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Eagleson R, Kikinov D, Bilbie L, de Ribaupierre S. Clinical trainee performance on task-based AR/VR-guided surgical simulation is correlated with their 3D image spatial reasoning scores. Healthc Technol Lett 2024; 11:117-125. [PMID: 38638489 PMCID: PMC11022220 DOI: 10.1049/htl2.12066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 12/05/2023] [Indexed: 04/20/2024] Open
Abstract
This paper describes a methodology for the assessment of training simulator-based computer-assisted intervention skills on an AR/VR-guided procedure making use of CT axial slice views for a neurosurgical procedure: external ventricular drain (EVD) placement. The task requires that trainees scroll through a stack of axial slices and form a mental representation of the anatomical structures in order to subsequently target the ventricles to insert an EVD. The process of observing the 2D CT image slices in order to build a mental representation of the 3D anatomical structures is the skill being taught, along with the cognitive control of the subsequent targeting, by planned motor actions, of the EVD tip to the ventricular system to drain cerebrospinal fluid (CSF). Convergence is established towards the validity of this assessment methodology by examining two objective measures of spatial reasoning, along with one subjective expert ranking methodology, and comparing these to AR/VR guidance. These measures have two components: the speed and accuracy of the targeting, which are used to derive the performance metric. Results of these correlations are presented for a population of PGY1 residents attending the Canadian Neurosurgical "Rookie Bootcamp" in 2019.
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Affiliation(s)
- Roy Eagleson
- Artificial Intelligence and Software EngineeringThe University of Western OntarioLondonCanada
| | - Denis Kikinov
- Artificial Intelligence and Software EngineeringThe University of Western OntarioLondonCanada
| | - Liam Bilbie
- Artificial Intelligence and Software EngineeringThe University of Western OntarioLondonCanada
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2
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Van Winssen C, Andrade AV, Andrade DM, Burneo JG, de Ribaupierre S, Donner E, Hassan A, Ibrahim G, Jones KC, Lomax LB, Muir K, Nouri MN, Porter N, Ramachandrannair R, Raymond P, Rutka J, Shapiro MJ, Steven DA, Swain D, Valiante T, Whiting S, Whitney R, Yau I, Fantaneanu TA. Evaluating the Current State of Epilepsy Care in the Province of Ontario. Can J Neurol Sci 2024:1-3. [PMID: 38425209 DOI: 10.1017/cjn.2024.30] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
There are numerous challenges pertaining to epilepsy care across Ontario, including Epilepsy Monitoring Unit (EMU) bed pressures, surgical access and community supports. We sampled the current clinical, community and operational state of Ontario epilepsy centres and community epilepsy agencies post COVID-19 pandemic. A 44-item survey was distributed to all 11 district and regional adult and paediatric Ontario epilepsy centres. Qualitative responses were collected from community epilepsy agencies. Results revealed ongoing gaps in epilepsy care across Ontario, with EMU bed pressures and labour shortages being limiting factors. A clinical network advising the Ontario Ministry of Health will improve access to epilepsy care.
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Affiliation(s)
- Christine Van Winssen
- Division of Neurology, Department of Medicine, University of Ottawa & The Ottawa Hospital, Ottawa, ON, Canada
| | - Andrea V Andrade
- Division of Neurology, Department of Pediatrics, Western University, London, ON, Canada
| | - Danielle M Andrade
- Division of Neurology, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Jorge G Burneo
- Division of Neurology, Department of Clinical Neurosciences, Western University, London, ON, Canada
| | - Sandrine de Ribaupierre
- Division of Neurosurgery, Department of Clinical Neurosciences, Western University, London, ON, Canada
| | - Elizabeth Donner
- Division of Neurology, Department of Pediatrics, Hospital for Sick Children & University of Toronto, Toronto, ON, Canada
| | - Ayman Hassan
- Division of Neurology, Northern Ontario School of Medicine, Thunder Bay, ON, Canada
| | - George Ibrahim
- Division of Neurosurgery, Department of Pediatrics, Hospital for Sick Children & University of Toronto, Toronto, ON, Canada
| | - Kevin C Jones
- Division of Neurology, Department of Pediatrics, McMaster Children's Hospital, Hamilton, ON, Canada
| | - Lysa Boissé Lomax
- Department of Medicine, Queen's University & Kingston Health Sciences Centre, Kingston, ON, Canada
| | - Katherine Muir
- Division of Neurology, Department of Pediatrics, University of Ottawa, Ottawa, ON, Canada
| | - Maryam N Nouri
- Division of Neurology, Department of Pediatrics, Western University, London, ON, Canada
| | | | - Rajesh Ramachandrannair
- Division of Neurology, Department of Pediatrics, McMaster Children's Hospital, Hamilton, ON, Canada
| | | | - James Rutka
- Division of Neurosurgery, Department of Pediatrics, Hospital for Sick Children & University of Toronto, Toronto, ON, Canada
| | - Michelle J Shapiro
- Division of Neurology, Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - David A Steven
- Division of Neurosurgery, Department of Clinical Neurosciences, Western University, London, ON, Canada
| | - Darryl Swain
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Taufik Valiante
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Sharon Whiting
- Division of Neurology, Department of Pediatrics, University of Ottawa, Ottawa, ON, Canada
| | - Robyn Whitney
- Division of Neurology, Department of Pediatrics, McMaster Children's Hospital, Hamilton, ON, Canada
| | - Ivanna Yau
- Division of Neurology, Department of Pediatrics, Hospital for Sick Children & University of Toronto, Toronto, ON, Canada
| | - Tadeu A Fantaneanu
- Division of Neurology, Department of Medicine, University of Ottawa & The Ottawa Hospital, Ottawa, ON, Canada
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
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3
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Tang L, Kebaya LMN, Altamimi T, Kowalczyk A, Musabi M, Roychaudhuri S, Vahidi H, Meyerink P, de Ribaupierre S, Bhattacharya S, de Moraes LTAR, St Lawrence K, Duerden EG. Altered resting-state functional connectivity in newborns with hypoxic ischemic encephalopathy assessed using high-density functional near-infrared spectroscopy. Sci Rep 2024; 14:3176. [PMID: 38326455 PMCID: PMC10850364 DOI: 10.1038/s41598-024-53256-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 01/30/2024] [Indexed: 02/09/2024] Open
Abstract
Hypoxic-ischemic encephalopathy (HIE) results from a lack of oxygen to the brain during the perinatal period. HIE can lead to mortality and various acute and long-term morbidities. Improved bedside monitoring methods are needed to identify biomarkers of brain health. Functional near-infrared spectroscopy (fNIRS) can assess resting-state functional connectivity (RSFC) at the bedside. We acquired resting-state fNIRS data from 21 neonates with HIE (postmenstrual age [PMA] = 39.96), in 19 neonates the scans were acquired post-therapeutic hypothermia (TH), and from 20 term-born healthy newborns (PMA = 39.93). Twelve HIE neonates also underwent resting-state functional magnetic resonance imaging (fMRI) post-TH. RSFC was calculated as correlation coefficients amongst the time courses for fNIRS and fMRI data, respectively. The fNIRS and fMRI RSFC maps were comparable. RSFC patterns were then measured with graph theory metrics and compared between HIE infants and healthy controls. HIE newborns showed significantly increased clustering coefficients, network efficiency and modularity compared to controls. Using a support vector machine algorithm, RSFC features demonstrated good performance in classifying the HIE and healthy newborns in separate groups. Our results indicate the utility of fNIRS-connectivity patterns as potential biomarkers for HIE and fNIRS as a new bedside tool for newborns with HIE.
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Affiliation(s)
- Lingkai Tang
- Biomedical Engineering, Faculty of Engineering, Western University, London, ON, Canada
| | - Lilian M N Kebaya
- Neuroscience, Schulich Faculty of Medicine and Dentistry, Western University, London, ON, Canada
- Neonatal-Perinatal Medicine, Schulich Faculty of Medicine and Dentistry, Western University, London, ON, Canada
- Department of Paediatrics, Division of Neonatal-Perinatal Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Talal Altamimi
- Neonatal-Perinatal Medicine, Schulich Faculty of Medicine and Dentistry, Western University, London, ON, Canada
| | - Alexandra Kowalczyk
- Neonatal-Perinatal Medicine, Schulich Faculty of Medicine and Dentistry, Western University, London, ON, Canada
| | - Melab Musabi
- Neonatal-Perinatal Medicine, Schulich Faculty of Medicine and Dentistry, Western University, London, ON, Canada
| | - Sriya Roychaudhuri
- Neonatal-Perinatal Medicine, Schulich Faculty of Medicine and Dentistry, Western University, London, ON, Canada
| | - Homa Vahidi
- Neuroscience, Schulich Faculty of Medicine and Dentistry, Western University, London, ON, Canada
| | - Paige Meyerink
- Neonatal-Perinatal Medicine, Schulich Faculty of Medicine and Dentistry, Western University, London, ON, Canada
| | - Sandrine de Ribaupierre
- Neuroscience, Schulich Faculty of Medicine and Dentistry, Western University, London, ON, Canada
- Clinical Neurological Sciences, Schulich Faculty of Medicine and Dentistry, Western University, London, ON, Canada
| | - Soume Bhattacharya
- Neonatal-Perinatal Medicine, Schulich Faculty of Medicine and Dentistry, Western University, London, ON, Canada
| | | | - Keith St Lawrence
- Biomedical Engineering, Faculty of Engineering, Western University, London, ON, Canada
- Medical Biophysics, Schulich Faculty of Medicine and Dentistry, Western University, London, ON, Canada
| | - Emma G Duerden
- Biomedical Engineering, Faculty of Engineering, Western University, London, ON, Canada.
- Neuroscience, Schulich Faculty of Medicine and Dentistry, Western University, London, ON, Canada.
- Applied Psychology, Faculty of Education, Western University, 1137 Western Rd, London, ON, N6G 1G7, Canada.
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Nichols ES, Al-Saoud S, de Vrijer B, McKenzie CA, Eagleson R, de Ribaupierre S, Duerden EG. T2* Mapping of Placental Oxygenation to Estimate Fetal Cortical and Subcortical Maturation. JAMA Netw Open 2024; 7:e240456. [PMID: 38411965 PMCID: PMC10900962 DOI: 10.1001/jamanetworkopen.2024.0456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/28/2024] Open
Abstract
This cohort study investigates the association between T2* mapping of placental oxygenation and cortical and subcortical fetal brain volumes in typically developing fetuses scanned longitudinally in the third trimester.
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Affiliation(s)
- Emily S Nichols
- Applied Psychology, Faculty of Education, Western University, London, Ontario, Canada
- Western Institute for Neuroscience, Western University, London, Ontario, Canada
| | - Sarah Al-Saoud
- Applied Psychology, Faculty of Education, Western University, London, Ontario, Canada
- Western Institute for Neuroscience, Western University, London, Ontario, Canada
| | - Barbra de Vrijer
- Obstetrics & Gynaecology, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
- Division of Maternal, Fetal and Newborn Health, Children's Health Research Institute
| | - Charles A McKenzie
- Division of Maternal, Fetal and Newborn Health, Children's Health Research Institute
- Medical Biophysics, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Roy Eagleson
- Western Institute for Neuroscience, Western University, London, Ontario, Canada
- Electrical and Computer Engineering, Faculty of Engineering, Western University, London, Ontario, Canada
| | - Sandrine de Ribaupierre
- Western Institute for Neuroscience, Western University, London, Ontario, Canada
- Division of Maternal, Fetal and Newborn Health, Children's Health Research Institute
- Medical Biophysics, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
- Electrical and Computer Engineering, Faculty of Engineering, Western University, London, Ontario, Canada
- Clinical Neurological Sciences, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
- Anatomy and Cell Biology, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Emma G Duerden
- Applied Psychology, Faculty of Education, Western University, London, Ontario, Canada
- Western Institute for Neuroscience, Western University, London, Ontario, Canada
- Division of Maternal, Fetal and Newborn Health, Children's Health Research Institute
- Biomedical Engineering, Western University, London, Ontario, Canada
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5
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Nichols ES, Grace M, Correa S, de Vrijer B, Eagleson R, McKenzie CA, de Ribaupierre S, Duerden EG. Sex- and age-based differences in fetal and early childhood hippocampus maturation: a cross-sectional and longitudinal analysis. Cereb Cortex 2024; 34:bhad421. [PMID: 37950876 PMCID: PMC10793584 DOI: 10.1093/cercor/bhad421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 10/13/2023] [Accepted: 10/14/2023] [Indexed: 11/13/2023] Open
Abstract
The hippocampus, essential for cognitive and affective processes, develops exponentially with differential trajectories seen in girls and boys, yet less is known about its development during early fetal life until early childhood. In a cross-sectional and longitudinal study, we examined the sex-, age-, and laterality-related developmental trajectories of hippocampal volumes in fetuses, infants, and toddlers associated with age. Third trimester fetuses (27-38 weeks' gestational age), newborns (0-4 weeks' postnatal age), infants (5-50 weeks' postnatal age), and toddlers (2-3 years postnatal age) were scanned with magnetic resonance imaging. A total of 133 datasets (62 female, postmenstrual age [weeks] M = 69.38, SD = 51.39, range = 27.6-195.3) were processed using semiautomatic segmentation methods. Hippocampal volumes increased exponentially during the third trimester and the first year of life, beginning to slow at approximately 2 years. Overall, boys had larger hippocampal volumes than girls. Lateralization differences were evident, with left hippocampal growth beginning to plateau sooner than the right. This period of rapid growth from the third trimester, continuing through the first year of life, may support the development of cognitive and affective function during this period.
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Affiliation(s)
- Emily S Nichols
- Department of Applied Psychology, Faculty of Education, Western University, 1137 Western Road, London, Ontario, Canada
- Western Institute for Neuroscience, Western University, 1151 Richmond Street, London, Ontario N6A 3K7, Canada
| | - Michael Grace
- Department of Physiology and Pharmacology, Western University, 1151 Richmond Street, London, Ontario N6A 3K7, Canada
| | - Susana Correa
- Western Institute for Neuroscience, Western University, 1151 Richmond Street, London, Ontario N6A 3K7, Canada
| | - Barbra de Vrijer
- Department of Obstetrics & Gynaecology, Schulich School of Medicine & Dentistry, Western University, London Health Sciences Centre-Victoria Hospital, B2-401, London, Ontario N6H 5W9, Canada
- Division of Maternal, Fetal and Newborn Health, Children's Health Research Institute, 800 Commissioners Road East, London, Ontario N6C 2V5, Canada
| | - Roy Eagleson
- Western Institute for Neuroscience, Western University, 1151 Richmond Street, London, Ontario N6A 3K7, Canada
- Department of Biomedical Engineering, Western University, Canada
- Department of Electrical and Computer Engineering, Western University, 1151 Richmond Street, London, Ontario N6A 3K7, Canada
| | - Charles A McKenzie
- Division of Maternal, Fetal and Newborn Health, Children's Health Research Institute, 800 Commissioners Road East, London, Ontario N6C 2V5, Canada
- Department of Medical Biophysics, Schulich School of Medicine & Dentistry, Western University, Canada
| | - Sandrine de Ribaupierre
- Western Institute for Neuroscience, Western University, 1151 Richmond Street, London, Ontario N6A 3K7, Canada
- Division of Maternal, Fetal and Newborn Health, Children's Health Research Institute, 800 Commissioners Road East, London, Ontario N6C 2V5, Canada
- Department of Biomedical Engineering, Western University, Canada
- Department of Medical Biophysics, Schulich School of Medicine & Dentistry, Western University, Canada
- Department of Clinical Neurological Sciences, Schulich School of Medicine & Dentistry, Western University, Canada
- Department of Anatomy and Cell Biology, Schulich School of Medicine & Dentistry, Western University, Canada
| | - Emma G Duerden
- Department of Applied Psychology, Faculty of Education, Western University, 1137 Western Road, London, Ontario, Canada
- Western Institute for Neuroscience, Western University, 1151 Richmond Street, London, Ontario N6A 3K7, Canada
- Division of Maternal, Fetal and Newborn Health, Children's Health Research Institute, 800 Commissioners Road East, London, Ontario N6C 2V5, Canada
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Boutin J, Kamoonpuri J, Faieghi R, Chung J, de Ribaupierre S, Eagleson R. Smart haptic gloves for virtual reality surgery simulation: a pilot study on external ventricular drain training. Front Robot AI 2024; 10:1273631. [PMID: 38269073 PMCID: PMC10806798 DOI: 10.3389/frobt.2023.1273631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Accepted: 12/14/2023] [Indexed: 01/26/2024] Open
Abstract
Smart haptic gloves are a new technology emerging in Virtual Reality (VR) with a promise to enhance sensory feedback in VR. This paper presents one of the first attempts to explore its application to surgical training for neurosurgery trainees using VR-based surgery simulators. We develop and evaluate a surgical simulator for External Ventricular Drain Placement (EVD), a common procedure in the field of neurosurgery. Haptic gloves are used in combination with a VR environment to augment the experience of burr hole placement, and flexible catheter manipulation. The simulator was integrated into the training curriculum at the 2022 Canadian Neurosurgery Rookie Bootcamp. Thirty neurosurgery residents used the simulator where objective performance metrics and subjective experience scores were acquired. We provide the details of the simulator development, as well as the user study results and draw conclusions on the benefits added by the haptic gloves and future directions.
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Affiliation(s)
- Jonah Boutin
- Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada
| | - Jafer Kamoonpuri
- Department of Aerospace Engineering, Toronto Metropolitan University, Toronto, ON, Canada
| | - Reza Faieghi
- Department of Aerospace Engineering, Toronto Metropolitan University, Toronto, ON, Canada
| | - Joon Chung
- Department of Aerospace Engineering, Toronto Metropolitan University, Toronto, ON, Canada
| | - Sandrine de Ribaupierre
- Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada
| | - Roy Eagleson
- Department of Electrical and Computer Engineering, University of Western Ontario, London, ON, Canada
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Ragguett RM, Eagleson R, de Ribaupierre S. Association between altered white matter networks and post operative ventricle volume in shunt-treated pediatric hydrocephalus. Brain Res Bull 2024; 206:110847. [PMID: 38103800 DOI: 10.1016/j.brainresbull.2023.110847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 11/26/2023] [Accepted: 12/12/2023] [Indexed: 12/19/2023]
Abstract
OBJECTIVE The objective of this study was to use probabilistic tractography in combination with white matter microstructure metrics to characterize differences in white matter networks between shunt-treated pediatric hydrocephalus patients relative to healthy controls. We were also able to explore the relationship between these white matter networks and postoperative ventricle volume. METHODS Network-based statistics was used in combination with whole-brain probabilistic tractography to determine dysregulated white matter networks in a sample of patients with pediatric hydrocephalus (n = 8), relative to controls (n = 36). Metrics such as streamline count (SC), as well as the mean of the fractional anisotropy along a tract, axial diffusivity (AD), mean diffusivity (MD), and radial diffusivity (RD) were assessed. In networks that were found to be significantly different for patients with hydrocephalus, tracts were evaluated to assess their relationship with postoperative lateral ventricle volume. RESULTS Patients with pediatric hydrocephalus had various networks that were either upregulated or downregulated relative to controls across all white matter measures. Predominately, network dysregulation occurred in tracts involving structures located outside of the frontal lobe. Furthermore tracts with values suggesting decreased white matter integrity were not only found between subcortical structures, but also cortical structures. While there were various tracts with white matter metrics that were initially predicted by lateral ventricle volume, only two tracts remained significant following multiple comparisons. CONCLUSIONS This cross-sectional study in pediatric patients with hydrocephalus and healthy controls demonstrated using whole-brain probabilistic tractography that there are various networks with dysregulated white matter integrity in hydrocephalus patients relative to controls. These dysregulated networks have tracts connecting structures throughout the brain, and the regions were predominately located centrally and posteriorly. Postoperative ventricle volume did not predict the white matter integrity of many tracts. Future studies with larger sample sizes are needed to further understand these results.
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Affiliation(s)
| | - Roy Eagleson
- School of Biomedical Engineering, Western University, London, Ontario, Canada; Department of Electrical and Computer Engineering, Western University, London, Ontario, Canada; Western Institute for Neuroscience, Western University, London, Ontario, Canada
| | - Sandrine de Ribaupierre
- School of Biomedical Engineering, Western University, London, Ontario, Canada; Western Institute for Neuroscience, Western University, London, Ontario, Canada; Department of Clinical Neurological Sciences, Schulich School of Medicine, Western University, London, Ontario, Canada.
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8
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Adil D, Duerden EG, Eagleson R, de Ribaupierre S. Structural Alterations of the Corpus Callosum in Children With Infantile Hydrocephalus. J Child Neurol 2024; 39:66-76. [PMID: 38387869 PMCID: PMC11083734 DOI: 10.1177/08830738241231343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 01/17/2024] [Accepted: 01/22/2024] [Indexed: 02/24/2024]
Abstract
This study investigates structural alterations of the corpus callosum in children diagnosed with infantile hydrocephalus. We aim to assess both macrostructural (volume) and microstructural (diffusion tensor imaging metrics) facets of the corpus callosum, providing insights into the nature and extent of alterations associated with this condition. Eighteen patients with infantile hydrocephalus (mean age = 9 years) and 18 age- and sex-matched typically developing healthy children participated in the study. Structural magnetic resonance imaging and diffusion tensor imaging were used to assess corpus callosum volume and microstructure, respectively. Our findings reveal significant alterations in corpus callosum volume, particularly in the posterior area, as well as distinct microstructural disparities, notably pronounced in these same segments. These results highlight the intricate interplay between macrostructural and microstructural aspects in understanding the impact of infantile hydrocephalus. Examining these structural alterations provides an understanding into the mechanisms underlying the effects of infantile hydrocephalus on corpus callosum integrity, given its pivotal role in interhemispheric communication. This knowledge offers a more nuanced perspective on neurologic disorders and underscores the significance of investigating the corpus callosum's health in such contexts.
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Affiliation(s)
- Derya Adil
- Western Institute for Neuroscience, Western University, London, Ontario, Canada
| | - Emma G. Duerden
- Western Institute for Neuroscience, Western University, London, Ontario, Canada
- Applied Psychology, Faculty of Education, Western University, London, Ontario, Canada
| | - Roy Eagleson
- Western Institute for Neuroscience, Western University, London, Ontario, Canada
- Electrical and Computer Engineering, Faculty of Engineering, Western University, London, Ontario, Canada
| | - Sandrine de Ribaupierre
- Western Institute for Neuroscience, Western University, London, Ontario, Canada
- Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
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9
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Kebaya LMN, Kapoor B, Mayorga PC, Meyerink P, Foglton K, Altamimi T, Nichols ES, de Ribaupierre S, Bhattacharya S, Tristao L, Jurkiewicz MT, Duerden EG. Subcortical brain volumes in neonatal hypoxic-ischemic encephalopathy. Pediatr Res 2023; 94:1797-1803. [PMID: 37353661 DOI: 10.1038/s41390-023-02695-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 05/07/2023] [Accepted: 05/21/2023] [Indexed: 06/25/2023]
Abstract
BACKGROUND Despite treatment with therapeutic hypothermia, hypoxic-ischemic encephalopathy (HIE) is associated with adverse developmental outcomes, suggesting the involvement of subcortical structures including the thalamus and basal ganglia, which may be vulnerable to perinatal asphyxia, particularly during the acute period. The aims were: (1) to examine subcortical macrostructure in neonates with HIE compared to age- and sex-matched healthy neonates within the first week of life; (2) to determine whether subcortical brain volumes are associated with HIE severity. METHODS Neonates (n = 56; HIE: n = 28; Healthy newborns from the Developing Human Connectome Project: n = 28) were scanned with MRI within the first week of life. Subcortical volumes were automatically extracted from T1-weighted images. General linear models assessed between-group differences in subcortical volumes, adjusting for sex, gestational age, postmenstrual age, and total cerebral volumes. Within-group analyses evaluated the association between subcortical volumes and HIE severity. RESULTS Neonates with HIE had smaller bilateral thalamic, basal ganglia and right hippocampal and cerebellar volumes compared to controls (all, p < 0.02). Within the HIE group, mild HIE severity was associated with smaller volumes of the left and right basal ganglia (both, p < 0.007) and the left hippocampus and thalamus (both, p < 0.04). CONCLUSIONS Findings suggest that, despite advances in neonatal care, HIE is associated with significant alterations in subcortical brain macrostructure. IMPACT Compared to their healthy counterparts, infants with HIE demonstrate significant alterations in subcortical brain macrostructure on MRI acquired as early as 4 days after birth. Smaller subcortical volumes impacting sensory and motor regions, including the thalamus, basal ganglia, and cerebellum, were seen in infants with HIE. Mild and moderate HIE were associated with smaller subcortical volumes.
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Affiliation(s)
- Lilian M N Kebaya
- Neuroscience program, Western University, London, ON, Canada.
- Division of Neonatal-Perinatal Medicine, Department of Paediatrics, London Health Sciences Centre, London, ON, Canada.
| | - Bhavya Kapoor
- Applied Psychology, Faculty of Education, Western University, London, ON, Canada
- Western Institute for Neuroscience, Western University, London, ON, Canada
| | - Paula Camila Mayorga
- Division of Neonatal-Perinatal Medicine, Department of Paediatrics, London Health Sciences Centre, London, ON, Canada
| | - Paige Meyerink
- Division of Neonatal-Perinatal Medicine, Department of Paediatrics, London Health Sciences Centre, London, ON, Canada
| | - Kathryn Foglton
- Division of Neonatal-Perinatal Medicine, Department of Paediatrics, London Health Sciences Centre, London, ON, Canada
| | - Talal Altamimi
- Division of Neonatal-Perinatal Medicine, Department of Paediatrics, London Health Sciences Centre, London, ON, Canada
- Division of Neonatal Intensive Care, Department of Pediatrics, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Emily S Nichols
- Applied Psychology, Faculty of Education, Western University, London, ON, Canada
- Western Institute for Neuroscience, Western University, London, ON, Canada
| | - Sandrine de Ribaupierre
- Neuroscience program, Western University, London, ON, Canada
- Western Institute for Neuroscience, Western University, London, ON, Canada
- Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
- Children's Health Research Institute, London, ON, Canada
| | - Soume Bhattacharya
- Division of Neonatal-Perinatal Medicine, Department of Paediatrics, London Health Sciences Centre, London, ON, Canada
| | - Leandro Tristao
- Department of Medical Imaging, London Health Sciences Centre, London, ON, Canada
| | - Michael T Jurkiewicz
- Neuroscience program, Western University, London, ON, Canada
- Western Institute for Neuroscience, Western University, London, ON, Canada
- Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
- Department of Medical Imaging, London Health Sciences Centre, London, ON, Canada
| | - Emma G Duerden
- Neuroscience program, Western University, London, ON, Canada
- Applied Psychology, Faculty of Education, Western University, London, ON, Canada
- Western Institute for Neuroscience, Western University, London, ON, Canada
- Children's Health Research Institute, London, ON, Canada
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Pur DR, Sivakumar GK, Bursztyn LLCD, Iordanous Y, de Ribaupierre S. Strabismus outcomes in pediatric patients undergoing disconnective hemispheric surgery for intractable epilepsy: a systematic review. Can J Ophthalmol 2023:S0008-4182(23)00244-2. [PMID: 37640228 DOI: 10.1016/j.jcjo.2023.07.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Revised: 06/09/2023] [Accepted: 07/31/2023] [Indexed: 08/31/2023]
Abstract
BACKGROUND Children undergoing hemispheric surgery for intractable seizures are susceptible to visual complications including strabismus. This systematic review aims to investigate the rates and characteristics of strabismus development after hemispheric surgery and evaluate clinical implications for ophthalmologic care. METHODS A systematic search of MEDLINE, EMBASE, Cochrane, PsychINFO, and Web of Science databases was performed from database inception to May 2022. Included articles referred to strabismus outcomes in pediatric populations after hemispherectomy or hemispherotomy. Reviews and non-English-language publications were excluded. Risk of bias was assessed using Joanna Briggs Institute critical appraisal tools. Demographic data and characteristics of strabismus were extracted and tabulated. RESULTS Of 41 articles identified, 10 studies consisting of 384 pediatric participants (48% females) and age at surgery between 6 months and 16 years were included. Preoperative strabismus rates ranged between 3% and 56%, whereas postoperative rates ranged between 38% and 100%. With respect to the site of hemispheric surgery, contralateral exodeviation was the most common (16%-67%; n = 7) and then ipsilateral exodeviation (16%-56%; n = 2), whereas ipsilateral esodeviation was infrequent (4%-9%; n = 3). CONCLUSIONS Contralateral exotropia and ipsilateral esotropia may occur after hemispheric surgery and may have the potential to be field expanding. Concerns regarding negative social reactions should be balanced with the risk of visual field reduction and (or) diplopia by strabismus surgery. Higher-quality articles with large, homogeneous, and well-described populations (i.e., complete pre- and postoperative ophthalmologic assessments) are required to establish the risks and rates of strabismus development after hemispheric surgery.
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Affiliation(s)
- Daiana R Pur
- Schulich School of Medicine and Dentistry, Western University, London, ON.
| | - Gayathri K Sivakumar
- Department of Ophthalmology, Schulich School of Medicine and Dentistry, Western University, London, ON
| | - Lulu L C D Bursztyn
- Department of Ophthalmology, Schulich School of Medicine and Dentistry, Western University, London, ON; Department of Clinical Neurological Sciences, Western University, London, ON
| | - Yiannis Iordanous
- Department of Ophthalmology, Schulich School of Medicine and Dentistry, Western University, London, ON
| | - Sandrine de Ribaupierre
- Department of Clinical Neurological Sciences, Western University, London, ON; Brain and Mind Institute, Western University, London, ON; Children's Health Research Institute, Western University, London, ON
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11
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Dinatolo MF, Pur DR, Eagleson R, de Ribaupierre S. The Role of Blood Oxygen Level Dependent Signal Variability in Pediatric Neuroscience: A Systematic Review. Life (Basel) 2023; 13:1587. [PMID: 37511962 PMCID: PMC10382051 DOI: 10.3390/life13071587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 06/27/2023] [Accepted: 07/10/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND As pediatric BOLD Signal Variability (SV) analysis is relatively novel, there is a need to provide a foundational framework that gives researchers an entry point into engaging with the topic. This begins with clarifying the definition of BOLD signal variability by identifying and categorizing the various metrics utilized to measure BOLD SV. METHODS A systematic review of the literature was conducted. Inclusion criteria were restricted to studies utilizing any metric of BOLD SV and with individuals younger than 18 in the study population. The definition of BOLD SV was any measure of intra-individual variability in the BOLD signal. Five databases were searched: Psychinfo, Healthstar, MEDLINE, Embase, and Scopus. RESULTS A total of 17 observational studies, including male (n = 1796) and female (n = 1324) pediatric participants were included. Eight studies quantified variability as the amount of deviation from the average BOLD signal, seven used complexity-based metrics, three used correlation measures of variability, and one used the structure of the hemodynamic response function. In this study, 10 methods of quantifying signal variability were identified. Associations and trends in BOLD SV were commonly found with age, factors specific to mental and/or neurological disorders such as attention deficit disorder, epilepsy, psychotic symptoms, and performance on psychological and behavioral tasks. CONCLUSIONS BOLD SV is a potential biomarker of neurodevelopmental and neurological conditions and symptom severity in mental disorders for defined pediatric populations. Studies that establish clinical trends and identify the mechanisms underlying BOLD SV with a low risk of bias are needed before clinical applications can be utilized by physicians.
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Affiliation(s)
- Michael F Dinatolo
- Schulich School of Medicine and Dentistry, Western University, London, ON N6A 5C1, Canada
| | - Daiana Roxana Pur
- Schulich School of Medicine and Dentistry, Western University, London, ON N6A 5C1, Canada
| | - Roy Eagleson
- Brain and Mind Institute, Western University, London, ON N6A 5B7, Canada
- Department of Electrical and Computer Engineering, Western University, London, ON N6A 3K7, Canada
| | - Sandrine de Ribaupierre
- Brain and Mind Institute, Western University, London, ON N6A 5B7, Canada
- Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Western University, London, ON N6A 5C1, Canada
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Nichols ES, Correa S, Van Dyken P, Kai J, Kuehn T, de Ribaupierre S, Duerden EG, Khan AR. Funcmasker-flex: An Automated BIDS-App for Brain Segmentation of Human Fetal Functional MRI data. Neuroinformatics 2023; 21:565-573. [PMID: 37000360 DOI: 10.1007/s12021-023-09629-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/21/2023] [Indexed: 04/01/2023]
Abstract
Fetal functional magnetic resonance imaging (fMRI) offers critical insight into the developing brain and could aid in predicting developmental outcomes. As the fetal brain is surrounded by heterogeneous tissue, it is not possible to use adult- or child-based segmentation toolboxes. Manually-segmented masks can be used to extract the fetal brain; however, this comes at significant time costs. Here, we present a new BIDS App for masking fetal fMRI, funcmasker-flex, that overcomes these issues with a robust 3D convolutional neural network (U-net) architecture implemented in an extensible and transparent Snakemake workflow. Open-access fetal fMRI data with manual brain masks from 159 fetuses (1103 total volumes) were used for training and testing the U-net model. We also tested generalizability of the model using 82 locally acquired functional scans from 19 fetuses, which included over 2300 manually segmented volumes. Dice metrics were used to compare performance of funcmasker-flex to the ground truth manually segmented volumes, and segmentations were consistently robust (all Dice metrics ≥ 0.74). The tool is freely available and can be applied to any BIDS dataset containing fetal bold sequences. Funcmasker-flex reduces the need for manual segmentation, even when applied to novel fetal functional datasets, resulting in significant time-cost savings for performing fetal fMRI analysis.
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Affiliation(s)
- Emily S Nichols
- Faculty of Education, Western University, London, Canada.
- Western Institute for Neuroscience, Western University, London, Canada.
- Applied Psychology, Faculty of Education, Room 1131, 1137 Western Rd, N6G 1G7, London, ON, Canada.
| | - Susana Correa
- Neuroscience program, Schulich School of Medicine & Dentistry, Western University, London, Canada
| | - Peter Van Dyken
- Neuroscience program, Schulich School of Medicine & Dentistry, Western University, London, Canada
- Robarts Research Institute, Schulich School of Medicine and Dentistry, Western University, London, Canada
| | - Jason Kai
- Robarts Research Institute, Schulich School of Medicine and Dentistry, Western University, London, Canada
- Medical Biophysics, Schulich School of Medicine & Dentistry, Western University, London, Canada
| | - Tristan Kuehn
- Robarts Research Institute, Schulich School of Medicine and Dentistry, Western University, London, Canada
- Medical Biophysics, Schulich School of Medicine & Dentistry, Western University, London, Canada
| | - Sandrine de Ribaupierre
- Western Institute for Neuroscience, Western University, London, Canada
- Neuroscience program, Schulich School of Medicine & Dentistry, Western University, London, Canada
- Medical Biophysics, Schulich School of Medicine & Dentistry, Western University, London, Canada
- Biomedical Engineering, Western University, London, Canada
- Clinical Neurological Sciences, Schulich School of Medicine & Dentistry, Western University, London, Canada
- Anatomy and Cell Biology, Schulich School of Medicine & Dentistry, Western University, London, Canada
| | - Emma G Duerden
- Faculty of Education, Western University, London, Canada
- Western Institute for Neuroscience, Western University, London, Canada
- Medical Biophysics, Schulich School of Medicine & Dentistry, Western University, London, Canada
| | - Ali R Khan
- Western Institute for Neuroscience, Western University, London, Canada
- Robarts Research Institute, Schulich School of Medicine and Dentistry, Western University, London, Canada
- Medical Biophysics, Schulich School of Medicine & Dentistry, Western University, London, Canada
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Correa S, Nichols ES, Mueller ME, de Vrijer B, Eagleson R, McKenzie CA, de Ribaupierre S, Duerden EG. Default mode network functional connectivity strength in utero and the association with fetal subcortical development. Cereb Cortex 2023:7187107. [PMID: 37259175 DOI: 10.1093/cercor/bhad190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 05/10/2023] [Accepted: 05/11/2023] [Indexed: 06/02/2023] Open
Abstract
The default mode network is essential for higher-order cognitive processes and is composed of an extensive network of functional and structural connections. Early in fetal life, the default mode network shows strong connectivity with other functional networks; however, the association with structural development is not well understood. In this study, resting-state functional magnetic resonance imaging and anatomical images were acquired in 30 pregnant women with singleton pregnancies. Participants completed 1 or 2 MR imaging sessions, on average 3 weeks apart (43 data sets), between 28- and 39-weeks postconceptional ages. Subcortical volumes were automatically segmented. Activation time courses from resting-state functional magnetic resonance imaging were extracted from the default mode network, medial temporal lobe network, and thalamocortical network. Generalized estimating equations were used to examine the association between functional connectivity strength between default mode network-medial temporal lobe, default mode network-thalamocortical network, and subcortical volumes, respectively. Increased functional connectivity strength in the default mode network-medial temporal lobe network was associated with smaller right hippocampal, left thalamic, and right caudate nucleus volumes, but larger volumes of the left caudate. Increased functional connectivity strength in the default mode network-thalamocortical network was associated with smaller left thalamic volumes. The strong associations seen among the default mode network functional connectivity networks and regionally specific subcortical volume development indicate the emergence of short-range connectivity in the third trimester.
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Affiliation(s)
- Susana Correa
- Neuroscience Program, Schulich School of Medicine & Dentistry, Western University, London, ON N6A 3K7, Canada
- Western Institute for Neuroscience, Western University, London, ON N6A 3K7, Canada
| | - Emily S Nichols
- Western Institute for Neuroscience, Western University, London, ON N6A 3K7, Canada
- Applied Psychology, Faculty of Education, Western University, London, ON N6A 3K7, Canada
| | - Megan E Mueller
- Applied Psychology, Faculty of Education, Western University, London, ON N6A 3K7, Canada
| | - Barbra de Vrijer
- Obstetrics & Gynaecology, Schulich School of Medicine & Dentistry, Western University, London, ON N6A 3K7, Canada
| | - Roy Eagleson
- Western Institute for Neuroscience, Western University, London, ON N6A 3K7, Canada
- Biomedical Engineering, Western University, London, ON N6A 3K7, Canada
- Electrical and Computer Engineering, Western University, London, ON N6A 3K7, Canada
| | - Charles A McKenzie
- Medical Biophysics, Schulich School of Medicine & Dentistry, Western University, London, ON N6A 3K7, Canada
| | - Sandrine de Ribaupierre
- Western Institute for Neuroscience, Western University, London, ON N6A 3K7, Canada
- Biomedical Engineering, Western University, London, ON N6A 3K7, Canada
- Medical Biophysics, Schulich School of Medicine & Dentistry, Western University, London, ON N6A 3K7, Canada
- Clinical Neurological Sciences, Schulich School of Medicine & Dentistry, Western University, London, ON N6A 3K7, Canada
- Anatomy and Cell Biology, Schulich School of Medicine & Dentistry, Western University, London, ON N6A 3K7, Canada
| | - Emma G Duerden
- Western Institute for Neuroscience, Western University, London, ON N6A 3K7, Canada
- Applied Psychology, Faculty of Education, Western University, London, ON N6A 3K7, Canada
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Zaika O, Boulton M, Eagleson R, de Ribaupierre S. Development of technical skills in simulated cerebral aneurysm coiling. Medicine (Baltimore) 2023; 102:e33209. [PMID: 36930081 PMCID: PMC10019155 DOI: 10.1097/md.0000000000033209] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Accepted: 02/15/2023] [Indexed: 03/18/2023] Open
Abstract
Endovascular surgical procedures require visual-spatial coordination in workspaces with restricted motions and temporally limited imaging. The development of the skills needed for these procedures can be facilitated by 3D simulator-based training. Cerebral angiography (CA) has lagged behind in this training approach due to the lack of validated, realistic training models, relying strictly on clinical case exposure frequency ("number of hours logged") as a means of assessing proficiency. The ANGIO Mentor visual-haptic simulator is regarded as an effective training tool, however, this simulator has not been tested thoroughly in its ability to train interventional skills. In particular, the details of the aneurysm coiling process during simulation-based training have not been assessed. In this study, 12 novice medical students were given simulation-based diagnostic CA training until a procedural plateau in performance, established in our previous work. Subsequently, they were trained using video tutorials and written instructions to identify, measure and intervene with cerebral aneurysms using endovascular coils. Over the span of 6 sessions, participants were assessed on their procedural task time, coiling quantity and quality, and perforation rates. Prior to commencing the study, participant spatial ability was assessed using a mental rotation test (MRT) and used as a comparative baseline for the performance analysis. We found that all individuals were able to perform the procedure faster after 6 sessions, reducing their average time from 42 to 24 minutes. Coil success rate improved over from 82% to 88% and coil packing rate remained consistent at 30% throughout testing. High perforation rate seen at the start of the study showed a trend of decreasing over the latter sessions, however, over half of aneurysms were still being perforated by the novice participants. No change in aneurysm coiling quality was found, with a slight decrease in number of parent artery coil protrusions. High MRT individuals were better able to establish necessary tools prior to coiling, however, no other MRT-specific changes were seen. This work identifies the utility of simulation-based CA training in identifying the particular difficulties trainees experience in learning procedural skills, including prevention of perforations, proper positioning and success of coils within the aneurysm.
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Affiliation(s)
- Oleksiy Zaika
- Anatomy & Cell Biology, University of Western Ontario, London, Canada
| | - Mel Boulton
- Clinical Neurological Sciences, University of Western Ontario, London, Canada
| | - Roy Eagleson
- Electrical & Computer Engineering, University of Western Ontario, London, Canada
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15
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Kregel M, Evans N, Wooten B, Campbell C, de Ribaupierre S, Andrade A. A Shared Decision-Making Process Utilizing a Decision Coach in Pediatric Epilepsy Surgery. Pediatr Neurol 2023; 143:13-18. [PMID: 36965334 DOI: 10.1016/j.pediatrneurol.2023.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 11/04/2022] [Accepted: 02/19/2023] [Indexed: 03/27/2023]
Abstract
BACKGROUND & RATIONALE The process to evaluate candidacy for epilepsy surgery is lengthy and stressful for caregivers, therefore the decision can be challenging. There is not a lot of information in regard to how families of a child living with epilepsy navigate the stressful decision during surgical candidacy evaluation. With difficult decisions comes the possibility of increased decisional conflict in both the child and the family. METHODS A project designed to provide greater knowledge to the family was conducted utilizing the shared decision-making (SDM) process to assist families in the decision-making during surgical candidacy evaluation; this was done using a decision coach, who is an unbiased health care professional, providing families with evidence-based information and support tools while supporting them in making decisions based on their values. RESULTS Results reveal that 90% (45 of 50) of families offered a consult with the decision coach agreed to participate. For these families, 78% (35 of 45) felt they were ready to move forward with surgery after the consult and 22% (10 of 45) felt they needed more information and testing. There was a significant improvement in the level of decisional conflict, uncertainty, and perception of preparation for decision making for the caregivers between the first and second consult, although 60% of families did not complete the postconflict survey. CONCLUSIONS The SDM process assists families in their need for more knowledge regarding risks, benefits, and options for treatment before making a surgical choice. SDM utilizing an impartial decision coach outside the direct circle of care and individualized epilepsy surgery education aids improves parental decision conflict and satisfaction.
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Affiliation(s)
- Michelle Kregel
- Children's Hospital, London Health Sciences, London, Ontario, Canada; Lawson Health Research Institute, London, Ontario, Canada.
| | - Natalie Evans
- Medical Students, Schulich School of Medicine & Dentistry, London, Ontario, Canada
| | - Bonnie Wooten
- Children's Hospital, London Health Sciences, London, Ontario, Canada
| | - Craig Campbell
- Department of Paediatrics, Schulich School of Medicine & Dentistry, London, Ontario, Canada
| | - Sandrine de Ribaupierre
- Department of Clinical Neurological Sciences, Schulich School of Medicine & Dentistry, London, Ontario, Canada
| | - Andrea Andrade
- Department of Paediatrics, Schulich School of Medicine & Dentistry, London, Ontario, Canada
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16
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Dong H, Shin H, Ho E, Jin HJ, Letourneau S, Banerjee T, Masschelein G, Davidson J, Wilson C, de Ribaupierre S, Eagleson R, Symonette CJ. Next-Generation Remote Hand Assessments: Cross-Platform DIGITS Web Application. Journal of Hand Surgery Global Online 2023. [DOI: 10.1016/j.jhsg.2023.01.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2023] Open
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17
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Roy P, Lo M, Tessier D, Kishimoto J, Bhattacharya S, Eagleson R, Fenster A, Ribaupierre SD. Can ventricular 3D ultrasound of neonates with posthemorrhagic hydrocephalus inform on the need for a ventriculoperitoneal shunt? J Neurosurg Pediatr 2023; 31:321-328. [PMID: 36670532 DOI: 10.3171/2022.12.peds22303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Accepted: 12/12/2022] [Indexed: 01/22/2023]
Abstract
OBJECTIVE Some neonates born prematurely with intraventricular hemorrhage develop posthemorrhagic hydrocephalus and require lifelong treatment to divert the flow of CSF. Early prediction of the eventual need for a ventriculoperitoneal shunt (VPS) is difficult, and early discussions with families are based on statistics and the grade of hemorrhage. The authors hypothesize that change in ventricular volume during ventricular taps that is measured with repeated 3D ultrasound (3D US) imaging of the lateral ventricles could be used to assess the risk of the future requirement of a VPS. METHODS A total of 92 neonates with intraventricular hemorrhage who were treated in the NICU were recruited between April 2012 and November 2019. Only patients who required ventricular taps (VTs) were included in this study, resulting in the analysis of 19 patients with a total of 61 VTs. Among them, 14 patients were treated with a VPS, and in 5 patients the hydrocephalus resolved spontaneously. Parameters studied were total ventricular volume measured with 3D US, ventricular volume change after VT, the ratio between volume reduction and tap amount, the difference between tap amount and volume reduction after tap, the average tap amount, the average number of days between taps, pre-tap head circumference, and reduction in head circumference after tap. RESULTS Statistically significant differences were found in ventricular volume reduction after tap (p = 0.007), the ratio between volume reduction and tap amount (p = 0.03), the difference between tap amount and volume reduction after tap (p = 0.05), and the interval of days between taps (p = 0.0115). CONCLUSIONS Measuring with 3D US before and after VT can be a useful tool for quantifying ventricular volume. The findings in this study showed that neonates who experience a large reduction of ventricular volume after VT are more likely to be treated with a shunt than are neonates who experience a small reduction.
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Affiliation(s)
- Priyanka Roy
- Departments of1Medical Biophysics.,2Robarts Research Institute, University of Western Ontario, London; and
| | - Marcus Lo
- 5Clinical Neurological Science, University of Western Ontario, London
| | - David Tessier
- Departments of1Medical Biophysics.,2Robarts Research Institute, University of Western Ontario, London; and
| | - Jessica Kishimoto
- Departments of1Medical Biophysics.,2Robarts Research Institute, University of Western Ontario, London; and
| | - Soume Bhattacharya
- 3Department of Pediatrics, Children's Health Research Institute, London, Ontario, Canada
| | | | - Aaron Fenster
- Departments of1Medical Biophysics.,2Robarts Research Institute, University of Western Ontario, London; and
| | - Sandrine de Ribaupierre
- Departments of1Medical Biophysics.,3Department of Pediatrics, Children's Health Research Institute, London, Ontario, Canada.,5Clinical Neurological Science, University of Western Ontario, London
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Abdi K, Adams E, Agarwal S, Ergun MA, Altamimi T, Aral A, Arfi H, Armour E, Armstrong L, Mulkey SB, Bambi J, Baxter L, Benner E, Bhattacharya S, Biselele T, Bolay H, Mayorga PC, Carrasco M, Carter E, Chao A, Cooke A, Corsi-Cabrera M, Cubero-Rego L, Cuddyer D, Gano DD, Cubero-Rego MDLA, de Ribaupierre S, Drobyshevsky A, El-Dib M, Elmazoglu Z, Emrick L, Epstein A, Erdei C, Flynn P, Duerden EG, Gibson K, Gregory S, Topa EGA, Aliyu MH, Harmony T, Harshbarger J, Hartley C, Hayakawa M, Kazan HH, Inder T, Ito Y, Jain V, Jurkiewicz M, Kapoor B, Kebaya L, Keles Gulnerman E, Kidokoro H, Kling E, Kumai S, Lebane D, Lemmon M, Salihu HM, Marchant S, Maxfield C, Mbayabo G, Meyerink P, Millman R, Mitsumatsu T, Nakata T, Narita H, Natsume J, Pacheco J, Pagano L, Pardo A, Peyton C, Pineda R, Reddy S, Ricardo-Garcell J, Rikard B, Roychaudhuri S, Nichols ES, Sadowska-Krawczenko I, Sato Y, Sawamura F, Scher M, Sharon D, Sheldon Y, Shiraki A, Singh E, Steele T, Suzui R, Tady BP, Taga G, Tarui T, Trapp N, Tristao L, Tuka D, Ushida T, Usman F, Venkatesan C, Watanabe H, Witulska-Alagöz A, Yamamoto H, Yarnykh V, Younge N. Proceedings of the 14th International Newborn Brain Conference: Fetal and/or neonatal brain development, both normal and abnormal. J Neonatal Perinatal Med 2023; 16:S1-S19. [PMID: 37599540 DOI: 10.3233/npm-239001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/22/2023]
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Wang J, Nichols ES, Mueller ME, de Vrijer B, Eagleson R, McKenzie CA, de Ribaupierre S, Duerden EG. Semi-automatic segmentation of the fetal brain from magnetic resonance imaging. Front Neurosci 2022; 16:1027084. [PMID: 36440277 PMCID: PMC9692018 DOI: 10.3389/fnins.2022.1027084] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 10/19/2022] [Indexed: 11/13/2023] Open
Abstract
BACKGROUND Volumetric measurements of fetal brain maturation in the third trimester of pregnancy are key predictors of developmental outcomes. Improved understanding of fetal brain development trajectories may aid in identifying and clinically managing at-risk fetuses. Currently, fetal brain structures in magnetic resonance images (MRI) are often manually segmented, which requires both time and expertise. To facilitate the targeting and measurement of brain structures in the fetus, we compared the results of five segmentation methods applied to fetal brain MRI data to gold-standard manual tracings. METHODS Adult women with singleton pregnancies (n = 21), of whom five were scanned twice, approximately 3 weeks apart, were recruited [26 total datasets, median gestational age (GA) = 34.8, IQR = 30.9-36.6]. T2-weighted single-shot fast spin echo images of the fetal brain were acquired on 1.5T and 3T MRI scanners. Images were first combined into a single 3D anatomical volume. Next, a trained tracer manually segmented the thalamus, cerebellum, and total cerebral volumes. The manual segmentations were compared with five automatic methods of segmentation available within Advanced Normalization Tools (ANTs) and FMRIB's Linear Image Registration Tool (FLIRT) toolboxes. The manual and automatic labels were compared using Dice similarity coefficients (DSCs). The DSC values were compared using Friedman's test for repeated measures. RESULTS Comparing cerebellum and thalamus masks against the manually segmented masks, the median DSC values for ANTs and FLIRT were 0.72 [interquartile range (IQR) = 0.6-0.8] and 0.54 (IQR = 0.4-0.6), respectively. A Friedman's test indicated that the ANTs registration methods, primarily nonlinear methods, performed better than FLIRT (p < 0.001). CONCLUSION Deformable registration methods provided the most accurate results relative to manual segmentation. Overall, this semi-automatic subcortical segmentation method provides reliable performance to segment subcortical volumes in fetal MR images. This method reduces the costs of manual segmentation, facilitating the measurement of typical and atypical fetal brain development.
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Affiliation(s)
- Jianan Wang
- Biomedical Engineering, Western University, London, ON, Canada
| | - Emily S. Nichols
- Applied Psychology, Faculty of Education, Western University, London, ON, Canada
- Western Institute for Neuroscience, Western University, London, ON, Canada
| | - Megan E. Mueller
- Applied Psychology, Faculty of Education, Western University, London, ON, Canada
| | - Barbra de Vrijer
- Department of Obstetrics and Gynaecology, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
| | - Roy Eagleson
- Biomedical Engineering, Western University, London, ON, Canada
- Western Institute for Neuroscience, Western University, London, ON, Canada
- Department of Electrical and Computer Engineering, Western University, London, ON, Canada
| | - Charles A. McKenzie
- Department of Medical Biophysics, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
| | - Sandrine de Ribaupierre
- Biomedical Engineering, Western University, London, ON, Canada
- Western Institute for Neuroscience, Western University, London, ON, Canada
- Department of Clinical Neurological Sciences, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
- Department of Anatomy and Cell Biology, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
| | - Emma G. Duerden
- Biomedical Engineering, Western University, London, ON, Canada
- Applied Psychology, Faculty of Education, Western University, London, ON, Canada
- Western Institute for Neuroscience, Western University, London, ON, Canada
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Abstract
OBJECTIVE This study aimed to determine whether there are differences in the lateral ventricular volumes, measured by three-dimensional ultrasound (3D US) depending on the posture of the neonate (right and left lateral decubitus). STUDY DESIGN This was a prospective analysis of the lateral ventricular volumes of preterm neonates recruited from Victoria Hospital, London, Ontario (June 2018-November 2019). A total of 24 premature neonates were recruited. The first cohort of 18 unstable premature neonates were imaged with 3D US in their current sides providing 15 right-sided and 16 left-sided 3D US images. The neonates in the second cohort of six relatively stable infants were imaged after positioning in each lateral decubitus position for 30 minutes, resulting in 40 3D US images obtained from 20 posture change sessions. The images were segmented and the ventricle volumes in each lateral posture were compared with determine whether the posture of the head influenced the volume of the upper and lower ventricle. RESULTS For the first cohort who did not have their posture changed, the mean of the right and left ventricle volumes were 23.81 ± 15.51 and 21.61 ± 16.19 cm3, respectively, for the 15 images obtained in a right lateral posture and 13.96 ± 8.69 and 14.92 ± 8.77 cm3, respectively, for the 16 images obtained in the left lateral posture. Similarly, for the second cohort who had their posture changed, the mean of right and left ventricle volumes were 20.92 ± 17.3 and 32.74 ± 32.33 cm3, respectively, after 30 minutes in the right lateral posture, and 21.25 ± 18.4 and 32.65 ± 31.58 cm3, respectively, after 30 minutes in the left lateral posture. Our results failed to show a statistically significant difference in ventricular volumes dependence on posture. CONCLUSION Head positioned to any lateral side for 30 minutes does not have any effect on the lateral ventricular volumes of neonates. KEY POINTS · Three-dimensional cranial ultrasound can measure neonatal ventricle volume.. · Ventricle volume in each lateral ventricle may be affected by posture of the neonate.. · The 30 minutes in any lateral posture is not sufficient to create volume difference in lateral ventricles..
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Affiliation(s)
- Priyanka Roy
- Department of Medical Biophysics, University of Western Ontario, London, Ontario, Canada.,Robarts Research Institute, University of Western Ontario, London, Ontario, Canada
| | - Marcus Lo
- Clinical Neurological Science, Lawson Health Research Institute, London, Ontario, Canada
| | - Soume Bhattacharya
- Department of Pediatrics, University of Western Ontario, London Health Science Centre, London, Ontario, Canada
| | - Roy Eagleson
- Department of Electrical and Computer Engineering, University of Western Ontario, London, Ontario, Canada
| | - Aaron Fenster
- Department of Medical Biophysics, University of Western Ontario, London, Ontario, Canada.,Robarts Research Institute, University of Western Ontario, London, Ontario, Canada
| | - Sandrine de Ribaupierre
- Department of Medical Biophysics, University of Western Ontario, London, Ontario, Canada.,Department of Pediatrics, University of Western Ontario, London Health Science Centre, London, Ontario, Canada.,Department of Clinical Neurological Science, University of Western Ontario, London Health Science Centre, London, Ontario, Canada
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21
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Pur DR, Preti MG, de Ribaupierre A, Van De Ville D, Eagleson R, Mella N, de Ribaupierre S. Mapping of Structure-Function Age-Related Connectivity Changes on Cognition Using Multimodal MRI. Front Aging Neurosci 2022; 14:757861. [PMID: 35663581 PMCID: PMC9158434 DOI: 10.3389/fnagi.2022.757861] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 04/21/2022] [Indexed: 11/13/2022] Open
Abstract
The relationship between age-related changes in brain structural connectivity (SC) and functional connectivity (FC) with cognition is not well understood. Furthermore, it is not clear whether cognition is represented via a similar spatial pattern of FC and SC or instead is mapped by distinct sets of distributed connectivity patterns. To this end, we used a longitudinal, within-subject, multimodal approach aiming to combine brain data from diffusion-weighted MRI (DW-MRI), and functional MRI (fMRI) with behavioral evaluation, to better understand how changes in FC and SC correlate with changes in cognition in a sample of older adults. FC and SC measures were derived from the multimodal scans acquired at two time points. Change in FC and SC was correlated with 13 behavioral measures of cognitive function using Partial Least Squares Correlation (PLSC). Two of the measures indicate an age-related change in cognition and the rest indicate baseline cognitive performance. FC and SC—cognition correlations were expressed across several cognitive measures, and numerous structural and functional cortical connections, mainly cingulo-opercular, dorsolateral prefrontal, somatosensory and motor, and temporo-parieto-occipital, contributed both positively and negatively to the brain-behavior relationship. Whole-brain FC and SC captured distinct and independent connections related to the cognitive measures. Overall, we examined age-related function-structure associations of the brain in a comprehensive and integrated manner, using a multimodal approach. We pointed out the behavioral relevance of age-related changes in FC and SC. Taken together, our results highlight that the heterogeneity in distributed FC and SC connectivity patterns provide unique information about the variable nature of healthy cognitive aging.
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Affiliation(s)
- Daiana Roxana Pur
- Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
- *Correspondence: Daiana Roxana Pur
| | - Maria Giulia Preti
- CIBM Center for Biomedical Imaging, Lausanne, Switzerland
- Institute of Bioengineering, Center for Neuroprosthetics, EPFL, Geneva, Switzerland
- Department of Radiology and Medical Informatics, University of Geneva (UNIGE), Geneva, Switzerland
| | | | - Dimitri Van De Ville
- CIBM Center for Biomedical Imaging, Lausanne, Switzerland
- Institute of Bioengineering, Center for Neuroprosthetics, EPFL, Geneva, Switzerland
- Department of Radiology and Medical Informatics, University of Geneva (UNIGE), Geneva, Switzerland
| | - Roy Eagleson
- Department of Electrical and Computer Engineering, Western University, London, ON, Canada
- The Brain and Mind Institute, Western University, London, ON, Canada
| | - Nathalie Mella
- Department of Psychology, University of Geneva, Geneva, Switzerland
| | - Sandrine de Ribaupierre
- Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
- The Brain and Mind Institute, Western University, London, ON, Canada
- Department of Clinical Neurological Sciences, Schulich School of Medicine, Western University, London, ON, Canada
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22
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Adam R, Ghahari D, Morton JB, Eagleson R, de Ribaupierre S. Brain Network Connectivity and Executive Function in Children with Previous Infantile Hydrocephalus. Brain Connect 2022; 12:784-798. [PMID: 35302386 DOI: 10.1089/brain.2021.0149] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Infantile hydrocephalus is a condition in which there is an abnormal build-up of cerebrospinal fluid in the ventricles within the first few months of life, which puts pressure on surrounding brain tissues. Compression of the developing brain increases the risk of secondary brain injury and cognitive disabilities. METHODS In this study, we used diffusion-weighted imaging and resting-state functional MRI to investigate the effects of ventricle dilatation on structural and functional brain networks in children with shunted infantile hydrocephalus and examined how these brain changes may impact executive function. RESULTS We found that children with hydrocephalus have altered structural and functional connectivity between and within large-scale networks. Moreover, hyperconnectivity between the ventral attention and default mode network in children with hydrocephalus correlated with reduced executive function scores. Compared to typically developing age-matched control participants, our patient population also had lower fractional anisotropy in posterior white matter. DISCUSSION Overall, these findings suggest that infantile hydrocephalus has long-term effects on brain network connectivity, white matter development, and executive function in children at school-age. Future work will examine the relationship between ventricular volumes prior to shunt placement in infancy and brain network development throughout childhood.
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Affiliation(s)
- Ramina Adam
- University of Western Ontario, 6221, 1151 Richmond Street, London, Canada, N6A 3K7;
| | | | | | - Roy Eagleson
- University of Western Ontario, 6221, London, Canada;
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23
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Salafian B, Fishel Ben E, Shlezinger N, de Ribaupierre S, Farsad N. Efficient Epileptic Seizure Detection Using CNN-Aided Factor Graphs. Annu Int Conf IEEE Eng Med Biol Soc 2021; 2021:424-429. [PMID: 34891324 DOI: 10.1109/embc46164.2021.9629917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
We propose a computationally efficient algorithm for seizure detection. Instead of using a purely data-driven approach, we develop a hybrid model-based/data-driven method, combining convolutional neural networks with factor graph inference. On the CHB-MIT dataset, we demonstrate that the proposed method can generalize well in a 6 fold leave-4-patient-out evaluation. Moreover, it is shown that our algorithm can achieve as much as 5% absolute improvement in performance compared to previous data-driven methods. This is achieved while the computational complexity of the proposed technique is a fraction of the complexity of prior work, making it suitable for real-time seizure detection.
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24
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Sethi S, Giza SA, Goldberg E, Empey MEET, de Ribaupierre S, Eastabrook GDM, de Vrijer B, McKenzie CA. Quantification of 1.5 T T 1 and T 2 * Relaxation Times of Fetal Tissues in Uncomplicated Pregnancies. J Magn Reson Imaging 2021; 54:113-121. [PMID: 33586269 DOI: 10.1002/jmri.27547] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 01/20/2021] [Accepted: 01/21/2021] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Despite its many advantages, experience with fetal magnetic resonance imaging (MRI) is limited, as is knowledge of how fetal tissue relaxation times change with gestational age (GA). Quantification of fetal tissue relaxation times as a function of GA provides insight into tissue changes during fetal development and facilitates comparison of images across time and subjects. This, therefore, can allow the determination of biophysical tissue parameters that may have clinical utility. PURPOSE To demonstrate the feasibility of quantifying previously unknown T1 and T2 * relaxation times of fetal tissues in uncomplicated pregnancies as a function of GA at 1.5 T. STUDY TYPE Pilot. POPULATION Nine women with singleton, uncomplicated pregnancies (28-38 weeks GA). FIELD STRENGTH/SEQUENCE All participants underwent two iterative decomposition of water and fat with echo asymmetry and least-squares estimation (IDEAL-IQ) acquisitions at different flip angles (6° and 20°) at 1.5 T. ASSESSMENT Segmentations of the lungs, liver, spleen, kidneys, muscle, and adipose tissue (AT) were conducted using water-only images and proton density fat fraction maps. Driven equilibrium single pulse observation of T1 (DESPOT1 ) was used to quantify the mean water T1 of the lungs, intraabdominal organs, and muscle, and the mean water and lipid T1 of AT. IDEAL T2 * maps were used to quantify the T2 * values of the lungs, intraabdominal organs, and muscle. STATISTICAL TESTS F-tests were performed to assess the T1 and T2 * changes of each analyzed tissue as a function of GA. RESULTS No tissue demonstrated a significant change in T1 as a function of GA (lungs [P = 0.89]; liver [P = 0.14]; spleen [P = 0.59]; kidneys [P = 0.97]; muscle [P = 0.22]; AT: water [P = 0.36] and lipid [P = 0.14]). Only the spleen and muscle T2 * showed a significant decrease as a function of GA (lungs [P = 0.67); liver [P = 0.05]; spleen [P < 0.05]; kidneys [P = 0.70]; muscle [P < 0.05]). DATA CONCLUSION These preliminary data suggest that the T1 of the investigated tissues is relatively stable over 28-38 weeks GA, while the T2 * change in spleen and muscle decreases significantly in that period. LEVEL OF EVIDENCE 3 TECHNICAL EFFICACY STAGE: 2.
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Affiliation(s)
- Simran Sethi
- Department of Medical Biophysics, Western University, London, Ontario, Canada
| | - Stephanie A Giza
- Department of Medical Biophysics, Western University, London, Ontario, Canada
| | - Estee Goldberg
- Department of Biomedical Engineering, Western University, London, Ontario, Canada
| | | | - Sandrine de Ribaupierre
- Department of Biomedical Engineering, Western University, London, Ontario, Canada.,Department of Clinical Neurological Sciences, London Health Sciences Centre, London, Ontario, Canada.,Brain and Mind Institute, Western University, London, Ontario, Canada.,Division of Maternal, Fetal and Newborn Health, Children's Health Research Institute, London, Ontario, Canada
| | - Genevieve D M Eastabrook
- Division of Maternal, Fetal and Newborn Health, Children's Health Research Institute, London, Ontario, Canada.,Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada.,Department of Obstetrics & Gynaecology, Western University, London, Ontario, Canada
| | - Barbra de Vrijer
- Division of Maternal, Fetal and Newborn Health, Children's Health Research Institute, London, Ontario, Canada.,Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada.,Department of Obstetrics & Gynaecology, Western University, London, Ontario, Canada
| | - Charles A McKenzie
- Department of Medical Biophysics, Western University, London, Ontario, Canada.,Division of Maternal, Fetal and Newborn Health, Children's Health Research Institute, London, Ontario, Canada
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25
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Pur DR, Eagleson R, Lo M, Jurkiewicz MT, Andrade A, de Ribaupierre S. Presurgical brain mapping of the language network in pediatric patients with epilepsy using resting-state fMRI. J Neurosurg Pediatr 2021; 27:259-268. [PMID: 33418528 DOI: 10.3171/2020.8.peds20517] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 08/17/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Epilepsy affects neural processing and often causes intra- or interhemispheric language reorganization, rendering localization solely based on anatomical landmarks (e.g., Broca's area) unreliable. Preoperative brain mapping is necessary to weigh the risk of resection with the risk of postoperative deficit. However, the use of conventional mapping methods (e.g., somatosensory stimulation, task-based functional MRI [fMRI]) in pediatric patients is technically difficult due to low compliance and their unique neurophysiology. Resting-state fMRI (rs-fMRI), a "task-free" technique based on the neural activity of the brain at rest, has the potential to overcome these limitations. The authors hypothesized that language networks can be identified from rs-fMRI by applying functional connectivity analyses. METHODS Cases in which both task-based fMRI and rs-fMRI were acquired as part of the preoperative clinical protocol for epilepsy surgery were reviewed. Task-based fMRI consisted of 2 language tasks and 1 motor task. Resting-state fMRI data were acquired while the patients watched an animated movie and were analyzed using independent component analysis (i.e., data-driven method). The authors extracted language networks from rs-fMRI data by performing a similarity analysis with functionally defined language network templates via a template-matching procedure. The Dice coefficient was used to quantify the overlap. RESULTS Thirteen children underwent conventional task-based fMRI (e.g., verb generation, object naming), rs-fMRI, and structural imaging at 1.5T. The language components with the highest overlap with the language templates were identified for each patient. Language lateralization results from task-based fMRI and rs-fMRI mapping were comparable, with good concordance in most cases. Resting-state fMRI-derived language maps indicated that language was on the left in 4 patients (31%), on the right in 5 patients (38%), and bilateral in 4 patients (31%). In some cases, rs-fMRI indicated a more extensive language representation. CONCLUSIONS Resting-state fMRI-derived language network data were identified at the patient level using a template-matching method. More than half of the patients in this study presented with atypical language lateralization, emphasizing the need for mapping. Overall, these data suggest that this technique may be used to preoperatively identify language networks in pediatric patients. It may also optimize presurgical planning of electrode placement and thereby guide the surgeon's approach to the epileptogenic zone.
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Affiliation(s)
| | - Roy Eagleson
- 2Department of Electrical and Computer Engineering, Brain and Mind Institute, University of Western Ontario, London
| | - Marcus Lo
- 3Lawson Health Research Institute, London
| | - Michael T Jurkiewicz
- 4Department of Medical Imaging, Children's Hospital at London Health Sciences Centre, London; and
| | | | - Sandrine de Ribaupierre
- 6Clinical Neurological Sciences, London Health Sciences Centre, University of Western Ontario, London, Ontario, Canada
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26
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Ribaupierre SD, Chalil A, Lo M, Ribaupierre SD. Increasing Head Circumference from Hydrocephalus, Not Only in Young Children: Case Report of a 7-Year-Old. Surg Case Rep 2020. [DOI: 10.31487/j.scr.2020.11.17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Introduction: Increasing head circumference is a common presentation of hydrocephalus within the first 2
years of life but is extremely rare in older children or adults. Here, we present a rare case of rapidly
increasing head circumference, as the sole symptom, as a new diagnosis of hydrocephalus in a 7-year-old
boy, who then re-presented with an increasing head circumference at the time of a VPS malfunction a year
later.
Case: A 7-year-old was referred to neurosurgery for papilledema and increased headaches. The mother
reports a rapidly increasing head circumference necessitating changes in hat size at least twice in the last
few months. The CT gave the diagnosis of a Dandy-Walker spectrum malformation and hydrocephalus. A
VPS was therefore inserted, with a stabilisation of his head circumference for a few months. He presented
again with a rapidly increasing head circumference over the course of a few months, from 57 cm up to 59.5
cm, in the setting of progressive headaches consistent with increased ICP. The patient subsequently
underwent a shunt valve replacement to improve CSF diversion.
Methods: The patient was followed over 18 months from diagnosis to shunt revision, with MRI of the head.
Volumetric measurements of the ventricles and head circumference are compared over the same time period.
Conclusion: We present a unique case of increasing head circumference in a 7-year-old boy with Dandy
Walker spectrum malformation, who then had another rapid increase almost two years later with a shunt
dysfunction. To our knowledge, no similar cases of that age were reported in the literature.
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Rajaram A, Yip LCM, Milej D, Suwalski M, Kewin M, Lo M, Carson JJL, Han V, Bhattacharya S, Diop M, de Ribaupierre S, St. Lawrence K. Perfusion and Metabolic Neuromonitoring during Ventricular Taps in Infants with Post-Hemorrhagic Ventricular Dilatation. Brain Sci 2020; 10:E452. [PMID: 32679665 PMCID: PMC7407524 DOI: 10.3390/brainsci10070452] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 07/03/2020] [Accepted: 07/13/2020] [Indexed: 01/08/2023] Open
Abstract
Post-hemorrhagic ventricular dilatation (PHVD) is characterized by a build-up of cerebral spinal fluid (CSF) in the ventricles, which increases intracranial pressure and compresses brain tissue. Clinical interventions (i.e., ventricular taps, VT) work to mitigate these complications through CSF drainage; however, the timing of these procedures remains imprecise. This study presents Neonatal NeuroMonitor (NNeMo), a portable optical device that combines broadband near-infrared spectroscopy (B-NIRS) and diffuse correlation spectroscopy (DCS) to provide simultaneous assessments of cerebral blood flow (CBF), tissue saturation (StO2), and the oxidation state of cytochrome c oxidase (oxCCO). In this study, NNeMo was used to monitor cerebral hemodynamics and metabolism in PHVD patients selected for a VT. Across multiple VTs in four patients, no significant changes were found in any of the three parameters: CBF increased by 14.6 ± 37.6% (p = 0.09), StO2 by 1.9 ± 4.9% (p = 0.2), and oxCCO by 0.4 ± 0.6 µM (p = 0.09). However, removing outliers resulted in significant, but small, increases in CBF (6.0 ± 7.7%) and oxCCO (0.1 ± 0.1 µM). The results of this study demonstrate NNeMo's ability to provide safe, non-invasive measurements of cerebral perfusion and metabolism for neuromonitoring applications in the neonatal intensive care unit.
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Affiliation(s)
- Ajay Rajaram
- Imaging Program, Lawson Health Research Institute, London, ON N6A 4V2, Canada; (L.C.M.Y.); (D.M.); (M.S.); (M.K.); (M.L.); (J.J.L.C.); (M.D.); (K.S.L.)
- Department of Medical Biophysics, Schulich School of Medicine and Dentistry, Western University, London, ON N6A 3K7, Canada;
| | - Lawrence C. M. Yip
- Imaging Program, Lawson Health Research Institute, London, ON N6A 4V2, Canada; (L.C.M.Y.); (D.M.); (M.S.); (M.K.); (M.L.); (J.J.L.C.); (M.D.); (K.S.L.)
- Department of Medical Biophysics, Schulich School of Medicine and Dentistry, Western University, London, ON N6A 3K7, Canada;
| | - Daniel Milej
- Imaging Program, Lawson Health Research Institute, London, ON N6A 4V2, Canada; (L.C.M.Y.); (D.M.); (M.S.); (M.K.); (M.L.); (J.J.L.C.); (M.D.); (K.S.L.)
- Department of Medical Biophysics, Schulich School of Medicine and Dentistry, Western University, London, ON N6A 3K7, Canada;
| | - Marianne Suwalski
- Imaging Program, Lawson Health Research Institute, London, ON N6A 4V2, Canada; (L.C.M.Y.); (D.M.); (M.S.); (M.K.); (M.L.); (J.J.L.C.); (M.D.); (K.S.L.)
- Department of Medical Biophysics, Schulich School of Medicine and Dentistry, Western University, London, ON N6A 3K7, Canada;
| | - Matthew Kewin
- Imaging Program, Lawson Health Research Institute, London, ON N6A 4V2, Canada; (L.C.M.Y.); (D.M.); (M.S.); (M.K.); (M.L.); (J.J.L.C.); (M.D.); (K.S.L.)
| | - Marcus Lo
- Imaging Program, Lawson Health Research Institute, London, ON N6A 4V2, Canada; (L.C.M.Y.); (D.M.); (M.S.); (M.K.); (M.L.); (J.J.L.C.); (M.D.); (K.S.L.)
| | - Jeffrey J. L. Carson
- Imaging Program, Lawson Health Research Institute, London, ON N6A 4V2, Canada; (L.C.M.Y.); (D.M.); (M.S.); (M.K.); (M.L.); (J.J.L.C.); (M.D.); (K.S.L.)
- Department of Medical Biophysics, Schulich School of Medicine and Dentistry, Western University, London, ON N6A 3K7, Canada;
| | - Victor Han
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, London Health Sciences Centre, London, ON N6A 3K7, Canada; (V.H.); (S.B.)
| | - Soume Bhattacharya
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, London Health Sciences Centre, London, ON N6A 3K7, Canada; (V.H.); (S.B.)
| | - Mamadou Diop
- Imaging Program, Lawson Health Research Institute, London, ON N6A 4V2, Canada; (L.C.M.Y.); (D.M.); (M.S.); (M.K.); (M.L.); (J.J.L.C.); (M.D.); (K.S.L.)
- Department of Medical Biophysics, Schulich School of Medicine and Dentistry, Western University, London, ON N6A 3K7, Canada;
| | - Sandrine de Ribaupierre
- Department of Medical Biophysics, Schulich School of Medicine and Dentistry, Western University, London, ON N6A 3K7, Canada;
- Department of Clinical Neurological Sciences, London Health Sciences Centre, London, ON N6A 5W9, Canada
| | - Keith St. Lawrence
- Imaging Program, Lawson Health Research Institute, London, ON N6A 4V2, Canada; (L.C.M.Y.); (D.M.); (M.S.); (M.K.); (M.L.); (J.J.L.C.); (M.D.); (K.S.L.)
- Department of Medical Biophysics, Schulich School of Medicine and Dentistry, Western University, London, ON N6A 3K7, Canada;
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Coulter IC, Kulkarni AV, Sgouros S, Constantini S, Constantini S, Sgouros S, Kulkarni AV, Leitner Y, Kestle JR, Cochrane DD, Choux M, Gjerris F, Sherer A, Akalan N, Bilginer B, Navarro R, Vujotic L, Haberl H, Thomale UW, Zúccaro G, Jaimovitch R, Frim D, Loftis L, Swift DM, Robertson B, Gargan L, Bognár L, Novák L, Cseke G, Cama A, Ravegnani GM, Preuß M, Schroeder HW, Fritsch M, Baldauf J, Mandera M, Luszawski J, Skorupka P, Mallucci C, Williams D, Zakrzewski K, Nowoslawska E, Srivastava C, Mahapatra AK, Kumar R, Sahu RN, Melikian AG, Korshunov A, Galstyan A, Suri A, Gupta D, Grotenhuis JA, van Lindert EJ, da Costa Val JA, Di Rocco C, Tamburrini G, Zymberg ST, Cavalheiro S, Jie M, Feng J, Friedman O, Rajmohamed N, Roszkowski M, Barszcz S, Jallo G, Pincus DW, Richter B, Mehdorn HM, Schultka S, de Ribaupierre S, Thompson D, Gatscher S, Wagner W, Koch D, Cipri S, Zaccone C, McDonald P. Cranial and ventricular size following shunting or endoscopic third ventriculostomy (ETV) in infants with aqueductal stenosis: further insights from the International Infant Hydrocephalus Study (IIHS). Childs Nerv Syst 2020; 36:1407-1414. [PMID: 31965292 DOI: 10.1007/s00381-020-04503-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Accepted: 01/02/2020] [Indexed: 11/24/2022]
Abstract
PURPOSE The craniometrics of head circumference (HC) and ventricular size are part of the clinical assessment of infants with hydrocephalus and are often utilized in conjunction with other clinical and radiological parameters to determine the success of treatment. We aimed to assess the effect of endoscopic third ventriculostomy (ETV) and shunting on craniometric measurements during the follow-up of a cohort of infants with symptomatic triventricular hydrocephalus secondary to aqueductal stenosis. METHODS We performed a post hoc analysis of data from the International Infant Hydrocephalus Study (IIHS)-a prospective, multicenter study of infants (< 24 months old) with hydrocephalus from aqueductal stenosis who were treated with either an ETV or shunt. During various stages of a 5-year follow-up period, the following craniometrics were measured: HC, HC centile, HC z-score, and frontal-occipital horn ratio (FOR). Data were compared in an analysis of covariance, adjusting for baseline variables including age at surgery and sex. RESULTS Of 158 enrolled patients, 115 underwent an ETV, while 43 received a shunt. Both procedures led to improvements in the mean HC centile position and z-score, a trend which continued until the 5-year assessment point. A similar trend was noted for FOR which was measured at 12 months and 3 years following initial treatment. Although the values were consistently higher for ETV compared with shunt, the differences in HC value, centile, and z-score were not significant. ETV was associated with a significantly higher FOR compared with shunting at 12 months (0.52 vs 0.44; p = 0.002) and 3 years (0.46 vs 0.38; p = 0.03) of follow-up. CONCLUSION ETV and shunting led to improvements in HC centile, z-score, and FOR measurements during long-term follow-up of infants with hydrocephalus secondary to aqueductal stenosis. Head size did not significantly differ between the treatment groups during follow-up, however ventricle size was greater in those undergoing ETV when measured at 1 and 3 years following treatment.
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Affiliation(s)
- Ian C Coulter
- The Hospital for Sick Children, University of Toronto, 555 University Avenue, Suite 1503, Toronto, Ontario, M5G 1X8, Canada
| | - Abhaya V Kulkarni
- The Hospital for Sick Children, University of Toronto, 555 University Avenue, Suite 1503, Toronto, Ontario, M5G 1X8, Canada.
| | - Spyros Sgouros
- Department of Pediatric Neurosurgery, Mitera Children's Hospital, Athens, Greece.,University of Athens Medical School, Athens, Greece
| | - Shlomi Constantini
- Department of Pediatric Neurosurgery, Dana Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv University, Tel Aviv, Israel
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Zaika O, Boulton M, Eagleson R, de Ribaupierre S. Simulation reduces navigational errors in cerebral angiography training. Adv Simul (Lond) 2020; 5:10. [PMID: 32547789 PMCID: PMC7291641 DOI: 10.1186/s41077-020-00125-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Accepted: 05/14/2020] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Simulation-based medical education (SBME) is growing as a powerful aid in delivering proficient skills training in many specialties. Cerebral angiography (CA), a spatially and navigationally challenging endovascular procedure, can benefit from SBME by training targetable skills outside of the Angiosuite. In order to standardize and specify training requirements, navigational challenges and needs have to be identified. Furthermore, to enable successful adoption of these strategies, simulation adoption barriers, such as necessity of supervisory resources, must be reduced. In this study, we assessed the navigational challenges in simulated CA through a self-guided novice training program. METHODS Novice participants (n = 14) received virtual reality (ANGIO Mentor, Simbionix) diagnostic cerebral angiography training and were tested on a right middle cerebral artery aneurysm case over 8 sessions with a reference instructional outline. The navigational trajectories for the guidewire and catheter were analyzed and rates in erroneous vessel access were analyzed. Participants were given a Mental Rotations Test (MRT) and were analyzed based on MRT performance. RESULTS After 8 sessions, there was a significant (p < 0.05) reduction on navigational error prevalence. The L-SUB and L-CCA saw the biggest drop in erroneous access, whereas the R-ECA, the biggest consumer of error time, saw no changes in access frequency. Individuals with high MRT score performed much better (p < 0.05) than those with low MRT score. CONCLUSIONS Through self-guided simulation training, we demonstrated the navigational challenges encountered in simulated CA. To establish better assessments and standards in medical training, we can create self-guided training curricula aimed at correcting errors, enabling repetitive practice, and reducing human resource needs.
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Affiliation(s)
- Oleksiy Zaika
- Anatomy & Cell Biology, Western University, London, Canada
- Schulich School of Medicine and Dentistry, Western University, London, Canada
| | - Mel Boulton
- Clinical Neurological Sciences, Western University, London, Canada
| | - Roy Eagleson
- Electrical & Computer Engineering, Western University, London, Canada
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Zaika O, Boulton M, Eagleson R, de Ribaupierre S. Surgical Workflow Analysis in Cerebral Aneurysm Coiling. FASEB J 2020. [DOI: 10.1096/fasebj.2020.34.s1.08691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Goldberg E, McKenzie CA, de Vrijer B, Eagleson R, de Ribaupierre S. Fetal Response to a Maternal Internal Auditory Stimulus. J Magn Reson Imaging 2020; 52:139-145. [PMID: 31951084 DOI: 10.1002/jmri.27033] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 12/06/2019] [Accepted: 12/11/2019] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Functional MRI (fMRI) is a noninvasive method to investigate the neural correlates of brain development. Insight into the rapidly developing brain in utero is limited, and fetal fMRI can be used to gain a greater understanding of the developmental process. Fetal brain fMRI is typically limited to resting-state fMRI due to the difficulty to instruct or provide a stimulus to the fetus. Previous studies have employed auditory task fMRI with an external sound stimulus directly on the abdomen of the mother; however, this practice has since been deemed unsafe for the developing fetus. PURPOSE To investigate a reliable and safe paradigm to study the development of fetal brain networks, we postulated that an internal task, such as the mother's singing, as the auditory stimulus would result in activation in the fetal primary auditory cortex. STUDY TYPE Cohort. POPULATION Pregnant women with singleton pregnancies (n = 9; 33-38 weeks gestational age). FIELD STRENGTH/SEQUENCE All subjects underwent two task-based block design blood oxygen level-dependent (BOLD) at 1.5T or 3T. ASSESSMENT Each volume was assessed for fetal motion and manually reoriented and realigned to correct for fetal motion. Once the motion was corrected, a gestational age-matched parcellated atlas with regions of interest overlaid onto the activation map was used to determine which regions in the brain had activation during task phases. STATISTICAL TESTS First Level Analysis. MRI data were analyzed using SPM 12 as a task fMRI. RESULTS Eight subjects had activation on the right Heschl's gyrus; six fetuses demonstrated activation on the left when exposed to the internal acoustic stimulus. Additionally, activation was found on the right and left middle cingulate cortex (MCC) and the left putamen. DATA CONCLUSION Maternal singing can be used as an internal stimulus to activate the auditory network and Heschl's gyrus during fetal fMRI. Level of Evidence 2 Technical Efficacy Stage 2 J. Magn. Reson. Imaging 2020;52:139-145.
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Affiliation(s)
- Estee Goldberg
- Biomedical Engineering, Western University, London, Ontario, Canada
| | - Charles A McKenzie
- Biomedical Engineering, Western University, London, Ontario, Canada.,Medical Biophysics, Western University, London, Ontario, Canada.,Children's Health Research Institute, Western University, London, Ontario, Canada
| | - Barbra de Vrijer
- Children's Health Research Institute, Western University, London, Ontario, Canada.,Department of Obstetrics and Gynaecology, Western University, London, Ontario, Canada
| | - Roy Eagleson
- Biomedical Engineering, Western University, London, Ontario, Canada.,Brain and Mind Institute, Professor of Engineering, Western University, London, Ontario, Canada
| | - Sandrine de Ribaupierre
- Biomedical Engineering, Western University, London, Ontario, Canada.,Medical Biophysics, Western University, London, Ontario, Canada.,Children's Health Research Institute, Western University, London, Ontario, Canada.,Brain and Mind Institute, Professor of Engineering, Western University, London, Ontario, Canada.,Department of Clinical Neurological Sciences, Western University, London, Ontario, Canada
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Pur DR, Eagleson RA, de Ribaupierre A, Mella N, de Ribaupierre S. Moderating Effect of Cortical Thickness on BOLD Signal Variability Age-Related Changes. Front Aging Neurosci 2019; 11:46. [PMID: 30914944 PMCID: PMC6422923 DOI: 10.3389/fnagi.2019.00046] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2018] [Accepted: 02/18/2019] [Indexed: 11/13/2022] Open
Abstract
The time course of neuroanatomical structural and functional measures across the lifespan is commonly reported in association with aging. Blood oxygen-level dependent signal variability, estimated using the standard deviation of the signal, or "BOLDSD," is an emerging metric of variability in neural processing, and has been shown to be positively correlated with cognitive flexibility. Generally, BOLDSD is reported to decrease with aging, and is thought to reflect age-related cognitive decline. Additionally, it is well established that normative aging is associated with structural changes in brain regions, and that these predict functional decline in various cognitive domains. Nevertheless, the interaction between alterations in cortical morphology and BOLDSD changes has not been modeled quantitatively. The objective of the current study was to investigate the influence of cortical morphology metrics [i.e., cortical thickness (CT), gray matter (GM) volume, and cortical area (CA)] on age-related BOLDSD changes by treating these cortical morphology metrics as possible physiological confounds using linear mixed models. We studied these metrics in 28 healthy older subjects scanned twice at approximately 2.5 years interval. Results show that BOLDSD is confounded by cortical morphology metrics. Respectively, changes in CT but not GM volume nor CA, show a significant interaction with BOLDSD alterations. Our study highlights that CT changes should be considered when evaluating BOLDSD alternations in the lifespan.
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Affiliation(s)
- Daiana R. Pur
- School of Biomedical Engineering, Western University, London, ON, Canada
| | - Roy A. Eagleson
- School of Biomedical Engineering, Western University, London, ON, Canada
- Department of Electrical and Computer Engineering, Western University, London, ON, Canada
| | | | - Nathalie Mella
- Department of Psychology, University of Geneva, Geneva, Switzerland
| | - Sandrine de Ribaupierre
- School of Biomedical Engineering, Western University, London, ON, Canada
- Department of Clinical Neurological Sciences, Schulich School of Medicine, Western University, London, ON, Canada
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Miao TL, Figueroa EL, Bajunaid K, Mayich M, de Ribaupierre S, Pandey SK. Use of a radial artery 'slender' sheath for facilitating transfemoral arterial access for neuroendovascular embolization in a very young infant. Interv Neuroradiol 2018; 25:353-356. [PMID: 30463500 DOI: 10.1177/1591019918813212] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Pediatric neuroendovascular procedures are increasingly performed as several studies have shown the safety of these interventions. In the literature, an upper limit of 4 French catheter size is conventionally used for femoral access in neuroangiography of very young infants. However, this constraint in luminal size may not allow for more complex procedures. We present the previously unreported use of a radial 5 French slender catheter with ultrathin walls for femoral access for aneurysm embolization in a 3-month-old boy presenting with left M2 aneurysm rupture.
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Affiliation(s)
- Timothy L Miao
- 1 Department of Medical Imaging, University Hospital, London Health Sciences Centre, London, Ontario, Canada
| | - Enriqueta Lucar Figueroa
- 2 Clinical Neurological Sciences, Division of Neurosurgery, University Hospital, London Health Sciences Centre, London, Ontario, Canada
| | - Khalid Bajunaid
- 1 Department of Medical Imaging, University Hospital, London Health Sciences Centre, London, Ontario, Canada.,3 Division of Neurosurgery, Faculty of Medicine, University of Jeddah, Jeddah, Saudi Arabia
| | - Michael Mayich
- 1 Department of Medical Imaging, University Hospital, London Health Sciences Centre, London, Ontario, Canada.,2 Clinical Neurological Sciences, Division of Neurosurgery, University Hospital, London Health Sciences Centre, London, Ontario, Canada
| | - Sandrine de Ribaupierre
- 2 Clinical Neurological Sciences, Division of Neurosurgery, University Hospital, London Health Sciences Centre, London, Ontario, Canada
| | - Sachin K Pandey
- 1 Department of Medical Imaging, University Hospital, London Health Sciences Centre, London, Ontario, Canada.,2 Clinical Neurological Sciences, Division of Neurosurgery, University Hospital, London Health Sciences Centre, London, Ontario, Canada
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Kishimoto J, Fenster A, Lee DSC, de Ribaupierre S. Quantitative 3-D head ultrasound measurements of ventricle volume to determine thresholds for preterm neonates requiring interventional therapies following posthemorrhagic ventricle dilatation. J Med Imaging (Bellingham) 2018; 5:026001. [PMID: 29963579 PMCID: PMC6018129 DOI: 10.1117/1.jmi.5.2.026001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Accepted: 06/04/2018] [Indexed: 01/04/2023] Open
Abstract
Dilatation of the cerebral ventricles is a common condition in preterm neonates with intraventricular hemorrhage. This posthemorrhagic ventricle dilatation (PHVD) can lead to lifelong neurological impairment through ischemic injury due to increased intracranial pressure, and without treatment can lead to death. Two-dimensional ultrasound (US) through the fontanelles of the patients is serially acquired to monitor the progression of PHVD. These images are used in conjunction with clinical experience and physical exams to determine when interventional therapies such as needle aspiration of the built up cerebrospinal fluid (ventricle tap, VT) might be indicated for a patient; however, quantitative measurements of the ventricles size are often not performed. We describe the potential utility of the quantitative three-dimensional (3-D) US measurements of ventricle volumes (VVs) in 38 preterm neonates to monitor and manage PHVD. Specifically, we determined 3-D US VV thresholds for patients who received VT in comparison to patients with PHVD who resolve without intervention. In addition, since many patients who have an initial VT will receive subsequent interventions, we determined which PHVD patients will receive additional VT after the initial one has been performed.
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Affiliation(s)
- Jessica Kishimoto
- University of Western Ontario, Department of Medical Biophysics, London, Ontario, Canada.,University of Western Ontario, Robarts Research Institute, Imaging Research Laboratories, London, Ontario, Canada
| | - Aaron Fenster
- University of Western Ontario, Department of Medical Biophysics, London, Ontario, Canada.,University of Western Ontario, Robarts Research Institute, Imaging Research Laboratories, London, Ontario, Canada
| | - David S C Lee
- University of Western Ontario, London Health Sciences Centre, Department of Clinical Neurological Sciences, London, Ontario, Canada
| | - Sandrine de Ribaupierre
- University of Western Ontario, Department of Medical Biophysics, London, Ontario, Canada.,University of Western Ontario, Robarts Research Institute, Imaging Research Laboratories, London, Ontario, Canada.,University of Western Ontario, London Health Sciences Centre, Department of Clinical Neurological Sciences, London, Ontario, Canada
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Santyr BG, Lau JC, Mirsattari SM, Burneo JG, de Ribaupierre S, Steven DA, Parrent AG, MacDougall K, Khan AR. Novel connectivity map normalization procedure for improved quantitative investigation of structural thalamic connectivity in temporal lobe epilepsy patients. J Magn Reson Imaging 2018; 48:1529-1539. [PMID: 29570898 DOI: 10.1002/jmri.26013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Accepted: 03/01/2018] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Connectivity studies targeting the thalamus have revealed patterns of atrophy and deafferentiation in temporal lobe epilepsy (TLE). The thalamus can be parcellated using probabilistic tractography to demonstrate regions of cortical connectivity; however, sensitivity to smaller or less connected regions is low. PURPOSE/HYPOTHESIS To investigate thalamic structural connectivity in a wider range of cortical and limbic structures in TLE patients using a novel connectivity map normalization procedure. STUDY TYPE Retrospective. POPULATION/SUBJECTS Patients (N = 23) with medication-resistant TLE and 34 healthy age-matched controls. FIELD STRENGTH/SEQUENCE For T1 and diffusion weighting a spoiled gradient sequence was used (41 gradient directions [b = 1000]). For T2 mapping balanced steady-state free precession was used. Images were acquired at 3T. ASSESSMENT Probabilistic tractography and a novel normalization procedure allowed comparison of groups with respect to thalamic connected volume, quantitative MRI, and diffusion tensor imaging (DTI) metrics. STATISTICAL TESTS Independent samples t-test, Cohen's d, and Mann-Whitney tests. RESULTS Following normalization, significant differences in thalamic connected volumes were found in left TLE vs. controls bilaterally within the posterior parahippocampal gyrus (L: P = 0.007, confidence interval [CI]: [173.306,1044.41], effect size [ES] = 1.072; R: P = 0.017, CI: [98.677,947.653], ES = 0.945), and contralaterally in the anterior temporal neocortex (P = 0.01, CI: (-2348.09, -333.719), ES = -1.021). This procedure revealed differences in thalamic connected volumes, where previously published procedures could not, and provided a basis for exploratory analysis of quantitative MRI and DTI metrics. DATA CONCLUSION The novel connectivity map normalization scheme proposed here successfully allowed comparison between a wider range of cortical and limbic structures. Multiple volumetric and quantitative MRI and DTI-related differences between TLE patients and controls were revealed following normalization. With validation from a larger cohort, thalamo-temporal connection aberrancies may become useful biomarkers of disease states and probabilistic tractography as a procedure for identification of thalamic targets in modulatory therapies for TLE. LEVEL OF EVIDENCE 3 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2018;48:1529-1539.
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Affiliation(s)
- Brendan G Santyr
- Imaging Research Laboratories, Robarts Research Institute - Western University, London, Ontario, Canada
| | - Jonathan C Lau
- Imaging Research Laboratories, Robarts Research Institute - Western University, London, Ontario, Canada.,Epilepsy Program, Department of Clinical Neurological Sciences, Schulich School of Medicine - Western University, London, Ontario, Canada
| | - Seyed M Mirsattari
- Epilepsy Program, Department of Clinical Neurological Sciences, Schulich School of Medicine - Western University, London, Ontario, Canada
| | - Jorge G Burneo
- Epilepsy Program, Department of Clinical Neurological Sciences, Schulich School of Medicine - Western University, London, Ontario, Canada.,Department of Epidemiology and Biostatistics, Schulich School of Medicine - Western University, London, Ontario, Canada
| | - Sandrine de Ribaupierre
- Imaging Research Laboratories, Robarts Research Institute - Western University, London, Ontario, Canada.,Epilepsy Program, Department of Clinical Neurological Sciences, Schulich School of Medicine - Western University, London, Ontario, Canada
| | - David A Steven
- Epilepsy Program, Department of Clinical Neurological Sciences, Schulich School of Medicine - Western University, London, Ontario, Canada
| | - Andrew G Parrent
- Epilepsy Program, Department of Clinical Neurological Sciences, Schulich School of Medicine - Western University, London, Ontario, Canada
| | - Keith MacDougall
- Epilepsy Program, Department of Clinical Neurological Sciences, Schulich School of Medicine - Western University, London, Ontario, Canada
| | - Ali R Khan
- Imaging Research Laboratories, Robarts Research Institute - Western University, London, Ontario, Canada.,Departments of Medical Biophysics and Medical Imaging - Western University, London, Ontario, Canada
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Dzongowski E, Coriolano K, de Ribaupierre S, Jones SA. Treatment of abdominal pseudocysts and associated ventricuoperitoneal shunt failure. Childs Nerv Syst 2017; 33:2087-2093. [PMID: 28993858 DOI: 10.1007/s00381-017-3609-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Accepted: 10/04/2017] [Indexed: 11/25/2022]
Abstract
PURPOSE The purpose of this study was to determine whether drainage and revision are an effective treatment for abdominal pseudocyst associated ventriculoperitoneal (VP) shunt failure by estimating the total rate of secondary shunt failure. METHODS We performed a retrospective review of children with hydrocephalus diagnosed with and treated for an abdominal pseudocyst at the Children's Hospital, London Health Sciences Centre (LHSC) between January 1, 2000 and May 31, 2016 (ethics approval # 108136). Patients with a VP shunt were included if (i) the development of an abdominal pseudocyst at age 2 to 18 years was identified, (ii) treatment of the pseudocyst by either interventional radiology (IR) or surgical drainage, and (iii) revision of the VP shunt. Demographic data and details of pseudocyst formation/ treatment as well as subsequent failures were identified. RESULTS Twelve patients who had a VP shunt developed abdominal pseudocyst and met inclusion criteria. A 91% shunt failure rate after drainage and shunt revision was identified. Three patients had the pseudocyst drained in interventional radiology and then externalized due to shunt infection. Nine patients were treated by surgical revision. Ten patients experienced recurrent shunt failure following initial drainage of the pseudocyst: pseudocyst reoccurrence (n = 3), distal obstruction from adhesions (n = 1), and uncleared infection (n = 6). CONCLUSION The results suggest that pseudocyst drainage and shunt revision is ineffective in providing long-term resolution of shunt problems.
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Affiliation(s)
- Emily Dzongowski
- Division of Paediatric Surgery, Department of Surgery, Western University, London, ON, Canada
| | - Kamary Coriolano
- Department of Paediatrics, Western University, London, ON, Canada
| | - Sandrine de Ribaupierre
- Division of Paediatric Surgery, Department of Clinical Neurological Sciences, Western University, London, ON, Canada
| | - Sarah A Jones
- Division of Paediatric Surgery, Department of Surgery, Western University, London, ON, Canada.
- Paediatric Surgery, Room B1-131, London Health Sciences Centre, 800 Commissioners Road East, London, ON, N6C 2V3, Canada.
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Bakhshmand SM, Eagleson R, de Ribaupierre S. Multimodal connectivity based eloquence score computation and visualisation for computer-aided neurosurgical path planning. Healthc Technol Lett 2017; 4:152-156. [PMID: 29184656 PMCID: PMC5683204 DOI: 10.1049/htl.2017.0073] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2017] [Accepted: 07/31/2017] [Indexed: 11/20/2022] Open
Abstract
Non-invasive assessment of cognitive importance has been a major challenge for planning of neurosurgical procedures. In the past decade, in vivo brain imaging modalities have been considered for estimating the ‘eloquence’ of brain areas. In order to estimate the impact of damage caused by an access path towards a target region inside of the skull, multi-modal metrics are introduced in this paper. Accordingly, this estimated damage is obtained by combining multi-modal metrics. In other words, this damage is an aggregate of intervened grey matter volume and axonal fibre numbers, weighted by their importance within the assigned anatomical and functional networks. To validate these metrics, an exhaustive search algorithm is implemented for characterising the solution space and visually representing connectional cost associated with a path initiated from underlying points. In this presentation, brain networks are built from resting state functional magnetic resonance imaging (fMRI) and deterministic tractography. their results demonstrate that the proposed approach is capable of refining traditional heuristics, such as choosing the minimal distance from the lesion, by supplementing connectional importance of the resected tissue. This provides complementary information to help the surgeon in avoiding important functional hubs and their anatomical linkages; which are derived from neuroimaging modalities and incorporated to the related anatomical landmarks.
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Affiliation(s)
- Saeed M Bakhshmand
- Biomedical Engineering Graduate Program, University of Western Ontario, London, ON, Canada
| | - Roy Eagleson
- Biomedical Engineering Graduate Program, University of Western Ontario, London, ON, Canada.,Department of Electrical and Computer Engineering, University of Western Ontario, London, ON, Canada
| | - Sandrine de Ribaupierre
- Biomedical Engineering Graduate Program, University of Western Ontario, London, ON, Canada.,Department of Clinical Neurological Sciences, University of Western Ontario, London, ON, Canada
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Abstract
There are a number of challenges that must be faced when trying to develop AR and VR-based Neurosurgical simulators, Surgical Navigation Platforms, and "Smart OR" systems. Trying to simulate an operating room environment and surgical tasks in Augmented and Virtual Reality is a challenge many are attempting to solve, in order to train surgeons or help them operate. What are some of the needs of the surgeon, and what are the challenges encountered (human computer interface, perception, workflow, etc). We discuss these tradeoffs and conclude with critical remarks.
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Sahovaler A, Yeh DH, Morrison D, de Ribaupierre S, Izawa J, Power A, Inculet R, Parry N, Palma DA, Landis M, Leung A, Fung K, MacNeil SD, Yoo J, Nichols AC. The incidence and management of non-head and neck incidentalomas for the head and neck surgeon. Oral Oncol 2017; 74:98-104. [PMID: 29103759 DOI: 10.1016/j.oraloncology.2017.09.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Revised: 08/16/2017] [Accepted: 09/02/2017] [Indexed: 12/11/2022]
Affiliation(s)
- Axel Sahovaler
- Department of Otolaryngology-Head and Neck Surgery, London Health Sciences Centre, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - David H Yeh
- Department of Otolaryngology-Head and Neck Surgery, London Health Sciences Centre, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Deric Morrison
- Department of Medicine, Division of Endocrinology, Western University, London Ontario, Canada
| | - Sandrine de Ribaupierre
- Department of Clinical Neurological Science, London Health Sciences Centre, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Jonathan Izawa
- Department of Surgery, Divisions of Urology and Surgical Oncology, Schulich School of Medicine & Dentistry Western University, Canada
| | - Adam Power
- Department of Surgery, Division of Vascular Surgery, London Health Sciences Centre, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Richard Inculet
- Division of Thoracic Surgery, Department of Surgery, London Health Sciences Centre, University of Western Ontario, London, ON, Canada
| | - Neil Parry
- Divisions of General Surgery and Critical Care, Departments of Surgery and Medicine, London Health Sciences Centre, University of Western Ontario, London, ON, Canada
| | - David A Palma
- Department of Radiation Oncology, London Regional Cancer Program, Schulich School of Medicine & Dentistry, University of Western Ontario, London, ON, Canada
| | - Mark Landis
- Department of Radiology, London Health Sciences Centre, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Andrew Leung
- Department of Radiology, London Health Sciences Centre, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Kevin Fung
- Department of Otolaryngology-Head and Neck Surgery, London Health Sciences Centre, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - S Danielle MacNeil
- Department of Otolaryngology-Head and Neck Surgery, London Health Sciences Centre, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - John Yoo
- Department of Otolaryngology-Head and Neck Surgery, London Health Sciences Centre, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Anthony C Nichols
- Department of Otolaryngology-Head and Neck Surgery, London Health Sciences Centre, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada.
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Bakhshmand SM, Khan AR, de Ribaupierre S, Eagleson R. MultiXplore: Visual exploration platform for multimodal neuroimaging data. J Neurosci Methods 2017; 290:1-12. [PMID: 28712912 DOI: 10.1016/j.jneumeth.2017.07.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Revised: 07/08/2017] [Accepted: 07/10/2017] [Indexed: 11/25/2022]
Abstract
BACKGROUND Construction of brain functional and structural networks by neuroimaging methods facilitates inter-modal studies. These type of studies often demand exploration tools to carry out functional-structural discoveries and answer questions regarding the anatomical basis of brain networks. NEW METHOD This paper describes the design and development of a software module for interactive visualization and exploration of dual-modal brain networks. Our objective was to equip the user with a research tool to investigate brain connectivity matrices while visualizing relevant anatomical landmarks within a 3D volumetric view. In order to create this view, MultiXplore was designed to load data from both structural and diffusion MRI and connectivity matrices. RESULTS Once user starts to select desired cells through an interactive matrix unit, associated axonal fiber pathways and grey matter regions are generated and displayed. Integration and visualization of functional and structural networks in this 3D interactive framework was successfully implemented and tested. COMPARISON WITH EXISTING METHOD(S) MultiXplore contributes to the transition of connectivity visualization techniques from node-link format to an anatomically more realistic graphical form and assists scientists in relating connectivity matrices to their anatomical correlates. This module also benefits from additional novel functionalities to annotate and differentiate fibers in a large bundle. Unlike traditional graph displays, interactive functionality helps in the inspection and visualization of relevant structures without cluttering the scene with excessive items. CONCLUSION This module was designed and developed as a plugin to 3D Slicer imaging platform and is accessible for neuroimaging researchers through NITRC (http://www.nitrc.org/projects/multixplore/).
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Affiliation(s)
- Saeed M Bakhshmand
- Biomedical Engineering Graduate Program, University of Western Ontario, 1151 Richmond Street, London, Ontario, Canada.
| | - Ali R Khan
- Biomedical Engineering Graduate Program, University of Western Ontario, 1151 Richmond Street, London, Ontario, Canada; Department of Medical Biophysics, University of Western Ontario, 1151 Richmond Street, London, Ontario, Canada
| | - Sandrine de Ribaupierre
- Biomedical Engineering Graduate Program, University of Western Ontario, 1151 Richmond Street, London, Ontario, Canada; Department of Clinical Neurological Sciences, University of Western Ontario, 1151 Richmond Street, London, Ontario, Canada
| | - Roy Eagleson
- Biomedical Engineering Graduate Program, University of Western Ontario, 1151 Richmond Street, London, Ontario, Canada; Department of Electrical and Computer Engineering, University of Western Ontario, 1151 Richmond Street, London, Ontario, Canada.
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McLachlan PJ, Kishimoto J, Diop M, Milej D, Lee DSC, de Ribaupierre S, St Lawrence K. Investigating the effects of cerebrospinal fluid removal on cerebral blood flow and oxidative metabolism in infants with post-hemorrhagic ventricular dilatation. Pediatr Res 2017; 82:634-641. [PMID: 28553990 DOI: 10.1038/pr.2017.131] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Accepted: 04/28/2017] [Indexed: 11/09/2022]
Abstract
BackgroundPost-hemorrhagic ventricular dilatation (PHVD) is predictive of mortality and morbidity among very-low-birth-weight preterm infants. Impaired cerebral blood flow (CBF) due to elevated intracranial pressure (ICP) is believed to be a contributing factor.MethodsA hyperspectral near-infrared spectroscopy (NIRS) method of measuring CBF and the cerebral metabolic rate of oxygen (CMRO2) was used to investigate perfusion and metabolism changes in patients receiving a ventricular tap (VT) based on clinical management. To improve measurement accuracy, the spectral analysis was modified to account for compression of the cortical mantle caused by PHVD and the possible presence of blood breakdown products.ResultsFrom nine patients (27 VTs), a significant CBF increase was measured (15.6%) following VT (14.6±4.2 to 16.9±6.6 ml/100 g/min), but with no corresponding change in CMRO2 (1.02±0.41 ml O2/100 g/min). Post-VT CBF was in good agreement with a control group of 13 patients with patent ductus arteriosus but no major cerebral pathology (16.5±7.7 ml/100 g/min), whereas tissue oxygen saturation (StO2) was significantly lower (58.9±12.1% vs. 70.5±9.1% for controls).ConclusionCBF was impeded in PHVD infants requiring a clinical intervention, but the effect is not large enough to alter CMRO2.
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Affiliation(s)
- Peter J McLachlan
- Department of Medical Biophysics, Western University, London, Ontario, Canada
| | - Jessica Kishimoto
- Department of Medical Biophysics, Western University, London, Ontario, Canada
| | - Mamadou Diop
- Imaging Division, Lawson Health Research Institute, London, Ontario, Canada
| | - Daniel Milej
- Imaging Division, Lawson Health Research Institute, London, Ontario, Canada
| | - David S C Lee
- Department of Pediatrics, Western University, London, Ontario, Canada
| | | | - Keith St Lawrence
- Imaging Division, Lawson Health Research Institute, London, Ontario, Canada
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Wright T, de Ribaupierre S, Eagleson R. Design and evaluation of an augmented reality simulator using leap motion. Healthc Technol Lett 2017; 4:210-215. [PMID: 29184667 PMCID: PMC5683193 DOI: 10.1049/htl.2017.0070] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Accepted: 07/31/2017] [Indexed: 01/07/2023] Open
Abstract
Advances in virtual and augmented reality (AR) are having an impact on the medical field in areas such as surgical simulation. Improvements to surgical simulation will provide students and residents with additional training and evaluation methods. This is particularly important for procedures such as the endoscopic third ventriculostomy (ETV), which residents perform regularly. Simulators such as NeuroTouch, have been designed to aid in training associated with this procedure. The authors have designed an affordable and easily accessible ETV simulator, and compare it with the existing NeuroTouch for its usability and training effectiveness. This simulator was developed using Unity, Vuforia and the leap motion (LM) for an AR environment. The participants, 16 novices and two expert neurosurgeons, were asked to complete 40 targeting tasks. Participants used the NeuroTouch tool or a virtual hand controlled by the LM to select the position and orientation for these tasks. The length of time to complete each task was recorded and the trajectory log files were used to calculate performance. The resulting data from the novices' and experts' speed and accuracy are compared, and they discuss the objective performance of training in terms of the speed and accuracy of targeting accuracy for each system.
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Affiliation(s)
- Trinette Wright
- Department of Biomedical Engineering, Western University, London, CanadaN6A 3K7
| | | | - Roy Eagleson
- Department of Biomedical Engineering, Western University, London, CanadaN6A 3K7.,Department of Electrical and Computer Engineering, Western University, London, CanadaN6A 3K7
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Qiu W, Chen Y, Kishimoto J, de Ribaupierre S, Chiu B, Fenster A, Menon BK, Yuan J. Longitudinal Analysis of Pre-Term Neonatal Cerebral Ventricles From 3D Ultrasound Images Using Spatial-Temporal Deformable Registration. IEEE Trans Med Imaging 2017; 36:1016-1026. [PMID: 28026756 DOI: 10.1109/tmi.2016.2643635] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Preterm neonates with a very low birth weight of less than 1,500 grams are at increased risk for developing intraventricular hemorrhage (IVH), which is a major cause of brain injury in preterm neonates. Quantitative measurements of ventricular dilatation or shrinkage play an important role in monitoring patients and evaluating treatment options. 3D ultrasound (US) has been developed to monitor ventricle volume as a biomarker for ventricular changes. However, ventricle volume as a global indicator does not allow for precise analysis of local ventricular changes, which could be linked to specific neurological problems often seen in the patient population later in life. In this work, a 3D+t spatial-temporal deformable registration approachis proposed, which is applied to the analysis of the detailed local changes of preterm IVH neonatal ventricles from 3D US images. In particular, a novel sequential convex/dual optimization algorithm is introduced to extract the optimal 3D+t spatial-temporal deformable field, which simultaneously optimizes the sequence of 3D deformation fieldswhile enjoying both efficiencyand simplicity in numerics. The developed registration technique was evaluated by comparing two manually extracted ventricle surfaces from the baseline and the registered follow-up images using the metrics of Dice similarity coefficient (DSC), mean absolute surface distance (MAD), and maximum absolute surface distance (MAXD). The performed experiments using 14 patients with 5 time-point images per patient show that the proposed 3D+t registration approach accurately recovered the longitudinal deformation of ventricle surfaces from 3D US images. The proposed approach may be potentially used to analyse the change pattern of cerebral ventricles of IVH patients, their response to different treatment options, and to elucidate the deficiencies that a patient could have later in life. To the best of our knowledge, this paper reports the first study on the longitudinalanalysis of neonatal ventricular system from 3D US images.
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Qiu W, Chen Y, Kishimoto J, de Ribaupierre S, Chiu B, Fenster A, Yuan J. Automatic segmentation approach to extracting neonatal cerebral ventricles from 3D ultrasound images. Med Image Anal 2017; 35:181-191. [DOI: 10.1016/j.media.2016.06.038] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Revised: 06/28/2016] [Accepted: 06/30/2016] [Indexed: 01/26/2023]
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Clay DE, Linke AC, Cameron DJ, Stojanoski B, Rulisa S, Wasunna A, de Ribaupierre S, Cusack R. Evaluating Affordable Cranial Ultrasonography in East African Neonatal Intensive Care Units. Ultrasound Med Biol 2017; 43:119-128. [PMID: 27773345 DOI: 10.1016/j.ultrasmedbio.2016.07.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Revised: 07/18/2016] [Accepted: 07/31/2016] [Indexed: 06/06/2023]
Abstract
Neuroimaging is a valuable diagnostic tool for the early detection of neonatal brain injury, but equipment and radiologic staff are expensive and unavailable to most hospitals in developing countries. We evaluated an affordable, portable ultrasound machine as a quantitative and qualitative diagnostic tool and to establish whether a novice sonographer could effectively operate the equipment and obtain clinically important information. Cranial ultrasonography was performed on term healthy, pre-term and term asphyxiated neonates in Rwandan and Kenyan hospitals. To evaluate the detection of ventriculomegaly and compression injuries, we measured the size of the lateral ventricles and corpus callosum. The images were also assessed for the presence of other cerebral abnormalities. Measurements were reliable across images, and cases of clinically relevant ventriculomegaly were detected. A novice sonographer had good-to-excellent agreement with an expert. This study demonstrates that affordable equipment and cranial ultrasound protocols can be used in low-resource settings to assess the newborn brain.
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Affiliation(s)
- David E Clay
- Anatomy and Cell Biology, Western University, London, Ontario, Canada
| | - Annika C Linke
- Brain and Mind Institute, Western University, London, Ontario, Canada.
| | - Daniel J Cameron
- Brain and Mind Institute, Western University, London, Ontario, Canada
| | - Bobby Stojanoski
- Brain and Mind Institute, Western University, London, Ontario, Canada
| | - Stephen Rulisa
- Centre Hospitalier Universitaire de Kigali, Kigali, Rwanda
| | - Aggrey Wasunna
- School of Medicine, University of Nairobi, Nairobi, Kenya
| | - Sandrine de Ribaupierre
- Anatomy and Cell Biology, Western University, London, Ontario, Canada; Brain and Mind Institute, Western University, London, Ontario, Canada; Clinical Neurological Sciences, Western University, London, Ontario, Canada
| | - Rhodri Cusack
- Brain and Mind Institute, Western University, London, Ontario, Canada
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Kishimoto J, de Ribaupierre S, Salehi F, Romano W, Lee DSC, Fenster A. Preterm neonatal lateral ventricle volume from three-dimensional ultrasound is not strongly correlated to two-dimensional ultrasound measurements. J Med Imaging (Bellingham) 2016; 3:046003. [PMID: 27872874 DOI: 10.1117/1.jmi.3.4.046003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Accepted: 10/06/2016] [Indexed: 11/14/2022] Open
Abstract
The aim of this study is to compare longitudinal two-dimensional (2-D) and three-dimensional (3-D) ultrasound (US) estimates of ventricle size in preterm neonates with posthemorrhagic ventricular dilatation (PHVD) using quantitative measurements of the lateral ventricles. Cranial 2-D US and 3-D US images were acquired from neonatal patients with diagnosed PHVD within 10 min of each other one to two times per week and analyzed offline. Ventricle index, anterior horn width, third ventricle width, and thalamo-occipital distance were measured on the 2-D images and ventricle volume (VV) was measured from 3-D US images. Changes in the measurements between successive image sets were also recorded. No strong correlations were found between VV and 2-D US measurements ([Formula: see text] between 0.69 and 0.36). Additionally, weak correlations were found between changes in 2-D US measurements and 3-D US VV ([Formula: see text] between 0.13 and 0.02). A trend was found between increasing 2-D US measurements and 3-D US-based VV, but this was not the case when comparing changes between 3-D US VV and 2-D US measurements. If 3-D US-based VV provides a more accurate estimate of ventricle size than 2-D US measurements, moderate-weak correlations with 3-D US suggest that monitoring preterm patients with PHVD using 2-D US measurements alone might not accurately represent whether the ventricles are progressively dilating. A volumetric measure (3-D US or MRI) could be used instead to more accurately represent changes.
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Affiliation(s)
- Jessica Kishimoto
- The University of Western Ontario, Robarts Research Institute, Imaging Research Laboratories, 1151 Richmond Street, London, Ontario N6A 3K7, Canada; The University of Western Ontario, Department of Medical Biophysics, 1151 Richmond Street, London, Ontario N6A 3K7, Canada
| | - Sandrine de Ribaupierre
- The University of Western Ontario, Department of Medical Biophysics, 1151 Richmond Street, London, Ontario N6A 3K7, Canada; London Health Sciences Centre, Children's Hospital, Department of Paediatrics, 800 Commissioners Road East, London, Ontario N6A 5W9, Canada; London Health Sciences Centre, Department of Clinical Neurological Sciences, 339 Windermere Road, London, Ontario N6A 5A5, Canada
| | - Fateme Salehi
- The University of Western Ontario , Department of Radiology, 1151 Richmond Street, London, Ontario N6A 3K7, Canada
| | - Walter Romano
- The University of Western Ontario , Department of Radiology, 1151 Richmond Street, London, Ontario N6A 3K7, Canada
| | - David S C Lee
- London Health Sciences Centre , Children's Hospital, Department of Paediatrics, 800 Commissioners Road East, London, Ontario N6A 5W9, Canada
| | - Aaron Fenster
- The University of Western Ontario, Robarts Research Institute, Imaging Research Laboratories, 1151 Richmond Street, London, Ontario N6A 3K7, Canada; The University of Western Ontario, Department of Medical Biophysics, 1151 Richmond Street, London, Ontario N6A 3K7, Canada
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Allen LK, Eagleson R, de Ribaupierre S. Evaluation of an online three-dimensional interactive resource for undergraduate neuroanatomy education. Anat Sci Educ 2016; 9:431-9. [PMID: 26990135 DOI: 10.1002/ase.1604] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Revised: 02/04/2016] [Accepted: 02/08/2016] [Indexed: 05/26/2023]
Abstract
Neuroanatomy is one of the most challenging subjects in anatomy, and novice students often experience difficulty grasping the complex three-dimensional (3D) spatial relationships. This study evaluated a 3D neuroanatomy e-learning module, as well as the relationship between spatial abilities and students' knowledge in neuroanatomy. The study's cross-over design divided the participants into two groups, each starting with tests for anatomy knowledge and spatial ability, followed by access to either the 3D online learning module or the gross anatomy laboratory. Participants completed a second knowledge test prior to accessing the other learning modality. Participants in both groups scored significantly higher on Quiz 1 than on the Pretest knowledge assessment (W = 47, P < 0.01; W = 30, P < 0.01). Students who initially accessed the 3D online resources scored significantly better on the Quiz 1 than students who accessed the gross anatomy resources (W = 397.5, P < 0.01). Scores significantly improved on Quiz 2 for participants who accessed the 3D learning module following exposure to the cadaveric resources (W = 94, P < 0.01). After exposure to both learning modalities, there were no significant differences between groups. Significant positive correlations were found between participants' spatial ability score and their performance on the Pretest, Quiz 1, and Quiz 2 assessments (r = 0.22, P = 0.04; r = 0.25, P = 0.02; r = 0.26, P = 0.02). These preliminary results found students appreciated working with the 3D e-learning module, and their learning outcomes significantly improved after accessing the resource. Anat Sci Educ 9: 431-439. © 2016 American Association of Anatomists.
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Affiliation(s)
- Lauren K Allen
- Department of Anatomy and Cell Biology, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Roy Eagleson
- Department of Electrical and Software Engineering, Faculty of Engineering, Western University, London, Ontario, Canada
| | - Sandrine de Ribaupierre
- Department of Anatomy and Cell Biology, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
- Department of Electrical and Software Engineering, Faculty of Engineering, Western University, London, Ontario, Canada
- Department of Clinical Neurological Sciences, Division of Neurosurgery, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
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48
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Haji FA, Cheung JJH, Woods N, Regehr G, de Ribaupierre S, Dubrowski A. Thrive or overload? The effect of task complexity on novices' simulation-based learning. Med Educ 2016; 50:955-68. [PMID: 27562895 DOI: 10.1111/medu.13086] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2015] [Revised: 07/30/2015] [Accepted: 03/21/2016] [Indexed: 05/08/2023]
Abstract
CONTEXT Fidelity is widely viewed as an important element of simulation instructional design based on its purported relationship with transfer of learning. However, higher levels of fidelity may increase task complexity to a point at which novices' cognitive resources become overloaded. OBJECTIVES In this experiment, we investigate the effects of variations in task complexity on novices' cognitive load and learning during simulation-based procedural skills training. METHODS Thirty-eight medical students were randomly assigned to simulation training on a simple or complex lumbar puncture (LP) task. Participants completed four practice trials on this task (skill acquisition). After 10 days of rest, all participants completed one additional trial on their assigned task (retention) and one trial on a 'very complex' simulation designed to be similar to the complex task (transfer). We assessed LP performance and cognitive load on each trial using multiple measures. RESULTS In both groups, LP performance improved significantly during skill acquisition (p ≤ 0.047, f = 0.29-0.96) and was maintained at retention. The simple task group demonstrated superior performance compared with the complex task group throughout these phases (p ≤ 0.002, d = 1.13-2.31). Cognitive load declined significantly in the simple task group (p < 0.009, f = 0.48-0.76), but not in the complex task group during skill acquisition, and remained lower at retention (p ≤ 0.024, d = 0.78-1.39). Between retention and transfer, LP performance declined and cognitive load increased in the simple task group, whereas both remained stable in the complex task group. At transfer, no group differences were observed in LP performance and cognitive load, except that the simple task group made significantly fewer breaches of sterility (p = 0.023, d = 0.80). CONCLUSIONS Reduced task complexity was associated with superior LP performance and lower cognitive load during skill acquisition and retention, but mixed results on transfer to a more complex task. These results indicate that task complexity is an important factor that may mediate (via cognitive overload) the relationship between instructional design elements (e.g. fidelity) and simulation-based learning outcomes.
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Affiliation(s)
- Faizal A Haji
- Wilson Centre, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- SickKids Learning Institute, Hospital for Sick Children, Toronto, Ontario, Canada
- Division of Clinical Neurological Sciences, Faculty of Medicine, Western University, London, Ontario, Canada
| | - Jeffrey J H Cheung
- Wilson Centre, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- SickKids Learning Institute, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Nicole Woods
- Wilson Centre, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Glenn Regehr
- Centre for Health Education Scholarship, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sandrine de Ribaupierre
- Division of Clinical Neurological Sciences, Faculty of Medicine, Western University, London, Ontario, Canada
| | - Adam Dubrowski
- Division of Emergency Medicine, Faculty of Medicine, Memorial University of Newfoundland, St John's, Newfoundland, Canada
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49
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Santyr BG, Goubran M, Lau JC, Kwan BYM, Salehi F, Lee DH, Mirsattari SM, Burneo JG, Steven DA, Parrent AG, de Ribaupierre S, Hammond RR, Peters TM, Khan AR. Investigation of hippocampal substructures in focal temporal lobe epilepsy with and without hippocampal sclerosis at 7T. J Magn Reson Imaging 2016; 45:1359-1370. [PMID: 27564217 DOI: 10.1002/jmri.25447] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2016] [Accepted: 08/11/2016] [Indexed: 11/10/2022] Open
Abstract
PURPOSE To provide a more detailed investigation of hippocampal subfields using 7T magnetic resonance imaging (MRI) for the identification of hippocampal sclerosis in temporal lobe epilepsy (TLE). MATERIALS AND METHODS Patients (n = 13) with drug-resistant TLE previously identified by conventional imaging as having hippocampal sclerosis (HS) or not (nine without HS, four HS) and 20 age-matched healthy controls were scanned and compared using a 7T MRI protocol. Using a manual segmentation scheme to delineate hippocampal subfields, subfield-specific volume changes and apparent transverse relaxation rate ( R2*) were studied between the two groups. In addition, qualitative assessment at 7T and clinical outcomes were correlated with measured subfield changes. RESULTS Volumetry of the hippocampus at 7T in HS patients revealed significant ipsilateral subfield atrophy in CA1 (P = 0.001) and CA4+DG (P < 0.001). Volumetry also uncovered subfield atrophy in 33% of patients without HS, which had not been detected using conventional imaging. R2* was significantly lower in the CA4+DG subfields (P = 0.001) and the whole hippocampus (P = 0.029) of HS patients compared to controls but not significantly lower than the group without HS (P = 0.077, P = 0.109). No correlation was found between quantitative volumetry and qualitative assessment as well as surgical outcomes (Sub, P = 0.495, P = 0.567, P = 0.528; CA1, P = 0.104 ± 0.171, P = 0.273, P = 0.554; CA2+CA3, P = 0.517, P = 0.952, P = 0.130 ± 0.256; CA4+DG, P = 0.052 ± 0.173, P = 0.212, P = 0.124 ± 0.204; WholeHipp, P = 0.187, P = 0.132 ± 0.197, P = 0.628). CONCLUSION These preliminary findings indicate that hippocampal subfield volumetry assessed at 7T is capable of identifying characteristic patterns of hippocampal atrophy in HS patients; however, difficulty remains in using imaging to identify hippocampal pathologies in cases without HS. LEVEL OF EVIDENCE 2 J. MAGN. RESON. IMAGING 2017;45:1359-1370.
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Affiliation(s)
- Brendan G Santyr
- Schulich School of Medicine and Dentistry - Western University, London, Ontario, Canada
| | - Maged Goubran
- Schulich School of Medicine and Dentistry - Western University, London, Ontario, Canada.,Departments of Medical Biophysics and Medical Imaging - Western University, London, Ontario, Canada
| | - Jonathan C Lau
- Department of Clinical Neurological Sciences - London Health Sciences Centre, London, Ontario, Canada
| | - Benjamin Y M Kwan
- Schulich School of Medicine and Dentistry - Western University, London, Ontario, Canada.,Departments of Medical Biophysics and Medical Imaging - Western University, London, Ontario, Canada
| | - Fateme Salehi
- Schulich School of Medicine and Dentistry - Western University, London, Ontario, Canada.,Departments of Medical Biophysics and Medical Imaging - Western University, London, Ontario, Canada
| | - Donald H Lee
- Schulich School of Medicine and Dentistry - Western University, London, Ontario, Canada.,Departments of Medical Biophysics and Medical Imaging - Western University, London, Ontario, Canada
| | - Seyed M Mirsattari
- Department of Clinical Neurological Sciences - London Health Sciences Centre, London, Ontario, Canada
| | - Jorge G Burneo
- Department of Clinical Neurological Sciences - London Health Sciences Centre, London, Ontario, Canada
| | - David A Steven
- Department of Clinical Neurological Sciences - London Health Sciences Centre, London, Ontario, Canada
| | - Andrew G Parrent
- Department of Clinical Neurological Sciences - London Health Sciences Centre, London, Ontario, Canada
| | - Sandrine de Ribaupierre
- Department of Clinical Neurological Sciences - London Health Sciences Centre, London, Ontario, Canada
| | - Robert R Hammond
- Department of Pathology and Laboratory Medicine - London Health Sciences Centre, London, Ontario, Canada
| | - Terry M Peters
- Schulich School of Medicine and Dentistry - Western University, London, Ontario, Canada.,Departments of Medical Biophysics and Medical Imaging - Western University, London, Ontario, Canada
| | - Ali R Khan
- Schulich School of Medicine and Dentistry - Western University, London, Ontario, Canada.,Departments of Medical Biophysics and Medical Imaging - Western University, London, Ontario, Canada
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50
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Kishimoto J, Fenster A, Lee DSC, de Ribaupierre S. In Vivo Validation of a 3-D Ultrasound System for Imaging the Lateral Ventricles of Neonates. Ultrasound Med Biol 2016; 42:971-979. [PMID: 26782271 DOI: 10.1016/j.ultrasmedbio.2015.11.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Revised: 11/05/2015] [Accepted: 11/13/2015] [Indexed: 06/05/2023]
Abstract
Intra-ventricular hemorrhage, with the resultant cerebral ventricle dilation, is a common cause of brain injury in preterm neonates. Clinically, monitoring is performed using 2-D ultrasound (US); however, its clinical utility in dilation is limited because it cannot provide accurate measurements of irregular volumes such as those of the ventricles, and this might delay treatment until the patient's condition deteriorates severely. We have developed a 3-D US system to image the lateral ventricles of neonates within the confines of incubators. We describe an in vivo ventricle volume validation study in two parts: (i) comparisons between ventricle volumes derived from 3-D US and magnetic resonance images obtained within 24 h; and (ii) the difference between 3-D US ventricle volumes before and after clinically necessary interventions (ventricle taps), which remove cerebral spinal fluid. Magnetic resonance imaging ventricle volumes were found to be 13% greater than 3-D US ventricle volumes; however, we observed high correlations (R(2) = 0.99) when comparing the two modalities. Differences in ventricle volume pre- and post-intervention compared with the reported volume of cerebrospinal fluid removed also were highly correlated (R(2) = 0.93); the slope was not found to be statistically significantly different from 1 (p < 0.05), and the y-intercept was not found to be statistically different from 0 (p < 0.05). Comparison between 3-D US images can detect the volume change after neonatal intra-ventricular hemorrhage. This could be used to determine which patients will have progressive ventricle dilation and allow for more timely surgical interventions. However, 3-D US ventricle volumes should not be directly compared with magnetic resonance imaging ventricle volumes.
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Affiliation(s)
- Jessica Kishimoto
- Department of Medical Biophysics, University of Western Ontario, London, Ontario, Canada; Robarts Imaging, University of Western Ontario, London, Ontario, Canada.
| | - Aaron Fenster
- Department of Medical Biophysics, University of Western Ontario, London, Ontario, Canada; Robarts Imaging, University of Western Ontario, London, Ontario, Canada
| | - David S C Lee
- Department of Paediatrics, University of Western Ontario, London Health Sciences Centre, London, Ontario, Canada
| | - Sandrine de Ribaupierre
- Department of Medical Biophysics, University of Western Ontario, London, Ontario, Canada; Department of Paediatrics, University of Western Ontario, London Health Sciences Centre, London, Ontario, Canada; Department of Clinical Neurological Sciences, University of Western Ontario, London Health Sciences Centre, London, Ontario, Canada
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