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Griffith J.F.,Interventional Imaging | Genant H.K.,University of California at San Francisco
Endocrine | Year: 2012

Tremendous advances have been made over the past several decades in assessing osteoporosis and its complications. High resolution imaging combined with sophisticated computational techniques now provide a detailed analysis of bone structure and a much more accurate prediction of bone strength. These techniques have shown how different mechanisms of age-related bone weakening exist in males and females. Limitations peculiar to these more advanced imaging techniques currently hinder their adoption into mainstream clinical practice. As such, the ultimate quest remains a readily available, safe, high resolution technique capable of fully predicting bone strength, capable of showing how bone strength is faltering and precisely monitoring treatment effect. Whether this technique will be based on acquisition of spine/hip data or data obtained at peripheral sites reflective of changes happening in the spine and hip regions is still not clear. In the meantime, mainstream imaging will continue to improve the detection of osteoporosis related insufficiency fracture in the clinical setting. We, as clinicians, should aim to increase awareness of this fracture type both as a frequent and varied source of pain in patients with osteoporosis and as the ultimate marker of severely impaired bone strength. © Springer Science+Business Media, LLC 2012.


News Article | February 16, 2017
Site: www.eurekalert.org

One of the main tools doctors use to detect diseases and injuries in cases ranging from multiple sclerosis to broken bones is magnetic resonance imaging (MRI). However, the results of an MRI scan take hours or days to interpret and analyze. This means that if a more detailed investigation is needed, or there is a problem with the scan, the patient needs to return for a follow-up. A new, supercomputing-powered, real-time analysis system may change that. Researchers from the Texas Advanced Computing Center (TACC), The University of Texas Health Science Center (UTHSC) and Philips Healthcare, have developed a new, automated platform capable of returning in-depth analyses of MRI scans in minutes, thereby minimizing patient callbacks, saving millions of dollars annually, and advancing precision medicine. The team presented a proof-of-concept demonstration of the platform at the International Conference on Biomedical and Health Informatics this week in Orlando, Florida. The platform they developed combines the imaging capabilities of the Philips MRI scanner with the processing power of the Stampede supercomputer -- one of the fastest in the world -- using the TACC-developed Agave API Platform infrastructure to facilitate communication, data transfer, and job control between the two. An API, or Application Program Interface, is a set of protocols and tools that specify how software components should interact. Agave manages the execution of the computing jobs and handles the flow of data from site to site. It has been used for a range of problems, from plant genomics to molecular simulations, and allows researchers to access cyberinfrastructure resources like Stampede via the web. "The Agave Platform brings the power of high-performance computing into the clinic," said William (Joe) Allen, a life science researcher for TACC and lead author on the paper. "This gives radiologists and other clinical staff the means to provide real-time quality control, precision medicine, and overall better care to the patient." For their demonstration project, staff at UTHSC performed MRI scans on a patient with a cartilage disorder to assess the state of the disease. Data from the MRI was passed through a proxy server to Stampede where it ran the GRAPE (GRAphical Pipelines Environment) analysis tool. Created by researchers at UTHSC, GRAPE characterizes the scanned tissue and returns pertinent information that can be used to do adaptive scanning - essentially telling a clinician to look more closely at a region of interest, thus accelerating the discovery of pathologies. The researchers demonstrated the system's effectiveness using a T1 mapping process, which converts raw data to useful imagery. The transformation involves computationally-intensive data analyses and is therefore a reasonable demonstration of a typical workflow for real-time, quantitative MRI. A full circuit, from MRI scan to supercomputer and back, took approximately five minutes to complete and was accomplished without any additional inputs or interventions. The system is designed to alert the scanner operator to redo a corrupted scan if the patient moves, or initiate additional scans as needed, while adding only minimal time to the overall scanning process. "We are very excited by this fruitful collaboration with TACC," said Refaat Gabr, an assistant professor of Diagnostic and Interventional Imaging at UTHSC and the lead researcher on the project. "By integrating the computational power of TACC, we plan to build a completely adaptive scan environment to study multiple sclerosis and other diseases." Ponnada Narayana, Gabr's co-principal investigator and the director of Magnetic Resonance Research at The University of Texas Medical School at Houston, elaborated. "Another potential of this technology is the extraction of quantitative, information-based texture analysis of MRI," he said. "There are a few thousand textures that can be quantified on MRI. These textures can be combined using appropriate mathematical models for radiomics. Combining radiomics with genetic profiles, referred to as radiogenomics, has the potential to predict outcomes in a number diseases, including cancer, and is a cornerstone of precision medicine." According to Allen, "science as a service" platforms like Agave will enable doctors to capture many kinds of biomedical data in real time and turn them into actionable insights. "Here, we demonstrated this is possible for MRI. But this same idea could be extended to virtually any medical device that gathers patient data," he said. "In a world of big health data and an almost limitless capacity to compute, there is little reason not to leverage high-performance computing resources in the clinic." The research is supported in part by National Science Foundation (NSF) award ACI-1450459, by the Clinical Translational Science Award (CTSA) Grant UL1-TR000371 from the National Institutes of Health (NIH) National Center for Advancing Translational Sciences, and by the Chair in Biomedical Engineering Endowment Fund. Stampede was generously funded by the NSF through award ACI-1134872.


News Article | November 3, 2016
Site: www.eurekalert.org

HOUSTON - (Nov. 3, 2016) - Results of a cellular therapy clinical trial for traumatic brain injury (TBI) using a patient's own stem cells showed that the therapy appears to dampen the body's neuroinflammatory response to trauma and preserve brain tissue, according to researchers at The University of Texas Health Science Center at Houston (UTHealth). The results, which also confirmed safety and feasibility as cited in earlier studies, were published online Nov. 1 in the journal STEM CELLS. "The data derived from this trial moves beyond just testing safety of this approach," said Charles S. Cox, Jr., M.D., principal investigator, the George and Cynthia Mitchell Distinguished Chair in Neurosciences at UTHealth, professor in the Department of Pediatric Surgery and co-director of the Memorial Hermann Red Duke Trauma Institute. "We now have a hint of a treatment effect that mirrors our pre-clinical work, and we are now pursuing this approach in a Phase 2b clinical trial sponsored by the Joint Warfighter Program within the U.S. Army Medical Research Acquisition Activity, as well as our ongoing Phase 2b pediatric severe TBI clinical trial - both using the same autologous cell therapy." Cox was recently awarded $6.8 million in funding from the U.S. Department of Defense (DOD) for the Phase 2b study to assess the safety and efficacy - including whether there are structural improvements in the brain - of autologous stem cell therapy in adults with emergent traumatic brain injury. Memorial Hermann-Texas Medical Center is the site for the study. According to the Centers for Disease Control, 1.7 million Americans sustain a traumatic brain injury annually. Of those, 275,000 are hospitalized and 52,000 die. TBI is a contributing factor to a third of all injury-related deaths in the country. According to published research cited in the paper, more than 6.5 million patients are burdened by the physical, cognitive and psychosocial deficits associated with TBI, leading to an economic impact of approximately $60 billion. There are few current therapies to treat TBI. Critical care teams work to stabilize patients and surgery is sometimes necessary to remove or repair damaged blood vessels or tissue, as well as provide relief from swelling. To potentially open a new avenue of treatment, Cox has been researching cell therapy for neurological disease in pre-clinical and clinical trials for more than two decades. The new study builds on his previously published research showing that autologous stem cell therapy after TBI is safe and reduces the therapeutic intensity requirements of neurocritical care. The theory is that the stem cells work in the brain to alleviate the body's inflammatory response to the trauma. Researchers enrolled 25 patients in a dose-escalation format with five controls followed by five patients in each of three different doses followed by five more controls for a total of 25. Bone marrow harvesting, cell processing and re-infusion occurred within 48 hours after injury. Cellular processing was done at The Evelyn H. Griffin Stem Cell Therapeutics Research Laboratory at McGovern Medical School. Functional and neurocognitive outcomes were measured and correlated with imaging data including magnetic resonance imaging (MRI) and diffusion tensor imaging (DTI) of white brain matter. According to the authors, despite the treatment group having greater injury severity, there was structural preservation of critical regions of interest that correlated with functional outcomes and key inflammatory cytokines were down-regulated after bone marrow cell infusion. The study was funded by DOD grant W81XWH-11-1-0460, National Institutes of Health grant 2T32 GM 0879201-11, the Glassell Foundation Stem Cell Research Program and The Brown Foundation, Inc. Making the trial possible was a large team of co-investigators from McGovern Medical School Departments of Neurosurgery, Surgery, Neurology, Pediatrics, and Diagnostic and Interventional Imaging; The University of Texas MD Anderson Cancer Center Department of Pediatrics; and related clinical care teams. McGovern Medical School co-investigators were Robert A. Hetz, M.D.; George P. Liao, M.D.; Benjamin M. Aertker, M.D.; Linda Ewing-Cobbs, Ph.D.; Jenifer Juranek, Ph.D.; Sean I. Savitz, M.D.; Margaret L. Jackson, M.D.; Anna M. Romanowska-Pawliczek, Ph.D.; Fabio Triolo, Ph.D.; Pramod K. Dash, Ph.D.; Claudia Pedroza, Ph.D.; HuiMahn A. Choi, M.D.; John B. Holcomb, M.D; and Ryan S Kitagawa, M.D. Other co-investigators were Dean A. Lee, Ph.D., Nationwide Children's Hospital; Laura Worth, MD Anderson Cancer Center, M.D., Ph.D.; and Imoigele P. Aisiku, M.D., Brigham and Women's Hospital.


Camici P.G.,San Raffaele Scientific Institute | Rimoldi O.E.,CNR Institute of Neuroscience | Gaemperli O.,Interventional Imaging | Libby P.,Brigham and Women's Hospital
European Heart Journal | Year: 2012

Over the last several decades, basic cardiovascular research has significantly enhanced our understanding of pathobiological processes leading to formation, progression, and complications of atherosclerotic plaques. By harnessing these advances in cardiovascular biology, imaging has advanced beyond its traditional anatomical domains to a tool that permits probing of particular molecular structures to image cellular behaviour and metabolic pathways involved in atherosclerosis. From the nascent atherosclerotic plaque to the death of inflammatory cells, several potential molecular and micro-anatomical targets for imaging with particular selective imaging probes and with a variety of imaging modalities have emerged from preclinical and animal investigations. Yet, substantive barriers stand between experimental use and wide clinical application of these novel imaging strategies. Each of the imaging modalities described herein faces hurdles-for example, sensitivity, resolution, radiation exposure, reproducibility, availability, standardization, or costs. This review summarizes the published literature reporting on functional imaging of vascular inflammation in atherosclerotic plaques emphasizing those techniques that have the greatest and/or most immediate potential for broad application in clinical practice. The prospective evaluation of these techniques and standardization of protocols by multinational networks could serve to determine their added value in clinical practice and guide their development and deployment. © 2012 The Author.


Loffroy R.,Interventional Imaging
World Journal of Gastroenterology | Year: 2013

Acute massive duodenal bleeding is one of the most frequent complications of peptic ulcer disease. Endoscopy is the first-line method for diagnosing and treating actively bleeding peptic ulcers because its success rate is high. Of the small group of patients whose bleeding fails to respond to endoscopic therapy, increasingly the majority is referred for embolotherapy. Indeed, advances in catheter-based techniques and newer embolic agents, as well as recognition of the effectiveness of minimally invasive treatment options, have expanded the role of interventional radiology in the management of hemorrhage from peptic ulcers over the past decade. Embolization may be effective for even the most gravely ill patients for whom surgery is not a viable option, even when extravasation is not visualized by angiography. However, it seems that careful selection of the embolic agents according to the bleeding vessel may play a role in a successful outcome. The role of the surgeon in this clinical sphere is dramatically diminishing and will certainly continue to diminish in ensuing years, surgery being typically reserved for patients whose bleeding failed to respond all previous treatments. Such a setting has become extremely rare. © 2013 Baishideng. All rights reserved.


Angioplasty and stenting using nitinol stents is a recognized treatment option for intracranial atherosclerosis. To identify procedure-related factors that may affect patient safety and technical outcome. In this prospective study of 57 consecutive patients, the primary end points were intraprocedural technical problems, periprocedure morbidity, and complications. Major periprocedure complication was defined as all stroke or death at 30 days. Technical failure was defined as the inability to complete the procedure because of technical or safety problems. Procedure failure was defined as a procedure outcome of technical failure or major periprocedure complication. Secondary end points were procedure-related factors that may affect patient safety and technical outcome. Procedure failure rate was 12.3% (7/57) (major periprocedure complication rate, 5.3% [3/57]; technical failure rate, 7% [4/57]). Initial failure in tracking of balloon or stent occurred in 20 patients, other technical problems occurred in 11 patients, including kinking or trapping of balloon catheter (2 cases), difficulty in unsheathing of stent (3 cases), forward migration of stent during deployment (4 cases), trapping of nose cone after stent deployment (1 case), fracture of delivery system (2 cases), and guidewire fracture (1 case). Unfavorable vascular morphology signified by the presence of 2 or more reverse curves along the access path was found to associate with initial failure in the tracking of instruments (OR = ∞), and occurrence of other technical problems (OR = 25). Procedure-related factors could be identified and lead to improvements in patient safety and technical outcome. Tortuous vascular morphology is a key factor to be overcome.


Hasan K.M.,Interventional Imaging | Frye R.E.,University of Texas Health Science Center at Houston
Human Brain Mapping | Year: 2011

In this communication, we extended a previously described and validated diffusion tensor imaging (DTI) method for segmenting whole brain cerebrospinal fluid (CSF) and gray and white matter (WM) tissue to provide regional volume and DTI metrics of WM tract and cortical and subcortical gray matter. This DTI-based regional segmentation was implemented using the statistical parametric mapping (SPM) toolbox and used the international consortium for brain mapping atlases and Montreal Neurological Institute brain templates. We used our DTI-based segmentation approach to calculate the left putamen volume in a cohort of 136 healthy right-handed males and females aged 15.8-62.8 years. We validated our approach by demonstrating its sensitivity to age-related changes of the putamen. Indeed, our method found that the putamen volume decreased with age (r = -0.30; P < 0.001) while the corresponding fractional anisotropy (FA) increased with advancing age (r = 0.5; P < 0.00001). It is then demonstrated, on a subset of our cohort (n = 31), that the putamen volume obtained by our method correlated with measurements obtained from FreeSurfer (r = 0.396, P < 0.05). Our novel approach increases the information obtained with a DTI examination by providing routine volumetry measure, thereby eliminating separate scans to obtain volumetry data. In addition, the labeled volumes obtained with our method have the potential to increase the accuracy of fiber tracking. In the future, this new approach can be automated to analyze large data sets to help discover noninvasive neuroimaging markers for clinical trials and brain-function studies in both health and disease. Hum Brain Mapp, 2010. © 2010 Wiley-Liss, Inc.


Behr G.G.,Morgan Stanley | Johnson C.,Interventional Imaging
American Journal of Roentgenology | Year: 2013

OBJECTIVE. The purpose of this study was to review the medical literature and the current classification of vascular anomalies to clarify common misconceptions and provide guidance for imaging and treatment. In this first article of a two-part series, we focus on the fast-flow vascular anomalies. CONCLUSION. Nonuniformity of terminology across the medical literature hampers understanding of the vascular anomalies. A familiarity with the classification and biology on which this terminology is based is essential for accurate and precise diagnosis. © American Roentgen Ray Society.


Kuil J.,Interventional Imaging | Kuil J.,Netherlands Cancer Institute | Buckle T.,Interventional Imaging | Van Leeuwen F.W.B.,Interventional Imaging
Chemical Society Reviews | Year: 2012

The interaction between the chemokine receptor 4 (CXCR4) and stromal cell-derived factor-1 (SDF-1, also known as CXCL12) is a natural regulatory process in the human body. However, CXCR4 over-expression is also found in diseases such as cancer, where it plays a role in, among others, the metastatic spread. For this reason it is an interesting biomarker for the field of diagnostic oncology, and therefore, it is gaining increasing interest for applications in molecular imaging. Especially "small-molecule" imaging agents based on T140, FC131 and AMD3100 have been extensively studied. SDF-1, antibodies, pepducins and bioluminescence have also been used to visualize CXCR4. In this critical review reported CXCR4 targeting imaging agents are described based on their affinity, specificity and biodistribution. The level wherein CXCR4 is up-regulated in cancer patients and its relation to the different cell lines and animal models used to evaluate the efficacy of the imaging agents is also discussed (221 references). © 2012 The Royal Society of Chemistry.


News Article | February 16, 2017
Site: phys.org

A new, supercomputing-powered, real-time analysis system may change that. Researchers from the Texas Advanced Computing Center (TACC), The University of Texas Health Science Center (UTHSC) and Philips Healthcare, have developed a new, automated platform capable of returning in-depth analyses of MRI scans in minutes, thereby minimizing patient callbacks, saving millions of dollars annually, and advancing precision medicine. The team presented a proof-of-concept demonstration of the platform at the International Conference on Biomedical and Health Informatics this week in Orlando, Florida. The platform they developed combines the imaging capabilities of the Philips MRI scanner with the processing power of the Stampede supercomputer—one of the fastest in the world—using the TACC-developed Agave API Platform infrastructure to facilitate communication, data transfer, and job control between the two. An API, or Application Program Interface, is a set of protocols and tools that specify how software components should interact. Agave manages the execution of the computing jobs and handles the flow of data from site to site. It has been used for a range of problems, from plant genomics to molecular simulations, and allows researchers to access cyberinfrastructure resources like Stampede via the web. "The Agave Platform brings the power of high-performance computing into the clinic," said William (Joe) Allen, a life science researcher for TACC and lead author on the paper. "This gives radiologists and other clinical staff the means to provide real-time quality control, precision medicine, and overall better care to the patient." For their demonstration project, staff at UTHSC performed MRI scans on a patient with a cartilage disorder to assess the state of the disease. Data from the MRI was passed through a proxy server to Stampede where it ran the GRAPE (GRAphical Pipelines Environment) analysis tool. Created by researchers at UTHSC, GRAPE characterizes the scanned tissue and returns pertinent information that can be used to do adaptive scanning - essentially telling a clinician to look more closely at a region of interest, thus accelerating the discovery of pathologies. The researchers demonstrated the system's effectiveness using a T1 mapping process, which converts raw data to useful imagery. The transformation involves computationally-intensive data analyses and is therefore a reasonable demonstration of a typical workflow for real-time, quantitative MRI. A full circuit, from MRI scan to supercomputer and back, took approximately five minutes to complete and was accomplished without any additional inputs or interventions. The system is designed to alert the scanner operator to redo a corrupted scan if the patient moves, or initiate additional scans as needed, while adding only minimal time to the overall scanning process. "We are very excited by this fruitful collaboration with TACC," said Refaat Gabr, an assistant professor of Diagnostic and Interventional Imaging at UTHSC and the lead researcher on the project. "By integrating the computational power of TACC, we plan to build a completely adaptive scan environment to study multiple sclerosis and other diseases." Ponnada Narayana, Gabr's co-principal investigator and the director of Magnetic Resonance Research at The University of Texas Medical School at Houston, elaborated. "Another potential of this technology is the extraction of quantitative, information-based texture analysis of MRI," he said. "There are a few thousand textures that can be quantified on MRI. These textures can be combined using appropriate mathematical models for radiomics. Combining radiomics with genetic profiles, referred to as radiogenomics, has the potential to predict outcomes in a number diseases, including cancer, and is a cornerstone of precision medicine." According to Allen, "science as a service" platforms like Agave will enable doctors to capture many kinds of biomedical data in real time and turn them into actionable insights. "Here, we demonstrated this is possible for MRI. But this same idea could be extended to virtually any medical device that gathers patient data," he said. "In a world of big health data and an almost limitless capacity to compute, there is little reason not to leverage high-performance computing resources in the clinic." Explore further: Stampede 2 drives the frontiers of science and engineering forward

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