In vivo characterization of the vestibulo-cochlear nerve motion by MRI.

The motion of the vestibulo-cochlear nerve (VCN) was quantified at the level of the cerebello-pontine angle in 28 healthy volunteers enrolled in a prospective study performed on a 3T MRI scanner. A phase contrast MRI (PCMRI) sequence was used. The VCN was divided into a cisternal part and a meatic part, both of which were measured for motion in the cranio-caudal (CC) and antero-posterior (AP) directions. Motion was cardiac-cycle-dependent in these two directions. The meatic VCN motion was delayed compared to the cisternal VCN motion. In the CC direction, the mean amplitude of the cisternal VCN motion was twice larger than the mean amplitude of the meatic VCN motion (0.37+/-0.14 mm versus 0.17+/-0.08 mm). In the AP direction, the mean amplitude of the cisternal VCN was 0.19+/-0.08 mm versus 0.16+/-0.14 mm for the meatic VCN. We used an "oscillating string" to explain the VCN motion. Reproducibility tests have shown small variations in measurements of the CC motion. PCMRI can be used to assess the VCN motion at the level of the cerebello-pontine angle.

Motion compensated generalized reconstruction for free-breathing dynamic contrast-enhanced MRI.

The analysis of abdominal and thoracic dynamic contrast-enhanced MRI is often impaired by artifacts and misregistration caused by physiological motion. Breath-hold is too short to cover long acquisitions. A novel multipurpose reconstruction technique, entitled dynamic contrast-enhanced generalized reconstruction by inversion of coupled systems, is presented. It performs respiratory motion compensation in terms of both motion artefact correction and registration. It comprises motion modeling and contrast-change modeling. The method feeds on physiological signals and x-f space properties of dynamic series to invert a coupled system of linear equations. The unknowns solved for represent the parameters for a linear nonrigid motion model and the parameters for a linear contrast-change model based on B-splines. Performance is demonstrated on myocardial perfusion imaging, on six simulated data sets and six clinical exams. The main purpose consists in removing motion-induced errors from time-intensity curves, thus improving curve analysis and postprocessing in general. This method alleviates postprocessing difficulties in dynamic contrast-enhanced MRI and opens new possibilities for dynamic contrast-enhanced MRI analysis.

Design and evaluation of an abbreviated pixelwise dynamic contrast enhancement analysis protocol for early extracellular volume fraction estimation.

INTRODUCTION: T1-based method is considered as the gold standard for extracellular volume fraction (ECV) mapping. This technique requires at least a 10 min delay after injection to acquire the post injection T1 map. Quantitative analysis of Dynamic Contrast Enhancement (DCE) images could lead to an earlier estimation of an ECV like parameter (2 min). The purpose of this study was to design a quantitative pixel-wise DCE analysis workflow to assess the feasibility of an early estimation of ECV. METHODS: Fourteen patients with mitral valve prolapse were included in this study. The MR protocol, performed on a 3 T MR scanner, included MOLLI sequences for T1 maps acquisition and a standard SR-turboFlash sequence for dynamic acquisition. DCE data were acquired for at least 120 s. We implemented a full DCE analysis pipeline with a pre-processing step using an innovative motion correction algorithm (RC-REG algorithm) and a post-processing step using the extended Tofts Model (ECVETM). Estimated ECVETM maps were compared to standard T1-based ECV maps (ECVT1) with both a Pearson correlation analysis and a group-wise analysis. RESULTS: Image and map quality assessment showed systematic improvements using the proposed workflow. Strong correlation was found between ECVETM, and ECVT1 values (r-square = 0.87). CONCLUSION: A DCE analysis workflow based on RC-REG algorithm and ETM analysis can provide good quality parametric maps. Therefore, it is possible to extract ECV values from a 2 min-long DCE acquisition that are strongly correlated with ECV values from the T1 based method.

Automated cortical projection of EEG sensors: anatomical correlation via the international 10-10 system.

Several studies have described cranio-cerebral correlations in accordance with the 10-20 electrode placement system. These studies have made a significant contribution to human brain imaging techniques, such as near-infrared spectroscopy and trans-magnetic stimulation. With the recent development of high resolution EEG, an extension of the 10-20 system has been proposed. This new configuration, namely the 10-10 system, allows the placement of a high number (64-256) of EEG electrodes. Here, we describe the cranio-cerebral correlations with the 10-10 system. Thanks to the development of a new EEG-MRI sensor and an automated algorithm which enables the projection of electrode positions onto the cortical surface, we studied the cortical projections in 16 healthy subjects using the Talairach stereotactic system and estimated the variability of cortical projections in a statistical way. We found that the cortical projections of the 10-10 system could be estimated with a grand standard deviation of 4.6 mm in x, 7.1 mm in y and 7.8 mm in z. We demonstrated that the variability of projections is greatest in the central region and parietal lobe and least in the frontal and temporal lobes. Knowledge of cranio-cerebral correlations with the 10-10 system should enable to increase the precision of surface brain imaging and should help electrophysiological analyses, such as localization of superficial focal cortical generators.

[Impact of PACS implementation in a university center on radiology practice profile]. / Changements des pratiques radiologiques induites par l'implantation d'un réseau images en milieu hospitalo-universitaire.

PURPOSE: To determine the impact of a joint PACS implementation at a university medical center and cancer center on the radiology practice profile. Materials and methods. In 5 radiology sections, patients, selected based on identifiable acute or chronic diseases, underwent US, CT or MRI. Data were collected on datasheets from each provider with regards to clinical history, availability of prior examinations, description of patient management during the different phases of the examination, duration of examinations, and satisfaction. Data obtained prior to PACS implementation and 6-12 months and 30-36 months after implementation were compared. RESULTS: A total of 1098 datasheets were collected. Hard copy readings rapidly decreased. Comparison with prior examinations improved (+20.6% to 25.6%) as well as frequency of post-processing (+29%). The time required for image management was much more reduced for technologists (-75%) than for physicians (-23%). PACS implementation only temporarily improved the availability of radiology reports and the distribution of work between senior and junior radiologists. User satisfaction, initially high, progressively decreased due to saturation of the archival capabilities. CONCLUSION: PACS implementation in a large university center improves the efficiency of image acquisition but does not solve some of the inefficiencies of hospital organization.

A Review of Numerical Simulation and Analytical Modeling for Medical Devices Safety in MRI.

OBJECTIVES: To review past and present challenges and ongoing trends in numerical simulation for MRI (Magnetic Resonance Imaging) safety evaluation of medical devices. METHODS: A wide literature review on numerical and analytical simulation on simple or complex medical devices in MRI electromagnetic fields shows the evolutions through time and a growing concern for MRI safety over the years. Major issues and achievements are described, as well as current trends and perspectives in this research field. RESULTS: Numerical simulation of medical devices is constantly evolving, supported by calculation methods now well-established. Implants with simple geometry can often be simulated in a computational human model, but one issue remaining today is the experimental validation of these human models. A great concern is to assess RF heating on implants too complex to be traditionally simulated, like pacemaker leads. Thus, ongoing researches focus on alternative hybrids methods, both numerical and experimental, with for example a transfer function method. For the static field and gradient fields, analytical models can be used for dimensioning simple implants shapes, but limited for complex geometries that cannot be studied with simplifying assumptions. CONCLUSIONS: Numerical simulation is an essential tool for MRI safety testing of medical devices. The main issues remain the accuracy of simulations compared to real life and the studies of complex devices; but as the research field is constantly evolving, some promising ideas are now under investigation to take up the challenges.

A new system for evaluation of armrest use in robotic surgery and validation of a new ergonomic concept - armrest load.

BACKGROUND: The da Vinci robot provides a sitting position and an armrest to decrease workload and increase dexterity. We investigated the surgeon's ergonomic behaviour by installing force sensors on the dV-Trainer® simulator's armrest to measure the 'armrest load' during the performance of simulated exercises. METHODS: Five experts and 48 novices performed two robotic simulation exercises on the dV-Trainer. We calculated the armrest load and evaluated their armrest-using habits. Overall score and workspace range were evaluated automatically by the simulator and compared with armrest load. RESULTS: Statistically significant differences exist for overall score, workspace range and armrest load between novices and experts. CONCLUSION: The armrest load score is a direct, sensitive measure for the ergonomic evaluation of a simulator's armrest use. This experience-dependent ergonomic difference between experts and novices (p = 0.007) highlights the importance of ergonomic training for novice robot users. Copyright © 2016 John Wiley & Sons, Ltd.

Effect of exercise on the creatine resonances in 1H MR spectra of human skeletal muscle.

1H MR spectra of human muscles were recorded before, during, and after fatiguing exercise. In contrast to expectations, it was found that the spectral contributions of creatine/phosphocreatine (Cr/PCr) were subject to change as a function of exercise. In particular, the dipolar-coupled methylene protons of Cr/PCr were found to be reduced in intensity in proportion to the co-registered PCr levels. Recovery after exercise and behavior under ischemic conditions provide further evidence to suggest that the contributions of the CH2 protons of Cr/PCr to 1H MR spectra of human muscle in vivo reflect PCr rather than Cr levels. Variation of experimental parameters showed that this effect is not due to a trivial change in relaxation times. At present it can only be speculated about why the Cr resonances have reduced NMR visibility. If temporary binding to macromolecules should be involved, the free Cr concentration-important for equilibrium calculations of the creatine kinase reaction-might be different from what was previously assumed.

Functional organisation of the saccadic reference system processing extraretinal signals in humans.

In order to investigate the neuronal network involved in processing extraretinal signals, functional magnetic resonance imaging (fMRI) was applied to subjects performing the double step saccade paradigm. There, the calculation of the amplitude of the second saccade must rely on extraretinal signals of the first. When compared to a task where both saccades could be performed by means of retinal signals alone, a parieto-frontal cortical network was activated, including lateral intraparietal area, precuneus, insula, inferior frontal gyrus and anterior cingulum.

Creatine supplementation--part II: in vivo magnetic resonance spectroscopy.

PURPOSE: Our purpose was to study effects of creatine (Cr) supplementation on muscle metabolites noninvasively by means of magnetic resonance spectroscopy (MRS) before and after supplementation with Cr or placebo. METHODS: 1H-MRS was used in a comprehensive, double-blind, cross-over study in 10 volunteers to measure Cr in m. tibialis anterior and m. rectus femoris at rest. PCr/ATP was observed in m. quadriceps femoris by 31P-MRS at rest and after exercise. RESULTS: A significant increase in total Cr was observed with Cr intake in m. tibialis anterior (+9.6 +/- 1.7%, P = 0.001) and in m. rectus femoris (+18.0 +/- 1.8%, P < 0.001). PCr/ATP showed a significant increase (+23.9 +/- 2.3%, P < 0.001) in m. quadriceps femoris at rest with Cr supplementation. Post-Cr supplementation recovery rates from exercise were significantly lower (k = 0.029 s(-1), P < 0.01) compared with postplacebo consumption (k = 0.034 s(-1)) and presupplementation (k = 0.037 s(-1)). However, higher levels of PCr/ATP at rest compensate for this reduction of the recovery rate after Cr supplementation. The increase of PCr/ATP determined by 31P-MRS correlates with the increase of Cr observed by 1H-MRS (r = 0.824, P < 0.001). CONCLUSION: Noninvasive observation of Cr and PCr after Cr supplementation shows an increase in a muscle specific manner. Higher preexercise levels of PCr/ATP at rest compensate for significantly slower recovery rates of PCr/ATP after Cr supplementation.

Effect of ethanol and fructose on liver metabolism: a dynamic 31Phosphorus magnetic resonance spectroscopy study in normal volunteers.

In vivo 31Phosphorus magnetic resonance spectroscopy (31P-MRS) permits evaluation of dynamic changes of individual phosphorus-containing metabolites in the liver parenchyma, such as phosphomonoester (PME), adenosine triphosphate, and inorganic phosphate (Pi). Intravenous fructose load alters phosphorus metabolites and allows assessment of liver function by 31P-MRS. 31P-MRS data obtained in alcoholic liver disease are however inconclusive. To study the hypothesis that fructose load can be used to investigate metabolic effects of ethanol ingestion, the interaction of different metabolites--i.e., fructose and ethanol--were followed in vivo. Using a 1.5 Tesla magnetic resonance system, six healthy volunteers were examined in three sessions each: a session after administration of (a) fructose only (250 mg/kg) was compared with (b) fructose load after ethanol ingestion (0.8 g/kg). A control experiment (c) was done after ethanol only. Spectra were acquired using one-dimensional chemical shift imaging with a temporal resolution of 5 min. Following a fructose load, the concomitant uptake of ethanol showed drastic changes of individual metabolic steps of the hepatic metabolism (averages +/- standard deviation). While the velocity of the net formation of PME (relative increase 0.46 +/- 0.11 without ethanol vs. 0.61 +/- 0.25 with ethanol) and the use of adenosine triphosphate (-0.13 +/- 0.03 vs. -0.16 +/- 0.03) and Pi (-0.022 +/- 0.009 vs. -0.021 +/- 0.004) were not significantly affected by ethanol uptake, a significant (p < 0.01) reduction of PME degradation (31.3 +/- 9.4 vs. 61.9 +/- 16.9 relative total area) and absence of an overshoot for Pi (10.5 +/- 4.9 vs. -7.1 +/- 5.3 relative area 13 min to 43 min) was observed after ethanol administration. Dynamic 31P-MRS allows the observation of individual steps of hepatic metabolism in situ; fructose metabolism in the human liver is slowed down by concomitant ethanol ingestion after the phosphorylation step of fructose. This could be explained by inhibition of aldolase rather than ethanol-induced changes of the hepatic redox state. Fructose load can be used to study effects of alcohol ingestion and might therefore be useful in patients with alcoholic liver disease.

Ergonomic assessment of the surgeon's physical workload during standard and robotic assisted laparoscopic procedures.

BACKGROUND: Standard laparoscopy is responsible for musculoskeletal problems because of surgeons anti-ergonomic positions. Robot-assisted laparoscopy seems to reduce these musculoskeletal disorders thanks to the surgeons seated position. The objective of this study is to evaluate the muscular strain and cognitive stress induced by these two techniques during real operations conducted on the pig. METHODS: Electromyographic activities, heart rate, physical and mental workloads (NASA Tlx and Borg CR-10) were recorded. RESULTS: Physical workload and perception of the effort invested was significantly greater during the standard laparoscopies (p<0.05). Mental stress was however identical for the two techniques. In Standard Laparoscopic group, greater physical activity was found for trapezius and dorso-lumbar muscles, and significant appearance of fatigue of the trapezius muscles should also be noted. Finally, heart rate during standard laparoscopy was increased (92.1 ± 1.6 bpm vs 83.7 ± 1.8, p<0,01), confirming greater physical expenditure. CONCLUSIONS: Robot-assisted laparoscopy is a less physically stressful surgical technique than standard laparoscopy.

Automatic localization and labeling of EEG sensors (ALLES) in MRI volume.

Spatial localization of scalp EEG electrodes is a major step for dipole source localization and must be accurate, reproducible and practical. Several methods have been proposed in the last 15 years. The most widely used method is currently electromagnetic digitization. Nevertheless, this method is difficult to use in a clinical environment and has not been validated with a high number of electrodes. In this paper, we introduce a new automatic method for localizing and labeling EEG sensors using MRI. First, we design a new scalp EEG sensor. Secondly, we validate this new technique on a head phantom and then in a clinical environment with volunteers and patients. For this, we compare the reproducibility, accuracy and performance of our method with electromagnetic digitization. We demonstrate that our method provides better reproducibility with a significant difference (p<0.01). Concerning precision, both methods are equally accurate with no statistical differences. To conclude, our method offers the possibility of using MRI volume for both source localization and spatial localization of EEG sensors. Automation makes this method very reproducible and easy to handle in a routine clinical environment.

Paradigms and experimental set-up for the determination of the acceptable delay in telesurgery.

The aim of this work was to develop an experimental set-up and realistic paradigms to study the effect of delay on video flux transmission and surgical performance. Four exercises were performed by 15 surgeons with 5 different simulated transmission delays. Large standard deviation of the duration of an exercise was found. Even with a short transmission delay of 150ms, some surgeon found that the surgical procedure was not possible. Further work has to be done to have a better evaluation of the surgical precision.

Suppression of MR gradient artefacts on electrophysiological signals based on an adaptive real-time filter with LMS coefficient updates.

Electrocardiogram (ECG) acquisition is still a challenge as gradient artefacts superimposed on the electrophysiological signal can only be partially removed. The signal shape of theses artefacts can be similar to the QRS-complex, causing possible misinterpretation during patient monitoring and false triggering/gating of the MRI. For their real-time suppression, an adaptive filter is proposed. The adaptive filter is based on the noise-canceller configuration with LMS coefficient updates. The references of the noise canceller are the three gradient signals that are acquired simultaneously with the noisy ECG. Tests were done on patients, on volunteers and using an MR-safe ECG simulator. The noise canceller's performance was measured offline, simulating real-time processing by point-by-point operations. To create worst-case scenarios, clinical sequences with strong- and fast-switching gradients have been chosen. The noise-cancelling filter reduces the gradient artefacts' peak amplitudes by 80-99% after adaptation, without changing the desired ECG signal shape. The estimated reduction of total average power of the MR gradient artefacts is 62-98%. The proposed filter is capable of reducing artefacts due to strong- and fast-switching gradients in real-time applications and worst-case situations. The quality of the ECG is sufficiently high that a standard one-lead QRS-detector can be used for gating/triggering the MRI. For permanent patient monitoring, further improvements are needed.

Amplitude demodulation of the electrocardiogram signal (ECG) for respiration monitoring and compensation during MR examinations.

A method for respiration monitoring during MR-sequences using the electrocardiogram signal (ECG) is presented. The basic principle is known in conventional patient monitoring and is based on the fact that the amplitude of the ECG-signal varies with respiratory motion. A demodulation of this "cardio-respiratory signal" yields a respiration curve that can be used for patient monitoring, triggering, or respiration compensation of MRI sequences. Since no drift is introduced by digital demodulation, this method is superior to analog signal processing. The proposed method was applied during MR examinations using an optically coupled ECG sensor that has the advantage of almost negligible interference due to the MR sequences (< < 10% of the main ECG signal). The respiration signal obtained is strongly correlated (r = 0.79 to 0.98) with the position of the diaphragm in inferior-superior direction measured during breath-holding MRI.

Electrocardiogram acquisition during MR examinations for patient monitoring and sequence triggering.

We have developed a method for measuring the electrocardiogram (ECG) continuously during MR examinations. In contrast to ECG acquisition by wires, our new method is to amplify and convert the ECG into an optical signal directly above the patient's heart. The optical signal is transmitted out of the magnet bore by optical fiber. The small and fixed dimensions of the ECG amplifier avoid interactions with the MR system because of shorter electrical structures and smaller enclosed areas. Tests of the proposed device in a 1.5 Tesla MR system show that continuous and reliable ECG monitoring and sequence triggering are possible.

Effects of physiologic motion of the human brain upon quantitative 1H-MRS: analysis and correction by retro-gating.

Signal loss and absolute quantitation errors in 1H-MRS (localized proton MR spectroscopy) because of physiologic brain motion are analyzed quantitatively. Cardiac and respiratory related motion lead to substantial phase dispersion when using a standard, short echo-time STEAM sequence. The loss in signal area varies from 6-7% with TM (middle interval time in a STEAM sequence) = 13.7 ms, to 25-39% with TM = 100 ms. The variation in signal area because of motion-related phase dispersion is up to 16% for TM = 100 ms. The signal phase as a function of the position in the cardiac cycle is shown to be reproducible. Maximal differences in the signal phase are over 180 degrees for long TMs. ECG-gating reduces the phase dispersion considerably but introduces problems with variable repetition times. Using a phase calibration curve recorded with the water suppression turned off, it is possible to retrogate subsequent untriggered acquisitions with the water suppression activated, if the time points in the cardiac cycle are recorded for each acquisition. The gain in signal intensity is between 3 and 21%. For absolute quantification via brain water, this phase analysis has the important consequence that reference scans must be phased individually before co-adding, otherwise metabolite concentrations may be severely overestimated.

Saccadic eye movement disturbances in whiplash patients with persistent complaints.

In order to analyse the possible basis of subjective complaints following whiplash injury, horizontal eye movements were examined in subjects with persistent complaints ('symptomatic group') and subjects who had completely recovered ('recovered group'). The results for the symptomatic and recovered groups were compared with those for age-matched, healthy volunteers (control group). A battery of different saccade paradigms was employed: two were reflexive saccade tasks including a gap and an overlap task, and two were intentional saccade tasks consisting of an antisaccade and a memory-guided saccade task. In addition, the symptomatic and recovered groups also underwent psychiatric evaluation in a structured clinical interview, and all groups were assessed for emotional functioning using the Beck Depression Inventory (BDI). The recovered group did not differ significantly from the control group in saccade performance and emotional functioning. The symptomatic group showed dissociation of their performances of reflexive and intentional saccade tasks: performance in reflexive saccade tasks was normal, but in intentional saccade tasks the symptomatic group showed significantly impaired inhibition of unwanted reflexive saccades, impaired saccade triggering (i.e. increased latency) and a higher percentage error in amplitude in memory-guided saccades. Based on clinical interviews, no signs of major depression or dysthymia were found in any of the groups. Compared with the other two groups, the symptomatic group had significantly higher overall BDI scores, but these resulted from BDI dimensions that were non-specific to depression, viz. 'physiological manifestations' (e.g. fatigue, sleep disturbance) or 'performance difficulty' (e.g. work inhibition). In summary, in the symptomatic group the pattern of eye movement disturbances together with normal performance in reflexive saccade tasks and impaired performance in the intentional saccade tasks, especially impaired inhibitory function, suggests dysfunction of prefrontal and frontal cortical structures.

Visual exploration behaviour during clock reading in Alzheimer's disease.

Eye movement behaviour during visual exploration of 24 patients with probable Alzheimer's disease and 24 age-matched controls was compared in a clock reading task. Controls were found to focus exploration on distinct areas at the end of each clock hand. The sum of these two areas of highest fixation density was defined as the informative region of interest (ROI). In Alzheimer's disease patients, visual exploration was less focused, with fewer fixations inside the ROI, and the time until the first fixation was inside the ROI was significantly delayed. Changes of fixation distribution correlated significantly with the ability to read the clock correctly, but did not correlate with dementia severity. In Alzheimer's disease patients, fixations were longer and saccade amplitudes were smaller. The altered visual exploration in Alzheimer's disease might be related to parietal dysfunction or to an imbalance between a degraded occipito-parietal and relatively preserved occipito-temporal visual network.