RESUMEN
OBJECTIVES: The chronic effects of neurotrauma consortium (CENC) observational study is a multisite investigation designed to examine the long-term longitudinal effects of mild traumatic brain injury (mTBI). All participants in this initial CENC cohort had a history of deployment in Operation Enduring Freedom (Afghanistan), Operation Iraqi Freedom (Iraq), and/or their follow-on conflicts (Operation Freedom's Sentinel). All participants undergo extensive medical, neuropsychological, and neuroimaging assessments and either meet criteria for any lifetime mTBI or not. These assessments are integrated into six CENC core studies-Biorepository, Biostatistics, Data and Study Management, Neuroimaging, and Neuropathology. METHODS: The current study outlines the quantitative neuroimaging methods managed by the Neuroimaging Core using FreeSurfer automated software for image quantification. RESULTS: At this writing, 319 participants from the CENC observational study have completed all baseline assessments including the imaging protocol and tertiary data quality assurance procedures. CONCLUSIONS/DISCUSSION: The preliminary findings of this initial cohort are reported to describe how the Neuroimaging Core manages neuroimaging quantification for CENC studies.
Asunto(s)
Conmoción Encefálica/diagnóstico por imagen , Encéfalo/diagnóstico por imagen , Neuroimagen , Adulto , Enfermedad Crónica , Estudios de Cohortes , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana EdadRESUMEN
Traumatic brain injury (TBI) has a poorly understood pathology. Patients suffer from a variety of physical and cognitive effects that worsen as the type of trauma worsens. Some noninvasive insights into the pathophysiology of TBI are possible using magnetic resonance imaging (MRI), computed tomography (CT), and many other forms of imaging as well. A recent workshop was convened to evaluate the common data elements (CDEs) that cut across the imaging field and given the charge to review the contributions of the various imaging modalities to TBI and to prepare an overview of the various clinical manifestations of TBI and their interpretation. Technical details regarding state-of-the-art protocols for both MRI and CT are also presented with the hope of guiding current and future research efforts as to what is possible in the field. Stress was also placed on the potential to create a database of CDEs as a means to best record information from a given patient from the reading of the images.
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Lesiones Encefálicas/diagnóstico , Diagnóstico por Imagen/métodos , Diagnóstico por Imagen/normas , Intensificación de Imagen Radiográfica , Electroencefalografía/métodos , Electroencefalografía/normas , Femenino , Humanos , Puntaje de Gravedad del Traumatismo , Imagen por Resonancia Magnética/métodos , Espectroscopía de Resonancia Magnética/métodos , Espectroscopía de Resonancia Magnética/normas , Masculino , Tomografía de Emisión de Positrones/métodos , Tomografía de Emisión de Positrones/normas , Guías de Práctica Clínica como Asunto , Interpretación de Imagen Radiográfica Asistida por Computador/métodos , Interpretación de Imagen Radiográfica Asistida por Computador/normas , Sensibilidad y Especificidad , Tomografía Computarizada por Rayos X/métodos , Tomografía Computarizada por Rayos X/normas , Ultrasonografía Doppler Transcraneal/normas , Ultrasonografía Doppler Transcraneal/tendenciasRESUMEN
Catheter-directed digital subtraction angiography (DSA) is considered the standard for evaluation of superficial temporal to middle cerebral artery (STA-MCA) bypass patency. Few clinical investigations have been performed that evaluate the efficacy of computed tomographic angiography (CTA) in the assessment of extracranial-intracranial bypass. Using multi-detector row CTA, STA-MCA bypass patency was assessed in the initial postoperative period and several months afterward and compared with DSA. No significant difference was identified in the evaluation of graft patency between DSA and CTA. Although multiple modalities exist to evaluate STA-MCA bypass graft patency, the multidetector CTA is widely available and allows for rapid, accurate patency assessment.
Asunto(s)
Angiografía Cerebral , Revascularización Cerebral/métodos , Arteria Cerebral Media/diagnóstico por imagen , Arteria Cerebral Media/cirugía , Arterias Temporales/diagnóstico por imagen , Arterias Temporales/cirugía , Tomografía Computarizada por Rayos X/métodos , Angiografía de Substracción Digital , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Grado de Desobstrucción VascularRESUMEN
OBJECTIVES: Computed tomography (CT) followed by lumbar puncture (LP) is currently the criterion standard for diagnosing subarachnoid hemorrhage (SAH) in the emergency department (ED); however, this is based on studies involving a limited number of patients. The authors sought to assess the ability of CT angiography (CTA), a new diagnostic modality, in conjunction with CT/LP to detect SAH. METHODS: Consecutive patients presenting to the ED with symptoms concerning for SAH were approached. All patients had an intravenous catheter placed and underwent a noncontrast head CT followed by CTA. Patients whose CT did not reveal evidence of SAH or other pathology underwent LP in the ED. CTAs were read within 24 hours by a neuroradiologist blinded to the patient's history. RESULTS: A total of 131 patients were approached, 116 were enrolled, and 106 completed the study. In six of 116 patients (5.1%), aneurysm was found on CTA with normal CT and positive findings on LP; three had a positive CTA with normal CT and LP findings (one of which had a negative cerebral angiogram), and there was one false-positive CTA. Follow-up of all 131 patients showed no previously undiagnosed intracranial pathology. In this patient population, 4.3% (5/116) were ultimately found to have an SAH and/or aneurysm. CONCLUSIONS: In this pilot study, CTA was found to be useful in the detection of cerebral aneurysms and may be useful in the diagnosis of aneurysmal SAH. A larger multicenter study would be useful to confirm these results.
Asunto(s)
Angiografía Cerebral , Medicina de Emergencia/métodos , Hemorragia Subaracnoidea/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Adulto , Anciano , Reacciones Falso Positivas , Femenino , Estudios de Seguimiento , Cefalea/etiología , Humanos , Masculino , Persona de Mediana Edad , Proyectos Piloto , Estudios Prospectivos , Sensibilidad y Especificidad , Hemorragia Subaracnoidea/complicacionesAsunto(s)
Neoplasias Encefálicas/diagnóstico por imagen , Glioblastoma/diagnóstico por imagen , Oligodendroglioma/diagnóstico por imagen , Lóbulo Parietal/diagnóstico por imagen , Lóbulo Temporal/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Adulto , Neoplasias Encefálicas/complicaciones , Neoplasias Encefálicas/patología , Neoplasias Encefálicas/radioterapia , Neoplasias Encefálicas/cirugía , Terapia Combinada , Craneotomía , Epilepsia Tónico-Clónica/etiología , Femenino , Glioblastoma/complicaciones , Glioblastoma/patología , Glioblastoma/radioterapia , Glioblastoma/cirugía , Humanos , Imagen por Resonancia Magnética , Oligodendroglioma/complicaciones , Oligodendroglioma/patología , Oligodendroglioma/radioterapia , Oligodendroglioma/cirugía , Radioterapia AdyuvanteRESUMEN
Vertebral body compression fractures can cause chronic pain and may result in progressive kyphosis. Although vertebroplasty has been used to treat pain, it does not attempt to restore vertebral body height and eliminate spinal deformity. Percutaneous balloon kyphoplasty is a novel technique, which involves the introduction of inflatable bone tamps into the fractured vertebral body for elevation of the endplates, prior to fixation of the fracture with bone cement. Our initial experience with this minimally invasive procedure indicates that percutaneous balloon kyphoplasty can be efficacious in the treatment of painful, osteoporotic vertebral compression fractures.