Demonstration of accuracy and clinical versatility of mutual information for automatic multimodality image fusion using affine and thin-plate spline warped geometric deformations

Validation of automatic target volume definition as demonstrated for 11C-choline PET/CT of human prostate cancer using multi-modality fusion techniques

RATIONALE AND OBJECTIVES

Positron emission tomography (PET) is actively investigated to aid in target volume definition for radiation therapy. The objectives of this study were to apply an automatic computer algorithm to compute target volumes and to validate the algorithm using histologic data from real human prostate cancer.

MATERIALS AND METHODS

Various modalities for prostate imaging were performed. In vivo imaging included T2 3-T magnetic resonance imaging and (11)C-choline PET. Ex vivo imaging included 3-T magnetic resonance imaging, histology, and block face photos of the prostate specimen. A novel registration method based on mutual information and thin-plate splines was applied to all modalities. Once PET is registered with histology, a voxel-by-voxel comparison between PET and histology is possible. A thresholding technique based on various fractions of the maximum standardized uptake value in the tumor was applied, and the respective computed threshold volume on PET was compared with histologic truth.

RESULTS

Sixteen patients whose primary tumor volumes ranged from 1.2 to 12.6 cm(3) were tested. PET has low spatial resolution, so only tumors > 4 cm(3) were considered. Four cases met this criterion. A threshold value of 60% of the (11)C-choline maximum standardized uptake value resulted in the highest volume overlap between threshold volume on PET and histology. Medial axis distances between threshold volume on PET and histology showed a mean error of 7.7 +/- 5.2 mm.

CONCLUSIONS

This is a proof-of-concept study demonstrating for the first time that histology-guided thresholding on PET can delineate tumor volumes in real human prostate cancer.

Parametric response map as an imaging biomarker to distinguish progression from pseudoprogression in high-grade glioma

PURPOSE

To assess whether a new method of quantifying therapy-associated hemodynamic alterations may help to distinguish pseudoprogression from true progression in patients with high-grade glioma.

PATIENTS AND METHODS

Patients with high-grade glioma received concurrent chemoradiotherapy. Relative cerebral blood volume (rCBV) and blood flow (rCBF) maps were acquired before chemoradiotherapy and at week 3 during treatment on a prospective institutional review board-approved study. Pseudoprogression was defined as imaging changes 1 to 3 months after chemoradiotherapy that mimic tumor progression but stabilized or improved without change in treatment or for which resection revealed radiation effects only. Clinical and conventional magnetic resonance (MR) parameters, including average percent change of rCBV and CBF, were evaluated as potential predictors of pseudoprogression. Parametric response map (PRM), an innovative, voxel-by-voxel method of image analysis, was also performed.

RESULTS

Median radiation dose was 72 Gy (range, 60 to 78 Gy). Of 27 patients, stable disease/partial response was noted in 13 patients and apparent progression was noted in 14 patients. Adjuvant temozolomide was continued in all patients. Pseudoprogression occurred in six patients. Based on PRM analysis, a significantly reduced blood volume (PRM(rCBV)) at week 3 was noted in patients with progressive disease as compared with those with pseudoprogression (P < .01). In contrast, change in average percent rCBV or rCBF, MR tumor volume changes, age, extent of resection, and Radiation Therapy Oncology Group recursive partitioning analysis classification did not distinguish progression from pseudoprogression.

CONCLUSION

PRM(rCBV) at week 3 during chemoradiotherapy is a potential early imaging biomarker of response that may be helpful in distinguishing pseudoprogression from true progression in patients with high-grade glioma.

Comparison of apparent diffusion coefficients and distributed diffusion coefficients in high-grade gliomas

PURPOSE

To compare apparent diffusion coefficients (ADCs) with distributed diffusion coefficients (DDCs) in high-grade gliomas.

MATERIALS AND METHODS

Twenty patients with high-grade gliomas prospectively underwent diffusion-weighted MRI. Traditional ADC maps were created using b-values of 0 and 1000 s/mm(2). In addition, DDC maps were created by applying the stretched-exponential model using b-values of 0, 1000, 2000, and 4000 s/mm(2). Whole-tumor ADCs and DDCs (in 10(-3) mm(2)/s) were measured and analyzed with a paired t-test, Pearson's correlation coefficient, and the Bland-Altman method.

RESULTS

Tumor ADCs (1.14 +/- 0.26) were significantly lower (P = 0.0001) than DDCs (1.64 +/- 0.71). Tumor ADCs and DDCs were strongly correlated (R = 0.9716; P < 0.0001), but mean bias +/- limits of agreement between tumor ADCs and DDCs was -0.50 +/- 0.90. There was a clear trend toward greater discordance between ADC and DDC at high ADC values.

CONCLUSION

Under the assumption that the stretched-exponential model provides a more accurate estimate of the average diffusion rate than the mono-exponential model, our results suggest that for a little diffusion attenuation the mono-exponential fit works rather well for quantifying diffusion in high-grade gliomas, whereas it works less well for a greater degree of diffusion attenuation.

Diffusion imaging for therapy response assessment of brain tumor

Advanced imaging provides insight into biophysical, physiologic, metabolic, or functional properties of tissues. Because water mobility is sensitive to cellular homeostasis, cellular density, and microstructural organization, it is considered a valuable tool in the advanced imaging arsenal. This article summarizes diffusion imaging concepts and highlights clinical applications of diffusion MR imaging for oncologic imaging. Diffusion tensor imaging and its derivative maps of diffusion anisotropy allow assessment of tumor compression or destruction of adjacent normal tissue anisotropy and may aid to assess tumor infiltration and aid presurgical planning.

Registration of serial SPECT/CT images for three-dimensional dosimetry in radionuclide therapy

For radionuclide therapy, individual patient pharmacokinetics can be measured in three dimensions by sequential SPECT imaging. Accurate registration of the time series of images is central for voxel-based calculations of the residence time and absorbed dose. In this work, rigid and non-rigid methods are evaluated for registration of 6-7 SPECT/CT images acquired over a week, in anatomical regions from the head-and-neck region down to the pelvis. A method for calculation of the absorbed dose, including a voxel mass determination from the CT images, is also described. Registration of the SPECT/CT images is based on a CT-derived spatial transformation. Evaluation is focused on the CT registration accuracy, and on its impact on values of residence time and absorbed dose. According to the CT evaluation, the non-rigid method produces a more accurate registration than the rigid one. For images of the residence time and absorbed dose, registration produces a sharpening of the images. For volumes-of-interest, the differences between rigid and non-rigid results are generally small. However, the non-rigid method is more consistent for regions where non-rigid patient movements are likely, such as in the head-neck-shoulder region.

Voxel-by-voxel functional diffusion mapping for early evaluation of breast cancer treatment

Quantitative isotropic diffusion MRI and voxel-based analysis of the apparent diffusion coefficient (ADC) changes have been demonstrated to be able to accurately predict early response of brain tumors to therapy. The ADC value changes measured during pre- and posttherapy interval are closely correlated to treatment response. This work was demonstrated using a voxel-based analysis of ADC change during therapy in the brains of both rats and humans, following rigidly registering pre- and post-therapeutic ADC MRI exams. The primary goal of this paper is to extend this voxel-by-voxel analysis to assess therapeutic response in breast cancer. Nonlinear registration (with higher degrees of freedom) between the pre- and post-treatment exams is needed to ensure that the corresponding voxels actually contain similar cellular partial contributions due to soft tissue deformations in the breast and compartmental tumor changes during treatment as well. With limited data sets, we have observed the correlation between changes of ADC values and treatment response also exists in breast cancers. With diffusion scans acquired at three different timepoints (pre-treatment, early post-treatment and late post-treatment), we have also shown that ADC changes across responders within 5 weeks are a function of time interval after the initiation of treatment. Comparison of the experimental results with pathology shows that ADC changes can be used to evaluate early response of breast cancer treatment.

Detection of aggressive primary prostate cancer with 11C-choline PET/CT using multimodality fusion techniques

The aim of the study was to assess whether (11)C-choline PET/CT could identify high-risk primary adenocarcinoma of the prostate.

METHODS

(11)C-choline PET/CT and transpelvic MRI were performed in 14 patients with untreated localized primary adenocarcinoma of the prostate, followed by radical prostatectomy as a form of primary monotherapy within 14 d of in vivo imaging. To allow accurate coregistration of whole-mount histology with in vivo imaging, additional ex vivo MR images of the prostatectomy specimen were obtained. Nonlinear 3-dimensional image deformations were used for registrations of PET/CT, MRI, and histology. Volumes of interest from tumor and benign tissue were defined on the basis of histology and were transferred into coregistered (11)C-choline PET/CT volumes to calculate the mean (T((mean))/B) and maximum (T((max))/B) ratio of tumor to benign prostate background. On the basis of MIB-1/Ki-67 expression in tumor tissues represented on a tissue microarray, we assessed whether (11)C-choline uptake correlated with local Gleason score and tumor proliferation.

RESULTS

Histology confirmed 42 tumor nodules with Gleason scores between 3 + 2 and 4 + 4, with volumes ranging from 0.03 to 12.6 cm(3). T((mean))/B (P < 0.01) and T((max))/B (P < 0.001) ratios were significantly increased in high-Gleason score (>or=4 + 3) lesions versus 3 + 4 and lower disease but failed to distinguish between 3 + 4 disease versus 3 + 3 and lower. T((mean))/B and T((max))/B ratios were significantly increased in tumors with an MIB-1/Ki-67 labeling index greater than or equal to 5% (P < 0.01).

CONCLUSION

On the basis of our preliminary data using ratios of tumor to benign prostate background, (11)C-choline preferentially identified aggressive primary prostate cancer.

Spatial registration of temporally separated whole breast 3D ultrasound images

The purpose of this study was to evaluate the potential for use of image volume based registration (IVBaR) to aid in measurement of changes in the tumor during chemotherapy of breast cancer. Successful IVBaR could aid in the detection of such changes in response to neoadjuvant chemotherapy and potentially be useful for routine breast cancer screening and diagnosis. IVBaR was employed in a new method of automated estimation of tumor volume in studies following the radiologist identification of the tumor region in the prechemotherapy scan. The authors have also introduced a new semiautomated method for validation of registration based on Doppler ultrasound (U.S.) signals that are independent of the grayscale signals used for registration. This Institutional Review Board approved study was conducted on 10 patients undergoing chemotherapy and 14 patients with a suspicious/unknown mass scheduled to undergo biopsy. Reasonably reproducible mammographic positioning and nearly whole breast U.S. imaging were achieved. The image volume was registered offline with a mutual information cost function and global interpolation based on a thin-plate spline using MIAMI FUSE software developed at the University of Michigan. The success and accuracy of registration of the three dimensional (3D) U.S. image volume were measured by means of mean registration error (MRE). IVBaR was successful with MRE of 4.3 +/- 1.7 mm in 9 out of 10 reproducibility automated breast ultrasound (ABU) studies and in 12 out of 17 ABU image pairs collected before, during, or after 115 +/- 14 days of chemotherapy. Semiautomated tumor volume estimation was performed on registered image volumes giving 86 +/- 8% mean accuracy compared to the radiologist hand-segmented tumor volume on seven cases. Doppler studies yielded fractional volume of color pixels in the region surrounding the lesion and its change with changing breast compression. The Doppler study of patients with detectable blood flow included five patients with suspicious masses and three undergoing chemotherapy. Spatial alignment of the 3D blood vessel data from the Doppler studies provided independent measures for the validation of registration. In 15 Doppler image volume pairs scanned with differing breast compression, the mean centerline separation value was 1.5 +/- 0.6 mm, while MRE based on a few identifiable structural points common to the two grayscale image volumes was 1.1 +/- 0.6 mm. Another measure, the overlap ratio of blood vessels, was shown to increase from 0.32 to 0.59 (+84%) with IVBaR for pairs at various compression levels. These results show that successful registration of ABU scans may be accomplished for comparison and integration of information.

Automated optimization of subcortical cerebral MR imaging-atlas coregistration for improved postoperative electrode localization in deep brain stimulation

BACKGROUND AND PURPOSE

The efficacy of deep brain stimulation in treating movement disorders depends critically on electrode localization, which is conventionally described by using coordinates relative to the midcommissural point. This approach requires manual measurement and lacks spatial normalization of anatomic variances. Normalization is based on intersubject spatial alignment (coregistration) of corresponding brain structures by using different geometric transformations. Here, we have devised and evaluated a scheme for automated subcortical optimization of coregistration (ASOC), which maximizes patient-to-atlas normalization accuracy of postoperative structural MR imaging into the standard Montreal Neurologic Institute (MNI) space for the basal ganglia.

MATERIALS AND METHODS

Postoperative T2-weighted MR imaging data from 39 patients with Parkinson disease and 32 patients with dystonia were globally normalized, representing the standard registration (control). The global transformations were regionally refined by 2 successive linear registration stages (RSs) (ASOC-1 and 2), focusing progressively on the basal ganglia with 2 anatomically selective brain masks, which specify the reference volume (weighted cost function). Accuracy of the RSs was quantified by spatial dispersion of 16 anatomic landmarks and their root-mean-square errors (RMSEs) with respect to predefined MNI-based reference points. The effects of CSF volume, age, and sex on RMSEs were calculated.

RESULTS

Mean RMSEs differed significantly (P < .001) between the global control (4.2 +/- 2.0 mm), ASOC-1 (1.92 +/- 1.02 mm), and ASOC-2 (1.29 +/- 0.78 mm).

CONCLUSIONS

The present method improves the registration accuracy of postoperative structural MR imaging data into MNI space within the basal ganglia, allowing automated normalization with increased precision at stereotactic targets, and enables lead-contact localization in MNI coordinates for quantitative group analysis.

Accelerated nonrigid intensity-based image registration using importance sampling

Nonrigid image registration methods using intensity-based similarity metrics are becoming increasingly common tools to estimate many types of deformations. Nonrigid warps can be very flexible with a large number of parameters and gradient optimization schemes are widely used to estimate them. However, for large datasets, the computation of the gradient of the similarity metric with respect to these many parameters becomes very time consuming. Using a small random subset of image voxels to approximate the gradient can reduce computation time. This work focuses on the use of importance sampling to reduce the variance of this gradient approximation. The proposed importance sampling framework is based on an edge-dependent adaptive sampling distribution designed for use with intensity-based registration algorithms. We compare the performance of registration based on stochastic approximations with and without importance sampling to that using deterministic gradient descent. Empirical results, on simulated magnetic resonance brain data and real computed tomography inhale-exhale lung data from eight subjects, show that a combination of stochastic approximation methods and importance sampling accelerates the registration process while preserving accuracy.

Functional and metabolic magnetic resonance imaging and positron emission tomography for tumor volume definition in high-grade gliomas

Although the addition of concurrent and adjuvant temozolomide (TMZ) to standard-dose radiation (60 Gy) improves survival, the pattern of failure continues to be local. Conventional contrast enhanced T1-weighted and T2-weighted magnetic resonance imaging (MRI) used for radiation planning reflect anatomic rather than molecular or functional, properties of the tumor. Functional and metabolic MRI and positron emission tomography are able to detect metabolic and functional abnormalities beyond the tumor volume seen on conventional MRI, assess early response to treatment, and delineate the regions of high risks for failure in high-grade gliomas. This article focuses on the potential of these functional and metabolic imaging techniques to refine our clinical target volumes.

Incorporation of preprocedural PET into CT-guided radiofrequency ablation of hepatic metastases: a nonrigid image registration validation study

This study evaluates the accuracy of augmenting initial intraprocedural computed tomography (CT) during radiofrequency ablation (RFA) of hepatic metastases with preprocedural positron emission tomography (PET) through a hardware-accelerated implementation of an automatic nonrigid PET-CT registration algorithm. The feasibility of augmenting intraprocedural CT with preprocedural PET to improve localization of CT-invisible but PET-positive tumors with images from actual RFA was explored. Preprocedural PET and intraprocedural CT images from 18 cases of hepatic RFA were included. All PET images in the study originated from a hybrid PET/CT scanner, and PET-CT registration was performed in two ways: (1) direct registration of preprocedural PET with intraprocedural CT and (2) indirect registration of preprocedural CT (i.e., the CT of hybrid PET/CT scan) with intraprocedural CT. A hardware-accelerated registration took approximately 2 min. Calculated registration errors were 7.0 and 8.4 mm for the direct and indirect methods, respectively. Overall, the direct registration was found to be statistically not distinct from that performed by a group of clinical experts. The accuracy, execution speed, and compactness of our implementation of nonrigid image registration suggest that existing PET can be overlaid on intraprocedural CT, promising a novel, technically feasible, and clinically viable approach for PET augmentation of CT guidance of RFA.

The parametric response map is an imaging biomarker for early cancer treatment outcome

Here we describe the parametric response map (PRM), a voxel-wise approach for image analysis and quantification of hemodynamic alterations during treatment for 44 patients with high-grade glioma. Relative cerebral blood volume (rCBV) and flow (rCBF) maps were acquired before treatment and after 1 and 3 weeks of therapy. We compared the standard approach using region-of-interest analysis for change in rCBV or rCBF to the change in perfusion parameters on the basis of PRM (PRM(rCBV) and PRM(rCBF)) for their accuracy in predicting overall survival. Neither the percentage change of rCBV or rCBF predicted survival, whereas the regional response evaluations made on the basis of PRM were highly predictive of survival. Even when accounting for baseline rCBV, which is prognostic, PRM(rCBV) proved more predictive of overall survival.

Breast ultrasound image improvement by pixel compounding of compression sequence

Pixel compounding is a technique that synthesizes the information of an image sequence involving slow decorrelation of the speckle to form a detail-recovered and speckle reduced image. To avoid extra data acquisition time and patient exposure, reuse of the existing data is desirable. In the procedure of elasticity imaging, a set of B-mode images with slight changes due to deformation is produced, which provides an ideal input for the pixel compounding. The improvement in image quality is evaluated quantitatively using a figure-of-merit (FOM) that indicates the quality of boundary information recovery and the contrast-to-noise ratio (CNR) over the phantom images. The increase in average CNR is from 0.4 in the original images to 0.8 in the pixel compounded images. The improvement in average FOM is from 0.15 to more than 0.5 on a scale of 0 to 1. In vivo results with a breast cyst, a fibroadenoma, and a breast cancer1 are also presented and the image quality improvement is subjectively evaluated. The results suggest that B-mode breast images from compression procedures are suitable data for pixel compounding, and that a speckle-reduced and detail-recovered or detail-maintained image can be produced. The improved imaging may provide alternative or better information for detection and diagnosis. A similar approach could be extended to elasticity imaging with other modalities.

Nonrigid registration of dynamic renal MR images using a saliency based MRF model

Nonrigid registration of contrast-enhanced MR images is a difficult problem due to the change in pixel intensity caused by the wash-in and wash-out of the contrast agent. In this paper we propose a novel saliency based Markov Random Field approach for effective nonrigid registration of contrast enhanced images. Saliency information obtained from the neurobiology-based saliency model alongwith intensity information is used to quantify the degree of similarity between images in the pre- and post-contrast stages. Information from these two features is combined by using an exponential function of the saliency difference such that it assigns low values to small differences in saliency and at the same time ensures that saliency information does not bias the energy term. Rotationally-invariant edge information from edge-orientation histograms was used to complement the saliency information resulting in better registration results. Tests on real patient datasets show that our algorithm results in accurate registration. We also simulated elastic motion on images, and the deformation field recovered by our algorithm was nearly the inverse of the simulated field.

Feature-based rectal contour propagation from planning CT to cone beam CT

The purpose of this work is to develop a novel feature-based registration strategy to automatically map the rectal contours from planning computed tomography (CT) (pCT) to cone beam CT (CBCT). The rectal contours were manually outlined on the pCT. A narrow band with the outlined contour as its interior surface was then constructed, so that we can exclude the volume inside the rectum in the registration process. The corresponding contour in the CBCT was found by using a feature-based registration algorithm, which consists of two steps: (1) automatically searching for control points in the pCT and CBCT based on the features of the surrounding tissue and matching the homologous control points using the scale invariance feature transformation; and (2) using the control points for a thin plate spline transformation to warp the narrow band and mapping the corresponding contours from pCT to CBCT. The proposed contour propagation technique is applied to digital phantoms and clinical cases and, in all cases, the contour mapping results are found to be clinically acceptable. For clinical cases, the method yielded satisfactory results even when there were significant rectal content changes between the pCT and CBCT scans. As a consequence, the accordance between the rectal volumes after deformable registration and the manually segmented rectum was found to be more than 90%. The proposed technique provides a powerful tool for adaptive radiotherapy of prostate, rectal, and gynecological cancers in the future.

Compartmental modeling of 11C-HOMADAM binding to the serotonin transporter in the healthy human brain

The novel PET radioligand (11)C-N,N-dimethyl-2-(2'-amino-4'-hydroxymethylphenylthio)benzylamine ((11)C-HOMADAM) binds with high affinity and selectively to the serotonin transporter (SERT). The purpose of this study was to develop a reliable kinetic model to describe the uptake of (11)C-HOMADAM in the healthy human brain.

METHODS

Eight volunteers participated in the study; 5 of them were fitted with arterial catheters for blood sampling and all were scanned on a high-resolution research tomograph after the injection of (11)C-HOMADAM. Regional distribution volumes and binding potentials were calculated with 2- and 4-parameter arterial-input compartment models, a 3-parameter reference tissue compartment model, and the Logan graphic approach.

RESULTS

The 2-parameter arterial-input compartment model was statistically superior to the 4-parameter model and described all brain regions. Calculated binding potentials agreed well between the arterial-input model and the reference tissue model when the cerebellum was used as the reference tissue. The Logan graphic approach was not able to estimate the higher concentration of SERT in the dorsal raphe than in the midbrain.

CONCLUSION

(11)C-HOMADAM is a highly promising radioligand with high ratios of specific binding to nonspecific binding in known SERT-rich structures, such as the raphe nuclei. The 3-parameter reference tissue model approach permits a simplified quantitatively accurate method for estimating SERT binding potentials.

Monoamine oxidase A genotype predicts human serotonin 1A receptor availability in vivo

The serotonergic system, including the serotonin 1A (5-HT(1A)) receptor, has been implicated in the pathophysiology of a number of neuropsychiatric disorders. Current data show substantial interindividual variation in the regional concentration of this receptor site, the source of which is unclear. Monoamine oxidase A (MAO-A) is a key regulator of serotonin metabolism, and polymorphic variation in the X-linked MAO-A gene influences its expression. We hypothesized that polymorphism in the MAO-A gene would be associated with sex-specific variation in 5-HT(1A) receptor expression. We used positron emission tomography and [(11)C]WAY-100635 to quantify 5-HT(1A) receptors in a group of 31 healthy and unmedicated depressed individuals. The same individuals were genotyped for an upstream variable number tandem repeat polymorphism in the promoter of the MAO-A gene. ANOVA of 5-HT(1A) receptor availability demonstrated a significant effect of MAO-A genotype in the raphe nuclei, medial and inferior temporal cortex, insula, medial prefrontal cortex, and anterior cingulate (p < 0.05). The effect persisted when age, race, body mass index, and diagnosis were included in the model. Genotypes with greater putative MAO-A activity were associated with greater 5-HT(1A) receptor availability in women, but not in men. Genotype predicted a substantial 42-74% of the variance in receptor availability in women, depending on the brain region (p < 0.05). Depression diagnosis was not associated with MAO-A genotype or 5-HT(1A) receptor availability in these regions. These results demonstrate a sex-specific interaction between two key molecules of the human serotonergic system, and suggest a neurobiological basis for sexual dimorphism in serotonin-modulated phenotypes.

Formulation of current density weighted indices for correspondence between functional MRI and electrocortical stimulation maps

OBJECTIVE

Accurate localization of functionally significant brain regions reduces risks of post-operative neurological deficits. The gold standard for presurgical brain mapping is subdural electrocortical stimulation (ECS), which is an open-cranium surgical procedure. Functional MRI (fMRI) may be a noninvasive alternative if it can be shown that fMRI and ECS maps are spatially consistent. We formulate new 3D current density weighted ECS-fMRI correspondence indices and illustrate their use on human data.

METHODS

Current density maps were computed for simulated and human datasets by solving the electrostatic Laplace equation. The proposed indices were characterized and compared with fixed radii and Euclidean distance indices.

RESULTS

Results from simulated datasets showed that the proposed indices quantify correspondence between fMRI and the ECS truth predictably, and provide conspicuous sensitivity increase from fixed radii indices, whereas Euclidean distances may not be suitable measures of the correspondence.

CONCLUSIONS

The proposed indices reflect contextual information from surrounding electrodes and may be physiologically more meaningful in evaluating ECS-fMRI correspondence.

SIGNIFICANCE

To identify safe limits of resection, an ECS map requires placement of electrodes on a patient's brain. Our proposed indices accurately quantify ECS-fMRI correspondence and may be used to evaluate fMRI as a noninvasive alternative for defining resection limits.

Black cohosh has central opioid activity in postmenopausal women: evidence from naloxone blockade and positron emission tomography neuroimaging

OBJECTIVE

To test whether black cohosh (BC) exhibits an action on the central endogenous opioid system in postmenopausal women.

DESIGN

This was a mechanistic study conducted in the same individuals of luteinizing hormone pulsatility with a saline/naloxone challenge (n = 6) and positron emission tomography with [C]carfentanil, a selective micro-opioid receptor radioligand (n = 5), before and after 12 weeks of unblinded treatment with a popular BC daily supplement.

RESULTS

BC treatment for 12 weeks at a standard dose (Remifemin, 40 mg/day) had no effect on spontaneous luteinizing hormone pulsatility or estrogen concentrations. With naloxone blockade, there was an unexpected suppression of mean luteinizing hormone pulse frequency (saline vs naloxone = 9.0 +/- 0.6 vs 6.0 +/- 0.7 pulses/16 h; P = 0.056), especially during sleep when the mean interpulse interval was prolonged by approximately 90 minutes (saline night interpulse interval = 103 +/- 9 min vs naloxone night interpulse interval = 191 +/- 31 min, P = 0.03). There were significant increases in mu-opioid receptor binding potential in the posterior and subgenual cingulate, temporal and orbitofrontal cortex, thalamus, and nucleus accumbens ranging from 10% to 61% across brain regions involved in emotional and cognitive function. In contrast, binding potential reductions of lesser magnitude were observed in regions known to be involved in the placebo response (anterior cingulate and anterior insular cortex).

CONCLUSIONS

Using two different challenge paradigms for the examination of central opioid function, a neuropharmacologic action of BC treatment was demonstrated in postmenopausal women.

Ingress of blood-borne macrophages across the blood-brain barrier in murine HIV-1 encephalitis

Blood-borne macrophage ingress into brain in HIV-1 associated neurocognitive disorders governs the tempo of disease. We used superparamagnetic iron-oxide particles loaded into murine bone marrow-derived macrophages (BMM) injected intravenously into HIV-1 encephalitis mice to quantitatively assess BMM entry into diseased brain regions. Magnetic resonance imaging tests were validated by histological coregistration and enhanced image processing. The demonstration of robust BMM migration into areas of focal encephalitis provide 'proof of concept' for the use of MRI to monitor macrophage ingress into brain.

Registration methodology for histological sections and in vivo imaging of human prostate

RATIONALE AND OBJECTIVES

Registration enables quantitative spatial correlation of features from different imaging modalities. Our objective is to register in vivo imaging with histologic sections of the human prostate so that histologic truth can be correlated with in vivo imaging features.

MATERIALS AND METHODS

In vivo imaging of the prostate included T2-weighted anatomic and diffusion weighted 3-T magnetic resonance imaging (MRI) as well as 11C-choline positron emission tomography (PET). In addition, ex vivo 3-T MRI of the prostate specimen, histology, and associated block face photos of the prostate specimen were obtained. A standard registration method based on mutual information (MI) and thin-plate spline (TPS) was applied. Registration among in vivo imaging modalities is well established; however, accurate registration involving histology is difficult. Our approach breaks up the difficult direct registration of histology and in vivo imaging into achievable subregistration tasks involving intermediate ex vivo modalities like block face photography and specimen MRI. Results of subregistration tasks are combined to compute the intended, final registration between in vivo imaging and histology.

RESULTS

The methodology was applied to two patients and found to be clinically feasible. Overall registered anatomic MRI, diffusion MRI, and 11C-choline PET aligned well with histology qualitatively for both patients. There is no ground truth of registration accuracy as the scans are real patient scans. An indirect validation of the registration accuracy has been proposed comparing tumor boundary markings found in diffusion MRI and histologic sections. Registration errors for two patients between diffusion MRI and histology were 3.74 and 2.26 mm.

CONCLUSION

This proof of concept paper demonstrates a method based on intrinsic image information content for successfully registering in vivo imaging of the human prostate with its post-resection histology, which does not require the use of extrinsic fiducial markers. The methodology successfully mapped histology onto the in vivo imaging space, allowing the observation of how well different in vivo imaging features correspond to histologic truth. The methodology is therefore the basis for a systematic comparison of in vivo imaging for staging of human prostate cancer.

Functional diffusion map as an early imaging biomarker for high-grade glioma: correlation with conventional radiologic response and overall survival

PURPOSE

Assessment of radiologic response (RR) for brain tumors utilizes the Macdonald criteria 8 to 10 weeks from the start of treatment. Diffusion magnetic resonance imaging (MRI) using a functional diffusion map (fDM) may provide an earlier measure to predict patient survival.

PATIENTS AND METHODS

Sixty patients with high-grade glioma were enrolled onto a study of intratreatment MRI at 1, 3, and 10 weeks. Receiver operating characteristic curve analysis was used to evaluate imaging parameters as a function of patient survival at 1 year. Both log-rank and Cox proportional hazards models were utilized to assess overall survival.

RESULTS

Greater increases in diffusion in response to therapy over time were observed in those patients alive at 1 year compared with those who died as a result of disease. The volume of tumor with increased diffusion by fDM at 3 weeks was the strongest predictor of patient survival at 1 year, with larger fDM predicting longer median survival (52.6 v 10.9 months; log-rank, P < .003; hazard ratio [HR] = 2.7; 95% CI, 1.5 to 5.9). Radiologic response at 10 weeks had similar prognostic value (median survival, 31.6 v 10.9 months; log-rank P < .0007; HR = 2.9; 95% CI, 1.7 to 7.2). Radiologic response and fDM differed in 25% of cases. A composite index of response including fDM and RR provided a robust predictor of patient survival and may identify patients in whom RR does not correlate with clinical outcome.

CONCLUSION

Compared with conventional neuroimaging, fDM provided an earlier assessment of equal predictive value, and the combination of fDM and RR provided a more accurate prediction of patient survival than either metric alone.

Continuous sampling in mutual-information registration

Mutual information is a popular and widely used metric in retrospective image registration. This metric excels especially with multimodal data due to the minimal assumptions about the correspondence between the image intensities. In certain situations, the mutual-information metric is known to produce artifacts that rule out subsample registration accuracy. Various methods have been developed to mitigate these artifacts, including higher order kernels for smoother sampling of the metric. This study introduces a novel concept of continuous sampling to provide new insight into the mutual-information methods currently in use. In particular, the connection between the partial volume interpolation and the recently introduced higher order partial-volume-type kernels is revealed.

Non-rigid registration of three-dimensional (3D) grayscale and Doppler ultrasound breast images

The purpose of this study is to evaluate the accuracy of image volume based registration (IVBaR) of 3D ultrasound (US) image volumes of the whole breast acquired at different times. Successful IVBaR could aid in detection of tumor changes in response to neoadjuvant chemotherapy and potentially be useful for routine breast cancer screening and diagnosis. IVBaR was successful in 9 of 10 reproducibility studies, 11 of 15 image pairs collected before and after approximately 45 days of chemotherapy. Doppler study yielded volume of blood flow to the region surrounding the lesion and its change when reducing breast compression. The color flow vessels provided independent measures for validation of registration of the grayscale portion of those images.

Affective circuitry and risk for alcoholism in late adolescence: differences in frontostriatal responses between vulnerable and resilient children of alcoholic parents

BACKGROUND

Children of alcoholics (COAs) are at elevated risk for alcohol use disorders (AUD), yet not all COAs will develop AUD. The 2 primary aims of this study were to identify neural activation mechanisms that may mark protection or vulnerability to AUD in COAs and to map the same activation patterns in relation to risk behavior (externalizing or internalizing behavior).

METHODS

Twenty-two adolescent COAs were recruited from an ongoing community longitudinal study of alcoholic and matched control families. They were categorized as either vulnerable (n = 11) or resilient (n = 11) based on the level of problem drinking over the course of adolescence. Six other adolescents with no parental history of alcoholism, and no evidence of their own problem drinking were recruited from the same study and labeled as low-risk controls. Valenced words were presented to the participants in a passive viewing task during functional magnetic resonance imaging. Activation to negative versus neutral words and positive versus neutral words were compared between groups. Behavior problems were assessed with the Youth Self-Report (YSR).

RESULTS

The resilient COA group had more activation of the orbital frontal gyrus (OFG), bilaterally, and left insula/putamen than the control and vulnerable groups, in response to emotional stimuli. In contrast, the vulnerable group had more activation of the dorsomedial prefrontal cortex and less activation of the ventral striatum and extended amygdala, bilaterally, to emotional stimuli than the control and resilient groups. The vulnerable group had more externalizing behaviors which correlated with increased dorsomedial prefrontal activation and decreased ventral striatal and extended amygdala activation.

CONCLUSIONS

These results are consistent with dissociable patterns of neural activation underlying risk and resiliency in COAs. We propose that the pattern observed in the resilient COAs represents an active emotional monitoring function, which may be a protective factor in this group. On the other hand, the vulnerable group displayed a pattern consistent with active suppression of affective responses, perhaps resulting in the inability to engage adaptively with emotional stimuli.

Ultrasound of the fingers for human identification using biometrics

It was hypothesized that the use of internal finger structure as imaged using commercially available ultrasound (US) scanners could act as a supplement to standard methods of biometric identification, as well as a means of assessing physiological and cardiovascular status. Anatomical structures in the finger including bone contour, tendon and features along the interphalangeal joint were investigated as potential biometric identifiers. Thirty-six pairs of three-dimensional (3D) gray-scale images of second to fourth finger (index, middle and ring) data taken from 20 individuals were spatially registered using MIAMI-Fuse software developed at our institution and also visually matched by four readers. The image-based registration met the criteria for matching successfully in 14 out of 15 image pairs on the same individual and did not meet criteria for matching in any of the 12 image pairs from different subjects, providing a sensitivity and specificity of 0.93 and 1.00, respectively. Visual matching of all image pairs by four readers yielded 96% successful match. Power Doppler imaging was performed to calculate the change in color pixel density due to physical exercise as a surrogate of stress level and to provide basic physiological information. (E-mail: gnarayan@umich.edu).

A feasibility study evaluating the functional diffusion map as a predictive imaging biomarker for detection of treatment response in a patient with metastatic prostate cancer to the bone

Prostate cancer (PCa) is the most commonly diagnosed cancer in American men with a subset inevitably presenting with metastatic disease to the bone. A well-recognized limitation in evaluating new treatments for metastatic PCa is the inability to use imaging to objectively assess response therapy. In this study, we evaluated the feasibility of clinically translating the functional diffusion map (fDM) imaging biomarker for quantifying the spatiotemporal effects of bone tumor response in a patient treated for metastatic PCa with bone metastases. A patient beginning therapy was scanned using MRI before treatment and again at 2 and 8 weeks post-treatment initiation to quantify changes in tumor diffusion values. Three metastatic lesions were identified for fDM analysis, all of which all demonstrated an early increase in diffusion values at 2 weeks, which increased further at 8 weeks post-treatment initiation. This finding correlated with a decrease in the patient's prostate-specific antigen (PSA) levels suggestive of patient response. CT, bone scans, and anatomic MRI images obtained posttreatment were found to be uninformative for the assessment of treatment effectiveness. This study presents the feasibility of fDM-measurements in osseous lesions over time and shows that changes in fDM values were consistent with therapeutic response. Thus, the fDM imaging biomarker may provide a quantifiable therapeutic endpoint to assess response in patients with metastatic bone cancer.

Comparative evaluation of similarity measures for the rigid registration of multi-modal head images

Image registrations that are based on similarity measures simply adjust the parameters of an appropriate spatial transformation model until the similarity measure reaches an optimum. The numerous similarity measures that have been proposed in the past are differently sensitive to imaging modality, image content and differences in the image content, selection of the floating and target image, partial image overlap, etc. In this paper, we evaluate and compare 12 similarity measures for the rigid registration. To study the impact of different imaging modalities on the behavior of similarity measures, we have used 16 CT/MR and 6 PET/MR image pairs with known 'gold standard' registrations. The results for the PET/MR registration and for the registration of CT to both rectified and unrectified MR images indicate that mutual information, normalized mutual information and the entropy correlation coefficient are the most accurate similarity measures and have the smallest risk of being trapped in a local optimum. The results of an experiment on the impact of exchanging the floating and target image indicate that, especially in MR/PET registrations, the behavior of some similarity measures, such as mutual information, significantly depends on which image is the floating and which is the target.

Adaptive non-rigid registration of real time 3D ultrasound to cardiovascular MR images

We present a new method to non-rigidly co-register a real-time 3D ultrasound volume slice to a cardiovascular MR image. The motivation for our research is to assist a clinician to automatically fuse the information from multiple imaging modalities for the early diagnosis and therapy of cardiac disease. The local phase presentation of both images is utilized as an image descriptor of the "featureness". The local deformation of ventricles is modeled by a polyaffine transformation. The anchor points (or control points) used in the polyaffine transformation are automatically detected and refined by calculating a local mis-match measure based on phase mutual information. The registration process is built in an adaptive multi-scale framework to maximize the phase-based similarity measure by optimizing the parameters of the polyaffine transformation. Registration results have demonstrated that this novel method is superior to our prior work, yielding an accurate registration to local cardiac regions.

Breast image registration techniques: a survey

Breast cancer is the most common type of cancer in women worldwide. Image registration plays an important role in breast cancer detection. This paper gives an overview of the current state-of-the-art in the breast image registration techniques. For the intramodality registration techniques, X-ray, MRI, and ultrasound are the primary focuses of interest. Intermodality techniques will cover the combination of different modalities. Validation of breast registration methods is also discussed.

Automatic segmentation of phase-correlated CT scans through nonrigid image registration using geometrically regularized free-form deformation

Conventional radiotherapy is planned using free-breathing computed tomography (CT), ignoring the motion and deformation of the anatomy from respiration. New breath-hold-synchronized, gated, and four-dimensional (4D) CT acquisition strategies are enabling radiotherapy planning utilizing a set of CT scans belonging to different phases of the breathing cycle. Such 4D treatment planning relies on the availability of tumor and organ contours in all phases. The current practice of manual segmentation is impractical for 4D CT, because it is time consuming and tedious. A viable solution is registration-based segmentation, through which contours provided by an expert for a particular phase are propagated to all other phases while accounting for phase-to-phase motion and anatomical deformation. Deformable image registration is central to this task, and a free-form deformation-based nonrigid image registration algorithm will be presented. Compared with the original algorithm, this version uses novel, computationally simpler geometric constraints to preserve the topology of the dense control-point grid used to represent free-form deformation and prevent tissue fold-over. Using mean squared difference as an image similarity criterion, the inhale phase is registered to the exhale phase of lung CT scans of five patients and of characteristically low-contrast abdominal CT scans of four patients. In addition, using expert contours for the inhale phase, the corresponding contours were automatically generated for the exhale phase. The accuracy of the segmentation (and hence deformable image registration) was judged by comparing automatically segmented contours with expert contours traced directly in the exhale phase scan using three metrics: volume overlap index, root mean square distance, and Hausdorff distance. The accuracy of the segmentation (in terms of radial distance mismatch) was approximately 2 mm in the thorax and 3 mm in the abdomen, which compares favorably to the accuracies reported elsewhere. Unlike most prior work, segmentation of the tumor is also presented. The clinical implementation of 4D treatment planning is critically dependent on automatic segmentation, for which is offered one of the most accurate algorithms yet presented.

Altered central micro-opioid receptor binding after psychological trauma

BACKGROUND

Functional neuroimaging studies have detected abnormal limbic and paralimbic activation to emotional probes in posttraumatic stress disorder (PTSD), but few studies have examined neurochemical mechanisms that underlie functional alterations in regional cerebral blood flow. The mu-opioid neurotransmitter system, implicated in responses to stress and suppression of pain, is distributed in and is thought to regulate the function of brain regions that are implicated in affective processing.

METHODS

Here we examined the micro-opioid system with positron emission tomography and the micro-opioid receptor-selective radiotracer [11C] carfentanil in 16 male patients with PTSD and two non-PTSD male control groups, with (n = 14) and without combat exposure (n = 15). Differences in micro-opioid receptor binding potential (BP2) were detected within discrete limbic and paralimbic regions.

RESULTS

Relative to healthy controls, both trauma-exposed groups had lower micro-opioid receptor BP2 in extended amygdala, nucleus accumbens, and dorsal frontal and insular cortex but had higher BP2 in the orbitofrontal cortex. PTSD patients exhibited reduced BP2 in anterior cingulate cortex compared with both control groups. Micro-opioid receptor BP2 in combat-exposed subjects without PTSD was lower in the amygdala but higher in the orbitofrontal cortex compared with both PTSD patients and healthy controls.

CONCLUSIONS

These findings differentiate the general response of the micro-opioid system to trauma from more specific changes associated with PTSD.

An imaging biomarker of early treatment response in prostate cancer that has metastasized to the bone

Prostate cancer ranks as the most common lethal malignancy diagnosed and the second leading cause of cancer mortality in American men. Although high response rates are achieved using androgen blockade as first-line therapy, most men progress toward hormone-refractory prostate cancer. Systemic chemotherapies have been shown to improve clinical outcome in hormone refractory prostate cancer patients; however, they are not curative. Due to the high incidence of bone involvement in hormone-refractory prostate cancer, assessment of treatment response in metastatic prostate cancer to the bone remains a major clinical need. In this current study, we investigated the feasibility of using the functional diffusion map (fDM) as an imaging biomarker for assessing early treatment response in a preclinical model of metastatic prostate cancer. The fDM biomarker requires a pretreatment and midtreatment magnetic resonance imaging diffusion map, which is used to quantify spatially distinct therapeutic-induced changes in the Brownian motion (or diffusion) of water within tumor tissue. Because water within tumor cells is in a restricted environment relative to extracellular water, loss of cell membrane integrity and cellular density during therapy will be detected by fDM as an increase in diffusion. Regions of significantly increased diffusion values were detected early using fDM in docetaxel-treated versus untreated metastatic prostate bone tumors at 7 days post treatment initiation (P < 0.05), indicating loss of tumor cell viability. Validation of fDM results was accomplished by histologic analysis of excised tissue. Results from this study show the capability of fDM as a biomarker for detection of bone cancer treatment efficacy, thus warranting clinical evaluation.

Brain functional localization: a survey of image registration techniques

Functional localization is a concept which involves the application of a sequence of geometrical and statistical image processing operations in order to define the location of brain activity or to produce functional/parametric maps with respect to the brain structure or anatomy. Considering that functional brain images do not normally convey detailed structural information and, thus, do not present an anatomically specific localization of functional activity, various image registration techniques are introduced in the literature for the purpose of mapping functional activity into an anatomical image or a brain atlas. The problems addressed by these techniques differ depending on the application and the type of analysis, i.e., single-subject versus group analysis. Functional to anatomical brain image registration is the core part of functional localization in most applications and is accompanied by intersubject and subject-to-atlas registration for group analysis studies. Cortical surface registration and automatic brain labeling are some of the other tools towards establishing a fully automatic functional localization procedure. While several previous survey papers have reviewed and classified general-purpose medical image registration techniques, this paper provides an overview of brain functional localization along with a survey and classification of the image registration techniques related to this problem.

Imaging and alignment for image-guided radiation therapy

Image-guided radiation therapy is an exciting new area that focuses heavily on the potential benefit of advanced imaging and image registration to improve precision, thus limiting morbidity and potentially allowing for safe delivery of increased dose. This review explores the issues surrounding the use of imaging and image registration for treatment planning and verification, with emphasis on the underlying patient model and alignment algorithms.

Predicting outcome of patients with high-grade gliomas after radiotherapy using quantitative analysis of T1-weighted magnetic resonance imaging

PURPOSE

The aim of this study was to test the hypothesis that measuring quantitative changes in signal intensity early after radiotherapy (RT) in the contrast-enhancing tumor rim and nonenhancing core may be a noninvasive marker of early treatment response in patients with high-grade gliomas.

METHODS AND MATERIALS

Twenty patients with high-grade gliomas had magnetic resonance imaging (MRI) performed 1 week before RT, during Weeks 1 and 3 of RT, and every 1 to 3 months after RT as part of a clinical prospective study. Regions of interest (ROI) including contrast-enhancing rim, and the nonenhancing core were defined automatically based on a calculated image of post- to precontrast T1-weighted MRI. Pretreatment T1-weighted MRI signal intensity changes were compared with Weeks 1 and 3 RT and 1 and 3 months post-RT MRI. Clinical and MRI parameters were then tested for prediction of overall survival.

RESULTS

Regional T1-weighted signal intensity changes in both the contrast-enhancing rim and the nonenhancing core were observed in all patients during Week 1 and Week 3 of RT. Imaging parameters including signal intensity change within the nonenhancing core after Weeks 1 to 2 RT (p = 0.004), Weeks 3 to 4 RT (p = 0.002) and 1 month after completion of RT (p = 0.002) were predictive of overall survival. Using multivariate analysis including RTOG recursive partitioning analysis (RPA) and signal intensity change, only the signal intensity change in the nonenhancing core at 1 month after RT (p = 0.01) retained significance.

CONCLUSION

Quantitative measurements of T1-weighted MRI signal intensity changes in the nonenhancing tumor core (using ratios of pre-post values) may provide valuable information regarding early response during treatment and improve our ability to predict posttreatment outcome.

Explicit incorporation of prior anatomical information into a nonrigid registration of thoracic and abdominal CT and 18-FDG whole-body emission PET images

The aim of this paper is to develop a registration methodology in order to combine anatomical and functional information provided by thoracic/abdominal computed tomography (CT) and whole-body positron emission tomography (PET) images. The proposed procedure is based on the incorporation of prior anatomical information in an intensity-based nonrigid registration algorithm. This incorporation is achieved in an explicit way, initializing the intensity-based registration stage with the solution obtained by a nonrigid registration of corresponding anatomical structures. A segmentation algorithm based on a hierarchically ordered set of anatomy-specific rules is used to obtain anatomical structures in CT and emission PET scans. Nonrigid deformations are modeled in both registration stages by means of free-form deformations, the optimization of the control points being achieved by means of an original vector field-based approach instead of the classical gradient-based techniques, considerably reducing the computational time of the structure registration stage. We have applied the proposed methodology to 38 sets of images (33 provided by standalone machines and five by hybrid systems) and an assessment protocol has been developed to furnish a qualitative evaluation of the algorithm performance.

Buprenorphine duration of action: mu-opioid receptor availability and pharmacokinetic and behavioral indices

BACKGROUND

Buprenorphine (BUP) is effective in the treatment of opioid dependence when given on alternating days, probably as a result of long-lasting occupation of micro opioid receptors (microORs). This study examined the duration of action of BUP at microORs and correlations with pharmacokinetic and pharmacodynamic outcomes in 10 heroin-dependent volunteers.

METHODS

Availability of microOR (measured with positron emission tomography and [(11)C]-carfentanil), plasma BUP concentration, opioid withdrawal symptoms, and blockade of hydromorphone (HYD; heroin-like agonist) effects were measured at 4, 28, 52, and 76 hours after omitting the 16 mg/d dose of BUP in a study reported elsewhere.

RESULTS

Relative to heroin-dependent volunteers maintained on BUP placebo, whole-brain microOR availability was 30%, 54%, 67%, and 82% at 4, 28, 52, and 76 hours after BUP. Regions of interest showed similar effects. Plasma concentrations of BUP were time dependent, as were withdrawal symptoms, carbon dioxide sensitivity and extent of HYD blockade. Availability of microOR was also correlated with BUP plasma concentration, withdrawal symptoms, and HYD blockade.

CONCLUSIONS

Together with our previous findings, it appears that microOR availability predicts changes in pharmacokinetic and pharmacodynamic measures and that about 50%-60% BUP occupancy is required for adequate withdrawal symptom suppression (in the absence of other opioids) and HYD blockade.

Comparing pairwise and simultaneous joint registrations of decorrelating interval exams using entropic graphs

The interest in registering a set of images has quickly risen in the field of medical image analysis. Mutual information (MI) based methods are well-established for pairwise registration but their extension to higher dimensions (multiple images) has encountered practical implementation difficulties. We extend the use of alpha mutual information (alphaMI) as the similarity measure to simultaneously register multiple images. alphaMI of a set of images can be directly estimated using entropic graphs spanning feature vectors extracted from the images, which is demonstrated to be practically feasible for joint registration. In this paper we are specifically interested in monitoring malignant tumor changes using simultaneous registration of multiple interval MR or CT scans. Tumor scans are typically a decorrelating sequence due to the cycles of heterogeneous cell death and growth. The accuracy of joint and pairwise registration using entropic graph methods is evaluated by registering several sets of interval exams. We show that for the parameters we investigated simultaneous joint registration method yields lower average registration errors compared to pairwise. Different degrees of decorrelation in the serial scans are studied and registration performance suggests that an appropriate scanning interval can be determined for efficiently monitoring lesion changes. Different levels of observation noise are added to the image sequences and the experimental results show that entropic graph based methods are robust and can be used reliably for multiple image registration.

Variations in the human pain stress experience mediated by ventral and dorsal basal ganglia dopamine activity

In addition to its involvement in motor control and in encoding reward value, increasing evidence also implicates basal ganglia dopaminergic mechanisms in responses to stress and aversive stimuli. Basal ganglia dopamine (DA) neurotransmission may then respond to environmental events depending on their saliency, orienting the subsequent responses of the organism to both positive and negative stimuli. Here we examined the involvement of DA neurotransmission in the human response to pain, a robust physical and emotional stressor across species. Positron emission tomography with the DA D2 receptor antagonist radiotracer [11C]raclopride detected significant activation of DA release in dorsal and ventral regions of the basal ganglia of healthy volunteers. Activation of nigrostriatal (dorsal nucleus caudate and putamen) DA D2 receptor-mediated neurotransmission was positively associated with individual variations in subjective ratings of sensory and affective qualities of the pain. In contrast, mesolimbic (nucleus accumbens) DA activation, which may impact on both D2 and D3 receptors, was exclusively associated with variations in the emotional responses of the individual during the pain challenge (increases in negative affect and fear ratings). These data demonstrate that basal ganglia dopamine D2 receptor-mediated neurotransmission is involved in responses to pain and that it contributes to individual variations in the pain experience at the levels of physical and emotional elements, albeit with different neuroanatomical substrates.

Image registration and data fusion in radiation therapy

This paper provides an overview of image registration and data fusion techniques used in radiation therapy, and examples of their use. They are used at all stages of the patient management process; for initial diagnosis and staging, during treatment planning and delivery, and after therapy to help monitor the patients' response to treatment. Most treatment planning systems now support some form of interactive or automated image registration and provide tools for mapping information, such as tissue outlines and computed dose from one imaging study to another. To complement this, modern treatment delivery systems offer means for acquiring and registering 2D and 3D image data at the treatment unit to aid patient setup. Techniques for adapting and customizing treatments during the course of therapy using 3D and 4D anatomic and functional imaging data are currently being introduced into the clinic. These techniques require sophisticated image registration and data fusion technology to accumulate properly the delivered dose and to analyse possible physiological and anatomical changes during treatment. Finally, the correlation of radiological changes after therapy with delivered dose also requires the use of image registration and fusion techniques.