Quantitative MRI: a reliable protocol for measurement of cerebral gyrification using stereology

A stereological assessment method for estimating the surface area of cycloids

OBJECTIVE

In this study, we sought to determine differences in estimations of surface area made by classical vertical uniform random (VUR) section series and vertical section series obtained perpendicular to a fixed horizontal plane.

MATERIALS AND METHODS

One volunteer subject (male, 25 years of age) with no neurological deficit was chosen at random from a bank of controls in the magnetic resonance (MR) image data library of the Department of Radiology. First, a soccer ball with known geometrical features (radius: 9.75 cm) was imaged using a T1-weighted MR scanner at 5-mm thickness (total 40 sections) to test the validity and reliability of surface area and volume measurements obtained via stereological methods. Second, T1-weighted MR section profiles were obtained from a volunteer individual. Surface area and volume estimation procedures were carried out using the Stereo Investigator 6, MicroBright-Field, Inc., USA.

CONCLUSIONS

We determined that there are no differences in either surface area or volume estimations made using VUR sections and direct vertical sections. We have performed an exhaustive series analysis with a variety of objects.

Development and characterization of a Yucatan miniature biomedical pig permanent middle cerebral artery occlusion stroke model

BACKGROUND

Efforts to develop stroke treatments have met with limited success despite an intense need to produce novel treatments. The failed translation of many of these therapies in clinical trials has lead to a close examination of the therapeutic development process. One of the major factors believed to be limiting effective screening of these treatments is the absence of an animal model more predictive of human responses to treatments. The pig may potentially fill this gap with a gyrencephalic brain that is larger in size with a more similar gray-white matter composition to humans than traditional stroke animal models. In this study we develop and characterize a novel pig middle cerebral artery occlusion (MCAO) ischemic stroke model.

METHODS

Eleven male pigs underwent MCAO surgery with the first 4 landrace pigs utilized to optimize stroke procedure and 7 additional Yucatan stroked pigs studied over a 90 day period. MRI analysis was done at 24 hrs and 90 days and included T2w, T2w FLAIR, T1w FLAIR and DWI sequences and associated ADC maps. Pigs were sacrificed at 90 days and underwent gross and microscopic histological evaluation. Significance in quantitative changes was determined by two-way analysis of variance and post-hoc Tukey's Pair-Wise comparisons.

RESULTS

MRI analysis of animals that underwent MCAO surgery at 24 hrs had hyperintense regions in T2w and DWI images with corresponding ADC maps having hypointense regions indicating cytotoxic edema consistent with an ischemic stroke. At 90 days, region of interest analysis of T1 FLAIR and ADC maps had an average lesion size of 59.17 cc, a loss of 8% brain matter. Histological examination of pig brains showed atrophy and loss of tissue, consistent with MRI, as well as glial scar formation and macrophage infiltration.

CONCLUSIONS

The MCAO procedure led to significant and consistent strokes with high survivability. These results suggest that the pig model is potentially a robust system for the study of stroke pathophysiology and potential diagnostics and therapeutics.

Sampling theory and automated simulations for vertical sections, applied to human brain

In recent years, there have been substantial developments in both magnetic resonance imaging techniques and automatic image analysis software. The purpose of this paper is to develop stereological image sampling theory (i.e. unbiased sampling rules) that can be used by image analysts for estimating geometric quantities such as surface area and volume, and to illustrate its implementation. The methods will ideally be applied automatically on segmented, properly sampled 2D images - although convenient manual application is always an option - and they are of wide applicability in many disciplines. In particular, the vertical sections design to estimate surface area is described in detail and applied to estimate the area of the pial surface and of the boundary between cortex and underlying white matter (i.e. subcortical surface area). For completeness, cortical volume and mean cortical thickness are also estimated. The aforementioned surfaces were triangulated in 3D with the aid of FreeSurfer software, which provided accurate surface area measures that served as gold standards. Furthermore, a software was developed to produce digitized trace curves of the triangulated target surfaces automatically from virtual sections. From such traces, a new method (called the 'lambda method') is presented to estimate surface area automatically. In addition, with the new software, intersections could be counted automatically between the relevant surface traces and a cycloid test grid for the classical design. This capability, together with the aforementioned gold standard, enabled us to thoroughly check the performance and the variability of the different estimators by Monte Carlo simulations for studying the human brain. In particular, new methods are offered to split the total error variance into the orientations, sectioning and cycloid components. The latter prediction was hitherto unavailable--one is proposed here and checked by way of simulations on a given set of digitized vertical sections with automatically superimposed cycloid grids of three different sizes. Concrete and detailed recommendations are given to implement the methods.

Volume estimation of the thalamus using freesurfer and stereology: consistency between methods

Freely available automated MR image analysis techniques are being increasingly used to investigate neuroanatomical abnormalities in patients with neurological disorders. It is important to assess the specificity and validity of automated measurements of structure volumes with respect to reliable manual methods that rely on human anatomical expertise. The thalamus is widely investigated in many neurological and neuropsychiatric disorders using MRI, but thalamic volumes are notoriously difficult to quantify given the poor between-tissue contrast at the thalamic gray-white matter interface. In the present study we investigated the reliability of automatically determined thalamic volume measurements obtained using FreeSurfer software with respect to a manual stereological technique on 3D T1-weighted MR images obtained from a 3 T MR system. Further to demonstrating impressive consistency between stereological and FreeSurfer volume estimates of the thalamus in healthy subjects and neurological patients, we demonstrate that the extent of agreeability between stereology and FreeSurfer is equal to the agreeability between two human anatomists estimating thalamic volume using stereological methods. Using patients with juvenile myoclonic epilepsy as a model for thalamic atrophy, we also show that both automated and manual methods provide very similar ratios of thalamic volume loss in patients. This work promotes the use of FreeSurfer for reliable estimation of global volume in healthy and diseased thalami.

Application of stereological methods to estimate post-mortem brain surface area using 3T MRI

The Cavalieri and Vertical Sections methods of design based stereology were applied in combination with 3 tesla (i.e. 3T) Magnetic Resonance Imaging (MRI) to estimate cortical and subcortical volume, area of the pial surface, area of the grey-white matter boundary, and thickness of the cerebral cortex. The material comprises eight human cadaveric cerebri which had been separated into sixteen cerebral hemisphere specimens prior to embedding in agar gel. The results from MRI were compared with corresponding 'gold standard' values subsequently obtained by application of the same methodology using physical sectioning of the specimens. 95% agreement intervals revealed poor agreement between MR imaging and physical sectioning, specially for pial surface and thickness, as well as cerebral cortex and subcortex volumes. On average, pial surface area was estimated to be almost half the extent using MRI compared to physical sectioning (i.e. 45%, p<0.05) and the average thickness of the cerebral cortex was calculated to be much greater (by 60.9%) on the MR images compared to the physical sections (3.7mm versus 2.3mm, p<0.001). The main cause of the discrepancies is that the resolution of the MR images is not sufficient to always allow reliable depiction of the cerebral sulci on 2D image sections. Accurate application of manual stereological methods for measuring the cortical surface area thus requires higher resolution MR imaging than is typically applied at 3T.

Cerebellar asymmetry in a pair of monozygotic handedness-discordant twins

Increasing evidence for a cerebellar role in human cognition has accrued with respect to anatomically and functionally distinct lobules. Questions of laterality, however, have been largely overlooked. This study therefore introduced and applied a novel measurement protocol for comparatively bias-free analysis of cerebellar asymmetries. Volumetric measurements were performed on magnetic resonance images from a single pair of monozygotic handedness-discordant twins. Against a background of functional cortical asymmetry for verbal and visuo-spatial functional magnetic resonance imaging activation, which was mirrored in the left-handed twin (Lux et al. 2008), between-twin differences in cerebellar asymmetry are described. Interestingly, asymmetry measures for the whole cerebellum did not correspond to either the direction of hand preference or to the weaker (functional magnetic resonance imaging) lateralization of the left-handed twin. The twins both showed clockwise cerebellar torques. This mirrored a counter-clockwise cerebral torque in the right-handed twin only. Selected single cerebellar lobules V and VII displayed between-twin laterality differences that partially reflected their discrepant handedness. Whole cerebellum anatomical measures appeared to be unrelated to single functional cortical asymmetries. These analyses contribute further anatomical evidence pertaining to the existence of multiple structurally and functionally distinct cortico-cerebellar networks of the healthy human brain in vivo.

Neuroanatomical correlates of psychosis in temporal lobe epilepsy: voxel-based morphometry study

BACKGROUND

Temporal lobe epilepsy is associated with a significant risk of psychosis but there are only limited studies investigating the underlying neurobiology.

AIMS

To characterise neuroanatomical changes in temporal lobe epilepsy and comorbid psychosis.

METHOD

The study population comprised all individuals with temporal lobe epilepsy on the epilepsy database at the National Centre for Epilepsy and Epilepsy Neurosurgery in Ireland (Beaumont Hospital) between 2002 and 2006. Ten people with temporal lobe epilepsy with psychosis were matched for age, gender, handedness, epilepsy duration, seizure laterality, severity of epilepsy and anti-epileptic medication with ten comparison participants with temporal lobe epilepsy only. Participants received a magnetic resonance imaging scan and voxel-based morphometry analyses were applied to grey and white matter anatomy.

RESULTS

Significant grey matter reduction was found bilaterally in those with temporal lobe epilepsy with psychosis in the temporal lobes in the inferior, middle and superior temporal gyri and fusiform gyri, and unilaterally in the left parahippocampal gyrus and hippocampus. Significant extratemporal grey matter reduction was found bilaterally in the insula, cerebellum, caudate nuclei and in the right cingulum and left inferior parietal lobule. Significant white matter reduction in those with temporal lobe epilepsy with psychosis was found bilaterally in the hippocampus, parahippocampal/fusiform gyri, middle/inferior temporal gyri, cingulum, corpus callosum, posterior thalamic radiation, anterior limb of internal capsule and white matter fibres from the caudate nuclei, and unilaterally in the left lingual gyrus and right midbrain and superior temporal gyrus.

CONCLUSIONS

Significant grey and white matter deficits occur in temporal lobe epilepsy with psychosis. These encompass the medial temporal lobe structures but also extend to lateral temporal and extratemporal regions. Some of these deficits overlap with those found in schizophrenia.

Application of stereological estimates in patients with severe head injuries using CT and MR scanning images

Severe brain damage is often followed by serious complications. Quantitative measurements, such as regional volume and surface area under various conditions, are essential for understanding functional changes in the brain and assessing prognosis. The affected brain tissue is variable, hence traditional imaging methods are not always applicable and automatic methods may not be able to match the individual observer. Stereological techniques are alternative tools in the quantitative description of biological structures, and have been increasingly applied to the human brain. In the present study, we applied stereological techniques to representative CT and MRI brain scans from five patients to describe how stereological methods, when applied to scans of trauma patients, can provide a useful supplement to the estimation of structural brain changes in head injuries. The reliability of the estimates was tested by obtaining repeated intra- and interobserver estimates of selected subdivisions of the brain in patients with acute head injury, as well as in an MR phantom. The estimates of different subdivisions showed a coefficient of variation (CV) below 12% in the patients and below 7% for phantom estimation. The validity of phantom estimates was tested by the average deviation from the true geometric values, and was below 10%. The stereological methods were compared with more traditional region-based methods performed on medical imaging, which showed a CV below 7% and bias below 14%. It is concluded that the stereological estimates may be useful tools in head injury quantification.

Estimation of cerebral surface area using vertical sectioning and magnetic resonance imaging: a stereological study

Stereological techniques using isotropic uniform random and vertical uniform random sections have been used for surface area estimation. However, there are a few studies in which the surface area of the brain is estimated using the vertical section technique in a stereological approach. The objective of the current study was to apply the vertical section technique using cycloid test probes for estimation of cerebral surface area in magnetic resonance imaging (MRI). In this study, cerebral surface areas were estimated in a total of 13 young subjects (6 males, 7 females) who were free of any neurological symptoms and signs. The means (+/-S.D.) of the surface areas were 1619.92+/-140. 97 cm (2), 1625.69+/-147. 58 cm(2) and 1674.69+/-160. 60 cm(2) for 36, 18 and 12 vertical sections, respectively. The mean coefficient of error obtained by applying cycloid test lines that use a 2. 8-cm ratio of area associated with each cycloid was estimated at <7% for the three models. No significant difference was found for each of the 36, 18 and 12 vertical sections (p>0.05). In addition, the three models correlated well with each other. From these results, it is concluded that the vertical section technique is an unbiased, efficient and reliable method and is ideally suited to in vivo examination of MRI data for estimating the surface area of the brain. Hence, we suggest that estimation of surface area using MRI and stereology may be clinically relevant for assessing cortical atrophy as well as for investigating the structure and function of cerebral hemispheres.

MRI-based kidney volume measurements in ADPKD: reliability and effect of gadolinium enhancement

BACKGROUND AND OBJECTIVES

To evaluate the inter- and intrareader reliability and the effect of gadolinium enhancement on kidney volume measurements obtained from pre- and postgadolinium T1 MR images in patients with autosomal dominant polycystic kidney disease (ADPKD).

DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS

Twenty subjects were randomly selected with approximately equal frequency from three kidney-size groups. Pre- and postgadolinium 3D T1 (pre-T1, post-T1) MR images were obtained. The stereology method was applied to segment and measure kidney volumes. The measurement process was repeated at two-wk intervals by two radiologists. Reliability was assessed with correlation coefficients. Intra- and inter-reader bias and measure differences were assessed with paired T-tests. The size effect on the pre- and post-T1 measurements was evaluated with one-way ANOVA.

RESULTS

The intra- and inter-reader reliability was extremely high in all measurements. No systematic intrareader bias but a small inter-reader bias for the post-T1 measurements was observed. All kidney volumes measured on the pre- and post-T1 images were highly correlated with each other for both readers. The post-T1 volumes were significantly higher than pre-T1 volumes. While the post-pre volume differences were relatively constant across the three kidney-size groups, the post-pre percent volume differences were significantly smaller as the size of the kidney increased.

CONCLUSIONS

Kidney volume measurements can be made with minimum intra- and inter-reader variability on both pre- and post-T1 MR images. Kidney volumes measured on the pre-T1 were smaller than those on post-T1, and percent differences between pre-T1 and post-T1 kidney volumes decreased with increasing kidney size.

Left posterior hippocampal density reduction using VBM and stereological MRI procedures in schizophrenia

Structural deficits in the hippocampus have been implicated in the pathophysiology of schizophrenia. However the role played by structural impairments in the hippocampus in the memory deficits of schizophrenic patients remains unclear. Magnetic resonance imaging was used in this study to investigate left, right, anterior and posterior hippocampal volume and density in 28 schizophrenic patients and 33 normal controls. Voxel-based morphometry analysis showed that schizophrenics had significantly lower density in the right and posterior hippocampus than controls. MRI stereological analysis revealed significant differences in left posterior hippocampus than controls. MRI stereological analysis revealed significant differences in anterior and posterior on both sides, with the left posterior region predominating. Schizophrenics showed significant impairments in verbal learning and long term retention (P<0.001). The correlation analyses between hippocampal density and memory variables yielded a significant correlation between forgetting and density of the anterior hippocampus. These findings support the hypothesis of a regional atrophy within the hippocampus in schizophrenic patients.

Cerebral cortical gyrification: a preliminary investigation in temporal lobe epilepsy

PURPOSE

To introduce a measure of global cortical folding in epilepsy by using stereology. Subtle developmental abnormalities associated with temporal lobe epilepsy may encompass brain morphologic changes such as an aberrant degree of cortical folding.

METHODS

Stereologic methods of volume and surface-area estimation were applied to in vivo MR brain-image data of a cohort of 20 temporal lobe epilepsy (TLE) patients (10 men, 10 women), and 20 neurologically normal controls (10 men, 10 women). Indices of cerebral gyrification and cerebral atrophy were generated. The impact of side of seizure onset, age at onset, history of febrile seizures, presence or absence of lesions, and presence or absence of secondarily generalized seizures on cerebral gyrification was assessed.

RESULTS

Although no significant group mean difference was found in the degree of cerebral gyrification between patients and controls, five of 10 of male patients had an abnormal gyrification when compared with male controls. One female patient had a significant change in gyrification compared with female controls. In general, patients with TLE demonstrated a significant degree of global cerebral atrophy compared with controls. Clinical factors were not demonstrated to affect significantly any of the quantitative parameters.

CONCLUSIONS

The results of this study suggest that an aberrant degree of global cerebral gyrification may occur in certain clinical groups of TLE patients. These findings have implications for general theories of developmental susceptibility in TLE.

Stereological evaluation of liver volume in living donor liver transplantation using MDCT via the Cavalieri method

In living donor liver transplantation (LDLT), obtaining the precise volume of the graft is very important to decrease volume-related postoperative complications, especially in cases with suspected small-for size grafts. We used stereology based on the Cavalieri method (CM), a new method to measure liver graft volume, and compared the results with those obtained through intraoperative measurement (IOM) and through multidetector computed tomography (MDCT) measurement. Liver volumes estimated using the 3 methods were well-correlated with each other (r(2) = 0.94 and P < 0.001 for IOM and CM; r(2) = 0.91 and P < 0.001 for IOM and MDCT, and r(2) = 0.95 and P < 0.001 for CM and MDCT); however, they were different from each other (in descending order, 908 +/- 124 cm(2), 861 +/- 121 cm(2), and 777 +/- 168 cm(2) for MDCT, CM, and IOM, respectively). Although MDCT and CM overestimated the volumes, the results of CM were almost similar to those obtained via IOM. In conclusion, our results suggest that CM measured the liver graft volume more reliably. Thus, its use, particularly in cases with suspected small-for-size graft, may prove useful.

MR volumetric measurements of the myomatous uterus: improved reliability of stereology over linear measurements

RATIONALE AND OBJECTIVES

Stereology is a simple, fast method for object segmentation that involves counting the number of intersections of a randomly positioned grid over an object. The objectives of this study were to determine observer reliability in making stereologic- and ellipsoid-based measurements of uterine and leiomyoma volumes and to test the agreement between these two methods of measurement.

MATERIALS AND METHODS

Two observers made uterine and dominant leiomyoma volume measurements on MR images in 30 patients using stereology and the popular ellipsoid-based technique. Stereologic volume measurements were made from high-resolution T2 images in two perpendicular planes (axial and sagittal). Ellipsoid volume was calculated by multiplying the maximal sagittal, anteroposterior, and transverse dimensions by pi/6. For these measurements, interobserver reliability was tested with paired t-tests and percent differences were determined. A mean stereologic volume and a mean ellipsoid volume were determined and tested for agreement with a paired t-test. Percent differences were also calculated.

RESULTS

Stereologic measurements demonstrated excellent interobserver reliability with 0.3% difference in mean uterine volumes (P = .69) and 0.3% difference (P = .81) in mean leiomyoma volumes. The ellipsoid method resulted in poorer interobserver reliability with 7% difference (P = .01) in mean uterine volumes and 4% difference (p = .24) in mean leiomyoma volumes. The ellipsoid method also significantly overestimated uterine volumes by 14% (P < .01) compared with stereology.

CONCLUSION

Stereology provided high interobserver reliability for leiomyoma and overall uterine volume measurements and was more reliable than the ellipsoid method, which uses linear measurements. Stereology appears well suited when precise volume measurements are desired for assessing response to uterine arterial embolization treatments.

Longitudinal magnetic resonance imaging study of rhesus monkey brain development

To examine early brain development, T1-weighted structural MRI scans of seven rhesus monkeys (Macaca mulatta) were obtained longitudinally between the ages of 1 week and 4 years at 12 age points. Total brain volume, calculated at each age point, increased significantly, by 56%, between 1 week and 4 years. The greatest increase of 22% occurred between 1 week and 1 month, followed by further significant increases between 1 and 2 months, and 3 and 4 months. Gradually smaller increases continued up to 3 years with no further significant changes thereafter. A robust maturation of white matter occurred between 1 week, at which the only easily identifiable fibre tracts were internal capsule and optic radiations, and 3 months, at which most large fibre tracts were visible; only at this age reproducible measurements were possible for all cases. White matter volume increased by 126% between 3 months and 4 years, with the biggest increase between 3 and 4 months (32%) followed by smaller but significant increases up to 4 years. The macaque brain development parallels that of humans by reaching the maximum in total brain volume around the age of sexual maturity (in macaques 3-4 years) and by the increases in white matter continuing beyond this age. The most rapid growth in both total brain volume and white matter from birth to approximately 4 months is consistent with the emergence of various cognitive abilities in macaques at that age.

Stereological evaluation of treatment response in patients with non-resectable hepatic alveolar echinococcosis using computed tomography via the Cavalieri method

INTRODUCTION

The purposes of this study were to describe and adapt the relevant methods of computed tomography (CT) and stereology to estimate parasitic volume in the liver, to compare the efficiency of benzimidazole treatment in hepatic alveolar echinococcosis (AE), and to determine whether the response rates measured by the stereological method are correlated with those measured by simple volumetric measurements (SVM).

METHODS

Nine eligible patients with non-resectable AE were included in the study. By using their abdominal CT at the baseline and after a year of treatment, treatment responses of the cases were evaluated both by the stereological method via a software and by SVM, retrospectively. The volume estimation was performed in our study using a different approach that consisted of three separate stages combined with the Cavalieri method of modern design stereology.

RESULTS

The response rates were -17 +/- 55% and -12 +/- 37% by the Cavalieri method and SVM, respectively; however, they were not statistically significant (P = 0.59 and 0.21 for the Cavalieri method and SVM, respectively). Although some cases had comparable results, others had different response rates, and the two methods showed no significant correlation (r = -0.31, P = 0.41).

CONCLUSIONS

Because this modified method provides accurate results by reducing margin of errors, even in case of bizarre shape of AE, a correct, unbiased, and reliable management of the cases with AE via this method may be possible. Owing to lack of a correlation with SVM, it is suggested that a measurement via SVM may be wrong and its use in the evaluation of the treatment response in such cases will not be sufficient and completely true.