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Stereotactic statistical imaging analysis of the brain using the easy Z-score imaging system for sharing a normal database.

Statistical brain imaging analysis has good objectivity and reproducibility. In Japan, statistical parametric mapping (SPM) and three-dimensional stereotactic surface projections (3D-SSP) are used nationwide as statistical imaging analysis with standard brain coordinates. They often help to interpret brain single photon emission computed tomography (SPECT) images by avoiding possible pitfalls (e.g., effects of aging, atrophy) with which clinicians are unfamiliar. However, this type of analysis presents a problem: statistical processing requires many normal subject images. The easy Z-score imaging system (eZIS) is one of the statistical analysis methods that uses SPM processing in normalization and smoothing, and it has the function of image conversion leading to statistical analysis without a control database. Therefore, statistical analysis can be used in clinical practice by sharing a prepared normal database. By unifying the image quality by processing a shared database, this program has great potential for sharing patient imaging data in many hospitals. It is expected that the eZIS will help perform detailed analysis in many functional diseases in collaborative studies. This article describes the interpretation of brain SPECT images and suggests the usefulness and potential of eZIS.

Aging↗

Pelvic phased array coil: image quality assessment for spin-echo MR imaging.

The NMR phased array coil (PA) provides improved signal-to-noise ratio (SNR) over that available with the body coil. We evaluated image quality obtained with a pelvic PA compared to that obtained with the body coil for spin-echo imaging. Thirty-three women undergoing clinical pelvic MRI were imaged with the body coil followed by imaging with the PA with the same field-of-view (FOV) in 11 patients, and with a small FOV in 23 patients. Image quality was assessed independently by two radiologists. In individual cases there was significant improvement in image quality with the PA, however the expected marked improvement in image quality was not consistently found. Two factors which may limit image quality are increased motion artifact and nonuniformity of signal with distance from the coils. Significant improvements in image quality may occur with improved techniques to decrease motion artifact.

Adult↗

Online ultrasound image guidance for radiotherapy of prostate cancer: impact of image acquisition on prostate displacement.

AIM: Numerous studies reported the use of ultrasound image-guidance system to assess and correct patient setup during radiotherapy for prostate cancer. We conducted a study to demonstrate and quantify prostate displacement resulting from pressure of the probe on the abdomen during transabdominal ultrasound image acquisition for prostate localization. MATERIAL AND METHODS: Ten healthy volunteers were asked to undergo one imaging procedure. The procedure was performed in a condition that simulates the localization of prostate during online ultrasound guidance. A 3D ultrasound machine was used. The procedure started with the placement of the probe on the abdomen above the pubis symphysis. The probe was tilted in a caudal and posterior direction until the prostate and seminal vesicle were visualized. The probe was then fixed with a rigid arm, which maintained the probe in a static position during image acquisition. The probe was then moved, in a short time, stepwise toward the prostate, acquiring images at each step. The prostate and seminal vesicles were identified and selected in all planes. The first 3D volume was used as reference 1, to which all other scans were matched using a gray value matching algorithm. RESULTS: Prostate motion was quantified as a 3D translation relative to the patient coordinate system. The resulting translations represented the amount of prostate movement as a function of probe displacement. Between 7 and 11 images were obtained per volunteer, with a maximal probe displacement ranging between 3 and 6 cm. Prostate displacement was measured in all volunteers for all the probe steps and in all directions. The largest displacements occurred in the posterior direction in all volunteers. The absolute prostate motion was less than 5 mm in 100% of the volunteers after 1 cm of probe displacement, in 80% after 1.5 cm, in 40% after 2 cm, in 10% after 2.5 cm, and 0% after 3 cm. To achieved a good-quality ultrasound images, the probe requires an average displacement of 1.2 cm, and this results in an average prostate displacement of 3.1 mm. No correlations were observed between prostate motion and prostate-probe distance or bladder size. CONCLUSION: Probe pressure during ultrasound image acquisition causes prostate displacement, which is correlated to the amount of probe displacement from initial contact. The induced uncertainty associated with this process needs to be carefully evaluated to determine a safe margin to be employed during online ultrasound image-guided radiotherapy of the prostate.

Adult↗

Digitizing life at the level of the cell: high-performance laser-scanning microscopy and image analysis for in toto imaging of development.

The field of biological imaging is progressing at an amazing rate. Advances in both laser-scanning microscopy and green fluorescent protein (GFP) technology are combining to make possible imaging-based approaches for studying developmental mechanisms that were previously impossible. Modern confocal and multi-photon microscopes are pushing the envelope of speed, sensitivity, spectral resolution, and depth resolution to allow in vivo imaging of whole, live embryos at cellular resolution over extended periods of time. In toto imaging, in which nearly every cell in an embryo or tissue can be tracked through space and time during development, may become a standard technique for small transparent embryos such as zebrafish and early stage chick and mouse embryos. GFP and its spectral variants can be used to mark a wide range of in vivo biological information for in toto imaging including gene expression patterns, mutant phenotypes, and protein subcellular localization patterns. Combining in toto imaging and GFP transgenic approaches on a large scale may usher in an explosion of in vivo, developmental data as has happened in the past several years with genomic data. There are significant challenges that must be met to reach these goals. This paper will discuss the current state-of-the-art, the challenges, and the prospects of in toto imaging in the areas of imaging, image analysis, and informatics.

Animals↗

MR imaging-controlled focused ultrasound ablation: a noninvasive image-guided surgery.

The history of MR-guided FUS demonstrates the need for merging advanced therapy technology with advanced imaging. Without the ability of MR imaging to localize the tumor margins and without the temperature-sensitive imaging that provides the closed-loop control of energy deposition, this method is inadequate for most clinical applications. Given these limitations,high-intensity focused ultrasound initially appeared to have a narrow application area and was not able to compete with other surgical or ablation methods. Today, MR imaging-guided FUS has become a safe and effective means of performing probe-delivered thermal ablations and minimally invasive surgery. Moreover, it has the potential to replace treatments that use ionizing radiation such as radiosurgery and brachytherapy. Although the cost of integrating"big ticket" MR imaging systems with complex and expensive phased arrays is high, this expenditure will largely be offset by eliminating hospitalization and anesthesia and by reducing complications. In effect, an investment in this emerging technology will ultimately redound to the benefit of the health care delivery system and, most important, to the patient. The FUS system provides a safe, repeatable treatment approach for benign tumors (eg, uterine fibroid and breast fibroadenoma) that do not require an aggressive approach. MR-guided FUS can also be used for debulking cancerous tissue. It has already been tested as a breast cancer treatment; its application for other malignancies in the brain, liver, and prostate is under development. MR-guided FUS offers an attractive alternative to conventional surgery because it incorporates intraoperative MR imaging, which provides far more precise target definition than is possible with the surgeon's direct visualization of the lesion. MR-guided FUS is undeniably the most promising interventional MR imaging method in the field of image-guided therapy today. It is applicable not only in the thermal coagulative treatment of tumors but also in several other medical situations for which invasive surgery or radiation may not be treatment options. The use of FUS for treating vascular malformation or functional disorders of the brain is also exciting. It is uniquely applicable for image-guided therapy using targeted drug delivery methods and gene therapy. Further advances in this technology will no doubt improve energy deposition and reduce treatment times. In the near future, FUS will offer a viable alternative to conventional surgery and radiation therapy; in the longer-term, it may also enable a host of targeted treatment methods aimed at eradicating or arresting heretofore intractable diseases such as certain brain malignancies and forms of epilepsy.

Humans↗

Magnetic resonance imaging of prostate cancer: comparison of image quality using endorectal and pelvic phased array coils.

OBJECTIVE: To compare endorectal coil (ERC) and pelvic phased array (PPA) coil magnetic resonance imaging for delineation of the prostate gland and seminal vesicles. To compare ERC images at different inflation volumes of the ERC air balloon. MATERIALS AND METHODS: Twenty-one patients underwent T2-weighted examinations using PPA and ERC. The ERC evaluations were performed at three balloon inflation volumes (60, 100 and 140 ml). All patients had proven prostate cancer. Images were analysed for visibility of anatomic structures, gland distortion, tumour visualization, artefacts (coil flare, coil-related artefact and rectal movement) and overall image quality. A grading system was used for each parameter. RESULTS: ERC assessments at increasing balloon inflations showed equivalent anatomical detail and overall image quality. However, increasing gland distortion and decreasing coil related flare was found with higher air inflations (P = 0.13 and P = 0.006, respectively). When compared with ERC images, visibility of the anterior gland and neurovascular bundles was better with the PPA coil (P = 0.0001 and 0.002, respectively). The overall image quality was superior with the PPA coil (P = 0.0001). However, no significant difference in visualization of tumour or delineation of tumour extent was observed between the two techniques. CONCLUSIONS: PPA imaging of the prostate gland provides images of superior quality compared with the ERC. This is mainly due to fewer artefacts with the PPA coil and improved anterior gland visibility. When ERC is used, air inflation to at least 100 ml reduces coil flare artefact.

Aged↗

JPEG compression of digital echocardiographic images: impact on image quality.

Routine echocardiograms are not handled digitally because of enormous storage needs. Image compression techniques can reduce memory requirements, but the impact on diagnostic content is unknown. We studied the effect of an internationally accepted compression algorithm called Joint Photographic Experts Group (JPEG) on digital echocardiographic images. Diagnostic and image quality of JPEG compressed, two-dimensional echocardiograms at ratios ranging from 4:1 to 40:1 was compared with that of uncompressed images both subjectively by a blinded expert panel (540 observations) and objectively by quantitative image-processing parameters (180 images). Accuracy of 432 measurements performed on compressed M-mode and spectral Doppler tracings was determined. Simultaneously acquired videotaped images and their never-compressed digital counterparts were compared quantitatively for image fidelity. This study demonstrates that the JPEG compression algorithm produces little degradation of echocardiographic images at compression ratios of at least 20:1, with less measured distortion than is produced by videotape recording. With JPEG, digital storage and retrieval in routine echocardiography are feasible.

Algorithms↗

Reliability of a quantification imaging system using magnetic resonance images to measure cartilage thickness and volume in human normal and osteoarthritic knees.

OBJECTIVE: The aim of this study was to evaluate the reliability of a software tool that assesses knee cartilage volumes using magnetic resonance (MR) images. The objectives were to assess measurement reliability by: (1) determining the differences between readings of the same image made by the same reader 2 weeks apart (test-retest reliability), (2) determining the differences between the readings of the same image made by different readers (between-reader agreement), and (3) determining the differences between the cartilage volume readings obtained from two MR images of the same knee image acquired a few hours apart (patient positioning reliability). METHODS: Forty-eight MR examinations of the knee from normal subjects, patients with different stages of symptomatic knee osteoarthritis (OA), and a subset of duplicate images were independently and blindly quantified by three readers using the imaging system. The following cartilage areas were analyzed to compute volumes: global cartilage, medial and lateral compartments, and medial and lateral femoral condyles. RESULTS: Between-reader agreement of measurements was excellent, as shown by intra-class correlation (ICC) coefficients ranging from 0.958 to 0.997 for global cartilage (P<0.0001), 0.974 to 0.998 for the compartments (P<0.0001), and 0.943 to 0.999 for the condyles(P<0.0001). Test-retest reliability of within-reader data was also excellent, with Pearson correlation coefficients ranging from 0.978 to 0.999 (P<0.0001). Patient positioning reliability was also excellent, with Pearson correlation coefficients ranging from 0.978 to 0.999 (P<0.0001). CONCLUSIONS: The results of this study establish the reliability of this MR imaging system. Test-retest reliability, between-reader agreement, and patient positioning reliability were all extremely high. This study represents a first step in the overall validation of an imaging system designed to follow progression of human knee OA.

Adult↗

Safety, tolerance, biodistribution, and MR imaging enhancement of the liver with gadobenate dimeglumine: results of clinical pharmacologic and pilot imaging studies in nonpatient and patient volunteers.

PURPOSE: The purpose of this study was to assess safety, tolerance, biodistribution, and magnetic resonance (MR) imaging enhancement of the liver with gadobenate dimeglumine. MATERIALS AND METHODS: Phase I single-blind studies were performed in 53 healthy volunteers, of whom 39 received gadobenate dimeglumine and 14 placebo. Another 106 patients with focal liver disease received gadobenate dimeglumine in parallel-group, open-label, phase II studies. The imaging potential of gadobenate dimeglumine was assessed in all 106 patients plus 11 healthy volunteers, whereas pharmacokinetics were determined for 42 healthy volunteers. Safety was assessed for all subjects enrolled in the study. Imaging protocols for healthy volunteers were similar to those for patients and comprised predose T2-weighted sequences and pre- and postinjection T1-weighted spin-echo and gradient-echo sequences. RESULTS: Gadobenate dimeglumine was safe and well tolerated in healthy volunteers and patients, with pharmacokinetics described adequately as a distribution phase and an elimination phase. Most of the injected dose of gadobenate was excreted unchanged in urine within 24 hours, although a fraction corresponding to 0.6%-4.0% of the injected dose was eliminated with the bile and recovered in the feces. The gadobenate dimeglumine-enhanced signal intensity of liver parenchyma was dose-related and constant for 120 minutes. Gadobenate dimeglumine-enhanced MR imaging was superior to nonenhanced MR imaging in more than 50% of patient studies, with more lesions seen in 26%-38% of patients and smaller lesions in 21%-33% of patients. In general, image sets acquired 40-180 minutes after administration of a dose were preferred, whereas images acquired during the dynamic phase after administration were typical of those obtained with extracellular fluid contrast agents. CONCLUSION: Gadobenate dimeglumine is a safe and efficacious MR imaging contrast agent suitable for both delayed and dynamic imaging of the liver.

Adult↗

Calibration of three-dimensional ultrasound images for image-guided radiation therapy.

A new technique of patient positioning for radiotherapy/radiosurgery of extracranial tumours using three-dimensional (3D) ultrasound images has been developed. The ultrasound probe position is tracked within the treatment room via infrared light emitting diodes (IRLEDs) attached to the probe. In order to retrieve the corresponding room position of the ultrasound image, we developed an initial ultrasound probe calibration technique for both 2D and 3D ultrasound systems. This technique is based on knowledge of points in both room and image coordinates. We first tested the performance of three algorithms in retrieving geometrical transformations using synthetic data with different noise levels. Closed form solution algorithms (singular value decomposition and Horn's quaternion algorithms) were shown to outperform the Hooke and Jeeves iterative algorithm in both speed and accuracy. Furthermore, these simulations show that for a random noise level of 2.5, 5, 7.5 and 10 mm, the number of points required for a transformation accuracy better than 1 mm is 25, 100, 200 and 500 points respectively. Finally, we verified the tracking accuracy of this system using a specially designed ultrasound phantom. Since ultrasound images have a high noise level, we designed an ultrasound phantom that provides a large number of points for the calibration. This tissue equivalent phantom is made of nylon wires, and its room position is optically tracked using IRLEDs. By obtaining multiple images through the nylon wires, the calibration technique uses an average of 300 points for 3D ultrasound volumes and 200 for 2D ultrasound images, and its stability is very good for both rotation (standard deviation: 0.4 degrees) and translation (standard deviation: 0.3 mm) transformations. After this initial calibration procedure, the position of any voxel in the ultrasound image volume can be determined in world space, thereby allowing real-time image guidance of therapeutic procedures. Finally, the overall tracking accuracy of our 3D ultrasound image-guided positioning system was measured to be on average 0.2 mm, 0.9 mm and 0.6 mm for the AP, lateral and axial directions respectively.

Algorithms↗

Value of three-dimensional surface display of brain perfusion imaging. Comparison with tomographic imaging.

The diagnostic ability of a three-dimensional surface display of I-123 IMP brain scintigrams and tomographic images was compared in 12 patients who underwent I-123 brain tomography for cerebral cortical hypoperfusion. Foci of decreased accumulation were independently diagnosed by four radiologists, first with transaxial images, second with three-dimensional images, and finally with both images subjectively compared for the purpose of diagnosing the existence, localization, and extent of lesions. Six different lesions (0 to 3 lesions/radiologist) were found only on the transaxial images, but 30 different lesions (1 to 14 lesions/radiologist) were found on the three-dimensional images. In 9 out of 12 cases, the three-dimensional images were regarded as superior for evaluating the extension of the lesion and for lesion existence and lesion localization in 5 out of 12 (P less than 0.05). In conclusion, a three-dimensional display of an I-123 IMP brain tomogram is superior to tomographic images in diagnosing the extent of cerebral cortical hypoperfusion. However, the display is not superior to tomographic images for diagnosing the existence and localization of hypoperfusion.

Amphetamines↗

Basic imaging properties of a large image intensifier-TV digital chest radiographic system.

The basic imaging properties of a large (57 cm) image intensifier (I.I.)-TV digital imaging system were examined to determine the effects of various physical parameters on the quality of the digital chest images obtained, and also to explore the clinical usefulness of the system. The characteristic curve of the digital system, which relates the output pixel value to the input relative x-ray intensity, was measured with an aluminum stepwedge. MTFs were determined using slit images, and the veiling-glare fraction was measured with a lead-disk technique. Noise Wiener spectra were obtained from uniformly exposed images. The current limitations of the large II-TV digital chest system are its low spatial resolution, and the presence of large amounts of veiling glare and structure mottle. Advantages of this system over other digital chest imaging systems include the high speed of image data acquisition and the capability of "real-time" dynamic imaging of the chest at a radiation dose comparable to that in conventional radiography of the chest.

Humans↗

Magnetic resonance image synthesis from analytic solutions of spin-echo and radio frequency-spoiled gradient-echo images.

RATIONALE AND OBJECTIVES: To synthesize magnetic resonance images (MRI) in real-time using a minimal data set obtained with routine clinical protocols and stored in a picture archiving and communication system (PACS) database. METHODS: Analytic solutions for T1 and T2 were obtained from a double and a single spin-echo set, with routine parameters. Analytic solutions from radio frequency-spoiled gradient-echo images, with TRs as low as 33 mseconds, also were used to synthesize gradient-echo images. RESULTS: Phantom studies showed that the errors in the synthesized images were significantly smaller than the errors in the T1- and T2-calculated images and similar to the source images. The gradient-echo images resulted in significant scan time savings. CONCLUSION: MRI synthesis from analytic solutions of T1, T2, and rho saves computational time and yields accurate values for the intrinsic parameters while allowing the use of routine clinical protocols. The availability of clinical images in the PACS database and the ability to synthesize images in real-time has allowed the development of a practical interactive teaching module.

Brain↗

The effect of irreversible image compression on diagnostic accuracy in thoracic imaging.

RATIONALE AND OBJECTIVES: Digital image compression reduces the storage requirements and network traffic on picture archiving and communications systems. Full-frame bit-allocation (FFBA) is an irreversible image-compression method based on the discrete cosine transform that provides for high compression ratios with a high degree of image fidelity. METHODS: One hundred twenty-two posteroanterior chest radiographs were obtained on patients in an ambulatory patient setting, including 30 cases of interstitial lung disease, 45 images containing combinations of lung nodules (N = 37) or mediastinal masses (N = 39), and 47 normal images containing none of the pathology for which we were testing. The images were digitized (nominal 2 K x 2 K x 12-bit resolution), printed on a 35 x 35-cm hard copy format, and compressed at an approximate compression ratio of 20:1. Observer performance tests were conducted with five radiologists using receiver operating characteristics analysis on digitized uncompressed and compressed hard copy images. RESULTS: There were no significant differences between the two display conditions for the detectability of any of the thoracic abnormalities. CONCLUSIONS: Our preliminary results suggest that irreversible image compression at ratios of 20:1 may be acceptable for use in digital thoracic imaging.

Algorithms↗

Fast spin-echo inversion-recovery imaging versus fast T2-weighted spin-echo imaging in bone marrow abnormalities.

RATIONALE AND OBJECTIVES: The purpose of this investigation is to compare a fat-suppressed T2-weighted fast spin-echo (FSE) sequence in bone marrow abnormalities with an FSE STIR sequence that recently has become commercially available. METHODS: Fast spin-echo images (repetition time [TR], 3500-5000 mseconds; echo time [TE], 96-114 mseconds) and FSE STIR images (TR, 3000-5000 mseconds; TE, 32-40 mseconds; inversion time [TI], 140-150 mseconds) were compared quantitatively and qualitatively calculating signal-to-noise ratios (SNRs), contrast-to-noise ratios (CNRs), and lesion conspicuity and using a qualitative scoring system. RESULTS: Signal-to-noise ratio (mean +/- standard deviation) was 36.4 +/- 19.3 for the FSE and 29.0 +/- 15.9 for the FSE STIR images (P = .002). Contrast-to-noise ratio (mean +/- standard deviation) was 18.7 +/- 14.3 for the FSE and 20.3 +/- 16.0 for the FSE STIR images (P = .45). Lesion conspicuity (mean +/- standard deviation) was 1.7 +/- 1.5 for the FSE and 3.5 +/- 4.0 for the FSE STIR images (P = .025). The most important difference in the qualitative evaluation related to the better signal homogeneity on the FSE STIR images. CONCLUSIONS: Fast spin-echo STIR images may be preferable to FSE images with fat suppression due to better image homogeneity and lesion conspicuity.

Adolescent↗

Spatially resolved imaging of myocardial function with strain-encoded MR: comparison with delayed contrast-enhanced MR imaging after myocardial infarction.

Strain-encoded magnetic resonance (MR) imaging was prospectively evaluated for direct imaging of systolic myocardial strain and compared with cross-registered delayed contrast material-enhanced MR imaging in five healthy volunteers and nine patients with infarction. Local contractile performance was decreased in infarcted myocardium versus that in remote and adjacent myocardium (P < .01) and in adjacent versus remote myocardium (P < .05). The extent of dysfunctional myocardium, as assessed with strain-encoded MR imaging, was greater than that of hyperenhancement, as assessed with delayed contrast-enhanced MR imaging (P < .05). Strain values obtained with strain-encoded MR imaging were strongly correlated with those obtained with three-dimensional tagged MR imaging (r = 0.75, P < .001). Strain-encoded MR imaging provides spatially resolved (1.5 x 2.5-mm) imaging and measurement of myocardial strain in humans without the need for postprocessing, which may improve routine comprehensive evaluation of myocardial viability.

Female↗

Cardiovascular screening with parallel imaging techniques and a whole-body MR imager.

The purpose of this study was to integrate parallel acquisition techniques into a comprehensive whole-body cardiovascular screening protocol to image all relevant organ systems without compromising spatial or temporal resolution. The study was approved by the institutional review board, and oral and written informed consent was obtained from each subject. Fifty subjects underwent whole-body magnetic resonance imaging that included imaging of heart, blood vessels, brain, lungs, and abdominal organs with a standard eight-channel imager. Image quality and pathologic findings were evaluated by two readers. The same protocol was then implemented with a new 32-channel whole-body imager. Depiction of 1476 (73.2%) of 2016 vessel segments was rated as good to excellent, and that of 1744 (86.5%), as without venous overlay. Interobserver agreement was good in evaluation of image quality and excellent in evaluation of pathologic findings. Acquisition time was reduced significantly (P < .05) with use of the whole-body imager and parallel acquisition techniques, which provided high-quality fast cardiovascular imaging.

Adult↗

Superconducting open-configuration MR imaging system for image-guided therapy.

PURPOSE: To develop a superconducting magnetic resonance (MR) imager that provides direct access to the patient and permits interactive MR-guided interventional procedures. MATERIALS AND METHODS: A 0.5-T superconducting magnet that allows a region of vertical access to the patient was designed and constructed. This magnet was integrated with newly designed shielded gradient coils, flexible surface coils, and nonmagnetic displays and with position-monitoring probes and device-tracking instrumentation. RESULTS: The magnet homogeneity was 12.3 ppm, and the gradient field was linear to within 1% over an imaging region 30 cm in diameter. The signal-to-noise ratio was 10% higher than in a comparable 0.5-T superconducting imager. Images were obtained in several anatomic regions with use of routine pulse sequences. Interactive image plane selection and near real-time imaging, with use of fast gradient-recalled echo sequences, were demonstrated at a rate of one image every 1.5 seconds. CONCLUSION: MR-guided interventional procedures can be performed with full patient access with use of an open-configuration, superconducting MR magnet with near real-time imaging and interactive image plane control.

Humans↗