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El Sayed R, Park CC, Shah Z, Nahab FB, Haussen DC, Allen JW, Oshinski JN. Assessment of Complex Flow Patterns in Patients With Carotid Webs, Patients With Carotid Atherosclerosis, and Healthy Subjects Using 4D Flow MRI. J Magn Reson Imaging 2024; 59:2001-2010. [PMID: 37706274 PMCID: PMC10937327 DOI: 10.1002/jmri.29013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 08/30/2023] [Accepted: 08/31/2023] [Indexed: 09/15/2023] Open
Abstract
BACKGROUND Carotid webs (CaWs) are fibromuscular projections in the internal carotid artery (ICA) that cause mild luminal narrowing (<50%), but may be causative in up to one-third of seemingly cryptogenic strokes. Understanding hemodynamic alterations caused by CaWs is imperative to assessing stroke risk. Time-Average Wall Shear Stress (TAWSS) and Oscillatory Shear Index (OSI) are hemodynamic parameters linked to vascular dysfunction and thrombosis. PURPOSE To test the hypothesis: "CaWs are associated with lower TAWSS and higher OSI than mild atherosclerosis or healthy carotid bifurcation." STUDY TYPE Prospective study. POPULATION A total of 35 subjects (N = 14 bifurcations with CaW, 11F, age: 49 ± 10, 10 mild atherosclerosis 6F, age: 72 ± 9, 11 healthy 9F, age: 42 ± 13). FIELD STRENGTH/SEQUENCE 4D flow/STAR-MATCH/3D TOF/3T MRI, CTA. ASSESSMENT 4D Flow velocity data were analyzed in two ways: 1) 3D ROI in the ICA bulbar segment (complex flow patterns are expected) was used to quantify the regions with low TAWSS and high OSI. 2) 2D planes were placed perpendicular to the centerline of the carotid bifurcation for detailed analysis of TAWSS and OSI. STATISTICAL TESTS Independent-samples Kruskal-Wallis-H test with 0.05 used for statistical significance. RESULTS The percent surface area where low TAWSS was present in the ICA bulb was 12.3 ± 8.0% (95% CI: 7.6-16.9) in CaW subjects, 1.6 ± 1.9% (95% CI: 0.2-2.9) in atherosclerosis, and 8.5 ± 7.7% (95% CI: 3.6-13.4) in healthy subjects, all differences were statistically significant (ƞ2 = 0.3 [95% CI: 0.05-0.5], P-value CaW vs. healthy = 0.2). OSI had similar values in the CCA between groups (ƞ2 = 0.07 [95% CI: 0.0-0.2], P-value = 0.5), but OSI was significantly higher downstream of the bifurcation in CaW subjects compared to atherosclerosis and normal subjects. OSI returned to similar values between groups 1.5 diameters distal to the bifurcation (ƞ2 = 0.03 [95% CI: 0.0-0.2], P-value = 0.7). CONCLUSION Lower TAWSS and higher OSI are present in the ICA bulb in patients with CaW when compared to patients with atherosclerotic or healthy subjects. EVIDENCE LEVEL 2 TECHNICAL EFFICACY: Stage 2.
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Affiliation(s)
- Retta El Sayed
- Department of Biomedical Engineering, Georgia Institute of Technology & Emory University, Atlanta, Georgia, USA
- Department of Radiology & Imaging Sciences, Emory University, Atlanta, Georgia, USA
| | - Charlie C. Park
- Department of Radiology & Imaging Sciences, Emory University, Atlanta, Georgia, USA
| | - Zahraw Shah
- Department of Biomedical Engineering, Georgia Institute of Technology & Emory University, Atlanta, Georgia, USA
| | - Fadi B. Nahab
- Department of Neurology, Emory University, Atlanta, Georgia, USA
| | - Diogo C. Haussen
- Department of Neurology, Emory University, Atlanta, Georgia, USA
| | - Jason W. Allen
- Department of Biomedical Engineering, Georgia Institute of Technology & Emory University, Atlanta, Georgia, USA
- Department of Radiology & Imaging Sciences, Emory University, Atlanta, Georgia, USA
- Department of Neurology, Emory University, Atlanta, Georgia, USA
| | - John N. Oshinski
- Department of Biomedical Engineering, Georgia Institute of Technology & Emory University, Atlanta, Georgia, USA
- Department of Radiology & Imaging Sciences, Emory University, Atlanta, Georgia, USA
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Jiang B, Ozkara BB, Zhu G, Boothroyd D, Allen JW, Barboriak DP, Chang P, Chan C, Chaudhari R, Chen H, Chukus A, Ding V, Douglas D, Filippi CG, Flanders AE, Godwin R, Hashmi S, Hess C, Hsu K, Lui YW, Maldjian JA, Michel P, Nalawade SS, Patel V, Raghavan P, Sair HI, Tanabe J, Welker K, Whitlow CT, Zaharchuk G, Wintermark M. Assessing the Performance of Artificial Intelligence Models: Insights from the American Society of Functional Neuroradiology Artificial Intelligence Competition. AJNR Am J Neuroradiol 2024:ajnr.A8317. [PMID: 38663992 DOI: 10.3174/ajnr.a8317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 04/22/2024] [Indexed: 05/05/2024]
Abstract
BACKGROUND AND PURPOSE Artificial intelligence (AI) models in radiology are frequently developed and validated using datasets from a single institution and are rarely tested on independent, external datasets, raising questions about their generalizability and applicability in clinical practice. The American Society of Functional Neuroradiology (ASFNR) organized a multi-center AI competition to evaluate the proficiency of developed models in identifying various pathologies on NCCT, assessing age-based normality and estimating medical urgency. MATERIALS AND METHODS In total, 1201 anonymized, full-head NCCT clinical scans from five institutions were pooled to form the dataset. The dataset encompassed normal studies as well as pathologies including acute ischemic stroke, intracranial hemorrhage, traumatic brain injury, and mass effect (detection of these-task 1). NCCTs were also assessed to determine if findings were consistent with expected brain changes for the patient's age (task 2: age-based normality assessment) and to identify any abnormalities requiring immediate medical attention (task 3: evaluation of findings for urgent intervention). Five neuroradiologists labeled each NCCT, with consensus interpretations serving as the ground truth. The competition was announced online, inviting academic institutions and companies. Independent central analysis assessed each model's performance. Accuracy, sensitivity, specificity, positive and negative predictive values, and receiver operating characteristic (ROC) curves were generated for each AI model, along with the area under the ROC curve (AUROC). RESULTS 1177 studies were processed by four teams. The median age of patients was 62, with an interquartile range of 33. 19 teams from various academic institutions registered for the competition. Of these, four teams submitted their final results. No commercial entities participated in the competition. For task 1, AUROCs ranged from 0.49 to 0.59. For task 2, two teams completed the task with AUROC values of 0.57 and 0.52. For task 3, teams had little to no agreement with the ground truth. CONCLUSIONS To assess the performance of AI models in real-world clinical scenarios, we analyzed their performance in the ASFNR AI Competition. The first ASFNR Competition underscored the gap between expectation and reality; the models largely fell short in their assessments. As the integration of AI tools into clinical workflows increases, neuroradiologists must carefully recognize the capabilities, constraints, and consistency of these technologies. Before institutions adopt these algorithms, thorough validation is essential to ensure acceptable levels of performance in clinical settings.ABBREVIATIONS: AI = artificial intelligence; ASFNR = American Society of Functional Neuroradiology; AUROC = area under the receiver operating characteristic curve; DICOM = Digital Imaging and Communications in Medicine; GEE = generalized estimation equation; IQR = interquartile range; NPV = negative predictive value; PPV = positive predictive value; ROC = receiver operating characteristic; TBI = traumatic brain injury.
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Affiliation(s)
- Bin Jiang
- From the Department of Radiology (B.J., C.C., R.C., A.C., D.D., S.H., G.Z.), and Department of Medicine (D.B., V.D.), Stanford University, Stanford, CA, USA; Department of Neuroradiology (B.B.O., H.C., M.W.), MD Anderson Cancer Center, Houston, TX, USA; Department of Neurology (G.Z.), University of Arizona, Tucson, AZ, USA; Department of Radiology and Imaging Sciences (J.W.A.), Indiana University, Indianapolis, IN, USA; Department of Radiology (D.P.B.), Duke University, Durham, NC, USA; Department of Radiological Sciences (P.C.), University of California, Irvine, Irvine, CA, USA; Department of Radiology (C.G.F.), Tufts University, Boston, MA, USA; Department of Radiology (A.E.F.), Thomas Jefferson University, Philadelphia, PA, USA; Department of Radiology (R.G.), University of Alabama at Birmingham, Birmingham, AL, USA; Department of Radiology & Biomedical Imaging (C.H.), University of California, San Francisco, San Francisco, CA, USA; Department of Radiology (K.H., Y.W.L.), New York University, New York, NY, USA; Department of Radiology (J.A.M., S.S.N.), University of Texas Southwestern, Dallas, TX, USA; Department of Clinical Neurosciences (P.M.), Lausanne University Hospital, Lausanne, Switzerland; Department of Radiology (V.P.), Mayo Clinic, Jacksonville, FL, USA; Department of Diagnostic Radiology and Nuclear Medicine (P.R.), University of Maryland, Baltimore, MD, USA; The Russell H. Morgan Department of Radiology and Radiological Sciences (H.I.S.), Johns Hopkins University, Baltimore, MD, USA; Department of Radiology (J.T.), University of Colorado, Aurora, CO, USA; Department of Radiology (K.W.), Mayo Clinic, Rochester, MN, USA; Department of Radiology (C.W.), Wake Forest University, Winston-Salem, NC, USA
| | - Burak Berksu Ozkara
- From the Department of Radiology (B.J., C.C., R.C., A.C., D.D., S.H., G.Z.), and Department of Medicine (D.B., V.D.), Stanford University, Stanford, CA, USA; Department of Neuroradiology (B.B.O., H.C., M.W.), MD Anderson Cancer Center, Houston, TX, USA; Department of Neurology (G.Z.), University of Arizona, Tucson, AZ, USA; Department of Radiology and Imaging Sciences (J.W.A.), Indiana University, Indianapolis, IN, USA; Department of Radiology (D.P.B.), Duke University, Durham, NC, USA; Department of Radiological Sciences (P.C.), University of California, Irvine, Irvine, CA, USA; Department of Radiology (C.G.F.), Tufts University, Boston, MA, USA; Department of Radiology (A.E.F.), Thomas Jefferson University, Philadelphia, PA, USA; Department of Radiology (R.G.), University of Alabama at Birmingham, Birmingham, AL, USA; Department of Radiology & Biomedical Imaging (C.H.), University of California, San Francisco, San Francisco, CA, USA; Department of Radiology (K.H., Y.W.L.), New York University, New York, NY, USA; Department of Radiology (J.A.M., S.S.N.), University of Texas Southwestern, Dallas, TX, USA; Department of Clinical Neurosciences (P.M.), Lausanne University Hospital, Lausanne, Switzerland; Department of Radiology (V.P.), Mayo Clinic, Jacksonville, FL, USA; Department of Diagnostic Radiology and Nuclear Medicine (P.R.), University of Maryland, Baltimore, MD, USA; The Russell H. Morgan Department of Radiology and Radiological Sciences (H.I.S.), Johns Hopkins University, Baltimore, MD, USA; Department of Radiology (J.T.), University of Colorado, Aurora, CO, USA; Department of Radiology (K.W.), Mayo Clinic, Rochester, MN, USA; Department of Radiology (C.W.), Wake Forest University, Winston-Salem, NC, USA
| | - Guangming Zhu
- From the Department of Radiology (B.J., C.C., R.C., A.C., D.D., S.H., G.Z.), and Department of Medicine (D.B., V.D.), Stanford University, Stanford, CA, USA; Department of Neuroradiology (B.B.O., H.C., M.W.), MD Anderson Cancer Center, Houston, TX, USA; Department of Neurology (G.Z.), University of Arizona, Tucson, AZ, USA; Department of Radiology and Imaging Sciences (J.W.A.), Indiana University, Indianapolis, IN, USA; Department of Radiology (D.P.B.), Duke University, Durham, NC, USA; Department of Radiological Sciences (P.C.), University of California, Irvine, Irvine, CA, USA; Department of Radiology (C.G.F.), Tufts University, Boston, MA, USA; Department of Radiology (A.E.F.), Thomas Jefferson University, Philadelphia, PA, USA; Department of Radiology (R.G.), University of Alabama at Birmingham, Birmingham, AL, USA; Department of Radiology & Biomedical Imaging (C.H.), University of California, San Francisco, San Francisco, CA, USA; Department of Radiology (K.H., Y.W.L.), New York University, New York, NY, USA; Department of Radiology (J.A.M., S.S.N.), University of Texas Southwestern, Dallas, TX, USA; Department of Clinical Neurosciences (P.M.), Lausanne University Hospital, Lausanne, Switzerland; Department of Radiology (V.P.), Mayo Clinic, Jacksonville, FL, USA; Department of Diagnostic Radiology and Nuclear Medicine (P.R.), University of Maryland, Baltimore, MD, USA; The Russell H. Morgan Department of Radiology and Radiological Sciences (H.I.S.), Johns Hopkins University, Baltimore, MD, USA; Department of Radiology (J.T.), University of Colorado, Aurora, CO, USA; Department of Radiology (K.W.), Mayo Clinic, Rochester, MN, USA; Department of Radiology (C.W.), Wake Forest University, Winston-Salem, NC, USA
| | - Derek Boothroyd
- From the Department of Radiology (B.J., C.C., R.C., A.C., D.D., S.H., G.Z.), and Department of Medicine (D.B., V.D.), Stanford University, Stanford, CA, USA; Department of Neuroradiology (B.B.O., H.C., M.W.), MD Anderson Cancer Center, Houston, TX, USA; Department of Neurology (G.Z.), University of Arizona, Tucson, AZ, USA; Department of Radiology and Imaging Sciences (J.W.A.), Indiana University, Indianapolis, IN, USA; Department of Radiology (D.P.B.), Duke University, Durham, NC, USA; Department of Radiological Sciences (P.C.), University of California, Irvine, Irvine, CA, USA; Department of Radiology (C.G.F.), Tufts University, Boston, MA, USA; Department of Radiology (A.E.F.), Thomas Jefferson University, Philadelphia, PA, USA; Department of Radiology (R.G.), University of Alabama at Birmingham, Birmingham, AL, USA; Department of Radiology & Biomedical Imaging (C.H.), University of California, San Francisco, San Francisco, CA, USA; Department of Radiology (K.H., Y.W.L.), New York University, New York, NY, USA; Department of Radiology (J.A.M., S.S.N.), University of Texas Southwestern, Dallas, TX, USA; Department of Clinical Neurosciences (P.M.), Lausanne University Hospital, Lausanne, Switzerland; Department of Radiology (V.P.), Mayo Clinic, Jacksonville, FL, USA; Department of Diagnostic Radiology and Nuclear Medicine (P.R.), University of Maryland, Baltimore, MD, USA; The Russell H. Morgan Department of Radiology and Radiological Sciences (H.I.S.), Johns Hopkins University, Baltimore, MD, USA; Department of Radiology (J.T.), University of Colorado, Aurora, CO, USA; Department of Radiology (K.W.), Mayo Clinic, Rochester, MN, USA; Department of Radiology (C.W.), Wake Forest University, Winston-Salem, NC, USA
| | - Jason W Allen
- From the Department of Radiology (B.J., C.C., R.C., A.C., D.D., S.H., G.Z.), and Department of Medicine (D.B., V.D.), Stanford University, Stanford, CA, USA; Department of Neuroradiology (B.B.O., H.C., M.W.), MD Anderson Cancer Center, Houston, TX, USA; Department of Neurology (G.Z.), University of Arizona, Tucson, AZ, USA; Department of Radiology and Imaging Sciences (J.W.A.), Indiana University, Indianapolis, IN, USA; Department of Radiology (D.P.B.), Duke University, Durham, NC, USA; Department of Radiological Sciences (P.C.), University of California, Irvine, Irvine, CA, USA; Department of Radiology (C.G.F.), Tufts University, Boston, MA, USA; Department of Radiology (A.E.F.), Thomas Jefferson University, Philadelphia, PA, USA; Department of Radiology (R.G.), University of Alabama at Birmingham, Birmingham, AL, USA; Department of Radiology & Biomedical Imaging (C.H.), University of California, San Francisco, San Francisco, CA, USA; Department of Radiology (K.H., Y.W.L.), New York University, New York, NY, USA; Department of Radiology (J.A.M., S.S.N.), University of Texas Southwestern, Dallas, TX, USA; Department of Clinical Neurosciences (P.M.), Lausanne University Hospital, Lausanne, Switzerland; Department of Radiology (V.P.), Mayo Clinic, Jacksonville, FL, USA; Department of Diagnostic Radiology and Nuclear Medicine (P.R.), University of Maryland, Baltimore, MD, USA; The Russell H. Morgan Department of Radiology and Radiological Sciences (H.I.S.), Johns Hopkins University, Baltimore, MD, USA; Department of Radiology (J.T.), University of Colorado, Aurora, CO, USA; Department of Radiology (K.W.), Mayo Clinic, Rochester, MN, USA; Department of Radiology (C.W.), Wake Forest University, Winston-Salem, NC, USA
| | - Daniel P Barboriak
- From the Department of Radiology (B.J., C.C., R.C., A.C., D.D., S.H., G.Z.), and Department of Medicine (D.B., V.D.), Stanford University, Stanford, CA, USA; Department of Neuroradiology (B.B.O., H.C., M.W.), MD Anderson Cancer Center, Houston, TX, USA; Department of Neurology (G.Z.), University of Arizona, Tucson, AZ, USA; Department of Radiology and Imaging Sciences (J.W.A.), Indiana University, Indianapolis, IN, USA; Department of Radiology (D.P.B.), Duke University, Durham, NC, USA; Department of Radiological Sciences (P.C.), University of California, Irvine, Irvine, CA, USA; Department of Radiology (C.G.F.), Tufts University, Boston, MA, USA; Department of Radiology (A.E.F.), Thomas Jefferson University, Philadelphia, PA, USA; Department of Radiology (R.G.), University of Alabama at Birmingham, Birmingham, AL, USA; Department of Radiology & Biomedical Imaging (C.H.), University of California, San Francisco, San Francisco, CA, USA; Department of Radiology (K.H., Y.W.L.), New York University, New York, NY, USA; Department of Radiology (J.A.M., S.S.N.), University of Texas Southwestern, Dallas, TX, USA; Department of Clinical Neurosciences (P.M.), Lausanne University Hospital, Lausanne, Switzerland; Department of Radiology (V.P.), Mayo Clinic, Jacksonville, FL, USA; Department of Diagnostic Radiology and Nuclear Medicine (P.R.), University of Maryland, Baltimore, MD, USA; The Russell H. Morgan Department of Radiology and Radiological Sciences (H.I.S.), Johns Hopkins University, Baltimore, MD, USA; Department of Radiology (J.T.), University of Colorado, Aurora, CO, USA; Department of Radiology (K.W.), Mayo Clinic, Rochester, MN, USA; Department of Radiology (C.W.), Wake Forest University, Winston-Salem, NC, USA
| | - Peter Chang
- From the Department of Radiology (B.J., C.C., R.C., A.C., D.D., S.H., G.Z.), and Department of Medicine (D.B., V.D.), Stanford University, Stanford, CA, USA; Department of Neuroradiology (B.B.O., H.C., M.W.), MD Anderson Cancer Center, Houston, TX, USA; Department of Neurology (G.Z.), University of Arizona, Tucson, AZ, USA; Department of Radiology and Imaging Sciences (J.W.A.), Indiana University, Indianapolis, IN, USA; Department of Radiology (D.P.B.), Duke University, Durham, NC, USA; Department of Radiological Sciences (P.C.), University of California, Irvine, Irvine, CA, USA; Department of Radiology (C.G.F.), Tufts University, Boston, MA, USA; Department of Radiology (A.E.F.), Thomas Jefferson University, Philadelphia, PA, USA; Department of Radiology (R.G.), University of Alabama at Birmingham, Birmingham, AL, USA; Department of Radiology & Biomedical Imaging (C.H.), University of California, San Francisco, San Francisco, CA, USA; Department of Radiology (K.H., Y.W.L.), New York University, New York, NY, USA; Department of Radiology (J.A.M., S.S.N.), University of Texas Southwestern, Dallas, TX, USA; Department of Clinical Neurosciences (P.M.), Lausanne University Hospital, Lausanne, Switzerland; Department of Radiology (V.P.), Mayo Clinic, Jacksonville, FL, USA; Department of Diagnostic Radiology and Nuclear Medicine (P.R.), University of Maryland, Baltimore, MD, USA; The Russell H. Morgan Department of Radiology and Radiological Sciences (H.I.S.), Johns Hopkins University, Baltimore, MD, USA; Department of Radiology (J.T.), University of Colorado, Aurora, CO, USA; Department of Radiology (K.W.), Mayo Clinic, Rochester, MN, USA; Department of Radiology (C.W.), Wake Forest University, Winston-Salem, NC, USA
| | - Cynthia Chan
- From the Department of Radiology (B.J., C.C., R.C., A.C., D.D., S.H., G.Z.), and Department of Medicine (D.B., V.D.), Stanford University, Stanford, CA, USA; Department of Neuroradiology (B.B.O., H.C., M.W.), MD Anderson Cancer Center, Houston, TX, USA; Department of Neurology (G.Z.), University of Arizona, Tucson, AZ, USA; Department of Radiology and Imaging Sciences (J.W.A.), Indiana University, Indianapolis, IN, USA; Department of Radiology (D.P.B.), Duke University, Durham, NC, USA; Department of Radiological Sciences (P.C.), University of California, Irvine, Irvine, CA, USA; Department of Radiology (C.G.F.), Tufts University, Boston, MA, USA; Department of Radiology (A.E.F.), Thomas Jefferson University, Philadelphia, PA, USA; Department of Radiology (R.G.), University of Alabama at Birmingham, Birmingham, AL, USA; Department of Radiology & Biomedical Imaging (C.H.), University of California, San Francisco, San Francisco, CA, USA; Department of Radiology (K.H., Y.W.L.), New York University, New York, NY, USA; Department of Radiology (J.A.M., S.S.N.), University of Texas Southwestern, Dallas, TX, USA; Department of Clinical Neurosciences (P.M.), Lausanne University Hospital, Lausanne, Switzerland; Department of Radiology (V.P.), Mayo Clinic, Jacksonville, FL, USA; Department of Diagnostic Radiology and Nuclear Medicine (P.R.), University of Maryland, Baltimore, MD, USA; The Russell H. Morgan Department of Radiology and Radiological Sciences (H.I.S.), Johns Hopkins University, Baltimore, MD, USA; Department of Radiology (J.T.), University of Colorado, Aurora, CO, USA; Department of Radiology (K.W.), Mayo Clinic, Rochester, MN, USA; Department of Radiology (C.W.), Wake Forest University, Winston-Salem, NC, USA
| | - Ruchir Chaudhari
- From the Department of Radiology (B.J., C.C., R.C., A.C., D.D., S.H., G.Z.), and Department of Medicine (D.B., V.D.), Stanford University, Stanford, CA, USA; Department of Neuroradiology (B.B.O., H.C., M.W.), MD Anderson Cancer Center, Houston, TX, USA; Department of Neurology (G.Z.), University of Arizona, Tucson, AZ, USA; Department of Radiology and Imaging Sciences (J.W.A.), Indiana University, Indianapolis, IN, USA; Department of Radiology (D.P.B.), Duke University, Durham, NC, USA; Department of Radiological Sciences (P.C.), University of California, Irvine, Irvine, CA, USA; Department of Radiology (C.G.F.), Tufts University, Boston, MA, USA; Department of Radiology (A.E.F.), Thomas Jefferson University, Philadelphia, PA, USA; Department of Radiology (R.G.), University of Alabama at Birmingham, Birmingham, AL, USA; Department of Radiology & Biomedical Imaging (C.H.), University of California, San Francisco, San Francisco, CA, USA; Department of Radiology (K.H., Y.W.L.), New York University, New York, NY, USA; Department of Radiology (J.A.M., S.S.N.), University of Texas Southwestern, Dallas, TX, USA; Department of Clinical Neurosciences (P.M.), Lausanne University Hospital, Lausanne, Switzerland; Department of Radiology (V.P.), Mayo Clinic, Jacksonville, FL, USA; Department of Diagnostic Radiology and Nuclear Medicine (P.R.), University of Maryland, Baltimore, MD, USA; The Russell H. Morgan Department of Radiology and Radiological Sciences (H.I.S.), Johns Hopkins University, Baltimore, MD, USA; Department of Radiology (J.T.), University of Colorado, Aurora, CO, USA; Department of Radiology (K.W.), Mayo Clinic, Rochester, MN, USA; Department of Radiology (C.W.), Wake Forest University, Winston-Salem, NC, USA
| | - Hui Chen
- From the Department of Radiology (B.J., C.C., R.C., A.C., D.D., S.H., G.Z.), and Department of Medicine (D.B., V.D.), Stanford University, Stanford, CA, USA; Department of Neuroradiology (B.B.O., H.C., M.W.), MD Anderson Cancer Center, Houston, TX, USA; Department of Neurology (G.Z.), University of Arizona, Tucson, AZ, USA; Department of Radiology and Imaging Sciences (J.W.A.), Indiana University, Indianapolis, IN, USA; Department of Radiology (D.P.B.), Duke University, Durham, NC, USA; Department of Radiological Sciences (P.C.), University of California, Irvine, Irvine, CA, USA; Department of Radiology (C.G.F.), Tufts University, Boston, MA, USA; Department of Radiology (A.E.F.), Thomas Jefferson University, Philadelphia, PA, USA; Department of Radiology (R.G.), University of Alabama at Birmingham, Birmingham, AL, USA; Department of Radiology & Biomedical Imaging (C.H.), University of California, San Francisco, San Francisco, CA, USA; Department of Radiology (K.H., Y.W.L.), New York University, New York, NY, USA; Department of Radiology (J.A.M., S.S.N.), University of Texas Southwestern, Dallas, TX, USA; Department of Clinical Neurosciences (P.M.), Lausanne University Hospital, Lausanne, Switzerland; Department of Radiology (V.P.), Mayo Clinic, Jacksonville, FL, USA; Department of Diagnostic Radiology and Nuclear Medicine (P.R.), University of Maryland, Baltimore, MD, USA; The Russell H. Morgan Department of Radiology and Radiological Sciences (H.I.S.), Johns Hopkins University, Baltimore, MD, USA; Department of Radiology (J.T.), University of Colorado, Aurora, CO, USA; Department of Radiology (K.W.), Mayo Clinic, Rochester, MN, USA; Department of Radiology (C.W.), Wake Forest University, Winston-Salem, NC, USA
| | - Anjeza Chukus
- From the Department of Radiology (B.J., C.C., R.C., A.C., D.D., S.H., G.Z.), and Department of Medicine (D.B., V.D.), Stanford University, Stanford, CA, USA; Department of Neuroradiology (B.B.O., H.C., M.W.), MD Anderson Cancer Center, Houston, TX, USA; Department of Neurology (G.Z.), University of Arizona, Tucson, AZ, USA; Department of Radiology and Imaging Sciences (J.W.A.), Indiana University, Indianapolis, IN, USA; Department of Radiology (D.P.B.), Duke University, Durham, NC, USA; Department of Radiological Sciences (P.C.), University of California, Irvine, Irvine, CA, USA; Department of Radiology (C.G.F.), Tufts University, Boston, MA, USA; Department of Radiology (A.E.F.), Thomas Jefferson University, Philadelphia, PA, USA; Department of Radiology (R.G.), University of Alabama at Birmingham, Birmingham, AL, USA; Department of Radiology & Biomedical Imaging (C.H.), University of California, San Francisco, San Francisco, CA, USA; Department of Radiology (K.H., Y.W.L.), New York University, New York, NY, USA; Department of Radiology (J.A.M., S.S.N.), University of Texas Southwestern, Dallas, TX, USA; Department of Clinical Neurosciences (P.M.), Lausanne University Hospital, Lausanne, Switzerland; Department of Radiology (V.P.), Mayo Clinic, Jacksonville, FL, USA; Department of Diagnostic Radiology and Nuclear Medicine (P.R.), University of Maryland, Baltimore, MD, USA; The Russell H. Morgan Department of Radiology and Radiological Sciences (H.I.S.), Johns Hopkins University, Baltimore, MD, USA; Department of Radiology (J.T.), University of Colorado, Aurora, CO, USA; Department of Radiology (K.W.), Mayo Clinic, Rochester, MN, USA; Department of Radiology (C.W.), Wake Forest University, Winston-Salem, NC, USA
| | - Victoria Ding
- From the Department of Radiology (B.J., C.C., R.C., A.C., D.D., S.H., G.Z.), and Department of Medicine (D.B., V.D.), Stanford University, Stanford, CA, USA; Department of Neuroradiology (B.B.O., H.C., M.W.), MD Anderson Cancer Center, Houston, TX, USA; Department of Neurology (G.Z.), University of Arizona, Tucson, AZ, USA; Department of Radiology and Imaging Sciences (J.W.A.), Indiana University, Indianapolis, IN, USA; Department of Radiology (D.P.B.), Duke University, Durham, NC, USA; Department of Radiological Sciences (P.C.), University of California, Irvine, Irvine, CA, USA; Department of Radiology (C.G.F.), Tufts University, Boston, MA, USA; Department of Radiology (A.E.F.), Thomas Jefferson University, Philadelphia, PA, USA; Department of Radiology (R.G.), University of Alabama at Birmingham, Birmingham, AL, USA; Department of Radiology & Biomedical Imaging (C.H.), University of California, San Francisco, San Francisco, CA, USA; Department of Radiology (K.H., Y.W.L.), New York University, New York, NY, USA; Department of Radiology (J.A.M., S.S.N.), University of Texas Southwestern, Dallas, TX, USA; Department of Clinical Neurosciences (P.M.), Lausanne University Hospital, Lausanne, Switzerland; Department of Radiology (V.P.), Mayo Clinic, Jacksonville, FL, USA; Department of Diagnostic Radiology and Nuclear Medicine (P.R.), University of Maryland, Baltimore, MD, USA; The Russell H. Morgan Department of Radiology and Radiological Sciences (H.I.S.), Johns Hopkins University, Baltimore, MD, USA; Department of Radiology (J.T.), University of Colorado, Aurora, CO, USA; Department of Radiology (K.W.), Mayo Clinic, Rochester, MN, USA; Department of Radiology (C.W.), Wake Forest University, Winston-Salem, NC, USA
| | - David Douglas
- From the Department of Radiology (B.J., C.C., R.C., A.C., D.D., S.H., G.Z.), and Department of Medicine (D.B., V.D.), Stanford University, Stanford, CA, USA; Department of Neuroradiology (B.B.O., H.C., M.W.), MD Anderson Cancer Center, Houston, TX, USA; Department of Neurology (G.Z.), University of Arizona, Tucson, AZ, USA; Department of Radiology and Imaging Sciences (J.W.A.), Indiana University, Indianapolis, IN, USA; Department of Radiology (D.P.B.), Duke University, Durham, NC, USA; Department of Radiological Sciences (P.C.), University of California, Irvine, Irvine, CA, USA; Department of Radiology (C.G.F.), Tufts University, Boston, MA, USA; Department of Radiology (A.E.F.), Thomas Jefferson University, Philadelphia, PA, USA; Department of Radiology (R.G.), University of Alabama at Birmingham, Birmingham, AL, USA; Department of Radiology & Biomedical Imaging (C.H.), University of California, San Francisco, San Francisco, CA, USA; Department of Radiology (K.H., Y.W.L.), New York University, New York, NY, USA; Department of Radiology (J.A.M., S.S.N.), University of Texas Southwestern, Dallas, TX, USA; Department of Clinical Neurosciences (P.M.), Lausanne University Hospital, Lausanne, Switzerland; Department of Radiology (V.P.), Mayo Clinic, Jacksonville, FL, USA; Department of Diagnostic Radiology and Nuclear Medicine (P.R.), University of Maryland, Baltimore, MD, USA; The Russell H. Morgan Department of Radiology and Radiological Sciences (H.I.S.), Johns Hopkins University, Baltimore, MD, USA; Department of Radiology (J.T.), University of Colorado, Aurora, CO, USA; Department of Radiology (K.W.), Mayo Clinic, Rochester, MN, USA; Department of Radiology (C.W.), Wake Forest University, Winston-Salem, NC, USA
| | - Christopher G Filippi
- From the Department of Radiology (B.J., C.C., R.C., A.C., D.D., S.H., G.Z.), and Department of Medicine (D.B., V.D.), Stanford University, Stanford, CA, USA; Department of Neuroradiology (B.B.O., H.C., M.W.), MD Anderson Cancer Center, Houston, TX, USA; Department of Neurology (G.Z.), University of Arizona, Tucson, AZ, USA; Department of Radiology and Imaging Sciences (J.W.A.), Indiana University, Indianapolis, IN, USA; Department of Radiology (D.P.B.), Duke University, Durham, NC, USA; Department of Radiological Sciences (P.C.), University of California, Irvine, Irvine, CA, USA; Department of Radiology (C.G.F.), Tufts University, Boston, MA, USA; Department of Radiology (A.E.F.), Thomas Jefferson University, Philadelphia, PA, USA; Department of Radiology (R.G.), University of Alabama at Birmingham, Birmingham, AL, USA; Department of Radiology & Biomedical Imaging (C.H.), University of California, San Francisco, San Francisco, CA, USA; Department of Radiology (K.H., Y.W.L.), New York University, New York, NY, USA; Department of Radiology (J.A.M., S.S.N.), University of Texas Southwestern, Dallas, TX, USA; Department of Clinical Neurosciences (P.M.), Lausanne University Hospital, Lausanne, Switzerland; Department of Radiology (V.P.), Mayo Clinic, Jacksonville, FL, USA; Department of Diagnostic Radiology and Nuclear Medicine (P.R.), University of Maryland, Baltimore, MD, USA; The Russell H. Morgan Department of Radiology and Radiological Sciences (H.I.S.), Johns Hopkins University, Baltimore, MD, USA; Department of Radiology (J.T.), University of Colorado, Aurora, CO, USA; Department of Radiology (K.W.), Mayo Clinic, Rochester, MN, USA; Department of Radiology (C.W.), Wake Forest University, Winston-Salem, NC, USA
| | - Adam E Flanders
- From the Department of Radiology (B.J., C.C., R.C., A.C., D.D., S.H., G.Z.), and Department of Medicine (D.B., V.D.), Stanford University, Stanford, CA, USA; Department of Neuroradiology (B.B.O., H.C., M.W.), MD Anderson Cancer Center, Houston, TX, USA; Department of Neurology (G.Z.), University of Arizona, Tucson, AZ, USA; Department of Radiology and Imaging Sciences (J.W.A.), Indiana University, Indianapolis, IN, USA; Department of Radiology (D.P.B.), Duke University, Durham, NC, USA; Department of Radiological Sciences (P.C.), University of California, Irvine, Irvine, CA, USA; Department of Radiology (C.G.F.), Tufts University, Boston, MA, USA; Department of Radiology (A.E.F.), Thomas Jefferson University, Philadelphia, PA, USA; Department of Radiology (R.G.), University of Alabama at Birmingham, Birmingham, AL, USA; Department of Radiology & Biomedical Imaging (C.H.), University of California, San Francisco, San Francisco, CA, USA; Department of Radiology (K.H., Y.W.L.), New York University, New York, NY, USA; Department of Radiology (J.A.M., S.S.N.), University of Texas Southwestern, Dallas, TX, USA; Department of Clinical Neurosciences (P.M.), Lausanne University Hospital, Lausanne, Switzerland; Department of Radiology (V.P.), Mayo Clinic, Jacksonville, FL, USA; Department of Diagnostic Radiology and Nuclear Medicine (P.R.), University of Maryland, Baltimore, MD, USA; The Russell H. Morgan Department of Radiology and Radiological Sciences (H.I.S.), Johns Hopkins University, Baltimore, MD, USA; Department of Radiology (J.T.), University of Colorado, Aurora, CO, USA; Department of Radiology (K.W.), Mayo Clinic, Rochester, MN, USA; Department of Radiology (C.W.), Wake Forest University, Winston-Salem, NC, USA
| | - Ryan Godwin
- From the Department of Radiology (B.J., C.C., R.C., A.C., D.D., S.H., G.Z.), and Department of Medicine (D.B., V.D.), Stanford University, Stanford, CA, USA; Department of Neuroradiology (B.B.O., H.C., M.W.), MD Anderson Cancer Center, Houston, TX, USA; Department of Neurology (G.Z.), University of Arizona, Tucson, AZ, USA; Department of Radiology and Imaging Sciences (J.W.A.), Indiana University, Indianapolis, IN, USA; Department of Radiology (D.P.B.), Duke University, Durham, NC, USA; Department of Radiological Sciences (P.C.), University of California, Irvine, Irvine, CA, USA; Department of Radiology (C.G.F.), Tufts University, Boston, MA, USA; Department of Radiology (A.E.F.), Thomas Jefferson University, Philadelphia, PA, USA; Department of Radiology (R.G.), University of Alabama at Birmingham, Birmingham, AL, USA; Department of Radiology & Biomedical Imaging (C.H.), University of California, San Francisco, San Francisco, CA, USA; Department of Radiology (K.H., Y.W.L.), New York University, New York, NY, USA; Department of Radiology (J.A.M., S.S.N.), University of Texas Southwestern, Dallas, TX, USA; Department of Clinical Neurosciences (P.M.), Lausanne University Hospital, Lausanne, Switzerland; Department of Radiology (V.P.), Mayo Clinic, Jacksonville, FL, USA; Department of Diagnostic Radiology and Nuclear Medicine (P.R.), University of Maryland, Baltimore, MD, USA; The Russell H. Morgan Department of Radiology and Radiological Sciences (H.I.S.), Johns Hopkins University, Baltimore, MD, USA; Department of Radiology (J.T.), University of Colorado, Aurora, CO, USA; Department of Radiology (K.W.), Mayo Clinic, Rochester, MN, USA; Department of Radiology (C.W.), Wake Forest University, Winston-Salem, NC, USA
| | - Syed Hashmi
- From the Department of Radiology (B.J., C.C., R.C., A.C., D.D., S.H., G.Z.), and Department of Medicine (D.B., V.D.), Stanford University, Stanford, CA, USA; Department of Neuroradiology (B.B.O., H.C., M.W.), MD Anderson Cancer Center, Houston, TX, USA; Department of Neurology (G.Z.), University of Arizona, Tucson, AZ, USA; Department of Radiology and Imaging Sciences (J.W.A.), Indiana University, Indianapolis, IN, USA; Department of Radiology (D.P.B.), Duke University, Durham, NC, USA; Department of Radiological Sciences (P.C.), University of California, Irvine, Irvine, CA, USA; Department of Radiology (C.G.F.), Tufts University, Boston, MA, USA; Department of Radiology (A.E.F.), Thomas Jefferson University, Philadelphia, PA, USA; Department of Radiology (R.G.), University of Alabama at Birmingham, Birmingham, AL, USA; Department of Radiology & Biomedical Imaging (C.H.), University of California, San Francisco, San Francisco, CA, USA; Department of Radiology (K.H., Y.W.L.), New York University, New York, NY, USA; Department of Radiology (J.A.M., S.S.N.), University of Texas Southwestern, Dallas, TX, USA; Department of Clinical Neurosciences (P.M.), Lausanne University Hospital, Lausanne, Switzerland; Department of Radiology (V.P.), Mayo Clinic, Jacksonville, FL, USA; Department of Diagnostic Radiology and Nuclear Medicine (P.R.), University of Maryland, Baltimore, MD, USA; The Russell H. Morgan Department of Radiology and Radiological Sciences (H.I.S.), Johns Hopkins University, Baltimore, MD, USA; Department of Radiology (J.T.), University of Colorado, Aurora, CO, USA; Department of Radiology (K.W.), Mayo Clinic, Rochester, MN, USA; Department of Radiology (C.W.), Wake Forest University, Winston-Salem, NC, USA
| | - Christopher Hess
- From the Department of Radiology (B.J., C.C., R.C., A.C., D.D., S.H., G.Z.), and Department of Medicine (D.B., V.D.), Stanford University, Stanford, CA, USA; Department of Neuroradiology (B.B.O., H.C., M.W.), MD Anderson Cancer Center, Houston, TX, USA; Department of Neurology (G.Z.), University of Arizona, Tucson, AZ, USA; Department of Radiology and Imaging Sciences (J.W.A.), Indiana University, Indianapolis, IN, USA; Department of Radiology (D.P.B.), Duke University, Durham, NC, USA; Department of Radiological Sciences (P.C.), University of California, Irvine, Irvine, CA, USA; Department of Radiology (C.G.F.), Tufts University, Boston, MA, USA; Department of Radiology (A.E.F.), Thomas Jefferson University, Philadelphia, PA, USA; Department of Radiology (R.G.), University of Alabama at Birmingham, Birmingham, AL, USA; Department of Radiology & Biomedical Imaging (C.H.), University of California, San Francisco, San Francisco, CA, USA; Department of Radiology (K.H., Y.W.L.), New York University, New York, NY, USA; Department of Radiology (J.A.M., S.S.N.), University of Texas Southwestern, Dallas, TX, USA; Department of Clinical Neurosciences (P.M.), Lausanne University Hospital, Lausanne, Switzerland; Department of Radiology (V.P.), Mayo Clinic, Jacksonville, FL, USA; Department of Diagnostic Radiology and Nuclear Medicine (P.R.), University of Maryland, Baltimore, MD, USA; The Russell H. Morgan Department of Radiology and Radiological Sciences (H.I.S.), Johns Hopkins University, Baltimore, MD, USA; Department of Radiology (J.T.), University of Colorado, Aurora, CO, USA; Department of Radiology (K.W.), Mayo Clinic, Rochester, MN, USA; Department of Radiology (C.W.), Wake Forest University, Winston-Salem, NC, USA
| | - Kevin Hsu
- From the Department of Radiology (B.J., C.C., R.C., A.C., D.D., S.H., G.Z.), and Department of Medicine (D.B., V.D.), Stanford University, Stanford, CA, USA; Department of Neuroradiology (B.B.O., H.C., M.W.), MD Anderson Cancer Center, Houston, TX, USA; Department of Neurology (G.Z.), University of Arizona, Tucson, AZ, USA; Department of Radiology and Imaging Sciences (J.W.A.), Indiana University, Indianapolis, IN, USA; Department of Radiology (D.P.B.), Duke University, Durham, NC, USA; Department of Radiological Sciences (P.C.), University of California, Irvine, Irvine, CA, USA; Department of Radiology (C.G.F.), Tufts University, Boston, MA, USA; Department of Radiology (A.E.F.), Thomas Jefferson University, Philadelphia, PA, USA; Department of Radiology (R.G.), University of Alabama at Birmingham, Birmingham, AL, USA; Department of Radiology & Biomedical Imaging (C.H.), University of California, San Francisco, San Francisco, CA, USA; Department of Radiology (K.H., Y.W.L.), New York University, New York, NY, USA; Department of Radiology (J.A.M., S.S.N.), University of Texas Southwestern, Dallas, TX, USA; Department of Clinical Neurosciences (P.M.), Lausanne University Hospital, Lausanne, Switzerland; Department of Radiology (V.P.), Mayo Clinic, Jacksonville, FL, USA; Department of Diagnostic Radiology and Nuclear Medicine (P.R.), University of Maryland, Baltimore, MD, USA; The Russell H. Morgan Department of Radiology and Radiological Sciences (H.I.S.), Johns Hopkins University, Baltimore, MD, USA; Department of Radiology (J.T.), University of Colorado, Aurora, CO, USA; Department of Radiology (K.W.), Mayo Clinic, Rochester, MN, USA; Department of Radiology (C.W.), Wake Forest University, Winston-Salem, NC, USA
| | - Yvonne W Lui
- From the Department of Radiology (B.J., C.C., R.C., A.C., D.D., S.H., G.Z.), and Department of Medicine (D.B., V.D.), Stanford University, Stanford, CA, USA; Department of Neuroradiology (B.B.O., H.C., M.W.), MD Anderson Cancer Center, Houston, TX, USA; Department of Neurology (G.Z.), University of Arizona, Tucson, AZ, USA; Department of Radiology and Imaging Sciences (J.W.A.), Indiana University, Indianapolis, IN, USA; Department of Radiology (D.P.B.), Duke University, Durham, NC, USA; Department of Radiological Sciences (P.C.), University of California, Irvine, Irvine, CA, USA; Department of Radiology (C.G.F.), Tufts University, Boston, MA, USA; Department of Radiology (A.E.F.), Thomas Jefferson University, Philadelphia, PA, USA; Department of Radiology (R.G.), University of Alabama at Birmingham, Birmingham, AL, USA; Department of Radiology & Biomedical Imaging (C.H.), University of California, San Francisco, San Francisco, CA, USA; Department of Radiology (K.H., Y.W.L.), New York University, New York, NY, USA; Department of Radiology (J.A.M., S.S.N.), University of Texas Southwestern, Dallas, TX, USA; Department of Clinical Neurosciences (P.M.), Lausanne University Hospital, Lausanne, Switzerland; Department of Radiology (V.P.), Mayo Clinic, Jacksonville, FL, USA; Department of Diagnostic Radiology and Nuclear Medicine (P.R.), University of Maryland, Baltimore, MD, USA; The Russell H. Morgan Department of Radiology and Radiological Sciences (H.I.S.), Johns Hopkins University, Baltimore, MD, USA; Department of Radiology (J.T.), University of Colorado, Aurora, CO, USA; Department of Radiology (K.W.), Mayo Clinic, Rochester, MN, USA; Department of Radiology (C.W.), Wake Forest University, Winston-Salem, NC, USA
| | - Joseph A Maldjian
- From the Department of Radiology (B.J., C.C., R.C., A.C., D.D., S.H., G.Z.), and Department of Medicine (D.B., V.D.), Stanford University, Stanford, CA, USA; Department of Neuroradiology (B.B.O., H.C., M.W.), MD Anderson Cancer Center, Houston, TX, USA; Department of Neurology (G.Z.), University of Arizona, Tucson, AZ, USA; Department of Radiology and Imaging Sciences (J.W.A.), Indiana University, Indianapolis, IN, USA; Department of Radiology (D.P.B.), Duke University, Durham, NC, USA; Department of Radiological Sciences (P.C.), University of California, Irvine, Irvine, CA, USA; Department of Radiology (C.G.F.), Tufts University, Boston, MA, USA; Department of Radiology (A.E.F.), Thomas Jefferson University, Philadelphia, PA, USA; Department of Radiology (R.G.), University of Alabama at Birmingham, Birmingham, AL, USA; Department of Radiology & Biomedical Imaging (C.H.), University of California, San Francisco, San Francisco, CA, USA; Department of Radiology (K.H., Y.W.L.), New York University, New York, NY, USA; Department of Radiology (J.A.M., S.S.N.), University of Texas Southwestern, Dallas, TX, USA; Department of Clinical Neurosciences (P.M.), Lausanne University Hospital, Lausanne, Switzerland; Department of Radiology (V.P.), Mayo Clinic, Jacksonville, FL, USA; Department of Diagnostic Radiology and Nuclear Medicine (P.R.), University of Maryland, Baltimore, MD, USA; The Russell H. Morgan Department of Radiology and Radiological Sciences (H.I.S.), Johns Hopkins University, Baltimore, MD, USA; Department of Radiology (J.T.), University of Colorado, Aurora, CO, USA; Department of Radiology (K.W.), Mayo Clinic, Rochester, MN, USA; Department of Radiology (C.W.), Wake Forest University, Winston-Salem, NC, USA
| | - Patrik Michel
- From the Department of Radiology (B.J., C.C., R.C., A.C., D.D., S.H., G.Z.), and Department of Medicine (D.B., V.D.), Stanford University, Stanford, CA, USA; Department of Neuroradiology (B.B.O., H.C., M.W.), MD Anderson Cancer Center, Houston, TX, USA; Department of Neurology (G.Z.), University of Arizona, Tucson, AZ, USA; Department of Radiology and Imaging Sciences (J.W.A.), Indiana University, Indianapolis, IN, USA; Department of Radiology (D.P.B.), Duke University, Durham, NC, USA; Department of Radiological Sciences (P.C.), University of California, Irvine, Irvine, CA, USA; Department of Radiology (C.G.F.), Tufts University, Boston, MA, USA; Department of Radiology (A.E.F.), Thomas Jefferson University, Philadelphia, PA, USA; Department of Radiology (R.G.), University of Alabama at Birmingham, Birmingham, AL, USA; Department of Radiology & Biomedical Imaging (C.H.), University of California, San Francisco, San Francisco, CA, USA; Department of Radiology (K.H., Y.W.L.), New York University, New York, NY, USA; Department of Radiology (J.A.M., S.S.N.), University of Texas Southwestern, Dallas, TX, USA; Department of Clinical Neurosciences (P.M.), Lausanne University Hospital, Lausanne, Switzerland; Department of Radiology (V.P.), Mayo Clinic, Jacksonville, FL, USA; Department of Diagnostic Radiology and Nuclear Medicine (P.R.), University of Maryland, Baltimore, MD, USA; The Russell H. Morgan Department of Radiology and Radiological Sciences (H.I.S.), Johns Hopkins University, Baltimore, MD, USA; Department of Radiology (J.T.), University of Colorado, Aurora, CO, USA; Department of Radiology (K.W.), Mayo Clinic, Rochester, MN, USA; Department of Radiology (C.W.), Wake Forest University, Winston-Salem, NC, USA
| | - Sahil S Nalawade
- From the Department of Radiology (B.J., C.C., R.C., A.C., D.D., S.H., G.Z.), and Department of Medicine (D.B., V.D.), Stanford University, Stanford, CA, USA; Department of Neuroradiology (B.B.O., H.C., M.W.), MD Anderson Cancer Center, Houston, TX, USA; Department of Neurology (G.Z.), University of Arizona, Tucson, AZ, USA; Department of Radiology and Imaging Sciences (J.W.A.), Indiana University, Indianapolis, IN, USA; Department of Radiology (D.P.B.), Duke University, Durham, NC, USA; Department of Radiological Sciences (P.C.), University of California, Irvine, Irvine, CA, USA; Department of Radiology (C.G.F.), Tufts University, Boston, MA, USA; Department of Radiology (A.E.F.), Thomas Jefferson University, Philadelphia, PA, USA; Department of Radiology (R.G.), University of Alabama at Birmingham, Birmingham, AL, USA; Department of Radiology & Biomedical Imaging (C.H.), University of California, San Francisco, San Francisco, CA, USA; Department of Radiology (K.H., Y.W.L.), New York University, New York, NY, USA; Department of Radiology (J.A.M., S.S.N.), University of Texas Southwestern, Dallas, TX, USA; Department of Clinical Neurosciences (P.M.), Lausanne University Hospital, Lausanne, Switzerland; Department of Radiology (V.P.), Mayo Clinic, Jacksonville, FL, USA; Department of Diagnostic Radiology and Nuclear Medicine (P.R.), University of Maryland, Baltimore, MD, USA; The Russell H. Morgan Department of Radiology and Radiological Sciences (H.I.S.), Johns Hopkins University, Baltimore, MD, USA; Department of Radiology (J.T.), University of Colorado, Aurora, CO, USA; Department of Radiology (K.W.), Mayo Clinic, Rochester, MN, USA; Department of Radiology (C.W.), Wake Forest University, Winston-Salem, NC, USA
| | - Vishal Patel
- From the Department of Radiology (B.J., C.C., R.C., A.C., D.D., S.H., G.Z.), and Department of Medicine (D.B., V.D.), Stanford University, Stanford, CA, USA; Department of Neuroradiology (B.B.O., H.C., M.W.), MD Anderson Cancer Center, Houston, TX, USA; Department of Neurology (G.Z.), University of Arizona, Tucson, AZ, USA; Department of Radiology and Imaging Sciences (J.W.A.), Indiana University, Indianapolis, IN, USA; Department of Radiology (D.P.B.), Duke University, Durham, NC, USA; Department of Radiological Sciences (P.C.), University of California, Irvine, Irvine, CA, USA; Department of Radiology (C.G.F.), Tufts University, Boston, MA, USA; Department of Radiology (A.E.F.), Thomas Jefferson University, Philadelphia, PA, USA; Department of Radiology (R.G.), University of Alabama at Birmingham, Birmingham, AL, USA; Department of Radiology & Biomedical Imaging (C.H.), University of California, San Francisco, San Francisco, CA, USA; Department of Radiology (K.H., Y.W.L.), New York University, New York, NY, USA; Department of Radiology (J.A.M., S.S.N.), University of Texas Southwestern, Dallas, TX, USA; Department of Clinical Neurosciences (P.M.), Lausanne University Hospital, Lausanne, Switzerland; Department of Radiology (V.P.), Mayo Clinic, Jacksonville, FL, USA; Department of Diagnostic Radiology and Nuclear Medicine (P.R.), University of Maryland, Baltimore, MD, USA; The Russell H. Morgan Department of Radiology and Radiological Sciences (H.I.S.), Johns Hopkins University, Baltimore, MD, USA; Department of Radiology (J.T.), University of Colorado, Aurora, CO, USA; Department of Radiology (K.W.), Mayo Clinic, Rochester, MN, USA; Department of Radiology (C.W.), Wake Forest University, Winston-Salem, NC, USA
| | - Prashant Raghavan
- From the Department of Radiology (B.J., C.C., R.C., A.C., D.D., S.H., G.Z.), and Department of Medicine (D.B., V.D.), Stanford University, Stanford, CA, USA; Department of Neuroradiology (B.B.O., H.C., M.W.), MD Anderson Cancer Center, Houston, TX, USA; Department of Neurology (G.Z.), University of Arizona, Tucson, AZ, USA; Department of Radiology and Imaging Sciences (J.W.A.), Indiana University, Indianapolis, IN, USA; Department of Radiology (D.P.B.), Duke University, Durham, NC, USA; Department of Radiological Sciences (P.C.), University of California, Irvine, Irvine, CA, USA; Department of Radiology (C.G.F.), Tufts University, Boston, MA, USA; Department of Radiology (A.E.F.), Thomas Jefferson University, Philadelphia, PA, USA; Department of Radiology (R.G.), University of Alabama at Birmingham, Birmingham, AL, USA; Department of Radiology & Biomedical Imaging (C.H.), University of California, San Francisco, San Francisco, CA, USA; Department of Radiology (K.H., Y.W.L.), New York University, New York, NY, USA; Department of Radiology (J.A.M., S.S.N.), University of Texas Southwestern, Dallas, TX, USA; Department of Clinical Neurosciences (P.M.), Lausanne University Hospital, Lausanne, Switzerland; Department of Radiology (V.P.), Mayo Clinic, Jacksonville, FL, USA; Department of Diagnostic Radiology and Nuclear Medicine (P.R.), University of Maryland, Baltimore, MD, USA; The Russell H. Morgan Department of Radiology and Radiological Sciences (H.I.S.), Johns Hopkins University, Baltimore, MD, USA; Department of Radiology (J.T.), University of Colorado, Aurora, CO, USA; Department of Radiology (K.W.), Mayo Clinic, Rochester, MN, USA; Department of Radiology (C.W.), Wake Forest University, Winston-Salem, NC, USA
| | - Haris I Sair
- From the Department of Radiology (B.J., C.C., R.C., A.C., D.D., S.H., G.Z.), and Department of Medicine (D.B., V.D.), Stanford University, Stanford, CA, USA; Department of Neuroradiology (B.B.O., H.C., M.W.), MD Anderson Cancer Center, Houston, TX, USA; Department of Neurology (G.Z.), University of Arizona, Tucson, AZ, USA; Department of Radiology and Imaging Sciences (J.W.A.), Indiana University, Indianapolis, IN, USA; Department of Radiology (D.P.B.), Duke University, Durham, NC, USA; Department of Radiological Sciences (P.C.), University of California, Irvine, Irvine, CA, USA; Department of Radiology (C.G.F.), Tufts University, Boston, MA, USA; Department of Radiology (A.E.F.), Thomas Jefferson University, Philadelphia, PA, USA; Department of Radiology (R.G.), University of Alabama at Birmingham, Birmingham, AL, USA; Department of Radiology & Biomedical Imaging (C.H.), University of California, San Francisco, San Francisco, CA, USA; Department of Radiology (K.H., Y.W.L.), New York University, New York, NY, USA; Department of Radiology (J.A.M., S.S.N.), University of Texas Southwestern, Dallas, TX, USA; Department of Clinical Neurosciences (P.M.), Lausanne University Hospital, Lausanne, Switzerland; Department of Radiology (V.P.), Mayo Clinic, Jacksonville, FL, USA; Department of Diagnostic Radiology and Nuclear Medicine (P.R.), University of Maryland, Baltimore, MD, USA; The Russell H. Morgan Department of Radiology and Radiological Sciences (H.I.S.), Johns Hopkins University, Baltimore, MD, USA; Department of Radiology (J.T.), University of Colorado, Aurora, CO, USA; Department of Radiology (K.W.), Mayo Clinic, Rochester, MN, USA; Department of Radiology (C.W.), Wake Forest University, Winston-Salem, NC, USA
| | - Jody Tanabe
- From the Department of Radiology (B.J., C.C., R.C., A.C., D.D., S.H., G.Z.), and Department of Medicine (D.B., V.D.), Stanford University, Stanford, CA, USA; Department of Neuroradiology (B.B.O., H.C., M.W.), MD Anderson Cancer Center, Houston, TX, USA; Department of Neurology (G.Z.), University of Arizona, Tucson, AZ, USA; Department of Radiology and Imaging Sciences (J.W.A.), Indiana University, Indianapolis, IN, USA; Department of Radiology (D.P.B.), Duke University, Durham, NC, USA; Department of Radiological Sciences (P.C.), University of California, Irvine, Irvine, CA, USA; Department of Radiology (C.G.F.), Tufts University, Boston, MA, USA; Department of Radiology (A.E.F.), Thomas Jefferson University, Philadelphia, PA, USA; Department of Radiology (R.G.), University of Alabama at Birmingham, Birmingham, AL, USA; Department of Radiology & Biomedical Imaging (C.H.), University of California, San Francisco, San Francisco, CA, USA; Department of Radiology (K.H., Y.W.L.), New York University, New York, NY, USA; Department of Radiology (J.A.M., S.S.N.), University of Texas Southwestern, Dallas, TX, USA; Department of Clinical Neurosciences (P.M.), Lausanne University Hospital, Lausanne, Switzerland; Department of Radiology (V.P.), Mayo Clinic, Jacksonville, FL, USA; Department of Diagnostic Radiology and Nuclear Medicine (P.R.), University of Maryland, Baltimore, MD, USA; The Russell H. Morgan Department of Radiology and Radiological Sciences (H.I.S.), Johns Hopkins University, Baltimore, MD, USA; Department of Radiology (J.T.), University of Colorado, Aurora, CO, USA; Department of Radiology (K.W.), Mayo Clinic, Rochester, MN, USA; Department of Radiology (C.W.), Wake Forest University, Winston-Salem, NC, USA
| | - Kirk Welker
- From the Department of Radiology (B.J., C.C., R.C., A.C., D.D., S.H., G.Z.), and Department of Medicine (D.B., V.D.), Stanford University, Stanford, CA, USA; Department of Neuroradiology (B.B.O., H.C., M.W.), MD Anderson Cancer Center, Houston, TX, USA; Department of Neurology (G.Z.), University of Arizona, Tucson, AZ, USA; Department of Radiology and Imaging Sciences (J.W.A.), Indiana University, Indianapolis, IN, USA; Department of Radiology (D.P.B.), Duke University, Durham, NC, USA; Department of Radiological Sciences (P.C.), University of California, Irvine, Irvine, CA, USA; Department of Radiology (C.G.F.), Tufts University, Boston, MA, USA; Department of Radiology (A.E.F.), Thomas Jefferson University, Philadelphia, PA, USA; Department of Radiology (R.G.), University of Alabama at Birmingham, Birmingham, AL, USA; Department of Radiology & Biomedical Imaging (C.H.), University of California, San Francisco, San Francisco, CA, USA; Department of Radiology (K.H., Y.W.L.), New York University, New York, NY, USA; Department of Radiology (J.A.M., S.S.N.), University of Texas Southwestern, Dallas, TX, USA; Department of Clinical Neurosciences (P.M.), Lausanne University Hospital, Lausanne, Switzerland; Department of Radiology (V.P.), Mayo Clinic, Jacksonville, FL, USA; Department of Diagnostic Radiology and Nuclear Medicine (P.R.), University of Maryland, Baltimore, MD, USA; The Russell H. Morgan Department of Radiology and Radiological Sciences (H.I.S.), Johns Hopkins University, Baltimore, MD, USA; Department of Radiology (J.T.), University of Colorado, Aurora, CO, USA; Department of Radiology (K.W.), Mayo Clinic, Rochester, MN, USA; Department of Radiology (C.W.), Wake Forest University, Winston-Salem, NC, USA
| | - Christopher T Whitlow
- From the Department of Radiology (B.J., C.C., R.C., A.C., D.D., S.H., G.Z.), and Department of Medicine (D.B., V.D.), Stanford University, Stanford, CA, USA; Department of Neuroradiology (B.B.O., H.C., M.W.), MD Anderson Cancer Center, Houston, TX, USA; Department of Neurology (G.Z.), University of Arizona, Tucson, AZ, USA; Department of Radiology and Imaging Sciences (J.W.A.), Indiana University, Indianapolis, IN, USA; Department of Radiology (D.P.B.), Duke University, Durham, NC, USA; Department of Radiological Sciences (P.C.), University of California, Irvine, Irvine, CA, USA; Department of Radiology (C.G.F.), Tufts University, Boston, MA, USA; Department of Radiology (A.E.F.), Thomas Jefferson University, Philadelphia, PA, USA; Department of Radiology (R.G.), University of Alabama at Birmingham, Birmingham, AL, USA; Department of Radiology & Biomedical Imaging (C.H.), University of California, San Francisco, San Francisco, CA, USA; Department of Radiology (K.H., Y.W.L.), New York University, New York, NY, USA; Department of Radiology (J.A.M., S.S.N.), University of Texas Southwestern, Dallas, TX, USA; Department of Clinical Neurosciences (P.M.), Lausanne University Hospital, Lausanne, Switzerland; Department of Radiology (V.P.), Mayo Clinic, Jacksonville, FL, USA; Department of Diagnostic Radiology and Nuclear Medicine (P.R.), University of Maryland, Baltimore, MD, USA; The Russell H. Morgan Department of Radiology and Radiological Sciences (H.I.S.), Johns Hopkins University, Baltimore, MD, USA; Department of Radiology (J.T.), University of Colorado, Aurora, CO, USA; Department of Radiology (K.W.), Mayo Clinic, Rochester, MN, USA; Department of Radiology (C.W.), Wake Forest University, Winston-Salem, NC, USA
| | - Greg Zaharchuk
- From the Department of Radiology (B.J., C.C., R.C., A.C., D.D., S.H., G.Z.), and Department of Medicine (D.B., V.D.), Stanford University, Stanford, CA, USA; Department of Neuroradiology (B.B.O., H.C., M.W.), MD Anderson Cancer Center, Houston, TX, USA; Department of Neurology (G.Z.), University of Arizona, Tucson, AZ, USA; Department of Radiology and Imaging Sciences (J.W.A.), Indiana University, Indianapolis, IN, USA; Department of Radiology (D.P.B.), Duke University, Durham, NC, USA; Department of Radiological Sciences (P.C.), University of California, Irvine, Irvine, CA, USA; Department of Radiology (C.G.F.), Tufts University, Boston, MA, USA; Department of Radiology (A.E.F.), Thomas Jefferson University, Philadelphia, PA, USA; Department of Radiology (R.G.), University of Alabama at Birmingham, Birmingham, AL, USA; Department of Radiology & Biomedical Imaging (C.H.), University of California, San Francisco, San Francisco, CA, USA; Department of Radiology (K.H., Y.W.L.), New York University, New York, NY, USA; Department of Radiology (J.A.M., S.S.N.), University of Texas Southwestern, Dallas, TX, USA; Department of Clinical Neurosciences (P.M.), Lausanne University Hospital, Lausanne, Switzerland; Department of Radiology (V.P.), Mayo Clinic, Jacksonville, FL, USA; Department of Diagnostic Radiology and Nuclear Medicine (P.R.), University of Maryland, Baltimore, MD, USA; The Russell H. Morgan Department of Radiology and Radiological Sciences (H.I.S.), Johns Hopkins University, Baltimore, MD, USA; Department of Radiology (J.T.), University of Colorado, Aurora, CO, USA; Department of Radiology (K.W.), Mayo Clinic, Rochester, MN, USA; Department of Radiology (C.W.), Wake Forest University, Winston-Salem, NC, USA
| | - Max Wintermark
- From the Department of Radiology (B.J., C.C., R.C., A.C., D.D., S.H., G.Z.), and Department of Medicine (D.B., V.D.), Stanford University, Stanford, CA, USA; Department of Neuroradiology (B.B.O., H.C., M.W.), MD Anderson Cancer Center, Houston, TX, USA; Department of Neurology (G.Z.), University of Arizona, Tucson, AZ, USA; Department of Radiology and Imaging Sciences (J.W.A.), Indiana University, Indianapolis, IN, USA; Department of Radiology (D.P.B.), Duke University, Durham, NC, USA; Department of Radiological Sciences (P.C.), University of California, Irvine, Irvine, CA, USA; Department of Radiology (C.G.F.), Tufts University, Boston, MA, USA; Department of Radiology (A.E.F.), Thomas Jefferson University, Philadelphia, PA, USA; Department of Radiology (R.G.), University of Alabama at Birmingham, Birmingham, AL, USA; Department of Radiology & Biomedical Imaging (C.H.), University of California, San Francisco, San Francisco, CA, USA; Department of Radiology (K.H., Y.W.L.), New York University, New York, NY, USA; Department of Radiology (J.A.M., S.S.N.), University of Texas Southwestern, Dallas, TX, USA; Department of Clinical Neurosciences (P.M.), Lausanne University Hospital, Lausanne, Switzerland; Department of Radiology (V.P.), Mayo Clinic, Jacksonville, FL, USA; Department of Diagnostic Radiology and Nuclear Medicine (P.R.), University of Maryland, Baltimore, MD, USA; The Russell H. Morgan Department of Radiology and Radiological Sciences (H.I.S.), Johns Hopkins University, Baltimore, MD, USA; Department of Radiology (J.T.), University of Colorado, Aurora, CO, USA; Department of Radiology (K.W.), Mayo Clinic, Rochester, MN, USA; Department of Radiology (C.W.), Wake Forest University, Winston-Salem, NC, USA
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3
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El Sayed R, Lucas CJ, Cebull HL, Nahab FB, Haussen DC, Allen JW, Oshinski JN. Subjects with carotid webs demonstrate pro-thrombotic hemodynamics compared to subjects with carotid atherosclerosis. Sci Rep 2024; 14:10092. [PMID: 38698141 PMCID: PMC11066020 DOI: 10.1038/s41598-024-60666-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 04/25/2024] [Indexed: 05/05/2024] Open
Abstract
Carotid artery webs (CaW) are non-atherosclerotic projections into the vascular lumen and have been linked to up to one-third of cryptogenic strokes in younger patients. Determining how CaW affects local hemodynamics is essential for understanding clot formation and stroke risk. Computational fluid dynamics simulations were used to investigate patient-specific hemodynamics in carotid artery bifurcations with CaW, bifurcations with atherosclerotic lesions having a similar degree of lumen narrowing, and with healthy carotid bifurcations. Simulations were conducted using segmented computed tomography angiography geometries with inlet boundary conditions extracted from 2D phase contrast MRI scans. The study included carotid bifurcations with CaW (n = 13), mild atherosclerosis (n = 7), and healthy bifurcation geometries (n = 6). Hemodynamic parameters associated with vascular dysfunction and clot formation, including shear rate, oscillatory shear index (OSI), low velocity, and flow stasis were calculated and compared between the subject groups. Patients with CaW had significantly larger regions containing low shear rate, high OSI, low velocity, and flow stasis in comparison to subjects with mild atherosclerosis or normal bifurcations. These abnormal hemodynamic metrics in patients with CaW are associated with clot formation and vascular dysfunction and suggest that hemodynamic assessment may be a tool to assess stroke risk in these patients.
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Affiliation(s)
- Retta El Sayed
- Department of Biomedical Engineering, Georgia Institute of Technology, Emory University, 1364 Clifton Rd, Atlanta, GA, 30322, USA
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, GA, USA
| | - Carissa J Lucas
- Department of Biomedical Engineering, Georgia Institute of Technology, Emory University, 1364 Clifton Rd, Atlanta, GA, 30322, USA
| | - Hannah L Cebull
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, GA, USA
| | - Fadi B Nahab
- Department of Neurology, Emory University, Atlanta, GA, USA
| | | | - Jason W Allen
- Department of Radiology and Imaging Sciences, Indiana University, Indianapolis, IN, USA
| | - John N Oshinski
- Department of Biomedical Engineering, Georgia Institute of Technology, Emory University, 1364 Clifton Rd, Atlanta, GA, 30322, USA.
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, GA, USA.
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4
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Martinez Luque E, Liu Z, Sung D, Goldberg RM, Agarwal R, Bhattacharya A, Ahmed NS, Allen JW, Fleischer CC. An Update on MR Spectroscopy in Cancer Management: Advances in Instrumentation, Acquisition, and Analysis. Radiol Imaging Cancer 2024; 6:e230101. [PMID: 38578207 DOI: 10.1148/rycan.230101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2024]
Abstract
MR spectroscopy (MRS) is a noninvasive imaging method enabling chemical and molecular profiling of tissues in a localized, multiplexed, and nonionizing manner. As metabolic reprogramming is a hallmark of cancer, MRS provides valuable metabolic and molecular information for cancer diagnosis, prognosis, treatment monitoring, and patient management. This review provides an update on the use of MRS for clinical cancer management. The first section includes an overview of the principles of MRS, current methods, and conventional metabolites of interest. The remainder of the review is focused on three key areas: advances in instrumentation, specifically ultrahigh-field-strength MRI scanners and hybrid systems; emerging methods for acquisition, including deuterium imaging, hyperpolarized carbon 13 MRI and MRS, chemical exchange saturation transfer, diffusion-weighted MRS, MR fingerprinting, and fast acquisition; and analysis aided by artificial intelligence. The review concludes with future recommendations to facilitate routine use of MRS in cancer management. Keywords: MR Spectroscopy, Spectroscopic Imaging, Molecular Imaging in Oncology, Metabolic Reprogramming, Clinical Cancer Management © RSNA, 2024.
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Affiliation(s)
- Eva Martinez Luque
- From the Departments of Radiology and Imaging Sciences (E.M.L., Z.L., D.S., J.W.A., C.C.F.) and Neurology (J.W.A.), Emory University School of Medicine, Atlanta, Ga; Department of Biomedical Engineering (E.M.L., Z.L., D.S., J.W.A., C.C.F.), Georgia Institute of Technology and Emory University, Atlanta, Ga; College of Arts and Sciences, Emory University, Atlanta, Ga (R.M.G.); and College of Business (R.A.) and College of Sciences (A.B., N.S.A.), Georgia Institute of Technology, Atlanta, Georgia
| | - Zexuan Liu
- From the Departments of Radiology and Imaging Sciences (E.M.L., Z.L., D.S., J.W.A., C.C.F.) and Neurology (J.W.A.), Emory University School of Medicine, Atlanta, Ga; Department of Biomedical Engineering (E.M.L., Z.L., D.S., J.W.A., C.C.F.), Georgia Institute of Technology and Emory University, Atlanta, Ga; College of Arts and Sciences, Emory University, Atlanta, Ga (R.M.G.); and College of Business (R.A.) and College of Sciences (A.B., N.S.A.), Georgia Institute of Technology, Atlanta, Georgia
| | - Dongsuk Sung
- From the Departments of Radiology and Imaging Sciences (E.M.L., Z.L., D.S., J.W.A., C.C.F.) and Neurology (J.W.A.), Emory University School of Medicine, Atlanta, Ga; Department of Biomedical Engineering (E.M.L., Z.L., D.S., J.W.A., C.C.F.), Georgia Institute of Technology and Emory University, Atlanta, Ga; College of Arts and Sciences, Emory University, Atlanta, Ga (R.M.G.); and College of Business (R.A.) and College of Sciences (A.B., N.S.A.), Georgia Institute of Technology, Atlanta, Georgia
| | - Rachel M Goldberg
- From the Departments of Radiology and Imaging Sciences (E.M.L., Z.L., D.S., J.W.A., C.C.F.) and Neurology (J.W.A.), Emory University School of Medicine, Atlanta, Ga; Department of Biomedical Engineering (E.M.L., Z.L., D.S., J.W.A., C.C.F.), Georgia Institute of Technology and Emory University, Atlanta, Ga; College of Arts and Sciences, Emory University, Atlanta, Ga (R.M.G.); and College of Business (R.A.) and College of Sciences (A.B., N.S.A.), Georgia Institute of Technology, Atlanta, Georgia
| | - Rishab Agarwal
- From the Departments of Radiology and Imaging Sciences (E.M.L., Z.L., D.S., J.W.A., C.C.F.) and Neurology (J.W.A.), Emory University School of Medicine, Atlanta, Ga; Department of Biomedical Engineering (E.M.L., Z.L., D.S., J.W.A., C.C.F.), Georgia Institute of Technology and Emory University, Atlanta, Ga; College of Arts and Sciences, Emory University, Atlanta, Ga (R.M.G.); and College of Business (R.A.) and College of Sciences (A.B., N.S.A.), Georgia Institute of Technology, Atlanta, Georgia
| | - Aditya Bhattacharya
- From the Departments of Radiology and Imaging Sciences (E.M.L., Z.L., D.S., J.W.A., C.C.F.) and Neurology (J.W.A.), Emory University School of Medicine, Atlanta, Ga; Department of Biomedical Engineering (E.M.L., Z.L., D.S., J.W.A., C.C.F.), Georgia Institute of Technology and Emory University, Atlanta, Ga; College of Arts and Sciences, Emory University, Atlanta, Ga (R.M.G.); and College of Business (R.A.) and College of Sciences (A.B., N.S.A.), Georgia Institute of Technology, Atlanta, Georgia
| | - Nadine S Ahmed
- From the Departments of Radiology and Imaging Sciences (E.M.L., Z.L., D.S., J.W.A., C.C.F.) and Neurology (J.W.A.), Emory University School of Medicine, Atlanta, Ga; Department of Biomedical Engineering (E.M.L., Z.L., D.S., J.W.A., C.C.F.), Georgia Institute of Technology and Emory University, Atlanta, Ga; College of Arts and Sciences, Emory University, Atlanta, Ga (R.M.G.); and College of Business (R.A.) and College of Sciences (A.B., N.S.A.), Georgia Institute of Technology, Atlanta, Georgia
| | - Jason W Allen
- From the Departments of Radiology and Imaging Sciences (E.M.L., Z.L., D.S., J.W.A., C.C.F.) and Neurology (J.W.A.), Emory University School of Medicine, Atlanta, Ga; Department of Biomedical Engineering (E.M.L., Z.L., D.S., J.W.A., C.C.F.), Georgia Institute of Technology and Emory University, Atlanta, Ga; College of Arts and Sciences, Emory University, Atlanta, Ga (R.M.G.); and College of Business (R.A.) and College of Sciences (A.B., N.S.A.), Georgia Institute of Technology, Atlanta, Georgia
| | - Candace C Fleischer
- From the Departments of Radiology and Imaging Sciences (E.M.L., Z.L., D.S., J.W.A., C.C.F.) and Neurology (J.W.A.), Emory University School of Medicine, Atlanta, Ga; Department of Biomedical Engineering (E.M.L., Z.L., D.S., J.W.A., C.C.F.), Georgia Institute of Technology and Emory University, Atlanta, Ga; College of Arts and Sciences, Emory University, Atlanta, Ga (R.M.G.); and College of Business (R.A.) and College of Sciences (A.B., N.S.A.), Georgia Institute of Technology, Atlanta, Georgia
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Wintermark M, Allen JW, Bhala R, Doshi AH, Mukherjee S, Nickerson J, Rykken JB, Shah V, Tanabe J, Kennedy T. Academic Neuroradiology: 2023 Update on Turn-Around Time, Financial Recruitment and Retention Strategies. AJNR Am J Neuroradiol 2024:ajnr.A8321. [PMID: 38684321 DOI: 10.3174/ajnr.a8321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Accepted: 04/17/2024] [Indexed: 05/02/2024]
Abstract
The ASNR Neuroradiology Division Chief Working Group's 2023 survey, with responses from 62 division chiefs, provides insights into turn-around times, faculty recruitment, moonlighting opportunities, and academic funds.In emergency cases, 61% aim for a turn-around time of less than 45-60 minutes, with two-thirds meeting this expectation more than 75% of the time. For inpatient CT and MRI scans, 54% achieve a turn-around time of 4-8 hours, with three quarters meeting this expectation at least 50% of the time. Outpatient scans have an expected turn-around time of 24-48 hours, which is met in 50% of cases.Faculty recruitment strategies included 35% offering sign-on bonuses, with a median of $30,000. Additionally, 23% provided bonuses to fellows during fellowship to retain them in the practice upon completion of their fellowship. Internal moonlighting opportunities for faculty were offered by 70% of divisions, with a median pay of $250 per hour.The median annual academic fund for a full-time neuroradiology faculty member was $6,000, typically excluding license fees but including ACR and ABR membership, leaving $4,000 for professional expenses.This survey calls for further dialogue on adapting and innovating academic institutions to meet evolving needs in neuroradiology.
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Affiliation(s)
- Max Wintermark
- From the Department of Neuroradiology, University of Texas MD Anderson Center, Houston, TX (M.W.), Department of Radiology and Imaging Sciences, Indiana University, Indianapolis, IN (J.W.A.), American Society of Neuroradiology, Oak Brook, IL (R.B.), Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (A.H.D.), Department of Radiology, University of Virginia Health System, Charlottesville, VA (S.M.), Department of Radiology, Oregon Health & Science University, Portland, OR (J.N.), Department of Radiology, University of Minnesota, Minneapolis, MN (J.B.R.), Department of Radiology, University of California San Francisco, San Francisco, CA (V.S.), Department of Radiology, University of Colorado, Denver, CO (J.T.), Department of Radiology, University of Wisconsin-Madison, Madison, WI (T.K.)
| | - Jason W Allen
- From the Department of Neuroradiology, University of Texas MD Anderson Center, Houston, TX (M.W.), Department of Radiology and Imaging Sciences, Indiana University, Indianapolis, IN (J.W.A.), American Society of Neuroradiology, Oak Brook, IL (R.B.), Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (A.H.D.), Department of Radiology, University of Virginia Health System, Charlottesville, VA (S.M.), Department of Radiology, Oregon Health & Science University, Portland, OR (J.N.), Department of Radiology, University of Minnesota, Minneapolis, MN (J.B.R.), Department of Radiology, University of California San Francisco, San Francisco, CA (V.S.), Department of Radiology, University of Colorado, Denver, CO (J.T.), Department of Radiology, University of Wisconsin-Madison, Madison, WI (T.K.)
| | - Rahul Bhala
- From the Department of Neuroradiology, University of Texas MD Anderson Center, Houston, TX (M.W.), Department of Radiology and Imaging Sciences, Indiana University, Indianapolis, IN (J.W.A.), American Society of Neuroradiology, Oak Brook, IL (R.B.), Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (A.H.D.), Department of Radiology, University of Virginia Health System, Charlottesville, VA (S.M.), Department of Radiology, Oregon Health & Science University, Portland, OR (J.N.), Department of Radiology, University of Minnesota, Minneapolis, MN (J.B.R.), Department of Radiology, University of California San Francisco, San Francisco, CA (V.S.), Department of Radiology, University of Colorado, Denver, CO (J.T.), Department of Radiology, University of Wisconsin-Madison, Madison, WI (T.K.)
| | - Amish H Doshi
- From the Department of Neuroradiology, University of Texas MD Anderson Center, Houston, TX (M.W.), Department of Radiology and Imaging Sciences, Indiana University, Indianapolis, IN (J.W.A.), American Society of Neuroradiology, Oak Brook, IL (R.B.), Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (A.H.D.), Department of Radiology, University of Virginia Health System, Charlottesville, VA (S.M.), Department of Radiology, Oregon Health & Science University, Portland, OR (J.N.), Department of Radiology, University of Minnesota, Minneapolis, MN (J.B.R.), Department of Radiology, University of California San Francisco, San Francisco, CA (V.S.), Department of Radiology, University of Colorado, Denver, CO (J.T.), Department of Radiology, University of Wisconsin-Madison, Madison, WI (T.K.)
| | - Sugoto Mukherjee
- From the Department of Neuroradiology, University of Texas MD Anderson Center, Houston, TX (M.W.), Department of Radiology and Imaging Sciences, Indiana University, Indianapolis, IN (J.W.A.), American Society of Neuroradiology, Oak Brook, IL (R.B.), Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (A.H.D.), Department of Radiology, University of Virginia Health System, Charlottesville, VA (S.M.), Department of Radiology, Oregon Health & Science University, Portland, OR (J.N.), Department of Radiology, University of Minnesota, Minneapolis, MN (J.B.R.), Department of Radiology, University of California San Francisco, San Francisco, CA (V.S.), Department of Radiology, University of Colorado, Denver, CO (J.T.), Department of Radiology, University of Wisconsin-Madison, Madison, WI (T.K.)
| | - Joshua Nickerson
- From the Department of Neuroradiology, University of Texas MD Anderson Center, Houston, TX (M.W.), Department of Radiology and Imaging Sciences, Indiana University, Indianapolis, IN (J.W.A.), American Society of Neuroradiology, Oak Brook, IL (R.B.), Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (A.H.D.), Department of Radiology, University of Virginia Health System, Charlottesville, VA (S.M.), Department of Radiology, Oregon Health & Science University, Portland, OR (J.N.), Department of Radiology, University of Minnesota, Minneapolis, MN (J.B.R.), Department of Radiology, University of California San Francisco, San Francisco, CA (V.S.), Department of Radiology, University of Colorado, Denver, CO (J.T.), Department of Radiology, University of Wisconsin-Madison, Madison, WI (T.K.)
| | - Jeffrey B Rykken
- From the Department of Neuroradiology, University of Texas MD Anderson Center, Houston, TX (M.W.), Department of Radiology and Imaging Sciences, Indiana University, Indianapolis, IN (J.W.A.), American Society of Neuroradiology, Oak Brook, IL (R.B.), Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (A.H.D.), Department of Radiology, University of Virginia Health System, Charlottesville, VA (S.M.), Department of Radiology, Oregon Health & Science University, Portland, OR (J.N.), Department of Radiology, University of Minnesota, Minneapolis, MN (J.B.R.), Department of Radiology, University of California San Francisco, San Francisco, CA (V.S.), Department of Radiology, University of Colorado, Denver, CO (J.T.), Department of Radiology, University of Wisconsin-Madison, Madison, WI (T.K.)
| | - Vinil Shah
- From the Department of Neuroradiology, University of Texas MD Anderson Center, Houston, TX (M.W.), Department of Radiology and Imaging Sciences, Indiana University, Indianapolis, IN (J.W.A.), American Society of Neuroradiology, Oak Brook, IL (R.B.), Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (A.H.D.), Department of Radiology, University of Virginia Health System, Charlottesville, VA (S.M.), Department of Radiology, Oregon Health & Science University, Portland, OR (J.N.), Department of Radiology, University of Minnesota, Minneapolis, MN (J.B.R.), Department of Radiology, University of California San Francisco, San Francisco, CA (V.S.), Department of Radiology, University of Colorado, Denver, CO (J.T.), Department of Radiology, University of Wisconsin-Madison, Madison, WI (T.K.)
| | - Jody Tanabe
- From the Department of Neuroradiology, University of Texas MD Anderson Center, Houston, TX (M.W.), Department of Radiology and Imaging Sciences, Indiana University, Indianapolis, IN (J.W.A.), American Society of Neuroradiology, Oak Brook, IL (R.B.), Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (A.H.D.), Department of Radiology, University of Virginia Health System, Charlottesville, VA (S.M.), Department of Radiology, Oregon Health & Science University, Portland, OR (J.N.), Department of Radiology, University of Minnesota, Minneapolis, MN (J.B.R.), Department of Radiology, University of California San Francisco, San Francisco, CA (V.S.), Department of Radiology, University of Colorado, Denver, CO (J.T.), Department of Radiology, University of Wisconsin-Madison, Madison, WI (T.K.)
| | - Tabassum Kennedy
- From the Department of Neuroradiology, University of Texas MD Anderson Center, Houston, TX (M.W.), Department of Radiology and Imaging Sciences, Indiana University, Indianapolis, IN (J.W.A.), American Society of Neuroradiology, Oak Brook, IL (R.B.), Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (A.H.D.), Department of Radiology, University of Virginia Health System, Charlottesville, VA (S.M.), Department of Radiology, Oregon Health & Science University, Portland, OR (J.N.), Department of Radiology, University of Minnesota, Minneapolis, MN (J.B.R.), Department of Radiology, University of California San Francisco, San Francisco, CA (V.S.), Department of Radiology, University of Colorado, Denver, CO (J.T.), Department of Radiology, University of Wisconsin-Madison, Madison, WI (T.K.)
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6
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Pradilla G, Ratcliff JJ, Hall AJ, Saville BR, Allen JW, Paulon G, McGlothlin A, Lewis RJ, Fitzgerald M, Caveney AF, Li XT, Bain M, Gomes J, Jankowitz B, Zenonos G, Molyneaux BJ, Davies J, Siddiqui A, Chicoine MR, Keyrouz SG, Grossberg JA, Shah MV, Singh R, Bohnstedt BN, Frankel M, Wright DW, Barrow DL. Trial of Early Minimally Invasive Removal of Intracerebral Hemorrhage. N Engl J Med 2024; 390:1277-1289. [PMID: 38598795 DOI: 10.1056/nejmoa2308440] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/12/2024]
Abstract
BACKGROUND Trials of surgical evacuation of supratentorial intracerebral hemorrhages have generally shown no functional benefit. Whether early minimally invasive surgical removal would result in better outcomes than medical management is not known. METHODS In this multicenter, randomized trial involving patients with an acute intracerebral hemorrhage, we assessed surgical removal of the hematoma as compared with medical management. Patients who had a lobar or anterior basal ganglia hemorrhage with a hematoma volume of 30 to 80 ml were assigned, in a 1:1 ratio, within 24 hours after the time that they were last known to be well, to minimally invasive surgical removal of the hematoma plus guideline-based medical management (surgery group) or to guideline-based medical management alone (control group). The primary efficacy end point was the mean score on the utility-weighted modified Rankin scale (range, 0 to 1, with higher scores indicating better outcomes, according to patients' assessment) at 180 days, with a prespecified threshold for posterior probability of superiority of 0.975 or higher. The trial included rules for adaptation of enrollment criteria on the basis of hemorrhage location. A primary safety end point was death within 30 days after enrollment. RESULTS A total of 300 patients were enrolled, of whom 30.7% had anterior basal ganglia hemorrhages and 69.3% had lobar hemorrhages. After 175 patients had been enrolled, an adaptation rule was triggered, and only persons with lobar hemorrhages were enrolled. The mean score on the utility-weighted modified Rankin scale at 180 days was 0.458 in the surgery group and 0.374 in the control group (difference, 0.084; 95% Bayesian credible interval, 0.005 to 0.163; posterior probability of superiority of surgery, 0.981). The mean between-group difference was 0.127 (95% Bayesian credible interval, 0.035 to 0.219) among patients with lobar hemorrhages and -0.013 (95% Bayesian credible interval, -0.147 to 0.116) among those with anterior basal ganglia hemorrhages. The percentage of patients who had died by 30 days was 9.3% in the surgery group and 18.0% in the control group. Five patients (3.3%) in the surgery group had postoperative rebleeding and neurologic deterioration. CONCLUSIONS Among patients in whom surgery could be performed within 24 hours after an acute intracerebral hemorrhage, minimally invasive hematoma evacuation resulted in better functional outcomes at 180 days than those with guideline-based medical management. The effect of surgery appeared to be attributable to intervention for lobar hemorrhages. (Funded by Nico; ENRICH ClinicalTrials.gov number, NCT02880878.).
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Affiliation(s)
- Gustavo Pradilla
- From the Departments of Neurosurgery (G. Pradilla, J.A.G., D.L.B.), Emergency Medicine (J.J.R., A.J.H., D.W.W.), Neurology (J.J.R., J.W.A., M. Frankel), and Radiology (J.W.A., X.T.L.), Emory University School of Medicine, and the Marcus Stroke and Neuroscience Center, Grady Memorial Hospital (G. Pradilla, J.J.R., A.J.H., J.A.G., M. Frankel, D.W.W.) - both in Atlanta; Berry Consultants, Austin, TX (B.R.S., G. Paulon, A.M., R.J.L., M. Fitzgerald); the Department of Biostatistics, Vanderbilt University School of Medicine, Nashville (B.R.S.); the Department of Emergency Medicine, Harbor-UCLA Medical Center, Torrance, CA (R.J.L.); the Department of Psychiatry, University of Michigan, Ann Arbor (A.F.C.); the Cerebrovascular Center, Cleveland Clinic, Cleveland (M.B., J.G.); the Department of Neurosurgery, University of Pennsylvania, Philadelphia (B.J.); the Department of Neurological Surgery, University of Pittsburgh, Pittsburgh (G.Z.); the Department of Neurology, Brigham and Women's Hospital, Boston (B.J.M.); the Department of Neurosurgery, State University of New York at Buffalo, Buffalo (J.D., A.S.); the Department of Neurosurgery, University of Missouri, Columbia (M.R.C.), and the Department of Neurology, Washington University, St. Louis (S.G.K.); and the Departments of Neurosurgery (M.V.S., B.N.B.) and Pulmonary and Critical Care Medicine (R.S.), Indiana University, Indianapolis
| | - Jonathan J Ratcliff
- From the Departments of Neurosurgery (G. Pradilla, J.A.G., D.L.B.), Emergency Medicine (J.J.R., A.J.H., D.W.W.), Neurology (J.J.R., J.W.A., M. Frankel), and Radiology (J.W.A., X.T.L.), Emory University School of Medicine, and the Marcus Stroke and Neuroscience Center, Grady Memorial Hospital (G. Pradilla, J.J.R., A.J.H., J.A.G., M. Frankel, D.W.W.) - both in Atlanta; Berry Consultants, Austin, TX (B.R.S., G. Paulon, A.M., R.J.L., M. Fitzgerald); the Department of Biostatistics, Vanderbilt University School of Medicine, Nashville (B.R.S.); the Department of Emergency Medicine, Harbor-UCLA Medical Center, Torrance, CA (R.J.L.); the Department of Psychiatry, University of Michigan, Ann Arbor (A.F.C.); the Cerebrovascular Center, Cleveland Clinic, Cleveland (M.B., J.G.); the Department of Neurosurgery, University of Pennsylvania, Philadelphia (B.J.); the Department of Neurological Surgery, University of Pittsburgh, Pittsburgh (G.Z.); the Department of Neurology, Brigham and Women's Hospital, Boston (B.J.M.); the Department of Neurosurgery, State University of New York at Buffalo, Buffalo (J.D., A.S.); the Department of Neurosurgery, University of Missouri, Columbia (M.R.C.), and the Department of Neurology, Washington University, St. Louis (S.G.K.); and the Departments of Neurosurgery (M.V.S., B.N.B.) and Pulmonary and Critical Care Medicine (R.S.), Indiana University, Indianapolis
| | - Alex J Hall
- From the Departments of Neurosurgery (G. Pradilla, J.A.G., D.L.B.), Emergency Medicine (J.J.R., A.J.H., D.W.W.), Neurology (J.J.R., J.W.A., M. Frankel), and Radiology (J.W.A., X.T.L.), Emory University School of Medicine, and the Marcus Stroke and Neuroscience Center, Grady Memorial Hospital (G. Pradilla, J.J.R., A.J.H., J.A.G., M. Frankel, D.W.W.) - both in Atlanta; Berry Consultants, Austin, TX (B.R.S., G. Paulon, A.M., R.J.L., M. Fitzgerald); the Department of Biostatistics, Vanderbilt University School of Medicine, Nashville (B.R.S.); the Department of Emergency Medicine, Harbor-UCLA Medical Center, Torrance, CA (R.J.L.); the Department of Psychiatry, University of Michigan, Ann Arbor (A.F.C.); the Cerebrovascular Center, Cleveland Clinic, Cleveland (M.B., J.G.); the Department of Neurosurgery, University of Pennsylvania, Philadelphia (B.J.); the Department of Neurological Surgery, University of Pittsburgh, Pittsburgh (G.Z.); the Department of Neurology, Brigham and Women's Hospital, Boston (B.J.M.); the Department of Neurosurgery, State University of New York at Buffalo, Buffalo (J.D., A.S.); the Department of Neurosurgery, University of Missouri, Columbia (M.R.C.), and the Department of Neurology, Washington University, St. Louis (S.G.K.); and the Departments of Neurosurgery (M.V.S., B.N.B.) and Pulmonary and Critical Care Medicine (R.S.), Indiana University, Indianapolis
| | - Benjamin R Saville
- From the Departments of Neurosurgery (G. Pradilla, J.A.G., D.L.B.), Emergency Medicine (J.J.R., A.J.H., D.W.W.), Neurology (J.J.R., J.W.A., M. Frankel), and Radiology (J.W.A., X.T.L.), Emory University School of Medicine, and the Marcus Stroke and Neuroscience Center, Grady Memorial Hospital (G. Pradilla, J.J.R., A.J.H., J.A.G., M. Frankel, D.W.W.) - both in Atlanta; Berry Consultants, Austin, TX (B.R.S., G. Paulon, A.M., R.J.L., M. Fitzgerald); the Department of Biostatistics, Vanderbilt University School of Medicine, Nashville (B.R.S.); the Department of Emergency Medicine, Harbor-UCLA Medical Center, Torrance, CA (R.J.L.); the Department of Psychiatry, University of Michigan, Ann Arbor (A.F.C.); the Cerebrovascular Center, Cleveland Clinic, Cleveland (M.B., J.G.); the Department of Neurosurgery, University of Pennsylvania, Philadelphia (B.J.); the Department of Neurological Surgery, University of Pittsburgh, Pittsburgh (G.Z.); the Department of Neurology, Brigham and Women's Hospital, Boston (B.J.M.); the Department of Neurosurgery, State University of New York at Buffalo, Buffalo (J.D., A.S.); the Department of Neurosurgery, University of Missouri, Columbia (M.R.C.), and the Department of Neurology, Washington University, St. Louis (S.G.K.); and the Departments of Neurosurgery (M.V.S., B.N.B.) and Pulmonary and Critical Care Medicine (R.S.), Indiana University, Indianapolis
| | - Jason W Allen
- From the Departments of Neurosurgery (G. Pradilla, J.A.G., D.L.B.), Emergency Medicine (J.J.R., A.J.H., D.W.W.), Neurology (J.J.R., J.W.A., M. Frankel), and Radiology (J.W.A., X.T.L.), Emory University School of Medicine, and the Marcus Stroke and Neuroscience Center, Grady Memorial Hospital (G. Pradilla, J.J.R., A.J.H., J.A.G., M. Frankel, D.W.W.) - both in Atlanta; Berry Consultants, Austin, TX (B.R.S., G. Paulon, A.M., R.J.L., M. Fitzgerald); the Department of Biostatistics, Vanderbilt University School of Medicine, Nashville (B.R.S.); the Department of Emergency Medicine, Harbor-UCLA Medical Center, Torrance, CA (R.J.L.); the Department of Psychiatry, University of Michigan, Ann Arbor (A.F.C.); the Cerebrovascular Center, Cleveland Clinic, Cleveland (M.B., J.G.); the Department of Neurosurgery, University of Pennsylvania, Philadelphia (B.J.); the Department of Neurological Surgery, University of Pittsburgh, Pittsburgh (G.Z.); the Department of Neurology, Brigham and Women's Hospital, Boston (B.J.M.); the Department of Neurosurgery, State University of New York at Buffalo, Buffalo (J.D., A.S.); the Department of Neurosurgery, University of Missouri, Columbia (M.R.C.), and the Department of Neurology, Washington University, St. Louis (S.G.K.); and the Departments of Neurosurgery (M.V.S., B.N.B.) and Pulmonary and Critical Care Medicine (R.S.), Indiana University, Indianapolis
| | - Giorgio Paulon
- From the Departments of Neurosurgery (G. Pradilla, J.A.G., D.L.B.), Emergency Medicine (J.J.R., A.J.H., D.W.W.), Neurology (J.J.R., J.W.A., M. Frankel), and Radiology (J.W.A., X.T.L.), Emory University School of Medicine, and the Marcus Stroke and Neuroscience Center, Grady Memorial Hospital (G. Pradilla, J.J.R., A.J.H., J.A.G., M. Frankel, D.W.W.) - both in Atlanta; Berry Consultants, Austin, TX (B.R.S., G. Paulon, A.M., R.J.L., M. Fitzgerald); the Department of Biostatistics, Vanderbilt University School of Medicine, Nashville (B.R.S.); the Department of Emergency Medicine, Harbor-UCLA Medical Center, Torrance, CA (R.J.L.); the Department of Psychiatry, University of Michigan, Ann Arbor (A.F.C.); the Cerebrovascular Center, Cleveland Clinic, Cleveland (M.B., J.G.); the Department of Neurosurgery, University of Pennsylvania, Philadelphia (B.J.); the Department of Neurological Surgery, University of Pittsburgh, Pittsburgh (G.Z.); the Department of Neurology, Brigham and Women's Hospital, Boston (B.J.M.); the Department of Neurosurgery, State University of New York at Buffalo, Buffalo (J.D., A.S.); the Department of Neurosurgery, University of Missouri, Columbia (M.R.C.), and the Department of Neurology, Washington University, St. Louis (S.G.K.); and the Departments of Neurosurgery (M.V.S., B.N.B.) and Pulmonary and Critical Care Medicine (R.S.), Indiana University, Indianapolis
| | - Anna McGlothlin
- From the Departments of Neurosurgery (G. Pradilla, J.A.G., D.L.B.), Emergency Medicine (J.J.R., A.J.H., D.W.W.), Neurology (J.J.R., J.W.A., M. Frankel), and Radiology (J.W.A., X.T.L.), Emory University School of Medicine, and the Marcus Stroke and Neuroscience Center, Grady Memorial Hospital (G. Pradilla, J.J.R., A.J.H., J.A.G., M. Frankel, D.W.W.) - both in Atlanta; Berry Consultants, Austin, TX (B.R.S., G. Paulon, A.M., R.J.L., M. Fitzgerald); the Department of Biostatistics, Vanderbilt University School of Medicine, Nashville (B.R.S.); the Department of Emergency Medicine, Harbor-UCLA Medical Center, Torrance, CA (R.J.L.); the Department of Psychiatry, University of Michigan, Ann Arbor (A.F.C.); the Cerebrovascular Center, Cleveland Clinic, Cleveland (M.B., J.G.); the Department of Neurosurgery, University of Pennsylvania, Philadelphia (B.J.); the Department of Neurological Surgery, University of Pittsburgh, Pittsburgh (G.Z.); the Department of Neurology, Brigham and Women's Hospital, Boston (B.J.M.); the Department of Neurosurgery, State University of New York at Buffalo, Buffalo (J.D., A.S.); the Department of Neurosurgery, University of Missouri, Columbia (M.R.C.), and the Department of Neurology, Washington University, St. Louis (S.G.K.); and the Departments of Neurosurgery (M.V.S., B.N.B.) and Pulmonary and Critical Care Medicine (R.S.), Indiana University, Indianapolis
| | - Roger J Lewis
- From the Departments of Neurosurgery (G. Pradilla, J.A.G., D.L.B.), Emergency Medicine (J.J.R., A.J.H., D.W.W.), Neurology (J.J.R., J.W.A., M. Frankel), and Radiology (J.W.A., X.T.L.), Emory University School of Medicine, and the Marcus Stroke and Neuroscience Center, Grady Memorial Hospital (G. Pradilla, J.J.R., A.J.H., J.A.G., M. Frankel, D.W.W.) - both in Atlanta; Berry Consultants, Austin, TX (B.R.S., G. Paulon, A.M., R.J.L., M. Fitzgerald); the Department of Biostatistics, Vanderbilt University School of Medicine, Nashville (B.R.S.); the Department of Emergency Medicine, Harbor-UCLA Medical Center, Torrance, CA (R.J.L.); the Department of Psychiatry, University of Michigan, Ann Arbor (A.F.C.); the Cerebrovascular Center, Cleveland Clinic, Cleveland (M.B., J.G.); the Department of Neurosurgery, University of Pennsylvania, Philadelphia (B.J.); the Department of Neurological Surgery, University of Pittsburgh, Pittsburgh (G.Z.); the Department of Neurology, Brigham and Women's Hospital, Boston (B.J.M.); the Department of Neurosurgery, State University of New York at Buffalo, Buffalo (J.D., A.S.); the Department of Neurosurgery, University of Missouri, Columbia (M.R.C.), and the Department of Neurology, Washington University, St. Louis (S.G.K.); and the Departments of Neurosurgery (M.V.S., B.N.B.) and Pulmonary and Critical Care Medicine (R.S.), Indiana University, Indianapolis
| | - Mark Fitzgerald
- From the Departments of Neurosurgery (G. Pradilla, J.A.G., D.L.B.), Emergency Medicine (J.J.R., A.J.H., D.W.W.), Neurology (J.J.R., J.W.A., M. Frankel), and Radiology (J.W.A., X.T.L.), Emory University School of Medicine, and the Marcus Stroke and Neuroscience Center, Grady Memorial Hospital (G. Pradilla, J.J.R., A.J.H., J.A.G., M. Frankel, D.W.W.) - both in Atlanta; Berry Consultants, Austin, TX (B.R.S., G. Paulon, A.M., R.J.L., M. Fitzgerald); the Department of Biostatistics, Vanderbilt University School of Medicine, Nashville (B.R.S.); the Department of Emergency Medicine, Harbor-UCLA Medical Center, Torrance, CA (R.J.L.); the Department of Psychiatry, University of Michigan, Ann Arbor (A.F.C.); the Cerebrovascular Center, Cleveland Clinic, Cleveland (M.B., J.G.); the Department of Neurosurgery, University of Pennsylvania, Philadelphia (B.J.); the Department of Neurological Surgery, University of Pittsburgh, Pittsburgh (G.Z.); the Department of Neurology, Brigham and Women's Hospital, Boston (B.J.M.); the Department of Neurosurgery, State University of New York at Buffalo, Buffalo (J.D., A.S.); the Department of Neurosurgery, University of Missouri, Columbia (M.R.C.), and the Department of Neurology, Washington University, St. Louis (S.G.K.); and the Departments of Neurosurgery (M.V.S., B.N.B.) and Pulmonary and Critical Care Medicine (R.S.), Indiana University, Indianapolis
| | - Angela F Caveney
- From the Departments of Neurosurgery (G. Pradilla, J.A.G., D.L.B.), Emergency Medicine (J.J.R., A.J.H., D.W.W.), Neurology (J.J.R., J.W.A., M. Frankel), and Radiology (J.W.A., X.T.L.), Emory University School of Medicine, and the Marcus Stroke and Neuroscience Center, Grady Memorial Hospital (G. Pradilla, J.J.R., A.J.H., J.A.G., M. Frankel, D.W.W.) - both in Atlanta; Berry Consultants, Austin, TX (B.R.S., G. Paulon, A.M., R.J.L., M. Fitzgerald); the Department of Biostatistics, Vanderbilt University School of Medicine, Nashville (B.R.S.); the Department of Emergency Medicine, Harbor-UCLA Medical Center, Torrance, CA (R.J.L.); the Department of Psychiatry, University of Michigan, Ann Arbor (A.F.C.); the Cerebrovascular Center, Cleveland Clinic, Cleveland (M.B., J.G.); the Department of Neurosurgery, University of Pennsylvania, Philadelphia (B.J.); the Department of Neurological Surgery, University of Pittsburgh, Pittsburgh (G.Z.); the Department of Neurology, Brigham and Women's Hospital, Boston (B.J.M.); the Department of Neurosurgery, State University of New York at Buffalo, Buffalo (J.D., A.S.); the Department of Neurosurgery, University of Missouri, Columbia (M.R.C.), and the Department of Neurology, Washington University, St. Louis (S.G.K.); and the Departments of Neurosurgery (M.V.S., B.N.B.) and Pulmonary and Critical Care Medicine (R.S.), Indiana University, Indianapolis
| | - Xiao T Li
- From the Departments of Neurosurgery (G. Pradilla, J.A.G., D.L.B.), Emergency Medicine (J.J.R., A.J.H., D.W.W.), Neurology (J.J.R., J.W.A., M. Frankel), and Radiology (J.W.A., X.T.L.), Emory University School of Medicine, and the Marcus Stroke and Neuroscience Center, Grady Memorial Hospital (G. Pradilla, J.J.R., A.J.H., J.A.G., M. Frankel, D.W.W.) - both in Atlanta; Berry Consultants, Austin, TX (B.R.S., G. Paulon, A.M., R.J.L., M. Fitzgerald); the Department of Biostatistics, Vanderbilt University School of Medicine, Nashville (B.R.S.); the Department of Emergency Medicine, Harbor-UCLA Medical Center, Torrance, CA (R.J.L.); the Department of Psychiatry, University of Michigan, Ann Arbor (A.F.C.); the Cerebrovascular Center, Cleveland Clinic, Cleveland (M.B., J.G.); the Department of Neurosurgery, University of Pennsylvania, Philadelphia (B.J.); the Department of Neurological Surgery, University of Pittsburgh, Pittsburgh (G.Z.); the Department of Neurology, Brigham and Women's Hospital, Boston (B.J.M.); the Department of Neurosurgery, State University of New York at Buffalo, Buffalo (J.D., A.S.); the Department of Neurosurgery, University of Missouri, Columbia (M.R.C.), and the Department of Neurology, Washington University, St. Louis (S.G.K.); and the Departments of Neurosurgery (M.V.S., B.N.B.) and Pulmonary and Critical Care Medicine (R.S.), Indiana University, Indianapolis
| | - Mark Bain
- From the Departments of Neurosurgery (G. Pradilla, J.A.G., D.L.B.), Emergency Medicine (J.J.R., A.J.H., D.W.W.), Neurology (J.J.R., J.W.A., M. Frankel), and Radiology (J.W.A., X.T.L.), Emory University School of Medicine, and the Marcus Stroke and Neuroscience Center, Grady Memorial Hospital (G. Pradilla, J.J.R., A.J.H., J.A.G., M. Frankel, D.W.W.) - both in Atlanta; Berry Consultants, Austin, TX (B.R.S., G. Paulon, A.M., R.J.L., M. Fitzgerald); the Department of Biostatistics, Vanderbilt University School of Medicine, Nashville (B.R.S.); the Department of Emergency Medicine, Harbor-UCLA Medical Center, Torrance, CA (R.J.L.); the Department of Psychiatry, University of Michigan, Ann Arbor (A.F.C.); the Cerebrovascular Center, Cleveland Clinic, Cleveland (M.B., J.G.); the Department of Neurosurgery, University of Pennsylvania, Philadelphia (B.J.); the Department of Neurological Surgery, University of Pittsburgh, Pittsburgh (G.Z.); the Department of Neurology, Brigham and Women's Hospital, Boston (B.J.M.); the Department of Neurosurgery, State University of New York at Buffalo, Buffalo (J.D., A.S.); the Department of Neurosurgery, University of Missouri, Columbia (M.R.C.), and the Department of Neurology, Washington University, St. Louis (S.G.K.); and the Departments of Neurosurgery (M.V.S., B.N.B.) and Pulmonary and Critical Care Medicine (R.S.), Indiana University, Indianapolis
| | - Joao Gomes
- From the Departments of Neurosurgery (G. Pradilla, J.A.G., D.L.B.), Emergency Medicine (J.J.R., A.J.H., D.W.W.), Neurology (J.J.R., J.W.A., M. Frankel), and Radiology (J.W.A., X.T.L.), Emory University School of Medicine, and the Marcus Stroke and Neuroscience Center, Grady Memorial Hospital (G. Pradilla, J.J.R., A.J.H., J.A.G., M. Frankel, D.W.W.) - both in Atlanta; Berry Consultants, Austin, TX (B.R.S., G. Paulon, A.M., R.J.L., M. Fitzgerald); the Department of Biostatistics, Vanderbilt University School of Medicine, Nashville (B.R.S.); the Department of Emergency Medicine, Harbor-UCLA Medical Center, Torrance, CA (R.J.L.); the Department of Psychiatry, University of Michigan, Ann Arbor (A.F.C.); the Cerebrovascular Center, Cleveland Clinic, Cleveland (M.B., J.G.); the Department of Neurosurgery, University of Pennsylvania, Philadelphia (B.J.); the Department of Neurological Surgery, University of Pittsburgh, Pittsburgh (G.Z.); the Department of Neurology, Brigham and Women's Hospital, Boston (B.J.M.); the Department of Neurosurgery, State University of New York at Buffalo, Buffalo (J.D., A.S.); the Department of Neurosurgery, University of Missouri, Columbia (M.R.C.), and the Department of Neurology, Washington University, St. Louis (S.G.K.); and the Departments of Neurosurgery (M.V.S., B.N.B.) and Pulmonary and Critical Care Medicine (R.S.), Indiana University, Indianapolis
| | - Brain Jankowitz
- From the Departments of Neurosurgery (G. Pradilla, J.A.G., D.L.B.), Emergency Medicine (J.J.R., A.J.H., D.W.W.), Neurology (J.J.R., J.W.A., M. Frankel), and Radiology (J.W.A., X.T.L.), Emory University School of Medicine, and the Marcus Stroke and Neuroscience Center, Grady Memorial Hospital (G. Pradilla, J.J.R., A.J.H., J.A.G., M. Frankel, D.W.W.) - both in Atlanta; Berry Consultants, Austin, TX (B.R.S., G. Paulon, A.M., R.J.L., M. Fitzgerald); the Department of Biostatistics, Vanderbilt University School of Medicine, Nashville (B.R.S.); the Department of Emergency Medicine, Harbor-UCLA Medical Center, Torrance, CA (R.J.L.); the Department of Psychiatry, University of Michigan, Ann Arbor (A.F.C.); the Cerebrovascular Center, Cleveland Clinic, Cleveland (M.B., J.G.); the Department of Neurosurgery, University of Pennsylvania, Philadelphia (B.J.); the Department of Neurological Surgery, University of Pittsburgh, Pittsburgh (G.Z.); the Department of Neurology, Brigham and Women's Hospital, Boston (B.J.M.); the Department of Neurosurgery, State University of New York at Buffalo, Buffalo (J.D., A.S.); the Department of Neurosurgery, University of Missouri, Columbia (M.R.C.), and the Department of Neurology, Washington University, St. Louis (S.G.K.); and the Departments of Neurosurgery (M.V.S., B.N.B.) and Pulmonary and Critical Care Medicine (R.S.), Indiana University, Indianapolis
| | - Georgios Zenonos
- From the Departments of Neurosurgery (G. Pradilla, J.A.G., D.L.B.), Emergency Medicine (J.J.R., A.J.H., D.W.W.), Neurology (J.J.R., J.W.A., M. Frankel), and Radiology (J.W.A., X.T.L.), Emory University School of Medicine, and the Marcus Stroke and Neuroscience Center, Grady Memorial Hospital (G. Pradilla, J.J.R., A.J.H., J.A.G., M. Frankel, D.W.W.) - both in Atlanta; Berry Consultants, Austin, TX (B.R.S., G. Paulon, A.M., R.J.L., M. Fitzgerald); the Department of Biostatistics, Vanderbilt University School of Medicine, Nashville (B.R.S.); the Department of Emergency Medicine, Harbor-UCLA Medical Center, Torrance, CA (R.J.L.); the Department of Psychiatry, University of Michigan, Ann Arbor (A.F.C.); the Cerebrovascular Center, Cleveland Clinic, Cleveland (M.B., J.G.); the Department of Neurosurgery, University of Pennsylvania, Philadelphia (B.J.); the Department of Neurological Surgery, University of Pittsburgh, Pittsburgh (G.Z.); the Department of Neurology, Brigham and Women's Hospital, Boston (B.J.M.); the Department of Neurosurgery, State University of New York at Buffalo, Buffalo (J.D., A.S.); the Department of Neurosurgery, University of Missouri, Columbia (M.R.C.), and the Department of Neurology, Washington University, St. Louis (S.G.K.); and the Departments of Neurosurgery (M.V.S., B.N.B.) and Pulmonary and Critical Care Medicine (R.S.), Indiana University, Indianapolis
| | - Bradley J Molyneaux
- From the Departments of Neurosurgery (G. Pradilla, J.A.G., D.L.B.), Emergency Medicine (J.J.R., A.J.H., D.W.W.), Neurology (J.J.R., J.W.A., M. Frankel), and Radiology (J.W.A., X.T.L.), Emory University School of Medicine, and the Marcus Stroke and Neuroscience Center, Grady Memorial Hospital (G. Pradilla, J.J.R., A.J.H., J.A.G., M. Frankel, D.W.W.) - both in Atlanta; Berry Consultants, Austin, TX (B.R.S., G. Paulon, A.M., R.J.L., M. Fitzgerald); the Department of Biostatistics, Vanderbilt University School of Medicine, Nashville (B.R.S.); the Department of Emergency Medicine, Harbor-UCLA Medical Center, Torrance, CA (R.J.L.); the Department of Psychiatry, University of Michigan, Ann Arbor (A.F.C.); the Cerebrovascular Center, Cleveland Clinic, Cleveland (M.B., J.G.); the Department of Neurosurgery, University of Pennsylvania, Philadelphia (B.J.); the Department of Neurological Surgery, University of Pittsburgh, Pittsburgh (G.Z.); the Department of Neurology, Brigham and Women's Hospital, Boston (B.J.M.); the Department of Neurosurgery, State University of New York at Buffalo, Buffalo (J.D., A.S.); the Department of Neurosurgery, University of Missouri, Columbia (M.R.C.), and the Department of Neurology, Washington University, St. Louis (S.G.K.); and the Departments of Neurosurgery (M.V.S., B.N.B.) and Pulmonary and Critical Care Medicine (R.S.), Indiana University, Indianapolis
| | - Jason Davies
- From the Departments of Neurosurgery (G. Pradilla, J.A.G., D.L.B.), Emergency Medicine (J.J.R., A.J.H., D.W.W.), Neurology (J.J.R., J.W.A., M. Frankel), and Radiology (J.W.A., X.T.L.), Emory University School of Medicine, and the Marcus Stroke and Neuroscience Center, Grady Memorial Hospital (G. Pradilla, J.J.R., A.J.H., J.A.G., M. Frankel, D.W.W.) - both in Atlanta; Berry Consultants, Austin, TX (B.R.S., G. Paulon, A.M., R.J.L., M. Fitzgerald); the Department of Biostatistics, Vanderbilt University School of Medicine, Nashville (B.R.S.); the Department of Emergency Medicine, Harbor-UCLA Medical Center, Torrance, CA (R.J.L.); the Department of Psychiatry, University of Michigan, Ann Arbor (A.F.C.); the Cerebrovascular Center, Cleveland Clinic, Cleveland (M.B., J.G.); the Department of Neurosurgery, University of Pennsylvania, Philadelphia (B.J.); the Department of Neurological Surgery, University of Pittsburgh, Pittsburgh (G.Z.); the Department of Neurology, Brigham and Women's Hospital, Boston (B.J.M.); the Department of Neurosurgery, State University of New York at Buffalo, Buffalo (J.D., A.S.); the Department of Neurosurgery, University of Missouri, Columbia (M.R.C.), and the Department of Neurology, Washington University, St. Louis (S.G.K.); and the Departments of Neurosurgery (M.V.S., B.N.B.) and Pulmonary and Critical Care Medicine (R.S.), Indiana University, Indianapolis
| | - Adnan Siddiqui
- From the Departments of Neurosurgery (G. Pradilla, J.A.G., D.L.B.), Emergency Medicine (J.J.R., A.J.H., D.W.W.), Neurology (J.J.R., J.W.A., M. Frankel), and Radiology (J.W.A., X.T.L.), Emory University School of Medicine, and the Marcus Stroke and Neuroscience Center, Grady Memorial Hospital (G. Pradilla, J.J.R., A.J.H., J.A.G., M. Frankel, D.W.W.) - both in Atlanta; Berry Consultants, Austin, TX (B.R.S., G. Paulon, A.M., R.J.L., M. Fitzgerald); the Department of Biostatistics, Vanderbilt University School of Medicine, Nashville (B.R.S.); the Department of Emergency Medicine, Harbor-UCLA Medical Center, Torrance, CA (R.J.L.); the Department of Psychiatry, University of Michigan, Ann Arbor (A.F.C.); the Cerebrovascular Center, Cleveland Clinic, Cleveland (M.B., J.G.); the Department of Neurosurgery, University of Pennsylvania, Philadelphia (B.J.); the Department of Neurological Surgery, University of Pittsburgh, Pittsburgh (G.Z.); the Department of Neurology, Brigham and Women's Hospital, Boston (B.J.M.); the Department of Neurosurgery, State University of New York at Buffalo, Buffalo (J.D., A.S.); the Department of Neurosurgery, University of Missouri, Columbia (M.R.C.), and the Department of Neurology, Washington University, St. Louis (S.G.K.); and the Departments of Neurosurgery (M.V.S., B.N.B.) and Pulmonary and Critical Care Medicine (R.S.), Indiana University, Indianapolis
| | - Michael R Chicoine
- From the Departments of Neurosurgery (G. Pradilla, J.A.G., D.L.B.), Emergency Medicine (J.J.R., A.J.H., D.W.W.), Neurology (J.J.R., J.W.A., M. Frankel), and Radiology (J.W.A., X.T.L.), Emory University School of Medicine, and the Marcus Stroke and Neuroscience Center, Grady Memorial Hospital (G. Pradilla, J.J.R., A.J.H., J.A.G., M. Frankel, D.W.W.) - both in Atlanta; Berry Consultants, Austin, TX (B.R.S., G. Paulon, A.M., R.J.L., M. Fitzgerald); the Department of Biostatistics, Vanderbilt University School of Medicine, Nashville (B.R.S.); the Department of Emergency Medicine, Harbor-UCLA Medical Center, Torrance, CA (R.J.L.); the Department of Psychiatry, University of Michigan, Ann Arbor (A.F.C.); the Cerebrovascular Center, Cleveland Clinic, Cleveland (M.B., J.G.); the Department of Neurosurgery, University of Pennsylvania, Philadelphia (B.J.); the Department of Neurological Surgery, University of Pittsburgh, Pittsburgh (G.Z.); the Department of Neurology, Brigham and Women's Hospital, Boston (B.J.M.); the Department of Neurosurgery, State University of New York at Buffalo, Buffalo (J.D., A.S.); the Department of Neurosurgery, University of Missouri, Columbia (M.R.C.), and the Department of Neurology, Washington University, St. Louis (S.G.K.); and the Departments of Neurosurgery (M.V.S., B.N.B.) and Pulmonary and Critical Care Medicine (R.S.), Indiana University, Indianapolis
| | - Salah G Keyrouz
- From the Departments of Neurosurgery (G. Pradilla, J.A.G., D.L.B.), Emergency Medicine (J.J.R., A.J.H., D.W.W.), Neurology (J.J.R., J.W.A., M. Frankel), and Radiology (J.W.A., X.T.L.), Emory University School of Medicine, and the Marcus Stroke and Neuroscience Center, Grady Memorial Hospital (G. Pradilla, J.J.R., A.J.H., J.A.G., M. Frankel, D.W.W.) - both in Atlanta; Berry Consultants, Austin, TX (B.R.S., G. Paulon, A.M., R.J.L., M. Fitzgerald); the Department of Biostatistics, Vanderbilt University School of Medicine, Nashville (B.R.S.); the Department of Emergency Medicine, Harbor-UCLA Medical Center, Torrance, CA (R.J.L.); the Department of Psychiatry, University of Michigan, Ann Arbor (A.F.C.); the Cerebrovascular Center, Cleveland Clinic, Cleveland (M.B., J.G.); the Department of Neurosurgery, University of Pennsylvania, Philadelphia (B.J.); the Department of Neurological Surgery, University of Pittsburgh, Pittsburgh (G.Z.); the Department of Neurology, Brigham and Women's Hospital, Boston (B.J.M.); the Department of Neurosurgery, State University of New York at Buffalo, Buffalo (J.D., A.S.); the Department of Neurosurgery, University of Missouri, Columbia (M.R.C.), and the Department of Neurology, Washington University, St. Louis (S.G.K.); and the Departments of Neurosurgery (M.V.S., B.N.B.) and Pulmonary and Critical Care Medicine (R.S.), Indiana University, Indianapolis
| | - Jonathan A Grossberg
- From the Departments of Neurosurgery (G. Pradilla, J.A.G., D.L.B.), Emergency Medicine (J.J.R., A.J.H., D.W.W.), Neurology (J.J.R., J.W.A., M. Frankel), and Radiology (J.W.A., X.T.L.), Emory University School of Medicine, and the Marcus Stroke and Neuroscience Center, Grady Memorial Hospital (G. Pradilla, J.J.R., A.J.H., J.A.G., M. Frankel, D.W.W.) - both in Atlanta; Berry Consultants, Austin, TX (B.R.S., G. Paulon, A.M., R.J.L., M. Fitzgerald); the Department of Biostatistics, Vanderbilt University School of Medicine, Nashville (B.R.S.); the Department of Emergency Medicine, Harbor-UCLA Medical Center, Torrance, CA (R.J.L.); the Department of Psychiatry, University of Michigan, Ann Arbor (A.F.C.); the Cerebrovascular Center, Cleveland Clinic, Cleveland (M.B., J.G.); the Department of Neurosurgery, University of Pennsylvania, Philadelphia (B.J.); the Department of Neurological Surgery, University of Pittsburgh, Pittsburgh (G.Z.); the Department of Neurology, Brigham and Women's Hospital, Boston (B.J.M.); the Department of Neurosurgery, State University of New York at Buffalo, Buffalo (J.D., A.S.); the Department of Neurosurgery, University of Missouri, Columbia (M.R.C.), and the Department of Neurology, Washington University, St. Louis (S.G.K.); and the Departments of Neurosurgery (M.V.S., B.N.B.) and Pulmonary and Critical Care Medicine (R.S.), Indiana University, Indianapolis
| | - Mitesh V Shah
- From the Departments of Neurosurgery (G. Pradilla, J.A.G., D.L.B.), Emergency Medicine (J.J.R., A.J.H., D.W.W.), Neurology (J.J.R., J.W.A., M. Frankel), and Radiology (J.W.A., X.T.L.), Emory University School of Medicine, and the Marcus Stroke and Neuroscience Center, Grady Memorial Hospital (G. Pradilla, J.J.R., A.J.H., J.A.G., M. Frankel, D.W.W.) - both in Atlanta; Berry Consultants, Austin, TX (B.R.S., G. Paulon, A.M., R.J.L., M. Fitzgerald); the Department of Biostatistics, Vanderbilt University School of Medicine, Nashville (B.R.S.); the Department of Emergency Medicine, Harbor-UCLA Medical Center, Torrance, CA (R.J.L.); the Department of Psychiatry, University of Michigan, Ann Arbor (A.F.C.); the Cerebrovascular Center, Cleveland Clinic, Cleveland (M.B., J.G.); the Department of Neurosurgery, University of Pennsylvania, Philadelphia (B.J.); the Department of Neurological Surgery, University of Pittsburgh, Pittsburgh (G.Z.); the Department of Neurology, Brigham and Women's Hospital, Boston (B.J.M.); the Department of Neurosurgery, State University of New York at Buffalo, Buffalo (J.D., A.S.); the Department of Neurosurgery, University of Missouri, Columbia (M.R.C.), and the Department of Neurology, Washington University, St. Louis (S.G.K.); and the Departments of Neurosurgery (M.V.S., B.N.B.) and Pulmonary and Critical Care Medicine (R.S.), Indiana University, Indianapolis
| | - Ranjeet Singh
- From the Departments of Neurosurgery (G. Pradilla, J.A.G., D.L.B.), Emergency Medicine (J.J.R., A.J.H., D.W.W.), Neurology (J.J.R., J.W.A., M. Frankel), and Radiology (J.W.A., X.T.L.), Emory University School of Medicine, and the Marcus Stroke and Neuroscience Center, Grady Memorial Hospital (G. Pradilla, J.J.R., A.J.H., J.A.G., M. Frankel, D.W.W.) - both in Atlanta; Berry Consultants, Austin, TX (B.R.S., G. Paulon, A.M., R.J.L., M. Fitzgerald); the Department of Biostatistics, Vanderbilt University School of Medicine, Nashville (B.R.S.); the Department of Emergency Medicine, Harbor-UCLA Medical Center, Torrance, CA (R.J.L.); the Department of Psychiatry, University of Michigan, Ann Arbor (A.F.C.); the Cerebrovascular Center, Cleveland Clinic, Cleveland (M.B., J.G.); the Department of Neurosurgery, University of Pennsylvania, Philadelphia (B.J.); the Department of Neurological Surgery, University of Pittsburgh, Pittsburgh (G.Z.); the Department of Neurology, Brigham and Women's Hospital, Boston (B.J.M.); the Department of Neurosurgery, State University of New York at Buffalo, Buffalo (J.D., A.S.); the Department of Neurosurgery, University of Missouri, Columbia (M.R.C.), and the Department of Neurology, Washington University, St. Louis (S.G.K.); and the Departments of Neurosurgery (M.V.S., B.N.B.) and Pulmonary and Critical Care Medicine (R.S.), Indiana University, Indianapolis
| | - Bradley N Bohnstedt
- From the Departments of Neurosurgery (G. Pradilla, J.A.G., D.L.B.), Emergency Medicine (J.J.R., A.J.H., D.W.W.), Neurology (J.J.R., J.W.A., M. Frankel), and Radiology (J.W.A., X.T.L.), Emory University School of Medicine, and the Marcus Stroke and Neuroscience Center, Grady Memorial Hospital (G. Pradilla, J.J.R., A.J.H., J.A.G., M. Frankel, D.W.W.) - both in Atlanta; Berry Consultants, Austin, TX (B.R.S., G. Paulon, A.M., R.J.L., M. Fitzgerald); the Department of Biostatistics, Vanderbilt University School of Medicine, Nashville (B.R.S.); the Department of Emergency Medicine, Harbor-UCLA Medical Center, Torrance, CA (R.J.L.); the Department of Psychiatry, University of Michigan, Ann Arbor (A.F.C.); the Cerebrovascular Center, Cleveland Clinic, Cleveland (M.B., J.G.); the Department of Neurosurgery, University of Pennsylvania, Philadelphia (B.J.); the Department of Neurological Surgery, University of Pittsburgh, Pittsburgh (G.Z.); the Department of Neurology, Brigham and Women's Hospital, Boston (B.J.M.); the Department of Neurosurgery, State University of New York at Buffalo, Buffalo (J.D., A.S.); the Department of Neurosurgery, University of Missouri, Columbia (M.R.C.), and the Department of Neurology, Washington University, St. Louis (S.G.K.); and the Departments of Neurosurgery (M.V.S., B.N.B.) and Pulmonary and Critical Care Medicine (R.S.), Indiana University, Indianapolis
| | - Michael Frankel
- From the Departments of Neurosurgery (G. Pradilla, J.A.G., D.L.B.), Emergency Medicine (J.J.R., A.J.H., D.W.W.), Neurology (J.J.R., J.W.A., M. Frankel), and Radiology (J.W.A., X.T.L.), Emory University School of Medicine, and the Marcus Stroke and Neuroscience Center, Grady Memorial Hospital (G. Pradilla, J.J.R., A.J.H., J.A.G., M. Frankel, D.W.W.) - both in Atlanta; Berry Consultants, Austin, TX (B.R.S., G. Paulon, A.M., R.J.L., M. Fitzgerald); the Department of Biostatistics, Vanderbilt University School of Medicine, Nashville (B.R.S.); the Department of Emergency Medicine, Harbor-UCLA Medical Center, Torrance, CA (R.J.L.); the Department of Psychiatry, University of Michigan, Ann Arbor (A.F.C.); the Cerebrovascular Center, Cleveland Clinic, Cleveland (M.B., J.G.); the Department of Neurosurgery, University of Pennsylvania, Philadelphia (B.J.); the Department of Neurological Surgery, University of Pittsburgh, Pittsburgh (G.Z.); the Department of Neurology, Brigham and Women's Hospital, Boston (B.J.M.); the Department of Neurosurgery, State University of New York at Buffalo, Buffalo (J.D., A.S.); the Department of Neurosurgery, University of Missouri, Columbia (M.R.C.), and the Department of Neurology, Washington University, St. Louis (S.G.K.); and the Departments of Neurosurgery (M.V.S., B.N.B.) and Pulmonary and Critical Care Medicine (R.S.), Indiana University, Indianapolis
| | - David W Wright
- From the Departments of Neurosurgery (G. Pradilla, J.A.G., D.L.B.), Emergency Medicine (J.J.R., A.J.H., D.W.W.), Neurology (J.J.R., J.W.A., M. Frankel), and Radiology (J.W.A., X.T.L.), Emory University School of Medicine, and the Marcus Stroke and Neuroscience Center, Grady Memorial Hospital (G. Pradilla, J.J.R., A.J.H., J.A.G., M. Frankel, D.W.W.) - both in Atlanta; Berry Consultants, Austin, TX (B.R.S., G. Paulon, A.M., R.J.L., M. Fitzgerald); the Department of Biostatistics, Vanderbilt University School of Medicine, Nashville (B.R.S.); the Department of Emergency Medicine, Harbor-UCLA Medical Center, Torrance, CA (R.J.L.); the Department of Psychiatry, University of Michigan, Ann Arbor (A.F.C.); the Cerebrovascular Center, Cleveland Clinic, Cleveland (M.B., J.G.); the Department of Neurosurgery, University of Pennsylvania, Philadelphia (B.J.); the Department of Neurological Surgery, University of Pittsburgh, Pittsburgh (G.Z.); the Department of Neurology, Brigham and Women's Hospital, Boston (B.J.M.); the Department of Neurosurgery, State University of New York at Buffalo, Buffalo (J.D., A.S.); the Department of Neurosurgery, University of Missouri, Columbia (M.R.C.), and the Department of Neurology, Washington University, St. Louis (S.G.K.); and the Departments of Neurosurgery (M.V.S., B.N.B.) and Pulmonary and Critical Care Medicine (R.S.), Indiana University, Indianapolis
| | - Daniel L Barrow
- From the Departments of Neurosurgery (G. Pradilla, J.A.G., D.L.B.), Emergency Medicine (J.J.R., A.J.H., D.W.W.), Neurology (J.J.R., J.W.A., M. Frankel), and Radiology (J.W.A., X.T.L.), Emory University School of Medicine, and the Marcus Stroke and Neuroscience Center, Grady Memorial Hospital (G. Pradilla, J.J.R., A.J.H., J.A.G., M. Frankel, D.W.W.) - both in Atlanta; Berry Consultants, Austin, TX (B.R.S., G. Paulon, A.M., R.J.L., M. Fitzgerald); the Department of Biostatistics, Vanderbilt University School of Medicine, Nashville (B.R.S.); the Department of Emergency Medicine, Harbor-UCLA Medical Center, Torrance, CA (R.J.L.); the Department of Psychiatry, University of Michigan, Ann Arbor (A.F.C.); the Cerebrovascular Center, Cleveland Clinic, Cleveland (M.B., J.G.); the Department of Neurosurgery, University of Pennsylvania, Philadelphia (B.J.); the Department of Neurological Surgery, University of Pittsburgh, Pittsburgh (G.Z.); the Department of Neurology, Brigham and Women's Hospital, Boston (B.J.M.); the Department of Neurosurgery, State University of New York at Buffalo, Buffalo (J.D., A.S.); the Department of Neurosurgery, University of Missouri, Columbia (M.R.C.), and the Department of Neurology, Washington University, St. Louis (S.G.K.); and the Departments of Neurosurgery (M.V.S., B.N.B.) and Pulmonary and Critical Care Medicine (R.S.), Indiana University, Indianapolis
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Meng Y, Allen JW, Sharghi VK, Qiu D. Motion and temporal B0 shift corrections for quantitative susceptibility mapping (QSM) and R2* mapping using dual-echo spiral navigators and conjugate-phase reconstruction. ArXiv 2024:arXiv:2403.12230v1. [PMID: 38562446 PMCID: PMC10984008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
PURPOSE To develop an efficient navigator-based motion and temporal B0 shift correction technique for 3D multi-echo gradient-echo (ME-GRE) MRI for quantitative susceptibility mapping (QSM) and R2* mapping. THEORY AND METHODS A dual-echo 3D spiral navigator was designed to interleave with the Cartesian ME-GRE acquisitions, allowing the acquisition of both low- and high-echo time signals. We additionally designed a novel conjugate-phase based reconstruction method for the joint correction of motion and temporal B0 shifts. We performed both numerical simulation and in vivo human scans to assess the performance of the methods. RESULTS Numerical simulation and human brain scans demonstrated that the proposed technique successfully corrected artifacts induced by both head motions and temporal B0 changes. Efficient B0-change correction with conjugate-phase reconstruction can be performed on less than 10 clustered k-space segments. In vivo scans showed that combining temporal B0 correction with motion correction further reduced artifacts and improved image quality in both R2* and QSM images. CONCLUSION Our proposed approach of using 3D spiral navigators and a novel conjugate-phase reconstruction method can improve susceptibility-related measurements using MR.
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Kumar VA, Lee J, Liu HL, Allen JW, Filippi CG, Holodny AI, Hsu K, Jain R, McAndrews MP, Peck KK, Shah G, Shimony JS, Singh S, Zeineh M, Tanabe J, Vachha B, Vossough A, Welker K, Whitlow C, Wintermark M, Zaharchuk G, Sair HI. Recommended Resting-State fMRI Acquisition and Preprocessing Steps for Preoperative Mapping of Language and Motor and Visual Areas in Adult and Pediatric Patients with Brain Tumors and Epilepsy. AJNR Am J Neuroradiol 2024; 45:139-148. [PMID: 38164572 DOI: 10.3174/ajnr.a8067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Accepted: 10/12/2023] [Indexed: 01/03/2024]
Abstract
Resting-state (rs) fMRI has been shown to be useful for preoperative mapping of functional areas in patients with brain tumors and epilepsy. However, its lack of standardization limits its widespread use and hinders multicenter collaboration. The American Society of Functional Neuroradiology, American Society of Pediatric Neuroradiology, and the American Society of Neuroradiology Functional and Diffusion MR Imaging Study Group recommend specific rs-fMRI acquisition approaches and preprocessing steps that will further support rs-fMRI for future clinical use. A task force with expertise in fMRI from multiple institutions provided recommendations on the rs-fMRI steps needed for mapping of language, motor, and visual areas in adult and pediatric patients with brain tumor and epilepsy. These were based on an extensive literature review and expert consensus.Following rs-fMRI acquisition parameters are recommended: minimum 6-minute acquisition time; scan with eyes open with fixation; obtain rs-fMRI before both task-based fMRI and contrast administration; temporal resolution of ≤2 seconds; scanner field strength of 3T or higher. The following rs-fMRI preprocessing steps and parameters are recommended: motion correction (seed-based correlation analysis [SBC], independent component analysis [ICA]); despiking (SBC); volume censoring (SBC, ICA); nuisance regression of CSF and white matter signals (SBC); head motion regression (SBC, ICA); bandpass filtering (SBC, ICA); and spatial smoothing with a kernel size that is twice the effective voxel size (SBC, ICA).The consensus recommendations put forth for rs-fMRI acquisition and preprocessing steps will aid in standardization of practice and guide rs-fMRI program development across institutions. Standardized rs-fMRI protocols and processing pipelines are essential for multicenter trials and to implement rs-fMRI as part of standard clinical practice.
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Affiliation(s)
- V A Kumar
- From the The University of Texas MD Anderson Cancer Center (V.A.K., J.L., H.-L.L., M.W.), Houston, Texas
| | - J Lee
- From the The University of Texas MD Anderson Cancer Center (V.A.K., J.L., H.-L.L., M.W.), Houston, Texas
| | - H-L Liu
- From the The University of Texas MD Anderson Cancer Center (V.A.K., J.L., H.-L.L., M.W.), Houston, Texas
| | - J W Allen
- Emory University (J.W.A.), Atlanta, Georgia
| | - C G Filippi
- Tufts University (C.G.F.), Boston, Massachusetts
| | - A I Holodny
- Memorial Sloan Kettering Cancer Center (A.I.H., K.K.P.), New York, New York
| | - K Hsu
- New York University (K.H., R.J.), New York, New York
| | - R Jain
- New York University (K.H., R.J.), New York, New York
| | - M P McAndrews
- University of Toronto (M.P.M.), Toronto, Ontario, Canada
| | - K K Peck
- Memorial Sloan Kettering Cancer Center (A.I.H., K.K.P.), New York, New York
| | - G Shah
- University of Michigan (G.S.), Ann Arbor, Michigan
| | - J S Shimony
- Washington University School of Medicine (J.S.S.), St. Louis, Missouri
| | - S Singh
- University of Texas Southwestern Medical Center (S.S.), Dallas, Texas
| | - M Zeineh
- Stanford University (M.Z., G.Z.), Palo Alto, California
| | - J Tanabe
- University of Colorado (J.T.), Aurora, Colorado
| | - B Vachha
- University of Massachusetts (B.V.), Worcester, Massachusetts
| | - A Vossough
- Children's Hospital of Philadelphia, University of Pennsylvania (A.V.), Philadelphia, Pennsylvania
| | - K Welker
- Mayo Clinic (K.W.), Rochester, Minnesota
| | - C Whitlow
- Wake Forest University (C.W.), Winston-Salem, North Carolina
| | - M Wintermark
- From the The University of Texas MD Anderson Cancer Center (V.A.K., J.L., H.-L.L., M.W.), Houston, Texas
| | - G Zaharchuk
- Stanford University (M.Z., G.Z.), Palo Alto, California
| | - H I Sair
- Johns Hopkins University (H.I.S.), Baltimore, Maryland
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Essien M, Lah J, Weinberg BD, Allen JW, Hu R. Comparison of Quantitative Hippocampal Volumes and Structured Scoring Scales in Predicting Alzheimer Disease Diagnosis. AJNR Am J Neuroradiol 2023; 44:1411-1417. [PMID: 38050003 PMCID: PMC10714860 DOI: 10.3174/ajnr.a8049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 10/04/2023] [Indexed: 12/06/2023]
Abstract
BACKGROUND AND PURPOSE Brain imaging plays an important role in investigating patients with cognitive decline and ruling out secondary causes of dementia. This study compares the diagnostic value of quantitative hippocampal volumes derived from automated volumetric software and structured scoring scales in differentiating Alzheimer disease, mild cognitive impairment, and subjective cognitive decline. MATERIALS AND METHODS Retrospectively, we reviewed images and medical records of adult patients who underwent MR imaging with a dementia protocol (2018-2021). Patients with postscanning diagnoses of Alzheimer disease, mild cognitive impairment, and subjective cognitive decline based on the International Statistical Classification of Diseases and Related Health Problems, 10th revision, were included. Diagnostic performances of automated normalized total hippocampal volume and structured manually assigned medial temporal atrophy and entorhinal cortical atrophy scores were assessed using multivariate logistic regression and receiver operating characteristic curve analysis. RESULTS We evaluated 328 patients (Alzheimer disease, n = 118; mild cognitive impairment, n = 172; subjective cognitive decline, n = 38). Patients with Alzheimer disease had lower normalized total hippocampal volume (median, 0.35%), higher medial temporal atrophy (median, 3), and higher entorhinal cortical atrophy (median, 2) scores than those with subjective cognitive decline (P < .001) and mild cognitive impairment (P < .001). For discriminating Alzheimer disease from subjective cognitive decline, an entorhinal cortical atrophy cutoff value of 2 had a higher specificity (87%) compared with normalized total hippocampal volume (74%) and medial temporal atrophy (66%), but a lower sensitivity (69%) than normalized total hippocampal volume (84%) and medial temporal atrophy (84%). In discriminating Alzheimer disease from mild cognitive impairment, an entorhinal cortical atrophy cutoff value of 3 had a specificity (66%), similar to that of normalized total hippocampal volume (67%) but higher than medial temporal atrophy (54%), and its sensitivity (69%) was also similar to that of normalized total hippocampal volume (71%) but lower than that of medial temporal atrophy (84%). CONCLUSIONS Entorhinal cortical atrophy and medial temporal atrophy may be useful adjuncts in discriminating Alzheimer disease from subjective cognitive decline, with reduced cost and implementation challenges compared with automated volumetric software.
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Affiliation(s)
- Michael Essien
- From the Departments of Radiology and Imaging Sciences (M.E., B.D.W., J.W.A., R.H.)
| | - James Lah
- Neurology (J.L.), Emory University School of Medicine, Atlanta, Georgia
| | - Brent D Weinberg
- From the Departments of Radiology and Imaging Sciences (M.E., B.D.W., J.W.A., R.H.)
| | - Jason W Allen
- From the Departments of Radiology and Imaging Sciences (M.E., B.D.W., J.W.A., R.H.)
| | - Ranliang Hu
- From the Departments of Radiology and Imaging Sciences (M.E., B.D.W., J.W.A., R.H.)
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Smith JL, Diekfuss JA, Dudley JA, Ahluwalia V, Zuleger TM, Slutsky-Ganesh AB, Yuan W, Foss KDB, Gore RK, Myer GD, Allen JW. Visuo-vestibular and cognitive connections of the vestibular neuromatrix are conserved across age and injury populations. J Neuroimaging 2023; 33:1003-1014. [PMID: 37303280 DOI: 10.1111/jon.13136] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 05/25/2023] [Accepted: 06/02/2023] [Indexed: 06/13/2023] Open
Abstract
BACKGROUND AND PURPOSE Given the prevalence of vestibular dysfunction in pediatric concussion, there is a need to better understand pathophysiological disruptions within vestibular and associated cognitive, affective, and sensory-integrative networks. Although current research leverages established intrinsic connectivity networks, these are nonspecific for vestibular function, suggesting that a pathologically guided approach is warranted. The purpose of this study was to evaluate the generalizability of the previously identified "vestibular neuromatrix" in adults with and without postconcussive vestibular dysfunction to young athletes aged 14-17. METHODS This retrospective study leveraged resting-state functional MRI data from two sites. Site A included adults with diagnosed postconcussive vestibular impairment and healthy adult controls and Site B consisted of young athletes with preseason, postconcussion, and postseason time points (prospective longitudinal data). Adjacency matrices were generated from preprocessed resting-state data from each sample and assessed for overlap and network structure in MATLAB. RESULTS Analyses indicated the presence of a conserved "core" network of vestibular regions as well as areas subserving visual, spatial, and attentional processing. Other vestibular connections were also conserved across samples but were not linked to the "core" subnetwork by regions of interest included in this study. CONCLUSIONS Our results suggest that connections between central vestibular, visuospatial, and known intrinsic connectivity networks are conserved across adult and pediatric participants with and without concussion, evincing the significance of this expanded, vestibular-associated network. Our findings thus support this network as a workable model for investigation in future studies of dysfunction in young athlete populations.
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Affiliation(s)
- Jeremy L Smith
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Jed A Diekfuss
- Emory Sports Performance and Research Center (SPARC), Flowery Branch, Georgia, USA
- Emory Sports Medicine Center, Atlanta, Georgia, USA
- Department of Orthopaedics, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Jonathan A Dudley
- Pediatric Neuroimaging Research Consortium, Division of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Vishwadeep Ahluwalia
- Georgia State University/Georgia Tech Center for Advanced Brain Imaging (CABI), Atlanta, Georgia, USA
| | - Taylor M Zuleger
- Emory Sports Performance and Research Center (SPARC), Flowery Branch, Georgia, USA
- Emory Sports Medicine Center, Atlanta, Georgia, USA
- Department of Orthopaedics, Emory University School of Medicine, Atlanta, Georgia, USA
- Neuroscience Graduate Program, University of Cincinnati, Cincinnati, Ohio, USA
| | - Alexis B Slutsky-Ganesh
- Emory Sports Performance and Research Center (SPARC), Flowery Branch, Georgia, USA
- Department of Orthopaedics, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Weihong Yuan
- Pediatric Neuroimaging Research Consortium, Division of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Kim D Barber Foss
- Emory Sports Performance and Research Center (SPARC), Flowery Branch, Georgia, USA
| | - Russell K Gore
- Mild TBI Brain Health and Recovery Lab, Shepherd Center, Atlanta, Georgia, USA
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, Georgia, USA
| | - Gregory D Myer
- Emory Sports Performance and Research Center (SPARC), Flowery Branch, Georgia, USA
- Emory Sports Medicine Center, Atlanta, Georgia, USA
- Department of Orthopaedics, Emory University School of Medicine, Atlanta, Georgia, USA
- Youth Physical Development Centre, Cardiff Metropolitan University, Wales, UK
| | - Jason W Allen
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia, USA
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, Georgia, USA
- Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA
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11
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Huang S, Lah JJ, Allen JW, Qiu D. Robust quantitative susceptibility mapping via approximate message passing with parameter estimation. Magn Reson Med 2023; 90:1414-1430. [PMID: 37249040 PMCID: PMC10664815 DOI: 10.1002/mrm.29722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 04/25/2023] [Accepted: 05/14/2023] [Indexed: 05/31/2023]
Abstract
PURPOSE For quantitative susceptibility mapping (QSM), the lack of ground-truth in clinical settings makes it challenging to determine suitable parameters for the dipole inversion. We propose a probabilistic Bayesian approach for QSM with built-in parameter estimation, and incorporate the nonlinear formulation of the dipole inversion to achieve a robust recovery of the susceptibility maps. THEORY From a Bayesian perspective, the image wavelet coefficients are approximately sparse and modeled by the Laplace distribution. The measurement noise is modeled by a Gaussian-mixture distribution with two components, where the second component is used to model the noise outliers. Through probabilistic inference, the susceptibility map and distribution parameters can be jointly recovered using approximate message passing (AMP). METHODS We compare our proposed AMP with built-in parameter estimation (AMP-PE) to the state-of-the-art L1-QSM, FANSI, and MEDI approaches on the simulated and in vivo datasets, and perform experiments to explore the optimal settings of AMP-PE. Reproducible code is available at: https://github.com/EmoryCN2L/QSM_AMP_PE. RESULTS On the simulated Sim2Snr1 dataset, AMP-PE achieved the lowest NRMSE, deviation from calcification moment and the highest SSIM, while MEDI achieved the lowest high-frequency error norm. On the in vivo datasets, AMP-PE is robust and successfully recovers the susceptibility maps using the estimated parameters, whereas L1-QSM, FANSI and MEDI typically require additional visual fine-tuning to select or double-check working parameters. CONCLUSION AMP-PE provides automatic and adaptive parameter estimation for QSM and avoids the subjectivity from the visual fine-tuning step, making it an excellent choice for the clinical setting.
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Affiliation(s)
- Shuai Huang
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, GA, 30322, USA
| | - James J. Lah
- Department of Neurology, Emory University, Atlanta, GA, 30322, USA
| | - Jason W. Allen
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, GA, 30322, USA
- Department of Neurology, Emory University, Atlanta, GA, 30322, USA
| | - Deqiang Qiu
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, GA, 30322, USA
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12
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Harder TJ, Leary OP, Yang Z, Lucke-Wold B, Liu DD, Still ME, Zhang M, Yeatts SD, Allen JW, Wright DW, Merck D, Merck LH. Early Signs of Elevated Intracranial Pressure on Computed Tomography Correlate With Measured Intracranial Pressure in the Intensive Care Unit and Six-Month Outcome After Moderate to Severe Traumatic Brain Injury. J Neurotrauma 2023; 40:1603-1613. [PMID: 37082956 PMCID: PMC10458381 DOI: 10.1089/neu.2022.0433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/22/2023] Open
Abstract
Traumatic brain injury (TBI) is a leading cause of death and disability in the United States. Early triage and treatment after TBI have been shown to improve outcome. Identifying patients at risk for increased intracranial pressure (ICP) via baseline computed tomography (CT) , however, has not been validated previously in a prospective dataset. We hypothesized that acute CT findings of elevated ICP, combined with direct ICP measurement, hold prognostic value in terms of six-month patient outcome after TBI. Data were obtained from the Progesterone for Traumatic Brain Injury, Experimental Clinical Treatment (ProTECTIII) multi-center clinical trial. Baseline CT scans for 881 participants were individually reviewed by a blinded central neuroradiologist. Five signs of elevated ICP were measured (sulcal obliteration, lateral ventricle compression, third ventricle compression, midline shift, and herniation). Associations between signs of increased ICP and outcomes (six-month functional outcome and death) were assessed. Secondary analyses of 354 patients with recorded ICP monitoring data available explored the relationships between hemorrhage phenotype/anatomic location, sustained ICP ≥20 mm Hg, and surgical intervention(s). Univariate and multi-variate logistic/linear regressions were performed; p < 0.05 is defined as statistically significant. Imaging characteristics associated with ICP in this cohort include sulcal obliteration (p = 0.029) and third ventricular compression (p = 0.039). Univariate regression analyses indicated that increasing combinations of the five defined signs of elevated ICP were associated with death, poor functional outcome, and time to death. There was also an increased likelihood of death if patients required craniotomy (odds ratio [OR] = 4.318, 95% confidence interval [1.330-16.030]) or hemicraniectomy (OR = 2.993 [1.109-8.482]). On multi-variate regression analyses, hemorrhage location was associated with death (posterior fossa, OR = 3.208 [1.120-9.188] and basal ganglia, OR = 3.079 [1.178-8.077]). Volume of hemorrhage >30 cc was also associated with increased death, OR = 3.702 [1.575-8.956]). The proportion of patient hours with sustained ICP ≥20 mm Hg, and maximum ICP ≥20 mm Hg were also directly correlated with increased death (OR = 6 4.99 [7.731-635.51]; and OR = 1.025 [1.004-1.047]), but not with functional outcome. Poor functional outcome was predicted by concurrent presence of all five radiographic signs of elevated ICP (OR = 4.44 [1.514-14.183]) and presence of frontal lobe (OR = 2.951 [1.265-7.067]), subarachnoid (OR = 2.231 [1.067-4.717]), or intraventricular (OR = 2.249 [1.159-4.508]) hemorrhage. Time to death was modulated by total patient days of elevated ICP ≥20 mm Hg (effect size = 3.424 [1.500, 5.439]) in the first two weeks of hospitalization. Sulcal obliteration and third ventricular compression, radiographic signs of elevated ICP, were significantly associated with measurements of ICP ≥20 mm Hg. These radiographic biomarkers were significantly associated with patient outcome. There is potential utility of ICP-related imaging variables in triage and prognostication for patients after moderate-severe TBI.
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Affiliation(s)
- Tyler J. Harder
- Department of Emergency Medicine, Brown University, Providence, Rhode Island, USA
| | - Owen P. Leary
- Department of Neurosurgery, Brown University, Providence, Rhode Island, USA
| | - Zhihui Yang
- Department of Neurosurgery, University of Florida, Gainesville, Florida, USA
| | - Brandon Lucke-Wold
- Department of Neurosurgery, University of Florida, Gainesville, Florida, USA
| | - David D. Liu
- Department of Neurosurgery, Brown University, Providence, Rhode Island, USA
- Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Megan E.H. Still
- Department of Neurosurgery, University of Florida, Gainesville, Florida, USA
| | - Miao Zhang
- Department of Information Systems and Operation Management, University of Florida, Gainesville, Florida, USA
| | - Sharon D. Yeatts
- Department of Biostatistics, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Jason W. Allen
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, Georgia, USA
| | - David W. Wright
- Department of Emergency Medicine, Emory University, Atlanta, Georgia, USA
| | - Derek Merck
- Department of Radiology, University of Florida, Gainesville, Florida, USA
| | - Lisa H. Merck
- Department of Neurosurgery, Brown University, Providence, Rhode Island, USA
- Department of Emergency Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
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13
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El Sayed R, Sharifi A, Park CC, Haussen DC, Allen JW, Oshinski JN. Optimization of 4D Flow MRI Spatial and Temporal Resolution for Examining Complex Hemodynamics in the Carotid Artery Bifurcation. Cardiovasc Eng Technol 2023; 14:476-488. [PMID: 37156900 PMCID: PMC10524741 DOI: 10.1007/s13239-023-00667-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 04/24/2023] [Indexed: 05/10/2023]
Abstract
BACKGROUND Three-dimensional, ECG-gated, time-resolved, three-directional, velocity-encoded phase-contrast MRI (4D flow MRI) has been applied extensively to measure blood velocity in great vessels but has been much less used in diseased carotid arteries. Carotid artery webs (CaW) are non-inflammatory intraluminal shelf-like projections into the internal carotid artery (ICA) bulb that are associated with complex flow and cryptogenic stroke. PURPOSE Optimize 4D flow MRI for measuring the velocity field of complex flow in the carotid artery bifurcation model that contains a CaW. METHODS A 3D printed phantom model created from computed tomography angiography (CTA) of a subject with CaW was placed in a pulsatile flow loop within the MRI scanner. 4D Flow MRI images of the phantom were acquired with five different spatial resolutions (0.50-2.00 mm3) and four different temporal resolutions (23-96 ms) and compared to a computational fluid dynamics (CFD) solution of the flow field as a reference. We examined four planes perpendicular to the vessel centerline, one in the common carotid artery (CCA) and three in the internal carotid artery (ICA) where complex flow was expected. At these four planes pixel-by-pixel velocity values, flow, and time average wall shear stress (TAWSS) were compared between 4D flow MRI and CFD. HYPOTHESIS An optimized 4D flow MRI protocol will provide a good correlation with CFD velocity and TAWSS values in areas of complex flow within a clinically feasible scan time (~ 10 min). RESULTS Spatial resolution affected the velocity values, time average flow, and TAWSS measurements. Qualitatively, a spatial resolution of 0.50 mm3 resulted in higher noise, while a lower spatial resolution of 1.50-2.00 mm3 did not adequately resolve the velocity profile. Isotropic spatial resolutions of 0.50-1.00 mm3 showed no significant difference in total flow compared to CFD. Pixel-by-pixel velocity correlation coefficients between 4D flow MRI and CFD were > 0.75 for 0.50-1.00 mm3 but were < 0.5 for 1.50 and 2.00 mm3. Regional TAWSS values determined from 4D flow MRI were generally lower than CFD and decreased at lower spatial resolutions (larger pixel sizes). TAWSS differences between 4D flow and CFD were not statistically significant at spatial resolutions of 0.50-1.00 mm3 but were different at 1.50 and 2.00 mm3. Differences in temporal resolution only affected the flow values when temporal resolution was > 48.4 ms; temporal resolution did not affect TAWSS values. CONCLUSION A spatial resolution of 0.74-1.00 mm3 and a temporal resolution of 23-48 ms (1-2 k-space segments) provides a 4D flow MRI protocol capable of imaging velocity and TAWSS in regions of complex flow within the carotid bifurcation at a clinically acceptable scan time.
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Affiliation(s)
- Retta El Sayed
- Department of Biomedical Engineering, The Wallace H. Coulter, Emory University and Georgia Institute of Technology, Atlanta, GA, USA
| | - Alireza Sharifi
- Department of Radiology & Imaging Sciences, Emory University, 1364 Clifton Rd, Atlanta, GA, 30322, USA
| | - Charlie C Park
- Department of Radiology & Imaging Sciences, Emory University, 1364 Clifton Rd, Atlanta, GA, 30322, USA
| | | | - Jason W Allen
- Department of Biomedical Engineering, The Wallace H. Coulter, Emory University and Georgia Institute of Technology, Atlanta, GA, USA
- Department of Radiology & Imaging Sciences, Emory University, 1364 Clifton Rd, Atlanta, GA, 30322, USA
- Department of Neurology, Emory University, Atlanta, GA, USA
| | - John N Oshinski
- Department of Biomedical Engineering, The Wallace H. Coulter, Emory University and Georgia Institute of Technology, Atlanta, GA, USA.
- Department of Radiology & Imaging Sciences, Emory University, 1364 Clifton Rd, Atlanta, GA, 30322, USA.
- Department of Neurology, Emory University, Atlanta, GA, USA.
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14
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Li XT, Allen JW, Hu R. Implementation of Automated Pipeline for Resting-State fMRI Analysis with PACS Integration. J Digit Imaging 2023; 36:1189-1197. [PMID: 36596936 PMCID: PMC10287855 DOI: 10.1007/s10278-022-00758-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 12/07/2022] [Accepted: 12/12/2022] [Indexed: 01/04/2023] Open
Abstract
In recent years, the quantity and complexity of medical imaging acquisition and processing have increased tremendously. The explosion in volume and need for advanced imaging analysis have led to the creation of numerous software programs, which have begun to be incorporated into clinical practice for indications such as automated stroke assessment, brain tumor perfusion processing, and hippocampal volume analysis. Despite these advances, there remains a need for specialized, custom-built software for advanced algorithms and new areas of research that is not widely available or adequately integrated in these "out-of-the-box" solutions. The purpose of this paper is to describe the implementation of an image-processing pipeline that is versatile and simple to create, which allows for rapid prototyping of image analysis algorithms and subsequent testing in a clinical environment. This pipeline uses a combination of Orthanc server, custom MATLAB code, and publicly available FMRIB Software Library and RestNeuMap tools to automatically receive and analyze resting-state functional MRI data collected from a custom filter on the MR scanner output. The processed files are then sent directly to Picture Archiving and Communications System (PACS) without the need for user input. This initial experience can serve as a framework for those interested in simple implementation of an automated pipeline customized to clinical needs.
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Affiliation(s)
- Xiao T Li
- Department of Radiology and Imaging Sciences, Emory University Hospital, Atlanta, GA, USA.
| | - Jason W Allen
- Department of Radiology and Imaging Sciences, Emory University Hospital, Atlanta, GA, USA
- Department of Neurology, Emory University Hospital, Atlanta, GA, USA
| | - Ranliang Hu
- Department of Radiology and Imaging Sciences, Emory University Hospital, Atlanta, GA, USA
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15
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Sung D, Rejimon A, Allen JW, Fedorov AG, Fleischer CC. Predicting brain temperature in humans using bioheat models: Progress and outlook. J Cereb Blood Flow Metab 2023; 43:833-842. [PMID: 36883416 PMCID: PMC10196749 DOI: 10.1177/0271678x231162173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 01/31/2023] [Accepted: 02/02/2023] [Indexed: 03/09/2023]
Abstract
Brain temperature, regulated by the balance between blood circulation and metabolic heat generation, is an important parameter related to neural activity, cerebral hemodynamics, and neuroinflammation. A key challenge for integrating brain temperature into clinical practice is the lack of reliable and non-invasive brain thermometry. The recognized importance of brain temperature and thermoregulation in both health and disease, combined with limited availability of experimental methods, has motivated the development of computational thermal models using bioheat equations to predict brain temperature. In this mini-review, we describe progress and the current state-of-the-art in brain thermal modeling in humans and discuss potential avenues for clinical applications.
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Affiliation(s)
- Dongsuk Sung
- Department of Biomedical
Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA,
USA
- Department of Radiology and Imaging
Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Abinand Rejimon
- Department of Biomedical
Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA,
USA
- Department of Radiology and Imaging
Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Jason W Allen
- Department of Biomedical
Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA,
USA
- Department of Radiology and Imaging
Sciences, Emory University School of Medicine, Atlanta, GA, USA
- Department of Neurology, Emory
University School of Medicine, Atlanta, GA, USA
| | - Andrei G Fedorov
- Woodruff School of Mechanical
Engineering, Georgia Institute of Technology, Atlanta, GA, USA
- Petit Institute for Bioengineering
and Bioscience, Georgia Institute of Technology, Atlanta, GA, USA
| | - Candace C Fleischer
- Department of Biomedical
Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA,
USA
- Department of Radiology and Imaging
Sciences, Emory University School of Medicine, Atlanta, GA, USA
- Petit Institute for Bioengineering
and Bioscience, Georgia Institute of Technology, Atlanta, GA, USA
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16
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Park CC, Brummer ME, Sadigh G, Saindane AM, Mullins ME, Allen JW, Hu R. Automated Registration and Color Labeling of Serial 3D Double Inversion Recovery MR Imaging for Detection of Lesion Progression in Multiple Sclerosis. J Digit Imaging 2023; 36:450-457. [PMID: 36352165 PMCID: PMC10039147 DOI: 10.1007/s10278-022-00737-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 11/01/2022] [Accepted: 11/02/2022] [Indexed: 11/11/2022] Open
Abstract
Automated co-registration and subtraction techniques have been shown to be useful in the assessment of longitudinal changes in multiple sclerosis (MS) lesion burden, but the majority depend on T2-fluid-attenuated inversion recovery sequences. We aimed to investigate the use of a novel automated temporal color complement imaging (CCI) map overlapped on 3D double inversion recovery (DIR), and to assess its diagnostic performance for detecting disease progression in patients with multiple sclerosis (MS) as compared to standard review of serial 3D DIR images. We developed a fully automated system that co-registers and compares baseline to follow-up 3D DIR images and outputs a pseudo-color RGB map in which red pixels indicate increased intensity values in the follow-up image (i.e., progression; new/enlarging lesion), blue-green pixels represent decreased intensity values (i.e., disappearing/shrinking lesion), and gray-scale pixels reflect unchanged intensity values. Three neuroradiologists blinded to clinical information independently reviewed each patient using standard DIR images alone and using CCI maps based on DIR images at two separate exams. Seventy-six follow-up examinations from 60 consecutive MS patients who underwent standard 3 T MR brain MS protocol that included 3D DIR were included. Median cohort age was 38.5 years, with 46 women, 59 relapsing-remitting type MS, and median follow-up interval of 250 days (interquartile range: 196-394 days). Lesion progression was detected in 67.1% of cases using CCI review versus 22.4% using standard review, with a total of 182 new or enlarged lesions using CCI review versus 28 using standard review. There was a statistically significant difference between the two methods in the rate of all progressive lesions (P < 0.001, McNemar's test) as well as cortical progressive lesions (P < 0.001). Automated CCI maps using co-registered serial 3D DIR, compared to standard review of 3D DIR alone, increased detection rate of MS lesion progression in patients undergoing clinical brain MRI exam.
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Affiliation(s)
- Charlie C Park
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1364 Clifton Road NE, Suite BG20, Atlanta, GA, 30322, USA
| | - Marijn E Brummer
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1364 Clifton Road NE, Suite BG20, Atlanta, GA, 30322, USA
| | - Gelareh Sadigh
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1364 Clifton Road NE, Suite BG20, Atlanta, GA, 30322, USA
| | - Amit M Saindane
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1364 Clifton Road NE, Suite BG20, Atlanta, GA, 30322, USA
| | - Mark E Mullins
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1364 Clifton Road NE, Suite BG20, Atlanta, GA, 30322, USA
| | - Jason W Allen
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1364 Clifton Road NE, Suite BG20, Atlanta, GA, 30322, USA
| | - Ranliang Hu
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1364 Clifton Road NE, Suite BG20, Atlanta, GA, 30322, USA.
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Sung D, Risk BB, Wang KJ, Allen JW, Fleischer CC. Resting-State Brain Temperature: Dynamic Fluctuations in Brain Temperature and the Brain-Body Temperature Gradient. J Magn Reson Imaging 2023; 57:1222-1228. [PMID: 35904094 PMCID: PMC9884314 DOI: 10.1002/jmri.28376] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 07/14/2022] [Accepted: 07/15/2022] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND While fluctuations in healthy brain temperature have been investigated over time periods of weeks to months, dynamics over shorter time periods are less clear. PURPOSE To identify physiological fluctuations in brain temperature in healthy volunteers over time scales of approximately 1 hour. STUDY TYPE Prospective. SUBJECTS A total of 30 healthy volunteers (15 female; 26 ± 4 years old). SEQUENCE AND FIELD STRENGTH 3 T; T1-weighted magnetization-prepared rapid gradient-echo (MPRAGE) and semi-localized by adiabatic selective refocusing (sLASER) single-voxel spectroscopy. ASSESSMENTS Brain temperature was calculated from the chemical shift difference between N-acetylaspartate and water. To evaluate within-scan repeatability of brain temperature and the brain-body temperature difference, 128 spectral transients were divided into two sets of 64-spectra. Between-scan repeatability was evaluated using two time periods, ~1-1.5 hours apart. STATISTICAL TESTS A hierarchical linear mixed model was used to calculate within-scan and between-scan correlations (Rw and Rb , respectively). Significance was determined at P ≤ .05. Values are reported as the mean ± standard deviation. RESULTS A significant difference in brain temperature was observed between scans (-0.4 °C) but body temperature was stable (P = .59). Brain temperature (37.9 ± 0.7 °C) was higher than body temperature (36.5 ± 0.5 °C) for all but one subject. Within-scan correlation was high for brain temperature (Rw = 0.95) and brain-body temperature differences (Rw = 0.96). Between scans, variability was high for both brain temperature (Rb = 0.30) and brain-body temperature differences (Rb = 0.41). DATA CONCLUSION Significant changes in brain temperature over time scales of ~1 hour were observed. High short-term repeatability suggests temperature changes appear to be due to physiology rather than measurement error. EVIDENCE LEVEL 2 TECHNICAL EFFICACY: Stage 1.
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Affiliation(s)
- Dongsuk Sung
- Department of Radiology and Imaging Sciences, Emory University School of Medicine
- Department of Biomedical Engineering, Georgia Institute of Technology and Emory University
| | - Benjamin B. Risk
- Department of Biostatistics and Bioinformatics, Emory University
| | - Kelly J. Wang
- Department of Radiology and Imaging Sciences, Emory University School of Medicine
- Department of Neuroscience, Georgia Institute of Technology
| | - Jason W. Allen
- Department of Radiology and Imaging Sciences, Emory University School of Medicine
- Department of Biomedical Engineering, Georgia Institute of Technology and Emory University
| | - Candace C. Fleischer
- Department of Radiology and Imaging Sciences, Emory University School of Medicine
- Department of Biomedical Engineering, Georgia Institute of Technology and Emory University
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Zohbi N, Castilho A, Kim S, Saindane AM, Allen JW, Hoch MJ, Weinberg BD. Cranial nerve abnormalities in spontaneous intracranial hypotension and their clinical relevance. J Neuroimaging 2023. [DOI: 10.1111/jon.13102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 02/27/2023] [Accepted: 03/10/2023] [Indexed: 03/29/2023] Open
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Ratcliff JJ, Hall AJ, Porto E, Saville BR, Lewis RJ, Allen JW, Frankel M, Wright DW, Barrow DL, Pradilla G. Early Minimally Invasive Removal of Intracerebral Hemorrhage (ENRICH): Study protocol for a multi-centered two-arm randomized adaptive trial. Front Neurol 2023; 14:1126958. [PMID: 37006503 PMCID: PMC10061000 DOI: 10.3389/fneur.2023.1126958] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Accepted: 02/27/2023] [Indexed: 03/18/2023] Open
Abstract
BackgroundIntracerebral hemorrhage (ICH) is a potentially devastating condition with elevated early mortality rates, poor functional outcomes, and high costs of care. Standard of care involves intensive supportive therapy to prevent secondary injury. To date, there is no randomized control study demonstrating benefit of early evacuation of supratentorial ICH.MethodsThe Early Minimally Invasive Removal of Intracerebral Hemorrhage (ENRICH) Trial was designed to evaluate the minimally invasive trans-sulcal parafascicular surgery (MIPS) approach, a technique for safe access to deep brain structures and ICH removal using the BrainPath® and Myriad® devices (NICO Corporation, Indianapolis, IN). ENRICH is a multi-centered, two-arm, randomized, adaptive comparative-effectiveness study, where patients are block randomized by ICH location and Glasgow Coma Score (GCS) to early ICH evacuation using MIPS plus standard guideline-based management vs. standard management alone to determine if MIPS results in improved outcomes defined by the utility-weighted modified Rankin score (UWmRS) at 180 days as the primary endpoint. Secondary endpoints include clinical and economic outcomes of MIPS using cost per quality-adjusted life years (QALYs). The inclusion and exclusion criteria aim to capture a broad group of patients with high risk of significant morbidity and mortality to determine optimal treatment strategy.DiscussionENRICH will result in improved understanding of the benefit of MIPS for both lobar and deep ICH affecting the basal ganglia. The ongoing study will lead to Level-I evidence to guide clinicians treatment options in the management of acute treatment of ICH.Trial registrationThis study is registered with clinicaltrials.gov (Identifier: NCT02880878).
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Affiliation(s)
- Jonathan J. Ratcliff
- Department of Emergency Medicine, Emory University School of Medicine, Atlanta, GA, United States
- Department of Neurology, Emory University School of Medicine, Grady Hospital, Atlanta, GA, United States
| | - Alex J. Hall
- Department of Emergency Medicine, Emory University School of Medicine, Atlanta, GA, United States
| | - Edoardo Porto
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, GA, United States
| | - Benjamin R. Saville
- Berry Consultants LLC, Austin, TX, United States
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Roger J. Lewis
- Berry Consultants LLC, Austin, TX, United States
- Department of Emergency Medicine, Harbor-UCLA Medical Center, UCLA, Torrance, CA, United States
| | - Jason W. Allen
- Department of Neurology, Emory University School of Medicine, Grady Hospital, Atlanta, GA, United States
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA, United States
| | - Michael Frankel
- Department of Neurology, Emory University School of Medicine, Grady Hospital, Atlanta, GA, United States
| | - David W. Wright
- Department of Emergency Medicine, Emory University School of Medicine, Atlanta, GA, United States
| | - Daniel L. Barrow
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, GA, United States
| | - Gustavo Pradilla
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, GA, United States
- *Correspondence: Gustavo Pradilla
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Wu H, Wright DW, Allen JW, Ding V, Boothroyd D, Glushakova OY, Hayes R, Jiang B, Wintermark M. Accuracy of head computed tomography scoring systems in predicting outcomes for patients with moderate to severe traumatic brain injury: A ProTECT III ancillary study. Neuroradiol J 2023; 36:38-48. [PMID: 35533263 PMCID: PMC9893165 DOI: 10.1177/19714009221101313] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Several types of head CT classification systems have been developed to prognosticate and stratify TBI patients. OBJECTIVE The purpose of our study was to compare the predictive value and accuracy of the different CT scoring systems, including the Marshall, Rotterdam, Stockholm, Helsinki, and NIRIS systems, to inform specific patient management actions, using the ProTECT III population of patients with moderate to severe acute traumatic brain injury (TBI). METHODS We used the data collected in the patients with moderate to severe (GCS score of 4-12) TBI enrolled in the ProTECT III clinical trial. ProTECT III was a NIH-funded, prospective, multicenter, randomized, double-blind, placebo-controlled clinical trial designed to determine the efficacy of early administration of IV progesterone. The CT scoring systems listed above were applied to the baseline CT scans obtained in the trial. We assessed the predictive accuracy of these scoring systems with respect to Glasgow Outcome Scale-Extended at 6 months, disability rating scale score, and mortality. RESULTS A total of 882 subjects were enrolled in ProTECT III. Worse scores for each head CT scoring systems were highly correlated with unfavorable outcome, disability outcome, and mortality. The NIRIS classification was more strongly correlated than the Stockholm and Rotterdam CT scores, followed by the Helsinki and Marshall CT classification. The highest correlation was observed between NIRIS and mortality (estimated odds ratios of 4.83). CONCLUSION All scores were highly associated with 6-month unfavorable, disability and mortality outcomes. NIRIS was also accurate in predicting TBI patients' management and disposition.
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Affiliation(s)
- Haijun Wu
- Department of Radiology, Neuroradiology Division, Stanford University, Stanford, CA, USA
- Department of Radiology, Guangdong Provincial People's
Hospital, Guangdong Academy of Medical Sciences, Guangdong,
China
- Department of Emergency Medicine, Emory University School of Medicine
and Grady Memorial Hospital, Atlanta, GA, USA
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, GA, USA
- Department of Medicine, Quantitative Sciences Unit, Stanford University, Stanford, CA, USA
- University of Virginia Cancer
Center, Charlottesville, VA, USA
- Department of Neurosurgery, Virginia Commonwealth
University, Richmond, VA, USA
- Department of Radiology, Neuroradiology Division, Stanford University, Stanford, CA, USA
| | - David W Wright
- Department of Radiology, Neuroradiology Division, Stanford University, Stanford, CA, USA
- Department of Radiology, Guangdong Provincial People's
Hospital, Guangdong Academy of Medical Sciences, Guangdong,
China
- Department of Emergency Medicine, Emory University School of Medicine
and Grady Memorial Hospital, Atlanta, GA, USA
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, GA, USA
- Department of Medicine, Quantitative Sciences Unit, Stanford University, Stanford, CA, USA
- University of Virginia Cancer
Center, Charlottesville, VA, USA
- Department of Neurosurgery, Virginia Commonwealth
University, Richmond, VA, USA
- Department of Radiology, Neuroradiology Division, Stanford University, Stanford, CA, USA
| | - Jason W Allen
- Department of Radiology, Neuroradiology Division, Stanford University, Stanford, CA, USA
- Department of Radiology, Guangdong Provincial People's
Hospital, Guangdong Academy of Medical Sciences, Guangdong,
China
- Department of Emergency Medicine, Emory University School of Medicine
and Grady Memorial Hospital, Atlanta, GA, USA
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, GA, USA
- Department of Medicine, Quantitative Sciences Unit, Stanford University, Stanford, CA, USA
- University of Virginia Cancer
Center, Charlottesville, VA, USA
- Department of Neurosurgery, Virginia Commonwealth
University, Richmond, VA, USA
- Department of Radiology, Neuroradiology Division, Stanford University, Stanford, CA, USA
| | - Victoria Ding
- Department of Radiology, Neuroradiology Division, Stanford University, Stanford, CA, USA
- Department of Radiology, Guangdong Provincial People's
Hospital, Guangdong Academy of Medical Sciences, Guangdong,
China
- Department of Emergency Medicine, Emory University School of Medicine
and Grady Memorial Hospital, Atlanta, GA, USA
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, GA, USA
- Department of Medicine, Quantitative Sciences Unit, Stanford University, Stanford, CA, USA
- University of Virginia Cancer
Center, Charlottesville, VA, USA
- Department of Neurosurgery, Virginia Commonwealth
University, Richmond, VA, USA
- Department of Radiology, Neuroradiology Division, Stanford University, Stanford, CA, USA
| | - Derek Boothroyd
- Department of Radiology, Neuroradiology Division, Stanford University, Stanford, CA, USA
- Department of Radiology, Guangdong Provincial People's
Hospital, Guangdong Academy of Medical Sciences, Guangdong,
China
- Department of Emergency Medicine, Emory University School of Medicine
and Grady Memorial Hospital, Atlanta, GA, USA
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, GA, USA
- Department of Medicine, Quantitative Sciences Unit, Stanford University, Stanford, CA, USA
- University of Virginia Cancer
Center, Charlottesville, VA, USA
- Department of Neurosurgery, Virginia Commonwealth
University, Richmond, VA, USA
- Department of Radiology, Neuroradiology Division, Stanford University, Stanford, CA, USA
| | - Olena Y Glushakova
- Department of Radiology, Neuroradiology Division, Stanford University, Stanford, CA, USA
- Department of Radiology, Guangdong Provincial People's
Hospital, Guangdong Academy of Medical Sciences, Guangdong,
China
- Department of Emergency Medicine, Emory University School of Medicine
and Grady Memorial Hospital, Atlanta, GA, USA
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, GA, USA
- Department of Medicine, Quantitative Sciences Unit, Stanford University, Stanford, CA, USA
- University of Virginia Cancer
Center, Charlottesville, VA, USA
- Department of Neurosurgery, Virginia Commonwealth
University, Richmond, VA, USA
- Department of Radiology, Neuroradiology Division, Stanford University, Stanford, CA, USA
| | - Ron Hayes
- Department of Radiology, Neuroradiology Division, Stanford University, Stanford, CA, USA
- Department of Radiology, Guangdong Provincial People's
Hospital, Guangdong Academy of Medical Sciences, Guangdong,
China
- Department of Emergency Medicine, Emory University School of Medicine
and Grady Memorial Hospital, Atlanta, GA, USA
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, GA, USA
- Department of Medicine, Quantitative Sciences Unit, Stanford University, Stanford, CA, USA
- University of Virginia Cancer
Center, Charlottesville, VA, USA
- Department of Neurosurgery, Virginia Commonwealth
University, Richmond, VA, USA
- Department of Radiology, Neuroradiology Division, Stanford University, Stanford, CA, USA
| | | | - Max Wintermark
- Max Wintermark, Department of Radiology,
Neuroradiology Division, Stanford University, 300 Pasteur Drive, Room S047,
Stanford, CA 94305-5105, USA.
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21
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Perry da Camara C, Nogueira RG, Al-Bayati AR, Pisani L, Mohammaden M, Allen JW, Nahab F, Olive Gadea M, Frankel MR, Haussen DC. Comparative analysis between 1-D, 2-D and 3-D carotid web quantification. J Neurointerv Surg 2023; 15:153-156. [PMID: 35172982 DOI: 10.1136/neurintsurg-2021-018192] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 01/09/2022] [Indexed: 01/14/2023]
Abstract
BACKGROUND Carotid webs (CaW) are now recognized as a cause of ischemic stroke in young patients. The thromboembolic potential appears related to the CaW's morphology and consequent impact on local flow dynamics. We aim to evaluate the reliability of different measurement methods for the quantification of CaW and their relationship to symptomatic status, presence of large vessel occlusion stroke (LVOS), clot burden and final infarct volume. METHODS This was a retrospective analysis of the local comprehensive stroke center CaW database (September 2014-July 2019). CT angiograms (CTAs) were reviewed independently by two raters, blinded to the clinical information and laterality of the stroke/transient ischemic attack. CaW were quantified with 1-D (length), 2-D (area) and 3-D (volume) measurements via Osirix software. Final infarct volume was calculated on MRI. Patients with superimposed CaW thrombus and no repeat imaging were excluded. RESULTS Forty-eight CaW (37 symptomatic and 11 contralateral/asymptomatic) in 38 patients were included. Mean age (±SD) was 48.7 (±8.5) years, 78.9% were women and 77.1% were black. Inter-rater agreement was 0.921 (p<0.001) for 1-D, 0.930 (p<0.001) for 2-D, and 0.937 (p<0.001) for 3-D CaW measurements. When comparing symptomatic with asymptomatic CaW, mean web length was 3.2 mm versus 2.5 mm (p<0.02), median area was 5.8 versus 5.0 mm2 (p=0.35) and median volume was 15.0 versus 10.6 mm3 (p<0.04), respectively. CaW with a thinner profile (longer intraluminal projection compared with the base) were more likely to be symptomatic (0.67±0.17 vs 0.88±0.37; p=0.01). Average CaW 1-D and final infarct volume had a weak but positive association (Κ=0.230, p<0.05), while no association among web measurements and the presence of LVOS or clot burden was observed. CONCLUSION CaW dimension quantification (1-D, 2-D and 3-D) is highly reproducible. Linear and volumetric measurements were more strongly associated with symptoms. The impact of CaW size on the presence of LVOS, clot burden and final infarct volume is unclear.
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Affiliation(s)
- Catarina Perry da Camara
- Marcus Stroke & Neuroscience Center, Grady Memorial Hospital, Emory University School of Medicine, Atlanta, Georgia, USA.,Department of Neuroradiology, Centro Hospitalar Universitário Lisboa Central, Lisboa, Portugal
| | - Raul G Nogueira
- Marcus Stroke & Neuroscience Center, Grady Memorial Hospital, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Alhamza R Al-Bayati
- Marcus Stroke & Neuroscience Center, Grady Memorial Hospital, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Leonardo Pisani
- Marcus Stroke & Neuroscience Center, Grady Memorial Hospital, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Mahmoud Mohammaden
- Marcus Stroke & Neuroscience Center, Grady Memorial Hospital, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Jason W Allen
- Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Fadi Nahab
- Neurology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Marta Olive Gadea
- Marcus Stroke & Neuroscience Center, Grady Memorial Hospital, Emory University School of Medicine, Atlanta, Georgia, USA.,Department of Neurology, Hospital Vall d'Hebron, Barcelona, Spain
| | - Michael R Frankel
- Marcus Stroke & Neuroscience Center, Grady Memorial Hospital, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Diogo C Haussen
- Marcus Stroke & Neuroscience Center, Grady Memorial Hospital, Emory University School of Medicine, Atlanta, Georgia, USA
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22
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Smith JL, Ahluwalia V, Gore RK, Allen JW. Eagle-449: A volumetric, whole-brain compilation of brain atlases for vestibular functional MRI research. Sci Data 2023; 10:29. [PMID: 36641517 PMCID: PMC9840609 DOI: 10.1038/s41597-023-01938-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 01/04/2023] [Indexed: 01/15/2023] Open
Abstract
Human vestibular processing involves distributed networks of cortical and subcortical regions which perform sensory and multimodal integrative functions. These functional hubs are also interconnected with areas subserving cognitive, affective, and body-representative domains. Analysis of these diverse components of the vestibular and vestibular-associated networks, and synthesis of their holistic functioning, is therefore vital to our understanding of the genesis of vestibular dysfunctions and aid treatment development. Novel neuroimaging methodologies, including functional and structural connectivity analyses, have provided important contributions in this area, but often require the use of atlases which are comprised of well-defined a priori regions of interest. Investigating vestibular dysfunction requires a more detailed atlas that encompasses cortical, subcortical, cerebellar, and brainstem regions. The present paper represents an effort to establish a compilation of existing, peer-reviewed brain atlases which collectively afford comprehensive coverage of these regions while explicitly focusing on vestibular substrates. It is expected that this compilation will be iteratively improved with additional contributions from researchers in the field.
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Affiliation(s)
- Jeremy L. Smith
- grid.189967.80000 0001 0941 6502Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia USA
| | - Vishwadeep Ahluwalia
- grid.213917.f0000 0001 2097 4943Georgia Institute of Technology, Atlanta, Georgia USA ,grid.256304.60000 0004 1936 7400GSU/GT Center for Advanced Brain Imaging, Atlanta, Georgia USA
| | - Russell K. Gore
- grid.213917.f0000 0001 2097 4943Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, Georgia USA ,grid.419148.10000 0004 0384 2537Shepherd Center, Atlanta, Georgia USA
| | - Jason W. Allen
- grid.189967.80000 0001 0941 6502Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia USA ,grid.213917.f0000 0001 2097 4943Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, Georgia USA ,grid.189967.80000 0001 0941 6502Department of Neurology, Emory University School of Medicine, Atlanta, Georgia USA
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23
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Giraldi E, Allen JW, Ioachimescu AG. Pituitary Incidentalomas: Best Practices and Looking Ahead. Endocr Pract 2023; 29:60-68. [PMID: 36270609 DOI: 10.1016/j.eprac.2022.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 09/30/2022] [Accepted: 10/11/2022] [Indexed: 01/11/2023]
Abstract
Pituitary Incidentalomas (PI) are pituitary lesions serendipitously identified on imaging. PIs have become common in clinical practice because of increased use of imaging and radiologic advances. The most frequently incidentally detected lesions in adults are pituitary adenomas, followed by cystic lesions, and rarely other types of tumors and infiltrative and inflammatory disorders. Biochemical screening for hyperprolactinemia and acromegaly is needed in all patients with PI, whereas testing for hyposecretion is recommended for lesions larger than 6.0 mm. Most PIs are small nonfunctioning adenomas or cysts, which can be conservatively managed. For larger lesions, a multidisciplinary approach including endocrinology, neurosurgery, and neuro-ophthalmology is required. For incidentally detected lactotroph, somatotroph, and corticotroph adenomas, disease-specific management guidelines apply. Prospective studies are needed to enhance our understanding of the long-term course and response to treatment.
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Affiliation(s)
- Erica Giraldi
- Department of Medicine (Endocrinology), Emory University School of Medicine, Atlanta, Georgia; Department of Neurosurgery, Emory University School of Medicine, Atlanta, Georgia
| | - Jason W Allen
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Adriana G Ioachimescu
- Department of Medicine (Endocrinology), Emory University School of Medicine, Atlanta, Georgia; Department of Neurosurgery, Emory University School of Medicine, Atlanta, Georgia.
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24
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Bettale CM, Allen JW, Mahdi ZK, Ioachimescu AG. Pancreatic ACTH Hypersecretion and Pituitary Macroadenoma. JCEM Case Rep 2023; 1:luad007. [PMID: 37908262 PMCID: PMC10578389 DOI: 10.1210/jcemcr/luad007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Indexed: 11/02/2023]
Abstract
A 55-year-old woman admitted for hypertensive emergency and myocardial infarction reported weight gain, muscle weakness, easy bruising, and recent-onset diabetes in the past 3 to 12 months. Urinary and salivary cortisol and adrenocorticotropin hormone (ACTH) levels were elevated. Pituitary imaging detected a macroadenoma. ACTH and cortisol did not increase after corticotropin-releasing hormone administration. Imaging revealed a large pancreatic mass. Pathology indicated a well-differentiated World Health Organization (WHO) grade 2 distal pancreatic neuroendocrine neoplasm which stained for ACTH by immunohistochemistry. Postoperatively, Cushing manifestations resolved, ACTH and cortisol levels became low, and patient required hydrocortisone replacement for 7 months. During the 3.5 years of follow-up, the pituitary macroadenoma size remained stable and pituitary hormone axes other than ACTH remained normal. This extremely rare case of ectopic ACTH-secreting pancreatic neuroendocrine tumor coexisting with a nonfunctioning pituitary macroadenoma illustrates the importance of dynamic endocrine testing in Cushing syndrome.
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Affiliation(s)
| | - Jason W Allen
- Department of Radiology and Imaging Services, Emory University School of Medicine, Atlanta, GA 30322, USA
- Department of Neurology, Emory University School of Medicine, Atlanta, GA 30322, USA
| | - Zaid K Mahdi
- Department of Pathology, Emory University School of Medicine, Atlanta, GA 30322, USA
| | - Adriana G Ioachimescu
- Department of Medicine, Division of Endocrinology, Metabolism and Lipids, Emory University School of Medicine, Atlanta, GA 30322, USA
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, GA 30322, USA
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25
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Sung D, Risk BB, Kottke PA, Allen JW, Nahab F, Fedorov AG, Fleischer CC. Comparisons of healthy human brain temperature predicted from biophysical modeling and measured with whole brain MR thermometry. Sci Rep 2022; 12:19285. [PMID: 36369468 PMCID: PMC9652378 DOI: 10.1038/s41598-022-22599-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Accepted: 10/17/2022] [Indexed: 11/13/2022] Open
Abstract
Brain temperature is an understudied parameter relevant to brain injury and ischemia. To advance our understanding of thermal dynamics in the human brain, combined with the challenges of routine experimental measurements, a biophysical modeling framework was developed to facilitate individualized brain temperature predictions. Model-predicted brain temperatures using our fully conserved model were compared with whole brain chemical shift thermometry acquired in 30 healthy human subjects (15 male and 15 female, age range 18-36 years old). Magnetic resonance (MR) thermometry, as well as structural imaging, angiography, and venography, were acquired prospectively on a Siemens Prisma whole body 3 T MR scanner. Bland-Altman plots demonstrate agreement between model-predicted and MR-measured brain temperatures at the voxel-level. Regional variations were similar between predicted and measured temperatures (< 0.55 °C for all 10 cortical and 12 subcortical regions of interest), and subcortical white matter temperatures were higher than cortical regions. We anticipate the advancement of brain temperature as a marker of health and injury will be facilitated by a well-validated computational model which can enable predictions when experiments are not feasible.
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Affiliation(s)
- Dongsuk Sung
- grid.213917.f0000 0001 2097 4943Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA USA
| | - Benjamin B. Risk
- grid.189967.80000 0001 0941 6502Department of Biostatistics and Bioinformatics, Emory University, Atlanta, GA USA
| | - Peter A. Kottke
- grid.213917.f0000 0001 2097 4943Woodruff School of Mechanical Engineering, Georgia Institute of Technology, Atlanta, GA USA
| | - Jason W. Allen
- grid.213917.f0000 0001 2097 4943Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA USA ,grid.189967.80000 0001 0941 6502Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA USA ,grid.189967.80000 0001 0941 6502Department of Neurology, Emory University School of Medicine, Atlanta, GA USA
| | - Fadi Nahab
- grid.189967.80000 0001 0941 6502Department of Neurology, Emory University School of Medicine, Atlanta, GA USA
| | - Andrei G. Fedorov
- grid.213917.f0000 0001 2097 4943Woodruff School of Mechanical Engineering, Georgia Institute of Technology, Atlanta, GA USA ,grid.213917.f0000 0001 2097 4943Petit Institute for Bioengineering and Bioscience, Georgia Institute of Technology, Atlanta, GA USA
| | - Candace C. Fleischer
- grid.213917.f0000 0001 2097 4943Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA USA ,grid.189967.80000 0001 0941 6502Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA USA ,grid.213917.f0000 0001 2097 4943Petit Institute for Bioengineering and Bioscience, Georgia Institute of Technology, Atlanta, GA USA ,grid.189967.80000 0001 0941 6502Wesley Woods Health Center, Emory University School of Medicine, 1841 Clifton Road, Atlanta, GA 30329 USA
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26
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Kadom N, Reddy KM, Khanna G, Simoneaux SF, Allen JW, Heilbrun ME. Peer Learning Program Metrics: A Pediatric Neuroradiology Example. AJNR Am J Neuroradiol 2022; 43:1680-1684. [PMID: 36229162 PMCID: PMC9731238 DOI: 10.3174/ajnr.a7673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 09/12/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND AND PURPOSE The American College of Radiology is now offering an accreditation pathway for programs that use peer learning. Here, we share feasibility and outcome data from a pilot peer learning program in a pediatric neuroradiology section that, in its design, follows the American College of Radiology peer learning accreditation pathway criteria. MATERIALS AND METHODS We retrospectively reviewed metrics from a peer learning program with 5 participating full-time pediatric neuroradiologists during 1 year: 1) number of cases submitted, 2) percentage of radiologists meeting targets, 3) monthly attendance, 4) number of cases reviewed, 5) learning points, and 6) improvement actions. In addition, a faculty survey was conducted and is reported here. RESULTS Three hundred twenty-four cases were submitted (mean, 7 cases/faculty/month). The faculty never met the monthly submission target. Peer learning meeting attendance was 100%. One hundred seventy-nine cases were reviewed during the peer learning meetings. There were 22 learning points throughout the year and 30 documented improvement actions. The faculty survey yielded the highest ratings (4.8 of 5) for ease of meeting the 100% attendance requirement and for the learning value of the peer learning sessions. The lowest rating (4.2 of 5) was given for the effectiveness of improvements as a result of peer learning discussions. CONCLUSIONS Implementing a peer learning program that follows the American College of Radiology peer learning accreditation pathway criteria is feasible. Program metric documentation can be time-consuming. Participant feedback led to meaningful program improvement, such as improving trust, expanding case submission categories, and delegating tasks to administrative staff. Effort to make peer learning operations more efficient and more effective is underway.
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Affiliation(s)
- N Kadom
- From the Department of Radiology and Imaging Sciences (N.K., K.M.R., G.K., S.F.S., J.W.A., M.E.H.), Emory University School of Medicine, Atlanta, Georgia
- Department of Radiology (N.K., K.M.R., G.K., S.F.S.), Children's Healthcare of Atlanta, Atlanta, Georgia
| | - K M Reddy
- From the Department of Radiology and Imaging Sciences (N.K., K.M.R., G.K., S.F.S., J.W.A., M.E.H.), Emory University School of Medicine, Atlanta, Georgia
- Department of Radiology (N.K., K.M.R., G.K., S.F.S.), Children's Healthcare of Atlanta, Atlanta, Georgia
| | - G Khanna
- From the Department of Radiology and Imaging Sciences (N.K., K.M.R., G.K., S.F.S., J.W.A., M.E.H.), Emory University School of Medicine, Atlanta, Georgia
- Department of Radiology (N.K., K.M.R., G.K., S.F.S.), Children's Healthcare of Atlanta, Atlanta, Georgia
| | - S F Simoneaux
- From the Department of Radiology and Imaging Sciences (N.K., K.M.R., G.K., S.F.S., J.W.A., M.E.H.), Emory University School of Medicine, Atlanta, Georgia
- Department of Radiology (N.K., K.M.R., G.K., S.F.S.), Children's Healthcare of Atlanta, Atlanta, Georgia
| | - J W Allen
- From the Department of Radiology and Imaging Sciences (N.K., K.M.R., G.K., S.F.S., J.W.A., M.E.H.), Emory University School of Medicine, Atlanta, Georgia
| | - M E Heilbrun
- From the Department of Radiology and Imaging Sciences (N.K., K.M.R., G.K., S.F.S., J.W.A., M.E.H.), Emory University School of Medicine, Atlanta, Georgia
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27
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Smith JL, Allen JW, Fleischer CC, Harper DE. Topology of pain networks in patients with temporomandibular disorder and pain-free controls with and without concurrent experimental pain: A pilot study. Front Pain Res (Lausanne) 2022; 3:966398. [PMID: 36324873 PMCID: PMC9619074 DOI: 10.3389/fpain.2022.966398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 09/26/2022] [Indexed: 11/26/2022]
Abstract
Temporomandibular disorders (TMD) involve chronic pain in the masticatory muscles and jaw joints, but the mechanisms underlying the pain are heterogenous and vary across individuals. In some cases, structural, functional, and metabolic changes in the brain may underlie the condition. In the present study, we evaluated the functional connectivity between 86 regions of interest (ROIs), which were chosen based on previously reported neuroimaging studies of pain and differences in brain morphology identified in an initial surface-based morphometry analysis. Our main objectives were to investigate the topology of the network formed by these ROIs and how it differs between individuals with TMD and chronic pain (n = 16) and pain-free control participants (n = 12). In addition to a true resting state functional connectivity scan, we also measured functional connectivity during a 6-min application of a noxious cuff stimulus applied to the left leg. Our principal finding is individuals with TMD exhibit more suprathreshold correlations (higher nodal degree) among all ROIs but fewer "hub" nodes (i.e., decreased betweenness centrality) across conditions and across all pain pathways. These results suggest is this pain-related network of nodes may be "over-wired" in individuals with TMD and chronic pain compared to controls, both at rest and during experimental pain.
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Affiliation(s)
- Jeremy L. Smith
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA, United States
| | - Jason W. Allen
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA, United States,Department of Neurology, Emory University School of Medicine, Atlanta, GA, United States
| | - Candace C. Fleischer
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA, United States,Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, United States
| | - Daniel E. Harper
- Department of Anesthesiology, Emory University School of Medicine, Atlanta, GA, United States,Department of Anesthesiology, University of Michigan, Ann Arbor, MI, United States,Correspondence: Daniel E. Harper
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28
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Huang S, Lah JJ, Allen JW, Qiu D. A probabilistic Bayesian approach to recover R2*$$ {R}_{2\ast } $$ map and phase images for quantitative susceptibility mapping. Magn Reson Med 2022; 88:1624-1642. [PMID: 35672899 PMCID: PMC10627109 DOI: 10.1002/mrm.29303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 04/04/2022] [Accepted: 04/26/2022] [Indexed: 12/29/2022]
Abstract
PURPOSE Undersampling is used to reduce the scan time for high-resolution three-dimensional magnetic resonance imaging. In order to achieve better image quality and avoid manual parameter tuning, we propose a probabilistic Bayesian approach to recover R 2 ∗ $$ {R}_2^{\ast } $$ map and phase images for quantitative susceptibility mapping (QSM), while allowing automatic parameter estimation from undersampled data. THEORY Sparse prior on the wavelet coefficients of images is interpreted from a Bayesian perspective as sparsity-promoting distribution. A novel nonlinear approximate message passing (AMP) framework that incorporates a mono-exponential decay model is proposed. The parameters are treated as unknown variables and jointly estimated with image wavelet coefficients. METHODS Undersampling takes place in the y-z plane of k-space according to the Poisson-disk pattern. Retrospective undersampling is performed to evaluate the performances of different reconstruction approaches, prospective undersampling is performed to demonstrate the feasibility of undersampling in practice. RESULTS The proposed AMP with parameter estimation (AMP-PE) approach successfully recovers R 2 ∗ $$ {R}_2^{\ast } $$ maps and phase images for QSM across various undersampling rates. It is more computationally efficient, and performs better than the state-of-the-art l 1 $$ {l}_1 $$ -norm regularization (L1) approach in general, except a few cases where the L1 approach performs as well as AMP-PE. CONCLUSION AMP-PE achieves better performance by drawing information from both the sparse prior and the mono-exponential decay model. It does not require parameter tuning, and works with a clinical, prospective undersampling scheme where parameter tuning is often impossible or difficult due to the lack of ground-truth image.
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Affiliation(s)
- Shuai Huang
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, GA, 30322, USA
| | - James J. Lah
- Department of Neurology, Emory University, Atlanta, GA, 30322, USA
| | - Jason W. Allen
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, GA, 30322, USA
| | - Deqiang Qiu
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, GA, 30322, USA
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Kosaraju S, Galatzer-Levy I, Schultebraucks K, Winters S, Hinrichs R, Reddi PJ, Maples-Keller JL, Hudak L, Michopoulos V, Jovanovic T, Ressler KJ, Allen JW, Stevens JS. Associations among civilian mild traumatic brain injury with loss of consciousness, posttraumatic stress disorder symptom trajectories, and structural brain volumetric data. J Trauma Stress 2022; 35:1521-1534. [PMID: 35776892 DOI: 10.1002/jts.22858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 05/14/2022] [Accepted: 05/16/2022] [Indexed: 11/08/2022]
Abstract
Posttraumatic stress disorder (PTSD) is prevalent and associated with significant morbidity. Mild traumatic brain injury (mTBI) concurrent with psychiatric trauma may be associated with PTSD. Prior studies of PTSD-related structural brain alterations have focused on military populations. The current study examined correlations between PTSD, acute mTBI, and structural brain alterations longitudinally in civilian patients (N = 504) who experienced a recent Criterion A traumatic event. Participants who reported loss of consciousness (LOC) were characterized as having mTBI; all others were included in the control group. PTSD symptoms were assessed at enrollment and over the following year; a subset of participants (n = 89) underwent volumetric brain MRI (M = 53 days posttrauma). Classes of PTSD symptom trajectories were modeled using latent growth mixture modeling. Associations between PTSD symptom trajectories and cortical thicknesses or subcortical volumes were assessed using a moderator-based regression. mTBI with LOC during trauma was positively correlated with the likelihood of developing a chronic PTSD symptom trajectory. mTBI showed significant interactions with cortical thickness in the rostral anterior cingulate cortex (rACC) in predicting PTSD symptoms, r = .461-.463. Bilateral rACC thickness positively predicted PTSD symptoms but only among participants who endorsed LOC, p < .001. The results demonstrate positive correlations between mTBI with LOC and PTSD symptom trajectories, and findings related to mTBI with LOC and rACC thickness interactions in predicting subsequent chronic PTSD symptoms suggest the importance of further understanding the role of mTBI in the context of PTSD to inform intervention and risk stratification.
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Affiliation(s)
- Siddhartha Kosaraju
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Isaac Galatzer-Levy
- Department of Psychiatry, New York University School of Medicine, New York, New York, USA
| | - Katharina Schultebraucks
- Department of Emergency Medicine, Vagelos School of Physicians and Surgeons, Columbia University Medical Center, New York, New York, USA
| | - Sterling Winters
- Department of Psychiatry, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Rebecca Hinrichs
- Department of Psychiatry, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Preethi J Reddi
- Department of Biology, Emory University School of Medicine, Atlanta, Georgia, USA
| | | | - Lauren Hudak
- Department of Emergency Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Vasiliki Michopoulos
- Department of Psychiatry, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Tanja Jovanovic
- Department of Psychiatry, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Kerry J Ressler
- Department of Psychiatry, McLean Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Jason W Allen
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Jennifer S Stevens
- Department of Psychiatry, New York University School of Medicine, New York, New York, USA
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30
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Woodbury A, Krishnamurthy LC, Bohsali A, Krishnamurthy V, Smith JL, Gebre M, Tyler K, Vernon M, Crosson B, Kalangara JP, Napadow V, Allen JW, Harper D. Percutaneous electric nerve field stimulation alters cortical thickness in a pilot study of veterans with fibromyalgia. Neurobiol Pain 2022; 12:100093. [PMID: 35733704 PMCID: PMC9207563 DOI: 10.1016/j.ynpai.2022.100093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 04/29/2022] [Accepted: 05/11/2022] [Indexed: 11/29/2022]
Abstract
Objective To evaluate changes in cortical thickness and right posterior insula (r-pIns) gamma-aminobutyric acid (GABA) concentrations in veterans with fibromyalgia treated with auricular percutaneous electric nerve field stimulation (PENFS). Materials & methods This was a randomized, controlled, open label investigation conducted in a government hospital. Twenty-one veterans with fibromyalgia were randomized to receive either standard therapy (ST; i.e., 4 weekly visits with a pain practitioner) or ST with auricular PENFS (ST + PENFS). Neuroimaging data was collected at baseline (i.e. before the first treatment session) and again within 2 weeks post-treatment. Clinical pain and physical function were also assessed at these timepoints. Single-voxel magnetic resonance spectroscopy was carried out in r-pIns to assess changes in r-pIns GABA concentrations and high-resolution T1-weighted images were collected to assess changes in regional gray matter volume using cortical thickness. Results Both the ST + PENFS and ST groups reported a decrease in pain with treatment. Volumetric: Cortical thickness significantly decreased in the left middle posterior cingulate (p = 0.018) and increased in the left cuneus (p = 0.014) following ST + PENFS treatment. These findings were significant following FDR correction for multiple comparisons. ST group right hemisphere insula cortical thickness increased post-treatment and was significantly (p = 0.02) inversely correlated with pain scores. ST + PENFS group right hemisphere posterior dorsal cingulate size significantly (p = 0.044) positively correlated with pain scores. GABA: There were no significant correlations with GABA, though a trend was noted towards increased GABA following treatment in both groups (p = 0.083) using a linear mixed effects model. Conclusions Results suggest a novel effect of PENFS reflected by differential volumetric changes compared to ST. The changes in GABA that occur in both groups are more likely related to ST. Insular GABA and cortical thickness in key regions of interest may be developed as potential biomarkers for evaluating chronic pain pathology and treatment outcomes.
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Affiliation(s)
- Anna Woodbury
- Emory University School of Medicine, Atlanta, GA, USA
- Atlanta Veterans Affairs Healthcare System, Atlanta, GA, USA
| | - Lisa C. Krishnamurthy
- Emory University School of Medicine, Atlanta, GA, USA
- Atlanta Veterans Affairs Healthcare System, Atlanta, GA, USA
- Georgia State University, Atlanta, GA, USA
| | | | - Venkatagiri Krishnamurthy
- Emory University School of Medicine, Atlanta, GA, USA
- Atlanta Veterans Affairs Healthcare System, Atlanta, GA, USA
| | | | - Melat Gebre
- Emory University School of Medicine, Atlanta, GA, USA
| | - Kari Tyler
- Emory University School of Medicine, Atlanta, GA, USA
- Atlanta Veterans Affairs Healthcare System, Atlanta, GA, USA
| | - Mark Vernon
- Atlanta Veterans Affairs Healthcare System, Atlanta, GA, USA
| | - Bruce Crosson
- Emory University School of Medicine, Atlanta, GA, USA
- Atlanta Veterans Affairs Healthcare System, Atlanta, GA, USA
| | - Jerry P. Kalangara
- Emory University School of Medicine, Atlanta, GA, USA
- Atlanta Veterans Affairs Healthcare System, Atlanta, GA, USA
| | - Vitaly Napadow
- Spaulding Rehabilitation Network, Harvard Medical School, Charlestown, MA, USA
| | | | - Daniel Harper
- Emory University School of Medicine, Atlanta, GA, USA
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Hu R, Kim H, Kim J, Allen JW, Sun PZ. Fast diffusion kurtosis imaging in acute ischemic stroke shows mean kurtosis-diffusivity mismatch. J Neuroimaging 2022; 32:941-946. [PMID: 35436024 DOI: 10.1111/jon.13000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 03/23/2022] [Accepted: 03/24/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND AND PURPOSE Diffusion kurtosis imaging (DKI) is an advanced technique more specific to irreversible ischemic injury than conventional diffusion-weighted imaging (DWI). However, its clinical translation has been limited by a long acquisition time and complex postprocessing. METHODS A fast DKI sequence (3 minutes) was implemented on a 3T MRI (Siemens Trio) and piloted as part of an inpatient brain MRI protocol. Mean kurtosis (MK) and mean diffusivity (MD) maps were postprocessed automatically at the scanner console and sent to the Picture Archiving and Communications System. We retrospectively reviewed consecutive patients in a 5-month period with acute ischemic stroke due to large vessel occlusion. MK and MD of the ischemic infarcts and contralateral normal brain were measured, and lesion volumes were measured in large infarcts using semiautomated segmentation. RESULTS Twenty-two patients were included in the study (median age 66). The median time from last known well to MRI was 37 hours. MD and MK maps were successfully processed and demonstrated acute infarction in concordance with DWI in all cases. Infarcted regions had higher MK and lower MD compared to contralateral normal-appearing regions. MK lesion volume was significantly smaller than MD volume. CONCLUSION In this pilot study, we demonstrated the feasibility of incorporating a fast DKI sequence into a clinical MRI protocol. Acute infarcts were depicted on kurtosis maps, and MK lesion volumes were smaller than MD, in accordance with prior works. Future studies are needed to determine the role of DKI in acute stroke treatment selection and prognostication.
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Affiliation(s)
- Ranliang Hu
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Hahnsung Kim
- Yerkes Imaging Center, Yerkes National Primate Research Center, Emory University, Atlanta, Georgia, USA
| | - Jinsuh Kim
- Deapartment of Radiology, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Jason W Allen
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Phillip Zhe Sun
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia, USA.,Yerkes Imaging Center, Yerkes National Primate Research Center, Emory University, Atlanta, Georgia, USA
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32
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Wu J, Nahab F, Allen JW, Hu R, Dehkharghani S, Qiu D. Alterations in Functional Network Topology Within Normal Hemispheres Contralateral to Anterior Circulation Steno-Occlusive Disease: A Resting-State BOLD Study. Front Neurol 2022; 13:780896. [PMID: 35392638 PMCID: PMC8980268 DOI: 10.3389/fneur.2022.780896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 02/21/2022] [Indexed: 11/20/2022] Open
Abstract
The purpose of this study was to assess spatially remote effects of hemodynamic impairment on functional network topology contralateral to unilateral anterior circulation steno-occlusive disease (SOD) using resting-state blood oxygen level-dependent (BOLD) imaging, and to investigate the relationships between network connectivity and cerebrovascular reactivity (CVR), a measure of hemodynamic stress. Twenty patients with unilateral, chronic anterior circulation SOD and 20 age-matched healthy controls underwent resting-state BOLD imaging. Five-minute standardized baseline BOLD acquisition was followed by acetazolamide infusion to measure CVR. The BOLD baseline was used to analyze network connectivity contralateral to the diseased hemispheres of SOD patients. Compared to healthy controls, reduced network degree (z-score = −1.158 ± 1.217, P < 0.001, false discovery rate (FDR) corrected), local efficiency (z-score = −1.213 ± 1.120, P < 0.001, FDR corrected), global efficiency (z-score = −1.346 ± 1.119, P < 0.001, FDR corrected), and enhanced modularity (z-score = 1.000 ± 1.205, P = 0.002, FDR corrected) were observed in the contralateral, normal hemispheres of SOD patients. Network degree (P = 0.089, FDR corrected; P = 0.027, uncorrected) and nodal efficiency (P = 0.089, FDR corrected; P = 0.045, uncorrected) showed a trend toward a positive association with CVR. The results indicate remote abnormalities in functional connectivity contralateral to the diseased hemispheres in patients with unilateral SOD, despite the absence of macrovascular disease or demonstrable hemodynamic impairment. The clinical impact of remote functional disruptions requires dedicated investigation but may portend far reaching consequence for even putatively unilateral cerebrovascular disease.
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Affiliation(s)
- Junjie Wu
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA, United States
| | - Fadi Nahab
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, United States
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, United States
| | - Jason W. Allen
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA, United States
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, United States
- Joint Department of Biomedical Engineering, Emory University and Georgia Institute of Technology, Atlanta, GA, United States
| | - Ranliang Hu
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA, United States
| | - Seena Dehkharghani
- Department of Radiology, New York University Langone Medical Center, New York, NY, United States
- Department of Neurology, New York University Langone Medical Center, New York, NY, United States
| | - Deqiang Qiu
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA, United States
- Joint Department of Biomedical Engineering, Emory University and Georgia Institute of Technology, Atlanta, GA, United States
- *Correspondence: Deqiang Qiu
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33
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Allen JW, Peterson RB, Hughes DR, Hemingway J, Rula EY, Rubin E, Duszak R. Evolving Radiology Trainee Neuroimaging Workloads: A National Medicare Claims-based Analysis. Acad Radiol 2022; 29 Suppl 3:S215-S221. [PMID: 34400079 DOI: 10.1016/j.acra.2021.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 07/06/2021] [Accepted: 07/07/2021] [Indexed: 11/20/2022]
Abstract
RATIONALE AND OBJECTIVES While radiology training programs aim to prepare trainees for clinical practice, the relationship between trainee, and national radiology workforce demands is unclear. This study assesses changing radiology trainee neuroimaging workloads nationwide for neuroimaging studies. MATERIALS AND METHODS Using aggregate Medicare claims files from 2002 to 2018, we identified all computed tomography (CT) and magnetic resonance (MR) examinations of the brain, head and neck, and spine (hereafter "neuroimaging") in Medicare fee-for-service beneficiaries nationwide. Using separate Medicare files, we calculated population utilization rates, and work relative value unit (wRVU) weights of all diagnostic neuroradiology services. Using claims modifiers, we identified services rendered by radiology trainees. Using separate national trainee enrollment files, we calculated mean annual per trainee wRVUs. RESULTS Between 2002 and 2018, total Medicare neuroimaging claims increased for both radiologists overall (86.1%) and trainees (162.5%), including increases in both CT (102.9% vs 196.8%), and MR (59.9% vs 106.6%). The national percentage of all radiologist neuroimaging wRVUs rendered by trainees increased 46.1% (3.8% of all wRVUs nationally in 2002 to 5.6% in 2018). National trainee increases were present across all neuroimaging services but greatest for head and neck CT (+86.5%). Mean annual per radiology trainee neuroimaging Medicare wRVUs increased +174.9% (42.1 per trainee in 2002 to 115.70 in 2018). Mean per trainee wRVU increases were greatest for spine CT (+394.2%) but present across all neuroimaging services. CONCLUSION As neuroimaging utilization in Medicare beneficiaries has grown, radiology trainee neuroimaging workloads have increased disproportionately.
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Affiliation(s)
- Jason W Allen
- Department of Radiology and Imaging Sciences, Emory University School of Medicine,1364 Clifton Rd NE, Atlanta, GA 30332.
| | - Ryan B Peterson
- Department of Radiology and Imaging Sciences, Emory University School of Medicine,1364 Clifton Rd NE, Atlanta, GA 30332
| | - Danny R Hughes
- Georgia Institute of Technology School of Economics, Old C.E. Building, 221 Bobby Dodd Way, Atlanta, GA 30332
| | - Jennifer Hemingway
- Harvey L. Neiman Health Policy Institute, 1891 Preston White Dr., Reston, VA 20191
| | - Elizabeth Y Rula
- Harvey L. Neiman Health Policy Institute, 1891 Preston White Dr., Reston, VA 20191
| | - Eric Rubin
- Crozer Health, 1 Medical Center Blvd, Upland, PA 19013
| | - Richard Duszak
- Department of Radiology and Imaging Sciences, Emory University School of Medicine,1364 Clifton Rd NE, Atlanta, GA 30332
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34
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Allen JW, Prater A, Kallas O, Abidi SA, Howard BM, Tong F, Agarwal S, Yaghi S, Dehkharghani S. Diagnostic Performance of Computed Tomography Angiography and Computed Tomography Perfusion Tissue Time-to-Maximum in Vasospasm Following Aneurysmal Subarachnoid Hemorrhage. J Am Heart Assoc 2021; 11:e023828. [PMID: 34970916 PMCID: PMC9075209 DOI: 10.1161/jaha.121.023828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
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.
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Affiliation(s)
- Jason W Allen
- Department of Radiology and Imaging Sciences Emory University Atlanta GA.,Department of Neurology Emory University Atlanta GA
| | - Adam Prater
- Department of Radiology and Imaging Sciences Emory University Atlanta GA
| | - Omar Kallas
- Department of Radiology and Imaging Sciences Emory University Atlanta GA
| | - Syed A Abidi
- Emory School of Medicine Emory University Atlanta GA
| | - Brian M Howard
- Department of Radiology and Imaging Sciences Emory University Atlanta GA.,Department of Neurosurgery Emory University Atlanta GA
| | - Frank Tong
- Department of Radiology and Imaging Sciences Emory University Atlanta GA.,Department of Neurosurgery Emory University Atlanta GA
| | | | - Shadi Yaghi
- Department of Neurology Brown University Providence RI
| | - Seena Dehkharghani
- Department of Neurology New York University New York NY.,Department of Radiology New York University New York NY
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35
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Sharashidze V, Nogueira RG, Al-Bayati AR, Bhatt N, Nahab FB, Yun J, Allen JW, Frankel M, Haussen DC. Carotid Web Phenotype Is Uncommonly Associated With Classic Fibromuscular Dysplasia: A Retrospective Observational Study. Stroke 2021; 53:e33-e36. [PMID: 34965739 DOI: 10.1161/strokeaha.121.036188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Carotid web (CaW) is an intimal form of fibromuscular dysplasia (FMD) involving the carotid bulb which has been increasingly recognized as a potential cause of recurrent ischemic strokes. It is overlooked as a separate entity and often dismissed if no coexistent signs of classic FMD changes are observed. We aim to evaluate the frequency of classic FMD in high-yield vascular territories in patients with symptomatic CaW. METHODS This was a retrospective analysis of a symptomatic CaW database of 2 comprehensive stroke centers (spanning September 2014-October 2020). The diagnosis of a CaW during a stroke workup was defined as the presence of a shelf-like linear filling defect in the posterior aspect of the carotid bulb on computed tomography angiography in patients with acute ischemic stroke or transient ischemic attack of undetermined cause after a thorough evaluation. Neck computed tomography angiography and renal conventional angiography images were independently evaluated by two readers blinded to the laterality and clinical details to inspect the presence of underlying classic FMD. RESULTS Sixty-six patients with CaW were identified. Median age was 51 years (interquartile range, 42-57), and 74% were women. All patients had neck computed tomography angiography (allowing for bilateral vertebral and carotid evaluation), whereas 47 patients had additional digital subtraction angiography (which evaluated 47 carotids ipsilateral to the stroke and 10 contralateral carotids). Internal carotid artery classic FMD changes were noted in only 6 out of 66 (9%) in the ipsilateral carotids. No contralateral carotid or vertebral artery classic FMD changes were observed. Renal artery catheter-based angiography was obtained in 16 patients/32 arteries and only 1 patient/2 renal arteries demonstrated classic FMD changes. CONCLUSIONS CaW phenotype is uncommonly associated with classic FMD changes. Coexistent classic FMD does not constitute a useful marker to corroborate or exclude CaW diagnosis.
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Affiliation(s)
- Vera Sharashidze
- Department of Neurology, Emory University/Grady Memorial Hospital, Atlanta, GA. (V.S., R.G.N., A.R.A-B., N.B., F.B.N., J.Y., M.F., D.C.H.)
| | - Raul G Nogueira
- Department of Neurology, Emory University/Grady Memorial Hospital, Atlanta, GA. (V.S., R.G.N., A.R.A-B., N.B., F.B.N., J.Y., M.F., D.C.H.)
| | - Alhamza R Al-Bayati
- Department of Neurology, Emory University/Grady Memorial Hospital, Atlanta, GA. (V.S., R.G.N., A.R.A-B., N.B., F.B.N., J.Y., M.F., D.C.H.)
| | - Nirav Bhatt
- Department of Neurology, Emory University/Grady Memorial Hospital, Atlanta, GA. (V.S., R.G.N., A.R.A-B., N.B., F.B.N., J.Y., M.F., D.C.H.)
| | - Fadi B Nahab
- Department of Neurology, Emory University/Grady Memorial Hospital, Atlanta, GA. (V.S., R.G.N., A.R.A-B., N.B., F.B.N., J.Y., M.F., D.C.H.)
| | - Johanna Yun
- Department of Neurology, Emory University/Grady Memorial Hospital, Atlanta, GA. (V.S., R.G.N., A.R.A-B., N.B., F.B.N., J.Y., M.F., D.C.H.)
| | - Jason W Allen
- Department of Radiology, Emory University/Grady Memorial Hospital, Atlanta, GA. (J.W.A.)
| | - Michael Frankel
- Department of Neurology, Emory University/Grady Memorial Hospital, Atlanta, GA. (V.S., R.G.N., A.R.A-B., N.B., F.B.N., J.Y., M.F., D.C.H.)
| | - Diogo C Haussen
- Department of Neurology, Emory University/Grady Memorial Hospital, Atlanta, GA. (V.S., R.G.N., A.R.A-B., N.B., F.B.N., J.Y., M.F., D.C.H.)
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36
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Smith JL, Trofimova A, Ahluwalia V, Casado Garrido JJ, Hurtado J, Frank R, Hodge A, Gore RK, Allen JW. The "vestibular neuromatrix": A proposed, expanded vestibular network from graph theory in post-concussive vestibular dysfunction. Hum Brain Mapp 2021; 43:1501-1518. [PMID: 34862683 PMCID: PMC8886666 DOI: 10.1002/hbm.25737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 11/21/2021] [Accepted: 11/23/2021] [Indexed: 11/07/2022] Open
Abstract
Convergent clinical and neuroimaging evidence suggests that higher vestibular function is subserved by a distributed network including visuospatial, cognitive-affective, proprioceptive, and integrative brain regions. Clinical vestibular syndromes may perturb this network, resulting in deficits across a variety of functional domains. Here, we leverage structural and functional neuroimaging to characterize this extended network in healthy control participants and patients with post-concussive vestibular dysfunction (PCVD). Then, 27 healthy control subjects (15 females) and 18 patients with subacute PCVD (12 female) were selected for participation. Eighty-two regions of interest (network nodes) were identified based on previous publications, group-wise differences in BOLD signal amplitude and connectivity, and multivariate pattern analysis on affective tests. Group-specific "core" networks, as well as a "consensus" network comprised of connections common to all participants, were then generated based on probabilistic tractography and functional connectivity between the 82 nodes and subjected to analyses of node centrality and community structure. Whereas the consensus network was comprised of affective, integrative, and vestibular nodes, PCVD participants exhibited diminished integration and centrality among vestibular and affective nodes and increased centrality of visual, supplementary motor, and frontal and cingulate eye field nodes. Clinical outcomes, derived from dynamic posturography, were associated with approximately 62% of all connections but best predicted by amygdalar, prefrontal, and cingulate connectivity. No group-wise differences in diffusion metrics or tractography were noted. These findings indicate that cognitive, affective, and proprioceptive substrates contribute to vestibular processing and performance and highlight the need to consider these domains during clinical diagnosis and treatment planning.
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Affiliation(s)
- Jeremy L Smith
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Anna Trofimova
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Vishwadeep Ahluwalia
- Georgia State University, Atlanta, Georgia, USA.,Center for Advanced Brain Imaging, Georgia Institute of Technology, Atlanta, Georgia, USA
| | - Jose J Casado Garrido
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, Georgia, USA
| | | | | | | | - Russell K Gore
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, Georgia, USA.,Shepherd Center, Atlanta, Georgia, USA
| | - Jason W Allen
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia, USA.,Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, Georgia, USA.,Department of Neurology, Emory University School of Medicine Emory University Hospital, Atlanta, Georgia, USA
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Min TL, Xu L, Choi JD, Hu R, Allen JW, Reeves C, Hsu D, Duszak R, Switchenko J, Sadigh G. COVID-19 Pandemic-Associated Changes in the Acuity of Brain MRI Findings: A Secondary Analysis of Reports Using Natural Language Processing. Curr Probl Diagn Radiol 2021; 51:529-533. [PMID: 34955284 PMCID: PMC8636309 DOI: 10.1067/j.cpradiol.2021.11.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 11/15/2021] [Accepted: 11/28/2021] [Indexed: 11/22/2022]
Abstract
Rationale and Objectives We aimed to assess early COVID-19 pandemic-associated changes in brain MRI examination frequency and acuity of imaging findings acuity. Methods Using a natural language processing model, we retrospectively categorized reported findings of 12,346 brain MRI examinations performed during 6-month pre-pandemic and early pandemic time periods across a large metropolitan health system into 3 acuity levels: (1) normal or near normal; (2) incidental or chronic findings not requiring a management change; and (3) new or progressive findings requiring a management change. Brain MRI frequency and imaging finding acuity level were compared over time. Results Between March and August of 2019 (pre-pandemic) and 2020 (early pandemic), our health system brain MRI examination volumes decreased 17.0% (6745 vs 5601). Comparing calendar-matched 6-month periods, the proportion of higher acuity findings increased significantly (P< 0.001) from pre-pandemic (22.5%, 43.6% and 34.0% in acuity level 1, 2, and 3, respectively) to early pandemic periods (19.1%, 40.9%, and 40.1%). During the second 3 months of the early pandemic period, as MRI volumes recovered to near baseline, the proportion of higher acuity findings remained high (42.6% vs 34.1%) compared with a similar pre-pandemic period. In a multivariable analysis, Black (B coefficient, 0.16) and underinsured population (B coefficient, 0.33) presented with higher acuity findings (P< 0.05). Conclusions As the volume of brain MRI examinations decreased during the early COVID-19 pandemic, the relative proportion of examinations with higher acuity findings increased significantly. Pandemic-related changes in patient outcomes related to reduced imaging access merits further attention.
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Affiliation(s)
- Taejin L Min
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA
| | - Liyan Xu
- Department of Computer Science, Emory University(,) Atlanta, GA
| | - Jinho D Choi
- Department of Computer Science, Emory University(,) Atlanta, GA
| | - Ranliang Hu
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA
| | - Jason W Allen
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA
| | - Christopher Reeves
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA
| | - Derek Hsu
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA
| | - Richard Duszak
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA
| | - Jeffrey Switchenko
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA
| | - Gelareh Sadigh
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA.
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Smith JL, Allen JW, Haack CI, Wehrmeyer KL, Alden KG, Lund MB, Mascaro JS. Impact of App-Delivered Mindfulness Meditation on Functional Connectivity, Mental Health, and Sleep Disturbances Among Physician Assistant Students: Randomized, Wait-list Controlled Pilot Study. JMIR Form Res 2021; 5:e24208. [PMID: 34665153 PMCID: PMC8564666 DOI: 10.2196/24208] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 04/23/2021] [Accepted: 07/23/2021] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Health care provider and trainee burnout results in substantial national and institutional costs and profound social effects. Identifying effective solutions and interventions to cultivate resilience among health care trainees is critical. Although less is known about the mental health needs of physician assistants (PAs) or PA students, accumulating research indicates that they experience similarly alarming rates of burnout, depression, and emotional exhaustion. Mobile app-delivered mindfulness meditation may be an effective part of salubrious programming to bolster long-term resilience and health among PA students. OBJECTIVE This study aims to examine the impact of app-delivered mindfulness meditation on self-reported mental health symptoms among PA students. A secondary aim is to investigate changes in brain connectivity to identify neurobiological changes related to changes in mental health symptoms. METHODS We recruited PA students enrolled in their third semester of PA school and used a longitudinal, randomized, wait-list-controlled design. Participants randomized to the mindfulness group were provided 1-year subscriptions to the 10% Happier app, a consumer-based meditation app, and asked to practice every day for 8 weeks. Before randomization and again after completion of the 8-week program, all participants completed resting-state functional magnetic resonance imaging as well as self-report assessments of burnout, depression, anxiety, and sleep impairment. App use was acquired as a measure of mindfulness practice time. RESULTS PA students randomized to the mindfulness group reported improvements in sleep impairment compared with those randomized to the wait-list control group (ηp2=0.42; P=.01). Sleep impairment decreased significantly in the mindfulness group (19% reduction; P=.006) but not in the control group (1% reduction; P=.71). There were no other significant changes in mental health for those randomized to app-delivered mindfulness. Across all students, changes in sleep impairment were associated with increased resting-state functional connectivity between the medial prefrontal cortex (a component of the default mode network) and the superior temporal gyrus, as well as between areas important for working memory. Changes in connectivity predicted categorical conversion from impaired to nonimpaired sleep in the mindfulness group. CONCLUSIONS This pilot study is the first to examine app-based mindfulness for PA students' mental health and investigate the impact of mindfulness on PA students' brain function. These findings suggest that app-delivered mindfulness may be an effective tool to improve sleep dysfunction and that it may be an important part of the programming necessary to reduce the epidemic of suffering among health profession trainees.
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Affiliation(s)
- Jeremy L Smith
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, GA, United States
| | - Jason W Allen
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, GA, United States
- Department of Neurology, Emory University, Atlanta, GA, United States
| | - Carla I Haack
- Department of Surgery, Emory University, Atlanta, GA, United States
| | - Kathryn L Wehrmeyer
- Department of Family and Preventative Medicine, Emory University, Atlanta, GA, United States
| | - Kayley G Alden
- Department of Family and Preventative Medicine, Emory University, Atlanta, GA, United States
| | - Maha B Lund
- Physician Assistant Program, Department of Family and Preventative Medicine, Emory University, Atlanta, GA, United States
| | - Jennifer S Mascaro
- Department of Family and Preventative Medicine, Emory University, Atlanta, GA, United States
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Park CC, El Sayed R, Risk BB, Haussen DC, Nogueira RG, Oshinski JN, Allen JW. Carotid webs produce greater hemodynamic disturbances than atherosclerotic disease: a DSA time-density curve study. J Neurointerv Surg 2021; 14:729-733. [PMID: 34315802 PMCID: PMC9209666 DOI: 10.1136/neurintsurg-2021-017588] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Accepted: 07/13/2021] [Indexed: 01/22/2023]
Abstract
Background Carotid webs (CaWs) are associated with ischemic strokes in younger patients without degrees of stenosis that are traditionally considered clinically significant. Objective To compare the hemodynamic parameters in the internal carotid artery (ICA) bulbar segment in patients with CaW with those in patients with atherosclerotic lesions using time–density curve (TDC) analysis of digital subtraction angiography (DSA) images. Methods We retrospectively assessed DSA images of 47 carotid arteries in 41 adult patients who underwent ICA catheter angiography for evaluation after ischemic stroke. Hemodynamic parameters, including full width at half maximum (FWHM) and area under the time–density curve (AUC) as proxies for increased flow stasis, were calculated using TDC analyses of a region of interest (ROI) in the ICA bulb immediately rostral to the web/atherosclerotic plaque, relative to a standardized ROI in the ipsilateral distal common carotid artery (eg, relative FWHM (rFWHM)). Hemodynamic parameters were compared using non-parametric Kruskal-Wallis tests. Logistic regression was used to predict CaW versus mild/moderate atherosclerosis for each hemodynamic parameter, adjusting for degree of stenosis. Results Mean age of patients was 56.0±13 years, with 22 (53.7%) women. 17 CaWs, 22 atherosclerotic plaques (15 mild/moderate and 7 severe), and eight normal carotid arteries were assessed. Significant between-group differences were present in the relative total AUC (p<0.001), relative AUC at wash out (p=0.031), and relative FWHM (p=0.001). Logistic regression to predict CaW versus mild/moderate atherosclerosis showed that rAUC total had the highest predictive value (pAUC=0.96, 95% CI 0.90 to 1.00), followed by rFWHM (0.87, 95% CI 0.74 to 1.00), and rAUC WO (0.74, 95% CI (0.57 to 0.91). Conclusion CaW results in larger local hemodynamic disruption, characterized by flow stasis, than mild/moderate carotid atherosclerotic lesions, suggesting that CaWs may produce larger regions of thrombogenic flow stasis.
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Affiliation(s)
- Charlie C Park
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Retta El Sayed
- Department of Biomedical Engineering, Emory University, Atlanta, Georgia, USA
| | - Benjamin B Risk
- Department of Biostatistics and Bioinformatics, Emory University, Atlanta, Georgia, USA
| | - Diogo C Haussen
- Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Raul G Nogueira
- Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - John N Oshinski
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia, USA.,Department of Biomedical Engineering, Emory University, Atlanta, Georgia, USA
| | - Jason W Allen
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia, USA .,Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA
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40
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Sung D, Smith JL, Yarabarla S, Prasad O, Owusu-Ansah M, Ekici S, Allen JW, Mines B, Fleischer CC. Changes in brain metabolites and resting-state connectivity in collegiate basketball players as a function of play time. J Neuroimaging 2021; 31:1146-1155. [PMID: 34288203 DOI: 10.1111/jon.12909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 07/08/2021] [Accepted: 07/09/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND AND PURPOSE Magnetic resonance (MR) biomarkers are emerging for sports-related traumatic brain injury (TBI), but the effect of play time has not been characterized. Our goal was to characterize brain and inflammatory marker changes as a function of play time. METHODS Nine male players (21±2 years old) from a single collegiate basketball team were included. MR imaging (MRI), MR spectroscopy, and plasma were collected pre, mid, and postseason. Game time played was calculated for each subject. Changes in brain volume, diffusion tensor imaging (DTI), metabolites (normalized to total creatine, tCr), temperature, structural and functional connectivity, and inflammatory markers were quantified. RESULTS Myo-inositol/tCr in the left frontal white matter and brain temperature in the left frontal lobe varied significantly between time points. Glutamate (Glu/tCr) in the right frontal white matter and N-acetylaspartate in the posterior cingulate cortex (PCC) were negatively associated with minutes played. Midseason play time was associated with stronger blood-oxygen-level-dependent correlations between PCC and occipital areas, and weaker correlations between PCC and superior frontal connectivity. PCC Glu/tCr was positively associated with connectivity between the PCC and posterior supramarginal gyrus at preseason and with connectivity across time points among several right hemisphere regions. Volume, DTI, and inflammatory markers did not vary significantly. CONCLUSION Given that MR parameters vary with game play time in the absence of diagnosed injury, play time should be considered as a factor in sports-related TBI research.
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Affiliation(s)
- Dongsuk Sung
- Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, Georgia, USA
| | - Jeremy L Smith
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Suma Yarabarla
- Department of Biochemistry and Molecular Biology, University of Georgia, Athens, Georgia, USA
| | - Ojaswa Prasad
- Department of Medicine, Philadelphia College of Osteopathic Medicine, Suwanee, Georgia, USA
| | - Maame Owusu-Ansah
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Selin Ekici
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Jason W Allen
- Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, Georgia, USA.,Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Brandon Mines
- Department of Orthopedics, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Candace C Fleischer
- Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, Georgia, USA.,Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia, USA
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Min TL, Allen JW, Velazquez Vega JE, Neill SG, Weinberg BD. MRI Imaging Characteristics of Glioblastoma with Concurrent Gain of Chromosomes 19 and 20. ACTA ACUST UNITED AC 2021; 7:228-237. [PMID: 34199376 PMCID: PMC8293438 DOI: 10.3390/tomography7020021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 05/17/2021] [Accepted: 05/27/2021] [Indexed: 11/16/2022]
Abstract
Glioblastoma (GBM) is the most common and deadly primary brain tumor in adults. Some of the genetic variations identified thus far, such as IDH mutation and MGMT promotor methylation, have implications for survival and response to therapy. A recent analysis of long-term GBM survivors showed that concurrent gain of chromosomes 19 and 20 (19/20 co-gain) is a positive prognostic factor that is independent of IDH mutation status. In this study, we retrospectively identified 18 patients with 19/20 co-gain and compared their imaging features to a control cohort without 19/20 co-gain. Imaging features such as tumor location, size, pial invasion, and ependymal extension were examined manually. When compared without further genetic subclassification, both groups showed similar imaging features except for rates of pial invasion. When each group was subclassified by MGMT promotor methylation status however, the two groups showed different imaging features in a number of additional ways including tumor location, size, and ependymal extension. Our results indicate that different permutations of various genetic mutations that coexist in GBM may interact in unpredictable ways to affect imaging appearance, and that imaging prognostication may be better approached in the context of the global genomic profile rather than individual genetic alterations.
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Affiliation(s)
- Taejin L. Min
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Emory University Hospital, Suite D112, 1364 Clifton Road NE, Atlanta, GA 30322, USA; (T.L.M.); (J.W.A.)
| | - Jason W. Allen
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Emory University Hospital, Suite D112, 1364 Clifton Road NE, Atlanta, GA 30322, USA; (T.L.M.); (J.W.A.)
| | - Jose E. Velazquez Vega
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Emory University Hospital, Room H184, 1364 Clifton Road NE, Atlanta, GA 30322, USA; (J.E.V.V.); (S.G.N.)
| | - Stewart G. Neill
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Emory University Hospital, Room H184, 1364 Clifton Road NE, Atlanta, GA 30322, USA; (J.E.V.V.); (S.G.N.)
| | - Brent D. Weinberg
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Emory University Hospital, Suite D112, 1364 Clifton Road NE, Atlanta, GA 30322, USA; (T.L.M.); (J.W.A.)
- Correspondence:
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Cooper ME, Risk B, Corey A, Fountain AJ, Allen JW. Statistical learning of blunt cerebrovascular injury risk factors using the elastic net. Emerg Radiol 2021; 28:929-937. [PMID: 34046756 DOI: 10.1007/s10140-021-01949-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 05/19/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE To compare logistic regression to elastic net for identifying and ranking clinical risk factors for blunt cerebrovascular injury (BCVI). MATERIALS AND METHODS Consecutive trauma patients undergoing screening CTA at a level 1 trauma center over a 2-year period. Each internal carotid artery (ICA) and vertebral artery (VA) was independently graded by 2 neuroradiologists using the Denver grading scale. Unadjusted odds ratios were calculated by univariate and adjusted odds ratios by multiple logistic regression with FDR correction. We applied logistic regression with the elastic net penalty and tenfold cross-validation. RESULTS Total of 467 patients; 73 patients with BCVI. Maxillofacial fracture, basilar skull fracture, and GCS had significant unadjusted odds ratios (OR) for ICA injury and C-spine fracture, spinal ligamentous injury, and age for VA injury. Only transverse foramen fracture had significant adjusted OR for VA injury, with none for ICA injury, after FDR correction. Using elastic net, ICA injury variables included maxillofacial fracture, basilar skull fracture, GCS, and carotid canal fracture. For VA injury, these included cervical spine transverse foramen fracture, ligamentous injury, C1-C3 fractures, posterior element fracture, and vertebral body fracture. CONCLUSION Elastic net statistical learning methods identified additional risk factors and outperformed multiple logistic regression for BCVI. Elastic net allows the study of a large number of variables, and is useful when covariates are correlated.
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Affiliation(s)
- Maxwell E Cooper
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1364 Clifton Road, NE, Suite BG20, GA, Atlanta, 30222, USA
| | - Benjamin Risk
- Department of Biostatistics and Bioinformatics, Emory University Rollins School of Public Health, Atlanta, GA, USA
| | - Amanda Corey
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1364 Clifton Road, NE, Suite BG20, GA, Atlanta, 30222, USA.,Department of Radiology, Atlanta Veterans Affairs Healthcare System, Atlanta, GA, USA
| | - Arthur J Fountain
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1364 Clifton Road, NE, Suite BG20, GA, Atlanta, 30222, USA
| | - Jason W Allen
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1364 Clifton Road, NE, Suite BG20, GA, Atlanta, 30222, USA. .,Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA.
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Allen JW, Trofimova A, Ahluwalia V, Smith JL, Abidi SA, Peters MAK, Rajananda S, Hurtado JE, Gore RK. Altered Processing of Complex Visual Stimuli in Patients with Postconcussive Visual Motion Sensitivity. AJNR Am J Neuroradiol 2021; 42:930-937. [PMID: 33574098 DOI: 10.3174/ajnr.a7007] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 11/16/2020] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Vestibular symptoms are common after concussion. Vestibular Ocular Motor Screening identifies vestibular impairment, including postconcussive visual motion sensitivity, though the underlying functional brain alterations are not defined. We hypothesized that alterations in multisensory processing are responsible for postconcussive visual motion sensitivity, are detectable on fMRI, and correlate with symptom severity. MATERIALS AND METHODS Twelve patients with subacute postconcussive visual motion sensitivity and 10 healthy control subjects underwent vestibular testing and a novel fMRI visual-vestibular paradigm including 30-second "neutral" or "provocative" videos. The presence of symptoms/intensity was rated immediately after each video. fMRI group-level analysis was performed for a "provocative-neutral" condition. Z-statistic images were nonparametrically thresholded using clusters determined by Z > 2.3 and a corrected cluster significance threshold of P = .05. Symptoms assessed on Vestibular Ocular Motor Screening were correlated with fMRI mean parameter estimates using Pearson correlation coefficients. RESULTS Subjects with postconcussive visual motion sensitivity had significantly more Vestibular Ocular Motor Screening abnormalities and increased symptoms while viewing provocative videos. While robust mean activation in the primary and secondary visual areas, the parietal lobe, parietoinsular vestibular cortex, and cingulate gyrus was seen in both groups, selective increased activation was seen in subjects with postconcussive visual motion sensitivity in the primary vestibular/adjacent cortex and inferior frontal gyrus, which are putative multisensory visual-vestibular processing centers. Moderate-to-strong correlations were found between Vestibular Ocular Motor Screening scores and fMRI activation in the left frontal eye field, left middle temporal visual area, and right posterior hippocampus. CONCLUSIONS Increased fMRI brain activation in visual-vestibular multisensory processing regions is selectively seen in patients with postconcussive visual motion sensitivity and is correlated with Vestibular Ocular Motor Screening symptom severity, suggesting that increased visual input weighting into the vestibular network may underlie postconcussive visual motion sensitivity.
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Affiliation(s)
- J W Allen
- From the Department of Radiology and Imaging Sciences (J.W.A., A.T., J.L.S.), Emory University, Atlanta, Georgia
- Department of Neurology (J.W.A.), Emory University, Atlanta, Georgia
- Wallace H. Coulter Department of Biomedical Engineering (J.W.A., R.K.G.), Georgia Institute of Technology and Emory University, Atlanta, Georgia
| | - A Trofimova
- From the Department of Radiology and Imaging Sciences (J.W.A., A.T., J.L.S.), Emory University, Atlanta, Georgia
| | - V Ahluwalia
- Georgia State University/Georgia Tech Center for Advanced Brain Imaging (V.A.), Atlanta, Georgia
| | - J L Smith
- From the Department of Radiology and Imaging Sciences (J.W.A., A.T., J.L.S.), Emory University, Atlanta, Georgia
| | - S A Abidi
- School of Medicine (S.A.A.), Emory University, Atlanta, Georgia
| | - M A K Peters
- Department of Bioengineering (M.A.K.P., S.R.), University of California, Riverside, Riverside, California
| | - S Rajananda
- Department of Bioengineering (M.A.K.P., S.R.), University of California, Riverside, Riverside, California
| | | | - R K Gore
- Wallace H. Coulter Department of Biomedical Engineering (J.W.A., R.K.G.), Georgia Institute of Technology and Emory University, Atlanta, Georgia
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Osehobo EM, Nogueira RG, Koneru S, Al-Bayati AR, de Camara CP, Nahab F, Liberato B, Frankel MR, Allen JW, Park CC, Haussen DC. Carotid web: an under-recognized and misdiagnosed ischemic stroke etiology. J Neurointerv Surg 2021; 14:138-142. [PMID: 33722967 DOI: 10.1136/neurintsurg-2021-017306] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 02/24/2021] [Accepted: 02/27/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND Carotid web (CaW) constitutes a possible cause of ischemic stroke, particularly large vessel occlusion syndromes. We aim to evaluate misdiagnosis rates and diagnosis trends for CaW. METHODS Based on CT angiography (CTA), we prospectively identified a cohort of patients with symptomatic CaW treated at two comprehensive stroke centers (CSC) from 2014 to 2020 to assess misdiagnosis. Official CTA reports from the CSCs and referring hospitals were then reviewed for mention of CaW. For diagnosis trends, we retrospectively analyzed a CSC electronic medical record, identifying patients with CaW mentioned in an official CTA report from 2011 to 2020. RESULTS For misdiagnosis, 56 patients with symptomatic CaW were identified in the CSCs; 16 (28%) had bilateral CaW, totaling 72 CaWs. Only one CaW (5.5%) was reported at referring facilities, from 14 patients/18 CaWs imaged with CTA. Conversely, 43 (69%) CaWs were reported from 49 patients/62 CaWs at the CSC (p<0.01). For diagnosis trends, from 2011 to 2020, 242 patients at a CSC accounted for 266 CTA reports mentioning CaW. The majority of these reports (n=206, 77%) were associated with stroke/transient ischemic attack (TIA) ICD-9/ICD-10 codes. The rate of CaW diagnosis adjusted per 1000 patients with stroke/TIA increased over time, 2015 being the most significant point of change ('joinpoint'; p=0.01). The analysis of CaW mentions normalized per 1000 CTA reports also showed increasing rates of diagnosis over time (joinpoint:2014; p<0.02). CONCLUSION CaW was predominantly identified in patients with strokes/TIAs rather than asymptomatic patients. CaW was commonly overlooked in facilities with lower levels of cerebrovascular certification. Recognition of CaW at a CSC has significantly increased over time, independent of overall imaging and stroke patient volume.
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Affiliation(s)
- Ehizele M Osehobo
- Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA.,Marcus Stroke and Neuroscience Center, Grady Health System, Atlanta, GA, USA
| | - Raul G Nogueira
- Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA.,Marcus Stroke and Neuroscience Center, Grady Health System, Atlanta, GA, USA
| | - Sitara Koneru
- Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA.,Marcus Stroke and Neuroscience Center, Grady Health System, Atlanta, GA, USA
| | - Alhamza R Al-Bayati
- Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA.,Marcus Stroke and Neuroscience Center, Grady Health System, Atlanta, GA, USA
| | | | - Fadi Nahab
- Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Bernardo Liberato
- Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA.,Marcus Stroke and Neuroscience Center, Grady Health System, Atlanta, GA, USA
| | - Michael R Frankel
- Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA.,Marcus Stroke and Neuroscience Center, Grady Health System, Atlanta, GA, USA
| | - Jason W Allen
- Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA.,Department of Radiology, Emory University School of Medicine, Atlanta, GA, USA
| | | | - Diogo C Haussen
- Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA .,Marcus Stroke and Neuroscience Center, Grady Health System, Atlanta, GA, USA
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Ho AD, Verkerke H, Allen JW, Saeedi BJ, Boyer D, Owens J, Shin S, Horwath M, Patel K, Paul A, Wu SC, Chonat S, Zerra P, Lough C, Roback JD, Neish A, Josephson CD, Arthur CM, Stowell SR. An automated approach to determine antibody endpoint titers for COVID-19 by an enzyme-linked immunosorbent assay. Immunohematology 2021; 37:33-43. [PMID: 33962490 DOI: 10.21307/immunohematology-2021-007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
While a variety of therapeutic options continue to emerge for COVID-19 treatment, convalescent plasma (CP) has been used as a possible treatment option early in the pandemic. One of the most significant challenges with CP therapy, however, both when defining its efficacy and implementing its approach clinically, is accurately and efficiently characterizing an otherwise heterogenous therapeutic treatment. Given current limitations, our goal is to leverage a SARS antibody testing platform with a newly developed automated endpoint titer analysis program to rapidly define SARS-CoV-2 antibody levels in CP donors and hospitalized patients. A newly developed antibody detection platform was used to perform a serial dilution enzyme-linked immunosorbent assay (ELISA) for immunoglobulin (Ig)G, IgM, and IgA SARS-CoV-2 antibodies. Data were then analyzed using commercially available software, GraphPad Prism, or a newly developed program developed in Python called TiterScape, to analyze endpoint titers. Endpoint titer calculations and analysis times were then compared between the two analysis approaches. Serial dilution analysis of SARS-CoV-2 antibody levels revealed a high level of heterogeneity between individuals. Commercial platform analysis required significant time for manual data input and extrapolated endpoint titer values when the last serial dilution was above the endpoint cutoff, occasionally producing erroneously high results. By contrast, TiterScape processed 1008 samples for endpoint titer results in roughly 14 minutes compared with the 8 hours required for the commercial software program analysis. Equally important, results generated by TiterScape and Prism were highly similar, with differences averaging 1.26 ± 0.2 percent (mean ± SD). The pandemic has created unprecedented challenges when seeking to accurately test large numbers of individuals for SARS-CoV-2 antibody levels with a rapid turnaround time. ELISA platforms capable of serial dilution analysis coupled with a highly flexible software interface may provide a useful tool when seeking to define endpoint titers in a high-throughput manner. Immunohematology 2021;37:33-43. While a variety of therapeutic options continue to emerge for COVID-19 treatment, convalescent plasma (CP) has been used as a possible treatment option early in the pandemic. One of the most significant challenges with CP therapy, however, both when defining its efficacy and implementing its approach clinically, is accurately and efficiently characterizing an otherwise heterogenous therapeutic treatment. Given current limitations, our goal is to leverage a SARS antibody testing platform with a newly developed automated endpoint titer analysis program to rapidly define SARS-CoV-2 antibody levels in CP donors and hospitalized patients. A newly developed antibody detection platform was used to perform a serial dilution enzyme-linked immunosorbent assay (ELISA) for immunoglobulin (Ig)G, IgM, and IgA SARS-CoV-2 antibodies. Data were then analyzed using commercially available software, GraphPad Prism, or a newly developed program developed in Python called TiterScape, to analyze endpoint titers. Endpoint titer calculations and analysis times were then compared between the two analysis approaches. Serial dilution analysis of SARS-CoV-2 antibody levels revealed a high level of heterogeneity between individuals. Commercial platform analysis required significant time for manual data input and extrapolated endpoint titer values when the last serial dilution was above the endpoint cutoff, occasionally producing erroneously high results. By contrast, TiterScape processed 1008 samples for endpoint titer results in roughly 14 minutes compared with the 8 hours required for the commercial software program analysis. Equally important, results generated by TiterScape and Prism were highly similar, with differences averaging 1.26 ± 0.2 percent (mean ± SD). The pandemic has created unprecedented challenges when seeking to accurately test large numbers of individuals for SARS-CoV-2 antibody levels with a rapid turnaround time. ELISA platforms capable of serial dilution analysis coupled with a highly flexible software interface may provide a useful tool when seeking to define endpoint titers in a high-throughput manner. Immunohematology 2021;37:33–43.
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Affiliation(s)
- A D Ho
- Center for Transfusion Medicine and Cellular Therapies, and Department of Pathology and Laboratory Medicine, Emory University School of Medicine , Atlanta, GA , and Joint Program in Transfusion Medicine, Department of Pathology, Brigham and Women's Hospital, Harvard Medical School , Boston, MA
| | - H Verkerke
- Center for Transfusion Medicine and Cellular Therapies, and Department of Pathology and Laboratory Medicine, Emory University School of Medicine , Atlanta, GA , and Joint Program in Transfusion Medicine, Department of Pathology, Brigham and Women's Hospital, Harvard Medical School , Boston, MA
| | - J W Allen
- Center for Transfusion Medicine and Cellular Therapies, and Department of Pathology and Laboratory Medicine, Emory University School of Medicine , Atlanta, GA , and Joint Program in Transfusion Medicine, Department of Pathology, Brigham and Women's Hospital, Harvard Medical School , Boston, MA
| | - B J Saeedi
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine , Atlanta, GA
| | - D Boyer
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine , Atlanta, GA
| | - J Owens
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine , Atlanta, GA
| | - S Shin
- Center for Transfusion Medicine and Cellular Therapies, and Department of Pathology and Laboratory Medicine, Emory University School of Medicine , Atlanta, GA
| | - M Horwath
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine , Atlanta, GA
| | - K Patel
- Joint Program in Transfusion Medicine, Department of Pathology, Brigham and Women's Hospital, Harvard Medical School , Boston, MA
| | - A Paul
- Joint Program in Transfusion Medicine, Department of Pathology, Brigham and Women's Hospital, Harvard Medical School , Boston, MA
| | - S-C Wu
- Joint Program in Transfusion Medicine, Department of Pathology, Brigham and Women's Hospital, Harvard Medical School , Boston, MA
| | - S Chonat
- Department of Pediatrics, Emory University School of Medicine , Atlanta, GA
| | - P Zerra
- Center for Transfusion Medicine and Cellular Therapies, and Department of Pathology and Laboratory Medicine, Emory University School of Medicine , Atlanta, GA
| | - C Lough
- Lifesouth Blood Donation Services , Gainesville, FL
| | - J D Roback
- Center for Transfusion Medicine and Cellular Therapies, and Department of Pathology and Laboratory Medicine, Emory University School of Medicine , Atlanta, GA
| | - A Neish
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine , Atlanta, GA
| | - C D Josephson
- Center for Transfusion Medicine and Cellular Therapies, and Department of Pathology and Laboratory Medicine, Emory University School of Medicine , Atlanta, GA
| | - C M Arthur
- Center for Transfusion Medicine and Cellular Therapies, and Department of Pathology and Laboratory Medicine, Emory University School of Medicine , Atlanta, GA
| | - S R Stowell
- Center for Transfusion Medicine and Cellular Therapies, and Department of Pathology and Laboratory Medicine, Emory University School of Medicine , 201 Dowman Drive, Atlanta, GA 30322 , and Joint Program in Transfusion Medicine, Department of Pathology, Brigham and Women's Hospital, Harvard Medical School , 630E New Research Building, 77 Avenue Louis Pasteur, Boston, MA 02115
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Leary OP, Merck LH, Yeatts SD, Pan I, Liu DD, Harder TJ, Jung S, Collins S, Braileanu M, Gokaslan ZL, Allen JW, Wright DW, Merck D. Computer-Assisted Measurement of Traumatic Brain Hemorrhage Volume Is More Predictive of Functional Outcome and Mortality than Standard ABC/2 Method: An Analysis of Computed Tomography Imaging Data from the Progesterone for Traumatic Brain Injury Experimental Clinical Treatment Phase-III Trial. J Neurotrauma 2021; 38:604-615. [PMID: 33191851 PMCID: PMC7898408 DOI: 10.1089/neu.2020.7209] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Hemorrhage volume is an important variable in emergently assessing traumatic brain injury (TBI). The most widely used method for rapid volume estimation is ABC/2, a simple algorithm that approximates lesion geometry as perfectly ellipsoid. The relative prognostic value of volume measurement based on more precise hematoma topology remains unknown. In this study, we compare volume measurements obtained using ABC/2 versus computer-assisted volumetry (CAV) for both intra- and extra-axial traumatic hemorrhages, and then quantify the association of measurements using both methods with patient outcome following moderate to severe TBI. A total of 517 computer tomography (CT) scans acquired during the Progesterone for Traumatic Brain Injury Experimental Clinical Treatment Phase-III (ProTECTIII) multi-center trial were retrospectively reviewed. Lesion volumes were measured using ABC/2 and CAV. Agreement between methods was tested using Bland-Altman analysis. Relationship of volume measurements with 6-month mortality, Extended Glasgow Outcome Scale (GOS-E), and Disability Rating Scale (DRS) were assessed using linear regression and area under the curve (AUC) analysis. In subdural hematoma (SDH) >50cm3, ABC/2 and CAV produce significantly different volume measurements (p < 0.0001), although the difference was not significant for smaller SDH or intra-axial lesions. The disparity between ABC/2 and CAV measurements varied significantly with hematoma size for both intra- and extra-axial lesions (p < 0.0001). Across all lesions, volume was significantly associated with outcome using either method (p < 0.001), but CAV measurement was a significantly better predictor of outcome than ABC/2 estimation for SDH. Among large traumatic SDH, ABC/2 significantly overestimates lesion volume compared with measurement based on precise bleed topology. CAV also offers significantly better prediction of patient functional outcofme and mortality.
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Affiliation(s)
- Owen P. Leary
- Department of Neurosurgery, Warren Alpert Medical School of Brown University, Providence Rhode Island, USA
- Department of Diagnostic Imaging, and Warren Alpert Medical School of Brown University, Providence Rhode Island, USA
| | - Lisa H. Merck
- Department of Neurosurgery, Warren Alpert Medical School of Brown University, Providence Rhode Island, USA
- Department of Diagnostic Imaging, and Warren Alpert Medical School of Brown University, Providence Rhode Island, USA
- Department of Emergency Medicine, Warren Alpert Medical School of Brown University, Providence Rhode Island, USA
- Department of Emergency Medicine, University of Florida College of Medicine, Gainesville Florida, USA
| | - Sharon D. Yeatts
- Department of Health Sciences, Medical University of South Carolina, Charleston South Carolina, USA
| | - Ian Pan
- Department of Diagnostic Imaging, and Warren Alpert Medical School of Brown University, Providence Rhode Island, USA
| | - David D. Liu
- Department of Neurosurgery, Warren Alpert Medical School of Brown University, Providence Rhode Island, USA
| | - Tyler J. Harder
- Department of Diagnostic Imaging, and Warren Alpert Medical School of Brown University, Providence Rhode Island, USA
- Department of Emergency Medicine, Warren Alpert Medical School of Brown University, Providence Rhode Island, USA
| | - Stefan Jung
- Department of Diagnostic Imaging, and Warren Alpert Medical School of Brown University, Providence Rhode Island, USA
- Department of Emergency Medicine, Warren Alpert Medical School of Brown University, Providence Rhode Island, USA
| | - Scott Collins
- Department of Diagnostic Imaging, and Warren Alpert Medical School of Brown University, Providence Rhode Island, USA
| | - Maria Braileanu
- Department of Radiology and Emory University School of Medicine, Atlanta Georgia, USA
| | - Ziya L. Gokaslan
- Department of Neurosurgery, Warren Alpert Medical School of Brown University, Providence Rhode Island, USA
| | - Jason W. Allen
- Department of Radiology and Emory University School of Medicine, Atlanta Georgia, USA
| | - David W. Wright
- Department of Emergency Medicine, Emory University School of Medicine, Atlanta Georgia, USA
| | - Derek Merck
- Department of Diagnostic Imaging, and Warren Alpert Medical School of Brown University, Providence Rhode Island, USA
- Department of Emergency Medicine, University of Florida College of Medicine, Gainesville Florida, USA
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Trofimova A, Smith JL, Ahluwalia V, Hurtado J, Gore RK, Allen JW. Alterations in Resting-State Functional Brain Connectivity and Correlations with Vestibular/Ocular-Motor Screening Measures in Postconcussion Vestibular Dysfunction. J Neuroimaging 2021; 31:277-286. [PMID: 33476477 DOI: 10.1111/jon.12834] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 12/31/2020] [Accepted: 12/31/2020] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND AND PURPOSE Vestibular symptoms after concussion are common and associated with protracted recovery. The purpose of this study is to define resting-state functional MRI (rs-fMRI) brain connectivity alterations in patients with postconcussion vestibular dysfunction (PCVD) and correlations between rs-fMRI connectivity and symptoms provoked during Vestibular/Ocular-Motor Screening (VOMS) assessment. METHODS Prospective IRB approved study. STUDY GROUP 12 subjects with subacute PCVD (2-10 weeks); control group: 10 age-matched subjects without history of concussion or vestibular impairment. Both groups underwent clinical vestibular assessment. rs-fMRI was acquired on 3.0T Siemens Trio with a 12-channel head coil. rs-fMRI data analysis included independent component analysis-based functional connectivity group differences, graph theory analysis, and ROI-to-ROI connectivity correlation analysis with VOMS clinical derivatives. Group difference maps between resting-state networks were calculated using dual regression method and corrected for multiple comparisons. Correlation analysis between ROI-to-ROI rs-fMRI brain activation and VOMS assessment ratings was performed using Pearson correlation coefficient, with a significance threshold of P ≤ .05. RESULTS Compared to controls, PCVD group demonstrated significantly increased rs-fMRI connectivity between the default-mode network and right middle frontal gyrus and right postcentral gyrus; and between a vestibular-sensorimotor network and right prefrontal cortex. Significant positive correlations were found between clinical derivative VOMS scores and components of the vestibular, visual networks, and multisensory processing cortical representations. CONCLUSION Altered rs-fMRI brain connectivity with increased connectivity of visual input, multisensory processing, and spatial memory in PCVD is correlative with clinical derivative VOMS scores, suggesting maladaptive brain plasticity underlying vestibular symptomatology.
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Affiliation(s)
- Anna Trofimova
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, GA
| | - Jeremy L Smith
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, GA
| | - Vishwadeep Ahluwalia
- Georgia Statue University/Georgia Tech Center for Advanced Brain Imaging, Atlanta, GA
| | | | - Russell K Gore
- Shepherd Center, Atlanta, GA.,Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA
| | - Jason W Allen
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, GA.,Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA.,Department of Neurology, Emory University, Atlanta, GA
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48
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Park CC, Thongkham DW, Sadigh G, Saindane AM, Chu R, Bakshi R, Allen JW, Hu R. Detection of Cortical and Deep Gray Matter Lesions in Multiple Sclerosis Using DIR and FLAIR at 3T. J Neuroimaging 2020; 31:408-414. [PMID: 33351983 DOI: 10.1111/jon.12822] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 11/27/2020] [Accepted: 11/27/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND AND PURPOSE The comparative detection rates of deep gray matter (GM) multiple sclerosis (MS) lesions using double inversion recovery (DIR) and fluid-attenuated inversion-recovery (FLAIR) on 3T MR imaging remain unknown. We aimed to assess the detectability of cortical and deep GM MS lesions using DIR and FLAIR on 3T clinical exams and evaluate the relationship between deep GM lesions and brain atrophy. METHODS One hundred fifty consecutive MS patients underwent routine brain MRI that included 3D DIR and 2D T2 FLAIR on the same 3T scanner. Three neuroradiologists independently reviewed all exams for cortical and deep GM lesions. Statistical parametric mapping (SPM) and FMRIB software library (FSL)-FIRST pipelines were used to determine normalized whole brain and deep GM volumes. RESULTS A total of 65 cortical and 98 deep lesions were detected on DIR versus 24 and 20, respectively, on FLAIR. Among all 150 patients, the number and percentage of patients with GM lesions on DIR and FLAIR were as follows: cortical 43 (28.7%) versus 24 (16.0%) (P < .001), thalamus 47 (31.3%) versus 20 (13.3%) (P < .001), putamen 10 (6.7%) versus 3 (2.0%) (P = .02), globus pallidus 9 (6.0%) versus 3 (1.3%) (P = .02), and caudate 5 (3.3%) versus 1 (0.7%) (P = .125). Presence of deep GM lesions weakly correlated with deep GM volume fractions. CONCLUSION Deep GM MS lesions can be detected using routine clinical brain MRI including DIR and FLAIR at 3T. Future studies to optimize these sequences may improve the detection rates of cortical and deep GM lesions. The presence of GM lesions showed weak correlation with GM atrophy.
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Affiliation(s)
- Charlie C Park
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, Georgia
| | - Dean W Thongkham
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, Georgia
| | - Gelareh Sadigh
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, Georgia
| | - Amit M Saindane
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, Georgia.,Department of Neurosurgery, Emory University, Atlanta, Georgia
| | - Renxin Chu
- Department of Neurology and Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Rohit Bakshi
- Department of Neurology and Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Jason W Allen
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, Georgia
| | - Ranliang Hu
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, Georgia
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49
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Asnafi S, Duszak R, Hemingway JM, Hughes DR, Allen JW. Evolving Use of fMRI in Medicare Beneficiaries. AJNR Am J Neuroradiol 2020; 41:1996-2000. [PMID: 33033048 DOI: 10.3174/ajnr.a6845] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 06/22/2020] [Indexed: 11/07/2022]
Abstract
Using the Medicare Physician-Supplier Procedure Summary Master File, we evaluated the evolving use of fMRI in Medicare fee-for-service beneficiaries from 2007 through 2017. Annual use rates (per 1,000,000 enrollees) increased from 17.7 to 32.8 through 2014 and have remained static since. Radiologists have remained the dominant specialty group from 2007 to 2017 (86.4% and 88.6% of all services, respectively), and the outpatient setting has remained the dominant place of service (65.4% and 65.4%, respectively).
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Affiliation(s)
- S Asnafi
- From the Department of Radiology and Imaging Sciences (S.A., R.D., J.W.A.)
| | - R Duszak
- From the Department of Radiology and Imaging Sciences (S.A., R.D., J.W.A.)
| | - J M Hemingway
- Harvey L. Neiman Health Policy Institute (J.M.H., D.R.H.), Reston, Virginia
| | - D R Hughes
- Harvey L. Neiman Health Policy Institute (J.M.H., D.R.H.), Reston, Virginia
- School of Economics (D.R.H.), Georgia Institute of Technology, Atlanta, Georgia
| | - J W Allen
- From the Department of Radiology and Imaging Sciences (S.A., R.D., J.W.A.)
- Neurology (J.W.A.), Emory University School of Medicine, Atlanta, Georgia
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50
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Smith JL, Allen JW, Haack C, Wehrmeyer K, Alden K, Lund MB, Mascaro JS. The Impact of App-Delivered Mindfulness Meditation on Functional Connectivity and Self-Reported Mindfulness Among Health Profession Trainees. Mindfulness (N Y) 2020; 12:92-106. [PMID: 33052251 PMCID: PMC7543678 DOI: 10.1007/s12671-020-01502-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/08/2020] [Indexed: 12/30/2022]
Abstract
Objectives Previous research indicates that mindfulness meditation reduces anxiety and depression and enhances well-being. We examined the impact of app-delivered mindfulness meditation on resting state functional MRI (fMRI) connectivity among physician assistant (PA) students and surgery residents. Methods PA students and residents were randomized to receive a popular meditation app or to wait-list control group. Before and after the 8-week meditation period, we acquired fMRI scans of participants’ resting state, and participants completed a self-report measure of mindfulness. We used a 2 × 2, within- and between-group factorial design and leveraged a whole-brain connectome approach to examine changes in within- and between-network connectivity across the entire brain, and to examine whether changes in connectivity were associated with app use or to changes in self-reported mindfulness. Results Meditation practitioners exhibited significantly stronger connectivity between the frontoparietal network and the left and right nucleus accumbens and between the default mode (DMN) and salience networks, among other regions. Mindfulness practice time was correlated with increased connectivity between the lateral parietal cortex and the supramarginal gyrus, which were also positively correlated with increased scores on the “Describing” subscale of the Five Facet Mindfulness Questionnaire between baseline and post-meditation. These findings are consistent with previous research indicating that mindfulness-based interventions alter functional connectivity within the DMN and between the DMN and other networks both during meditation and at rest, as well as increased connectivity in systems important for emotion and reward. Conclusions Recent commentaries call for healthcare provider and trainee wellness programs that are sustainable and preventive in nature rather than reactive; these data indicate that even brief sessions of app-delivered mindfulness practice are associated with functional connectivity changes in a dose-dependent manner. Electronic supplementary material The online version of this article (10.1007/s12671-020-01502-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jeremy L Smith
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, GA USA
| | - Jason W Allen
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, GA USA.,Department of Neurology, Emory University, Atlanta, GA USA
| | - Carla Haack
- Department of Surgery, Emory University, Atlanta, GA USA
| | - Kathryn Wehrmeyer
- Department of Family and Preventive Medicine, Emory University, 1841 Clifton Road NE, Suite 507, Atlanta, GA 30329 USA
| | - Kayley Alden
- Department of Family and Preventive Medicine, Emory University, 1841 Clifton Road NE, Suite 507, Atlanta, GA 30329 USA
| | - Maha B Lund
- Department of Family and Preventive Medicine, Physician Assistant Program, Emory University, Atlanta, GA USA
| | - Jennifer S Mascaro
- Department of Family and Preventive Medicine, Emory University, 1841 Clifton Road NE, Suite 507, Atlanta, GA 30329 USA
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