| 1. |
- Bladen, Catherine L., et al.
(author)
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The TREAT-NMD Duchenne Muscular Dystrophy Registries : Conception, Design, and Utilization by Industry and Academia
- 2013
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In: Human Mutation. - : Hindawi Limited. - 1059-7794 .- 1098-1004. ; 34:11, s. 1449-1457
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Journal article (peer-reviewed)abstract
- Duchenne muscular dystrophy (DMD) is an X-linked genetic disease, caused by the absence of the dystrophin protein. Although many novel therapies are under development for DMD, there is currently no cure and affected individuals are often confined to a wheelchair by their teens and die in their twenties/thirties. DMD is a rare disease (prevalence<5/10,000). Even the largest countries do not have enough affected patients to rigorously assess novel therapies, unravel genetic complexities, and determine patient outcomes. TREAT-NMD is a worldwide network for neuromuscular diseases that provides an infrastructure to support the delivery of promising new therapies for patients. The harmonized implementation of national and ultimately global patient registries has been central to the success of TREAT-NMD. For the DMD registries within TREAT-NMD, individual countries have chosen to collect patient information in the form of standardized patient registries to increase the overall patient population on which clinical outcomes and new technologies can be assessed. The registries comprise more than 13,500 patients from 31 different countries. Here, we describe how the TREAT-NMD national patient registries for DMD were established. We look at their continued growth and assess how successful they have been at fostering collaboration between academia, patient organizations, and industry.
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| 2. |
- Brabec, Jan
(author)
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Applications of diffusion MRI: Tensor-valued encoding, time-dependent diffusion, and histological validation
- 2022. - 1
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Doctoral thesis (other academic/artistic)abstract
- Diffusion MRI (dMRI) sensitizes the MR signal to the diffusion of water molecules at the microscopic level and thereby non-invasively probes tissue microstructure. This is relevant when determining biological properties of tissues, for example, cancer type and its malignancy. The problem is, however, that dMRI lacks sensitivity and specificity to distinct microstructural features because an image voxel contains vast number of different features that are mapped onto relatively few dMRI observables. To tackle this issue, we aimed at solving two gaps in current knowledge—the first was related to what microstructural aspects are of most importance and the second to how adding new observables to the dMRI measurement could improve brain tumor imaging.In this work, we first investigate the biological underpinnings of dMRI observables—focusing on the degree to which larger-scale microstructural arrangements are of relevance. In Paper I, we investigated the effects of non-straight propagation of axons and found that they are indistinguishable from those originating from the diameter of a straight axon, at least for typical measurements with a clinical scanner. We propose that the use of short diffusion times could help separate them. In Paper II, in a comparison between histology and microimaging of meningioma brain tumors, we quantified to what degree the common biological interpretation of one of the most used dMRI observable holds—mean diffusivity (MD) as reflecting cell density and fractional anisotropy reflecting tissue anisotropy. We found that the local variability in MD was explained in minority of the samples whereas FA in majority by the common interpretations. We suggested additional relevant features such as tumor vascularization, psammoma bodies, microcysts or tissue cohesivity for explaining MD variability.Second, we examined whether a framework that introduces a new measurement observable brings value in intracranial tumor imaging. This new variable is termed the b-tensor shape and is derived from the tensor-valued dMRI paradigm. In Paper IV, we adjusted and shortened by 40 % (from 5 to 3 minutes) a tensor-valued dMRI protocol for clinical imaging of intracranial tumors and applied it to characterize to a wide range of different intracranial tumors. The protocol was also used in clinical studies of patients with intracranial tumors—gliomas and meningiomas—in Paper III and Paper V, respectively. In Paper III, we found that using so-called spherical b-tensor encoding leads to enhanced conspicuity of glioma hyperintensities to white matter in all patients and on average the signal-intensity-ratio increased by 28 %. In Paper V we found that it may also inform on meningiomas preoperatively. The standard deviation of isotropic kurtosis was associated with tumor grade and with and the 10th percentiles of the mean and anisotropic kurtoses with firm tumor consistency. Preoperative knowledge of the consistency is important for the neurosurgeons when choosing the optimal surgical procedure.
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| 3. |
- Brabec, Jan, et al.
(author)
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Coregistered histology sections with diffusion tensor imaging data at 200 µm resolution in meningioma tumors
- 2023
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In: Data in Brief. - 2352-3409. ; 48
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Journal article (peer-reviewed)abstract
- A significant problem in diffusion MRI (dMRI) is the lack of understanding regarding which microstructural features account for the variability in the diffusion tensor imaging (DTI) parameters observed in meningioma tumors. A common assumption is that mean diffusivity (MD) and fractional anisotropy (FA) from DTI are inversely proportional to cell density and proportional to tissue anisotropy, respectively. Although these associations have been established across a wide range of tumors, they have been challenged for interpreting within-tumor variations where several additional microstructural features have been suggested as contributing to MD and FA.To facilitate the investigation of the biological underpinnings of DTI parameters, we performed ex-vivo DTI at 200 µm isotropic resolution on 16 excised meningioma tumor samples. The samples exhibit a variety of microstructural features because the dataset includes meningiomas of six different meningioma types and two different grades. Diffusion-weighted signal (DWI) maps, DWI maps averaged over all directions for given b-value, signal intensities without diffusion encoding (S0) as well as DTI parameters: MD, FA, in-plane FA (FAIP), axial diffusivity (AD) and radial diffusivity (RD), were coregistered to Hematoxylin & Eosin- (H&E) and Elastica van Gieson-stained (EVG) histological sections by a non-linear landmark-based approach.Here, we provide DWI signal and DTI maps coregistered to histology sections and describe the pipeline for processing the raw DTI data and the coregistration. The raw, processed, and coregistered data are hosted by Analytic Imaging Diagnostics Arena (AIDA) data hub registry, and software tools for processing are provided via GitHub. We hope that data can be used in research and education concerning the link between the meningioma microstructure and parameters obtained by DTI.
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| 4. |
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| 5. |
- Brabec, Jan, et al.
(author)
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Histogram analysis of tensor-valued diffusion MRI in meningiomas : Relation to consistency, histological grade and type
- 2022
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In: NeuroImage: Clinical. - : Elsevier BV. - 2213-1582. ; 33
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Journal article (peer-reviewed)abstract
- BACKGROUND: Preoperative radiological assessment of meningioma characteristics is of value for pre- and post-operative patient management, counselling, and surgical approach.PURPOSE: To investigate whether tensor-valued diffusion MRI can add to the preoperative prediction of meningioma consistency, grade and type.MATERIALS AND METHODS: 30 patients with intracranial meningiomas (22 WHO grade I, 8 WHO grade II) underwent MRI prior to surgery. Diffusion MRI was performed with linear and spherical b-tensors with b-values up to 2000 s/mm2. The data were used to estimate mean diffusivity (MD), fractional anisotropy (FA), mean kurtosis (MK) and its components-the anisotropic and isotropic kurtoses (MKA and MKI). Meningioma consistency was estimated for 16 patients during resection based on ultrasonic aspiration intensity, ease of resection with instrumentation or suction. Grade and type were determined by histopathological analysis. The relation between consistency, grade and type and dMRI parameters was analyzed inside the tumor ("whole-tumor") and within brain tissue in the immediate periphery outside the tumor ("rim") by histogram analysis.RESULTS: Lower 10th percentiles of MK and MKA in the whole-tumor were associated with firm consistency compared with pooled soft and variable consistency (n = 7 vs 9; U test, p = 0.02 for MKA 10 and p = 0.04 for MK10) and lower 10th percentile of MD with variable against soft and firm (n = 5 vs 11; U test, p = 0.02). Higher standard deviation of MKI in the rim was associated with lower grade (n = 22 vs 8; U test, p = 0.04) and in the MKI maps we observed elevated rim-like structure that could be associated with grade. Higher median MKA and lower median MKI distinguished psammomatous type from other pooled meningioma types (n = 5 vs 25; U test; p = 0.03 for MKA 50 and p = 0.03 and p = 0.04 for MKI 50).CONCLUSION: Parameters from tensor-valued dMRI can facilitate prediction of consistency, grade and type.
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| 6. |
- Brabec, Jan, et al.
(author)
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Meningioma microstructure assessed by diffusion MRI : An investigation of the source of mean diffusivity and fractional anisotropy by quantitative histology
- 2023
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In: NeuroImage: Clinical. - : Elsevier BV. - 2213-1582. ; 37
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Journal article (peer-reviewed)abstract
- BACKGROUND: Mean diffusivity (MD) and fractional anisotropy (FA) from diffusion MRI (dMRI) have been associated with cell density and tissue anisotropy across tumors, but it is unknown whether these associations persist at the microscopic level.PURPOSE: To quantify the degree to which cell density and anisotropy, as determined from histology, account for the intra-tumor variability of MD and FA in meningioma tumors. Furthermore, to clarify whether other histological features account for additional intra-tumor variability of dMRI parameters.MATERIALS AND METHODS: We performed ex-vivo dMRI at 200 μm isotropic resolution and histological imaging of 16 excised meningioma tumor samples. Diffusion tensor imaging (DTI) was used to map MD and FA, as well as the in-plane FA (FA IP). Histology images were analyzed in terms of cell nuclei density (CD) and structure anisotropy (SA; obtained from structure tensor analysis) and were used separately in a regression analysis to predict MD and FA IP, respectively. A convolutional neural network (CNN) was also trained to predict the dMRI parameters from histology patches. The association between MRI and histology was analyzed in terms of out-of-sample (R 2 OS) on the intra-tumor level and within-sample R 2 across tumors. Regions where the dMRI parameters were poorly predicted from histology were analyzed to identify features apart from CD and SA that could influence MD and FA IP, respectively. RESULTS: Cell density assessed by histology poorly explained intra-tumor variability of MD at the mesoscopic level (200 μm), as median R 2 OS = 0.04 (interquartile range 0.01-0.26). Structure anisotropy explained more of the variation in FA IP (median R 2 OS = 0.31, 0.20-0.42). Samples with low R 2 OS for FA IP exhibited low variations throughout the samples and thus low explainable variability, however, this was not the case for MD. Across tumors, CD and SA were clearly associated with MD (R 2 = 0.60) and FA IP (R 2 = 0.81), respectively. In 37% of the samples (6 out of 16), cell density did not explain intra-tumor variability of MD when compared to the degree explained by the CNN. Tumor vascularization, psammoma bodies, microcysts, and tissue cohesivity were associated with bias in MD prediction based solely on CD. Our results support that FA IP is high in the presence of elongated and aligned cell structures, but low otherwise. CONCLUSION: Cell density and structure anisotropy account for variability in MD and FA IP across tumors but cell density does not explain MD variations within the tumor, which means that low or high values of MD locally may not always reflect high or low tumor cell density. Features beyond cell density need to be considered when interpreting MD.
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| 7. |
- Brabec, Jan, et al.
(author)
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Separating Glioma Hyperintensities From White Matter by Diffusion-Weighted Imaging With Spherical Tensor Encoding
- 2022
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In: Frontiers in Neuroscience. - : Frontiers Media SA. - 1662-4548 .- 1662-453X. ; 16
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Journal article (peer-reviewed)abstract
- Background: Tumor-related hyperintensities in high b-value diffusion-weighted imaging (DWI) are radiologically important in the workup of gliomas. However, the white matter may also appear as hyperintense, which may conflate interpretation.Purpose: To investigate whether DWI with spherical b-tensor encoding (STE) can be used to suppress white matter and enhance the conspicuity of glioma hyperintensities unrelated to white matter.Materials and Methods: Twenty-five patients with a glioma tumor and at least one pathology-related hyperintensity on DWI underwent conventional MRI at 3 T. The DWI was performed both with linear and spherical tensor encoding (LTE-DWI and STE-DWI). The LTE-DWI here refers to the DWI obtained with conventional diffusion encoding and averaged across diffusion-encoding directions. Retrospectively, the differences in contrast between LTE-DWI and STE-DWI, obtained at a b-value of 2,000 s/mm2, were evaluated by comparing hyperintensities and contralateral normal-appearing white matter (NAWM) both visually and quantitatively in terms of the signal intensity ratio (SIR) and contrast-to-noise ratio efficiency (CNReff).Results: The spherical tensor encoding DWI was more effective than LTE-DWI at suppressing signals from white matter and improved conspicuity of pathology-related hyperintensities. The median SIR improved in all cases and on average by 28%. The median (interquartile range) SIR was 1.9 (1.6 - 2.1) for STE and 1.4 (1.3 - 1.7) for LTE, with a significant difference of 0.4 (0.3 -0.5) (p < 10-4, paired U-test). In 40% of the patients, the SIR was above 2 for STE-DWI, but with LTE-DWI, the SIR was below 2 for all patients. The CNReff of STE-DWI was significantly higher than of LTE-DWI: 2.5 (2 - 3.5) vs. 2.3 (1.7 - 3.1), with a significant difference of 0.4 (-0.1 -0.6) (p < 10-3, paired U-test). The STE improved CNReff in 70% of the cases. We illustrate the benefits of STE-DWI in three patients, where STE-DWI may facilitate an improved radiological description of tumor-related hyperintensity, including one case that could have been missed out if only LTE-DWI was inspected.Conclusion: The contrast mechanism of high b-value STE-DWI results in a stronger suppression of white matter than conventional LTE-DWI, and may, therefore, be more sensitive and specific for assessment of glioma tumors and DWI-hyperintensities.
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| 8. |
- Brabec, Jan, et al.
(author)
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Time-dependent diffusion in undulating thin fibers : Impact on axon diameter estimation
- 2020
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In: NMR in Biomedicine. - : Wiley. - 0952-3480 .- 1099-1492. ; 33:3
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Journal article (peer-reviewed)abstract
- Diffusion MRI may enable non-invasive mapping of axonal microstructure. Most approaches infer axon diameters from effects of time-dependent diffusion on the diffusion-weighted MR signal by modeling axons as straight cylinders. Axons do not, however, propagate in straight trajectories, and so far the impact of the axonal trajectory on diameter estimation has been insufficiently investigated. Here, we employ a toy model of axons, which we refer to as the undulating thin fiber model, to analyze the impact of undulating trajectories on the time dependence of diffusion. We study time-dependent diffusion in the frequency domain and characterize the diffusion spectrum by its height, width, and low-frequency behavior (power law exponent). Results show that microscopic orientation dispersion of the thin fibers is the main parameter that determines the characteristics of the diffusion spectra. At lower frequencies (longer diffusion times), straight cylinders and undulating thin fibers can have virtually identical spectra. If the straight-cylinder assumption is used to interpret data from undulating thin axons, the diameter is overestimated by an amount proportional to the undulation amplitude and microscopic orientation dispersion of the fibers. At higher frequencies (shorter diffusion times), spectra from cylinders and undulating thin fibers differ. The low-frequency behavior of the spectra from the undulating thin fibers may also differ from that of cylinders, because the power law exponent of undulating fibers can reach values below 2 for experimentally relevant frequency ranges. In conclusion, we argue that the non-straight nature of axonal trajectories should not be overlooked when analyzing and interpreting diffusion MRI data.
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| 9. |
- Chakwizira, Arthur, et al.
(author)
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Diffusion MRI with pulsed and free gradient waveforms : effects of restricted diffusion and exchange
- 2023
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In: NMR in Biomedicine. - : Wiley. - 0952-3480 .- 1099-1492. ; 36:1
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Journal article (peer-reviewed)abstract
- Monitoring time-dependence with diffusion MRI yields observables sensitive to compartment sizes (restricted diffusion) and membrane permeability (water exchange). However, restricted diffusion and exchange have opposite effects on the diffusion-weighted signal, which can lead to errors in parameter estimates. In this work, we propose a signal representation that incorporates the effects of both restricted diffusion and exchange up to second order in b-value and is compatible with gradient waveforms of arbitrary shape. The representation features mappings from a gradient waveform to two scalars that separately control the sensitivity to restriction and exchange. We demonstrate that these scalars span a two-dimensional space that can be used to choose waveforms that selectively probe restricted diffusion or exchange, eliminating the correlation between the two phenomena. We found that waveforms with specific but unconventional shapes provide an advantage over conventional pulsed and oscillating gradient acquisitions. We also show that parametrisation of waveforms into a two-dimensional space can be used to understand protocols from other approaches that probe restricted diffusion and exchange. For example, we found that the variation of mixing time in filter-exchange imaging corresponds to variation of our exchange-weighting scalar at a fixed value of the restriction-weighting scalar. The proposed signal representation was evaluated using Monte Carlo simulations in identical parallel cylinders with hexagonal and random packing as well as parallel cylinders with gamma-distributed radii. Results showed that the approach is sensitive to sizes in the interval 4 - 12 μm and exchange rates in the simulated range of 0 to 20 s -1 , but also that there is a sensitivity to the extracellular geometry. The presented theory constitutes a simple and intuitive description of how restricted diffusion and exchange influence the signal as well as a guide to protocol design capable of separating the two effects.
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| 10. |
- Nilsson, Markus, et al.
(author)
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Tensor-valued diffusion MRI in under 3 minutes : an initial survey of microscopic anisotropy and tissue heterogeneity in intracranial tumors
- 2020
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In: Magnetic Resonance in Medicine. - : Wiley. - 0740-3194 .- 1522-2594. ; 83:2, s. 608-620
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Journal article (peer-reviewed)abstract
- Purpose: To evaluate the feasibility of a 3-minutes protocol for assessment of the microscopic anisotropy and tissue heterogeneity based on tensor-valued diffusion MRI in a wide range of intracranial tumors. Methods: B-tensor encoding was performed in 42 patients with intracranial tumors (gliomas, meningiomas, adenomas, and metastases). Microscopic anisotropy and tissue heterogeneity were evaluated by estimating the anisotropic kurtosis (MKA) and isotropic kurtosis (MKI), respectively. An extensive imaging protocol was compared with a 3-minutes protocol. Results: The fast imaging protocol yielded parameters with characteristics in terms of bias and precision similar to the full protocol. Glioblastomas had lower microscopic anisotropy than meningiomas (MKA = 0.29 ± 0.06 vs. 0.45 ± 0.08, P = 0.003). Metastases had higher tissue heterogeneity (MKI = 0.57 ± 0.07) than both the glioblastomas (0.44 ± 0.06, P < 0.001) and meningiomas (0.46 ± 0.06, P = 0.03). Conclusion: Evaluation of the microscopic anisotropy and tissue heterogeneity in intracranial tumor patients is feasible in clinically relevant times frames.
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