Neuroimaging in specific phobia disorder: a systematic review of the literature

OBJECTIVE: Specific phobia (SP) is characterized by irrational fear associated with avoidance of specific stimuli. In recent years, neuroimaging techniques have been used in an attempt to better understand the neurobiology of anxiety disorders. The objective of this study was to perform a systematic review of articles that used neuroimaging techniques to study SP. METHOD:A literature search was conducted through electronic databases, using the keywords: imaging, neuroimaging, PET, spectroscopy, functional magnetic resonance, structural magnetic resonance, SPECT, MRI, DTI, and tractography, combined with simple phobia and specific phobia. One-hundred fifteen articles were found, of which 38 were selected for the present review. From these, 24 used fMRI, 11 used PET, 1 used SPECT, 2 used structural MRI, and none used spectroscopy. RESULT: The search showed that studies in this area were published recently and that the neuroanatomic substrate of SP has not yet been consolidated. CONCLUSION: In spite of methodological differences among studies, results converge to a greater activation in the insula, anterior cingulate cortex, amygdala, and prefrontal and orbitofrontal cortex of patients exposed to phobia-related situations compared to controls. These findings support the hypotheses of the hyperactivation of a neuroanatomic structural network involved in SP.

Imaging studies for diagnosing Graves' orbitopathy and dysthyroid optic neuropathy

Although the diagnosis of Graves' orbitopathy is primarily made clinically based on laboratory tests indicative of thyroid dysfunction and autoimmunity, imaging studies, such as computed tomography, magnetic resonance imaging, ultrasound and color Doppler imaging, play an important role both in the diagnosis and follow-up after clinical or surgical treatment of the disease. Imaging studies can be used to evaluate morphological abnormalities of the orbital structures during the diagnostic workup when a differential diagnosis versus other orbital diseases is needed. Imaging may also be useful to distinguish the inflammatory early stage from the inactive stage of the disease. Finally, imaging studies can be of great help in identifying patients prone to develop dysthyroid optic neuropathy and therefore enabling the timely diagnosis and treatment of the condition, avoiding permanent visual loss. In this paper, we review the imaging modalities that aid in the diagnosis and management of Graves' orbitopathy, with special emphasis on the diagnosis of optic nerve dysfunction in this condition.

Applicazione della neurodiagnostica avanzata allo studio dei disturbi psicologici nelle malattie infiammatorie croniche intestinali

Background and aim Ulcerative Colitis (UC) and Crohn’s Disease (CD), collectively labelled as inflammatory bowel disease (IBD), are idiopathic, chronic inflammatory disorder of the bowel with a remitting and relapsing course. IBD are associated to poor emotional functioning and psychological distress. We have investigated the brain involvement in patients with IBD using functional magnetic resonance imaging (fMRI). Materials and methods We developed an emotional visual task to investigate the emotional functioning in 10 UC patients and 10 healthy controls (HC). Furthermore, we have compared the brain stress response between a group of 20 CD patients and a group of 18 HC. Finally, we evaluated potential morphological differences between 18 CD patients and 18 HC in a voxel based morphometry (VBM) study. Results We found brain functional changes in UC patients characterized by decreased activity in the amygdala in response to positive emotional stimuli. Moreover, in CD patients, the brain stress response and habituation to stressful stimuli were significantly different in the medial temporal lobe (including the amygdala and hippocampus), the insula and cerebellum. Finally, in CD patients there were morphological abnormalities in the anterior mid cingulated cortex (aMCC). Conclusion IBD are associated to functional and morphological brain abnormalities. The previous intestinal inflammatory activity in IBD patients might have contributed to determine the functional and morphological changes we found. On the other hand, the dysfunctions of the brain structures we found may influence the course of the disease. Our findings might have clinical implications. The differences in the emotional processing may play a role in the development of psychological disorders in UC patients. Furthermore, in CD patients, the different habituation to stress might contribute to stress related inflammatory exacerbations. Finally, the structural changes in the aMCC might be involved in the pain symptoms associated to the bowel disorder.

NMR spectroscopy and imaging of hyperpolarized gases

Since the discovery of the nuclear magnetic resonance (NMR) phenomenon, countless NMR techniques have been developed that are today indispensable tools in physics, chemistry, biology, and medicine. As one of the main obstacles in NMR is its notorious lack of sensitivity, different hyperpolarization (HP) methods have been established to increase signals up to several orders of magnitude. In this work, different aspects of magnetic resonance, using HP noble gases, are studied, hereby combining different disciplines of research. The first part examines new fundamental effects in NMR of HP gases, in theory and experiment. The spin echo phenomenon, which provides the basis of numerous modern experiments, is studied in detail in the gas phase. The changes of the echo signal in terms of amplitude, shape, and position, due to the fast translational motion, are described by an extension of the existing theory and computer simulations. With this knowledge as a prerequisite, the detection of intermolecular double-quantum coherences was accomplished for the first time in the gas phase. The second part of this thesis focuses on the development of a practical method to enhance the dissolution process of HP 129Xe, without loss of polarization or shortening of T1. Two different setups for application in NMR spectroscopy and magnetic resonance imaging (MRI) are presented. The continuous operation allows biological and multidimensional spectroscopy in solutions. Also, first in vitro MRI images with dissolved HP 129Xe as contrast agent were obtained at a clinical scanner.

Diffusion of laser polarized gases in MRI

The use of Magnetic Resonance Imaging (MRI) as a diagnostic tool is increasingly employing functional contrast agents to study or contrast entire mechanisms. Contrast agents in MRI can be classified in two categories. One type of contrast agents alters the NMR signal of the protons in its surrounding, e.g. lowers the T1 relaxation time. The other type enhances the Nuclear Magnetic Resonance (NMR) signal of specific nuclei. For hyperpolarized gases the NMR signal is improved up to several orders of magnitude. However, gases have a high diffusivity which strongly influences the NMR signal strength, hence the resolution and appearance of the images. The most interesting question in spatially resolved experiments is of course the achievable resolution and contrast by controlling the diffusivity of the gas. The influence of such diffusive processes scales with the diffusion coefficient, the strength of the magnetic field gradients and the timings used in the experiment. Diffusion may not only limit the MRI resolution, but also distort the line shape of MR images for samples, which contain boundaries or diffusion barriers within the sampled space. In addition, due to the large polarization in gaseous 3He and 129Xe, spin diffusion (different from particle diffusion) could play a role in MRI experiments. It is demonstrated that for low temperatures some corrections to the NMR measured diffusion coefficient have to be done, which depend on quantum exchange effects for indistinguishable particles. Physically, if these effects can not change the spin current, they can do it indirectly by modifying the velocity distribution of the different spin states separately, so that the subsequent collisions between atoms and therefore the diffusion coefficient can eventually be affected. A detailed study of the hyperpolarized gas diffusion coefficient is presented, demonstrating the absence of spin diffusion (different from particle diffusion) influence in MRI at clinical conditions. A novel procedure is proposed to control the diffusion coefficient of gases in MRI by admixture of inert buffer gases. The experimental measured diffusion agrees with theoretical simulations. Therefore, the molecular mass and concentration enter as additional parameters into the equations that describe structural contrast. This allows for setting a structural threshold up to which structures contribute to the image. For MRI of the lung this allows for images of very small structural elements (alveoli) only, or in the other extreme, all airways can be displayed with minimal signal loss due to diffusion.

Automated Segmentation and Non-Rigid Registration for the Quantitative Evaluation of Myocardial Perfusion from Magnetic Resonance Images

Myocardial perfusion quantification by means of Contrast-Enhanced Cardiac Magnetic Resonance images relies on time consuming frame-by-frame manual tracing of regions of interest. In this Thesis, a novel automated technique for myocardial segmentation and non-rigid registration as a basis for perfusion quantification is presented. The proposed technique is based on three steps: reference frame selection, myocardial segmentation and non-rigid registration. In the first step, the reference frame in which both endo- and epicardial segmentation will be performed is chosen. Endocardial segmentation is achieved by means of a statistical region-based level-set technique followed by a curvature-based regularization motion. Epicardial segmentation is achieved by means of an edge-based level-set technique followed again by a regularization motion. To take into account the changes in position, size and shape of myocardium throughout the sequence due to out of plane respiratory motion, a non-rigid registration algorithm is required. The proposed non-rigid registration scheme consists in a novel multiscale extension of the normalized cross-correlation algorithm in combination with level-set methods. The myocardium is then divided into standard segments. Contrast enhancement curves are computed measuring the mean pixel intensity of each segment over time, and perfusion indices are extracted from each curve. The overall approach has been tested on synthetic and real datasets. For validation purposes, the sequences have been manually traced by an experienced interpreter, and contrast enhancement curves as well as perfusion indices have been computed. Comparisons between automatically extracted and manually obtained contours and enhancement curves showed high inter-technique agreement. Comparisons of perfusion indices computed using both approaches against quantitative coronary angiography and visual interpretation demonstrated that the two technique have similar diagnostic accuracy. In conclusion, the proposed technique allows fast, automated and accurate measurement of intra-myocardial contrast dynamics, and may thus address the strong clinical need for quantitative evaluation of myocardial perfusion.

Design of multifunctional magnetic nanomaterials for biomedical applications

Diese Arbeit ist ein Beitrag zu den schnell wachsenden Forschungsgebieten der Nano-Biotechnologie und Nanomedizin. Sie behandelt die spezifische Gestaltung magnetischer Nanomaterialien für verschiedene biomedizinische Anwendungsgebiete, wie beispielsweise Kontrastmittel für die magnetische Resonanztomographie (MRT) oder "theragnostische" Agenzien für simultane optische/MR Detektion und Behandlung mittels photodynamischer Therapie (PDT).rnEine Vielzahl magnetischer Nanopartikel (NP) mit unterschiedlichsten magnetischen Eigenschaften wurden im Rahmen dieser Arbeit synthetisiert und erschöpfend charakterisiert. Darüber hinaus wurde eine ganze Reihe von Oberflächenmodifizierungsstrategien entwickelt, um sowohl die kolloidale als auch die chemische Stabilität der Partikel zu verbessern, und dadurch den hohen Anforderungen der in vitro und in vivo Applikation gerecht zu werden. Diese Strategien beinhalteten nicht nur die Verwendung bi-funktionaler und multifunktioneller Polymerliganden, sondern auch die Kondensation geeigneter Silanverbindungen, um eine robuste, chemisch inerte und hydrophile Siliziumdioxid- (SiO2) Schale um die magnetischen NP auszubilden.rnGenauer gesagt, der Bildungsmechanismus und die magnetischen Eigenschaften monodisperser MnO NPs wurden ausgiebig untersucht. Aufgrund ihres einzigartigen magnetischen Verhaltens eignen sich diese NPs besonders als (positive) Kontrastmittel zur Verkürzung der longitudinalen Relaxationszeit T1, was zu einer Aufhellung im entsprechenden MRT-Bild führt. Tatsächlich wurde dieses kontrastverbessernde Potential in mehreren Studien mit unterschiedlichen Oberflächenliganden bestätigt. Au@MnO „Nanoblumen“, auf der anderen Seite, sind Vertreter einer weiteren Klasse von Nanomaterialien, die in den vergangenen Jahren erhebliches Interesse in der wissenschaftlichen Welt geweckt hat und oft „Nano-hetero-Materialien“ genannt wird. Solche Nano-hetero-partikel vereinen die individuellen physikalischen und chemischen Eigenschaften der jeweiligen Komponenten in einem nanopartikulärem System und erhöhen dadurch die Vielseitigkeit der möglichen Anwendungen. Sowohl die magnetischen Merkmale von MnO, als auch die optischen Eigenschaften von Au bieten die Möglichkeit, diese „Nanoblumen“ für die kombinierte MRT und optische Bildgebung zu verwenden. Darüber hinaus erlaubt das Vorliegen zweier chemisch unterschiedlicher Oberflächen die gleichzeitige selektive Anbindung von Katecholliganden (auf MnO) und Thiolliganden (auf Au). Außerdem wurde das therapeutische Potential von magnetischen NPs anhand von MnO NPs demonstriert, die mit dem Photosensibilisator Protoporhyrin IX (PP) funktionalisiert waren. Bei Bestrahlung mit sichtbarem Licht initiiert PP die Produktion von zytotoxisch-reaktivem Sauerstoff. Wir zeigen, dass Nierenkrebszellen, die mit PP-funktionalisierten MnO NPs inkubiert wurden nach Bestrahlung mit Laserlicht verenden, während sie ohne Bestrahlung unverändert bleiben. In einem ähnlichen Experiment untersuchten wir die Eigenschaften von SiO2 beschichteten MnO NPs. Dafür wurde eigens eine neuartige SiO2-Beschichtungsmethode entwickelt, die einer nachfolgende weitere Anbindung verschiedenster Liganden und die Einlagerung von Fluoreszenzfarbstoffen durch herkömmliche Silan- Sol-Gel Chemie erlaubt. Die Partikel zeigten eine ausgezeichnete Stabilität in einer ganzen Reihe wässriger Lösungen, darunter auch physiologische Kochsalzlösung, Pufferlösungen und humanes Blutserum, und waren weniger anfällig gegenüber Mn-Ionenauswaschung als einfache PEGylierte MnO NPs. Des Weiteren konnte bewiesen werden, dass die dünne SiO2 Schicht nur einen geringen Einfluss auf das magnetische Verhalten der NPs hatte, so dass sie weiterhin als T1-Kontrastmittel verwendet werden können. Schließlich konnten zusätzlich FePt@MnO NPs hergestellt werden, welche die individuellen magnetischen Merkmale eines ferromagnetischen (FePt) und eines antiferromagnetischen (MnO) Materials vereinen. Wir zeigen, dass wir die jeweiligen Partikelgrößen, und damit das resultierende magnetische Verhalten, durch Veränderung der experimentellen Parameter variieren können. Die magnetische Wechselwirkung zwischen beiden Materialien kann dabei auf Spinkommunikation an der Grenzfläche zwischen beiden NP-Sorten zurückgeführt werden.rn

Smart magnetic dispersions - from switchable release to well-defined hybrid nanofibers

The synthesis, characterization and application of aqueous dispersions of superparamagnetic/polymer hybrid nanoparticles and capsules is described. Implementation of the superparamagnetic moiety into the polymer matrix enables a response of the nanomaterials towards an external magnetic field. Application of the external field is used for two main purposes: i) As heat generator, when an alternating magnetic field is applied. ii) As structuring agent to self-assemble superparamagnetic nanoparticles in the external field.rnIn the first part, superparamagnetic nanoparticles were used as heat generators in order to achieve a magnetic field induced release of an active compound from nanocontainers. To achieve such a release in remote-controlled fashion, the encapsulation of superparamagnetic nanoparticles into polymer nanocapsules was combined with the integration of a thermolabile compound into the shell of the nanocontainers. The magnetic nanoparticles acted as generators for heat, which decomposed the thermolabile compound. Pores were created in the degrading shell and an active substance was released.rn Additionally, the self-assembly of polymer nanoparticles, which were labeled with a superparamagnetic moiety as structuring agent, could be demonstrated. A combination of a magnetic field induced self-assembly and a sintering of neighboring particles upon an increase in temperature above the glass transition temperature of the polymer was used to form stable architectures. Various structures with tunable periodicity could be obtained ranging from smooth linear nanofibers to zigzag fibers. Besides solely creating linear architectures, the frugal process additionally allowed the creation of arrangements in analogy to more complex polymer architectures: By the introduction of defined junction points, the generation of branched structures and networks was demonstrated. Additionally, by tailoring the interaction of differently sized particles, the preparation of nanoparticle arrangements in statistical or block copolymer fashion was shown. Moreover, a reversible linear assembly and linkage of the nanoparticles was demonstrated following a lock/unlock mechanism. Therefore, the particles were locked in their linear assembly by a stable iron(III) hydroxamato-complex and unlocked by addition of a reducing agent and formation of a less stable iron(II)-complex.Further, in various projects with collaboration partners, nanoparticles and nanocapsules were labeled with a superparamagnetic moiety for their use as contrast agents in magnetic resonance imaging or as magnetically separable dispersions.

Neuroimaging in childhood arterial ischaemic stroke: evaluation of imaging modalities and aetiologies

Aim The aim of this study was to describe neuroimaging patterns associated with arterial ischaemic stroke (AIS) in childhood and to differentiate them according to stroke aetiology. Method Clinical and neuroimaging (acute and follow-up) findings were analysed prospectively in 79 children (48 males, 31 females) aged 2 months to 15 years 8 months (median 5y 3mo) at the time of stroke by the Swiss Neuropaediatric Stroke Registry from 2000 to 2006. Results Stroke was confirmed in the acute period in 36 out of 41 children who underwent computed tomography, in 53 of 57 who underwent T2-weighted magnetic resonance imaging (MRI) and in all 48 children who underwent diffusion-weighted MRI. AIS occurred in the anterior cerebral artery (ACA) in 63 participants and in all cases was associated with lesions of the middle cerebral artery (MCA). The lesion was cortical-subcortical in 30 out of 63 children, cortical in 25 out of 63, and subcortical in 8 of 63 children. Among participants with AIS in the posterior circulation territory, the stroke was cortical-subcortical in 8 out of 16, cortical in 5 of 16, and thalamic in 3 out of 16 children. Interpretation AIS mainly involves the anterior circulation territory, with both the ACA and the MCA being affected. The classification of Ganesan is an appropriate population-based classification for our Swiss cohort, but the neuroimaging pattern alone is insufficient to determine the aetiology of stroke in a paediatric population. The results show a poor correlation between lesion pattern and aetiology.

Noninvasive assessment of exercise-related intramyocellular acetylcarnitine in euglycemia and hyperglycemia in patients with type 1 diabetes using ¹H magnetic resonance spectroscopy: a randomized single-blind crossover study

Intramyocellular acetylcarnitine (IMAC) is involved in exercise-related fuel metabolism. It is not known whether levels of systemic glucose influence IMAC levels in type 1 diabetes.