Stephan G. Erberich

Cortical activation patterns during complex motor tasks in piano players and control subjects. A functional magnetic resonance imaging study

We performed functional magnetic resonance imaging (MRI) in professional piano players and control subjects during an overtrained complex finger movement task using a blood oxygenation level dependent echo-planar gradient echo sequence. Activation clusters were seen in primary motor cortex, supplementary motor area, premotor cortex and superior parietal lobule. We found significant differences in the extent of cerebral activation between both groups with piano players having a smaller number of activated voxels. We conclude that, due to long-term motor practice a different cortical activation pattern can be visualized in piano players. For the same movements lesser neurons need to be recruited. The different volume of the activated ortical areas might therefore reflect the different effort necessary for motor performance in both groups.

Somatosensory lateralization in the newborn brain

Since the onset and early postnatal development of hemispheric lateralization in the human brain are unknown, we studied cortical activation induced by passive extension and flexion of the hand in neonates using functional magnetic resonance imaging (fMRI). In contrast to that seen in older age groups, somatosensory areas in the pre- and postcentral gyri of the neonate showed no significant hemispheric lateralization at term. Instead, our findings from independent left- and right-hand experiments suggest the presence of an emerging trend of contralateral lateralization of the somatosensory system at around term.

Functional MRI in neonates using neonatal head coil and MR compatible incubator.

Structural and functional magnetic resonance imaging of the newborn brain is a complex and challenging task. Term and preterm neonates require a controlled microenvironment and close monitoring during the MRI study to maintain respiratory and cardiovascular functions, body temperature, and fluid and electrolyte homeostasis. In addition, to minimize motion artifacts, most neonates also need to be sedated, which carries the risk of respiratory depression compromising the neonates ability to maintain appropriate ventilation and oxygenation during the procedure. Finally, because of their small head size, the use of the standard MR head coils results in suboptimal picture quality in the neonate. Thus, these limitations affect our ability to obtain both high quality structural and functional MRI studies. To overcome these difficulties, we have utilized an MR compatible incubator with a built-in radiofrequency head coil optimized for the neonatal brain volume. In this study we demonstrate that functional MRI and high-resolution structural MRI of the newborn brain can be achieved with this novel design. The use of this equipment offers potential for studying the development of the preterm and term neonatal brain and obtaining state-of-the-art, high-resolution structural and functional imaging in this most vulnerable patient population.

PACS-based functional Magnetic Resonance Imaging

The picture archiving and communication system (PACS) technology reaches its 10th anniversary. Retrospectively no one could foresee the impact the PACS would have to the health care enterprise, but it is common consent today, that PACS is the key technology crucial to daily clinical image operations and especially to image related basic and clinical research. During the past 10 years the PACS has been matured from a research and developmental stage into commercial products which are provided by all major modality and health care equipment vendors. The PACS, originally implemented in the Radiology Department, needs to grow and has already carried well beyond departmental limits conquering all image relevant areas inside the hospital. During the past 10 years a dramatic development in imaging techniques especially within MRI emerged. Advanced 3D- and 4D-MR imaging techniques result in much more images and more complex data objects than ever before which need to be implemented into the existing PACS. These new imaging techniques require intensive post-processing apart from the imaging modality which need to be integrated into the image workflow and the PACS implementation. Along with these new imaging techniques new clinical applications, e.g. stroke detection, and research applications, e.g. study of heart and brain function, in Neurology and Cardiology require changes to the traditional PACS concept. Therefore inter-disciplinary image distribution will become the high-water mark for the next 10 years in the PACS endeavor. This paper focuses on one new advanced imaging technique, functional magnetic resonance imaging (fMRI), and discusses how fMRI data is defined, what fMRI requires in terms of clinical and research applications and how to implement fMRI in the existing PACS.

funcLAB/G—service-oriented architecture for standards-based analysis of functional magnetic resonance imaging in HealthGrids

Functional MRI is successfully being used in clinical and research applications including preoperative planning, language mapping, and outcome monitoring. However, clinical use of fMRI is less widespread due to its complexity of imaging, image workflow, post-processing, and lack of algorithmic standards hindering result comparability. As a consequence, wide-spread adoption of fMRI as clinical tool is low contributing to the uncertainty of community physicians how to integrate fMRI into practice. In addition, training of physicians with fMRI is in its infancy and requires clinical and technical understanding. Therefore, many institutions which perform fMRI have a team of basic researchers and physicians to perform fMRI as a routine imaging tool. In order to provide fMRI as an advanced diagnostic tool to the benefit of a larger patient population, image acquisition and image post-processing must be streamlined, standardized, and available at any institution which does not have these resources available. Here we describe a software architecture, the functional imaging laboratory (funcLAB/G), which addresses (i) standardized image processing using Statistical Parametric Mapping and (ii) its extension to secure sharing and availability for the community using standards-based Grid technology (Globus Toolkit). funcLAB/G carries the potential to overcome the limitations of fMRI in clinical use and thus makes standardized fMRI available to the broader healthcare enterprise utilizing the Internet and HealthGrid Web Services technology.

Extending PACS functionality: towards facilitating the conversion of clinical necessities into research-derived applications

The Picture Administration and Communications System (PACS) was designed to replace the old film archiving system in hospitals in order to store and move varying medical image modalities. Using the standard Internet transport protocol, PACS creators designed a robust digital signaling platform to optimize media use, availability, and confidentiality. Nowadays PACS has become ubiquitous in medical facilities but lacks imaging analytical capabilities. A myriad of initiatives have been launched in the hope of achieving this goal, but current solutions face issues with security and ease-of-use that have precluded their widespread adoption. Here, we present a PACS-based image processing tool that safeguards patient confidentiality, is user-friendly and is easy to implement. The final product is platform-independent, has a small degree of intrusiveness and is well suited to clinical and research work flows.

Grid based medical image workflow and archiving for research and enterprise PACS applications

PACS provides a consistent model to communicate and to store images with recent additions to fault tolerance and disaster reliability. However PACS still lacks fine granulated user based authentication and authorization, flexible data distribution, and semantic associations between images and their embedded information. These are critical components for future Enterprise operations in dynamic medical research and health care environments. Here we introduce a flexible Grid based model of a PACS in order to add these methods and to describe its implementation in the Childrens Oncology Group (COG) Grid. The combination of existing standards for medical images, DICOM, and the abstraction to files and meta catalog information in the Grid domain provides new flexibility beyond traditional PACS design. We conclude that Grid technology demonstrates a reliable and efficient distributed informatics infrastructure which is well applicable to medical informatics as described in this work. Grid technology will provide new opportunities for PACS deployment and subsequently new medical image applications.

Neurodevelopment assessment of newborns with combined fMRI and DTI

Functional Magnetic Resonance Imaging (fMRI) provides the location and regional extent of a task correlated activation in the brain. Recently we have demonstrated, that fMRI of passive sensory tasks (visual, auditory, motor) can be successfully used to map cortical activation in the newborn brain. However the interpretation of the functional response in the immature brain is difficult, as the blood oxygen level dependent (BOLD) physiological signal and location of the activation is quite different compared to adult fMRI responses of similar tasks. We expect, that the major reason for these differences are primarily caused by the immature myelination of the white matter tracts at this age. Diffusion tensor imaging (DTI) can be used to measure the white matter tract development in the newborn brain. The purpose of this paper is to report how to obtain and to combine fMRI and DTI data processing to enhance functional brain mapping in newborns. We obtained simultaneous fMRI and DTI data of 18 newborns, post-conceptional age (gestational age at study) between 34-week and 52-week, which were referred for clinical indicated MRI. 16 out of 18 subjects have been successfully investigated with combined fMRI and DTI and functional activation could be obtained. Fiber tracking was successfully in the visual and auditory cortex, but proofed difficult in the motor-cortex. The additional tract information supported the functional findings and the interpretation in the immature brain. The novel functional imaging in newborn is challenging because of the yet unknown physiological response and location of activation in the newborn brain. Therefore one need additional evidence that the functional findings are valid in the context of structural development. The maturation of myelination is an essential information to compare and to interpret fMRI in newborns. We conclude that the proposed method of combined fMRI and DTI, derived from adult neuroimaging, will be most relevant to understand the physiological response and thus the neurodevelopment of the newborn brain.

Improving the picture archiving and communication system: towards one-click clinical quantifying applications

AbstractThe picture archiving and communication system (PACS) replaced the old film archiving mechanism that stored and moved the data produced by different image-acquisition devices within hospita...

Relevant information retrieval and fusion of anatomic, physiologic, and metabolic neuroimaging

MRI Neuroimaging provides a rich source of image content including structural (MRI, Diffusion DTI), functional (fMRI, Perfusion ASL), and metabolic (MRS) information. Today MRI capabilities allow to acquire these imaging techniques in one session in most cases. In order to be of diagnostic value, the immense and diverse data needs to be (i) automatically post-processed to extract the relevant information, e.g. 3D brain maps from 4D fMRI, and to be (ii) fused and visualized to correlate the voxel-based findings. The purpose of this study is to demonstrate the feasibility of automatic relevant information retrieval and fusion of MRI, fMRI, DTI, ASL, and MRS data of a pediatric population into a single semantic data representation. By using advanced imaging, we may able to detect a larger spectrum of abnormalities in the neonatal brain. Each imaging application, provides unique information about the physiology (fMRI, ASL), the anatomy (DTI), and the biochemistry (MRS) of the newborn brain in relation to normal development and brain injury. By being able to integrate this technology, we will be able to combine biochemical, physiologic and anatomic information which can provide unique insight about not only the normal development of the brain, but also injury of the neonatal brain.