Comparison of frequency difference reconstruction algorithms for the detection of acute stroke using EIT in a realistic head-shaped tank.

Imaging of acute stroke might be possible using multi-frequency electrical impedance tomography (MFEIT) but requires absolute or frequency difference imaging. Simple linear frequency difference reconstruction has been shown to be ineffective in imaging with a frequency-dependant background conductivity; this has been overcome with a weighted frequency difference approach with correction for the background but this has only been validated for a cylindrical and hemispherical tank. The feasibility of MFEIT for imaging of acute stroke in a realistic head geometry was examined by imaging a potato perturbation against a saline background and a carrot-saline frequency-dependant background conductivity, in a head-shaped tank with the UCLH Mk2.5 MFEIT system. Reconstruction was performed with time difference (TD), frequency difference (FD), FD adjacent (FDA), weighted FD (WFD) and weighted FDA (WFDA) linear algorithms. The perturbation in reconstructed images corresponded to the true position to <9.5% of image diameter with an image SNR of >5.4 for all algorithms in saline but only for TD, WFDA and WFD in the carrot-saline background. No reliable imaging was possible with FD and FDA. This indicates that the WFD approach is also effective for a realistic head geometry and supports its use for human imaging in the future.

A novel method for recording neuronal depolarization with recording at 125-825 Hz: implications for imaging fast neural activity in the brain with electrical impedance tomography.

Electrical impedance tomography (EIT) is a recently developed medical imaging method which has the potential to produce images of fast neuronal depolarization in the brain. Previous modelling suggested that applied current needed to be below 100 Hz but the signal-to-noise ratio (SNR) recorded with scalp electrodes during evoked responses was too low to permit imaging. A novel method in which contemporaneous evoked potentials are subtracted is presented with current applied at 225 Hz to cerebral cortex during evoked activity; although the signal is smaller than at DC by about 10×, the principal noise from the EEG is reduced by about 1000×, resulting in an improved SNR. It was validated with recording of compound action potentials in crab walking leg nerve where peak changes of -0.2% at 125 and 175 Hz tallied with biophysical modelling. In recording from rat cerebral cortex during somatosensory evoked responses, peak impedance decreases of -0.07 ± 0.006% (mean ± SE) with a SNR of >50 could be recorded at 225 Hz. This method provides a reproducible and artefact free means for recording resistance changes during neuronal activity which could form the basis for imaging fast neural activity in the brain.

A method for removing artefacts from continuous EEG recordings during functional electrical impedance tomography for the detection of epileptic seizures.

Electrical impedance tomography (EIT) is a portable, non-invasive medical imaging method, which could be employed to image the seizure onset in subjects undergoing assessment prior to epilepsy surgery. Each image is obtained from impedance measurements conducted with imperceptible current at tens of kHz. For concurrent imaging with video electroencephalogram (EEG), the EIT introduces a substantial artefact into the EEG due to current switching at frequencies in the EEG band. We present here a method for its removal, so that EIT and the EEG could be acquired simultaneously. A low-pass analogue filter for EEG channels (-6 dB at 48 Hz) and a high-pass filter (-3 dB at 72 Hz) for EIT channels reduced the artefact from 2-3 mV to 50-300 microV, but still left a periodic artefact at about 3 Hz. This was reduced to less than 10 microV with a software filter, which subtracted an artefact template from the EEG raw traces. The EEG was made clinically acceptable at four times its acquisition speed. This method could enable EIT to become a technique for imaging on telemetry units alongside EEG, without interfering with routine EEG reporting.

Imaging cerebral haemorrhage with magnetic induction tomography: numerical modelling.

Magnetic induction tomography (MIT) is a new electromagnetic imaging modality which has the potential to image changes in the electrical conductivity of the brain due to different pathologies. In this study the feasibility of detecting haemorrhagic cerebral stroke with a 16-channel MIT system operating at 10 MHz was investigated. The finite-element method combined with a realistic, multi-layer, head model comprising 12 different tissues, was used for the simulations in the commercial FE package, Comsol Multiphysics. The eddy-current problem was solved and the MIT signals computed for strokes of different volumes occurring at different locations in the brain. The results revealed that a large, peripheral stroke (volume 49 cm(3)) produced phase changes that would be detectable with our currently achievable instrumentation phase noise level (17 m degrees ) in 70 (27%) of the 256 exciter/sensor channel combinations. However, reconstructed images showed that a lower noise level than this, of 1 m degrees , was necessary to obtain good visualization of the strokes. The simulated MIT measurements were compared with those from an independent transmission-line-matrix model in order to give confidence in the results.

A modelling study to inform specification and optimal electrode placement for imaging of neuronal depolarization during visual evoked responses by electrical and magnetic detection impedance tomography.

Electrical impedance tomography (EIT) has the potential to achieve non-invasive functional imaging of fast neuronal activity in the human brain due to opening of ion channels during neuronal depolarization. Local changes of resistance in the cerebral cortex are about 1%, but the size and location of changes recorded on the scalp are unknown. The purpose of this work was to develop an anatomically realistic finite element model of the adult human head and use it to predict the amplitude and topography of changes on the scalp, and so inform specification for an in vivo measuring system. A detailed anatomically realistic finite element (FE) model of the head was produced from high resolution MRI. Simulations were performed for impedance changes in the visual cortex during evoked activity with recording of scalp potentials by electrodes or magnetic flux density by magnetoencephalography (MEG) in response to current injected with electrodes. The predicted changes were validated by recordings in saline filled tanks and with boundary voltages measured on the human scalp. Peak changes were 1.03 +/- 0.75 microV (0.0039 +/- 0.0034%) and 27 +/- 13 fT (0.2 +/- 0.5%) respectively, which yielded an estimated peak signal-to-noise ratio of about 4 for in vivo averaging over 10 min and 1 mA current injection. The largest scalp changes were over the occipital cortex. This modelling suggests, for the first time, that reproducible changes could be recorded on the scalp in vivo in single channels, although a higher SNR would be desirable for accurate image production. The findings suggest that an in vivo study is warranted in order to determine signal size but methods to improve SNR, such as prolonged averaging or other signal processing may be needed for accurate image production.

An electrode addressing protocol for imaging brain function with electrical impedance tomography using a 16-channel semi-parallel system.

Electrical impedance tomography of brain function poses special problems because applied current is diverted by the resistive skull. In the past, image resolution was maximized with the use of an electrode addressing protocol with widely spaced drive electrode pairs and use of a multiplexer so that many electrode pairs could be flexibly addressed. The purpose of this study was to develop and test an electrode protocol for a 16-channel semi-parallel system which uses parallel recording channels with fixed wiring, the Kyung Hee University (KHU) Mk1. Ten protocols were tested, all addressing pairs of electrodes for recording or current drive, based on recording with a spiral, spiral with suboccipital electrodes (spiral s-o) and zig-zag configurations, and combinations of current injection from electrode pairs at 180 degrees , 120 degrees and 60 degrees . These were compared by assessing the image reconstruction quality of five simulated perturbations in a homogenous model of the human head and of four epileptic foci in an anatomically realistic model in the presence of realistic noise, in terms of localization error, resolution, image distortion and sensitivity in the region of interest. The spiral s-o with current injection at 180 degrees + 120 degrees + 60 degrees gave the best image quality and permitted reconstruction with a localization error of less than 10% of the head diameter. This encourages the view that it might be possible to obtain satisfactory images of focal abnormalities in the human brain with 16 scalp electrodes and improved instrumentation avoiding multiplexers on recording circuits.

A comparison of two EIT systems suitable for imaging impedance changes in epilepsy.

Electrical impedance tomography (EIT) has the potential to produce functional images of the conductivity changes associated with epilepsy to help localization of epileptic foci. Scalp voltage changes associated with internal conductivity changes due to focal seizures have been shown at the limit of detectability for present EIT systems. The performances of two EIT systems, which may be employed in clinical recordings during presurgical assessment of intractable epilepsy, were compared. Those were the 32-channel serial UCH Mk2.5 and the 16-channel semi-parallel KHU Mk1. Images of three conductivity perturbations, simulating epileptic foci, in a head-shaped saline tank without and with a real human skull were recorded using 31-channel and 16-channel protocols with the UCH Mk2.5, while only 16-channel protocols with the KHU Mk1. The UCH Mk2.5 employing the 31-channel protocol had better overall performance with a localization error of 12.7% of the tank diameter, which would be sufficient for lateralization of the epileptic activity. More blurred images, but with similar localization, were obtained using 16 electrodes.

Impedance changes recorded with scalp electrodes during visual evoked responses: implications for Electrical Impedance Tomography of fast neural activity.

Electrical Impedance Tomography (EIT) is a recently developed medical imaging method which could enable fast neural imaging in the brain by recording the resistance changes which occur as ion channels open during neuronal depolarization. In published studies in animal models with intracranial electrodes, changes of 0.005 to 3% have been reported but the amplitude of changes in the human is not known. The purpose of this work was to determine if resistance changes could be recorded non-invasively in humans during evoked activity which could form the basis for EIT of fast neural activity. Resistance was recorded with scalp electrodes during 2 Hz pattern visual evoked responses over 10 min using an insensible 1 Hz square wave constant current of 0.1-1 mA. Significant resistance decreases of 0.0010+/-0.0005% (0.30+/-0.15 microV, signal-to-noise ratio (SNR) of 2:1, n=16 recordings over 6 subjects) (mean+/-SE) were recorded. These are in broad agreement with modelling which estimated changes of 0.0039+/-0.0034% (1.03+/-0.75 microV) using an anatomically realistic finite element model. This is the first demonstration of such changes in humans and so encourages the belief that EIT could be used for neural imaging. Unfortunately, the signal-to-noise ratio was not sufficient to permit imaging at present because recording over multiple injection sites needed for imaging would require impractically long recording times. However, in the future, invasive imaging with intracranial electrodes in animal models or humans and improved signal processing or recording may still enable imaging; this would constitute a significant advance in neuroscience technology.

Code-division-multiplexed electrical impedance tomography spectroscopy.

Electrical impedance tomography uses multiple impedance measurements to image the internal conductivity of an object, such as the human body. Code-division multiplexing is proposed as a new method that can provide simultaneous impedance measurements of the multiple channels. Code division provides clear advantages of a wide frequency range at reduced cost and reduced complexity of sources. A potential drawback is the lack of perfectly orthogonal code sets. This caused an increase of 0.62% in root-mean-square spectral error when two codes were used to record two impedance channels simultaneously on a low-pass filter network. The method described provides images and spectra which are equivalent to the conventional time-multiplexed method, with increases in frequency resolution and measurement speed which may be of benefit in some applications of electrical impedance tomography spectroscopy.

Sub-trochanteric fracture of the femur following electric shock.

We report a case of a unilateral sub-trochanteric femoral fracture resulting from an accidental electric shock: an unusual injury. It is well documented that fractures occurring from electrical injuries commonly involve the upper extremities; those affecting the lower limb have rarely been documented. Such injuries need to be identified and treated without delay.

Use of statistical parametric mapping (SPM) to enhance electrical impedance tomography (EIT) image sets.

Use of statistical parametric mapping (SPM), which is widely used in analysis of neuroimaging studies with fMRI and PET, has the potential to improve quality of EIT images for clinical use. Minimal modification to SPM is needed, but statistical analysis based on height, not extent thresholds, should be employed, due to the 20-80% variation of the point spread function, across EIT images. SPM was assessed in EIT images reconstructed with a linear time difference algorithm utilizing an anatomically realistic finite element model of the human head. Images of the average of data sets were compared with those produced using SPM over 10-40 individual image data sets without averaging. For a point disturbance, a sponge 15% of the diameter of an anatomically realistic saline-filled tank including a skull, with a contrast of 15%, and for visual evoked response data in 14 normal human volunteers, images produced with SPM were less noisy than the average images. For the human data, no consistent physiologically realistic changes were seen with either SPM or direct reconstruction; however, only a small data set was available, limiting the power of the SPM analysis. SPM may be used on EIT images and has the potential to extract improved images from clinical data series with a low signal-to-noise ratio.

A review of errors in multi-frequency EIT instrumentation.

Multi-frequency electrical impedance tomography (MFEIT) was proposed over 10 years ago as a potential spectroscopic impedance imaging method. At least seven systems have been developed for imaging the lung, heart, breast and brain, yet none has yet achieved clinical acceptance. While the absolute impedance varies considerably between different tissues, the changes in the spectrum due to physiological changes are expected to be quite small, especially when measured through a volume. This places substantial requirements on the MFEIT instrumentation to maintain a flat system frequency response over a broad frequency range (dc-MHz). In this work, the EIT measurement problem is described from a multi-frequency perspective. Solutions to the common problems are considered from recent MFEIT systems, and the debate over four-terminal or two-terminal (multiple source) architecture is revisited. An analysis of the sources of MFEIT errors identifies the major sources of error as stray capacitance and common-mode voltages which lead to a load dependence in the frequency response of MFEIT systems. A system that employs active electrodes appears to be the most able to cope with these errors (Li et al 1996). A distributed system with digitization at the electrode is suggested as a next step in MFEIT system development.

Analysis of resting noise characteristics of three EIT systems in order to compare suitability for time difference imaging with scalp electrodes during epileptic seizures.

Electrical impedance tomography measurements in clinical applications are limited by an undesired noise component. We have investigated the noise in three systems suitable for imaging epileptic seizures, the UCH Mark1b, UCH Mark2.5 and KHU Mark1 16 channel, at applied frequencies in three steps from 1 to 100 kHz, by varying load impedance, single terminal or multiplexed measurements, and in test objects of increasing complexity from a resistor to a saline filled tank and human volunteer. The noise was white, and increased from about 0.03% rms on the resistor to 0.08% on the human; it increased with load but was independent of use of the multiplexer. The KHU Mark1 delivered the best performance with noise spectra of about 0.02%, which could be further reduced by averaging to a level where reliable imaging of changes of about 0.1% estimated during epileptic seizures appears plausible.

Design of electrodes and current limits for low frequency electrical impedance tomography of the brain.

For the novel application of recording of resistivity changes related to neuronal depolarization in the brain with electrical impedance tomography, optimal recording is with applied currents below 100 Hz, which might cause neural stimulation of skin or underlying brain. The purpose of this work was to develop a method for application of low frequency currents to the scalp, which delivered the maximum current without significant stimulation of skin or underlying brain. We propose a recessed electrode design which enabled current injection with an acceptable skin sensation to be increased from 100 muA using EEG electrodes, to 1 mA in 16 normal volunteers. The effect of current delivered to the brain was assessed with an anatomically realistic finite element model of the adult head. The modelled peak cerebral current density was 0.3 A/m(2), which was 5 to 25-fold less than the threshold for stimulation of the brain estimated from literature review.

Multi-frequency electrical impedance tomography (EIT) of the adult human head: initial findings in brain tumours, arteriovenous malformations and chronic stroke, development of an analysis method and calibration.

MFEIT (multi-frequency electrical impedance tomography) could distinguish between ischaemic and haemorrhagic stroke and permit the urgent use of thrombolytic drugs in patients with ischaemic stroke. The purpose of this study was to characterize the UCLH Mk 2 MFEIT system, designed for this purpose, with 32 electrodes and a multiplexed 2 kHz to 1.6 MHz single impedance measuring circuit. Data were collected in seven subjects with brain tumours, arteriovenous malformations or chronic stroke, as these resembled the changes in haemorrhagic or ischaemic stroke. Calibration studies indicated that the reliable bandwidth was only 16-64 kHz because of front-end components placed to permit simultaneous EEG recording. In raw in-phase component data, the SD of 16-64 kHz data for one electrode combination across subjects was 2.45 +/- 0.9%, compared to a largest predicted change of 0.35% estimated using the FEM of the head. Using newly developed methods of examining the most sensitive channels from the FEM, and nonlinear imaging constrained to the known site of the lesion, no reproducible changes between pathologies were observed. This study has identified a specification for accuracy in EITS in acute stroke, identified the size of variability in relation to this in human recordings, and presents new methods for analysis of data. Although no reproducible changes were identified, we hope this will provide a foundation for future studies in this demanding but potentially powerful novel application.

Factors limiting the application of electrical impedance tomography for identification of regional conductivity changes using scalp electrodes during epileptic seizures in humans.

Electrical impedance tomography (EIT) has the potential to produce images during epileptic seizures. This might improve the accuracy of the localization of epileptic foci in patients undergoing presurgical assessment for curative neurosurgery. It has already been shown that impedance increases by up to 22% during induced epileptic seizures in animal models, using cortical or implanted electrodes in controlled experiments. The purpose of this study was to determine if reproducible raw impedance changes and EIT images could be collected during epileptic seizures in patients who were undergoing observation with video-electroencephalography (EEG) telemetry as part of evaluation prior to neurosurgery to resect the region of brain causing the epilepsy. A secondary purpose was to develop an objective method for processing and evaluating data, as seizures arose at unpredictable times from a noisy baseline. Four-terminal impedance measurements from 258 combinations were collected continuously using 32 EEG scalp electrodes in 22 seizure episodes from 7 patients during their presurgical assessment together with the standard EEG recordings. A reliable method for defining the pre-seizure baseline and recording impedance data and EIT images was developed, in which EIT and EEG could be acquired simultaneously after filtering of EIT artefact from the EEG signal. Fluctuations of several per cent over minutes were observed in the baseline between seizures. During seizures, boundary voltage changes diverged with a standard deviation of 1-54% from the baseline. No reproducible changes with the expected time course of some tens of seconds and magnitude of about 0.1% could be reliably measured. This demonstrates that it is feasible to acquire EIT images in parallel with standard EEG during presurgical assessment but, unfortunately, expected EIT changes on the scalp of about 0.1% are swamped by much larger movement and systematic artefact. Nevertheless, EIT has the unique potential to provide invaluable neuroimaging data for this purpose and may still become possible with improvements in electrode design and instrumentation.

Identification of a suitable current waveform for acute stroke imaging.

MFEIT (multi-frequency electrical impedance tomography) has the potential to provide a portable non-invasive neuroimaging method ideal for use in acute stroke. Skin perception has not previously occurred in MFEIT with injected frequencies above 2 kHz, but use in brain imaging requires applied current below 100 Hz, which could stimulate cutaneous nerve endings. The purpose of this work was to find the most suitable current pattern that could be employed in MFEIT measurements in the adult head with the UCLH Mk2.5 system, which applies currents from 20 Hz-1.6 MHz. Single frequency current waveforms of 0.28 mA peak-to-peak at 20 Hz-80 Hz were applied to the forearms of three volunteers; although the skin was abraded, none of these were perceived, which agrees with similar studies in the literature. When a full frequency pattern at 20 Hz-1.6 MHz was applied to the forearm or head in four healthy subjects, with the same current amplitude of 0.28 mA for each component, an unpleasant tingling sensation was perceived, due to summation of the applied currents. The sensation was reduced or abolished by attenuation or removal of frequencies below 100 Hz; the optimal compromise was a pattern with absence of 40 Hz, and with 80 and 20 Hz respectively reduced to 75% and 50%.

Using the GRID to improve the computation speed of electrical impedance tomography (EIT) reconstruction algorithms.

In our group at University College London, we have been developing electrical impedance tomography (EIT) of brain function. We have attempted to improve image quality by the use of realistic anatomical meshes and, more recently, non-linear reconstruction methods. Reconstruction with linear methods, with pre-processing, may take up to a few minutes per image for even detailed meshes. However, iterative non-linear reconstruction methods require much more computational resources, and reconstruction with detailed meshes was taking far too long for clinical use. We present a solution to this timing bottleneck, using the resources of the GRID, the development of coordinated computing resources over the internet that are not subject to centralized control using standard, open, general-purpose protocols and are transparent to the user. Optimization was performed by splitting reconstruction of image series into individual jobs of one image each; no parallelization was attempted. Using the GRID middleware 'Condor' and a cluster of 920 nodes, reconstruction of EIT images of the human head with a non-linear algorithm was speeded up by 25-40 times compared to serial processing of each image. This distributed method is of direct practical value in applications such as EIT of epileptic seizures where hundreds of images are collected over the few minutes of a seizure and will be of value to clinical data collection with similar requirements. In the future, the same resources could be employed for the more ambitious task of parallelized code.

Generating accurate finite element meshes for the forward model of the human head in EIT.

The use of realistic anatomy in the model used for image reconstruction in EIT of brain function appears to confer significant improvements compared to geometric shapes such as a sphere. Accurate model geometry may be achieved by numerical models based on magnetic resonance images (MRIs) of the head, and this group has elected to use finite element meshing (FEM) as it enables detailed internal anatomy to be modelled and has the capability to incorporate information about tissue anisotropy. In this paper a method for generating accurate FEMs of the human head is presented where MRI images are manually segmented using custom adaptation of industry standard commercial design software packages. This is illustrated with example surface models and meshes from adult epilepsy patients, a neonatal baby and a phantom latex tank incorporating a real skull. Mesh quality is assessed in terms of element stretch and hence distortion.

The effect of layers in imaging brain function using electrical impedance tomograghy.

Electrical impedance tomography (EIT) has promise for imaging brain function with rings of scalp electrodes, but hitherto human images have been collected and reconstructed using a simple algorithm in which the head was modelled as a homogeneous sphere. The purpose of this work was to assess the improvement in image quality which could be achieved by adding layers to represent the cerebro-spinal fluid (CSF), skull and scalp in the forward model employed by the reconstruction algorithm. Solutions to the forward model were produced analytically and using the linear finite element method (FEM). This was undertaken for computer simulated data when a spherical conductivity change of 10%, radius 5 mm, was moved through 29 positions within a head modelled as four concentric spheres of radius 80-92 mm in order to verify the accuracy of the linear FEM by comparison with the analytical method. Test data were also recorded in a 93.5 mm, spherical, saline-filled tank in which the skull was simulated by a hollow sphere of plaster of Paris, 5 mm thick and a 20 x 20 mm right-cylindrical Perspex object, a 100% conductivity decrease, was moved through 39 positions. The best images were achieved by reconstruction with a four- or three-shell analytical model, giving a spatial accuracy of 5.8 +/- 2.2 mm for computer simulated or 14.0 +/- 5.8 mm for tank data. Mean FWHM was 57 mm and 91 mm in the XY-plane and along the z-axis, respectively. Reconstruction with a homogeneous analytical model gave localization errors greater by about 50-300%, but a reduction in FWHM of about 5% of the image diameter. Unexpectedly, reconstruction with FEM models gave poorer results similar to the analytical homogeneous case. This confirms that addition of shells to the forward model improves image quality as expected with an analytical model for reconstruction, but that the FEM method employed, which used a medium mesh and a linear element computation, requires improvement in order to yield the expected benefits.