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Patel Y, Sharp I, Enocson L, Khambay BS. An innovative analysis of nasolabial dynamics of surgically managed adult patients with unilateral cleft lip and palate using 3D facial motion capture. J Plast Reconstr Aesthet Surg 2023; 85:287-298. [PMID: 37541045 DOI: 10.1016/j.bjps.2023.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 06/30/2023] [Accepted: 07/04/2023] [Indexed: 08/06/2023]
Abstract
AIM To compare dynamic nasolabial movement between end-of-treatment cleft and a matched non-cleft group in adult patients. MATERIALS AND METHODS Thirteen treated adult participants with unilateral cleft lip and palate had images taken using a facial motion capture system performing a maximum smile. Seventeen landmarks were automatically tracked. For each landmark pair, on either side of the midline, changes in the x, y, and z directions were used to analyze the magnitude of displacement and path of motion. An asymmetry score was developed at rest, mid-smile, and maximum smile to assess the shape of the mouth and/or nose. RESULTS At maximum smile, displacement of right and left cheilion was clinically and statistically (p < 0.05) less in the cleft group. The lip asymmetry score was greater (p < 0.05) at each time point in the cleft group using the clinical midline. Using Procrustes superimposition, the differences were significant (p < 0.05) only at rest and mid-smile. The alar bases were displaced significantly less (p < 0.05) in the z direction in the cleft group. The asymmetry score of the alar base was significantly higher using the clinical midline than using Procrustes superimposition in patients with cleft conditions (p < 0.001). In the cleft group, at maximum smile, the right and left cristae philter moved significantly less (p < 0.05) in the x and z directions. CONCLUSIONS There was an increase in asymmetry score of the corners of the mouth and alar bases from rest to maximum smile. The lips were similar in shape but oriented differently in the faces of patients with cleft conditions than in individuals without those conditions.
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Affiliation(s)
- Y Patel
- Institute of Clinical Sciences, College of Medical and Dental Sciences, The School of Dentistry, University of Birmingham, UK
| | - I Sharp
- Department of Oral and Maxillofacial Surgery, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, UK
| | - L Enocson
- Department of Oral and Maxillofacial Surgery, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, UK
| | - B S Khambay
- Institute of Clinical Sciences, College of Medical and Dental Sciences, The School of Dentistry, University of Birmingham, UK.
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Katina S, Vittert L, W. Bowman A. Functional data analysis and visualisation of three-dimensional surface shape. J R Stat Soc Ser C Appl Stat 2021; 70:691-713. [PMID: 34690375 PMCID: PMC8518487 DOI: 10.1111/rssc.12482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 11/19/2020] [Accepted: 02/15/2021] [Indexed: 11/30/2022]
Abstract
The advent of high-resolution imaging has made data on surface shape widespread. Methods for the analysis of shape based on landmarks are well established but high-resolution data require a functional approach. The starting point is a systematic and consistent description of each surface shape and a method for creating this is described. Three innovative forms of analysis are then introduced. The first uses surface integration to address issues of registration, principal component analysis and the measurement of asymmetry, all in functional form. Computational issues are handled through discrete approximations to integrals, based in this case on appropriate surface area weighted sums. The second innovation is to focus on sub-spaces where interesting behaviour such as group differences are exhibited, rather than on individual principal components. The third innovation concerns the comparison of individual shapes with a relevant control set, where the concept of a normal range is extended to the highly multivariate setting of surface shape. This has particularly strong applications to medical contexts where the assessment of individual patients is very important. All of these ideas are developed and illustrated in the important context of human facial shape, with a strong emphasis on the effective visual communication of effects of interest.
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Affiliation(s)
- Stanislav Katina
- Institute of Mathematics & StatisticsMasaryk UniversityBrnoCzech Republic
- Institute of Computer Science of the Czech Academy of SciencesPragueCzech Republic
| | - Liberty Vittert
- Olin Business SchoolWashington University in St. LouisSt. LouisMOUSA
| | - Adrian W. Bowman
- School of Mathematics & StatisticsThe University of GlasgowGlasgowUK
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Varón-González C, Navarro N. Epistasis regulates the developmental stability of the mouse craniofacial shape. Heredity (Edinb) 2019; 122:501-512. [PMID: 30209292 PMCID: PMC6461946 DOI: 10.1038/s41437-018-0140-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Revised: 07/13/2018] [Accepted: 07/14/2018] [Indexed: 12/19/2022] Open
Abstract
Fluctuating asymmetry is a classic concept linked to organismal development. It has traditionally been used as a measure of developmental instability, which is the inability of an organism to buffer environmental fluctuations during development. Developmental stability has a genetic component that influences the final phenotype of the organism and can lead to congenital disorders. According to alternative hypotheses, this genetic component might be either the result of additive genetic effects or a by-product of developmental gene networks. Here we present a genome-wide association study of the genetic architecture of fluctuating asymmetry of the skull shape in mice. Geometric morphometric methods were applied to quantify fluctuating asymmetry: we estimated fluctuating asymmetry as Mahalanobis distances to the mean asymmetry, correcting first for genetic directional asymmetry. We applied the marginal epistasis test to study epistasis among genomic regions. Results showed no evidence of additive effects but several interacting regions significantly associated with fluctuating asymmetry. Among the candidate genes overlapping these interacting regions we found an over-representation of genes involved in craniofacial development. A gene network is likely to be associated with skull developmental stability, and genes originally described as buffering genes (e.g., Hspa2) might occupy central positions within these networks, where regulatory elements may also play an important role. Our results constitute an important step in the exploration of the molecular roots of developmental stability and the first empirical evidence about its genetic architecture.
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Affiliation(s)
- Ceferino Varón-González
- Biogéosciences, UMR CNRS 6282, Université Bourgogne Franche-Comté, 6 Bd Gabriel, 21000, Dijon, France
| | - Nicolas Navarro
- Biogéosciences, UMR CNRS 6282, Université Bourgogne Franche-Comté, 6 Bd Gabriel, 21000, Dijon, France.
- EPHE, PSL University, 6 Bd Gabriel, 21000, Dijon, France.
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Fluctuating asymmetry of dynamic smiles in normal individuals. Int J Oral Maxillofac Surg 2019; 48:1372-1379. [PMID: 30940397 DOI: 10.1016/j.ijom.2019.01.032] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2018] [Revised: 12/17/2018] [Accepted: 01/29/2019] [Indexed: 11/22/2022]
Abstract
The aim of this study was to quantify the fluctuating dynamic facial asymmetry during smiling in a group of 'normal' adults, using three-dimensional (3D) motion facial capture technology. Fifty-four male and 54 female volunteers were recruited. Each subject was imaged using a passive markerless 3D motion capture system (DI4D). Eighteen landmarks were tracked through the 3D capture sequence. A facial asymmetry score was calculated based on either a clinically derived midline or Procrustes alignment; scores were based on the Euclidean distance between landmark pairs. Facial asymmetry scores were determined at three time points: rest, median, and maximum frame. Based on the clinically derived midline and on Procrustes alignment, the differences between male and female volunteers, as well as those at the three different time points, were not clinically significant. However, throughout a smile, facial and lip asymmetry scores increased over the duration of the smile. Fluctuating facial asymmetry exists within individuals, as well as between individuals. Procrustes superimposition and the clinically derived midline produced similar asymmetry scores and both are valid for symmetrical faces. However, with facial asymmetry, Procrustes superimposition may not be a valid measure, and the use of the clinically derived midline may be more appropriate, although this requires further investigation.
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Vittert L, Katina S, Ayoub A, Khambay B, Bowman AW. Assessing the outcome of orthognathic surgery by three-dimensional soft tissue analysis. Int J Oral Maxillofac Surg 2018; 47:1587-1595. [PMID: 29933911 PMCID: PMC6234045 DOI: 10.1016/j.ijom.2018.05.024] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Revised: 04/26/2018] [Accepted: 05/30/2018] [Indexed: 11/28/2022]
Abstract
Studies of orthognathic surgery often focus on pre-surgical versus post-surgical changes in facial shape. In contrast, this study provides an innovative comparison between post-surgical and control shape. Forty orthognathic surgery patients were included, who underwent three different types of surgical correction: Le Fort I maxillary advancement, bilateral sagittal split mandibular advancement, and bimaxillary advancement surgery. Control facial images were captured from volunteers from local communities in Glasgow, with patterns of age, sex, and ethnic background that matched those of the surgical patients. Facial models were fitted and Procrustes registration and principal components analysis used to allow quantitative analysis, including the comparison of group mean shape and mean asymmetry. The primary characteristic of the difference in shape was found to be residual mandibular prognathism in the group of female patients who underwent Le Fort I maxillary advancement. Individual cases were assessed against this type of shape difference, using a quantitative scale to aid clinical audit. Analysis of the combined surgical groups provided strong evidence that surgery reduces asymmetry in some parts of the face such as the upper lip region. No evidence was found that mean asymmetry in post-surgical patients is greater than that in controls.
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Affiliation(s)
- L Vittert
- School of Mathematics and Statistics, The University of Glasgow, Glasgow, UK
| | - S Katina
- Institute of Mathematics and Statistics, Masaryk University, Brno, Czech Republic
| | - A Ayoub
- Glasgow Dental Hospital and School, The University of Glasgow, Glasgow, UK
| | - B Khambay
- School of Dentistry, University of Birmingham, Birmingham, UK
| | - A W Bowman
- School of Mathematics and Statistics, The University of Glasgow, Glasgow, UK.
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Wong KWF, Keeling A, Achal K, Khambay B. Using three-dimensional average facial meshes to determine nasolabial soft tissue deformity in adult UCLP patients. Surgeon 2018; 17:19-27. [PMID: 29880431 DOI: 10.1016/j.surge.2018.04.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Revised: 04/21/2018] [Accepted: 04/30/2018] [Indexed: 01/28/2023]
Abstract
BACKGROUND AND PURPOSE There is limited literature discussing the residual nasolabial deformity of adult patients prior to undergoing orthognathic surgery. The purpose of this study is to determine the site and severity of the residual nasolabial soft tissue deformity between adult unilateral cleft lip and palate (UCLP) patients and a non-cleft reference group, prior to orthognathic surgery. MATERIAL AND METHODS Sixteen adult male UCLP patients, who all received primary lip and palate surgery according to a standardised Hong Kong protocol were recruited for this study. Facial images of each individual were captured using three-dimensional (3D) stereophotogrammetry and compared to a previous published Hong Kong non-cleft reference group of 48 male adults. Using two-sample t-tests differences in linear and angular measurements and asymmetry scores were evaluated between the two groups. In addition a "conformed" average UCLP facial template was superimposed and compared to conformed average non-cleft reference group facial template. Reproducibility of the measurements were assessed using Students paired t-tests and coefficients of reliability. MAIN FINDINGS Significant differences in linear and angular measurements and asymmetry scores were observed between the two groups (p < 0.05). Adult UCLP patients showed significantly narrower nostril floor widths, longer columella length on the unaffected side, a wider nose, shorter cutaneous lip height, shorter upper lip length and shorter philtrum length. Prior to orthognathic surgery adult UCLP patients showed significantly more facial asymmetry. Superimposition of the average facial meshes clearly showed the site and severity of the deficiency in the x, y and z-directions. CONCLUSIONS Many of the nasolabial characteristics reported to be present in children following primary UCLP repair continue into adulthood. The detrimental soft tissue effects of orthognathic surgery for UCLP patients may be different to non-cleft individuals; and as such the site and severity of the residual deformity should be assessed prior to surgery.
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Affiliation(s)
- Ka Wai Frank Wong
- Paediatric Dentistry and Orthodontics, Faculty of Dentistry, The University of Hong Kong, 34 Hospital Road, Sai Ying Pun, Hong Kong
| | - Andrew Keeling
- School of Dentistry, University of Leeds, Worsley Building, Leeds LS2 9NL, UK
| | - Kulraj Achal
- School of Dentistry, University of Leeds, Worsley Building, Leeds LS2 9NL, UK
| | - Balvinder Khambay
- Paediatric Dentistry and Orthodontics, Faculty of Dentistry, The University of Hong Kong, 34 Hospital Road, Sai Ying Pun, Hong Kong; Institute of Clinical Sciences, College of Medical and Dental Sciences, The School of Dentistry, University of Birmingham, 5 Mill Pool Way, Edgbaston, Birmingham, B5 7EG, UK.
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The Application of Three-Dimensional Surface Imaging System in Plastic and Reconstructive Surgery. Ann Plast Surg 2016; 77 Suppl 1:S76-83. [DOI: 10.1097/sap.0000000000000813] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Katina S, McNeil K, Ayoub A, Guilfoyle B, Khambay B, Siebert P, Sukno F, Rojas M, Vittert L, Waddington J, Whelan PF, Bowman AW. The definitions of three-dimensional landmarks on the human face: an interdisciplinary view. J Anat 2015; 228:355-65. [PMID: 26659272 PMCID: PMC4832301 DOI: 10.1111/joa.12407] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/05/2015] [Indexed: 11/29/2022] Open
Abstract
The analysis of shape is a key part of anatomical research and in the large majority of cases landmarks provide a standard starting point. However, while the technology of image capture has developed rapidly and in particular three‐dimensional imaging is widely available, the definitions of anatomical landmarks remain rooted in their two‐dimensional origins. In the important case of the human face, standard definitions often require careful orientation of the subject. This paper considers the definitions of facial landmarks from an interdisciplinary perspective, including biological and clinical motivations, issues associated with imaging and subsequent analysis, and the mathematical definition of surface shape using differential geometry. This last perspective provides a route to definitions of landmarks based on surface curvature, often making use of ridge and valley curves, which is genuinely three‐dimensional and is independent of orientation. Specific definitions based on curvature are proposed. These are evaluated, along with traditional definitions, in a study that uses a hierarchical (random effects) model to estimate the error variation that is present at several different levels within the image capture process. The estimates of variation at these different levels are of interest in their own right but, in addition, evidence is provided that variation is reduced at the observer level when the new landmark definitions are used.
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Affiliation(s)
- Stanislav Katina
- Institute of Mathematics and Statistics, Masaryk University, Brno, Czech Republic.,School of Mathematics and Statistics, The University of Glasgow, Glasgow, UK
| | - Kathryn McNeil
- School of Mathematics and Statistics, The University of Glasgow, Glasgow, UK
| | - Ashraf Ayoub
- College of MVLS, School of Medicine, Dental School, The University of Glasgow, Glasgow, UK
| | | | | | - Paul Siebert
- School of Computing Science, The University of Glasgow, Glasgow, UK
| | - Federico Sukno
- Department of Information and Communication Technologies, Pompeu Fabra University, Barcelona, Spain
| | - Mario Rojas
- Molecular and Cellular Therapeutics, Royal College of Surgeons in Ireland, Dublin, Ireland.,Centre for Image Processing and Analysis, Dublin City University, Dublin, Ireland
| | - Liberty Vittert
- School of Mathematics and Statistics, The University of Glasgow, Glasgow, UK
| | - John Waddington
- Molecular and Cellular Therapeutics, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Paul F Whelan
- Centre for Image Processing and Analysis, Dublin City University, Dublin, Ireland
| | - Adrian W Bowman
- School of Mathematics and Statistics, The University of Glasgow, Glasgow, UK
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Subjective versus objective assessment of breast reconstruction. J Plast Reconstr Aesthet Surg 2013; 66:634-9. [DOI: 10.1016/j.bjps.2013.01.006] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2012] [Revised: 12/29/2012] [Accepted: 01/07/2013] [Indexed: 11/19/2022]
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Bell A, Lo TWR, Brown D, Bowman AW, Siebert JP, Simmons DR, Millett DT, Ayoub AF. Three-dimensional assessment of facial appearance following surgical repair of unilateral cleft lip and palate. Cleft Palate Craniofac J 2013; 51:462-71. [PMID: 23369016 DOI: 10.1597/12-140] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Objective assessment of postsurgical facial asymmetry can be difficult, but three-dimensional (3D) imaging techniques have made this possible. The objective of this study was to assess residual asymmetry in surgically repaired unilateral cleft lip (UCL) and unilateral cleft lip and palate (UCLP) patients and to compare this with noncleft controls. DESIGN Retrospective multicohort comparative study. PATIENTS AND METHODS Fifty-one 10-year-old children with surgically managed UCLP and 44 children with UCL were compared with a control group of 68 ten-year-olds. The 3D facial models at rest and with maximum smile were created using a 3D imaging system. Asymmetry scores were produced using both anatomical landmarks and a novel method of facial curve analysis. RESULTS Asymmetry for the whole face was significantly higher in both cleft groups compared with controls (P < .001). UCLP asymmetry was higher than UCL (P < .001). In cleft patients, the upper lip and nasal rim were the most asymmetric (P < .001 to .05). Control subjects also displayed a degree of facial asymmetry. Maximum smile did not significantly affect the symmetry of the whole face, but it increased asymmetry of the vermillion border and nasal rim in all three groups (P < .001). CONCLUSIONS Despite surgical intervention at an early age, asymmetry remains significant in cleft patients at 10 years of age. Three-dimensional imaging is a noninvasive objective assessment tool that identifies specific areas of the face responsible for asymmetry. Facial curve analysis describes the face more comprehensively and characterizes soft tissue contours.
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Henseler H, Smith J, Bowman A, Khambay BS, Ju X, Ayoub A, Ray AK. Objective evaluation of the latissimus dorsi flap for breast reconstruction using three-dimensional imaging. J Plast Reconstr Aesthet Surg 2012; 65:1209-15. [DOI: 10.1016/j.bjps.2012.03.043] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2011] [Revised: 03/24/2012] [Accepted: 03/27/2012] [Indexed: 11/25/2022]
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Millar K, Bell A, Bowman A, Brown D, Lo TW, Siebert P, Simmons D, Ayoub A. Psychological status as a function of residual scarring and facial asymmetry after surgical repair of cleft lip and palate. Cleft Palate Craniofac J 2011; 50:150-7. [PMID: 21846256 DOI: 10.1597/10-222] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objective : Objective measure of scarring and three-dimensional (3D) facial asymmetry after surgical correction of unilateral cleft lip (UCL) and unilateral cleft lip (UCLP). It was hypothesized that the degree of scarring or asymmetry would be correlated with poorer psychological function. Design : In a cross-sectional design, children underwent 3D imaging of the face and completed standardized assessments of self-esteem, depression, and state and trait anxiety. Parents rated children's adjustment with a standard scale. Setting : Glasgow Dental School, School of Medicine, College of Medical, Veterinary and Life Sciences. Patients : Fifty-one children aged 10 years with UCLP and 43 with UCL were recruited from the cohort treated with the surgical protocol of the CLEFTSIS managed clinical network in Scotland. Methods : Objective assessment to determine the luminance and redness of the scar and facial asymmetry. Depression, anxiety, and a self-esteem assessment battery were used for the psychological analysis. Results : Cleft cases showed superior psychological adjustment when compared with normative data. Prevalence of depression matched the population norm. The visibility of the scar (luminance ratio) was significantly correlated with lower self-esteem and higher trait anxiety in UCLP children (P = .004). Similar but nonsignificant trends were seen in the UCL group. Parental ratings of poorer adjustment also correlated with greater luminance of the scar. Conclusions : The objectively defined degree of postoperative cleft scarring was associated with subclinical symptoms of anxiety, depression, and low self-esteem.
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Three-Dimensional Facial Asymmetry in Attractive and Normal People from Childhood to Young Adulthood. Symmetry (Basel) 2010. [DOI: 10.3390/sym2041925] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Brignell CJ, Dryden IL, Gattone SA, Park B, Leask S, Browne WJ, Flynn S. Surface shape analysis with an application to brain surface asymmetry in schizophrenia. Biostatistics 2010; 11:609-30. [PMID: 20350956 DOI: 10.1093/biostatistics/kxq016] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Some methods for the statistical analysis of surface shapes and asymmetry are introduced. We focus on a case study where magnetic resonance images of the brain are available from groups of 30 schizophrenia patients and 38 controls, and we investigate large-scale brain surface shape differences. Key aspects of shape analysis are to remove nuisance transformations by registration and to identify which parts of one object correspond with the parts of another object. We introduce maximum likelihood and Bayesian methods for registering brain images and providing large-scale correspondences of the brain surfaces. Brain surface size-and-shape analysis is considered using random field theory, and also dimension reduction is carried out using principal and independent components analysis. Some small but significant differences are observed between the the patient and control groups. We then investigate a particular type of asymmetry called torque. Differences in asymmetry are observed between the control and patient groups, which add strength to other observations in the literature. Further investigations of the midline plane location in the 2 groups and the fitting of nonplanar curved midlines are also considered.
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Affiliation(s)
- Dennis E. Slice
- Department of Anthropology, University of Vienna, A-1091 Vienna, Austria;
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