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Segmentation of Corpus Callosum using diffusion tensor imaging: validation in patients with glioblastoma
Background:
This paper presents a three-dimensional (3D) method for segmenting corpus callosum in normal subjects and brain cancer patients with glioblastoma.
Methods:
Nineteen patients with histologically confirmed treatment naive glioblastoma and eleven normal control subjects underwent DTI on a 3T scanner. Based on the information inherent in diffusion tensors, a similarity measure was proposed and used in the proposed algorithm. In this algorithm, diffusion pattern of corpus callosum was used as prior information. Subsequently, corpus callosum was automatically divided into Witelson subdivisions. We simulated the potential rotation of corpus callosum under tumor pressure and studied the reproducibility of the proposed segmentation method in such cases.
Results:
Dice coefficients, estimated to compare automatic and manual segmentation results for Witelson subdivisions, ranged from 94% to 98% for control subjects and from 81% to 95% for tumor patients, illustrating closeness of automatic and manual segmentations. Studying the effect of corpus callosum rotation by different Euler angles showed that although segmentation results were more sensitive to azimuth and elevation than skew, rotations caused by brain tumors do not have major effects on the segmentation results.
Conclusions:
The proposed method and similarity measure segment corpus callosum by propagating a hyper-surface inside the structure (resulting in high sensitivity), without penetrating into neighboring fiber bundles (resulting in high specificity).
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Myocardial strains from 3D displacement encoded magnetic resonance imaging
Background:
The ability to measure and quantify myocardial motion and deformation provides a useful tool to assist in the diagnosis, prognosis and management of heart disease. The recent development of magnetic resonance imaging methods, such as harmonic phase analysis of tagging and displacement encoding with stimulated echoes (DENSE), make detailed non-invasive 3D kinematic analyses of human myocardium possible in the clinic and for research purposes. A robust analysis method is required, however.
Methods:
We propose to estimate strain using a polynomial function which produces local models of the displacement field obtained with DENSE. Given a specific polynomial order, the model is obtained as the least squares fit of the acquired displacement field. These local models are subsequently used to produce estimates of the full strain tensor.
Results:
The proposed method is evaluated on a numerical phantom as well as in vivo on a healthy human heart. The evaluation showed that the proposed method produced accurate results and showed low sensitivity to noise in the numerical phantom. The method was also demonstrated in vivo by assessment of the full strain tensor and to resolve transmural strain variations.
Conclusions:
Strain estimation within a 3D myocardial volume based on polynomial functions yields accurate and robust results when validated on an analytical model. The polynomial field is capable of resolving the measured material positions from the in vivo data, and the obtained in vivo strains values agree with previously reported myocardial strains in normal human hearts.
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Volumetric BOLD fMRI simulation: from neurovascular coupling to multivoxel imaging
Background:
The blood oxygenation-level dependent (BOLD) functional magnetic resonance imaging (fMRI) modality has been numerically simulated by calculating single voxel signals. However, the observation on single voxel signals cannot provide information regarding the spatial distribution of the signals. Specifically, a single BOLD voxel signal simulation cannot answer the fundamental question: is the magnetic resonance (MR) image a replica of its underling magnetic susceptibility source? In this paper, we address this problem by proposing a multivoxel volumetric BOLD fMRI simulation model and a susceptibility expression formula for linear neurovascular coupling process, that allow us to examine the BOLD fMRI procedure from neurovascular coupling to MR image formation.
Methods:
Since MRI technology only senses the magnetism property, we represent a linear neurovascular-coupled BOLD state by a magnetic susceptibility expression formula, which accounts for the parameters of cortical vasculature, intravascular blood oxygenation level, and local neuroactivity. Upon the susceptibility expression of a BOLD state, we carry out volumetric BOLD fMRI simulation by calculating the fieldmap (established by susceptibility magnetization) and the complex multivoxel MR image (by intravoxel dephasing). Given the predefined susceptibility source and the calculated complex MR image, we compare the MR magnitude (phase, respectively) image with the predefined susceptibility source (the calculated fieldmap) by spatial correlation.
Results:
The spatial correlation between the MR magnitude image and the magnetic susceptibility source is about 0.90 for the settings of TE = 30 ms, B0 = 3 T, voxel size = 100micron, vessel radius = 3micron, and blood volume fraction = 2%. Using these parameters value, the spatial correlation between the MR phase image and the susceptibility-induced fieldmap is close to 1.00.
Conclusion:
Our simulation results show that the MR magnitude image is not an exact replica of the magnetic susceptibility source (spatial correlation [almost equal to] 0.90), and that the MR phase image conforms closely with the susceptibility-induced fieldmap (spatial correlation [almost equal to] 1.00).
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Reliability and validity of the ultrasound technique to measure the rectus femoris muscle diameter in older CAD-patients
Background:
The increasing age of coronary artery disease (CAD) patients and the occurrence of sarcopenia in the elderly population accompanied by 'fear of moving' and hospitalization in these patients often results in a substantial loss of skeletal muscle mass and muscle strength. Cardiac rehabilitation can improve exercise tolerance and muscle strength in CAD patients but less data describe eventual morphological muscular changes possibly by more difficult access to imaging techniques. Therefore the aim of this study is to assess and quantify the reliability and validity of an easy applicable method, the ultrasound (US) technique, to measure the diameter of rectus femoris muscle in comparison to the muscle dimensions measured with CT scans.
Methods:
45 older CAD patients without cardiac event during the last 9 months were included in this study. 25 patients were tested twice with ultrasound with a two day interval to assess test-retest reliability and 20 patients were tested twice (once with US and once with CT) on the same day to assess the validity of the US technique compared to CT as the gold standard. Isometric and isokinetic muscle testing was performed to test potential zero-order correlations between muscle diameter, muscle volume and muscle force.
Results:
An intraclass correlation coefficient (ICC) of 0.97 ((95%CL: 0.92 - 0.99) was found for the test-retest reliability of US and the ICC computed between US and CT was 0.92 (95%CL: 0.81 - 0.97). The absolute difference between both techniques was 0.01 ± 0.12 cm (p = 0.66) resulting in a typical percentage error of 4.4%. Significant zero-order correlations were found between local muscle volume and muscle diameter assessed with CT (r = 0.67, p = 0.001) and assessed with US (r = 0.49, p < 0.05). Muscle strength parameters were also significantly correlated with muscle diameter assessed with both techniques (range r = 0.45-r = 0.61, p < 0.05).
Conclusions:
Ultrasound imaging can be used as a valid and reliable measurement tool to assess the rectus femoris muscle diameter in older CAD patients.
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Semi-automatic analysis of standardised uptake values in serial PET/CT studies in patients with lung cancer and lymphoma
Background:
Changes in maximum standardised uptake values (SUVmax) between serial PET/CT studies are used to determine disease progression or regression in oncologic patients. To measure these changes manually can be time consuming in a clinical routine. A semi-automatic method for calculation of SUVmax in serial PET/CT studies was developed and compared to a conventional manual method. The semi-automatic method first aligns the serial PET/CT studies based on the CT images. Thereafter, the reader selects an abnormal lesion in one of the PET studies. After this manual step, the program automatically detects the corresponding lesion in the other PET study, segments the two lesions and calculates the SUVmax in both studies as well as the difference between the SUVmax values. The results of the semi-automatic analysis were compared to that of a manual SUVmax analysis using a Philips PET/CT workstation. Three readers did the SUVmax readings in both methods. Sixteen patients with lung cancer or lymphoma who had undergone two PET/CT studies were included. There were a total of 26 lesions.
Results:
Linear regression analysis of changes in SUVmax show that intercepts and slopes are close to the line of identity for all readers (reader 1: intercept = 1.02, R2 = 0.96; reader 2: intercept = 0.97, R2 = 0.98; reader 3: intercept = 0.99, R2 = 0.98). Manual and semi-automatic method agreed in all cases whether SUVmax had increased or decreased between the serial studies. The average time to measure SUVmax changes in two serial PET/CT examinations was four to five times longer for the manual method compared to the semi-automatic method for all readers (reader 1: 53.7 vs. 10.5 s; reader 2: 27.3 vs. 6.9 s; reader 3: 47.5 vs. 9.5 s; p < 0.001 for all).
Conclusions:
Good agreement was shown in assessment of SUVmax changes between manual and semi-automatic method. The semi-automatic analysis was four to five times faster to perform than the manual analysis. These findings show the feasibility of using semi-automatic methods for calculation of SUVmax in clinical routine and encourage further development of programs using this type of methods.
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Standardized volumetric 3D-analysis of SPECT/CT imaging in orthopaedics: overcoming the limitations of qualitative 2D analysis
Background:
SPECT/CT combines high resolution anatomical 3D computerized tomography (CT) and single photon emission computerized tomography (SPECT) as functional imaging, which provides 3D information about biological processes into a single imaging modality. The clinical utility of SPECT/CT imaging has been recognized in a variety of medical fields and most recently in orthopaedics; however, clinical adoption has been limited due to shortcomings of analytical tools available. Specifically, SPECT analyses are mainly qualitative due to variation in overall metabolic uptake among patients. Furthermore, most analyses are done in 2D, although rich 3D data are available. Consequently, it is difficult to quantitatively compare the position, size, and intensity of SPECT uptake regions among patients, and therefore difficult to draw meaningful clinical conclusions.
Methods:
Here, we propose a method for normalizing orthopaedic SPECT/CT data, which enables standardised 3D volumetric quantitative measurements and comparison among patients. Our overall goal is to provide a normalization scheme that can allow direct comparison of positions and intensities between two SPECT/CT scans. This would allow, straightforward analysis of the size of a lesion for a particular patient over time (despite errors due to patient alignment in the CT scanner, or global metabolic effects changing the raw SPECT intensity values). It would also enable the comparison of two different patients, removing the effects of inter-patient variation of global metabolic levels, as well as limb size and positioning in the scanner.
Results:
Our method is based on 3D localisation using clinically relevant anatomical landmarks and frames of reference, along with intensity value normalisation using clinically relevant reference regions. This normalisation approach takes advantage of the unique combination of anatomic and metabolic information available with SPECT/CT imaging. It is demonstrated how the normalised, 3D-rendered data can provide a richer source of clinical information and allow quantitative comparison of SPECT/CT measurements across patients. Our goal is to facilitate a standardised approach to quantitative data collection and comparison of clinical studies using SPECT/CT, enabling more widespread clinical use of this powerful imaging tool.
Conclusions:
Conventional orthopaedic frames of reference, 3D volumetric data analysis and thresholding are used to distinguish clinically relevant hot spots from background activity. Using the proposed techniques we have found a solution for the problem of inter- and intra-patient variation in overall tracer uptake. It is demonstrated how the normalised, 3D-rendered data may provide a richer source of clinical information and allow quantitative comparison of SPECT/CT measurements across patients.
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Herlyn-werner-wunderlich syndrome:
MRI findings, radiological guide (two cases and literature review), and differential diagnosis
Background:
Herlyn-Werner-Wunderlich (HWW) syndrome is a very rare congenital anomaly of the urogenital tract involving Müllerian ducts and Wolffian structures, and it is characterized by the triad of didelphys uterus, obstructed hemivagina and ipsilateral renal agenesis. It generally occurs at puberty and exhibits non-specific and variable symptoms with acute or pelvic pain shortly following menarche, causing a delay in the diagnosis. Moreover, the diagnosis is complicated by the infrequency of this syndrome, because Müllerian duct anomalies (MDA) are infrequently encountered in a routine clinical setting.Cases presentationtwo cases of HWW syndrome in adolescents and a differential diagnosis for one case of a different MDA, and the impact of magnetic resonance (MR) imaging technology to achieve the correct diagnosis.
Conclusions:
MR imaging is a very suitable diagnostic tool in order to perform the correct diagnosis of HWW syndrome.
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Small Bowel Enteroclysis with Magnetic Resonance Imaging and Computed Tomography in Patients with Failed and Uncertain Passage of a Patency Capsule
Background:
Video capsule enteroscopy (VCE) has revolutionized small bowel imaging, enabling visual examination of the mucosa of the entire small bowel, while MR enteroclysis (MRE) and CT enteroclysis (CTE) have largely replaced conventional barium enteroclysis. A new indication for MRE and CTE is the clinical suspicion of small bowel strictures, as indicated by delayed or non-delivery of a test capsule given before a VCE examination, to exclude stenosis. The aim of this study was to determine the clinical value of subsequent MRE and CTE in patients in whom a test capsule did not present itself in due time.
Methods:
Seventy-five consecutive patients were identified with a delayed or unnoticed delivery of the test capsule. Seventy patients consented to participate and underwent MRE (44) or CTE (26). The medical records and imaging studies were retrospectively reviewed and symptoms, laboratory results and imaging findings recorded.
Results:
Lesions compatible with Crohns disease were shown by MRE in 5 patients, by CTE in one and by VCE in four, one of whom had lesions on MRE. In patients without alarm symptoms and findings (weight loss, haematochezia, anaemia, nocturnal diarrheoa, ileus, fistula, abscess and abnormal blood tests) imaging studies did not unveil any such lesion. VCE's were performed in only 20 patients, mainly younger than 50 years of age, although no stenotic lesion was shown by MRE and CTE. In the remaining 50 patients no VCE or other endoscopic intervention was performed indicating that the referring physician was content with the diagnostic information from MRE or CTE.
Conclusion:
The diagnostic value of MRE and CTE is sufficient for clinical management of most patients with suspected small bowel disease, and thus VCE may be omitted or at least postponed for later usage.
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Air column in esophagus and symptoms of gastroesophageal reflux disease
Background:
During imaging of the normal esophagus, air is often detected. The purpose of this study was to determine the correlation between the appearance of air bubbles on imaging and Gastroesophageal Reflux Disease (GERD) symptoms.
Methods:
The cross-sectional imaging study was conducted at Rasole Akram Hospital, Tehran, Iran. A total of 44 patients underwent X-ray computed tomography (CT) scanning; the presence of air in the esophagus and visible on CT imaging was scrutinized.
Results:
The average age of the subjects was 59 and the male to female ratio was 0.83. We found a significant relationship between the presence of GERD symptoms, the size of air bubbles and esophageal dilation (ED) on the CT scan.
Conclusions:
Air bubbles in the esophagus may be seen frequently in CT scans, but their size and location can vary. The GERD symptoms can arise when a small diameter air column is present within the esophagus, especially in the middle and lower parts.
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Diagnosis of osteoporosis from dental panoramic radiographs using the support vector machine method in a computer-aided system
Background:
Early diagnosis of osteoporosis can potentially decrease the risk of fractures and improve the quality of life. Detection of thin inferior cortices of the mandible on dental panoramic radiographs could be useful for identifying postmenopausal women with low bone mineral density (BMD) or osteoporosis. The aim of our study was to assess the diagnostic efficacy of using kernel-based support vector machine (SVM) learning regarding the cortical width of the mandible on dental panoramic radiographs to identify postmenopausal women with low BMD.
Methods:
We employed our newly adopted SVM method for continuous measurement of the cortical width of the mandible on dental panoramic radiographs to identify women with low BMD or osteoporosis. The original X-ray image was enhanced, cortical boundaries were determined, distances among the upper and lower boundaries were evaluated and discrimination was performed by a radial basis function. We evaluated the diagnostic efficacy of this newly developed method for identifying women with low BMD (BMD T-score of -1.0 or less) at the lumbar spine and femoral neck in 100 postmenopausal women (≥50 years old) with no previous diagnosis of osteoporosis. Sixty women were used for system training, and 40 were used in testing.
Results:
The sensitivity and specificity using RBF kernel-SVM method for identifying women with low BMD were 90.9% [95% confidence interval (CI), 85.3-96.5] and 83.8% (95% CI, 76.6-91.0), respectively at the lumbar spine and 90.0% (95% CI, 84.1-95.9) and 69.1% (95% CI, 60.1-78.6), respectively at the femoral neck. The sensitivity and specificity for identifying women with low BMD at either the lumbar spine or femoral neck were 90.6% (95% CI, 92.0-100) and 80.9% (95% CI, 71.0-86.9), respectively.
Conclusion:
Our results suggest that the newly developed system with the SVM method would be useful for identifying postmenopausal women with low skeletal BMD.
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