temporal counterpart. Incorporation of adjacency, both in training and classification, enhances the overall architecture with robustness and adaptability. The proposed scheme is validated both theoretically, through an error propagation study, and experimentally, on the recognition of individual signs, performed by different, native Greek Sign Language users. Results illustrate the architecture's superiority when compared to Hidden Markov Model techniques and variations both in terms of classification performance and computational cost.

Low kilovoltage CT of the neck with 70 kVp: comparison with a standard protocol.

BACKGROUND AND PURPOSE: CT protocols should aim for radiation doses being as low as reasonably achievable. The purpose of our study was to assess the image quality and radiation dose of neck CT at a tube potential of 70 kVp. MATERIALS AND METHODS: Twenty patients (7 female, mean age 51.4 years, age range 19-81 years) underwent contrast-enhanced 64-section CT of the neck at 70 kVp (ATCM, effective tube current-time product 614 eff.mAs, range 467-713 eff.mAs). All 20 patients had a previous neck CT at 120 kVp on the same scanner. Two radiologists assessed image quality and artifacts in the upper, middle, and lower neck. Image noise and attenuation were measured, and the CNR was calculated. Effective radiation dose was calculated. RESULTS: Interobserver agreement regarding image quality of soft tissue for 70-kVp and 120-kVp scans was good to excellent. At 70 kVp, soft tissues were of diagnostic image quality in all scans, whereas the lower cervical spine was not of diagnostic quality in 3 and 4 scans per both readers. No difference was found among 70-kVp and 120-kVp scans for soft tissue image quality in the upper neck, while image quality was significantly better in the middle at 70 kVp (P < .05) and better in the lower third at 120 kVp (P < .05). CNR was significantly higher at 70 kVp in all levels for both readers (P < .001). Effective radiation dose at 70 kVp was significantly lower (0.88 ± 0.2 mSv) than at 120 kVp (1.33 ± 0.2 mSv, P < .001). CONCLUSIONS: CT of the cervical soft tissues at 70 kVp is feasible, provides diagnostic image quality with improved CNR, and reduces radiation dose by approximately 34% compared with a standard protocol at 120 kVp. In contrast, low kVp CT of the lower cervical spine suffers from compromised image quality.

Multiple intracranial meningiomas and cavernous hemangiomas.

Intracerebral meningiomas and cavernous hemangiomas (hemangiomas, cavernomas) are entities frequently encountered by neuroradiologists and neurosurgeons. Even multiple tumors can often be observed in patients with certain congenital conditions, eg. multiple meningiomas in neurofibromatosis type 2 or multiple cavernous hemangiomas in familial cavernous malformations. However, there are only very few reported cases of concurrent meningiomas and cavernous hemangiomas, all but one related to prior radiotherapy. We describe the second case of concurrent multiple meningiomas and cavernous hemangiomas occurring de novo without a history of radiation.

Neuroradiology of cholesteatomas.

The relevant aspects of cholesteatomas are reviewed with the emphasis on their diagnosis by using cross-sectional imaging. The indications and limitations of CT and MR imaging and the use of novel MR imaging techniques in the diagnosis of cholesteatomas are described. HRCT of the temporal bone has an excellent spatial resolution, thus even small soft-tissue lesions can be accurately delineated (high sensitivity). However, CT has poor specificity (ie, soft-tissue structures cannot be differentiated). MR imaging with the conventional sequences (T1WI, T2WI, postcontrast T1WI) provides additional information for distinguishing different pathologic entities and for accurately diagnosing primary (nonsurgical) and residual/recurrent (surgical) cholesteatomas. Higher diagnostic specificity is achieved by introducing DW-EPI, delayed postcontrast imaging, DW-non-EPI, and DWI-PROPELLER techniques. Studies using DW-non-EPI and DWI-PROPELLER sequences show promising results related to improved diagnostic sensitivity and specificity for even small (<5 mm) cholesteatomas, thus allowing avoidance of second-look surgery in the future.

Diffusion-weighted imaging of the entire spinal cord.

In spite of their diagnostic potential, the poor quality of available diffusion-weighted spinal cord images often restricts clinical application to cervical regions, and improved spatial resolution is highly desirable. To address these needs, a novel technique based on the combination of two recently presented reduced field-of-view approaches is proposed, enabling high-resolution acquisition over the entire spinal cord. Field-of-view reduction is achieved by the application of non-coplanar excitation and refocusing pulses combined with outer volume suppression for removal of unwanted transition zones. The non-coplanar excitation is performed such that a gap-less volume is acquired in a dedicated interleaved slice order within two repetition times. The resulting inner volume selectivity was evaluated in vitro. In vivo diffusion tensor imaging data on the cervical, thoracic and lumbar spinal cord were acquired in transverse orientation in each of four healthy subjects. An in-plane resolution of 0.7 x 0.7 mm(2) was achieved without notable aliasing, motion or susceptibility artifacts. The measured mean +/- SD fractional anisotropy was 0.69 +/- 0.11 in the thoracic spinal cord and 0.75 +/- 0.07 and 0.63 +/- 0.08 in cervical and lumbar white matter, respectively.

Combining fMRI and DTI: a framework for exploring the limits of fMRI-guided DTI fiber tracking and for verifying DTI-based fiber tractography results.

A powerful, non-invasive technique for estimating and visualizing white matter tracts in the human brain in vivo is white matter fiber tractography that uses magnetic resonance diffusion tensor imaging. The success of this method depends strongly on the capability of the applied tracking algorithm and the quality of the underlying data set. However, DTI-based fiber tractography still lacks standardized validation. In the present work, a combined fMRI/DTI study was performed, both to develop a setup for verifying fiber tracking results using fMRI-derived functional connections and to explore the limitations of fMRI based DTI fiber tracking. Therefore, a minor fiber bundle that features several fiber crossings and intersections was examined: The striatum and its connections to the primary motor cortex were examined by using two approaches to derive the somatotopic organization of the striatum. First, an fMRI-based somatotopic map of the striatum was reconstructed, based on fMRI activations that were provoked by unilateral motor tasks. Second, fMRI-guided DTI fiber tracking was performed to generate DTI-based somatotopic maps, using a standard line propagation and an advanced fast marching algorithm. The results show that the fiber connections reconstructed by the advanced fast marching algorithm are in good agreement with known anatomy, and that the DTI-revealed somatotopy is similar to the fMRI somatotopy. Furthermore, the study illustrates that the combination of fMRI with DTI can supply additional information in order to choose reasonable seed regions for generating functionally relevant networks and to validate reconstructed fibers.

Preliminary experience with visualization of intracortical fibers by focused high-resolution diffusion tensor imaging.

BACKGROUND AND PURPOSE: The inherent low anisotropy of gray matter and the lack of adequate imaging sensitivity and resolution has, so far, impeded depiction of axonal fibers to their intracortical origin or termination. We tested the hypothesis that an experimental approach with high-resolution diffusion tensor imaging (DTI) provides anisotropic data for fiber tractography with sufficient sensitivity to visualize in vivo the fine distribution of white matter bundles at the intracortical level. MATERIALS AND METHODS: We conducted phantom measurements of signal-to-noise ratio (SNR) and obtained diffusion tensor maps of the occipital lobe in 6 healthy volunteers using a dedicated miniature phased array detector at 3T. We reconstructed virtual fibers using a standard tracking algorithm. RESULTS: The coil array provided a SNR of 8.0 times higher at the head surface compared with a standard quadrature whole head coil. Diffusion tensor maps could be obtained with an in-plane resolution of 0.58 x 0.58 mm(2). The axonal trajectories reconstructed from the diffusion data penetrate into the cortical ribbon perpendicular to the pial surface. This is the expected pattern for the terminations of thalamocortical afferent fibers to the middle layers of the occipital cortex and is consistent with the known microstructural organization of the mammalian cerebral cortex. CONCLUSION: High-resolution DTI reveals intracortical anisotropy with a distinct parallel geometrical order, perpendicular to the pial surface, consistent with structures that may be identified as the terminal afferents in cortical gray matter.

Lipoma of the parotid gland.

We describe three cases of parotid gland lipoma, a relatively rare, asymptomatic, slow growing, freely movable, soft tissue mass. Preoperative clinical diagnosis is generally difficult but MRI using fat saturation techniques provides accurate diagnostic information regarding this benign parotid gland tumor, enabling better treatment planning.

New technologies and concepts for rehabilitation in the acute phase of stroke: a collaborative matrix.

The process of developing a successful stroke rehabilitation methodology requires four key components: a good understanding of the pathophysiological mechanisms underlying this brain disease, clear neuroscientific hypotheses to guide therapy, adequate clinical assessments of its efficacy on multiple timescales, and a systematic approach to the application of modern technologies to assist in the everyday work of therapists. Achieving this goal requires collaboration between neuroscientists, technologists and clinicians to develop well-founded systems and clinical protocols that are able to provide quantitatively validated improvements in patient rehabilitation outcomes. In this article we present three new applications of complementary technologies developed in an interdisciplinary matrix for acute-phase upper limb stroke rehabilitation - functional electrical stimulation, arm robot-assisted therapy and virtual reality-based cognitive therapy. We also outline the neuroscientific basis of our approach, present our detailed clinical assessment protocol and provide preliminary results from patient testing of each of the three systems showing their viability for patient use.

Reduced field-of-view MRI using outer volume suppression for spinal cord diffusion imaging.

A spin-echo single-shot echo-planar imaging (SS-EPI) technique with a reduced field of view (FOV) in the phase-encoding direction is presented that simultaneously reduces susceptibility effects and motion artifacts in diffusion-weighted (DW) imaging (DWI) of the spinal cord at a high field strength (3T). To minimize aliasing, an outer volume suppression (OVS) sequence was implemented. Effective fat suppression was achieved with the use of a slice-selection gradient-reversal technique. The OVS was optimized by numerical simulations with respect to T(1) relaxation times and B(1) variations. The optimized sequence was evaluated in vitro and in vivo. In simulations the optimized OVS showed suppression to <0.25% and approximately 3% in an optimal and worst-case scenario, respectively. In vitro measurements showed a mean residual signal of <0.95% +/- 0.42 for all suppressed areas. In vivo acquisition with 0.9 x 1.05 mm(2) in-plane resolution resulted in artifact-free images. The short imaging time of this technique makes it promising for clinical studies.

Transient epileptic opercular syndrome.

Ictal transient opercular syndrome is rarely observed in benign epilepsy with centro-temporal spikes in children, and even more rarely in epilepsia partialis continua and symptomatic focal status epilepticus in adults. Here we report the ictal and interictal neuroimaging and electrophysiological findings in an adult female suffering from discontinuous focal status epilepticus presenting as a transient opercular syndrome. This patient was unusual insofar as the discharges were strictly unilateral, i.e., that even with extensive neuroimaging no structural abnormalities could be found.

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

BACKGROUND AND PURPOSE: Diffusion tensor and diffusion-weighted spinal cord imaging remain relatively unexplored techniques despite demonstrations that such images can be obtained and may yield clinically relevant findings. In this study, we examined the temporal dynamics of spinal cord motion and their impact on diffusion tensor image quality. METHODS: Four healthy volunteers underwent phase contrast-based velocity mapping and segmented echo-planar diffusion tensor scans of the cervical spinal cord. Regions of interest in the cord were used to identify the temporal patterns of motion. The delay of data acquisition after the cardiac trigger was varied to correspond to either quiescence or motion of the cord. RESULTS: The cervical spinal cord consistently displayed maximal velocities in the range of 0.5 cm/s and accelerations of up to 25 cm/s(2). In both these respects, the cervical cord values were greater than those of the medulla. Despite this pronounced motion, approximately 40% of the cardiac cycle can be described as relatively calm, with absolute velocities and accelerations less than 20% of the maximum values. Confining image acquisition to this window reduced ghosting artifacts and increased the consistency with which the dominant direction of diffusion was along the rostral-caudal axis in both gray and white matter of the spine. Preliminary clinical application and fiber tracking in pathologic cases was feasible, and alterations of the diffusion properties by multiple sclerosis lesions, tumor, and syringomyelia were seen. CONCLUSIONS: Acquiring DTI data during the quiescent phase of spinal cord motion can reduce ghosting artifacts and improve fiber tracking.