Computerized Analysis of Magnetic Resonance Images to Study Cerebral Anatomy in Developing Neonates

The study of cerebral anatomy in developing neonates is of great importance for the understanding of brain development during the early period of life. This dissertation therefore focuses on three challenges in the modelling of cerebral anatomy in neonates during brain development. The methods that have been developed all use Magnetic Resonance Images (MRI) as source data. To facilitate study of vascular development in the neonatal period, a set of image analysis algorithms are developed to automatically extract and model cerebral vessel trees. The whole process consists of cerebral vessel tracking from automatically placed seed points, vessel tree generation, and vasculature registration and matching. These algorithms have been tested on clinical Time-of- Flight (TOF) MR angiographic datasets. To facilitate study of the neonatal cortex a complete cerebral cortex segmentation and reconstruction pipeline has been developed. Segmentation of the neonatal cortex is not effectively done by existing algorithms designed for the adult brain because the contrast between grey and white matter is reversed. This causes pixels containing tissue mixtures to be incorrectly labelled by conventional methods. The neonatal cortical segmentation method that has been developed is based on a novel expectation-maximization (EM) method with explicit correction for mislabelled partial volume voxels. Based on the resulting cortical segmentation, an implicit surface evolution technique is adopted for the reconstruction of the cortex in neonates. The performance of the method is investigated by performing a detailed landmark study. To facilitate study of cortical development, a cortical surface registration algorithm for aligning the cortical surface is developed. The method first inflates extracted cortical surfaces and then performs a non-rigid surface registration using free-form deformations (FFDs) to remove residual alignment. Validation experiments using data labelled by an expert observer demonstrate that the method can capture local changes and follow the growth of specific sulcus

Comprehensive Brain MRI Segmentation in High Risk Preterm Newborns

Most extremely preterm newborns exhibit cerebral atrophy/growth disturbances and white matter signal abnormalities on MRI at term-equivalent age. MRI brain volumes could serve as biomarkers for evaluating the effects of neonatal intensive care and predicting neurodevelopmental outcomes. This requires detailed, accurate, and reliable brain MRI segmentation methods. We describe our efforts to develop such methods in high risk newborns using a combination of manual and automated segmentation tools. After intensive efforts to accurately define structural boundaries, two trained raters independently performed manual segmentation of nine subcortical structures using axial T2-weighted MRI scans from 20 randomly selected extremely preterm infants. All scans were re-segmented by both raters to assess reliability. High intra-rater reliability was achieved, as assessed by repeatability and intra-class correlation coefficients (ICC range: 0.97 to 0.99) for all manually segmented regions. Inter-rater reliability was slightly lower (ICC range: 0.93 to 0.99). A semi-automated segmentation approach was developed that combined the parametric strengths of the Hidden Markov Random Field Expectation Maximization algorithm with non-parametric Parzen window classifier resulting in accurate white matter, gray matter, and CSF segmentation. Final manual correction of misclassification errors improved accuracy (similarity index range: 0.87 to 0.89) and facilitated objective quantification of white matter signal abnormalities. The semi-automated and manual methods were seamlessly integrated to generate full brain segmentation within two hours. This comprehensive approach can facilitate the evaluation of large cohorts to rigorously evaluate the utility of regional brain volumes as biomarkers of neonatal care and surrogate endpoints for neurodevelopmental outcomes

Diffusion Kurtosis Imaging of neonatal Spinal Cord in clinical routine

Diffusion kurtosis imaging (DKI) has undisputed advantages over the more classical diffusion magnetic resonance imaging (dMRI) as witnessed by the fast-increasing number of clinical applications and software packages widely adopted in brain imaging. However, in the neonatal setting, DKI is still largely underutilized, in particular in spinal cord (SC) imaging, because of its inherently demanding technological requirements. Due to its extreme sensitivity to non-Gaussian diffusion, DKI proves particularly suitable for detecting complex, subtle, fast microstructural changes occurring in this area at this early and critical stage of development, which are not identifiable with only DTI. Given the multiplicity of congenital anomalies of the spinal canal, their crucial effect on later developmental outcome, and the close interconnection between the SC region and the brain above, managing to apply such a method to the neonatal cohort becomes of utmost importance. This study will (i) mention current methodological challenges associated with the application of advanced dMRI methods, like DKI, in early infancy, (ii) illustrate the first semi-automated pipeline built on Spinal Cord Toolbox for handling the DKI data of neonatal SC, from acquisition setting to estimation of diffusion measures, through accurate adjustment of processing algorithms customized for adult SC, and (iii) present results of its application in a pilot clinical case study. With the proposed pipeline, we preliminarily show that DKI is more sensitive than DTI-related measures to alterations caused by brain white matter injuries in the underlying cervical SC

Neonatal brain tissue classification with morphological adaptation and unified segmentation

Measuring the distribution of brain tissue types (tissue classification) in neonates is necessary for studying typical and atypical brain development, such as that associated with preterm birth, and may provide biomarkers for neurodevelopmental outcomes. Compared with magnetic resonance images of adults, neonatal images present specific challenges that require the development of specialized, population-specific methods. This paper introduces MANTiS (Morphologically Adaptive Neonatal Tissue Segmentation), which extends the unified segmentation approach to tissue classification implemented in Statistical Parametric Mapping (SPM) software to neonates. MANTiS utilizes a combination of unified segmentation, template adaptation via morphological segmentation tools and topological filtering, to segment the neonatal brain into eight tissue classes: cortical gray matter, white matter, deep nuclear gray matter, cerebellum, brainstem, cerebrospinal fluid (CSF), hippocampus and amygdala. We evaluated the performance of MANTiS using two independent datasets. The first dataset, provided by the NeoBrainS12 challenge, consisted of coronal T2-weighted images of preterm infants (born ≤30 weeks’ gestation) acquired at 30 weeks’ corrected gestational age (n= 5), coronal T2-weighted images of preterm infants acquired at 40 weeks’ corrected gestational age (n= 5) and axial T2-weighted images of preterm infants acquired at 40 weeks’ corrected gestational age (n= 5). The second dataset, provided by the Washington University NeuroDevelopmental Research (WUNDeR) group, consisted of T2-weighted images of preterm infants (born <30 weeks’ gestation) acquired shortly after birth (n= 12), preterm infants acquired at term-equivalent age (n= 12), and healthy term-born infants (born ≥38 weeks’ gestation) acquired within the first nine days of life (n= 12). For the NeoBrainS12 dataset, mean Dice scores comparing MANTiS with manual segmentations were all above 0.7, except for the cortical gray matter for coronal images acquired at 30 weeks. This demonstrates that MANTiS’ performance is competitive with existing techniques. For the WUNDeR dataset, mean Dice scores comparing MANTiS with manually edited segmentations demonstrated good agreement, where all scores were above 0.75, except for the hippocampus and amygdala. The results show that MANTiS is able to segment neonatal brain tissues well, even in images that have brain abnormalities common in preterm infants. MANTiS is available for download as an SPM toolbox from http://developmentalimagingmcri.github.io/mantis

Probing resting-state functional connectivity in the infant brain: methods and potentiality

Early brain development is characterized by rapid growth and perpetual reconfiguration, driven by a dynamic milieu of heterogeneous processes. Moreover, potent postnatal brain plasticity engenders increased vulnerability to environmental stimuli. However, little is known regarding the ontogeny and temporal manifestations of inter- and intra-regional functional connectivity that comprise functional brain networks. Recently, resting-state functional magnetic resonance imaging (fMRI) emerged as a promising non-invasive neuroinvestigative tool, measuring spontaneous fluctuations in blood oxygen level dependent (BOLD) signal at rest that reflect baseline neuronal activity. Its application has expanded to infant populations in the past decade, providing unprecedented insight into functional organization of the developing brain, as well as early biomarkers of abnormal/ disease states. However, rapid extension of the resting-state technique to infant populations leaves many methodological issues need to be resolved prior to standardization of the technique. The purpose of this thesis is to describe a protocol for intrinsic functional connectivity analysis, and extraction of resting-state networks in infants <12 months of age using the data-driven approach independent component analysis (ICA). To begin, we review the evolution of resting-state fMRI application in infant populations, including the biological premise for neural networks. Next, we present a protocol designed such that investigators without previous knowledge in the field can implement the analysis and reliably obtain viable results consistent with previous literature. Presented protocol provides detailed, albeit basic framework for RSN analysis, with interwoven discussion of basic theory behind each technique, as well as the rationale behind selecting parameters. The overarching goal is to catalyze efforts towards development of robust, infant-specific acquisition and preprocessing pipelines, as well as promote greater transparency by researchers regarding methods used. Finally, we review the literature, current methodological challenges and potential future directions for the field of infant resting-state fMRI

Sequelae of premature birth in young adults

Background and Purpose Qualitative studies about the abnormalities appreciated on routine magnetic resonance imaging (MRI) sequences in prematurely born adults are lacking. This article aimed at filling this knowledge gap by (1) qualitatively describing routine imaging findings in prematurely born adults, (2) evaluating measures for routine image interpretation and (3) investigating the impact of perinatal variables related to premature birth. Methods In this study two board-certified radiologists assessed T1-weighted and FLAIR-weighted images of 100 prematurely born adults born very preterm (VP <32 weeks) and/or at very low birth weight (VLBW <1500 g) and 106 controls born at full term (FT) (mean age 26.8 ± 0.7 years). The number of white matter lesions (WML) was counted according to localization. Lateral ventricle volume (LVV) was evaluated subjectively and by measurements of Evans’ index (EI) and frontal-occipital-horn ratio (FOHR). Freesurfer-based volumetry served as reference standard. Miscellaneous incidental findings were noted as free text. Results The LVV was increased in 24.7% of VP/VLBW individuals and significantly larger than in FT controls. This was best identified by measurement of FOHR (AUC = 0.928). Ventricular enlargement was predicted by low gestational age (odds ratio: 0.71, 95% CI 0.51–0.98) and presence of neonatal intracranial hemorrhage (odds ratio: 0.26, 95% CI 0.07–0.92). The numbers of deep and periventricular WML were increased while subcortical WMLs were not. Conclusion Enlargement of the LVV and deep and periventricular WMLs are typical sequelae of premature birth that can be appreciated on routine brain MRI. To increase sensitivity of abnormal LVV detection, measurement of FOHR seems feasible in clinical practice

Individualised Clinical Neuroimaging in the Developing Brain: Abnormality Detection

Perinatal neuroanatomical structure is incredibly intricate and, at time of birth, is undergoing continuous change due to interweaving developmental processes (growth, myelination and gyrification). While there is some small variability in structure and rates of development, all follow proscribed pathways with well documented milestones. Brain injury or other disruption of these processes can result in poor neurodevelopmental outcomes or mortality, making their early identification critical to estimate, and potentially forestall, negative effects. MRI is an increasingly used method of investigating suspected neonatal encephalopathies and injuries.Identification of these injuries and malformations is more challenging in neonates compared to adults due to the brain’s continuously evolving appearance. This makes radiological review of neonatal MRI an intensive and time-consuming task which, in an ideal setting, requires a team of highly skilled clinicians and radiologists with complementary training and extensive experience. To assist this review process, some localisation method that highlights areas likely to contain tissue abnormalities would be highly desirable, as it could quickly draw attention to these locations. In addition, identifying neonates whose MRI is likely to contain some form of pathology could allow for review prioritisation.In this thesis, I first investigated using normative models of neonatal tissue intensity for brain tissue abnormality detection. I applied voxel-wise Gaussian process (GP) regression to a training cohort of neonates with no obvious lesions, all born preterm (&lt;37 weeks) but imaged between 28-55 weeks. Gestational age at birth (GA), postmenstrual age at scan (PMA) and sex were used as input variables and voxel intensity as the output variable. GPs output a mean value and its variance inferred from neonates within the training cohort whose demographic information most closely matched those of the prediction target. The voxel specific models were put together to form a synthesised typical image and standard deviation image derived from the variance outputs. Z-score abnormality maps were constructed by taking the difference between neonates actual MRI and GP-calculated synthetic image and scaling by their standard deviation map. Higher Z-score map values indicate voxels more likely to contain abnormal tissue intensity. Using manually delineated masks of common brain injuries seen in a subset of neonates, these abnormality Z-score maps demonstrated good detection performance using area under the curve of receiver operating characteristic scores, with the exception of small punctate lesions.The initial voxel-wise models had substantial false positives around the edges of the brain where there is large typical heterogeneity. I next investigated if incorporating local structural information into predictive models could improve their ability to accommodate typical anatomical heterogeneity seen across individual brains and improve the accuracy of synthetic images and abnormality detection. To achieve this, voxel intensity values in a patch surrounding the prediction target were appended to the design matrix, alongside GMA, PMA and sex. The patch-based synthetic images were able to match an individual’s brain structure more closely and had lower false positives in normal appearing tissue. However, a weakness was that the centre of some larger lesions was included in the predictions (thereby classified as ‘healthy’ tissue), having a deleterious effect on their coverage, increasing false negatives. This was offset by much better coverage of smaller, more subtle lesions, to the extent that overall performance was higher compared to that seen in the earlier model.I also investigated if the Z-score abnormality maps could be used to classify neonates with MRI positive brain injury from those with normal appearing brains. While many machine learning algorism see frequent use in neuroimaging classification tasks, I opted for a logistic regression model due to its high levels of interpretability and simple implementation. Using the histograms of the Z-score abnormality maps as inputs, the model demonstrated good performance, being able to correctly identify neonates with injuries, but not those with subtle lesions like punctate lesions, whilst minimising false identification of neonates with normal appearing brains.To ascertain if performance could be improved, I explored multiple classification methods. Specifically, the use of other more complex classifiers (random forest, support vector machines, GP classification) and the use of a regional abnormal voxel count, that allowed localisation of lesioned tissue rather than the more global detection ability of the Z-score histograms. Using these innovations, I investigated their application towards a specific pathology; hypoxic ischemic encephalopathy (HIE). This is a good test for the system, as HIE has high incidence rates, multiple associated lesion types and a time dependant appearance. Further, I wanted to know if, given a positive HIE diagnosis, the Z-score abnormality maps could be used to predict long-term outcomes (normal vs poor). Several models demonstrated an excellent ability to separate HIE and healthy control neonates achieving &gt;90% accuracy, a statistically significant result even after false discovery rate (FDR) correction (p-value &lt; 0.05). While the outcome prediction models achieved reasonable accuracy, &gt;70% in multiple models, none of these were statistically significant after FDR correction.Overall, this work demonstrates how normative modelling can be used to create individual voxel-wise / image-wise estimation of tissue abnormality for neonatal MRI across a range of gestational ages. It further demonstrates that these abnormality maps can be utilised for additional tasks, in this instance, three increasingly challenging neurological classification problems. These include the separation of neonates with and without MRI positive lesions, identification of neonates with a specific pathological condition (HIE) and prediction of long-term functional outcome (normal vs poor). Within a radiological setting, these classifications task can be considered analogous to three radiological challenges, image triage, diagnostic detection and estimation of developmental prognosis, important for the clinical team but also infants and their families