Biomedical subjects

Frederik Maes

Publications and source records attributed to Frederik Maes.

At least 19 recordsLinked to original sources

PubMed2006

Assessment of bone segmentation quality of cone-beam CT versus multislice spiral CT: a pilot study.

OBJECTIVES: The objective of this study was to quantitatively assess the quality of jawbone models generated from cone beam computed tomography (CBCT) by comparison with similar models obtained from multislice spiral computed tomography (MSCT). MATERIAL AND METHODS: Three case studies were performed involving images of anthropomorphic head phantoms and real patients acquired with 3 CBCT (NewTom 9000 DVT, Accuitomo 3D, and i-CAT) and 2 MSCT scanners (Somatom VolumeZoom and Lightspeed). Bone was segmented from the CBCT and MSCT images using global thresholding. CBCT vs MSCT segmentation differences were assessed by comparing bone thickness measurements at anatomically corresponding sites, identified automatically by CBCT to MSCT image registration. RESULTS: There was a statistically significant difference between the MSCT and CBCT segmented bone thicknesses, varying from 0.05 +/- 0.47 mm (i-CAT) up to 1.2 +/- 1.00 mm (3D Accuitomo, posterior maxilla). CONCLUSIONS: An automated, reproducible, and observer-independent method has been developed to assess the quality of CBCT bone models using MSCT as a clinically established method of reference. Our validation method is generally applicable in cases where no geometric ground-truth is available.

Algorithms↗

PubMed2006

Computer-aided detection of colonic polyps using low-dose CT acquisitions.

RATIONALE AND OBJECTIVES: This report proposes an alternative method for the automatic detection of colonic polyps that is robust enough to be directly applicable on low-dose computed tomographic data. MATERIALS AND METHODS: The polyp modeling process takes into account both the gray-level appearance of polyps (intensity profiles) and their geometry (extended Gaussian images). Spherical harmonic decompositions are used for comparison purposes, allowing fast estimation of the similarity between a candidate and a set of previously computed models. Starting from the original raw data (acquired at 55 mA), five patient data sets (prone and supine scans) are reconstructed at different dose levels (to 5 mA) by using different kernel filters, slice overlaps, and increments. Additionally, the efficacy of applying an edge-preserving smoothing filter before detection is assessed. RESULTS: Although image quality decreases when decreasing acquisition milliamperes, all polyps greater than 6 mm are detected successfully, even at 15 mA. Although not important at high doses, smoothing improves detection results for ultra-low-dose (tube current<15 mA) data. CONCLUSION: The advantage of low-dose scans is a significant decrease in effective dose from 4.93 to 1.61 mSv while retaining high detection values, particularly important when thinking of population screening.

Algorithms↗

PubMed2006

An information theoretic approach for non-rigid image registration using voxel class probabilities.

We propose two information theoretic similarity measures that allow to incorporate tissue class information in non-rigid image registration. The first measure assumes that tissue class probabilities have been assigned to each of the images to be registered by prior segmentation of both of them. One image is then non-rigidly deformed to match the other such that the fuzzy overlap of corresponding voxel object labels becomes similar to the ideal case whereby the tissue probability maps of both images are identical. Image similarity is assessed during registration by the divergence between the ideal and actual joint class probability distributions of both images. A second registration measure is proposed that applies in case a segmentation is available for only one of the images, for instance an atlas image that is to be matched to a study image to guide the segmentation thereof. Intensities in one image are matched to the fuzzy class labels in the other image by minimizing the conditional entropy of the intensities in the first image given the class labels in the second image. We derive analytic expressions for the gradient of each measure with respect to individual voxel displacements to derive a force field that drives the registration process, which is regularized by a viscous fluid model. The performance of the class-based measures is evaluated in the context of non-rigid inter-subject registration and atlas-based segmentation of MR brain images and compared with maximization of mutual information using only intensity information. Our results demonstrate that incorporation of class information in the registration measure significantly improves the overlap between corresponding tissue classes after non-rigid matching. The methods proposed here open new perspectives for integrating segmentation and registration in a single process, whereby the output of one is used to guide the other.

Algorithms↗

PubMed2005

Cardiac three-dimensional magnetic resonance imaging and fluoroscopy merging: a new approach for electroanatomic mapping to assist catheter ablation.

BACKGROUND: Modern nonfluoroscopic mapping systems construct 3D electroanatomic maps by tracking intracardiac catheters. They require specialized catheters and/or dedicated hardware. We developed a new method for electroanatomic mapping by merging detailed 3D models of the endocardial cavities with fluoroscopic images without the need for specialized hardware. This developmental work focused on the right atrium because of the difficulties in visualizing its anatomic landmarks in 3D with current approaches. METHODS AND RESULTS: Cardiac MRI images were acquired in 39 patients referred for radiofrequency catheter ablation using balanced steady state free-precession sequences. We optimized acquisition and developed software for construction of detailed 3D models, after contouring of endocardial cavities with cross-checking of different imaging planes. 3D models were then merged with biplane fluoroscopic images by methods for image calibration and registration implemented in a custom software application. The feasibility and accuracy of this merging process were determined in heart-cast experiments and electroanatomic mapping in patients. Right atrial dimensions and relevant anatomic landmarks could be identified and measured in all 3D models. Cephalocaudal, posteroanterior, and lateroseptal diameters were, respectively, 65+/-11, 54+/-11, and 57+/-9 mm; posterior isthmus length was 26+/-6 mm; Eustachian valve height was 5+/-5 mm; and coronary sinus ostium height and width were 16+/-3 and 12+/-3 mm, respectively (n=39). The average alignment error was 0.2+/-0.3 mm in heart casts (n=40) and 1.9 to 2.5 mm in patient experiments (n=9), ie, acceptable for clinical use. In 11 patients, reliable catheter positioning and projection of activation times resulted in 3D electroanatomic maps with an unprecedented level of anatomic detail, which assisted ablation. CONCLUSIONS: This new approach allows activation visualization in a highly detailed 3D anatomic environment without the need for a specialized nonfluoroscopic mapping system.

Arrhythmias, Cardiac↗

PubMed2005

Relationship between multiple sclerosis intention tremor severity and lesion load in the brainstem.

Intention tremor due to multiple sclerosis is clinically similar to cerebellar tremor. This study investigated, in 14 multiple sclerosis patients, the relationship between intention tremor severity and the lesion load in different infratentorial regions. Tremor amplitude was quantified during step-tracking tasks. The lesion load was measured on magnetic resonance images using an automated segmentation method. Intention tremor amplitude was significantly related to lesion load in the brainstem but not in the cerebellum. Specifically, tremor amplitude correlated with the lesion load in the contralateral pons, and patients with more severe tremor in both arms had a greater lesion load bilaterally in the pons. These results support the view that multiple sclerosis intention tremor is related to dysfunction of cerebellar inflow and/or outflow pathways.

Brain Stem↗

PubMed2005

Feature-based statistical analysis of structural MR data for automatic detection of focal cortical dysplastic lesions.

This paper presents a method for fully automated detection and localization of Focal Cortical Dysplastic (FCD) lesions from anatomical magnetic resonance (MR) images of the human brain. Model-based tissue classification of the image under study was applied first such that a gray matter (GM) segmentation map is obtained of which we demonstrate that it also includes possible FCD lesions. Cortical thickness was estimated at each voxel using an appropriate distance transform applied to the binarized GM object and an FCD specific feature map was constructed by computing the ratio of cortical thickness over absolute image intensity gradient at each voxel. In absence of any prior anatomical hypothesis on the spatial location of the lesion, a statistical parameter map was constructed by evaluating the evidence for each gray matter voxel against the null hypothesis of no difference in the feature map of the patient versus similar maps obtained for a group of normal controls. Voxel clusters for which the null hypothesis was found to be improbable at optimally selected thresholds for cluster height and extent were reported as lesions. The method was applied to a surgical series of 17 FCD patient images that were compared against a group of 64 neurologically normal controls. The method correctly detected and located the FCD lesion in 9 out of 17 FCD cases (53%) using a threshold that minimized false positives and 12 of 17 (71%) using a threshold that allowed more false positive results. The detected lesions had a median volume of 7.2 cm(3) versus 2.9 cm(3) for the non-detected lesions. The detected lesions more often had an increased cortical thickness on T1 than the non-detected lesions (P=0.015, Fisher's exact test). Due to a high variance of the feature maps in the temporal lobes and insula, detection of FCD lesions in these regions appeared more difficult than in other brain regions with lower variance.

Adolescent↗

PubMed2005

Magnetic resonance imaging study of the level of termination of the conus medullaris and the thecal sac: influence of age and gender.

STUDY DESIGN: Sequential study of magnetic resonance imaging (MRI) of the spine for assessing the level of termination of the conus medullaris (CMT) and thecal sac (TST). OBJECTIVES: To determine the variation in CMT and the TST as a function of age and gender in an adult population without spinal deformity and to investigate the relationship between CMT and TST. SUMMARY OF BACKGROUND DATA: It is generally accepted that the conus medullaris terminates in the lower third of L1; however, a wide range of values has been reported in cadaver studies as well as in MRI studies during life. There have been only a few reports on the influence of gender on the CMT, and the influence of age has not been studied at all. There have been few studies on the range of termination of the thecal sac, and the influence of age and gender remain unexplored. METHODS: We reviewed the 3-mm sagittal MR images of 635 patients, including 297 women and 338 men, with a mean age of 49.43 years. The CMT and TST were located in relation to spinal levels and assigned numerical values ranging from 0 to 13. Parametric and nonparametric statistical tests were used for the data analysis. RESULTS: Mean CMT was at the level of the middle third of L1. The range span extended from the lower third of Th11 to the upper third of L3. The CMT displayed a small but significant positive correlation with age and with gender. Mean TST was at the level of the upper third of S2. The range extended from the lower third of L3 to the upper third of S5. The TST was not affected by gender, but age had an effect on TST. CONCLUSIONS: The CMT and TST displayed a wide range of values in our study. We detected small but systematic influences of gender and age on CMT and of age on TST, as well as a positive correlation between CMT and TST. These effects are small in amplitude, but they met all the criteria for statistical significance and have practical value for clinicians, as well as theoretical value for the medical and biologic community.

Adolescent↗

PubMed2005

Automatic analysis of cerebral asymmetry: an exploratory study of the relationship between brain torque and planum temporale asymmetry.

Leftward occipital and rightward frontal lobe asymmetry (brain torque) and leftward planum temporale asymmetry have been consistently reported in postmortem and in vivo neuroimaging studies of the human brain. Here automatic image analysis techniques are applied to quantify global and local asymmetries, and investigate the relationship between brain torque and planum temporale asymmetries on T1-weighted magnetic resonance (MR) images of 30 right-handed young healthy subjects (15 male, 15 female). Previously described automatic cerebral hemisphere extraction and 3D interhemispheric reflection-based methods for studying brain asymmetry are applied with a new technique, LowD (Low Dimension), which enables automatic quantification of brain torque. LowD integrates extracted left and right cerebral hemispheres in columns orthogonal to the midsagittal plane (2D column maps), and subsequently integrates slices along the brain's anterior-posterior axis (1D slice profiles). A torque index defined as the magnitude of occipital and frontal lobe asymmetry is computed allowing exploratory investigation of relationships between this global asymmetry and local asymmetries found in the planum temporale. LowD detected significant torque in the 30 subjects with occipital and frontal components found to be highly correlated (P<0.02). Significant leftward planum temporale asymmetry was detected (P<0.05), and the torque index correlated with planum temporale asymmetry (P<0.001). However, torque and total brain volume were not correlated. Therefore, although components of cerebral asymmetry may be related, their magnitude is not influenced by total hemisphere volume. LowD provides increased sensitivity for detection and quantification of brain torque on an individual subject basis, and future studies will apply these techniques to investigate the relationship between cerebral asymmetry and functional laterality.

Adult↗

PubMed2005

Clinical validation of high-resolution fast spin-echo MR colonography after colon distention with air.

To evaluate the feasibility of MR colonography (MRC) with air using two-dimensional (2D) T1-weighted fast spin-echo (T1wFSE) in patients scheduled for conventional colonoscopy (CC) after classic bowel preparation, and assess the ability of the technique to detect colonic lesions. The distention was sufficient for diagnosis, and the technique provided adequate delineation of the wall in the majority of segments. Residual fluid obscured the wall in different segments, especially in the ascending and descending colon (supine position) and in the cecum, transverse, and sigmoid colon (prone position). These findings were consistent with CT colonography. MRC visualized three lesions, missed one lesion >10 mm, visualized none of four lesions <5 mm, and yielded one false-positive lesion (5-10 mm). Missed lesions can be due to inconsistency in the slice positions between consecutive breath-holds, which is inherent to the multishot technique. Residual fluid may have obscured the smaller lesions. The shortcomings of the technique are limited coverage and signal drop-off at the borders of the field of view (FOV). Before multishot 2D T1wFSE colonography can become a valid screening method, improved patient preparation and a more practical technique are needed.

Adult↗

PubMed2005

Combined T1-T2 mapping of human femoro-tibial cartilage with turbo-mixed imaging at 1.5T.

PURPOSE: To evaluate the influence of Gd-DTPA on cartilage T2 mapping using turbo-mixed (tMIX) imaging, and to show the possible usefulness of the tMIX technique for simultaneously acquiring T1 and T2 information in cartilage. MATERIALS AND METHODS: Twenty volunteers underwent MRI of the knee using the tMIX sequence before and after gadolinium administration. T1 and T2 maps were calculated. The mean T1 was determined on the pre- and postcontrast T1 maps. T2 relaxation values before and after gadolinium administration were statistically analyzed. RESULTS: The obtained relaxation values are in correspondence with previously published data. The mean T1 before gadolinium administration was 449 msec +/- 34.2 msec (SD), and after gadolinium administration it was 357 msec +/- 55.8 msec (SD). The postcontrast T1 relaxation range was 221.5-572.8 msec. The mean T2 of the precontrast T2 maps was 34.2 msec +/- 3.1 msec (SD), and the mean T2 of the postcontrast T2 maps was 32.5 msec +/- 3.1 msec (SD). These are statistically significant different values. A correction for the postcontrast T2 values, using a back-calculation algorithm, yielded a 98% correlation with the precontrast T2 values. CONCLUSION: The absolute difference of pre- and postcontrast T2 is very small and is ruled out using the back-calculation algorithm. Combined T1-T2 tMIX cartilage mapping is a valuable alternative for separate T1 and T2 cartilage mapping.

Adolescent↗

PubMed2005

Plaque and stent artifact reduction in subtraction CT angiography using nonrigid registration and a volume penalty.

Computed tomography angiography (CTA) is an established tool for vessel imaging. Yet, high-intense structures in the contrast image can seriously hamper luminal visualisation. This can be solved by subtraction CTA, where a native image is subtracted from the contrast image. However, patient and organ motion limit the application of this technique. Within this paper, a fully automated intensity-based nonrigid 3D registration algorithm for subtraction CT angiography is presented, using a penalty term to avoid volume change during registration. Visual and automated validation on four clinical datasets clearly show that the algorithm strongly reduces motion artifacts in subtraction CTA. With our method, 39% to 99% of the artifacts disappear, also those caused by minimal displacement of stents or calcified plaques. This results in a better visualisation of the vessel lumen, also of the smaller vessels, allowing a faster and more accurate inspection of the whole vascular structure, especially in case of stenosis.

Algorithms↗

PubMed2005

An augmented reality system for patient-specific guidance of cardiac catheter ablation procedures.

We present a system to assist in the treatment of cardiac arrhythmias by catheter ablation. A patient-specific three-dimensional (3-D) anatomical model, constructed from magnetic resonance images, is merged with fluoroscopic images in an augmented reality environment that enables the transfer of electrocardiography (ECG) measurements and cardiac activation times onto the model. Accurate mapping is realized through the combination of: a new calibration technique, adapted to catheter guided treatments; a visual matching registration technique, allowing the electrophysiologist to align the model with contrast-enhanced images; and the use of virtual catheters, which enable the annotation of multiple ECG measurements on the model. These annotations can be visualized by color coding on the patient model. We provide an accuracy analysis of each of these components independently. Based on simulation and experiments, we determined a segmentation error of 0.6 mm, a calibration error in the order of 1 mm and a target registration error of 1.04 +/- 0.45 mm. The system provides a 3-D visualization of the cardiac activation pattern which may facilitate and improve diagnosis and treatment of the arrhytmia. Because of its low cost and similar advantages we believe our approach can compete with existing commercial solutions, which rely on dedicated hardware and costly catheters. We provide qualitative results of the first clinical use of the system in 11 ablation procedures.

Algorithms↗

PubMed2005

High-speed digital imaging method for ciliary beat frequency measurement.

The aim of this study was to develop a high-speed digital imaging system and related software for ciliary beat frequency (CFB) analysis in order to establish an automated and reliable method that is observer independent and faster compared to the conventional computerized microscope photometry method. Using primary human nasal epithelial cell cultures, the CBF was recorded with a computerized microscope photometry system and a high-speed digital imaging system. To obtain a wide range of frequencies, glycocholate (0.5%) and chlorocresol (0.005%) were used as ciliostimulatory and cilio-inhibitory reference compounds, respectively. The mean values in hertz (+/- s.d.) obtained with the photometry and high-speed digital imaging systems were: controls 8.2 +/- 0.9 and 7.9 +/- 1.1; chlorocresol 5.0 +/- 0.9 and 5.1 +/- 1.1; glycocholate 9.8 +/- 1.0 and 9.7 +/- 0.8. A similar increase (by 20 and 24%) and decrease (by 38 and 35%) in CBF was determined by the two methods after glycocholate and chlorocresol treatment, respectively. The mean difference between the photometry and high-speed digital imaging methods was 0.2 +/- 0.6 Hz, and the Bland-Altman limits of agreement were from -1.0 to +1.4 Hz, suggesting that the results obtained by these two methods could be used interchangeably. These results show the reliability of the high-speed digital imaging system and the software developed for in-vitro CBF measurements. The advantages of the system include: (i) fast data acquisition and calculation, (ii) whole field automated CBF analysis and (iii) reduction in selection bias.

Cells, Cultured↗

PubMed2004

T2 mapping of human femorotibial cartilage with turbo mixed MR imaging at 1.5 T: feasibility.

The feasibility of a high-spatial-resolution technique for mapping T1 and T2 in articular cartilage in the human knee was evaluated. The technique, turbo mixed magnetic resonance (MR) imaging, is based on a pulse sequence in which inversion-recovery and spin-echo measurements are interleaved. The sequence was first validated in a phantom experiment in which T1 and T2 values obtained with an accepted spectroscopic technique were correlated with those obtained by using a clinical magnetic resonance imager with the turbo mixed technique. T2 maps were obtained with turbo mixed imaging in 25 volunteers (17 men, eight women; mean age, 30.8 years; range, 23-45 years). A high correlation (r = 0.99) was found between T1 and T2 values obtained at spectroscopy and those obtained at turbo mixed imaging. Relative differences in the range of cartilage relaxation times between the two techniques were less than 20%. Turbo mixed imaging in human volunteers showed T2 cartilage relaxation times that corresponded with previously published data. Turbo mixed imaging, thus, is feasible for T2 mapping of cartilage.

Adult↗

PubMed2004

High-spatial-resolution 3D balanced turbo field-echo technique for MR angiography of the renal arteries: initial experience.

PURPOSE: To compare a multislab balanced turbo field-echo magnetic resonance (MR) angiographic technique, without the use of a contrast agent, with digital subtraction angiography (DSA) for imaging of the renal arteries. MATERIALS AND METHODS: Twenty-five randomly selected patients (eight women and 17 men; age range, 27-88 years; mean age, 72 years) suspected of having renal artery stenosis underwent both DSA and balanced turbo field-echo MR angiography. A consensus result was obtained among three radiologists in evaluation of main renal arteries on balanced turbo field-echo images and DSA images. Sensitivity, specificity, and negative and positive predictive values of the balanced turbo field-echo technique were calculated, and receiver operating characteristic analysis was performed for depiction of hemodynamically significant stenosis. Cohen kappa analysis was used to assess agreement between the two imaging methods in grading of stenoses and depiction of significant stenosis. Accessory renal arteries also were evaluated. RESULTS: Fifty main renal arteries and 11 accessory arteries were fully depicted with DSA. DSA depicted 11 stenotic lesions in the main renal arteries. In comparison, balanced turbo field-echo MR angiography enabled visualization of 46 of 50 main renal arteries to their first branching points and depicted 10 of 11 accessory arteries. Sensitivity, specificity, negative predictive value, and positive predictive value of this technique for depiction of significant stenosis were 100% (four of four), 98% (41 of 42), 100% (41 of 41), and 80% (four of five), respectively. The area under the receiver operating characteristic curve was 0.988. kappa was 0.782 for grading of stenoses and 0.877 for depiction of significant stenosis. CONCLUSION: Multislab balanced turbo field-echo imaging has potential as an MR angiography technique for depiction of normal and diseased renal arteries.

Adult↗

PubMed2004

Magnetic resonance angiography in suspected cerebral vasculitis.

The purpose of this study was to determine the technical capacity and diagnostic accuracy of 3D time-of-flight magnetic resonance angiography (MRA) in suspected cerebral vasculitis in a retrospective analysis of MRA and digital subtraction angiography (DSA) in 14 young patients with clinical and/or radiological suspicion of cerebral vasculitis. A total of nine arteries were evaluated in each patient. Consensus review of DSA by three observers was the reference standard. The sensitivity for detecting a stenosis varied from 62 to 79% for MRA and from 76 to 94% for DSA, depending on the observer. The specificity for detecting a stenosis varied from 83 to 87% for MRA and from 83 to 97% for DSA. Using the criterion "more than two stenoses in at least two separate vascular distributions" to consider the examination as being true positive, the false-positive rates for MRA and DSA were comparable. MRA plays a role as the first angiographical examination in the diagnostic work-up of suspected cerebral vasculitis. When more than two stenoses in at least two separate vascular distributions are depicted on MRA, DSA is not expected to add a significant diagnostic contribution in a patient with suspected cerebral vasculitis. DSA remains necessary when MRA is normal or when less than three stenoses are seen.

Adult↗

PubMed2004

Dynamic contrast-enhanced MRI of the pancreas: initial results in healthy volunteers and patients with chronic pancreatitis.

PURPOSE: To characterize pancreatic perfusion in volunteers and patients with chronic pancreatitis (CP) by dynamic contrast-enhanced (DCE) MRI. MATERIALS AND METHODS: Pancreatic enhancement after bolus injection of Gd-DTPA with a three-dimensional ultrafast partial-Fourier radiofrequency (RF) spoiled gradient-echo (GE) acquisition was examined prospectively. An acquisition volume of the pancreatic parenchyma was obtained every 4.2 seconds during a single breath-hold in 31 volunteers and 19 patients with CP. We calculated the wash-in rate and a newly defined parameter, the "time-to-inflow deceleration" (TID). A statistical analysis of the differences between both groups was performed with the use of Student's t-test. RESULTS: Significant differences in the TID and wash-in rate were found for the head and body of the pancreas: the TID was 22.4 sec +/- 4.4 sec and 23.5 sec +/- 6.1 sec in the pancreatic head and body of the healthy volunteers, and 29.8 sec +/- 8.6 sec and 29.4 sec +/- 3.8 sec in patients with CP. The wash-in rate was 96 +/- 37 sec(-1) and 101 +/- 27 sec(-1) in controls, and 62 +/- 17 sec(-1) and 75 +/- 27 sec(-1) in CP. CONCLUSION: CP can be identified by semiquantitative changes on DCE-MRI. Whether DCE-MRI of the pancreas can be used to detect early CP remains to be validated.

Adult↗

PubMed2003

Application of a new image analysis technique to study brain asymmetry in schizophrenia.

The hypothesis that normal brain torque (i.e. rightward frontal and leftward occipital asymmetry) is anomalous in schizophrenia (Crow, 1997. Trends in Neuroscience, 20, 339-343) was tested by application of a novel image analysis technique on three-dimensional magnetic resonance images obtained in 26 adult patients with chronic schizophrenia (18 males, 8 females) and 24 controls (14 males, 10 females). Right and left cerebral hemisphere tissue was extracted via non-linear co-registration with a mask image, and maps were computed of inter-hemispheric differences in tissue volume in an array of columns of voxels orthogonal to the mid-plane (2D), and profiles of coronal slice volumes (1D). Furthermore, integration of two-dimensional column maps gave approximate lobar asymmetries, and occipital and frontal asymmetries were combined to give a volumetric measure of brain torque. Significant brain torque was revealed in male and female control and patient groups, and did not correlate with brain size. Frontal and occipital asymmetries were significantly correlated in all groups. Both frontal and occipital components of torque were significantly increased in males than females. Patients tended to have reduced torque, particularly the leftward occipital component. Furthermore, 3/26 patients (but no controls) had reversed torque (leftward frontal and rightward occipital asymmetry). Contrary to Crow's hypothesis, brain torque was not significantly reduced in patients with schizophrenia relative to controls, although reversal of torque was found in three cases. Future studies with larger sample sizes should consider sexual dimorphism and specific symptoms in relation to asymmetry.

Brain↗