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PubMed2000

[Multimodal SPECT and MRT imaging data analysis for an improvement in the diagnosis of idiopathic Parkinson's syndrome].

Parkinson's disease (PD) is characterized by a degeneration of nigrostriatal dopaminergic neurons, which can be imaged with 123I-labeled 2 beta-carbomethoxy-3 beta-(4-iodophenyl) tropane ([123I]beta-CIT) and single-photon emission computed tomography (SPECT). However, the quality of the region of interest (ROI) technique used for quantitative analysis of SPECT data is compromised by limited anatomical information in the images. We investigated whether the diagnosis of PD can be improved by combining the use of SPECT images with morphological image data from magnetic resonance imaging (MRI)/computed tomography (CT). We examined 27 patients (8 men, 19 women; aged 55 +/- 13 years) with PD (Hoehn and Yahr stage 2.1 +/- 0.8) by high-resolution [123I]beta-CIT SPECT (185-200 MBq, Ceraspect camera). SPECT images were analyzed both by a unimodal technique (ROIs defined directly within the SPECT studies) and a multimodal technique (ROIs defined within individual MRI/CT studies and transferred to the corresponding interactively coregistered SPECT studies). [123I]beta-CIT binding ratios (cerebellum as reference), which were obtained for heads of caudate nuclei (CA), putamina (PU), and global striatal structures were compared with clinical parameters. Differences between contra- and ipsilateral (related to symptom dominance) striatal [123I]beta-CIT binding ratios proved to be larger in the multimodal ROI technique than in the unimodal approach (e.g., for PU: 1.2 vs. 0.7). Binding ratios obtained by the unimodal ROI technique were significantly correlated with those of the multimodal technique (e.g., for CA: y = 0.97x + 2.8; r = 0.70; P < 0.001). Concerning the correlations between SPECT data and clinical parameters, the significance levels in the multimodal ROI technique, for example, for the correlation between CA and the UPDRScom subscore (r = -0.49 vs. -0.32). These results show that the impact of [123I]beta-CIT SPECT for diagnosing PD is affected by the method used to analyze the SPECT images. The described multimodal approach, which is based on coregistration of SPECT and morphological imaging data, leads to improved determination of the degree of this dopaminergic disorder.

Adult↗
PubMed1983

Example for applying the COMSTAT multimodal factor analysis algorithm to EEG data to describe variance sources.

An example is given for the application of the COMSTAT algorithm for multimodal factor analysis to EEG power spectral data. The COMSTAT algorithm enlarges Tucker 's three-mode factor analysis to a multimodal one, and improves his algorithm by a least squares solution. The EEG power spectral data from 65 healthy subjects with an occipital rhythm between 8 and 12 Hz were taken. For demonstration purposes we selected three modes, which have been used by other authors: mode 1: 29 frequency classes, 1n of relative power, in delta f = 1.0-Hz steps between 1 and 30 Hz; mode 2: 16 segments, 40 s each, during the two situational vigilance conditions reaction time (RT) and resting (RS), and mode 3: 65 persons. The frequency mode could be described sufficiently by five factors which we called: delta F/alpha F1; nu F/alpha F2; beta F1/alpha F1; beta F2; beta F3. The factor-loading profiles were similar to those described earlier in independent data. Thus, in the three-mode model we obtained results comparable to those of two-mode models. In the level of 16 situational segments only two factors were extractable. They described the two situations RT, higher vigilance level, and RS, lower vigilance level. In order to demonstrate the changes in factor structure, if a two-mode model is enlarged by a third mode, we used two models for the description of personal (P) variance. When the matrix persons X segments (P X V) was taken, only two factors were extractable.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMedDate not supplied

Early oral feeding after elective abdominal surgery--what are the issues?

This review analyzes the literature and the historical concerns (restrictions, traditions, nasogastric tube) and pathophysiologic factors (postoperative ileus, risk of anastomotic dehiscence, nausea and vomiting, loss of appetite) invoked for not instituting early oral feeding after major abdominal procedures. It appears that several factors may promote postoperative oral feeding such as thoracic epidural analgesia, multimodal anti-emetic treatment, opioid-sparing analgesia, selective peripheral opioid antagonists, and enforced oral nutrition. Recent data from multimodal fast-track rehabilitation surgical programs in abdominal surgery provide a rational basis for future studies to investigate and facilitate enforced oral feeding after major abdominal procedures.

Abdomen↗
PubMed2004

Multimodal integration of EEG and MEG data: a simulation study with variable signal-to-noise ratio and number of sensors.

Previous simulation studies have stressed the importance of the multimodal integration of electroencephalography (EEG) and magnetoencephalography (MEG) data in the estimation of cortical current density. In such studies, no systematic variations of the signal-to-noise ratio (SNR) and of the number of sensors were explicitly taken into account in the estimation process. We investigated effects of variable SNR and number of sensors on the accuracy of current density estimate by using multimodal EEG and MEG data. This was done by using as the dependent variable both the correlation coefficient (CC) and the relative error (RE) between imposed and estimated waveforms at the level of cortical region of interests (ROI). A realistic head and cortical surface model was used. Factors used in the simulations were: (1). the SNR of the simulated scalp data (with seven levels: infinite, 30, 20, 10, 5, 3, 1); (2). the particular inverse operator used to estimate the cortical source activity from the simulated scalp data (INVERSE, with two levels, including minimum norm and weighted minimum norm); and (3). the number of EEG or MEG sensors employed in the analysis (SENSORS, with three levels: 128, 61, 29 for EEG and 153, 61, or 38 in MEG). Analysis of variance demonstrated that all the considered factors significantly affect the CC and the RE indexes. Combined EEG-MEG data produced statistically significant lower RE and higher CC in source current density reconstructions compared to that estimated by the EEG and MEG data considered separately. These observations hold for the range of SNR values presented by the analyzed data. The superiority of current density estimation by multimodal integration of EEG and MEG was not due to differences in number of sensors between unimodal (EEG, MEG) and combined (EEG-MEG) inverse estimates. In fact, the current density estimate relative to the EEG-MEG multimodal integration involved 61 EEG plus 63 MEG sensors, whereas estimations carried out with the single modalities alone involved 128 sensors for EEG and 153 sensors for MEG. The results of the simulations also suggest that the use of simultaneous 29 EEG sensors during the MEG measurements carried out with full sensor arrangements (153 sensors) returned an accuracy of the cortical source estimate statistically similar to that obtained by combining 64 EEG and 153 MEG sensors.

Brain↗
PubMed2003

Display of fused images: methods, interpretation, and diagnostic improvements.

The use of integrated visualization for medical images aims at assisting clinicians in the difficult task of mentally translating and integrating medical image data from multiple sources into a three-dimensional (3D) representation of the patient. This interpretation of the enormous amount and complexity of contemporary, multiparameter, and multimodal image data demands efficient methods for integrated presentation. This article reviews methods for fused display with the main focus on integration of functional with anatomical images. First, an overview of integrated two-dimensional (2D) and 3D medical image display techniques is presented, and topics related to the interpretation of the integrated images are discussed. Then we address the key issue for clinical acceptance, ie, whether these novel visualization techniques lead to diagnostic improvements. Methods for fused display appear to be powerful tools to assist the clinician in the retrieval of relevant information from multivariate medical image data. Evaluation of the different methods for fused display indicates that the diagnostic process improves, notably as concerns the anatomical localization (typically of functional processes), the registration procedure, enhancement of signal, and efficiency of information presentation (which increases speed of interpretation and comprehension). Consequently, fused display improves communication with referring specialists, increases confidence in the observations, and facilitates the intra- and intersubject comparison of a large part of the data from the different sources, thereby simplifying the extraction of additional, valuable information. In most diagnostic tasks the clinician is served best by providing several (interactive and flexible) 2D and 3D methods for fused display for a thorough assessment of the wealth of image information from multiple sources.

Anatomy, Cross-Sectional↗
PubMed2006

LONI visualization environment.

Over the past decade, the use of informatics to solve complex neuroscientific problems has increased dramatically. Many of these research endeavors involve examining large amounts of imaging, behavioral, genetic, neurobiological, and neuropsychiatric data. Superimposing, processing, visualizing, or interpreting such a complex cohort of datasets frequently becomes a challenge. We developed a new software environment that allows investigators to integrate multimodal imaging data, hierarchical brain ontology systems, on-line genetic and phylogenic databases, and 3D virtual data reconstruction models. The Laboratory of Neuro Imaging visualization environment (LONI Viz) consists of the following components: a sectional viewer for imaging data, an interactive 3D display for surface and volume rendering of imaging data, a brain ontology viewer, and an external database query system. The synchronization of all components according to stereotaxic coordinates, region name, hierarchical ontology, and genetic labels is achieved via a comprehensive BrainMapper functionality, which directly maps between position, structure name, database, and functional connectivity information. This environment is freely available, portable, and extensible, and may prove very useful for neurobiologists, neurogenetisists, brain mappers, and for other clinical, pedagogical, and research endeavors.

Brain Mapping↗
PubMed1997

A neural model of multimodal adaptive saccadic eye movement control by superior colliculus.

How does the saccadic movement system select a target when visual, auditory, and planned movement commands differ? How do retinal, head-centered, and motor error coordinates interact during the selection process? Recent data on superior colliculus (SC) reveal a spreading wave of activation across buildup cells the peak activity of which covaries with the current gaze error. In contrast, the locus of peak activity remains constant at burst cells, whereas their activity level decays with residual gaze error. A neural model answers these questions and simulates burst and buildup responses in visual, overlap, memory, and gap tasks. The model also simulates data on multimodal enhancement and suppression of activity in the deeper SC layers and suggests a functional role for NMDA receptors in this region. In particular, the model suggests how auditory and planned saccadic target positions become aligned and compete with visually reactive target positions to select a movement command. For this to occur, a transformation between auditory and planned head-centered representations and a retinotopic target representation is learned. Burst cells in the model generate teaching signals to the spreading wave layer. Spreading waves are produced by corollary discharges that render planned and visually reactive targets dimensionally consistent and enable them to compete for attention to generate a movement command in motor error coordinates. The attentional selection process also helps to stabilize the map-learning process. The model functionally interprets cells in the superior colliculus, frontal eye field, parietal cortex, mesencephalic reticular formation, paramedian pontine reticular formation, and substantia nigra pars reticulata.

Animals↗
PubMed2026

CAUSAL artificial intelligence and data-driven decision intelligence in personalized medicine: a review of healthcare informatics systems.

This review examines the integration of causal artificial intelligence (AI) and data-driven decision intelligence within healthcare informatics systems to advance personalized medicine and clinical decision-making. A narrative review methodology was employed, synthesizing interdisciplinary literature from major databases, including PubMed, Scopus, Web of Science, IEEE Xplore, and ScienceDirect. Studies focusing on causal inference, decision intelligence, and healthcare informatics applications in personalized medicine were included. Data were extracted on methodological approaches, healthcare settings, analytical techniques, and clinical applications, followed by thematic synthesis. Findings indicate that causal AI enhances clinical decision support by enabling estimation of treatment effects and simulation of intervention outcomes at the individual patient level. Integration of multimodal health data such as electronic health records, genomic data, and real-time monitoring improves prediction accuracy and supports tailored treatment strategies. Additionally, causal models improve interpretability, fostering clinician trust and facilitating transparent decision-making. Robust healthcare informatics infrastructures, including interoperable systems and data warehouses, were identified as critical enablers of causal analytics. Overall, causal AI represents a transformative advancement in healthcare analytics, supporting more informed, individualized, and evidence-based clinical decisions. Its integration within healthcare informatics systems has significant potential to improve patient outcomes and guide the future of intelligent, personalized healthcare delivery.

Precision Medicine↗
PubMed2005

Methods for quantifying the informational structure of sensory and motor data.

Embodied agents (organisms and robots) are situated in specific environments sampled by their sensors and within which they carry out motor activity. Their control architectures or nervous systems attend to and process streams of sensory stimulation, and ultimately generate sequences of motor actions, which in turn affect the selection of information. Thus, sensory input and motor activity are continuously and dynamically coupled with the surrounding environment. In this article, we propose that the ability of embodied agents to actively structure their sensory input and to generate statistical regularities represents a major functional rationale for the dynamic coupling between sensory and motor systems. Statistical regularities in the multimodal sensory data relayed to the brain are critical for enabling appropriate developmental processes, perceptual categorization, adaptation, and learning. To characterize the informational structure of sensory and motor data, we introduce and illustrate a set of univariate and multivariate statistical measures (available in an accompanying Matlab toolbox). We show how such measures can be used to quantify the information structure in sensory and motor channels of a robot capable of saliency-based attentional behavior, and discuss their potential importance for understanding sensorimotor coordination in organisms and for robot design.

Animals↗
PubMed1994

Expanding the use and effectiveness of dose-volume histograms for 3-D treatment planning. I: Integration of 3-D dose-display.

PURPOSE: A technique is presented for overcoming a major deficiency of histogram analysis in three-dimensional (3-D) radiotherapy treatment planning; the lack of spatial information. METHODS AND MATERIALS: In this technique, histogram data and anatomic images are displayed in a side-by-side fashion. The histogram curve is used as a guide to interactively probe the nature of the corresponding 3-D dose distribution. Regions of dose that contribute to a specific dose bin or range of bins are interactively highlighted on the anatomic display as a window-style cursor is positioned along the dose-axis of the histogram display. This dose range highlighting can be applied to two-dimensional (2-D) images and to 3-D views which contain anatomic surfaces, multimodality image data, and representations of radiation beams and beam modifiers. Additionally, as a range of histogram bins is specified, dose and volume statistics for the range are continually updated and displayed. RESULTS: The implementation of these techniques is presented and their use illustrated for a nonaxial three field treatment of a hepatic tumor. CONCLUSION: By integrating displays of 3-D doses and the corresponding histogram data, it is possible to recover the positional information inherently lost in the calculation of a histogram. Important questions such as the size and location of hot spots in normal tissues and cold spots within target volumes can be more easily uncovered, making the iterative improvement of treatment plans more efficient.

Humans↗
PubMed2004

Automatic image registration of three-dimensional images of the head of cats and dogs by use of maximization of mutual information.

OBJECTIVE: To validate mutual information criterion as a ready-to-use technique for automated alignment (ie, registration) of 3-dimensional (3-D) multimodal image data of the head of cats and dogs. SAMPLE POPULATION: Corresponding 3-D magnetic resonance imaging (MRI) and computed tomography (CT) brain scans of a 6-month-old Doberman Pinscher with a brain cyst; CT images of the head of a European shorthair cat with a meningioma before and immediately, 3, and 6 months after surgical resection; and CT and corresponding stacked anatomic cryosection images of the entire head of a 2-year-old sexually intact female Beagle. PROCEDURE: All images were matched retrospectively by use of an in-house computer program developed on the basis of a mutual information image registration algorithm. Accuracy of the resulting registrations was evaluated by visual inspection. RESULTS: All registrations were judged to be highly accurate. Additional manual corrections were not necessary. CONCLUSIONS AND CLINICAL RELEVANCE: Mutual information registration criterion can by applied to 3-D multimodal head images of cats and dogs for full automatic rigid-body image registration. The combination of such aligned images would considerably facilitate efforts of veterinary clinicians as indicated by its widespread use in brain surgery and radiation therapy of humans.

Animals↗
PubMed1996

Computed tomography slice-by-slice target-volume delineation for stereotactic proton irradiation of large intracranial arteriovenous malformations: an iterative approach using angiography, computed tomography, and magnetic resonance imaging.

PURPOSE: Target-volume delineation for stereotactic irradiation is problematic for large and irregularly shaped arteriovenous malformations (AVMs). The purpose of this report is to quantify modifications in the target volume that result from iterative treatment planning that incorporates multimodality imaging data. METHODS AND MATERIALS: Stereotactic neuroimaging procedures were performed for 20 consecutive patients with AVM volumes > 10 cm3. Angiographically defined extrema were transformed into computed tomography (CT) space. The resulting target contours were then modified by a multidisciplinary treatment planning team after iterative review of angiographic, CT, and magnetic resonance imaging (MRI) data. Volumes of interest and dose-volume histograms for proton irradiation were calculated before and after iterative target delineation. RESULTS: Initial (angiographically defined) target volumes ranged from 15.3 to 96.1 cm3 (mean, 43.6 cm3). Final (iteratively defined) target volumes ranged from 10.7 to 114.0 cm3 (mean, 38.4 cm3). The volume of presumed normal tissue excluded by iterative planning ranged from 2.6 to 47.0 cm3 (mean, 15.5 cm3). Initially untargeted AVM, most commonly obscured by embolization material, was identified in all cases (range, 0.3 to 57.8 cm3; mean, 10.3 cm3). Corresponding dose-volume histograms demonstrated marked differences regarding lesion coverage and sparing of normal tissue structures. CONCLUSIONS: Iterative target-volume delineation resulted in significant modifications from initial, angiographically defined target volumes. Substantial amounts of apparently normal tissue were excluded from the final target, and additional abnormal vascular structures were identified for incorporation. We conclude that an iterative multimodality approach to target-volume delineation may improve the overall results for stereotactic irradiation of large and complex AVMs.

Humans↗
PubMed1989

Thalamic connections of the cortex of the superior temporal sulcus in the rhesus monkey.

The thalamocortical connections of the superior temporal sulcus (STS) were studied by means of the WGA-HRP retrograde tracing technique. The results indicate that the distribution of thalamic projections varies along the rostral-caudal dimension of the STS. Thus the rostral portion of the upper bank receives input primarily from the medialmost portion of the medial pulvinar (PM) nucleus. The middle region of the upper bank receives projections from medial and central portions of the PM nucleus, and also from the oral pulvinar, limitans, suprageniculate, medial geniculate, and dorsomedial nuclei. The cortex of the caudal portion of the upper bank has basically similar thalamic input; however, the projections from the PM nucleus originate in central and lateral portions. Additionally, there are projections from the lateral pulvinar (PL), ventroposterolateral, central lateral, parafascicular, and paracentral nuclei. In contrast to the dorsal bank, the cortex of the ventral bank of the STS receives somewhat different and less extensive thalamic input. The rostral portion of the lower bank receives projections only from the ventromedial sector of the PM nucleus, whereas the middle portion of the lower bank receives projections from the PL and the inferior pulvinar nuclei as well as from the PM nucleus. The upper bank of the STS, on the basis of physiological and anatomical studies (Jones and Powell, '70; Seltzer and Pandya, '78; Gross et al., '81; Baylis et al., '87), has been shown to contain multimodal areas. The present data indicate that the multimodal region of the STS has a preferential relationship with the central sector of the PM nucleus.

Animals↗
PubMed2001

A six-degree-of-freedom passive arm with dynamic constraints (PADyC) for cardiac surgery application: preliminary experiments.

The purpose of Computer-Assisted Surgery (CAS) is to help physicians and surgeons plan and execute optimal strategies from multimodal image data. The execution of such planned strategies may be assisted by guidance systems. Some of these systems, called synergistic systems, are based on the cooperation of a robotic device with a human operator. We have developed such a synergistic device: PADyC (Passive Arm with Dynamic Constraints). The basic principle of PADyC is to have a manually actuated arm that dynamically constrains the authorized motions of the surgical tool held by the human operator during a planned task. Dynamic constraints are computed from the task definition, and are implemented by a patented mechanical system. In this paper, we first introduce synergistic systems and then focus on modeling and algorithmic issues related to the dynamic constraints. Finally, we describe a 6-degree-of-freedom prototype robot designed for a clinical application (cardiac surgery) and report on preliminary experiments to date. The experimental results are then discussed, and future work is proposed.

Algorithms↗
PubMed2006

Advanced approach for intraoperative MRI guidance and potential benefit for neurosurgical applications.

PURPOSE: To present an advanced approach for intraoperative image guidance in an open 0.5 T MRI and to evaluate its effectiveness for neurosurgical interventions by comparison with a dynamic scan-guided localization technique. MATERIALS AND METHODS: The built-in scan guidance mode relied on successive interactive MRI scans. The additional advanced mode provided real-time navigation based on reformatted high-quality, intraoperatively acquired MR reference data, allowed multimodal image fusion, and used the successive scans of the built-in mode for quick verification of the position only. Analysis involved tumor resections and biopsies in either scan guidance (N = 36) or advanced mode (N = 59) by the same three neurosurgeons. Technical, surgical, and workflow aspects were compared. RESULTS: The image quality and hand-eye coordination of the advanced approach were improved. While the average extent of resection, neurologic outcome after functional MRI (fMRI) integration, and diagnostic yield appeared to be slightly better under advanced guidance, particularly for the main surgeon, statistical analysis revealed no significant differences. Resection times were comparable, while biopsies took around 30 minutes longer. CONCLUSION: The presented approach is safe and provides more detailed images and higher navigation speed at the expense of actuality. The surgical outcome achieved with advanced guidance is (at least) as good as that obtained with dynamic scan guidance.

Adult↗
PubMed1998

Continuous intracranial multimodality monitoring comparing local cerebral blood flow, cerebral perfusion pressure, and microvascular resistance.

Maintaining cerebral perfusion pressure (CPP) above 70 mmHg is currently a mainstay of neurosurgical critical care. Shalmon, et al. recently showed poor correlation between CPP and regional cerebral blood flow (CBF) [1]. To study the relationship between CPP and CBF, at a microvascular level, we retrospectively analyzed multimodality digital data from 12 neurosurgical critical care patients in whom a combined intracranial pressure (ICP)--laser Doppler flowmetry (LDF) probe (Camino, San Diego) had been placed. Over the entire interval of continuous monitoring for all patients, 97% of local CBF data was at ischemic levels below a CPP of 70 mmHg. For CPP above 70 mmHg, local CBF data had considerable dispersion ranging from ischemic (71%), to normal (19%), and hyperemic (10%) levels. Elevated jugular bulb oxyhemoglobin saturation levels (SjO2) complemented intervals of hyperemia. Autoregulation was impaired or absent in all monitored patients. We conclude that with disrupted autoregulation, CPP above 70 mmHg does not necessarily insure adequate levels of cerebral perfusion. Restoration and maintenance of adequate cerebral perfusion should be performed under the guidance of direct CBF monitoring.

Adolescent↗
PubMed2000

Potential pitfalls in nuclear medicine: a paediatric teaching case.

An infant with complex cardiac defects and isomerism had a persistent pyrexia of undetermined aetiology following cardiac surgery. Radionuclide leucocyte scan showed a focus of increased uptake in the right upper quadrant (RUQ) felt to be compatible with an abscess. However, correlation with clinical data and multimodality imaging allowed the correct diagnosis of ectopic splenic tissue in the RUQ to be made. This report emphasises the need for an integrated approach to imaging. Patients with abnormalities of viscero-atrial situs require careful assessment of their splenic status. Visceral heterotaxy may result in confusing imaging appearances unless the anatomy has been accurately documented.

Abdomen↗
PubMed1990

Analysis of the probability distribution of small random samples by nonlinear fitting of integrated probabilities.

Small random samples of biochemical and biological data are often representative of complex distribution functions and are difficult to analyze in detail by conventional means. The common approaches reduce the data to a few representative parameters (such as their moments) or combine the data into a histogram plot. Both approaches reduce the information content of the data. By fitting the empirical cumulative distribution function itself with models of integrated probability distributions, the information content of the raw data can be fully utilized. This approach, distribution analysis by nonlinear fitting of integrated probabilities, allows analysis of normally distributed samples, truncated data sets, and multimodal distributions with a single, powerful data processing procedure.

Data Interpretation, Statistical↗