Semi-automatic segmentation for 3D motion analysis of the tongue with dynamic MRI

Quantification of gastric emptying with magnetic resonance imaging in healthy volunteers: A systematic review

BACKGROUND

Several magnetic resonance imaging (MRI) protocols have been used to assess gastric emptying (GE) with MRI. This systematic review summarizes the current literature on the topic. The aim was to provide an overview of the available imaging protocols and underline the items that appear most agreed upon and those that deserve further investigation.

METHODS

According to PRISMA guidelines, two independent reviewers conducted a systematic literature search with a pre-specified strategy in different databases. Peer-reviewed articles that utilized MRI techniques to assess GE in healthy volunteers (HVs) were included. The quality and the outcomes of the studies were reported and analyzed.

KEY RESULTS

The literature search yielded 30 studies (531 HVs, weighted mean age 27.4, weighted mean body mass index 23.0 kg/m² ), T2-weighted sequences, balanced turbo field echo, and balanced gradient echo were evenly utilized, with volunteers in the supine position (74% of the studies). After overnight fasting, both liquid (56%) and mixed (44%) meals were equally utilized. Segmentation of the volumes was predominantly performed manually (63%) with a reported mean T50 ranging from 7 to 330 min.

CONCLUSIONS & INFERENCES

As observed in this systematic review, MRI is a flexible tool for assessing GE. Different protocols were analyzed, showing an equal capacity to assess the GE. However, many items in these protocols still require further investigation to obtain a common standard and increase this assessment quality.

Characterization of surface motion patterns in highly deformable soft tissue organs from dynamic MRI: An application to assess 4D bladder motion

BACKGROUND AND OBJECTIVES

Dynamic Magnetic Resonance Imaging (MRI) may capture temporal anatomical changes in soft tissue organs with high-contrast but the obtained sequences usually suffer from limited volume coverage which makes the high-resolution reconstruction of organ shape trajectories a major challenge in temporal studies. Because of the variability of abdominal organ shapes across time and subjects, the objective of the present study is to go towards 3D dense velocity measurements to fully cover the entire surface and to extract meaningful features characterizing the observed organ deformations and enabling clinical action or decision.

METHODS

We present a pipeline for characterization of bladder surface dynamics during deep respiratory movements. For a compact shape representation, the reconstructed temporal volumes were first used to establish subject-specific dynamical 4D mesh sequences using the large deformation diffeomorphic metric mapping (LDDMM) framework. Then, we performed a statistical characterization of organ dynamics from mechanical parameters such as mesh elongations and distortions. Since we refer to organs as non-flat surfaces, we have also used the mean curvature change as metric to quantify surface evolution. However, the numerical computation of curvature is strongly dependant on the surface parameterization (i.e. the mesh resolution). To cope with this dependency, we employed a non-parametric method for surface deformation analysis. Independent of parameterization and minimizing the length of the geodesic curves, it stretches smoothly the surface curves towards a sphere by minimizing a Dirichlet energy. An Eulerian PDE approach is used to derive a shape descriptor from the curve-shortening flow. Intercorrelations between individuals' motion patterns are computed using the Laplace-Beltrami Operator (LBO) eigenfunctions for spherical mapping.

RESULTS

Application to extracting characterization correlation curves for locally-controlled simulated shape trajectories demonstrates the stability of the proposed shape descriptor. Its usability was shown on MRI acquired for seven healthy participants for which the bladder was highly deformed by maximum of inspiration. As expected, the study showed that deformations occured essentially on the top lateral regions.

CONCLUSION

Promising results were obtained, showing the organ in its 3D complexity during deformation due to strain conditions. Smooth genus-0 manifold reconstruction from sparse dynamic MRI data is employed to perform a statistical shape analysis for the determination of bladder deformation.

Short and Long-Term Innovations on Dietary Behavior Assessment and Coaching: Present Efforts and Vision of the Pride and Prejudice Consortium

Overweight, obesity and cardiometabolic diseases are major global health concerns. Lifestyle factors, including diet, have been acknowledged to play a key role in the solution of these health risks. However, as shown by numerous studies, and in clinical practice, it is extremely challenging to quantify dietary behaviors as well as influencing them via dietary interventions. As shown by the limited success of 'one-size-fits-all' nutritional campaigns catered to an entire population or subpopulation, the need for more personalized coaching approaches is evident. New technology-based innovations provide opportunities to further improve the accuracy of dietary assessment and develop approaches to coach individuals towards healthier dietary behaviors. Pride & Prejudice (P&P) is a unique multi-disciplinary consortium consisting of researchers in life, nutrition, ICT, design, behavioral and social sciences from all four Dutch Universities of Technology. P&P focuses on the development and integration of innovative technological techniques such as artificial intelligence (AI), machine learning, conversational agents, behavior change theory and personalized coaching to improve current practices and establish lasting dietary behavior change.

Detection of prostate cancer with multiparametric MRI utilizing the anatomic structure of the prostate

Multiparametric magnetic resonance imaging (mpMRI), which combines traditional anatomic and newer quantitative MRI methods, has been shown to result in improved voxel-wise classification of prostate cancer as compared with any single MRI parameter. While these results are promising, substantial heterogeneity in the mpMRI parameter values and voxel-wise prostate cancer risk has been observed both between and within regions of the prostate. This suggests that classification of prostate cancer can potentially be improved by incorporating structural information into the classifier. In this paper, we propose a novel voxel-wise classifier of prostate cancer that accounts for the anatomic structure of the prostate by Bayesian hierarchical modeling, which can be combined with post hoc spatial Gaussian kernel smoothing to account for residual spatial correlation. Our proposed classifier results in significantly improved area under the ROC curve (0.822 vs 0.729, P < .001) and sensitivity corresponding to 90% specificity (0.599 vs 0.429, P < .001), compared with a baseline model that does not account for the anatomic structure of the prostate. Furthermore, the classifier can also be applied on voxels with missing mpMRI parameters, resulting in similar performance, which is an important practical consideration that cannot be easily accommodated using regression-based classifiers. In addition, our classifier achieved high computational efficiency with a closed-form solution for the posterior predictive cancer probability.

The Effects of Palate Features and Glossectomy Surgery on /s/ Production

PURPOSE

The aims of this article were to determine the effects of hard palate morphology and glossectomy surgery on tongue position and shape during /s/ for patients with small tumors. The first expectation was that laminal /s/ would be more prevalent in patients, than apical, due to reduced tongue tip control after surgery. The second was that patients would hold the tongue more anteriorly than controls to compensate for reduced tongue mass.

METHOD

Three-dimensional tongue volumes were calculated from magnetic resonance imaging for the whole tongue and the portion anterior to the first molar during the /s/ in /əsuk/ for 21 controls and 14 patients. These volumes were used to calculate tongue anteriority and cross-sectional shape. Dental casts were used to measure palate perimeter, height, and width of the hard palate.

RESULTS

Palate height correlated with tongue height in controls (p < .05), but not patients. In patients, tongue anteriority correlated negatively with canine width and cross-sectional tongue shape (p < .05). Controls with a high palate favored laminal /s/. Patients preferred laminal /s/ regardless of palate height (p < .01).

CONCLUSIONS

For controls, hard palate height affected tongue height; a higher palate yielded a higher tongue. For patients, hard palate width affected tongue width; a narrower palate yielded a more anterior tongue. Tongue shape was unaffected by any palate features. Preference for /s/ showed an interaction effect between subject and palate height. Controls with high palates preferred a laminal /s/. All patients preferred a laminal /s/; glossectomy surgery may reduce tongue tip control.

Tongue movement during articulation in magnetic resonance imaging: Findings in 20 healthy volunteers and a patient with anterior floor of the mouth squamous cell carcinoma

PURPOSE

Combined ablative and reconstructive oral maxillofacial surgery involves a multitude of anatomical and functional structures for speech and swallowing. Although there are a few methods to objectively examine swallowing function, this is not true for speech. We describe the development of an objective visualization and measurement tool for magnetic resonance imaging (MRI) to evaluate speech and its first application in a patient.

MATERIAL AND METHODS

A total of 20 healthy patients and one patient with squamous cell carcinoma localized in the anterior floor of the mouth were included in the study. Examination included an MRI examination of a paced, defined set of fictive words representing all sounds of the German language. The patient underwent MRI preoperatively and 1, 3, 6 and 12 months postoperatively. MRI findings were correlated with speech intelligibility.

RESULTS

In sagittal planes, the correct identification of vowels and consonants was feasible and showed a high accordance between two independent observers and repetitions. Measurements for the patient showed significant deviations 1 month postoperatively but gradually decreased over time. Aberrant values were persistent for sound /s/. Findings correlated with clinical findings of speech intelligibility.

CONCLUSION

The presented tool seems to be promising for evaluating articulation in (tumor) patients.

Phase Vector Incompressible Registration Algorithm for Motion Estimation From Tagged Magnetic Resonance Images

Tagged magnetic resonance imaging has been used for decades to observe and quantify motion and strain of deforming tissue. It is challenging to obtain 3-D motion estimates due to a tradeoff between image slice density and acquisition time. Typically, interpolation methods are used either to combine 2-D motion extracted from sparse slice acquisitions into 3-D motion or to construct a dense volume from sparse acquisitions before image registration methods are applied. This paper proposes a new phase-based 3-D motion estimation technique that first computes harmonic phase volumes from interpolated tagged slices and then matches them using an image registration framework. The approach uses several concepts from diffeomorphic image registration with a key novelty that defines a symmetric similarity metric on harmonic phase volumes from multiple orientations. The material property of harmonic phase solves the aperture problem of optical flow and intensity-based methods and is robust to tag fading. A harmonic magnitude volume is used in enforcing incompressibility in the tissue regions. The estimated motion fields are dense, incompressible, diffeomorphic, and inverse-consistent at a 3-D voxel level. The method was evaluated using simulated phantoms, human brain data in mild head accelerations, human tongue data during speech, and an open cardiac data set. The method shows comparable accuracy to three existing methods while demonstrating low computation time and robustness to tag fading and noise.

Test-retest repeatability of human speech biomarkers from static and real-time dynamic magnetic resonance imaging

Static anatomical and real-time dynamic magnetic resonance imaging (RT-MRI) of the upper airway is a valuable method for studying speech production in research and clinical settings. The test-retest repeatability of quantitative imaging biomarkers is an important parameter, since it limits the effect sizes and intragroup differences that can be studied. Therefore, this study aims to present a framework for determining the test-retest repeatability of quantitative speech biomarkers from static MRI and RT-MRI, and apply the framework to healthy volunteers. Subjects (n = 8, 4 females, 4 males) are imaged in two scans on the same day, including static images and dynamic RT-MRI of speech tasks. The inter-study agreement is quantified using intraclass correlation coefficient (ICC) and mean within-subject standard deviation (σ_e). Inter-study agreement is strong to very strong for static measures (ICC: min/median/max 0.71/0.89/0.98, σ_e: 0.90/2.20/6.72 mm), poor to strong for dynamic RT-MRI measures of articulator motion range (ICC: 0.26/0.75/0.90, σ_e: 1.6/2.5/3.6 mm), and poor to very strong for velocities (ICC: 0.21/0.56/0.93, σ_e: 2.2/4.4/16.7 cm/s). In conclusion, this study characterizes repeatability of static and dynamic MRI-derived speech biomarkers using state-of-the-art imaging. The introduced framework can be used to guide future development of speech biomarkers. Test-retest MRI data are provided free for research use.

Analysis of 3-D Tongue Motion From Tagged and Cine Magnetic Resonance Images

PURPOSE

Measuring tongue deformation and internal muscle motion during speech has been a challenging task because the tongue deforms in 3 dimensions, contains interdigitated muscles, and is largely hidden within the vocal tract. In this article, a new method is proposed to analyze tagged and cine magnetic resonance images of the tongue during speech in order to estimate 3-dimensional tissue displacement and deformation over time.

METHOD

The method involves computing 2-dimensional motion components using a standard tag-processing method called harmonic phase, constructing superresolution tongue volumes using cine magnetic resonance images, segmenting the tongue region using a random-walker algorithm, and estimating 3-dimensional tongue motion using an incompressible deformation estimation algorithm.

RESULTS

Evaluation of the method is presented with a control group and a group of people who had received a glossectomy carrying out a speech task. A 2-step principal-components analysis is then used to reveal the unique motion patterns of the subjects. Azimuth motion angles and motion on the mirrored hemi-tongues are analyzed.

CONCLUSION

Tests of the method with a various collection of subjects show its capability of capturing patient motion patterns and indicate its potential value in future speech studies.

A Spatio-Temporal Atlas and Statistical Model of the Tongue During Speech from Cine-MRI

Statistical modeling of tongue motion during speech using cine magnetic resonance imaging (MRI) provides key information about the relationship between structure and motion of the tongue. In order to study the variability of tongue shape and motion in populations, a consistent integration and characterization of inter-subject variability is needed. In this paper, a method to construct a spatio-temporal atlas comprising a mean motion model and statistical modes of variation during speech is presented. The model is based on the cine-MRI from twenty two normal speakers and consists of several steps involving both spatial and temporal alignment problems independently. First, all images are registered into a common reference space, which is taken to be a neutral resting position of the tongue. Second, the tongue shapes of each individual relative to this reference space are produced. Third, a time warping approach (several are evaluated) is used to align the time frames of each subject to a common time series of initial mean images. Finally, the spatio-temporal atlas is created by time-warping each subject, generating new mean images at each time, and producing shape statistics around these mean images using principal component analysis at each reference time frame. Experimental results consist of comparison of various parameters and methods in creation of the atlas and a demonstration of the final modes of variations at various key time frames in a sample phrase.

Structure and variability in human tongue muscle anatomy

The human tongue has a complex architecture, consistent with its complex roles in eating, speaking and breathing. Tongue muscle architecture has been depicted in drawings and photographs, but not quantified volumetrically. This paper aims to fill that gap by measuring the muscle architecture of the tongue for 14 people captured in high-resolution 3D MRI volumes. The results show the structure, relationships and variability among the muscles, as well as the effects of age, gender and weight on muscle volume. Since the tongue consists of partially interdigitated muscles, we consider the muscle volumes in two ways. The functional muscle volume encompasses the region of the tongue served by the muscle. The structural volume halves the volume of the muscle in regions where it interdigitates with other muscles. Results show similarity of scaling across subjects, and speculate on functional effects of the anatomical structure.

Atlas-Based Automatic Generation of Subject-Specific Finite Element Tongue Meshes

Generation of subject-specific 3D finite element (FE) models requires the processing of numerous medical images in order to precisely extract geometrical information about subject-specific anatomy. This processing remains extremely challenging. To overcome this difficulty, we present an automatic atlas-based method that generates subject-specific FE meshes via a 3D registration guided by Magnetic Resonance images. The method extracts a 3D transformation by registering the atlas' volume image to the subject's one, and establishes a one-to-one correspondence between the two volumes. The 3D transformation field deforms the atlas' mesh to generate the subject-specific FE mesh. To preserve the quality of the subject-specific mesh, a diffeomorphic non-rigid registration based on B-spline free-form deformations is used, which guarantees a non-folding and one-to-one transformation. Two evaluations of the method are provided. First, a publicly available CT-database is used to assess the capability to accurately capture the complexity of each subject-specific Lung's geometry. Second, FE tongue meshes are generated for two healthy volunteers and two patients suffering from tongue cancer using MR images. It is shown that the method generates an appropriate representation of the subject-specific geometry while preserving the quality of the FE meshes for subsequent FE analysis. To demonstrate the importance of our method in a clinical context, a subject-specific mesh is used to simulate tongue's biomechanical response to the activation of an important tongue muscle, before and after cancer surgery.

Construction of An Unbiased Spatio-Temporal Atlas of the Tongue During Speech

Quantitative characterization and comparison of tongue motion during speech and swallowing present fundamental challenges because of striking variations in tongue structure and motion across subjects. A reliable and objective description of the dynamics tongue motion requires the consistent integration of inter-subject variability to detect the subtle changes in populations. To this end, in this work, we present an approach to constructing an unbiased spatio-temporal atlas of the tongue during speech for the first time, based on cine-MRI from twenty two normal subjects. First, we create a common spatial space using images from the reference time frame, a neutral position, in which the unbiased spatio-temporal atlas can be created. Second, we transport images from all time frames of all subjects into this common space via the single transformation. Third, we construct atlases for each time frame via groupwise diffeomorphic registration, which serves as the initial spatio-temporal atlas. Fourth, we update the spatio-temporal atlas by realigning each time sequence based on the Lipschitz norm on diffeomorphisms between each subject and the initial atlas. We evaluate and compare different configurations such as similarity measures to build the atlas. Our proposed method permits to accurately and objectively explain the main pattern of tongue surface motion.

From CT scanning to 3-D printing technology for the preoperative planning in laparoscopic splenectomy

BACKGROUND

Three-dimensional printing technology is rapidly changing the way we produce all sort of objects, having also included medical applications. We embarked in a pilot study to assess the value of patient-specific 3-D physical manufacturing of spleno-pancreatic anatomy in helping during patient's counseling and for preoperative planning.

METHODS

Twelve patients scheduled for a laparoscopic splenectomy underwent contrast CT and subsequent post-processing to create virtual 3-D models of the target anatomy, and 3-D printing of the relative solid objects. The printing process, its cost and encountered problems were monitored and recorded. Patients were asked to rate the value of 3-D objects on a 1-5 scale in facilitating their understanding of the proposed procedure. Also 10 surgical residents were required to evaluate the perceived extra value of 3-D printing in the preoperative planning process.

RESULTS

The post-processing analysis required an average of 2; 20 h was needed to physically print each model and 4 additional hours to finalize each object. The cost for the material employed for each object was around 300 euros. Ten patients gave a score of 5, two a score of 4. Six residents gave a score of 5, four a score of 4.

CONCLUSIONS

Three-dimensional printing is helpful in understanding complex anatomy for educational purposes at all levels. Cost and working time to produce good quality objects are still considerable.