Toki Saito

Combined use of diffusion tensor tractography and multifused contrast-enhanced FIESTA for predicting facial and cochlear nerve positions in relation to vestibular schwannoma

OBJECT The authors assessed whether the combined use of diffusion tensor tractography (DTT) and contrast-enhanced (CE) fast imaging employing steady-state acquisition (FIESTA) could improve the accuracy of predicting the courses of the facial and cochlear nerves before surgery. METHODS The population was composed of 22 patients with vestibular schwannoma in whom both the facial and cochlear nerves could be identified during surgery. According to DTT, depicted fibers running from the internal auditory canal to the brainstem were judged to represent the facial or vestibulocochlear nerve. With regard to imaging, the authors investigated multifused CE-FIESTA scans, in which all 3D vessel models were shown simultaneously, from various angles. The low-intensity areas running along the tumor from brainstem to the internal auditory canal were judged to represent the facial or vestibulocochlear nerve. RESULTS For all 22 patients, the rate of fibers depicted by DTT coinciding with the facial nerve was 13.6% (3/22), and that of fibers depicted by DTT coinciding with the cochlear nerve was 63.6% (14/22). The rate of candidates for nerves predicted by multifused CE-FIESTA coinciding with the facial nerve was 59.1% (13/22), and that of candidates for nerves predicted by multifused CE-FIESTA coinciding with the cochlear nerve was 4.5% (1/22). The rate of candidates for nerves predicted by combined DTT and multifused CE-FIESTA coinciding with the facial nerve was 63.6% (14/22), and that of candidates for nerves predicted by combined DTT and multifused CE-FIESTA coinciding with the cochlear nerve was 63.6% (14/22). The rate of candidates predicted by DTT coinciding with both facial and cochlear nerves was 0.0% (0/22), that of candidates predicted by multifused CE-FIESTA coinciding with both facial and cochlear nerves was 4.5% (1/22), and that of candidates predicted by combined DTT and multifused CE-FIESTA coinciding with both the facial and cochlear nerves was 45.5% (10/22). CONCLUSIONS By using a combination of DTT and multifused CE-FIESTA, the authors were able to increase the number of vestibular schwannoma patients for whom predicted results corresponded with the courses of both the facial and cochlear nerves, a result that has been considered difficult to achieve by use of a single modality only. Although the 3D image including these prediction results helped with comprehension of the 3D operative anatomy, the reliability of prediction remains to be established.

How can machine-learning methods assist in virtual screening for hyperuricemia? A healthcare machine-learning approach

OBJECT Our purpose was to develop a new machine-learning approach (a virtual health check-up) toward identification of those at high risk of hyperuricemia. Applying the system to general health check-ups is expected to reduce medical costs compared with administering an additional test. METHODS Data were collected during annual health check-ups performed in Japan between 2011 and 2013 (inclusive). We prepared training and test datasets from the health check-up data to build prediction models; these were composed of 43,524 and 17,789 persons, respectively. Gradient-boosting decision tree (GBDT), random forest (RF), and logistic regression (LR) approaches were trained using the training dataset and were then used to predict hyperuricemia in the test dataset. Undersampling was applied to build the prediction models to deal with the imbalanced class dataset. RESULTS The results showed that the RF and GBDT approaches afforded the best performances in terms of sensitivity and specificity, respectively. The area under the curve (AUC) values of the models, which reflected the total discriminative ability of the classification, were 0.796 [95% confidence interval (CI): 0.766-0.825] for the GBDT, 0.784 [95% CI: 0.752-0.815] for the RF, and 0.785 [95% CI: 0.752-0.819] for the LR approaches. No significant differences were observed between pairs of each approach. Small changes occurred in the AUCs after applying undersampling to build the models. CONCLUSIONS We developed a virtual health check-up that predicted the development of hyperuricemia using machine-learning methods. The GBDT, RF, and LR methods had similar predictive capability. Undersampling did not remarkably improve predictive power.

Microsurgery Simulator of Cerebral Aneurysm Clipping with Interactive Cerebral Deformation Featuring a Virtual Arachnoid

BACKGROUND A virtual reality simulator for aneurysmal clipping surgery is an attractive research target for neurosurgeons. Brain deformation is one of the most important functionalities necessary for an accurate clipping simulator and is vastly affected by the status of the supporting tissue, such as the arachnoid membrane. However, no virtual reality simulator implementing the supporting tissue of the brain has yet been developed. OBJECTIVE To develop a virtual reality clipping simulator possessing interactive brain deforming capability closely dependent on arachnoid dissection and apply it to clinical cases. METHODS Three-dimensional computer graphics models of cerebral tissue and surrounding structures were extracted from medical images. We developed a new method for modifiable cerebral tissue complex deformation by incorporating a nonmedical image-derived virtual arachnoid/trabecula in a process called multitissue integrated interactive deformation (MTIID). MTIID made it possible for cerebral tissue complexes to selectively deform at the site of dissection. Simulations for 8 cases of actual clipping surgery were performed before surgery and evaluated for their usefulness in surgical approach planning. RESULTS Preoperatively, each operative field was precisely reproduced and visualized with the virtual brain retraction defined by users. The clear visualization of the optimal approach to treating the aneurysm via an appropriate arachnoid incision was possible with MTIID. CONCLUSION A virtual clipping simulator mainly focusing on supporting tissues and less on physical properties seemed to be useful in the surgical simulation of cerebral aneurysm clipping. To our knowledge, this article is the first to report brain deformation based on supporting tissues.

Usefulness of high-resolution 3D multifusion medical imaging for preoperative planning in patients with posterior fossa hemangioblastoma: technical note

Successful resection of hemangioblastoma depends on preoperative assessment of the precise locations of feeding arteries and draining veins. Simultaneous 3D visualization of feeding arteries, draining veins, and surrounding structures is needed. The present study evaluated the usefulness of high-resolution 3D multifusion medical imaging (hr-3DMMI) for preoperative planning of hemangioblastoma. The hr-3DMMI combined MRI, MR angiography, thin-slice CT, and 3D rotated angiography. Surface rendering was mainly used for the creation of hr-3DMMI using multiple thresholds to create 3D models, and processing took approximately 3-5 hours. This hr-3DMMI technique was used in 5 patients for preoperative planning and the imaging findings were compared with the operative findings. Hr-3DMMI could simulate the whole 3D tumor as a unique sphere and show the precise penetration points of both feeding arteries and draining veins with the same spatial relationships as the original tumor. All feeding arteries and draining veins were found intraoperatively at the same position as estimated preoperatively, and were occluded as planned preoperatively. This hr-3DMMI technique could demonstrate the precise locations of feeding arteries and draining veins preoperatively and estimate the appropriate route for resection of the tumor. Hr-3DMMI is expected to be a very useful support tool for surgery of hemangioblastoma.

A Microscopic Optically Tracking Navigation System That Uses High-resolution 3D Computer Graphics

Three-dimensional (3D) computer graphics (CG) are useful for preoperative planning of neurosurgical operations. However, application of 3D CG to intraoperative navigation is not widespread because existing commercial operative navigation systems do not show 3D CG in sufficient detail. We have developed a microscopic optically tracking navigation system that uses high-resolution 3D CG. This article presents the technical details of our microscopic optically tracking navigation system. Our navigation system consists of three components: the operative microscope, registration, and the image display system. An optical tracker was attached to the microscope to monitor the position and attitude of the microscope in real time; point-pair registration was used to register the operation room coordinate system, and the image coordinate system; and the image display system showed the 3D CG image in the field-of-view of the microscope. Ten neurosurgeons (seven males, two females; mean age 32.9 years) participated in an experiment to assess the accuracy of this system using a phantom model. Accuracy of our system was compared with the commercial system. The 3D CG provided by the navigation system coincided well with the operative scene under the microscope. Target registration error for our system was 2.9 ± 1.9 mm. Our navigation system provides a clear image of the operation position and the surrounding structures. Systems like this may reduce intraoperative complications.

Neurosurgical Virtual Reality Simulation for Brain Tumor Using High-definition Computer Graphics: A Review of the Literature

Simulation and planning of surgery using a virtual reality model is becoming common with advances in computer technology. In this study, we conducted a literature search to find trends in virtual simulation of surgery for brain tumors. A MEDLINE search for “neurosurgery AND (simulation OR virtual reality)” retrieved a total of 1,298 articles published in the past 10 years. After eliminating studies designed solely for education and training purposes, 28 articles about the clinical application remained. The finding that the vast majority of the articles were about education and training rather than clinical applications suggests that several issues need be addressed for clinical application of surgical simulation. In addition, 10 of the 28 articles were from Japanese groups. In general, the 28 articles demonstrated clinical benefits of virtual surgical simulation. Simulation was particularly useful in better understanding complicated spatial relations of anatomical landmarks and in examining surgical approaches. In some studies, Virtual reality models were used on either surgical navigation system or augmented reality technology, which projects virtual reality images onto the operating field. Reported problems were difficulties in standardized, objective evaluation of surgical simulation systems; inability to respond to tissue deformation caused by surgical maneuvers; absence of the system functionality to reflect features of tissue (e.g., hardness and adhesion); and many problems with image processing. The amount of description about image processing tended to be insufficient, indicating that the level of evidence, risk of bias, precision, and reproducibility need to be addressed for further advances and ultimately for full clinical application.

Optimal control of cutting feed rate in the robotic milling for total knee arthroplasty

For the total knee arthroplasty, we developed the robotic system, such as the cutting feed rate is controlled depending on the hardness of the bone tissue predicted on the basis of the medical image. Since the cutting force is reduced by this system, the displacement of the bone is minimized during the bone cutting process. Therefore it makes a possibility to fix the target bone using “safer” and less-invasive fixation technique.

Mice lacking a functional NMDA receptor exhibit social subordination in a group‐housed environment

Social dominance, in which an individual asserts control over others or benefits most after social conflict, has an influence on social behaviour. However, the mechanisms mediating social dominance remain unclear. Social dominance within social groups determines the distribution of rewards such as food and access to mating partners, which can act as reinforcers. In this study, we used the water competition test to determine whether mice were dominant or subordinate. It has been previously reported that mice heterozygous for a missense mutation in Grin1 (Grin1Rgsc174) showed altered social behaviour, with increased locomotor activity, novelty seeking and anxiety. However, social dominance in these mice has not been previously investigated. We subjected Grin1Rgsc174/+ mice to the water competition test using IntelliCage and observed that Grin1 influences competitive dominance. We found that Grin1Rgsc174/+ mice exhibited social subordination characterised by decreased corner visit frequency and occupancy time at the beginning of the task. However, Grin1Rgsc174/+ mice retained increased basal activity and exploring behaviour under a group‐housed environment. Our findings suggested that Grin1 plays an important role in determining social dominance.

Impact of predicting health-guidance candidates using massive health check-up data: A data-driven analysis

INTRODUCTION Starting in 2008, specific health checkups and health guidance to prevent non-communicable diseases have been provided in Japan, which has the highest proportion of elderly citizens in the world. The attendance rate for health guidance appointments is 17.7%, which is far from the national goal of the system (45%). To improve the attendance rate, we present a model for predicting whether an examinee is a candidate for health guidance; this model was based on a machine learning method and a restricted but massive amount of health checkup information. MATERIALS AND METHODS Using machine learning methods, we developed the following five prediction models for identifying health-guidance candidates: baseline: this model included sex and age; model 1: this model included variables that can be measured in person+information on whether the examinee was a candidate in the past year; model 2: model 1+systolic blood pressure+diastolic blood pressure; model 3: model 2+all health checkup results from the past year; and model 4: model 3 using the training dataset excluding cases with missing data. RESULTS The performance levels of the five prediction models (the AUC values of the models for the test dataset) were as follows: 0.592 [95% CI: 0.586-0.596] for the baseline model, 0.855 [95% CI: 0.851-0.858] for model 1, 0.985 [95% CI: 0.984-0.985] for model 2, 0.993 [95% CI: 0.993-0.993] for model 3, and 0.943 [95% CI: 0.941-0.945] for model 4. CONCLUSIONS We studied five models for identifying health-guidance candidates. The model that used all health checkup results from the past year had the highest predictive power. Application of the prediction model developed in the present study to the selection of health-guidance candidates could reduce the cost of guidance.

Interactive Volume Segmentation with Threshold Field Painting

An interactive method for segmentation and isosurface extraction of medical volume data is proposed. In conventional methods, users decompose a volume into multiple regions iteratively, segment each region using a threshold, and then manually clean the segmentation result by removing clutter in each region. However, this is tedious and requires many mouse operations from different camera views. We propose an alternative approach whereby the user simply applies painting operations to the volume using tools commonly seen in painting systems, such as flood fill and brushes. This significantly reduces the number of mouse and camera control operations. Our technical contribution is in the introduction of the threshold field, which assigns spatially-varying threshold values to individual voxels. This generalizes discrete decomposition of a volume into regions and segmentation using a constant threshold in each region, thereby offering a much more flexible and efficient workflow. This paper describes the details of the user interaction and its implementation. Furthermore, the results of a user study are discussed. The results indicate that the proposed method can be a few times faster than a conventional method.