1
|
Heuvelink A, Saini P, Taşar Ö, Nauts S. Improving Pediatric Patients' Magnetic Resonance Imaging Experience With an In-Bore Solution: Design and Usability Study. JMIR Serious Games 2025; 13:e55720. [PMID: 39946688 PMCID: PMC11888108 DOI: 10.2196/55720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 05/31/2024] [Accepted: 11/20/2024] [Indexed: 03/10/2025] Open
Abstract
BACKGROUND Annually, millions of children undergo a magnetic resonance imaging (MRI) examination. Hospitals increasingly aim to scan young children awake, as doing so benefits both patients and health care systems. To help hospitals reduce the need for anesthesia, we have developed solutions to prepare pediatric patients at home and in the hospital. OBJECTIVE The goal of our project was to design, develop, and test a solution that extends our preparation solutions by guiding and engaging children during their MRI examination. METHODS Pediatric In-bore was designed to deliver a familiar experience by reusing design elements from our preparation solutions. It offers child-friendly movies and auditory and visual guidance about examination progress and breath holding. To evaluate children's liking and understanding of the solution, we conducted a usability study. Ten healthy children participated in a mock MRI examination featuring pediatric In-bore. We observed task compliance (ability to lie still and hold one's breath) and conducted guided interviews to assess their experience and understanding of the guidance offered. RESULTS Participants (aged 5 to 10 years) were generally positive about pediatric In-bore. They liked the main character (Ollie the elephant) and her movie. Auditory and visual guidance were generally liked and understood. All but one participant successfully managed to lie still during the mock examination, and 6 (60%) out of 10 participants successfully held their breath. CONCLUSIONS Pediatric In-bore appears promising for engaging and guiding young children during awake MRI. It completes the Pediatric Coaching solution that now offers guidance throughout the MRI journey. Future research can expand on this work by evaluating the clinical impact of the Pediatric Coaching solution in a larger and more diverse sample of pediatric patients.
Collapse
Affiliation(s)
| | | | - Özgür Taşar
- Ambient Experience, Philips Medical Systems, Best, Netherlands
| | - Sanne Nauts
- Imaging Innovation, Philips Medical Systems, Eindhoven, Netherlands
| |
Collapse
|
2
|
Zhang XX, Zhang XH, Dong YC. Effects of psychological nursing in Parkinson's related depression patients undergoing functional magnetic resonance imaging: A randomized controlled trial. World J Clin Cases 2024; 12:3086-3093. [PMID: 38898827 PMCID: PMC11185393 DOI: 10.12998/wjcc.v12.i17.3086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 04/11/2024] [Accepted: 04/23/2024] [Indexed: 06/04/2024] Open
Abstract
BACKGROUND Patients with Parkinson's disease (PD) often experience depression, and some may require magnetic resonance imaging (MRI) for diagnosis, which can lead to MRI failure due to claustrophobia. AIM To explore the value of psychological interventions in successfully completing functional MRI scans of the brain for PD-related depression. METHODS Ninety-six patients with PD were randomly divided into two groups. The control group (47 patients) received general care, and the experimental group (49 patients) received general care combined with psychological care. The Unified Parkinson's Disease Assessment Scale (UPDRS), Hamilton Depression Scale (HAMD), and Geriatric Depression Scale (GDS)-15 scores, heart rate, systolic blood pressure, and MRI-Anxiety Questionnaire (MRI-AQ) scores before and after the scan were recorded. The completion rate of magnetic resonance (MR) scanning, scanning duration, and image quality scores were recorded. RESULTS Before scanning, no statistically significant difference was observed between the two groups in terms of heart rate, systolic blood pressure, and UPDRS, HAMD, GDS-15, and MRI-AQ scores. After scanning, systolic blood pressure, MRI-AQ score, and scan time in the experimental group were significantly lower than those in the control group, whereas the scan completion rate and image quality score were significantly higher than those in the control group. CONCLUSION Psychological nursing interventions are helpful in alleviating PD-related depression and assessing MR depression scores and may be helpful in the successful completion of functional MRI scans of the patient's brain.
Collapse
Affiliation(s)
- Xiao-Xia Zhang
- Department of Internal Medicine, The First hospital of Qinhuangdao, Qinhuangdao 066000, Hebei Province, China
| | - Xiao-Hui Zhang
- Department of Gastroscope, The First hospital of Qinhuangdao, Qinhuangdao 066000, Hebei Province, China
| | - Yan-Chao Dong
- Medical Imaging Center, The First hospital of Qinhuangdao, Qinhuangdao 066000, Hebei Province, China
| |
Collapse
|
3
|
Flick K, Smeets R, Gosau M, Meyer L, Hanning U, Kyselyova AA, Scheifele C, Höhmann B, Henningsen A. Assessment of the intrasinusidal volume before and after maxillary sinus augmentation using mri - a pilot study of eight patients. BMC Oral Health 2024; 24:142. [PMID: 38287339 PMCID: PMC10823631 DOI: 10.1186/s12903-024-03858-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 01/04/2024] [Indexed: 01/31/2024] Open
Abstract
PURPOSE The purpose of this study was to evaluate the suitability, accuracy, and reliability of a non-invasive 3-Tesla magnetic resonance imaging technique (3 T-MRI) for the visualization of maxillary sinus grafts in comparison to conventional, X-ray-based, established standard imaging techniques. METHODS A total of eight patients with alveolar bone atrophy who required surgical sinus floor augmentation in the course of dental implantation were included in this pilot study. Alongside pre-operative cone-beam computed tomography (CBCT), 3 T-MRI was performed before and 6 months after sinus floor augmentation. Two investigators measured the maxillary sinus volume preoperatively and after bone augmentation. RESULTS In all cases, MRI demonstrated accurately the volumes of the maxillary sinus grafts. Following surgery, the bony structures suitable for an implant placement increased at an average of 4.89 cm3, corresponding with the decrease of the intrasinusidal volumes. In general, interexaminer discrepancies were low and without statistical significance. CONCLUSION In this preliminary study, we could demonstrate the feasibility of MRI bone volume measurement as a radiation-free alternative with comparable accuracy to CT/CBCT before procedures like sinus floor augmentation. Nevertheless, costs and artifacts, also present in MRI, have to be taken into account. Larger studies will be necessary to justify the practicability of MRI bone volume evaluation.
Collapse
Affiliation(s)
- K Flick
- Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.
- Division of "Regenerative Orofacial Medicine", Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - R Smeets
- Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
- Division of "Regenerative Orofacial Medicine", Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - M Gosau
- Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - L Meyer
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - U Hanning
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - A A Kyselyova
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - C Scheifele
- Dental Radiology Unit, Center for Dental and Oral Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - B Höhmann
- Department of Preventive and Restorative Dentistry, Center for Dental and Oral Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - A Henningsen
- Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
- Division of "Regenerative Orofacial Medicine", Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| |
Collapse
|
4
|
Boele FW, Rudkin SE, Absolom K, Latchford G, Short SC, Booth TC. The experience of interval scans for adults living with primary malignant brain tumors. Support Care Cancer 2023; 31:356. [PMID: 37243744 PMCID: PMC10221741 DOI: 10.1007/s00520-023-07818-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 05/15/2023] [Indexed: 05/29/2023]
Abstract
PURPOSE People with primary malignant brain tumors (PMBT) undergo anti-tumor treatment and are followed up with MRI interval scans. There are potential burdens and benefits to interval scanning, yet high-quality evidence to suggest whether scans are beneficial or alter outcomes of importance for patients is lacking. We aimed to gain an in-depth understanding of how adults living with PMBTs experience and cope with interval scanning. METHODS Twelve patients diagnosed with WHO grade III or IV PMBT from two sites in the UK took part. Using a semi-structured interview guide, they were asked about their experiences of interval scans. A constructivist grounded theory approach was used to analyze data. RESULTS Although most participants found interval scans uncomfortable, they accepted that scans were something that they had to do and were using various coping methods to get through the MRI scan. All participants said that the wait between their scan and results was the most difficult part. Despite the difficulties they experienced, all participants said that they would rather have interval scans than wait for a change in their symptoms. Most of the time, scans provided relief, gave participants some certainty in an uncertain situation, and a short-term sense of control over their lives. CONCLUSION The present study shows that interval scanning is important and highly valued by patients living with PMBT. Although interval scans are anxiety provoking, they appear to help people living with PMBT cope with the uncertainty of their condition.
Collapse
Affiliation(s)
- Florien W Boele
- Leeds Institute of Medical Research at St James's, St James's University Hospital, University of Leeds, Leeds, UK.
- Leeds Institute of Health Sciences, Faculty of Medicine and Health, University of Leeds, Leeds, UK.
| | - Sarah E Rudkin
- Leeds Institute of Medical Research at St James's, St James's University Hospital, University of Leeds, Leeds, UK
| | - Kate Absolom
- Leeds Institute of Medical Research at St James's, St James's University Hospital, University of Leeds, Leeds, UK
- Leeds Institute of Health Sciences, Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - Gary Latchford
- Leeds Institute of Health Sciences, Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - Susan C Short
- Leeds Institute of Medical Research at St James's, St James's University Hospital, University of Leeds, Leeds, UK
| | - Thomas C Booth
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
- Kings College Hospital NHS Foundation Trust, London, UK
| |
Collapse
|
5
|
Alghamdi A, Algamdi MM, Alatawi K, Alghamdi B, Alanazi H, Alamri S, Alamri S, Albishi Z. Nurses’ Roles in Managing Patient Anxiety Before MRI Scans Using Informative Video. REPORTS IN MEDICAL IMAGING 2022. [DOI: 10.2147/rmi.s353700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
|
6
|
Krej M, Osuch T, Anuszkiewicz A, Stopinski S, Anders K, Matuk K, Weigl A, Tarasow E, Piramidowicz R, Dziuda L. Deep learning-based method for the continuous detection of heart rate in signals from a multi-fiber Bragg grating sensor compatible with magnetic resonance imaging. BIOMEDICAL OPTICS EXPRESS 2021; 12:7790-7806. [PMID: 35003867 PMCID: PMC8713690 DOI: 10.1364/boe.441932] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 10/21/2021] [Accepted: 10/22/2021] [Indexed: 05/10/2023]
Abstract
A method for the continuous detection of heart rate (HR) in signals acquired from patients using a sensor mat comprising a nine-element array of fiber Bragg gratings during routine magnetic resonance imaging (MRI) procedures is proposed. The method is based on a deep learning neural network model, which learned from signals acquired from 153 MRI patients. In addition, signals from 343 MRI patients were used for result verification. The proposed method provides automatic continuous extraction of HR with the root mean square error of 2.67 bpm, and the limits of agreement were -4.98-5.45 bpm relative to the reference HR.
Collapse
Affiliation(s)
- Mariusz Krej
- Military Institute of Aviation Medicine, Department of Psychophysiological Measurements and Human Factor Research, Krasinskiego 54/56, 01-755 Warsaw, Poland
| | - Tomasz Osuch
- Warsaw University of Technology, Faculty of Electronics and Information Technology, Institute of Electronic Systems, Warsaw University of Technology, Nowowiejska 15/19, 00-665 Warsaw, Poland
- National Institute of Telecommunications, Szachowa 1, 04-894 Warsaw, Poland
| | - Alicja Anuszkiewicz
- Warsaw University of Technology, Faculty of Electronics and Information Technology, Institute of Electronic Systems, Warsaw University of Technology, Nowowiejska 15/19, 00-665 Warsaw, Poland
- Lukasiewicz Research Network - Institute of Microelectronics and Photonics, Photonic Materials Group, al. Lotnikow 32/46, 02-668 Warsaw, Poland
| | - Stanisław Stopinski
- Warsaw University of Technology, Faculty of Electronics and Information Technology, Institute of Microelectronics and Optoelectronics, Koszykowa 75, 00-662 Warsaw, Poland
| | - Krzysztof Anders
- Warsaw University of Technology, Faculty of Electronics and Information Technology, Institute of Microelectronics and Optoelectronics, Koszykowa 75, 00-662 Warsaw, Poland
| | - Krzysztof Matuk
- TMS Diagnostyka Sp. z o.o., Wiertnicza 84, 02-952 Warsaw, Poland
| | - Andrzej Weigl
- TMS Diagnostyka Sp. z o.o., Wiertnicza 84, 02-952 Warsaw, Poland
| | - Eugeniusz Tarasow
- TMS Diagnostyka Sp. z o.o., Wiertnicza 84, 02-952 Warsaw, Poland
- Medical University of Bialystok, Faculty of Medicine, Department of Radiology, Kilinskiego 1, 15-089 Bialystok, Poland
| | - Ryszard Piramidowicz
- Warsaw University of Technology, Faculty of Electronics and Information Technology, Institute of Microelectronics and Optoelectronics, Koszykowa 75, 00-662 Warsaw, Poland
| | - Lukasz Dziuda
- Military Institute of Aviation Medicine, Department of Psychophysiological Measurements and Human Factor Research, Krasinskiego 54/56, 01-755 Warsaw, Poland
| |
Collapse
|
7
|
Canfora F, Calabria E, Cuocolo R, Ugga L, Buono G, Marenzi G, Gasparro R, Pecoraro G, Aria M, D'Aniello L, Mignogna MD, Adamo D. Burning Fog: Cognitive Impairment in Burning Mouth Syndrome. Front Aging Neurosci 2021; 13:727417. [PMID: 34475821 PMCID: PMC8406777 DOI: 10.3389/fnagi.2021.727417] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 07/14/2021] [Indexed: 01/25/2023] Open
Abstract
Background: Due to its common association with chronic pain experience, cognitive impairment (CI) has never been evaluated in patients with burning mouth syndrome (BMS). The purpose of this study is to assess the prevalence of CI in patients with BMS and to evaluate its relationship with potential predictors such as pain, mood disorders, blood biomarkers, and white matter changes (WMCs). Methods: A case-control study was conducted by enrolling 40 patients with BMS and an equal number of healthy controls matched for age, gender, and education. Neurocognitive assessment [Mini Mental State Examination (MMSE), Digit Cancellation Test (DCT), the Forward and Backward Digit Span task (FDS and BDS), Corsi Block-Tapping Test (CB-TT), Rey Auditory Verbal Learning Test (RAVLT), Copying Geometric Drawings (CGD), Frontal Assessment Battery (FAB), and Trail Making A and B (TMT-A and TMT-B)], psychological assessment [Hamilton Rating Scale for Depression and Anxiety (HAM-D and HAM-A), Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), and 36-Item Short Form Health Survey (SF-36)], and pain assessment [Visual Analogic Scale (VAS), Total Pain Rating index (T-PRI), Brief Pain Inventory (BPI), and Pain DETECT Questionnaire (PD-Q)] were performed. In addition, blood biomarkers and MRI of the brain were recorded for the detection of Age-Related WMCs (ARWMCs). Descriptive statistics, the Mann-Whitney U-test, the Pearson Chi-Squared test and Spearman's correlation analysis were used. Results: Patients with BMS had impairments in most cognitive domains compared with controls (p < 0.001**) except in RAVLT and CGD. The HAM-D, HAM-A, PSQI, ESS, SF-36, VAS, T-PRI, BPI and PD-Q scores were statistically different between BMS patients and controls (p < 0.001**) the WMCs frequency and ARWMC scores in the right temporal (RT) and left temporal (LT) lobe were higher in patients with BMS (p = 0.023*). Conclusions: Meanwhile, BMS is associated with a higher decline in cognitive functions, particularly attention, working memory, and executive functions, but other functions such as praxis-constructive skills and verbal memory are preserved. The early identification of CI and associated factors may help clinicians to identify patients at risk of developing time-based neurodegenerative disorders, such as Alzheimer's disease (AD) and vascular dementia (VD), for planning the early, comprehensive, and multidisciplinary assessment and treatment.
Collapse
Affiliation(s)
- Federica Canfora
- Department of Neurosciences, Reproductive Sciences and Dentistry, University of Naples "Federico II", Naples, Italy
| | - Elena Calabria
- Department of Neurosciences, Reproductive Sciences and Dentistry, University of Naples "Federico II", Naples, Italy
| | - Renato Cuocolo
- Department of Clinical Medicine and Surgery, University of Naples "Federico II", Naples, Italy
| | - Lorenzo Ugga
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy
| | - Giuseppe Buono
- Department of Diagnostical Morphological and Functional, University of Naples "Federico II", Naples, Italy
| | - Gaetano Marenzi
- Department of Neurosciences, Reproductive Sciences and Dentistry, University of Naples "Federico II", Naples, Italy
| | - Roberta Gasparro
- Department of Neurosciences, Reproductive Sciences and Dentistry, University of Naples "Federico II", Naples, Italy
| | - Giuseppe Pecoraro
- Department of Neurosciences, Reproductive Sciences and Dentistry, University of Naples "Federico II", Naples, Italy
| | - Massimo Aria
- Department of Economics and Statistics, University of Naples "Federico II", Naples, Italy
| | - Luca D'Aniello
- Department of Economics and Statistics, University of Campania "Luigi Vanvitelli", Caserta, Italy
| | - Michele Davide Mignogna
- Department of Neurosciences, Reproductive Sciences and Dentistry, University of Naples "Federico II", Naples, Italy
| | - Daniela Adamo
- Department of Neurosciences, Reproductive Sciences and Dentistry, University of Naples "Federico II", Naples, Italy
| |
Collapse
|
8
|
Warren HJM, Ioachim G, Powers JM, Stroman PW. How fMRI Analysis Using Structural Equation Modeling Techniques Can Improve Our Understanding of Pain Processing in Fibromyalgia. J Pain Res 2021; 14:381-398. [PMID: 33603453 PMCID: PMC7882802 DOI: 10.2147/jpr.s290795] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 01/16/2021] [Indexed: 12/18/2022] Open
Abstract
PURPOSE The purpose of this study was to investigate the utility of data-driven analyses of functional magnetic resonance imaging (fMRI) data, by means of structural equation modeling, for the investigation of pain processing in fibromyalgia (FM). PATIENTS AND METHODS Datasets from two separate pain fMRI studies involving healthy controls (HC) and participants with FM were re-analyzed using both a conventional model-driven approach and a data-driven approach, and the results from these analyses were compared. The first dataset contained 15 women with FM and 15 women as healthy controls. The second dataset contained 15 women with FM and 11 women as healthy controls. RESULTS Consistent with previous studies, the model-driven analyses did not identify differences in pain processing between the HC and FM study groups in both datasets. On the other hand, the data-driven analyses identified significant group differences in both datasets. CONCLUSION Data-driven analyses can enhance our understanding of pain processing in healthy controls and in clinical populations by identifying activity associated with pain processing specific to the clinical groups that conventional model-driven analyses may miss.
Collapse
Affiliation(s)
- Howard J M Warren
- Centre for Neuroscience Studies, Queen’s University, Kingston, Ontario, Canada
| | - Gabriela Ioachim
- Centre for Neuroscience Studies, Queen’s University, Kingston, Ontario, Canada
| | - Jocelyn M Powers
- Centre for Neuroscience Studies, Queen’s University, Kingston, Ontario, Canada
| | - Patrick W Stroman
- Centre for Neuroscience Studies, Queen’s University, Kingston, Ontario, Canada
- Department of Biomedical and Molecular Sciences, Queen’s University, Kingston, Ontario, Canada
- Department of Physics, Queen’s University, Kingston, Ontario, Canada
| |
Collapse
|
9
|
Booth TC, Thompson G, Bulbeck H, Boele F, Buckley C, Cardoso J, Dos Santos Canas L, Jenkinson D, Ashkan K, Kreindler J, Huskens N, Luis A, McBain C, Mills SJ, Modat M, Morley N, Murphy C, Ourselin S, Pennington M, Powell J, Summers D, Waldman AD, Watts C, Williams M, Grant R, Jenkinson MD. A Position Statement on the Utility of Interval Imaging in Standard of Care Brain Tumour Management: Defining the Evidence Gap and Opportunities for Future Research. Front Oncol 2021; 11:620070. [PMID: 33634034 PMCID: PMC7900557 DOI: 10.3389/fonc.2021.620070] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 01/06/2021] [Indexed: 12/19/2022] Open
Abstract
OBJECTIV E To summarise current evidence for the utility of interval imaging in monitoring disease in adult brain tumours, and to develop a position for future evidence gathering while incorporating the application of data science and health economics. METHODS Experts in 'interval imaging' (imaging at pre-planned time-points to assess tumour status); data science; health economics, trial management of adult brain tumours, and patient representatives convened in London, UK. The current evidence on the use of interval imaging for monitoring brain tumours was reviewed. To improve the evidence that interval imaging has a role in disease management, we discussed specific themes of data science, health economics, statistical considerations, patient and carer perspectives, and multi-centre study design. Suggestions for future studies aimed at filling knowledge gaps were discussed. RESULTS Meningioma and glioma were identified as priorities for interval imaging utility analysis. The "monitoring biomarkers" most commonly used in adult brain tumour patients were standard structural MRI features. Interval imaging was commonly scheduled to provide reported imaging prior to planned, regular clinic visits. There is limited evidence relating interval imaging in the absence of clinical deterioration to management change that alters morbidity, mortality, quality of life, or resource use. Progression-free survival is confounded as an outcome measure when using structural MRI in glioma. Uncertainty from imaging causes distress for some patients and their caregivers, while for others it provides an important indicator of disease activity. Any study design that changes imaging regimens should consider the potential for influencing current or planned therapeutic trials, ensure that opportunity costs are measured, and capture indirect benefits and added value. CONCLUSION Evidence for the value, and therefore utility, of regular interval imaging is currently lacking. Ongoing collaborative efforts will improve trial design and generate the evidence to optimise monitoring imaging biomarkers in standard of care brain tumour management.
Collapse
Affiliation(s)
- Thomas C. Booth
- School of Biomedical Engineering & Imaging Sciences, King’s College London, London, United Kingdom
- Department of Neuroradiology, King’s College Hospital NHS Foundation Trust, London, United Kingdom
| | - Gerard Thompson
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | | | - Florien Boele
- Leeds Institute of Medical Research at St James’s, St James’s University Hospital, Leeds, United Kingdom
- Faculty of Medicine and Health, Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom
| | | | - Jorge Cardoso
- School of Biomedical Engineering & Imaging Sciences, King’s College London, London, United Kingdom
| | - Liane Dos Santos Canas
- School of Biomedical Engineering & Imaging Sciences, King’s College London, London, United Kingdom
| | | | - Keyoumars Ashkan
- Department of Neurosurgery, King’s College Hospital NHS Foundation Trust, London, United Kingdom
| | | | - Nicky Huskens
- The Tessa Jowell Brain Cancer Mission, London, United Kingdom
| | - Aysha Luis
- School of Biomedical Engineering & Imaging Sciences, King’s College London, London, United Kingdom
- Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, London, United Kingdom
| | - Catherine McBain
- Department of Oncology, Christie Hospital NHS Foundation Trust, Manchester, United Kingdom
| | - Samantha J. Mills
- Department of Neuroradiology, The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom
| | - Marc Modat
- School of Biomedical Engineering & Imaging Sciences, King’s College London, London, United Kingdom
| | - Nick Morley
- Department of Radiology, Wales Research and Diagnostic PET Imaging Centre, Cardiff University School of Medicine, Cardiff, United Kingdom
| | - Caroline Murphy
- King’s College Trials Unit, King’s College London, London, United Kingdom
| | - Sebastian Ourselin
- School of Biomedical Engineering & Imaging Sciences, King’s College London, London, United Kingdom
| | - Mark Pennington
- King’s Health Economics, King’s College London, London, United Kingdom
| | - James Powell
- Department of Oncology, Velindre Cancer Centre, Cardiff, United Kingdom
| | - David Summers
- Department of Neuroradiology, Western General Hospital, Edinburgh, United Kingdom
| | - Adam D. Waldman
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Colin Watts
- Birmingham Brain Cancer Program, University of Birmingham, Birmingham, United Kingdom
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Matthew Williams
- Department of Neuro-oncology, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Robin Grant
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Michael D. Jenkinson
- Institute of Translational Medicine, University of Liverpool, Liverpool, United Kingdom
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom
| |
Collapse
|
10
|
Wood TC, Damestani NL, Lawrence AJ, Ljungberg E, Barker GJ, Solana AB, Wiesinger F, Williams SCR. Silent myelin-weighted magnetic resonance imaging. Wellcome Open Res 2020; 5:74. [PMID: 32832700 PMCID: PMC7431975 DOI: 10.12688/wellcomeopenres.15845.2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/06/2020] [Indexed: 12/14/2022] Open
Abstract
Background: Inhomogeneous Magnetization Transfer (ihMT) is an emerging, uniquely myelin-specific magnetic resonance imaging (MRI) contrast. Current ihMT acquisitions utilise fast Gradient Echo sequences which are among the most acoustically noisy MRI sequences, reducing patient comfort during acquisition. We sought to address this by modifying a near silent MRI sequence to include ihMT contrast. Methods: A Magnetization Transfer preparation module was incorporated into a radial Zero Echo-Time sequence. Repeatability of the ihMT ratio and inverse ihMT ratio were assessed in a cohort of healthy subjects. We also investigated how head orientation affects ihMT across subjects, as a previous study in a single subject suggests this as a potential confound. Results: We demonstrated that ihMT ratios comparable to existing, acoustically loud, implementations could be obtained with the silent sequence. We observed a small but significant effect of head orientation on inverse ihMTR. Conclusions: Silent ihMT imaging is a comparable alternative to conventional, noisy, alternatives. For all future ihMT studies we recommend careful positioning of the subject within the scanner.
Collapse
Affiliation(s)
- Tobias C Wood
- Department of Neuroimaging, King's College London, London, UK
| | | | - Andrew J Lawrence
- Department of Psychological Medicine, King's College London, London, UK
| | - Emil Ljungberg
- Department of Neuroimaging, King's College London, London, UK
| | - Gareth J Barker
- Department of Neuroimaging, King's College London, London, UK
| | | | - Florian Wiesinger
- Department of Neuroimaging, King's College London, London, UK.,ASL Europe, GE Healthcare, Munich, Germany
| | | |
Collapse
|
11
|
Wood TC, Damestani NL, Lawrence AJ, Ljungberg E, Barker GJ, Solana AB, Wiesinger F, Williams SCR. Silent myelin-weighted magnetic resonance imaging. Wellcome Open Res 2020; 5:74. [PMID: 32832700 DOI: 10.12688/wellcomeopenres.15845.1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/16/2020] [Indexed: 02/03/2023] Open
Abstract
Background: Inhomogeneous Magnetization Transfer (ihMT) is an emerging, uniquely myelin-specific magnetic resonance imaging (MRI) contrast. Current ihMT acquisitions utilise fast Gradient Echo sequences which are among the most acoustically noisy MRI sequences, reducing patient comfort during acquisition. We sought to address this by modifying a near silent MRI sequence to include ihMT contrast. Methods: A Magnetization Transfer preparation module was incorporated into a radial Zero Echo-Time sequence. Repeatability of the ihMT ratio and inverse ihMT ratio were assessed in a cohort of healthy subjects. We also investigated how head orientation affects ihMT across subjects, as a previous study in a single subject suggests this as a potential confound. Results: We demonstrated that ihMT ratios comparable to existing, acoustically loud, implementations could be obtained with the silent sequence. We observed a small but significant effect of head orientation on inverse ihMTR. Conclusions: Silent ihMT imaging is a comparable alternative to conventional, noisy, alternatives. For all future ihMT studies we recommend careful positioning of the subject within the scanner.
Collapse
Affiliation(s)
- Tobias C Wood
- Department of Neuroimaging, King's College London, London, UK
| | | | - Andrew J Lawrence
- Department of Psychological Medicine, King's College London, London, UK
| | - Emil Ljungberg
- Department of Neuroimaging, King's College London, London, UK
| | - Gareth J Barker
- Department of Neuroimaging, King's College London, London, UK
| | | | - Florian Wiesinger
- Department of Neuroimaging, King's College London, London, UK.,ASL Europe, GE Healthcare, Munich, Germany
| | | |
Collapse
|
12
|
Taylor SA, Mallett S, Miles A, Morris S, Quinn L, Clarke CS, Beare S, Bridgewater J, Goh V, Janes S, Koh DM, Morton A, Navani N, Oliver A, Padhani A, Punwani S, Rockall A, Halligan S. Whole-body MRI compared with standard pathways for staging metastatic disease in lung and colorectal cancer: the Streamline diagnostic accuracy studies. Health Technol Assess 2019; 23:1-270. [PMID: 31855148 PMCID: PMC6936168 DOI: 10.3310/hta23660] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Whole-body magnetic resonance imaging is advocated as an alternative to standard pathways for staging cancer. OBJECTIVES The objectives were to compare diagnostic accuracy, efficiency, patient acceptability, observer variability and cost-effectiveness of whole-body magnetic resonance imaging and standard pathways in staging newly diagnosed non-small-cell lung cancer (Streamline L) and colorectal cancer (Streamline C). DESIGN The design was a prospective multicentre cohort study. SETTING The setting was 16 NHS hospitals. PARTICIPANTS Consecutive patients aged ≥ 18 years with histologically proven or suspected colorectal (Streamline C) or non-small-cell lung cancer (Streamline L). INTERVENTIONS Whole-body magnetic resonance imaging. Standard staging investigations (e.g. computed tomography and positron emission tomography-computed tomography). REFERENCE STANDARD Consensus panel decision using 12-month follow-up data. MAIN OUTCOME MEASURES The primary outcome was per-patient sensitivity difference between whole-body magnetic resonance imaging and standard staging pathways for metastasis. Secondary outcomes included differences in specificity, the nature of the first major treatment decision, time and number of tests to complete staging, patient experience and cost-effectiveness. RESULTS Streamline C - 299 participants were included. Per-patient sensitivity for metastatic disease was 67% (95% confidence interval 56% to 78%) and 63% (95% confidence interval 51% to 74%) for whole-body magnetic resonance imaging and standard pathways, respectively, a difference in sensitivity of 4% (95% confidence interval -5% to 13%; p = 0.51). Specificity was 95% (95% confidence interval 92% to 97%) and 93% (95% confidence interval 90% to 96%) respectively, a difference of 2% (95% confidence interval -2% to 6%). Pathway treatment decisions agreed with the multidisciplinary team treatment decision in 96% and 95% of cases, respectively, a difference of 1% (95% confidence interval -2% to 4%). Time for staging was 8 days (95% confidence interval 6 to 9 days) and 13 days (95% confidence interval 11 to 15 days) for whole-body magnetic resonance imaging and standard pathways, respectively, a difference of 5 days (95% confidence interval 3 to 7 days). The whole-body magnetic resonance imaging pathway was cheaper than the standard staging pathway: £216 (95% confidence interval £211 to £221) versus £285 (95% confidence interval £260 to £310). Streamline L - 187 participants were included. Per-patient sensitivity for metastatic disease was 50% (95% confidence interval 37% to 63%) and 54% (95% confidence interval 41% to 67%) for whole-body magnetic resonance imaging and standard pathways, respectively, a difference in sensitivity of 4% (95% confidence interval -7% to 15%; p = 0.73). Specificity was 93% (95% confidence interval 88% to 96%) and 95% (95% confidence interval 91% to 98%), respectively, a difference of 2% (95% confidence interval -2% to 7%). Pathway treatment decisions agreed with the multidisciplinary team treatment decision in 98% and 99% of cases, respectively, a difference of 1% (95% confidence interval -2% to 4%). Time for staging was 13 days (95% confidence interval 12 to 14 days) and 19 days (95% confidence interval 17 to 21 days) for whole-body magnetic resonance imaging and standard pathways, respectively, a difference of 6 days (95% confidence interval 4 to 8 days). The whole-body magnetic resonance imaging pathway was cheaper than the standard staging pathway: £317 (95% confidence interval £273 to £361) versus £620 (95% confidence interval £574 to £666). Participants generally found whole-body magnetic resonance imaging more burdensome than standard imaging but most participants preferred the whole-body magnetic resonance imaging staging pathway if it reduced time to staging and/or number of tests. LIMITATIONS Whole-body magnetic resonance imaging was interpreted by practitioners blinded to other clinical data, which may not fully reflect how it is used in clinical practice. CONCLUSIONS In colorectal and non-small-cell lung cancer, the whole-body magnetic resonance imaging staging pathway has similar accuracy to standard staging pathways, is generally preferred by patients, improves staging efficiency and has lower staging costs. Future work should address the utility of whole-body magnetic resonance imaging for treatment response assessment. TRIAL REGISTRATION Current Controlled Trials ISRCTN43958015 and ISRCTN50436483. FUNDING This project was funded by the NIHR Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 23, No. 66. See the NIHR Journals Library website for further project information.
Collapse
Affiliation(s)
- Stuart A Taylor
- Centre for Medical Imaging, University College London, London, UK
| | - Susan Mallett
- Institute of Applied Health Research, NIHR Birmingham Biomedical Research Centre, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Anne Miles
- Department of Psychological Sciences, Birkbeck, University of London, London, UK
| | - Stephen Morris
- Applied Health Research, University College London, London, UK
| | - Laura Quinn
- Institute of Applied Health Research, NIHR Birmingham Biomedical Research Centre, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Caroline S Clarke
- Research Department of Primary Care and Population Health, and Priment Clinical Trials Unit, University College London, London, UK
| | - Sandy Beare
- Cancer Research UK & UCL Cancer Trials Centre, University College London, London, UK
| | | | - Vicky Goh
- Department of Cancer Imaging, School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Sam Janes
- Lungs for Living Research Centre, UCL Respiratory, University College London, London, UK
| | - Dow-Mu Koh
- Department of Radiology, The Royal Marsden Hospital, Sutton, UK
| | - Alison Morton
- c/o Centre for Medical Imaging, University College London, London, UK
| | - Neal Navani
- Lungs for Living Research Centre, UCL Respiratory, University College London, London, UK
| | - Alfred Oliver
- c/o Centre for Medical Imaging, University College London, London, UK
| | - Anwar Padhani
- Mount Vernon Centre for Cancer Treatment, Mount Vernon Hospital, Northwood, UK
| | - Shonit Punwani
- Centre for Medical Imaging, University College London, London, UK
| | - Andrea Rockall
- Imaging Department, Imperial College Healthcare NHS Trust, London, UK
| | - Steve Halligan
- Centre for Medical Imaging, University College London, London, UK
| |
Collapse
|
13
|
McMillan S, Chhabra A, Hassebrock JD, Ford E, Amin NH. Risks and Complications Associated With Intra-articular Arthroscopy of the Knee and Shoulder in an Office Setting. Orthop J Sports Med 2019; 7:2325967119869846. [PMID: 31632993 PMCID: PMC6767734 DOI: 10.1177/2325967119869846] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Classically, arthroscopy has been considered one of the diagnostic gold standards for assessing intra-articular knee and shoulder abnormality. PURPOSE To assess the risks associated with in-office needle arthroscopy. STUDY DESIGN Case series; Level of evidence, 4. METHODS A retrospective case series analysis was performed by evaluating consecutive diagnostic needle arthroscopies performed by 13 physicians at 13 independent institutions. The findings of both major and minor complications were reported by each of the 13 surgeons based on office documentation. The data were analyzed as a lump sum of both knee and shoulder cases and then subdivided and examined separately. The patients' ages ranged from 14 to 78 years, and no statistical difference was noted between the numbers of men and women. A major complication was defined as infection, chondral toxicity, or the need for alternative treatment at an urgent care or emergency room secondary to the procedure. Minor complications were defined as a vasovagal event, pain that persisted after 24 hours, or the need for crutches or sling postprocedure. RESULTS Of the 1419 cases, no major complications were reported. The overall rate of vasovagal events was 1.9% for all procedures (1.6% in knees, 3% in shoulders). Persistent pain longer than 24 hours postprocedure was reported in 0.3% of cases. No patient required crutches or a sling. Postarthroscopy magnetic resonance imaging was needed in 1.4% of cases. No device failures were reported. CONCLUSION Previous literature has evaluated the efficacy, sensitivity, and specificity of in-office diagnostic arthroscopy, and this study validates needle arthroscopy as safe in the office setting, with minimal risk of major or minor complications.
Collapse
Affiliation(s)
- Sean McMillan
- Department of Orthopedics, Lourdes Health Systems, Burlington, New Jersey, USA
| | - Anikar Chhabra
- Department of Orthopedics, Mayo Clinic, Phoenix, Arizona, USA
| | | | - Elizabeth Ford
- Department of Orthopedics, Lourdes Health Systems, Burlington, New Jersey, USA
| | | |
Collapse
|
14
|
Evans RE, Taylor SA, Beare S, Halligan S, Morton A, Oliver A, Rockall A, Miles A. Perceived patient burden and acceptability of whole body MRI for staging lung and colorectal cancer; comparison with standard staging investigations. Br J Radiol 2018. [PMID: 29528257 PMCID: PMC6223281 DOI: 10.1259/bjr.20170731] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Objective: To evaluate perceived patient burden and acceptability of whole body MRI (WB-MRI) compared to standard staging investigations, and identify predictors of reduced tolerance. Methods: Patients recruited to multicentre trials comparing WB-MRI with standard staging scans for lung and colorectal cancer were invited to complete two questionnaires: a baseline questionnaire at recruitment, measuring demographics, comorbidities, and distress; and a follow-up questionnaire after staging, measuring recovery time, comparative acceptability/satisfaction between WB-MRI and CT (colorectal cancer) and PET-CT (lung cancer), and perceived scan burden (scored 1, low; 7, high). Results: 115 patients (median age 66.3 years; 67 males) completed follow up and 103 baseline questionnaires. 69 (63.9%) reported “immediate” recovery from WB-MRI and 73 (65.2%) judged it “very acceptable”. Perceived WB-MRI burden was greater than for CT (p < 0.001) and PET-CT (p < 0.001). High distress and comorbidities were associated with greater WB-MRI burden in adjusted analyses, with deprivation only approaching significance (adjusted regression β = 0.223, p = 0.025; β = 0.191, p = 0.048; β = −0.186, p = 0.059 respectively). Age (p = 0.535), gender (p = 0.389), ethnicity (p = 0.081) and cancer type (p = 0.201) were not predictive of WB-MRI burden. Conclusion: WB-MRI is marginally less acceptable and more burdensome than standard scans, particularly for patients with pre-existing distress and comorbidities. Advances in knowledge: This research shows that WB-MRI scan burden, although low, is higher than for current staging modalities among patients with suspected colorectal or lung cancer. Psychological and physical comorbidities adversely impact on patient experience of WB-MRI. Patients with high distress or comorbid illness may need additional support to undergo a WB-MRI.
Collapse
Affiliation(s)
- Ruth Ec Evans
- 1 Deparment of Psychological Sciences, Birkbeck, University of London , London , UK
| | - Stuart A Taylor
- 2 Division of Medicine, Centre for Medical Imaging, University College London , London , UK
| | - Sandra Beare
- 3 Cancer Research UK and UCL Cancer Trials Centre , London , UK
| | - Steve Halligan
- 2 Division of Medicine, Centre for Medical Imaging, University College London , London , UK
| | - Alison Morton
- 4 C/O National Cancer Research Institute, Angel Building , London , UK
| | - Alf Oliver
- 4 C/O National Cancer Research Institute, Angel Building , London , UK
| | - Andrea Rockall
- 5 Department of Surgery and Cancer, Imperial College London, Kensington , London , UK.,6 Department of Radiology, Royal Marsden NHS Foundation Hospital Trust , London , UK
| | - Anne Miles
- 1 Deparment of Psychological Sciences, Birkbeck, University of London , London , UK
| |
Collapse
|
15
|
Evans R, Taylor S, Janes S, Halligan S, Morton A, Navani N, Oliver A, Rockall A, Teague J, Miles A. Patient experience and perceived acceptability of whole-body magnetic resonance imaging for staging colorectal and lung cancer compared with current staging scans: a qualitative study. BMJ Open 2017; 7:e016391. [PMID: 28882915 PMCID: PMC5588966 DOI: 10.1136/bmjopen-2017-016391] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Revised: 06/02/2017] [Accepted: 06/07/2017] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE To describe the experience and acceptability of whole-body magnetic resonance imaging (WB-MRI) staging compared with standard scans among patients with highly suspected or known colorectal or lung cancer. DESIGN Qualitative study using one-to-one interviews with thematic analysis. SETTING Patients recruited from 10 hospitals in London, East and South East England between March 2013 and July 2014. PARTICIPANTS 51 patients (31 male, age range 40-89 years), with varying levels of social deprivation, were recruited consecutively from two parallel clinical trials comparing the diagnostic accuracy and cost-effectiveness of WB-MRI with standard scans for staging colorectal and lung cancer ('Streamline-C' and 'Streamline-L'). WB-MRI was offered as an additional scan as part of the trials. RESULTS In general WB-MRI presented a greater challenge than standard scans, although all but four patients completed the WB-MRI. Key challenges were enclosed space, noise and scan duration; reduced patient tolerance was associated with claustrophobia, pulmonary symptoms and existing comorbidities. Coping strategies facilitated scan tolerance and were grouped into (1) those intended to help with physical and emotional challenges, and (2) those focused on motivation to complete the scan, for example focusing on health benefit. Our study suggests that good staff communication could reduce anxiety and boost coping strategies. CONCLUSIONS Although WB-MRI was perceived as more challenging than standard scans, it was sufficiently acceptable and tolerated by most patients to potentially replace them if appropriate. TRIAL REGISTRATION NUMBER ISRCTN43958015 and ISRCTN50436483.
Collapse
Affiliation(s)
- Ruth Evans
- Department of Psychological Sciences, Birkbeck University of London, London, United Kingdom
| | - Stuart Taylor
- Division of Medicine, Centre for Medical Imaging, University College London, London, United Kingdom
| | - Sam Janes
- Division of Medicine, Lungs for Living Research Centre, University College London, London, United Kingdom
| | - Steve Halligan
- Division of Medicine, Centre for Medical Imaging, University College London, London, United Kingdom
| | - Alison Morton
- C/O National Cancer Research Institute, London, United Kingdom
| | - Neal Navani
- Division of Medicine, Lungs for Living Research Centre, University College London, London, United Kingdom
| | - Alf Oliver
- C/O National Cancer Research Institute, London, United Kingdom
| | - Andrea Rockall
- Department of Surgery and Cancer, Imperial College, London, United Kingdom
- Department of Radiology, Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Jonathan Teague
- Cancer Research UK & UCL Clinical Trials Centre, London, United Kingdom
| | - Anne Miles
- Department of Psychological Sciences, Birkbeck University of London, London, United Kingdom
| |
Collapse
|
16
|
Jamil A, Batsikadze G, Kuo H, Labruna L, Hasan A, Paulus W, Nitsche MA. Systematic evaluation of the impact of stimulation intensity on neuroplastic after-effects induced by transcranial direct current stimulation. J Physiol 2017; 595:1273-1288. [PMID: 27723104 PMCID: PMC5309387 DOI: 10.1113/jp272738] [Citation(s) in RCA: 280] [Impact Index Per Article: 35.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Accepted: 10/04/2016] [Indexed: 11/08/2022] Open
Abstract
KEY POINTS Applications of transcranial direct current stimulation to modulate human neuroplasticity have increased in research and clinical settings. However, the need for longer-lasting effects, combined with marked inter-individual variability, necessitates a deeper understanding of the relationship between stimulation parameters and physiological effects. We systematically investigated the full DC intensity range (0.5-2.0 mA) for both anodal and cathodal tDCS in a sham-controlled repeated measures design, monitoring changes in motor-cortical excitability via transcranial magnetic stimulation up to 2 h after stimulation. For both tDCS polarities, the excitability after-effects did not linearly correlate with increasing DC intensity; effects of lower intensities (0.5, 1.0 mA) showed equal, if not greater effects in motor-cortical excitability. Further, while intra-individual responses showed good reliability, inter-individual sensitivity to TMS accounted for a modest percentage of the variance in the early after-effects of 1.0 mA anodal tDCS, which may be of practical relevance for future optimizations. ABSTRACT Contemporary non-invasive neuromodulatory techniques, such as transcranial direct current stimulation (tDCS), have shown promising potential in both restituting impairments in cortical physiology in clinical settings, as well as modulating cognitive abilities in the healthy population. However, neuroplastic after-effects of tDCS are highly dependent on stimulation parameters, relatively short lasting, and not expectedly uniform between individuals. The present study systematically investigates the full range of current intensity between 0.5 and 2.0 mA on left primary motor cortex (M1) plasticity, as well as the impact of individual-level covariates on explaining inter-individual variability. Thirty-eight healthy subjects were divided into groups of anodal and cathodal tDCS. Five DC intensities (sham, 0.5, 1.0, 1.5 and 2.0 mA) were investigated in separate sessions. Using transcranial magnetic stimulation (TMS), 25 motor-evoked potentials (MEPs) were recorded before, and 10 time points up to 2 h following 15 min of tDCS. Repeated-measures ANOVAs indicated a main effect of intensity for both anodal and cathodal tDCS. With anodal tDCS, all active intensities resulted in equivalent facilitatory effects relative to sham while for cathodal tDCS, only 1.0 mA resulted in sustained excitability diminution. An additional experiment conducted to assess intra-individual variability revealed generally good reliability of 1.0 mA anodal tDCS (ICC(2,1) = 0.74 over the first 30 min). A post hoc analysis to discern sources of inter-individual variability confirmed a previous finding in which individual TMS SI1mV (stimulus intensity for 1 mV MEP amplitude) sensitivity correlated negatively with 1.0 mA anodal tDCS effects on excitability. Our study thus provides further insights on the extent of non-linear intensity-dependent neuroplastic after-effects of anodal and cathodal tDCS.
Collapse
Affiliation(s)
- Asif Jamil
- Department of Clinical NeurophysiologyUniversity Medical Center, University of Göttingen37075GöttingenGermany
- Leibniz Research Centre for Working Environment and Human Factors44139DortmundGermany
| | - Giorgi Batsikadze
- Department of Clinical NeurophysiologyUniversity Medical Center, University of Göttingen37075GöttingenGermany
| | - Hsiao‐I. Kuo
- Department of Clinical NeurophysiologyUniversity Medical Center, University of Göttingen37075GöttingenGermany
- Leibniz Research Centre for Working Environment and Human Factors44139DortmundGermany
| | - Ludovica Labruna
- Department of PsychologyUniversity of CaliforniaBerkeleyCA94720USA
| | - Alkomiet Hasan
- Department of Psychiatry and PsychotherapyKlinikum der Universität München80336MünchenGermany
| | - Walter Paulus
- Department of Clinical NeurophysiologyUniversity Medical Center, University of Göttingen37075GöttingenGermany
| | - Michael A. Nitsche
- Leibniz Research Centre for Working Environment and Human Factors44139DortmundGermany
- University Medical Hospital Bergmannsheil44789BochumGermany
| |
Collapse
|
17
|
Yiu KCY, Greenspoon JN. Clinical surveillance compared with clinical and magnetic resonance imaging surveillance for brain metastasis: a feasibility survey. ACTA ACUST UNITED AC 2016; 23:356-360. [PMID: 27803601 DOI: 10.3747/co.23.3155] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION After stereotactic radiosurgery (srs) for brain metastases, patients are routinely monitored with magnetic resonance imaging (mri). The high rate of new brain metastases after srs treatment alone might not be as concerning with modern mri and target localization treatment. Intensive surveillance might induce anxiety, lowering the patient's quality of life (qol). The present work is the feasibility component of a prospective study evaluating the role of surveillance mri on qol in patients with limited (1-3) brain metastases. METHODS Patients with limited brain metastases treated with srs alone, an Eastern Cooperative Oncology Group performance status of 2 or less, and documented stability in treated lesions, with no new lesions seen on mri at weeks 6-10 after srs, were eligible. All were asked about their interest in participating in the control (mri and clinical surveillance) or the experimental arm (symptom-directed mri and clinical surveillance). If 33% or more agreed to participate in the experimental arm, it would be considered feasible to conduct the prospective study. RESULTS From November 2014 to July 2015, 45% of patients (10 of 22) agreed to participate in the experimental arm. Subgroup analyses found that the decision to participate has no statistically significant association with time of presentation (p = 0.696), display of symptoms (p = 0.840), age (p = 0.135), or number of lesions (p = 0.171). CONCLUSIONS Results show that it is feasible to conduct the prospective cohort study. Because of the small sample size, we are limited in the conclusions able to be drawn in the subgroup analyses. However, the future study would allow for a better understanding of the attitudes of patients toward mri and its effect on qol.
Collapse
Affiliation(s)
| | - J N Greenspoon
- McMaster University, Hamilton, ON.; Juravinski Cancer Centre, Hamilton, ON
| |
Collapse
|
18
|
Kragel PA, Knodt AR, Hariri AR, LaBar KS. Decoding Spontaneous Emotional States in the Human Brain. PLoS Biol 2016; 14:e2000106. [PMID: 27627738 PMCID: PMC5023171 DOI: 10.1371/journal.pbio.2000106] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Accepted: 08/11/2016] [Indexed: 11/19/2022] Open
Abstract
Pattern classification of human brain activity provides unique insight into the neural underpinnings of diverse mental states. These multivariate tools have recently been used within the field of affective neuroscience to classify distributed patterns of brain activation evoked during emotion induction procedures. Here we assess whether neural models developed to discriminate among distinct emotion categories exhibit predictive validity in the absence of exteroceptive emotional stimulation. In two experiments, we show that spontaneous fluctuations in human resting-state brain activity can be decoded into categories of experience delineating unique emotional states that exhibit spatiotemporal coherence, covary with individual differences in mood and personality traits, and predict on-line, self-reported feelings. These findings validate objective, brain-based models of emotion and show how emotional states dynamically emerge from the activity of separable neural systems. Functional brain imaging techniques provide a window into neural activity underpinning diverse cognitive processes, including visual perception, decision-making, and memory, among many others. By treating functional imaging data as a pattern-recognition problem, similar to face- or character-recognition, researchers have successfully identified patterns of brain activity that predict specific mental states; for example, the kind of an object being viewed. Moreover, these methods are capable of predicting mental states in the absence of external stimulation. For example, pattern-classifiers trained on brain responses to visual stimuli can successfully predict the contents of imagery during sleep. This research shows that internally mediated brain activity can be used to infer subjective mental states; however, it is not known whether more complex emotional mental states can be decoded from neuroimaging data in the absence of experimental manipulations. Here we show that brain-based models of specific emotions can detect individual differences in mood and emotional traits and are consistent with self-reports of emotional experience during intermittent periods of wakeful rest. These findings show that the brain dynamically fluctuates among multiple distinct emotional states at rest. More practically, the results suggest that brain-based models of emotion may help assess emotional status in clinical settings, particularly in individuals incapable of providing self-report of their own emotional experience.
Collapse
Affiliation(s)
- Philip A. Kragel
- Department of Psychology & Neuroscience, Duke University, Durham, North Carolina, United States of America
| | - Annchen R. Knodt
- Department of Psychology & Neuroscience, Duke University, Durham, North Carolina, United States of America
| | - Ahmad R. Hariri
- Department of Psychology & Neuroscience, Duke University, Durham, North Carolina, United States of America
| | - Kevin S. LaBar
- Department of Psychology & Neuroscience, Duke University, Durham, North Carolina, United States of America
- * E-mail:
| |
Collapse
|