A Comparison of Global Brain Volumetrics Obtained from CT versus MRI Using 2 Publicly Available Software Packages.

BACKGROUND AND PURPOSE: Brain volumetrics have historically been obtained from MR imaging data. However, advances in CT, along with refined publicly available software packages, may support tissue-level segmentations of clinical CT images. Here, brain volumetrics obtained by applying two publicly available software packages to paired CT-MR data are compared. MATERIALS AND METHODS: In a group of patients (n = 69; 35 men) who underwent both MR imaging and CT brain scans within 12 months of one another, brain tissue was segmented into WM, GM, and CSF compartments using 2 publicly available software packages: Statistical Parametric Mapping and FMRIB Software Library. A subset of patients with repeat imaging sessions was used to assess the repeatability of each segmentation. Regression analysis and Bland-Altman limits of agreement were used to determine the level of agreement between segmented volumes. RESULTS: Regression analysis showed good agreement between volumes derived from MR images versus those from CT. The correlation coefficients between the 2 methods were 0.93 and 0.98 for Statistical Parametric Mapping and FMRIB Software Library, respectively. Differences between global volumes were significant (P < .05) for all volumes compared within a given segmentation pipeline. WM bias was 36% (SD, 38%) and 18% (SD, 18%) for Statistical Parametric Mapping and FMRIB Software Library, respectively, and 10% (SD, 30%) and 6% (SD, 20%) for GM (bias ± limits of agreement), with CT overestimating WM and underestimating GM compared with MR imaging. Repeatability was good for all segmentations, with coefficients of variation of <10% for all volumes. CONCLUSIONS: The repeatability of CT segmentations using publicly available software is good, with good correlation with MR imaging. With careful study design and acknowledgment of measurement biases, CT may be a viable alternative to MR imaging in certain settings.

Head CT: Toward Making Full Use of the Information the X-Rays Give.

Although clinical head CT images are typically interpreted qualitatively, automated methods applied to routine clinical head CTs enable quantitative assessment of brain volume, brain parenchymal fraction, brain radiodensity, and brain radiomass. These metrics gain clinical meaning when viewed relative to a reference database and expressed as quantile regression values. Quantitative imaging data can aid in objective reporting and in the identification of outliers, with possible diagnostic implications. The comparison to a reference database necessitates standardization of head CT imaging parameters and protocols. Future research is needed to learn the effects of virtual monochromatic imaging on the quantitative characteristics of head CT images.

Pediatric Head CT: Automated Quantitative Analysis with Quantile Regression.

BACKGROUND AND PURPOSE: Together with quantile regression methods, such a model would have the potential for clinical utility through automated quantitative comparison of individual cases relative to their age and gender-matched peer group. Our aim was to demonstrate the automated processing of digital clinical head CT data in the development of a clinically useful model of age-related changes of the brain in the first 2 decades of life. MATERIALS AND METHODS: A total of 415 (209 female) consecutive, clinical head CTs with radiographically normal findings from patients from birth through 20 years of age were retrospectively selected and subjected to automated segmentation. Brain volume, brain parenchymal fraction, brain radiodensity, and brain radiomass were assessed as a function of patient age. Statistical modeling and quantile regression were performed. RESULTS: Brain volume increased from 400 cm3 at birth to 1350 cm3 at 20 years of age (>3-fold). Males had a slightly steeper growth trajectory than females, with approximately 8% difference in volume between the sexes established in the first few years of life. Brain parenchymal fraction was variable at younger than 2 years of age, stabilizing between 0.85 and 0.92 at 2-3 years of age. Brain mean radiodensity was lower at birth (24 HU) and increased through 3 years of age, after which it stabilized near 30 HU, an approximately 25% increase. The product of brain volume and mean brain radiodensity (radiomass), increased from 700 HU × mL at birth to 3900 HU × mL, a 5.6-fold increase, with approximately 5% difference between males and females at 20 years. Quantile regression enables a given metric to be interpreted relative to an age- and sex-matched peer group. CONCLUSIONS: Automated segmentation of clinical head CT images permitted the generation of a reference database for quantitative analysis of pediatric and adolescent brains. Quantile regression facilitates clinical application.

Aging and the Brain: A Quantitative Study of Clinical CT Images.

BACKGROUND AND PURPOSE: Though CT is a highly calibrated imaging modality, head CT is typically interpreted qualitatively. Our aim was to initiate the establishment of a reference quantitative database for clinical head CT. MATERIALS AND METHODS: An automated segmentation algorithm was developed and applied to 354 clinical head CT scans with radiographically normal findings (ages, 18-101 years; 203 women) to measure brain volume, brain parenchymal fraction, brain radiodensity, and brain parenchymal radiomass. Brain parenchymal fraction was modeled using quantile regression analysis. RESULTS: Brain parenchymal fraction is highly correlated with age (R 2 = 0.908 for men and 0.950 for women), with 11% overall brain volume loss in the adult life span (1%/year from 20 to 50 years and 2%/year after 50 years of age). Third-order polynomial quantile regression curves for brain parenchymal fraction were rationalized and statistically validated. Total brain parenchymal radiodensity shows a decline as a function of age (14.9% for men, 14.7% for women; slopes not significantly different, P = .760). Age-related loss of brain radiomass (the product of volume and radiodensity) is approximately 20% for both sexes, significantly greater than the loss of brain volume (P < .001). CONCLUSIONS: An automated segmentation algorithm has been developed and applied to clinical head CT images to initiate the development of a reference database for quantitative brain CT imaging. Such a database can be subject to quantile regression analysis to stratify patient brain CT scans by metrics such as brain parenchymal fraction, radiodensity, and radiomass, to aid in the identification of statistical outliers and lend quantitative assessment to image interpretation.

Modeling Early Postnatal Brain Growth and Development with CT: Changes in the Brain Radiodensity Histogram from Birth to 2 Years.

BACKGROUND AND PURPOSE: The majority of brain growth and development occur in the first 2 years of life. This study investigated these changes by analysis of the brain radiodensity histogram of head CT scans from the clinical population, 0-2 years of age. MATERIALS AND METHODS: One hundred twenty consecutive head CTs with normal findings meeting the inclusion criteria from children from birth to 2 years were retrospectively identified from 3 different CT scan platforms. Histogram analysis was performed on brain-extracted images, and histogram mean, mode, full width at half maximum, skewness, kurtosis, and SD were correlated with subject age. The effects of scan platform were investigated. Normative curves were fitted by polynomial regression analysis. RESULTS: Average total brain volume was 360 cm3 at birth, 948 cm3 at 1 year, and 1072 cm3 at 2 years. Total brain tissue density showed an 11% increase in mean density at 1 year and 19% at 2 years. Brain radiodensity histogram skewness was positive at birth, declining logarithmically in the first 200 days of life. The histogram kurtosis also decreased in the first 200 days to approach a normal distribution. Direct segmentation of CT images showed that changes in brain radiodensity histogram skewness correlated with, and can be explained by, a relative increase in gray matter volume and an increase in gray and white matter tissue density that occurs during this period of brain maturation. CONCLUSIONS: Normative metrics of the brain radiodensity histogram derived from routine clinical head CT images can be used to develop a model of normal brain development.

A Simple Automated Method for Detecting Recurrence in High-Grade Glioma.

Our aim was to develop an automated multiparametric MR imaging analysis of routinely acquired imaging sequences to identify areas of focally recurrent high-grade glioma. Data from 141 patients treated with radiation therapy with a diagnosis of high-grade glioma were reviewed. Strict inclusion/exclusion criteria identified a homogeneous cohort of 12 patients with a nodular recurrence of high-grade glioma that was amenable to focal re-irradiation (cohort 1). T1WI, FLAIR, and DWI data were used to create subtraction maps across time points. Linear regression was performed to identify the pattern of change in these 3 imaging sequences that best correlated with recurrence. The ability of these parameters to guide treatment decisions in individual patients was assessed in a separate cohort of 4 patients who were treated with radiosurgery for recurrent high-grade glioma (cohort 2). A leave-one-out analysis of cohort 1 revealed that automated subtraction maps consistently predicted the radiologist-identified area of recurrence (median area under the receiver operating characteristic curve = 0.91). The regression model was tested in preradiosurgery MRI in cohort 2 and identified 8 recurrent lesions. Six lesions were treated with radiosurgery and were controlled on follow-up imaging, but the remaining 2 lesions were not treated and progressed, consistent with the predictions of the model. Multiparametric subtraction maps can predict areas of nodular progression in patients with previously treated high-grade gliomas. This automated method based on routine imaging sequences is a valuable tool to be prospectively validated in subsequent studies of treatment planning and posttreatment surveillance.

Apparent diffusion coefficient measurements to support a diagnosis of intracranial hypotension.

OBJECTIVE: Intracranial hypotension (ICH) can be a challenging diagnosis, as cerebrospinal fluid leaks may be difficult to confirm, patients may have other causes for clinical symptoms and imaging findings can be non-specific, particularly in the setting of comorbidities. We investigate the use of brain diffusion measurements [apparent diffusion coefficient (ADC) values] in the assessment of ICH. METHODS: 13 cases of ICH were identified retrospectively based on imaging findings and their clinical histories were compared with 13 control subjects. Regional ADC values and average diffusion constant (Dav) from brain slice ADC histograms were measured. RESULTS: ADC values trended higher in all brain regions in patients with ICH than those in control subjects, with statistically significant differences in frontal white matter, mid-brain and deep grey structures. Dav determined by a single-slice ADC histogram was significantly higher in patients with ICH than in the control group (p = 0.008). In two cases followed longitudinally, Dav correlated with the patient's symptoms and decreased towards normal value with blood patch. In one case, decreased Dav correlated with the formation of subdural collections. CONCLUSION: Cerebral oedema as assessed by increased ADC is strongly correlated with ICH (10 of 13 cases). Histographic analysis of ADC values may offer increased accuracy of ADC measurement. ADC value assessment in the determination of ICH may be particularly useful in complex clinical cases, where treatment is followed over time or where gadolinium is not used and meningeal enhancement cannot be assessed. ADVANCES IN KNOWLEDGE: This article investigates the use of brain diffusion measurements in the assessment of ICH in the clinical setting.

MR imaging of psychosurgery: rostral atrophy following stereotacic subcaudate tractotomy.

There are few reports of MR imaging findings following psychosurgery. Here, we report the findings of 3T MR imaging of the sequelae of stereotactic subcaudate tractotomy (SST). Rostral atrophy is noted on conventional imaging. Diffusion tensor (DT) tractography demonstrated no communicating white matter tracts between the inferior frontal lobes, which appeared normally as thick fibre bundles in age-matched controls. DT tractography provides a unique tool for the evaluation of sequelae of ablative psychosurgical procedures.

Communicating hydrocephalus after gamma knife radiosurgery for vestibular schwannoma: an MR imaging study.

Vestibular schwannomas are common, and gamma knife radiosurgery is a treatment option of symptomatic tumors. Hydrocephalus may be a complication of gamma knife treatment of vestibular schwannoma, though the cause-and-effect relationship can be debated because tumors can cause hydrocephalus without treatment. We present an MR imaging study of an unusual case of communicating hydrocephalus after gamma knife radiosurgery of a vestibular schwannoma in which the timeline of events strongly suggests that gamma knife played a contributory role in the development of hydrocephalus. We discuss risk factors for the development of hydrocephalus after radiation therapy and the role of MR CSF cine-flow study in the evaluation of treatment options for hydrocephalus in this setting.

Transferable anergy: superantigen treatment induces CD4+ T cell tolerance that is reversible and requires CD4-CD8- cells and interferon gamma.

Bacterial superantigens induce peripheral unresponsiveness in CD4+ T cell populations that express appropriate Vbeta chains. We have used Vbeta3/Valpha11 T cell receptor transgenic (Tg) mice and the Vbeta3-specific superantigen staphylococcal enterotoxin A (SEA) to further investigate the mechanisms that contribute to such unresponsiveness. As in other models, in vivo exposure to SEA rendered the Tg CD4+ cells unresponsive to subsequent restimulation in vitro with antigen or mitogens. However, when the SEA-treated CD4+ cells were completely purified away from all other contaminating cells, they regained the ability to proliferate and secrete cytokines. Moreover, enriched CD4-CD8- cells from the SEA-treated mice suppressed the responses of fresh control CD4+ cells in mixed cultures indicating that the apparent "anergy" was both transferable and reversible. Further analysis demonstrated that interferon gamma, but not the Fas receptor, played a critical role in the suppression.

Rapid expression of novel proteins in goldfish retina following optic nerve crush.

Polyadenylated messenger RNA was isolated from goldfish retinas at various times following unilateral crush of the optic nerve. RNA was translated in a cell-free system and product proteins analyzed by two-dimensional gel electrophoresis and autofluorography. Poly(A)+ mRNA-directed protein synthesis revealed an 8-fold increase in the labeling of polypeptides of about 30 kd Mr and a pI of 5.5 in retinas 2 d following optic nerve crush, compared with control retina mRNA translation products. In vitro labeling of retinal proteins revealed the enhanced synthesis of comparable 30 kd proteins in 2 d post-crush retinas. Evidence presented suggests that this 30 kd protein cluster may correspond to fish 30 kd stress or heat-shock proteins (hsp-30).