Estimation of fetal volume by magnetic resonance imaging and stereology

Perinatal exposure to the immune-suppressant di-n-octyltin dichloride affects brain development in rats

Disruption of the immune system during embryonic brain development by environmental chemicals was proposed as a possible cause of neurodevelopmental disorders. We previously found adverse effects of di-n-octyltin dichloride (DOTC) on maternal and developing immune systems of rats in an extended one-generation reproductive toxicity study according to the OECD 443 test guideline. We hypothesize that the DOTC-induced changes in the immune system can affect neurodevelopment. Therefore, we used in-vivo MRI and PET imaging and genomics, in addition to behavioral testing and neuropathology as proposed in OECD test guideline 443, to investigate the effect of DOTC on structural and functional brain development. Male rats were exposed to DOTC (0, 3, 10, or 30 mg/kg of diet) from 2 weeks prior to mating of the F0-generation until sacrifice of F1-animals. The brains of rats, exposed to DOTC showed a transiently enlarged volume of specific brain regions (MRI), altered specific gravity, and transient hyper-metabolism ([18F]FDG PET). The alterations in brain development concurred with hyper-responsiveness in auditory startle response and slight hyperactivity in young adult animals. Genomics identified altered transcription of key regulators involved in neurodevelopment and neural function (e.g. Nrgrn, Shank3, Igf1r, Cck, Apba2, Foxp2); and regulators involved in cell size, cell proliferation, and organ development, especially immune system development and functioning (e.g. LOC679869, Itga11, Arhgap5, Cd47, Dlg1, Gas6, Cml5, Mef2c). The results suggest the involvement of immunotoxicity in the impairment of the nervous system by DOTC and support the hypothesis of a close connection between the immune and nervous systems in brain development.

Age-Related Alterations of Hyaluronan and Collagen in Extracellular Matrix of the Muscle Spindles

Background: Muscle spindles (MSs) play a crucial role in proprioception and locomotor coordination. Although the elasticity and viscosity of the extracellular matrix (ECM) within which MSs are embedded may play a key role in MS function, the impact of aging on ECM components is unclear. The aim of the current study was to investigate the age-related physiological changes of the ECM and to verify if these could be due to alterations of the environment directly surrounding MSs. Methods: Hematoxylin Eosin and picrosirius-red staining was carried out; collagen types I (COLI) and III (COLIII) were assessed, and biotinylated hyaluronan binding protein (HABP) immunohistochemical analysis was undertaken to evaluate alterations of the ECM in the intramuscular connective tissue (IMCT) of the hindlimbs of C57BL/6J male mice. Assessments were carried out on 6-week-old (Group A), 8-month-old (Group B), and 2-year-old (Group C) laboratory mice. Results: The capsule’s outer layer became progressively thicker with aging (it was 3.02 ± 0.26 μm in Group A, 3.64 ± 0.31 μm in Group B, and 5.81 ± 0.85 μm in Group C). The collagen in IMCT around and within the MSs was significantly higher in Group C, but there were no significant differences between Groups A and B. The MS capsules and continuous IMCT were primarily made up of COLI and COLIII. The average optical density (AOD) values of COLI in IMCT surrounding MS were significantly higher after aging (p < 0.05), but there were no significant differences in COLIII in the three groups (p > 0.05). HA was present in IMCT and filled the MSs capsule. The AOD of HABP of MS showed that there were lower HA levels in Group C with respect to Group A (p = 0.022); no significant differences were noted neither between Groups A and B nor between Groups B and C (p > 0.05). Conclusion: Age-related collagen accumulation and lower HA in the ECM in which the MSs were embedded may probably cause more stiffness in the ECM in vivo, which could help to partly explain the peripheral mechanisms underlying the age-related decline in functional changes related to MSs.

A Feasibility Study of Quantifying Longitudinal Brain Changes in Herpes Simplex Virus (HSV) Encephalitis Using Magnetic Resonance Imaging (MRI) and Stereology

OBJECTIVES

To assess whether it is feasible to quantify acute change in temporal lobe volume and total oedema volumes in herpes simplex virus (HSV) encephalitis as a preliminary to a trial of corticosteroid therapy.

METHODS

The study analysed serially acquired magnetic resonance images (MRI), of patients with acute HSV encephalitis who had neuroimaging repeated within four weeks of the first scan. We performed volumetric measurements of the left and right temporal lobes and of cerebral oedema visible on T2 weighted Fluid Attenuated Inversion Recovery (FLAIR) images using stereology in conjunction with point counting.

RESULTS

Temporal lobe volumes increased on average by 1.6% (standard deviation (SD 11%) in five patients who had not received corticosteroid therapy and decreased in two patients who had received corticosteroids by 8.5%. FLAIR hyperintensity volumes increased by 9% in patients not receiving treatment with corticosteroids and decreased by 29% in the two patients that had received corticosteroids.

CONCLUSIONS

This study has shown it is feasible to quantify acute change in temporal lobe and total oedema volumes in HSV encephalitis and suggests a potential resolution of swelling in response to corticosteroid therapy. These techniques could be used as part of a randomized control trial to investigate the efficacy of corticosteroids for treating HSV encephalitis in conjunction with assessing clinical outcomes and could be of potential value in helping to predict the clinical outcomes of patients with HSV encephalitis.

Variance prediction under systematic sampling with geometric probes

In design stereology, and in the context of geometric sampling in general, the problem often arises of estimating the integral of a bounded non-random function over a bounded manifold D ⊂ ℝ n by systematic sampling with geometric probes. Variance predictors, often based on Matheron's theory of regionalized variables, are available when the relevant function is sampled at the points of a grid intersecting D, but not when the dimension of the probes is greater than zero. For instance, the volume of a bounded object may be estimated using parallel systematic planes, which amounts to sampling on ℝ1 with systematic points, or using parallel systematic slabs of thickness t &gt; 0, which amounts to sampling on ℝ1 with non-overlapping systematic segments of length t &gt; 0. Useful variance predictors exist for the former case, but not for the latter. In this paper we set out a general scheme to predict estimation variances when the dimension of either D, or of the probes, is n. We make some progress when both dimensions are equal to n, and obtain explicit results for n = 1 (e.g. for systematic slice sampling). We check and illustrate our results for the volume estimators of ellipsoids and of rat lung.

Variance prediction under systematic sampling with geometric probes

In design stereology, and in the context of geometric sampling in general, the problem often arises of estimating the integral of a bounded non-random function over a bounded manifold D ⊂ ℝn by systematic sampling with geometric probes. Variance predictors, often based on Matheron's theory of regionalized variables, are available when the relevant function is sampled at the points of a grid intersecting D, but not when the dimension of the probes is greater than zero. For instance, the volume of a bounded object may be estimated using parallel systematic planes, which amounts to sampling on ℝ1 with systematic points, or using parallel systematic slabs of thickness t > 0, which amounts to sampling on ℝ1 with non-overlapping systematic segments of length t > 0. Useful variance predictors exist for the former case, but not for the latter. In this paper we set out a general scheme to predict estimation variances when the dimension of either D, or of the probes, is n. We make some progress when both dimensions are equal to n, and obtain explicit results for n = 1 (e.g. for systematic slice sampling). We check and illustrate our results for the volume estimators of ellipsoids and of rat lung.

Accuracy of the method for estimating breast volume on three-dimensional simulated magnetic resonance imaging scans in breast reconstruction

BACKGROUND

The authors have developed a simple and intuitive method for measuring breast volume based on three-dimensional simulated images of magnetic resonance imaging scans to accurately estimate breast volume before breast reconstruction.

METHODS

The authors performed a retrospective review of the medical records of 18 patients (20 breasts) who had undergone breast reconstruction at Yeouido St. Mary's Hospital from March of 2009 to July of 2012. All of the patients underwent preoperative assessment of breast volume with two methods: a plaster cast maneuver and a three-dimensional simulated magnetic resonance imaging scan. To determine the accuracy of each method, the authors compared the mastectomy volume with the plaster cast maneuver and with three-dimensional simulated magnetic resonance imaging.

RESULTS

In the authors' series, the mean values of the plaster cast maneuver, three-dimensional simulated magnetic resonance imaging, and mastectomy volume were 433.85 ± 176.65 ml, 529 ± 193.33 ml, and 495.25 ± 192.45 ml, respectively. In addition, the mean error between the plaster cast maneuver and mastectomy volume was 137.4 ± 97.66 ml and that between three-dimensional simulated magnetic resonance imaging and mastectomy volume was 54.63 ± 46.30 ml. From a linear regression curve, the correlation coefficient (r2) of the plaster cast maneuver was 0.629 (p = 0.003) and that of three-dimensional simulated magnetic resonance imaging was 0.945 (p < 0.001).

CONCLUSIONS

The authors' method for preoperatively measuring breast volume on three-dimensional simulated magnetic resonance imaging scans was both efficient and accurate. It would therefore be useful for achieving better aesthetic outcomes of breast reconstruction.

Maternal smoking during pregnancy and fetal organ growth: a magnetic resonance imaging study

Objective

To study whether maternal cigarette smoking during pregnancy is associated with alterations in the growth of fetal lungs, kidneys, liver, brain, and placenta.

Design

A case-control study, with operators performing the image analysis blinded.

Setting

Study performed on a research-dedicated magnetic resonance imaging (MRI) scanner (1.5 T) with participants recruited from a large teaching hospital in the United Kingdom.

Participants

A total of 26 pregnant women (13 current smokers, 13 non smokers) were recruited; 18 women (10 current smokers, 8 nonsmokers) returned for the second scan later in their pregnancy.

Methods

Each fetus was scanned with MRI at 22–27 weeks and 33–38 weeks gestational age (GA).

Main outcome measures

Images obtained with MRI were used to measure volumes of the fetal brain, kidneys, lungs, liver and overall fetal size, as well as placental volumes.

Results

Exposed fetuses showed lower brain volumes, kidney volumes, and total fetal volumes, with this effect being greater at visit 2 than at visit 1 for brain and kidney volumes, and greater at visit 1 than at visit 2 for total fetal volume. Exposed fetuses also demonstrated lower lung volume and placental volume, and this effect was similar at both visits. No difference was found between the exposed and nonexposed fetuses with regards to liver volume.

Conclusion

Magnetic resonance imaging has been used to show that maternal smoking is associated with reduced growth of fetal brain, lung and kidney; this effect persists even when the volumes are corrected for maternal education, gestational age, and fetal sex. As expected, the fetuses exposed to maternal smoking are smaller in size. Similarly, placental volumes are smaller in smoking versus nonsmoking pregnant women.

Fetal weight estimation: comparison of two-dimensional US and MR imaging assessments

PURPOSE

To prospectively define fetal density in the second half of pregnancy by using magnetic resonance (MR) imaging and to compare estimates of fetal weight based on ultrasonography (US) and MR imaging with actual birth weight.

MATERIALS AND METHODS

Written informed consent was obtained for this ethics committee-approved study. In this cross-sectional study between March 2011 and May 2012, fetal density was calculated as actual birth weight at delivery divided by fetal body volume at MR imaging in 188 fetuses between 20 weeks and 2 days and 42 weeks and 1 day of gestational age. Regression analysis was used to investigate the effect of variables, including sex, on fetal density. The US estimate of fetal weight was performed according to Hadlock et al, and the MR estimate of fetal weight was calculated based on the equation developed by Baker et al. US and MR estimates of fetal weight were compared with actual birth weights by using regression analysis.

RESULTS

Median fetal density was equal to 1.04 (range, 0.95-1.18). Fetal density was significantly associated with gestational age at delivery but not with fetal sex. In 26.6% of fetuses, the US estimate of fetal weight had a relative error of more than 10%, while a similar relative error for the MR estimate of fetal weight occurred in only 1.1% of fetuses. The limits of agreement were narrower with the MR estimate of fetal weight compared with the US estimate of fetal weight.

CONCLUSION

In the second half of pregnancy, fetal density varies with gestational age. Fetal weight estimates by using fetal MR imaging are better than those by using prenatal US.

Protective effect of folic acid on cyclosporine-induced bone loss in rats

Hyperhomocysteinemia is seen in patients with decreased bone mineral density. Cyclosporine can cause alveolar bone loss and osteopenia. It is also associated with elevated serum homocysteine levels. We aimed to investigate the effect of cyclosporine on serum homocysteine level, bone volume, and bone density, and determine whether folic acid had a protective effect against bone loss. In an experimental study, 40 male Sprague-Dawley rats were randomly assigned to five groups and received dietary supplementation for 6 weeks with olive oil (Group A), cyclosporine (Group B), folic acid (Group C), and cyclosporine plus folic acid (Group D), or no supplementation (Group F, control). Serum homocysteine, calcium, alkaline phosphatase, total bone volume, periodontal ligament volume, and volume density of bone were compared between groups. Mean serum homocysteine level (10.84 ± 0.93 μmol/l) was significantly higher in group B (cyclosporine supplementation) compared with the other groups (P = 0.001). Mean total mandibular volume was 46.3 ± 13.6 mm(3) in rats treated with cyclosporine, 80.4 ± 15.70 mm(3) in rats treated with folic acid (P = 0.004), and 73.9 ± 21.3 mm(3) in rats treated with cyclosporine plus folic acid (P = 0.028). In our experimental model, cyclosporine increased serum homocysteine levels and decreased bone volume and density. Folic acid may have a preventive role against bone loss in rats treated with cyclosporine.

Assessment of left ventricular function and mass by MR imaging: a stereological study based on the systematic slice sampling procedure

RATIONALE AND OBJECTIVES

The aim of this study was to combine the stereological technique with magnetic resonance (MR) imaging data for the volumetric and functional analysis of the left ventricle (LV).

MATERIALS AND METHODS

Cardiac MR examinations were performed in 13 consecutive subjects with known or suspected coronary artery disease. The end-diastolic volume (EDV), end-systolic volume, ejection fraction (EF), and mass were estimated by stereology using the entire slice set depicting LV and systematic sampling intensities of 1/2 and 1/3 that provided samples with every second and third slice, respectively. The repeatability of stereology was evaluated. Stereological assessments were compared with the reference values derived by manually tracing the endocardial and epicardial contours on MR images.

RESULTS

Stereological EDV and EF estimations obtained by the 1/3 systematic sampling scheme were significantly different from those by manual delineation (P < .05). No difference was observed between the reference values and the LV parameters estimated by the entire slice set or a sampling intensity of 1/2 (P > .05). For these stereological approaches, a high correlation (r(2) = 0.80-0.93) and clinically acceptable limits of agreement were found with the reference method. Stereological estimations obtained by both sample sizes presented comparable coefficient of variation values of 2.9-5.8%. The mean time for stereological measurements on the entire slice set was 3.4 ± 0.6 minutes and it was reduced to 2.5 ± 0.5 minutes with the 1/2 systematic sampling scheme.

CONCLUSION

Stereological analysis on systematic samples of MR slices generated by the 1/2 sampling intensity provided efficient and quick assessment of LV volumes, function, and mass.

Fetal brain volumetry through MRI volumetric reconstruction and segmentation

PURPOSE

Fetal MRI volumetry is a useful technique but it is limited by a dependency upon motion-free scans, tedious manual segmentation, and spatial inaccuracy due to thick-slice scans. An image processing pipeline that addresses these limitations was developed and tested.

MATERIALS AND METHODS

The principal sequences acquired in fetal MRI clinical practice are multiple orthogonal single-shot fast spin echo scans. State-of-the-art image processing techniques were used for inter-slice motion correction and super-resolution reconstruction of high-resolution volumetric images from these scans. The reconstructed volume images were processed with intensity non-uniformity correction and the fetal brain extracted by using supervised automated segmentation.

RESULTS

Reconstruction, segmentation and volumetry of the fetal brains for a cohort of twenty-five clinically acquired fetal MRI scans was done. Performance metrics for volume reconstruction, segmentation and volumetry were determined by comparing to manual tracings in five randomly chosen cases. Finally, analysis of the fetal brain and parenchymal volumes was performed based on the gestational age of the fetuses.

CONCLUSION

The image processing pipeline developed in this study enables volume rendering and accurate fetal brain volumetry by addressing the limitations of current volumetry techniques, which include dependency on motion-free scans, manual segmentation, and inaccurate thick-slice interpolation.

Can the language-dominant hemisphere be predicted by brain anatomy?

It has long been suspected that cortical interhemispheric asymmetries may underlie hemispheric language dominance (HLD). To test this hypothesis, we determined interhemispheric asymmetries using stereology and MRI of three cortical regions hypothesized to be related to HLD (Broca's area, planum temporale, and insula) in healthy adults in whom HLD was determined using functional transcranial Doppler sonography and functional MRI (15 left HLD, 10 right HLD). We observed no relationship between volume asymmetry of the gyral correlates of Broca's area or planum temporale and HLD. However, we observed a robust relationship between volume asymmetry of the insula and HLD (p = .008), which predicted unilateral HLD in 88% individuals (86.7% left HDL and 90% right HLD). There was also a subtle but significant positive correlation between the extent of HLD and insula volume asymmetry (p = .02), indicating that a larger insula predicted functional lateralization to the same hemispheric side for the majority of subjects. We found no visual evidence of basic anatomical markers of HLD other than that the termination of the right posterior sylvian fissure was more likely to be vertical than horizontal in right HLD subjects (p = .02). Predicting HLD by virtue of gross brain anatomy is complicated by interindividual variability in sulcal contours, and the possibility remains that morphological and cytoarchitectural organization of the classical language regions may underlie HLD when analyses are not constrained by the natural limits imposed by measurement of gyral volume. Although the anatomical correlates of HLD will most likely be found to include complex intra- and interhemispheric connections, there is the possibility that such connectivity may correlate with gray matter morphology. We suggest that the potential significance of insular morphology should be considered in future studies addressing the anatomical correlates of human language lateralization.

Dichotic listening impairments in early onset schizophrenia are associated with reduced left temporal lobe volume

Dichotic listening (DL) impairments, in particular the loss or reduction of right ear advantage (REA) in people with schizophrenia have been variously interpreted as both a state and trait marker for schizophrenia. To date, there has been no comprehensive investigation of dichotic language impairments in relation to the structural integrity of the temporal cortex--the likely neural substrate for such impairments. In this study of 39 early onset patients and matched controls we used a dichotic listening procedure and examined the findings in relation to MRI measurements of gross and regional cerebral volumes. No overall group difference in ear advantage was found between patients and controls but patients who showed absence of REA also demonstrated an accompanying reduction of left temporal lobe volume compared with patients who showed normal ear advantage and controls. The findings suggest that impaired DL performance is a correlate of structural change in the temporal lobe and that this is apparent in early onset cases.

Numerical quantification of Perkinsus marinus in the American oyster Crassostrea virginica (Gmelin, 1791) (Mollusca: Bivalvia) by modern stereology

Species of Perkinsus are responsible for high mortalities of bivalve molluscs world-wide. Techniques to accurately estimate parasites in tissues are required to improve understanding of perkinsosis. This study quantifies the number and tissue distribution of Perkinsus marinus in Crassostrea virginica by modern stereology and immunohistochemistry. Mean total number of trophozoites were (mean +/- SE) 11.80 +/- 3.91 million and 11.55 +/- 3.88 million for the optical disector and optical fractionator methods, respectively. The mean empirical error between both stereological approaches was 3.8 +/- 1.0%. Trophozoites were detected intracellularly in the following tissues: intestine (30.1%), Leydig tissue (21.3%), hemocytes (14.9%), digestive gland (11.4%), gills (6.1%), connective tissues (5.7%), gonads (4.1%), palps (2.2%), muscle (1.9%), mantle connective (0.8%), pericardium (0.7%), mantle epithelium (0.1%), and heart (0.1%). The remaining 0.6% were found extracellularly. Percentages of trophozoite stages were (mean +/- SE): large, log-phase trophonts, i.e., signet rings, 97.0 +/- 1.2%; meronts, 2.0 +/- 0.9%; clusters of small, log-phase trophonts, i.e., merozoites, 1.0 +/- 0.5%. Levels of infection in hemocytes and Leydig tissue were representative of total parasite intensity. These techniques are a powerful tool to follow parasite distribution and invasion, and to further explore mechanisms of Perkinsus spp. pathogenesis in bivalves.

Effects of sex and age on regional prefrontal brain volume in two human cohorts

This study examined interactive effects of sex and age on prefrontal brain anatomy in humans. It specifically targeted ranges of the adult life span and regions of cortex that previously showed male-female differences. Participants were 68 healthy human males and females aged 20-72 years. Data collection and analysis were conducted in parallel across two cohorts (laboratories) to investigate reproducibility of effects in relation to sex and age. Volumes for four regional prefrontal subfields per hemisphere were obtained from high-resolution MRI. Regional sex by age interactions were replicated across cohorts. In men, age effects were greatest in medial prefrontal volume, with decreases in dorsal medial and orbital medial regions. In women, age-related changes in medial prefrontal regions were limited to the dorsal volume, with additional decreases observed in lateral subfields. Cohort and Cohort x Age effects in total brain and total prefrontal volume were linked to a combination of methodological and sampling-related factors. Findings indicated that neuroanatomical changes throughout adulthood unfold along different time scales in men and women. Results also showed that sex differences in ageing localized to medial prefrontal regions were particularly robust to variation across cohorts.

Confidence intervals in Cavalieri sampling

The aim of this study is to derive a formula that allows the prediction, from a Cavalieri data sample, of an appropriate confidence interval for a parameter Q. Two different approaches are used to address the problem. The first approach is to investigate whether the asymptotic distribution of the Cavalieri estimator exists when the sampling period T tends to zero. In particular, the distribution of the standardized version of the Cavalieri estimator z(T) is analysed for a measurement function f whose smoothness constant is an integer number m. The analysis reveals that when the first noncontinuous derivative of f, f((m)), exhibits a unique discontinuity, the asymptotic distribution of z(T) exists and it has a bounded support. An analytical expression of the distribution is derived for the cases m = 0 and 1. However, when f((m)) has two or more discontinuities, the asymptotic distribution of z(T) does not exist and its support may be unbounded. In the second approach, a generalized version of the refined Euler Mac-Laurin summation formula, valid for measurement functions with a fractional, rather than just an integer, smoothness constant, is applied to the Cavalieri estimator. As a result, a formula that predicts a lower and upper bound for the true parameter is derived for small T. This bound prediction formula is applied to Cavalieri data samples of human cerebral cortex. In particular, for sample sizes n = 8, 12 and 16, the true volume of cerebral cortex is bounded by relative distances 8%, 4% and 2% of the Cavalieri estimate, respectively.

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

Stereology is a sampling technique used to generate mathematically unbiased estimates of geometric properties of three-dimensional structures based on two-dimensional slices of the object. Using this method, volume and surface area estimates may be generated in a robust, reliable and time-efficient manner based on magnetic resonance (MR) image data. We present a method of determining the isoperimetric ratio, which may be used as an index of gyrification of the human cerebrum, using stereological volume and surface area estimates applied to in vivo MR image data. This parameter may be of use in identifying subtle cortical developmental malformations in diseases such as epilepsy and schizophrenia. We also conduct a series of inter- and intrarater repeatability tests based on 20 normal brains, which demonstrated the reliability and robustness of stereological techniques.

Obstetric MRI

Ultrasound is the imaging modality of choice for pregnant patients. However, MRI is increasingly utilized in patients in whom the sonographic diagnosis is unclear. These include maternal conditions unique to pregnancy such as ectopic pregnancy, placenta accreta, and uterine dehiscence. MRI is also being increasingly utilized in the assessment of abdominopelvic pain in pregnancy, in particular in assessment for appendicitis. Fetal MRI is performed to assess central nervous system (CNS) abnormalities and patients who are considering fetal surgery for conditions such as neural tube defects, congenital diaphragmatic hernia, and masses that obstruct the airway. In the future, functional MRI and fetal volumetry may provide additional information that can aid in our care of complicated pregnancies.

Magnetic Resonance Imaging Evaluation of Hepatic Cysts in Early Autosomal-Dominant Polycystic Kidney Disease: The Consortium for Radiologic Imaging Studies of Polycystic Kidney Disease Cohort

The objective of this study was to investigate the prevalence of hepatic cysts by age and gender in patients with early autosomal-dominant polycystic kidney disease (ADPKD) and to determine whether hepatic cyst volume is related to renal and renal cyst volumes by using magnetic resonance imaging (MRI). A total of 230 patients with ADPKD (94 men and 136 women) who were aged 15 to 46 yr and had relatively preserved renal function were studied. MRI images of the kidney and liver were obtained to measure renal, renal cyst, and hepatic cyst volumes. These volume measurements and hepatic cyst prevalence were compared in all patients and in subgroups on the basis of gender and age (15 to 24, 25 to 34, and 35 to 46 yr). The overall prevalence of hepatic cysts was 83%; the prevalence was 58, 85, and 94% in the sequential age groups and 85% in women and 79% in men. The prevalence was related directly to renal volume (chi2 = 4.30, P = 0.04) and to renal cyst volume (chi2 = 5.59, P = 0.02). The total hepatic cyst volume was significantly greater in women than in men (a logarithmic transformation mean of 5.27 versus 1.94 ml; P = 0.003). The average hepatic cyst volume was 0.25, 5.75, and 22.78 ml in sequential age groups. Hepatic cysts are evident in 94% of patients who are older than 35 yr and in 55% of individuals who are younger than 25 yr. Hepatic cysts are more prevalent and larger in total cyst volume in women than in men. Hepatic cyst prevalence and aggregate total hepatic cyst volume increased with age.

A new approach for the estimation of intervertebral disc volume using the Cavalieri principle and computed tomography images

This study was carried out to describe a simple, accurate and practical technique for estimating the volume of intervertebral disc (ID) by the combination of the Cavalieri principle and computed tomography (CT) images. Total eight lumbar IDs from two cadavers were CT scanned in axial, sagittal and coronal sections. The consecutive sections with 5 and 3mm thickness were used to estimate the volume of the IDs by the Cavalieri principle. Three investigators estimated the volume of IDs independently to evaluate inter-observer differences. When the results were compared to the real volumes of IDs measured by the fluid displacement technique, there was no significant difference between the real volume measurements and the Cavalieri estimation results of ID volumes (P > 0.05). Moreover, findings of three investigators did not show significant variations (P > 0.05). Our results indicate that the section thickness and the section planes did not affect the accuracy of the disc volume estimation. Thus the combination of CT scanning with the Cavalieri principle may be used as a direct and reliable technique to estimate the volume of IDs with a mean of 4 min workload per ID.

Design-based stereology in neuroscience

Quantitative morphology of the CNS has recently undergone major developments. In particular, several new approaches, known as design-based stereologic methods, have become available and have been successfully applied to neuromorphological research. However, much confusion and uncertainty remains about the meaning, implications, and advantages of these design-based stereologic methods. The objective of this review is to provide some clarification. It does not comprise a full description of all stereologic methods available. Rather, it is written by users for users, provides the reader with a guided tour through the relevant literature. It has been the experience of the authors that most neuroscientists potentially interested in design-based stereology need to analyze volumes of brain regions, numbers of cells (neurons, glial cells) within these brain regions, mean volumes (nuclear, perikaryal) of these cells, length densities of linear biological structures such as vessels and nerve fibers within brain regions, and the cytoarchitecture of brain regions (i.e. the spatial distribution of cells within a region of interest). Therefore, a comprehensive introduction to design-based stereologic methods for estimating these parameters is provided. It is demonstrated that results obtained with design-based stereology are representative for the entire brain region of interest, and are independent of the size, shape, spatial orientation, and spatial distribution of the cells to be investigated. Also, it is shown that bias (i.e. systematic error) in results obtained with design-based stereology can be limited to a minimum, and that it is possible to assess the variability of these results. These characteristics establish the advantages of design-based stereologic methods in quantitative neuromorphology.

Comments on the shortcomings of predicting the precision of Cavalieri volume estimates based upon assumed measurement functions

It is well known that the estimation of an object's volume by means of serial cross-sections, the so-called Cavalieri method, yields an unbiased estimate. But by itself it provides no means by which to estimate how precise this estimate is unless the shape of the volume is fully known beforehand. This knowledge can only be partially determined from the serial section information that is collected. Methods have been developed that claim to surmount this difficulty by using the serial section data to create a mathematical model of the volume's shape properties. The model then is used to estimate (predict) the precision of the volume estimate (its CE) from the single set of data available. Unfortunately, the theory underlying the model is flawed and so the model itself amounts to no more than an unsubstantiated guess about the shape of the volume. Therefore, the precision of the volume estimates that one obtains from the method is only as good as the model and this cannot be ascertained from the single set of acquired data. In this letter I explain the inadequacies of the modelling method. I suggest that it be used only with caution, if at all. Instead I suggest two alternative ways to predict the CE, one that is based upon a rule-of-thumb approach to the object's shape, and another that is based upon spectral analysis of the measurement function and that is easy to implement with available computer software.

Optimal sampling of MRI slices for the assessment of knee cartilage volume for cross-sectional and longitudinal studies

Background

MRI slices of 1.5 mm thickness have been used in both cross sectional and longitudinal studies of osteoarthritis, but is difficult to apply to large studies as most techniques used in measuring knee cartilage volumes require substantial post-image processing. The aim of this study was to determine the optimal sampling of 1.5 mm thick slices of MRI scans to estimate knee cartilage volume in males and females for cross-sectional and longitudinal studies.

Methods

A total of 150 subjects had a sagittal T1-weighted fat-suppressed MRI scan of the right knee at a partition thickness of 1.5 mm to determine their cartilage volume. Fifty subjects had both baseline and 2-year follow up MRI scans. Lateral, medial tibial and patellar cartilage volumes were calculated with different samples from 1.5 mm thick slices by extracting one in two, one in three, and one in four to compare to cartilage volume and its rate of change. Agreement was assessed by means of intraclass correlation coefficient (ICC) and Bland & Altman plots.

Results

Compared to the whole sample of 1.5 mm thick slices, measuring every second to fourth slice led to very little under or over estimation in cartilage volume and its annual change. At all sites and subgroups, measuring every second slice had less than 1% mean difference in cartilage volume and its annual rate of change with all ICCs ≥ 0.98.

Conclusion

Sampling alternate 1.5 mm thick MRI slices is sufficient for knee cartilage volume measurement in cross-sectional and longitudinal epidemiological studies with little increase in measurement error. This approach will lead to a substantial decrease in post-scan processing time.

Notable sequential alterations in notochord volume during development in the Adriamycin rat model

BACKGROUND/PURPOSE

The Adriamycin rat model (ARM) is a well-established model of the vertebral, anorectal, cardiac, tracheoesophageal, renal, and limb association. An important finding in the ARM is that Adriamycin induces abnormal notochord morphology in the region of the foregut. Having recently demonstrated notochord hypertrophy in ARM embryos, the authors designed this study to assess notochord volume sequentially from gestational days 10 to 14 (E10-E14) to test the hypothesis that notochord hypertrophy occurs maximally soon after Adriamycin administration.

METHODS

Adriamycin (1.75 mg/kg) was administered intraperitoneally to pregnant rats on E7, E8, and E9. Control animals were given saline. Embryos were recovered at E10, E11, E12, E13, and E14 and embedded in paraffin. Quantitative morphology using the Cavalieri technique was performed on hematoxylin and eosin-stained transverse serial sections to determine total embryo and total notochord volume.

RESULTS

The percentage volume of notochord per embryo was significantly increased (P < .05) in Adriamycin-treated embryos at all gestational time frames from E10 to E14 when compared with equivalent controls. This increased volume of notochord was found to be maximal at E11.

CONCLUSIONS

These data support the authors' previous finding that Adriamycin induces notochord hypertrophy and suggest that notochord volume is increased relative to embryo volume soon after Adriamycin administration and is maximal on E11. The abnormal increase in notochord volume during the critical phase of development may interfere with organogenesis, resulting in the vertebral, anorectal, cardiac, tracheoesophageal, renal, and limb association.

Aging of Oocyte, Ovary, and Human Reproduction

We review age-related changes in the ovary and their effect on female fertility, with particular emphasis on follicle formation, follicle dynamics, and oocyte quality. The evidence indicates that the developmental processes leading to follicle formation set the rules determining follicle quiescence and growth. This regulatory system is maintained until menopause and is directly affected in at least some models of premature ovarian failure (POF), most strikingly in the Foxl2 mouse knockout, a model of human POF with monogenic etiology (blepharophimosis/ptosis/epicanthus inversus syndrome). Several lines of evidence indicate that if the ovarian germ cell lineage maintains regenerative potential, as recently suggested in the mouse, a role in follicle dynamics for germ stem cells, if any, is likely indirect or secondary. In addition, age-related variations in oocyte quality in animal models suggest that reproductive competence is acquired progressively and might depend on parallel growth and differentiation of follicle cells and stroma. Genomewide analyses of the mouse oocyte transcriptome have begun to be used to systematically investigate the mechanisms of reproductive competence that are altered with aging. Investigative and therapeutic strategies can benefit from considering the role of continuous interactions between follicle cells and oocytes from the beginning of histogenesis to full maturation.

The direct measurement of embryogenic volume and nucleo-cytoplasmic ratio during mouse pre-implantation development

After fertilization, the mammalian conceptus undergoes cleavage, a process of cell proliferation in the absence of interphase growth. It is not known when cleavage ends and gives way to fully replicative cell cycles with a stable nucleo-cytoplasmic ratio. We have used two-photon excitation and confocal microscopy to measure directly volumes and nucleo-cytoplasmic ratios of whole murine concepti and their individual constituent blastomeres during pre-implantation development up to the early uterine attachment stage (day 5). We show that the total cytoplasmic volume of the conceptus remains constant during pre-implantation development, and that the average nucleo-cytoplasmic ratio increases exponentially throughout the same period. Data from individual blastomeres show that both volume and nucleo-cytoplasmic ratio diverge in the inner and outer subpopulations evident from the 16-cell stage (fifth developmental cycle) onwards. Cells from emergent outer trophoblast populations are larger and have smaller nucleo-cytoplasmic ratios than those from emergent inner pluriblast populations. Moreover, the nucleo-cytoplasmic ratio of the trophoblast appears to be stabilizing, suggesting that for this subpopulation cleavage may end at the 16–32-cell transition. Putative hypoblast and epiblast cell subpopulations within the pluriblast were not distinguishable by volume or nucleo-cytoplasmic ratio. Embryonic stem cell volume was higher than that of either cell subpopulation of expanded blastocysts, and their nucleo-cytoplasmic ratio was similar to that of trophoblast cells.

Growth patterns of human ovarian volume during intrauterine and postnatal organogenesis

BACKGROUND

Ovarian volumes during pre-pubertal, reproductive or menopausal life in a healthy female have been studied by in vivo and anatomical methods. In contrast, conclusive studies on normal human ovarian volume during intrauterine and postnatal organogenesis, when the folliculogenesis occurs, do not exist.

AIM

To assess the growth patterns of ovarian volume during human ovarian definitive histogenesis using morphometric methods.

SUBJECTS

Twenty-five left ovaries removed from fetuses, newborns and children with karyotype 46,XX, ranging from 15 to 74 weeks of development.

OUTCOME MEASURES

The ovaries were completely cut obtaining serial sections. Ovarian volume was calculated both with the ellipsoid method, using its length, maximum and minimum diameters, and the Cavalieri quantitative morphometric method. The age-related pattern of ovarian volume was studied using linear regression analyses.

RESULTS

Ovarian volume calculated with the Cavalieri method increased from 16 mm3 at the 15th week of development to over 300 mm3 at the end of the process, with a 20-fold increase compared to the initial volume. Ovarian volume calculated with the ellipsoid method ranged between 25 to over 380 mm3, with a 15-fold increase. On average, ellipsoidal volume over-estimated the true Cavalieri volume (mean difference -14%, S.D. 29, p=0.014, Student's t-test for paired samples). Linear regression curves were developed to predict ovarian volume at any age. Overall, the approximation was better for Cavalieri volume (approximately, 72% of variance explained by the linear regression) than for ellipsoid volume (59% of explained variance).

CONCLUSIONS

During the intrauterine and postnatal organogenesis, the normal growth rate of human ovary was almost linear. The calculation of ovarian volume using Cavalieri method does not depend on assumptions about the organ shape and it appears to be more appropriate.

Stereology versus planimetry to estimate the volume of malignant liver lesions on MR imaging

Liver tumor volume measurements are clinically useful in patients undergoing cancer treatment. The techniques of planimetry and stereology were applied for this purpose on magnetic resonance (MR) imaging. Fifty-eight malignant liver lesions were depicted on MR images in 20 consecutive patients. The volume of all lesions was estimated using stereology technique, based on point counting. Stereological tumor volume estimations were compared with those determined by manual planimetry. The repeatability of both techniques was assessed. Tumor volumes estimated by the two techniques were highly correlated (r = 0.98, p < 0.0001). The 95% limits of agreement showed that the stereological volume estimations may differ from the planimetric assessments by less than 23%. Both techniques presented comparable intra- and interobserver variability. The planimetry was 1.5 times faster than the stereology. Both volumetric techniques may provide reliable and reproducible liver tumor volume estimations. The planimetry may be the method of choice because of its superior speed.

Estimation of breast prosthesis volume by the Cavalieri principle using magnetic resonance images

BACKGROUND

The purpose of this study was to search the accuracy and reproducibility of the Cavalieri method for the estimation of the breast prosthesis volume on magnetic resonance images (MRI).

METHODS

Nine breast prostheses were scanned in axial and coronal section planes by MRI. The consecutive sections in 5-mm thickness were taken, after which the volumes of the prostheses were measured and estimated by means of the fluid displacement technique and three-dimensional postprocessing software, respectively. The volumes of the prostheses also were estimated by three performers using the Cavalieri principle to check the accuracy and interobserver interrelation of the suggested technique

RESULTS

There were no significant differences between the Cavalieri estimate and the real volumes of the breast prostheses (p > 0.05), nor between the performers's volume estimates (p > 0.05). The orientation of the section planes did not affect the accuracy of the estimates (p > 0.05)

CONCLUSIONS

This report describes a rapid, simple, accurate, and practical technique for estimating the volume of the breast prostheses without changing the routine process in the clinics. It was concluded that the combination of MRI with the Cavalieri principle is a direct and accurate technique that can be applied safely for estimating the volume of the breast prosthesis in 4 min and 34 s per prosthesis.

Rapid estimation of the vertebral body volume: a combination of the Cavalieri principle and computed tomography images

OBJECTIVE

The exact volume of the vertebral body is necessary for the evaluation, treatment and surgical application of related vertebral body. Thereby, the volume changes of the vertebral body are monitored, such as infectious diseases of vertebra and traumatic or non-traumatic fractures and deformities of the spine. Several studies have been conducted for the assessment of the vertebral body size based on the evaluation of the different criteria of the spine using different techniques. However, we have not found any detailed study in the literature describing the combination of the Cavalieri principle and vertebral body volume estimation.

MATERIALS AND METHODS

In the present study we describe a rapid, simple, accurate and practical technique for estimating the volume of vertebral body. Two specimens were taken from the cadavers including ten lumbar vertebras and were scanned in axial, sagittal and coronal section planes by a computed tomography (CT) machine. The consecutive sections in 5 and 3 mm thicknesses were used to estimate the total volume of the vertebral bodies by means of the Cavalieri principle. Furthermore, to evaluate inter-observer differences the volume estimations were carried out by three performers.

RESULTS

There were no significant differences between the performers' estimates and real volumes of the vertebral bodies (P>0.05) and also between the performers' volume estimates (P>0.05). The section thickness and the section plains did not affect the accuracy of the estimates (P>0.05). A high correlation was seen between the estimates of performers and the real volumes of the vertebral bodies (r=0.881).

CONCLUSION

We concluded that the combination of CT scanning with the Cavalieri principle is a direct and accurate technique that can be safely applied to estimate the volume of the vertebral body with the mean of 5 min and 11 s workload per vertebra.

Adriamycin induces notochord hypertrophy with conservation of sonic hedgehog expression in abnormal ectopic notochord in the adriamycin rat model

BACKGROUND/PURPOSE

The Adriamycin rat model (ARM) is a well-established model of the Vertebral, Anorectal, Cardiac, Tracheoesophageal, Renal, Limb (VACTERL) association. The notochord, which expresses Sonic Hedgehog (Shh), has been found to be grossly malformed with ventral ectopic branches in the foregut region of embryos in the ARM. The authors designed this study to test the hypothesis that Shh-expressing ectopic notochord could contribute to an increased volume of notochord relative to total embryo volume, resulting in an increased concentration of Shh in the notochord of affected embryos.

METHODS

Adriamycin was administered intraperitoneally to rats on days 7 (E7), E8, and E9 of gestation and saline to control animals. Embryos recovered at E12 and E14 were examined immunohistochemically for Shh expression. Quantitative morphology using the Cavalieri technique was performed to determine embryo and notochord volume.

RESULTS

Embryos in both Adriamycin and control groups at E12 and E14 showed comparable levels of Shh expression in notochord at all locations. The percentage of notochord per embryo was significantly increased in Adriamycin embryos at E12 and E14 compared with equivalent controls.

CONCLUSIONS

These data suggest that Adriamycin induces notochord hypertrophy. With all regions of the notochord secreting Shh, this could result in a higher concentration gradient of Shh in close abnormal proximity to the foregut, possibly contributing to the malformations found in the VACTERL association.

Quantification of tumour response to radiotherapy

In 1979, the World Health Organization (WHO) established criteria based on tumour volume change for classifying response to therapy as (i) progressive disease (PD), (ii) partial recovery (PR), and (iii) no change (NC). Typically, the tumour volume is reported from diameter measurements, using the calliper method. Alternatively, the Cavalieri method provides unbiased volume estimates of any structure without assumptions about its shape. In this study, we applied the Cavalieri method in combination with point counting to investigate the changes in tumour volume in four patients with high grade glioma, using 3D MRI. In particular, the volume of tumour within the enhancement boundary, the enhancing abnormality (EA), was estimated from T(1) weighted images, and the volume of the non-enhancing abnormality, (NEA) enhancing abnormality, was estimated from T(2) relaxation time and magnetic transfer ratio tissue characterization maps. We compared changes in tumour volume estimated by the Cavalieri method with those obtained using the calliper method. Absolute tumour volume differed significantly between the two methods. Analysis of relative change in tumour volume, based on the WHO criteria, provided a different classification using the calliper and Cavalieri methods. The benefit of the Cavalieri method over the calliper method in the estimation of tumour volume is justified by the following factors. First, Cavalieri volume estimates are mathematically unbiased. Second, the Cavalieri method is highly efficient under an appropriate sampling density (i.e. EA volume estimates can be obtained with a coefficient of error no higher than 5% in 2-3 min). Third, the source of variation of the volume estimates due to disagreements between observers, and within observer, is much greater in the positioning of the calliper diameters than in the identification of the tumour boundaries when applying the Cavalieri method. Additionally, the error prediction formula, available to estimate the coefficient of error of Cavalieri volume estimates from the data, allows us to establish more precise classification criteria against which to identify potentially clinical significant changes in tumour volume.

Magnetic resonance measurements of renal blood flow as a marker of disease severity in autosomal-dominant polycystic kidney disease11Thomas Andreoli, M.D., served as Guest Editor for this paper

BACKGROUND

Autosomal-dominant polycystic kidney disease (ADPKD) is an inherited disorder characterized by renal cyst growth, early development of hypertension, and late occurrence of renal insufficiency. Despite evidence for the importance of nephroangiosclerosis in the progression of renal insufficiency in ADPKD, evaluation of renal blood flow (RBF) as a surrogate marker of disease severity has received little attention.

METHODS

Flow phantoms and repeat RBF measurements assessed accuracy and reproducibility. One hundred twenty-seven ADPKD subjects with creatinine clearances >70 mL/min underwent measurements of RBF, total, and cyst renal volumes, and % cyst volumes by magnetic resonance (MR) and of glomerular filtration rate (GFR). Renal vascular resistance (RVR) was calculated. MR blood flow sequences utilized a two-dimensional cine phase-contrast breath-hold pulse sequence perpendicular to the renal arteries. Flow rates were calculated utilizing FLOW software. Volumetric analysis was performed using stereology and region-based thresholding.

RESULTS

Excellent accuracy and intraobserver and interobserver reproducibility were demonstrated. Anatomic (total kidney volume, total cyst volume, and % cyst volume), hemodynamic (RBF and RVR), and functional (GFR) parameters were strongly correlated. Left polycystic kidneys were larger and had more severe disease. Regression analysis showed that age, diagnosis of hypertension, anatomic parameters and hemodynamic parameters were significant predictors of GFR. Multiple linear regression analysis identified age and hemodynamic parameters only as separate predictors of GFR. Anatomic, hemodynamic, and functional parameters discriminated between normotensive and hypertensive subjects despite antihypertensive treatments.

CONCLUSION

Renal hemodynamic parameters measured by MR correlate with anatomic and functional indices of disease severity, are the strongest predictors of renal function, and deserve further consideration as an outcome measure in clinical trials to guide therapy in ADPKD.

Renal structure in early autosomal-dominant polycystic kidney disease (ADPKD): The Consortium for Radiologic Imaging Studies of Polycystic Kidney Disease (CRISP) cohort

BACKGROUND

Autosomal-dominant polycystic kidney disease (ADPKD) is characterized by gradual renal enlargement and cyst growth prior to loss of renal function. Standard radiographic imaging has not provided the resolution and accuracy necessary to detect small changes in renal volume or to reliably measure renal cyst volumes. The Consortium for Radiologic Imaging Studies in Polycystic Kidney Disease (CRISP) is longitudinally observing ADPKD individuals using high-resolution magnetic resonance (MR) imaging to determine if change in renal and cyst volumes can be detected over a short period of time, and if they correlate with decline in renal function early in disease.

METHODS

Standardization studies were conducted in phantoms and four subjects at each participating clinical center. After, in the full-scale protocol, healthy ADPKD individuals 15 to 45 years old with creatinine clearance>70 mL/min underwent standardized MR renal imaging, renal iothalamate clearance, comprehensive clinical evaluation, and determination of 24-hour urinary albumin and electrolyte excretion. Stereology was used from T1-weighted images to quantify renal volume, and region-growing thresholding was used from T2-weighted images to determine cyst volume. Renal structures were evaluated in relation to demographic, clinical, and biochemical variables using means/medians, standard deviations, and Pearson correlations.

RESULTS

Reliability coefficients for MR renal and cyst volume measurements in phantoms were 99.9% and 89.2%, respectively. In the full-scale protocol, 241 ADPKD individuals (145 women and 96 men) were enrolled. Total renal, cyst, and % cyst volume were significantly greater in each decade group. Hypertensive individuals demonstrated greater renal, cyst, and % cyst volume than normotensive subjects. Age-adjusted renal (r = -0.31, P < 0.0001), cyst (r = -0.36, P < 0.0001), and % cyst volume (r = -0.35, P < 0.0001) were inversely related to glomerular filtration rate (GFR). Age-adjusted renal volume (r = 0.42, P < 0.0001), cystic (r = 0.39, P < 0.0001, and % cyst volume (r = 0.41, P < 0.0001) were related with urinary albumin excretion.

CONCLUSION

MR measures of renal and cyst volume are reliable and accurate in patients with ADPKD. ADPKD is characterized by significant cystic involvement that increases with age. Structure (renal and cyst volume) and function (GFR) are inversely related and directly related with the presence of hypertension and urinary albumin excretion in individuals with normal renal function.

Unbiased estimation of the liver volume by the Cavalieri principle using magnetic resonance images

OBJECTIVE

It is often useful to know the exact volume of the liver, such as in monitoring the effects of a disease, treatment, dieting regime, training program or surgical application. Some non-invasive methodologies have been previously described which estimate the volume of the liver. However, these preliminary techniques need special software or skilled performers and they are not ideal for daily use in clinical practice. Here, we describe a simple, accurate and practical technique for estimating liver volume without changing the routine magnetic resonance imaging scanning procedure.

MATERIALS AND METHODS

In this study, five normal livers, obtained from cadavers, were scanned by 0.5 T MR machine, in horizontal and sagittal planes. The consecutive sections, in 10 mm thickness, were used to estimate the whole volume of the liver by means of the Cavalieri principle. The volume estimations were done by three different performers to evaluate the reproducibility.

RESULTS

There are no statistical differences between the performers and real liver volumes (P > 0.05). There is also high correlation between the estimates of performers and the real liver volume (r = 0.993).

CONCLUSION

We conclude that the combination of MR imaging with the Cavalieri principle is a non-invasive, direct and unbiased technique that can be safely applied to estimate liver volume with a very moderate workload per individual.

Brain volume, asymmetry and intellectual impairment in relation to sex in early-onset schizophrenia

BACKGROUND

Accumulating evidence suggests that early-onset schizophrenia arises from a disturbance in the normal trajectory of cerebral development.

AIMS

To investigate brain structure, asymmetry and IQ in early-onset schizophrenia.

METHOD

Volumes of left and right cerebral hemispheres and IQ were assessed in 33 participants with early-onset DSM-IV schizophrenia and 30 members of a matched, normal control group.

RESULTS

Total brain volume was significantly smaller in the group with early-onset disease ('cases') relative to the control group (4.5%), especially for the left hemisphere in males (6.0%). A significant sex x diagnosis interaction in hemisphere asymmetry revealed that the female cases group had significantly reduced rightward asymmetry relative to the female control group and that the male cases tended to have reduced leftward asymmetry relative to the male control group. Decreased left hemisphere volume in males and decreased rightward hemispheric asymmetry in females correlated with reduced IQ.

CONCLUSIONS

Sexually dimorphic alterations in asymmetry correlate with degree of intellectual impairment in early-onset schizophrenia.

Estimation of the amniotic fluid volume using the Cavalieri method on ultrasound images

OBJECTIVES

Presently, a design-based and practical method for measuring amniotic fluid volume (AFV) for routine clinical examinations has not been proposed. In this study we describe a new method, which combines the Cavalieri method with ultrasound imaging to estimate AFV.

METHODS

We measured the AFVs of 14 women in the third trimester of pregnancy, and repeated our measurements three times for each woman. Parallel planimetric ultrasonographic images were obtained at every 2 cm along the longitudinal uterine axis. AFVs were calculated as the total of the multiples of the estimated cut surface areas by the section thickness.

RESULTS

The mean estimated AFV was 380.5 cm3. The coefficient of error of each measurement was calculated and the mean was 0.108. The coefficient of correlation between the amniotic fluid index and our AFV estimations was 0.87.

CONCLUSIONS

Design-based and efficient estimation of AFV is possible with the combination of consecutive ultrasound images and the Cavalieri method.

Quantitative frontal and temporal structural MRI studies in personality-disordered offenders and control subjects

High rates of temporal and frontal lobe dysfunction have been reported in neuropsychological and EEG studies of incarcerated personality-disordered (PD) offenders, but there have been few quantitative structural magnetic resonance imaging (MRI) studies. We investigated whether impulsive-aggressive male PD patients showed evidence of reduced brain volumes in frontal and temporal brain regions on MRI compared with healthy control subjects. All subjects were screened for axis I pathology and brain abnormalities. Quantitative measures of frontal and temporal lobe volume were computed on MR images of the brain in 19 control subjects and 18 patients who did not show any evidence of brain pathology on diagnostic MRI scans. Temporal lobe volumes were 20% smaller in PD patients than control subjects, but the predicted reductions in frontal lobe volume did not occur, despite evidence of impairments in executive function. There was no evidence of differences in asymmetry of brain structures. The study further implicates temporal lobes in the pathogenesis of severe personality disorder, but does not support the notion that PDs characterised by impulsive-aggressive traits have abnormalities in brain symmetry similar to those reported in mentally ill populations. Higher-resolution MRI studies are needed to localise the abnormalities and to determine their nature.

Voxel based morphometry of grey matter abnormalities in patients with medically intractable temporal lobe epilepsy: effects of side of seizure onset and epilepsy duration

OBJECTIVES

To investigate the use of whole brain voxel based morphometry (VBM) and stereological analysis to study brain morphology in patients with medically intractable temporal lobe epilepsy; and to determine the relation between side, duration, and age of onset of temporal lobe epilepsy, history of childhood febrile convulsions, and grey matter structure.

METHODS

Three dimensional magnetic resonance images were obtained from 58 patients with left sided seizure onset (LSSO) and 58 patients with right sided seizure onset (RSSO), defined using EEG and foramen ovale recordings in the course of presurgical evaluation for temporal lobectomy. Fifty eight normal controls formed a comparison group. VBM was used to characterise whole brain grey matter concentration, while the Cavalieri method of modern design stereology in conjunction with point counting was used to estimate hippocampal and amygdala volume. Age and sex were used as confounding covariates in analyses.

RESULTS

LSSO and RSSO patients showed significant reductions in volume (using stereology) and grey matter concentration (using VBM) of the hippocampus, but not of the amygdala, in the presumed epileptogenic zone when compared with controls, but hippocampal (and amygdala) volume and grey matter concentration were not related to duration or age of onset of epilepsy. LSSO and RSSO patients with a history of childhood febrile convulsions had reduced hippocampal volumes in the presumed epileptogenic zone compared with patients without such a history. Left amygdala volume was also reduced in LSSO patients with a history of childhood convulsions. VBM results indicated bilateral thalamic, prefrontal, and cerebellar GMC reduction in patients, which correlated with duration and age of onset of epilepsy.

CONCLUSIONS

Hippocampal sclerosis is not necessarily the consequence of recurrent temporal lobe seizures. A major cause of hippocampal sclerosis appears to be an early aberrant neurological insult, such as childhood febrile seizures. Secondary brain abnormalities exist in regions outside the presumed epileptogenic zone and may result from recurrent seizures.

Comparison of two volumetric techniques for estimating liver volume using magnetic resonance imaging

PURPOSE

To compare the conventional technique of manual planimetry with the point counting technique for estimating liver volume from magnetic resonance imaging (MRI) data.

MATERIALS AND METHODS

This study comprised abdominal MR examinations of 38 consecutive patients. Evaluation of the images showed that liver size appeared normal in 27 patients and increased in 11. Liver volume was estimated using the techniques of planimetry and point counting. Both techniques were used in combination with the Cavalieri method of modern design stereology. A systematic slice sampling procedure was performed to estimate liver volumes using both volumetric techniques. The point counting technique was optimized by altering the point spacing of the grid. The agreement between the two techniques was found. Measurement repeatability of both volumetric techniques was also evaluated.

RESULTS

Both techniques allowed the same degree of optimization through the procedure of systematic section sampling. The application of a point spacing of 2.5 cm reduced the time measurement by a factor of 3.5 in relation with the time needed with planimetry. An excellent agreement was observed between the two volumetric techniques with mean differences (+/-SD) of 2.4 +/- 41.6 cm(3) and 8.5 +/- 49.8 cm(3) for the patients presenting normal and increased liver sizes, respectively. Both techniques were highly reproducible.

CONCLUSION

The point counting technique could be considered a more efficient approach than planimetry for estimating liver volume from MRI, due to its speed and simplicity.

Voxel-based morphometric comparison of hippocampal and extrahippocampal abnormalities in patients with left and right hippocampal atrophy

We used voxel-based morphometry (VBM), an automatic whole-brain MR image analysis technique, to investigate gray matter abnormalities in patients with temporal lobe epilepsy (TLE), in whom hippocampal atrophy (HA) was demonstrated by application of the Cavalieri method of modern design stereology. VBM results (P < 0.05, corrected) indicated preferential gray matter concentration (GMC) reduction in anterior hippocampus in patients with left HA and posterior hippocampus in patients with right HA. GMC reduction was also found in right dorsal prefrontal cortex in left and right HA patients. Prefrontal atrophy may be due to epileptiform excitotoxic discharges from the reciprocally connected pathological hippocampus, and may be the underlying biological cause for executive dysfunction in patients with TLE. GMC excess in ipsilateral parahippocampal, cerebellar, and pericallosal regions was common to both left and right HA groups relative to controls, and is hypothesized to reflect diminished gray-white matter demarcation, underlying white matter atrophy, or structural displacement due to cerebrospinal fluid expansion. However, bilateral temporal lobe GMC excess was observed in left HA patients, while ipsilateral temporal lobe GMC excess was observed in right HA patients. This work demonstrates methodological consistency between automated VBM and manual stereological analysis of the hippocampus in group comparisons, indicates widespread extrahippocampal gray matter abnormalities in unilateral HA, and suggests that there may be inherent differences in the effect of TLE on temporal lobe structures depending on the side of HA.

Muscle spindle distribution, morphology, and density in longus colli and multifidus muscles of the cervical spine

STUDY DESIGN

Tissue blocks comprising muscle and bone from C5 to C7 segments were harvested at autopsy from 16 individuals ranging in age from 4 to 77 years. The prevertebral longus colli and postvertebral multifidus muscle pairs from one side in each individual were randomly selected for this study of muscle spindles.

OBJECTIVES

To determine muscle spindle distribution, morphology, and density for the longus colli and multifidus in caudal segments of the human cervical spine, and to assess whether changes are evident from infancy to old age.

SUMMARY OF BACKGROUND DATA

Age-related changes to the osteoligamentous framework of the cervical spine have been well documented. Postural modification accompanies these structural alterations, but there have been limited attempts to document whether muscle sustains a comparable level of morphologic alteration. Previous studies have examined muscle spindles in the neck muscles of various animal models and in a variety of isolated human muscles. However, most of these studies incurred bias through sampling and methodologic assumptions.

METHODS

The longus colli and multifidus were resected between C5 and C7, and between left and right pairs selected randomly for spindle analysis. These vertebral segments were selected deliberately because they form the apex of the cervical lordosis and the site at which the greatest age-related modification occurs. The tissue was processed in paraffin, sectioned, and then stained by Masson's trichrome. Spindle characteristics were examined using light microscopy and analyzed by unbiased stereologic methods. A one-sample paired t test was used to ascertain whether the differences in spindle density between the two muscles were statistically significant.

RESULTS

The longus colli has a high density of muscle spindles, which appear clustered and concentrated anterolaterally, away from the vertebral body. The multifidus has a low density of muscle spindles, which are found predominantly as single units concentrated closely to the vertebral lamina. No change in spindle distribution, morphology, and density were observed with age.

CONCLUSIONS

The current study examined spindle characteristics for an intrinsic neck muscle pair whose coactivation contributes to segmental stability of the cervical spine. The distribution and morphology of muscle spindles differ between the longus colli and the multifidus. In addition, these muscles have significant differences in terms of mean spindle density. Spindle characteristics represent one of many factors that govern proprioceptive regulation in skeletal muscle, and in neck muscles, the central connectivity of these receptors remains undefined. Therefore, although there are anatomic differences between the neck flexor and extensor, the functional implications of these differences are not clear. It is also of interest that spindle characteristics remain unchanged in these intrinsic muscles whose underlying segments are subject to age-related osteoligamentous changes.