Advanced brain age in deployment-related traumatic brain injury: A LIMBIC-CENC neuroimaging study.

OBJECTIVE: To determine if history of mild traumatic brain injury (mTBI) is associated with advanced or accelerated brain aging among the United States (US) military Service Members and Veterans. METHODS: Eight hundred and twenty-two participants (mean age = 40.4 years, 714 male/108 female) underwent MRI sessions at eight sites across the US. Two hundred and one participants completed a follow-up scan between five months and four years later. Predicted brain ages were calculated using T1-weighted MRIs and then compared with chronological ages to generate an Age Deviation Score for cross-sectional analyses and an Interval Deviation Score for longitudinal analyses. Participants also completed a neuropsychological battery, including measures of both cognitive functioning and psychological health. RESULT: In cross-sectional analyses, males with a history of deployment-related mTBI showed advanced brain age compared to those without (t(884) = 2.1, p = .038), while this association was not significant in females. In follow-up analyses of the male participants, severity of posttraumatic stress disorder (PTSD), depression symptoms, and alcohol misuse were also associated with advanced brain age. CONCLUSION: History of deployment-related mTBI, severity of PTSD and depression symptoms, and alcohol misuse are associated with advanced brain aging in male US military Service Members and Veterans.

Intradiscal quantitative chemical exchange saturation transfer MRI signal correlates with discogenic pain in human patients.

Low back pain (LBP) is often a result of a degenerative process in the intervertebral disc. The precise origin of discogenic pain is diagnosed by the invasive procedure of provocative discography (PD). Previously, we developed quantitative chemical exchange saturation transfer (qCEST) magnetic resonance imaging (MRI) to detect pH as a biomarker for discogenic pain. Based on these findings we initiated a clinical study with the goal to evaluate the correlation between qCEST values and PD results in LBP patients. Twenty five volunteers with chronic low back pain were subjected to T2-weighted (T2w) and qCEST MRI scans followed by PD. A total of 72 discs were analyzed. The average qCEST signal value of painful discs was significantly higher than non-painful discs (p = 0.012). The ratio between qCEST and normalized T2w was found to be significantly higher in painful discs compared to non-painful discs (p = 0.0022). A receiver operating characteristics (ROC) analysis indicated that qCEST/T2w ratio could be used to differentiate between painful and non-painful discs with 78% sensitivity and 81% specificity. The results of the study suggest that qCEST could be used for the diagnosis of discogenic pain, in conjunction with the commonly used T2w scan.

Oncogenic GOPC-ROS1 Fusion Identified in a Congenital Glioblastoma Case.

Congenital glioblastoma (GBM) is a rare brain tumor of infancy. While histologically they resemble pediatric and adult GBM, growing evidence suggests a distinct molecular profile. We report the case of a 7-day-old infant female with congenital GBM found to harbor a GOPC-ROS1 fusion. She underwent surgical resection, moderate-intensity chemotherapy without radiation, and remains disease-free 4 years from completion of therapy. While the frequency of this mutation is not known, the identification of this oncogenic driver may provide insight into the pathogenesis of GBM in this age group and may serve as a molecular target for select patients.

Brain imaging with synthetic MR in children: clinical quality assessment.

INTRODUCTION: Synthetic magnetic resonance imaging is a quantitative imaging technique that measures inherent T1-relaxation, T2-relaxation, and proton density. These inherent tissue properties allow synthesis of various imaging sequences from a single acquisition. Clinical use of synthetic MR imaging has been described in adult populations. However, use of synthetic MR imaging has not been previously reported in children. The purpose of this study is to report our assessment of diagnostic image quality using synthetic MR imaging in children. METHODS: Synthetic MR acquisition was obtained in a sample of children undergoing brain MR imaging. Image quality assessments were performed on conventional and synthetic T1-weighted, T2-weighted, and FLAIR images. Standardized linear measurements were performed on conventional and synthetic T2 images. Estimates of patient age based upon myelination patterns were also performed. RESULTS: Conventional and synthetic MR images were evaluated on 30 children. Using a 4-point assessment scale, conventional imaging performed better than synthetic imaging for T1-weighted, T2-weighted, and FLAIR images. When the assessment was simplified to a dichotomized scale, the conventional and synthetic T1-weighted and T2-weighted images performed similarly. However, the superiority of conventional FLAIR images persisted in the dichotomized assessment. There were no statistically significant differences between linear measurements made on T2-weighted images. Estimates of patient age based upon pattern of myelination were also similar between conventional and synthetic techniques. CONCLUSION: Synthetic MR imaging may be acceptable for clinical use in children. However, users should be aware of current limitations that could impact clinical utility in the software version used in this study.

Reduced Field of View Diffusion-Weighted Imaging in the Evaluation of Congenital Spine Malformations.

BACKGROUND: Reduced field of view diffusion-weighted imaging (rFOV DWI) is a more recently described technique in the evaluation of spine pathology. In adults, this technique has been shown to increase clinician confidence in identification of diffusion restricting lesions. PURPOSE: In this study, we evaluate the image quality and diagnostic confidence of the rFOV DWI technique in pediatric spine MRI. METHODS: We included patients with MRI of the lumbar spine for suspected congenital abnormalities who had conventional SS-EPI (single shot echo planar imaging) with full field of view (fFOV) and rFOV DWI performed. Images were graded for image quality and observer confidence for detection of lesions with reduced diffusion. Position of the conus and L3 vertebral body measurements were recorded. Comparisons were made between the fFOV and rFOV scores. RESULTS: Fifty children (30 girls, 20 boys) were included (median 3.6 years). Compared to the fFOV images, the rFOV images scored higher in image quality (P < 0.0001) and for confidence in detecting lesions with reduced diffusion (P < 0.0001). The average spread of identified conus position was smaller for in rFOV compared to fFOV (P = 0.0042). There was no significant difference in the L3 vertebral body measurements between the two methods. In rFOV, the anterior aspects of the vertebral bodies were excluded in a few studies due to narrow FOV. CONCLUSION: rFOV DWI of the lumbar spine in the pediatric population has qualitatively improved image quality and observer confidence for lesion detection when compared to conventional fFOV SS-EPI DWI.

Magnetic resonance imaging in sinonasal disease.

Computed tomography (CT) is often the primary imaging modality for the evaluation of sinonasal disease. For some indications, magnetic resonance imaging (MRI) may provide additional information. There are established indications for using MRI in complicated sinonasal inflammatory disease, invasive fungal sinus disease, and sinonasal mass lesions. When MRI is used in the evaluation of sinonasal disease, it is usually used as a complementary modality in addition to CT. Magnetic resonance imaging in sinonasal disease can be used to further characterize the primary sinonasal disease process and to evaluate the extent of complications such as orbital or intracranial involvement. When MRI is used in sinonasal disease, it should be evaluated in the context of the clinical situation and CT imaging features. This will help radiologists provide a meaningful differential diagnosis to assist in clinical management.

A systematic approach to CT evaluation of orbital trauma.

Computed tomography (CT) is widely used in the initial evaluation of patients with craniofacial trauma. Due to anatomical proximity, craniofacial trauma often involves concomitant injury to the eye and orbit. These injuries may have devastating consequences to vision, ocular motility, and cosmesis. CT imaging provides a rapid and detailed evaluation of bony structures and soft tissues of the orbit, is sensitive in detection of orbital foreign bodies, and often guides clinical and surgical management decisions in orbital trauma. For this reason, radiologists should be prepared to rapidly recognize common orbital fracture patterns, accurately describe soft tissue injuries of the orbit, detect and localize retained foreign bodies within the globe and orbit, and recognize abnormalities of the contents and integrity of the globe. In this review, we present a systematic approach to assist radiologists in the rapid evaluation of orbital trauma using the "BALPINE" mnemonic-bones, anterior chamber, lens, posterior globe structures, intraconal orbit, neurovascular structures, and extraocular muscles/extraconal orbit. Using this approach, we describe common traumatic findings within each of these spaces, and present common postsurgical appearances that can mimic findings of acute trauma.

Efficiency of automation and electronic health records in optometric practice.

BACKGROUND: Health information technology (HIT) consists of technological advancements in health care instrumentation, integration, and documentation. It is now beginning to reach a level of consistency, and its benefits are being realized in clinical practice. Comparisons between paper and digital documentation have been conducted in various specialties. There have also been studies comparing manual and automated documentation. Our study was designed to compare the overall benefit of an electronic health record (EHR) and clinical automation accompanied with HIT advancements to traditional modes of practice within the Optometry Clinic at Walter Reed Army Medical Center. PATIENTS AND METHODS: All processes and procedures used in the study were equivalent to those used in patient visits common to most optometric practices. They included patient check-in, pretesting by an ophthalmic technician, and a comprehensive eye examination by an optometrist. In addition to the quantitative time measurements for these procedures, the frequency of certain events was recorded to ascertain the value of automation versus conventional methods of patient management, testing, treatment, and documentation. RESULTS: Although no process time showed any statistically significant difference, some trends were evident. There was a trend toward increased efficiency in the automated group during "Doctor Examination" and "Total Time" subsections. Also, there was a trend toward decreased efficiency with the automated group during the "Check-In" section. CONCLUSIONS: Automation and EHR technology will likely improve over time and surpass the medical efficiency of conventional modes of care. It is impressive that the early stage of HIT used in this study showed no detraction from clinical efficiency while potentially offering many patient, provider, and administrative benefits.

Visual performance and comfort with the Rose K lens for keratoconus.

PURPOSE: The "Rose K Lens for Keratoconus" is a proprietary rigid contact lens design that has been reported and marketed as a lens that provides better visual acuity and comfort than other rigid contact lens designs for keratoconus. METHODS: Twenty patients with keratoconus who were wearing rigid contact lenses were refitted into the Rose K lenses. Visual acuity measurements were taken with habitual lenses at the baseline visit and with the Rose K lenses at the completion of the study. Questionnaires were used to assess vision-specific quality of life, contact lens comfort, and self-reported assessment of vision. RESULTS: There were no statistically significant changes in high- or low-contrast visual acuity with the Rose K lenses. There was statistically significant improvement in self-reported assessment of vision and self-reported assessment of comfort in the eyes with more advanced keratoconus. At the conclusion of the study, 72% of patients preferred the Rose K lenses over their habitual lenses, and 87% reported that they would continue wearing the Rose K lenses. CONCLUSIONS: There was no difference in the visual acuity with the Rose K lenses compared with the patients' habitual lenses. Subjective assessment of vision and comfort indicate a statistical improvement for more advanced keratoconus with the Rose K lens. We could not rule out a placebo effect as a source of subjective improvement in vision and comfort. Nevertheless, the successful fit rate and patient preference demonstrate the usefulness of the Rose K lens in clinical practice.