Optimization of automated quantification of 123I-IBZM uptake in the striatum applied to parkinsonism.

UNLABELLED: Evaluation of therapies for parkinsonism by dopamine receptor SPECT requires a reproducible, optimized quantitation technique. This study presents a new, objective, automated technique for semiquantitative analysis of dopamine receptor density, as applied to the differential diagnosis of parkinsonism. METHODS: Dopamine receptor density measured by 123I-iodobenzamide (IBZM) SPECT was retrospectively analyzed in nonidiopathic parkinsonism (NIPS), in Parkinson's disease (PD), and in healthy volunteers (n = 19, 38, and 13, respectively). A mean template was created from coregistered control studies. Registration errors were assessed using studies with simulated binding deficits. Patient studies were registered to the mean template, and striatal binding was calculated from a corresponding map of 3-dimensional regions of interest (ROIs). The striatal binding ratio and deficits determined by voxelwise comparison with the normal template were investigated and tested with various 3-dimensional ROI sizes and positions. Separation of patient groups was determined by tscore after automatically processing all studies. Results were compared with manual ROI analyses. RESULTS: The automatic method was completely reproducible in 64 of 70 cases. The best diagnostic discriminator was the minimum binding ratio of the 2 striatal nuclei, with the following values: NIPS, 1.33+/-0.13; PD, 1.50+/-0.12; healthy volunteers, 1.49+/-0.08 (+/-SD). The deficit size from voxelwise analysis was: NIPS, 20.5+/-8.2 mL; PD, 9.5+/-8.3; healthy volunteers, 8.9+/-6.0 (+/-SD). The accuracy, measured by receiver operating characteristic areas, was 0.85+/-0.05, 0.77+/-0.06, and 0.80+/-0.06 (+/-SE) for the optimal predictor (automated) and 2 blinded observers (manual), respectively. CONCLUSION: A new 3-dimensional, automated technique has been developed to semiquantitate receptor density that dramatically improves reproducibility. The optimal diagnostic discriminator of parkinsonism determined by the automatic technique has good accuracy compared with the manual technique.

Evaluation of linear registration algorithms for brain SPECT and the errors due to hypoperfusion lesions.

The semiquantitative analysis of perfusion single-photon emission computed tomography (SPECT) images requires a reproducible, objective method. Automated spatial standardization (registration) of images is a prerequisite to this goal. A source of registration error is the presence of hypoperfusion defects, which was evaluated in this study with simulated lesions. The brain perfusion images measured by 99mTc-HMPAO SPECT from 21 patients with probable Alzheimer's disease and 35 control subjects were retrospectively analyzed. An automatic segmentation method was developed to remove external activity. Three registration methods, robust least squares, normalized mutual information (NMI), and count difference were implemented and the effects of simulated defects were compared. The tested registration methods required segmentation of the cerebrum from external activity, and the automatic and manual methods differed by a three-dimensional displacement of 1.4+/-1.1 mm. NMI registration proved to be least adversely effected by simulated defects with 3 mm average displacement caused by severe defects. The error in quantifying the patient-template parietal ratio due to misregistration was 2.0% for large defects (70% hypoperfusion) and 0.5% for smaller defects (85% hypoperfusion).

Automated three-dimensional quantification of myocardial perfusion and brain SPECT.

To allow automated and objective reading of nuclear medicine tomography, we have developed a set of tools for clinical analysis of myocardial perfusion tomography (PERFIT) and Brain SPECT/PET (BRASS). We exploit algorithms for image registration and use three-dimensional (3D) "normal models" for individual patient comparisons to composite datasets on a "voxel-by-voxel basis" in order to automatically determine the statistically significant abnormalities. A multistage, 3D iterative inter-subject registration of patient images to normal templates is applied, including automated masking of the external activity before final fit. In separate projects, the software has been applied to the analysis of myocardial perfusion SPECT, as well as brain SPECT and PET data. Automatic reading was consistent with visual analysis; it can be applied to the whole spectrum of clinical images, and aid physicians in the daily interpretation of tomographic nuclear medicine images.

In-vivo MRI and in-vivo electro-anatomical voltage map characteristics of infarct heterogeneity in a swine model.

The arrhythmogenic substrate in patients with prior myocardial infarct (MI) is located at the border zone, BZ. In this study we correlated the BZ identified by two methods: electro-anatomical voltage mapping (EAVM) and a novel MRI method, multi-contrast late enhancement (MCLE). A pre-clinical porcine model with chronic MI was used to characterize BZ via MRI and EAVM. Results focus on the comparison between scar percentage and BZ percentage identified by each method. The correlation coefficient for BZ percentage between the two methods was 0.74 with a p-value of less the 0.0001. Bland-Altman plots were also used to compare between the two methods (slope of 0.83 ± 0.045). For a case of subtle infarct, there was only 1.3% infarct identified on EAVM compared to 22.2% on the corresponding slice on MCLE. The percentage of infarct on MCLE in subtle infarct does not relate to percentage of infarct in EAVM. Future registration between T(1) maps and EAVM will permit a quantitative comparison of MRI and EAVM measures.

Three-dimensional eye, head, and chest orientations after large gaze shifts and the underlying neural strategies.

1. The fixation orientations adopted by the eye, head, and chest were examined when all three were allowed to participate in gaze shifts to visual targets. The objective was to discover whether there are invariant, neurally determined laws governing these orientations that might provide clues to the processes of perception and motor control. This is an extension of the classical studies of eye-only saccades that determined that there is only one eye orientation for each gaze direction (Donders' law) and that the rotations necessary to take the eye from a reference orientation to all other orientations adopted are about axes that lie in a plane (Listing's law). 2. The three-dimensional orientations of the static eyes, head, and chest were measured after each gaze shift to a visual target, the targets having been fixed at positions ranging from 0 to 135 degrees to the left and right of center and 45 degrees up and down. These measurements were taken of seven human subjects by means of the search coil technique with coils attached to the sternum, head, and right eye. Orientations were plotted as quaternion vectors so that those orientations obeying Donders' law formed a surface and those obeying Listing's law formed a plane. 3. The orientations adopted by the eye, head, and chest were found to be a small subset of those possible under the biomechanical and task-imposed constraints. Thus there is a neurally implemented restriction, specifically of the rotation of the eye relative to space (i.e., the orientation variable es) and to the head (eh); also of the rotation of the head relative to space (hs) and to the chest (hc), and the rotation of the chest relative to space (cs). Plotted as quaternion vectors, the data for each orientation variable formed a characteristic surfacelike shape. In the case of es, hs, and hc these were twisted surfaces, whereas for eh the surface was planar and for cs it was nearly linear. Thus to a first approximation each of the orientation variables conformed to Donders' law. 4. The eye adopted a pointing (gaze) direction that has the ratio of vertical to horizontal components generally greater than one when fixating each of the corner targets. The chest, by contrast, moved almost entirely in the horizontal direction, whereas the head performed an intermediate role. 5. The es-, hs-, and hc-fitted surfaces and cs-fitted lines were titled remarkably little from the vertical axis (i.e., the gravity direction) despite larger tilts being possible.(ABSTRACT TRUNCATED AT 400 WORDS)