In this longitudinal pilot study, magnetic resonance imaging (MRI) and Early Erosions in Rheumatoid Arthritis (EERA) software were used to quantify bone erosive damage in the metacarpophalangeal (MCP) 2-5 joints of the worst-affected hand (i.e. greatest swelling and tenderness at baseline) of patients with rheumatoid arthritis (n=35). Firstly, Spearman’s rho (rs) was used to evaluate the correlation between total change in sum erosive damage and change in functional ability, as well as the correlation between rate of change in sum erosive damage and change in functional ability. The rs (p-value) for total change and rate of change in sum erosive damage was 0.099 (0.585) and 0.104 (0.565), respectively. Therefore, the null hypothesis that neither variable was associated with change in functional ability could not be rejected. Participants were also classified into three groups based on total change in sum erosive damage (improvement, stable or progression) and were examined for possible differences in a variety of measures using an exploratory, non-statistical approach. Most notably, participants in the improvement group had more than five times the mean sum erosive damage at baseline compared to the progression group and also appeared to be the least aggresively medicated of the three cohorts. This study is the first to apply EERA in a way that helps to address clinically important questions related to change in erosive damage and functional ability. Future studies should use the ideas and concepts generated in this pilot study to further explore the use of this highly reproducible erosion quantification software, with the ultimate goal of expanding the applications of EERA in both the research and clinical settings. / Thesis / Master of Science (MSc) / In this study, the hands of patients with rheumatoid arthritis (RA) were assessed using magnetic resonance imaging (MRI) to investigate how erosive damage to the bone changes over time. Specialized computer software entitled Early Erosions in Rheumatoid Arthritis (EERA) was used to perform this analysis. Firstly, change in erosive damage was not found to be related to change in functional ability (e.g. eating, grip, etc.). Secondly, it appeared that individuals who demonstrated improvement in bone damage over time had significant damage at the beginning of the study period. Overall, this study provides new information for researchers and clinicians in terms of how this unique software can be used to enhance our understanding of RA. Future studies will continue to explore ways in which this software can be applied to address questions that are important to RA patients.

L'objectif de cette thèse était d'explorer le potentiel de l’imagerie du cerveau humain par ultrasons. L'anatomie, le flux sanguin et la rigidité des tissus mous ont déjà été étudiés avec l'imagerie ultrasonore ultrarapide chez l'homme et validés sur plusieurs organes, tels que le sein et le foie, mais pas encore sur le cerveau adulte. La principale limitation de l'imagerie échographique transcrânienne est aujourd'hui le très fort artefact d'aberration induit par le crâne. En effet, l’os, de par sa composition ne permet pas la propagation des ultrasons comme ailleurs dans le corps humain. Dans cette thèse, nous avons utilisé l'imagerie ultrasonore ultrarapide pour l'évaluation de la rigidité des tissus mous et l'imagerie neurofonctionnelle dans le cerveau humain adulte, lors de chirurgies du cerveau afin de contourner dans un premier temps le problème des aberrations induites par le crâne. La dernière partie de cette thèse était axée sur la correction d’aberration pour l’échographie quantitative et l’imagerie ultrasonore transcrânienne. Nous avons tout d’abord fourni plusieurs preuves de l'intérêt d'utiliser l’élastographie par onde de cisaillement pendant la chirurgie du cerveau. Nous avons également présenté notre nouvelle technique d’élastographie par onde de cisaillement en 3D à l'aide d'une sonde matricielle dans le but de pouvoir dépasser les limitations du 2D et notamment être moins dépendant de l’opérateur.Dans un second volet, nous avons démontré la capacité des ultrasons ultrarapides à identifier, cartographier et différencier en profondeur les régions d'activation corticales en réponse à un stimulus, à la fois chez les patients éveillés et chez les patients anesthésiés. Nous avons démontré que l'imagerie neurofonctionnelle par ultrasons a le potentiel de devenir une modalité complète de neuroimagerie avec des avantages majeurs pour une utilisation peropératoire.Dans un troisième volet, nous avons utilisé une technique en trois étapes pour calculer précisément la vitesse du son (SSE) dans un milieu. Cette technique a été testée dans des fantômes ultrasonores et in vivo dans les foies de patients. Dans les deux cas, notre méthode a été capable de trouver la vitesse du son correspondant au milieu. Nous avons démontré que la SSE était liée à la fraction de graisse. Cette analyse a permis de conclure que la SSE était en mesure de distinguer un foie sain et d’un foie malade aussi bien avec la biopsie qu’avec l’IRM comme méthode de référence. Combiné à l'utilisation de la formule de Wood, nous avons même pu avoir accès à une fraction de graisse mesurée par ultrasons de manière non invasive. Puis nous avons combiné la correction d’aberration de phase, d'amplitude et de vitesse du son pour faire de l’imagerie transcrânienne en simulation numérique. Nous avons atteint notre objectif en obtenant des images représentant fidèlement le milieu (position latérale et profondeur) et caractérisées par une résolution et un contraste similaires à ceux obtenus avec une source ponctuelle dans le milieu / The objective of this thesis was to explore the potential of human brain ultrasound imaging. Anatomy, blood flow and soft tissue stiffness have already been studied with ultrafast ultrasound imaging in humans and validated in several organs, such as, the breast and liver but not yet on the adult brain. The main limitation of transcranial ultrasound imaging is today the very strong skull-induced aberration artefact. Indeed, the bone, due to its composition, does not allow for ultrasound propagation as elsewhere in the human body. Therefore, this thesis was focused on the development of ultrafast ultrasound imaging for the evaluation of soft tissue stiffness and neurofunctional imaging in the adult human brain, during brain surgery to bypass the problem of skull aberration, and on an aberration correction technique for transcranial ultrasound imaging.We first provided several evidence of the benefit of using shear wave elastography during brain surgery. We also presented our new technique for 3D shear wave elastography using a matrix array in order to be able to overcome the limitations of 2D imaging and in particular to reduce the operator dependence.In a second phase, we demonstrated the capability of ultrasound to identify, map and differentiate in depth cortical regions of activation in response to a stimulus, both in awake patients and in anaesthetized patients. We have demonstrated that ultrasound neurofunctional imaging has the potential to become a comprehensive modality of neuroimaging with major benefits for intraoperative use. In a third part, we developed a new sound speed estimation (SSE) technique, based on a three-step technique that estimates the sound speed accurately corresponding to the illuminated medium. This technique was tested in ultrasound phantoms and in vivo in patient’s liver. In both cases, our method was able to find the sound speed corresponding to the medium. We demonstrated that SSE was related to the fat fraction. This analysis led to the conclusion that SSE was able to distinguish a healthy liver from a diseased liver with both biopsy and MRI as gold standard. Combined with the use of the Wood’s formula, we were even able to access a fat fraction measured by non-invasive ultrasound. Finally, by combining the phase, the amplitude and the sound speed estimation, we have developed a new aberration correction algorithm to perform transcranial ultrasound imaging. By performing numerical simulations, we obtained images that faithfully represented the medium (lateral position and depth) and characterized by one resolution and one contrast similar to those obtained with a punctual source in the medium

The determination of exact tumor boundaries within eloquent brain regions is essential to maximize the extent of resection. Recent studies showed that intraoperative optical imaging (IOI) combined with median nerve stimulation is a helpful tool for visualization of the primary sensory cortex (PSC). In this technical note, we describe a novel approach of using IOI with painless tactile irritation to demonstrate the feasibility of topographic mapping of different body regions within the PSC. In addition, we compared the IOI results with preoperative functional MRI (fMRI) findings. In five patients with tumors located near the PSC who received tumor removal, IOI with tactile irritation of different body parts and fMRI was applied. We showed that tactile irritation of the hand in local and general anesthesia leads to reliable changes of cerebral blood volume during IOI. Hereby, we observed comparable IOI activation maps regarding the median nerve stimulation, fMRI and tactile irritation of the hand. The tactile irritation of different body areas revealed a plausible topographic distribution along the PSC. With this approach, IOI is also suitable for awake surgeries, since the tactile irritation is painless compared with median nerve stimulation and is congruent to fMRI findings. Further studies are ongoing to standardize this method to enable a broad application within the neurosurgical community.

The physical complications of Type 1 diabetes mellitus (T1DM) have been understood as an accelerated ageing process (Morley, 2008). Do people with T1DM also experience accelerated cognitive and brain ageing? Using findings from research of the normal cognitive and brain ageing process and conceptualized in theories of the functional brain changes in cognitive ageing, a combination of cognitive testing and functional magnetic resonance imaging (fMRI) techniques were used to evaluate evidence of accelerated cognitive and brain ageing in middle-aged adults with T1DM. The first part of this thesis comprises a cognitive study of 94 adults (≥ 45 years of age) with long duration (≥ 10 years) of T1DM. Participants completed cognitive assessment and questionnaires on general mood and feelings about living with diabetes. Findings highlighted the importance of microvascular disease (specifically retinopathy) as an independent predictor of cognitive function. The incidence and predictors of mild cognitive impairment (MCI) were then explored. Results indicate a higher percentage of the group met criteria for MCI than expected based on incidence rates in the general population, providing initial evidence of accelerated cognitive ageing. Psychological factors were explored next. The relationship between the measures of well-being, diabetes health, and cognitive function highlighted the need for attention to patient's psychological well-being in diabetes care. Finally, a subgroup of 30 participants between the ages of 45 and 65 who differed on severity of retinopathy were selected to take part in an fMRI study. Blood oxygen level dependent (BOLD) activity was evaluated while participants were engaged in cognitive tasks and during rest. The findings provided evidence that the pattern of BOLD activation and functional connectivity for those with high severity of retinopathy are similar to patterns found in adults over the age of 65. In line with the theories of cognitive ageing, functional brain changes appear to maintain a level of cognitive function. Evidence of accelerated brain ageing in this primarily middle-aged group, emphasizes the importance of treatments and regimens to prevent or minimize microvascular complications.