Prevalence and Risk Factors of Brain Infarcts and Associations With Cognitive Performance in Tenants of Marginal Housing.

Background Homeless and vulnerably housed individuals are at increased risk for multimorbidity compared with the general population. We assessed prevalence of brain infarcts on neuroimaging and associations with vascular risk factors and cognitive performance in a prospective study of residents living in marginal housing. Methods and Results Two hundred twenty-eight participants underwent structured clinical interviews, targeted clinical, laboratory, and neuropsychological assessments, and magnetic resonance imaging with T1, T2-fluid-attenuated inversion recovery and susceptibility-weighted images. Subjects underwent cognitive testing to assess premorbid IQ , verbal learning and memory, inhibition, sustained attention, mental flexibility, and decision making. In this sample (mean age 44.0 years [ SD 9.4], 77% male), prevalence of conventional vascular risk factors was lower than in the general population apart from tobacco use (94%). Ten-year Framingham risk for any cardiovascular event was 11.4%±9.2%. Brain infarcts were present in 25/228 (11%). All were ischemic (40% cortical, 56% lacunar, 4% both). Participants with infarcts were older than those without (48.9±9.4 versus 43.4±9.2, P=0.006). In a multivariable regression analysis, only age remained a significant predictor of brain infarcts (odds ratio 1.08, 95% CI 1.02-1.14, P=0.004). After controlling for age and education, the presence of infarct was a significant predictor of impaired decision making on the Iowa Gambling Task of decision making (ß -28.2, 95% CI -42.7 to -14.1, P<0.001). Conclusions Prevalence of infarcts on neuroimaging in this disadvantaged, community-dwelling cohort was much higher than expected for age and was associated with impaired decision making. Further research is needed to identify individuals at highest risk who may benefit from targeted preventative strategies.

Comparison of MERGE and axial T2-weighted fast spin-echo sequences for detection of multiple sclerosis lesions in the cervical spinal cord.

OBJECTIVE: The purpose of our study was to compare axial multiple-echo recombined gradient echo (MERGE) with axial T2-weighted fast spin-echo (FSE) imaging for the detection of multiple sclerosis (MS) lesions in the cervical spinal cord on MRI. MATERIALS AND METHODS: Twenty-nine cervical spine MRI studies of patients with MS lesions and 29 control cases were reviewed retrospectively. Two blinded neuroradiologists independently assessed randomized axial MERGE and axial T2-weighted FSE sequences from each study, documenting the location and number of cord lesions, the degree of confidence in calling each lesion, and the presence of artifacts. The reference standard was determined by an unblinded consensus review of all sequences performed for each case, with lesions considered present if detected on two or more sequences. Lesion detection rates and conspicuity, false-positive findings, and reader confidence and artifact scores were compared for the sequences, and interreader agreement was assessed. RESULTS: Eighty-three lesions were assessed. The mean true-positive lesion detection rate was 87% (95% CI, 79-93%) with MERGE and 67% (60-75%) with T2-weighted FSE, with interreader positive agreement scores of 74% and 75%, respectively. A greater number of false-positive findings were seen with MERGE for both the MS and control cases. Average confidence and artifact scores were similar for both sequences. Subjectively, lesions were more conspicuous in 21 cases with MERGE and four cases with T2-weighted FSE and were equally conspicuous in four cases. CONCLUSION: MERGE and T2-weighted FSE sequences are complementary. MERGE provided greater sensitivity for cord lesions whereas axial T2-weighted FSE provided improved lesion specificity. Further investigation is required to assess the clinical impact of MERGE in the diagnosis and management of MS.

Imaging in adult scoliosis: preoperative assessment and postoperative complications.

Adult scoliosis rates range from 2 to 32%. Surgery for scoliosis is common. Accurate and surgically relevant information should be provided to the referring surgeon from pre- and postoperative imaging. There are various methods to correct scoliosis surgically with the end points correction of the curve and relief of symptoms. This is achieved through the placement of spinal instrumentation with a goal of osseous fusion across the instrumented levels. There are many potential postoperative complications. The initial and postoperative imaging, types of surgery, and hardware are reviewed along with the common early and late complications with relevant illustrations.

Plain radiograph assessment of spinal hardware.

The frequency and variety of spinal instrumentation has increased tremendously over the past 100 years, and imaging plays an important role in evaluating the postoperative spine. Although assessment of spinal hardware often involves a multimodality approach, plain radiographs are the most commonly used modality, given accessibility, cost, relatively low radiation dose compared with computed tomography, and provision of positional information. An approach to assessment of plain radiographs of the postoperative spine is discussed, and examples of common postoperative complications are provided, including infection, hardware failure, incomplete fusion, and junctional failure.