Defect distribution index: A novel metric for functional lung MRI in cystic fibrosis.

PURPOSE Lung impairment from functional MRI is frequently assessed as defect percentage. The defect distribution, however, is currently not quantified. The purpose of this work was to develop a novel measure that quantifies how clustered or scattered defects in functional lung MRI appear, and to evaluate it in pediatric cystic fibrosis. THEORY The defect distribution index (DDI) calculates a score for each lung voxel categorized as defected. The index increases according to how densely and how far an expanding circle around a defect voxel contains more than 50% defect voxels. METHODS Fractional ventilation and perfusion maps of 53 children with cystic fibrosis were previously acquired with matrix pencil decomposition MRI. In this work, the DDI is compared to a visual score of 3 raters who evaluated how clustered the lung defects appear. Further, spearman correlations between DDI and lung function parameters were determined. RESULTS The DDI strongly correlates with the visual scoring (r = 0.90 for ventilation; r = 0.88 for perfusion; P < .0001). Although correlations between DDI and defect percentage are moderate to strong (r = 0.61 for ventilation; r = 0.75 for perfusion; P < .0001), the DDI distinguishes between patients with comparable defect percentage. CONCLUSION The DDI is a novel measure for functional lung MRI. It provides complementary information to the defect percentage because the DDI assesses defect distribution rather than defect size. The DDI is applicable to matrix pencil MRI data of cystic fibrosis patients and shows very good agreement with human perception of defect distributions

Finite element analysis of normal pressure hydrocephalus: influence of CSF content and anisotropy in permeability

Hydrocephalus is a cerebral disease where brain ventricles enlarge and compress the brain parenchyma towards the skull leading to symptoms like dementia, walking disorder and incontinence. The origin of normal pressure hydrocephalus is still obscure. In order to study this disease, a finite element model is built using the geometries of the ventricles and the skull measured by magnetic resonance imaging. The brain parenchyma is modelled as a porous medium fully saturated with cerebrospinal fluid (CSF) using Biot’s theory of consolidation (1941). Owing to the existence of bundles of axons, the brain parenchyma shows locally anisotropic behaviour. Indeed, permeability is higher along the fibre tracts in the white matter region. In contrast, grey matter is isotropic. Diffusion tensor imaging is used to establish the local CSF content and the fibre tracts direction together with the associated local frame where the permeability coefficients are given by dedicated formulas. The present study shows that both inhomogeneous CSF content and anisotropy in permeability have a great influence on the CSF flow pattern through the parenchyma under an imposed pressure gradient between the ventricles and the subarachnoid spaces

Bio Simulation of Brain Ventricle Dilation in Normal Pressure Hydrocephalus

Hydrocephalus is a brain disease wherein the ventricles dilate and compress the parenchyma towards the skull. It is primarily characterized by the disruption of the cerebrospinal fluid (CSF) flow within the ventricular system. Normal pressure hydrocephalus (NPH) is a form of hydrocephalus for which the enlargement of ventricles occurs although the intracranial pressure (ICP) remains close to normal. The pressure gradient between the source of CSF production in the ventricles and the absorption sites is reported to be very low (∼1 mm Hg), i.e. within the experimental errors. The mechanism of NPH evolution is still obscure and its distinction from the other causes of dementia such as Alzheimer and neurodegenerative diseases is difficult. The present work contributes to a better understanding of the NPH mechanism in terms of CSF disturbances and/or parenchyma defects. To this end, imaging techniques such as Magnetic resonance imaging (MRI), Diffusion tensor imaging (DTI) and Magnetic resonance elastography (MRE) are used together with a finite element (FE) model. As a final step, NPH onset and evolution are clarified via a theoretical model for healthy and NPH brains assuming a spherical geometry. The proposed mechanism is further analyzed in a realistic 3D model of the brain parenchyma. Geometries of ventricular system and skull are obtained from MRI images of a human brain. DTI data are used to establish the fiber tracts direction as well as the local frame of anisotropic elasticity and permeability. The brain parenchyma is considered as a poro-elastic material where the tissue displacement and CSF flow are modeled using the Biot's theory. A link between the CSF diffusion and CSF permeability in brain parenchyma is established and the importance of space dependent CSF content and transverse isotropic (TI) permeability is highlighted in case of low pressure gradient hydrocephalus. Calculations are carried out to simulate the ventricular dilation using FE softwares such as MATLAB® and COMSOL®. The numerical results show that consideration of space dependent CSF content and TI permeability leads to a much more realistic model for NPH in terms of CSF velocity and CSF content. Anisotropic MRE experiment is conducted over selected slices of a healthy human brain. The experimental results are statistically refined and further used to assess the healthy brain stiffness as well as the degree of anisotropy in elasticity. Moreover, the constitutive behavior of the white matter is modeled as a composite material containing fiber tracts surrounded by a matrix; with the assumption of a low fiber-matrix bonding and fiber tract undulation. A non-linear elastic model is proposed in order to take into account the load transfer from white matter matrix to fiber tracts when these are fully stretched. The unknown value of the elastic coefficients in a sick brain is determined by using inverse modeling, i.e. by adjusting these coefficients so that the right ventricle dilation is obtained. It is demonstrated that NPH development can be associated with a degradation of the brain parenchyma elastic stiffness in NPH patients. It is shown that during NPH development, a load transfer from the white matter matrix (cell bodies and interstitial fluid) to fiber tracts takes place, initiating elastic anisotropy in white matter tissues at rather large strains. An analytical approach is developed to seek the underlying NPH mechanism in a simplified model of brain. Without further refinement in the constitutive equation or adding complexity to the material behavior, the Biot's formulation is regarded as the basis. However, an absorption term is added to the Biot's model to consider the possible transparenchymal CSF resorption. The ventricle stability concept is introduced and is further utilized to investigate the equilibrium positions. The influence of different biomechanical parameters on the stable ventricle geometry is assessed and the healthy and NPH equilibrium positions are found to be dependent in particular on the CSF seepage through the ventricle wall and the absorption and permeability coefficients of the brain parenchyma. Although very simple, the proposed analytical model is able to predict the onset and development of NPH conditions as a deviation from healthy conditions. Incorporating the stability concept in a more realistic geometry of brain (3D), the respective equilibrium positions are recaptured using the parameter values provided by the analytical spherical model. The disruption of ventricle surface during the NPH development increases CSF seepage and consequently the medium permeability. A dilation dependent permeability is moreover incorporated in a 3D model of the brain. The results emphasize the importance of strain dependent permeability which favors the ventricle equilibrations in more realistic geometries of brain. Future works might consider the time dependent deformation (creep effects and stress induced remodeling) of ventricles and the incorporation of anisotropic permeability and elasticity in the 3D model. The geometry should be extended to the full ventricular system including the subarachnoid spaces (SAS)

Soft Tissue Alterations in Esthetic Postextraction Sites: A 3-Dimensional Analysis.

Dimensional alterations of the facial soft and bone tissues following tooth extraction in the esthetic zone play an essential role to achieve successful outcomes in implant therapy. This prospective study is the first to investigate the interplay between the soft tissue dimensions and the underlying bone anatomy during an 8-wk healing period. The analysis is based on sequential 3-dimensional digital surface model superimpositions of the soft and bone tissues using digital impressions and cone beam computed tomography during an 8-wk healing period. Soft tissue thickness in thin and thick bone phenotypes at extraction was similar, averaging 0.7 mm and 0.8 mm, respectively. Interestingly, thin bone phenotypes revealed a 7-fold increase in soft tissue thickness after an 8-wk healing period, whereas in thick bone phenotypes, the soft tissue dimensions remained unchanged. The observed spontaneous soft tissue thickening in thin bone phenotypes resulted in a vertical soft tissue loss of only 1.6 mm, which concealed the underlying vertical bone resorption of 7.5 mm. Because of spontaneous soft tissue thickening, no significant differences were detected in the total tissue loss between thin and thick bone phenotypes at 2, 4, 6, and 8 wk. More than 51% of these dimensional alterations occurred within 2 wk of healing. Even though the observed spontaneous soft tissue thickening in thin bone phenotypes following tooth extraction conceals the pronounced underlying bone resorption pattern by masking the true bone deficiency, spontaneous soft tissue thickening offers advantages for subsequent bone regeneration and implant therapies in sites with high esthetic demand (Clinicaltrials.gov NCT02403700)

Stammzelltransplantation aus der Nabelschnur: Was ist heute schon Realität – was wird in Zukunft möglich?

In cranio-maxillofacial surgery, the determination of a proper surgical plan is an important step to attain a desired aesthetic facial profile and a complete denture closure. In the present paper, we propose an efficient modeling approach to predict the surgical planning on the basis of the desired facial appearance and optimal occlusion. To evaluate the proposed planning approach, the predicted osteotomy plan of six clinical cases that underwent CMF surgery were compared to the real clinical plan. Thereafter, simulated soft-tissue outcomes were compared using the predicted and real clinical plan. This preliminary retrospective comparison of both osteotomy planning and facial outlook shows a good agreement and thereby demonstrates the potential application of the proposed approach in cranio-maxillofacial surgical planning prediction

Novel Collagen Matrix to Increase Tissue Thickness Simultaneous with Guided Bone Regeneration and Implant Placement in Esthetic Implant Sites: A Feasibility Study.

The purpose of this case series was to assess safety and feasibility of a novel resorbable collagen matrix (CMX) to enhance tissue thickness simultaneous with implant placement and guided bone regeneration (GBR) in esthetic sites over an 8-week healing period. Soft tissue thickness at implant sites and adjacent teeth was monitored with an ultrasonic device. Overall tissue contour changes were assessed by sequential digital surface model superimpositions. Periodontal parameters and patient-related outcomes revealed no significant changes. Combining a novel CMX and GBR revealed a significant soft tissue thickness increase of 1.56 mm at implant sites after 8 weeks, with no significant decrease between 4 and 8 weeks. The overall tissue contour increase was most significant at a distance of 5 mm from the mucosal margin, corresponding to a tissue increase at the implant shoulder area. No effect was observed at adjacent teeth after 8 weeks

Novel Collagen Matrix to Increase Tissue Thickness Simultaneous with Guided Bone Regeneration and Implant Placement in Esthetic Implant Sites: A Feasibility Study

The purpose of this case series was to assess safety and feasibility of a novel resorbable collagen matrix (CMX) to enhance tissue thickness simultaneous with implant placement and guided bone regeneration (GBR) in esthetic sites over an 8-week healing period. Soft tissue thickness at implant sites and adjacent teeth was monitored with an ultrasonic device. Overall tissue contour changes were assessed by sequential digital surface model superimpositions. Periodontal parameters and patient-related outcomes revealed no significant changes. Combining a novel CMX and GBR revealed a significant soft tissue thickness increase of 1.56 mm at implant sites after 8 weeks, with no significant decrease between 4 and 8 weeks. The overall tissue contour increase was most significant at a distance of 5 mm from the mucosal margin, corresponding to a tissue increase at the implant shoulder area. No effect was observed at adjacent teeth after 8 weeks