Quantitative Medical Imaging in Health Research - Impact on the Study of Cognitive Aging

Transcription

1 Quantitative Medical Imaging in Health Research - Impact on the Study of Cognitive Aging Arvid Lundervold MD, PhD Neuroinformatics and Image Analysis Laboratory Neural Networks Research Group Department of Biomedicine, University of Bergen, Norway Health Research with Real Impact School of Health, University of Central Lancashire, UK events/health research real impact conference.php 15 May 2013 Quantitative Medical Imaging in Health Research Impact on the Study of Cognitive Aging 1 / 15

2 Outline Quantitative medical imaging is an interdisciplinary field where medicine and biology meet engineering, computer science and mathematics. Quantitative imaging (QI) is increasingly important for the development and evaluation of image-based descriptions, biomarkers, and decisions that are effective, non-subjective, and reproducible. The aim of quantitative imaging is to improve diagnosis, prognosis, therapy, and follow-up of individual patients. QI can be regarded as an enabling technology that supports automation and standardization, and the emerging concept of P4 - predictive, preventive, personalized, and participatory medicine. I will present the concepts of QI and examples from a longitudinal study of cognitive aging using multimodal magnetic resonance image (MRI) acquisitions, neuropsychological examinations and genetic profiling. Quantitative Medical Imaging in Health Research Impact on the Study of Cognitive Aging 2 / 15

3 What is Quantitative Imaging (QI)? The extraction of quantifiable features from medical images for the assessment of normal or the severity, degree of change, or status of a disease, injury, or chronic condition relative to normal. Includes the development, standardization, and optimization of anatomical, functional, and molecular imaging acquisition protocols, data analyses, display methods, and reporting structures. These features permit the validation of accurately and precisely obtained image-derived metrics with anatomically and physiologically relevant parameters, including treatment response and outcome, and the use of such metrics in research and patient care. Radiological Society of North America - Quantitative Medical Imaging in Health Research Impact on the Study of Cognitive Aging 3 / 15

4 What is P4 medicine? Quantitative Medical Imaging in Health Research Impact on the Study of Cognitive Aging 4 / 15

5 Healthy and pathological cognitive aging Individual differences Quantitative Medical Imaging in Health Research Impact on the Study of Cognitive Aging 5 / 15

6 Understanding aging processes - from nano to macro The large range of spatial and temporal scales: Atom m Protein 10-9 m Cell 10-6 m Tissue 10-3 m Organ 100 m [ whole brain MRI ] Organ system & organism Physiology Brain Spinal cord Peri- pheral nerves Gene networks Pathway models 10-6 s molecular events (ion channel ga?ng) Stochas?c models 10-3 s diffusion cell signalling 100 s mo?lity Ordinary Differen?al Equa?ons 103 s mitosis Con?nuum models (Par?al Differen?al Equa?ons) 106 s protein turnover Systems models 109 s human life?me Quantitative Medical Imaging in Health Research Impact on the Study of Cognitive Aging 6 / 15

7 Structural 3D MRI - [The cognitive aging project] Brain segmentadon: rawavg.mgz aseg.mgz axial view aseg.mgz coronal view FreeSurferColorLUT Brain surface reconstrucdon and cordcal parcelladon: lh.pial 507_3 lateral view lh.pial medial view FreeSurfer 5.1 & Freeview Quantitative Medical Imaging in Health Research Impact on the Study of Cognitive Aging 7 / 15

8 Tractography from DTI Sagi+al view [The cognitive aging project] Whole- brain tractography : A Coronal view S P L R I Tract selec4on : Cor4cospinal tract Forceps anterior 507_3 Quantitative Medical Imaging in Health Research Impact on the Study of Cognitive Aging 8 / 15

9 Resting state fmri - [The cognitive aging project] a) 3D+@me fmri b) 3D anatomical MRI c) Volume rendering d) Observed BOLD course from a single voxel Voxel 'me course in right cerebral hemisphere from subject 651. a) Time frame from the res@ng state fmri recording, where a voxel- of- interest in the visual area of the occipital lobe is marked with a cross- hair. b) Corresponding voxel in the 3D T1- weighted anatomical image. c) Same voxel in the volume- rendered 3D anatomical image d) Plot of signal intensity (S.I.) for the same voxel. A. Lundervold, Nonlinear Biomed Physics (2010) Quantitative Medical Imaging in Health Research Impact on the Study of Cognitive Aging 9 / 15

10 Brain connectivity - [The cognitive aging project]!;0<!=#$%$&29!!!!>?@!a-(bc!!!!!!!!!!!!!5!,100?21d01!!e!!a-f(ga,"!:! A-BC! A-J!!!"#$%$&'()*+,-!./01!/234%0!!!!!!!!!!!!!!!!!!!!!!5!"1$67)89!:!!!!!,F!!!!!;0<!)*+,-!6'&H'303=!'D!I*@!A-(J!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!5!A-F(GA,"!:!!!92/KCLM!! 53NMOO:!!!?A! 5$P2P:!!"#$%% ()*+,-*./%+-**0+,1234% 536)+3)6./%+-**0+,1234%!"#&'% sec Quantitative Medical Imaging in Health Research Impact on the Study of Cognitive Aging 10 / 15

11 Connectivity vs. cognition - [The cognitive aging project] IC1 - Thalamus IC4 - Putamen IC6 - Frontal DMN IC9 - Dorsal afengon network ExecuGve funcgon FA residuals (age gender)) Processing speed FNC FA residuals) FA ExecuGve funcgon FA residuals) Processing speed FA residuals) FNC FA Ystad et al. Neuroimage 2010 Suppl. Fig 4 FA = FracGonal anisotropy (DTI); FNC = FuncGonal network connecgvity (rs- fmri) Quantitative Medical Imaging in Health Research Impact on the Study of Cognitive Aging 11 / 15

12 Age-related brain atrophy NeuroQuant Age-Related Atrophy Report PATIENT INFORMATION Patient ID: 005_S_0221 Accession Number: MORPHOMETRY RESULTS Patient Name: Smith, John Jr. Referring Physician: Jones, Steven MD,PhD Sex: M CorTechs Labs, Inc 1020 Prospect St., #450 La Jolla, Ca, Tel:(858) Exam Date: 2006/02/22 10:18:17 AM Brain Structure Volume (cm³) % of ICV (5%- 95% Normative Percentile*) Normative Percentile* Hippocampi ( ) < 5 Lateral Ventricles ( ) 92 Inferior Lateral Ventricles ( ) > 95 Quantitative Medical Imaging in Health Research Impact on the Study of Cognitive Aging 12 / 15

13 Brain Structure Volume (cm³) % of ICV (5%95% Normative Percentile*) Hippocampi ( ) <5 Lateral Ventricles ( ) R 92 NeuroQuant Inferior Lateral Ventricles ( ) > 95 Age-related brain atrophy report Normative Percentile* AGE-MATCHED REFERENCE CHARTS* Personalized (!) Par5cipatory (! ) Predic5ve (?) Preven5ve (?) *Charts and normative values are provided for reference purposes only. The FDA has not approved their use for diagnostic purposes. Comments: Mr. Smith's hippocampal size of 5.83cc's is well below the mean of the population of his age and his inferior lateral ventricles size of 4.74cc's is larger than that expected of his age. This suggests a large amount of brain atrophy in the medial temporal lobe. With greather than expected atrophy at this age it is possible that a neurodegenerative disorder, such as Alzheimer's disease, is the cause of his memory complaints. Signed: Steven Jones, MD, PhD towards P4 medicine CorTechs Labs, Inc. NeuroQuant Age-Related Atrophy Report CorTechs Labs, Inc 1020 Prospect St., #450 La Jolla, Ca, Tel:(858) PATIENT INFORMATION Patient ID: Patient Name: Sex: Quantitative Medical Imaging in Health Research Impact on the Study of Cognitive Aging 005_S_0221 Smith, John Jr. M 13 / 15

14 the BRAIN initiative (USA)... the Human Brain Project (EU)... [ message to the young researcher... ] h"p:// press- office/2013/04/02/fact- sheet- brain- inicacve and the Human Brain Project has been selected as a European Flagship! h"p:// h"p://vimeo.com/humanbrainproject/overview h"p:// launches- project- to- understand- the- human- brain Quantitative Medical Imaging in Health Research Impact on the Study of Cognitive Aging 14 / 15

15 Summary P4 (predictive, preventive, personalized, and participatory) medicine is based on systems biology and systems medicine, consumer-driven healthcare and social networks, and the digital revolution... Quantitative imaging will improve diagnosis, prognosis, treatment and follow-up of patients; it is reproducible, cost-effective, and supports P4-med. Cognitive aging & dementia is one of the grand challenges in modern neuroscience, clinical medicine, health care, and in society Health research on cognitive aging and dementia with real impact must relate to P4 medicine and quantitative imaging... Thanks1! events/health research real impact conference.php 1 Joint work with Prof. Astri J. Lundervold; PhD Erlend Hodneland; MD,PhD Martin Ystad, et al. Quantitative Medical Imaging in Health Research Impact on the Study of Cognitive Aging 15 / 15