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The world’s first MRI/PET image software tool for the diagnosis of neurodegenerative diseases.

The University Medical Center Hamburg-Eppendorf (UKE) and Royal Philips Electronics have developed a computer aided diagnostics (CAD) system for neurodegenerative diseases to support clinicians in diagnosing the onset and type of disease as early as possible. The new diagnostic technique, which has already proven its accuracy using historical image data and known patient outcomes, is about to undergo clinical evaluation at UKE.

The CAD system is a software package that automatically interprets PET (Positron Emission Tomography) brain scans of patients suspected of having a neurodegenerative disease that leads to dementia, and combines them with MRI (Magnetic Resonance Imaging) scans for accurate differential diagnosis. The development of such a system will ultimately mean a better quality of life for patients by enabling earlier prescription of drugs that delay progression of the disease, and hence delay the worst effects of dementia. It will also provide pharmaceutical companies and clinicians with a valuable tool for the development and testing of new, potentially curative drugs for neurodegenerative diseases such as Alzheimer’s.

“In the not too distant future there is going to be much greater demand for the accurate early diagnosis of neurodegenerative disease and not everyone will have access to the clinical expertise of a university hospital to obtain it,” says Dr. Ralph Buchert of the Department of Nuclear Medicine at UKE. “The availability of an automated system will help less experienced physicians to achieve the same high level of accuracy in their diagnoses.”

Dementia is a debilitating condition that already affects more than 25 million people worldwide*, the commonest form being Alzheimer’s disease. As the demographics of world populations increasingly shift towards older age groups, dementia is widely expected to reach epidemic proportions unless effective treatments are found for it.

“Building on our expertise in multi-modal diagnostic imaging, we’ve combined functional and structural brain-scan information into a fully integrated and easy to use system for diagnosing the principal neurodegenerative diseases that cause dementia,” says Dr. Lothar Spies, Head of the Digital Imaging Department at Philips Research. “Ultimately, it will enable early treatment and highly personalized therapies.”

The software tool developed by Philips Research and UKE accurately overlays anatomical images of the brain obtained from MRI scans with PET scans that display brain activity – specifically the uptake of glucose that fuels brain activity. By using advanced image processing and computer learning techniques in combination with a database of reference brain-scans, the system then analyses the images automatically and displays anomalous brain patterns in a concise way. Based on these patterns, it then suggests a diagnosis. As a result, the system will help less experienced doctors to achieve the same diagnostic accuracy as highly trained specialists.

The clinical evaluation that is about to start will run the computer aided diagnostic system alongside UKE’s existing dementia diagnosis procedures with the aim of fine-tuning the system’s ability to detect and differentiate the three most common types of neurodegenerative disease – Alzheimer’s Disease, Lewy-body Dementia and Frontotemporal Dementia.

News Inside News:
Background of this Invention-
An innovative system jointly developed by the University Medical Center Hamburg-Eppendorf and Philips

As a result of improved living standards and medical care, people now live longer than ever before. The average age expectancy for men and women in Western Europe, for example, is already almost 80 years. However, many elderly people are not disease free. A large number of them suffer chronic disease, and one of the most debilitating in terms of quality-of-life is dementia.

Dementia currently affects well over 25 million people worldwide, and with the demographic shift to older populations it is set to reach epidemic proportions unless effective treatments can be found. The cost of today’s treatment is already putting massive burdens on healthcare authorities and the societal impact on patients and their caregivers is immense.

Dementia is the end result of a number of progressive degenerative diseases of the brain. These diseases are associated with changes in brain chemistry that are thought to begin ten or more years before patients suffer symptoms of cognitive impairment. The most common neurodegenerative diseases are Alzheimer’s Disease, Lewy-body Dementia and Frontotemporal Dementia. These three diseases account for around 60%, 15% and 10% of all dementia cases respectively and are at the moment incurable. Current treatments, such as Cholinesterase inhibitors, provide symptomatic relief in the mild to moderate stages of the disease but do not arrest its progression. Alternative therapeutic options, currently under development, attempt to interrupt the disease process at an earlier stage. There is therefore a growing need for the early detection of neurodegenerative disease and reliable diagnosis of its underlying type.

“It is quite clear that in the next few years there will be new medications for Alzheimer’s disease and other forms of dementia that will have to be given much earlier on if they are to be effective,” says Dr. Holger Jahn, Consultant in Clinical Psychiatry at the University Medical Center Hamburg-Eppendorf (UKE). “Unfortunately, at the moment we make the diagnosis of dementia quite late on in the course of the disease.”

The highly effective blood-brain barrier in the human body makes it currently not possible to detect biomarkers for neurodegenerative disease in blood samples. In-vitro analysis of cerebrospinal fluid (obtained via a lumbar puncture) and in-vivo FDG-PET imaging (Positron Emission Tomography using the tracer Fluorodeoxyglucose) are therefore used as diagnostic tools.

By providing a quantitative indication of the amount of glucose being used in different parts of the brain to fuel brain activity, FDG-PET scans can reveal abnormal brain conditions. However, the resultant FDG-PET images are difficult to interpret. Particularly in the early stages of neurodegenerative disease, it requires the expertise of a highly skilled specialist to make an accurate diagnosis. The limited number of such specialists means that an easier, faster and more convenient method of diagnosing neurodegenerative disease is required.

Computer Aided Diagnosis (CAD)
The solution jointly developed by the University Medical Center Hamburg-Eppendorf (UKE) and Philips Research combines advanced image processing and computer learning techniques with a database of reference brain scans to create an expert system that interprets FDG-PET images automatically to assist clinicians in the accurate differential diagnosis of neurodegenerative diseases.

The first stage in the process is automatic alignment of FDG-PET brain-scan images to a reference model of the human brain – a process known as ‘elastic registration’. This not only corrects for the orientation of a particular patient’s head in the scanner but also for anatomical variation in the brains of different patients (different shape and/or size etc.). The ‘elastically registered’ FDG-PET image is then compared with a set of reference brain scans that represent typical disease patterns, such as that for Alzheimer’s disease, Lewy-body Dementia or Frontotemporal Dementia. Depending on the fit between the patient’s scan and these reference scans, the system provides clinicians with a probable diagnosis.

In developing this automated diagnostic system, emphasis has been placed on making it as highly integrated and user-friendly as possible so that less experienced clinicians can use it as a ‘second-reader’ to achieve the same high level of accuracy in their diagnoses as clinical experts.

The system has already been retrospectively tested using historical brain-scan images of patients with known disease outcomes. It is now being clinically evaluated by running it alongside UKE’s existing dementia diagnosis procedures. This clinical evaluation will also be used to fine-tune the system’s ability to differentiate between the three most common types of dementia by expanding the database of reference images that the system can refer to and by incorporating more of UKE’s expert knowledge into the computer program.

The system is also being extended to combine the metabolic information obtained from FDG-PET scans with structural information revealed by imaging the patient’s brain with an MRI (Magnetic Resonance Imaging) scanner. MRI scans provide very clear and detailed information about brain structure and this can be used both to improve the elastic registration of FDG-PET images and to provide additional diagnostic clues.

Screening and therapy monitoring
The potential of the UKE/Philips computer aided diagnostic system to detect dementia-related diseases well before patients begin to suffer symptoms could make it a powerful screening tool. Although it is unlikely to be used for whole population screening, it could be used to screen people who are considered at risk of contracting neurodegenerative diseases such as Alzheimer’s – for example, those with specific gene constellations or a family history of neurodegenerative disease.

The system could also provide a convenient and easy-to-use means of therapy response monitoring, making it a powerful tool in the development of new drugs to control or cure neurodegenerative diseases of the brain. Many of the new drugs under development are specifically targeted for use in the very early stages of diseases such as Alzheimer’s, which means that their efficacy cannot be evaluated by symptom-based studies.

Personalized medicine
Because many of these drugs are powerful ‘mind-changing’ substances, the development of a pathology-based system that can be used to monitor individual patient responses would help doctors to devise patient-specific drug therapies that maximize efficacy while minimizing side effects. This will bring the current trend of personalized medicine to yet another area of clinical care, improving patient outcomes and reducing healthcare costs for both the treatment and aftercare of dementia related diseases. It will also help to prevent today’s high incidence of dementia in elderly people from reaching the epidemic proportions that so many people fear.
For more information please contact:

University Medical Center Hamburg-Eppendorf
Dr. Mathias Goyen
Tel.: (040) 42803 - 4747
Fax: (040) 42803 - 4932
E-mail : pressestelle@uke.uni-hamburg.de
Web: http://www.uke.uni-hamburg.de/index.php

Philips
Steve Klink
Philips Research / Communications Department
Tel.: +31 40 27 43703
Mobile: +31 6 10888824
E-mail: steve.klink@philips.com


About Royal Philips Electronics
Royal Philips Electronics of the Netherlands (NYSE: PHG, AEX: PHI) is a global leader in healthcare, lifestyle and technology, delivering products, services and solutions through the brand promise of “sense and simplicity”. Headquartered in the Netherlands, Philips employs approximately 124,300 employees in more than 60 countries worldwide. With sales of EUR 27 billion in 2006, the company is a market leader in medical diagnostic imaging and patient monitoring systems, energy efficient lighting solutions, personal care and home appliances, as well as consumer electronics

In The Images-
A screenshot of the interface of the Computer Aided Diagnosis system that automatically interprets PET brain scans of patients suspected of having a neurodegenerative disease.

Release link: http://www.philips.com/newscenter