Ultrasound-assisted carbon ion dosimetry and range measurement using injectable polymer-shelled phase-change nanodroplets: in vitro study.

Methods allowing for in situ dosimetry and range verification are essential in radiotherapy to reduce the safety margins required to account for uncertainties introduced in the entire treatment workflow. This study suggests a non-invasive dosimetry concept for carbon ion radiotherapy based on phase-change ultrasound contrast agents. Injectable nanodroplets made of a metastable perfluorobutane (PFB) liquid core, stabilized with a crosslinked poly(vinylalcohol) shell, are vaporized at physiological temperature when exposed to carbon ion radiation (C-ions), converting them into echogenic microbubbles. Nanodroplets, embedded in tissue-mimicking phantoms, are exposed at 37 °C to a 312 MeV/u clinical C-ions beam at different doses between 0.1 and 4 Gy. The evaluation of the contrast enhancement from ultrasound imaging of the phantoms, pre- and post-irradiation, reveals a significant radiation-triggered nanodroplets vaporization occurring at the C-ions Bragg peak with sub-millimeter shift reproducibility and dose dependency. The specific response of the nanodroplets to C-ions is further confirmed by varying the phantom position, the beam range, and by performing spread-out Bragg peak irradiation. The nanodroplets' response to C-ions is influenced by their concentration and is dose rate independent. These early findings show the ground-breaking potential of polymer-shelled PFB nanodroplets to enable in vivo carbon ion dosimetry and range verification.

Ultrasound-assisted investigation of photon triggered vaporization of poly(vinylalcohol) phase-change nanodroplets: A preliminary concept study with dosimetry perspective.

PURPOSE: We investigate the vaporization of phase-change ultrasound contrast agents using photon radiation for dosimetry perspectives in radiotherapy. METHODS: We studied superheated perfluorobutane nanodroplets with a crosslinked poly(vinylalcohol) shell. The nanodroplets' physico-chemical properties, and their acoustic transition have been assessed firstly. Then, poly(vinylalcohol)-perfluorobutane nanodroplets were dispersed in poly(acrylamide) hydrogel phantoms and exposed to a photon beam. We addressed the effect of several parameters influencing the nanodroplets radiation sensitivity (energy/delivered dose/dose rate/temperature). The nanodroplets-vaporization post-photon exposure was evaluated using ultrasound imaging at a low mechanical index. RESULTS: Poly(vinylalcohol)-perfluorobutane nanodroplets show a good colloidal stability over four weeks and remain highly stable at temperatures up to 78 °C. Nanodroplets acoustically-triggered phase transition leads to microbubbles with diameters <10 µm and an activation threshold of mechanical index = 0.4, at 7.5 MHz. A small number of vaporization events occur post-photon exposure (6MV/15MV), at doses between 2 and 10 Gy, leading to ultrasound contrast increase up to 60% at RT. The nanodroplets become efficiently sensitive to photons when heated to a temperature of 65 °C (while remaining below the superheat limit temperature) during irradiation. CONCLUSIONS: Nanodroplets' core is linked to the degree of superheat in the metastable state and plays a critical role in determining nanodroplet' stability and sensitivity to ionizing radiation, requiring higher or lower linear energy transfer vaporization thresholds. While poly(vinylalcohol)-perfluorobutane nanodroplets could be slightly activated by photons at ambient conditions, a good balance between the degree of superheat and stability will aim at optimizing the design of nanodroplets to reach high sensitivity to photons at physiological conditions.

Effect of a Radiotherapeutic Megavoltage Beam on Ultrasound Contrast Agents.

Collateral damage to healthy surrounding tissue during conventional radiotherapy increases when deviations from the treatment plan occur. Ultrasound contrast agents (UCAs) are a possible candidate for radiation dose monitoring. This study investigated the size distribution and acoustic response of two commercial formulations, SonoVue/Lumason and Definity/Luminity, as a function of dose on clinical megavoltage photon beam exposure (24 Gy). SonoVue samples exhibited a decrease in concentration of bubbles smaller than 7 µm, together with an increase in acoustic attenuation and a decrease in acoustic scattering. Definity samples did not exhibit a significant response to radiation, suggesting that the effect of megavoltage photons depends on the UCA formulation. For SonoVue, the influence of the megavoltage photon beam was especially apparent at the second harmonic frequency, and can be captured using pulse inversion and amplitude modulation (3.5-dB decrease for the maximum dose), which could eventually be used for dosimetry in a well-controlled environment.

Modulating ultrasound contrast generation from injectable nanodroplets for proton range verification by varying the degree of superheat.

PURPOSE: Despite the physical benefits of protons over conventional photon radiation in cancer treatment, range uncertainties impede the ability to harness the full potential of proton therapy. While monitoring the proton range in vivo could reduce the currently adopted safety margins, a routinely applicable range verification technique is still lacking. Recently, phase-change nanodroplets were proposed for proton range verification, demonstrating a reproducible relationship between the proton range and generated ultrasound contrast after radiation-induced vaporization at 25°C. In this study, previous findings are extended with proton irradiations at different temperatures, including the physiological temperature of 37°C, for a novel nanodroplet formulation. Moreover, the potential to modulate the linear energy transfer (LET) threshold for vaporization by varying the degree of superheat is investigated, where the aim is to demonstrate vaporization of nanodroplets directly by primary protons. METHODS: Perfluorobutane nanodroplets with a shell made of polyvinyl alcohol (PVA-PFB) or 10,12-pentacosadyinoic acid (PCDA-PFB) were dispersed in polyacrylamide hydrogels and irradiated with 62 MeV passively scattered protons at temperatures of 37°C and 50°C. Nanodroplet transition into echogenic microbubbles was assessed using ultrasound imaging (gray value and attenuation analysis) and optical images. The proton range was measured independently and compared to the generated contrast. RESULTS: Nanodroplet design proved crucial to ensure thermal stability, as PVA-shelled nanodroplets dramatically outperformed their PCDA-shelled counterpart. At body temperature, a uniform radiation response proximal to the Bragg peak is attributed to nuclear reaction products interacting with PVA-PFB nanodroplets, with the 50% drop in ultrasound contrast being 0.17 mm ± 0.20 mm (mean ± standard deviation) in front of the proton range. Also at 50°C, highly reproducible ultrasound contrast profiles were obtained with shifts of -0.74 mm ± 0.09 mm (gray value analysis), -0.86 mm ± 0.04 mm (attenuation analysis) and -0.64 mm ± 0.29 mm (optical analysis). Moreover, a strong contrast enhancement was observed near the Bragg peak, suggesting that nanodroplets were sensitive to primary protons. CONCLUSIONS: By varying the degree of superheat of the nanodroplets' core, one can modulate the intensity of the generated ultrasound contrast. Moreover, a submillimeter reproducible relationship between the ultrasound contrast and the proton range was obtained, either indirectly via the visualization of secondary reaction products or directly through the detection of primary protons, depending on the degree of superheat. The potential of PVA-PFB nanodroplets for in vivo proton range verification was confirmed by observing a reproducible radiation response at physiological temperature, and further studies aim to assess the nanodroplets' performance in a physiological environment. Ultimately, cost-effective online or offline ultrasound imaging of radiation-induced nanodroplet vaporization could facilitate the reduction of safety margins in treatment planning and enable adaptive proton therapy.

Characterization of an inorganic scintillator for small-field dosimetry in MR-guided radiotherapy.

INTRODUCTION: Aim of this study is to dosimetrically characterize a new inorganic scintillator designed for magnetic resonance-guided radiotherapy (MRgRT) in the presence of 0.35 tesla magnetic field (B). METHODS: The detector was characterized in terms of signal to noise ratio (SNR), reproducibility, dose linearity, angular response, and dependence by energy, field size, and B orientation using a 6 MV magnetic resonance (MR)-Linac and a water tank. Field size dependence was investigated by measuring the output factor (OF) at 1.5 cm. The results were compared with those measured using other detectors (ion chamber and synthetic diamond) and those calculated using a Monte Carlo (MC) algorithm. Energy dependence was investigated by acquiring a percentage depth dose (PDD) curve at two field sizes (3.32 × 3.32 and 9.96 × 9.96 cm2 ) and repeating the OF measurements at 5 and 10 cm depths. RESULTS: The mean SNR was 116.3 ± 0.6. Detector repeatability was within 1%, angular dependence was <2% and its response variation based on the orientation with respect to the B lines was <1%. The detector has a temporal resolution of 10 Hz and it showed a linear response (R2  = 1) in the dose range investigated. All the OF values measured at 1.5 cm depth using the scintillator are in accordance within 1% with those measured with other detectors and are calculated using the MC algorithm. PDD values are in accordance with MC algorithm only for 3.32 × 3.32 cm2 field. Numerical models can be applied to compensate for energy dependence in case of larger fields. CONCLUSION: The inorganic scintillator in the present form can represent a valuable detector for small-field dosimetry and periodic quality controls at MR-Linacs such as dose stability, OFs, and dose linearity. In particular, the detector can be effectively used for small-field dosimetry at 1.5 cm depth and for PDD measurements if the field dimension of 3.32 × 3.32 cm2 is not exceeded.

Proton range verification with ultrasound imaging using injectable radiation sensitive nanodroplets: a feasibility study.

Technologies enabling in vivo range verification during proton therapy are actively sought as a means to reduce the clinical safety margins currently adopted to avoid tumor underdosage. In this contribution, we applied the semi-empirical theory of radiation-induced vaporization of superheated liquids to coated nanodroplets. Nanodroplets are injectable phase-change contrast agents that can vaporize into highly echogenic microbubbles to provide contrast in ultrasound images. We exposed nanodroplet dispersions in aqueous phantoms to monoenergetic proton beams of varying energies and doses. Ultrasound imaging of the phantoms revealed that radiation-induced droplet vaporization occurred in regions proximal to the proton Bragg peak. A statistically significant increase in contrast was observed in irradiated regions for doses as low as 2 Gy and found to be proportional to the proton fluence. The absence of enhanced response in the vicinity of the Bragg peak, combined with theoretical considerations, suggest that droplet vaporization is induced by high linear energy transfer (LET) recoil ions produced by nuclear reactions with incoming protons. Vaporization profiles were compared to non-elastic cross sections and LET characteristics of oxygen recoils. Shifts between the ultrasound image contrast drop and the expected proton range showed a sub-millimeter reproducibility. These early findings confirm the potential of superheated nanodroplets as a novel tool for proton range verification.

Phase Change Ultrasound Contrast Agents with a Photopolymerized Diacetylene Shell.

Phase change contrast agents for ultrasound (US) imaging consist of nanodroplets (NDs) with a perfluorocarbon (PFC) liquid core stabilized with a lipid or a polymer shell. Liquid ↔ gas transition, occurring in the core, can be triggered by US to produce acoustically active microbubbles (MBs) in a process named acoustic droplet vaporization (ADV). MB shells containing polymerized diacetylene moiety were considered as a good trade off between the lipid MBs, showing optimal attenuation, and the polymeric ones, displaying enhanced stability. This work reports on novel perfluoropentane and perfluorobutane NDs stabilized with a monolayer of an amphiphilic fatty acid, i.e. 10,12-pentacosadiynoic acid (PCDA), cured with ultraviolet (UV) irradiation. The photopolymerization of the diacetylene groups, evidenced by the appearance of a blue color due to the conjugation of ene-yne sequences, exhibits a chromatic transition from the nonfluorescent blue color to a fluorescent red color when the NDs are heated or the pH of the suspension is basic. An estimate of the molecular weights reached by the polymerized PCDA in the shell, poly(PCDA), has been obtained using gel permeation chromatography and MALDI-TOF mass spectrometry. The poly(PCDA)/PFC NDs show good biocompatibility with fibroblast cells. ADV efficiency and acoustic properties before and after the transition were tested using a 1 MHz probe, revealing a resonance frequency between 1 and 2 MHz similar to other lipidic MBs. The surface of PCDA shelled NDs can be easily modified without influencing the stability and the acoustic performances of droplets. As a proof of concept we report on the conjugation of cyclic RGD and PEG chains of the particles to support targeting ability toward endothelial cells.

Attenuation estimation by repeatedly solving the forward scattering problem.

Estimation of the attenuation is important in medical ultrasound not only for correct time-gain compensation but also for tissue characterization. In this paper, the feasibility of a new method for attenuation estimation is tested. The proposed method estimates the attenuation by repeatedly solving the forward wave propagation problem and matching the simulated signals to the measured ones. This approach allows avoiding common assumptions made by other methodologies and potentially allows to account and correct for other acoustic effects that may bias the attenuation estimate. The performance of the method was validated on simulated data and on data recorded in tissue mimicking phantoms with known attenuation properties, and was compared to the spectral-shift and spectral-difference methods. Simulation results showed the different methods to have good accuracy when noise-free signals were considered (the average relative error of the attenuation estimation did not exceed 15%). However, the accuracy of the conventional methods decreased rapidly in the presence of measurement noise and varying scatterer concentration, while the relative error of the proposed method remained below 15%. Furthermore, the proposed method outperformed conventional attenuation estimators in the experimental phantom study, where its average error was 8%, while the average error of the spectral-shift and spectral-difference methods was 26% and 32%, respectively. In summary, these findings demonstrate the feasibility of the proposed approach and motivate us to refine the method for solving more general problems.

Modeling the dose dependence of the vis-absorption spectrum of EBT3 GafChromic™ films.

PURPOSE: The aim of this work was to model the dose dependence of the darkening of GafChromic™ EBT3 films by combining the optical properties of the polydiacetylene polymer phases, and a modified version of the single-hit model, which will take the stick-like shape of the monomer microcrystals into account. Second, a comparison is made between the quantification of the film darkening by flatbed scanning and by UV-vis absorption spectroscopy. METHOD: GafChromicTM EBT3 films were irradiated with a 6 MV photon beam at dose levels between 0 and 50 Gy. The radiation-induced darkening of the films is quantified by a flatbed scanner, and by UV-vis absorption spectroscopy in the wavelength range of 220-750 nm. From the UV-vis absorption spectra, the contribution of each polymer phase to the absorbance was deduced. Next, the dose dependence of the polymer content is described by a modified single-hit model where the size distribution of polymerizable centers is approximated by way of the size distribution of the monomer microcrystals in the film. RESULTS: The absorption properties of the film can be accurately quantified by UV-vis spectroscopy for dose levels between 0 and 10 Gy. Over 10 Gy, the absorption spectrum saturates due to the limited sensitivity of the spectrometer. The modified single-hit model was successful in describing the increasing polymer concentration with radiation dose, using a log-normal distribution for the length of the stick-like monomer microcrystals. The dose dependence of the polymer content, deduced from the UV-vis absorption spectrum, differs from that of the flatbed scanning method and is more sensitive to changes in dose. CONCLUSION: The dose dependence of the polymer concentration can be modeled by taking into account the distribution of active centers using the microstructure of the active layer for dose levels between 0 and 10 Gy. The dissimilar dose dependence of the polymer concentration and the absorbance must be accounted for when modeling darkening from the kinetics of the photopolymerization reaction.

A multidisciplinary approach unravels early and persistent effects of X-ray exposure at the onset of prenatal neurogenesis.

BACKGROUND: In humans, in utero exposure to ionising radiation results in an increased prevalence of neurological aberrations, such as small head size, mental retardation and decreased IQ levels. Yet, the association between early damaging events and long-term neuronal anomalies remains largely elusive. METHODS: Mice were exposed to different X-ray doses, ranging between 0.0 and 1.0 Gy, at embryonic days (E) 10, 11 or 12 and subjected to behavioural tests at 12 weeks of age. Underlying mechanisms of irradiation at E11 were further unravelled using magnetic resonance imaging (MRI) and spectroscopy, diffusion tensor imaging, gene expression profiling, histology and immunohistochemistry. RESULTS: Irradiation at the onset of neurogenesis elicited behavioural changes in young adult mice, dependent on the timing of exposure. As locomotor behaviour and hippocampal-dependent spatial learning and memory were most particularly affected after irradiation at E11 with 1.0 Gy, this condition was used for further mechanistic analyses, focusing on the cerebral cortex and hippocampus. A classical p53-mediated apoptotic response was found shortly after exposure. Strikingly, in the neocortex, the majority of apoptotic and microglial cells were residing in the outer layer at 24 h after irradiation, suggesting cell death occurrence in differentiating neurons rather than proliferating cells. Furthermore, total brain volume, cortical thickness and ventricle size were decreased in the irradiated embryos. At 40 weeks of age, MRI showed that the ventricles were enlarged whereas N-acetyl aspartate concentrations and functional anisotropy were reduced in the cortex of the irradiated animals, indicating a decrease in neuronal cell number and persistent neuroinflammation. Finally, in the hippocampus, we revealed a reduction in general neurogenic proliferation and in the amount of Sox2-positive precursors after radiation exposure, although only at a juvenile age. CONCLUSIONS: Our findings provide evidence for a radiation-induced disruption of mouse brain development, resulting in behavioural differences. We propose that alterations in cortical morphology and juvenile hippocampal neurogenesis might both contribute to the observed aberrant behaviour. Furthermore, our results challenge the generally assumed view of a higher radiosensitivity in dividing cells. Overall, this study offers new insights into irradiation-dependent effects in the embryonic brain, of relevance for the neurodevelopmental and radiobiological field.

Longitudinal in vivo microcomputed tomography of mouse lungs: No evidence for radiotoxicity.

Before microcomputed tomography (micro-CT) can be exploited to its full potential for longitudinal monitoring of transgenic and experimental mouse models of lung diseases, radiotoxic side effects such as inflammation or fibrosis must be considered. We evaluated dose and potential radiotoxicity to the lungs for long-term respiratory-gated high-resolution micro-CT protocols. Free-breathing C57Bl/6 mice underwent four different retrospectively respiratory gated micro-CT imaging schedules of repeated scans during 5 or 12 wk, followed by ex vivo micro-CT and detailed histological and biochemical assessment of lung damage. Radiation exposure, dose, and absorbed dose were determined by ionization chamber, thermoluminescent dosimeter measurements and Monte Carlo calculations. Despite the relatively large radiation dose delivered per micro-CT acquisition, mice did not show any signs of radiation-induced lung damage or fibrosis when scanned weekly during 5 and up to 12 wk. Doubling the scanning frequency and once tripling the radiation dose as to mimic the instant repetition of a failed scan also stayed without detectable toxicity after 5 wk of scanning. Histological analyses confirmed the absence of radiotoxic damage to the lungs, thereby demonstrating that long-term monitoring of mouse lungs using high-resolution micro-CT is safe. This opens perspectives for longitudinal monitoring of (transgenic) mouse models of lung diseases and therapeutic response on an individual basis with high spatial and temporal resolution, without concerns for radiation toxicity that could potentially influence the readout of micro-CT-derived lung biomarkers. This work further supports the introduction of micro-CT for routine use in the preclinical pulmonary research field where postmortem histological approaches are still the gold standard.

Geometric regularization for 2-D myocardial strain quantification in mice: an in-silico study.

Myocardial strain quantification in the mouse based on 2-D speckle tracking using real-time ultrasound datasets is feasible but remains challenging. The major difficulty lies in the fact that the frame rate-to-heart rate ratio is relatively low, causing significant decorrelation between subsequent frames. In this setting, regularization is therefore particularly important to discard motion estimates that are improbable. Different regularization methods have been proposed, among which is a class of regularizers based on enforcing preset geometrical characteristics of the motion field. To date, these regularization methods have not been contrasted. The aim of this study was thus to compare the performance of different geometric regularizers in the setting of myocardial motion and strain estimation in murine echocardiography using simulated datasets. In normal models, restricting the spatial curvature of the motion fields resulted in worse radial strain estimates (mean root-mean-square [RMS] error increased from 0.06 to 0.09; p < 0.05), but better circumferential strain estimates (mean RMS error decreased from 0.035 to 0.01; p < 0.05). More accurate circumferential strain estimates were also obtained by convolving a Gaussian function with the lateral motion components (mean RMS error decreased to 0.015; p < 0.05). In infarcted models, no significant differences were found between regularized and nonregularized radial strains. However, for circumferential strain, the curvature method yielded better strain estimates in all regions (mean RMS error decreased from 0.043 to 0.015; p < 0.05), whereas the Gaussian method only improved strain assessment in the remote myocardium (mean RMS error decreased to 0.021; p < 0.05).

Hippocampal malrotation in pediatric patients with epilepsy associated with complex prefrontal dysfunction.

PURPOSE: The cognitive consequences of hippocampal malrotation (HIMAL) were investigated in a matched control study of children with epilepsy. METHODS: Seven children with HIMAL were compared on a range of memory and attention tasks with 21 control children with epilepsy without temporal role pathology and 7 children with epilepsy and magnetic resonance imaging (MRI)-documented hippocampal sclerosis. In addition, in a statistical morphometric analysis, MRI studies from four children with HIMAL were compared to similar images of 20 age-matched typically developing control children. RESULTS: Although the task battery was sensitive to the memory deficit of the children with hippocampal sclerosis, it did not reveal memory impairment in the patients with HIMAL. In contrast, the patients with HIMAL were impaired on the attentionally more demanding dual tasks, compared to both the control and the hippocampal sclerosis group. The structural MRI analysis revealed morphometric abnormalities in the tail of the affected hippocampus, the adjacent neocortex, and the ipsilateral medial thalamus. The basal forebrain was bilaterally affected. Abnormalities in remote cortex were found in the ipsilateral temporal lobe, the contralateral anterior cingulate gyrus, and bilateral in the dorsolateral and lateral-orbitofrontal prefrontal cortex. DISCUSSION: Because the prefrontal cortical regions have been shown to be active during dual-task performance, the MRI results converge with the neuropsychological findings of impairment on these tasks. We conclude that HIMAL had no direct memory repercussions, but was secondary to subtle but widespread neurologic abnormalities that also affected morphology and functioning of the prefrontal cortex.

On the construction of an inter-subject diffusion tensor magnetic resonance atlas of the healthy human brain.

Voxel based morphometry (VBM) has been increasingly applied to detect diffusion tensor (DT) image abnormalities in patients for different pathologies. An important requisite for a robust VBM analysis is the availability of a high-dimensional non-rigid coregistration technique that is able to align both the spatial and the orientational DT information. Consequently, there is a need for an inter-subject DTI atlas as a group specific reference frame that also contains this orientational DT information. In this work, a population based DTI atlas has been developed that incorporates such orientational DT information with high accuracy and precision. The proposed methodology for constructing such an atlas is compared with a subject based DTI atlas, in which a single subject is selected as the reference image. Our results demonstrate that the population based atlas framework is more accurate with respect to the underlying diffusion information.

Nonrigid coregistration of diffusion tensor images using a viscous fluid model and mutual information.

In this paper, a nonrigid coregistration algorithm based on a viscous fluid model is proposed that has been optimized for diffusion tensor images (DTI), in which image correspondence is measured by the mutual information criterion. Several coregistration strategies are introduced and evaluated both on simulated data and on brain intersubject DTI data. Two tensor reorientation methods have been incorporated and quantitatively evaluated. Simulation as well as experimental results show that the proposed viscous fluid model can provide a high coregistration accuracy, although the tensor reorientation was observed to be highly sensitive to the local deformation field. Nevertheless, this coregistration method has demonstrated to significantly improve spatial alignment compared to affine image matching.

Atlas-to-image non-rigid registration by minimization of conditional local entropy.

In this paper an algorithm for atlas-to-image non-rigid registration based on regional entropy minimization is presented. Tissue class probabilities in the atlas are registered with the intensities in the target image. The novel aspect of the paper consists in using tissue class probability maps that include the three main regions (for the brain, white matter, gray matter and csf) and a further partitioning thereof. For example, gray matter is further subdivided into basal ganglia (each of them defining its own class) and the rest (of gray matter). This guarantees a regional entropy minimization instead of just a global one. In other words, the local labels in the atlas will be adjusted in order to obtain the best explanation for the intensity distribution in the corresponding subregion of the target image.

Linear normalization of MR brain images in pediatric patients with periventricular leukomalacia.

The feasibility of linear normalization of child brain images with structural abnormalities due to periventricular leukomalacia (PVL) was assessed in terms of success rate and accuracy of the normalization algorithm. Ten T1-weighted brain images from healthy adult subject and 51 from children (4-11 years of age) were linearly transformed to achieve spatial registration with the standard MNI brain template. Twelve of the child brain images were radiologically normal, 22 showed PVL and 17 showed PVL with additional enlargement of the lateral ventricles. The effects of simple modifications to the normalization process were evaluated: changing the initial orientation and zoom parameters, masking non-brain areas, smoothing the images and using a pediatric template instead of the MNI template. Normalization failure was reduced by changing the initial zoom parameters and by removing background noise. The overall performance of the normalization algorithm was only improved when background noise was removed from the images. The results show that linear normalization of PVL affected brain images is feasible.

An information theoretic approach for non-rigid image registration using voxel class probabilities.

We propose two information theoretic similarity measures that allow to incorporate tissue class information in non-rigid image registration. The first measure assumes that tissue class probabilities have been assigned to each of the images to be registered by prior segmentation of both of them. One image is then non-rigidly deformed to match the other such that the fuzzy overlap of corresponding voxel object labels becomes similar to the ideal case whereby the tissue probability maps of both images are identical. Image similarity is assessed during registration by the divergence between the ideal and actual joint class probability distributions of both images. A second registration measure is proposed that applies in case a segmentation is available for only one of the images, for instance an atlas image that is to be matched to a study image to guide the segmentation thereof. Intensities in one image are matched to the fuzzy class labels in the other image by minimizing the conditional entropy of the intensities in the first image given the class labels in the second image. We derive analytic expressions for the gradient of each measure with respect to individual voxel displacements to derive a force field that drives the registration process, which is regularized by a viscous fluid model. The performance of the class-based measures is evaluated in the context of non-rigid inter-subject registration and atlas-based segmentation of MR brain images and compared with maximization of mutual information using only intensity information. Our results demonstrate that incorporation of class information in the registration measure significantly improves the overlap between corresponding tissue classes after non-rigid matching. The methods proposed here open new perspectives for integrating segmentation and registration in a single process, whereby the output of one is used to guide the other.

Atypical neuropsychological profile in a boy with 22q11.2 Deletion Syndrome.

In this article the general and specific cognitive impairments of the boy R.H. with a de novo deletion 22q11.2 are described. His full-scale IQ was 73, and he obtained only slightly better verbal than non-verbal subtest scores. Neuropsychological assessment revealed specific impairments in perceptual categorization of objects presented suboptimal, matching of unfamiliar faces, and verbal learning and memory. In contrast, he performed in accordance with his intelligence level on other visual perceptual tasks, on non-verbal learning and memory tasks, and on attention tasks. Voxel-wise statistical comparison of a high-resolution T1-weighted magnetic resonance image of R.H's brain with similar images obtained from 14 normal control children revealed as major abnormalities a reduction of the right inferior parietal and superior occipital lobe, and a bilateral reduction of deep white matter behind the inferior frontal gyrus. These cognitive impairments and MRI abnormalities are not commonly described in 22q11.2 Deletion Syndrome and may indicate a larger heterogeneity in the neurocognitive phenotype than currently evidenced. At least in this boy the microdeletion seems to have interfered with the development and functioning of particular neural subsystems, while the structure and functioning of other subsystems was left intact.

Construction and validation of mean shape atlas templates for atlas-based brain image segmentation.

In this paper, we evaluate different schemes for constructing a mean shape anatomical atlas for atlas-based segmentation of MR brain images. Each atlas is constructed and validated using a database of 20 images for which detailed manual delineations of 49 different subcortical structures are available. Atlas construction and atlas based segmentation are performed by non-rigid intensity-based registration using a viscous fluid deformation model with parameters that were optimally tuned for this particular task. The segmentation performance of each atlas scheme is evaluated on the same database using a leave-one-out approach and measured by the volume overlap of corresponding regions in the ground-truth manual segmentation and the warped atlas label image.