Philips (Finland)

Hypoxic Ischemic Encephalopathy (HIE) represents a brain dysfunction, affecting approximately 1 to 5 per 1000 full-term neonates. The precise delineation and segmentation of HIE-related lesions in neonatal brain Magnetic Resonance Images (MRI) are pivotal in advancing outcome predictions, identifying patients at high risk, elucidating neurological manifestations, and assessing treatment efficacies. Despite its importance, the development of algorithms for segmenting HIE lesions from MRI volumes has been impeded by data scarcity. Addressing this critical gap, we organized the first BONBID-HIE challenge with diffusion MRI data (Apparent Diffusion Coefficient (ADC) maps) for HIE lesion segmentation, in conjunction with the MICCAI 2023. Totally 14 algorithms were submitted, employing a gamut of cutting-edge automatic machine-learning-based segmentation algorithms. Our comprehensive analysis of HIE lesion segmentation and submitted algorithms facilitates an in-depth evaluation of the current technological zenith, outlines directions for future advancements, and highlights persistent hurdles. To foster ongoing research and benchmarking, the annotated HIE dataset, developed algorithm dockers, and unified evaluation codes are accessible through a dedicated online platform (https://bonbid-hie2023.grand-challenge.org).

Congenital syphilis (CS) is highly preventable through prenatal screening and treatment. However, populations disproportionately impacted by prenatal syphilis often face barriers to access, in part due to housing instability and substance use. This study assessed Pregnancy Connections, a pilot program designed to prevent CS by offering comprehensive, patient-centered prenatal care, with added support and comprehensive case management services, for patients experiencing unstable housing and/or substance use. This qualitative study involved interviews with three groups: program staff (n=13), patients (n=10), and individuals eligible for the prenatal program but not enrolled (n=14). Interviews were transcribed and analyzed to identify program successes, challenges, and lessons learned. Key successes included the provision of respectful and responsive care, reduced barriers to care, improved collaboration and coordination, and improved patient outcomes. The main challenges included difficulties in care coordination within the health center and with external services, suboptimal patient engagement, and limited program outreach and awareness. Lessons learned for future implementation highlighted the critical need for services and outreach for this vulnerable and often stigmatized population. Additionally, thoughtful referral systems and incentives, clinic champions, and organizational support were key. Identifying and developing effective interventions is essential to address this critical public health issue. Providing respectful, patient-centered prenatal care with added support for populations at elevated risk of syphilis is a promising approach.

To develop a radiomics model utilizing contrast-enhanced computed tomography (CECT) for predicting the prognosis of post-acute pancreatitis diabetes mellitus (PPDM-A) and to explain the model’s internal predictive mechanisms using Shapley Additive exPlanations (SHAP). 226 PPDM-A patients were retrospectively recruited from three centers, with 107 in training, 46 in internal, and 73 in external cohorts. There were 34, 15 and 28 patients with complications in each cohort. The complications included microvascular complications, infection, diabetic ketosis and hypoglycemia. In PPDM-A patients’ first pancreatitis episode, 2398 radiomics features were extracted from CECT images (arterial and venous phases). FeAture Explorer generated the machine learning pipeline and selected important radiomics features. Gaussian processes classifiers built radiomics and clinical-radiomics models, while Naive Bayes classifiers built the clinical model. The SHAP method was applied to provide insights into the model’s predictive process. The radiomics model predicted PPDM-A complications with the area under the receiver operating characteristic curve (AUC) of 0.95, 0.888, and 0.948 in training, internal, and external cohorts. In external cohort, the radiomics model significantly outperformed the clinical model (AUC 0.948 vs. 0.713, p = 0.002), while the combined model showed no significant difference from the radiomics model (AUC 0.933 vs. 0.948, p = 0.638). The SHAP technology provided physicians with insights into the global and individual impacts of radiomic features on model predictions. The CECT‑based radiomics model showed favorable prognostic performance for the prognosis of PPDM‑A. SHAP analysis interpreted the model’s mechanism, enhancing its clinical reliability and transparency.

To compare the diagnostic quality of deep learning (DL) super-resolution reconstructed breath-hold (BH) and free-breathing (FB) single-shot (SSH) black-blood T2-weighted short tau inversion recovery (STIR) imaging with standard BH T2-STIR in cardiovascular magnetic resonance (CMR). In this prospective study, short-axis BH and FB SSH T2-STIR were added to a standard cardiomyopathy CMR protocol at 1.5T, and DL super-resolution reconstruction was performed. Two readers evaluated diagnostic quality and certainty using a five-point Likert scale. Presence of focal edema was assessed on T2-weighted sequences, including standard T2-STIR and T2 mapping (both used for reference clinical assessment) as well as SSH T2 STIR and DL-SSH T2-STIR. Friedman test and one-way ANOVA were performed. Eighty-one participants (mean age: 54 ±20 years; 50 men) were included. No difference was found in edema detection between reference assessment and DL-SSH T2-STIR (both 26%, (21/81 participants)). Scan time was reduced by 63% for BH and 86% for FB DL-SSH T2-STIR compared to standard T2-STIR (90± 6s vs. 35± 3s vs. 243± 16s; p<.0001). BH and FB DL-SSH T2-STIR achieved lower artifact burden (5 [IQR, 4-5] vs. 4 [IQR, 4-5] vs. 4 [IQR, 3-5]; p<.0001), superior image contrast and sharpness compared to standard T2-STIR, especially in non-cooperative or arrhythmic participants. BH and FB DL-SSH T2-STIR imaging provided higher diagnostic certainty than standard T2-STIR (5 [IQR, 5-5] vs. 5 [IQR, 5-5] vs. 4 [IQR, 4-5]; p<.0001). Edema visibility was superior in BH DL-SSH compared to BH-SSH and standard T2-STIR (5 [IQR, 4.8-5] vs. 4 [IQR, 3.3-5] vs. 4 [IQR, 3-4.8]; p<.0001). Inter-rater agreement was substantial to excellent in the rating of edema visibility (BH DL-SSH T2-STIR, κ: 0.73 [95% CI: 0.44-1.0]; BH SSH T2-STIR, κ: 0.79 [95% CI: 0.66-0.97]; standard T2-STIR, κ: 0.86 [95% CI: 0.71-1.0]). Slice level-analysis showed that BH DL-SSH T2-STIR consistently provided superior image quality in apical slices compared to BH SSH and standard T2-STIR (4 [IQR, 4-5] vs. 4 [IQR, 4-4] vs. 4 [IQR, 3-4]; p<.0001). DL-SSH imaging enabled ultrafast T2-STIR acquisition and robust edema assessment in routine clinical CMR.

In this work, we aimed to develop and evaluate multi-band outer volume suppression pulses for increased acceleration rates in simultaneous multi-slice accelerated cardiac MRI. MB-OVS pulses were constructed from a multi-band combination of two slab-selective saturation pulses and tested for various pulse shapes using Bloch simulation and phantom experiment. The MB-OVS pulses were interleaved between imaging pulses to ensure homogeneous suppression throughout the cardiac cycle/imaging window in vivo. Simultaneous multi-slice (SMS) CINE and first-pass myocardial perfusion scans with and without the proposed MB-OVS pulses were compared in terms of residual artifacts at high acceleration rates. Among the tested pulses, both Bloch simulation and phantom experiments showed that amplitude-optimized sinc pulses provided the best trade-off in suppression efficiency, the required B1+, SAR, and slab profile. CINE imaging with 5-fold SMS-OVS acceleration significantly outperformed imaging without MB-OVS, maintaining leakage-free image quality, even when adding 2-fold in-plane acceleration. SMS-OVS also enabled perfusion imaging in 9 slices with 1.7 × 1.7 mm2 resolution, achieving a 16-fold spatial-only acceleration while ensuring accurate contrast dynamics without leakage artifacts. Interleaved MB-OVS modules enabled thorough leakage artifact suppression in cardiac SMS-accelerated CINE and perfusion imaging, particularly at high acceleration rates. The proposed approach may be promising for unlocking further acceleration potential of SMS in cardiac imaging.

Tinnitus affects 10-15% of adults globally, yet there are still no effective treatments for this major health condition. Repetitive transcranial magnetic stimulation (rTMS), a noninvasive neuromodulation technique, allows modulation of pathologically altered functional activities to promote symptom remission. However, its efficacy critically depends on the selection of stimulation targets, and substantial interindividual variability has been observed in clinical trials. Here, we aimed to identify potential target regions that are causally involved in alleviating distinct functional abnormalities using the digital twin brain (DTB). A cohort of 89 participants was used to characterize whole-brain neural activity patterns. Multimodal neuroimaging data were used to develop the tinnitus-specific DTB and to generate causal response maps based on more than 1.64 million virtual stimulations. Whole-brain gene expression data were further integrated to examine the neurobiological plausibility of the DTB-derived causal response maps. Finally, we validated the predictive capacity of such response maps using an independent rTMS dataset. We identified two aberrant brain states that emerged sequentially with disease progression, predominantly overlapping with the somatomotor and default mode networks, respectively. DTB-derived causal response maps revealed that the modulation of sensory and cognitive states requires stimulation of distinct, functionally specialized regions. Specifically, parieto-occipital regions play a crucial role in sensory modulation, while the dorsolateral prefrontal cortex exerts a causal influence on cognitive modulation. Moreover, these causal response maps correlate with the expression of tinnitus risk genes. By incorporating individual connectivity profiles of target regions, DTB-derived causal response maps accurately predicted rTMS effects on both sensory state (r > 0.85, Ppermutation < 0.01) and cognitive state (r > 0.78, Ppermutation < 0.05). Particularly, the predictive capacity exhibited a state-specific nature. This work suggests that brain functional alterations in tinnitus evolve with disease progression, and DTB has the potential to predict rTMS effects on distinct brain states, thereby informing more precise and targeted noninvasive brain stimulation interventions for tinnitus. Trial registered with https://www.chictr.org.cn/indexEN.html , Explore the mechanism of repetitive transcranial magnetic stimulation intervention in tinnitus based on multi-modal functional magnetic resonance imaging (ChiCTR2100047989), Submitted June 2021, First Patient Enrolled July 2021.

To evaluate the non-contrast-enhanced relaxation-enhanced angiography without contrast (REACT) sequence for the assessment of extrathoracic vessels in pediatric patients compared to contrast-enhanced (CE), multiphasic magnetic resonance angiography (MRA). In this prospective, single-center study, pediatric patients referred for clinically indicated contrast-enhanced MRI of various extrathoracic body regions underwent additional free-breathing REACT and multiphasic, free-breathing CE-MRA at 1.5 T (Philips Ingenia). REACT was acquired using Cartesian k-space order, except in the abdomen, where it was acquired using a radial stack of stars k-space sampling (REACT VANE). The acquisition time was recorded. Image quality (Likert scale 1-5, with 5 being the best) and vessel diameter were evaluated by two independent readers in four predefined vessels in each body region. Furthermore, a quantitative analysis of SNR and CNR was performed. 30 patients (age: 12.3 ± 4 years) successfully completed REACT and CE-MRA. The acquisition time for REACT was 2:49 ± 1:03 min, while abdominal REACT VANE required 4:51 ± 0:52 min. The CE-MRA acquisition time was 3:49 ± 1:03 min. The median image quality ratings were good to excellent (Likert scale 4-5) for both readers. No significant difference in the image quality ratings was found (p = 0.12 - 0.58). Interobserver agreement of image quality ratings of the two readers was moderate to substantial (Cohen's kappa REACT: 0.58, CE-MRA: 0.64). Vessel diameter measurements showed a strong correlation (r = 0.93) between REACT and CE-MRA with high intraclass correlation coefficients (REACT: 0.97, CE-MRA: 0.97). Quantitative analysis showed a higher venous SNR and higher arterial and venous CNR in REACT (p = 0.001-0.018). Given the good and comparable image quality, REACT can be useful in vascular imaging in children under free-breathing, while potentially eliminating the need for contrast agent injection. · MR angiography is widely used in pediatric imaging for vessel assessment.. · Contrast-enhanced MRA has limitations due to the use of gadolinium-based contrast agents.. · REACT is a novel contrast-free MRA technique performed during free breathing.. · REACT provides image quality comparable to contrast-enhanced free-breathing MRA.. · Spogis J, Tsiflikas I, Katemann C et al. Free-breathing non-contrast-enhanced flow-independent MR angiography using REACT: A prospective study for pediatric vessel assessment. Rofo 2026; 10.1055/a-2781-8861.

For heart diagnostics, ultrasound is generally the modality of choice due to its high temporal and spatial resolution, availability, and patient safety. Although 3D echocardiography captures the complex shape and motion of the heart with more precision than 2D, it suffers to a greater extent from poor resolution, noise, and limited field-of-view. Multi-perspective echocardiography has proven to significantly enhance both image quality and field-of-view. The greatest improvements occur when combining acquisitions from widely differing insonification angles, but this process is challenging because of substantial local structural and brightness variations and ultrasound's anisotropic nature. To handle these inconsistencies, a novel temporal and spatial registration algorithm designed is proposed. Temporal registration is achieved using low-frequency cardiac wall features and motion extracted via singular value decomposition of a spatio-temporal Casorati matrix, while spatial registration is performed using phase-only correlation of low-frequency data. The acquisitions are seamlessly fused using a 3D, oriented, wavelet transform including a near-field clutter algorithm. In vitro and in vivo testing highlights the benefits of this approach. Temporal alignment, validated against electrocardiograms, is precise, with an average error of just 2 ± 10 ms. Furthermore, our method outperforms a six-degree-of-freedom encoder-based probe tracker, reducing spatial registration error to 5 ± 3 mm from 19 ± 10 mm. The resulting longitudinal and radial strain measurements closely align with those obtained by tagged magnetic resonance imaging, demonstrating the accuracy and feasibility of this technique.

BackgroundParkinson’s disease (PD) entails widespread neurodegenerative changes extending beyond motor symptoms to cognitive and large-scale network alterations that compromise functional autonomy. Financial abilities (FAs) are complex, ecologically relevant skills crucial for independent living, yet their neurocognitive and neurofunctional substrates in PD remain largely unexplored. This study investigates the cognitive, structural, and neurofunctional correlates of basic and advanced FAs in PD with mild cognitive impairment (PD-MCI), using voxel-based morphometry to identify structural brain changes associated with FAs and resting-state network analyses to elucidate how brain connectivity supports preserved financial functioning.MethodsThirty three individuals with PD-MCI completed a comprehensive neuropsychological assessment, including the Numerical Activities of Daily Living-Financial Short battery, to evaluate basic and advanced FAs. A subset of patients (n = 24) underwent acquisition of 3T structural and resting-state functional neuroimaging data. To identify cognitive and neural predictors of basic and advanced FAs, multiple regression models incorporating demographic covariates, cognitive and neuroimaging predictors were employed via stepwise Akaike Information Criterion and LASSO procedures.ResultsBasic FAs were associated with general cognition and formal numerical competence (i.e., arithmetic knowledge), alongside negative functional correlations between somatomotor and subcortical networks. Advanced FAs were associated with different cognitive functions, such as executive ones, informal numerical competencies (i.e., use of numbers in everyday life), social cognition, language, and memory, and were linked to cerebellar network dynamics, specifically, increased anti-correlation with salience and limbic systems and enhanced synchronization with frontoparietal and subcortical circuits.DiscussionFAs in PD-MCI rely on a dynamic balance between network specialization and compensatory integration, reflecting adaptive reorganization of cortico-subcortical and cerebellar systems that may sustain complex cognitive functioning and functional independence.