Shallow vs deep learning architectures for white matter lesion segmentation in the early stages of multiple sclerosis

In this work, we present a comparison of a shallow and a deep learning architecture for the automated segmentation of white matter lesions in MR images of multiple sclerosis patients. In particular, we train and test both methods on early stage disease patients, to verify their performance in challenging conditions, more similar to a clinical setting than what is typically provided in multiple sclerosis segmentation challenges. Furthermore, we evaluate a prototype naive combination of the two methods, which refines the final segmentation. All methods were trained on 32 patients, and the evaluation was performed on a pure test set of 73 cases. Results show low lesion-wise false positives (30%) for the deep learning architecture, whereas the shallow architecture yields the best Dice coefficient (63%) and volume difference (19%). Combining both shallow and deep architectures further improves the lesion-wise metrics (69% and 26% lesion-wise true and false positive rate, respectively).Comment: Accepted to the MICCAI 2018 Brain Lesion (BrainLes) worksho

Cerebellum and neurodegenerative diseases: Beyond conventional magnetic resonance imaging

The cerebellum plays a key role in movement control and in cognition and cerebellar involvement is described in several neurodegenerative diseases. While conventional magnetic resonance imaging (MRI) is widely used for brain and cerebellar morphologic evaluation, advanced MRI techniques allow the investigation of cerebellar microstructural and functional characteristics. Volumetry, voxel-based morphometry, diffusion MRI based fiber tractography, resting state and task related functional MRI, perfusion, and proton MR spectroscopy are among the most common techniques applied to the study of cerebellum. In the present review, after providing a brief description of each technique's advantages and limitations, we focus on their application to the study of cerebellar injury in major neurodegenerative diseases, such as multiple sclerosis, Parkinson's and Alzheimer's disease and hereditary ataxia. A brief introduction to the pathological substrate of cerebellar involvement is provided for each disease, followed by the review of MRI studies exploring structural and functional cerebellar abnormalities and by a discussion of the clinical relevance of MRI measures of cerebellar damage in terms of both clinical status and cognitive performance

Dynamic imaging of coherent sources reveals different network connectivity underlying the generation and perpetuation of epileptic seizures

The concept of focal epilepsies includes a seizure origin in brain regions with hyper synchronous activity (epileptogenic zone and seizure onset zone) and a complex epileptic network of different brain areas involved in the generation, propagation, and modulation of seizures. The purpose of this work was to study functional and effective connectivity between regions involved in networks of epileptic seizures. The beginning and middle part of focal seizures from ictal surface EEG data were analyzed using dynamic imaging of coherent sources (DICS), an inverse solution in the frequency domain which describes neuronal networks and coherences of oscillatory brain activities. The information flow (effective connectivity) between coherent sources was investigated using the renormalized partial directed coherence (RPDC) method. In 8/11 patients, the first and second source of epileptic activity as found by DICS were concordant with the operative resection site; these patients became seizure free after epilepsy surgery. In the remaining 3 patients, the results of DICS / RPDC calculations and the resection site were discordant; these patients had a poorer post-operative outcome. The first sources as found by DICS were located predominantly in cortical structures; subsequent sources included some subcortical structures: thalamus, Nucl. Subthalamicus and cerebellum. DICS seems to be a powerful tool to define the seizure onset zone and the epileptic networks involved. Seizure generation seems to be related to the propagation of epileptic activity from the primary source in the seizure onset zone, and maintenance of seizures is attributed to the perpetuation of epileptic activity between nodes in the epileptic network. Despite of these promising results, this proof of principle study needs further confirmation prior to the use of the described methods in the clinical praxis

Cerebellum and neurodegenerative diseases: Beyond conventional magnetic resonance imaging

The cerebellum plays a key role in movement control and in cognition and cerebellar involvement is described in several neurodegenerative diseases. While conventional magnetic resonance imaging (MRI) is widely used for brain and cerebellar morphologic evaluation, advanced MRI techniques allow the investigation of cerebellar microstructural and functional characteristics. Volumetry, voxel-based morphometry, diffusion MRI based fiber tractography, resting state and task related functional MRI, perfusion, and proton MR spectroscopy are among the most common techniques applied to the study of cerebellum. In the present review, after providing a brief description of each technique's advantages and limitations, we focus on their application to the study of cerebellar injury in major neurodegenerative diseases, such as multiple sclerosis, Parkinson's and Alzheimer's disease and hereditary ataxia. A brief introduction to the pathological substrate of cerebellar involvement is provided for each disease, followed by the review of MRI studies exploring structural and functional cerebellar abnormalities and by a discussion of the clinical relevance of MRI measures of cerebellar damage in terms of both clinical status and cognitive performance

Adaptive microstructure-informed tractography for accurate brain connectivity analyses

Human brain has been subject of deep interest for centuries, given it's central role in controlling and directing the actions and functions of the body as response to external stimuli. The neural tissue is primarily constituted of neurons and, together with dendrites and the nerve synapses, constitute the gray matter (GM) which plays a major role in cognitive functions. The information processed in the GM travel from one region to the other of the brain along nerve cell projections, called axons. All together they constitute the white matter (WM) whose wiring organization still remains challenging to uncover. The relationship between structure organization of the brain and function has been deeply investigated on humans and animals based on the assumption that the anatomic architecture determine the network dynamics. In response to that, many different imaging techniques raised, among which diffusion-weighted magnetic resonance imaging (DW-MRI) has triggered tremendous hopes and expectations. Diffusion-weighted imaging measures both restricted and unrestricted diffusion, i.e. the degree of movement freedom of the water molecules, allowing to map the tissue fiber architecture in vivo and non-invasively. Based on DW-MRI data, tractography is able to exploit information of the local fiber orientation to recover global fiber pathways, called streamlines, that represent groups of axons. This, in turn, allows to infer the WM structural connectivity, becoming widely used in many different clinical applications as for diagnoses, virtual dissections and surgical planning. However, despite this unique and compelling ability, data acquisition still suffers from technical limitations and recent studies have highlighted the poor anatomical accuracy of the reconstructions obtained with this technique and challenged its effectiveness for studying brain connectivity. The focus of this Ph.D. project is to specifically address these limitations and to improve the anatomical accuracy of the structural connectivity estimates. To this aim, we developed a global optimization algorithm that exploits micro and macro-structure information, introducing an iterative procedure that uses the underlying tissue properties to drive the reconstruction using a semi-global approach. Then, we investigated the possibility to dynamically adapt the position of a set of candidate streamlines while embedding the anatomical prior of trajectories smoothness and adapting the configuration based on the observed data. Finally, we introduced the concept of bundle-o-graphy by implementing a method to model groups of streamlines based on the concept that axons are organized into fascicles, adapting their shape and extent based on the underlying microstructure

Tractographie adaptative basée sur la microstructure pour des analyses précises de la connectivité cérébrale

Le cerveau est un sujet de recherche depuis plusieurs décennies, puisque son rôle est central dans la compréhension du genre humain. Le cerveau est composé de neurones, où leurs dendrites et synapses se retrouvent dans la matière grise alors que les axones en constituent la matière blanche. L’information traitée dans les différentes régions de la matière grise est ensuite transmise par l’intermédiaire des axones afin d’accomplir différentes fonctions cognitives. La matière blanche forme une structure d’interconnections complexe encore dif- ficile à comprendre et à étudier. La relation entre l’architecture et la fonction du cerveau a été étudiée chez les humains ainsi que pour d’autres espèces, croyant que l’architecture des axones déterminait la dynamique du réseau fonctionnel. Dans ce même objectif, l’Imagerie par résonance (IRM) est un outil formidable qui nous permet de visualiser les tissus cérébraux de façon non-invasive. Plus partic- ulièrement, l’IRM de diffusion permet d’estimer et de séparer la diffusion libre de celle restreinte par la structure des tissus. Cette mesure de restriction peut être utilisée afin d’inférer l’orientation locale des faisceaux de matière blanche. L’algorithme de tractographie exploite cette carte d’orientation pour reconstruire plusieurs connexions de la matière blanche (nommées “streamlines”). Cette modélisation de la matière blanche permet d’estimer la connectivité cérébrale dite structurelle entre les différentes régions du cerveau. Ces résultats peuvent être employés directement pour la planification chirurgicale ou indirectement pour l’analyse ou une évaluation clinique. Malgré plusieurs de ses limitations, telles que sa variabilité et son imprécision, la tractographie reste l’unique moyen d’étudier l’architecture de la matière blanche ainsi que la connectivité cérébrale de façon non invasive. L’objectif de ce projet de doctorat est de répondre spécifiquement à ces limitations et d’améliorer la précision anatomique des estimations de connectivité structurelle. Dans ce but, nous avons développé un algorithme d’optimisation globale qui exploite les informations de micro et macrostructure, en introduisant une procédure itéra- tive qui utilise les propriétés sous-jacentes des tissus pour piloter la reconstruction en utilisant une approche semi-globale. Ensuite, nous avons étudié la possibilité d’adapter dynamiquement la position d’un ensemble de lignes de courant candidates tout en intégrant le préalable anatomique de la douceur des trajectoires et en adap- tant la configuration en fonction des données observées. Enfin, nous avons introduit le concept de bundle-o-graphy en mettant en œuvre une méthode pour modéliser des groupes de lignes de courant basées sur le concept que les axones sont organisés en fascicules, en adaptant leur forme et leur étendue en fonction de la microstructure sous-jacente.Abstract : Human brain has been subject of deep interest for centuries, given it’s central role in controlling and directing the actions and functions of the body as response to external stimuli. The neural tissue is primarily constituted of neurons and, together with dendrites and the nerve synapses, constitute the gray matter (GM) which plays a major role in cognitive functions. The information processed in the GM travel from one region to the other of the brain along nerve cell projections, called axons. All together they constitute the white matter (WM) whose wiring organization still remains challenging to uncover. The relationship between structure organization of the brain and function has been deeply investigated on humans and animals based on the assumption that the anatomic architecture determine the network dynamics. In response to that, many different imaging techniques raised, among which diffusion-weighted magnetic resonance imaging (DW-MRI) has triggered tremendous hopes and expectations. Diffusion-weighted imaging measures both restricted and unrestricted diffusion, i.e. the degree of movement freedom of the water molecules, allowing to map the tissue fiber architecture in vivo and non-invasively. Based on DW-MRI data, tractography is able to exploit information of the local fiber orien- tation to recover global fiber pathways, called streamlines, that represent groups of axons. This, in turn, allows to infer the WM structural connectivity, becoming widely used in many different clinical applications as for diagnoses, virtual dissections and surgical planning. However, despite this unique and compelling ability, data acqui- sition still suffers from technical limitations and recent studies have highlighted the poor anatomical accuracy of the reconstructions obtained with this technique and challenged its effectiveness for studying brain connectivity. The focus of this Ph.D. project is to specifically address these limitations and to improve the anatomical accuracy of the structural connectivity estimates. To this aim, we developed a global optimization algorithm that exploits micro and macro- structure information, introducing an iterative procedure that uses the underlying tissue properties to drive the reconstruction using a semi-global approach. Then, we investigated the possibility to dynamically adapt the position of a set of candidate streamlines while embedding the anatomical prior of trajectories smoothness and adapting the configuration based on the observed data. Finally, we introduced the concept of bundle-o-graphy by implementing a method to model groups of streamlines based on the concept that axons are organized into fascicles, adapting their shape and extent based on the underlying microstructure.Sommario : Il cervello umano è oggetto di profondo interesse da secoli, dato il suo ruolo centrale nel controllare e dirigere le azioni e le funzioni del corpo in risposta a stimoli esterno. Il tessuto neurale è costituito principalmente da neuroni che, insieme ai dendriti e alle sinapsi nervose, costituiscono la materia grigia (GM), la quale riveste un ruolo centrale nelle funzioni cognitive. Le informazioni processate nella GM viaggiano da una regione all’altra del cervello lungo estensioni delle cellule nervose, chiamate assoni. Tutti insieme costituiscono la materia bianca (WM) la cui organizzazione strutturale rimane tuttora sconosciuta. Il legame tra struttura e funzione del cervello sono stati studiati a fondo su esseri umani e animali partendo dal presupposto che l’architettura anatomica determini la dinamica della rete funzionale. In risposta a ciò, sono emerse diverse tecniche di imaging, tra cui la risonanza magnetica pesata per diffusione (DW-MRI) ha suscitato enormi speranze e aspettative. Questa tecnica misura la diffusione sia libera che ristretta, ovvero il grado di libertà di movimento delle molecole d’acqua, consentendo di mappare l’architettura delle fibre neuronali in vivo e in maniera non invasiva. Basata su dati DW-MRI, la trattografia è in grado di sfruttare le informazioni sull’orientamento locale delle fibre per ricostruirne i percorsi a livello globale. Questo, a sua volta, consente di estrarre la connettività strutturale della WM, utilizzata in diverse applicazioni cliniche come per diagnosi, dissezioni virtuali e pianificazione chirurgica. Tuttavia, nonostante questa capacità unica e promettente, l’acquisizione dei dati soffre ancora di limitazioni tecniche e recenti studi hanno messo in evidenza la scarsa accuratezza anatomica delle ricostruzioni ottenute con questa tecnica, mettendone in dubbio l’efficacia per lo studio della connettività cerebrale. Il focus di questo progetto di dottorato è quello di affrontare in modo specifico queste limitazioni e di migliorare l’accuratezza anatomica delle stime di connettività strutturale. A tal fine, abbiamo sviluppato un algoritmo di ottimizzazione globale che sfrutta le informazioni sia micro che macrostrutturali, introducendo una procedura iterativa che utilizza le proprietà del tessuto neuronale per guidare la ricostruzione utilizzando un approccio semi-globale. Successivamente, abbiamo studiato la possibilità di adattare dinamicamente la posizione di un insieme di streamline candidate incorporando il prior anatomico per cui devono seguire traiettorie regolari e adattando la configurazione in base ai dati osservati. Infine, abbiamo introdotto il concetto di bundle-o-graphy implementando un metodo per modellare gruppi di streamline basato sul concetto che gli assoni sono organizzati in fasci, adattando la loro forma ed estensione in base alla microstruttura sottostante

Imagerie de la dégénérescence neuronale dans une maladie démyélinisante : la sclérose en plaques

Multiple sclerosis (MS) has long been regarded as an inflammatory demyelinating disorder of the white matter. But post-mortem studies have recently shed light on the extensive involvement of the grey matter (GM). Neuronal damage, characterized by synaptic and dendritic loss as well as neuronal apoptosis, is thought to be a major substrate of physical and cognitive deterioration in MS patients. There is a crucial need for new imaging techniques able to specifically assess neuronal damage in MS. Using positron emission tomography (PET) with [11C]flumazenil ([11C]FMZ), an antagonist of the central benzodiazepine site located within the GABAA receptor, and a non-invasive quantification method, we measured and mapped neurodegenerative changes in the GM of patients with MS at distinct disease stages. A cohort of 18 MS patients was compared to 8 healthy controls and underwent neurological and cognitive evaluations, high-resolution dynamic [11C]FMZ PET imaging and brain MRI. PET data were evaluated using a region of interest and a surface-based approach. [11C]FMZ binding was significantly decreased in the cortical and subcortical GM of MS patients compared to controls. These changes were significant in both progressive and relapsing-remitting forms of the disease and correlated moderately with white matter lesion load. [11C]FMZ cortical binding was also associated with cognitive performance. This pilot study is the first to quantify in vivo the neurodegenerative changes occurring in MS. Our results show that PET with [11C]FMZ could be a promising and sensitive quantitative marker to assess and map the neuronal substrate of GM pathology in MS.La sclérose en plaques (SEP) a longtemps été considérée comme une affection inflammatoire démyélinisante de la substance blanche. (SB) Hors, de nombreuses études ont démontré l’implication extensive de la substance grise (SG). La souffrance neuronale joue un rôle majeur dans la détérioration physique et cognitive des patients atteints de SEP. Le développement de nouvelles techniques d’imagerie capables de quantifier cette atteinte neuronale est devenu crucial. Grace à la tomographie par émission de positons (TEP) et au radiotraceur [11C]flumazenil ([11C]FMZ), antagoniste du récepteur central aux benzodiazépines, nous avons quantifié de façon non-invasive la souffrance neuronale de la SG chez des patients atteints de SEP à différents stades de la maladie. Une cohorte de 18 patients atteints de SEP a été comparée à 8 sujets sains. Les participants ont bénéficié d’une évaluation clinique, cognitive, et radiologique par TEP au [11C]FMZ et IRM. Les données TEP ont été évaluées par région d’intérêt et vertex-à- vertex. Des réductions significatives de l’activité TEP au [11C]FMZ ont été mises en évidence au sein de la SG corticale et sous-corticale des patients comparés aux contrôles. Ces changements étaient présents dès le stade rémittent de la maladie et corrélaient modérément avec la charge lésionnelle de la SB. L’activité TEP corticale était aussi associée à la performance cognitive des patients. Cette étude pilote est la première à quantifier in vivo la souffrance neuronale chez des patients atteints de SEP. Nos résultats permettent de proposer la TEP au [11C]FMZ comme marqueur spécifique et discriminant de l’atteinte neuronale de la SG dans la SEP

Recommendations to improve imaging and analysis of brain lesion load and atrophy in longitudinal studies of multiple sclerosis

Focal lesions and brain atrophy are the most extensively studied aspects of multiple sclerosis (MS), but the image acquisition and analysis techniques used can be further improved, especially those for studying within-patient changes of lesion load and atrophy longitudinally. Improved accuracy and sensitivity will reduce the numbers of patients required to detect a given treatment effect in a trial, and ultimately, will allow reliable characterization of individual patients for personalized treatment. Based on open issues in the field of MS research, and the current state of the art in magnetic resonance image analysis methods for assessing brain lesion load and atrophy, this paper makes recommendations to improve these measures for longitudinal studies of MS. Briefly, they are (1) images should be acquired using 3D pulse sequences, with near-isotropic spatial resolution and multiple image contrasts to allow more comprehensive analyses of lesion load and atrophy, across timepoints. Image artifacts need special attention given their effects on image analysis results. (2) Automated image segmentation methods integrating the assessment of lesion load and atrophy are desirable. (3) A standard dataset with benchmark results should be set up to facilitate development, calibration, and objective evaluation of image analysis methods for MS