PMOD Neuro Tool Introduction (PNEURO)

Precise knowledge of the functional brain areas in the individual patient is crucial for the accurate quantitative analysis of brain PET images and their meaningful interpretation. Often however, functional regions are manually outlined in a casual manner, with subjective results as the outcome. This fundamental flaw can be overcome with PMOD’s PNEURO tool which offers both objective region outlining as well as pattern analysis methods via easy step-by-step procedures. These methods are provided as three modules on separate pages of the user interface.

Automatic Brain Regions by Probabilistic Atlas (N30R83)

A well established way of obtaining brain volumes of interest (VOIs) automatically is by leveraging the most likely localization of brain areas as encoded in the maximum probability atlas constructed by Hammers et al. [1]. The corresponding PNEURO component allows the user to adjust the atlas to the individual patient anatomy with a spatial normalization procedure, which is preferably obtained from the T₁-MR image. Alternatively, the normalization can be directly derived from the PET image, making this solution also applicable for PET-only studies.

Automatic Brain Regions by T1-MRI Parcellation

It is desirable that every brain PET study be complemented with a T₁-weighted MRI which precisely represents the patient’s brain anatomy. The PNEURO tool includes a sophisticated component which applies knowledge-base technology to accurately segment the cortex and the basal ganglia from the T₁-MRIs. These segments are then converted to VOIs which can be projected to the PET images and used for regional statistics.

Normal Brain PET Databases

PET studies with patients can rarely be done in a fully quantitative manner. Rather, a static image of the PET tracer concentration is acquired after an appropriate equilibration time. In this situation, an image analysis is based on the fact that with consistent study protocols, the normal brain uptake exhibits a characteristic uptake pattern. The database component in the PNEURO tool readily allows for pooling the uptake across a set of normal volunteers, and thus establishing the normal pattern together with its variability. Once such a normal database has been created, the anomalies of the tracer uptake in a patient’s brain can be easily localized without any prior assumptions or operator variability and presented as a z-score map.

System Requirements

For productively working with the parcellation tool, the following workstation system requirements should be met:

• 64-Bit operating system (Windows, Mac OS X, Linux)
• ≥ 16 GB RAM
• ≥ 8 processing cores (hyper-threading is also viable)

8GB RAM and 4 cores is at the edge of practicability.

Starting the PNEURO Tool

The PNEURO tool is started with the Neuro button from the PMOD ToolBox

or by directly dragging image files onto the above button.

Organization of the PNEURO User Interface

The user interface of PNEURO consists of five pages which can be selected by tabs:

1. DB Load page: Loading of images from a PMOD database, making them available for processing in all modules of PNEURO. This page is not shown if the database functionality is disabled. The images may also directly be loaded in the different modules.
2. Maximum Probability Atlas page: Creation of brain VOIs by adjusting the N30R83 maximum probability atlas to the patient anatomy.
3. Brain Parcellation page: Creation of brain VOIs by knowledge-based segmentation of anatomical T₁-MR images.
4. Compare to Norm page: Comparison of a static PET image to a Brain Norm. Brain Norms can be created in PNEURO from a set of images acquired with normal controls using the Edit Norm tool from the menu.
5. Statistics page: The VOIs created by the two methods above can directly be applied to the (dynamic) PET images for calculating the regional uptake, optionally with a partial volume correction. The resulting statistics or curves are shown on the Statistics page and from there can be saved or submitted to the kinetic modeling tool.

The user selects the appropriate module for data processing by the corresponding tab in the user interface of PNEURO. Each of the pages is described in a separate section of this guide.