Morphometric analysis of atlas lateral mass in Down syndrome cases with relevance to surgical intervention.

PURPOSE: Surgical stabilization of the Atlas vertebrae is indicated for severe atlantoaxial instability (AAI) in patients with Down syndrome (DS). This study aims to evaluate the morphological characteristics of the Atlas lateral mass (ALM) in patients with DS with regard to safe instrumentation for surgical stabilization and to compare them with non-syndromic group. METHODS: This multicenter, retrospective, case-control study included age- and sex-matched patients with and without DS aged > 7 years with a cervical computed tomography (CT) scan. After three-dimensional CT reconstruction, nine parameters were evaluated for both groups. All included measurements were performed by a neuroradiologist who was blinded to clinical data. RESULTS: Forty-three of 3,275 patients with DS were included in this study. Matching number of consecutive patients without DS were identified (mean age: 16 years). Patients with DS were significantly shorter than those without DS. Seven of nine parameters related to ALM were significantly lower in patients with DS than in those in the control group, including anterior wall height (AH), posterior wall height (PH), their ratio, and arch-ALM angle. On adjusting data for patient height, patients with DS had a smaller PH, lower PH/AH ratio, and steeper arch-ALM angle than the control group. CONCLUSIONS: Patients with DS had a smaller posterior ALM wall and a steeper arch-ALM angle than the control group without DS. This information is important for surgical planning of safe posterior ALM exposure and safe instrumentation for surgical stabilization in patients with DS.

A Critical Examination of Academic Hospital Practices-Paving the Way for Standardized Structured Reports in Neuroimaging.

Background/Objectives: Imaging studies are often an integral part of patient evaluation and serve as the primary means of communication between radiologists and referring physicians. This study aimed to evaluate brain Magnetic Resonance Imaging (MRI) reports and to determine whether these reports follow a standardized or narrative format. Methods: A series of 466 anonymized MRI reports from an academic hospital were downloaded from the Picture Archiving and Communication System (PACS) in portable document format (pdf) for the period between August 2017 and March 2018. Two hundred brain MRI reports, written by four radiologists, were compared to a structured report template from the Radiology Society of North America (RSNA) and were included, whereas MR-modified techniques, such as MRI orbits and MR venography reports, were excluded (n = 266). All statistical analyses were conducted using Statistical Package for the Social Sciences (SPSS) statistical software (version 16.4.1, MedCalc Software). Results: None of the included studies used the RSNA template for structured reports (SRs). The highest number of brain-reported pathologies was for vascular disease (24%), while the lowest was for infections (3.5%) and motor dysfunction (5.5%). Radiologists specified the Technique (n = 170, 85%), Clinical Information (n = 187, 93.5%), and Impression (n = 197, 98.5%) in almost all reports. However, information in the Findings section was often missing. As hypothesized, radiologists with less experience showed a greater commitment to reporting additional elements than those with more experience. Conclusions: The SR template for medical imaging has been accessible online for over a decade. However, many hospitals and radiologists still use the free-text style for reporting. Our study was conducted in an academic hospital with a fellowship program, and we found that structured reporting had not yet been implemented. As the health system transitions towards teleservices and teleradiology, more efforts need to be put into advocating standardized reporting in medical imaging.

Physical exercise keeps the brain connected by increasing white matter integrity in healthy controls.

ABSTRACT: Physical exercise leads to structural changes in the brain. However, it is unclear whether the initiation or continuous practice of physical exercise causes this effect and whether brain connectivity benefits from exercise. We examined the effect of 6 months of exercise on the brain in participants who exercise regularly (n = 25) and in matched healthy controls (n = 20). Diffusion tensor imaging brain scans were obtained from both groups. Our findings demonstrate that regular physical exercise significantly increases the integrity of white matter fiber tracts, especially those related to frontal function. This implies that exercise improves brain connectivity in healthy individuals, which has important implications for understanding the effect of fitness programs on the brains of healthy subjects.

Cortical thickness, neurocognitive, and body composition effects of fasting during Ramadan.

BACKGROUND: We aimed to study the anatomical, physiological, and cognitive function of healthy individuals practicing fasting during the month of Ramadan. Measurements were taken 1 week before and 2 weeks after Ramadan fasting. MATERIALS AND METHODS: Twelve healthy male individuals (mean age ± standard error of the mean: 34.3 ± 2.9 years; body mass index: 26.26 ± 1.4 kg/m2) were assessed for various parameters before and after Ramadan fasting. All the tests were performed in the morning. Body composition characteristics were assessed by bioelectrical impedance analysis using a commercially available body composition analyzer. For neurocognitive analysis, participants underwent the stop signal task (SST), pattern recognition memory task (PRM), and spatial working memory strategy (SWM) from the Cambridge Neuropsychological Test Automated Battery. T1-weighted, 1 mm-thick magnetic resonance images were also acquired. RESULTS: Anthropometric analysis showed a significant decrease in body weight, fat-free mass (FFM), trunk FFM, and trunk predicted muscle mass, while the other body composition parameters did not exhibit any changes. The stop signal reaction time (SSRT) latency (ms) (P > 0.05) and PRM did not show any significant difference before and after fasting. SWM task (P < 0.05) improved significantly after fasting. Cortical thickness data of the whole brain were not significantly different after fasting at any brain location. There was a significant correlation between the left amygdala and the SWM strategy (r 2 = 0.518) and between fat and brain segmentation volume (r 2 = 0.375). CONCLUSION: Our pilot data suggest that Ramadan fasting leads to weight loss and FFM reductions and improve cognitive function.

Volumetric and Shape Analysis of the Subcortical Regions in Schizophrenia Patients: A Pilot Study.

OBJECTIVE: Investigation of brain structure in disease has been enhanced by developments in shape analysis methods that can identify subtle regional surface distortions. High-resolution magnetic resonance (MR) imaging was used to compare volumetric and shape analysis in schizophrenia (SCZ) patients and healthy controls (CON). METHODS: T1-weighted, 1-mm thick MR images were acquired for 15 patients with SCZ and 15 age-matched healthy controls using subcortical volume and shape analysis, which we believe to be complimentary to volumetric measures. RESULTS: SCZ patients showed significant shape differences compared to healthy controls in the right hippocampus (P < 0.005), left and right putamen (P < 0.044 and P < 0.031), left caudate (P < 0.029), right pallidum (P < 0.019), and left thalamus (P < 0.033). CONCLUSION: Our results provide evidence for subcortical neuroanatomical changes in patients with SCZ. Hence, shape analysis may aid in the identification of structural biomarkers for identifying individuals of SCZ.

Meningioma Consistency: Correlation Between Magnetic Resonance Imaging Characteristics, Operative Findings, and Histopathological Features.

INTRODUCTION: Intracranial meningiomas account for 30% of all primary intracranial tumors. Surgical resection remains the mainstay of the treatment for meningiomas. The magnetic resonance of intracranial meningiomas has been largely discussed in many reports of the radiological and neurosurgical literature. To date, a few studies have been attempted to differentiate the tumor characteristics of meningiomas based on magnetic resonance imaging (MRI) studies. OBJECTIVE: The objective of the study is to evaluate the relationship between MRI signal characteristics of intracranial meningiomas and consistency of tumor using objective measures. MATERIALS AND METHODS: A prospective study included all the patients who were admitted for surgery with an MRI finding suggestive of meningioma. All patients were subjected to routine radiological investigations. Surgical resection was performed for patients eligible for surgery using cavitron ultrasonic aspirator (CUSA). The relationship and correlation between the radiological, intraoperative measurements and the histopathological diagnosis were studied. The tumor consistency was measured using mean CUSA level. Intensity on T2, fluid-attenuated inversion recovery (FLAIR), and diffusion-weighted imaging (DWI) was measured using circular regions of interest (ROI) on the MRI. Multiple ROIs were placed initially on the lesions avoiding the obvious blood vessels, if any, then on the brain cortex to avoid the vasogenic edema. The mean ROI (mROI) results from the lesion were subtracted from the mean ROI from the brain cortex for each lesion to achieve normalized ratio. The results of lesion mROI-cortex mROI were compared to the operative and histopathology results using Pearson's correlation test and linear regression test. RESULTS: The total number of patients was seventy. The mean age of the patients was 51 ± 14.8, with 72% of them being females and 28% males. There was a strong statistically significant (P = 0.046) and (P = 0.003) correlation between mean CUSA and FLAIR mROI difference or T2 mROI difference, respectively. On the other hand, there was an inversely proportional relationship between mean CUSA and FLAIR mROI difference and mean CUSA and T2 mROI difference. The value of the regression test (r) shows that there was a slight linear relationship between FLAIR mROI difference or T2 mROI difference and mean CUSA values, in which the mean CUSA value = 50.1 + (-0.088) × FLAIR mROI difference (r = -0.273, P = 0.046) or mean CUSA value = 50.8 + (-0.055) × T2 mROI difference (r = 0.4, P = 0.003). There was no statistical significance in the relation between CUSA values and tumor histological subtypes, DWI values, age, or gender. CONCLUSION: This study presents a new objective method to measure the consistency of intracranial meningiomas based on a simple algorithmic formula. Such information will aid in planning surgery and assessing the resectability of the tumor. To date, this is the first objective measurement of meningioma consistency based on MRI studies and objective intraoperative evaluation.

Biallelic mutations in human DCC cause developmental split-brain syndrome.

Motor, sensory, and integrative activities of the brain are coordinated by a series of midline-bridging neuronal commissures whose development is tightly regulated. Here we report a new human syndrome in which these commissures are widely disrupted, thus causing clinical manifestations of horizontal gaze palsy, scoliosis, and intellectual disability. Affected individuals were found to possess biallelic loss-of-function mutations in the gene encoding the axon-guidance receptor 'deleted in colorectal carcinoma' (DCC), which has been implicated in congenital mirror movements when it is mutated in the heterozygous state but whose biallelic loss-of-function human phenotype has not been reported. Structural MRI and diffusion tractography demonstrated broad disorganization of white-matter tracts throughout the human central nervous system (CNS), including loss of all commissural tracts at multiple levels of the neuraxis. Combined with data from animal models, these findings show that DCC is a master regulator of midline crossing and development of white-matter projections throughout the human CNS.