Neuroimaging of structural pathology and connectomics in traumatic brain injury: Toward personalized outcome prediction.

Recent contributions to the body of knowledge on traumatic brain injury (TBI) favor the view that multimodal neuroimaging using structural and functional magnetic resonance imaging (MRI and fMRI, respectively) as well as diffusion tensor imaging (DTI) has excellent potential to identify novel biomarkers and predictors of TBI outcome. This is particularly the case when such methods are appropriately combined with volumetric/morphometric analysis of brain structures and with the exploration of TBI-related changes in brain network properties at the level of the connectome. In this context, our present review summarizes recent developments on the roles of these two techniques in the search for novel structural neuroimaging biomarkers that have TBI outcome prognostication value. The themes being explored cover notable trends in this area of research, including (1) the role of advanced MRI processing methods in the analysis of structural pathology, (2) the use of brain connectomics and network analysis to identify outcome biomarkers, and (3) the application of multivariate statistics to predict outcome using neuroimaging metrics. The goal of the review is to draw the community's attention to these recent advances on TBI outcome prediction methods and to encourage the development of new methodologies whereby structural neuroimaging can be used to identify biomarkers of TBI outcome

Comparison of Distances for Supervised Segmentation of White Matter Tractography

Tractograms are mathematical representations of the main paths of axons within the white matter of the brain, from diffusion MRI data. Such representations are in the form of polylines, called streamlines, and one streamline approximates the common path of tens of thousands of axons. The analysis of tractograms is a task of interest in multiple fields, like neurosurgery and neurology. A basic building block of many pipelines of analysis is the definition of a distance function between streamlines. Multiple distance functions have been proposed in the literature, and different authors use different distances, usually without a specific reason other than invoking the "common practice". To this end, in this work we want to test such common practices, in order to obtain factual reasons for choosing one distance over another. For these reasons, in this work we compare many streamline distance functions available in the literature. We focus on the common task of automatic bundle segmentation and we adopt the recent approach of supervised segmentation from expert-based examples. Using the HCP dataset, we compare several distances obtaining guidelines on the choice of which distance function one should use for supervised bundle segmentation

Using neurite orientation dispersion and density imaging and tracts constrained by underlying anatomy to differentiate between subjects along the Alzheimer's disease continuum

OBJECTIVE: To assess the involvement of the white matter of the brain in the pathology of Alzheimer’s disease. Using Neurite Orientation Density and Dispersion Imaging (NODDI) and the probabilistic white matter parcellation tool Tracula as a means for understanding whether alterations in the white matter underlie changes in perceived cognitive abilities across the spectrum from health aging to Alzheimer’s disease. METHOD: Data were obtained from 28 participants in the Health Outreach Program for the Elderly (HOPE) at the Boston University Alzheimer’s Disease Center (BU ADC) Clinical Core Registry. MRI scans included an MPRAGE T1 scan, multi-b shell diffusion scan and a High Angular Resolution Diffusion Imaging scan (HARDI). Scans were processed with Freesurfer v6.0 and the NODDI Python2.7 toolkit. The resulting data included the orientation dispersion index (ODI) and Fractional Anisotropy (FA) values for cortical and subcortical regions in the DKT atlas space as well as specific Tracts Constrained by Underlying Anatomy (TRACULA) measurements for 18 specific established white matter tracts. Statistical models using measures of pathway integrity (FA and ODI data) were used to assess relationships with Informant Cognitive Change Index (ICCI), self-described Cognitive Change Index (CCI), and Clinical Dementia Rating (CDR) values. RESULTS: Measures of white matter integrity within several tracts predicted ICCI and CDR well in statistical models. FA and ODI values of the bilateral superior longitudinal fasciculi, inferior longitudinal fasciculi, and the cingulum bundle tracts were all related to ICCI and CDR. None of the known tracts’ FA or ODI values were related to CCI. CONCLUSIONS: Measures of white matter pathway integrity were predictive of ICCI and CDR scores but not CCI. These finding support the notion that self-report of cognitive abilities may be compromised by alterations in insight and reinforce the need for informed study partners and clinical ratings to evaluate potential MCI and AD

Learning-based Single-step Quantitative Susceptibility Mapping Reconstruction Without Brain Extraction

Quantitative susceptibility mapping (QSM) estimates the underlying tissue magnetic susceptibility from MRI gradient-echo phase signal and typically requires several processing steps. These steps involve phase unwrapping, brain volume extraction, background phase removal and solving an ill-posed inverse problem. The resulting susceptibility map is known to suffer from inaccuracy near the edges of the brain tissues, in part due to imperfect brain extraction, edge erosion of the brain tissue and the lack of phase measurement outside the brain. This inaccuracy has thus hindered the application of QSM for measuring the susceptibility of tissues near the brain edges, e.g., quantifying cortical layers and generating superficial venography. To address these challenges, we propose a learning-based QSM reconstruction method that directly estimates the magnetic susceptibility from total phase images without the need for brain extraction and background phase removal, referred to as autoQSM. The neural network has a modified U-net structure and is trained using QSM maps computed by a two-step QSM method. 209 healthy subjects with ages ranging from 11 to 82 years were employed for patch-wise network training. The network was validated on data dissimilar to the training data, e.g. in vivo mouse brain data and brains with lesions, which suggests that the network has generalized and learned the underlying mathematical relationship between magnetic field perturbation and magnetic susceptibility. AutoQSM was able to recover magnetic susceptibility of anatomical structures near the edges of the brain including the veins covering the cortical surface, spinal cord and nerve tracts near the mouse brain boundaries. The advantages of high-quality maps, no need for brain volume extraction and high reconstruction speed demonstrate its potential for future applications.Comment: 26 page

Improving the clinico-radiological association in neurological diseases

Despite the key role of magnetic resonance imaging (MRI) in the diagnosis and monitoring of multiple sclerosis (MS) and cerebral small vessel disease (SVD), the association between clinical and radiological disease manifestations is often only moderate, limiting the use of MRI-derived markers in the clinical routine or as endpoints in clinical trials. In the projects conducted as part of this thesis, we addressed this clinico-radiological gap using two different approaches. Lesion-symptom association: In two voxel-based lesion-symptom mapping studies, we aimed at strengthening lesion-symptom associations by identifying strategic lesion locations. Lesion mapping was performed in two large cohorts: a dataset of 2348 relapsing-remitting MS patients, and a population-based cohort of 1017 elderly subjects. T2-weighted lesion masks were anatomically aligned and a voxel-based statistical approach to relate lesion location to different clinical rating scales was implemented. In the MS lesion mapping, significant associations between white matter (WM) lesion location and several clinical scores were found in periventricular areas. Such lesion clusters appear to be associated with impairment of different physical and cognitive abilities, probably because they affect commissural and long projection fibers. In the SVD lesion mapping, the same WM fibers and the caudate nucleus were identified to significantly relate to the subjects’ cerebrovascular risk profiles, while no other locations were found to be associated with cognitive impairment. Atrophy-symptom association: With the construction of an anatomical physical phantom, we aimed at addressing reliability and robustness of atrophy-symptom associations through the provision of a “ground truth” for atrophy quantification. The built phantom prototype is composed of agar gels doped with MRI and computed tomography (CT) contrast agents, which realistically mimic T1 relaxation times of WM and grey matter (GM) and showing distinguishable attenuation coefficients using CT. Moreover, due to the design of anatomically simulated molds, both WM and GM are characterized by shapes comparable to the human counterpart. In a proof-of-principle study, the designed phantom was used to validate automatic brain tissue quantification by two popular software tools, where “ground truth” volumes were derived from high-resolution CT scans. In general, results from the same software yielded reliable and robust results across scans, while results across software were highly variable reaching volume differences of up to 8%

Multi-branch Convolutional Neural Network for Multiple Sclerosis Lesion Segmentation

In this paper, we present an automated approach for segmenting multiple sclerosis (MS) lesions from multi-modal brain magnetic resonance images. Our method is based on a deep end-to-end 2D convolutional neural network (CNN) for slice-based segmentation of 3D volumetric data. The proposed CNN includes a multi-branch downsampling path, which enables the network to encode information from multiple modalities separately. Multi-scale feature fusion blocks are proposed to combine feature maps from different modalities at different stages of the network. Then, multi-scale feature upsampling blocks are introduced to upsize combined feature maps to leverage information from lesion shape and location. We trained and tested the proposed model using orthogonal plane orientations of each 3D modality to exploit the contextual information in all directions. The proposed pipeline is evaluated on two different datasets: a private dataset including 37 MS patients and a publicly available dataset known as the ISBI 2015 longitudinal MS lesion segmentation challenge dataset, consisting of 14 MS patients. Considering the ISBI challenge, at the time of submission, our method was amongst the top performing solutions. On the private dataset, using the same array of performance metrics as in the ISBI challenge, the proposed approach shows high improvements in MS lesion segmentation compared with other publicly available tools.Comment: This paper has been accepted for publication in NeuroImag