Lateralized attentional abnormality in schizophrenia is correlated with severity of symptoms.

Numerous studies have demonstrated a lateralized impairment of attention in schizophrenia. In this study, attention in schizophrenia is investigated with a task that involves centering a rod while blindfolded. Symptoms were rated on the Brief Psychiatric Rating Scale (BPRS) for each of the 20 schizophrenic subjects. The more symptomatic patients demonstrated a right-sided hemineglect compared to the less symptomatic patients (p = 0.013). Furthermore, the difference between more and less symptomatic patients was even more distinct when they were categorized by the BPRS schizophrenia subscale alone (p = 0.0025). These findings support the hypothesis that the pathophysiology of schizophrenia involves a lateralized defect in the control of attention, and that this defect is associated with the severity of symptoms. This raises the possibility that effects of neuroleptic medication may be asymmetric, which could account for some of the inconsistencies in studies of hemispheric dysfunction in schizophrenia.

A positron emission tomographic comparison of diffuse and lobar oleic acid lung injury.

We tested whether severity of injury measured from the pulmonary transcapillary escape rate for transferrin (PTCER), lung water accumulation, and changes in regional pulmonary blood flow (PBF) would be similar after oleic acid (OA) injection into either all lung lobes or directly into the pulmonary artery feeding the left caudal lobe (LCL) only. Measurements were made with positron emission tomography. After 0.015 ml/kg OA was injected into the LCL (Lobar, n = 5), lung water increased in the left dorsal region from 37 +/- 5 to 50 +/- 8 ml/100 ml lung (P less than 0.05), PTCER was 533 +/- 59 10(-4)/min, and regional PBF decreased 62%. No significant change occurred in the uninjured right dorsal lung where PTCER was 85 +/- 32. In the left ventral region PTCER was 357 +/- 60, PBF decreased only 31%, and the increase in lung water was less (25 +/- 3 to 30 +/- 6). In contrast after 0.08 ml/kg OA was injected via the right atrium (Diffuse, n = 6), PTCER (283 +/- 94) was lower in the left dorsal region of this group than in the corresponding region of the Lobar group (P less than 0.05). The increase in lung water, however, was the same, but no change occurred in PBF distribution. These results indicate important differences between the two methods of causing lung injury with OA. After injury lung water accumulates primarily in dependent portions of lung and is not always accompanied by a decrease in regional PBF. These decreases, when they occur, may instead indicate severe vascular injury.

Visual attention in obsessive-compulsive disorder.

Performance on neuropsychological tasks was compared in 15 subjects with obsessive-compulsive disorder (OCD) and 15 age- and sex-matched psychiatrically screened control subjects. The tasks chosen are known from studies in other patient groups to demonstrate lateralized abnormalities of visual and limited capacity attentional impairment. The Posner task performance of the OCD group demonstrated decreased inhibition of return for left visual field targets and no inhibition of return for right visual field targets. The OCD group's spatial-linguistic conflict task responses were significantly slowed in the conflict condition, as predicted. The results are discussed in relation to the phenomenology of OCD and prior neuropsychological evaluations.

Navigation in diagnosis and therapy.

Image-guided navigation for surgery and other therapeutic interventions has grown in importance in recent years. During image-guided navigation a target is detected, localized and characterized for diagnosis and therapy. Thus, images are used to select, plan, guide and evaluate therapy, thereby reducing invasiveness and improving outcomes. A shift from traditional open surgery to less-invasive image-guided surgery will continue to impact the surgical marketplace. Increases in the speed and capacity of computers and computer networks have enabled image-guided interventions. Key elements in image navigation systems are pre-operative 3D imaging (or real-time image acquisition), a graphical display and interactive input devices, such as surgical instruments with light emitting diodes (LEDs). CT and MRI, 3D imaging devices, are commonplace today and 3D images are useful in complex interventions such as radiation oncology and surgery. For example, integrated surgical imaging workstations can be used for frameless stereotaxy during neurosurgical interventions. In addition, imaging systems are being expanded to include decision aids in diagnosis and treatment. Electronic atlases, such as Voxel Man or others derived from the Visible Human Project, combine a set of image data with non-image knowledge such as anatomic labels. Robot assistants and magnetic guidance technology are being developed for minimally invasive surgery and other therapeutic interventions. Major progress is expected at the interface between the disciplines of radiology and surgery where imaging, intervention and informatics converge.

Mandibular bone density and fractal dimension in rabbits with induced osteoporosis.

OBJECTIVE: Our goal in this investigation was to examine the mandibular bone density and radiographic textural changes and the relationship between mandibular and spinal bone mineral density in an osteoporotic rabbit model. STUDY DESIGN: Three adult female New Zealand white rabbits in each of 4 groups received daily injections of cortisone acetate at a dosage of 0.0 (control), 3.0, 7.5, or 15.0 mg/kg for 4 weeks. The rabbits were then killed, and the mandible and spine of each animal were removed. Digital radiographs (70 kVp, 10 mA, 8 impulses) of the hemimandibles and spines were made. Lateral and anteroposterior bone densities of the lumbar spine (L2) were calculated, and average mandibular interdental bone density, fractal dimension, and gradient values were calculated. RESULTS: Correlation analysis revealed that cumulative steroid dose was strongly related to mandibular bone density (r = -0.80, P <.01), moderately related to mandibular fractal dimension (r = -0.61, P <. 05), and moderately related to anteroposterior lumbar spine density (r = -0.64, P <.05). Moderate correlations were found between mandibular interdental bone density and spinal density (r = 0.56, P <.05), but mandibular fractal dimension was not related to spinal density. CONCLUSIONS: In osteoporotic female rabbits, mandibular bone mineral density decreases in relation to spinal density and cumulative steroid dose. Mandibular fractal dimension decreases with cumulative steroid dose but is not significantly related to either mandibular density or spinal density.

Three-dimensional computed tomography landmark measurement in craniofacial surgical planning: experimental validation in vitro.

PURPOSE: This study evaluated the measurement accuracy of three-dimensional (3D) volumetric images from spiral computed tomography (CT) in vitro. MATERIALS AND METHODS: The study sample consisted of nine cadaver heads that were submitted to an impact force by a special device to promote blunt traumatic craniofacial fractures. The heads were subsequently scanned by a spiral CT scanner (Toshiba Xpress S/X). The archived CT data were transferred to networked computer workstations (Sun Microsystems with Cemax VIP version 1.4 software) to generate 3D volumetric images. The visualization software was used to make interactive linear measurements on the 3D images. Measurements were made on the images twice by two observers, based on conventional craniofacial anatomic landmarks. The soft tissues were subsequently removed, and the same measurements were repeated on the cadaver heads with an electromagnetic digitizer (3 Space, Polhemus, Colchester, VT). RESULTS: The results showed no statistically significant differences between the 3D-CT and the physical measurements, with P>.05 for all measurements. The mean difference between the image and real measurements was less than 2 mm in all instances. CONCLUSIONS: It is concluded that measurement of the skull and facial bone landmarks by 3D reconstruction is quantitatively accurate for surgical planning and treatment evaluation of craniofacial fractures.

Real-time multiple linear regression for fMRI supported by time-aware acquisition and processing.

Real-time parametric statistical analysis of functional MRI (fMRI) data would potentially enlarge the scope of experimentation and facilitate its application to clinical populations. A system is described that addresses the need for rapid analysis of fMRI data and lays the foundation for dealing with problems that impede the application of fMRI to clinical populations. The system, I/OWA (Input/Output time-aWare Architecture), combines a general architecture for sampling and time-stamping relevant information channels in fMRI (image acquisition, stimulation, subject responses, cardiac and respiratory monitors, etc.) and an efficient approach to manipulating these data, featuring incremental subsecond multiple linear regression. The advantages of the system are the simplification of event timing and efficient and unified data formatting. Substantial parametric analysis can be performed and displayed in real-time. Immediate (replay) and delayed off-line analysis can also be performed with the same interface. The capabilities of the system are demonstrated in normal subjects using a polar visual angle phase mapping paradigm. The system provides a time-accounting infrastructure that readily supports standard and innovative approaches to fMRI. Magn Reson Med 45:289-298, 2001.

Hippocampal MR imaging morphometry by means of general pattern matching.

PURPOSE: To determine the repeatability and validity of a pattern-matching method for the segmentation and measurement of hippocampi on magnetic resonance (MR) images. MATERIALS AND METHODS: Comparable two-dimensional MR images obtained in 18 subjects (nine healthy control subjects [six men, three women; aged 24-54 years] and nine patients with schizophrenia [six men, three women; aged 22-61 years]) were twice segmented manually and twice segmented by using pattern matching with digital atlas transformation. The atlas transformation was accomplished in two steps: global followed by local matching. Global matching was performed with use of landmarks; local matching was performed with use of a viscous fluid model. RESULTS: The mean percentage of difference between two atlas-based measurements was 1.33% +/- 1.23 (+/- standard deviation); that between two manual measurements was 4.67% +/- 4.71. The validity of the atlas transformation measurements was demonstrated by means of the high correlation (intraclass correlation coefficient = .96) with manual segmentation measurements. Schizophrenic hippocampal areas tended to be smaller; however, no differences in hippocampal shape were found between patients with schizophrenia and patients with control subjects. CONCLUSION: General pattern matching of a digital brain atlas to an individual MR image is a mathematically robust method of measurement that is reproducible and less variable than manual measurement.

Three-dimensional hippocampal MR morphometry with high-dimensional transformation of a neuroanatomic atlas.

PURPOSE: To test automated three-dimensional magnetic resonance (MR) imaging morphometry of the human hippocampus, to determine the potential gain in precision compared with conventional manual morphometry. MATERIAL AND METHODS: A canonical three-dimensional MR image atlas was used as a deformable template and automatically matched to three-dimensional MR images of 10 individuals (five healthy and five schizophrenic subjects). A subvolume containing the hippocampus was defined by using 16 landmarks that constrained the automated search for hippocampal boundaries. Transformation of the hippocampus template was automatically performed by using global pattern matching through a sequence of low-then high-dimensional translations, rotations, and scalings. RESULTS: The average test-retest volume difference measured with the automatic method was 3.1%, compared with the manual test-retest difference of 7.1%. Correlation between automated and manually determined volumes demonstrated the validity of the automated technique (intraclass correlation coefficient = .86). CONCLUSION: The automated method estimates hippocampal volumes with less variability (ie, lower variance) than that of manual out-lining.

Hippocampal morphometry in schizophrenia by high dimensional brain mapping.

Theories of the pathophysiology of schizophrenia have implicated the hippocampus, but controversy remains regarding hippocampal abnormalities in patients with schizophrenia. In vivo studies of hippocampal anatomy using high resolution magnetic resonance scanning and manual methods for volumetric measurement have yielded inconclusive results, perhaps because of the normal variability in hippocampal volume and the error involved in manual measurement techniques. To resolve this controversy, high dimensional transformations of a computerized brain template were used to compare hippocampal volumes and shape characteristics in 15 matched pairs of schizophrenia and control subjects. The transformations were derived from principles of general pattern matching and were constrained according to the physical properties of fluids. The analysis and comparison of hippocampal shapes based on these transformations were far superior to the comparison of hippocampal volumes or other global indices of hippocampal anatomy in showing a statistically significant difference between the two groups. In the schizophrenia subjects, hippocampal shape deformations were found to be localized to subregions of the structure that send projections to prefrontal cortex. The results of this study demonstrate that abnormalities of hippocampal anatomy occur in schizophrenia and support current hypotheses that schizophrenia involves a disturbance of hippocampal-prefrontal connections. These results also show that comparisons of neuroanatomical shapes can be more informative than volume comparisons for identifying individuals with neuropsychiatric diseases, such as schizophrenia.