95 research outputs found

    The prefrontal cortex of the bottlenose dolphin (Tursiops truncatus Montagu, 1821): a tractography study and comparison with the human

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    Cetaceans are well known for their remarkable cognitive abilities including self-recognition, sound imitation and decision making. In other mammals, the prefrontal cortex (PFC) takes a key role in such cognitive feats. In cetaceans, however, a PFC could up to now not be discerned based on its usual topography. Classical in vivo methods like tract tracing are legally not possible to perform in Cetacea, leaving diffusion-weighted imaging (DWI) as the most viable alternative. This is the first investigation focussed on the identification of the cetacean PFC homologue. In our study, we applied the constrained spherical deconvolution (CSD) algorithm on 3 T DWI scans of three formalin-fixed brains of bottlenose dolphins (Tursiops truncatus) and compared the obtained results to human brains, using the same methodology. We first identified fibres related to the medio-dorsal thalamic nuclei (MD) and then seeded the obtained putative PFC in the dolphin as well as the known PFC in humans. Our results outlined the dolphin PFC in areas not previously studied, in the cranio-lateral, ectolateral and opercular gyri, and furthermore demonstrated a similar connectivity pattern between the human and dolphin PFC. The antero-lateral rotation of the PFC, like in other areas, might be the result of the telescoping process which occurred in these animals during evolution

    Diffusion and Perfusion MRI in Paediatric Posterior Fossa Tumours

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    Brain tumours in children frequently occur in the posterior fossa. Most undergo surgical resection, after which up to 25% develop cerebellar mutism syndrome (CMS), characterised by mutism, emotional lability and cerebellar motor signs; these typically improve over several months. This thesis examines the application of diffusion (dMRI) and arterial spin labelling (ASL) perfusion MRI in children with posterior fossa tumours. dMRI enables non-invasive in vivo investigation of brain microstructure and connectivity by a computational process known as tractography. The results of a unique survey of British neurosurgeons’ attitudes towards tractography are presented, demonstrating its widespread adoption and numerous limitations. State-of-the-art modelling of dMRI data combined with tractography is used to probe the anatomy of cerebellofrontal tracts in healthy children, revealing the first evidence of a topographic organization of projections to the frontal cortex at the superior cerebellar peduncle. Retrospective review of a large institutional series shows that CMS remains the most common complication of posterior fossa tumour resection, and that surgical approach does not influence surgical morbidity in this cohort. A prospective case-control study of children with posterior fossa tumours treated at Great Ormond Street Hospital is reported, in which children underwent longitudinal MR imaging at three timepoints. A region-of-interest based approach did not reveal any differences in dMRI metrics with respect to CMS status. However, the candidate also conducted an analysis of a separate retrospective cohort of medulloblastoma patients at Stanford University using an automated tractography pipeline. This demonstrated, in unprecedented spatiotemporal detail, a fine-grained evolution of changes in cerebellar white matter tracts in children with CMS. ASL studies in the prospective cohort showed that following tumour resection, increases in cortical cerebral blood flow were seen alongside reductions in blood arrival time, and these effects were modulated by clinical features of hydrocephalus and CMS. The results contained in this thesis are discussed in the context of the current understanding of CMS, and the novel anatomical insights presented provide a foundation for future research into the condition

    MR in vivo tractography for the reconstruction of cranial nerves course

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    Aim The aim of my Ph.D. was to implement a diffusion tensor tractography (DTT) pipeline to reconstruct cranial nerve I (olfactory) to study COVID-19 patients, and anterior optic pathway (AOP, including optic nerve, chiasm, and optic tract) to study patients with sellar/parasellar tumors, and with Leber’s Hereditary Optic Neuropathy (LHON). Methods We recruited 23 patients with olfactory dysfunction after COVID-19 infection (mean age 37±14 years, 12 females); 27 patients with sellar/parasellar tumors displacing the optic chiasm eligible for endonasal endoscopic surgery (mean age 53. ±16.4 years, 13 female) and 6 LHON patients (mutation 11778/MT-ND4, mean age 24.9±15.7 years). Sex- and age-matched healthy control were also recruited. In LHON patients, optical coherence tomography (OCT) was performed. Acquisitions were performed on a clinical high field 3-T MRI scanner, using a multi-shell HARDI (High Angular Resolution Diffusion Imaging) sequence (b-values 0-300-1000-2000 s/mm2, 64 maximum gradient directions, 2mm3 isotropic voxel). DTT was performed with a multi-tissue spherical deconvolution approach and mean diffusivity (MD) DTT metrics were compared with healthy controls using an unpaired t-test. Correlations of DTT metrics with clinical data were sought by regression analysis. Results In all 23 hypo/anosmic patients with previous COVID-19 infection the CN I was successfully reconstructed with no DTT metrics alterations, thus suggesting the pathogenetic role of central olfactory cortical system dysfunction. In all 27 patients with sellar/parasellar tumors the AOP was reconstructed, and in 11/13 (84.7%) undergoing endonasal endoscopic surgery the anatomical fidelity of the reconstruction was confirmed; a significant decrease in MD within the chiasma (p<0.0001) was also found. In LHON patients a reduction of MD in the AOP was significantly associated with OCT parameters (p=0.036). Conclusions Multi-shell HARDI diffusion-weighted MRI followed by multi-tissue spherical deconvolution for the DTT reconstruction of the CN I and AOP has been implemented, and its utility demonstrated in clinical practice

    Nerve diffusion tensor imaging

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    Diffusion tensor imaging (DTI) is a magnetic resonance imaging technique that in vivo visualises random translational movement of water molecules. DTI has inherent difficulties with low signal-to-noise ratio, sensitivity to patient motion, field inhomogeneities and fast T2 relaxation. It has been used in the central nervous system, although it has not been assessed in the peripheral nervous system. The aim of this thesis was to investigate if DTI in peripheral nerves was feasible, and if so, to investigate clinical implications. Study I showed that in healthy volunteers the peripheral nerves, the sciatic nerves, could be visualised in vivo using DTI and fiber tracking. Study II showed that sciatic nerves, including their division into the tibial and common fibular nerves, have a characteristic diffusion pattern with most impaired diffusion perpendicular to the nerve direction. This allowed nerves, excluding other tissues and artifacts, to be visualised using a novel approach called diffusion-direction- dependent imaging and with a simple unidirectional diffusion maximum-intensity projection approach. Study III showed that the olfactory bulbs (OBs) and olfactory tracts could be visualised in vivo using DTI and fiber tracking. In Study IV, Parkinson’s disease (PD) patients with impaired olfaction were evaluated with DTI of the OBs. A novel approach of DTI was used, taking advantage of the technique’s inherent directional information, for region of interest placement and diffusion measurements in the OBs. In the PD patient group diffusion was altered in the OBs, compared to healthy controls. This was hypothesised, since α-synuclein inclusions and Lewy neurites interfering with nerve structure have been detected in the OBs. However, the coefficient of variation between two identical DTI series was high, due to the small size of the OBs and their location in an area susceptible to artifacts, and the difference between the groups was statistically significant only for the first of two series. In Study V, patients of the Swedish ‘Huddinge Spinocerebellar ataxia (SCA) Family’ with peripheral neuropathy, were evaluated with DTI of a peripheral nerve. Diffusion alterations were found in peripheral nerves in SCA patients, compared to healthy controls, which was statistically significant. In conclusion, DTI in peripheral nerves is feasible and can be used to detect diffusion alterations in OBs in PD patients and in peripheral nerves in SCA patients with peripheral neuropathy

    SHEEP AS ANIMAL MODEL IN MINIMALLY INVASIVE NEUROSURGERY IN EDEN2020

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    Glioblastomas (GBMs) is a malignant type of central nervous system tumours and its presentation is almost 80% of all malignant primary brain neoplasia. This kind of tumour is highly invasive infiltrating the white matter area and is confined to the central nervous with a very poor patient outcome survival around 10 months. Of the existing treatment approaches, Convection Enhanced drug Delivery (CED) offers several advantages for the patient but still suffers from significant shortcomings. Enhanced Delivery Ecosystem for Neurosurgery in 2020 (EDEN2020) is a European project supported with a new catheter development as the key project point in an integrated technology platform for minimally invasive neurosurgery. Due to the particular anatomy and size, sheep (Ovis aries) have been selected as experimental large animal model and a new Head Frame system MRI/CT compatible has been made and validated ad hoc for the project. In order to understand experimentally the best target point for the catheter introduction a sheep brain DTI atlas has been created. Corticospinal tract (CST), corpus callosum (CC), fornix (FX), visual pathway (VP) and occipitofrontal fascicle (OF), have been identified bilaterally for all the animals. Three of these white matter tracts, the corpus callosum, the fornix and the corona radiata, have been selected to understand the drugs diffusion properties and create a computational model of diffusivity inside the white matter substance. The analysis have been conducted via Focused Ion Beam using scanning Electron Microscopy combined with focused ion beam milling and a 2D analysis and 3D reconstruction made. The results showed homogeneous myelination via detection of ~40% content of lipids in all the different fibre tracts and the fibrous organisation of the tissue described as composite material presenting elliptical tubular fibres with an average cross-sectional area of circa 0.52\u3bcm2 and an estimated mean diameter of 1.15\u3bcm. Finally, as the project is currently ongoing, we provided an overview on the future experimental steps focalised on the brain tissue damage after the rigid catheter introduction

    Computer-Assisted Planning and Robotics in Epilepsy Surgery

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    Epilepsy is a severe and devastating condition that affects ~1% of the population. Around 30% of these patients are drug-refractory. Epilepsy surgery may provide a cure in selected individuals with drug-resistant focal epilepsy if the epileptogenic zone can be identified and safely resected or ablated. Stereoelectroencephalography (SEEG) is a diagnostic procedure that is performed to aid in the delineation of the seizure onset zone when non-invasive investigations are not sufficiently informative or discordant. Utilizing a multi-modal imaging platform, a novel computer-assisted planning (CAP) algorithm was adapted, applied and clinically validated for optimizing safe SEEG trajectory planning. In an initial retrospective validation study, 13 patients with 116 electrodes were enrolled and safety parameters between automated CAP trajectories and expert manual plans were compared. The automated CAP trajectories returned statistically significant improvements in all of the compared clinical metrics including overall risk score (CAP 0.57 +/- 0.39 (mean +/- SD) and manual 1.00 +/- 0.60, p < 0.001). Assessment of the inter-rater variability revealed there was no difference in external expert surgeon ratings. Both manual and CAP electrodes were rated as feasible in 42.8% (42/98) of cases. CAP was able to provide feasible electrodes in 19.4% (19/98), whereas manual planning was able to generate a feasible electrode in 26.5% (26/98) when the alternative generation method was not feasible. Based on the encouraging results from the retrospective analysis a prospective validation study including an additional 125 electrodes in 13 patients was then undertaken to compare CAP to expert manual plans from two neurosurgeons. The manual plans were performed separately and blindly from the CAP. Computer-generated trajectories were found to carry lower risks scores (absolute difference of 0.04 mm (95% CI = -0.42-0.01), p = 0.04) and were subsequently implanted in all cases without complication. The pipeline has been fully integrated into the clinical service and has now replaced manual SEEG planning at our institution. Further efforts were then focused on the distillation of optimal entry and target points for common SEEG trajectories and applying machine learning methods to develop an active learning algorithm to adapt to individual surgeon preferences. Thirty-two patients were prospectively enrolled in the study. The first 12 patients underwent prospective CAP planning and implantation following the pipeline outlined in the previous study. These patients were used as a training set and all of the 108 electrodes after successful implantation were normalized to atlas space to generate ‘spatial priors’, using a K-Nearest Neighbour (K-NN) classifier. A subsequent test set of 20 patients (210 electrodes) were then used to prospectively validate the spatial priors. From the test set, 78% (123/157) of the implanted trajectories passed through both the entry and target spatial priors defined from the training set. To improve the generalizability of the spatial priors to other neurosurgical centres undertaking SEEG and to take into account the potential for changing institutional practices, an active learning algorithm was implemented. The K-NN classifier was shown to dynamically learn and refine the spatial priors. The progressive refinement of CAP SEEG planning outlined in this and previous studies has culminated in an algorithm that not only optimizes the surgical heuristics and risk scores related to SEEG planning but can also learn from previous experience. Overall, safe and feasible trajectory schema were returning in 30% of the time required for manual SEEG planning. Computer-assisted planning was then applied to optimize laser interstitial thermal therapy (LITT) trajectory planning, which is a minimally invasive alternative to open mesial temporal resections, focal lesion ablation and anterior 2/3 corpus callosotomy. We describe and validate the first CAP algorithm for mesial temporal LITT ablations for epilepsy treatment. Twenty-five patients that had previously undergone LITT ablations at a single institution and with a median follow up of 2 years were included. Trajectory parameters for the CAP algorithm were derived from expert consensus to maximize distance from vasculature and ablation of the amygdalohippocampal complex, minimize collateral damage to adjacent brain structures whilst avoiding transgression of the ventricles and sulci. Trajectory parameters were also optimized to reduce the drilling angle to the skull and overall catheter length. Simulated cavities attributable to the CAP trajectories were calculated using a 5-15 mm ablation diameter. In comparison to manually planned and implemented LITT trajectories,CAP resulted in a significant increase in the percentage ablation of the amygdalohippocampal complex (manual 57.82 +/- 15.05% (mean +/- S.D.) and unablated medial hippocampal head depth (manual 4.45 +/- 1.58 mm (mean +/- S.D.), CAP 1.19 +/- 1.37 (mean +/- S.D.), p = 0.0001). As LITT ablation of the mesial temporal structures is a novel procedure there are no established standards for trajectory planning. A data-driven machine learning approach was, therefore, applied to identify hitherto unknown CAP trajectory parameter combinations. All possible combinations of planning parameters were calculated culminating in 720 unique combinations per patient. Linear regression and random forest machine learning algorithms were trained on half of the data set (3800 trajectories) and tested on the remaining unseen trajectories (3800 trajectories). The linear regression and random forest methods returned good predictive accuracies with both returning Pearson correlations of ρ = 0.7 and root mean squared errors of 0.13 and 0.12 respectively. The machine learning algorithm revealed that the optimal entry points were centred over the junction of the inferior occipital, middle temporal and middle occipital gyri. The optimal target points were anterior and medial translations of the centre of the amygdala. A large multicenter external validation study of 95 patients was then undertaken comparing the manually planned and implemented trajectories, CAP trajectories targeting the centre of the amygdala, the CAP parameters derived from expert consensus and the CAP trajectories utilizing the machine learning derived parameters. Three external blinded expert surgeons were then selected to undertake feasibility ratings and preference rankings of the trajectories. CAP generated trajectories result in a significant improvement in many of the planning metrics, notably the risk score (manual 1.3 +/- 0.1 (mean +/- S.D.), CAP 1.1 +/- 0.2 (mean +/- S.D.), p<0.000) and overall ablation of the amygdala (manual 45.3 +/- 22.2 % (mean +/- S.D.), CAP 64.2 +/- 20 % (mean +/- S.D.), p<0.000). Blinded external feasibility ratings revealed that manual trajectories were less preferable than CAP planned trajectories with an estimated probability of being ranked 4th (lowest) of 0.62. Traditional open corpus callosotomy requires a midline craniotomy, interhemispheric dissection and disconnection of the rostrum, genu and body of the corpus callosum. In cases where drop attacks persist a completion corpus callosotomy to disrupt the remaining fibres in the splenium is then performed. The emergence of LITT technology has raised the possibility of being able to undertake this procedure in a minimally invasive fashion and without the need for a craniotomy using two or three individual trajectories. Early case series have shown LITT anterior two-thirds corpus callosotomy to be safe and efficacious. Whole-brain probabilistic tractography connectomes were generated utilizing 3-Tesla multi-shell imaging data and constrained spherical deconvolution (CSD). Two independent blinded expert neurosurgeons with experience of performing the procedure using LITT then planned the trajectories in each patient following their current clinical practice. Automated trajectories returned a significant reduction in the risk score (manual 1.3 +/- 0.1 (mean +/- S.D.), CAP 1.1 +/- 0.1 (mean +/- S.D.), p<0.000). Finally, we investigate the different methods of surgical implantation for SEEG electrodes. As an initial study, a systematic review and meta-analysis of the literature to date were performed. This revealed a wide variety of implantation methods including traditional frame-based, frameless, robotic and custom-3D printed jigs were being used in clinical practice. Of concern, all comparative reports from institutions that had changed from one implantation method to another, such as following the introduction of robotic systems, did not undertake parallel-group comparisons. This suggests that patients may have been exposed to risks associated with learning curves and potential harms related to the new device until the efficacy was known. A pragmatic randomized control trial of a novel non-CE marked robotic trajectory guidance system (iSYS1) was then devised. Before clinical implantations began a series of pre-clinical investigations utilizing 3D printed phantom heads from previously implanted patients was performed to provide pilot data and also assess the surgical learning curve. The surgeons had comparatively little clinical experience with the new robotic device which replicates the introduction of such novel technologies to clinical practice. The study confirmed that the learning curve with the iSYS1 devices was minimal and the accuracies and workflow were similar to the conventional manual method. The randomized control trial represents the first of its kind for stereotactic neurosurgical procedures. Thirty-two patients were enrolled with 16 patients randomized to the iSYS1 intervention arm and 16 patients to the manual implantation arm. The intervention allocation was concealed from the patients. The surgical and research team could be not blinded. Trial management, independent data monitoring and trial steering committees were convened at four points doing the trial (after every 8 patients implanted). Based on the high level of accuracy required for both methods, the main distinguishing factor would be the time to achieve the alignment to the prespecified trajectory. The primary outcome for comparison, therefore, was the time for individual SEEG electrode implantation. Secondary outcomes included the implantation accuracy derived from the post-operative CT scan, infection, intracranial haemorrhage and neurological deficit rates. Overall, 32 patients (328 electrodes) completed the trial (16 in each intervention arm) and the baseline demographics were broadly similar between the two groups. The time for individual electrode implantation was significantly less with the iSYS1 device (median of 3.36 (95% CI 5.72 to 7.07) than for the PAD group (median of 9.06 minutes (95% CI 8.16 to 10.06), p=0.0001). Target point accuracy was significantly greater with the PAD (median of 1.58 mm (95% CI 1.38 to 1.82) compared to the iSYS1 (median of 1.16 mm (95% CI 1.01 to 1.33), p=0.004). The difference between the target point accuracies are not clinically significant for SEEG but may have implications for procedures such as deep brain stimulation that require higher placement accuracy. All of the electrodes achieved their respective intended anatomical targets. In 12 of 16 patients following robotic implantations, and 10 of 16 following manual PAD implantations a seizure onset zone was identified and resection recommended. The aforementioned systematic review and meta-analysis were updated to include additional studies published during the trial duration. In this context, the iSYS1 device entry and target point accuracies were similar to those reported in other published studies of robotic devices including the ROSA, Neuromate and iSYS1. The PAD accuracies, however, outperformed the previously published results for other frameless stereotaxy methods. In conclusion, the presented studies report the integration and validation of a complex clinical decision support software into the clinical neurosurgical workflow for SEEG planning. The stereotactic planning platform was further refined by integrating machine learning techniques and also extended towards optimisation of LITT trajectories for ablation of mesial temporal structures and corpus callosotomy. The platform was then used to seamlessly integrate with a novel trajectory planning software to effectively and safely guide the implantation of the SEEG electrodes. Through a single-blinded randomised control trial, the ISYS1 device was shown to reduce the time taken for individual electrode insertion. Taken together, this work presents and validates the first fully integrated stereotactic trajectory planning platform that can be used for both SEEG and LITT trajectory planning followed by surgical implantation through the use of a novel trajectory guidance system

    Neuroimaging research on olfactory rehabilitation after COVID

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    Els estudis i les evidències dels avantatges que aporten les teràpies de rehabilitació en relació a la neuroplasticitat son cada vegada més abundants. En aquest projecte, amb col·laboració amb el laboratori LAIMBIO (Laboratori d’Anàlisi d’Imatge Mèdica i Biometria) de la Universitat Rey Juan Carlos, s’ha fet un estudi per investigar la rehabilitació olfactiva de pacients amb anòsmia després d’haver passat COVID-19. El TFM s'ha desenvolupat dins del projecte finançat per la URJC “Nova teràpia de rehabilitació olfactòria per al tractament de persones amb seqüeles a l'olfacte per afectació pel COVID-19”. El problema principal és que la malaltia del COVID-19 és molt recent i encara es desconeixen molts dels seus efectes a nivell neuronal. En aquest projecte s’utilitzen tècniques de neuroimatge per veure l’efecte a nivell cerebral. Es comparen imatges del cervell dels pacients abans de fer teràpia de rehabilitació olfactiva, i després de fer-la. En aquest estudi s’ha treballat amb imatges de ressonància magnètica funcional (fMRI) obtingudes a l’Hospital Universitari Quironsalud Madrid. S'han inclòs quatre subjectes a l'estudi i s'han aconseguit identificar les zones cerebrals amb activació abans de fer la teràpia olfactiva i després de fer-la. Per últim, s’han obtingut resultats de les imatges a nivell de preprocessat, anàlisi estadístic (de primer i segon nivell) i anàlisis ROI (region of interest). Aquests resultats han estat interpretats i s’han extret les respectives conclusionsLos estudios y las evidencias de las ventajas que aportan las terapias de rehabilitación en relación con la neuroplasticidad son cada vez más abundantes. En este proyecto, en colaboración con el laboratorio LAIMBIO (Laboratorio de Análisis de Imagen Médica y Biometría) de la Universidad Rey Juan Carlos, se ha realizado un estudio para investigar la rehabilitación olfativa de pacientes con anosmia después de haber pasado COVID-19. El TFM se ha desarrollado dentro del proyecto financiado por la URJC “Nueva terapia de rehabilitación olfatoria para el tratamiento de personas con secuelas en el olfato por afectación por el COVID-19”. El principal problema es que la enfermedad del COVID-19 es muy reciente y todavía se desconocen muchos de sus efectos a nivel neuronal. En este proyecto se utilizan técnicas de neuroimagen para ver el efecto a nivel cerebral. Se comparan imágenes del cerebro de los pacientes antes de realizar terapia de rehabilitación olfativa, y después de realizarla. En este estudio se ha trabajado con imágenes de resonancia magnética funcional (fMRI) obtenidas en el Hospital Universitario Quironsalud Madrid. Se han incluido cuatro sujetos en el estudio y se ha conseguido identificar las zonas cerebrales con activación antes de hacer la terápia olfativa y después de hacerla. Por último, se han obtenido resultados de las imágenes a nivel de preprocesado, análisis estadístico (de primer y segundo nivel) y análisis ROI (region of interest). Estos resultados han sido interpretados y se han extraído las respectivas conclusionesObjectius de Desenvolupament Sostenible::3 - Salut i Benesta

    Translation of Novel Imaging Techniques into Clinical Use for Patients with Epilepsy

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    Temporal lobe epilepsy is the most common focal epilepsy. Up to 40% of patients are refractory to medication. Anterior temporal lobe resection (ATLR) is an effective treatment but damage to the optic radiation can result in a visual field deficit (VFD) that precludes driving, a key goal of surgery. Diffusion tensor imaging tractography allows the in vivo delineation of white matter tracts such as the optic radiation. This thesis addresses the role of optic radiation tractography in planning and subsequently improving the safety of epilepsy surgery. I show how tractography assists risk stratification and surgical planning in patients with lesions near the optic radiation and assess the utility of different tractography methods for surgical planning. To derive the greatest benefit, tractography information should be available during surgery which requires correction for intraoperative brain shift and other sources of image distortion. I apply software developed at UCL in a clinical population underlying ATLR to show that postoperative imaging can predict the VFD and then use this software in real time during surgery in an intraoperative MRI suite. Updated anatomical scans can be acquired during surgery and tractography data accurately mapped on to these and displayed on the operating microscope display. I demonstrate that this image guidance allows the neurosurgeon to avoid significant VFD without affecting the seizure outcome. Diffusion imaging can also probe tissue microstructure. I explore how structural changes within the frontoparietal working memory network and temporal lobes are related to working memory impairment in TLE. I describe the structural changes that occur following ATLR showing both Wallerian degeneration and structural plasticity. Finally, I show how a novel diffusion model (NODDI) could aid the clinical assessment of patients with focal cortical dysplasia. The emphasis throughout this thesis is how diffusion imaging can be clinically useful and address clinically relevant outcomes

    Diseases of the Brain, Head and Neck, Spine 2020–2023

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    This open access book offers an essential overview of brain, head and neck, and spine imaging. Over the last few years, there have been considerable advances in this area, driven by both clinical and technological developments. Written by leading international experts and teachers, the chapters are disease-oriented and cover all relevant imaging modalities, with a focus on magnetic resonance imaging and computed tomography. The book also includes a synopsis of pediatric imaging. IDKD books are rewritten (not merely updated) every four years, which means they offer a comprehensive review of the state-of-the-art in imaging. The book is clearly structured and features learning objectives, abstracts, subheadings, tables and take-home points, supported by design elements to help readers navigate the text. It will particularly appeal to general radiologists, radiology residents, and interventional radiologists who want to update their diagnostic expertise, as well as clinicians from other specialties who are interested in imaging for their patient care

    Growing up with one ear : central auditory structure and function in unilateral ear canal atresia

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    The following thesis aims to give more insight into the functional and structural response of the central auditory system to congenital unilateral ear canal atresia (UCA) and the accompanying asymmetric hearing with conductive hearing loss on the atretic side. There is clear evidence that unilateral hearing loss, including UCA, has a negative impact on sound localization ability and perception of speech in noise. There is a spread in performance within the group, and the reason for this is not well known. In paper I of this thesis we examined sound localization with eye tracking and perception of speech in a cocktail party setting, in participants with congenital unilateral ear canal atresia, who had no hearing aids before age 12 (n=12) and compared to normal hearing references. Results show that the level of hearing loss on the atretic ear was associated with sound localization ability but not to speech perception. In the second study, participants with UCA (n=17) underwent MRI-scanning of the brain with diffusion weighted imaging (DWI). A method is described how to segment the white matter bundle between the medial geniculate body of the thalamus and the primary auditory cortex, the acoustic radiation (AR). Methods to define the AR are previously described in high resolution diffusion weighted imaging (DWI) scans but is very time consuming or has problems with including more structures around the primary auditory cortex (PAC). An algorithm was trained to quickly segment the core of the AR in individual clinical scans. The white matter tract was also assessed with measurements of fractional anisotropy (FA), but no differences were found between UCA and normal hearing (NH) controls. The third study describes the measurements of the grey matter of the primary auditory cortex of the Heschl’s gyrus in the same participants as in paper II. Thickness and volume of the Heschl’s gyrus were compared within the groups of UCA and controls, and between the groups. A difference in thickness was found between the left and right side (right thicker than left, corrected p=0.0012) in UCA, whereas controls had symmetric thickness. Volumes and total thickness were not different compared to controls. Rat brains from 12 months old rats with a surgically constructed left-sided ear canal atresia were examined in study IV. DWI was acquired in a research camera for rodents, 9.4 T magnetic field and a prolonged scanning time. Tractography and FA measurements were obtained both from whole brains and from tracts between auditory regions of interest (ROIs) using two different software. FA was generally higher in UCA rats than in controls. The AR was asymmetric in FA (left<right) in UCA, whereas FA was symmetric in controls. The FA was found to be lower at the left connection (same side as hearing loss) cochlear nucleus -inferior colliculus compared to the right side in UCA, while it was symmetric in controls. This finding (CN-IC) aligns with previous histology findings in ferrets with unilateral conductive hearing loss
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