White matter microstructure and cognitive function in young women with polycystic ovary syndrome

Context: Polycystic ovary syndrome (PCOS) is a disorder characterized by insulin resistance and hyperandrogenism, which leads to an increased risk of type 2 diabetes in later life. Androgens and insulin signaling affect brain function but little is known about brain structure and function in younger adults with PCOS. Objective: To establish whether young women with PCOS display altered white matter microstructure and cognitive function. Patients, interventions, and main outcome measures: Eighteen individuals with PCOS (age, 31 ± 6 y; body mass index [BMI] 30 ± 6 kg/m2) and 18 control subjects (age, 31 ± 7 y; BMI, 29 ± 6 kg/m2), matched for age, IQ, and BMI, underwent anthropometric and metabolic evaluation, diffusion tensor MRI, a technique especially sensitive to brain white matter structure, and cognitive assessment. Cognitive scores and white matter diffusion metrics were compared between groups. White matter microstructure was evaluated across the whole white matter skeleton using tract-based spatial statistics. Associations with metabolic indices were also evaluated. Results: PCOS was associated with a widespread reduction in axial diffusivity (diffusion along the main axis of white matter fibers) and increased tissue volume fraction (the proportion of volume filled by white or grey matter rather than cerebrospinal fluid) in the corpus callosum. Cognitive performance was reduced compared with controls (first principal component, t = 2.9, P = .007), reflecting subtle decrements across a broad range of cognitive tests, despite similar education and premorbid intelligence. In PCOS, there was a reversal of the relationship seen in controls between brain microstructure and both androgens and insulin resistance. Conclusions: White matter microstructure is altered, and cognitive performance is compromised, in young adults with PCOS. These alterations in brain structure and function are independent of age, education and BMI. If reversible, these changes represent a potential target for treatment

Improving the predictions of computational models of convection-enhanced drug delivery by accounting for diffusion non-gaussianity

Convection-enhanced delivery (CED) is an innovative method of drug delivery to the human brain, that bypasses the blood-brain barrier by injecting the drug directly into the brain. CED aims to target pathological tissue for central nervous system conditions such as Parkinson's and Huntington's disease, epilepsy, brain tumors, and ischemic stroke. Computational fluid dynamics models have been constructed to predict the drug distribution in CED, allowing clinicians advance planning of the procedure. These models require patient-specific information about the microstructure of the brain tissue, which can be collected non-invasively using magnetic resonance imaging (MRI) pre-infusion. Existing models employ the diffusion tensor, which represents Gaussian diffusion in brain tissue, to provide predictions for the drug concentration. However, those predictions are not always in agreement with experimental observations. In this work we present a novel computational fluid dynamics model for CED that does not use the diffusion tensor, but rather the diffusion probability that is experimentally measured through diffusion MRI, at an individual-participant level. Our model takes into account effects of the brain microstructure on the motion of drug molecules not taken into account in previous approaches, namely the restriction and hindrance that those molecules experience when moving in the brain tissue, and can improve the drug concentration predictions. The duration of the associated MRI protocol is 19 min, and therefore feasible for clinical populations. We first prove theoretically that the two models predict different drug distributions. Then, using in vivo high-resolution diffusion MRI data from a healthy participant, we derive and compare predictions using both models, in order to identify the impact of including the effects of restriction and hindrance. Including those effects results in different drug distributions, and the observed differences exhibit statistically significant correlations with measures of diffusion non-Gaussianity in brain tissue. The differences are more pronounced for infusion in white-matter areas of the brain. Using experimental results from the literature along with our simulation results, we show that the inclusion of the effects of diffusion non-Gaussianity in models of CED is necessary, if reliable predictions that can be used in the clinic are to be generated by CED models

A pitfall in the reconstruction of fibre ODFs using spherical deconvolution of diffusion MRI data

Diffusion weighted ( DW ) MRI facilitates non-invasive quantification of tissue microstructure and, in combination with appropriate signal processing, three-dimensional estimates of fibrous orientation. In recent years, attention has shifted from the diffusion tensor model, which assumes a unimodal Gaussian diffusion displacement profile to recover fibre orientation ( with various well-documented limitations ), towards more complex high angular resolution diffusion imaging ( HARDI ) analysis techniques. Spherical deconvolution ( SD ) approaches assume that the fibre orientation density function ( fODF ) within a voxel can be obtained by deconvolving a ‘common’ single fibre response function from the observed set of DW signals. In practice, this common response function is not known a priori and thus an estimated fibre response must be used. Here the establishment of this single-fibre response function is referred to as ‘calibration’. This work examines the vulnerability of two different SD approaches to inappropriate response function calibration: ( 1 ) constrained spherical harmonic deconvolution ( CSHD )—a technique that exploits spherical harmonic basis sets and ( 2 ) damped Richardson–Lucy ( dRL ) deconvolution—a technique based on the standard Richardson–Lucy deconvolution. Through simulations, the impact of a discrepancy between the calibrated diffusion profiles and the observed ( ‘Target’ ) DW-signals in both single and crossing-fibre configurations was investigated. The results show that CSHD produces spurious fODF peaks ( consistent with well known ringing artefacts ) as the discrepancy between calibration and target response increases, while dRL demonstrates a lower over-all sensitivity to miscalibration ( with a calibration response function for a highly anisotropic fibre being optimal ). However, dRL demonstrates a reduced ability to resolve low anisotropy crossing-fibres compared to CSHD. It is concluded that the range and spatial-distribution of expected single-fibre anisotropies within an image must be carefully considered to ensure selection of the appropriate algorithm, parameters and calibration. Failure to choose the calibration response function carefully may severely impact the quality of any resultant tractography

Subgenual cingulum microstructure supports control of emotional conflict

Major depressive disorder (MDD) is associated with specific difficulties in attentional disengagement from negatively valenced material. Diffusion MRI studies have demonstrated altered white matter microstructure in the subgenual cingulum bundle (CB) in individuals with MDD, though the functional significance of these alterations has not been examined formally. This study explored whether individual differences in selective attention to negatively valenced stimuli are related to interindividual differences in subgenual CB microstructure. Forty-six individuals (21 with remitted MDD, 25 never depressed) completed an emotional Stroop task, using happy and angry distractor faces overlaid by pleasant or unpleasant target words and a control gender-based Stroop task. CBs were reconstructed in 38 individuals using diffusion-weighted imaging and tractography, and mean fractional anisotropy (FA) computed for the subgenual, retrosplenial, and parahippocampal subdivisions. No significant correlations were found between FA and performance in the control gender-based Stroop task in any CB region. However, the degree of interference produced by angry face distractors on time to identify pleasant words (emotional conflict) correlated selectively with FA in the subgenual CB (r = −0.53; P = 0.01). Higher FA was associated with reduced interference, irrespective of a diagnosis of MDD, suggesting that subgenual CB microstructure is functionally relevant for regulating attentional bias toward negative interpersonal stimul

Impact of b-value on estimates of apparent fibre density

Recent advances in diffusion magnetic resonance imaging (dMRI) analysis techniques have improved our understanding of fibre-specific variations in white matter microstructure. Increasingly, studies are adopting multi-shell dMRI acquisitions to improve the robustness of dMRI-based inferences. However, the impact of b-value choice on the estimation of dMRI measures such as apparent fibre density (AFD) derived from spherical deconvolution is not known. Here, we investigate the impact of b-value sampling scheme on estimates of AFD. First, we performed simulations to assess the correspondence between AFD and simulated intra-axonal signal fraction across multiple b-value sampling schemes. We then studied the impact of sampling scheme on the relationship between AFD and age in a developmental population (n=78) aged 8-18 (mean=12.4, SD=2.9 years) using hierarchical clustering and whole brain fixel-based analyses. Multi-shell dMRI data were collected at 3.0T using ultra-strong gradients (300 mT/m), using 6 diffusion-weighted shells ranging from 0 – 6000 s/mm2. Simulations revealed that the correspondence between estimated AFD and simulated intra-axonal signal fraction was improved with high b-value shells due to increased suppression of the extra-axonal signal. These results were supported by in vivo data, as sensitivity to developmental age-relationships was improved with increasing b-value (b=6000 s/mm2, median R2 = .34; b=4000 s/mm2, median R2 = .29; b=2400 s/mm2, median R2 = .21; b=1200 s/mm2, median R2 = .17) in a tract-specific fashion. Overall, estimates of AFD and age-related microstructural development were better characterised at high diffusion-weightings due to improved correspondence with intra-axonal properties

Dissociable roles of the inferior longitudinal fasciculus and fornix in face and place perception

We tested a novel hypothesis, generated from representational accounts of medial temporal lobe (MTL) function, that the major white matter tracts converging on perirhinal cortex (PrC) and hippocampus (HC) would be differentially involved in face and scene perception, respectively. Diffusion tensor imaging was applied in healthy participants alongside an odd-one-out paradigm sensitive to PrC and HC lesions in animals and humans. Microstructure of inferior longitudinal fasciculus (ILF, connecting occipital and ventro-anterior temporal lobe, including PrC) and fornix (the main HC input/output pathway) correlated with accuracy on odd-one-out judgements involving faces and scenes, respectively. Similarly, blood oxygen level-dependent (BOLD) response in PrC and HC, elicited during oddity judgements, was correlated with face and scene oddity performance, respectively. We also observed associations between ILF and fornix microstructure and category-selective BOLD response in PrC and HC, respectively. These striking three-way associations highlight functionally dissociable, structurally instantiated MTL neurocognitive networks for complex face and scene perception

GeneLink: a database to facilitate genetic studies of complex traits

BACKGROUND: In contrast to gene-mapping studies of simple Mendelian disorders, genetic analyses of complex traits are far more challenging, and high quality data management systems are often critical to the success of these projects. To minimize the difficulties inherent in complex trait studies, we have developed GeneLink, a Web-accessible, password-protected Sybase database. RESULTS: GeneLink is a powerful tool for complex trait mapping, enabling genotypic data to be easily merged with pedigree and extensive phenotypic data. Specifically designed to facilitate large-scale (multi-center) genetic linkage or association studies, GeneLink securely and efficiently handles large amounts of data and provides additional features to facilitate data analysis by existing software packages and quality control. These include the ability to download chromosome-specific data files containing marker data in map order in various formats appropriate for downstream analyses (e.g., GAS and LINKAGE). Furthermore, an unlimited number of phenotypes (either qualitative or quantitative) can be stored and analyzed. Finally, GeneLink generates several quality assurance reports, including genotyping success rates of specified DNA samples or success and heterozygosity rates for specified markers. CONCLUSIONS: GeneLink has already proven an invaluable tool for complex trait mapping studies and is discussed primarily in the context of our large, multi-center study of hereditary prostate cancer (HPC). GeneLink is freely available at

The effects of a video intervention on posthospitalization pulmonary rehabilitation uptake

Rationale: Pulmonary rehabilitation (PR) after hospitalizations for exacerbations of chronic obstructive pulmonary disease (COPD) improves exercise capacity and health-related quality of life and reduces readmissions. However, posthospitalization PR uptake is low. To date, no trials of interventions to increase uptake have been conducted.Objectives: To study the effect of a codesigned education video as an adjunct to usual care on posthospitalization PR uptake.Methods: The present study was an assessor- and statistician-blinded randomized controlled trial with nested, qualitative interviews of participants in the intervention group. Participants hospitalized with COPD exacerbations were assigned 1:1 to receive either usual care (COPD discharge bundle including PR information leaflet) or usual care plus the codesigned education video delivered via a handheld tablet device at discharge. Randomization used minimization to balance age, sex, FEV1 % predicted, frailty, transport availability, and previous PR experience.Measurements and Main Results: The primary outcome was PR uptake within 28 days of hospital discharge. A total of 200 patients were recruited, and 196 were randomized (51% female, median FEV1% predicted, 36 [interquartile range, 27-48]). PR uptake was 41% and 34% in the usual care and intervention groups, respectively (P = 0.37), with no differences in secondary (PR referral and completion) or safety (readmissions and death) endpoints. A total of 6 of the 15 participants interviewed could not recall receiving the video.Conclusions: A codesigned education video delivered at hospital discharge did not improve posthospitalization PR uptake, referral, or completion

A comparative study of gradient nonlinearity correction strategies for processing diffusion data obtained with ultra-strong-gradient MRI scanner

Purpose: The analysis of diffusion data obtained under large gradient nonlinearities necessitates corrections during data reconstruction and analysis. While two such preprocessing pipelines have been proposed, no comparative studies assessing their performance exist. Furthermore, both pipelines neglect the impact of subject motion during acquisition, which, in the presence of gradient nonlinearities, induces spatio‐temporal B‐matrix variations. Here, spatio‐temporal B‐matrix tracking (STB) is proposed and its performance compared to established pipelines. Methods: Diffusion tensor MRI (DT‐MRI) was performed using a 300 mT/m gradient system. Data were acquired with volunteers positioned in regions with pronounced gradient nonlinearities, and used to compare the performance of six different processing pipelines, including STB. Results: Up to 30% errors were observed in DT‐MRI parameter estimates when neglecting gradient nonlinearities. Moreover, the order in which b0 inhomogeneity, eddy current and gradient nonlinearity corrections were performed was found to impact the consistency of parameter estimates significantly. Although, no pipeline emerged as a clear winner, the STB approach seemed to yield the most consistent parameter estimates under large gradient nonlinearities. Conclusions: Under large gradient nonlinearities, the choice of preprocessing pipeline significantly impacts the estimated diffusion parameters. Motion‐induced spatio‐temporal B‐matrix variations can lead to systematic bias in the parameter estimates, that can be ameliorated using the proposed STB framework

Drumming motor sequence training induces apparent myelin remodelling in Huntington’s disease: a longitudinal diffusion MRI and quantitative magnetization transfer study

Background:Impaired myelination may contribute to Huntington’s disease (HD) pathogenesis. Objective:This study assessed differences in white matter (WM) microstructure between HD patients and controls, and tested whether drumming training stimulates WM remodelling in HD. Furthermore, it examined whether training-induced microstructural changes are related to improvements in motor and cognitive function. Methods:Participants undertook two months of drumming exercises. Working memory and executive function were assessed before and post-training. Changes in WM microstructure were investigated with diffusion tensor magnetic resonance imaging (DT-MRI)-based metrics, the restricted diffusion signal fraction (Fr) from the composite hindered and restricted model of diffusion (CHARMED) and the macromolecular proton fraction (MPF) from quantitative magnetization transfer (qMT) imaging. WM pathways linking putamen and supplementary motor areas (SMA-Putamen), and three segments of the corpus callosum (CCI, CCII, CCIII) were studied using deterministic tractography. Baseline MPF differences between patients and controls were assessed with tract-based spatial statistics. Results:MPF was reduced in the mid-section of the CC in HD subjects at baseline, while a significantly greater change in MPF was detected in HD patients relative to controls in the CCII, CCIII, and the right SMA-putamen post-training. Further, although patients improved their drumming and executive function performance, such improvements did not correlate with microstructural changes. Increased MPF suggests training-induced myelin changes in HD. Conclusion:Though only preliminary and based on a small sample size, these results suggest that tailored behavioural stimulation may lead to neural benefits in early HD, that could be exploited for delaying disease progression