Feasibility of estimation of brain volume and 2-deoxy-2-(18)F-fluoro-D-glucose metabolism using a novel automated image analysis method: application in Alzheimer's disease.

The development of clinically-applicable quantitative methods for the analysis of brain fluorine-18 fluoro desoxyglucose-positron emission tomography ((18)F-FDG-PET) images is a major area of research in many neurologic diseases, particularly Alzheimer's disease (AD). Region of interest visualization, evaluation, and image registration (ROVER) is a novel commercially-available software package which provides automated partial volume corrected measures of volume and glucose uptake from (18)F-FDG PET data. We performed a pilot study of ROVER analysis of brain (18)F-FDG PET images for the first time in a small cohort of patients with AD and controls. Brain (18)F-FDG-PET and volumetric magnetic resonance imaging (MRI) were performed on 14 AD patients and 18 age-matched controls. Images were subjected to ROVER analysis, and voxel-based analysis using SPM5. Volumes by ROVER were 35% lower than MRI volumes in AD patients (as hypometabolic regions were excluded in ROVER-derived volume measurement ) while average ROVER- and MRI-derived cortical volumes were nearly identical in control population. Whole brain volumes when ROVER-derived and whole brain metabolic volumetric products (MVP) were significantly lower in AD and accurately distinguished AD patients from controls (Area Under the Curve (AUC) of Receiver Operator Characteristic (ROC) curves 0.89 and 0.86, respectively). This diagnostic accuracy was similar to voxel-based analyses. Analysis by ROVER of (18)F-FDG-PET images provides a unique index of metabolically-active brain volume, and can accurately distinguish between AD patients and controls as a proof of concept. In conclusion, our findings suggest that ROVER may serve as a useful quantitative adjunct to visual or regional assessment and aid analysis of whole-brain metabolism in AD and other neurologic and psychiatric diseases.

CAVASS: a computer-assisted visualization and analysis software system.

The Medical Image Processing Group at the University of Pennsylvania has been developing (and distributing with source code) medical image analysis and visualization software systems for a long period of time. Our most recent system, 3DVIEWNIX, was first released in 1993. Since that time, a number of significant advancements have taken place with regard to computer platforms and operating systems, networking capability, the rise of parallel processing standards, and the development of open-source toolkits. The development of CAVASS by our group is the next generation of 3DVIEWNIX. CAVASS will be freely available and open source, and it is integrated with toolkits such as Insight Toolkit and Visualization Toolkit. CAVASS runs on Windows, Unix, Linux, and Mac but shares a single code base. Rather than requiring expensive multiprocessor systems, it seamlessly provides for parallel processing via inexpensive clusters of work stations for more time-consuming algorithms. Most importantly, CAVASS is directed at the visualization, processing, and analysis of 3-dimensional and higher-dimensional medical imagery, so support for digital imaging and communication in medicine data and the efficient implementation of algorithms is given paramount importance.

Age-related structural and functional changes in the breast: multimodality correlation with digital mammography, computed tomography, magnetic resonance imaging, and positron emission tomography.

Preliminary results generated from digital mammography, computed tomography, magnetic resonance imaging, and (18)F-fluorodeoxyglucose positron emission tomography demonstrate concordant findings of decreasing glandular tissue and decreasing metabolic activity with increasing age. These results are presented in the context of a detailed literature review summarizing age-related changes in the breast, both from the histologic/physiologic and the imaging perspectives. We also discuss potential applications of this approach and emphasize the importance of new advanced imaging technologies to offer high levels of quantitative precision for tissue characterization for research and clinical purposes.

Structural and functional imaging of normal bone marrow and evaluation of its age-related changes.

A number of noninvasive imaging techniques have been used for the evaluation of bone marrow, including magnetic resonance imaging (MRI) and bone marrow scintigraphy. The appearance of bone marrow on MRI varies considerably depending on the proportion of red and yellow marrow, and the composition of the red marrow and its distribution with relation to age and sex. The composition of bone marrow also can vary under physiological and pathological conditions. MRI is a highly sensitive technique for evaluating the bone marrow, but it is limited in its practical use for whole-body bone marrow screening. Bone marrow scintigraphy with radiolabeled compounds such as technetium-99m-labeled nanocolloid and monoclonal antibodies has the advantage of evaluating the entire bone marrow, and has been used for the diagnosis of various bone marrow disorders. In addition, (18)F-fluorodeoxyglucose positron emission tomography (FDG-PET) imaging can be used to evaluate bone marrow metabolism and disease and to provide information about the state of the primary tumor, lymph nodes, and distant metastases. Understanding of the appearance of normal bone marrow, including age- and sex-specific differences with each of these imaging modalities, is essential to permit accurate diagnosis of benign and malignant bone marrow disorders. We present a review of MRI and scintigraphy of normal bone marrow with some emphasis on FDG-PET imaging in assessing marrow activity in normal and abnormal states and also present preliminary data regarding normal age-related changes in bone marrow through use of FDG-PET, as well as the role of segmentation of bone marrow on MRI for quantitative calculation of the metabolic volumetric product for red marrow metabolism using FDG-PET.

Detection of age-related changes in thoracic structure and function by computed tomography, magnetic resonance imaging, and positron emission tomography.

It is useful to understand the normal changes in structure and function in the thorax that occur with age. Thus, we present the following quantitative preliminary data obtained from retrospective quantitative analysis of computed tomography (CT) and positron emission tomography (PET) examinations in subjects 0 to 90 years of age: Mean lung standard uptake values were found to significantly increase with increasing age and with increasing body mass index (BMI). Mean lung attenuation was seen to statistically significantly decrease with increasing age in subjects who had a CT scan, had a nonsignificant tendency to decrease with increasing age in subjects with a PET/CT scan, had a nonsignificant tendency to increase with increasing BMI, and was seen to significantly increase with increasing mean lung standard uptake values. Mean lung volumes were not noted to significantly change with increasing age in adult subjects whether or not they were normalized to the craniocaudal thoracic lengths, although mean lung volumes significantly increased with increasing age in pediatric subjects. Mean lung volumes had a nonsignificant tendency to decrease with increasing BMI, although normalized mean lung volumes significantly decreased with increasing BMI. Lung metabolic volumetric products were not noted to significantly change with increasing BMI or with increasing age. In this work, we also review the literature regarding normal structural and functional changes in the thorax with age.