Automatic Identification of Ultrasound Images of the Tibial Nerve in Different Ankle Positions Using Deep Learning.

Peripheral nerve tension is known to be related to the pathophysiology of neuropathy; however, assessing this tension is difficult in a clinical setting. In this study, we aimed to develop a deep learning algorithm for the automatic assessment of tibial nerve tension using B-mode ultrasound imaging. To develop the algorithm, we used 204 ultrasound images of the tibial nerve in three positions: the maximum dorsiflexion position and -10° and -20° plantar flexion from maximum dorsiflexion. The images were taken of 68 healthy volunteers who did not have any abnormalities in the lower limbs at the time of testing. The tibial nerve was manually segmented in all images, and 163 cases were automatically extracted as the training dataset using U-Net. Additionally, convolutional neural network (CNN)-based classification was performed to determine each ankle position. The automatic classification was validated using five-fold cross-validation from the testing data composed of 41 data points. The highest mean accuracy (0.92) was achieved using manual segmentation. The mean accuracy of the full auto-classification of the tibial nerve at each ankle position was more than 0.77 using five-fold cross-validation. Thus, the tension of the tibial nerve can be accurately assessed with different dorsiflexion angles using an ultrasound imaging analysis with U-Net and a CNN.

Evaluation of factors associated with the effectiveness of radiation protection glasses.

The effects of lead equivalent and lens area of radiation-protective eyewear on lens exposure control were examined. The simulated patient underwent 10-min X-ray fluoroscopy, and the lens dose of the simulated surgeon wearing radiation protection glasses was measured using lens dosemeters attached to the corner of the eye and eyeball. In total, 10 types of radiation protection glasses were selected for measurement. Correlation analysis of the equivalent dose in the lens of the eye with lead equivalence and lens area was performed. The equivalent dose in the lens of the eye of the corner of the eye was negatively correlated with the area of the lens. The equivalent dose in the lens of the eye and the eyeball showed a strong negative correlation with lead equivalence. Lens dosemeters worn at the corner of the eye may overestimate the equivalent dose in the lens of the eye. Moreover, the reduction in exposure of the lens was significantly influenced by the lead equivalent.

Neural correlates of head restraint: Unsolicited neuronal activation and dopamine release.

To minimize motion-related distortion of reconstructed images, conventional positron emission tomography (PET) measurements of the brain inevitably require a firm and tight head restraint. While such a restraint is now a routine procedure in brain imaging, the physiological and psychological consequences resulting from the restraint have not been elucidated. To address this problem, we developed a restraint-free brain PET system and conducted PET scans under both restrained and non-restrained conditions. We examined whether head restraint during PET scans could alter brain activities such as regional cerebral blood flow (rCBF) and dopamine release along with psychological stress related to head restraint. Under both conditions, 20 healthy male participants underwent [15O]H2O and [11C]Raclopride PET scans during working memory tasks with the same PET system. Before, during, and after each PET scan, we measured physiological and psychological stress responses, including the State-Trait Anxiety Inventory (STAI) scores. Analysis of the [15O]H2O-PET data revealed higher rCBF in regions such as the parahippocampus in the restrained condition. We found the binding potential (BPND) of [11C]Raclopride in the putamen was significantly reduced in the restrained condition, which reflects an increase in dopamine release. Moreover, the restraint-induced change in BPND was correlated with a shift in the state anxiety score of the STAI, indicating that less anxiety accompanied smaller dopamine release. These results suggest that the stress from head restraint could cause unsolicited responses in brain physiology and emotional states. The restraint-free imaging system may thus be a key enabling technology for the natural depiction of the mind.

4D deep image prior: dynamic PET image denoising using an unsupervised four-dimensional branch convolutional neural network.

Although convolutional neural networks (CNNs) demonstrate the superior performance in denoising positron emission tomography (PET) images, a supervised training of the CNN requires a pair of large, high-quality PET image datasets. As an unsupervised learning method, a deep image prior (DIP) has recently been proposed; it can perform denoising with only the target image. In this study, we propose an innovative procedure for the DIP approach with a four-dimensional (4D) branch CNN architecture in end-to-end training to denoise dynamic PET images. Our proposed 4D CNN architecture can be applied to end-to-end dynamic PET image denoising by introducing a feature extractor and a reconstruction branch for each time frame of the dynamic PET image. In the proposed DIP method, it is not necessary to prepare high-quality and large patient-related PET images. Instead, a subject's own static PET image is used as additional information, dynamic PET images are treated as training labels, and denoised dynamic PET images are obtained from the CNN outputs. Both simulation with [18F]fluoro-2-deoxy-D-glucose (FDG) and preclinical data with [18F]FDG and [11C]raclopride were used to evaluate the proposed framework. The results showed that our 4D DIP framework quantitatively and qualitatively outperformed 3D DIP and other unsupervised denoising methods. The proposed 4D DIP framework thus provides a promising procedure for dynamic PET image denoising.

Biopathological Significance of Early-Phase Amyloid Imaging in the Spectrum of Alzheimer's Disease.

BACKGROUND: Amyloid imaging with positron emission tomography (PET) often comes with glucose metabolic imaging in diagnosis of Alzheimer's disease (AD). OBJECTIVE: The present purpose was to explore the clinical valence of early amyloid-ß (Aß) PET scans to determine whether they could substitute for other imaging biomarkers (early and delayed Aß images of 11C-Pittsburgh compound B (PIB) and 18F-fluorodeoxyglucose (FDG) images) in the AD spectrum. METHODS: Thirty healthy control subjects, 20 patients with mild cognitive impairment, and 45 patients with AD underwent 11C-PIB and 18F- FDG PET. Image analyses were performed with three-dimensional stereotactic surface projection and Brodmann's area regions-of-interest methods. Since early accumulation of PIB (ePIB) reflects blood flow, we classified all subjects according to the level of ePIB in the posterior cingulate gyrus, precuneus, and lateral parietal cortex. We compared the PET parameters (ePIB, delayed-phase PIB accumulation or dPIB, FDG) to determine whether ePIB-based categorization reflected Aß deposition in a Braak stage-related fashion. RESULTS: We found that ePIB images were similar to 18F-FDG images and that the progress of Aß deposition deduced from the reduction in ePIB index was similar to the pathological progress of Braak staging. A decrease in the ePIB level in the posterior cingulate gyrus, precuneus, and parietal cortex was shown to correspond to greater and wider Aß deposition in the medial frontal, anterior, and posterior cingulate gyri. CONCLUSIONS: The early-phase 11C-PIB index can be an alternative to the neurogenerative markers of glucose hypometabolism and reflects the Braak stage of Aß deposition in the living AD brain.

Automated segmentation of 2D low-dose CT images of the psoas-major muscle using deep convolutional neural networks.

The psoas-major muscle has been reported as a predictive factor of sarcopenia. The cross-sectional area (CSA) of the psoas-major muscle in axial images has been indicated to correlate well with the whole-body skeletal muscle mass. In this study, we evaluated the segmentation accuracy of low-dose X-ray computed tomography (CT) images of the psoas-major muscle using the U-Net convolutional neural network, which is a deep-learning technique. Deep learning has been recently known to outperform conventional image-segmentation techniques. We used fivefold cross validation to validate the segmentation performance (n = 100) of the psoas-major muscle. For the intersection over union and CSA ratio, segmentation accuracies of 86.0 and 103.1%, respectively, were achieved. These results suggest that the U-Net network is competitive compared with the previous methods. Therefore, the proposed technique is useful for segmenting the psoas-major muscle even in low-dose CT images.

In vivo Depiction of α7 Nicotinic Receptor Loss for Cognitive Decline in Alzheimer's Disease.

BACKGROUND: The α7 subtype of the nicotinic acetylcholine receptor (nAChR) is considered important in higher cognitive functions, and cholinergic loss underpins the pathophysiology of Alzheimer's disease (AD). However, the relationships between α7 nAChR function and clinical functions or amyloid-ß (Aß) deposition remain to be explored in the living AD brain. OBJECTIVE: We aimed to elucidate the relationship between α7 nAChR availability in the specific cholinergic region and cognitive decline in the Aß-confirmed AD brain. METHODS: Twenty AD patients and ten age-matched healthy subjects were examined. The α7-nAChR availability and Aß deposition were evaluated using positron emission tomography with an α7 nAChR radiotracer 11C-(R)-MeQAA and 11C-Pittsburg compound B (11C-PiB), respectively. Semi-quantified values of tracer binding were estimated with a simplified reference tissue method for BPND of 11C-(R)-MeQAA and a tissue ratio method for SUVR of 11C-PiB. These parameters and clinical scores were compared voxel-wise using a statistical parametric mapping method. RESULTS: The levels of 11C-(R)-MeQAA BPND in the temporal and prefrontal cholinergic projection regions were significantly lower in AD, and negative correlations were found between 11C-PiB SUVR and 11C-(R)-MeQAA BPND in the region of the nucleus basalis magnocellularis and medial prefrontal cortex. Levels of 11C-(R)-MeQAA BPND were significantly correlated with memory and frontal function scores in AD. CONCLUSION: The association between Aß burden and α7-nAChR reduction in the basal forebrain cholinergic system was highlighted in relation to cognitive decline in AD. This suggests that Aß-linked α7-nAChR reduction is clinico-pathophyisologically important for considering a good therapeutic target in AD.

Age-Related Sex-Specific Changes in Brain Metabolism and Morphology.

UNLABELLED: With a large database, we aimed to evaluate sex-specific distinctive changes in brain glucose metabolism and morphology during normal aging using MRI and (18)F-FDG PET. METHODS: A total of 963 cognitively healthy adults were included in this study. All subjects completed a medical questionnaire, took the mini-mental state examination, and underwent brain MRI and whole-body (18)F-FDG PET. The MR and PET images were statistically analyzed using 3-dimensional stereotactic surface projection. All images were corrected for whole-brain pixel value to identify the brain regions with significant changes, and regions of interest were set up with reference to Brodmann areas. We evaluated morphologic and glucose metabolic changes by cross-sectional analysis. The baseline database consisted of subjects from 30 to 40 y old, and the age-step for comparison was 5-y ranges. We also compared sex-specific differences in MR and PET images in each age group. RESULTS: Regarding age-related changes, in both sexes brain atrophy was observed in the lateral frontal and parietal regions and glucose hypometabolism in the medial frontal regions. There were significant differences in these parameters between the sexes; parallel changes in volume and metabolism were manifested in the medial frontal cortex in men and in the lateral and medial temporal cortex in women. By contrast, metabolism-dominant reductions were manifested in the lateral and medial parietal cortex in men and in the ventrolateral prefrontal cortex, including the Broca area, in women. These differences became insignificant in individuals 66 y or older. CONCLUSION: Our brain mapping study with a large number of reference human brain data demonstrated age-related parallel changes between morphology and metabolism in the medial frontal regions and sex-specific hypometabolism in the parietal (male) and ventrolateral prefrontal (female) cortices. These findings may suggest an aging vulnerability in sex-specific brain regions: the parietal cortex for visuospatial ability in men and the Broca area for speech processing in women.

The Possible Link between GABAergic Dysfunction and Cognitive Decline in a Patient with Idiopathic Hypoparathyroidism.

Idiopathic hypoparathyroidism (IHP) is accompanied by cognitive impairment. We report the case of a 70-year-old IHP patient with cognitive disturbance. Brain computed tomography showed bilateral calcification in basal ganglia, thalamus, and cerebellum. Neuropsychological assessment revealed low scores for intelligence, memory, and perseverative errors. Brain positron emission tomography showed a significant reduction in [(18)F]-Fludeoxyglucose (FDG) uptake in bilateral frontal, left temporal and parietal cortices, along with a marked reduction in [(11)C]-flumazenil binding in left frontal, temporal, parietal, and bilateral cerebellum. These findings suggest cognitive impairment in IHP may be ascribed to GABAergic dysfunction, thus leading to, or coexisting with, cerebral hypometabolism.

New computer-aided diagnosis of dementia using positron emission tomography: brain regional sensitivity-mapping method.

PURPOSE: We devised a new computer-aided diagnosis method to segregate dementia using one estimated index (Total Z score) derived from the Brodmann area (BA) sensitivity map on the stereotaxic brain atlas. The purpose of this study is to investigate its accuracy to differentiate patients with Alzheimer's disease (AD) or mild cognitive impairment (MCI) from normal adults (NL). METHODS: We studied 101 adults (NL: 40, AD: 37, MCI: 24) who underwent (18)FDG positron emission tomography (PET) measurement. We divided NL and AD groups into two categories: a training group with (Category A) and a test group without (Category B) clinical information. In Category A, we estimated sensitivity by comparing the standard uptake value per BA (SUVR) between NL and AD groups. Then, we calculated a summated index (Total Z score) by utilizing the sensitivity-distribution maps and each BA z-score to segregate AD patterns. To confirm the validity of this method, we examined the accuracy in Category B. Finally, we applied this method to MCI patients. RESULTS: In Category A, we found that the sensitivity and specificity of differentiation between NL and AD were all 100%. In Category B, those were 100% and 95%, respectively. Furthermore, we found this method attained 88% to differentiate AD-converters from non-converters in MCI group. CONCLUSIONS: The present automated computer-aided evaluation method based on a single estimated index provided good accuracy for differential diagnosis of AD and MCI. This good differentiation power suggests its usefulness not only for dementia diagnosis but also in a longitudinal study.

Evaluation of the accuracy of computed tomography-based navigation for femoral stem orientation and leg length discrepancy.

Although there is a great deal in the literature about the clinical accuracy of computed tomography (CT)-based navigation systems for acetabular cup orientation and leg length discrepancy in total hip arthroplasty, there is little analysis of femoral stem orientation. Thirty total hip arthroplasties in which CT-based navigation system had been used had their anteversion, valgus angle of stem, and leg length discrepancy measured on postoperative CT data. Differences in postoperative measurements from intraoperative records were -0.6° ± 4.8° (range, -11° to 10°) for stem anteversion, -0.2° ± 1.8° (range, -4° to 3°) for valgus angle of stem, and 1.3 ± 4.1 mm (range, -6 to 10 mm) for leg length. Although this system may need further improvement for stem orientation, it was helpful for intraoperative leg length adjustment.

A comparison between robotic-assisted and manual implantation of cementless total hip arthroplasty.

BACKGROUND: The benefits of robotic techniques for implanting femoral components during THA are still controversial. QUESTIONS/PURPOSES: The purpose of this study was to prospectively compare the results and complications of robotic-assisted and hand-rasping stem implantation techniques. METHOD: The minimum followup was 5 years (mean, 67 months; range, 60-85 months). One hundred forty-six primary THAs on 130 patients were included in this study. Robot-assisted primary THA was performed on 75 hips and a hand-rasping technique was used on 71 hips. RESULTS: At 2 and 3 years postoperatively, the Japanese Orthopaedic Association (JOA) clinical score was slightly better in the robotic-assisted group. At 5 years followup, however, the differences were not significant. Postoperative limb lengths of the robotic-milling group had significantly less variance than the hand-rasping group. At 2 years postoperatively, there was significantly more stress shielding of the proximal femur in the hand-rasping group; this difference was more significant 5 years postoperatively. CONCLUSIONS: Substantially more precise implant positioning seems to have led to less variance in limb-length inequality and less stress shielding of the proximal femur 5 years postoperatively. LEVEL OF EVIDENCE: Level II, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

Robot-assisted primary cementless total hip arthroplasty using surface registration techniques: a short-term clinical report.

PURPOSE: The purpose of this study was to compare non-fiducial based surface registration technique (DigiMatch) with the conventional locator pin-based registration technique in performing cementless total hip arthroplasty (THA) using ROBODOC system. METHODS: Eighty-one THA were performed using pin-based technique and forty-three were performed using the DigiMatch technique. The average follow-up term was 38 months. RESULTS: Postoperatively, the Japanese Orthopedic Association hip scores were significantly better in the DigiMatch group than in pin-based group. The accuracy of postoperative stem alignment of the DigiMatch technique was comparable with that of pin-based method. CONCLUSIONS: No need for prior pin implantation surgery and no concern for pin related knee pain were the advantages of DigiMatch technique. Short-term follow-up clinical results showed that DigiMatch ROBODOC THA was safe and effective.

CT-based planning of a single-radius femoral component in total knee arthroplasty using the ROBODOC system.

OBJECTIVE: The purpose of this study was to propose our CT-based planning approach for knee arthroplasty on the basis of the femoral flexion-extension (FE) axis, and to evaluate whether this approach was valid by comparing the results with those obtained using conventional anterior-referenced planning. MATERIALS AND METHODS: Virtual implantation of a sagittal single-radius component was performed in 34 normal knees. The transepicondylar axis (TEA) was identified as the FE axis, and was modified in the coronal plane to intersect the femoral mechanical axis at a right angle, if necessary. The implant was then selected that had a radius closest to the distance between the modified TEA and the distal condyle end. The implant position and size were compared for the two plans. RESULTS: In almost all cases, slight modification of the TEA was required. However, there was no significant change in the distance from the TEA to the posterior and distal condyles. In comparison to the results obtained with our planning approach, the conventional plan resulted in antero-superior deviation of the implant sagittal center to the FE axis and/or selection of a larger size of prosthesis. CONCLUSION: Although the TEA must be modified slightly when referencing it as the FE axis, our planning approach may be valid for femoral single-radius components because the single axis of the component could be matched with the FE axis.

Effect of robotic milling on periprosthetic bone remodeling.

The ROBODOC system has provided better fit and fill of the stem and less destruction of the bony architecture than with manual surgery. These benefits might affect femoral periprosthetic bone remodeling. We evaluated the effects of robotic milling in cementless total hip arthroplasty (THA) in a longitudinal 24-month follow-up study using dual energy X-ray absorptiometry (DEXA) and plain radiographs of 29 patients (31 hips) after ROBODOC THA and 24 patients (27 hips) after manual THA with the same stem design. To minimize the influence of other factors on bone remodeling, only female osteoarthritis patients, who had no drugs that might affect bone metabolism were enrolled. Significantly less bone loss occurred at the proximal periprosthetic areas in the ROBODOC group. In zone 1, the decrease was 15.5 versus 29.9% using conventional rasping; in zone 7, the loss was 17.0% with ROBODOC compared to 30.5% with conventional rasping (p < 0.05). On radiographs, endosteal spot welds in the proximal medial portion were more pronounced in the ROBODOC group (48 vs. 11% in the conventional group, p < 0.05). Our results suggest that robotic milling is effective in facilitating proximal load transfer around the femoral component and minimizing bone loss after cementless THA.

Recovery of walking speed and symmetrical movement of the pelvis and lower extremity joints after unilateral THA.

In 17 patients with unilateral hip disease who underwent total hip arthroplasty (THA), the gait was analyzed preoperatively and 1, 3, 6, and 12 months after unilateral THA using a Vicon system to assess the recovery of walking speed and symmetrical movement of the hip, knee, ankle, and pelvis. The walking speed of these patients reached that of normal Japanese persons by 12 months after surgery. Walking speed was correlated with the range of hip motion on the operated side at 1 month postoperatively, and was correlated with the hip joint extension moment of force on both sides from 3 to 6 months after surgery. Before THA, asymmetry was observed in the range of the hip motion, maximum hip flexion, maximum hip extension, maximum knee flexion, as well as in pelvic obliquity, pelvic tilt, and pelvic rotation. There were no differences of the stride length or step length between both sides throughout the observation period. The preoperative range of hip flexion on the operated side during a gait cycle (21.3+/-7.9 degrees ) was significantly smaller than on the non-operated side (46.7+/-7.1 degrees ), and the difference between sides was still significant at 12 months after surgery (35.1+/-6.2 degrees on the operated side and 43.6+/-5.7 degrees on the non-operated side). The majority (74%) of the difference in hip motion range during this period was due to the difference in maximum extension of the hip. The increase in the range of pelvic tilt and the range of motion of the opposite hip showed an inverse correlation with the range of motion of the operated hip, suggesting a compensatory preoperative role. However, this correlation became insignificant after 6 months postoperatively. Asymmetry of the range of hip motion persisted at 12 months after THA in patients with unilateral coxoarthropathy during free level walking, while the operation normalized the spatial asymmetry of other joints and the walking speed prior to the recovery of hip motion.