Statistical Parametric Mapping Research Articles

Multiparametric MRI of Knees in Collegiate Basketball Players: Associations With Morphological Abnormalities and Functional Deficits.

Rates of cartilage degeneration in asymptomatic elite basketball players are significantly higher compared with the general population due to excessive loads on the knee. Compositional quantitative magnetic resonance imaging (qMRI) techniques can identify local biochemical changes of macromolecules observed in cartilage degeneration. The purpose of this study was to utilize multiparametric qMRI to (1) quantify how T1ρ and T2 relaxation times differ based on the presence of anatomic abnormalities and (2) correlate T1ρ and T2 with self-reported functional deficits. It was hypothesized that prolonged relaxation times will be associated with knees with MRI-graded abnormalities and knees belonging to basketball players with greater self-reported functional deficits. Cross-sectional study; Level of evidence, 3. A total of 75 knees from National Collegiate Athletic Association Division I basketball players (40 female, 35 male) were included in this multicenter study. All players completed the Knee injury and Osteoarthritis Outcome Score (KOOS) and had bilateral knee MRI scans taken. T1ρ and T2 were calculated on a voxel-by-voxel basis. The cartilage surfaces were segmented into 6 compartments: lateral femoral condyle, lateral tibia, medial femoral condyle, medial tibia (MT), patella (PAT), and trochlea (TRO). Lesions from the MRI scans were graded for imaging abnormalities, and statistical parametric mapping was performed to study cross-sectional differences based on MRI scan grading of anatomic knee abnormalities. Pearson partial correlations between relaxation times and KOOS subscore values were computed, obtaining r value statistical parametric mappings and P value clusters. Knees without patellar tendinosis displayed significantly higher T1ρ in the PAT compared with those with patellar tendinosis (average percentage difference, 10.4%; P = .02). Significant prolongation of T1ρ was observed in the MT, TRO, and PAT of knees without compared with those with quadriceps tendinosis (average percentage difference, 12.7%, 13.3%, and 13.4%, respectively; P ≤ .05). A weak correlation was found between the KOOS-Symptoms subscale values and T1ρ/T2. Certain tissues that bear the brunt of impact developed tendinosis but spared cartilage degeneration. Whereas participants reported minimal functional deficits, their high-impact activities resulted in structural damage that may lead to osteoarthritis after their collegiate careers.

Altered patterns of brain activity during a fMRI memory task in cognitively normal adults carrying the APOE ε4 allele

AbstractBackgroundThe e4 allele of the Apolipoprotein E gene (APOE) is a well‐established risk factor for Alzheimer’s disease (AD), e4 carriers showing earlier onset and more severe memory impairment than non‐carriers. Neuroimaging evidence suggests that APOEe4 may modulate neural activity in AD since early stages. The purpose of this study was to determine whether APOEe4 influences brain activity in the memory circuit in older cognitively unimpaired individuals.MethodThirty cognitively unimpaired participants (n = 10 APOEe4 heterozygous carriers, age = 65± 5 years, 50% females, MMSE score = 29±1; n = 20 APOEe4 non‐carriers, age = 68±5 years, 35% females, MMSE score = 30±1) were recruited and underwent multidomain (i.e., memory, visuospatial abilities, language, attention) neuropsychological exams and functional MRI scan during an associative memory task, which consisted of two phases: (i) encoding of face‐name associations; (ii) recognition of the name associated to each face. Image preprocessing and voxel‐wise comparisons were conducted using the Statistical Parametric Mapping (SPM, v12). Clusters were considered significant at an uncorrected threshold of p<0.001.ResultParticipants were comparable for demographic and cognitive features (p>0.10) and performed similarly on the in‐scanner face‐name association memory task (p>0.10). Compared to e4 non‐carriers, carriers showed (i) greater activation during the encoding task in the left temporo‐occipital cortex/fusiform gyrus, (ii) greater activation during the recognition task in the middle temporal gyrus/temporo‐occipital cortex bilaterally and in the right cerebellum, and (iii) lower activation during the recognition task in the medial supplementary motor area.ConclusionThese preliminary results confirm that the APOE e4 allele is associated with a different pattern of brain functional activity during an associative memory task in cognitively unimpaired older. Given the similar cognitive performance between groups, higher activation in temporo‐occipital regions might reflect a compensatory process in regions vulnerable to AD pathology.

Prospective Randomized Placebo‐Controlled Trial of Long‐Term Durability of Effect of One Year of Grape Consumption on Preventing Decline of Cerebral Function

AbstractBackgroundLong‐term impact of one year of grape consumption on regional brain metabolism and associated neuropsychologic status was examined across multiple years of follow‐up.MethodTwenty subjects (74.6±5.4 years) were randomized to consume an active grape formulation (36g reconstituted freeze‐dried grape powder) or placebo (matched for sweetness and appearance but free of polyphenols) twice daily for one year. Changes in brain metabolism were assessed by PET with radiotracer [F‐18]fluorodeoxyglucose and cognitive performance was measured through neuropsychological testing, at baseline, 1 year after initiating consumption of grape or placebo formulation, and again 2 to 3 years after completing the randomized regimen in half of the subjects on each arm, with all subjects remaining blinded to which regimen they had been assigned until after final assessments. Activity in 47 standardized volumes of interest (sVOI’s) were measured, voxel‐based analyses using statistical parametric mapping were conducted, and associations were examined between interval changes in metabolism and neuropsychologic status.ResultDuring the year while consuming formulations, subjects randomized to placebo underwent metabolic decline in 27 sVOI’s, including particularly inferior posterior temporal (p = 0.006) and inferior frontal (p = 0.004) areas, correlating with neuropsychologic decline, while significant (p<0.05) decline was seen in none of the 47 sVOI’s in the active formulation group. Voxel‐based analyses corroborated differential metabolic decline in placebo and active formulation groups, and direct difference‐of‐differences analyses further documented significantly more decline in the placebo group. Moreover, a significant difference in regional metabolism persisted at the end of follow‐up, after having discontinued randomized formulations for 28.1±5.7 months (40.0±5.4 after baseline), with mean medial temporal sVOI’s demonstrating significant decline in the group that had been randomized to placebo (‐4.6%, p = 0.009), but not in the group that had been in the active arm (‐1.5%, N.S.). Difference of magnitudes of long‐term metabolic decline between arms was significant in direct difference‐of‐differences analysis, and correlated with neuropsychologic decline (p<0.001) in both inferior posterior temporal and inferior frontal regions.ConclusionSubjects randomized to consume reconstituted grapes twice daily enjoyed long‐term protection from loss of cerebral function, as assessed more than two years beyond the last consumed dose.

Automatic analysis of skull thickness, scalp‐to‐cortex distance and association with age and sex in cognitively normal elderly

AbstractBackgroundTranscranial brain stimulation has been a potential treatment for many brain diseases. The skull compartment exerts a strong influence on the delivery of stimulation, implying the need to accurately examine its geometry and alterations in the population. In addition, personalized neurostimulation requires better understanding of skull geometry and scalp‐to‐cortex distance for optimization.MethodHere, we developed an open source efficient pipeline BrainCalculator based on BrainSuite Skullfinder for automatically computing the skull thickness map to locate the position of minimum thickness, SCD, and brain volume based on structural T1‐weighted MRI 3T data. We examined the influence of age and sex cross‐sectionally in 407 cognitively normal older adults (71.93±7.98 years, 60.2% female) from the ADNI on the minimum skull thickness, SCD and brain volume of the whole‐head MR data. We demonstrated the compatibility of BrainCalculator with available preprocessing toolboxes, including FSL Brain Extraction Tool (BET) 2 and Statistical Parametric Mapping (SPM)12‐based unified segmentation, and compared their performance.ResultOur pipeline was able to compute automatically the skull thinkness, SCD and brain volume using T1 MR data in 8 minutes. We found that the sphenoid bone and temporal bone were thinnest among the skull regions. There was no increase in minimum skull thickness at different regions with increasing age except in the female sphenoid bone. No sex difference in minimum skull thickness or SCD in different age groups was observed. Positive correlations between age and SCD in both males and females were observed, and the slope was higher in the temporal cortex SCD in females (0.307%/y) than in males (0.216%/y) but comparable in other regions. A negative correlation between age and whole brain volume computed based on brain surface in both males and females was observed, and the slope was slightly higher in females (‐1.031%/y) than in males (‐0.998%/y).ConclusionWe developed a pipeline for MR‐based skull thickness and SCD brain volume automatic analysis and demonstrated the sex‐dependent association between minimum regional skull thickness, SCD and brain volume with age. This pipeline is potentially useful for personalized neurostimulation.

Functional neuroanatomic validity of a novel, smartphone‐based remote assessment of processing speed in early Alzheimer’s Disease

AbstractBackgroundThe quantification of information processing speed (IPS) and its changes over time is a cornerstone of neuropsychological assessment for early Alzheimer’s disease (eAD). Additionally, clinical practice and drug development increasingly require tools enabling the remote assessment of cognition. We previously reported the feasibility, reliability and clinical validity of a novel, smartphone‐based IPS test remotely self‐administered to healthy controls (HC) and individuals with subjective cognitive decline (SCD) and eAD. The present study performed whole‐brain voxel‐based morphometry (VBM) analyses to determine whether smartphone‐based IPS performance indeed correlated with atrophy of brain regions known to support processing speed.Method31 HC, 31 SCDn (amyloid‐PET negative), 31 SCDp (amyloid‐PET positive) and 30 eAD individuals participated in a Alzheimer’s Digital Assessment Suite (AD‐DAS) Proof‐of‐Concept study (https://www.isrctn.com/ISRCTN17035495). Participants performed 9 IPS assessments (90s digit‐symbol matching) over 28 days on provisioned smartphones. Each response sequence and digit‐symbol pairing was novel and matched for difficulty within/across sessions.High‐resolution anatomic, T1‐weighted MRI were submitted to whole‐brain VBM analyses (Computational Anatomy Toolbox, SPM12/Matlab 2021) testing whether performance (number correct) correlated with gray matter signal intensities (covariates: age, gender, years of education, study site, total intracranial volume). The statistical parametric map was thresholded at p<0.001 uncorrected (voxel‐level) and family‐wise error corrected p<0.05 (cluster‐level). Peak voxel MNI coordinates and t‐values, cluster‐level p‐values are reported.ResultPoor smartphone‐based IPS performance correlated with atrophy in five regions centered in: (1) right insula (57, ‐14, 15; t = 5.83; p<0.0001), (2) right lingual gyrus (14, ‐64, ‐8; t = 5.21; p = 0.006), (3) left hippocampus (‐36, ‐24, ‐16; t = 4.83; p = 0.021), (4) left precuneus (‐10, ‐57, 26; t = 4.73; p = 0.017), (5) right fusiform gyrus (27, ‐38, ‐15; t = 4.69; p = 0.043), replicating previous functional MRI findings with IPS (lingual gyrus, precuneus) and known neuroanatomical correlates of working memory (insula, hippocampus).ConclusionThese findings support the functional neuroanatomic validity of a novel smartphone‐based IPS task and thus remote, clinically meaningful characterization of preclinical/early AD individuals’ IPS impairments in clinical monitoring and drug trials.

Hydrocephalus as a confounding factor in FDG-PET statistical parametric mapping for dementia assessment

Hydrocephalus as a confounding factor in FDG-PET statistical parametric mapping for dementia assessment

A longitudinal analysis of brain volume changes in myelin oligodendrocyte glycoprotein antibody-associated disease.

Myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) is a relapsing demyelinating condition. There are several cross-sectional studies showing evidence of brain atrophy in people with MOGAD (pwMOGAD), but longitudinal brain volumetric assessment is still an unmet need. Current recommendations do not include monitoring with MRI and assume distinct attacks. Evidence of ongoing axon loss will have diagnostic and therapeutic implications. In this study, we assessed brain volume changes in pwMOGAD over a mean follow-up period of 2years and compared this to changes in people with multiple sclerosis (pwMS). This is a retrospective single-center study over a 7-year period from 2014 to 2021. MRI brain scans at the time of diagnosis and follow-up in remission were collected from 14 Caucasian pwMOGAD, confirmed by serum myelin oligodendrocyte glycoprotein immunoglobulin G antibody presence, detected by live cell-based assays. Total brain volume (TBV), white matter (WM), gray matter (GM), and demyelinating lesion volumes were assessed automatically using the Statistical Parametric Mapping and FMRIB automated segmentation tools. MRI brain scans at diagnosis and follow-up on remission were collected from 32-matched pwMS for comparison. Statistical analysis was done using analysis of variance. There is evidence of TBV loss, affecting particularly GM, over an approximately 2-year follow-up period in pwMOGAD (p<.05), comparable to pwMS. WM and lesion volume change over the same period were not statistically significant (p>.1). We found evidence of loss of GM and TBV over time in pwMOGAD, similar to pwMS, although the WM and lesion volumes were unchanged.

Inlay vs. onlay humeral components in reverse total shoulder arthroplasty: a biorobotic shoulder simulator study

BackgroundBoth inlay and onlay humeral implants are available for reverse total shoulder arthroplasty (rTSA), but biomechanical data comparing these components remains limited. This study investigated the effects of inlay and onlay rTSA humeral components on shoulder biomechanics using a biorobotic shoulder simulator. MethodsTwenty fresh-frozen cadaver shoulders were tested before and after rTSA with either an inlay or onlay humeral implant. Comparisons were performed between the most commonly implanted configurations for each implant (baseline), and a modification to provide equivalent neck shaft angle (NSA) for the inlay and onlay configurations. Specimens underwent passive range of motion (ROM) assessment with the scapula held static, and performed scapular plane abduction driven by previously collected human-subject scapulothoracic and glenohumeral kinematics. Passive ROM glenohumeral joint angles were compared using t-tests while muscle force and excursion data during scapular plane elevation were evaluated with statistical parametric mapping and t-tests. ResultsMaximum passive elevation was reduced for the inlay versus onlay humeral component, while both implants caused reduced passive elevation versus the native joint. Inlay rTSA also demonstrated reduced passive internal rotation at rest and increased external rotation at 90° humerothoracic elevation versus the native joint. All preoperative plan ROM estimates differed from experiments. Rotator cuff forces were elevated with an onlay versus inlay humeral implant, but simulated muscle excursions did not differ between systems. Compared to the native joint, rotator cuff forces were increased for both inlay and onlay implants and deltoid forces were reduced for inlay. The rTSA dramatically altered muscle excursions versus the native joint. Comparisons of inlay and onlay humeral implants with equivalent NSA were consistent with the baseline comparisons. ConclusionsRotator cuff forces required to perform scapular plane abduction increase following rTSA using both inlay and onlay implants. Rotator cuff forces are lower with inlay implants compared to onlay, although inlay implants also result in reduced passive elevation ROM. Deltoid forces are lower with inlay implants in comparison to native, but not with onlay implants. The differences between inlay and onlay components are largely unaffected by NSA, indicating that these differences are inherent to the inlay and onlay designs. In those patients with an intact rotator cuff, decreased rotator cuff forces to perform abduction with an inlay humeral implant compared to an onlay implant may promote improved long-term outcomes due to reduced deltoid muscle fatigue when using an inlay implant.

Ground reaction forces in baseball pitching: temporal associations with pitch velocity among high-velocity pitchers

ABSTRACT How baseball pitchers interact with the ground is an important aspect of pitching technique and performance. Previous studies on ground reaction forces in baseball pitching have largely been limited to pitchers at the youth or adolescent level, with only a few studies examining higher velocity pitchers. Additionally, previous studies have limited their analyses to only peak kinetic values, neglecting any temporal importance of when these peak values occur. Therefore, our purpose was to provide normative ground reaction force values and examine the associations between pitch velocity and ground reaction forces in high-velocity pitchers. We retrospectively extracted pitch velocities as well as rear and lead leg ground reaction force data from internal databases for 105 high-velocity pitchers. We analysed the associations between the full ground reaction force time series and pitch velocity using statistical parametric mapping regression. Regression analysis revealed pitch velocity significantly predicted lead leg braking ground reaction force from approximately 27% to 35% of the period between front foot contact and ball release. These data reinforce the importance of effective braking forces for achieving maximal pitch velocities. Additionally, our observed peak ground reaction force values were considerably higher than those previously reported.

Influence of Wearing a Tactical Harness on Three-Dimensional Thoracic Limb Kinematics.

The aim of this study was to assess the impact of a tactical harness on three-dimensional motion of the thoracic limb in dogs. Five adult mixed-breed dogs (age: 4-6 years, weight: 25-35 kg) were used in this study. Custom-fit tactical harnesses were applied to each dog and 19 retroreflective skin markers were used to determine three-dimensional joint motion during dynamic motion, with and without the harness. Sagittal plane (flexion-extension), transverse plane (internal-external rotation), and frontal plane (abduction-adduction) kinematics were created for the shoulder, elbow, and carpus from motion capture data, with and without the harness. Kinematic waveforms were analysed using statistical parametric mapping paired t-tests (a = 0.05). Angular displacements were determined, and total joint range of motion was compared using paired t-tests (a = 0.05). Wearing a tactical harness increased sagittal angular displacement in the elbow but decreased it in the shoulder and carpus. Significant differences were found in the kinematic waveforms in almost all joints at both a walk and trot. Dogs wearing the tactical harness had reduced flexion and increased abduction of the shoulder joint at a walk. The elbow joint had increased extension, reduced external rotation and increased abduction at both walk and trot. The carpus had reduced flexion at a trot and walk, as well as increased internal rotation and abduction at a walk. Wearing a tactical harness affected kinematic gait data of all joints of the forelimb. The elbow was affected in all three planes at both a walk and trot, while the shoulder joint was only affected at a walk when wearing a tactical harness. The clinical impact of wearing a tactical harness is unknown at this time, particularly when dogs are performing their duties while wearing harnesses.

Perfusion Imaging and Inflammation Biomarkers Provide Complementary Information in Alzheimer's Disease.

Single photon emission tomography (SPECT) can detect early changes in brain perfusion to support the diagnosis of dementia. Inflammation is a driver for dementia progression and measures of inflammation may further support dementia diagnosis. In this study, we assessed whether combining imaging with markers of inflammation improves prediction of the likelihood of Alzheimer's disease (AD). We analyzed 91 participants datasets (Institutional Ethics Approval 20/NW/0222). AD biomarkers and markers of inflammation were measured in cerebrospinal fluid. Statistical parametric mapping was used to quantify brain perfusion differences in perfusion SPECT images. Logistic regression models were trained to evaluate the ability of imaging and inflammation markers, both individually and combined, to predict AD. Regional perfusion reduction in the precuneus and medial temporal regions predicted Aβ42 status. Increase in inflammation markers predicted tau and neurodegeneration. Matrix metalloproteneinase-10, a marker of blood-brain barrier regulation, was associated with perfusion reduction in the right temporal lobe. Adenosine deaminase, an enzyme involved in sleep homeostasis and inflammation, was the strongest predictor of neurodegeneration with an odds ratio of 10.3. The area under the receiver operator characteristic curve for the logistic regression model was 0.76 for imaging and 0.76 for inflammation. Combining inflammation and imaging markers yielded an area under the curve of 0.85. Study results showed that markers of brain perfusion imaging and markers of inflammation provide complementary information in AD evaluation. Inflammation markers better predict tau status while perfusion imaging measures represent amyloid status. Combining imaging and inflammation improves AD prediction.

Assessment of an IMU-Based Experimental Set-Up for Upper Limb Motion in Obese Subjects.

In recent years, wearable systems based on inertial sensors opened new perspectives for functional motor assessment with respect to the gold standard motion capture systems. The aim of this study was to validate an experimental set-up based on 17 body-worn inertial sensors (Awinda, Xsens, The Netherlands), addressing specific body segments with respect to the state-of-the art system (VICON, Oxford Metrics Ltd., Oxford, UK) to assess upper limb kinematics in obese, with respect to healthy subjects. Twenty-three obese and thirty healthy weight individuals were simultaneously acquainted with the two systems across a set of three tasks for upper limbs (i.e., frontal arm rise, lateral arm rise, and reaching). Root Mean Square error (RMSE) was computed to quantify the differences between the measurements provided by the systems in terms of range of motion (ROM), whilst their agreement was assessed via Pearson's correlation coefficient (PCC) and Bland-Altman (BA) plots. In addition, the signal waveforms were compared via one-dimensional statistical parametrical mapping (SPM) based on a paired t-test and a two-way ANOVA was applied on ROMs. The overall results partially confirmed the correlation and the agreement between the two systems, reporting only a moderate correlation for shoulder principal rotation angle in each task (r~0.40) and for elbow/flexion extension in obese subjects (r = 0.66), whilst no correlation was found for most non-principal rotation angles (r < 0.40). Across the performed tasks, an average RMSE of 34° and 26° was reported in obese and healthy controls, respectively. At the current state, the presence of bias limits the applicability of the inertial-based system in clinics; further research is intended in this context.

Characterisation of a novel [18F]FDG brain PET database and combination with a second database for optimising detection of focal abnormalities, using focal cortical dysplasia as an example

BackgroundBrain [18F]FDG PET is used clinically mainly in the presurgical evaluation for epilepsy surgery and in the differential diagnosis of neurodegenerative disorders. While scans are usually interpreted visually on an individual basis, comparison against normative cohorts allows statistical assessment of abnormalities and potentially higher sensitivity for detecting abnormalities. Little work has been done on out-of-sample databases (acquired differently to the patient data). Combination of different databases would potentially allow better power and discrimination. We fully characterised an unpublished healthy control brain [18F]FDG PET database (Marseille, n = 60, ages 21–78 years) and compared it to another publicly available database (MRXFDG, n = 37, ages 23–65 years). We measured and then harmonised spatial resolution and global values. A collection of patient scans (n = 34, 13–48 years) with histologically confirmed focal cortical dysplasias (FCDs) obtained on three generations of scanners was used to estimate abnormality detection rates using standard software (statistical parametric mapping, SPM12).ResultsRegional SUVs showed similar patterns, but global values and resolutions were different as expected. Detection rates for the FCDs were 50% for comparison with the Marseille database and 53% for MRXFDG. Simply combining both databases worsened the detection rate to 41%. After harmonisation of spatial resolution, using a full factorial design matrix to accommodate global differences, and leaving out controls older than 60 years, we achieved detection rates of up to 71% for both databases combined. Detection rates were similar across the three scanner types used for patients, and high for patients whose MRI had been normal (n = 10/11).ConclusionsAs expected, global and regional data characteristics are database specific. However, our work shows the value of increasing database size and suggests ways in which database differences can be overcome. This may inform analysis via traditional statistics or machine learning, and clinical implementation.

Acute effects of robot-assisted body weight unloading on biomechanical movement patterns during overground walking

Body weight unloading (BWU) is used in rehabilitation/training settings to reduce kinetic requirements, however different BWU methods may be unequally capable of preserving biomechanical movement patterns. Biomechanical analysis of both kinetic and kinematic movement trajectories rather than discrete variables has not previously been performed to describe the effect of BWU on gait patterns during horizontal walking. The aim of the present study was to investigate how robot-assisted BWU producing an dynamic unloading force on the body centre of mass, affects kinematic, kinetic, and spatiotemporal gait parameters in healthy young adults by use of time-continuous analysis. Twenty participants walked overground in a 3-D motion-capture lab at 0, 10, 20, 30, 40, and 50 % BWU at a self-selected speed. Vertical and anterior-posterior ground reaction forces (GRFs) and lower limb internal joint moments were obtained during the stance phase, while joint angles were obtained during entire strides. Time-continuous data were analysed using Statistical Parametric Mapping (SPM) and discrete data using conventional statistics to compare different BWU conditions by means of One-Way Repeated Measures Anova. With increasing BWU, corresponding reductions were observed for GRFs, internal joint moments, joint angles, walking speed, stride/step length and cadence. Observed effects were partially caused by decreased walking speed and increased BWU. While amplitude reductions were observed for kinetic and kinematic variables, trajectory shapes were largely preserved. In conclusion, dynamic robot-assisted BWU enables reduced kinetic requirements without distorting biomechanically normal gait patterns during overground walking in young healthy adults.

NIMG-86. ESTIMATING BRAIN TUMOR RELATED EDEMA FROM NON-INVASIVE IMAGING IN A CLINICALLY RELEVANT TIMELINE

Abstract Image-based mathematical modeling is emerging as an advantageous tool to integrate into the care routine for patients with brain tumors. These tools can be used for a variety of tasks including predicting tumor growth, indicating spatial genomic alterations, and guiding radiation therapy. Often, the methods to produce these maps are developed in silos, using cohorts of retrospective patients and switching to a per patient map calculation can be an afterthought. Automatic pipelines are needed to enable creating mathematical maps in a clinically-relevant workflow. To this end, we developed a pipeline to create an image-based mathematical map of edema abundance based on T2-weighted (T2W) magnetic resonance imaging that includes preprocessing steps, abnormality and tissue type segmentation, brain extraction, map generation, and conversion between image file formats. The python-based pipeline was designed to take in T1-weighted (T1W), T1W with gadolinium contrast (T1Gd), T2W, and fluid attenuated inversion recovery (FLAIR) DICOM images for a single patient as input and convert them to NIfTIs for downstream steps. The pipeline preprocessed images by correcting bias field fluctuations using the N4 algorithm and normalizing intensities. The T1W, T1Gd, and FLAIR are then registered to the T2W. T1Gd and FLAIR are used in a deep learning algorithm to delineate the brain and abnormality including enhancing tumor, necrosis, and peripheral edema. Normal tissue segmentations are performed using the statistical parametric mapping (SPM) segmentation routine. The segmentations and preprocessed images are all utilized in the edema mathematical model. The resulting edema map is then reformatted as a DICOM and output for further use by clinicians and clinical imaging systems. Our future goals include integrating our pipeline in a clinical workstation and sending final maps to our hospital’s picture archiving and communication system (PACS) to allow for deployment of these models for patient care in a clinically efficient timeline.

Abstract 13410: Severe Brain White Matter Hyperintensity is Associated With Local Brain Atrophy of Parahippocampal Gyrus and Predicts Prognosis in Heart Failure Patients Without Dementia

Introduction: Aged heart failure (HF) patients without dementia may have a risk of cognitive impairment (CI) that attenuates the effect of treatment for HF. White Matter Hyperintensity (WMH) is a potential risk of CI through a disconnection of subcortical brain network. On the other hand, patients with CI have severe brain atrophy in parahippocampal gyrus (PHG). However, it is not clear whether WMH is associated with atrophy in PHG and predicts prognosis of HF patients. Hypothesis: In HF patients without dementia, WMH is associated with brain atrophy of PHG, a potential risk of CI, and predicts prognosis. Methods: Sixty-five HF patients (age 76±11 years, NYHA class II, EF47±17 %) were enrolled. We excluded patients with dementia using mini-mental state examination. We took 3D-T1 weighted images and Fluid Attenuated Inversion Recovery (FLAIR) images of whole brain using 1.5T magnetic resonance imaging. Image analysis was performed to evaluate the severity of atrophy of PHG and volume of WMH using 2mm voxel-based morphometry by the statistical parametric mapping software. The Z-score value was calculated to evaluate the severity of atrophy in PHG. A Kaplan-Meier Curve adjusted with age, sex, presence of atrial fibrillation, and blood pressure was constructed using inverse probability weighting method. Results: We determined the cut-off point of the volume of WMH for estimating cardiac death using a receiver operating characteristic curve. Patients were divided into High-WMH group (n=37, volume of WMH 30±13 mL) and Low-WMH group (n=28, volume of WMH 8±5 mL) according to the cut-off value (15mL). As shown in representative cases (Figure1), the Z-score value in PHG (pink circle) was higher in High-WMH group (1.45±0.78, white arrow) compared to Low-WMH group (0.94±0.57, P=0.006). Adjusted Kaplan-Meier curves showed poor prognosis of High-WMH group (Figure 2). Conclusions: In HF patients without dementia, severe WMH is a potential risk of CI and predicts poor prognosis.

A CAD system design using iteratively reweighted fuzzy c-means and deep tree training for Alzheimer's disease diagnosis

Alzheimer's disease (AD) is a neurodegenerative disorder characterized by memory loss and other cognitive abnormalities. In this research work, an MRI-based Computer-Aided Diagnosis (CAD) system is presented for clinical practice. While current algorithms used for detecting Alzheimer's disease perform inefficiently. Those algorithms are unable to detect minor changes in the disease due to discrepancies in feature extraction, segmentation, and classification methods. To overcome the issues in algorithm, a new iteratively reweighted adaptive spatial fuzzy c-means approach (IRW-ASFCM) is used to segment the brain tissue efficiently. Initially, the Magnetic resonance images (MRI) will pre-processed by using the Statistical parametric mapping (SPM) tool. After pre-processing, the segmentation is done using IRW-ASFCM to get effective tissue segments. Then, a 2-level selective Wavelet Kernel (2LS-WaveCNN ensemble) based CNN ensemble model will be used to extract the feature map from the Gray matter (GM), White matter (WM) and Cerebrospinal fluid (CSF) regions after segmenting the images. The Wave CNN networks built from hidden layers are trained using Deep Tree Training (DTT) for AD classification. The simulation results demonstrate that the suggested CAD system is superior to the state-of-the-art systems in terms of accuracy (99.54 %), sensitivity (99.26 %), and specificity (99.64 %) for multi-class problems.

Walking with individualized 3D-printed minimal footwear increases foot strength and produces subtle changes in unroll pattern

IntroductionThis 5-month follow-up study, involving 66 subjects (38 intervention, 28 control; 34 females, 32 males), evaluated the biomechanics of walking while wearing bespoke, 3D-printed footwear.MethodsA 3D scanner was used to obtain foot shape, which was subsequently modified to yield a suitable instep and additional room in the forefoot and toe areas, to allow for potential shape changes of the foot. Shoes were manufactured using TPU laser sintering. Pre (T0) and post (T1) the intervention, plantar pressures were collected using a plantar pressure plate (3 trials per foot) and toe flexor strength (5 trials per foot) was measured using a dynamometer, for control and intervention groups. Plantar pressure peak patterns and center-of-pressure (CoP) timing was analysed using 2D and 1D Statistical Parametric Mapping, respectively. Toe strength changes were expressed in percent and per individual as: 100 x ((strength@T1strength@T0) / strength@T0).ResultsPeak pressure distribution did not differ between control and intervention populations, or between T0 and T1. Center-of-pressure unroll differed between barefoot and shod conditions at T0 for the intervention group. When barefoot, the intervention group at T1 showed a more lateral CoP in early stance and a more anterior CoP in late stance compared to T0. In the intervention group, toe strength increased significantly by 48.5% between T0 and T1.DiscussionOverall, the results indicate that the bespoke, 3D-printed footwear did not significantly affect peak pressure distribution compared to barefoot walking. However, center-of-pressure patterns during gait were influenced, particularly in the intervention group, with analysis indicative of barefoot subjects' CoP moving faster in early and mid-stance than when shod. Additionally, the intervention led to a significant increase in toe strength. These findings contribute to our understanding of the biomechanical effects of customized 3D-printed footwear and highlight the potential benefits of such interventions in improving foot function and strength.

The Immediate Biomechanical Effects of a Flat, Flexible School Shoe in Adolescents with Patellofemoral Pain.

Treatment options for adolescent patellofemoral pain (PFP) are limited. School footwear might be a suitable intervention to modulate patellofemoral joint (PFJ) loads in adolescents with PFP. This study examined the immediate effects of a flat, flexible school shoe compared with a traditional school shoe on knee joint kinematics and kinetics, and PFJ reaction force during walking and running in adolescents with PFP. A total of 28 adolescents (12 female, 16 male; mean ± SD age, 14.3 ± 1.7 yr) with PFP walked and ran on an instrumented treadmill in two randomly ordered conditions: (i) flat, flexible school shoe and (ii) traditional school shoe. Three-dimensional marker trajectory and ground reaction force data were sampled at 250 and 1000 Hz, respectively. Continuous ankle and knee joint angles and moments, PFJ reaction force, and ankle power were compared between conditions using one-dimensional statistical parametric mapping paired t -tests ( α < 0.05). Walking in the flat, flexible school shoe resulted in a significant reduction in knee flexion (15%-35% of gait cycle, P < 0.001), knee extension moment (15%-40% of gait cycle, P < 0.001), and PFJ reaction force (15%-40% of gait cycle, P < 0.001) compared with the traditional school shoe. During running, knee flexion (10%-33% of gait cycle, P < 0.001), knee extension moment (15%-25% of gait cycle, P < 0.001), and PFJ reaction force (15%-25% of gait cycle, P < 0.001) were lower when wearing the flat, flexible school shoe compared with the traditional school shoe. PFJ reaction force is reduced when adolescents walk and run in a flat, flexible school shoe compared with a traditional school shoe. Flat, flexible school shoes may be an effective intervention to modulate biomechanical factors related to PFP.

Hip Contact Forces During Sprinting in Femoroacetabular Impingement Syndrome.

Sprinting often provokes hip pain in individuals with femoroacetabular impingement syndrome (FAIS). Asphericity of the femoral head-neck junction (cam morphology) characteristic of FAIS can increase the risk of anterior-superior acetabular cartilage damage. This study aimed to 1) compare hip contact forces (magnitude and direction) during sprinting between individuals with FAIS, asymptomatic cam morphology (CAM), and controls without cam morphology, and 2) identify the phases of sprinting with high levels of anteriorly directed hip contact forces. Forty-six recreationally active individuals with comparable levels of physical activity were divided into three groups (FAIS, 14; CAM, 15; control, 17) based on their history of hip/groin pain, results of clinical impingement tests, and presence of cam morphology (alpha angle >55°). Three-dimensional marker trajectories, ground reaction forces, and electromyograms from 12 lower-limb muscles were recorded during 10-m overground sprinting trials. A linearly scaled electromyogram-informed neuromusculoskeletal model was used to calculate hip contact force magnitude (resultant, anterior-posterior, inferior-superior, medio-lateral) and angle (sagittal and frontal planes). Between-group comparisons were made using two-sample t -tests via statistical parametric mapping ( P < 0.05). No significant differences in magnitude or direction of hip contact forces were observed between FAIS and CAM or between FAIS and control groups during any phase of the sprint cycle. The highest anteriorly directed hip contact forces were observed during the initial swing phase of the sprint cycle. Hip contact forces during sprinting do not differentiate recreationally active individuals with FAIS from asymptomatic individuals with and without cam morphology. Hip loading during early swing, where peak anterior loading occurs, may be a potential mechanism for cartilage damage during sprinting-related sports in individuals with FAIS and/or asymptomatic cam morphology.