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Somatotopic organization of the ventral and dorsal finger surface representations in human primary sensory cortex evaluated by magnetoencephalography.

Cortical reorganization of the subtly differentiated hand map after peripheral nerve injury might be better understood if there was a topographic conception of the homuncular representation of the dorsal finger surfaces in humans, in addition to the well-established sequential rostrocaudal array of the ventral finger aspects in cortical area 3b. In the present magnetoencephalographic study, tactile pneumatic stimulation was delivered to the fingertip and to the ventral and dorsal proximal phalanx of each digit of the dominant hand in 20 right-handed volunteers. Source localization of equivalent current dipoles underlying the recorded somatosensory evoked magnetic field was performed using a Cartesian coordinate system established by the anatomical landmarks nasion and preauricular points. Of the first major peak of each somatosensory evoked field, the region with the maximum field power (root-mean-square across channels) was selected for source reconstruction. Analysis of variance for repeated measures yielded significant results with respect to the arrangement of digits along the vertical coordinate axis, demonstrating a sequential array from the most inferiorly located D1 to the most superiorly located D5 for all different stimulus positions. This is the first study providing evidence for a sequential topographical arrangement of not only the ventral but also the dorsal surface representations of the individual digits in the human somatosensory cortex. The study contributes to a better understanding of the somatosensory hand representation in human primary cortex and provides useful information with regard to cortical plasticity studies in patients with peripheral nerve injuries at the upper extremity.

Adult↗

Generators of movement-related cortical potentials: fMRI-constrained EEG dipole source analysis.

To clarify the precise location and timing of the mo tor cortical activation in voluntary movement, dipole source analysis integrating multiple constraints wa conducted for the movement-related cortical potentia (MRCP). Six healthy subjects performed single self paced extensions of the right index finger at about 15-intervals during EEG and event-related fMRI acquisi tions. EEG was recorded from 58 scalp electrodes, and fMRI of the entire brain was obtained every 2.6 s. Coordinates of the two methods were coregistered us ing anatomical landmarks. During dipole source mod eling, a realistic three-layer head model was used as a volume conductor. To identify the number of uncorre lated source s in the MRCP, principal component (PC analysis was performed, which was consistent with the existence of six sources in the left (Lt SM1) and right (Rt SMI) sensorimotor and medial frontocentral (MFC) areas. After dipoles were seeded at the acti vated spots revealed by fMRI, dipole orientations were fixed based on the interpretation of the topography of distribution of the PC. The strength of the six dipoles (three dipoles in Lt SMI, two in Rt SMI, and one in MFC) was then computed over time. Within the bilat eral SM1, activation of the precentral gyrus occurs bilaterally with similar strength from -1.2 s, followed by that of the precentral bank from -0.5 s with con tralateral preponderance. Subsequently, the postcen tral bank becomes active only on the contralateral side at 0.1 s after movement. Activation of the MFC shows timing similar to that of the bilateral precentral gyri These deduced patterns of activation are consis tent with previous studies of electrocorticography in humans.

Adult↗

Hybrid segmentation framework for tissue images containing gene expression data.

Associating specific gene activity with functional locations in the brain results in a greater understanding of the role of the gene. To perform such an association for the over 20,000 genes in the mammalian genome, reliable automated methods that characterize the distribution of gene expression in relation to a standard anatomical model are required. In this work, we propose a new automatic method that results in the segmentation of gene expression images into distinct anatomical regions in which the expression can be quantified and compared with other images. Our method utilizes shape models from training images, texture differentiation at region boundaries, and features of anatomical landmarks, to deform a subdivision mesh-based atlas to fit gene expression images. The subdivision mesh provides a common coordinate system for internal brain data through which gene expression patterns can be compared across images. The automated large-scale annotation will help scientists interpret gene expression patterns at cellular resolution more efficiently.

Algorithms↗

Validation of PET imaging by alignment to histology slices.

The aim of this project is to verify the accuracy of positron emission tomography (PET) in identifying the tumour boundary and eventually to enable PET-guided resection with removal of significantly smaller margins. We present a novel use of an image-guided surgery system to enable alignment of preoperative PET images to postoperative histology. The oral cancer patients must have a high resolution CT scan as well as undergoing PET imaging. Registration of these images to the patient during surgery is achieved using a device that attaches to the patient's upper or lower teeth. During the procedure markers are placed around the lesion within tissue that is to be resected. These are marked along with any convenient anatomical landmarks using the image guidance system, providing the location of the points in the preoperative images. After the sample has been resected, slices through at least 3 of these points are made and photographed. Registration should be possible using these landmarks, but the accuracy of alignment is much improved by marking the bone surface in the histology image and registering to preoperative CT.

Algorithms↗

Macroscopic three-dimensional motion patterns of the left ventricle.

The pattern of displacements in the left ventricle (LV) can be described by 13 modes of motion and deformation. Three functional modes of deformation are essential for ejection: a decrease in cavity volume, torsion, and ellipticalization. Four additional modes are used to describe asymmetric deformation. Six modes of rigid body motion describe rotation and translation. In the LV 14-20 radiopaque markers were inserted in the wall of the LV. They were distributed more or less evenly from base to apex and around the circumference. Torsion and volume changes require the definition of a cardiac coordinate system. The point at which ejection focuses is used as the origin, and the torsion axis is used as the z-axis. In the present study the coordinate system was positioned objectively by a least squares fit of the kinematic model to the measured motion of markers. In five dogs in the control state the kinematic parameters were determined as a function of time for all 13 modes. The torsion axis was displaced 4 +/- 2 mm (mean +/- sd) from the center of the cross-section of the LV towards the lateral free wall. The direction of the torsion axis closely coincided with anatomical landmarks at the apex and base. During systole, a unique relation was found between the ratio of cavity volume to wall volume and torsion. This relation was universal to all LVs, the cylinder-symmetric mathematical model of cardiac mechanics inclusive. In diastole the patterns of deformation seem less universal and reproducible.

Animals↗

Usefulness of technetium-99m hydroxymethylene diphosphonate scans in localizing bone metastases of differentiated thyroid carcinoma.

Iodine-131 is uniquely able to demonstrate iodine uptake of differentiated thyroid carcinoma (DTC), but precise localization may be difficult, especially in the thorax, due to the quality of image resolution with 131I and the lack of anatomical landmarks. When bone metastases do not show radioiodine uptake bone scintigraphy can be used to detect them. We studied two groups of patients. In group 1, 15 patients with known bone metastases of DTC were treated with 3.7 GBq 131I. After 4 or 5 days, technetium-99m hydroxymethylene diphosphonate (HMDP; 740 MBq) was injected and a whole-body scan with simultaneous acquisition of 131I and 99mTc-HMDP images was carried out using a large field of view gamma camera fitted with a high-energy collimator. Technetium uptake was abnormal in 47 of 63 localizations, being increased in 29 foci, decreased in 7 and heterogeneous in 11. The superimposition of 131I and 99mTc-HMDP scans permitted an accurate localization in 80% of spine metastases and in 46% of osseous thoracic localizations, even in the presence of lung metastases. In group 2, 9 patients, who had bone pain, neurological signs or elevated serum thyroglobulin, had DTC bone metastases without iodine uptake. They received a diagnostic dose of 99mTc-HMDP 3h prior to scintigraphy with a large field of view gamma camera fitted with a low-energy collimator. Technetium uptake was abnormal in 37 of 38 localizations, being increased in 34 foci and decreased in 3. One false-negative was found in a skull metastasis. In both groups of patients, 99mTc-HMDP scans were useful.(ABSTRACT TRUNCATED AT 250 WORDS)

Adenocarcinoma, Follicular↗

Superimposition of computed tomography and single photon emission tomography immunoscintigraphic images in the pelvis: validation in patients with colorectal or ovarian carcinoma recurrence.

A method of superimposing computed tomography (CT) and immunoscintigraphic (IS) single photon emission tomography (SPET) slices is presented and has been applied to 10 patients with suspected cancer recurrence. IS was performed with carcinoembryonic antigen (CEA)-specific indium-111 monoclonal antibodies (MoAbs) in 5 patients with colorectal cancer, and with OC125 111In-MoAbs in 5 patients with ovarian cancer. All patients had an abnormal CT image result in the pelvis, which was interpreted 5 times as recurrence, once as doubtful and four times as scar fibrosis. Recurrence was subsequently proven in all patients. Bone scintigraphy (BS) SPET was recorded at the same time as IS. No special technique was used during BS, IS or CT acquisition. CT images were fed into a computer using a CCD camera. Using the internal anatomical landmarks provided by the pelvic bone structures seen on CT and BS, an operator had to select corresponding fiducial points, which were used by the software to register the images. The final results were CT-BS and CT-IS superimposed images. CT-BS images were used for quality control. In all patients, the inspection of CT-BS and CT-IS showed that the registration process is accurate and assists in the co-interpretation of CT and IS images.

Colorectal Neoplasms↗

Postural displacements of the brain--on the feasibility of using CT for determination of stereotactic coordinates.

Ten patients were studied with CT. In order to achieve consistent and reproducible CT slices an external helmet fixation system was used. Certain well defined cerebral structures were chosen as anatomical landmarks and their relationship to the skull determined with the patient in supine, lateral and prone positions. No displacements of brain structures could be observed. The results show the feasibility of using the same coordinates for intracranial structures at CT and at operation irrespective of the position of the patient's head at these procedures. Four of these patients were examined after lumbar intrathecal administration of 5 ml metrizamide (200 mgJ/ml). This small amount of positive contrast does not seem to influence on the position for the brain.

Brain↗

Referencing procedure for location of lumbosacral alpha-motoneurons.

This report presents a simple referencing procedure to facilitate microelectrode positioning within a desired motor nucleus in the cat spinal cord. The procedure is used in conjunction with the conventional technique of interpreting microelectrode position in the ventral gray column on the basis of the relative amplitude of antidromically or orthodromically evoked field potentials from select motor nuclei. The procedure optimizes the use of a single surface anatomical landmark such that the nuclei can be quantitatively referenced both horizontally and sagitally.

Animals↗

The human skull base angle during the second trimester of gestation.

In an attempt to demonstrate and explain the radiographic findings and changes in the skull base angle (SBA) during the second trimester of gestation, we examined 26 human fetal heads of 15-25 weeks gestational age by direct sagittal and axial high resolution computed tomography. The fetuses were preserved in 10% formalin. On magnified sagittal tomograms tracings of the skull base were made and three anatomical landmarks (nasion, sella turcica and the lowest part of the clivus) were used to define the SBA formed between them. The changes in the SBA during the second trimester were related to the gestational age of the fetuses. We found a significant increase of the SBA, of approximately 27 degrees, during the second trimester of gestation. This is different from previous measurements.

Embryonic and Fetal Development↗

Preliminary experience with intracorporeal laparoscopic ultrasonography using a sector scanning probe. A prospective comparison with intraoperative cholangiography in the detection of choledocholithiasis.

Laparoscopic ultrasonography is a novel technique which may be useful in screening for choledocholithiasis during laparoscopic cholecystectomy. Following concerns regarding the "learning curve" and accuracy associated with the adoption of this user-dependent technology, we have prospectively evaluated a commercially available 90 degrees sector scanning laparoscopic ultrasound probe during elective laparoscopic cholecystectomy. Laparoscopic ultrasonography was performed in 60 patients and identified common duct stones in nine patients (one "false positive" and "one false negative"), and previously unsuspected duct stones were defined in three out of four patients. The gallbladder and portal vein were constantly defined anatomical landmarks throughout the study, whereas the suprapancreatic bile duct, intrapancreatic bile duct, and pancreatic duct were identified in 100%, 80%, and 85% of patients in the third consecutive group of 20 patients examined. Laparoscopic ultrasonography has the potential to accurately identify common duct stones during laparoscopic cholecystectomy and thereby implement a policy of "superselective" operative cholangiography. However, adequate training for surgeons unfamiliar with this technology is recommended.

Cholangiography↗

A technique for laparoscopic retraction of the acutely inflamed thick-walled gallbladder.

Utilizing the described technique, we have been able to obtain adequate cephalad retraction of the acutely inflamed, tense, and thick-walled gallbladder with minimal trauma. This has made it possible to more adequately identify key anatomical landmarks and to more safely perform the dissection in this area. We believe that the benefits of a shorter hospital stay, decreased postoperative pain, and earlier return to normal activity that patients realize when having an elective laparoscopic cholecystectomy for chronic cholecystitis can be made available as well to more patients presenting with acute cholecystitis.

Acute Disease↗

Early immunoscintigraphic localisation of a mediastinal tumour with indium 111-DTPA CEA-specific F(ab')2 monoclonal antibody fragments (BW 431/31) using second tracer isocontour technique.

A female patient with steadily increasing carcinoembryonic antigen (CEA) serum levels of unknown origin was referred for immunoscintigraphy with indium 111-labelled CEA-specific monoclonal antibody. The procedure revealed a tumour, undetectable by conventional diagnostic methods. Anatomical landmarking using the second tracer isocontour technique allowed the distinction between an intra- or extrapulmonary lesion. Two months later, tumour infiltration along the aortic arch was confirmed by a targeted angio-CT scan. Upon surgery, the diagnosis was definitely established histologically (undifferentiated, solid large cell carcinoma, most probably arising from the bronchus), and staining by CEA-specific immunohistochemistry confirmed the presence of the CEA antigen.

Adult↗

Techniques for percutaneous renal biopsies.

The technique of renal biopsy includes the preparation of the patient, the localization of the kidneys, the biopsy itself and the postbiopsy care of the patient. A review of the literature and a survey of pediatric nephrologists practicing in the New York metropolitan area and in Philadelphia was used to determine what those techniques were. In preparation for biopsy, bleeding disorders are excluded and corrected if present. In units that localize the kidney by anatomical landmarks, a sonogram is performed at some earlier time to determine that the patient has two kidneys in the usual location. After sedation, patients are placed in the prone position, with a bolster under the abdomen. Sonography is the most commonly used localization method. This is followed by probing to confirm localization and depth. The Tru-Cut needle and the Franklin Vim Silverman needles are the two most commonly used. All nephrologists in the New York area then have the specimen examined to ensure adequacy of sampling. Postbiopsy care includes observation of vital signs, bed rest overnight and some limitation of activity for 2 days to 2 weeks subsequently. In the biopsy of renal allografts, palpation achieves adequate localization. The technique is otherwise the same as for the biopsy of native kidneys.

Biopsy, Needle↗

Individual somatotopy of primary sensorimotor cortex revealed by intermodal matching of MEG, PET, and MRI.

A method for comparing estimated magnetoencephalographic (MEG) dipole localizations with regional cerebral blood flow (rCBF) activation areas is presented. This approach utilizes individual intermodal matching of MEG data, of rCBF measurements with [15O]-butanol and positron emission tomography (PET), and of anatomical information obtained from magnetic resonance (MR) images. The MEG data and the rCBF measurements were recorded in a healthy subject during right-sided simple voluntary movements of the foot, thumb, index finger, and mouth. High resolution 3D-FLASH MR images of the brain consisting of 128 contiguous sagittal slices of 1.17-mm thickness were used. MEG/MR integration was performed by superimposing the 3D head coordinate system constructed during the MEG measurement onto the MR image data using identical anatomical landmarks as references. PET/MR integration was achieved by a phantom-validated iterative front-to-back-projection algorithm resulting in one integrated MEG/PET/MR image. The estimated dipole locations followed the somatotopic organisation of the task-specific rCBF increases as evident from PET, although they did not match point-to-point. Our results demonstrate that intermodal matching of MEG, PET and MR data provides a tool for relating estimated neuromagnetic field locations to task-specific rCBF changes in individual subjects. Our method offers the perspective of refined dipole modelling.

Adult↗

Head surface digitization and registration: a method for mapping positions on the head onto magnetic resonance images.

We have developed a method for mapping positions on the head, such as anatomical landmarks, electrode locations, and stimulation sites, onto magnetic resonance (MR) images of the head. This method is based on the registration of two representations of the head surface: a series of contours obtained from MR images and a set of points measured from the head. The three-dimensional coordinates of each head point were acquired with the use of a magnetic digitizer, whose source was removed from the equipment and mounted on top of the subject's head. This arrangement seemed less uncomfortable for the subject than head immobilization and allowed the acquisition of many points without compromising the precision of the measurements. The digitized head surface was registered to MR image head contours using a surface registration algorithm. The registration provided the rotation and translation parameters needed for mapping head positions onto MR images. The precision of this mapping method has been estimated to be in the range of 3 to 8 mm. This method has been used to map dipole sources in electroencephalography and magneto-encephalography and to impose maps of scalp sites used in transcranial magnetic stimulation onto MR and PET images of the brain.

Adult↗

Image-directed functional neurosurgery with the Cosman-Roberts-Wells stereotactic instrument.

An isocentered system for functional stereotactic procedures with the Cosman-Roberts-Wells frame and a CT localizer that allows extrapolation of target data directly from the CT slice is presented. Based on anatomical landmarks and on the scaled corresponding transverse plates of the Schaltenbrand and Wahren atlas, we delineate the thalamic and cerebellar nuclei. Twenty three image-directed functional procedures were performed in one year on 18 patients (7 with Parkinson's disease, 4 with dystonia, 3 persons with essential tremor, 2 patients with choreo-athetosis and 2 with de-afferentiation pain). The 23 procedures included 19 thalamotomies, two dentatotomies and two stereotactic implantations of deep seated brain electrodes. Successful targeting was verified by intra-operative electrical stimulation and postoperative CT scan. Complete reduction of symptoms was observed in 4 persons with Parkinson's disease and in 2 patients with essential tremor with significant improvement observed in the rest of the patients with the exception of the individual with choreo-athetosis. There were no operation-related complications. The reported technique is safer and less distressing for patients than previous radiological procedures and it makes image-directed stereotactic functional neurosurgery available to many units with the CRW frame.

Athetosis↗

Planning and surgical strategies for early management of vertebral artery and vertebrobasilar junction aneurysms.

Selection of the approach and technique for surgical repair of aneurysm of the vertebrobasilar artery system is mainly based on angiographic features. This report emphasizes that planning the surgical procedure should also include preoperative evaluation of the individual skull base configuration, as well as the relationship between aneurysm site and surrounding bony structures. These features are evaluated on thin slice CT scans using bone tissue algorithms and are particularly important for adequate exposure of distal vertebral artery (VA) or midline aneurysms, because these cases require drilling of the jugular tubercle. For the use of lateral approaches, the surgeon must be familiar with the extradural and intradural anatomy of the foramen magnum region and may rely on at least five anatomical landmarks for orientation during surgery: 1) the dural entrance of the vertebral artery; 2) the posterior condylar emissary vein; 3) the medial rim of the distal sigmoid sinus; 4) the hypoglossal canal; 5) the jugular tubercle. To increase the safety of the procedure, the authors recommend an individualized tailoring of the surgical approach according to the variable morphological situation of each patient.

Arteries↗