Segmentation of the Globus Pallidus Internus Using Probabilistic Diffusion Tractography for Deep Brain Stimulation Targeting in Parkinson Disease.

BACKGROUND AND PURPOSE: Although globus pallidus internus deep brain stimulation is a widely accepted treatment for Parkinson disease, there is persistent variability in outcomes that is not yet fully understood. In this pilot study, we aimed to investigate the potential role of globus pallidus internus segmentation using probabilistic tractography as a supplement to traditional targeting methods. MATERIALS AND METHODS: Eleven patients undergoing globus pallidus internus deep brain stimulation were included in this retrospective analysis. Using multidirection diffusion-weighted MR imaging, we performed probabilistic tractography at all individual globus pallidus internus voxels. Each globus pallidus internus voxel was then assigned to the 1 ROI with the greatest number of propagated paths. On the basis of deep brain stimulation programming settings, the volume of tissue activated was generated for each patient using a finite element method solution. For each patient, the volume of tissue activated within each of the 10 segmented globus pallidus internus regions was calculated and examined for association with a change in the Unified Parkinson Disease Rating Scale, Part III score before and after treatment. RESULTS: Increasing volume of tissue activated was most strongly correlated with a change in the Unified Parkinson Disease Rating Scale, Part III score for the primary motor region (Spearman r = 0.74, P = .010), followed by the supplementary motor area/premotor cortex (Spearman r = 0.47, P = .15). CONCLUSIONS: In this pilot study, we assessed a novel method of segmentation of the globus pallidus internus based on probabilistic tractography as a supplement to traditional targeting methods. Our results suggest that our method may be an independent predictor of deep brain stimulation outcome, and evaluation of a larger cohort or prospective study is warranted to validate these findings.

Reduction of Motion Artifacts and Noise Using Independent Component Analysis in Task-Based Functional MRI for Preoperative Planning in Patients with Brain Tumor.

BACKGROUND AND PURPOSE: Although it is a potentially powerful presurgical tool, fMRI can be fraught with artifacts, leading to interpretive errors, many of which are not fully accounted for in routinely applied correction methods. The purpose of this investigation was to evaluate the effects of data denoising by independent component analysis in patients undergoing preoperative evaluation for glioma resection compared with more routinely applied correction methods such as realignment or motion scrubbing. MATERIALS AND METHODS: Thirty-five functional runs (both motor and language) in 12 consecutive patients with glioma were analyzed retrospectively by double-blind review. Data were processed and compared with the following: 1) realignment alone, 2) motion scrubbing, 3) independent component analysis denoising, and 4) both independent component analysis denoising and motion scrubbing. Primary outcome measures included a change in false-positives, false-negatives, z score, and diagnostic rating. RESULTS: Independent component analysis denoising reduced false-positives in 63% of studies versus realignment alone. There was also an increase in the z score in areas of true activation in 71.4% of studies. Areas of new expected activation (previous false-negatives) were revealed in 34.4% of cases with independent component analysis denoising versus motion scrubbing or realignment alone. Of studies deemed nondiagnostic with realignment or motion scrubbing alone, 65% were considered diagnostic after independent component analysis denoising. CONCLUSIONS: The addition of independent component analysis denoising of fMRI data in preoperative patients with glioma has a significant impact on data quality, resulting in reduced false-positives and an increase in true-positives compared with more commonly applied motion scrubbing or simple realignment methods.

Atypical imaging findings of infantile hemangioendothelioma: a case report.

Infantile hemangioendothelioma is the third most common hepatic tumor in children, and the most common benign vascular tumor of the liver in infancy. On computed tomography (CT) and magnetic resonance imaging (MRI), typical enhancement patterns similar to those seen in adult hemangiomas may help establish the diagnosis. However, atypical enhancement patterns may also occur. In this paper, we report a rare form of solitary infantile hemangioendothelioma that showed a rim-like calcification and rim-like enhancement on CT and MRI.