Anoxic Brain Injury Detection with the Normalized Diffusion to ASL Perfusion Ratio: Implications for Blood-Brain Barrier Injury and Permeability.

BACKGROUND AND PURPOSE: Anoxic brain injury is a result of prolonged hypoxia. We sought to describe the nonquantitative arterial spin-labeling perfusion imaging patterns of anoxic brain injury, characterize the relationship of arterial spin-labeling and DWI, and evaluate the normalized diffusion-to-perfusion ratio to differentiate patients with anoxic brain injury from healthy controls. MATERIALS AND METHODS: We identified all patients diagnosed with anoxic brain injuries from 2002 to 2019. Twelve ROIs were drawn on arterial spin-labeling with coordinate-matched ROIs identified on DWI. Linear regression analysis was performed to examine the relationship between arterial spin-labeling perfusion and diffusion signal. Normalized diffusion-to-perfusion maps were generated using a custom-built algorithm. RESULTS: Thirty-five patients with anoxic brain injuries and 34 healthy controls were identified. Linear regression analysis demonstrated a significant positive correlation between arterial spin-labeling and DWI signal. By means of a combinatory cutoff of slope of >0 and R2 of > 0.78, linear regression using arterial spin-labeling and DWI showed a sensitivity of 0.86 (95% CI, 0.71-0.94) and specificity of 0.82 (95% CI, 0.66-0.92) for anoxic brain injuries. A normalized diffusion-to-perfusion color map demonstrated heterogeneous ratios throughout the brain in healthy controls and homogeneous ratios in patients with anoxic brain injuries. CONCLUSIONS: In anoxic brain injuries, a homogeneously positive correlation between qualitative perfusion and DWI signal was identified so that areas of increased diffusion signal showed increased ASL signal. By exploiting this relationship, the normalized diffusion-to-perfusion ratio color map may be a valuable imaging biomarker for diagnosing anoxic brain injury and potentially assessing BBB integrity.

Virtual design prototyping applied to medical facilities.

Over the past five years, MITRE has developed rapid 3D modeling and immersive environment capabilities that supports the application of virtual environment technology to many traditional and non-traditional domains [1]. This paper provides background information on these capabilities and describes the application of this technology to the experimental design prototyping of operating rooms of the future and to the design and retrofit of existing or proposed medical facilities. These capabilities employ contemporary commercial hardware and software and exploit stereoscopic projection displays and headsets. A unique user interface facilitates object manipulation within these immersive environments and addresses two key areas: 1) Visualization of the contents on the model server or library in a catalog form; and 2) Natural interaction and immersion of the user with the visualized catalog and selected visualized objects in a 3D synthetic environment. A brief discussion of two developing applications of this technology will be presented. In one application example, the modeling environment can be used to synthesize physical replicas (potentially full stereo scale) of actual surgical rooms used for training of medical personnel. Alternatively, it can be employed as the infrastructure for a new form of collaborative interactive visualization, namely, telesurgery. In another example, the rapid modeling capability provides designers, architects and medical personnel with a means of rapidly developing synthetic renderings of (potentially interactive and remotely operative) proposed medical facilities prior to construction. We also discuss key issues needing to be resolved for successful model interchange.