Compressed sensing reconstruction improves sensitivity of variable density spiral fMRI.

PURPOSE: Functional MRI (fMRI) techniques that can provide excellent blood oxygen level dependent contrast, rapid whole brain imaging, and minimal spatial distortion are in demand. This study explored whether fMRI sensitivity can be improved through the use of compressed sensing (CS) reconstruction of variable density spiral fMRI. METHODS: Three different CS-reconstructed 1-shot variable density spirals were explored (corresponding to 28%, 35%, and 46% under-sampling), and compared with conventional 1-shot and 2-shot Archimedean spirals acquired using matched echo time and volume repetition time. fMRI maps were reconstructed with or without CS MRI and sensitivity was compared using identically matched voxels. RESULTS: The results demonstrated that an l1 -norm based CS reconstruction only led to an increase in functional contrast when applied to 28% under-sampled data. A whole brain t-contrast map revealed that 2-shot uniformly sampled spiral and 28% under-sampled spiral data reconstructed with CS yield equivalent sensitivity, even with matched echo time and volume repetition time CONCLUSION: VD spiral exhibits a useful operating range, in the region of 25-30% under-sampling, for which CS reconstruction can be used to increase the sensitivity of fMRI to brain activity. Using CS, VD acquisitions achieve the same sensitivity as 2-shot Archimedean acquisitions, but require only a single shot.

Differences in perceived shape from shading correlate with activity in early visual areas.

The perception of shape from shading depends on the orientation of the shading gradient [1] [2] [3] [4]. Displays composed of elements with vertically oriented shading gradients of opposite polarity produce a strong and stable percept of 'concave' and 'convex' elements. If the shading gradients are rotated 90 degrees , the depth percept is reduced and appears much more ambiguous. Results from psychophysical [1] [2] [3] [4] [5] [6], neuropsychological [7] and computational studies [8] [9] suggest that the perception of shape from shading engages specific mechanisms in early cortical visual areas. In a three-dimensional functional magnetic resonance imaging (fMRI) study at 1.5 Tesla using a three-dimensional, interleaved-echoplanar imaging technique and a surface radio frequency (RF) coil placed under the visual cortex, we investigated the activity in these early visual areas associated with viewing shape from shading displays at two different orientations. We found significantly greater activation in area V1 and neighbouring low-level visual areas of cortex when subjects viewed displays that led to weak and unstable depth percepts than when they viewed displays that led to strong and stable depth percepts.

Restriction fragment-length polymorphism analysis of the major histocompatibility complex in New Zealand white rabbits.

As a model system, rabbits are particularly useful in transplantation studies because of their size and accessibility. However, inbred rabbits of known MHC haplotype are not commercially available, and there are few monoclonal antibody reagents available to permit serological typing of experimental animals prior to transplant. Here we present a rapid and reliable method to distinguish rabbits that differ at their MHC class I and class II loci, and present 34 class I and 16 class II haplotypes determined by restriction fragment-length polymorphism analysis of outbred heterozygous rabbits. The applicability of this molecular typing system to transplantation experiments in the New Zealand White rabbit is discussed.

Pregnancy-induced carpal tunnel syndrome requiring surgical release longer than 2 years after delivery.

OBJECTIVE: To determine the percentage of patients in whom carpal tunnel syndrome was induced by pregnancy, the presence of any risk factors causing persistent symptoms after delivery, and the outcome of surgical decompression in these patients. METHODS: We reviewed retrospectively the records of 100 consecutive women treated by carpal tunnel release in our unit from 1988-1991. RESULTS: Seven patients had the onset of hand symptoms during pregnancy. One patient was diabetic and worked as a machine operator, but none of the others had predisposing factors that could have led to persistent postpartum symptoms. The hand symptoms persisting after delivery initially required conservative treatment only. However, 2-16 years later, symptoms became severe enough to warrant surgical release of the carpal tunnel. All patients had resolution of symptoms after surgery. CONCLUSION: Some patients with mild residual hand symptoms due to carpal tunnel syndrome may initially respond to conservative treatment, but 2-16 years later, symptoms may become severe enough to warrant surgical release. We recommend long-term follow-up of patients with residual postpartum hand symptoms.

In vivo measurements of multi-component T2 relaxation behaviour in guinea pig brain.

Multi-echo Carr-Purcell-Meiboom-Gill (CPMG) imaging sequences were implemented on 1.5 T and 4.0 T imaging systems to test their ability to measure in vivo multi-component T2 relaxation behavior in normal guinea pig brain. The known dependence of accurate T2 measurements on the signal-to-noise ratio (SNR) was explored in vivo by comparing T2 decay data obtained using three methods to increase SNR (improved RF coil design, signal averaging and increased magnetic field strength). Good agreement between T2 values of nickel-doped agarose phantoms was found between imaging and spectroscopic methods. T2 values were determined for gray matter (GM) and white matter (WM) locations from images of guinea pig brain in vivo. T2 measurements of GM were found to be monoexponential at both field strengths. The mean T2 times for GM were 71 ms at 1.5 T, and 53 ms at 4.0T. The highest average SNR was achieved using an improved RF coil at 4.0T. In this case, two peaks were extracted in WM, a "short" T2 peak at approximately 6 ms, and a "medium" T2 peak at approximately 48 ms. T2 values in GM and the major component of WM were significantly decreased at 4.0T compared to 1.5 T. The improved SNR attained with this optimized imaging protocol at 4.0T has allowed for the first time extraction of the myelin-sensitive T2 component of WM in animal brain in vivo.

Experimental microvascular growth plate transfers. Part 2--Investigation of feasibility.

We investigated the feasibility in the dog of using transfers of the distal ulna into the radius either as growth plate replacements or as accessory growth plates in the diaphysis. Preliminary work determined the most satisfactory method of skeletal fixation. The experimental study showed that transfers used as growth plate replacements grew at almost normal rates, uniting with the recipient bone in a mean of 7.1 weeks. Transfers into the diaphysis initially nearly doubled the growth rate of the radius, although in the long-term results were unsatisfactory, because of fracture of the graft after a mean period of 8.2 weeks.

Microvascular transplantation of physeal allografts.

We compared growth in vascularised allograft transplants, autografts and in non-operated physes in rabbits immunosuppressed with cyclosporin A and in non-immunosuppressed animals. Molecular haplotyping was undertaken before operation to ensure allogenicity. Postoperative bone scans and fluorochrome labelling were used to confirm physeal vascularity. The animals were killed at three or five weeks. Proximal tibial physeal autografts, with or without cyclosporin A, or allografts with cyclosporin A, grew at similar rates to the physes of non-operated rabbits. All the operated physes grew at rates significantly greater than their contralateral controls. 99mTc-MDP bone scans accurately predicted the viability of the epiphyseal plate. Quantitative histomorphological analysis of the heights of the physeal proliferative and hypertrophic zones showed that successful physeal transplants have a normal appearance, but when unsuccessful have thickened hypertrophic zones compatible with physeal ischaemia. We discuss the significance of these results in relation to the transplantation of physes in children.

Experimental microvascular growth plate transfers. Part I--Investigation of vascularity.

A model was developed in the dog to allow both the metaphysis and epiphysis of the distal ulnar growth plate to be microsurgically revascularised from the pedicle of the anterior interosseous vessels. With both circulations revascularised, grafts retained their structural integrity and growth continued at rates only slightly less than normal (mean 85%). If either or both circulations were not revascularised, growth rates were lower and were associated with skeletal collapse in the ischaemic bone segment.

Microvascular anastomoses. A comparative study of fibrinogen adhesive and interrupted suture techniques.

A modified sleeve technique was developed for making microsurgical anastomoses using a commercially produced fibrinogen adhesive called Tisseel. A controlled study was then carried out to compare the new fibrinogen adhesive anastomoses with conventional suture anastomoses in a bilateral groin flap model using 50 consecutive rabbits. Statistical analysis of the results indicated that flap survival rate and vascular patency rate were comparable for the two techniques. The fibrinogen adhesive anastomoses took less time to complete and, subjectively, were less difficult technically. The suture anastomoses were more versatile. Histologic studies revealed that the adhesive did not flow through the sleeve into the lumen, and that, although there was a brief inflammatory response associated with healing, this inflammation was very localized and did not involve the inner layers of the vessel wall or lumen. It was concluded that the new technique was a useful addition to techniques already available.

Identification of a free skin flap from the region vascularized by the deep circumflex iliac artery of horses.

Areas of skin vascularized by large axial vessels potentially suitable for microvascular anastomosis were investigated in 10 horse cadavers. Eleven such areas were dissected, and the skin over the flank region vascularized by the deep circumflex iliac artery was most suitable. The anatomy of this area was further defined, using angiography and latex injection studies on 10 cadavers.

Outcome of carpal tunnel release in diabetic patients.

A retrospective study of 15 diabetic patients (20 hands), who underwent carpal tunnel release, was performed to determine the outcome. All patients had a minimum of 18 months of follow-up. Outcome was considered excellent if there was complete resolution of symptoms and this occurred in 35% of the treated hands. Eight hands (40%) had a good outcome with significant improvement of pre-operative symptoms. Outcome was considered poor when symptoms were minimally improved, unchanged, or worse after surgery and this occurred in 25% of treated hands. All hands with a poor final result had either no electrodiagnostic evidence of localized compression or only mild compression in pre-operative nerve conduction studies. It was postulated that the contribution of localized compression to pre-operative hand symptoms was less than the contribution of peripheral neuropathy in these hands.

Osteoid osteomata of the distal phalanx.

Osteoid osteomata are rarely found in the distal phalanges of the hand. The 23 cases in the English language literature are discussed and two additional cases are described. The usual presenting features are chronic pain, nail enlargement and increase in size of the terminal part of the digit. Diagnosis is difficult but surgical excision is effective for treating the patients' pain.

Unsatisfactory outcome after lower limb salvage: decision-making pitfalls.

We examined unsatisfactory outcome after microvascular reconstruction of 34 injured lower extremities at the Toronto Hospital between 1987 and 1992. Our purpose was to examine those factors that contributed to poor outcome in order to improve decislon making when treating the traumatized lower extremity. For the purpose of this review, poor outcome was defined by either secondary elective amputation or patient dissatisfaction. Patients were divided according to preoperative problem into one of three groups: osteo/cutaneous deficit (group 1), septic nonunion (group 2), and osteomyelitis (group 3). Despite successful microvascular reconstruction in each case, unsatisfactory outcome occurred in six (18%) patients. Four had undergone secondary elective amputation, and two were dissatisfied because of residual pain from another musculoskeletal source. Close examination of the factors that contributed to poor outcome in each of these cases has allowed identification of potential pitfalls that may compromise final outcome after limb salvage. On the basis of our observations and an up-to-date review of the relevant literature, we provide basic guidelines as to when and when not to attempt limb salvage.

Complex injuries of the forearm. Coverage considerations.

Complex forearm injuries involve damage to the skin and underlying tissues. The best results are obtained when a multidisciplinary approach is taken to their management. Management of the acute injury should be done in a manner that takes into consideration late reconstructive procedures and best possible final function outcome. This article reviews initial management and options for soft-tissue coverage. Advantages and disadvantages of a wide variety of procedures are discussed and in addition the authors review some of the more controversial areas and give personal preferences.

Health status following recessional ulnar osteotomy.

This study describes the health status of 31 patients who underwent recessional ulnar osteotomy for ulnocarpal impingement. An additional lunotriquetral fusion was performed in 11/31 patients for joint degeneration. Outcomes included the DASH (Disability of arm, shoulder and hand) questionnaire, SF-36 Acute Health Survey, complications, and satisfaction with surgical outcome. Patients were stratified into two groups for analysis: osteotomy alone and osteotomy + fusion. The overall results indicated that osteotomy plus fusion in patients with more advanced ulnocarpal impingement did not equalise patients' post-operative health status to that reported by patients requiring osteotomy alone. Mean DASH and SF-36 physical component scores indicated better health status in the osteotomy group compared with the osteotomy + fusion group after surgery. Forty-one point nine per cent of patients required plate removal, and scar pain persisted in 58%. One patient in each group developed a non-union requiring revision surgery. Patients in both groups were generally satisfied with their surgical result, with a higher proportion of very or completely satisfied patients in the osteotomy group (65%) compared to the osteotomy + fusion group (27%). Overall, recessional ulnar osteotomy appears to be a successful procedure for the treatment of ulnocarpal impingement.

Early detection of cerebral glucose uptake changes in the 5XFAD mouse.

Brain glucose hypometabolism has been observed in Alzheimer's disease (AD) patients, and is detected with (18)F radiolabelled glucose, using positron emission tomography. A pathological hallmark of AD is deposition of brain ß- amyloid plaques that may influence cerebral glucose metabolism. The five times familial AD (5XFAD) mouse is a model of brain amyloidosis exhibiting AD-like phenotypes. This study examines brain ß-amyloid plaque deposition and (18)FDG uptake, to search for an early biomarker distinguishing 5XFAD from wild-type mice. Thus, brain (18)FDG uptake and plaque deposition was studied in these mice at age 2, 5 and 13 months. The 5XFAD mice demonstrated significantly reduced brain (18)FDG uptake at 13 months relative to wild-type controls but not in younger mice, despite substantial ß- amyloid plaque deposition. However, by comparing the ratio of uptake values for glucose in different regions in the same brain, 5XFAD mice could be distinguished from controls at age 2 months. This method of measuring altered glucose metabolism may represent an early biomarker for the progression of amyloid deposition in the brain. We conclude that brain (18)FDG uptake can be a sensitive biomarker for early detection of abnormal metabolism in the 5XFAD mouse when alternative relative uptake values are utilized.

Degradation and drug release in calcium polyphosphate bioceramics: an MRI-based characterization.

Degradable, bioceramic bone implants made of calcium polyphosphate (CPP) hold potential for controlled release of therapeutic agents in the treatment of localized bone disease. Magnetic resonance imaging techniques for non-invasively mapping fluid distribution, T(1) and T(2) relaxation times and the apparent diffusion coefficient were performed in conjunction with a drug elution protocol to resolve free and bound water components within the material microstructure in two CPP formulations (G1 and G2). The T(2) maps provided the most accurate estimates of free and bound water, and showed that G1 disks contained a detectable free water component at all times, with drug release dominated by a Fickian diffusion mechanism. Drug release from G2 disks was characterized by a combined diffusional/structural relaxation mechanism, which may be related to the gradual infiltration of a free water component associated with swelling and/or chemical degradation.

Bernard O'Brien: the microsurgical transfer of immature bone.

Bernard O'Brien was one of the pioneers of vascularized epiphyseal plate transfer. His clear understanding of the wide array of potential applications for reconstructive microsurgery stimulated his interest in the transfer of growing long bones. Investigations have been carried out in his laboratory since the earliest days of skeletal free tissue transfers. This paper describes the work done with epiphyseal plate transfers in O'Brien's laboratory. Research from other centers is then reviewed. Finally, the experience with clinical application is described.

Heterotopic microvascular epiphyseal plate transplantation: a new model using the rabbit metatarsal.

The purpose of this study is to develop a new vascularized epiphyseal plate model in the New Zealand White rabbit using a metatarsal epiphyseal plate having limited longitudinal growth potential. Such a model could be utilized in various experiments aimed at manipulating epiphyseal plate growth. The viability of the harvested live subject grafts was demonstrated with continued epiphyseal uptake during Tc99-MDP radionuclide bone scanning. The currently described models used in epiphyseal transplant research all involve long bone epiphyseal plates with significantly greater growth potential than the new metatarsal model. This new model therefore fills a void in the field by allowing investigators to transplant a growth plate with limited growth potential into any heterotopic site and study the effects of various hormonal and physical influences upon epiphyseal plate growth performance.