Evaluation of the Aggregated Time Savings in Adopting Fast Brain MRI Techniques for Outpatient Brain MRI.

INTRODUCTION: Clinical validation studies have demonstrated the ability of accelerated MRI sequences to decrease acquisition time and motion artifact while preserving image quality. The operational benefits, however, have been less explored. Here, we report our initial clinical experience in implementing fast MRI techniques for outpatient brain imaging during the COVID-19 pandemic. METHODS: Aggregate acquisition times were extracted from the medical record on consecutive imaging examinations performed during matched pre-implementation (7/1/2019-12/31/2019) and post-implementation periods (7/1/2020-12/31/2020). Expected acquisition time reduction for each MRI protocol was calculated through manual collection of acquisition times for the conventional and accelerated sequences performed during the pre- and post-implementation periods. Aggregate and expected acquisition times were compared for the five most frequently performed brain MRI protocols: brain without contrast (BR-), brain with and without contrast (BR+), multiple sclerosis (MS), memory loss (MML), and epilepsy (EPL). RESULTS: The expected time reductions for BR-, BR+, MS, MML, and EPL protocols were 6.6 min, 11.9 min, 14 min, 10.8 min, and 14.1 min, respectively. The overall median aggregate acquisition time was 31 [25, 36] min for the pre-implementation period and 18 [15, 22] min for the post-implementation period, with a difference of 13 min (42%). The median acquisition time was reduced by 4 min (25%) for BR-, 14.0 min (44%) for BR+, 14 min (38%) for MS, 11 min (52%) for MML, and 16 min (35%) for EPL. CONCLUSION: The implementation of fast brain MRI sequences significantly reduced the acquisition times for the most commonly performed outpatient brain MRI protocols.

Aberrant impulse control circuitry in obesity.

The ventromedial prefrontal cortex (vmPFC) to nucleus accumbens (NAc) circuit has been implicated in impulsive reward-seeking. This disinhibition has been implicated in obesity and often manifests as binge eating, which is associated with worse treatment outcomes and comorbidities. It remains unclear whether the vmPFC-NAc circuit is perturbed in impulsive eaters with obesity. Initially, we analyzed publicly available, high-resolution, normative imaging data to localize where vmPFC structural connections converged within the NAc. These structural connections were found to converge ventromedially in the presumed NAc shell subregion. We then analyzed multimodal clinical and imaging data to test the a priori hypothesis that the vmPFC-NAc shell circuit is linked to obesity in a sample of female participants that regularly engaged in impulsive eating (i.e., binge eating). Functionally, vmPFC-NAc shell resting-state connectivity was inversely related to body mass index (BMI) and decreased in the obese state. Structurally, vmPFC-NAc shell structural connectivity and vmPFC thickness were inversely correlated with BMI; obese binge-prone participants exhibited decreased vmPFC-NAc structural connectivity and vmPFC thickness. Finally, to examine a causal link to binge eating, we directly probed this circuit in one binge-prone obese female using NAc deep brain stimulation in a first-in-human trial. Direct stimulation of the NAc shell subregion guided by local behaviorally relevant electrophysiology was associated with a decrease in number of weekly episodes of uncontrolled eating and decreased BMI. This study unraveled vmPFC-NAc shell circuit aberrations in obesity that can be modulated to restore control over eating behavior in obesity.

High-fidelity fast volumetric brain MRI using synergistic wave-controlled aliasing in parallel imaging and a hybrid denoising generative adversarial network (HDnGAN).

PURPOSE: The goal of this study is to leverage an advanced fast imaging technique, wave-controlled aliasing in parallel imaging (Wave-CAIPI), and a generative adversarial network (GAN) for denoising to achieve accelerated high-quality high-signal-to-noise-ratio (SNR) volumetric magnetic resonance imaging (MRI). METHODS: Three-dimensional (3D) T2 -weighted fluid-attenuated inversion recovery (FLAIR) image data were acquired on 33 multiple sclerosis (MS) patients using a prototype Wave-CAIPI sequence (acceleration factor R = 3 × 2, 2.75 min) and a standard T2 -sampling perfection with application-optimized contrasts by using flip angle evolution (SPACE) FLAIR sequence (R = 2, 7.25 min). A hybrid denoising GAN entitled "HDnGAN" consisting of a 3D generator and a 2D discriminator was proposed to denoise highly accelerated Wave-CAIPI images. HDnGAN benefits from the improved image synthesis performance provided by the 3D generator and increased training samples from a limited number of patients for training the 2D discriminator. HDnGAN was trained and validated on data from 25 MS patients with the standard FLAIR images as the target and evaluated on data from eight MS patients not seen during training. HDnGAN was compared to other denoising methods including adaptive optimized nonlocal means (AONLM), block matching with 4D filtering (BM4D), modified U-Net (MU-Net), and 3D GAN in qualitative and quantitative analysis of output images using the mean squared error (MSE) and Visual Geometry Group (VGG) perceptual loss compared to standard FLAIR images, and a reader assessment by two neuroradiologists regarding sharpness, SNR, lesion conspicuity, and overall quality. Finally, the performance of these denoising methods was compared at higher noise levels using simulated data with added Rician noise. RESULTS: HDnGAN effectively denoised low-SNR Wave-CAIPI images with sharpness and rich textural details, which could be adjusted by controlling the contribution of the adversarial loss to the total loss when training the generator. Quantitatively, HDnGAN (λ = 10-3 ) achieved low MSE and the lowest VGG perceptual loss. The reader study showed that HDnGAN (λ = 10-3 ) significantly improved the SNR of Wave-CAIPI images (p < 0.001), outperformed AONLM (p = 0.015), BM4D (p < 0.001), MU-Net (p < 0.001), and 3D GAN (λ = 10-3 ) (p < 0.001) regarding image sharpness, and outperformed MU-Net (p < 0.001) and 3D GAN (λ = 10-3 ) (p = 0.001) regarding lesion conspicuity. The overall quality score of HDnGAN (λ = 10-3 ) (4.25 ± 0.43) was significantly higher than those from Wave-CAIPI (3.69 ± 0.46, p = 0.003), BM4D (3.50 ± 0.71, p = 0.001), MU-Net (3.25 ± 0.75, p < 0.001), and 3D GAN (λ = 10-3 ) (3.50 ± 0.50, p < 0.001), with no significant difference compared to standard FLAIR images (4.38 ± 0.48, p = 0.333). The advantages of HDnGAN over other methods were more obvious at higher noise levels. CONCLUSION: HDnGAN provides robust and feasible denoising while preserving rich textural detail in empirical volumetric MRI data. Our study using empirical patient data and systematic evaluation supports the use of HDnGAN in combination with modern fast imaging techniques such as Wave-CAIPI to achieve high-fidelity fast volumetric MRI and represents an important step to the clinical translation of GANs.

An Artificial Intelligence-Based Chest X-ray Model on Human Nodule Detection Accuracy From a Multicenter Study.

Importance: Most early lung cancers present as pulmonary nodules on imaging, but these can be easily missed on chest radiographs. Objective: To assess if a novel artificial intelligence (AI) algorithm can help detect pulmonary nodules on radiographs at different levels of detection difficulty. Design, Setting, and Participants: This diagnostic study included 100 posteroanterior chest radiograph images taken between 2000 and 2010 of adult patients from an ambulatory health care center in Germany and a lung image database in the US. Included images were selected to represent nodules with different levels of detection difficulties (from easy to difficult), and comprised both normal and nonnormal control. Exposures: All images were processed with a novel AI algorithm, the AI Rad Companion Chest X-ray. Two thoracic radiologists established the ground truth and 9 test radiologists from Germany and the US independently reviewed all images in 2 sessions (unaided and AI-aided mode) with at least a 1-month washout period. Main Outcomes and Measures: Each test radiologist recorded the presence of 5 findings (pulmonary nodules, atelectasis, consolidation, pneumothorax, and pleural effusion) and their level of confidence for detecting the individual finding on a scale of 1 to 10 (1 representing lowest confidence; 10, highest confidence). The analyzed metrics for nodules included sensitivity, specificity, accuracy, and receiver operating characteristics curve area under the curve (AUC). Results: Images from 100 patients were included, with a mean (SD) age of 55 (20) years and including 64 men and 36 women. Mean detection accuracy across the 9 radiologists improved by 6.4% (95% CI, 2.3% to 10.6%) with AI-aided interpretation compared with unaided interpretation. Partial AUCs within the effective interval range of 0 to 0.2 false positive rate improved by 5.6% (95% CI, -1.4% to 12.0%) with AI-aided interpretation. Junior radiologists saw greater improvement in sensitivity for nodule detection with AI-aided interpretation as compared with their senior counterparts (12%; 95% CI, 4% to 19% vs 9%; 95% CI, 1% to 17%) while senior radiologists experienced similar improvement in specificity (4%; 95% CI, -2% to 9%) as compared with junior radiologists (4%; 95% CI, -3% to 5%). Conclusions and Relevance: In this diagnostic study, an AI algorithm was associated with improved detection of pulmonary nodules on chest radiographs compared with unaided interpretation for different levels of detection difficulty and for readers with different experience.

A Frequency-Programmable Miniaturized Radio Frequency Transmitter for Animal Tracking.

In animal tracking applications, smaller transmitters can reduce the impact of the transmitter on the tagged animal and thus provide more accurate data about animal behavior. By combining a novel circuit design and a newly developed micro-battery, we developed frequency-programmable and more powerful radio frequency transmitters that are about 40% smaller and lighter in weight than the smallest commercial counterpart for animal monitoring at the time of development. The new radio frequency transmitter has a miniaturized form factor for studying small animals. Designs of two coding schemes were developed: one transmits unmodulated signals (weight: 152 mg; dimensions: Ø 2.95 mm × 11.22 mm), and the other transmits modulated signals (weight: 160 mg; dimensions: Ø 2.95 mm × 11.85 mm). To accommodate different transmitter life requirements, each design can be configured to transmit in high or low signal strength. Prototypes of these transmitters were evaluated in the laboratory and exhibited comparable or longer service life and higher signal strength compared to their smallest commercial counterparts.

Multimodal characterization of the human nucleus accumbens.

Dysregulation of the nucleus accumbens (NAc) is implicated in numerous neuropsychiatric disorders. Treatments targeting this area directly (e.g. deep brain stimulation) demonstrate variable efficacy, perhaps owing to non-specific targeting of a functionally heterogeneous nucleus. Here we provide support for this notion, first observing disparate behavioral effects in response to direct simulation of different locations within the NAc in a human patient. These observations motivate a segmentation of the NAc into subregions, which we produce from a diffusion-tractography based analysis of 245 young, unrelated healthy subjects. We further explore the mechanism of these stimulation-induced behavioral responses by identifying the most probable subset of axons activated using a patient-specific computational model. We validate our diffusion-based segmentation using evidence from several modalities, including MRI-based measures of function and microstructure, human post-mortem immunohistochemical staining, and cross-species comparison of cortical-NAc projections that are known to be conserved. Finally, we visualize the passage of individual axon bundles through one NAc subregion in a post-mortem human sample using CLARITY 3D histology corroborated by 7T tractography. Collectively, these findings extensively characterize human NAc subregions and provide insight into their structural and functional distinctions with implications for stereotactic treatments targeting this region.

Frameless stereotactic dual lead placement through single burr hole: A technical report.

Deep Brain Stimulation (DBS) surgery is a neurosurgical procedure involving the placement of stimulatory leads in subcortical structures. Rarely, DBS requires placement of dual ipsilateral leads. Previously, techniques for placing dual ipsilateral leads through a single burr hole were reported using a traditional stereotactic frame. Here, we demonstrate that dual ipsilateral leads can be safely and effectively placed through a single burr hole using a frameless stereotactic DBS system (NexFrame®) with only simple modifications to existing equipment.

Early Cerebral Vein After Endovascular Ischemic Stroke Treatment Predicts Symptomatic Reperfusion Hemorrhage.

BACKGROUND AND PURPOSE: Parenchymal hemorrhage (PH) after endovascular mechanical thrombectomy in acute ischemic stroke leads to worse outcomes. Better clinical and imaging biomarkers of symptomatic reperfusion PH are needed to identify patients at risk. We identified clinical and imaging predictors of reperfusion PH after endovascular mechanical thrombectomy with attention to early cerebral veins (ECVs) on postreperfusion digital subtraction angiography. METHODS: We performed a retrospective cohort study of consecutive acute ischemic stroke patients undergoing endovascular mechanical thrombectomy at our neurovascular referral center. Clinical and imaging characteristics were collected from patient health records, and random forest variable importance measures were used to identify predictors of symptomatic PH. Predictors of secondary outcomes, including 90-day mortality, functional dependence (modified Rankin Scale score, >2), and National Institutes of Health Stroke Scale shift, were also determined. Diagnostic test characteristics of ECV for symptomatic PH were determined using a receiver operating characteristic analysis. Differences between patients with and without symptomatic PH were assessed with Fisher exact test and the Wilcoxon rank sum (Mann-Whitney U test) test at the 0.05 significance level. RESULTS: Of 64 patients with anterior circulation large-vessel occlusion identified, 6 (9.4%) developed symptomatic PH. ECV was the strongest predictor of symptomatic PH with more than twice the importance of the next best predictor, male sex. Although ECV was also predictive of 90-day mortality and functional dependence, other characteristics were more important than ECV for these outcomes. The sensitivity and specificity of ECV alone for subsequent hemorrhage were both 0.83, with an area under the curve of 0.83 and 95% confidence interval of 0.66 to 1.00. CONCLUSIONS: ECV on postendovascular mechanical thrombectomy digital subtraction angiography is highly diagnostic of subsequent symptomatic reperfusion hemorrhage in this data set. This finding has important implications for post-treatment management of blood pressure and anticoagulation.

Wide-Temperature Electrolytes for Lithium-Ion Batteries.

Formulating electrolytes with solvents of low freezing points and high dielectric constants is a direct approach to extend the service-temperature range of lithium (Li)-ion batteries (LIBs). In this study, we report such wide-temperature electrolyte formulations by optimizing the ethylene carbonate (EC) content in the ternary solvent system of EC, propylene carbonate (PC), and ethyl methyl carbonate (EMC) with LiPF6 salt and CsPF6 additive. An extended service-temperature range from -40 to 60 °C was obtained in LIBs with lithium nickel cobalt aluminum oxide (LiNi0.80Co0.15Al0.05O2, NCA) as cathode and graphite as anode. The discharge capacities at low temperatures and the cycle life at room temperature and elevated temperatures were systematically investigated together with the ionic conductivity and phase-transition behaviors. The most promising electrolyte formulation was identified as 1.0 M LiPF6 in EC-PC-EMC (1:1:8 by wt) with 0.05 M CsPF6, which was demonstrated in both coin cells of graphite∥NCA and 1 Ah pouch cells of graphite∥LiNi1/3Mn1/3Co1/3O2. This optimized electrolyte enables excellent wide-temperature performances, as evidenced by the high capacity retention (68%) at -40 °C and C/5 rate, significantly higher than that (20%) of the conventional LIB electrolyte, and the nearly identical stable cycle life as the conventional LIB electrolyte at room temperature and elevated temperatures up to 60 °C.

Micro-battery development for juvenile salmon acoustic telemetry system applications.

The Endangered Species Act requires actions that improve the passage and survival rates for migrating salmonoids and other fish species that sustain injury and mortality when passing through hydroelectric dams. To develop a low-cost revolutionary acoustic transmitter that may be injected instead of surgically implanted into the fish, one major challenge that needs to be addressed is the micro-battery power source. This work focuses on the design and fabrication of micro-batteries for injectable fish tags. High pulse current and required service life have both been achieved as well as doubling the gravimetric energy density of the battery. The newly designed micro-batteries have intrinsically low impedance, leading to significantly improved electrochemical performances at low temperatures as compared with commercial SR416 batteries. Successful field trial by using the micro-battery powered transmitters injected into fish has been demonstrated, providing an exemplary model of transferring fundamental research into practical devices with controlled qualities.

Neural antecedents of social decision-making in a partner choice task.

Experiments in financial decision-making point to two complementary processes that encode prospective gain and loss preceding the choice to purchase consumer goods. These processes involve the nucleus accumbens (NAcc) and the right anterior insula, respectively. The current experiment used functional MRI to investigate whether these regions served a similar function during an analogous social decision-making task without the influence of monetary outcomes. In this task, subjects chose partners based on face stimuli of varying attractiveness (operationalizing value) and ratings of compatibility with the participant (operationalizing likelihood of rejection). The NAcc responded to anticipated gain; the right anterior insula responded to compatibility, but not in a manner that suggests an analogy to anticipated cost. Logistic regression modeling demonstrated that both regions predicted subsequent choice above and beyond the influence of group attractiveness ratings or compatibility alone. Although the function of the insula may differ between tasks, these results suggest that financial and social decision-making recruit a similar network of brain regions.