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Arora, A

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Arora

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Arora, A

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2009 - 200912010 - 20143

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Author's Publications: search.filters.isAuthorOfPublication.f9b9ba9d-fceb-44fe-9447-212ef1b73952

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    The Impact of Lesion In-Painting and Registration Methods on Voxel-Based Morphometry in Detecting Regional Cerebral Gray Matter Atrophy in Multiple Sclerosis
    (American Society of Neuroradiology (ASNR), 2012) Ceccarelli, A.; Jackson, J. S.; Tauhid, S.; Arora, A; Gorky, J.; Dell, E.; Bakshi, A.; Chitnis, Tanuja; Khoury, Samia; Weiner, Howard; Guttmann, Charles; Bakshi, Rohit; Neema, M
    Background and Purpose: VBM has been widely used to study GM atrophy in MS. MS lesions lead to segmentation and registration errors that may affect the reliability of VBM results. Improved segmentation and registration have been demonstrated by WM LI before segmentation. DARTEL appears to improve registration versus the USM. Our aim was to compare the performance of VBM-DARTEL versus VBM-USM and the effect of LI in the regional analysis of GM atrophy in MS. Materials and Methods: 3T T1 MR imaging scans were acquired from 26 patients with RRMS and 28 age-matched NC. LI replaced WM lesions with normal-appearing WM intensities before image segmentation. VBM analysis was performed in SPM8 by using DARTEL and USM with and without LI, allowing the comparison of 4 VBM methods (DARTEL + LI, DARTEL − LI, USM + LI, and USM − LI). Accuracy of VBM was assessed by using NMI, CC, and a simulation analysis. Results: Overall, DARTEL + LI yielded the most accurate GM maps among the 4 methods (highest NMI and CC, P < .001). DARTEL + LI showed significant GM loss in the bilateral thalami and caudate nuclei in patients with RRMS versus NC. The other 3 methods overestimated the number of regions of GM loss in RRMS versus NC. LI improved the accuracy of both VBM methods. Simulated data suggested the accuracy of the results provided from patient MR imaging analysis. Conclusions: We introduce a pipeline that shows promise in limiting segmentation and registration errors in VBM analysis in MS.
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    Brain MRI Lesion Load at 1.5T and 3T versus Clinical Status in Multiple Sclerosis
    (Wiley-Blackwell, 2011) Stankiewicz, James; Glanz, Bonnie; Healy, Brian; Arora, A; Neema, M; Benedict, Ralph H.B.; Guss, Zachary D.; Tauhid, Shahamat; Buckle, Guy J.; Houtchens, Maria; Khoury, Samia; Weiner, Howard; Guttmann, Charles; Bakshi, Rohit
    Background/Purpose: To assess correlation between brain lesions and clinical status with 1.5T and 3T magnetic resonance imaging (MRI). Methods: Brain MRI fluid-attenuated inversion-recovery (FLAIR) sequences were performed in 32 multiple sclerosis (MS) patients. Expanded Disability Status Scale (EDSS) score (mean ± standard deviation) was 2 ± 2.0 (range 0-8), disease duration 9.3 ± 8.0 (range .8-29) years. Results: FLAIR lesion volume (FLLV) at 3T was higher than at 1.5T (P= .01). Correlation between 1.5T FLLV and EDSS score was poor, while 3T FLLV correlated moderately and significantly (rs= .39, P= .03). When controlling for age and depression, correlations between FLLV and cognitive measures were significant at 1.5T for the Judgment of Line Orientation test (JLO) (rs=−.44, P= .05), the Symbol Digit Modalities Test (SDMT) (rs=−.49, P= .02), and the California Verbal Learning Test Delayed Free Recall (CVLT DR) (rs=−.44, P= .04). Correlations at 3T were also significant for these tests, but of greater magnitude: JLO (rs=−.70, P= .0005), SDMT (rs=−.73, P= .0001), CVLT DR (rs=−.061, P= .003). Additional significant correlations obtained only at 3T included the 2 second-paced auditory serial addition test (rs=−.55, P= .01), the Brief Visuospatial Memory Test-Delayed Free Recall (rs=−.56, P= .007), and the California Verbal Learning Test Total Recall (rs=−.42, P= .05). Conclusion: MRI at 3T may boost sensitivity and improve validity in MS brain lesion assessment.
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    Normal Findings on Brain Fluid-Attenuated Inversion Recovery MR Images at 3T
    (American Society of Neuroradiology (ASNR), 2009) Neema, M; Guss, Z.D.; Stankiewicz, James; Arora, A; Healy, Brian; Bakshi, Rohit
    Background and Purpose: Fluid attenuated inversion recovery (FLAIR) MR imaging of the brain has become a routine tool for assessing lesions in patients with suspected neurologic disorders. There is growing interest in 3T brain FLAIR MR imaging but little normative data are available. The purpose of this study was to evaluate the frequency and topography of cerebral hyperintensities seen with FLAIR MR imaging of the brain at 3T in a normal population and compare those findings to 1.5T.Materials and Methods: Whole-brain 2D FLAIR MR imaging was performed in 22 healthy controls (mean age, 44 ± 8 years; range, 30–53 years) at 3T. Fifteen of these subjects also underwent 2D FLAIR at 1.5T, with similar optimized parameters and voxel size. Cerebral hyperintense areas, including discrete foci, anterior and posterior periventricular capping, diffuse parenchymal hyperintensity, septal hyperintensity, corticospinal tract hyperintensity, and CSF flow artifacts were assessed. The Spearman rank test assessed the correlation between discrete hyperintense foci and age. The Wilcoxon signed rank test compared foci detectability at 3T versus 1.5T. Results: FLAIR at 3T commonly showed hyperintensities such as discrete foci (mean, 10.68 per subject; at least 1 present in 68% of subjects), anterior and posterior periventricular capping, diffuse posterior white matter hyperintensity, septal hyperintensity, corticospinal tract hyperintensity, and ventricular CSF flow artifacts. FLAIR at 3T showed a higher hyperintense foci volume (170 ± 243 versus 93 ± 152 mm3, P < .01) and number (9.4 ± 13 versus 5.5 ± 9.2, P < .01) than at 1.5T. No significant differences (P = .68) in the length/diameter of individual discrete hyperintense foci were seen between 3T and 1.5T. Discrete foci volume (r = 0.72 at 3T, r = 0.70 at 1.5T) and number (r = 0.74 at 3T; r = 0.69 at 1.5T) correlated with age to a similar degree on both platforms. All discrete foci were confined to the noncallosal supratentorial white matter. The other nonfocal hyperintensities (anterior and posterior periventricular capping, diffuse parenchymal hyperintensity, septal hyperintensity, corticospinal tract hyperintensity, and CSF flow artifacts) were generally more common and prominent at 3T than at 1.5T. Conclusions: Discrete and diffuse parenchymal brain white matter FLAIR hyperintensities are more common and prominent at 3T than at 1.5T in healthy volunteers.
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    Quantification of Global Cerebral Atrophy in Multiple Sclerosis from 3T MRI Using SPM: The Role of Misclassification Errors
    (BlackWell Publishing Ltd, 2014) Dell’Oglio, Elisa; Ceccarelli, Antonia; Glanz, Bonnie; Healy, Brian; Tauhid, Shahamat; Arora, A; Saravanan, Nikila; Bruha, Matthew J; Vartanian, Alexander V; Dupuy, Sheena L; Benedict, Ralph HB; Bakshi, Rohit; Neema, M
    Purpose We tested the validity of a freely available segmentation pipeline to measure compartmental brain volumes from 3T MRI in patients with multiple sclerosis (MS). Our primary focus was methodological to explore the effect of segmentation corrections on the clinical relevance of the output metrics. Methods: Three-dimensional T1-weighted images were acquired to compare 61 MS patients to 30 age- and gender-matched normal controls (NC). We also tested the within patient MRI relationship to disability (eg, expanded disability status scale [EDSS] score) and cognition. Statistical parametric mapping v. 8 (SPM8)-derived gray matter (GMF), white matter (WMF), and total brain parenchyma fractions (BPF) were derived before and after correcting errors from T1 hypointense MS lesions and/or ineffective deep GM contouring. Results: MS patients had lower GMF and BPF as compared to NC (P<.05). Cognitively impaired patients had lower BPF than cognitively preserved patients (P<.05). BPF was related to EDSS; BPF and GMF were related to disease duration (all P<.05). Errors caused bias in GMFs and WMFs but had no discernable influence on BPFs or any MRI-clinical associations. Conclusions: We report the validity of a segmentation pipeline for the detection of MS-related brain atrophy with 3T MRI. Longitudinal studies are warranted to extend these results.