Donald McRobbie

Changes in brain morphology associated with obstructive sleep apnea

OBJECTIVE Obstructive sleep apnea (OSA) causes hypoxemia and fragmented sleep, which lead to neurocognitive deficits. We hypothesised that focal loss of cortical gray matter generally within areas associated with memory processing and learning and specifically within the hippocampus would occur in OSA. METHODS Voxel-based morphometry, an automated processing technique for magnetic resonance images, was used to characterise structural changes in gray matter in seven right handed, male patients with newly diagnosed OSA and seven non-apneic, male controls matched for handedness and age. RESULTS The analysis revealed a significantly lower gray matter concentration within the left hippocampus (p=0.004) in the apneic patients. No further significant focal gray matter differences were seen in the right hippocampus and in other brain regions. There was no difference in total gray matter volume between apneics and controls. CONCLUSION This preliminary report indicates changes in brain morphology in OSA, in the hippocampus, a key area for cognitive processing.

Pseudotumors in Association with Well-functioning Metal-on-metal Hip Prostheses: A Case-control Study Using Three-dimensional Computed Tomography and Magnetic Resonance Imaging

INTRODUCTION Many papers have been published recently on the subject of pseudotumors surrounding metal-on-metal hip resurfacing and replacement prostheses. These pseudotumors are sterile, inflammatory lesions within the periprosthetic tissues and have been variously termed masses, cysts, bursae, collections, or aseptic lymphocyte-dominated vasculitis-associated lesions (ALVAL). The prevalence of pseudotumors in patients with a well-functioning metal-on-metal hip prosthesis is not well known. The purpose of this study was to quantify the prevalence of pseudotumors adjacent to well-functioning and painful metal-on-metal hip prostheses, to characterize these lesions with use of magnetic resonance imaging, and to assess the relationship between their presence and acetabular cup position with use of three-dimensional computed tomography. METHODS We performed a case-control study to compare the magnetic resonance imaging findings of patients with a well-functioning unilateral metal-on-metal hip prosthesis and patients with a painful prosthesis (defined by either revision arthroplasty performed because of unexplained pain or an Oxford hip score of <30 of 48 possible points). Thirty patients with a painful hip prosthesis and twenty-eight controls with a well-functioning prosthesis were recruited consecutively. All patients also underwent computed tomography to assess the position of the acetabular component. RESULTS Thirty-four patients were diagnosed with a pseudotumor. However, the prevalence of pseudotumors in patients with a painful hip (seventeen of thirty, 57%) was not significantly different from the prevalence in the control group (seventeen of twenty-eight, 61%). No objective differences in pseudotumor characteristics between the groups were identified. No clear association between the presence of a pseudotumor and acetabular component position was identified. The Oxford hip score in the group with a painful hip (mean, 20.2; 95% confidence interval [CI], 12.7 to 45.8) was poorer than that in the control group (mean, 41.2; 95% CI, 18.5 to 45.8; p ≤ 0.0001). CONCLUSIONS A periprosthetic cystic pseudotumor was diagnosed commonly (in thirty-four [59%] of the entire study cohort) with use of metal artifact reduction sequence (MARS) magnetic resonance imaging in this series of patients with a metal-on-metal hip prosthesis. The prevalence of pseudotumors was similar in patients with a well-functioning hip prosthesis and patients with a painful hip. Pseudotumors were also diagnosed commonly in patients with a well-positioned acetabular component. Although magnetic resonance imaging is useful for surgical planning, the presence of a cystic pseudotumor may not necessarily indicate the need for revision arthroplasty. Further correlation of clinical and imaging data is needed to determine the natural history of pseudotumors to guide clinical practice.

Involvement of prefrontal cortex in visual search

Visual search for target items embedded within a set of distracting items has consistently been shown to engage regions of occipital and parietal cortex, but the contribution of different regions of prefrontal cortex remains unclear. Here, we used fMRI to compare brain activity in 12 healthy participants performing efficient and inefficient search tasks in which target discriminability and the number of distractor items were manipulated. Matched baseline conditions were incorporated to control for visual and motor components of the tasks, allowing cortical activity associated with each type of search to be isolated. Region of interest analysis was applied to critical regions of prefrontal cortex to determine whether their involvement was common to both efficient and inefficient search, or unique to inefficient search alone. We found regions of the inferior and middle frontal cortex were only active during inefficient search, whereas an area in the superior frontal cortex (in the region of FEF) was active for both efficient and inefficient search. Thus, regions of ventral as well as dorsal prefrontal cortex are recruited during inefficient search, and we propose that this activity is related to processes that guide, control and monitor the allocation of selective attention.

Contact heat evoked potentials using simultaneous EEG and fMRI and their correlation with evoked pain

BackgroundThe Contact Heat Evoked Potential Stimulator (CHEPS) utilises rapidly delivered heat pulses with adjustable peak temperatures to stimulate the differential warm/heat thresholds of receptors expressed by Aδ and C fibres. The resulting evoked potentials can be recorded and measured, providing a useful clinical tool for the study of thermal and nociceptive pathways. Concurrent recording of contact heat evoked potentials using electroencephalogram (EEG) and functional magnetic resonance imaging (fMRI) has not previously been reported with CHEPS. Developing simultaneous EEG and fMRI with CHEPS is highly desirable, as it provides an opportunity to exploit the high temporal resolution of EEG and the high spatial resolution of fMRI to study the reaction of the human brain to thermal and nociceptive stimuli.MethodsIn this study we have recorded evoked potentials stimulated by 51°C contact heat pulses from CHEPS using EEG, under normal conditions (baseline), and during continuous and simultaneous acquisition of fMRI images in ten healthy volunteers, during two sessions. The pain evoked by CHEPS was recorded on a Visual Analogue Scale (VAS).ResultsAnalysis of EEG data revealed that the latencies and amplitudes of evoked potentials recorded during continuous fMRI did not differ significantly from baseline recordings. fMRI results were consistent with previous thermal pain studies, and showed Blood Oxygen Level Dependent (BOLD) changes in the insula, post-central gyrus, supplementary motor area (SMA), middle cingulate cortex and pre-central gyrus. There was a significant positive correlation between the evoked potential amplitude (EEG) and the psychophysical perception of pain on the VAS.ConclusionThe results of this study demonstrate the feasibility of recording contact heat evoked potentials with EEG during continuous and simultaneous fMRI. The combined use of the two methods can lead to identification of distinct patterns of brain activity indicative of pain and pro-nociceptive sensitisation in healthy subjects and chronic pain patients. Further studies are required for the technique to progress as a useful tool in clinical trials of novel analgesics.

A phantom for diffusion-weighted MRI (DW-MRI)

To develop tissue‐equivalent diffusivity materials and build a spherical diffusion phantom which mimics the conditions typically found in biological tissues. Also, to assess the reproducibility of ADC measurements from a whole‐body diffusion protocol.

Numerical simulation of SAR induced around Co-Cr-Mo hip prostheses in situ exposed to RF fields associated with 1.5 and 3 T MRI body coils.

When patients with metallic prosthetic implants undergo an MR procedure, the interaction between the RF field and the prosthetic device may lead to an increase in specific absorption rate (SAR) in tissues surrounding the prosthesis. In this work, the distribution of SAR10g around bilateral CoCrMo alloy hip prostheses in situ in anatomically realistic voxel models of an adult male and female due to RF fields from a generic birdcage coil driven at 64 or 128 MHz are predicted using a time‐domain finite integration technique. Results indicate that the spatial distribution and maximum values of SAR10g are dependent on body model, frequency, and the position of the coil relative to the body. Enhancement of SAR10g close to the extremities of a prosthesis is predicted. Values of SAR10g close to the prostheses are compliant with recommended limits if the prostheses are located outside the coil. However, caution is required when the prostheses are within the coil since the predicted SAR10g close to an extremity of a prosthesis exceeds recommended limits when the whole body averaged SAR is 2 W kg−1. Compliance with recommended limits is likely to require a reduction in the time averaged input power. Magn Reson Med, 2012.

System for 3-D Real-Time Tracking of MRI-Compatible Devices by Image Processing

Real-time processing of MRIs is reported as a method of 3D tracking of mechanical devices within the field of view using passive microcoil fiducials. The specific implementation described makes use of two scan planes for full 3D tracking of a 5-DOF manipulator arm used for prostate biopsy under image guidance. Real-time tracking was observed with a maximum update rate of 0.42 frames per second for a maximum probe velocity of 10 mm/s. The localization of fiducials had a mean error of 0.36 (plusmn0.17) mm (p < 0.02), leading to a mean error in the needle tip position of 2.6 (plusmn0.3) mm (p < 0.05).

A three-dimensional volumetric test object for geometry evaluation in magnetic resonance imaging

The design of a test object for the volumetric evaluation of geometric image quality parameters in magnetic resonance imaging (MRI) is presented. Two-dimensional parameters: linearity, distortion, slice position, slice width, slice oblique angle, spatial resolution, line spread function (LSF) are measurable in all slice planes within a volume corresponding to a typical head examination. Additionally, parameters particular to three-dimensional Fourier transform (3-DFT) imaging are measurable: 3D ghosting and 3D LSF. Parameter measurements are correctable with regard to test object positioning through the determination of the six degrees of freedom of the test object within the scanners field of view.

Comparison between diffusion-weighted MRI (DW-MRI) at 1.5 and 3 tesla: A phantom study

To compare DW‐MRI between 1.5 and 3 Tesla (T) in terms of image quality, apparent diffusion coefficient (ADC), reproducibility, lesion‐to‐background contrast and signal‐to‐noise ratio (SNR), using a test object.

Biasing visual selection: Functional neuroimaging of the interplay between spatial cueing and feature memory guidance

The authors investigate the interplay between spatial attention and memory-based feature guidance of visual selection. Three types of guidance were tested: working memory, spatial cueing and passive memory. In all cases the memory-cue was not relevant to a subsequent search task, whilst the spatial cue always provided valid information. Behaviourally, search performance was influenced by spatial cueing and by feature-based cueing from the contents of working memory; both forms of guidance interacted, with feature guidance being more effective when the targets location was not pre-cued. Spatial cueing recruited the dorsal fronto-parietal network which was silent during the WM-only condition. Memory guidance of selection was reflected in activity in a frontal-temporal-occipital network. Interestingly, when spatial and memory guidance were pitted against each other, neural activity in this latter network was greatly attenuated. Connectivity analysis showed that the posterior parietal cortices inhibit the responses of occipital and temporal regions to the onset of memory-items in the search display. In the presence of a reliable spatial cue the posterior parietal cortex resumes control of attentional deployment. These results illustrate how different forms of attention guidance interact to optimise visual selection.