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Objectives We sought to investigate up to which level of Joint Photographic Experts Group (JPEG) data compression the perceived image quality and the detection of diagnostic features remain equivalent to the quality and detectability found in uncompressed coronary angiograms.Background Digital coronary angiograms represent an enormous amount of data and therefore require costly computerized communication and archiving systems. Earlier studies on the viability of medical image compression were not fully conclusive.Methods Twenty-one raters evaluated sets of 91 cine runs. Uncompressed and compressed versions of the images were presented side by side on one monitor, and image quality differences were assessed on a scale featuring six scores. In addition, the raters had to detect pre-defined clinical features. Compression ratios (CR) were 6:1, 10:1 and 16:1. Statistical evaluation was based on descriptive statistics and on the equivalence t -test.Results At the lowest CR (CR 6:1), there was already a small (15%) increase in assigning the aesthetic quality score indicating “quality difference is barely discernible—the images are equivalent.’ At CR 10:1 and CR 16:1, close to 10% and 55%, respectively, of the compressed images were rated to be “clearly degraded, but still adequate for clinical use’ or worse. Concerning diagnostic features, at CR 10:1 and CR 16:1 the error rate was 9·6% and 13·1%, respectively, compared with 9% for the baseline error rate in uncompressed images.Conclusions Compression at CR 6:1 provides equivalence with the original cine runs. If CR 16:1 were used, one would have to tolerate a significant increase in the diagnostic error rate over the baseline error rate. At CR 10:1, intermediate results were obtained. [ABSTRACT FROM PUBLISHER]

The purpose of this study was to assess cortisol dynamics in the acute phase after aneurysmal subarachnoid hemorrhage (SAH) and to set the parameters of cortisol release in relation to the severity of illness and outcome. In 22 consecutive patients with aneurysmal SAH, cortisol, corticosteroid binding globulin, interleukin-6, and adrenocorticotrophic hormone were measured immediately after hospital admission (t(0)), 7 days (t(1)) later, and at least 14 days later (t(2)). Additionally, diurnal profiles of cortisol secretion were assessed at t(1) and t(2), and area under the curve (AUC) was computed for calculated free serum cortisol (CFSC). In this study, normal diurnal CFSC profiles were associated with a significantly shorter ICU-stay, less complications, and a more favorable outcome than abnormal diurnal profiles. AUC and 8 a.m. cortisol were not related to clinical course or outcome. It is concluded that cortisol secretion patterns are associated with the severity and outcome of SAH. For an appraisal of the hypothalamo-pituitary-adrenal axis in SAH patients, single cortisol measurements are insufficient.

Objective: Hypomania accounts for approximately 4% to 13% of psychotropic adverse events during subthalamic nucleus (STN) deep brain stimulation (DBS) for Parkinson's disease. Diffusion of current into the inferior and medial "limbic" STN is often reported to be the cause. We suggest a different explanation, in which the coactivation of the medial forebrain bundle (MFB), outside the STN, leads to hypomania during STN DBS., Methods: Six patients with advanced Parkinson's disease (age, 54 +/- 11 years) underwent bilateral STN DBS surgery. Preoperative diffusion tensor imaging scans for fiber tracking of the MFB were conducted on a 3T magnetic resonance imaging scanner. After implantation, the electrode positions were determined with computed tomography and integrated in a diffusion tensor imaging software environment., Results: The medial STN was shown to send tributaries to the MFB using it as a pathway to connect to the reward circuitry. One patient, who had a transient, stimulation-induced acute hypomanic episode, showed a direct contact between 1 active electrode contact and these putative limbic STN tributaries to the MFB unilaterally on the left. In 5 asymptomatic patients, the active contacts were between 2.9 and 7.5 mm distant from the MFB or its limbic STN tributaries., Conclusion: We hypothesize that STN DBS-induced reversible acute hypomania might be elicited by inadvertent and unilateral coactivation of putative limbic STN tributaries to the MFB. These findings may provide insight into the neural pathways of hypomania and may facilitate future investigations of the pathophysiology of mood disorders.

Background: Fiber tract portrayal, based on diffusion tensor imaging (DTI), is becoming more and more important in functional neuronavigation. No standard exists to guarantee anatomically correct fiber tract depiction for neurosurgical purposes. Therefore, showing the anatomically correct extension of fiber tracts beyond the pure connection of functional areas remains an area of important research and investigation. Standards for fiber tracking software applications are elusive. The purpose of this study was to compare the performance of different fiber tracking software tools (FT-tools). We tested the software performance, comparability and anatomical accuracy of the tracking results of several programs., Material and Methods: A single DTI dataset of a healthy control subject was submitted to four different fiber tracking software applications (two commercial, two freeware), three of them based on Fiber Assignment by Continuous Tracking, one based on the Tensorline Propagation Algorithm. The corticospinal tract (CST) was investigated. The tracking procedure was controlled by the following input variables: single regions of interest (ROIs): brain stem, or internal capsule, or subcortical white matter of the precentral gyrus; background threshold, fractional anisotropy (FA) threshold, maximum fiber angulation and fiber length. Tracking results were compared for 2-D correlated triplanar images (axial, coronal, sagittal) and in 3-D. For all FT-tools, the time used to generate the CST was measured. The inter-rater variability for tracking time and for the tracked CST volumes was recorded for two of the four FT-tools., Results and Conclusions: Distinct FT-tools performed very differently with respect to the time required to achieve CST portrayal (track generation time varied between 16 and 50 min). None of the software applications was able to display the CST in its full anatomical extent. Especially the lateral precentral areas were not pictured. Surprisingly, the application of the four distinct FT-tools did not lead to comparable tracking results. As very similar or identical tracking algorithms were used, this difference cannot be easily explained. Clearly, neurosurgeons have to be cautious about applying fiber tracking results intraoperatively, especially when dealing with an abnormal or distorted fiber tract anatomy. The authors recommend the use of adjunct strategies such as intraoperative electrophysiology to enhance patient safety and improve anatomical accuracy when using tracking results for surgical procedures.

Objectives: Spinal epidural abscess (SEA) is a rare disease and its early detection and appropriate treatment is essential to prevent high morbidity and mortality. There are only few single-institution series who report their experiences with the microsurgical management of SEA and treatment strategies are discussed controversially. Within the last 15 years the authors have treated 46 patients with SEA. This comparatively high number of cases encouraged us to review our experiences with SEA focussing on the clinical presentation, microsurgical management and outcome., Methods: Clinical charts of 46 cases with a spinal epidural abscess treated between 1990 and 2004 were reviewed. There were 30 men and 16 women, the age ranged between 32 and 86 years (mean: 57 years). The clinical mean follow-up was 8.5 months (range: 2-84). The clinical presentation and severity of neurological deficits were measured by the Frankel grading system on admission and on follow-up visit., Results: The abscess was located in the cervical spine in 8, the thoracic spine in 17 and the lumbar spine in 21 patients. On admission 8 patients were in Frankel grade A, 7 in B, 15 in C, 8 in D and 8 in E. During follow-up 1 patient was in Frankel grade A, 1 in B, 5 in C, 13 in D and 24 in E. 37 patients underwent primary microsurgery with abscess drainage or removal of chronic granulomatous tissue. The clinical symptoms in 4 patients worsened shortly after the operation due to a compression fracture of the vertebral body (n=2) or progress of the abscess (n=2) making re-operation necessary. 9 patients with severe critical illness or without neurological deficits had primarily a CT-guided puncture for assessment of the causative organism. 3 of them needed additional surgical therapy within the hospital stay because of a new neurological deficit. All patients were immobilised and treated with antibiotics for at least 6 weeks. The mortality was 6.5%. As for complications we noted septicaemia (n=5), meningitis (n=1) and a transient malresorptive hydrocephalus (n=1)., Conclusion: Early diagnosis, microsurgical therapy with appropriate antibiotic therapy and careful observation of patients are the keys to successful management of SEA. The goal of surgical treatment is to isolate the causative organism and to perform a decompression at the site of maximal cord compression in cases of neurological deterioration or severe pain. Instrumentation with primary fixation does not seem to be imperative. In cases of post-operative worsening, a fracture of additionally infected bony elements has to be considered and a stabilisation should be discussed on an individual basis.

Variation in gray matter (GM) and white matter (WM) volume of the adult human brain is primarily genetically determined. Moreover, total brain volume is positively correlated with general intelligence, and both share a common genetic origin. However, although genetic effects on morphology of specific GM areas in the brain have been studied, the heritability of focal WM is unknown. Similarly, it is unresolved whether there is a common genetic origin of focal GM and WM structures with intelligence. We explored the genetic influence on focal GM and WM densities in magnetic resonance brain images of 54 monozygotic and 58 dizygotic twin pairs and 34 of their siblings. For genetic analyses, we used structural equation modeling and voxel-based morphometry. To explore the common genetic origin of focal GM and WM areas with intelligence, we obtained cross-trait/cross-twin correlations in which the focal GM and WM densities of each twin are correlated with the psychometric intelligence quotient of his/her cotwin. Genes influenced individual differences in left and right superior occipitofrontal fascicle (heritability up to 0.79 and 0.77), corpus callosum (0.82, 0.80), optic radiation (0.69, 0.79), corticospinal tract (0.78, 0.79), medial frontal cortex (0.78, 0.83), superior frontal cortex (0.76, 0.80), superior temporal cortex (0.80, 0.77), left occipital cortex (0.85), left postcentral cortex (0.83), left posterior cingulate cortex (0.83), right parahippocampal cortex (0.69), and amygdala (0.80, 0.55). Intelligence shared a common genetic origin with superior occipitofrontal, callosal, and left optical radiation WM and frontal, occipital, and parahippocampal GM (phenotypic correlations up to 0.35). These findings point to a neural network that shares a common genetic origin with human intelligence.

The position and extent of individual fiber tracts within the white matter of human brains can be identified in vivo using diffusion tensor imaging (DTI) and fiber tracking methods. Previous to this study, however, the lack of three-dimensional (3-D) probability maps precluded comparing the anatomical precision of MRI studies with microscopically defined fiber tracts in human postmortem brains. The present study provides 3-D registered maps of the topography, course and intersubject variability of major fiber tracts, which were identified at microscopic resolution. The analyzed tracts include the corticospinal tract, optic and acoustic radiations, fornix, cingulum, corpus callosum, superior longitudinal, superior and inferior occipito-frontal and uncinate fascicles; sources and targets of fiber tracts include the lateral and medial geniculate nuclei and mamillary bodies. Tracts and nuclei were identified in serial myelin-stained histological sections of ten postmortem brains. The sections were 3-D reconstructed and registered to a standardized stereotaxic space of an in vivo MR reference brain by means of linear and non-linear, elastic transformations. The individual fiber tracts and nuclei were superimposed in the reference space, and probability maps were generated as a quantitative measure of intersubject variability for each voxel of the stereotaxic space. This study presents the first stereotaxic atlas of the course, location and extent of fiber tracts and related nuclei based on microscopically defined localization and topographic data taken at multiple levels on each of the three orthogonal planes. The maps are useful for evaluating and identifying fiber bundles in DTI, for localizing subcortical lesions visible in anatomical MR images and for studying neuronal connectivity.

Background: Lossless or lossy compression of coronary angiogram data can reduce the enormous amounts of data generated by coronary angiographic imaging. The recent International Study of Angiographic Data Compression (ISAC) assessed the clinical viability of lossy Joint Photographic Expert Group (JPEG) compression but was unable to resolve two related questions: (A) the performance of lossless modes of compression in coronary angiography and (B) the performance of newer lossy wavelet algorithms. This present study seeks to supply some of this information., Methods: The performance of several lossless image compression methods was measured in the same set of images as used in the ISAC study. For the assessment of the relative image quality of lossy JPEG and wavelet compression, the observers ranked the perceived image quality of computer-generated coronary angiograms compressed with wavelet compression relative to the same images with JPEG compression. This ranking allowed the matching of compression ratios for wavelet compression with the clinically viable compression ratios for the JPEG method as obtained in the ISAC study., Results: The best lossless compression scheme (LOCO-I) offered a mean compression ratio (CR) of 3.80:1. The quality of images compressed with the lossy wavelet-based method at CR = 10:1 and 20:1 was comparable to JPEG compression at CR = 6:1 and 10:1, respectively., Conclusion: The study has shown that lossless compression can exceed the CR of 2:1 usually quoted. For lossy compression, the range of clinically viable compression ratios can probably be extended by 50 to 100% when applying wavelet compression algorithms as compared to JPEG compression. These results can motivate a larger clinical study.

Objectives: We sought to investigate up to which level of Joint Photographic Experts Group JPEG) data compression the perceived image quality and the detection of diagnostic features remain equivalent to the quality and detectability found in uncompressed coronary angiograms., Background: Digital coronary angiograms represent an enormous amount of data and therefore require costly computerized communication and archiving systems. Earlier studies on the viability of medical image compression were not fully conclusive., Methods: Twenty-one raters evaluated sets of 91 cine runs. Uncompressed and compressed versions of the images were presented side by side on one monitor, and image quality differences were assessed on a scale featuring six scores. In addition, the raters had to detect pre-defined clinical features. Compression ratios (CR) were 6:1, 10:1 and 16:1. Statistical evaluation was based on descriptive statistics and on the equivalence t-test., Results: At the lowest CR (CR 6:1), there was already a small (15%) increase in assigning the aesthetic quality score indicating "quality difference is barely discernible-the images are equivalent." At CR 10:1 and CR 16:1, close to 10% and 55%, respectively, of the compressed images were rated to be "clearly degraded, but still adequate for clinical use" or worse. Concerning diagnostic features, at CR 10:1 and CR 16:1 the error rate was 9.6% and 13.1%, respectively, compared with 9% for the baseline error rate in uncompressed images., Conclusions: Compression at CR 6:1 provides equivalence with the original cine runs. If CR 16:1 were used, one would have to tolerate a significant increase in the diagnostic error rate over the baseline error rate. At CR 10:1, intermediate results were obtained.

The sizes of Brodmann's areas 44 and 45 (Broca's speech region) and their extent in relation to macroscopic landmarks and surrounding areas differ considerably among the available cytoarchitectonic maps. Such variability may be due to intersubject differences in anatomy, observer-dependent discrepancies in cytoarchitectonic mapping, or both. Because a reliable definition of cytoarchitectonic borders is important for interpreting functional imaging data, we mapped areas 44 and 45 by means of an observer-independent technique. In 10 human brains, the laminar distributions of cell densities were measured vertical to the cortical surface in serial coronal sections stained for perikarya. Thousands of density profiles were obtained. Cytoarchitectonic borders were defined as statistically significant changes in laminar patterns. The analysis of the three-dimensional reconstructed brains and the two areas showed that cytoarchitectonic borders did not consistently coincide with sulcal contours. Therefore, macroscopic features are not reliable landmarks of cytoarchitectonic borders. Intersubject variability in the cytoarchitecture of areas 44 and 45 was significantly greater than cytoarchitectonic differences between these areas in individual brains. Although the volumes of area 44 differed across subjects by up to a factor of 10, area 44 but not area 45 was left-over-right asymmetrical in all brains. All five male but only three of five female brains had significantly higher cell densities on the left than on the right side. Such hemispheric and gender differences were not detected in area 45. These morphologic asymmetries of area 44 provide a putative correlate of the functional lateralization of speech production., (Copyright 1999 Wiley-Liss, Inc.)

The position and extent of fiber pathways and their intersubject variability in the white matter of the forebrain have not been analyzed with histological techniques in the adult human brain. This is due mainly to the lack of a staining procedure with which the different fiber tracts can be visualized with sufficient contrast. The here described modification of the Heidenhain-Woelcke myelin stain yields increased contrast between heavily and less heavily myelinated pathways, facilitating identification and tracing of single fiber tracts. The modification makes the microscopical resolution possible which is necessary for preparing comprehensive maps of fiber tracts. Such maps are valuable tools for clinical diagnosis, since they provide a basis for localizing anatomically the structures involved in subcortical lesions. Correlations between the size of a lesion and its location relative to identified fiber tracts on the one hand and postlesional functional alterations and recovery on the other can only be made on the basis of topographic and morphometric maps of these structures in the normal adult human brain.

The degree of cortical folding (GI) and the relation between sulci and borders of cyto- and receptorarchitectonically defined areas were analyzed in postmortem human brains. The GI reaches adult levels (with highest values in the association cortices) around birth and does not decrease during aging. It shows a sex-dependent left-over-right asymmetry. Sulci and borders of architectonical areas coincide only in a few examples; thus, sulci are not generally valid landmarks of the microstructural organization of the cortex. Individual sulci were studied in 3D-reconstructed MRI sequences of living brains. A considerable intersubject variability of the distances between the sulcal surfaces of individual brains and their mean sulcal surfaces is apparent. The depth of the central sulcus varies with manual skill and handedness., (Copyright (c) 1997 Wiley-Liss, Inc.)

The primary motor area (M1) of mammals has long been considered to be structurally and functionally homogeneous. This area corresponds to Brodmann's cytoarchitectural area 4. A few reports showing that arm and hand are doubly represented in M1 of macaque monkeys and perhaps man, and that each subarea has separate connections from somatosensory areas, have, with a few exceptions, gone largely unnoticed. Here we show that area 4 in man can be subdivided into areas '4 anterior' (4a) and '4 posterior' (4p) on the basis of both quantitative cytoarchitecture and quantitative distributions of transmitter-binding sites. We also show by positron emission tomography that two representations of the fingers exist, one in area 4a and one in area 4p. Roughness discrimination activated area 4p significantly more than a control condition of self-generated movements. We therefore suggest that the primary motor area is subdivided on the basis of anatomy, neurochemistry and function.