Extensive white matter dysfunction in cognitively impaired patients with secondary-progressive multiple sclerosis.

BACKGROUND AND PURPOSE: Cognitive impairment is a common, disabling symptom of MS. We investigated the association between cognitive impairment and WM dysfunction in secondary-progressive multiple sclerosis using DTI. MATERIALS AND METHODS: Cognitive performance was assessed with a standard neuropsychological battery, the Minimal Assessment of Cognitive Function in Multiple Sclerosis. Cognitive impairment was defined as scoring >1.5 standard deviations below healthy controls on ≥2 subtests. Fractional anisotropy maps were compared against cognitive status using tract-based spatial statistics with threshold-free cluster enhancement. RESULTS: Forty-five patients with secondary-progressive multiple sclerosis (median age: 55 years, female/male: 27/18, median Expanded Disability Status Scale Score: 6.5) were prospectively recruited. Cognitively impaired patients (25/45) displayed significantly less normalized global GM and WM volumes (P = .001, P = .024), more normalized T2-weighted and T1-weighted WM lesion volumes (P = .002, P = .006), and lower WM skeleton fractional anisotropy (P < .001) than non-impaired patients. Impaired patients also had significantly lower fractional anisotropy (p(corr) < .05) in over 50% of voxels within every major WM tract. The most extensively impinged tracts were the left posterior thalamic radiation (100.0%), corpus callosum (97.8%), and right sagittal stratum (97.5%). No WM voxels had significantly higher fractional anisotropy in patients with cognitive impairment compared with their non-impaired counterparts (p(corr) > .05). After the inclusion of confounders in a multivariate logistic regression, only fractional anisotropy remained a significant predictor of cognitive status. CONCLUSIONS: Cognitively impaired patients with secondary-progressive multiple sclerosis exhibited extensive WM dysfunction, though preferential involvement of WM tracts associated with cognition, such as the corpus callosum, was apparent. Multivariate analysis revealed that only WM skeleton fractional anisotropy was a significant predictor of cognitive status.

Early rate of contrast extravasation in patients with intracerebral hemorrhage.

BACKGROUND AND PURPOSE: For patients with ICH, knowing the rate of CT contrast extravasation may provide insight into the pathophysiology of hematoma expansion. This study assessed whether the PCT-derived PS can measure different rates of CT contrast extravasation for admission CTA spot signs, PCCT, PCL, and regions without extravasation in patients with ICH. MATERIALS AND METHODS: CT was performed at admission and at 24 hours for 16 patients with ICH with/without contrast extravasation seen on CTA and PCCT. PCT-PS was measured at admission. The Wilcoxon rank sum test with a Bonferroni correction was used to compare PS values from the following regions of interest: 1) spot sign lesions only (9 foci), 2) PCL lesions only (9 foci), 3) hematoma excluding extravasation, 4) regions contralateral to extravasation, 5) hematoma in patients without extravasation, and 6) an area contralateral to that in 5. Additionally, hematoma expansion was determined at 24 hours defined by NCCT. RESULTS: PS was 6.5 ± 1.60 mL · min(-1) × (100 g)(-1), 0.95 ± 0.39 mL · min(-1) × (100 g)(-1), 0.12 ± 0.39 mL · min(-1) × (100 g)(-1), 0.26 ± 0.09 mL · min(-1) × (100 g)(-1), 0.38 ± 0.26 mL · min(-1) × (100 g)(-1), and 0.09 ± 0.32 mL · min(-1) × (100 g)(-1) for the following: 1) spot sign lesions only (9 foci), 2) PCL lesions only (9 foci), 3) hematoma excluding extravasation, 4) regions contralateral to extravasation, 5) hematoma in patients without extravasation, and 6) an area contralateral to that in 5. PS values from spot sign lesions and PCL lesions were significantly different from each other and all other regions, respectively (P < .05). Hematoma volume increased from 34.1 ± 41.0 mL to 40.2 ± 46.1 mL in extravasation-positive patients and decreased from 19.8 ± 31.8 mL to 17.4 ± 27.3 mL in extravasation-negative patients. CONCLUSIONS: The PCT-PS parameter measures a higher rate of contrast extravasation for CTA spot sign lesions compared with PCL lesions and hematoma. Early extravasation was associated with hematoma expansion.

A method for rectifying grid junctions in grid-coded images using cross ratio.

In the grid-coding technique, the accurate grid junction locations are vital to the surface computation. Noise arising from the imaging formation and processing processes will jeopardize the computation accuracy. The objective of this study is to make use of the geometric property of cross ratio to improve the accuracy of grid junction locations in grid-coded images. A method is devised to regenerate grid junctions from the original (i.e. raw) junction data of an image. Through a statistical error analysis, we show that the regenerated junction data are generally more accurate than the old ones in the image taken from a wide range of viewing angles.

Recursive parameter identification of constrained systems: an application to electrically stimulated muscle.

In the application of real-time identification methods for diagnosis or adaptive control of biomedical systems, there is often known model information that is ignored. Constraints on the allowable values of parameters, which may be based on physical considerations, are often neglected because the information does "fit" easily into commonly used parameter-identification algorithms. In this paper a method of incorporating constraints on model parameters is developed. This method is applicable to most recursive parameter-identification algorithms. It enforces linear equality constraints on identified parameters. The use of this method for the real-time identification of autoregressive moving-average-type time series models, subject to parameter constraints, is described in detail. These constraints may be time varying. At each time step, the parameter estimate obtained by a recursive least squares estimator is orthogonally projected onto the constraint surface. This simple idea, when appropriately executed, enhances the output prediction accuracy of estimated parameters. Using constraint information in this way is important when we do not wish to destroy a "natural" parameterization of the model (by an initial projection to incorporate equality constraints), or when we cannot use a single initial model simplification (because the constraints are time varying or involve inputs and outputs). Because it improves output prediction at future times, this method is advantageous for use in predictive adaptive controllers. The use of this algorithm is demonstrated in the identification of electrically stimulated quadriceps muscles in paraplegic human subjects, using percutaneous intramuscular electrodes. The nonlinear steady-state force versus pulsewidth recruitment characteristic of the electrode-muscle system is identified simultaneously with the input-output muscle response dynamics, using a Hammerstein-type model. Knowledge of the recruitment curve's shape is translated into constraints on the identified parameters. This information improves the experimental predictive quality of the identified model.