RESUMO
Auditory processing disorders are common following mild traumatic brain injury (mTBI), but the neurocircuitry involved is not well understood. The present study used functional MRI to examine auditory cortex activation patterns during a passive listening task in a normative population and mTBI patients with and without clinical central auditory processing deficits (APD) as defined by the SCAN-3:A clinical battery. Patients with mTBI had overall patterns of lower auditory cortex activation during the listening tasks as compared to normative controls. A significant lateralization pattern (pairwise t-test; p⟨0.05) was observed in normative controls and in those with mTBI and APD during single-side stimulation. Additionally, baseline connectivity between left and right auditory cortices was lower in mTBI patients than in controls (p=0.01) and significantly reduced in the mTBI with APD group (p=0.008). Correlation was also observed between bilateral task-related activation and competing words subscore of the SCAN-3:A. These findings suggest the passive listening task is well suited to probe auditory function in military personnel with an mTBI diagnosis. Further, the study supports the use of multiple approaches for detecting and assessing central auditory deficits to improve monitoring of short- and long-term outcomes.
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Córtex Auditivo/fisiopatologia , Doenças Auditivas Centrais/fisiopatologia , Vias Auditivas/fisiopatologia , Concussão Encefálica/fisiopatologia , Imageamento por Ressonância Magnética , Adolescente , Adulto , Idoso , Análise de Variância , Córtex Auditivo/diagnóstico por imagem , Doenças Auditivas Centrais/diagnóstico , Doenças Auditivas Centrais/etiologia , Vias Auditivas/lesões , Concussão Encefálica/complicações , Estudos de Casos e Controles , Feminino , Audição/fisiologia , Testes Auditivos , Humanos , Processamento de Imagem Assistida por Computador , Masculino , Pessoa de Meia-Idade , Militares , Testes de Função Vestibular , Veteranos , Adulto JovemRESUMO
Functional magnetic resonance imaging (fMRI) has been available commercially for clinical diagnostic use for many years. However, both clinical interpretation of fMRI by a neuroradiologist and quantitative analysis of fMRI data can require significant personnel resources that exceed reimbursement. In this report, a fully automated computer-based quantification methodology (Enumerated Auditory Response, EAR) has been developed to provide an auditory fMRI assessment of patients who have suffered a mild traumatic brain injury. Fifty-five study participants with interpretable auditory fMRI sequence data were assessed by EAR analysis, as well as both clinical radiologist fMRI interpretation and voxelwise general linear model (GLM) analysis. Comparison between the clinical interpretation and the two computer analysis methods resulted in 67% concordance (identical), 32% nearconcordance (one level difference), and 1% discordant. Comparison between the clinical computer-based quantification (EAR) and GLM analysis yielded significant correlations in right and left ear responses (p⟨0.05) for the full subject group. Automated fMRI quantification analysis equivalent to EAR might be appropriate for both future research projects with constrained resources, as well as possible routine clinical use.
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Doenças Auditivas Centrais/diagnóstico por imagem , Concussão Encefálica/fisiopatologia , Diagnóstico por Computador/métodos , Técnicas de Diagnóstico Otológico , Imageamento por Ressonância Magnética/métodos , Doenças Auditivas Centrais/fisiopatologia , Concussão Encefálica/diagnóstico por imagem , Feminino , Humanos , Modelos Lineares , Masculino , Militares , VeteranosRESUMO
INTRODUCTION: We evaluated magnetic resonance spectroscopy (MRS) in United States military personnel with persistent symptoms after mild traumatic brain injury (mTBI), comparing over time two groups randomized to receive hyperbaric oxygen or sham chamber sessions and a third group of normative controls. METHODS: Active-duty or veteran military personnel and normative controls underwent MRS outcome measures at baseline, 13 weeks (mTBI group only), and six months. Participants received 3.0 Tesla brain MRS for analysis of water-suppressed two-dimensional (2D) multivoxel 1H-MRS of the brain using point resolved spectroscopy (PRESS) with volume selection localized above the lateral ventricles and within the brain parenchyma, of which one voxel was chosen in each hemisphere without artifact. Script-based automatic data processing was used to assess N-acetylaspartate (NAA), creatine (Cr), and choline (Cho). Metabolite ratios for white matter were then calculated for NAA/Cr (Area), Cho/Cr (Area), and Cho/NAA (Area). These ratios were compared using standard analysis methodology. RESULTS: There were no observable differences between participants with mTBI and normative controls nor any observable changes over time in the NAA/Cr (area), Cho/Cr (area), and Cho/NAA (area) ratios. Similarly, the control and injured participants were indistinguishable. DISCUSSION: While participants with mild TBI showed no difference in MRS compared to normative controls, our results are limited by the few voxels chosen and potentially by less sensitive MRS markers.
Assuntos
Ácido Aspártico/análogos & derivados , Química Encefálica , Concussão Encefálica/metabolismo , Colina/análise , Creatina/análise , Espectroscopia de Ressonância Magnética/métodos , Adulto , Ácido Aspártico/análise , Concussão Encefálica/terapia , Estudos de Casos e Controles , Feminino , Humanos , Oxigenoterapia Hiperbárica , Ventrículos Laterais/química , Masculino , Militares , Síndrome Pós-Concussão/metabolismo , Fatores de Tempo , VeteranosRESUMO
BACKGROUND: In prior military randomized trials, participants with persistent symptoms after mild traumatic brain injury (TBI) reported improvement regardless of receiving hyperbaric oxygen (HBO2) or sham intervention. This study's objectives were to identify outcomes for future efficacy trials and describe changes by intervention. METHODS: This Phase II, randomized, double-blind, sham-controlled trial enrolled military personnel with mild TBI and persistent post-concussive symptoms. Participants were randomized to receive 40 HBO2 (1.5 atmospheres absolute (ATA), ⟩99% oxygen, 60 minutes) or sham chamber sessions (1.2 ATA, room air, 60 minutes) over 12 weeks. Participants and evaluators were blinded to allocation. Outcomes assessed at baseline, 13 weeks and six months included symptoms, quality of life, neuropsychological, neurological, electroencephalography, sleep, auditory, vestibular, autonomic, visual, neuroimaging, and laboratory testing. Participants completed 12-month questionnaires. Intention-to-treat results are reported. RESULTS: From 9/11/2012 to 5/19/2014, 71 randomized participants received HBO2 (n=36) or sham (n=35). At baseline, 35 participants (49%) met post-traumatic stress disorder (PTSD) criteria. By the Neurobehavioral Symptom Inventory, the HBO2 group had improved 13-week scores (mean change -3.6 points, P=0.03) compared to sham (+3.9 points). In participants with PTSD, change with HBO2 was more pronounced (-8.6 vs. +4.8 points with sham, P=0.02). PTSD symptoms also improved in the HBO2 group, and more so in the subgroup with PTSD. Improvements regressed at six and 12 months. Hyperbaric oxygen improved some cognitive processing speed and sleep measures. Participants with PTSD receiving HBO2 had improved functional balance and reduced vestibular complaints at 13 weeks. CONCLUSIONS: By 13 weeks, HBO2 improved post-concussive and PTSD symptoms, cognitive processing speed, sleep quality, and balance function, most dramatically in those with PTSD. Changes did not persist beyond six months. Several outcomes appeared sensitive to change; additional studies are warranted.
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Concussão Encefálica/complicações , Oxigenoterapia Hiperbárica/métodos , Militares , Síndrome Pós-Concussão/terapia , Adulto , Método Duplo-Cego , Feminino , Humanos , Oxigenoterapia Hiperbárica/estatística & dados numéricos , Análise de Intenção de Tratamento , Masculino , Testes de Estado Mental e Demência , Pessoa de Meia-Idade , Síndrome Pós-Concussão/etiologia , Qualidade de Vida , Transtornos de Estresse Pós-Traumáticos/etiologia , Transtornos de Estresse Pós-Traumáticos/terapia , Avaliação de Sintomas , Fatores de Tempo , Resultado do Tratamento , Estados Unidos , Teste de Caminhada , Adulto JovemRESUMO
Introduction: Even though mild traumatic brain injury is common and can result in persistent symptoms, traditional measurement tools can be insensitive in detecting functional deficits after injury. Some newer assessments do not have well-established norms, and little is known about how these measures perform over time or how cross-domain assessments correlate with one another. We conducted an exploratory study to measure the distribution, stability, and correlation of results from assessments used in mild traumatic brain injury in healthy, community-dwelling adults. Materials and Methods: In this prospective cohort study, healthy adult men and women without a history of brain injury underwent a comprehensive brain injury evaluation that included self-report questionnaires and neurological, electroencephalography, sleep, audiology/vestibular, autonomic, visual, neuroimaging, and laboratory testing. Most testing was performed at 3 intervals over 6 months. Results: The study enrolled 83 participants, and 75 were included in the primary analysis. Mean age was 38 years, 58 were male, and 53 were civilians. Participants did not endorse symptoms of post-concussive syndrome, PTSD, or depression. Abnormal neurological examination findings were rare, and 6 had generalized slowing on electroencephalography. Actigraphy and sleep diary showed good sleep maintenance efficiency, but 21 reported poor sleep quality. Heart rate variability was most stable over time in the sleep segment. Dynavision performance was normal, but 41 participants had abnormal ocular torsion. On eye tracking, circular, horizontal ramp, and reading tasks were more likely to be abnormal than other tasks. Most participants had normal hearing, videonystagmography, and rotational chair testing, but computerized dynamic posturography was abnormal in up to 21% of participants. Twenty-two participants had greater than expected white matter changes for age by MRI. Most abnormal findings were dispersed across the population, though a few participants had clusters of abnormalities. Conclusions: Despite our efforts to enroll normal, healthy volunteers, abnormalities on some measures were surprisingly common. Trial Registration: This study was registered at www.clinicaltrials.gov, trial identifier NCT01925963.
RESUMO
OBJECTIVE: Some practitioners advocate hyperbaric oxygen (HBO2) for sequelae following brain injury. This study assessed recruitment, tolerance and safety in preparation for a randomized clinical trial. DESIGN: Prospective, open-label feasibility study. SETTING: Hyperbaric medicine department of a tertiary academic hospital. PARTICIPANTS: Participatory adult outpatients with problems from stroke (n=22), anoxia (13) or trauma (28) that occurred at least 12 months before enrollment, without contraindications to HBO2. Sixty-three participants enrolled in the study (21 females,42 males). Age was 45 +/- 16 years (18-76) and time from injury was 6.9 +/- 7.1 years (1.0-29.3). Fifty-three completed the study intervention, and 55 completed the assessment battery. METHODS: PARTICIPANTS underwent 60 daily HBO2 sessions (1.5 atm abs, 100% oxygen, 60 minutes). Assessments were conducted at baseline, after the HBO2 course, and six months later. MAIN OUTCOME MEASUREMENTS: The prime outcome was feasibility. To estimate the immediate and long-term effects of HBO2, we assessed neuropsychological measures, questionnaires, neurologic exam and physical functioning measures. Some participants also had pre- and post-HBO2 speech evaluation (n=27) and neuroimaging (n=17). RESULTS: The study met our a priori definition for feasibility for recruitment, but 44% required additional time to complete the 60 sessions (up to 105 days). HBO2-related adverse events were rare and not serious. Although many participants reported improvement in symptoms (51% memory, 51% attention/concentration, 48% balance/coordination, 45% endurance, 20% sleep) post-HBO2, and 93% reported that they would participate in the study again, no standardized testing showed clinically important improvement. In the small subset of those undergoing neuroimaging, apparent improvement was observed in auditory functional MRI (8/13), MR spectroscopy (9/17) and brain perfusionby CT angiography (5/9). CONCLUSIONS: Conducting an HBO2 clinical trial in this population was feasible. Although many participants reported improvement, the lack of concurrent controls limits the strength of inferences from this trial, especially considering lack of change in standardized testing. The clinical relevance of neuroimaging changes is unknown. The findings of this study may indicate a need for caution when considering the broad application of HBO2 more than one year after brain injury due to stroke, severe TBI and anoxia, until there is more compelling evidence from carefully designed sham-controlled, blinded clinical trials.
Assuntos
Dano Encefálico Crônico/terapia , Lesões Encefálicas/complicações , Oxigenoterapia Hiperbárica/métodos , Hipóxia Encefálica/complicações , Acidente Vascular Cerebral/complicações , Adolescente , Adulto , Idoso , Análise de Variância , Dano Encefálico Crônico/etiologia , Angiografia Cerebral/métodos , Estudos de Viabilidade , Feminino , Humanos , Oxigenoterapia Hiperbárica/efeitos adversos , Imageamento por Ressonância Magnética , Espectroscopia de Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Exame Neurológico , Segurança do Paciente , Seleção de Pacientes , Estudos Prospectivos , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Adulto JovemRESUMO
OBJECTIVE: Whole-brain computed tomography perfusion (CTP) data sets generated by tracer delay-insensitive singular value decomposition plus (SVD+) and standard singular value decomposition (sSVD) deconvolution algorithms were evaluated to quantify relatedness and discrepancies in CTP results. METHODS: Twenty females with symmetrical hemispheric CTP maps indicative of brain tissue without apparent abnormalities were studied. Tissue-specific CTP values were analyzed. RESULTS: Standard SVD values were higher than SVD+ for cerebral blood flow. Other CTP values had minimal differences across brain regions. All simple linear regression models were statistically significant (P < 0.05) except for cerebral blood flow in white matter (P = 0.06). Cerebral blood volume had a good model fit, and mean transit time, a poor fit. CONCLUSIONS: Corresponding fitted CTP values for sSVD and SVD+ based on regression equations for brain-tissue types are presented. Additional research is required to compare SVD+ and sSVD in disease states when significant hemodynamic brain alterations are present.
Assuntos
Encéfalo/irrigação sanguínea , Encéfalo/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Ácidos Tri-Iodobenzoicos/farmacocinética , Adulto , Algoritmos , Área Sob a Curva , Volume Sanguíneo , Isquemia Encefálica/diagnóstico por imagem , Circulação Cerebrovascular , Traumatismos Craniocerebrais/diagnóstico por imagem , Feminino , Cefaleia/diagnóstico por imagem , Humanos , Modelos Lineares , Pessoa de Meia-Idade , Doses de Radiação , Valores de Referência , Estudos RetrospectivosRESUMO
OBJECTIVE: The objective of this study was to compare the variability of computed tomography perfusion (CTP) results in identical data sets of middle cerebral artery (MCA) acute ischemic stroke (AIS) generated by standard singular value decomposition (sSVD) deconvolution and tracer delay-insensitive singular value decomposition (SVD+) algorithm analyses. METHODS: Whole-brain 320-detector-row CTP data sets from 9 unilateral MCA AIS cases and 9 controls were retrospectively analyzed. Computed tomography perfusion values for the combined core/penumbra, contralateral hemispheres and arterial territories were measured and compared with literature values. Simple linear regression models are provided to predict corresponding SVD+ value and sSVD CTP values. RESULTS: In the core/penumbra, sSVD generated lower cerebral blood flow (CBF) values, higher mean transit time (MTT) values, and a broader range of CBF and MTT values as compared with SVD+. Mean transit time value differences between the core/penumbra and contralateral hemispheres were statistically significant using sSVD, whereas those of SVD+ were not. Goodness of fit between algorithms for the core/penumbra was lower for CBF (0.483) and MTT (0.494), as compared with time to peak (0.891) and cerebral blood volume (0.997). CONCLUSIONS: In this study using identical source data for patients with MCA AIS, use of either sSVD or SVD+ analyses created statistically significant differences in the CTP value results. Tracer delay-sensitive and -insensitive algorithms impact CTP results in AIS and controls, highlighting the need to pursue additional studies that assess the variability, accuracy, and clinical implications of CTP results generated when using heterogeneous deconvolution algorithms.
Assuntos
Isquemia Encefálica/diagnóstico por imagem , Circulação Cerebrovascular , Infarto da Artéria Cerebral Média/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Idoso , Idoso de 80 Anos ou mais , Algoritmos , Estudos de Casos e Controles , Meios de Contraste/farmacocinética , Feminino , Humanos , Imageamento Tridimensional , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Doses de Radiação , Interpretação de Imagem Radiográfica Assistida por Computador , Estudos RetrospectivosRESUMO
OBJECTIVE: Human cerebrovasculature has not been quantified in volume, length, and vascular-brain relationships. We investigated this using imaging. METHODS: From 0.5-mm 7T and 320-row CT acquisitions, 6 arterial and 4 venous systems were reconstructed, measured, and analyzed. RESULTS: The ratio of the volume of arterial to venous system is approximately 1:3. The ratio of the volume of dural sinuses to vasculature is 1:2. The ratio of the posterior (PCA) to anterior (ACA) to middle cerebral artery (MCA) is 1:2:4 in volume and length. Ratios of left to right vessels are 1:1 for arteries and veins. Ratios of branching frequency for the ACA, MCA, and PCA are 1:1:1. The branching frequency ratio for superficial to deep veins is 1:2. The MCA occupies 1/2 of arterial length and 1/4 of vascular length. The ratio of the length of superficial to deep veins is 1:1 and each is equal to 1/4 of the vascular length. The ratio of cerebrovasculature to brain volume is 2.5%. CONCLUSIONS: Despite its enormous complexity, cerebrovasculature is characterized by 4 approximate proportions, 1:1, 1:2, 1:3, 1:4, and their combinations, 1:1:1 and 1:2:4.
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Encéfalo/irrigação sanguínea , Angiografia Cerebral/métodos , Imageamento por Ressonância Magnética/métodos , Tomografia Computadorizada por Raios X/métodos , Adulto , Idoso , Feminino , Humanos , Processamento de Imagem Assistida por Computador , Imageamento Tridimensional , Masculino , Pessoa de Meia-IdadeRESUMO
BACKGROUND: To evaluate the effect of vascular clips and endovascular coils placed for intracranial aneurysms and arteriovenous malformations on whole-brain computed tomography (CT) angiography and perfusion. METHODS: A 320-detector row dynamic volume CT system imaged 11 patients following surgical placement of vascular clips or endovascular coils. The extent of clip and coil subtraction by automated software was evaluated using CT digital subtraction angiography and CT perfusion. Impact on CT perfusion values by retained intracranial devices was compared to age- and gender-matched controls. RESULTS: Clip and coil subtraction on CT angiography was graded as good in 8 and moderate in 3 cases. A residual neck and additional aneurysm were noted in 1 of 11 patients. Post-procedural axial slice level CT perfusion values decreased in reliability with increasing proximity to the metallic devices secondary to beam hardening. However, the intracranial devices did not affect axial slice level CTP values of cerebral blood volume, cerebral blood flow and mean transit time outside of the level of the device. Time to peak values was globally decreased outside of the immediate vascular intervention region. CONCLUSIONS: Advances in CT technology have provided clinically useful subtraction of intracranial clips and coils. While CT perfusion values were altered in device subtraction areas and within beam hardening artifact areas; they can provide valuable postoperative information on whole-brain hemodynamics. In selected cases, the combination of CT angiography and whole-brain CT perfusion can offer an alternative to conventional angiography that is a more invasive option.
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Angiografia Cerebral/métodos , Embolização Terapêutica/métodos , Aneurisma Intracraniano/diagnóstico por imagem , Aneurisma Intracraniano/cirurgia , Imagem de Perfusão/métodos , Instrumentos Cirúrgicos , Tomografia Computadorizada por Raios X/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Resultado do TratamentoRESUMO
The surgical management of neocortical epilepsy is challenging because many patients are without obvious structural lesions, or lesions are small and easily overlooked during routine clinical interpretation of magnetic resonance imaging (MRI) data. Even when functional imaging data suggest focal epileptiform pathology, in the absence of a concordant structural lesion, invasive monitoring is often required to confirm that an appropriate surgical target has been identified. This study sought to determine the extent to which knowledge of magnetoencephalography (MEG) data can augment the MRI-based detection of structural brain lesions. MRI and whole-head MEG data were obtained from 40 patients with neocortical epilepsy. As a result of MEG data, 29 cases were sent for MRI reevaluation. In seven of these cases, MEG-guided review led to specification of now clear, but previously unidentified, lesions. There were two additional cases for which follow-up high-resolution imaging did not confirm structural abnormalities. In patients with neocortical epilepsy, MEG is a useful adjunct to MRI for the identification of structural lesions.
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Encéfalo/patologia , Epilepsia/patologia , Magnetoencefalografia , Adolescente , Adulto , Encéfalo/fisiopatologia , Criança , Pré-Escolar , Eletroencefalografia , Epilepsia/diagnóstico , Epilepsia/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Convulsões/diagnóstico , Convulsões/patologia , Convulsões/fisiopatologia , Adulto JovemRESUMO
Clinical indications and utilization patterns for 3963 CT scans on 2500 consecutive patents on a 320-detector row CT in an outpatient setting were retrospectively analyzed and compared with previously reported CT studies. The impact of the latest generation CT technology, including whole organ perfusion, on indications and utilization patterns during the study period was also assessed. The top five requested CT scan types were abdomen/pelvis, chest, head, sinuses, and coronary CT angiography. Indication and utilization rates were similar to prior studies for abdomen/pelvis, non-cardiac chest, and head CT scans. Abdominal pain and headaches were the most frequent indications for abdomen/pelvis and head CTs, respectively. The 7.3% cardiac CT scan utilization rate was not comparable to rates of up to 72% in self-referral outpatient settings. Whole organ volume CT imaging was utilized in 100% of coronary CT angiography and 22.7% of head CTs. The 320-row CT had fewer negative head and body CT findings as compared to prior reports. The availability of new technology, such as whole organ dynamic scans, appears to have influenced CT indications, utilization and finding rates with a decrease in negative brain and body results. Comparisons with previous outpatient CT studies were similar for multiple categories with the exception of cardiac CT utilization, which is heavily influenced by self-referral. Further study of outpatient imaging indications and utilization rates from multiple centers may benefit from a standardized categorization to improve understanding of the disparate outpatient imaging environment.
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Assistência Ambulatorial/métodos , Padrões de Prática Médica/estatística & dados numéricos , Tomografia Computadorizada por Raios X/estatística & dados numéricos , Dor Abdominal/diagnóstico por imagem , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Dor no Peito/diagnóstico por imagem , Criança , Pré-Escolar , Angiografia Coronária , Feminino , Cefaleia/diagnóstico por imagem , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Nevada , Doenças dos Seios Paranasais/diagnóstico por imagem , Estudos RetrospectivosRESUMO
INTRODUCTION: Developmental venous anomalies (DVA) consist of dilated intramedullary veins that converge into a large collecting vein. The appearance of these anomalies was evaluated on whole-brain computed tomography (CT) digital subtraction angiography (DSA) and CT perfusion (CTP) studies. METHODS: CT data sets of ten anonymized patients were retrospectively analyzed. Five patients had evidence of DVA and five age- and sex-matched controls were without known neurovascular abnormalities. CT angiograms, CT arterial-venous views, 4-D CT DSA and CTP maps were acquired on a dynamic volume imaging protocol on a 320-detector row CT scanner. Whole-brain CTP parameters were evaluated for cerebral blood flow (CBF), cerebral blood volume (CBV), time to peak (TTP), mean transit time (MTT), and delay. DSA was utilized to visualize DVA anatomy. Radiation dose was recorded from the scanner console. RESULTS: Increased CTP values were present in the DVA relative to the unaffected contralateral hemisphere of 48%, 32%, and 26%; and for the control group with matched hemispheric comparisons of 2%, -10%, and 9% for CBF, CBV, and MTT, respectively. Average effective radiation dose was 4.4 mSv. CONCLUSION: Whole-brain DSA and CTP imaging can demonstrate a characteristic appearance of altered DVA hemodynamic parameters and capture the anomalies in superior cortices of the cerebrum and the cerebellum. Future research may identify the rare subsets of patients at increased risk of adverse outcomes secondary to the altered hemodynamics to facilitate tailored imaging surveillance and application of appropriate preventive therapeutic measures.
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Angiografia Digital , Encéfalo/irrigação sanguínea , Encéfalo/diagnóstico por imagem , Veias Cerebrais/diagnóstico por imagem , Malformações Arteriovenosas Intracranianas/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Adulto , Volume Sanguíneo , Estudos de Casos e Controles , Angiografia Cerebral , Veias Cerebrais/anormalidades , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Perfusão , Estudos Retrospectivos , Fatores de TempoRESUMO
OBJECT: When the number of lumbar and sacral vertebrae is being assessed, variations from typical lumbosacral anatomy may confuse the practitioner, potentially leading to significant clinical errors. In this study, the authors describe the statistical variation in lumbar spine anatomy in an outpatient imaging setting, evaluate the potential implications for clinical practice based on the variation in the number of lumbar-type vertebrae identified, and recommend a method for rapidly determining the number of lumbar spine vertebral bodies (VBs) in outpatients referred for lumbar spine MR imaging. METHODS: A total of 762 patients (male and female) who presented with low back-related medical conditions underwent whole-spine MR imaging in an outpatient setting. RESULTS: The high-speed whole-spine evaluation was successful for determining the number of lumbar-type VBs in 750 (98%) of 762 consecutive patients. The sagittal whole-spine 3-T MR imaging system images obtained between the beginning of January 2005 and the end of February 2007 were reviewed. The VBs were counted successively from the level of C-2 inferiorly to the intervertebral disc below the most inferior lumbar-type VB. Numbers of disc herniations were also evaluated in the context of the number of VBs. CONCLUSIONS: One in 5 of these outpatients did not have 5 lumbar-type vertebrae: 14.5% had 6; 5.3% had 4; and 1 (0.13%) had the rare finding of 3 lumbar-type vertebrae. Two-thirds of the individuals with 6 lumbar-type vertebrae were male and two-thirds of the individuals with 4 lumbar-type vertebrae were female. Sagittal whole-spine MR imaging can be performed rapidly and efficiently in the majority of patients (98%), and provides improved accuracy for the determination of the number of lumbar-type VBs. A supplementary coronal MR, Ferguson view radiograph or intraoperative fluoroscopic determination for the presence of lumbosacral transitional vertebrae may add additional information when indicated for clinical treatment or surgical planning.
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Processamento de Imagem Assistida por Computador , Vértebras Lombares/patologia , Imageamento por Ressonância Magnética , Coluna Vertebral/patologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Assistência Ambulatorial , Análise de Variância , Criança , Feminino , Humanos , Deslocamento do Disco Intervertebral/diagnóstico , Dor Lombar/etiologia , Masculino , Pessoa de Meia-Idade , Esclerose Múltipla/diagnóstico , Complicações Pós-Operatórias/diagnóstico , Valores de Referência , Estudos Retrospectivos , Sacro/patologia , Fatores Sexuais , Traumatismos da Coluna Vertebral/diagnóstico , Neoplasias da Coluna Vertebral/diagnóstico , Adulto JovemRESUMO
A femoral vein thrombosis, originally diagnosed with conventional ultrasound, was fully elucidated and monitored utilizing serial high-resolution magnetic resonance venography in a 19-year-old female with a family history of venous thromboembolism. Genetic testing revealed she was heterozygous for a F5 gene mutation, an abnormality that predisposes carriers to factor V Leiden thrombophilia. An additional risk factor included use of oral contraceptive pills. Subsequent testing of her family uncovered other carriers of the mutation, allowing for the implementation of preventive measures for the entire family. Although magnetic resonance venography has not yet proven to be a cost-effective method for monitoring clot resolution, the case presented here encourages further research on the clinical utility and cost-benefit of utilizing this technology for monitoring venous thrombosis and for clinical management purposes.
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Fator V/genética , Angiografia por Ressonância Magnética , Pelve/irrigação sanguínea , Flebografia/métodos , Trombose Venosa/diagnóstico , Trombose Venosa/genética , Anticoagulantes/uso terapêutico , Anticoncepcionais Orais Hormonais/efeitos adversos , Análise Mutacional de DNA , Feminino , Predisposição Genética para Doença , Testes Genéticos , Heterozigoto , Humanos , Mutação , Linhagem , Valor Preditivo dos Testes , Fatores de Risco , Trombose Venosa/tratamento farmacológico , Adulto JovemRESUMO
This study reviewed the literature for the extent of neuroimaging findings in boxers, indicative of traumatic brain injury (TBI) as identified in magnetic resonance imaging (MRI). The study then utilized a systematic checklist approach to assess 100 unselected consecutive 1.5- and 3.0-Tesla MRI examinations of professional unarmed combatants to determine the extent of identifiable TBI findings. The percentage of positive findings and the localization of lesions were quantified using the checklist that included the MRI findings previously reported in the medical literature. Seventy-six percent of the unarmed combatants had at least one finding that may be associated with TBI: 59% hippocampal atrophy, 43% cavum septum pellucidum, 32% dilated perivascular spaces, 29% diffuse axonal injury, 24% cerebral atrophy, 19% increased lateral ventricular size, 14% pituitary gland atrophy, 5% arachnoid cysts, and 2% had contusions. Statistical relationships were found between number of bouts and lateral ventricular size (tau-b = 0.149, p = 0.0489), with years of fighting correlating with the presence of dilated perivascular spaces (tau-b = 0.167, p = 0.0388) and diffuse axonal injury (tau-b = 0.287, p = 0.0013) findings. The improved resolution and increased signal-to-noise ratio on 1.5- and 3.0-Tesla high-field MRI systems defines the range of pathological variations that may occur in professional unarmed combatants. Additionally, the use of a systematic checklist approach insures evaluation for all possible TBI-related abnormalities. This knowledge can be used to anticipate the regions of potential brain pathology for radiologists and emergency medicine physicians, and provides important information for evaluating unarmed combatants relative to their safety and long-term neurocognitive outcome.
Assuntos
Boxe/fisiologia , Lesões Encefálicas/patologia , Imageamento por Ressonância Magnética , Adulto , Cistos Aracnóideos/patologia , Atrofia , Axônios/patologia , Vasos Sanguíneos/patologia , Encéfalo/patologia , Angiografia Cerebral , Doença Crônica , Hemossiderina/metabolismo , Hipocampo/patologia , Humanos , Ventrículos Laterais/patologia , Angiografia por Ressonância Magnética , Masculino , Hipófise/patologia , Estudos Retrospectivos , Septo Pelúcido/patologia , Adulto JovemRESUMO
OBJECT: Whole-spine magnetic resonance (MR) images were obtained using a cylindrical 3-T MR imaging system in 5 contortionists to assess the pathological changes possibly associated with the practice of contortion. Whole-spine dynamic MR images were obtained using a 1-T open MR imaging system in 2 of these contortionists with the purpose of defining the range of motion (ROM) achieved during extreme contortion. The range of spinal motion in this unique population was then quantified. METHODS: The study included 5 female contortionists 20-49 years of age. Imaging was performed using open 1-T and cylindrical 3-T high-field MR imaging systems. Data were viewed and analyzed with DICOM-compliant tools. Real-time, dynamic, and standard MR imaging allowed for quantification of the contortionists' ROM. RESULTS: There was a difference of 238 degrees between full spinal extension and full flexion. Three of the 5 contortionists had 4 anterosuperior limbus vertebrae at T-11 and the upper lumbar levels. CONCLUSIONS: Whole-spine dynamic MR imaging is a valuable tool for the evaluation of the extreme ROM in contortionists, allowing for the quantification of extreme mobility. The limbus fractures present in 3 of the 5 contortionists is postulated to be due to avulsion on hyperextension. Future research may open the use of whole-spine dynamic MR imaging into such areas as pain management and traumatic spinal injuries.
Assuntos
Imageamento por Ressonância Magnética/métodos , Doenças da Coluna Vertebral/patologia , Coluna Vertebral/anatomia & histologia , Esportes , Adulto , Vértebras Cervicais/patologia , Feminino , Humanos , Disco Intervertebral/patologia , Deslocamento do Disco Intervertebral/patologia , Deslocamento do Disco Intervertebral/fisiopatologia , Instabilidade Articular/patologia , Instabilidade Articular/fisiopatologia , Lordose/patologia , Vértebras Lombares/patologia , Pessoa de Meia-Idade , Amplitude de Movimento Articular/fisiologia , Escoliose/patologia , Escoliose/fisiopatologia , Doenças da Coluna Vertebral/fisiopatologia , Osteofitose Vertebral/patologia , Osteofitose Vertebral/fisiopatologia , Coluna Vertebral/fisiologia , Espondilartrite/patologia , Espondilartrite/fisiopatologia , Esportes/fisiologia , Vértebras Torácicas/patologia , Fatores de TempoAssuntos
Autoanticorpos/análise , Miastenia Gravis/complicações , Transtornos da Motilidade Ocular/etiologia , Músculos Oculomotores/patologia , Receptores Proteína Tirosina Quinases/imunologia , Receptores Colinérgicos/imunologia , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Atrofia Muscular/etiologiaRESUMO
OBJECTIVE: To determine to what extent magnetic resonance imaging (MRI), single photon emission computed tomography (SPECT), and magnetoencephalography (MEG) can provide objective evidence of brain injury in adult patients with persistent (>1 year) postconcussive symptoms following mild blunt head trauma. DESIGN: A retrospective and blind review of imaging data with respect to the presence of specific somatic, psychiatric, and cognitive complaints. SETTING/PARTICIPANTS: Thirty complete data sets (with MRI, SPECT, MEG, and neuropsychological testing results) were collected between 1994 and 2000 from the MEG programs at the Albuquerque VAMC and the University of Utah. MAIN OUTCOME MEASURES: MRI data were evaluated for focal and diffuse structural abnormalities, SPECT data for regions of hypoperfusion, and resting MEG data for abnormal dipolar slow wave activity (DSWA) and epileptiform transients. RESULTS: Structural MRI was abnormal for 4 patients. SPECT showed regions of hypoperfusion in 12 patients, while MEG showed abnormal activity in 19 patients. None of the imaging methods produced findings statistically associated with postconcussive psychiatric symptoms. A significant association was found between basal ganglia hypoperfusion and postconcussive headaches. For patients with cognitive complaints, abnormalities were more likely to be detected by MEG (86%) than either SPECT (40%) or MRI (18%) (P<.01). MEG also revealed significant (P<.01) associations between temporal lobe DSWA and memory problems, parietal DSWA and attention problems, and frontal DSWA and problems in executive function. CONCLUSIONS: Functional brain imaging data collected in a resting state can provide objective evidence of brain injury in mild blunt head trauma patients with persistent postconcussive somatic and/or cognitive symptoms. MEG proved to be particularly informative for patients with cognitive symptoms.
Assuntos
Lesões Encefálicas/diagnóstico , Traumatismos Craniocerebrais/complicações , Imageamento por Ressonância Magnética , Magnetoencefalografia , Tomografia Computadorizada de Emissão de Fóton Único , Ferimentos não Penetrantes/complicações , Adolescente , Adulto , Idoso , Transtorno do Deficit de Atenção com Hiperatividade/diagnóstico , Gânglios da Base/irrigação sanguínea , Circulação Cerebrovascular/fisiologia , Transtornos Cognitivos/diagnóstico , Epilepsia/diagnóstico , Feminino , Seguimentos , Cefaleia/diagnóstico , Humanos , Masculino , Transtornos da Memória/diagnóstico , Processos Mentais/fisiologia , Pessoa de Meia-Idade , Testes Neuropsicológicos , Síndrome Pós-Concussão/diagnóstico , Estudos Retrospectivos , Método Simples-CegoRESUMO
The aim of this study was to demonstrate the effectiveness of a radiation-absorbing shield in reducing physicians' occupational radiation exposure during pectoral device implantation. A sterile, disposable, lead-free radiation-absorbing surgical drape containing x-ray attenuation material was evaluated. Twenty procedures used the radiation absorbing drape, and 20 were performed without the shielding. Radiation exposure was measured using thermoluminescent dosimetry collar badges. Use of the protective shield was associated with a time adjusted 80% reduction in radiation dose (0.009 mrem/s with shielding vs 0.047 mrem/s without shielding, P < 0.05) to the physician performing the procedures. The radiation-absorbing surgical drape did not interfere with technical performance nor add procedural time, and all procedures were successfully completed. This study demonstrates that a sterile, disposable, radiation-absorbing drape provides a convenient means of augmenting conventional radiation shielding. Use of this protective shielding greatly reduces operators' occupational exposure to scatter radiation during pectoral device implantation without compromising sterility or procedural technique.