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Poirier SE, Suskin NG, Khaw AV, Thiessen JD, Shoemaker JK, Anazodo UC. Probing Evidence of Cerebral White Matter Microstructural Disruptions in Ischemic Heart Disease Before and Following Cardiac Rehabilitation: A Diffusion Tensor MR Imaging Study. J Magn Reson Imaging 2024; 59:2137-2149. [PMID: 37589418 DOI: 10.1002/jmri.28964] [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: 05/05/2023] [Revised: 07/31/2023] [Accepted: 08/03/2023] [Indexed: 08/18/2023] Open
Abstract
BACKGROUND Ischemic heart disease (IHD) is linked to brain white matter (WM) breakdown but how age or disease effects WM integrity, and whether it is reversible using cardiac rehabilitation (CR), remains unclear. PURPOSE To assess the effects of brain aging, cardiovascular disease, and CR on WM microstructure in brains of IHD patients following a cardiac event. STUDY TYPE Retrospective. POPULATION Thirty-five IHD patients (9 females; mean age = 59 ± 8 years), 21 age-matched healthy controls (10 females; mean age = 59 ± 8 years), and 25 younger controls (14 females; mean age = 26 ± 4 years). FIELD STRENGTH/SEQUENCE 3 T diffusion-weighted imaging with single-shot echo planar imaging acquired at 3 months and 9 months post-cardiac event. ASSESSMENT Tract-based spatial statistics (TBSS) and tractometry were used to compare fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (AD), and radial diffusivity (RD) in cerebral WM between: 1) older and younger controls to distinguish age-related from disease-related WM changes; 2) IHD patients at baseline (pre-CR) and age-matched controls to investigate if cardiovascular disease exacerbates age-related WM changes; and 3) IHD patients pre-CR and post-CR to investigate the neuroplastic effect of CR on WM microstructure. STATISTICAL TESTS Two-sample unpaired t-test (age: older vs. younger controls; IHD: IHD pre-CR vs. age-matched controls). One-sample paired t-test (CR: IHD pre- vs. post-CR). Statistical threshold: P < 0.05 (FWE-corrected). RESULTS TBSS and tractometry revealed widespread WM changes in older controls compared to younger controls while WM clusters of decreased FA in the fornix and increased MD in body of corpus callosum were observed in IHD patients pre-CR compared to age-matched controls. Robust WM improvements (increased FA, increased AD) were observed in IHD patients post-CR. DATA CONCLUSION In IHD, both brain aging and cardiovascular disease may contribute to WM disruptions. IHD-related WM disruptions may be favorably modified by CR. LEVEL OF EVIDENCE 3 TECHNICAL EFFICACY: Stage 2.
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Affiliation(s)
- Stefan E Poirier
- Lawson Imaging, Lawson Health Research Institute, London, Ontario, Canada
- Department of Medical Biophysics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Neville G Suskin
- Division of Cardiology, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Alexander V Khaw
- Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Jonathan D Thiessen
- Lawson Imaging, Lawson Health Research Institute, London, Ontario, Canada
- Department of Medical Biophysics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
- Department of Medical Imaging, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Joel K Shoemaker
- School of Kinesiology, Western University, London, Ontario, Canada
| | - Udunna C Anazodo
- Lawson Imaging, Lawson Health Research Institute, London, Ontario, Canada
- Department of Medical Biophysics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
- Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
- Research Centre for Studies in Aging, McGill University, Montréal, Québec, Canada
- Department of Neurology and Neurosurgery, McGill University, Montréal, Québec, Canada
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Anazodo UC, Wong DY, Théberge J, Dacey M, Gomes J, Penny JD, van Ginkel M, Poirier SE, McIntyre CW. Hemodialysis-Related Acute Brain Injury Demonstrated by Application of Intradialytic Magnetic Resonance Imaging and Spectroscopy. J Am Soc Nephrol 2023; 34:1090-1104. [PMID: 36890644 PMCID: PMC10278857 DOI: 10.1681/asn.0000000000000105] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [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: 01/28/2022] [Accepted: 02/11/2023] [Indexed: 03/10/2023] Open
Abstract
SIGNIFICANCE STATEMENT Hemodialysis (HD) results in reduced brain blood flow, and HD-related circulatory stress and regional ischemia are associated with brain injury over time. However, studies to date have not provided definitive direct evidence of acute brain injury during a HD treatment session. Using intradialytic magnetic resonance imaging (MRI) and spectroscopy to examine HD-associated changes in brain structure and neurochemistry, the authors found that multiple white (WM) tracts had diffusion imaging changes characteristic of cytotoxic edema, a consequence of ischemic insult and a precursor to fixed structural WM injury. Spectroscopy showed decreases in prefrontal N -acetyl aspartate (NAA) and choline concentrations consistent with energy deficit and perfusion anomaly. This suggests that one HD session can cause brain injury and that studies of interventions that mitigate this treatment's effects on the brain are warranted. BACKGROUND Hemodialysis (HD) treatment-related hemodynamic stress results in recurrent ischemic injury to organs such as the heart and brain. Short-term reduction in brain blood flow and long-term white matter changes have been reported, but the basis of HD-induced brain injury is neither well-recognized nor understood, although progressive cognitive impairment is common. METHODS We used neurocognitive assessments, intradialytic anatomical magnetic resonance imaging, diffusion tensor imaging, and proton magnetic resonance spectroscopy to examine the nature of acute HD-associated brain injury and associated changes in brain structure and neurochemistry relevant to ischemia. Data acquired before HD and during the last 60 minutes of HD (during maximal circulatory stress) were analyzed to assess the acute effects of HD on the brain. RESULTS We studied 17 patients (mean age 63±13 years; 58.8% were male, 76.5% were White, 17.6% were Black, and 5.9% were of Indigenous ethnicity). We found intradialytic changes, including the development of multiple regions of white matter exhibiting increased fractional anisotropy with associated decreases in mean diffusivity and radial diffusivity-characteristic features of cytotoxic edema (with increase in global brain volumes). We also observed decreases in proton magnetic resonance spectroscopy-measured N -acetyl aspartate and choline concentrations during HD, indicative of regional ischemia. CONCLUSIONS This study demonstrates for the first time that significant intradialytic changes in brain tissue volume, diffusion metrics, and brain metabolite concentrations consistent with ischemic injury occur in a single dialysis session. These findings raise the possibility that HD might have long-term neurological consequences. Further study is needed to establish an association between intradialytic magnetic resonance imaging findings of brain injury and cognitive impairment and to understand the chronic effects of HD-induced brain injury. CLINICAL TRIALS INFORMATION NCT03342183 .
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Affiliation(s)
- Udunna C. Anazodo
- Lawson Health Research Institute, London, Ontario, Canada
- Department of Medical Biophysics, Western University, London, Ontario, Canada
| | - Dickson Y. Wong
- Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Jean Théberge
- Lawson Health Research Institute, London, Ontario, Canada
- Department of Medical Biophysics, Western University, London, Ontario, Canada
- Department of Medical Imaging, Western University, London, Ontario, Canada
| | - Madeleine Dacey
- Department of Medical Biophysics, Western University, London, Ontario, Canada
| | - Janice Gomes
- Department of Pathology and Laboratory Medicine, Western University, London, Ontario, Canada
- Lilibeth Caberto Kidney Clinical Research Unit, London Health Sciences Centre, London, Ontario, Canada
| | - Jarrin D. Penny
- Department of Medical Biophysics, Western University, London, Ontario, Canada
- Lilibeth Caberto Kidney Clinical Research Unit, London Health Sciences Centre, London, Ontario, Canada
| | - Michael van Ginkel
- Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Stefan E. Poirier
- Lawson Health Research Institute, London, Ontario, Canada
- Department of Medical Biophysics, Western University, London, Ontario, Canada
| | - Christopher W. McIntyre
- Lawson Health Research Institute, London, Ontario, Canada
- Department of Medical Biophysics, Western University, London, Ontario, Canada
- Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
- Lilibeth Caberto Kidney Clinical Research Unit, London Health Sciences Centre, London, Ontario, Canada
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Adewole M, Rudie JD, Gbdamosi A, Toyobo O, Raymond C, Zhang D, Omidiji O, Akinola R, Suwaid MA, Emegoakor A, Ojo N, Aguh K, Kalaiwo C, Babatunde G, Ogunleye A, Gbadamosi Y, Iorpagher K, Calabrese E, Aboian M, Linguraru M, Albrecht J, Wiestler B, Kofler F, Janas A, LaBella D, Kzerooni AF, Li HB, Iglesias JE, Farahani K, Eddy J, Bergquist T, Chung V, Shinohara RT, Wiggins W, Reitman Z, Wang C, Liu X, Jiang Z, Familiar A, Van Leemput K, Bukas C, Piraud M, Conte GM, Johansson E, Meier Z, Menze BH, Baid U, Bakas S, Dako F, Fatade A, Anazodo UC. The Brain Tumor Segmentation (BraTS) Challenge 2023: Glioma Segmentation in Sub-Saharan Africa Patient Population (BraTS-Africa). ArXiv 2023:arXiv:2305.19369v1. [PMID: 37396608 PMCID: PMC10312814] [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] [Subscribe] [Scholar Register] [Indexed: 07/04/2023]
Abstract
Gliomas are the most common type of primary brain tumors. Although gliomas are relatively rare, they are among the deadliest types of cancer, with a survival rate of less than 2 years after diagnosis. Gliomas are challenging to diagnose, hard to treat and inherently resistant to conventional therapy. Years of extensive research to improve diagnosis and treatment of gliomas have decreased mortality rates across the Global North, while chances of survival among individuals in low- and middle-income countries (LMICs) remain unchanged and are significantly worse in Sub-Saharan Africa (SSA) populations. Long-term survival with glioma is associated with the identification of appropriate pathological features on brain MRI and confirmation by histopathology. Since 2012, the Brain Tumor Segmentation (BraTS) Challenge have evaluated state-of-the-art machine learning methods to detect, characterize, and classify gliomas. However, it is unclear if the state-of-the-art methods can be widely implemented in SSA given the extensive use of lower-quality MRI technology, which produces poor image contrast and resolution and more importantly, the propensity for late presentation of disease at advanced stages as well as the unique characteristics of gliomas in SSA (i.e., suspected higher rates of gliomatosis cerebri). Thus, the BraTS-Africa Challenge provides a unique opportunity to include brain MRI glioma cases from SSA in global efforts through the BraTS Challenge to develop and evaluate computer-aided-diagnostic (CAD) methods for the detection and characterization of glioma in resource-limited settings, where the potential for CAD tools to transform healthcare are more likely.
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Affiliation(s)
- Maruf Adewole
- Medical Artificial Intelligence Laboratory (MAI Lab), Lagos, Nigeria
- Department of Radiation Biology, Radiotherapy and Radiodiagnosis, University of Lagos, Lagos, Nigeria
| | - Jeffrey D Rudie
- Department of Radiology, University of California, San Diego
| | - Anu Gbdamosi
- Medical Artificial Intelligence Laboratory (MAI Lab), Lagos, Nigeria
- Crestview Radiology Limited, Lagos, Nigeria
| | - Oluyemisi Toyobo
- Medical Artificial Intelligence Laboratory (MAI Lab), Lagos, Nigeria
- Crestview Radiology Limited, Lagos, Nigeria
| | | | - Dong Zhang
- Medical Artificial Intelligence Laboratory (MAI Lab), Lagos, Nigeria
| | - Olubukola Omidiji
- Medical Artificial Intelligence Laboratory (MAI Lab), Lagos, Nigeria
- Lagos University Teaching Hospital, Lagos, Nigeria
| | - Rachel Akinola
- Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria
| | | | - Adaobi Emegoakor
- Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra State, Nigeria
| | - Nancy Ojo
- Federal Medical Centre, Abeokuta, Ogun State, Nigeria
| | - Kenneth Aguh
- Federal Medical Centre, Umahia, Abia State, Nigeria
| | | | | | | | | | - Kator Iorpagher
- Benue State University Teaching Hospital, Markurdi, Benue State, Nigeria
| | - Evan Calabrese
- Duke University Medical Center, Department of Radiology, USA
- University of California San Francisco, CA, USA
| | | | - Marius Linguraru
- Children's National Hospital, Washington DC, USA
- George Washington University, Washington DC, USA
| | | | - Benedikt Wiestler
- Department of Neuroradiology, Technical University of Munich, Munich, Germany
| | - Florian Kofler
- Department of Neuroradiology, Technical University of Munich, Munich, Germany
- Helmholtz Research Center, Munich, Germany
| | | | - Dominic LaBella
- Duke University Medical Center, Department of Radiation Oncology, USA
| | - Anahita Fathi Kzerooni
- Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, USA
- Center for AI and Data Science for Integrated Diagnostics (AI2D) & Center for Biomedical Image Computing and Analytics (CBICA), University of Pennsylvania, Philadelphia, PA, USA
| | - Hongwei Bran Li
- Department of Neuroradiology, Technical University of Munich, Munich, Germany
- Athinoula A Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Boston, MA, USA
- University of Zurich, Switzerland
| | - Juan Eugenio Iglesias
- Athinoula A Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Boston, MA, USA
| | - Keyvan Farahani
- Cancer Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, MD 20814, USA
| | | | | | | | - Russell Takeshi Shinohara
- Center for AI and Data Science for Integrated Diagnostics (AI2D) & Center for Biomedical Image Computing and Analytics (CBICA), University of Pennsylvania, Philadelphia, PA, USA
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, USA
| | - Walter Wiggins
- Duke University Medical Center, Department of Radiology, USA
| | - Zachary Reitman
- Duke University Medical Center, Department of Radiation Oncology, USA
| | - Chunhao Wang
- Duke University Medical Center, Department of Radiation Oncology, USA
| | - Xinyang Liu
- Children's National Hospital, Washington DC, USA
- George Washington University, Washington DC, USA
| | - Zhifan Jiang
- Children's National Hospital, Washington DC, USA
- George Washington University, Washington DC, USA
| | - Ariana Familiar
- Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, USA
| | - Koen Van Leemput
- Department of Applied Mathematics and Computer Science, Technical University of Denmark, Denmark
| | | | | | | | - Elaine Johansson
- Precision FDA, U.S. Food and Drug Administration, Silver Spring, MD, USA
| | | | - Bjoern H Menze
- Department of Neuroradiology, Technical University of Munich, Munich, Germany
- University of Zurich, Switzerland
| | - Ujjwal Baid
- Center for AI and Data Science for Integrated Diagnostics (AI2D) & Center for Biomedical Image Computing and Analytics (CBICA), University of Pennsylvania, Philadelphia, PA, USA
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Spyridon Bakas
- Center for AI and Data Science for Integrated Diagnostics (AI2D) & Center for Biomedical Image Computing and Analytics (CBICA), University of Pennsylvania, Philadelphia, PA, USA
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Farouk Dako
- Center for Global Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Abiodun Fatade
- Medical Artificial Intelligence Laboratory (MAI Lab), Lagos, Nigeria
- Crestview Radiology Limited, Lagos, Nigeria
| | - Udunna C Anazodo
- Medical Artificial Intelligence Laboratory (MAI Lab), Lagos, Nigeria
- Montreal Neurological Institute, McGill University, Montreal, Canada
- Department of Medicine, University of Cape Town, South Africa
- Department of Radiation Medicine, University of Cape Town, South Africa
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Tang JM, McClennan A, Liu L, Hadway J, Ronald JA, Hicks JW, Hoffman L, Anazodo UC. A Protocol for Simultaneous In Vivo Imaging of Cardiac and Neuroinflammation in Dystrophin-Deficient MDX Mice Using [ 18F]FEPPA PET. Int J Mol Sci 2023; 24:ijms24087522. [PMID: 37108685 PMCID: PMC10144317 DOI: 10.3390/ijms24087522] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Revised: 04/14/2023] [Accepted: 04/18/2023] [Indexed: 04/29/2023] Open
Abstract
Duchenne muscular dystrophy (DMD) is a neuromuscular disorder caused by dystrophin loss-notably within muscles and the central neurons system. DMD presents as cognitive weakness, progressive skeletal and cardiac muscle degeneration until pre-mature death from cardiac or respiratory failure. Innovative therapies have improved life expectancy; however, this is accompanied by increased late-onset heart failure and emergent cognitive degeneration. Thus, better assessment of dystrophic heart and brain pathophysiology is needed. Chronic inflammation is strongly associated with skeletal and cardiac muscle degeneration; however, neuroinflammation's role is largely unknown in DMD despite being prevalent in other neurodegenerative diseases. Here, we present an inflammatory marker translocator protein (TSPO) positron emission tomography (PET) protocol for in vivo concomitant assessment of immune cell response in hearts and brains of a dystrophin-deficient mouse model [mdx:utrn(+/-)]. Preliminary analysis of whole-body PET imaging using the TSPO radiotracer, [18F]FEPPA in four mdx:utrn(+/-) and six wildtype mice are presented with ex vivo TSPO-immunofluorescence tissue staining. The mdx:utrn(+/-) mice showed significant elevations in heart and brain [18F]FEPPA activity, which correlated with increased ex vivo fluorescence intensity, highlighting the potential of TSPO-PET to simultaneously assess presence of cardiac and neuroinflammation in dystrophic heart and brain, as well as in several organs within a DMD model.
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Affiliation(s)
- Joanne M Tang
- Department of Medical Biophysics, Western University, London, ON N6A 3K7, Canada
- Lawson Health Research Institute, London, ON N6A 4V2, Canada
| | - Andrew McClennan
- Department of Medical Biophysics, Western University, London, ON N6A 3K7, Canada
- Lawson Health Research Institute, London, ON N6A 4V2, Canada
| | - Linshan Liu
- Lawson Health Research Institute, London, ON N6A 4V2, Canada
| | - Jennifer Hadway
- Lawson Health Research Institute, London, ON N6A 4V2, Canada
| | - John A Ronald
- Department of Medical Biophysics, Western University, London, ON N6A 3K7, Canada
- Robarts Research Institute, Western University, London, ON N6A 3K7, Canada
| | - Justin W Hicks
- Department of Medical Biophysics, Western University, London, ON N6A 3K7, Canada
- Lawson Health Research Institute, London, ON N6A 4V2, Canada
| | - Lisa Hoffman
- Department of Medical Biophysics, Western University, London, ON N6A 3K7, Canada
- Lawson Health Research Institute, London, ON N6A 4V2, Canada
- Department of Anatomy and Cell Biology, Western University, London, ON N6A 3K7, Canada
| | - Udunna C Anazodo
- Department of Medical Biophysics, Western University, London, ON N6A 3K7, Canada
- Lawson Health Research Institute, London, ON N6A 4V2, Canada
- Department of Neurology and Neurosurgery, Montreal Neurological Institute, McGill University, Montreal, QC H3A 0G4, Canada
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Anazodo UC, Ng JJ, Ehiogu B, Obungoloch J, Fatade A, Mutsaerts HJMM, Secca MF, Diop M, Opadele A, Alexander DC, Dada MO, Ogbole G, Nunes R, Figueiredo P, Figini M, Aribisala B, Awojoyogbe BO, Aduluwa H, Sprenger C, Wagner R, Olakunle A, Romeo D, Sun Y, Fezeu F, Orunmuyi AT, Geethanath S, Gulani V, Nganga EC, Adeleke S, Ntobeuko N, Minja FJ, Webb AG, Asllani I, Dako F. A framework for advancing sustainable magnetic resonance imaging access in Africa. NMR Biomed 2023; 36:e4846. [PMID: 36259628 DOI: 10.1002/nbm.4846] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [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: 03/22/2022] [Revised: 10/03/2022] [Accepted: 10/05/2022] [Indexed: 06/16/2023]
Abstract
Magnetic resonance imaging (MRI) technology has profoundly transformed current healthcare systems globally, owing to advances in hardware and software research innovations. Despite these advances, MRI remains largely inaccessible to clinicians, patients, and researchers in low-resource areas, such as Africa. The rapidly growing burden of noncommunicable diseases in Africa underscores the importance of improving access to MRI equipment as well as training and research opportunities on the continent. The Consortium for Advancement of MRI Education and Research in Africa (CAMERA) is a network of African biomedical imaging experts and global partners, implementing novel strategies to advance MRI access and research in Africa. Upon its inception in 2019, CAMERA sets out to identify challenges to MRI usage and provide a framework for addressing MRI needs in the region. To this end, CAMERA conducted a needs assessment survey (NAS) and a series of symposia at international MRI society meetings over a 2-year period. The 68-question NAS was distributed to MRI users in Africa and was completed by 157 clinicians and scientists from across Sub-Saharan Africa (SSA). On average, the number of MRI scanners per million people remained at less than one, of which 39% were obsolete low-field systems but still in use to meet daily clinical needs. The feasibility of coupling stable energy supplies from various sources has contributed to the growing number of higher-field (1.5 T) MRI scanners in the region. However, these systems are underutilized, with only 8% of facilities reporting clinical scans of 15 or more patients per day, per scanner. The most frequently reported MRI scans were neurological and musculoskeletal. The CAMERA NAS combined with the World Health Organization and International Atomic Energy Agency data provides the most up-to-date data on MRI density in Africa and offers a unique insight into Africa's MRI needs. Reported gaps in training, maintenance, and research capacity indicate ongoing challenges in providing sustainable high-value MRI access in SSA. Findings from the NAS and focused discussions at international MRI society meetings provided the basis for the framework presented here for advancing MRI capacity in SSA. While these findings pertain to SSA, the framework provides a model for advancing imaging needs in other low-resource settings.
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Affiliation(s)
- Udunna C Anazodo
- Department of Neurology and Neurosurgery, Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada
| | - Jinggang J Ng
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Boaz Ehiogu
- Lawson Health Research Institute, London, Ontario, Canada
| | | | | | - Henk J M M Mutsaerts
- Department of Radiology and Nuclear Medicine, Amsterdam UMC Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Brain Imaging, Amsterdam, The Netherlands
| | | | - Mamadou Diop
- Lawson Health Research Institute, London, Ontario, Canada
- Department of Medical Biophysics, Western University, London, Ontario, Canada
| | - Abayomi Opadele
- Molecular and Cellular Dynamics Research, Graduate School of Biomedical Science and Engineering, Hokkaido University, Hokkaido, Japan
| | | | - Michael O Dada
- Department of Physics, Federal University of Technology, Minna, Niger State, Nigeria
| | - Godwin Ogbole
- Department of Radiology, University College Hospital Ibadan, Ibadan, Nigeria
| | - Rita Nunes
- Department of Bioengineering, Instituto Superior, Técnico, Universidade de Lisboa, Lisbon, Portugal
| | - Patricia Figueiredo
- Department of Bioengineering, Instituto Superior, Técnico, Universidade de Lisboa, Lisbon, Portugal
| | - Matteo Figini
- Department of Computer Science, University College London, London, UK
| | | | - Bamidele O Awojoyogbe
- Department of Physics, Federal University of Technology, Minna, Niger State, Nigeria
| | | | - Christian Sprenger
- Department of Anesthesiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Rachel Wagner
- Mbarara University of Science and Technology, Mbarara, Uganda
- Department of Medical Biophysics, Western University, London, Ontario, Canada
| | | | - Dominic Romeo
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Yusha Sun
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Francis Fezeu
- Neurosurgery & Neurology, BRAIN Global, Salisbury, Maryland, USA
| | - Akintunde T Orunmuyi
- Department of Nuclear Medicine, University of Ibadan, Ibadan, Oyo State, Nigeria
| | - Sairam Geethanath
- Mortimer B. Zuckerman Mind Brain Behavior Institute, Columbia University, New York, USA
| | - Vikas Gulani
- Department of Radiology, University of Michigan, Ann Arbor, Michigan, USA
| | | | - Sola Adeleke
- Department of Oncology, Guy's & St Thomas' Hospital, London, UK
| | - Ntusi Ntobeuko
- Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Frank J Minja
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, Georgia, USA
| | - Andrew G Webb
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Iris Asllani
- Department of Neuroscience, University of Sussex, Brighton, UK
- Department of Biomedical Engineering, Rochester Institute of Technology, Rochester, New York, USA
| | - Farouk Dako
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- RAD-AID International, Chevy Chase, Maryland, USA
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6
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Raymond C, Jurkiewicz MT, Orunmuyi A, Liu L, Dada MO, Ladefoged CN, Teuho J, Anazodo UC. The performance of machine learning approaches for attenuation correction of PET in neuroimaging: A meta-analysis. J Neuroradiol 2023; 50:315-326. [PMID: 36738990 DOI: 10.1016/j.neurad.2023.01.157] [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: 12/12/2022] [Accepted: 01/28/2023] [Indexed: 02/05/2023]
Abstract
PURPOSE This systematic review provides a consensus on the clinical feasibility of machine learning (ML) methods for brain PET attenuation correction (AC). Performance of ML-AC were compared to clinical standards. METHODS Two hundred and eighty studies were identified through electronic searches of brain PET studies published between January 1, 2008, and August 1, 2022. Reported outcomes for image quality, tissue classification performance, regional and global bias were extracted to evaluate ML-AC performance. Methodological quality of included studies and the quality of evidence of analysed outcomes were assessed using QUADAS-2 and GRADE, respectively. RESULTS A total of 19 studies (2371 participants) met the inclusion criteria. Overall, the global bias of ML methods was 0.76 ± 1.2%. For image quality, the relative mean square error (RMSE) was 0.20 ± 0.4 while for tissues classification, the Dice similarity coefficient (DSC) for bone/soft tissue/air were 0.82 ± 0.1 / 0.95 ± 0.03 / 0.85 ± 0.14. CONCLUSIONS In general, ML-AC performance is within acceptable limits for clinical PET imaging. The sparse information on ML-AC robustness and its limited qualitative clinical evaluation may hinder clinical implementation in neuroimaging, especially for PET/MRI or emerging brain PET systems where standard AC approaches are not readily available.
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Affiliation(s)
- Confidence Raymond
- Department of Medical Biophysics, Western University, London, ON, Canada; Lawson Health Research Institute, London, ON, Canada
| | - Michael T Jurkiewicz
- Department of Medical Biophysics, Western University, London, ON, Canada; Lawson Health Research Institute, London, ON, Canada; Department of Medical Imaging, Western University, London, ON, Canada
| | - Akintunde Orunmuyi
- Kenyatta University Teaching, Research and Referral Hospital, Nairobi, Kenya
| | - Linshan Liu
- Lawson Health Research Institute, London, ON, Canada
| | | | - Claes N Ladefoged
- Department of Clinical Physiology, Nuclear Medicine, and PET, Rigshospitalet, Copenhagen, Denmark
| | - Jarmo Teuho
- Turku PET Centre, Turku University, Turku, Finland; Turku University Hospital, Turku, Finland
| | - Udunna C Anazodo
- Department of Medical Biophysics, Western University, London, ON, Canada; Lawson Health Research Institute, London, ON, Canada; Montreal Neurological Institute, 3801 Rue University, Montreal, QC H3A 2B4, Canada.
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Dassanayake P, Anazodo UC, Liu L, Narciso L, Iacobelli M, Hicks J, Rusjan P, Finger E, St Lawrence K. Development of a minimally invasive simultaneous estimation method for quantifying translocator protein binding with [ 18F]FEPPA positron emission tomography. EJNMMI Res 2023; 13:1. [PMID: 36633702 PMCID: PMC9837356 DOI: 10.1186/s13550-023-00950-1] [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: 10/04/2022] [Accepted: 01/01/2023] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND The purpose of this study was to assess the feasibility of using a minimally invasive simultaneous estimation method (SIME) to quantify the binding of the 18-kDa translocator protein tracer [18F]FEPPA. Arterial sampling was avoided by extracting an image-derived input function (IDIF) that was metabolite-corrected using venous blood samples. The possibility of reducing scan duration to 90 min from the recommended 2-3 h was investigated by assuming a uniform non-displaceable distribution volume (VND) to simplify the SIME fitting. RESULTS SIME was applied to retrospective data from healthy volunteers and was comprised of both high-affinity binders (HABs) and mixed-affinity binders (MABs). Estimates of global VND and regional total distribution volume (VT) from SIME were not significantly different from values obtained using a two-tissue compartment model (2CTM). Regional VT estimates were greater for HABs compared to MABs for both the 2TCM and SIME, while the SIME estimates had lower inter-subject variability (41 ± 17% reduction). Binding potential (BPND) values calculated from regional VT and brain-wide VND estimates were also greater for HABs, and reducing the scan time from 120 to 90 min had no significant effect on BPND. The feasibility of using venous metabolite correction was evaluated in a large animal model involving a simultaneous collection of arterial and venous samples. Strong linear correlations were found between venous and arterial measurements of the blood-to-plasma ratio and the remaining [18F]FEPPA fraction. Lastly, estimates of BPND and the specific distribution volume (i.e., VS = VT - VND) from a separate group of healthy volunteers (90 min scan time, venous-scaled IDIFs) agreed with estimates from the retrospective data for both genotypes. CONCLUSIONS The results of this study demonstrate that accurate estimates of regional VT, BPND and VS can be obtained by applying SIME to [18F]FEPPA data. Furthermore, the application of SIME enabled the scan time to be reduced to 90 min, and the approach worked well with IDIFs that were scaled and metabolite-corrected using venous blood samples.
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Affiliation(s)
- Praveen Dassanayake
- grid.39381.300000 0004 1936 8884Department of Medical Biophysics, University of Western Ontario, London, ON Canada ,grid.415847.b0000 0001 0556 2414Lawson Health Research Institute, 268 Grosvenor St, London, ON N6A 4V2 Canada
| | - Udunna C. Anazodo
- grid.39381.300000 0004 1936 8884Department of Medical Biophysics, University of Western Ontario, London, ON Canada ,grid.415847.b0000 0001 0556 2414Lawson Health Research Institute, 268 Grosvenor St, London, ON N6A 4V2 Canada ,grid.14709.3b0000 0004 1936 8649Department of Neurology and Neurosurgery, McGill University, Montréal, QC Canada
| | - Linshan Liu
- grid.415847.b0000 0001 0556 2414Lawson Health Research Institute, 268 Grosvenor St, London, ON N6A 4V2 Canada
| | - Lucas Narciso
- grid.39381.300000 0004 1936 8884Department of Medical Biophysics, University of Western Ontario, London, ON Canada ,grid.415847.b0000 0001 0556 2414Lawson Health Research Institute, 268 Grosvenor St, London, ON N6A 4V2 Canada
| | - Maryssa Iacobelli
- grid.415847.b0000 0001 0556 2414Lawson Health Research Institute, 268 Grosvenor St, London, ON N6A 4V2 Canada
| | - Justin Hicks
- grid.39381.300000 0004 1936 8884Department of Medical Biophysics, University of Western Ontario, London, ON Canada ,grid.415847.b0000 0001 0556 2414Lawson Health Research Institute, 268 Grosvenor St, London, ON N6A 4V2 Canada
| | - Pablo Rusjan
- Douglas Research Centre, Human Neuroscience Division, Montréal, QC Canada ,grid.14709.3b0000 0004 1936 8649Department of Psychiatry, McGill University, Montréal, QC Canada
| | - Elizabeth Finger
- grid.415847.b0000 0001 0556 2414Lawson Health Research Institute, 268 Grosvenor St, London, ON N6A 4V2 Canada ,grid.39381.300000 0004 1936 8884Department of Clinical Neurological Sciences, University of Western Ontario, London, ON Canada
| | - Keith St Lawrence
- grid.39381.300000 0004 1936 8884Department of Medical Biophysics, University of Western Ontario, London, ON Canada ,grid.415847.b0000 0001 0556 2414Lawson Health Research Institute, 268 Grosvenor St, London, ON N6A 4V2 Canada
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Moyaert P, Padrela BE, Morgan CA, Petr J, Versijpt J, Barkhof F, Jurkiewicz MT, Shao X, Oyeniran O, Manson T, Wang DJJ, Günther M, Achten E, Mutsaerts HJMM, Anazodo UC. Imaging blood-brain barrier dysfunction: A state-of-the-art review from a clinical perspective. Front Aging Neurosci 2023; 15:1132077. [PMID: 37139088 PMCID: PMC10150073 DOI: 10.3389/fnagi.2023.1132077] [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: 12/26/2022] [Accepted: 03/15/2023] [Indexed: 05/05/2023] Open
Abstract
The blood-brain barrier (BBB) consists of specialized cells that tightly regulate the in- and outflow of molecules from the blood to brain parenchyma, protecting the brain's microenvironment. If one of the BBB components starts to fail, its dysfunction can lead to a cascade of neuroinflammatory events leading to neuronal dysfunction and degeneration. Preliminary imaging findings suggest that BBB dysfunction could serve as an early diagnostic and prognostic biomarker for a number of neurological diseases. This review aims to provide clinicians with an overview of the emerging field of BBB imaging in humans by answering three key questions: (1. Disease) In which diseases could BBB imaging be useful? (2. Device) What are currently available imaging methods for evaluating BBB integrity? And (3. Distribution) what is the potential of BBB imaging in different environments, particularly in resource limited settings? We conclude that further advances are needed, such as the validation, standardization and implementation of readily available, low-cost and non-contrast BBB imaging techniques, for BBB imaging to be a useful clinical biomarker in both resource-limited and well-resourced settings.
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Affiliation(s)
- Paulien Moyaert
- Department of Medical Imaging, Ghent University Hospital, Ghent, Belgium
- Lawson Health Research Institute, London, ON, Canada
- Department of Neurology, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium
- *Correspondence: Paulien Moyaert,
| | - Beatriz E. Padrela
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Center, Amsterdam Neuroscience, Amsterdam, Netherlands
- Amsterdam Neuroscience, Brain Imaging, Amsterdam, Netherlands
| | - Catherine A. Morgan
- School of Psychology and Centre for Brain Research, The University of Auckland, Auckland, New Zealand
- Centre for Advanced MRI, Auckland UniServices Limited, Auckland, New Zealand
| | - Jan Petr
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Center, Amsterdam Neuroscience, Amsterdam, Netherlands
- Amsterdam Neuroscience, Brain Imaging, Amsterdam, Netherlands
- Helmholtz-Zentrum Dresden-Rossendorf, Institute of Radiopharmaceutical Cancer Research, Dresden, Germany
| | - Jan Versijpt
- Department of Neurology, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium
| | - Frederik Barkhof
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Center, Amsterdam Neuroscience, Amsterdam, Netherlands
- Amsterdam Neuroscience, Brain Imaging, Amsterdam, Netherlands
- Queen Square Institute of Neurology and Centre for Medical Image Computing, University College London, London, United Kingdom
| | | | - Xingfeng Shao
- Laboratory of FMRI Technology (LOFT), USC Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Olujide Oyeniran
- Lawson Health Research Institute, London, ON, Canada
- Department of Medical Biophysics, Western University, London, ON, Canada
| | - Tabitha Manson
- Centre for Advanced MRI, Auckland UniServices Limited, Auckland, New Zealand
- Auckland Bioengineering Institute, The University of Auckland, Auckland, New Zealand
| | - Danny J. J. Wang
- Laboratory of FMRI Technology (LOFT), USC Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Matthias Günther
- Fraunhofer Institute for Digital Medicine, University of Bremen, Bremen, Germany
| | - Eric Achten
- Department of Medical Imaging, Ghent University Hospital, Ghent, Belgium
| | - Henk J. M. M. Mutsaerts
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Center, Amsterdam Neuroscience, Amsterdam, Netherlands
- Amsterdam Neuroscience, Brain Imaging, Amsterdam, Netherlands
| | - Udunna C. Anazodo
- Lawson Health Research Institute, London, ON, Canada
- Montreal Neurological Institute, McGill University, Montreal, QC, Canada
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Anazodo UC, Adewole M, Dako F. AI for Population and Global Health in Radiology. Radiol Artif Intell 2022; 4:e220107. [PMID: 35923372 PMCID: PMC9344206 DOI: 10.1148/ryai.220107] [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] [Received: 05/27/2022] [Revised: 06/05/2022] [Accepted: 06/08/2022] [Indexed: 06/15/2023]
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Cakmak JD, Liu L, Poirier SE, Schaefer B, Poolacherla R, Burhan AM, Sabesan P, St. Lawrence K, Théberge J, Hicks JW, Finger E, Palaniyappan L, Anazodo UC. The functional and structural associations of aberrant microglial activity in major depressive disorder. J Psychiatry Neurosci 2022; 47:E197-E208. [PMID: 35654450 PMCID: PMC9343118 DOI: 10.1503/jpn.210124] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 12/13/2021] [Accepted: 03/13/2022] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Major depressive disorder (MDD) is a debilitating mental illness that has been linked to increases in markers of inflammation, as well as to changes in brain functional and structural connectivity, particularly between the insula and the subgenual anterior cingulate cortex (sgACC). In this study, we directly related inflammation and dysconnectivity in treatment-resistant MDD by concurrently measuring the following: microglial activity with [18F]N-2-(fluoroethoxyl)benzyl-N-(4phenoxypyridin-3-yl)acetamide ([18F]FEPPA) positron emission tomography (PET); the severity of MDD; and functional or structural connectivity among insula or sgACC nodes. METHODS Twelve patients with treatment-resistant MDD (8 female, 4 male; mean age ± standard deviation 54.9 ± 4.5 years and 23 healthy controls (11 female, 12 male; 60.3 ± 8.5 years) completed a hybrid [18F]FEPPA PET and MRI acquisition. From these, we extracted relative standardized uptake values for [18F]FEPPA activity and Pearson r-to-z scores representing functional connectivity from our regions of interest. We extracted diffusion tensor imaging metrics from the cingulum bundle, a key white matter bundle in MDD. We performed regressions to relate microglial activity with functional connectivity, structural connectivity and scores on the 17-item Hamilton Depression Rating Scale. RESULTS We found significantly increased [18F]FEPPA uptake in the left sgACC in patients with treatment-resistant MDD compared to healthy controls. Patients with MDD also had a reduction in connectivity between the sgACC and the insula. The [18F]FEPPA uptake in the left sgACC was significantly related to functional connectivity with the insula, and to the structural connectivity of the cingulum bundle. [18F]FEPPA uptake also predicted scores on the Hamilton Depression Rating Scale.Limitations: A relatively small sample size, lack of functional task data and concomitant medication use may have affected our findings. CONCLUSION We present preliminary evidence linking a network-level dysfunction relevant to the pathophysiology of depression and related to increased microglial activity in MDD.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Lena Palaniyappan
- From the Department of Neuroscience, Western University, London, Ont. (Cakmak, Schaefer, Sabesan, Palaniyappan); the Robarts Research Institute, Western University, London, Ont. (Cakmak, Palaniyappan); the Lawson Health Research Institute, London, Ont. (Liu, Poirier, Burhan, St. Lawrence, Théberge, Hicks, Finger, Anazodo); the Department of Medical Biophysics, Western University, London, Ont. (Poirier, Sabesan, St. Lawrence, Théberge, Hicks, Anazodo); the London Health Sciences Centre, London, Ont. (Schaefer, Poolacherla, Palaniyappan); the Department of Psychiatry, Western University, London, Ont. (Burhan, Théberge, Palaniyappan); the Department of Psychiatry, University of Toronto, Toronto, Ont. (Burhan); the Ontario Shores Centre for Mental Health Sciences, Whitby, Ont. (Burhan); the Department of Clinical Neurological Sciences, Western University, London, Ont. (Finger); the Department of Anesthesia and Perioperative Medicine, Western University, London, Ont. (Poolacherla)
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11
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Dassanayake P, Cui L, Finger E, Kewin M, Hadaway J, Soddu A, Jakoby B, Zuehlsdorf S, Lawrence KSS, Moran G, Anazodo UC. caliPER: A software for blood-free parametric Patlak mapping using PET/MRI input function. Neuroimage 2022; 256:119261. [PMID: 35500806 DOI: 10.1016/j.neuroimage.2022.119261] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 04/05/2022] [Accepted: 04/26/2022] [Indexed: 01/23/2023] Open
Abstract
Routine clinical use of absolute PET quantification techniques is limited by the need for serial arterial blood sampling for input function and more importantly by the lack of automated pharmacokinetic analysis tools that can be readily implemented in clinic with minimal effort. PET/MRI provides the ability for absolute quantification of PET probes without the need for serial arterial blood sampling using image-derived input functions (IDIFs). Here we introduce caliPER, a modular and scalable software for simplified pharmacokinetic modelling of PET probes with irreversible uptake or binding based on PET/MR IDIFs and Patlak Plot analysis. caliPER generates regional values or parametric maps of net influx rate (Ki) using reconstructed dynamic PET images and anatomical MRI aligned to PET for IDIF vessel delineation. We evaluated the performance of caliPER for blood-free region-based and pixel-wise Patlak analyses of [18F] FDG by comparing caliPER IDIF to serial arterial blood input functions and its application in imaging brain glucose hypometabolism in Frontotemporal dementia. IDIFs corrected for partial volume errors including spill-out and spill-in effects were similar to arterial blood input functions with a general bias of around 6-8%, even for arteries <5 mm. The Ki and cerebral metabolic rate of glucose estimated using caliPER IDIF were similar to estimates using arterial blood sampling (<2%) and within limits of whole brain values reported in literature. Overall, caliPER is a promising tool for irreversible PET tracer quantification and can simplify the ability to perform parametric analysis in clinical settings without the need for blood sampling.
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Affiliation(s)
- Praveen Dassanayake
- Lawson Health Research Institute, Ontario, London, Canada; Department of Medical Biophysics, Western University, Ontario, London, Canada
| | - Lumeng Cui
- Division of Biomedical Engineering, University of Saskatchewan, Saskatoon, Canada; Siemens Healthineers, Ontario, Mississauga, Oakville, Canada
| | - Elizabeth Finger
- Lawson Health Research Institute, Ontario, London, Canada; Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Western University, Ontario, London, Canada
| | - Matthew Kewin
- Department of Medical Biophysics, Western University, Ontario, London, Canada
| | | | - Andrea Soddu
- Department of Physics and Astronomy, Western University, Ontario, London, Canada
| | - Bjoern Jakoby
- Siemens Healthcare GmbH, Healthineers, Erlangen, Germany
| | - Sven Zuehlsdorf
- Siemens Medical Solutions USA, Inc. Hoffman Estates, IL, USA
| | - Keith S St Lawrence
- Lawson Health Research Institute, Ontario, London, Canada; Department of Medical Biophysics, Western University, Ontario, London, Canada
| | - Gerald Moran
- Siemens Healthineers, Ontario, Mississauga, Oakville, Canada
| | - Udunna C Anazodo
- Lawson Health Research Institute, Ontario, London, Canada; Department of Medical Biophysics, Western University, Ontario, London, Canada; Department of Neurology and Neurosurgery, Montreal Neurological Institute, Montreal, Canada.
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12
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Ssali T, Narciso L, Hicks J, Liu L, Jesso S, Richardson L, Günther M, Konstandin S, Eickel K, Prato F, Anazodo UC, Finger E, St Lawrence K. Concordance of regional hypoperfusion by pCASL MRI and 15O-water PET in frontotemporal dementia: Is pCASL an efficacious alternative? Neuroimage Clin 2022; 33:102950. [PMID: 35134705 PMCID: PMC8829802 DOI: 10.1016/j.nicl.2022.102950] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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: 09/24/2021] [Revised: 01/21/2022] [Accepted: 01/25/2022] [Indexed: 12/11/2022]
Abstract
ASL is an alternative to 15O-water for identifying hypoperfusion in FTD patients. ROI-based perfusion by ASL and 15O-water were strongly correlated (R > 0.75). Hypoperfusion patterns identified by 15O-water and ASL were in good agreement. Careful selection of the reference region is required to avoid erroneous results.
Background Clinical diagnosis of frontotemporal dementia (FTD) remains a challenge due to the overlap of symptoms among FTD subtypes and with other psychiatric disorders. Perfusion imaging by arterial spin labeling (ASL) is a promising non-invasive alternative to established PET techniques; however, its sensitivity to imaging parameters can hinder its ability to detect perfusion abnormalities. Purpose This study evaluated the similarity of regional hypoperfusion patterns detected by ASL relative to the gold standard for imaging perfusion, PET with radiolabeled water (15O-water). Methods and materials Perfusion by single-delay pseudo continuous ASL (SD-pCASL), free-lunch Hadamard encoded pCASL (FL_TE-pCASL), and 15O-water data were acquired on a hybrid PET/MR scanner in 13 controls and 9 FTD patients. Cerebral blood flow (CBF) by 15O-water was quantified by a non-invasive approach (PMRFlow). Regional hypoperfusion was determined by comparing individual patients to the control group. This was performed using absolute (aCBF) and CBF normalized to whole-brain perfusion (rCBF). Agreement was assessed based on the fraction of overlapping voxels. Sensitivity and specificity of pCASL was estimated using hypoperfused regions of interest identified by 15O-water. Results Region of interest (ROI) based perfusion measured by 15O-water strongly correlated with SD-pCASL (R = 0.85 ± 0.1) and FL_TE-pCASL (R = 0.81 ± 0.14). Good agreement in terms of regional hypoperfusion patterns was found between 15O-water and SD-pCASL (sensitivity = 70%, specificity = 78%) and between 15O-water and FL_TE-pCASL (sensitivity = 71%, specificity = 73%). However, SD-pCASL showed greater overlap (43.4 ± 21.3%) with 15O-water than FL_TE-pCASL (29.9 ± 21.3%). Although aCBF and rCBF showed no significant differences regarding spatial overlap and metrics of agreement with 15O-water, rCBF showed considerable variability across subtypes, indicating that care must be taken when selecting a reference region. Conclusions This study demonstrates the potential of pCASL for assessing regional hypoperfusion related to FTD and supports its use as a cost-effective alternative to PET.
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Affiliation(s)
- Tracy Ssali
- Lawson Health Research Institute, London, Canada; Department of Medical Biophysics, Western University, London, Canada.
| | - Lucas Narciso
- Lawson Health Research Institute, London, Canada; Department of Medical Biophysics, Western University, London, Canada
| | - Justin Hicks
- Lawson Health Research Institute, London, Canada; Department of Medical Biophysics, Western University, London, Canada
| | - Linshan Liu
- Lawson Health Research Institute, London, Canada; Department of Medical Biophysics, Western University, London, Canada
| | - Sarah Jesso
- Lawson Health Research Institute, London, Canada; St. Joseph's Health Care, London, Canada
| | - Lauryn Richardson
- Lawson Health Research Institute, London, Canada; St. Joseph's Health Care, London, Canada
| | - Matthias Günther
- Fraunhofer Institute for Medical Image Computing MEVIS, Bremen, Germany; University Bremen, Bremen, Germany
| | - Simon Konstandin
- Fraunhofer Institute for Medical Image Computing MEVIS, Bremen, Germany; Mediri GmbH, Heidelberg, Germany
| | | | - Frank Prato
- Lawson Health Research Institute, London, Canada; Department of Medical Biophysics, Western University, London, Canada
| | - Udunna C Anazodo
- Lawson Health Research Institute, London, Canada; Department of Medical Biophysics, Western University, London, Canada
| | - Elizabeth Finger
- Lawson Health Research Institute, London, Canada; Department of Medical Biophysics, Western University, London, Canada; Department of Clinical Neurological Sciences, Western University, London, Canada
| | - Keith St Lawrence
- Lawson Health Research Institute, London, Canada; Department of Medical Biophysics, Western University, London, Canada
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Qin C, Murali S, Lee E, Supramaniam V, Hausenloy DJ, Obungoloch J, Brecher J, Lin R, Ding H, Akudjedu TN, Anazodo UC, Jagannathan NR, Ntusi NAB, Simonetti OP, Campbell-Washburn AE, Niendorf T, Mammen R, Adeleke S. Sustainable low-field cardiovascular magnetic resonance in changing healthcare systems. Eur Heart J Cardiovasc Imaging 2022; 23:e246-e260. [PMID: 35157038 PMCID: PMC9159744 DOI: 10.1093/ehjci/jeab286] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 12/14/2021] [Indexed: 11/14/2022] Open
Abstract
Cardiovascular disease continues to be a major burden facing healthcare systems worldwide. In the developed world, cardiovascular magnetic resonance (CMR) is a well-established non-invasive imaging modality in the diagnosis of cardiovascular disease. However, there is significant global inequality in availability and access to CMR due to its high cost, technical demands as well as existing disparities in healthcare and technical infrastructures across high-income and low-income countries. Recent renewed interest in low-field CMR has been spurred by the clinical need to provide sustainable imaging technology capable of yielding diagnosticquality images whilst also being tailored to the local populations and healthcare ecosystems. This review aims to evaluate the technical, practical and cost considerations of low field CMR whilst also exploring the key barriers to implementing sustainable MRI in both the developing and developed world.
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Affiliation(s)
- Cathy Qin
- Department of Imaging, Imperial College Healthcare NHS Trust, London, UK
| | - Sanjana Murali
- Department of Imaging, Imperial College Healthcare NHS Trust, London, UK
| | - Elsa Lee
- School of Medicine, Faculty of Medicine, Imperial College London, London, UK
| | | | - Derek J Hausenloy
- Division of Medicine, University College London, London, UK.,Cardiovascular & Metabolic Disorders Program, Duke-National University of Singapore Medical School, Singapore, Singapore.,National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore, Singapore.,Yong Loo Lin School of Medicine, National University Singapore, Singapore, Singapore.,Hatter Cardiovascular Institue, UCL Institute of Cardiovascular Sciences, University College London, London, UK.,Cardiovascular Research Center, College of Medical and Health Sciences, Asia University, Taichung, Taiwan
| | - Johnes Obungoloch
- Department of Biomedical Engineering, Mbarara University of Science and Technology, Mbarara, Uganda
| | | | - Rongyu Lin
- School of Medicine, University College London, London, UK
| | - Hao Ding
- Department of Imaging, Imperial College Healthcare NHS Trust, London, UK
| | - Theophilus N Akudjedu
- Institute of Medical Imaging and Visualisation, Faculty of Health and Social Science, Bournemouth University, Poole, UK
| | | | - Naranamangalam R Jagannathan
- Department of Electrical Engineering, Indian Institute of Technology, Chennai, India.,Department of Radiology, Sri Ramachandra University Medical College, Chennai, India.,Department of Radiology, Chettinad Hospital and Research Institute, Kelambakkam, India
| | - Ntobeko A B Ntusi
- Department of Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, Western Cape, South Africa
| | - Orlando P Simonetti
- Division of Cardiovascular Medicine, Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, OH, USA.,Department of Radiology, College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Adrienne E Campbell-Washburn
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Thoralf Niendorf
- Berlin Ultrahigh Field Facility (B.U.F.F.), Max-Delbrück Centre for Molecular Medicine in the Helmholtz Association, Berlin, Germany
| | - Regina Mammen
- Department of Cardiology, The Essex Cardiothoracic Centre, Basildon, UK
| | - Sola Adeleke
- School of Cancer & Pharmaceutical Sciences, King's College London, Queen Square, London WC1N 3BG, UK.,High Dimensional Neurology, Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, University College London, London, UK
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14
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Ssali T, Anazodo UC, Narciso L, Liu L, Jesso S, Richardson L, Günther M, Konstandin S, Eickel K, Prato F, Finger E, St Lawrence K. Sensitivity of arterial Spin labeling for characterization of longitudinal perfusion changes in Frontotemporal dementia and related disorders. Neuroimage Clin 2021; 35:102853. [PMID: 34697009 PMCID: PMC9421452 DOI: 10.1016/j.nicl.2021.102853] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 09/24/2021] [Accepted: 10/04/2021] [Indexed: 11/28/2022]
Abstract
This study demonstrates the value of ASL for longitudinal monitoring of perfusion in FTD patients. Good agreement was found in repeat measures of CBF in patients and controls. Transit times were not a significant source of error for the selected post labeling delay (2 s).
Background Advances in the understanding of the pathophysiology of frontotemporal dementia (FTD) and related disorders, along with the development of novel candidate disease modifying treatments, have stimulated the need for tools to assess the efficacy of new therapies. While perfusion imaging by arterial spin labeling (ASL) is an attractive approach for longitudinal imaging biomarkers of neurodegeneration, sources of variability between sessions including arterial transit times (ATT) and fluctuations in resting perfusion can reduce its sensitivity. Establishing the magnitude of perfusion changes that can be reliably detected is necessary to delineate longitudinal perfusion changes related to disease processes from the effects of these sources of error. Purpose To assess the feasibility of ASL for longitudinal monitoring of patients with FTD by quantifying between-session variability of perfusion on a voxel-by-voxel basis. Methods and materials ASL data were collected in 13 healthy controls and 8 patients with FTD or progressive supra-nuclear palsy. Variability in cerebral blood flow (CBF) by single delay pseudo-continuous ASL (SD-pCASL) acquired one month apart were quantified by the coefficient of variation (CV) and intraclass correlation coefficient (ICC). Additionally, CBF by SD-pCASL and ATT by low-resolution multiple inversion time ASL (LowRes-pCASL) were compared to Hadamard encoded sequences which are able to simultaneously measure CBF and ATT with improved time-efficiency. Results Agreement of grey-matter perfusion between sessions was found for both patients and controls (CV = 10.8% and 8.3% respectively) with good reliability for both groups (ICC > 0.6). Intensity normalization to remove day-to-day fluctuations in resting perfusion reduced the CV by 28%. Less than 5% of voxels had ATTs above the chosen post labelling delay (2 s), indicating that the ATT was not a significant source of error. Hadamard-encoded perfusion imaging yielded systematically higher CBF compared to SD-pCASL, but produced similar transit-time measurements. Power analysis revealed that SD-pCASL has the sensitivity to detect longitudinal changes as low as 10% with as few as 10 patient participants. Conclusion With the appropriate labeling parameters, SD-pCASL is a promising approach for assessing longitudinal changes in CBF associated with FTD.
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Affiliation(s)
- Tracy Ssali
- Lawson Health Research Institute, London, Canada; Department of Medical Biophysics, Western University, London, Canada.
| | - Udunna C Anazodo
- Lawson Health Research Institute, London, Canada; Department of Medical Biophysics, Western University, London, Canada
| | - Lucas Narciso
- Lawson Health Research Institute, London, Canada; Department of Medical Biophysics, Western University, London, Canada
| | - Linshan Liu
- Lawson Health Research Institute, London, Canada; Department of Medical Biophysics, Western University, London, Canada
| | - Sarah Jesso
- Lawson Health Research Institute, London, Canada; St. Joseph's Health Care, London, Canada
| | - Lauryn Richardson
- Lawson Health Research Institute, London, Canada; St. Joseph's Health Care, London, Canada
| | - Matthias Günther
- Fraunhofer Institute for Medical Image Computing MEVIS, Bremen, Germany; University Bremen, Bremen, Germany
| | - Simon Konstandin
- Fraunhofer Institute for Medical Image Computing MEVIS, Bremen, Germany; Mediri GmbH, Heidelberg, Germany
| | | | - Frank Prato
- Lawson Health Research Institute, London, Canada; Department of Medical Biophysics, Western University, London, Canada
| | - Elizabeth Finger
- Lawson Health Research Institute, London, Canada; Department of Medical Biophysics, Western University, London, Canada; Department of Clinical Neurological Sciences, Western University, London, Canada
| | - Keith St Lawrence
- Lawson Health Research Institute, London, Canada; Department of Medical Biophysics, Western University, London, Canada
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15
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Poirier SE, Kwan BYM, Jurkiewicz MT, Samargandy L, Iacobelli M, Steven DA, Lam Shin Cheung V, Moran G, Prato FS, Thompson RT, Burneo JG, Anazodo UC, Thiessen JD. An evaluation of the diagnostic equivalence of 18F-FDG-PET between hybrid PET/MRI and PET/CT in drug-resistant epilepsy: A pilot study. Epilepsy Res 2021; 172:106583. [PMID: 33636504 DOI: 10.1016/j.eplepsyres.2021.106583] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 09/12/2020] [Revised: 01/27/2021] [Accepted: 02/09/2021] [Indexed: 01/19/2023]
Abstract
OBJECTIVE Hybrid PET/MRI may improve detection of seizure-onset zone (SOZ) in drug-resistant epilepsy (DRE), however, concerns over PET bias from MRI-based attenuation correction (MRAC) have limited clinical adoption of PET/MRI. This study evaluated the diagnostic equivalency and potential clinical value of PET/MRI against PET/CT in DRE. MATERIALS AND METHODS MRI, FDG-PET and CT images (n = 18) were acquired using a hybrid PET/MRI and a CT scanner. To assess diagnostic equivalency, PET was reconstructed using MRAC (RESOLUTE) and CT-based attenuation correction (CTAC) to generate PET/MRI and PET/CT images, respectively. PET/MRI and PET/CT images were compared qualitatively through visual assessment and quantitatively through regional standardized uptake value (SUV) and z-score assessment. Diagnostic accuracy and sensitivity of PET/MRI and PET/CT for SOZ detection were calculated through comparison to reference standards (clinical hypothesis and histopathology, respectively). RESULTS Inter-reader agreement in visual assessment of PET/MRI and PET/CT images was 78 % and 81 %, respectively. PET/MRI and PET/CT were strongly correlated in mean SUV (r = 0.99, p < 0.001) and z-scores (r = 0.92, p < 0.001) across all brain regions. MRAC SUV bias was <5% in most brain regions except the inferior temporal gyrus, temporal pole, and cerebellum. Diagnostic accuracy and sensitivity were similar between PET/MRI and PET/CT (87 % vs. 85 % and 83 % vs. 83 %, respectively). CONCLUSION We demonstrate here that PET/MRI with optimal MRAC can yield similar diagnostic performance as PET/CT. Nevertheless, further exploration of the potential added value of PET/MRI is necessary before clinical adoption of PET/MRI for epilepsy imaging.
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Affiliation(s)
- Stefan E Poirier
- Lawson Imaging, Lawson Health Research Institute, London, ON, Canada; Department of Medical Biophysics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.
| | - Benjamin Y M Kwan
- Department of Diagnostic Radiology, Queen's University, Kingston, ON, Canada
| | - Michael T Jurkiewicz
- Department of Medical Imaging, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Lina Samargandy
- Department of Medical Imaging, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Maryssa Iacobelli
- Lawson Imaging, Lawson Health Research Institute, London, ON, Canada
| | - David A Steven
- Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada; Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Victor Lam Shin Cheung
- Department of Medical Imaging, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | | | - Frank S Prato
- Lawson Imaging, Lawson Health Research Institute, London, ON, Canada; Department of Medical Biophysics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada; Department of Medical Imaging, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - R Terry Thompson
- Lawson Imaging, Lawson Health Research Institute, London, ON, Canada; Department of Medical Biophysics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada; Department of Medical Imaging, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Jorge G Burneo
- Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada; Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Udunna C Anazodo
- Lawson Imaging, Lawson Health Research Institute, London, ON, Canada; Department of Medical Biophysics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada; Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada; Research Centre for Studies in Aging, McGill University, Montréal, QC, Canada.
| | - Jonathan D Thiessen
- Lawson Imaging, Lawson Health Research Institute, London, ON, Canada; Department of Medical Biophysics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada; Department of Medical Imaging, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
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16
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Warnert EAH, Kasper L, Meltzer CC, Lightfoote JB, Bucknor MD, Haroon H, Duggan G, Gowland P, Wald L, Miller KL, Morris EA, Anazodo UC. Resonate: Reaching Excellence Through Equity, Diversity, and Inclusion in ISMRM. J Magn Reson Imaging 2020; 53:1608-1611. [PMID: 33350020 DOI: 10.1002/jmri.27476] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 12/01/2020] [Indexed: 11/10/2022] Open
Affiliation(s)
- Esther A H Warnert
- Department of Radiology & Nuclear Medicine, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Lars Kasper
- Techna Institute, University Health Network, Toronto, Ontario, Canada.,Institute for Biomedical Engineering, ETH Zurich and University of Zurich, Zurich, Switzerland.,Translational Neuromodeling Unit, Institute for Biomedical Engineering, University of Zurich and ETH Zurich, Zurich, Switzerland
| | - Carolyn C Meltzer
- Departments of Radiology and Imaging Sciences, Neurology, and Psychiatry and Behavioral Science, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Johnson B Lightfoote
- Chair, Commission for Women and Diversity, American College of Radiology, Reston, Virginia, USA.,Pomona Valley Hospital Medical Center, Pomona, California, USA
| | - Matthew D Bucknor
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, USA
| | - Hamied Haroon
- Division of Neuroscience & Experimental Psychology, The University of Manchester, Manchester, UK
| | | | - Penny Gowland
- School of Physics and Astronomy, University of Nottingham, Nottingham, UK
| | - Larry Wald
- A.A. Martinos Center, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Karla L Miller
- Nuffield Department of Clinical Neurosciences University of Oxford, Wellcome Centre for Integrative Neuroimaging, FMRIB, Oxford, UK
| | - Elizabeth A Morris
- Department of Radiology, Memorial Sloan Kettering Cancer Center New York, New York, New York, USA
| | - Udunna C Anazodo
- Department of Medical Biophysics, Western University, London, Ontario, Canada.,Lawson Health Research Institute, St Joseph's Health Care, London, Ontario, Canada
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17
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Al-Khishman NU, Qi Q, Roseborough AD, Levit A, Allman BL, Anazodo UC, Fox MS, Whitehead SN, Thiessen JD. TSPO PET detects acute neuroinflammation but not diffuse chronically activated MHCII microglia in the rat. EJNMMI Res 2020; 10:113. [PMID: 32990808 PMCID: PMC7524910 DOI: 10.1186/s13550-020-00699-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [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: 06/07/2020] [Accepted: 09/11/2020] [Indexed: 12/19/2022] Open
Abstract
Background Accurate and sensitive imaging biomarkers are required to study the progression of white matter (WM) inflammation in neurodegenerative diseases. Radioligands targeting the translocator protein (TSPO) are considered sensitive indicators of neuroinflammation, but it is not clear how well the expression of TSPO coincides with major histocompatibility complex class II (MHCII) molecules in WM. This study aimed to test the ability of TSPO to detect activated WM microglia that are immunohistochemically positive for MHCII in rat models of prodromal Alzheimer’s disease and acute subcortical stroke. Methods Fischer 344 wild-type (n = 12) and TgAPP21 (n = 11) rats were imaged with [18F]FEPPA PET and MRI to investigate TSPO tracer uptake in the corpus callosum, a WM region known to have high levels of MHCII activated microglia in TgAPP21 rats. Wild-type rats subsequently received an endothelin-1 (ET1) subcortical stroke and were imaged at days 7 and 28 post-stroke before immunohistochemistry of TSPO, GFAP, iNOS, and the MHCII rat antigen, OX6. Results [18F]FEPPA PET was not significantly affected by genotype in WM and only detected increases near the ET1 infarct (P = 0.033, infarct/cerebellum uptake ratio: baseline = 0.94 ± 0.16; day 7 = 2.10 ± 0.78; day 28 = 1.77 ± 0.35). Immunohistochemistry confirmed that only the infarct (TSPO cells/mm2: day 7 = 555 ± 181; day 28 = 307 ± 153) and WM that is proximal to the infarct had TSPO expression (TSPO cells/mm2: day 7 = 113 ± 93; day 28 = 5 ± 7). TSPO and iNOS were not able to detect the chronic WM microglial activation that was detected with MHCII in the contralateral corpus callosum (day 28 OX6% area: saline = 0.62 ± 0.38; stroke = 4.30 ± 2.83; P = .029). Conclusion TSPO was only expressed in the stroke-induced insult and proximal tissue and therefore was unable to detect remote and non-insult-related chronically activated microglia overexpressing MHCII in WM. This suggests that research in neuroinflammation, particularly in the WM, would benefit from MHCII-sensitive radiotracers.
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Affiliation(s)
- Nassir U Al-Khishman
- Department of Medical Biophysics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.,Lawson Health Research Institute, B5-003a, 268 Grosvenor St, Stn. B, P.O. Box 5777, London, ON, N6A 4V2, Canada
| | - Qi Qi
- Department of Medical Biophysics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.,Lawson Health Research Institute, B5-003a, 268 Grosvenor St, Stn. B, P.O. Box 5777, London, ON, N6A 4V2, Canada
| | - Austyn D Roseborough
- Department of Anatomy and Cell Biology, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Alexander Levit
- Department of Anatomy and Cell Biology, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Brian L Allman
- Department of Anatomy and Cell Biology, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Udunna C Anazodo
- Department of Medical Biophysics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.,Research Centre for Studies in Aging, McGill University, Montreal, QC, Canada
| | - Matthew S Fox
- Department of Physics and Astronomy, Western University, London, ON, Canada.,Lawson Health Research Institute, B5-003a, 268 Grosvenor St, Stn. B, P.O. Box 5777, London, ON, N6A 4V2, Canada
| | - Shawn N Whitehead
- Department of Anatomy and Cell Biology, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Jonathan D Thiessen
- Department of Medical Biophysics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada. .,Lawson Health Research Institute, B5-003a, 268 Grosvenor St, Stn. B, P.O. Box 5777, London, ON, N6A 4V2, Canada.
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18
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Milej D, He L, Abdalmalak A, Baker WB, Anazodo UC, Diop M, Dolui S, Kavuri VC, Pavlosky W, Wang L, Balu R, Detre JA, Amendolia O, Quattrone F, Kofke WA, Yodh AG, St Lawrence K. Quantification of cerebral blood flow in adults by contrast-enhanced near-infrared spectroscopy: Validation against MRI. J Cereb Blood Flow Metab 2020; 40:1672-1684. [PMID: 31500522 PMCID: PMC7370369 DOI: 10.1177/0271678x19872564] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [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: 01/13/2019] [Accepted: 07/29/2019] [Indexed: 12/11/2022]
Abstract
The purpose of this study was to assess the accuracy of absolute cerebral blood flow (CBF) measurements obtained by dynamic contrast-enhanced (DCE) near-infrared spectroscopy (NIRS) using indocyanine green as a perfusion contrast agent. For validation, CBF was measured independently using the MRI perfusion method arterial spin labeling (ASL). Data were acquired at two sites and under two flow conditions (normocapnia and hypercapnia). Depth sensitivity was enhanced using time-resolved detection, which was demonstrated in a separate set of experiments using a tourniquet to temporally impede scalp blood flow. A strong correlation between CBF measurements from ASL and DCE-NIRS was observed (slope = 0.99 ± 0.08, y-intercept = -1.7 ± 7.4 mL/100 g/min, and R2 = 0.88). Mean difference between the two techniques was 1.9 mL/100 g/min (95% confidence interval ranged from -15 to 19 mL/100g/min and the mean ASL CBF was 75.4 mL/100 g/min). Error analysis showed that structural information and baseline absorption coefficient were needed for optimal CBF reconstruction with DCE-NIRS. This study demonstrated that DCE-NIRS is sensitive to blood flow in the adult brain and can provide accurate CBF measurements with the appropriate modeling techniques.
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Affiliation(s)
- Daniel Milej
- Department of Medical Biophysics, Western University, London, ON, Canada
- Imaging Division, Lawson Health Research Institute, London, ON, Canada
| | - Lian He
- Department of Physics and Astronomy, University of Pennsylvania, Philadelphia, PA, USA
| | - Androu Abdalmalak
- Department of Medical Biophysics, Western University, London, ON, Canada
- Imaging Division, Lawson Health Research Institute, London, ON, Canada
| | - Wesley B Baker
- Department of Anesthesiology and Critical Care, University of Pennsylvania, Philadelphia, PA, USA
| | - Udunna C Anazodo
- Department of Medical Biophysics, Western University, London, ON, Canada
- Imaging Division, Lawson Health Research Institute, London, ON, Canada
| | - Mamadou Diop
- Department of Medical Biophysics, Western University, London, ON, Canada
- Imaging Division, Lawson Health Research Institute, London, ON, Canada
| | - Sudipto Dolui
- Department of Neurology, University of Pennsylvania, Philadelphia, PA, USA
| | - Venkaiah C Kavuri
- Department of Physics and Astronomy, University of Pennsylvania, Philadelphia, PA, USA
| | - William Pavlosky
- Imaging Division, Lawson Health Research Institute, London, ON, Canada
| | - Lin Wang
- Department of Physics and Astronomy, University of Pennsylvania, Philadelphia, PA, USA
| | - Ramani Balu
- Department of Neurology, University of Pennsylvania, Philadelphia, PA, USA
| | - John A Detre
- Department of Neurology, University of Pennsylvania, Philadelphia, PA, USA
| | - Olivia Amendolia
- Department of Neurosurgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Francis Quattrone
- Department of Neurosurgery, University of Pennsylvania, Philadelphia, PA, USA
| | - W Andrew Kofke
- Department of Anesthesiology and Critical Care, University of Pennsylvania, Philadelphia, PA, USA
- Department of Neurosurgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Arjun G Yodh
- Department of Physics and Astronomy, University of Pennsylvania, Philadelphia, PA, USA
| | - Keith St Lawrence
- Department of Medical Biophysics, Western University, London, ON, Canada
- Imaging Division, Lawson Health Research Institute, London, ON, Canada
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19
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Poirier SE, Kwan BYM, Jurkiewicz MT, Samargandy L, Steven DA, Suller-Marti A, Lam Shin Cheung V, Khan AR, Romsa J, Prato FS, Burneo JG, Thiessen JD, Anazodo UC. 18F-FDG PET-guided diffusion tractography reveals white matter abnormalities around the epileptic focus in medically refractory epilepsy: implications for epilepsy surgical evaluation. Eur J Hybrid Imaging 2020; 4:10. [PMID: 34191151 PMCID: PMC8218143 DOI: 10.1186/s41824-020-00079-7] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 06/12/2020] [Indexed: 02/28/2023] Open
Abstract
BACKGROUND Hybrid PET/MRI can non-invasively improve localization and delineation of the epileptic focus (EF) prior to surgical resection in medically refractory epilepsy (MRE), especially when MRI is negative or equivocal. In this study, we developed a PET-guided diffusion tractography (PET/DTI) approach combining 18F-fluorodeoxyglucose PET (FDG-PET) and diffusion MRI to investigate white matter (WM) integrity in MRI-negative MRE patients and its potential impact on epilepsy surgical planning. METHODS FDG-PET and diffusion MRI of 14 MRI-negative or equivocal MRE patients were used to retrospectively pilot the PET/DTI approach. We used asymmetry index (AI) mapping of FDG-PET to detect the EF as brain areas showing the largest decrease in FDG uptake between hemispheres. Seed-based WM fiber tracking was performed on DTI images with a seed location in WM 3 mm from the EF. Fiber tractography was repeated in the contralateral brain region (opposite to EF), which served as a control for this study. WM fibers were quantified by calculating the fiber count, mean fractional anisotropy (FA), mean fiber length, and mean cross-section of each fiber bundle. WM integrity was assessed through fiber visualization and by normalizing ipsilateral fiber measurements to contralateral fiber measurements. The added value of PET/DTI in clinical decision-making was evaluated by a senior neurologist. RESULTS In over 60% of the patient cohort, AI mapping findings were concordant with clinical reports on seizure-onset localization and lateralization. Mean FA, fiber count, and mean fiber length were decreased in 14/14 (100%), 13/14 (93%), and 12/14 (86%) patients, respectively. PET/DTI improved diagnostic confidence in 10/14 (71%) patients and indicated that surgical candidacy be reassessed in 3/6 (50%) patients who had not undergone surgery. CONCLUSIONS We demonstrate here the utility of AI mapping in detecting the EF based on brain regions showing decreased FDG-PET activity and, when coupled with DTI, could be a powerful tool for detecting EF and assessing WM integrity in MRI-negative epilepsy. PET/DTI could be used to further enhance clinical decision-making in epilepsy surgery.
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Affiliation(s)
- Stefan E Poirier
- Lawson Imaging, Lawson Health Research Institute, 268 Grosvenor St., London, Ontario, N6A 4 V2, Canada. .,Department of Medical Biophysics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.
| | - Benjamin Y M Kwan
- Department of Diagnostic Radiology, Queen's University, Kingston, Ontario, Canada
| | - Michael T Jurkiewicz
- Department of Medical Imaging, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Lina Samargandy
- Department of Medical Imaging, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - David A Steven
- Epilepsy Program, Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.,Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Ana Suller-Marti
- Epilepsy Program, Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | | | - Ali R Khan
- Department of Medical Biophysics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.,Department of Medical Imaging, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.,Imaging Research Laboratories, Robarts Research Institute, London, Ontario, Canada
| | - Jonathan Romsa
- Department of Medical Imaging, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Frank S Prato
- Lawson Imaging, Lawson Health Research Institute, 268 Grosvenor St., London, Ontario, N6A 4 V2, Canada.,Department of Medical Biophysics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.,Department of Medical Imaging, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Jorge G Burneo
- Epilepsy Program, Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.,Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Jonathan D Thiessen
- Lawson Imaging, Lawson Health Research Institute, 268 Grosvenor St., London, Ontario, N6A 4 V2, Canada.,Department of Medical Biophysics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.,Department of Medical Imaging, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Udunna C Anazodo
- Lawson Imaging, Lawson Health Research Institute, 268 Grosvenor St., London, Ontario, N6A 4 V2, Canada. .,Department of Medical Biophysics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.
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20
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Mutsaerts HJMM, Petr J, Groot P, Vandemaele P, Ingala S, Robertson AD, Václavů L, Groote I, Kuijf H, Zelaya F, O'Daly O, Hilal S, Wink AM, Kant I, Caan MWA, Morgan C, de Bresser J, Lysvik E, Schrantee A, Bjørnebekk A, Clement P, Shirzadi Z, Kuijer JPA, Wottschel V, Anazodo UC, Pajkrt D, Richard E, Bokkers RPH, Reneman L, Masellis M, Günther M, MacIntosh BJ, Achten E, Chappell MA, van Osch MJP, Golay X, Thomas DL, De Vita E, Bjørnerud A, Nederveen A, Hendrikse J, Asllani I, Barkhof F. ExploreASL: An image processing pipeline for multi-center ASL perfusion MRI studies. Neuroimage 2020; 219:117031. [PMID: 32526385 DOI: 10.1016/j.neuroimage.2020.117031] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [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: 12/20/2019] [Revised: 05/29/2020] [Accepted: 06/04/2020] [Indexed: 01/01/2023] Open
Abstract
Arterial spin labeling (ASL) has undergone significant development since its inception, with a focus on improving standardization and reproducibility of its acquisition and quantification. In a community-wide effort towards robust and reproducible clinical ASL image processing, we developed the software package ExploreASL, allowing standardized analyses across centers and scanners. The procedures used in ExploreASL capitalize on published image processing advancements and address the challenges of multi-center datasets with scanner-specific processing and artifact reduction to limit patient exclusion. ExploreASL is self-contained, written in MATLAB and based on Statistical Parameter Mapping (SPM) and runs on multiple operating systems. To facilitate collaboration and data-exchange, the toolbox follows several standards and recommendations for data structure, provenance, and best analysis practice. ExploreASL was iteratively refined and tested in the analysis of >10,000 ASL scans using different pulse-sequences in a variety of clinical populations, resulting in four processing modules: Import, Structural, ASL, and Population that perform tasks, respectively, for data curation, structural and ASL image processing and quality control, and finally preparing the results for statistical analyses on both single-subject and group level. We illustrate ExploreASL processing results from three cohorts: perinatally HIV-infected children, healthy adults, and elderly at risk for neurodegenerative disease. We show the reproducibility for each cohort when processed at different centers with different operating systems and MATLAB versions, and its effects on the quantification of gray matter cerebral blood flow. ExploreASL facilitates the standardization of image processing and quality control, allowing the pooling of cohorts which may increase statistical power and discover between-group perfusion differences. Ultimately, this workflow may advance ASL for wider adoption in clinical studies, trials, and practice.
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Affiliation(s)
- Henk J M M Mutsaerts
- Department of Radiology and Nuclear Medicine, Amsterdam Neuroscience, Amsterdam University Medical Center, Location VUmc, Amsterdam, the Netherlands; Radiology and Nuclear Medicine, Amsterdam Neuroscience, Amsterdam University Medical Centers, Location Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands; Radiology, University Medical Center Utrecht, Utrecht, the Netherlands; Kate Gleason College of Engineering, Rochester Institute of Technology, NY, USA; Ghent Institute for Functional and Metabolic Imaging (GIfMI), Ghent University, Ghent, Belgium.
| | - Jan Petr
- Kate Gleason College of Engineering, Rochester Institute of Technology, NY, USA; Helmholtz-Zentrum Dresden-Rossendorf, Institute of Radiopharmaceutical Cancer Research, Dresden, Germany
| | - Paul Groot
- Radiology and Nuclear Medicine, Amsterdam Neuroscience, Amsterdam University Medical Centers, Location Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Pieter Vandemaele
- Ghent Institute for Functional and Metabolic Imaging (GIfMI), Ghent University, Ghent, Belgium
| | - Silvia Ingala
- Department of Radiology and Nuclear Medicine, Amsterdam Neuroscience, Amsterdam University Medical Center, Location VUmc, Amsterdam, the Netherlands
| | - Andrew D Robertson
- Schlegel-UW Research Institute for Aging, University of Waterloo, Waterloo, Ontario, Canada
| | - Lena Václavů
- C.J. Gorter Center for High Field MRI, Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Inge Groote
- Department of Diagnostic Physics, Oslo University Hospital, Oslo, Norway
| | - Hugo Kuijf
- Image Sciences Institute, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Fernando Zelaya
- Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Owen O'Daly
- Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Saima Hilal
- Department of Pharmacology, National University of Singapore, Singapore; Memory Aging and Cognition Center, National University Health System, Singapore; Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Alle Meije Wink
- Department of Radiology and Nuclear Medicine, Amsterdam Neuroscience, Amsterdam University Medical Center, Location VUmc, Amsterdam, the Netherlands
| | - Ilse Kant
- Radiology, University Medical Center Utrecht, Utrecht, the Netherlands; Department of Intensive Care, University Medical Centre, Utrecht, the Netherlands
| | - Matthan W A Caan
- Department of Biomedical Engineering and Physics, Amsterdam University Medical Center, Location Academic Medical Center, Amsterdam, the Netherlands
| | - Catherine Morgan
- School of Psychology and Centre for Brain Research, University of Auckland, Auckland, New Zealand
| | - Jeroen de Bresser
- Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Elisabeth Lysvik
- Department of Diagnostic Physics, Oslo University Hospital, Oslo, Norway
| | - Anouk Schrantee
- Radiology and Nuclear Medicine, Amsterdam Neuroscience, Amsterdam University Medical Centers, Location Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Astrid Bjørnebekk
- The Anabolic Androgenic Steroid Research Group, National Advisory Unit on Substance Use Disorder Treatment, Oslo University Hospital, Oslo, Norway
| | - Patricia Clement
- Ghent Institute for Functional and Metabolic Imaging (GIfMI), Ghent University, Ghent, Belgium
| | - Zahra Shirzadi
- Sunnybrook Research Institute, University of Toronto, Toronto, Canada
| | - Joost P A Kuijer
- Department of Radiology and Nuclear Medicine, Amsterdam Neuroscience, Amsterdam University Medical Center, Location VUmc, Amsterdam, the Netherlands
| | - Viktor Wottschel
- Department of Radiology and Nuclear Medicine, Amsterdam Neuroscience, Amsterdam University Medical Center, Location VUmc, Amsterdam, the Netherlands
| | - Udunna C Anazodo
- Department of Medical Biophysics, University of Western Ontario, London, Canada; Imaging Division, Lawson Health Research Institute, London, Canada
| | - Dasja Pajkrt
- Department of Pediatric Infectious Diseases, Emma Children's Hospital, Amsterdam University Medical Centre, Location Academic Medical Center, Amsterdam, the Netherlands
| | - Edo Richard
- Department of Neurology, Donders Institute for Brain, Behavior and Cognition, Radboud University Medical Centre, Nijmegen, the Netherlands; Neurology, Amsterdam University Medical Center, Location Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Reinoud P H Bokkers
- Department of Radiology, Medical Imaging Center, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Liesbeth Reneman
- Radiology and Nuclear Medicine, Amsterdam Neuroscience, Amsterdam University Medical Centers, Location Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Mario Masellis
- Sunnybrook Research Institute, University of Toronto, Toronto, Canada
| | - Matthias Günther
- Fraunhofer MEVIS, Bremen, Germany; University of Bremen, Bremen, Germany; Mediri GmbH, Heidelberg, Germany
| | | | - Eric Achten
- Ghent Institute for Functional and Metabolic Imaging (GIfMI), Ghent University, Ghent, Belgium
| | - Michael A Chappell
- Institute of Biomedical Engineering, Department of Engineering Science & Wellcome Centre for Integrative Neuroimaging, FMRIB, Nuffield Department of Clinical Neuroscience, University of Oxford, Oxford, UK
| | - Matthias J P van Osch
- C.J. Gorter Center for High Field MRI, Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Xavier Golay
- UCL Queen Square Institute of Neurology, University College London, London, UK
| | - David L Thomas
- UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Enrico De Vita
- Department of Biomedical Engineering, School of Biomedical Engineering & Imaging Sciences, King's College London, King's Health Partners, St Thomas' Hospital, London, SE1 7EH, UK
| | - Atle Bjørnerud
- Department of Diagnostic Physics, Oslo University Hospital, Oslo, Norway; Department of Psychology, University of Oslo, Norway
| | - Aart Nederveen
- Radiology and Nuclear Medicine, Amsterdam Neuroscience, Amsterdam University Medical Centers, Location Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Jeroen Hendrikse
- Radiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Iris Asllani
- Kate Gleason College of Engineering, Rochester Institute of Technology, NY, USA; Clinical Imaging Sciences Centre, Department of Neuroscience, Brighton and Sussex Medical School, Brighton, UK
| | - Frederik Barkhof
- Department of Radiology and Nuclear Medicine, Amsterdam Neuroscience, Amsterdam University Medical Center, Location VUmc, Amsterdam, the Netherlands; UCL Queen Square Institute of Neurology, University College London, London, UK; Centre for Medical Image Computing (CMIC), Faculty of Engineering Science, University College London, London, UK
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Warnert EAH, Nayak K, Menon R, Rice C, Port J, Morris EA, Sodickson DK, Sundgren P, Miller KL, Anazodo UC. Resonate: Reflections and recommendations on implicit biases within the ISMRM. J Magn Reson Imaging 2019; 49:1509-1511. [PMID: 30666751 DOI: 10.1002/jmri.26593] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2018] [Revised: 11/16/2018] [Accepted: 11/16/2018] [Indexed: 11/07/2022] Open
Affiliation(s)
- Esther A H Warnert
- Department of Radiology & Nuclear Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Krishna Nayak
- Ming Hsieh Department of Electrical Engineering, Viterbi School of Engineering, University of Southern California, Los Angeles, California, USA
| | - Ravi Menon
- Department of Medical Biophysics, Western University, London, Ontario, Canada
| | - Curt Rice
- Oslo and Akershus University College of Applied Sciences, Oslo, Norway
| | - John Port
- Department of Radiology, Mayo Clinic Rochester, Minnesota, USA
| | | | - Daniel K Sodickson
- Department of Radiology, New York University School of Medicine, New York, USA
- Center for Advanced Imaging Innovation and Research (CAI2R), New York University School of Medicine, New York, USA
| | - Pia Sundgren
- Department of Diagnostic Radiology, Clinical Sciences, Lund University, Lund, Sweden
| | - Karla L Miller
- Wellcome Centre for Integrative Neuroimaging, FMRIB, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Udunna C Anazodo
- Department of Medical Biophysics, Western University, London, Ontario, Canada
- Lawson Health Research Institute, St Joseph's Health Care, London, Ontario, Canada
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22
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Ssali T, Anazodo UC, Thiessen JD, Prato FS, St. Lawrence K. A Noninvasive Method for Quantifying Cerebral Blood Flow by Hybrid PET/MRI. J Nucl Med 2018. [DOI: 10.2967/jnumed.117.203414] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
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23
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Anazodo UC, Finger E, Kwan BYM, Pavlosky W, Warrington JC, Günther M, Prato FS, Thiessen JD, St Lawrence KS. Using simultaneous PET/MRI to compare the accuracy of diagnosing frontotemporal dementia by arterial spin labelling MRI and FDG-PET. Neuroimage Clin 2017; 17:405-414. [PMID: 29159053 PMCID: PMC5683801 DOI: 10.1016/j.nicl.2017.10.033] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Revised: 10/24/2017] [Accepted: 10/28/2017] [Indexed: 11/30/2022]
Abstract
Purpose The clinical utility of FDG-PET in diagnosing frontotemporal dementia (FTD) has been well demonstrated over the past decades. On the contrary, the diagnostic value of arterial spin labelling (ASL) MRI - a relatively new technique - in clinical diagnosis of FTD has yet to be confirmed. Using simultaneous PET/MRI, we evaluated the diagnostic performance of ASL in identifying pathological abnormalities in FTD (FTD) to determine whether ASL can provide similar diagnostic value as FDG-PET. Methods ASL and FDG-PET images were compared in 10 patients with FTD and 10 healthy older adults. Qualitative and quantitative measures of diagnostic equivalency were used to determine the diagnostic utility of ASL compared to FDG-PET. Sensitivity, specificity, and inter-rater reliability were calculated for each modality from scores of subjective visual ratings and from analysis of regional mean values in thirteen a priori regions of interest (ROI). To determine the extent of concordance between modalities in each patient, individual statistical maps generated from comparison of each patient to controls were compared between modalities using the Jaccard similarity index (JI). Results Visual assessments revealed lower sensitivity, specificity and inter-rater reliability for ASL (66.67%/62.12%/0.2) compared to FDG-PET (88.43%/90.91%/0.61). Across all regions, ASL performed lower than FDG-PET in discriminating patients from controls (areas under the receiver operating curve: ASL = 0.75 and FDG-PET = 0.87). In all patients, ASL identified patterns of reduced perfusion consistent with FTD, but areas of hypometabolism exceeded hypoperfused areas (group-mean JI = 0.30 ± 0.22). Conclusion This pilot study demonstrated that ASL can detect similar spatial patterns of abnormalities in individual FTD patients compared to FDG-PET, but its sensitivity and specificity for discriminant diagnosis of a patient from healthy individuals remained unmatched to FDG-PET. Further studies at the individual level are required to confirm the clinical role of ASL in FTD management.
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Affiliation(s)
- Udunna C Anazodo
- Lawson Health Research Institute, St Joseph's Health Care, 268 Grosvenor St., London, Ontario N6A 4V2, Canada; Department of Medical Biophysics, Schulich School of Medicine and Dentistry, Western University, Medical Sciences Building, Rm M407, London, Ontario N6A 5C1, Canada.
| | - Elizabeth Finger
- Department of Clinical Neurological Sciences, Western University, 339 Windermere Road, London, Ontario N6A 5A5, Canada.
| | - Benjamin Yin Ming Kwan
- Department of Medical Imaging, Schulich School of Medicine and Dentistry, Western University, London, Ontario N6A 5W9, Canada
| | - William Pavlosky
- Lawson Health Research Institute, St Joseph's Health Care, 268 Grosvenor St., London, Ontario N6A 4V2, Canada; Department of Medical Imaging, Schulich School of Medicine and Dentistry, Western University, London, Ontario N6A 5W9, Canada.
| | - James Claude Warrington
- Department of Medical Imaging, Schulich School of Medicine and Dentistry, Western University, London, Ontario N6A 5W9, Canada.
| | - Matthias Günther
- Fraunhofer Institute for Medical Image Computing MEVIS, Am Fallturm 1, 28359 Bremen, Germany.; University Bremen, Faculty 1, Otto-Hahn-Allee 1, 28359 Bremen, Germany.
| | - Frank S Prato
- Lawson Health Research Institute, St Joseph's Health Care, 268 Grosvenor St., London, Ontario N6A 4V2, Canada; Department of Medical Biophysics, Schulich School of Medicine and Dentistry, Western University, Medical Sciences Building, Rm M407, London, Ontario N6A 5C1, Canada.
| | - Jonathan D Thiessen
- Lawson Health Research Institute, St Joseph's Health Care, 268 Grosvenor St., London, Ontario N6A 4V2, Canada; Department of Medical Biophysics, Schulich School of Medicine and Dentistry, Western University, Medical Sciences Building, Rm M407, London, Ontario N6A 5C1, Canada.
| | - Keith S St Lawrence
- Lawson Health Research Institute, St Joseph's Health Care, 268 Grosvenor St., London, Ontario N6A 4V2, Canada; Department of Medical Biophysics, Schulich School of Medicine and Dentistry, Western University, Medical Sciences Building, Rm M407, London, Ontario N6A 5C1, Canada.
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24
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Ssali T, Anazodo UC, Bureau Y, MacIntosh BJ, Günther M, St. Lawrence K. Mapping Long-Term Functional Changes in Cerebral Blood Flow by Arterial Spin Labeling. PLoS One 2016; 11:e0164112. [PMID: 27706218 PMCID: PMC5051683 DOI: 10.1371/journal.pone.0164112] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Accepted: 09/20/2016] [Indexed: 12/02/2022] Open
Abstract
Although arterial spin labeling (ASL) is appealing for mapping long-term changes in functional activity, inter-sessional variations in basal blood flow, arterial transit times (ATTs), and alignment errors, can result in significant false activation when comparing images from separate sessions. By taking steps to reduce these sources of noise, this study assessed the ability of ASL to detect functional CBF changes between sessions. ASL data were collected in three sessions to image ATT, resting CBF and CBF changes associated with motor activation (7 participants). Activation maps were generated using rest and task images acquired in the same session and from sessions separated by up to a month. Good agreement was found when comparing between-session activation maps to within-session activation maps with only a 16% decrease in precision (within-session: 90 ± 7%) and a 13% decrease in the Dice similarity (within-session: 0.75 ± 0.07) coefficient after a month. In addition, voxel-wise reproducibility (within-session: 4.7 ± 4.5%) and reliability (within-session: 0.89 ± 0.20) of resting grey-matter CBF decreased by less than 18% for the between-session analysis relative to within-session values. ATT variability between sessions (5.0 ± 2.7%) was roughly half the between-subject variability, indicating that its effects on longitudinal CBF were minimal. These results demonstrate that conducting voxel-wise analysis on CBF images acquired on different days is feasible with only modest loss in precision, highlighting the potential of ASL for longitudinal studies.
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Affiliation(s)
- Tracy Ssali
- Lawson Health Research Institute, London, ON, Canada
- Department of Medical Biophysics, Western University, London, ON, Canada
- * E-mail:
| | - Udunna C. Anazodo
- Lawson Health Research Institute, London, ON, Canada
- Department of Medical Biophysics, Western University, London, ON, Canada
| | - Yves Bureau
- Lawson Health Research Institute, London, ON, Canada
| | | | - Matthias Günther
- Fraunhofer Institute for Medical Image Computing MEVIS, Bremen, Germany
- Mediri GmbH, Heidelberg, Germany
| | - Keith St. Lawrence
- Lawson Health Research Institute, London, ON, Canada
- Department of Medical Biophysics, Western University, London, ON, Canada
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25
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Anazodo UC, Shoemaker JK, Suskin N, Ssali T, Wang DJJ, St Lawrence KS. Impaired Cerebrovascular Function in Coronary Artery Disease Patients and Recovery Following Cardiac Rehabilitation. Front Aging Neurosci 2016; 7:224. [PMID: 26779011 PMCID: PMC4700211 DOI: 10.3389/fnagi.2015.00224] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [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: 08/31/2015] [Accepted: 11/19/2015] [Indexed: 01/01/2023] Open
Abstract
Coronary artery disease (CAD) poses a risk to the cerebrovascular function of older adults and has been linked to impaired cognitive abilities. Using magnetic resonance perfusion imaging, we investigated changes in resting cerebral blood flow (CBF) and cerebrovascular reactivity (CVR) to hypercapnia in 34 CAD patients and 21 age-matched controls. Gray matter volume (GMV) images were acquired and used as a confounding variable to separate changes in structure from function. Compared to healthy controls, CAD patients demonstrated reduced CBF in the superior frontal, anterior cingulate (AC), insular, pre- and post-central gyri, middle temporal, and superior temporal regions. Subsequent analysis of these regions demonstrated decreased CVR in the AC, insula, post-central and superior frontal regions. Except in the superior frontal and precentral regions, regional reductions in CBF and CVR were identified in brain areas where no detectable reductions in GMV were observed, demonstrating that these vascular changes were independent of brain atrophy. Because aerobic fitness training can improve brain function, potential changes in regional CBF were investigated in the CAD patients after completion of a 6-months exercise-based cardiac rehabilitation program. Increased CBF was observed in the bilateral AC, as well as recovery of CBF in the dorsal aspect of the right AC, where the magnitude of increased CBF was roughly equal to the reduction in CBF at baseline compared to controls. These exercise-related improvements in CBF in the AC is intriguing given the role of this area in cognitive processing and regulation of cardiovascular autonomic control.
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Affiliation(s)
- Udunna C Anazodo
- Lawson Health Research Institute, LondonON, Canada; Department of Medical Biophysics, Western University, LondonON, Canada; Laboratory for Brain and Heart Health, School of Kinesiology, Western University, LondonON, Canada
| | - J K Shoemaker
- Department of Medical Biophysics, Western University, LondonON, Canada; Laboratory for Brain and Heart Health, School of Kinesiology, Western University, LondonON, Canada
| | - Neville Suskin
- London Health Sciences Cardiology Rehabilitation Program, London ON, Canada
| | - Tracy Ssali
- Lawson Health Research Institute, LondonON, Canada; Department of Medical Biophysics, Western University, LondonON, Canada
| | - Danny J J Wang
- Department of Neurology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles CA, USA
| | - Keith S St Lawrence
- Lawson Health Research Institute, LondonON, Canada; Department of Medical Biophysics, Western University, LondonON, Canada
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Burhan AM, Marlatt NM, Palaniyappan L, Anazodo UC, Prato FS. Role of Hybrid Brain Imaging in Neuropsychiatric Disorders. Diagnostics (Basel) 2015; 5:577-614. [PMID: 26854172 PMCID: PMC4728476 DOI: 10.3390/diagnostics5040577] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [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: 10/05/2015] [Revised: 11/21/2015] [Accepted: 11/26/2015] [Indexed: 01/09/2023] Open
Abstract
This is a focused review of imaging literature to scope the utility of hybrid brain imaging in neuropsychiatric disorders. The review focuses on brain imaging modalities that utilize hybrid (fusion) techniques to characterize abnormal brain molecular signals in combination with structural and functional changes that have been observed in neuropsychiatric disorders. An overview of clinical hybrid brain imaging technologies for human use is followed by a selective review of the literature that conceptualizes the use of these technologies in understanding basic mechanisms of major neuropsychiatric disorders and their therapeutics. Neuronal network abnormalities are highlighted throughout this review to scope the utility of hybrid imaging as a potential biomarker for each disorder.
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Affiliation(s)
- Amer M Burhan
- St. Joseph's Health Care London, Parkwood Institute, 550 Wellington Road, London, ON N6C 0A7, Canada.
- Department of Psychiatry, Schulich School of Medicine & Dentistry, University of Western Ontario, London, ON N6C 2R6, Canada.
| | - Nicole M Marlatt
- St. Joseph's Health Care London, Parkwood Institute, 550 Wellington Road, London, ON N6C 0A7, Canada.
| | - Lena Palaniyappan
- Department of Psychiatry, Schulich School of Medicine & Dentistry, University of Western Ontario, London, ON N6C 2R6, Canada.
| | | | - Frank S Prato
- Lawson Health Research Institute, London, ON N6C 2R5, Canada.
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Anazodo UC, Thiessen JD, Ssali T, Mandel J, Günther M, Butler J, Pavlosky W, Prato FS, Thompson RT, St Lawrence KS. Feasibility of simultaneous whole-brain imaging on an integrated PET-MRI system using an enhanced 2-point Dixon attenuation correction method. Front Neurosci 2015; 8:434. [PMID: 25601825 PMCID: PMC4283546 DOI: 10.3389/fnins.2014.00434] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [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: 08/28/2014] [Accepted: 12/10/2014] [Indexed: 02/05/2023] Open
Abstract
PURPOSE To evaluate a potential approach for improved attenuation correction (AC) of PET in simultaneous PET and MRI brain imaging, a straightforward approach that adds bone information missing on Dixon AC was explored. METHODS Bone information derived from individual T1-weighted MRI data using segmentation tools in SPM8, were added to the standard Dixon AC map. Percent relative difference between PET reconstructed with Dixon+bone and with Dixon AC maps were compared across brain regions of 13 oncology patients. The clinical potential of the improved Dixon AC was investigated by comparing relative perfusion (rCBF) measured with arterial spin labeling to relative glucose uptake (rPETdxbone) measured simultaneously with (18)F-flurodexoyglucose in several regions across the brain. RESULTS A gradual increase in PET signal from center to the edge of the brain was observed in PET reconstructed with Dixon+bone. A 5-20% reduction in regional PET signals were observed in data corrected with standard Dixon AC maps. These regional underestimations of PET were either reduced or removed when Dixon+bone AC was applied. The mean relative correlation coefficient between rCBF and rPETdxbone was r = 0.53 (p < 0.001). Marked regional variations in rCBF-to-rPET correlation were observed, with the highest associations in the caudate and cingulate and the lowest in limbic structures. All findings were well matched to observations from previous studies conducted with PET data reconstructed with computed tomography derived AC maps. CONCLUSION Adding bone information derived from T1-weighted MRI to Dixon AC maps can improve underestimation of PET activity in hybrid PET-MRI neuroimaging.
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Affiliation(s)
- Udunna C Anazodo
- Lawson Health Research Institute London, ON, Canada ; Medical Biophysics, Western University London, ON, Canada
| | - Jonathan D Thiessen
- Lawson Health Research Institute London, ON, Canada ; Medical Biophysics, Western University London, ON, Canada
| | - Tracy Ssali
- Lawson Health Research Institute London, ON, Canada ; Medical Biophysics, Western University London, ON, Canada
| | - Jonathan Mandel
- Diagnostic Imaging, St. Joseph's Health Care London, ON, Canada
| | - Matthias Günther
- Fraunhofer Institute for Medical Image Computing MEVIS Bremen, Germany
| | - John Butler
- Lawson Health Research Institute London, ON, Canada
| | | | - Frank S Prato
- Lawson Health Research Institute London, ON, Canada ; Medical Biophysics, Western University London, ON, Canada
| | - R Terry Thompson
- Lawson Health Research Institute London, ON, Canada ; Medical Biophysics, Western University London, ON, Canada
| | - Keith S St Lawrence
- Lawson Health Research Institute London, ON, Canada ; Medical Biophysics, Western University London, ON, Canada
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