Using Brain Tumor MRI Structured Reporting to Quantify the Impact of Imaging on Brain Tumor Boards.

Multidisciplinary tumor boards (TB) are an essential part of brain tumor care, but quantifying the impact of imaging on patient management is challenging due to treatment complexity and a lack of quantitative outcome measures. This work uses a structured reporting system for classifying brain tumor MRIs, the brain tumor reporting and data system (BT-RADS), in a TB setting to prospectively assess the impact of imaging review on patient management. Published criteria were used to prospectively assign three separate BT-RADS scores (an initial radiology report, secondary TB presenter review, and TB consensus) to brain MRIs reviewed at an adult brain TB. Clinical recommendations at TB were noted and management changes within 90 days after TB were determined by chart review. In total, 212 MRIs in 130 patients (median age = 57 years) were reviewed. Agreement was 82.2% between report and presenter, 79.0% between report and consensus, and 90.1% between presenter and consensus. Rates of management change increased with increasing BT-RADS scores (0-3.1%, 1a-0%, 1b-66.7%, 2-8.3%, 3a-38.5%, 3b-55.9, 3c-92.0%, and 4-95.6%). Of 184 (86.8%) cases with clinical follow-up within 90 days after the tumor board, 155 (84.2%) of the recommendations were implemented. Structured scoring of MRIs provides a quantitative way to assess rates of agreement interpretation alongside how often management changes are recommended and implemented in a TB setting.

Technology-enhanced visual desensitization home exercise program for post-concussive visually induced dizziness: a case series.

PURPOSE: Post-concussive visually induced dizziness (VID), in which symptoms are provoked by exposure to complex visual motion, is associated with protracted recovery. Although vestibular rehabilitation therapy (VRT) is recommended to treat post-concussive dizziness, there is sparse literature reporting on specific VRT interventions treating VID. METHODS: A consecutive series of 26 individuals referred for VRT post-concussion were retrospectively assessed for inclusion in this case series. Each participant underwent a combination of conventional VRT and a technology-enhanced visual desensitization home exercise program (HEP). Self-report and objective measures were recorded from initial and discharge therapy evaluations. Twenty-three individuals (mean age 23.1 ± 12.4) with post-concussive dizziness (mean 109 ± 56 days post-injury) and no evidence for peripheral vestibular dysfunction were included. Treatment duration averaged 6.9 ± 2.5 weeks. RESULTS: There were significant improvements in post-intervention on subjective and objective measures of dizziness and gait (p < .05). The response to intervention was independent of pre-injury migraine history but pre-injury depression/anxiety increased self-report of post-treatment anxiety. Concurrent treatment with medications did not influence response to treatment. CONCLUSIONS: The combination therapy intervention improved outcome measures consistent with VRT treatment outcomes in both concussion and non-traumatic vestibular conditions. Individuals referred for VRT post-concussion warrant assessment for VID and may benefit from the addition of technology-enhanced visual desensitization.

Diagnostic Performance of Computed Tomography Angiography and Computed Tomography Perfusion Tissue Time-to-Maximum in Vasospasm Following Aneurysmal Subarachnoid Hemorrhage.

Background Vasospasm is a treatable cause of deterioration following aneurysmal subarachnoid hemorrhage. Cerebral computed tomography perfusion mean transit times have been proposed as a predictor of vasospasm but suffer from well-known technical limitations. We evaluated fully automated, thresholded time-to-maxima of the tissue residue function (Tmax) for determination of vasospasm following aneurysmal subarachnoid hemorrhage. Methods and Results Retrospective analysis of 540 arterial segments from 36 encounters in 31 consecutive patients with aneurysmal subarachnoid hemorrhage undergoing computed tomography angiography (CTA), computed tomography perfusion, and digital subtraction angiography (DSA) within 24 hours. Tmax at 4, 6, 8, and 10 s was generated using RAPID (iSchemaView Inc., Menlo Park, CA). Dual-reader CTA and computed tomography perfusion interpretations were compared for patients with and without vasospasm on DSA (DSA+ and DSA-). Logistic regression models were developed using CTA and Tmax as input predictors and DSA vasospasm as outcome in adjusted and unadjusted models. Imaging studies from all 31 subjects (mean age 47.3±11.1, 77% female, 65% with single aneurysm with mean size of 6.0±2.9 mm) were included. Vasospasm was identified in 42 segments on DSA and 59 segments on CTA, with significant associations across individual vessel segments (P<0.001). In adjusted analyses, DSA vasospasm was associated with CTA (odds ratio [OR], 2.43; 95% CI, 0.94-6.32; P=0.068) as well as territory-specific Tmax>6 seconds delays (OR, 3.57; 95% CI, 1.36-9.35; P=0.009). Sensitivity/specificity for DSA vasospasm was 31%/91% for CTA, 26%/89% for Tmax>6 seconds, and 12%/99% for CTA+Tmax>6 seconds. Conclusions CTA and Tmax offer high specificity for presence of vasospasm; their utility, even in combination, as screening tests is, however, limited by poor sensitivity.