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Stephen M Smith

Publications and source records attributed to Stephen M Smith.

46 records · Page 3Linked to original sources

General multilevel linear modeling for group analysis in FMRI.

This article discusses general modeling of multisubject and/or multisession FMRI data. In particular, we show that a two-level mixed-effects model (where parameters of interest at the group level are estimated from parameter and variance estimates from the single-session level) can be made equivalent to a single complete mixed-effects model (where parameters of interest at the group level are estimated directly from all of the original single sessions' time series data) if the (co-)variance at the second level is set equal to the sum of the (co-)variances in the single-level form, using the BLUE with known covariances. This result has significant implications for group studies in FMRI, since it shows that the group analysis requires only values of the parameter estimates and their (co-)variance from the first level, generalizing the well-established "summary statistics" approach in FMRI. The simple and generalized framework allows different prewhitening and different first-level regressors to be used for each subject. The framework incorporates multiple levels and cases such as repeated measures, paired or unpaired t tests and F tests at the group level; explicit examples of such models are given in the article. Using numerical simulations based on typical first-level covariance structures from real FMRI data we demonstrate that by taking into account lower-level covariances and heterogeneity a substantial increase in higher-level Z score is possible.

Algorithms↗

Fast robust automated brain extraction.

An automated method for segmenting magnetic resonance head images into brain and non-brain has been developed. It is very robust and accurate and has been tested on thousands of data sets from a wide variety of scanners and taken with a wide variety of MR sequences. The method, Brain Extraction Tool (BET), uses a deformable model that evolves to fit the brain's surface by the application of a set of locally adaptive model forces. The method is very fast and requires no preregistration or other pre-processing before being applied. We describe the new method and give examples of results and the results of extensive quantitative testing against "gold-standard" hand segmentations, and two other popular automated methods.

Algorithms↗

Accurate, robust, and automated longitudinal and cross-sectional brain change analysis.

Quantitative measurement of brain size, shape, and temporal change (for example, in order to estimate atrophy) is increasingly important in biomedical image analysis applications. New methods of structural analysis attempt to improve robustness, accuracy, and extent of automation. A fully automated method of longitudinal (temporal change) analysis, SIENA, was presented previously. In this paper, improvements to this method are described, and also an extension of SIENA to a new method for cross-sectional (single time point) analysis. The methods are fully automated, robust, and accurate: 0.15% brain volume change error (longitudinal): 0.5-1% brain volume accuracy for single-time point (cross-sectional). A particular advantage is the relative insensitivity to differences in scanning parameters. The methods provide easy manual review of their output by the automatic production of summary images which show the results of the brain extraction, registration, tissue segmentation, and final atrophy estimation.

Algorithms↗

Monitoring disease activity and progression in primary progressive multiple sclerosis using MRI: sub-voxel registration to identify lesion changes and to detect cerebral atrophy.

OBJECTIVE: To explore the potential usefulness of two new magnetic resonance imaging (MRI) analysis techniques for assessment of progressive cerebral atrophy and T2 lesion activity in primary progressive multiple sclerosis (PPMS), and thereby assess the relationship between MRI activity and atrophy in this patient group. BACKGROUND: Measurements of cerebral atrophy and net change in T2 lesion volumes are currently used as surrogate markers of disease progression in multiple sclerosis (MS). However, manual implementation of these techniques is time-consuming and the pathological specificity of T2 lesion change is low. Advances in serial scan registration have facilitated the development of a new, fully-automated technique to measure cerebral volume (SIENA; Structural Image Evaluation, using Normalisation, of Atrophy), and a technique to measure the total new T2 lesion volume selectively (MRI difference imaging). METHOD: SIENA measures changes in cerebral size based on sub-voxel detection of shifts in edge contours. The lesion difference imaging method measures differences in lesion volumes over time as defined by a semi-automated outlining technique. The two new methods were validated against the T2 lesion volume contour technique and a previously described measure of partial brain volume (which uses six slices centred on the presumed area of greatest change around the lateral ventricles). All were applied to serially acquired MR images from a cohort of 39 patients with PPMS, who also underwent scoring on the expanded disability status scale (EDSS) twice, two years apart. RESULTS: The two measures reflecting cerebral atrophy correlated strongly (r = 0.58, p < 0.001). T2 lesion load measurements using the two techniques correlated very highly (r = 0.999, p < 0.001). 91% of the total new T2 lesion volume was from enlargement of pre-existent lesions and only 9 % from new, discrete, lesions. No relationship was seen between the traditional measure of net gain in T2 lesion load and either measure of atrophy. However, the fully-automated measure of total new T2 load correlated with both measures of atrophy (SIENA technique, r= -0.37, p= 0.02; six slice measure, r = -0.41, p = 0.01). There was no relationship between the MRI measures and changes in the EDSS. CONCLUSION: Both of the new image analysis techniques appear to be promising as sensitive markers for disease progression in PPMS. The correlation of total new T2 lesion volume with the progression of cerebral atrophy (which is known to be a consequence of axonal loss in progressive disease), compared with a lack of correlation with the traditional net gain in T2 lesion load is interesting and suggests that the total new T2 lesion volume may ultimately be the most useful measure.

Adult↗

Imaging how attention modulates pain in humans using functional MRI.

Current clinical and experimental literature strongly supports the phenomenon of reduced pain perception whilst attention is distracted away from noxious stimuli. This study used functional MRI to elucidate the underlying neural systems and mechanisms involved. An analogue of the Stroop task, the counting Stroop, was used as a cognitive distraction task whilst subjects received intermittent painful thermal stimuli. Pain intensity scores were significantly reduced when subjects took part in the more cognitively demanding interference task of the counting Stroop than in the less demanding neutral task. When subjects were distracted during painful stimulation, brain areas associated with the affective division of the anterior cingulate cortex (ACC) and orbitofrontal regions showed increased activation. In contrast, many areas of the pain matrix (i.e. thalamus, insula, cognitive division of the ACC) displayed reduced activation, supporting the behavioural results of reduced pain perception.

Adult↗

Correlation between motor improvements and altered fMRI activity after rehabilitative therapy.

Motor rehabilitation therapy is commonly employed after strokes, but outcomes are variable and there is little specific information about the changes in brain activity that are associated with improved function. We performed serial functional MRI (fMRI) on a group of seven patients receiving a form of rehabilitation therapy after stroke in order to characterize functional changes in the brain that correlate with behavioural improvements. Patients were scanned while performing a hand flexion-extension movement twice before and twice after a two-week home-based therapy programme combining restraint of the unaffected limb with progressive exercises for the affected limb. As expected, the extent of improvement in hand function after therapy varied between patients. Therapy-related improvements in hand function correlated with increases in fMRI activity in the premotor cortex and secondary somatosensory cortex contralateral to the affected hand, and in superior posterior regions of the cerebellar hemispheres bilaterally (Crus I and lobule VI). fMRI offers a promising, objective approach for specifically identifying changes in brain activity potentially responsible for rehabilitation-mediated recovery of function after stroke. Our results suggest that activity changes in sensorimotor regions are associated with successful motor rehabilitation.

Adult↗

HIV vaccine development in the nonhuman primate model of AIDS.

Development of a prophylactic human immunodeficiency virus type 1 (HIV-1) vaccine is a leading priority in biomedical research. Much of this work has been done with the nonhuman primate model of AIDS. In a historical context, vaccine studies, which use this model, are summarized and discussed.

AIDS Vaccines↗

West Virginia Medical Institute: the Quality Improvement Organization for West Virginia.

The Federal Quality Improvement program, (QIO), charged with quality improvement and some case review activities is conducted under a contract with the Centers for Medicare and Medicaid Services (formerly HCFA), now CMS. Every state has one organization which handles this program and in West Virginia, the West Virginia Medical Institute has been responsible for this work for over 30 years. When case review is involved, the conclusions are communicated to individual physicians and hospitals. Occasionally, serious quality of care concerns are encountered. This article explains the case review process and why cases are selected, and also makes suggestions about how individual physicians may appeal or respond. It is designed to help enhance understanding of the program and its goals.

Centers for Medicare and Medicaid Services, U.S.↗