Reliability of Skeletal Muscle Area Measurement on CT with Different Parameters: A Phantom Study.

OBJECTIVE: To evaluate the reliability of CT measurements of muscle quantity and quality using variable CT parameters. MATERIALS AND METHODS: A phantom, simulating the L2-4 vertebral levels, was used for this study. CT images were repeatedly acquired with modulation of tube voltage, tube current, slice thickness, and the image reconstruction algorithm. Reference standard muscle compartments were obtained from the reference maps of the phantom. Cross-sectional area based on the Hounsfield unit (HU) thresholds of muscle and its components, and the mean density of the reference standard muscle compartment, were used to measure the muscle quantity and quality using different CT protocols. Signal-to-noise ratios (SNRs) were calculated in the images acquired with different settings. RESULTS: The skeletal muscle area (threshold, ?29 to 150 HU) was constant, regardless of the protocol, occupying at least 91.7% of the reference standard muscle compartment. Conversely, normal attenuation muscle area (30-150 HU) was not constant in the different protocols, varying between 59.7% and 81.7% of the reference standard muscle compartment. The mean density was lower than the target density stated by the manufacturer (45 HU) in all cases (range, 39.0-44.9 HU). The SNR decreased with low tube voltage, low tube current, and in sections with thin slices, whereas it increased when the iterative reconstruction algorithm was used. CONCLUSION: Measurement of muscle quantity using HU threshold was reliable, regardless of the CT protocol used. Conversely, the measurement of muscle quality using the mean density and narrow HU thresholds were inconsistent and inaccurate across different CT protocols. Therefore, further studies are warranted in future to determine the optimal CT protocols for reliable measurements of muscle quality.

Robust detection of event-related potentials in a user-voluntary short-term imagery task.

Event-related potentials (ERPs) represent neuronal activity in the brain elicited by external visual or auditory stimulation and are widely used in brain-computer interface (BCI) systems. The ERP responses are elicited a few milliseconds after attending to an oddball stimulus; target and non-target stimuli are repeatedly flashed, and the ERP trials are averaged over time in order to improve their decoding accuracy. To reduce this time-consuming process, previous studies have attempted to evoke stronger ERP responses by changing certain experimental parameters like color, size, or the use of a face image as a target symbol. Since these exogenous potentials can be naturally evoked by merely looking at a target symbol, the BCI system could generate unintended commands while subjects are gazing at one of the symbols in a non-intentional mental state. We approached this problem of unintended command generation by assuming that a greater effort by the user in a short-term imagery task would evoke a discriminative ERP response. Three tasks were defined: passive attention, counting, and pitch-imagery. Users were instructed to passively attend to a target symbol, or to perform a mental tally of the number of target presentations, or to perform the novel task of imagining a high-pitch tone when the target symbol was highlighted. The decoding accuracy were 71.4%, 83.5%, and 89.2% for passive attention, counting, and pitch-imagery, respectively, after the fourth averaging procedure. We found stronger deflections in the N500 component corresponding to the levels of mental effort (passive attention: -1.094 ±0.88 µV, counting: -2.226 ±0.97 µV, and pitch-imagery: -2.883 ±0.74 µV), which highly influenced the decoding accuracy. In addition, the rate of binary classification between passive attention and pitch-imagery tasks was 73.5%, which is an adequate classification rate that motivated us to propose a two-stage classification strategy wherein the target symbols are estimated in the first stage and the passive or active mental state is decoded in the second stage. In this study, we found that the ERP response and the decoding accuracy are highly influenced by the user's voluntary mental tasks. This could lead to a useful approach in practical ERP systems in two respects. Firstly, the user-voluntary tasks can be easily utilized in many different types of BCI systems, and performance enhancement is less dependent on the manipulation of the system's external, visual stimulus parameters. Secondly, we propose an ERP system that classifies the brain state as intended or unintended by considering the measurable differences between passively gazing and actively performing the pitch-imagery tasks in the EEG signal thus minimizing unintended commands to the BCI system.