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1.  Deriving Hounsfield units using grey levels in cone beam computed tomography 
Dentomaxillofacial Radiology  2010;39(6):323-335.
Objectives
An in vitro study was performed to investigate the relationship between grey levels in dental cone beam CT (CBCT) and Hounsfield units (HU) in CBCT scanners.
Methods
A phantom containing 8 different materials of known composition and density was imaged with 11 different dental CBCT scanners and 2 medical CT scanners. The phantom was scanned under three conditions: phantom alone and phantom in a small and large water container. The reconstructed data were exported as Digital Imaging and Communications in Medicine (DICOM) and analysed with On Demand 3D® by Cybermed, Seoul, Korea. The relationship between grey levels and linear attenuation coefficients was investigated.
Results
It was demonstrated that a linear relationship between the grey levels and the attenuation coefficients of each of the materials exists at some “effective” energy. From the linear regression equation of the reference materials, attenuation coefficients were obtained for each of the materials and CT numbers in HU were derived using the standard equation.
Conclusions
HU can be derived from the grey levels in dental CBCT scanners using linear attenuation coefficients as an intermediate step.
doi:10.1259/dmfr/19603304
PMCID: PMC3520236  PMID: 20729181
Hounsfield units; cone beam computed tomography; grey levels
2.  Medical Image Compression Based on Vector Quantization with Variable Block Sizes in Wavelet Domain 
An optimized medical image compression algorithm based on wavelet transform and improved vector quantization is introduced. The goal of the proposed method is to maintain the diagnostic-related information of the medical image at a high compression ratio. Wavelet transformation was first applied to the image. For the lowest-frequency subband of wavelet coefficients, a lossless compression method was exploited; for each of the high-frequency subbands, an optimized vector quantization with variable block size was implemented. In the novel vector quantization method, local fractal dimension (LFD) was used to analyze the local complexity of each wavelet coefficients, subband. Then an optimal quadtree method was employed to partition each wavelet coefficients, subband into several sizes of subblocks. After that, a modified K-means approach which is based on energy function was used in the codebook training phase. At last, vector quantization coding was implemented in different types of sub-blocks. In order to verify the effectiveness of the proposed algorithm, JPEG, JPEG2000, and fractal coding approach were chosen as contrast algorithms. Experimental results show that the proposed method can improve the compression performance and can achieve a balance between the compression ratio and the image visual quality.
doi:10.1155/2012/541890
PMCID: PMC3459264  PMID: 23049544
3.  Inter-individual differences in empathy are reflected in human brain structure 
Neuroimage  2012;62(3):2034-2039.
Empathy is a multi-faceted concept consisting of our ability not only to share emotions but also to exert cognitive control and perspective taking in our interactions with others. Here we examined whether inter-individual variability in different components of empathy was related to differences in brain structure assessed using voxel-based morphometry. Following a magnetic resonance imaging (MRI) scan, participants completed the Interpersonal Reactivity Index (IRI). Multiple regression was then used to assess the relationship between individual differences in grey matter volume and individual differences in empathy traits. We found that individual differences in affective empathic abilities oriented towards another person were negatively correlated with grey matter volume in the precuneus, inferior frontal gyrus, and anterior cingulate. Differences in self-oriented affective empathy were negatively correlated with grey matter volume of the somatosensory cortex, but positively correlated with volume in the insula; cognitive perspective taking abilities were positively correlated with grey matter volume of the anterior cingulate; and the ability to empathise with fictional characters was positively related to grey matter changes in the right dorsolateral prefrontal cortex. These findings are discussed in relation to neurocognitive models of empathy.
Highlights
► We studied how individual variability in empathy is linked to brain structure. ► Affective empathy was linked to changes in the precuneus and anterior cingulate. ► Changes in the inferior frontal gyrus were also linked with affective empathy. ► Perspective taking was related to changes in the anterior cingulate. ► Personal distress was linked to changes in the somatosensory cortex and insula.
doi:10.1016/j.neuroimage.2012.05.081
PMCID: PMC3778747  PMID: 22683384
Empathy; Voxel based morphometry; Interpersonal reactivity index; Structure; Individual differences; Social neuroscience
4.  Quality Degradation in Lossy Wavelet Image Compression  
Journal of Digital Imaging  2003;16(2):210-215.
The objective of this study was to develop a method for measuring quality degradation in lossy wavelet image compression. Quality degradation is due to denoising and edge blurring effects that cause smoothness in the compressed image. The peak Moran z histogram ratio between the reconstructed and original images is used as an index for degradation after image compression. The Moran test is applied to images randomly selected from each medical modality, computerized tomography, magnetic resonance imaging, and computed radiography and compressed using the wavelet compression at various levels. The relationship between the quality degradation and compression ratio for each image modality agrees with previous reports that showed a preference for mildly compressed images. Preliminary results show that the peak Moran z histogram ratio can be used to quantify the quality degradation in lossy image compression. The potential for this method is applications for determining the optimal compression ratio (the maximized compression without seriously degrading image quality) of an image for teleradiology.
doi:10.1007/s10278-003-1652-0
PMCID: PMC3046470  PMID: 14517721
Wavelet compression; quality evaluation; Moran test
5.  Blind compressive sensing dynamic MRI 
IEEE transactions on medical imaging  2013;32(6):1132-1145.
We propose a novel blind compressive sensing (BCS) frame work to recover dynamic magnetic resonance images from undersampled measurements. This scheme models the dynamic signal as a sparse linear combination of temporal basis functions, chosen from a large dictionary. In contrast to classical compressed sensing, the BCS scheme simultaneously estimates the dictionary and the sparse coefficients from the undersampled measurements. Apart from the sparsity of the coefficients, the key difference of the BCS scheme with current low rank methods is the non-orthogonal nature of the dictionary basis functions. Since the number of degrees of freedom of the BCS model is smaller than that of the low-rank methods, it provides improved reconstructions at high acceleration rates. We formulate the reconstruction as a constrained optimization problem; the objective function is the linear combination of a data consistency term and sparsity promoting ℓ1 prior of the coefficients. The Frobenius norm dictionary constraint is used to avoid scale ambiguity. We introduce a simple and efficient majorize-minimize algorithm, which decouples the original criterion into three simpler sub problems. An alternating minimization strategy is used, where we cycle through the minimization of three simpler problems. This algorithm is seen to be considerably faster than approaches that alternates between sparse coding and dictionary estimation, as well as the extension of K-SVD dictionary learning scheme. The use of the ℓ1 penalty and Frobenius norm dictionary constraint enables the attenuation of insignificant basis functions compared to the ℓ0 norm and column norm constraint assumed in most dictionary learning algorithms; this is especially important since the number of basis functions that can be reliably estimated is restricted by the available measurements. We also observe that the proposed scheme is more robust to local minima compared to K-SVD method, which relies on greedy sparse coding. Our phase transition experiments demonstrate that the BCS scheme provides much better recovery rates than classical Fourier-based CS schemes, while being only marginally worse than the dictionary aware setting. Since the overhead in additionally estimating the dictionary is low, this method can be very useful in dynamic MRI applications, where the signal is not sparse in known dictionaries. We demonstrate the utility of the BCS scheme in accelerating contrast enhanced dynamic data. We observe superior reconstruction performance with the BCS scheme in comparison to existing low rank and compressed sensing schemes.
doi:10.1109/TMI.2013.2255133
PMCID: PMC3902976  PMID: 23542951
Dynamic MRI; undersampled reconstruction; blind compressed sensing
6.  The val158met COMT polymorphism's effect on atrophy in healthy aging and Parkinson's disease 
Neurobiology of Aging  2010;31(6):1064-1068.
We investigated whether the val158met functional polymorphism of catechol-o-methyltransferase influenced age-related changes in grey matter density and volume, both in healthy individuals (n = 80, ages 18–79) and those with Parkinson's disease (n = 50). Global grey matter volumes and voxelwise estimates of grey matter volume and density were determined from structural magnetic resonance images at 3 T. Male and female ValVal homozygotes (low prefrontal cortical dopamine) had more grey matter in early adulthood, but this difference disappeared with increasing age. The insula and ventral prefrontal cortex had higher grey matter volume in younger, but not older, ValVal homozygotes. Conversely, the dominant premotor cortex revealed genotypic differences in grey matter density in later life. There were no global or local interactions between Parkinson's disease and COMT val158met genotype on morphometry. Since the val158met polymorphism is associated with differences in cortical dopamine metabolism, our data suggest a role for dopamine in cortical development followed by differential vulnerability to cortical atrophy across the adult life span.
doi:10.1016/j.neurobiolaging.2008.07.009
PMCID: PMC3898476  PMID: 18755526
COMT; Catechol-o-methyltransferase; VBM; Parkinson's disease; Healthy aging; MRI
7.  Fractal Dimension Analysis of the Cortical Ribbon in Mild Alzheimer’s Disease 
NeuroImage  2010;53(2):471-479.
Fractal analysis methods are used to quantify the complexity of the human cerebral cortex. Many recent studies have focused on high resolution three-dimensional reconstructions of either the outer (pial) surface of the brain or the junction between the grey and white matter, but ignore the structure between these surfaces. This study uses a new method to incorporate the entire cortical thickness. Data were obtained from the Alzheimer’s Disease (AD) Neuroimaging Initiative database (Control N=35, Mild AD N=35). Image segmentation was performed using a semi-automated analysis program. The fractal dimensions of three cortical models (the pial surface, grey/white surface and entire cortical ribbon) were calculated using a custom cube-counting triangle-intersection algorithm. The fractal dimension of the cortical ribbon showed highly significant differences between control and AD subjects (p<0.001). The inner surface analysis also found smaller but significant differences (p< 0.05). The pial surface dimensionality was not significantly different between the two groups. All three models had a significant positive correlation with the cortical gyrification index (r > 0.55, p<0.001). Only the cortical ribbon had a significant correlation with cortical thickness (r = 0.832, p< 0.001) and the Alzheimer’s Disease Assessment Scale cognitive battery (r = −0.513, p = 0.002). The cortical ribbon dimensionality showed a larger effect size (d=1.12) in separating control and mild AD subjects than cortical thickness (d=1.01) or gyrification index (d=0.84). The methodological change shown in this paper may allow for further clinical application of cortical fractal dimension as a biomarker for structural changes that accrue with neurodegenerative diseases.
doi:10.1016/j.neuroimage.2010.06.050
PMCID: PMC2942777  PMID: 20600974
Fractal Dimension; Cortex; Complexity; Alzheimer’s disease; Cortical Thickness; Gyrification Index
8.  Estimation of Tree Size Diversity Using Object Oriented Texture Analysis and Aster Imagery 
Sensors (Basel, Switzerland)  2008;8(8):4709-4724.
This study investigates the potential of object-based texture parameters extracted from 15m spatial resolution ASTER imagery for estimating tree size diversity in a Mediterranean forested landscape in Turkey. Tree size diversity based on tree basal area was determined using the Shannon index and Gini Coefficient at the sampling plot level. Image texture parameters were calculated based on the grey level co-occurrence matrix (GLCM) for various image segmentation levels. Analyses of relationships between tree size diversity and texture parameters found that relationships between the Gini Coefficient and the GLCM values were the most statistically significant, with the highest correlation (r=0.69) being with GLCM Homogeneity values. In contrast, Shannon Index values were weakly correlated with image derived texture parameters. The results suggest that 15m resolution Aster imagery has considerable potential in estimating tree size diversity based on the Gini Coefficient for heterogeneous Mediterranean forests.
doi:10.3390/s8084709
PMCID: PMC3705467
Tree size diversity; remote sensing; brutian pine; texture analysis; image segmentation
9.  Temporal evolution of water diffusion parameters is different in grey and white matter in human ischaemic stroke 
Objectives: Our purpose was to investigate whether differences exist in the values and temporal evolution of mean diffusivity () and fractional anisotropy (FA) of grey and white matter after human ischaemic stroke.
Methods: Thirty two patients with lesions affecting both grey and white matter underwent serial diffusion tensor magnetic resonance imaging (DT-MRI) within 24 hours, and at 4–7 days, 10–14 days, 1 month, and 3 months after stroke. Multiple small circular regions of interest (ROI) were placed in the grey and white matter within the lesion and in the contralateral hemisphere. Values of {grey}, {white}, FA{grey} and FA{white} were measured in these ROI at each time point and the ratios of ischaemic to normal contralateral values (R and FAR) calculated.
Results: and FA showed different patterns of evolution after stroke. After an initial decline, the rate of increase of {grey} was faster than {white} from 4–7 to 10–14 days. FA{white} decreased more rapidly than FA{grey} during the first week, thereafter for both tissue types the FA decreased gradually. However, FA{white} was still higher than FA{grey} at three months indicating that some organised axonal structure remained. This effect was more marked in some patients than in others. R{grey} was significantly higher than R{white} within 24 hours and at 10–14 days (p<0.05), and FAR{white} was significantly more reduced than FAR{grey} at all time points (p<0.001).
Conclusions: The values and temporal evolution of and FA are different for grey and white matter after human ischaemic stroke. The observation that there is patient-to-patient variability in the degree of white matter structure remaining within the infarct at three months may have implications for predicting patient outcome.
doi:10.1136/jnnp.2003.033852
PMCID: PMC1738833  PMID: 15548489
10.  Anatomical correlates of blepharospasm 
Background
Focal dystonia is a neurological disorder characterized by unwanted muscle spasms. Blepharospasm is a focal dystonia producing an involuntary closure of the eyelid. Its etiology is unknown.
Objective
To investigate if there are structural changes in the white and grey matter of blepharospasm patients, and if the changes are related to disease features.
Methods
T1 and diffusion-weighted magnetic resonance imaging scans were collected from 14 female blepharospasm patients and 14 healthy matched controls. Grey matter volumes, fractional anisotropy (FA), and mean diffusivity maps were compared between the groups. Based on grey matter differences within the facial portion of the primary motor cortex, the corticobulbar tract was traced and compared between groups.
Results
Changes in grey matter in patients included the facial portion of the sensorimotor area and anterior cingulate gyrus. These changes did not correlate with disease duration. Corticobulbar tract volume and peak tract connectivity were decreased in patients compared with controls. There were no significant differences in FA or mean diffusivity between groups.
Conclusions
Grey matter changes within the primary sensorimotor and the anterior cingulate cortices in blepharospasm patients may help explain involuntary eyelid closure and the abnormal sensations often reported in this condition.
doi:10.1186/2047-9158-1-12
PMCID: PMC3514098  PMID: 23210426
Blepharospasm; Dystonia; Volumetric MRI; Magnetic resonance imaging; Diffusion weighted imaging
11.  Quality of Compressed Medical Images 
Journal of Digital Imaging  2007;20(2):149-159.
Previous studies have shown that Joint Photographic Experts Group (JPEG) 2000 compression is better than JPEG at higher compression ratio levels. However, some findings revealed that this is not valid at lower levels. In this study, the qualities of compressed medical images in these ratio areas (∼20), including computed radiography, computed tomography head and body, mammographic, and magnetic resonance T1 and T2 images, were estimated using both a pixel-based (peak signal to noise ratio) and two 8 × 8 window-based [Q index and Moran peak ratio (MPR)] metrics. To diminish the effects of blocking artifacts from JPEG, jump windows were used in both window-based metrics. Comparing the image quality indices between jump and sliding windows, the results showed that blocking artifacts were produced from JPEG compression, even at low compression ratios. However, even after the blocking artifacts were omitted in JPEG compressed images, JPEG2000 outperformed JPEG at low compression levels. We found in this study that the image contrast and the average gray level play important roles in image compression and quality evaluation. There were drawbacks in all metrics that we used. In the future, the image gray level and contrast effect should be considered in developing new objective metrics.
doi:10.1007/s10278-007-9013-z
PMCID: PMC3043905  PMID: 17318703
Image quality; JPEG; JPEG2000; image compression
12.  Depth-resolved model-based reconstruction of attenuation coefficients in optical coherence tomography 
Biomedical Optics Express  2013;5(1):322-337.
We present a method, based on a single scattering model, to calculate the attenuation coefficient of each pixel in optical coherence tomography (OCT) depth profiles. Numerical simulations were used to determine the model’s response to different depths and attenuation coefficients. Experiments were performed on uniform and layered phantoms with varying attenuation coefficients. They were measured by a 1300 nm OCT system and their attenuation coefficients were evaluated by our proposed method and by fitting the OCT slope as the gold standard. Both methods showed largely consistent results for the uniform phantoms. On the layered phantom, only our proposed method accurately estimated the attenuation coefficients. For all phantoms, the proposed method largely reduced the variability of the estimated attenuation coefficients. The method was illustrated on an in-vivo retinal OCT scan, effectively removing common imaging artifacts such as shadowing. By providing localized, per-pixel attenuation coefficients, this method enables tissue characterization based on attenuation coefficient estimates from OCT data.
doi:10.1364/BOE.5.000322
PMCID: PMC3891343  PMID: 24466497
(110.3010) Image reconstruction techniques; (110.3200) Inverse scattering; (110.4500) Optical coherence tomography; (170.4500) Optical coherence tomography; (170.4580) Optical diagnostics for medicine; (170.6935) Tissue characterization
13.  A Blurring Index for Medical Images 
Journal of Digital Imaging  2005;19(2):118-125.
This study was undertaken to investigate a useful image blurring index. This work is based on our previously developed method, the Moran peak ratio. Medical images are often deteriorated by noise or blurring. Image processing techniques are used to eliminate these two factors. The denoising process may improve image visibility with a trade-off of edge blurring and may introduce undesirable effects in an image. These effects also exist in images reconstructed using the lossy image compression technique. Blurring and degradation in image quality increases with an increase in the lossy image compression ratio. Objective image quality metrics [e.g., normalized mean square error (NMSE)] currently do not provide spatial information about image blurring. In this article, the Moran peak ratio is proposed for quantitative measurement of blurring in medical images. We show that the quantity of image blurring is dependent upon the ratio between the processed peak of Moran's Z histogram and the original image. The peak ratio of Moran's Z histogram can be used to quantify the degree of image blurring. This method produces better results than the standard gray level distribution deviation. The proposed method can also be used to discern blurriness in an image using different image compression algorithms.
doi:10.1007/s10278-005-8736-y
PMCID: PMC3045183  PMID: 16283091
Moran peak ratio; image blurring; image quality
14.  An Image Compression and Enhancement System for Diagnostic Electron Microscopy 
Data compression will reduce storage device problems and shorten the time required for transmission of high spatial resolution medical images. Thus far, two dimensional discrete cosine transform (DCT) appears to be the most efficient and promising. DCT was applied to 1K × 1K × 8 digitized images of diagnostic human tissue sections acquired by a scanning transmission electron microscope (STEM). The image data were reduced to 1 bit/pixel without noticeable degradation of image quality, and to 0.5 bits/pixel with slight degradation of image quality easily restored by enhancement. DCT appears to be the most efficient method of compression and decompression for medical images. It is possible to improve DCT compressed image quality with a small overhead by adding extra bits to the coefficients with a large variance.
Images
PMCID: PMC2578578
15.  Strongly reduced volumes of putamen and thalamus in Alzheimer's disease: an MRI study 
Brain  2008;131(12):3277-3285.
Atrophy is regarded a sensitive marker of neurodegenerative pathology. In addition to confirming the well-known presence of decreased global grey matter and hippocampal volumes in Alzheimer's disease, this study investigated whether deep grey matter structure also suffer degeneration in Alzheimer's disease, and whether such degeneration is associated with cognitive deterioration. In this cross-sectional correlation study, two groups were compared on volumes of seven subcortical regions: 70 memory complainers (MCs) and 69 subjects diagnosed with probable Alzheimer's disease. Using 3T 3D T1 MR images, volumes of nucleus accumbens, amygdala, caudate nucleus, hippocampus, pallidum, putamen and thalamus were automatically calculated by the FMRIB's Integrated Registration and Segmentation Tool (FIRST)—algorithm FMRIB's Software Library (FSL). Subsequently, the volumes of the different regions were correlated with cognitive test results. In addition to finding the expected association between hippocampal atrophy and cognitive decline in Alzheimer's disease, volumes of putamen and thalamus were significantly reduced in patients diagnosed with probable Alzheimer's disease. We also found that the decrease in volume correlated linearly with impaired global cognitive performance. These findings strongly suggest that, beside neo-cortical atrophy, deep grey matter structures in Alzheimer's disease suffer atrophy as well and that degenerative processes in the putamen and thalamus, like the hippocampus, may contribute to cognitive decline in Alzheimer's disease.
doi:10.1093/brain/awn278
PMCID: PMC2639208  PMID: 19022861
Alzheimer's disease; subcortical atrophy; thalamus; putamen; FIRST
16.  Reduced Hippocampal Volume in Healthy Young ApoE4 Carriers: An MRI Study 
PLoS ONE  2012;7(11):e48895.
The E4 allele of the ApoE gene has consistently been shown to be related to an increased risk of Alzheimer's disease (AD). The E4 allele is also associated with functional and structural grey matter (GM) changes in healthy young, middle-aged and older subjects. Here, we assess volumes of deep grey matter structures of 22 healthy younger ApoE4 carriers and 22 non-carriers (20–38 years). Volumes of the nucleus accumbens, amygdala, caudate nucleus, hippocampus, pallidum, putamen, thalamus and brain stem were calculated by FMRIB's Integrated Registration and Segmentation Tool (FIRST) algorithm. A significant drop in volume was found in the right hippocampus of ApoE4 carriers (ApoE4+) relative to non-carriers (ApoE4−), while there was a borderline significant decrease in the volume of the left hippocampus of ApoE4 carriers. The volumes of no other structures were found to be significantly affected by genotype. Atrophy has been found to be a sensitive marker of neurodegenerative changes, and our results show that within a healthy young population, the presence of the ApoE4+ carrier gene leads to volume reduction in a structure that is vitally important for memory formation. Our results suggest that the hippocampus may be particularly vulnerable to further degeneration in ApoE4 carriers as they enter middle and old age. Although volume reductions were noted bilaterally in the hippocampus, atrophy was more pronounced in the right hippocampus. This finding relates to previous work which has noted a compensatory increase in right hemisphere activity in ApoE4 carriers in response to preclinical declines in memory function. Possession of the ApoE4 allele may lead to greater predilection for right hemisphere atrophy even in healthy young subjects in their twenties.
doi:10.1371/journal.pone.0048895
PMCID: PMC3494711  PMID: 23152815
17.  Cardiac Magnetic Resonance Imaging for the Diagnosis of Coronary Artery Disease 
Executive Summary
In July 2009, the Medical Advisory Secretariat (MAS) began work on Non-Invasive Cardiac Imaging Technologies for the Diagnosis of Coronary Artery Disease (CAD), an evidence-based review of the literature surrounding different cardiac imaging modalities to ensure that appropriate technologies are accessed by patients suspected of having CAD. This project came about when the Health Services Branch at the Ministry of Health and Long-Term Care asked MAS to provide an evidentiary platform on effectiveness and cost-effectiveness of non-invasive cardiac imaging modalities.
After an initial review of the strategy and consultation with experts, MAS identified five key non-invasive cardiac imaging technologies for the diagnosis of CAD. Evidence-based analyses have been prepared for each of these five imaging modalities: cardiac magnetic resonance imaging, single photon emission computed tomography, 64-slice computed tomographic angiography, stress echocardiography, and stress echocardiography with contrast. For each technology, an economic analysis was also completed (where appropriate). A summary decision analytic model was then developed to encapsulate the data from each of these reports (available on the OHTAC and MAS website).
The Non-Invasive Cardiac Imaging Technologies for the Diagnosis of Coronary Artery Disease series is made up of the following reports, which can be publicly accessed at the MAS website at: www.health.gov.on.ca/mas or at www.health.gov.on.ca/english/providers/program/mas/mas_about.html
Single Photon Emission Computed Tomography for the Diagnosis of Coronary Artery Disease: An Evidence-Based Analysis
Stress Echocardiography for the Diagnosis of Coronary Artery Disease: An Evidence-Based Analysis
Stress Echocardiography with Contrast for the Diagnosis of Coronary Artery Disease: An Evidence-Based Analysis
64-Slice Computed Tomographic Angiography for the Diagnosis of Coronary Artery Disease: An Evidence-Based Analysis
Cardiac Magnetic Resonance Imaging for the Diagnosis of Coronary Artery Disease: An Evidence-Based Analysis
Pease note that two related evidence-based analyses of non-invasive cardiac imaging technologies for the assessment of myocardial viability are also available on the MAS website:
Positron Emission Tomography for the Assessment of Myocardial Viability: An Evidence-Based Analysis
Magnetic Resonance Imaging for the Assessment of Myocardial Viability: an Evidence-Based Analysis
The Toronto Health Economics and Technology Assessment Collaborative has also produced an associated economic report entitled:
The Relative Cost-effectiveness of Five Non-invasive Cardiac Imaging Technologies for Diagnosing Coronary Artery Disease in Ontario [Internet]. Available from: http://theta.utoronto.ca/reports/?id=7
Objective
The objective of this analysis was to determine the diagnostic accuracy of cardiac magnetic resonance imaging (MRI) for the diagnosis of patients with known/suspected coronary artery disease (CAD) compared to coronary angiography.
Cardiac MRI
Stress cardiac MRI is a non-invasive, x-ray free imaging technique that takes approximately 30 to 45 minutes to complete and can be performed using to two different methods, a) perfusion imaging following a first pass of an intravenous bolus of gadolinium contrast, or b) wall motion imaging. Stress is induced pharmacologically with either dobutamine, dipyridamole, or adenosine, as physical exercise is difficult to perform within the magnet bore and often induces motion artifacts. Alternatives to stress cardiac perfusion MRI include stress single-photon emission computed tomography (SPECT) and stress echocardiography (ECHO). The advantage of cardiac MRI is that it does not pose the radiation burden associated with SPECT. During the same sitting, cardiac MRI can also assess left and right ventricular dimensions, viability, and cardiac mass. It may also mitigate the need for invasive diagnostic coronary angiography in patients with intermediate risk factors for CAD.
Evidence-Based Analysis
Literature Search
A literature search was performed on October 9, 2009 using OVID MEDLINE, MEDLINE In-Process and Other Non-Indexed Citations, EMBASE, the Cumulative Index to Nursing & Allied Health Literature (CINAHL), the Cochrane Library, and the International Agency for Health Technology Assessment (INAHTA) for studies published from January 1, 2005 to October 9, 2008. Abstracts were reviewed by a single reviewer and, for those studies meeting the eligibility criteria, full-text articles were obtained. Reference lists were also examined for any relevant studies not identified through the search. Articles with unknown eligibility were reviewed with a second clinical epidemiologist and then a group of epidemiologists until consensus was established. The quality of evidence was assessed as high, moderate, low or very low according to GRADE methodology.
Given the large amount of clinical heterogeneity of the articles meeting the inclusion criteria, as well as suggestions from an Expert Advisory Panel Meeting held on October 5, 2009, the inclusion criteria were revised to examine the effectiveness of cardiac MRI for the detection of CAD.
Heath technology assessments, systematic reviews, randomized controlled trials, observational studies
≥20 adult patients enrolled.
Published 2004-2009
Licensed by Health Canada
For diagnosis of CAD:
Reference standard is coronary angiography
Significant CAD defined as ≥ 50% coronary stenosis
Patients with suspected or known CAD
Reported results by patient, not segment
Non-English studies
Grey literature
Planar imaging
MUGA
Patients with recent MI (i.e., within 1 month)
Patients with non-ischemic heart disease
Studies done exclusively in special populations (e.g., women, diabetics)
Outcomes of Interest
Sensitivity and specificity
Area under the curve (AUC)
Diagnostic odds ratio (DOR)
Summary of Findings
Stress cardiac MRI using perfusion analysis yielded a pooled sensitivity of 0.91 (95% CI: 0.89 to 0.92) and specificity of 0.79 (95% CI: 0.76 to 0.82) for the detection of CAD.
Stress cardiac MRI using wall motion analysis yielded a pooled sensitivity of 0.81 (95% CI: 0.77 to 0.84) and specificity of 0.85 (95% CI: 0.81 to 0.89) for the detection of CAD.
Based on DORs, there was no significant difference between pooled stress cardiac MRI using perfusion analysis and pooled stress cardiac MRI using wall motion analysis (P=0.26) for the detection of CAD.
Pooled subgroup analysis of stress cardiac MRI using perfusion analysis showed no significant difference in the DORs between 1.5T and 3T MRI (P=0.72) for the detection of CAD.
One study (N=60) was identified that examined stress cardiac MRI using wall motion analysis with a 3T MRI. The sensitivity and specificity of 3T MRI were 0.64 (95% CI: 0.44 to 0.81) and 1.00 (95% CI: 0.89 to 1.00), respectively, for the detection of CAD.
The effectiveness of stress cardiac MRI for the detection of CAD in unstable patients with acute coronary syndrome was reported in only one study (N=35). Using perfusion analysis, the sensitivity and specificity were 0.72 (95% CI: 0.53 to 0.87) and 1.00 (95% CI: 0.54 to 1.00), respectively, for the detection of CAD.
Ontario Health System Impact Analysis
According to an expert consultant, in Ontario:
Stress first pass perfusion is currently performed in small numbers in London (London Health Sciences Centre) and Toronto (University Health Network at the Toronto General Hospital site and Sunnybrook Health Sciences Centre).
Stress wall motion is only performed as part of research protocols and not very often.
Cardiac MRI machines use 1.5T almost exclusively, with 3T used in research for first pass perfusion.
On November 25 2009, the Cardiac Imaging Expert Advisory Panel met and made the following comments about stress cardiac MRI for perfusion analysis:
Accessibility to cardiac MRI is limited and generally used to assess structural abnormalities. Most MRIs in Ontario are already in 24–hour, constant use and it would thus be difficult to add cardiac MRI for CAD diagnosis as an additional indication.
The performance of cardiac MRI for the diagnosis of CAD can be technically challenging.
GRADE Quality of Evidence for Cardiac MRI in the Diagnosis of CAD
The quality of the body of evidence was assessed according to the GRADE Working Group criteria for diagnostic tests. For perfusion analysis, the overall quality was determined to be low and for wall motion analysis the overall quality was very low.
PMCID: PMC3377522  PMID: 23074389
18.  Fractal Analysis of Periapical Bone from Lossy Compressed Radiographs: A Comparison of Two Lossy Compression Methods 
Journal of Digital Imaging  2011;24(6):993-998.
The aim of the study was to evaluate the effect of two lossy image compression methods on fractal dimension (FD) calculation. Ten periapical images of the posterior teeth with no restorations or previous root canal therapy were obtained using storage phosphor plates and were saved in TIF format. Then, all images were compressed with lossy JPEG and JPEG2000 compression methods at five compression levels, i.e., 90, 70, 50, 30, and 10. Compressed file sizes from all images and compression ratios were calculated. On each image, two regions of interest (ROIs) containing healthy trabecular bone in the posterior periapical area were selected. The FD of each ROI on the original and compressed images was calculated using differential box counting method. Both image compression and analysis were performed by a public domain software. Altogether, the FD of 220 ROIs was calculated. FDs were compared using ANOVA and Dunnett tests. The FD decreased gradually with compression level. A statistically significant decrease of the FD values was found for JPEG 10, JPEG2000 10, and JPEG2000 30 compression levels (p < 0.05). At comparable file sizes, the JPEG induced a smaller FD difference. In conclusion, lossy compressed images with appropriate compression level may be used for FD calculation.
doi:10.1007/s10278-011-9383-0
PMCID: PMC3222549  PMID: 21465294
Compression; Computer analysis; Computer-assisted detection
19.  Influence of cone beam CT scanning parameters on grey value measurements at an implant site 
Dentomaxillofacial Radiology  2013;42(3):79884780.
Objectives:
The aim of this study was to determine the grey value variation at the implant site with different scan settings, including field of view (FOV), spatial resolution, number of projections, exposure time and dose selections in two cone beam CT (CBCT) systems and to compare the results with those obtained from a multislice CT system.
Methods:
A partially edentulous human mandibular cadaver was scanned by three CT modalities: multislice CT (MSCT) (Philips, Best, the Netherlands), and two CBCT systems: (Accuitomo 170®, Morita, Japan) and (NewTom 5G®, QR, Verona, Italy). Using different scan settings 36 and 24 scans were obtained from the Accuitomo and the NewTom, respectively. The scans were converted to digital imaging and communications in medicine 3 format. The analysis of the data was performed using 3Diagnosys® software (v. 3.1, 3diemme, Cantù, Italy) and Geomagic studio® 2012 (Morrisville, NC). On the MSCT scan, one probe designating the site for pre-operative implant placement was inserted. The inserted probe on MSCT was transformed to the same region on each CBCT scan using a volume-based three-dimensional registration algorithm. The mean voxel grey value of the region around the probe was derived separately for each CBCT. The influence of scanning parameters on the measured mean voxel grey values was assessed.
Results:
Grey values in both CBCT systems significantly deviated from Hounsfield unit values measured with MSCT (p = 0.0001). In both CBCT systems, scan FOV and spatial resolution selections had a statistically significant influence on grey value measurements (p = 0.0001). The number of projections selection had a statistically significant influence in the Accuitomo system (p = 0.0001) while exposure time and dose selections had no statistically significant influence on grey value measurements in the NewTom (p = 0.43 and p = 0.37, respectively).
Conclusions:
Grey-level values from CBCT images are influenced by device and scanning settings.
doi:10.1259/dmfr/79884780
PMCID: PMC3667541  PMID: 22933535
cone beam CT; registration; grey values; bone density
20.  White Matter Changes and Word Finding Failures with Increasing Age 
PLoS ONE  2011;6(1):e14496.
Background
Increasing life expectancy necessitates the better understanding of the neurophysiological underpinnings of age-related cognitive changes. The majority of research examining structural-cognitive relationships in aging focuses on the role of age-related changes to grey matter integrity. In the current study, we examined the relationship between age-related changes in white matter and language production. More specifically, we concentrated on word-finding failures, which increase with age.
Methodology/Principal Findings
We used Diffusion tensor MRI (a technique used to image, in vivo, the diffusion of water molecules in brain tissue) to relate white matter integrity to measures of successful and unsuccessful picture naming. Diffusion tensor images were used to calculate Fractional Anisotropy (FA) images. FA is considered to be a measure of white matter organization/integrity. FA images were related to measures of successful picture naming and to word finding failures using voxel-based linear regression analyses. Successful naming rates correlated positively with white matter integrity across a broad range of regions implicated in language production. However, word finding failure rates correlated negatively with a more restricted region in the posterior aspect of superior longitudinal fasciculus.
Conclusions/Significance
The use of DTI-MRI provides evidence for the relationship between age-related white matter changes in specific language regions and word finding failures in old age.
doi:10.1371/journal.pone.0014496
PMCID: PMC3017545  PMID: 21249127
21.  The Self-Liking Brain: A VBM Study on the Structural Substrate of Self-Esteem 
PLoS ONE  2014;9(1):e86430.
Abundant evidence suggests that self-esteem is an important personality resource for emotion regulation in response to stressful experiences. It was thus hypothesized that the relative grey matter volume of brain regions involved in responding to and coping with stress is related to individual differences in trait self-esteem. Using structural magnetic resonance imaging of 48 healthy adults in conjunction with voxel-based morphometry and diffeomorphic anatomical registration using exponentiated lie algebra (VBM-DARTEL), positive associations between self-esteem and regional grey matter volume were indeed found in the anterior cingulate cortex (ACC), right lateral prefrontal cortex (LPFC), right hippocampus, and left hypothalamus. In addition, self-esteem positively covaried with grey matter volume in the right temporo-parietal junction (TPJ), which has been implicated in pride and theory of mind. The results suggest that persons with low self-esteem have reduced grey matter volume in brain regions that contribute to emotion/stress regulation, pride, and theory of mind. The findings provide novel neuroanatomical evidence for the view that self-esteem constitutes a vital coping resource.
doi:10.1371/journal.pone.0086430
PMCID: PMC3906048  PMID: 24489727
22.  Determining optimal medical image compression: psychometric and image distortion analysis 
BMC Medical Imaging  2012;12:24.
Background
Storage issues and bandwidth over networks have led to a need to optimally compress medical imaging files while leaving clinical image quality uncompromised.
Methods
To determine the range of clinically acceptable medical image compression across multiple modalities (CT, MR, and XR), we performed psychometric analysis of image distortion thresholds using physician readers and also performed subtraction analysis of medical image distortion by varying degrees of compression.
Results
When physician readers were asked to determine the threshold of compression beyond which images were clinically compromised, the mean image distortion threshold was a JPEG Q value of 23.1 ± 7.0. In Receiver-Operator Characteristics (ROC) plot analysis, compressed images could not be reliably distinguished from original images at any compression level between Q = 50 and Q = 95. Below this range, some readers were able to discriminate the compressed and original images, but high sensitivity and specificity for this discrimination was only encountered at the lowest JPEG Q value tested (Q = 5). Analysis of directly measured magnitude of image distortion from subtracted image pairs showed that the relationship between JPEG Q value and degree of image distortion underwent an upward inflection in the region of the two thresholds determined psychometrically (approximately Q = 25 to Q = 50), with 75 % of the image distortion occurring between Q = 50 and Q = 1.
Conclusion
It is possible to apply lossy JPEG compression to medical images without compromise of clinical image quality. Modest degrees of compression, with a JPEG Q value of 50 or higher (corresponding approximately to a compression ratio of 15:1 or less), can be applied to medical images while leaving the images indistinguishable from the original.
doi:10.1186/1471-2342-12-24
PMCID: PMC3431233  PMID: 22849336
Medical image compression; JPEG; Lossy; Psychometrics; Image analysis
23.  T2 Mapping from highly undersampled data by REconstruction of Principal COmponent coefficient Maps (REPCOM) using Compressed Sensing 
Magnetic Resonance in Medicine  2011;67(5):1355-1366.
Recently, there has been an increased interest in quantitative MR parameters to improve diagnosis and treatment. Parameter mapping requires multiple images acquired with different timings usually resulting in long acquisition times. While acquisition time can be reduced by acquiring undersampled data, obtaining accurate estimates of parameters from undersampled data is a challenging problem, in particular for structures with high spatial frequency content. In this work, Principal Component Analysis (PCA) is combined with a model-based algorithm to reconstruct maps of selected principal component coefficients from highly undersampled radial MRI data. This novel approach linearizes the cost function of the optimization problem yielding a more accurate and reliable estimation of MR parameter maps. The proposed algorithm - REconstruction of Principal COmponent coefficient Maps (REPCOM) using Compressed Sensing - is demonstrated in phantoms and in vivo and compared to two other algorithms previously developed for undersampled data.
doi:10.1002/mrm.23128
PMCID: PMC3311721  PMID: 22190358
Parameter mapping; T2; radial MRI; FSE; compressed sensing; Principal Component Analysis
24.  Refractive index measurement of acute rat brain tissue slices using optical coherence tomography 
Optics Express  2012;20(2):1084-1095.
An optical coherence tomography (OCT) system employing a microelectromechanical system (MEMS) mirror was used to measure the refractive index (RI) of anatomically different regions in acute brain tissue slices, in which viability was maintained. RI was measured in white-matter and grey-matter regions, including the cerebral cortex, putamen, hippocampus, thalamus and corpus callosum. The RI in the corpus callosum was found to be ~4% higher than the RIs in other regions. Changes in RI with tissue deformation were also measured in the cerebral cortex and corpus callosum under uniform compression (20-80% strain). For 80% strain, measured RIs increased nonlinearly by up to 70% and 90% in the cerebral cortex and corpus callosum respectively. Knowledge of RI in heterogeneous tissues can be used to correct distorted optical images caused by RI variations between different regions. Also deformation-dependent changes in RI can be applied to OCT elastography or to mechanical tests based on optical imaging such as indentation tests.
doi:10.1364/OE.20.001084
PMCID: PMC3501791  PMID: 22274454
(110.4500) Optical coherence tomography; (290.3030) Index measurements; (230.4685) Optical microelectromechanical devices; (170.3880) Medical and biological imaging
25.  Perceived fidelity of compressed and reconstructed radiological images: A preliminary exploration of compression, luminance, and viewing distance 
Journal of Digital Imaging  1998;11(4):168-175.
The authors’ goal was to explore the impact of image compression algorithm and ratio, image luminance, and viewing distance on radiologists’ perception of reconstructed image fidelity. Five radiologists viewed 16 sets of four hard-copy chest radiographs prepared for secondary interpretation. Each set included one uncompressed, and three compressed and reconstruted images prepared using three different algorithms but the same compression ratio. The sets were prepared using two subjects, four compression ratios (10∶1, 20∶1, 30∶1, 40∶1), and two luminance levels (2,400 cd/m2, standard lightbox illumination, and 200 cd/m2, simulating a typical CRT display). Readers ranked image quality and evaluated obviousness and clinical importance of differences. Viewing distances for image screening, inspection, and comparison were recorded. At 10∶1 compression, the compressed and uncompressed images were nearly indistinguishable; the three algorithms were very similar, and differences were rated “not obvious” and “not important.” At higher compression, readers consistently preferred uncompressed images, with notable differences between algorithms. The obviousness and clinical importance of differences were rated higher at lightbox luminance. Viewing distances appeared to be idiosyncratic
doi:10.1007/BF03178079
PMCID: PMC3453155  PMID: 9848049
thorax; radiography; images; compression; fidelity

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