A Neuroimaging Preparation Protocol Tailored for Autism

This paper describes the key basic elements required for a successful multi-parametric MRI data acquisition in awake children with autism. The procedure was designed by taking into account methodological challenges arising from the acquisition of Resting State fMRI (RS fMRI) data, and factors such as cost, time, and staff availability. The ultimate aim was to prepare an imaging preparation protocol with high transferability to the whole autism spectrum, adaptable for use in a multi-site research with multiple time points. As part of a randomized pharmaco-intervention study, 31 children aged 4-10 years with Neurofibromatosis 1 and autism underwent MR imaging at baseline and end of intervention. The protocol consisted of tailored habituation instructions including gradual exposure to scanner noise, a social stories booklet, positive incentive strategies, and Play Therapy support. Success rate for initial acquisition was 71% for GABA+ MR spectroscopy at either location, 87% for perfusion, and 67% for diffusion assessment, and 71% for RS fMRI. Qualitative data indicated that 84% parents found the habituation protocol helpful. LAY SUMMARY: Here we describe a protocol for brain Magnetic Resonance Imaging (MRI) tailored for children with ASD to help reduce stress and avoid sedation during scanning. This procedure can make advanced medical imaging more accessible and promote a better MRI experience for families of children with ASD.

Randomised controlled trial of simvastatin treatment for autism in young children with neurofibromatosis type 1 (SANTA)

Background

Neurofibromatosis 1 (NF1) is a monogenic model for syndromic autism. Statins rescue the social and cognitive phenotype in animal knockout models, but translational trials with subjects > 8 years using cognition/behaviour outcomes have shown mixed results. This trial breaks new ground by studying statin effects for the first time in younger children with NF1 and co-morbid autism and by using multiparametric imaging outcomes.

Methods

A single-site triple-blind RCT of simvastatin vs. placebo was done. Assessment (baseline and 12-week endpoint) included peripheral MAPK assay, awake magnetic resonance imaging spectroscopy (MRS; GABA and glutamate+glutamine (Glx)), arterial spin labelling (ASL), apparent diffusion coefficient (ADC), resting state functional MRI, and autism behavioural outcomes (Aberrant Behaviour Checklist and Clinical Global Impression).

Results

Thirty subjects had a mean age of 8.1 years (SD 1.8). Simvastatin was well tolerated. The amount of imaging data varied by test. Simvastatin treatment was associated with (i) increased frontal white matter MRS GABA (t(12) = - 2.12, p = .055), GABA/Glx ratio (t(12) = - 2.78, p = .016), and reduced grey nuclei Glx (ANCOVA p < 0.05, Mann-Whitney p < 0.01); (ii) increased ASL perfusion in ventral diencephalon (Mann-Whitney p < 0.01); and (iii) decreased ADC in cingulate gyrus (Mann-Whitney p < 0.01). Machine-learning classification of imaging outcomes achieved 79% (p < .05) accuracy differentiating groups at endpoint against chance level (64%, p = 0.25) at baseline. Three of 12 (25%) simvastatin cases compared to none in placebo met 'clinical responder' criteria for behavioural outcome.

Conclusions

We show feasibility of peripheral MAPK assay and autism symptom measurement, but the study was not powered to test effectiveness. Multiparametric imaging suggests possible simvastatin effects in brain areas previously associated with NF1 pathophysiology and the social brain network.

Trial registration

EU Clinical Trial Register (EudraCT) 2012-005742-38 (www.clinicaltrialsregister.eu).

Elimination of beam walk-off in low-coherence off-axis photorefractive holography

Whole-field photorefractive holography can be combined with low-coherence interferometry for three-dimensional imaging and other applications, including imaging through turbid media, but the off-axis holographic recording geometry results in a limited field of view when light of low temporal coherence is used. We show that tilting the energy fronts with respect to the wave fronts by use of prisms can eliminate this problem and point out that this approach will be useful for many linear and nonlinear wave-mixing experiments.

Direct-to-video holographic 3-D imaging using photorefractive multiple quantum well devices: errata

Due to an oversight during the revision process, one of the authors was not mentioned in this paper. The author list should read: R. Jones, M. Tziraki, D. Parsons Karavassilis, P. M. W. French, K. M. Kwolek, D. D. Nolte and M. R. Melloch.

Direct-to-video holographic 3-D imaging using photorefractive multiple quantum well devices

Customised photorefractive quantum well devices have been developed for real-time video acquisition of coherence-gated, three-dimensional images. Holographic imaging with direct video capture has been demonstrated. The technique has been applied to 3-D imaging through turbid media with 50 mm transverse and 60 mm depth resolution being achieved using near infrared light through a phantom of 13 mean free paths scattering depth. Spectrally-resolved holographic imaging has also been demonstrated.

Evaluation of the temporally extrapolated absorbance method for dual-wavelength imaging through tissuelike scattering media

An independent assessment is described of a dual-wavelength imaging technique, known as the temporally extrapolated absorbance method (TEAM), proposed by Yamada et al. [Opt. Eng. 32, 634-641 (1993)]. The technique involves recording the temporal distribution of light transmitted across a scattering medium at two carefully chosen wavelengths at which the scattering properties of the medium are assumed to be identical. The objective is to image internal structure that absorbs more strongly at one wavelength than it does at the other. A simple theoretical treatment of TEAM is presented that employs a perturbation model of photon transport. This indicates that despite the lack of a secure theoretical basis, the technique may provide a potentially effective ad hoc method of generating images of highly scattering media. The method was also evaluated experimentally by using, for the first time to our knowledge, a single object and two wavelengths. A single-projection, two-dimensional image was obtained of a solid phantom with optical properties representative of breast tissue. The results exhibited good agreement with the theoretical model, and a small embedded feature that absorbs 3.5 times as strongly as the surrounding medium at one wavelength was revealed successfully.