2,153 research outputs found

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

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    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

    Computational analysis reveals increased blood deposition following repeated mild traumatic brain injury.

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    Mild traumatic brain injury (mTBI) has become an increasing public health concern as subsequent injuries can exacerbate existing neuropathology and result in neurological deficits. This study investigated the temporal development of cortical lesions using magnetic resonance imaging (MRI) to assess two mTBIs delivered to opposite cortical hemispheres. The controlled cortical impact model was used to produce an initial mTBI on the right cortex followed by a second injury induced on the left cortex at 3 (rmTBI 3d) or 7 (rmTBI 7d) days later. Histogram analysis was combined with a novel semi-automated computational approach to perform a voxel-wise examination of extravascular blood and edema volumes within the lesion. Examination of lesion volume 1d post last injury revealed increased tissue abnormalities within rmTBI 7d animals compared to other groups, particularly at the site of the second impact. Histogram analysis of lesion T2 values suggested increased edematous tissue within the rmTBI 3d group and elevated blood deposition in the rm TBI 7d animals. Further quantification of lesion composition for blood and edema containing voxels supported our histogram findings, with increased edema at the site of second impact in rmTBI 3d animals and elevated blood deposition in the rmTBI 7d group at the site of the first injury. Histological measurements revealed spatial overlap of regions containing blood deposition and microglial activation within the cortices of all animals. In conclusion, our findings suggest that there is a window of tissue vulnerability where a second distant mTBI, induced 7d after an initial injury, exacerbates tissue abnormalities consistent with hemorrhagic progression

    Automatic Reporting of TBI Lesion Location in CT based on Deep Learning and Atlas Mapping

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    Tese de mestrado integrado, Engenharia Biomédica e Biofísica (Biofísica Médica e Fisiologia de Sistemas), 2021, Universidade de Lisboa, Faculdade de CiênciasThe assessment of Computed Tomography (CT) scans for Traumatic Brain Injury (TBI) management remains a time consuming and challenging task for physicians. Computational methods for quantitative lesion segmentation and localisation may increase consistency in diagnosis and prognosis criteria. Our goal was to develop a registration-based tool to accurately localise several lesion classes (i.e., calculate the volume of lesion per brain region), as an extension of the Brain Lesion Analysis and Segmentation Tool for CT (BLAST-CT). Lesions were located by projecting a Magnetic Resonance Imaging (MRI) labelled atlas from the Montreal Neurological Institute (MNI MRI atlas) to a lesion map in native space. We created a CT template to work as an intermediate step between the two imaging spaces, using 182 non-lesioned CT scans and an unbiased iterative registration approach. We then non-linearly registered the parcellated atlas to the CT template, subsequently registering (affine) the result to native space. From the final atlas alignment, it was possible to calculate the volume of each lesion class per brain region. This pipeline was validated on a multi-centre dataset (n=839 scans), and defined three methods to flag any scans that presented sub-optimal results. The first one was based on the similarity metric of the registration of every scan to the study-specific CT template, the second aimed to identify any scans with regions that were completely collapsed post registration, and the final one identified scans with a significant volume of intra-ventricular haemorrhage outside of the ventricles. Additionally, an assessment of lesion prevalence and of the false negative and false positive rates of the algorithm, per anatomical region, was conducted, along with a bias assessment of the BLAST-CT tool. Our results show that the constructed pipeline is able to successfully localise TBI lesions across the whole brain, although without voxel-wise accuracy. We found the error rates calculated for each brain region to be inversely correlated with the lesion volume within that region. No considerable bias was identified on BLAST-CT, as all the significant correlation coefficients calculated between the Dice scores and clinical variables (i.e., age, Glasgow Coma Scale, Extended Glasgow Outcome Scale and Injury Severity Score) were below 0.2. Our results also suggest that the variation in DSC between male and female patients within a specific age range was caused by the discrepancy in lesion volume presented by the scans included in each sample

    Development of a lesion localisation tool to improve outcome prediction in Traumatic Brain Injury patients

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    Tese de mestrado integrado, Engenharia Biomédica e Biofísica (Engenharia Clínica e Instrumentação Médica) Universidade de Lisboa, Faculdade de Ciências, 2022Traumatic brain injury (TBI) is a highly heterogeneous pathology that poses severe health and socioeconomic problems on a global scale. Neuroimaging research and development has advanced its clinical care in numerous ways, as injured brains are being imaged and studied in greater detail. The size and location of TBI lesions are often necessary to accurately determine a prognosis, which is key in defining a patient-specific rehabilitation program. This dissertation aims to investigate the impact of lesion characteristics, such as volume and location, on outcome prediction in TBI patients. Lesion localisation was achieved by comparing annotated TBI lesions to a brain atlas. Furthermore, other lesion characteristics were examined across different Magnetic Resonance Imaging (MRI) sequences and scanners, with results suggesting that the use of different scanners or MRI contrasts introduced biases in said lesion characteristics. Patient outcome was predicted using four generalised linear models. Besides clinical variables, these models included lesion volume, group and location as predictors. Model comparison indicated that lesion volume could be beneficial for outcome prediction, but may be dependent on both lesion group and location. Overall, this methodology showed potential in uncovering the effect that certain lesion groups and/or locations have on patient outcome after TBI

    Tracking the neurodegenerative gradient after spinal cord injury

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    Objective To quantify neurodegenerative changes along the cervical spinal cord rostral to a spinal cord injury (SCI) by means of quantitative MRI (qMRI) and to determine its relationship with clinical impairment. Methods Thirty chronic SCI patients (15 tetraplegics and 15 paraplegics) and 23 healthy controls underwent a high-resolution T1-weighted and myelin-sensitive magnetization transfer (MT) MRI. We assessed macro- and microstructural changes along the cervical cord from levels C1 to C4, calculating cross-sectional spinal cord area, its anterior-posterior and left-right width and myelin content (i.e. MT). Regression analysis determined associations between qMRI parameters and clinical impairment. Results In SCI patients, cord area decreased by 2.67 mm2 (p=0.004) and left-right width decreased by 0.35 mm (p=0.002) per level in caudal direction when compared to the healthy controls. This gradient of neurodegeneration was greater in tetraplegic than paraplegics in the cord area (by 3.28 mm2, p=0.011), left-right width (by 0.36 mm, p=0.03), and MT (by 0.13%, p=0.04), but independant of lesion severity (p>0.05). Higher lesion level was associated with greater magnitudes of neurodegeneration. Greater loss in myelin content in the dorsal columns and spinothalamic tract was associated with worse light touch (p=0.016) and pin prick score (p=0.024), respectively. Conclusions A gradient of neurodegeneration is evident in the high cervical cord remote from a SCI. Tract-specific associations with appropriate clinical outcomes highlight that remote neurodegenerative changes are clinically eloquent. Monitoring the neurodegenerative gradient could be used to track treatment effects of regenerative and neuroprotective agents, both in trials targeting cervical and thoracic SCI patients

    Multi-parametric MRI Study of Brain Insults (Traumatic Brain Injury and Brain Tumor) in Animal Models

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    abstract: The objective of this small animal pre-clinical research project was to study quantitatively the long-term micro- and macro- structural brain changes employing multiparametric MRI (Magnetic Resonance Imaging) techniques. Two separate projects make up the basis of this thesis. The first part focuses on obtaining prognostic information at early stages in the case of Traumatic Brain Injury (TBI) in rat animal model using imaging data acquired at 24-hours and 7-days post injury. The obtained parametric T2 and diffusion values from DTI (Diffusion Tensor Imaging) showed significant deviations in the signal intensities from the control and were potentially useful as an early indicator of the severity of post-traumatic injury damage. DTI was especially critical in distinguishing between the cytotoxic and vasogenic edema and in identification of injury regions resolving to normal control values by day-7. These results indicate the potential of quantitative MRI as a clinical marker in predicting prognosis following TBI. The second part of this thesis focuses on studying the effect of novel therapeutic strategies employing dendritic cell (DC) based vaccinations in mice glioma model. The treatment cohorts included comparing a single dose of Azacytidine drug vs. mice getting three doses of drug per week. Another cohort was used as an untreated control group. The MRI results did not show any significant changes in between the two treated cohorts with no reduction in tumor volumes compared to the control group. The future studies would be focused on issues regarding the optimal dose for the application of DC vaccine. Together, the quantitative MRI plays an important role in the prognosis and diagnosis of the above mentioned pathologies, providing essential information about the anatomical location, micro-structural tissue environment, lesion volume and treatment response.Dissertation/ThesisMasters Thesis Bioengineering 201

    Technical and clinical validation of commercial automated volumetric MRI tools for dementia diagnosis-a systematic review

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    Developments in neuroradiological MRI analysis offer promise in enhancing objectivity and consistency in dementia diagnosis through the use of quantitative volumetric reporting tools (QReports). Translation into clinical settings should follow a structured framework of development, including technical and clinical validation steps. However, published technical and clinical validation of the available commercial/proprietary tools is not always easy to find and pathways for successful integration into the clinical workflow are varied. The quantitative neuroradiology initiative (QNI) framework highlights six necessary steps for the development, validation and integration of quantitative tools in the clinic. In this paper, we reviewed the published evidence regarding regulatory-approved QReports for use in the memory clinic and to what extent this evidence fulfils the steps of the QNI framework. We summarize unbiased technical details of available products in order to increase the transparency of evidence and present the range of reporting tools on the market. Our intention is to assist neuroradiologists in making informed decisions regarding the adoption of these methods in the clinic. For the 17 products identified, 11 companies have published some form of technical validation on their methods, but only 4 have published clinical validation of their QReports in a dementia population. Upon systematically reviewing the published evidence for regulatory-approved QReports in dementia, we concluded that there is a significant evidence gap in the literature regarding clinical validation, workflow integration and in-use evaluation of these tools in dementia MRI diagnosis
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