Present and Future Innovations in AI and Cardiac MRI.

Cardiac MRI is used to diagnose and treat patients with a multitude of cardiovascular diseases. Despite the growth of clinical cardiac MRI, complicated image prescriptions and long acquisition protocols limit the specialty and restrain its impact on the practice of medicine. Artificial intelligence (AI)-the ability to mimic human intelligence in learning and performing tasks-will impact nearly all aspects of MRI. Deep learning (DL) primarily uses an artificial neural network to learn a specific task from example data sets. Self-driving scanners are increasingly available, where AI automatically controls cardiac image prescriptions. These scanners offer faster image collection with higher spatial and temporal resolution, eliminating the need for cardiac triggering or breath holding. In the future, fully automated inline image analysis will most likely provide all contour drawings and initial measurements to the reader. Advanced analysis using radiomic or DL features may provide new insights and information not typically extracted in the current analysis workflow. AI may further help integrate these features with clinical, genetic, wearable-device, and "omics" data to improve patient outcomes. This article presents an overview of AI and its application in cardiac MRI, including in image acquisition, reconstruction, and processing, and opportunities for more personalized cardiovascular care through extraction of novel imaging markers.

MRI Assessment of Myocardial Deformation for Risk Stratification of Major Arrhythmic Events in Patients With Non-Ischemic Cardiomyopathy Eligible for Primary Prevention Implantable Cardioverter Defibrillators.

BACKGROUND: Implantable cardioverter-defibrillator (ICD) intervention is an established prophylactic measure. Identifying high-benefit patients poses challenges. PURPOSE: To assess the prognostic value of cardiac magnetic resonance imaging (MRI) parameters including myocardial deformation for risk stratification of ICD intervention in non-ischemic cardiomyopathy (NICM) while accounting for competing mortality risk. STUDY TYPE: Retrospective and prospective. POPULATION: One hundred and fifty-nine NICM patients eligible for primary ICD (117 male, 54 ± 13 years) and 49 control subjects (38 male, 53 ± 5 years). FIELD STRENGTH/SEQUENCE: Balanced steady state free precession (bSSFP) and three-dimensional phase-sensitive inversion-recovery late gadolinium enhancement (LGE) sequences at 1.5 T or 3 T. ASSESSMENT: Patients underwent MRI before ICD implantation and were followed up. Functional parameters, left ventricular global radial, circumferential and longitudinal strain, right ventricular free wall longitudinal strain (RV FWLS) and left atrial strain were measured (Circle, cvi42). LGE presence was assessed visually. The primary endpoint was appropriate ICD intervention. Models were developed to determine outcome, with and without accounting for competing risk (non-sudden cardiac death), and compared to a baseline model including LGE and clinical features. STATISTICAL TESTS: Wilcoxon non-parametric test, Cox's proportional hazards regression, Fine-Gray competing risk model, and cumulative incidence functions. Harrell's c statistic was used for model selection. A P value <0.05 was considered statistically significant. RESULTS: Follow-up duration was 1176 ± 960 days (median: 896). Twenty-six patients (16%) met the primary endpoint. RV FWLS demonstrated a significant difference between patients with and without events (-12.5% ± 5 vs. -16.4% ± 5.5). Univariable analyses showed LGE and RV FWLS were significantly associated with outcome (LGE: hazard ratio [HR] = 3.69, 95% CI = 1.28-10.62; RV FWLS: HR = 2.04, 95% CI = 1.30-3.22). RV FWLS significantly improved the prognostic value of baseline model and remained significant in multivariable analysis, accounting for competing risk (HR = 1.73, 95% CI = 1.12-2.66). DATA CONCLUSIONS: In NICM, RV FWLS may provide additional predictive value for predicting appropriate ICD intervention. LEVEL OF EVIDENCE: 2 TECHNICAL EFFICACY: Stage 5.

Highly accelerated free-breathing real-time myocardial tagging for exercise cardiovascular magnetic resonance.

BACKGROUND: Exercise cardiovascular magnetic resonance (Ex-CMR) myocardial tagging would enable quantification of myocardial deformation after exercise. However, current electrocardiogram (ECG)-segmented sequences are limited for Ex-CMR. METHODS: We developed a highly accelerated balanced steady-state free-precession real-time tagging technique for 3 T. A 12-fold acceleration was achieved using incoherent sixfold random Cartesian sampling, twofold truncated outer phase encoding, and a deep learning resolution enhancement model. The technique was tested in two prospective studies. In a rest study of 27 patients referred for clinical CMR and 19 healthy subjects, a set of ECG-segmented for comparison and two sets of real-time tagging images for repeatability assessment were collected in 2-chamber and short-axis views with spatiotemporal resolution 2.0 × 2.0 mm2 and 29 ms. In an Ex-CMR study of 26 patients with known or suspected cardiac disease and 23 healthy subjects, real-time images were collected before and after exercise. Deformation was quantified using measures of short-axis global circumferential strain (GCS). Two experienced CMR readers evaluated the image quality of all real-time data pooled from both studies using a 4-point Likert scale for tagline quality (1-excellent; 2-good; 3-moderate; 4-poor) and artifact level (1-none; 2-minimal; 3-moderate; 4-significant). Statistical evaluation included Pearson correlation coefficient (r), intraclass correlation coefficient (ICC), and coefficient of variation (CoV). RESULTS: In the rest study, deformation was successfully quantified in 90% of cases. There was a good correlation (r = 0.71) between ECG-segmented and real-time measures of GCS, and repeatability was good to excellent (ICC = 0.86 [0.71, 0.94]) with a CoV of 4.7%. In the Ex-CMR study, deformation was successfully quantified in 96% of subjects pre-exercise and 84% of subjects post-exercise. Short-axis and 2-chamber tagline quality were 1.6 ± 0.7 and 1.9 ± 0.8 at rest and 1.9 ± 0.7 and 2.5 ± 0.8 after exercise, respectively. Short-axis and 2-chamber artifact level was 1.2 ± 0.5 and 1.4 ± 0.7 at rest and 1.3 ± 0.6 and 1.5 ± 0.8 post-exercise, respectively. CONCLUSION: We developed a highly accelerated real-time tagging technique and demonstrated its potential for Ex-CMR quantification of myocardial deformation. Further studies are needed to assess the clinical utility of our technique.

Uso de isotretinoina para manejo de la piel gruesa en rinoplastia. Revisión de alcance / Use of isotretinoin to manage thick skin in rhinoplasty. Scoping review

Introducción y objetivo: El cirujano plástico que realiza rinoplastia se enfrenta a pacientes con diferentes características según su etnia. Entre las estrategias implementadas para pacientes sometidos a rinoplastia se ha descrito el uso de isotretinoina para el manejo de pieles gruesas. Actualmente existen diferentes vacíos en la literatura sobre el beneficio y las complicaciones asociadas a este tipo de tratamiento en rinoplastia. El objetivo del presente trabajo es revisar la evidencia disponible en la literatura sobre los beneficios y riesgos derivados del uso de isotretinoina y rinoplastia Material y método: Desarrollamos una revisión del alcance del conocimiento en las diferentes bases de datos: Cochrane, PubMed, Embase, SAGE, Sciencie Direct, Taylor and Francis, utilizando los términos Mesh “Rhinoplasty AND Isotretinoin” para posteriormente evaluar los diferentes criterios de inclusión y exclusión que permitieron filtrar artículos evaluados en inglés y español. Resultados: Recogimos en total 2621 artículos publicados entre enero del 2005 y junio del 2022, de los cuales 13 cumplieron con los criterios establecidos por los investigadores para su análisis: 5 reportes de caso, 2 revisiones narrativas, 2 artículos tipo experimental, 1 consenso de expertos, 1 de casos y controles, 1 estudio multicéntrico y 1 revisión sistemática de la literatura. Conclusiones: La isotretinoina es un medicamento que, en diferentes artículos revisados, se demuestra seguro en su uso concomitante con procedimientos faciales como la rinoplastia y genera resultados favorables estéticos en paciente con nariz de piel gruesa en los 6 primeros meses de postoperatorio. Sin embargo, su uso debe ser analizado de manera individual puesto que puede llegar a producir efectos adversos tales como piel seca y adelgazamiento excesivo de la piel nasal. (AU)

Background and objective: Plastic surgeons who perform rhinoplasty face with patients with different characteristics depending on their ethnicity. Among the strategies implemented for these patients, the use of isotretinoin has been described for the management of thick skin. Currently, there are multiple gaps in the literature regarding the benefit and associated complications of this type of treatment in rhinoplasty. The objective of this study is to review the evidence available in the literature on the benefits and risks derived from the use of isotretinoin and rhinoplasty. Methods: A scoping review of the literature was developed on data base: PubMed Central (PMC), Cochrane, Sciencie Direct, Taylor and Francis Databases using Mesh terms “Rhinoplsaty AND Isotretinoin”. The articles were evaluated and classified to identify the available evidence in English and Spanish. Results: A review of 2621 articles published on different databases between January 2005 and June 2022 was performed, and 13 articles met the criteria established by the researchers for their analysis: 5 case reports, 2 narrative reviews, 2 controlled trials, 1 expert consensus, 1 case and control, 1 multicenter study, and 1 systematic review of the literature. Conclusions: Isotretinoin is a safe drug in concomitant use with facial procedures such as rhinoplasty and generates favorable aesthetic results in patients with a thick-skinned nose in the first 6 postoperative months. However, its use must be analyzed individually in every case since it can produce adverse effects such as dry skin and excessive thinning of the nasal skin. (AU)

Accelerated Cardiac MRI Cine with Use of Resolution Enhancement Generative Adversarial Inline Neural Network.

Background Cardiac cine can benefit from deep learning-based image reconstruction to reduce scan time and/or increase spatial and temporal resolution. Purpose To develop and evaluate a deep learning model that can be combined with parallel imaging or compressed sensing (CS). Materials and Methods The deep learning model was built on the enhanced super-resolution generative adversarial inline neural network, trained with use of retrospectively identified cine images and evaluated in participants prospectively enrolled from September 2021 to September 2022. The model was applied to breath-hold electrocardiography (ECG)-gated segmented and free-breathing real-time cine images collected with reduced spatial resolution with use of generalized autocalibrating partially parallel acquisitions (GRAPPA) or CS. The deep learning model subsequently restored spatial resolution. For comparison, GRAPPA-accelerated cine images were collected. Diagnostic quality and artifacts were evaluated by two readers with use of Likert scales and compared with use of Wilcoxon signed-rank tests. Agreement for left ventricle (LV) function, volume, and strain was assessed with Bland-Altman analysis. Results The deep learning model was trained on 1616 patients (mean age ± SD, 56 years ± 16; 920 men) and evaluated in 181 individuals, 126 patients (mean age, 57 years ± 16; 77 men) and 55 healthy subjects (mean age, 27 years ± 10; 15 men). In breath-hold ECG-gated segmented cine and free-breathing real-time cine, the deep learning model and GRAPPA showed similar diagnostic quality scores (2.9 vs 2.9, P = .41, deep learning vs GRAPPA) and artifact score (4.4 vs 4.3, P = .55, deep learning vs GRAPPA). Deep learning acquired more sections per breath-hold than GRAPPA (3.1 vs one section, P < .001). In free-breathing real-time cine, the deep learning showed a similar diagnostic quality score (2.9 vs 2.9, P = .21, deep learning vs GRAPPA) and lower artifact score (3.9 vs 4.3, P < .001, deep learning vs GRAPPA). For both sequences, the deep learning model showed excellent agreement for LV parameters, with near-zero mean differences and narrow limits of agreement compared with GRAPPA. Conclusion Deep learning-accelerated cardiac cine showed similarly accurate quantification of cardiac function, volume, and strain to a standardized parallel imaging method. © RSNA, 2023 Supplemental material is available for this article. See also the editorial by Vannier and Wang in this issue.

Comparison of DeepStrain and Feature Tracking for Cardiac MRI Strain Analysis.

BACKGROUND: Myocardial feature tracking (FT) provides a comprehensive analysis of myocardial deformation from cine balanced steady-state free-precession images (bSSFP). However, FT remains time-consuming, precluding its clinical adoption. PURPOSE: To compare left-ventricular global radial strain (GRS) and global circumferential strain (GCS) values measured using automated DeepStrain analysis of short-axis cine images to those calculated using manual commercially available FT analysis. STUDY TYPE: Retrospective, single-center. POPULATION: A total of 30 healthy subjects and 120 patients with cardiac disease for DeepStrain development. For evaluation, 47 healthy subjects (36 male, 53 ± 5 years) and 533 patients who had undergone a clinical cardiac MRI (373 male, 59 ± 14 years). FIELD STRENGTH/SEQUENCE: bSSFP sequence at 1.5 T (Phillips) and 3 T (Siemens). ASSESSMENT: Automated DeepStrain measurements of GRS and GCS were compared to commercially available FT (Circle, cvi42) measures obtained by readers with 1 year and 3 years of experience. Comparisons were performed overall and stratified by scanner manufacturer. STATISTICAL TESTS: Paired t-test, linear regression slope, Pearson correlation coefficient (r). RESULTS: Overall, FT and DeepStrain measurements of GCS were not significantly different (P = 0.207), but measures of GRS were significantly different. Measurements of GRS from Philips (slope = 1.06 [1.03 1.08], r = 0.85) and Siemens (slope = 1.04 [0.99 1.09], r = 0.83) data showed a very strong correlation and agreement between techniques. Measurements of GCS from Philips (slope = 0.98 [0.98 1.01], r = 0.91) and Siemens (slope = 1.0 [0.96 1.03], r = 0.88) data similarly showed a very strong correlation. The average analysis time per subject was 4.1 ± 1.2 minutes for FT and 34.7 ± 3.3 seconds for DeepStrain, representing a 7-fold reduction in analysis time. DATA CONCLUSION: This study demonstrated high correlation of myocardial GCS and GRS measurements between freely available fully automated DeepStrain and commercially available manual FT software, with substantial time-saving in the analysis. EVIDENCE LEVEL: 3 TECHNICAL EFFICACY: Stage 3.

An inline deep learning based free-breathing ECG-free cine for exercise cardiovascular magnetic resonance.

BACKGROUND: Exercise cardiovascular magnetic resonance (Ex-CMR) is a promising stress imaging test for coronary artery disease (CAD). However, Ex-CMR requires accelerated imaging techniques that result in significant aliasing artifacts. Our goal was to develop and evaluate a free-breathing and electrocardiogram (ECG)-free real-time cine with deep learning (DL)-based radial acceleration for Ex-CMR. METHODS: A 3D (2D + time) convolutional neural network was implemented to suppress artifacts from aliased radial cine images. The network was trained using synthetic real-time radial cine images simulated using breath-hold, ECG-gated segmented Cartesian k-space data acquired at 3 T from 503 patients at rest. A prototype real-time radial sequence with acceleration rate = 12 was used to collect images with inline DL reconstruction. Performance was evaluated in 8 healthy subjects in whom only rest images were collected. Subsequently, 14 subjects (6 healthy and 8 patients with suspected CAD) were prospectively recruited for an Ex-CMR to evaluate image quality. At rest (n = 22), standard breath-hold ECG-gated Cartesian segmented cine and free-breathing ECG-free real-time radial cine images were acquired. During post-exercise stress (n = 14), only real-time radial cine images were acquired. Three readers evaluated residual artifact level in all collected images on a 4-point Likert scale (1-non-diagnostic, 2-severe, 3-moderate, 4-minimal). RESULTS: The DL model substantially suppressed artifacts in real-time radial cine images acquired at rest and during post-exercise stress. In real-time images at rest, 89.4% of scores were moderate to minimal. The mean score was 3.3 ± 0.7, representing increased (P < 0.001) artifacts compared to standard cine (3.9 ± 0.3). In real-time images during post-exercise stress, 84.6% of scores were moderate to minimal, and the mean artifact level score was 3.1 ± 0.6. Comparison of left-ventricular (LV) measures derived from standard and real-time cine at rest showed differences in LV end-diastolic volume (3.0 mL [- 11.7, 17.8], P = 0.320) that were not significantly different from zero. Differences in measures of LV end-systolic volume (7.0 mL [- 1.3, 15.3], P < 0.001) and LV ejection fraction (- 5.0% [- 11.1, 1.0], P < 0.001) were significant. Total inline reconstruction time of real-time radial images was 16.6 ms per frame. CONCLUSIONS: Our proof-of-concept study demonstrated the feasibility of inline real-time cine with DL-based radial acceleration for Ex-CMR.

DeepStrain Evidence of Asymptomatic Left Ventricular Diastolic and Systolic Dysfunction in Young Adults With Cardiac Risk Factors.

Purpose: To evaluate if a fully-automatic deep learning method for myocardial strain analysis based on magnetic resonance imaging (MRI) cine images can detect asymptomatic dysfunction in young adults with cardiac risk factors. Methods: An automated workflow termed DeepStrain was implemented using two U-Net models for segmentation and motion tracking. DeepStrain was trained and tested using short-axis cine-MRI images from healthy subjects and patients with cardiac disease. Subsequently, subjects aged 18-45 years were prospectively recruited and classified among age- and gender-matched groups: risk factor group (RFG) 1 including overweight without hypertension or type 2 diabetes; RFG2 including hypertension without type 2 diabetes, regardless of overweight; RFG3 including type 2 diabetes, regardless of overweight or hypertension. Subjects underwent cardiac short-axis cine-MRI image acquisition. Differences in DeepStrain-based left ventricular global circumferential and radial strain and strain rate among groups were evaluated. Results: The cohort consisted of 119 participants: 30 controls, 39 in RFG1, 30 in RFG2, and 20 in RFG3. Despite comparable (>0.05) left-ventricular mass, volumes, and ejection fraction, all groups (RFG1, RFG2, RFG3) showed signs of asymptomatic left ventricular diastolic and systolic dysfunction, evidenced by lower circumferential early-diastolic strain rate (<0.05, <0.001, <0.01), and lower septal circumferential end-systolic strain (<0.001, <0.05, <0.001) compared with controls. Multivariate linear regression showed that body surface area correlated negatively with all strain measures (<0.01), and mean arterial pressure correlated negatively with early-diastolic strain rate (<0.01). Conclusion: DeepStrain fully-automatically provided evidence of asymptomatic left ventricular diastolic and systolic dysfunction in asymptomatic young adults with overweight, hypertension, and type 2 diabetes risk factors.

Evaluation of Deep Learning-Based Approaches to Segment Bowel Air Pockets and Generate Pelvic Attenuation Maps from CAIPIRINHA-Accelerated Dixon MR Images.

Attenuation correction remains a challenge in pelvic PET/MRI. In addition to the segmentation/model-based approaches, deep learning methods have shown promise in synthesizing accurate pelvic attenuation maps (µ-maps). However, these methods often misclassify air pockets in the digestive tract, potentially introducing bias in the reconstructed PET images. The aims of this work were to develop deep learning-based methods to automatically segment air pockets and generate pseudo-CT images from CAIPIRINHA-accelerated MR Dixon images. Methods: A convolutional neural network (CNN) was trained to segment air pockets using 3-dimensional CAIPIRINHA-accelerated MR Dixon datasets from 35 subjects and was evaluated against semiautomated segmentations. A separate CNN was trained to synthesize pseudo-CT µ-maps from the Dixon images. Its accuracy was evaluated by comparing the deep learning-, model-, and CT-based µ-maps using data from 30 of the subjects. Finally, the impact of different µ-maps and air pocket segmentation methods on the PET quantification was investigated. Results: Air pockets segmented using the CNN agreed well with semiautomated segmentations, with a mean Dice similarity coefficient of 0.75. The volumetric similarity score between 2 segmentations was 0.85 ± 0.14. The mean absolute relative changes with respect to the CT-based µ-maps were 2.6% and 5.1% in the whole pelvis for the deep learning-based and model-based µ-maps, respectively. The average relative change between PET images reconstructed with deep learning-based and CT-based µ-maps was 2.6%. Conclusion: We developed a deep learning-based method to automatically segment air pockets from CAIPIRINHA-accelerated Dixon images, with accuracy comparable to that of semiautomatic segmentations. The µ-maps synthesized using a deep learning-based method from CAIPIRINHA-accelerated Dixon images were more accurate than those generated with the model-based approach available on integrated PET/MRI scanners.

DeepStrain: A Deep Learning Workflow for the Automated Characterization of Cardiac Mechanics.

Myocardial strain analysis from cinematic magnetic resonance imaging (cine-MRI) data provides a more thorough characterization of cardiac mechanics than volumetric parameters such as left-ventricular ejection fraction, but sources of variation including segmentation and motion estimation have limited its wider clinical use. We designed and validated a fast, fully-automatic deep learning (DL) workflow to generate both volumetric parameters and strain measures from cine-MRI data consisting of segmentation and motion estimation convolutional neural networks. The final motion network design, loss function, and associated hyperparameters are the result of a thorough ad hoc implementation that we carefully planned specific for strain quantification, tested, and compared to other potential alternatives. The optimal configuration was trained using healthy and cardiovascular disease (CVD) subjects (n = 150). DL-based volumetric parameters were correlated (>0.98) and without significant bias relative to parameters derived from manual segmentations in 50 healthy and CVD test subjects. Compared to landmarks manually-tracked on tagging-MRI images from 15 healthy subjects, landmark deformation using DL-based motion estimates from paired cine-MRI data resulted in an end-point-error of 2.9 ± 1.5 mm. Measures of end-systolic global strain from these cine-MRI data showed no significant biases relative to a tagging-MRI reference method. On 10 healthy subjects, intraclass correlation coefficient for intra-scanner repeatability was good to excellent (>0.75) for all global measures and most polar map segments. In conclusion, we developed and evaluated the first end-to-end learning-based workflow for automated strain analysis from cine-MRI data to quantitatively characterize cardiac mechanics of healthy and CVD subjects.

Implementation and Validation of a Three-dimensional Cardiac Motion Estimation Network.

PURPOSE: To describe an unsupervised three-dimensional cardiac motion estimation network (CarMEN) for deformable motion estimation from two-dimensional cine MR images. MATERIALS AND METHODS: A function was implemented using CarMEN, a convolutional neural network that takes two three-dimensional input volumes and outputs a motion field. A smoothness constraint was imposed on the field by regularizing the Frobenius norm of its Jacobian matrix. CarMEN was trained and tested with data from 150 cardiac patients who underwent MRI examinations and was validated on synthetic (n = 100) and pediatric (n = 33) datasets. CarMEN was compared to five state-of-the-art nonrigid body registration methods by using several performance metrics, including Dice similarity coefficient (DSC) and end-point error. RESULTS: On the synthetic dataset, CarMEN achieved a median DSC of 0.85, which was higher than all five methods (minimum-maximum median [or MMM], 0.67-0.84; P < .001), and a median end-point error of 1.7, which was lower than (MMM, 2.1-2.7; P < .001) or similar to (MMM, 1.6-1.7; P > .05) all other techniques. On the real datasets, CarMEN achieved a median DSC of 0.73 for Automated Cardiac Diagnosis Challenge data, which was higher than (MMM, 0.33; P < .0001) or similar to (MMM, 0.72-0.75; P > .05) all other methods, and a median DSC of 0.77 for pediatric data, which was higher than (MMM, 0.71-0.76; P < .0001) or similar to (MMM, 0.77-0.78; P > .05) all other methods. All P values were derived from pairwise testing. For all other metrics, CarMEN achieved better accuracy on all datasets than all other techniques except for one, which had the worst motion estimation accuracy. CONCLUSION: The proposed deep learning-based approach for three-dimensional cardiac motion estimation allowed the derivation of a motion model that balances motion characterization and image registration accuracy and achieved motion estimation accuracy comparable to or better than that of several state-of-the-art image registration algorithms.© RSNA, 2019Supplemental material is available for this article.

Dixon-VIBE Deep Learning (DIVIDE) Pseudo-CT Synthesis for Pelvis PET/MR Attenuation Correction.

Whole-body attenuation correction (AC) is still challenging in combined PET/MR scanners. We describe Dixon-VIBE Deep Learning (DIVIDE), a deep-learning network that allows synthesizing pelvis pseudo-CT maps based only on the standard Dixon volumetric interpolated breath-hold examination (Dixon-VIBE) images currently acquired for AC in some commercial scanners. Methods: We propose a network that maps between the four 2-dimensional (2D) Dixon MR images (water, fat, in-phase, and out-of-phase) and their corresponding 2D CT image. In contrast to previous methods, we used transposed convolutions to learn the up-sampling parameters, we used whole 2D slices to provide context information, and we pretrained the network with brain images. Twenty-eight datasets obtained from 19 patients who underwent PET/CT and PET/MR examinations were used to evaluate the proposed method. We assessed the accuracy of the µ-maps and reconstructed PET images by performing voxel- and region-based analysis comparing the SUVs (in g/mL) obtained after AC using the Dixon-VIBE (PETDixon), DIVIDE (PETDIVIDE), and CT-based (PETCT) methods. Additionally, the bias in quantification was estimated in synthetic lesions defined in the prostate, rectum, pelvis, and spine. Results: Absolute mean relative change values relative to CT AC were lower than 2% on average for the DIVIDE method in every region of interest except for bone tissue, where it was lower than 4% and 6.75 times smaller than the relative change of the Dixon method. There was an excellent voxel-by-voxel correlation between PETCT and PETDIVIDE (R2 = 0.9998, P < 0.01). The Bland-Altman plot between PETCT and PETDIVIDE showed that the average of the differences and the variability were lower (mean PETCT-PETDIVIDE SUV, 0.0003; PETCT-PETDIVIDE SD, 0.0094; 95% confidence interval, [-0.0180,0.0188]) than the average of differences between PETCT and PETDixon (mean PETCT-PETDixon SUV, 0.0006; PETCT-PETDixon SD, 0.0264; 95% confidence interval, [-0.0510,0.0524]). Statistically significant changes in PET data quantification were observed between the 2 methods in the synthetic lesions, with the largest improvement in femur and spine lesions. Conclusion: The DIVIDE method can accurately synthesize a pelvis pseudo-CT scan from standard Dixon-VIBE images, allowing for accurate AC in combined PET/MR scanners. Additionally, our implementation allows rapid pseudo-CT synthesis, making it suitable for routine applications and even allowing retrospective processing of Dixon-VIBE data.

Mechanisms of aggregation in an ant-tended treehopper: Attraction to mutualists is balanced by conspecific competition.

Understanding the spatial structure of populations and communities has been a dominant focus of ecological research, and spatial structure is increasingly seen as critical for understanding population dynamics. Habitat (or host) preference is a proximate mechanism that can generate aggregation or overdispersion, lending insight into the ultimate consequences of observed spatial distributions. Publilia concava is a univoltine phloem-feeding insect that forms mutualistic associations with ants, which consume honeydew and protect treehoppers from predation. Treehopper adults and nymphs are aggregated at the scale of goldenrod plant stems, and previous studies have suggested that this aggregation is an adaptive response that increases feeding performance or maximizes benefits of ant-tending. Previous studies have also shown experimentally that individual treehoppers preferentially oviposit on plants with ants present, but a complimentary hypothesis that treehoppers prefer to oviposit near conspecifics (e.g., to take advantage of density-dependent ant attraction) remains untested. We show that, as expected, the probability of treehopper oviposition increases with ant-presence and relative ant abundance. However, we also find that treehopper oviposition decreases with increasing treehopper density. Thus our results are inconsistent with the hypothesis that treehopper aggregation is a socially cooperative strategy to attract ants; we suggest that aggregation is a form of conflict and an unavoidable by-product of individual responses to ant-tending levels.

Cavity mode enhancement of terahertz emission from equilateral triangular microstrip antennas of the high-T c superconductor Bi2Sr2CaCu2O8 + δ.

We study the transverse magnetic (TM) electromagnetic cavity mode wave functions for an ideal equilateral triangular microstrip antenna (MSA) exhibiting C 3v point group symmetry. When the C 3v operations are imposed upon the antenna, the TM(m,n) modes with wave vectors [Formula: see text] are much less dense than commonly thought. The R 3 operations restrict the integral n and m to satisfy [Formula: see text], where [Formula: see text] and [Formula: see text] for the modes even and odd under reflections about the three mirror planes, respectively. We calculate the forms of representative wave functions and the angular dependence of the output power when these modes are excited by the uniform and non-uniform ac Josephson current sources in thin, ideally equilateral triangular MSAs employing the intrinsic Josephson junctions in the high transition temperature T c superconductor Bi2Sr2CaCu2 [Formula: see text], and fit the emissions data from an earlier sample for which the C 3v symmetry was apparently broken.

Model selection analysis of temporal variation in benefit for an ant-tended treehopper.

Recent studies of mutualism have emphasized both that the net benefit to participants depends on the ecological context and that the density-dependent pattern of benefit is key to understanding the population dynamics of mutualism. Indeed, changes in the ecological context are likely to drive changes in both the magnitude of benefit and the density-dependent pattern of benefit. Despite the close linkage between these two areas of research, however, few studies have addressed the factors underlying variation in the density-dependent pattern of benefit. Here I use model selection to evaluate how variation in the benefits of a mutualism drives temporal variation in the density-dependent pattern of net benefit for the ant-tended treehopper Publilia concava. In the interaction between ants and treehoppers in the genus Publilia, ants collect the sugary excretions of treehoppers as a food resource, and treehoppers benefit both directly (e.g., by feeding facilitation) and indirectly (e.g., by predator protection). Results presented here show that temporal changes in the relative magnitude of direct and indirect benefit components of ant tending, especially the effectiveness of predator protection by ants, qualitatively change the overall pattern of density-dependent benefit between years with maximum benefit shifting from treehoppers in small to large aggregations. These results emphasize the need for empirical studies that evaluate the long-term dynamics of mutualism and theoretical studies that consider the population dynamics consequences of variation in the density-dependent pattern of benefit.

Isolation and characterization of nine microsatellite loci in an ant-tended treehopper Publilia concava.

Publilia concava is an eastern North American membracid commonly occurring in large but spatially patchy aggregations, primarily on the host plant Solidago altissima. Like other myrmecophiles, P. concava provides sugary excretions to ants in return for the various protective, competitive or even sanitary benefits that ants provide. We developed nine microsatellite loci from P. concava. Mean per locus allele number was 6.78, and observed heterozygosities ranged from 0.03 to 0.850. One locus exhibited significant heterozygote deficit, possibly due to the presence of null alleles. These markers provide important tools for future spatial ecological studies in this model system for the study of mutualism.

Acoustic alarm signalling facilitates predator protection of treehoppers by mutualist ant bodyguards.

Mutualism is a net positive interaction that includes varying degrees of both costs and benefits. Because tension between the costs and benefits of mutualism can lead to evolutionary instability, identifying mechanisms that regulate investment between partners is critical to understanding the evolution and maintenance of mutualism. Recently, studies have highlighted the importance of interspecific signalling as one mechanism for regulating investment between mutualist partners. Here, we provide evidence for interspecific alarm signalling in an insect protection mutualism and we demonstrate a functional link between this acoustic signalling and efficacy of protection. The treehopper Publilia concava Say (Hemiptera: Membracidae) is an insect that provides ants with a carbohydrate-rich excretion called honeydew in return for protection from predators. Adults of this species produce distinct vibrational signals in the context of predator encounters. In laboratory trials, putative alarm signal production significantly increased following initial contact with ladybeetle predators (primarily Harmonia axyridis Pallas, Coleoptera: Coccinellidae), but not following initial contact with ants. In field trials, playback of a recorded treehopper alarm signal resulted in a significant increase in both ant activity and the probability of ladybeetle discovery by ants relative to both silence and treehopper courtship signal controls. Our results show that P. concava treehoppers produce alarm signals in response to predator threat and that this signalling can increase effectiveness of predator protection by ants.

A phenological mid-domain effect in flowering diversity.

In this paper, we test the mid-domain hypothesis as an explanation for observed patterns of flowering diversity in two sub-alpine communities of insect-pollinated plants. Observed species richness patterns showed an early-season increase in richness, a mid-season peak, and a late-season decrease. We show that a "mid-domain" null model can qualitatively match this pattern of flowering species richness, with R(2) values typically greater than 60%. We find significant or marginally significant departures from expected patterns of diversity for only 3 out of 12 year-site combinations. On the other hand, we do find a consistent pattern of departure when comparing observed versus null-model predicted flowering diversity averaged across years. Our results therefore support the hypothesis that ecological factors shape patterns of flowering phenology, but that the strength or nature of these environmental forcings may differ between years or the two habitats we studied, or may depend on species-specific characteristics of these plant communities. We conclude that mid-domain null models provide an important baseline from which to test departure of expected patterns of flowering diversity across temporal domains. Geometric constraints should be included first in the list of factors that drive seasonal patterns of flowering diversity.

Variation in timing and abundance of flowering by Delphinium barbeyi Huth (Ranunculaceae): the roles of snowpack, frost, and La Niña, in the context of climate change.

Delphinium barbeyi is a common herbaceous wildflower in montane meadows at 2,900 m near the Rocky Mountain Biological Laboratory, and its flowers are important nectar resources for bumblebees and hummingbirds. During the period 1977-1999 flowering was highly variable in both timing (date of first flower ranged from 5 July to 6 August, mean=17 July) and abundance (maximum open flowers per 2×2-m plot ranged from 11.3 to 197.9, mean=82). Time and abundance of flowering are highly correlated with the previous winter's snowpack, as measured by the amount of snow remaining on the ground on 15 May (range 0-185 cm, mean=67.1). We used structural equation modeling to investigate relationships among snowpack, first date of bare ground, first date of flowering, number of inflorescences produced, and peak number of flowers, all of which are significantly correlated with each other. Snowpack depth on 15 May is a significant predictor of the first date of bare ground (R 2=0.872), which in turn is a significant predictor of the first date of flowering (R 2=0.858); snowpack depth is also significantly correlated with number of inflorescences produced (R 2=0.713). Both the number of inflorescences and mean date of first flowering are significant predictors of flowers produced (but with no residual effect of snowpack). Part of the effect of snowpack on flowering may be mediated through an increased probability of frost damage in years with lower snowpack - the frequency of early-season "frost events" explained a significant proportion of the variance in the number of flowers per stem. There is significant reduction of flower production in La Niña episodes. The variation in number of flowers we have observed is likely to affect the pollination, mating system, and demography of the species. Through its effect on snowpack, frost events, and their interaction, climate change may influence all of these variables.