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Lowet DS, Vaida F, Hesselink JR, Ewing-Cobbs L, Schachar RJ, Chapman SB, Bigler ED, Wilde EA, Saunders AE, Yang TT, Tymofiyeva O, Huang M, Max JE. Novel Oppositional Defiant Disorder or Conduct Disorder 24 Months After Traumatic Brain Injury in Children and Adolescents. J Neuropsychiatry Clin Neurosci 2023; 36:53-62. [PMID: 37559510 PMCID: PMC10840932 DOI: 10.1176/appi.neuropsych.20220094] [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] [Indexed: 08/11/2023]
Abstract
OBJECTIVE The authors sought to identify predictive factors of new-onset or novel oppositional defiant disorder or conduct disorder assessed 24 months after traumatic brain injury (TBI). METHODS Children ages 5 to 14 years who had experienced TBI were recruited from consecutive hospital admissions. Soon after injury, participants were assessed for preinjury characteristics, including psychiatric disorders, socioeconomic status (SES), psychosocial adversity, and family function, and the presence and location of lesions were documented by MRI. Psychiatric outcomes, including novel oppositional defiant disorder or conduct disorder, were assessed 24 months after injury. RESULTS Of the children without preinjury oppositional defiant disorder, conduct disorder, or disruptive behavior disorder not otherwise specified who were recruited in this study, 165 were included in this sample; 95 of these children returned for the 24-month assessment. Multiple imputation was used to address attrition. The prevalence of novel oppositional defiant disorder or conduct disorder was 23.7 out of 165 (14%). In univariable analyses, novel oppositional defiant disorder or conduct disorder was significantly associated with psychosocial adversity (p=0.049) and frontal white matter lesions (p=0.016) and was marginally but not significantly associated with SES. In the final multipredictor model, frontal white matter lesions were significantly associated with novel oppositional defiant disorder or conduct disorder (p=0.021), and psychosocial adversity score was marginally but not significantly associated with the outcome. The odds ratio of novel oppositional defiant disorder or conduct disorder among the children with versus those without novel depressive disorder was significantly higher for girls than boys (p=0.025), and the odds ratio of novel oppositional defiant disorder or conduct disorder among the children with versus those without novel attention-deficit hyperactivity disorder (ADHD) was significantly higher for boys than girls (p=0.006). CONCLUSION Approximately 14% of children with TBI developed oppositional defiant disorder or conduct disorder. The risk for novel oppositional defiant disorder or conduct disorder can be understood from a biopsychosocial perspective. Sex differences were evident for comorbid novel depressive disorder and comorbid novel ADHD.
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Affiliation(s)
- Daniel S. Lowet
- University of California, San Diego, Department of Psychiatry
| | - Florin Vaida
- University of California, San Diego, Herbert Wertheim School of Public Health, Division of Biostatistics & Bioinformatics
| | | | | | | | | | - Erin D. Bigler
- Brigham Young University, Department of Psychology
- University of Utah, TBI and Concussion Center, Department of Neurology
| | | | | | - Tony T. Yang
- University of California, San Francisco, Department of Psychiatry and Behavioral Sciences, Division of Child and Adolescent Psychiatry, Weill Institute for Neurosciences
| | - Olga Tymofiyeva
- University of California, San Francisco, Department of Radiology and Biomedical Imaging
| | - Mingxiong Huang
- University of California, San Diego, Department of Radiology
| | - Jeffrey E. Max
- University of California, San Diego, Department of Psychiatry
- Rady Children’s Hospital, San Diego
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Huang MX, Angeles-Quinto A, Robb-Swan A, De-la-Garza BG, Huang CW, Cheng CK, Hesselink JR, Bigler ED, Wilde EA, Vaida F, Troyer EA, Max JE. Assessing Pediatric Mild Traumatic Brain Injury and Its Recovery Using Resting-State Magnetoencephalography Source Magnitude Imaging and Machine Learning. J Neurotrauma 2023; 40:1112-1129. [PMID: 36884305 PMCID: PMC10259613 DOI: 10.1089/neu.2022.0220] [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: 03/09/2023] Open
Abstract
The objectives of this machine-learning (ML) resting-state magnetoencephalography (rs-MEG) study involving children with mild traumatic brain injury (mTBI) and orthopedic injury (OI) controls were to define a neural injury signature of mTBI and to delineate the pattern(s) of neural injury that determine behavioral recovery. Children ages 8-15 years with mTBI (n = 59) and OI (n = 39) from consecutive admissions to an emergency department were studied prospectively for parent-rated post-concussion symptoms (PCS) at: 1) baseline (average of 3 weeks post-injury) to measure pre-injury symptoms and also concurrent symptoms; and 2) at 3-months post-injury. rs-MEG was conducted at the baseline assessment. The ML algorithm predicted cases of mTBI versus OI with sensitivity of 95.5 ± 1.6% and specificity of 90.2 ± 2.7% at 3-weeks post-injury for the combined delta-gamma frequencies. The sensitivity and specificity were significantly better (p < 0.0001) for the combined delta-gamma frequencies compared with the delta-only and gamma-only frequencies. There were also spatial differences in rs-MEG activity between mTBI and OI groups in both delta and gamma bands in frontal and temporal lobe, as well as more widespread differences in the brain. The ML algorithm accounted for 84.5% of the variance in predicting recovery measured by PCS changes between 3 weeks and 3 months post-injury in the mTBI group, and this was significantly lower (p < 10-4) in the OI group (65.6%). Frontal lobe pole (higher) gamma activity was significantly (p < 0.001) associated with (worse) PCS recovery exclusively in the mTBI group. These findings demonstrate a neural injury signature of pediatric mTBI and patterns of mTBI-induced neural injury related to behavioral recovery.
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Affiliation(s)
- Ming-Xiong Huang
- Department of Radiology, University of California, San Diego, California, USA
- Radiology and Research Services, VA San Diego Healthcare System, San Diego, California, USA
| | - Annemarie Angeles-Quinto
- Department of Radiology, University of California, San Diego, California, USA
- Radiology and Research Services, VA San Diego Healthcare System, San Diego, California, USA
| | - Ashley Robb-Swan
- Department of Radiology, University of California, San Diego, California, USA
- Radiology and Research Services, VA San Diego Healthcare System, San Diego, California, USA
| | | | - Charles W. Huang
- Department of Bioengineering, Stanford University, Stanford, California, USA
| | - Chung-Kuan Cheng
- Department of Computer Science and Engineering, University of California, San Diego, California, USA
| | - John R. Hesselink
- Department of Radiology, University of California, San Diego, California, USA
| | - Erin D. Bigler
- Department of Neurology, University of Utah, Salt Lake City, Utah, USA
| | | | - Florin Vaida
- Herbert Wertheim School of Public Health, Division of Biostatistics and Bioinformatics, University of California, San Diego, California, USA
| | - Emily A. Troyer
- Department of Psychiatry, University of California, San Diego, California, USA
| | - Jeffrey E. Max
- Department of Psychiatry, University of California, San Diego, California, USA
- Department of Psychiatry, Rady Children's Hospital, San Diego, California, USA
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Max JE, Drake I, Vaida F, Hesselink JR, Ewing-Cobbs L, Schachar RJ, Chapman SB, Bigler ED, Wilde EA, Saunders AE, Yang TT, Tymofiyeva O, Levin HS. Novel Psychiatric Disorder 6 Months After Traumatic Brain Injury in Children and Adolescents. J Neuropsychiatry Clin Neurosci 2022; 35:141-150. [PMID: 35989573 PMCID: PMC10317586 DOI: 10.1176/appi.neuropsych.21120301] [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] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To investigate the factors predictive of novel psychiatric disorders in the interval 0-6 months following traumatic brain injury (TBI). METHODS Children ages 5-14 years consecutively hospitalized for mild to severe TBI at five hospitals were recruited. Participants were evaluated at baseline (soon after injury) for pre-injury characteristics including psychiatric disorders, socioeconomic status (SES), psychosocial adversity, family function, family psychiatric history, and adaptive function. In addition to the psychosocial variables, injury severity and lesion location detected with acquisition of a research MRI were measured to develop a biopsychosocial predictive model for development of novel psychiatric disorders. Psychiatric outcome, including occurrence of a novel psychiatric disorder, was assessed 6 months after the injury. RESULTS The recruited sample numbered 177 children, and 141 children (80%) returned for the six-month assessment. Of the 141 children, 58 (41%) developed a novel psychiatric disorder. In univariable analyses, novel psychiatric disorder was significantly associated with lower SES, higher psychosocial adversity, and lesions in frontal lobe locations, such as frontal white matter, superior frontal gyrus, inferior frontal gyrus, and orbital gyrus. Multivariable analyses found that novel psychiatric disorder was independently and significantly associated with frontal-lobe white matter, superior frontal gyrus, and orbital gyrus lesions. CONCLUSION The results demonstrate that occurrence of novel psychiatric disorders following pediatric TBI requiring hospitalization is common and has identifiable psychosocial and specific biological predictors. However, only the lesion predictors were independently related to this adverse psychiatric outcome.
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Affiliation(s)
- Jeffrey E. Max
- University of California, San Diego, Department of Psychiatry
- Rady Children’s Hospital, San Diego
| | | | - Florin Vaida
- University of California, San Diego, Herbert Wertheim School of Public Health, Division of Biostatistics & Bioinformatics
| | | | | | | | | | - Erin D. Bigler
- Brigham Young University, Department of Psychology
- University of Utah, TBI and Concussion Center, Department of Neurology
| | - Elisabeth A. Wilde
- University of Utah, TBI and Concussion Center, Department of Neurology
- Baylor College of Medicine, Department of Physical Medicine and Rehabilitation
| | | | - Tony T. Yang
- University of California, San Francisco, Department of Psychiatry and Behavioral Sciences, Division of Child and Adolescent Psychiatry, Weill Institute for Neurosciences
| | - Olga Tymofiyeva
- University of California, San Francisco, Department of Radiology and Biomedical Imaging
| | - Harvey S. Levin
- Baylor College of Medicine, Department of Physical Medicine and Rehabilitation
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Lowet DS, Vaida F, Hesselink JR, Levin HS, Ewing-Cobbs L, Schachar RJ, Chapman SB, Bigler ED, Wilde EA, Saunders AE, Yang TT, Tymofiyeva O, Max JE. Novel Oppositional Defiant Disorder 12 Months After Traumatic Brain Injury in Children and Adolescents. J Neuropsychiatry Clin Neurosci 2022; 34:149-157. [PMID: 35040660 DOI: 10.1176/appi.neuropsych.21060149] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The investigators examined the factors predictive of novel oppositional defiant disorder in the 6-12 months following traumatic brain injury (TBI). METHODS Children ages 5-14 years old who experienced a TBI were recruited from consecutive admissions to five hospitals. Participants were evaluated soon after injury (baseline) for preinjury characteristics, including psychiatric disorders, adaptive function, family function, psychosocial adversity, family psychiatric history, socioeconomic status, and injury severity, to develop a biopsychosocial predictive model for development of novel oppositional defiant disorder. MRI analyses were conducted to examine potential brain lesions. Psychiatric outcome, including that of novel oppositional defiant disorder, was assessed 12 months after injury. RESULTS Although 177 children were recruited for the study, 120 children without preinjury oppositional defiant disorder, conduct disorder, or disruptive behavior disorder not otherwise specified (DBD NOS) returned for the 12-month assessment. Of these 120 children, seven (5.8%) exhibited novel oppositional defiant disorder, and none developed conduct disorder or DBD NOS in the 6-12 months postinjury. Novel oppositional defiant disorder was significantly associated with lower socioeconomic status, higher psychosocial adversity, and lower preinjury adaptive functioning. CONCLUSIONS These results demonstrate that novel oppositional defiant disorder following TBI selectively and negatively affects an identifiable group of children. Both proximal (preinjury adaptive function) and distal (socioeconomic status and psychosocial adversity) psychosocial variables significantly increase risk for this outcome.
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Affiliation(s)
- Daniel S Lowet
- Department of Psychiatry, University of California, San Diego (Lowet, Max), Herbert Wertheim School of Public Health, Division of Biostatistics and Bioinformatics, University of California, San Diego (Vaida); Department of Radiology, University of California, San Diego (Hesselink); Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston (Levin); Department of Pediatrics, University of Texas Health Science Center, Houston (Ewing-Cobbs); Department of Psychiatry, University of Texas Health Science Center, Houston (Saunders); The Hospital for Sick Children, University of Toronto (Schachar); Center for BrainHealth, University of Texas, Dallas (Chapman); Department of Psychology, Brigham Young University, Provo, Utah (Bigler); Department of Neurology, Traumatic Brain Injury and Concussion Center, University of Utah, Salt Lake City (Bigler, Wilde); Department of Psychiatry and Behavioral Sciences, Division of Child and Adolescent Psychiatry, Weill Institute for Neurosciences, University of California, San Francisco (Yang); Department of Radiology and Biomedical Imaging, University of California, San Francisco (Tymofiyeva); and Rady Children's Hospital, San Diego (Max)
| | - Florin Vaida
- Department of Psychiatry, University of California, San Diego (Lowet, Max), Herbert Wertheim School of Public Health, Division of Biostatistics and Bioinformatics, University of California, San Diego (Vaida); Department of Radiology, University of California, San Diego (Hesselink); Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston (Levin); Department of Pediatrics, University of Texas Health Science Center, Houston (Ewing-Cobbs); Department of Psychiatry, University of Texas Health Science Center, Houston (Saunders); The Hospital for Sick Children, University of Toronto (Schachar); Center for BrainHealth, University of Texas, Dallas (Chapman); Department of Psychology, Brigham Young University, Provo, Utah (Bigler); Department of Neurology, Traumatic Brain Injury and Concussion Center, University of Utah, Salt Lake City (Bigler, Wilde); Department of Psychiatry and Behavioral Sciences, Division of Child and Adolescent Psychiatry, Weill Institute for Neurosciences, University of California, San Francisco (Yang); Department of Radiology and Biomedical Imaging, University of California, San Francisco (Tymofiyeva); and Rady Children's Hospital, San Diego (Max)
| | - John R Hesselink
- Department of Psychiatry, University of California, San Diego (Lowet, Max), Herbert Wertheim School of Public Health, Division of Biostatistics and Bioinformatics, University of California, San Diego (Vaida); Department of Radiology, University of California, San Diego (Hesselink); Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston (Levin); Department of Pediatrics, University of Texas Health Science Center, Houston (Ewing-Cobbs); Department of Psychiatry, University of Texas Health Science Center, Houston (Saunders); The Hospital for Sick Children, University of Toronto (Schachar); Center for BrainHealth, University of Texas, Dallas (Chapman); Department of Psychology, Brigham Young University, Provo, Utah (Bigler); Department of Neurology, Traumatic Brain Injury and Concussion Center, University of Utah, Salt Lake City (Bigler, Wilde); Department of Psychiatry and Behavioral Sciences, Division of Child and Adolescent Psychiatry, Weill Institute for Neurosciences, University of California, San Francisco (Yang); Department of Radiology and Biomedical Imaging, University of California, San Francisco (Tymofiyeva); and Rady Children's Hospital, San Diego (Max)
| | - Harvey S Levin
- Department of Psychiatry, University of California, San Diego (Lowet, Max), Herbert Wertheim School of Public Health, Division of Biostatistics and Bioinformatics, University of California, San Diego (Vaida); Department of Radiology, University of California, San Diego (Hesselink); Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston (Levin); Department of Pediatrics, University of Texas Health Science Center, Houston (Ewing-Cobbs); Department of Psychiatry, University of Texas Health Science Center, Houston (Saunders); The Hospital for Sick Children, University of Toronto (Schachar); Center for BrainHealth, University of Texas, Dallas (Chapman); Department of Psychology, Brigham Young University, Provo, Utah (Bigler); Department of Neurology, Traumatic Brain Injury and Concussion Center, University of Utah, Salt Lake City (Bigler, Wilde); Department of Psychiatry and Behavioral Sciences, Division of Child and Adolescent Psychiatry, Weill Institute for Neurosciences, University of California, San Francisco (Yang); Department of Radiology and Biomedical Imaging, University of California, San Francisco (Tymofiyeva); and Rady Children's Hospital, San Diego (Max)
| | - Linda Ewing-Cobbs
- Department of Psychiatry, University of California, San Diego (Lowet, Max), Herbert Wertheim School of Public Health, Division of Biostatistics and Bioinformatics, University of California, San Diego (Vaida); Department of Radiology, University of California, San Diego (Hesselink); Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston (Levin); Department of Pediatrics, University of Texas Health Science Center, Houston (Ewing-Cobbs); Department of Psychiatry, University of Texas Health Science Center, Houston (Saunders); The Hospital for Sick Children, University of Toronto (Schachar); Center for BrainHealth, University of Texas, Dallas (Chapman); Department of Psychology, Brigham Young University, Provo, Utah (Bigler); Department of Neurology, Traumatic Brain Injury and Concussion Center, University of Utah, Salt Lake City (Bigler, Wilde); Department of Psychiatry and Behavioral Sciences, Division of Child and Adolescent Psychiatry, Weill Institute for Neurosciences, University of California, San Francisco (Yang); Department of Radiology and Biomedical Imaging, University of California, San Francisco (Tymofiyeva); and Rady Children's Hospital, San Diego (Max)
| | - Russell J Schachar
- Department of Psychiatry, University of California, San Diego (Lowet, Max), Herbert Wertheim School of Public Health, Division of Biostatistics and Bioinformatics, University of California, San Diego (Vaida); Department of Radiology, University of California, San Diego (Hesselink); Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston (Levin); Department of Pediatrics, University of Texas Health Science Center, Houston (Ewing-Cobbs); Department of Psychiatry, University of Texas Health Science Center, Houston (Saunders); The Hospital for Sick Children, University of Toronto (Schachar); Center for BrainHealth, University of Texas, Dallas (Chapman); Department of Psychology, Brigham Young University, Provo, Utah (Bigler); Department of Neurology, Traumatic Brain Injury and Concussion Center, University of Utah, Salt Lake City (Bigler, Wilde); Department of Psychiatry and Behavioral Sciences, Division of Child and Adolescent Psychiatry, Weill Institute for Neurosciences, University of California, San Francisco (Yang); Department of Radiology and Biomedical Imaging, University of California, San Francisco (Tymofiyeva); and Rady Children's Hospital, San Diego (Max)
| | - Sandra B Chapman
- Department of Psychiatry, University of California, San Diego (Lowet, Max), Herbert Wertheim School of Public Health, Division of Biostatistics and Bioinformatics, University of California, San Diego (Vaida); Department of Radiology, University of California, San Diego (Hesselink); Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston (Levin); Department of Pediatrics, University of Texas Health Science Center, Houston (Ewing-Cobbs); Department of Psychiatry, University of Texas Health Science Center, Houston (Saunders); The Hospital for Sick Children, University of Toronto (Schachar); Center for BrainHealth, University of Texas, Dallas (Chapman); Department of Psychology, Brigham Young University, Provo, Utah (Bigler); Department of Neurology, Traumatic Brain Injury and Concussion Center, University of Utah, Salt Lake City (Bigler, Wilde); Department of Psychiatry and Behavioral Sciences, Division of Child and Adolescent Psychiatry, Weill Institute for Neurosciences, University of California, San Francisco (Yang); Department of Radiology and Biomedical Imaging, University of California, San Francisco (Tymofiyeva); and Rady Children's Hospital, San Diego (Max)
| | - Erin D Bigler
- Department of Psychiatry, University of California, San Diego (Lowet, Max), Herbert Wertheim School of Public Health, Division of Biostatistics and Bioinformatics, University of California, San Diego (Vaida); Department of Radiology, University of California, San Diego (Hesselink); Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston (Levin); Department of Pediatrics, University of Texas Health Science Center, Houston (Ewing-Cobbs); Department of Psychiatry, University of Texas Health Science Center, Houston (Saunders); The Hospital for Sick Children, University of Toronto (Schachar); Center for BrainHealth, University of Texas, Dallas (Chapman); Department of Psychology, Brigham Young University, Provo, Utah (Bigler); Department of Neurology, Traumatic Brain Injury and Concussion Center, University of Utah, Salt Lake City (Bigler, Wilde); Department of Psychiatry and Behavioral Sciences, Division of Child and Adolescent Psychiatry, Weill Institute for Neurosciences, University of California, San Francisco (Yang); Department of Radiology and Biomedical Imaging, University of California, San Francisco (Tymofiyeva); and Rady Children's Hospital, San Diego (Max)
| | - Elisabeth A Wilde
- Department of Psychiatry, University of California, San Diego (Lowet, Max), Herbert Wertheim School of Public Health, Division of Biostatistics and Bioinformatics, University of California, San Diego (Vaida); Department of Radiology, University of California, San Diego (Hesselink); Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston (Levin); Department of Pediatrics, University of Texas Health Science Center, Houston (Ewing-Cobbs); Department of Psychiatry, University of Texas Health Science Center, Houston (Saunders); The Hospital for Sick Children, University of Toronto (Schachar); Center for BrainHealth, University of Texas, Dallas (Chapman); Department of Psychology, Brigham Young University, Provo, Utah (Bigler); Department of Neurology, Traumatic Brain Injury and Concussion Center, University of Utah, Salt Lake City (Bigler, Wilde); Department of Psychiatry and Behavioral Sciences, Division of Child and Adolescent Psychiatry, Weill Institute for Neurosciences, University of California, San Francisco (Yang); Department of Radiology and Biomedical Imaging, University of California, San Francisco (Tymofiyeva); and Rady Children's Hospital, San Diego (Max)
| | - Ann E Saunders
- Department of Psychiatry, University of California, San Diego (Lowet, Max), Herbert Wertheim School of Public Health, Division of Biostatistics and Bioinformatics, University of California, San Diego (Vaida); Department of Radiology, University of California, San Diego (Hesselink); Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston (Levin); Department of Pediatrics, University of Texas Health Science Center, Houston (Ewing-Cobbs); Department of Psychiatry, University of Texas Health Science Center, Houston (Saunders); The Hospital for Sick Children, University of Toronto (Schachar); Center for BrainHealth, University of Texas, Dallas (Chapman); Department of Psychology, Brigham Young University, Provo, Utah (Bigler); Department of Neurology, Traumatic Brain Injury and Concussion Center, University of Utah, Salt Lake City (Bigler, Wilde); Department of Psychiatry and Behavioral Sciences, Division of Child and Adolescent Psychiatry, Weill Institute for Neurosciences, University of California, San Francisco (Yang); Department of Radiology and Biomedical Imaging, University of California, San Francisco (Tymofiyeva); and Rady Children's Hospital, San Diego (Max)
| | - Tony T Yang
- Department of Psychiatry, University of California, San Diego (Lowet, Max), Herbert Wertheim School of Public Health, Division of Biostatistics and Bioinformatics, University of California, San Diego (Vaida); Department of Radiology, University of California, San Diego (Hesselink); Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston (Levin); Department of Pediatrics, University of Texas Health Science Center, Houston (Ewing-Cobbs); Department of Psychiatry, University of Texas Health Science Center, Houston (Saunders); The Hospital for Sick Children, University of Toronto (Schachar); Center for BrainHealth, University of Texas, Dallas (Chapman); Department of Psychology, Brigham Young University, Provo, Utah (Bigler); Department of Neurology, Traumatic Brain Injury and Concussion Center, University of Utah, Salt Lake City (Bigler, Wilde); Department of Psychiatry and Behavioral Sciences, Division of Child and Adolescent Psychiatry, Weill Institute for Neurosciences, University of California, San Francisco (Yang); Department of Radiology and Biomedical Imaging, University of California, San Francisco (Tymofiyeva); and Rady Children's Hospital, San Diego (Max)
| | - Olga Tymofiyeva
- Department of Psychiatry, University of California, San Diego (Lowet, Max), Herbert Wertheim School of Public Health, Division of Biostatistics and Bioinformatics, University of California, San Diego (Vaida); Department of Radiology, University of California, San Diego (Hesselink); Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston (Levin); Department of Pediatrics, University of Texas Health Science Center, Houston (Ewing-Cobbs); Department of Psychiatry, University of Texas Health Science Center, Houston (Saunders); The Hospital for Sick Children, University of Toronto (Schachar); Center for BrainHealth, University of Texas, Dallas (Chapman); Department of Psychology, Brigham Young University, Provo, Utah (Bigler); Department of Neurology, Traumatic Brain Injury and Concussion Center, University of Utah, Salt Lake City (Bigler, Wilde); Department of Psychiatry and Behavioral Sciences, Division of Child and Adolescent Psychiatry, Weill Institute for Neurosciences, University of California, San Francisco (Yang); Department of Radiology and Biomedical Imaging, University of California, San Francisco (Tymofiyeva); and Rady Children's Hospital, San Diego (Max)
| | - Jeffrey E Max
- Department of Psychiatry, University of California, San Diego (Lowet, Max), Herbert Wertheim School of Public Health, Division of Biostatistics and Bioinformatics, University of California, San Diego (Vaida); Department of Radiology, University of California, San Diego (Hesselink); Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston (Levin); Department of Pediatrics, University of Texas Health Science Center, Houston (Ewing-Cobbs); Department of Psychiatry, University of Texas Health Science Center, Houston (Saunders); The Hospital for Sick Children, University of Toronto (Schachar); Center for BrainHealth, University of Texas, Dallas (Chapman); Department of Psychology, Brigham Young University, Provo, Utah (Bigler); Department of Neurology, Traumatic Brain Injury and Concussion Center, University of Utah, Salt Lake City (Bigler, Wilde); Department of Psychiatry and Behavioral Sciences, Division of Child and Adolescent Psychiatry, Weill Institute for Neurosciences, University of California, San Francisco (Yang); Department of Radiology and Biomedical Imaging, University of California, San Francisco (Tymofiyeva); and Rady Children's Hospital, San Diego (Max)
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5
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Lowet DS, Kolan A, Vaida F, Hesselink JR, Levin HS, Ewing-Cobbs L, Schachar RJ, Chapman SB, Bigler ED, Wilde EA, Saunders AE, Yang TT, Tymofiyeva O, Arif H, Max JE. Novel Oppositional Defiant Disorder 6 Months After Traumatic Brain Injury in Children and Adolescents. J Neuropsychiatry Clin Neurosci 2022; 34:68-76. [PMID: 34763527 PMCID: PMC10362978 DOI: 10.1176/appi.neuropsych.21020052] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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] [Indexed: 12/01/2022]
Abstract
OBJECTIVE The investigators aimed to assess predictive factors of novel oppositional defiant disorder (ODD) among children and adolescents in the first 6 months following traumatic brain injury (TBI). METHODS Children ages 5-14 years who experienced a TBI were recruited from consecutive admissions to five hospitals. Testing of a biopsychosocial model that may elucidate the development of novel ODD included assessment soon after injury (baseline) of preinjury characteristics, including psychiatric disorders, adaptive function, family function, psychosocial adversity, family psychiatric history, socioeconomic status, injury severity, and postinjury processing speed (which may be a proxy for brain injury). MRI analyses were also conducted to examine potential brain lesions. Psychiatric outcome, including that of novel ODD, was assessed 6 months after the injury. RESULTS A total of 177 children and adolescents were recruited for the study, and 134 who were without preinjury ODD, conduct disorder, or disruptive behavior disorder not otherwise specified (DBD NOS) returned for the 6-month assessment. Of those who returned 6 months postinjury, 11 (8.2%) developed novel ODD, and none developed novel conduct disorder or DBD NOS. Novel ODD was significantly associated with socioeconomic status, preinjury family functioning, psychosocial adversity, and processing speed. CONCLUSIONS These findings show that an important minority of children with TBI developed ODD. Psychosocial and injury-related variables, including socioeconomic status, lower family function, psychosocial adversity, and processing speed, significantly increase risk for this outcome.
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Affiliation(s)
- Daniel S Lowet
- Department of Psychiatry, University of California, San Diego (Lowet, Arif, Max); Quinnipiac University, Hamden, Conn. (Kolan); Herbert Wertheim School of Public Health, Division of Biostatistics & Bioinformatics, University of California, San Diego (Vaida); Department of Radiology, University of California, San Diego (Hesselink); Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston (Levin); Departments of Pediatrics (Ewing-Cobbs) and Psychiatry (Saunders), University of Texas Health Science Center, Houston; the Hospital for Sick Children, University of Toronto (Schachar); Center for BrainHealth, University of Texas, Dallas (Chapman); Department of Psychology, Brigham Young University, Provo, Utah (Bigler); Department of Neurology, Traumatic Brain Injury and Concussion Center, University of Utah, Salt Lake City (Bigler, Wilde); Department of Psychiatry and Behavioral Sciences, Division of Child and Adolescent Psychiatry, University of California, San Francisco (Yang); Department of Radiology and Biomedical Imaging, University of California, San Francisco (Tymofiyeva); and Rady Children's Hospital, San Diego (Max)
| | - Anish Kolan
- Department of Psychiatry, University of California, San Diego (Lowet, Arif, Max); Quinnipiac University, Hamden, Conn. (Kolan); Herbert Wertheim School of Public Health, Division of Biostatistics & Bioinformatics, University of California, San Diego (Vaida); Department of Radiology, University of California, San Diego (Hesselink); Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston (Levin); Departments of Pediatrics (Ewing-Cobbs) and Psychiatry (Saunders), University of Texas Health Science Center, Houston; the Hospital for Sick Children, University of Toronto (Schachar); Center for BrainHealth, University of Texas, Dallas (Chapman); Department of Psychology, Brigham Young University, Provo, Utah (Bigler); Department of Neurology, Traumatic Brain Injury and Concussion Center, University of Utah, Salt Lake City (Bigler, Wilde); Department of Psychiatry and Behavioral Sciences, Division of Child and Adolescent Psychiatry, University of California, San Francisco (Yang); Department of Radiology and Biomedical Imaging, University of California, San Francisco (Tymofiyeva); and Rady Children's Hospital, San Diego (Max)
| | - Florin Vaida
- Department of Psychiatry, University of California, San Diego (Lowet, Arif, Max); Quinnipiac University, Hamden, Conn. (Kolan); Herbert Wertheim School of Public Health, Division of Biostatistics & Bioinformatics, University of California, San Diego (Vaida); Department of Radiology, University of California, San Diego (Hesselink); Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston (Levin); Departments of Pediatrics (Ewing-Cobbs) and Psychiatry (Saunders), University of Texas Health Science Center, Houston; the Hospital for Sick Children, University of Toronto (Schachar); Center for BrainHealth, University of Texas, Dallas (Chapman); Department of Psychology, Brigham Young University, Provo, Utah (Bigler); Department of Neurology, Traumatic Brain Injury and Concussion Center, University of Utah, Salt Lake City (Bigler, Wilde); Department of Psychiatry and Behavioral Sciences, Division of Child and Adolescent Psychiatry, University of California, San Francisco (Yang); Department of Radiology and Biomedical Imaging, University of California, San Francisco (Tymofiyeva); and Rady Children's Hospital, San Diego (Max)
| | - John R Hesselink
- Department of Psychiatry, University of California, San Diego (Lowet, Arif, Max); Quinnipiac University, Hamden, Conn. (Kolan); Herbert Wertheim School of Public Health, Division of Biostatistics & Bioinformatics, University of California, San Diego (Vaida); Department of Radiology, University of California, San Diego (Hesselink); Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston (Levin); Departments of Pediatrics (Ewing-Cobbs) and Psychiatry (Saunders), University of Texas Health Science Center, Houston; the Hospital for Sick Children, University of Toronto (Schachar); Center for BrainHealth, University of Texas, Dallas (Chapman); Department of Psychology, Brigham Young University, Provo, Utah (Bigler); Department of Neurology, Traumatic Brain Injury and Concussion Center, University of Utah, Salt Lake City (Bigler, Wilde); Department of Psychiatry and Behavioral Sciences, Division of Child and Adolescent Psychiatry, University of California, San Francisco (Yang); Department of Radiology and Biomedical Imaging, University of California, San Francisco (Tymofiyeva); and Rady Children's Hospital, San Diego (Max)
| | - Harvey S Levin
- Department of Psychiatry, University of California, San Diego (Lowet, Arif, Max); Quinnipiac University, Hamden, Conn. (Kolan); Herbert Wertheim School of Public Health, Division of Biostatistics & Bioinformatics, University of California, San Diego (Vaida); Department of Radiology, University of California, San Diego (Hesselink); Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston (Levin); Departments of Pediatrics (Ewing-Cobbs) and Psychiatry (Saunders), University of Texas Health Science Center, Houston; the Hospital for Sick Children, University of Toronto (Schachar); Center for BrainHealth, University of Texas, Dallas (Chapman); Department of Psychology, Brigham Young University, Provo, Utah (Bigler); Department of Neurology, Traumatic Brain Injury and Concussion Center, University of Utah, Salt Lake City (Bigler, Wilde); Department of Psychiatry and Behavioral Sciences, Division of Child and Adolescent Psychiatry, University of California, San Francisco (Yang); Department of Radiology and Biomedical Imaging, University of California, San Francisco (Tymofiyeva); and Rady Children's Hospital, San Diego (Max)
| | - Linda Ewing-Cobbs
- Department of Psychiatry, University of California, San Diego (Lowet, Arif, Max); Quinnipiac University, Hamden, Conn. (Kolan); Herbert Wertheim School of Public Health, Division of Biostatistics & Bioinformatics, University of California, San Diego (Vaida); Department of Radiology, University of California, San Diego (Hesselink); Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston (Levin); Departments of Pediatrics (Ewing-Cobbs) and Psychiatry (Saunders), University of Texas Health Science Center, Houston; the Hospital for Sick Children, University of Toronto (Schachar); Center for BrainHealth, University of Texas, Dallas (Chapman); Department of Psychology, Brigham Young University, Provo, Utah (Bigler); Department of Neurology, Traumatic Brain Injury and Concussion Center, University of Utah, Salt Lake City (Bigler, Wilde); Department of Psychiatry and Behavioral Sciences, Division of Child and Adolescent Psychiatry, University of California, San Francisco (Yang); Department of Radiology and Biomedical Imaging, University of California, San Francisco (Tymofiyeva); and Rady Children's Hospital, San Diego (Max)
| | - Russell J Schachar
- Department of Psychiatry, University of California, San Diego (Lowet, Arif, Max); Quinnipiac University, Hamden, Conn. (Kolan); Herbert Wertheim School of Public Health, Division of Biostatistics & Bioinformatics, University of California, San Diego (Vaida); Department of Radiology, University of California, San Diego (Hesselink); Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston (Levin); Departments of Pediatrics (Ewing-Cobbs) and Psychiatry (Saunders), University of Texas Health Science Center, Houston; the Hospital for Sick Children, University of Toronto (Schachar); Center for BrainHealth, University of Texas, Dallas (Chapman); Department of Psychology, Brigham Young University, Provo, Utah (Bigler); Department of Neurology, Traumatic Brain Injury and Concussion Center, University of Utah, Salt Lake City (Bigler, Wilde); Department of Psychiatry and Behavioral Sciences, Division of Child and Adolescent Psychiatry, University of California, San Francisco (Yang); Department of Radiology and Biomedical Imaging, University of California, San Francisco (Tymofiyeva); and Rady Children's Hospital, San Diego (Max)
| | - Sandra B Chapman
- Department of Psychiatry, University of California, San Diego (Lowet, Arif, Max); Quinnipiac University, Hamden, Conn. (Kolan); Herbert Wertheim School of Public Health, Division of Biostatistics & Bioinformatics, University of California, San Diego (Vaida); Department of Radiology, University of California, San Diego (Hesselink); Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston (Levin); Departments of Pediatrics (Ewing-Cobbs) and Psychiatry (Saunders), University of Texas Health Science Center, Houston; the Hospital for Sick Children, University of Toronto (Schachar); Center for BrainHealth, University of Texas, Dallas (Chapman); Department of Psychology, Brigham Young University, Provo, Utah (Bigler); Department of Neurology, Traumatic Brain Injury and Concussion Center, University of Utah, Salt Lake City (Bigler, Wilde); Department of Psychiatry and Behavioral Sciences, Division of Child and Adolescent Psychiatry, University of California, San Francisco (Yang); Department of Radiology and Biomedical Imaging, University of California, San Francisco (Tymofiyeva); and Rady Children's Hospital, San Diego (Max)
| | - Erin D Bigler
- Department of Psychiatry, University of California, San Diego (Lowet, Arif, Max); Quinnipiac University, Hamden, Conn. (Kolan); Herbert Wertheim School of Public Health, Division of Biostatistics & Bioinformatics, University of California, San Diego (Vaida); Department of Radiology, University of California, San Diego (Hesselink); Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston (Levin); Departments of Pediatrics (Ewing-Cobbs) and Psychiatry (Saunders), University of Texas Health Science Center, Houston; the Hospital for Sick Children, University of Toronto (Schachar); Center for BrainHealth, University of Texas, Dallas (Chapman); Department of Psychology, Brigham Young University, Provo, Utah (Bigler); Department of Neurology, Traumatic Brain Injury and Concussion Center, University of Utah, Salt Lake City (Bigler, Wilde); Department of Psychiatry and Behavioral Sciences, Division of Child and Adolescent Psychiatry, University of California, San Francisco (Yang); Department of Radiology and Biomedical Imaging, University of California, San Francisco (Tymofiyeva); and Rady Children's Hospital, San Diego (Max)
| | - Elisabeth A Wilde
- Department of Psychiatry, University of California, San Diego (Lowet, Arif, Max); Quinnipiac University, Hamden, Conn. (Kolan); Herbert Wertheim School of Public Health, Division of Biostatistics & Bioinformatics, University of California, San Diego (Vaida); Department of Radiology, University of California, San Diego (Hesselink); Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston (Levin); Departments of Pediatrics (Ewing-Cobbs) and Psychiatry (Saunders), University of Texas Health Science Center, Houston; the Hospital for Sick Children, University of Toronto (Schachar); Center for BrainHealth, University of Texas, Dallas (Chapman); Department of Psychology, Brigham Young University, Provo, Utah (Bigler); Department of Neurology, Traumatic Brain Injury and Concussion Center, University of Utah, Salt Lake City (Bigler, Wilde); Department of Psychiatry and Behavioral Sciences, Division of Child and Adolescent Psychiatry, University of California, San Francisco (Yang); Department of Radiology and Biomedical Imaging, University of California, San Francisco (Tymofiyeva); and Rady Children's Hospital, San Diego (Max)
| | - Ann E Saunders
- Department of Psychiatry, University of California, San Diego (Lowet, Arif, Max); Quinnipiac University, Hamden, Conn. (Kolan); Herbert Wertheim School of Public Health, Division of Biostatistics & Bioinformatics, University of California, San Diego (Vaida); Department of Radiology, University of California, San Diego (Hesselink); Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston (Levin); Departments of Pediatrics (Ewing-Cobbs) and Psychiatry (Saunders), University of Texas Health Science Center, Houston; the Hospital for Sick Children, University of Toronto (Schachar); Center for BrainHealth, University of Texas, Dallas (Chapman); Department of Psychology, Brigham Young University, Provo, Utah (Bigler); Department of Neurology, Traumatic Brain Injury and Concussion Center, University of Utah, Salt Lake City (Bigler, Wilde); Department of Psychiatry and Behavioral Sciences, Division of Child and Adolescent Psychiatry, University of California, San Francisco (Yang); Department of Radiology and Biomedical Imaging, University of California, San Francisco (Tymofiyeva); and Rady Children's Hospital, San Diego (Max)
| | - Tony T Yang
- Department of Psychiatry, University of California, San Diego (Lowet, Arif, Max); Quinnipiac University, Hamden, Conn. (Kolan); Herbert Wertheim School of Public Health, Division of Biostatistics & Bioinformatics, University of California, San Diego (Vaida); Department of Radiology, University of California, San Diego (Hesselink); Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston (Levin); Departments of Pediatrics (Ewing-Cobbs) and Psychiatry (Saunders), University of Texas Health Science Center, Houston; the Hospital for Sick Children, University of Toronto (Schachar); Center for BrainHealth, University of Texas, Dallas (Chapman); Department of Psychology, Brigham Young University, Provo, Utah (Bigler); Department of Neurology, Traumatic Brain Injury and Concussion Center, University of Utah, Salt Lake City (Bigler, Wilde); Department of Psychiatry and Behavioral Sciences, Division of Child and Adolescent Psychiatry, University of California, San Francisco (Yang); Department of Radiology and Biomedical Imaging, University of California, San Francisco (Tymofiyeva); and Rady Children's Hospital, San Diego (Max)
| | - Olga Tymofiyeva
- Department of Psychiatry, University of California, San Diego (Lowet, Arif, Max); Quinnipiac University, Hamden, Conn. (Kolan); Herbert Wertheim School of Public Health, Division of Biostatistics & Bioinformatics, University of California, San Diego (Vaida); Department of Radiology, University of California, San Diego (Hesselink); Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston (Levin); Departments of Pediatrics (Ewing-Cobbs) and Psychiatry (Saunders), University of Texas Health Science Center, Houston; the Hospital for Sick Children, University of Toronto (Schachar); Center for BrainHealth, University of Texas, Dallas (Chapman); Department of Psychology, Brigham Young University, Provo, Utah (Bigler); Department of Neurology, Traumatic Brain Injury and Concussion Center, University of Utah, Salt Lake City (Bigler, Wilde); Department of Psychiatry and Behavioral Sciences, Division of Child and Adolescent Psychiatry, University of California, San Francisco (Yang); Department of Radiology and Biomedical Imaging, University of California, San Francisco (Tymofiyeva); and Rady Children's Hospital, San Diego (Max)
| | - Hattan Arif
- Department of Psychiatry, University of California, San Diego (Lowet, Arif, Max); Quinnipiac University, Hamden, Conn. (Kolan); Herbert Wertheim School of Public Health, Division of Biostatistics & Bioinformatics, University of California, San Diego (Vaida); Department of Radiology, University of California, San Diego (Hesselink); Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston (Levin); Departments of Pediatrics (Ewing-Cobbs) and Psychiatry (Saunders), University of Texas Health Science Center, Houston; the Hospital for Sick Children, University of Toronto (Schachar); Center for BrainHealth, University of Texas, Dallas (Chapman); Department of Psychology, Brigham Young University, Provo, Utah (Bigler); Department of Neurology, Traumatic Brain Injury and Concussion Center, University of Utah, Salt Lake City (Bigler, Wilde); Department of Psychiatry and Behavioral Sciences, Division of Child and Adolescent Psychiatry, University of California, San Francisco (Yang); Department of Radiology and Biomedical Imaging, University of California, San Francisco (Tymofiyeva); and Rady Children's Hospital, San Diego (Max)
| | - Jeffrey E Max
- Department of Psychiatry, University of California, San Diego (Lowet, Arif, Max); Quinnipiac University, Hamden, Conn. (Kolan); Herbert Wertheim School of Public Health, Division of Biostatistics & Bioinformatics, University of California, San Diego (Vaida); Department of Radiology, University of California, San Diego (Hesselink); Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston (Levin); Departments of Pediatrics (Ewing-Cobbs) and Psychiatry (Saunders), University of Texas Health Science Center, Houston; the Hospital for Sick Children, University of Toronto (Schachar); Center for BrainHealth, University of Texas, Dallas (Chapman); Department of Psychology, Brigham Young University, Provo, Utah (Bigler); Department of Neurology, Traumatic Brain Injury and Concussion Center, University of Utah, Salt Lake City (Bigler, Wilde); Department of Psychiatry and Behavioral Sciences, Division of Child and Adolescent Psychiatry, University of California, San Francisco (Yang); Department of Radiology and Biomedical Imaging, University of California, San Francisco (Tymofiyeva); and Rady Children's Hospital, San Diego (Max)
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Max JE, Troyer EA, Arif H, Vaida F, Wilde EA, Bigler ED, Hesselink JR, Yang TT, Tymofiyeva O, Wade O, Paulsen JS. Traumatic Brain Injury in Children and Adolescents: Psychiatric Disorders 24 Years Later. J Neuropsychiatry Clin Neurosci 2022; 34:60-67. [PMID: 34538075 PMCID: PMC9818773 DOI: 10.1176/appi.neuropsych.20050104] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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] [Indexed: 01/11/2023]
Abstract
OBJECTIVE The investigators aimed to extend findings regarding predictive factors of psychiatric outcomes among children and adolescents with traumatic brain injury (TBI) from 2 to 24 years postinjury. METHODS Youths aged 6-14 years who were hospitalized following TBI from 1992 to 1994 were assessed at baseline for TBI severity and for preinjury psychiatric, adaptive, and behavioral functioning; family functioning; family psychiatric history; socioeconomic status; and intelligence within weeks of injury. Predictors of psychiatric outcomes following pediatric TBI at 3, 6, 12, and 24 months postinjury have previously been reported. In this study, repeat psychiatric assessments were completed at 24 years postinjury with the same cohort, now adults aged 29-39 years, with the outcome measure being presence of a psychiatric disorder not present before the TBI ("novel psychiatric disorder"). RESULTS Fifty participants with pediatric TBI were initially enrolled, and the long-term outcome analyses focused on data from 45 individuals. Novel psychiatric disorder was present in 24 out of 45 (53%) participants. Presence of a current novel psychiatric disorder was independently predicted by the presence of a preinjury lifetime psychiatric disorder and by severity of TBI. CONCLUSIONS Long-term psychiatric outcome (mean=23.92 years [SD=2.17]) in children and adolescents hospitalized for TBI can be predicted at the point of the initial hospitalization encounter by the presence of a preinjury psychiatric disorder and by greater injury severity.
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Affiliation(s)
- Jeffrey E. Max
- Department of Psychiatry, University of California, San Diego (Max, Troyer, Arif);Rady Children’s Hospital, San Diego (Max); Department of Psychiatry, University of Iowa, Iowa City (Max, Wade, Paulsen); Department of Family Medicine and Public Health, University of California, San Diego (Vaida); Department of Neurology, TBI and Concussion Center, University of Utah, Salt Lake City (Wilde, Bigler); Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston (Wilde); Department
| | - Emily A. Troyer
- Department of Psychiatry, University of California, San Diego (Max, Troyer, Arif);Rady Children’s Hospital, San Diego (Max); Department of Psychiatry, University of Iowa, Iowa City (Max, Wade, Paulsen); Department of Family Medicine and Public Health, University of California, San Diego (Vaida); Department of Neurology, TBI and Concussion Center, University of Utah, Salt Lake City (Wilde, Bigler); Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston (Wilde); Department
| | - Hattan Arif
- Department of Psychiatry, University of California, San Diego (Max, Troyer, Arif);Rady Children’s Hospital, San Diego (Max); Department of Psychiatry, University of Iowa, Iowa City (Max, Wade, Paulsen); Department of Family Medicine and Public Health, University of California, San Diego (Vaida); Department of Neurology, TBI and Concussion Center, University of Utah, Salt Lake City (Wilde, Bigler); Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston (Wilde); Department
| | - Florin Vaida
- Department of Psychiatry, University of California, San Diego (Max, Troyer, Arif);Rady Children’s Hospital, San Diego (Max); Department of Psychiatry, University of Iowa, Iowa City (Max, Wade, Paulsen); Department of Family Medicine and Public Health, University of California, San Diego (Vaida); Department of Neurology, TBI and Concussion Center, University of Utah, Salt Lake City (Wilde, Bigler); Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston (Wilde); Department
| | - Elisabeth A. Wilde
- Department of Psychiatry, University of California, San Diego (Max, Troyer, Arif);Rady Children’s Hospital, San Diego (Max); Department of Psychiatry, University of Iowa, Iowa City (Max, Wade, Paulsen); Department of Family Medicine and Public Health, University of California, San Diego (Vaida); Department of Neurology, TBI and Concussion Center, University of Utah, Salt Lake City (Wilde, Bigler); Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston (Wilde); Department
| | - Erin D. Bigler
- Department of Psychiatry, University of California, San Diego (Max, Troyer, Arif);Rady Children’s Hospital, San Diego (Max); Department of Psychiatry, University of Iowa, Iowa City (Max, Wade, Paulsen); Department of Family Medicine and Public Health, University of California, San Diego (Vaida); Department of Neurology, TBI and Concussion Center, University of Utah, Salt Lake City (Wilde, Bigler); Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston (Wilde); Department
| | - John R. Hesselink
- Department of Psychiatry, University of California, San Diego (Max, Troyer, Arif);Rady Children’s Hospital, San Diego (Max); Department of Psychiatry, University of Iowa, Iowa City (Max, Wade, Paulsen); Department of Family Medicine and Public Health, University of California, San Diego (Vaida); Department of Neurology, TBI and Concussion Center, University of Utah, Salt Lake City (Wilde, Bigler); Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston (Wilde); Department
| | - Tony T. Yang
- Department of Psychiatry, University of California, San Diego (Max, Troyer, Arif);Rady Children’s Hospital, San Diego (Max); Department of Psychiatry, University of Iowa, Iowa City (Max, Wade, Paulsen); Department of Family Medicine and Public Health, University of California, San Diego (Vaida); Department of Neurology, TBI and Concussion Center, University of Utah, Salt Lake City (Wilde, Bigler); Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston (Wilde); Department
| | - Olga Tymofiyeva
- Department of Psychiatry, University of California, San Diego (Max, Troyer, Arif);Rady Children’s Hospital, San Diego (Max); Department of Psychiatry, University of Iowa, Iowa City (Max, Wade, Paulsen); Department of Family Medicine and Public Health, University of California, San Diego (Vaida); Department of Neurology, TBI and Concussion Center, University of Utah, Salt Lake City (Wilde, Bigler); Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston (Wilde); Department
| | - Owen Wade
- Department of Psychiatry, University of California, San Diego (Max, Troyer, Arif);Rady Children’s Hospital, San Diego (Max); Department of Psychiatry, University of Iowa, Iowa City (Max, Wade, Paulsen); Department of Family Medicine and Public Health, University of California, San Diego (Vaida); Department of Neurology, TBI and Concussion Center, University of Utah, Salt Lake City (Wilde, Bigler); Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston (Wilde); Department
| | - Jane S. Paulsen
- Department of Psychiatry, University of California, San Diego (Max, Troyer, Arif);Rady Children’s Hospital, San Diego (Max); Department of Psychiatry, University of Iowa, Iowa City (Max, Wade, Paulsen); Department of Family Medicine and Public Health, University of California, San Diego (Vaida); Department of Neurology, TBI and Concussion Center, University of Utah, Salt Lake City (Wilde, Bigler); Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston (Wilde); Department
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Arif H, Troyer EA, Paulsen JS, Vaida F, Wilde EA, Bigler ED, Hesselink JR, Yang TT, Tymofiyeva O, Wade O, Max JE. Long-Term Psychiatric Outcomes in Adults with History of Pediatric Traumatic Brain Injury. J Neurotrauma 2021; 38:1515-1525. [PMID: 33765846 PMCID: PMC8336207 DOI: 10.1089/neu.2020.7238] [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: 11/13/2022] Open
Abstract
The objective of the study was to compare psychiatric outcomes in adults with and without history of pediatric traumatic brain injury (TBI). Youth ages 6 to 14 years hospitalized for TBI from 1992 to 1994 were assessed at baseline and at 3, 6, 12, and 24 months post-injury. In the current study, psychiatric assessments were repeated at 24 years post-injury with the same cohort, now adults ages 29 to 39 years. A control group of healthy adults also was recruited for one-time cross-sectional assessments. Outcome measures included: 1) presence of a psychiatric disorder since the 24-month assessment not present before the TBI ("novel psychiatric disorder," NPD), or in the control group, the presence of a psychiatric disorder that developed after the mean age of injury of the TBI group plus 2 years; and 2) Time-to-Event for onset of an NPD during the same time periods. In the TBI group, NPDs were significantly more common, and presence of a current NPD was significantly predicted by presence of a pre-injury lifetime psychiatric disorder and by abnormal day-of-injury computed tomography (CT) scan. Compared with controls, the TBI group also had significantly shorter Time-to-Event for onset of any NPD. These findings demonstrate that long-term psychiatric outcomes in adults previously hospitalized for pediatric TBI are significantly worse when compared with adult controls without history of pediatric TBI, both in terms of prevalence and earlier onset of NPD. Further, in the TBI group, long-term NPD outcome is predicted independently by presence of pre-injury psychiatric disorder and abnormal day-of-injury CT scan.
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Affiliation(s)
- Hattan Arif
- Departments of Psychiatry, University of California, San Diego, San Diego, California, USA
| | - Emily A. Troyer
- Departments of Psychiatry, University of California, San Diego, San Diego, California, USA
| | - Jane S. Paulsen
- Departments of Neuroscience, University of Iowa, Iowa City, Iowa, USA
- Neurology, University of Iowa, Iowa City, Iowa, USA
- Psychiatry, and University of Iowa, Iowa City, Iowa, USA
- Psychology, University of Iowa, Iowa City, Iowa, USA
| | - Florin Vaida
- Family Medicine and Public Health, University of California, San Diego, San Diego, California, USA
| | - Elisabeth A. Wilde
- Department of Neurology, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Erin D. Bigler
- Department of Psychology and Neuroscience, Brigham Young University, Provo, Utah, USA
| | - John R. Hesselink
- Radiology, University of California, San Diego, San Diego, California, USA
| | - Tony T. Yang
- Department of Psychiatry, Division of Child and Adolescent Psychiatry, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, California, USA
| | - Olga Tymofiyeva
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California, USA
| | - Owen Wade
- Psychiatry, and University of Iowa, Iowa City, Iowa, USA
| | - Jeffrey E. Max
- Departments of Psychiatry, University of California, San Diego, San Diego, California, USA
- Psychiatry, and University of Iowa, Iowa City, Iowa, USA
- Rady Children's Hospital, San Diego, San Diego, California, USA
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Kinori M, Pansara M, Mai DD, Robbins SL, Hesselink JR, Granet DB. Inferior rectus displacement in heavy eye syndrome and sagging eye syndrome. Graefes Arch Clin Exp Ophthalmol 2020; 258:1109-1113. [PMID: 32095879 DOI: 10.1007/s00417-020-04629-4] [Citation(s) in RCA: 4] [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: 10/23/2019] [Revised: 02/08/2020] [Accepted: 02/13/2020] [Indexed: 11/25/2022] Open
Abstract
PURPOSE To evaluate if there is a nasal displacement of the vertical rectus muscles in heavy eye syndrome (HES) and/or sagging eye syndrome (SES) compared with age-matched controls. METHODS We reviewed the charts of all patients with the diagnosis of HES or SES who were seen at the University of California San Diego (UCSD) between the years 2008-2016 who underwent magnetic resonance imaging (MRI) of the brain and orbits. The control group included patients who had brain and orbital MRIs at UCSD in the absence of known pathology in the orbits or globes. Measurements were taken by 3 separate examiners for all groups. RESULTS Twenty-four patients (16 with SES and 8 with HES) and 24 age-matched controls were retrospectively reviewed. The superior rectus (SR) of patients with HES and SES was more nasally displaced from the midline compared with that of age-matched controls (p = 0.04, p = 0.03, respectively). The inferior rectus (IR) of patients with HES but not with SES was more nasally displaced from the midline compared with that of age-matched controls (p = 0.04, p = 0.62, respectively). In all groups, the IR nasal displacement from the midline was approximately double compared with the SR. CONCLUSIONS There is a significant nasal displacement of the SR in HES and SES and IR in HES. The observed IR nasal displacement in HES is a new finding and may explain the residual hypotropia and/or esotropia following surgical interventions for HES not involving the IR.
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Affiliation(s)
- Michael Kinori
- Ratner Children's Eye Center at the Shiley Eye Institute, University of California, San Diego, 9415 Campus Point Drive, La Jolla, San Diego, CA, 92093, USA
- The Goldschleger Eye Institute, Sheba Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Hashomer, Israel
| | - Megha Pansara
- Ratner Children's Eye Center at the Shiley Eye Institute, University of California, San Diego, 9415 Campus Point Drive, La Jolla, San Diego, CA, 92093, USA
| | - Derek D Mai
- Ratner Children's Eye Center at the Shiley Eye Institute, University of California, San Diego, 9415 Campus Point Drive, La Jolla, San Diego, CA, 92093, USA
| | - Shira L Robbins
- Ratner Children's Eye Center at the Shiley Eye Institute, University of California, San Diego, 9415 Campus Point Drive, La Jolla, San Diego, CA, 92093, USA
| | - John R Hesselink
- Department of Radiology, University of California, San Diego, USA
| | - David B Granet
- Ratner Children's Eye Center at the Shiley Eye Institute, University of California, San Diego, 9415 Campus Point Drive, La Jolla, San Diego, CA, 92093, USA.
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Huang MX, Robb Swan A, Angeles Quinto A, Huang JW, De-la-Garza BG, Huang CW, Hesselink JR, Bigler ED, Wilde EA, Max JE. Resting-State Magnetoencephalography Source Imaging Pilot Study in Children with Mild Traumatic Brain Injury. J Neurotrauma 2019; 37:994-1001. [PMID: 31724480 DOI: 10.1089/neu.2019.6417] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 11/13/2022] Open
Abstract
Mild traumatic brain injury (mTBI) accounts for the vast majority of all pediatric TBI. An important minority of children who have suffered an mTBI have enduring cognitive and emotional symptoms. However, the mechanisms of chronic symptoms in children with pediatric mTBI are not fully understood. This is in part due to the limited sensitivity of conventional neuroimaging technologies. The present study examined resting-state magnetoencephalography (rs-MEG) source images in 12 children who had mTBI and 12 age-matched control children. The rs-MEG exams were performed in children with mTBI 6 months after injury when they reported no clinically significant post-injury psychiatric changes and few if any somatic sensorimotor symptoms but did report cognitive symptoms. MEG source magnitude images were obtained for different frequency bands in alpha (8-12 Hz), beta (15-30 Hz), gamma (30-90 Hz), and low-frequency (1-7 Hz) bands. In contrast to the control participants, rs-MEG source imaging in the children with mTBI showed: 1) hyperactivity from the bilateral insular cortices in alpha, beta, and low-frequency bands, from the left amygdala in alpha band, and from the left precuneus in beta band; 2) hypoactivity from the bilateral dorsolateral prefrontal cortices (dlPFC) in alpha and beta bands, from the ventromedial prefrontal cortex (vmPFC) in beta band, from the ventrolateral prefrontal cortex (vlPFC) in gamma band, from the anterior cingulate cortex (ACC) in alpha band, and from the right precuneus in alpha band. The present study showed that MEG source imaging technique revealed abnormalities in the resting-state electromagnetic signals from the children with mTBI.
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Affiliation(s)
- Ming-Xiong Huang
- Department of Radiology, University of California, San Diego, California.,Radiology, Research, and Psychiatry Services, VA San Diego Healthcare System, San Diego, California
| | - Ashley Robb Swan
- Department of Radiology, University of California, San Diego, California.,Radiology, Research, and Psychiatry Services, VA San Diego Healthcare System, San Diego, California
| | - Annemarie Angeles Quinto
- Department of Radiology, University of California, San Diego, California.,Radiology, Research, and Psychiatry Services, VA San Diego Healthcare System, San Diego, California
| | - Jeffrey W Huang
- Department of Computer Sciences, Columbia University, New York, New York
| | | | - Charles W Huang
- Department of Bioengineering, Stanford University, Stanford, California
| | - John R Hesselink
- Department of Radiology, University of California, San Diego, California
| | - Erin D Bigler
- Department of Neurology, University of Utah, Salt Lake City, Utah
| | | | - Jeffrey E Max
- Department of Psychiatry, University of California, San Diego, California.,Department of Psychiatry, Rady Children's Hospital, San Diego, California
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10
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Bigler ED, Finuf C, Abildskov TJ, Goodrich-Hunsaker NJ, Petrie JA, Wood DM, Hesselink JR, Wilde EA, Max JE. Cortical thickness in pediatric mild traumatic brain injury including sports-related concussion. Int J Psychophysiol 2018; 132:99-104. [DOI: 10.1016/j.ijpsycho.2018.07.474] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Revised: 07/07/2018] [Accepted: 07/18/2018] [Indexed: 12/18/2022]
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11
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Thompson A, Madan N, Hesselink JR, Weinstein G, Munoz del Rio A, Haughton V. The Cervical Spinal Canal Tapers Differently in Patients with Chiari I with and without Syringomyelia. AJNR Am J Neuroradiol 2015; 37:755-8. [PMID: 26585256 DOI: 10.3174/ajnr.a4597] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2015] [Accepted: 09/15/2015] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE The cause of syringomyelia in patients with Chiari I remains uncertain. Cervical spine anatomy modifies CSF velocities, flow patterns, and pressure gradients, which may affect the spinal cord. We tested the hypothesis that cervical spinal anatomy differs between Chiari I patients with and without syringomyelia. MATERIALS AND METHODS We identified consecutive patients with Chiari I at 3 institutions and divided them into groups with and without syringomyelia. Five readers measured anteroposterior cervical spinal diameters, tonsillar herniation, and syrinx dimensions on cervical MR images. Taper ratios for C1-C7, C1-C4, and C4-C7 spinal segments were calculated by linear least squares fitting to the appropriate spinal canal diameters. Mean taper ratios and tonsillar herniation for groups were compared and tested for statistical significance with a Kruskal-Wallis test. Inter- and intrareader agreement and correlations in the data were measured. RESULTS One hundred fifty patients were included, of which 49 had syringomyelia. C1-C7 taper ratios were smaller and C4-C7 taper ratios greater for patients with syringomyelia than for those without it. C1-C4 taper ratios did not differ significantly between groups. Patients with syringomyelia had, on average, greater tonsillar herniation than those without a syrinx. However, C4-C7 taper ratios were steeper, for all degrees of tonsil herniation, in patients with syringomyelia. Differences among readers did not exceed differences among patient groups. CONCLUSIONS The tapering of the lower cervical spine may contribute to the development of syringomyelia in patients with Chiari I.
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Affiliation(s)
- A Thompson
- From the Departments of Radiology (A.T., A.M.d.R., V.H.)
| | - N Madan
- Department of Radiology (N.M., G.W.), Tufts University School of Medicine, Boston, Massachusetts
| | - J R Hesselink
- Department of Radiology (J.R.H.), University of California San Diego, San Diego, California
| | - G Weinstein
- Department of Radiology (N.M., G.W.), Tufts University School of Medicine, Boston, Massachusetts
| | - A Munoz del Rio
- From the Departments of Radiology (A.T., A.M.d.R., V.H.) Medical Physics (A.M.d.R.), University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - V Haughton
- From the Departments of Radiology (A.T., A.M.d.R., V.H.)
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12
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Fruehwald-Pallamar J, Hesselink JR, Mafee MF, Holzer-Fruehwald L, Czerny C, Mayerhoefer ME. Texture-Based Analysis of 100 MR Examinations of Head and Neck Tumors - Is It Possible to Discriminate Between Benign and Malignant Masses in a Multicenter Trial? ROFO-FORTSCHR RONTG 2015; 188:195-202. [PMID: 26422418 DOI: 10.1055/s-0041-106066] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
AIM To evaluate whether texture-based analysis of standard MRI sequences can help in the discrimination between benign and malignant head and neck tumors. MATERIALS AND METHODS The MR images of 100 patients with a histologically clarified head or neck mass, from two different institutions, were analyzed. Texture-based analysis was performed using texture analysis software, with region of interest measurements for 2 D and 3 D evaluation independently for all axial sequences. COC, RUN, GRA, ARM, and WAV features were calculated for all ROIs. 10 texture feature subsets were used for a linear discriminant analysis, in combination with k-nearest-neighbor classification. Benign and malignant tumors were compared with regard to texture-based values. RESULTS There were differences in the images from different field-strength scanners, as well as from different vendors. For the differentiation of benign and malignant tumors, we found differences on STIR and T2-weighted images for 2 D, and on contrast-enhanced T1-TSE with fat saturation for 3 D evaluation. In a separate analysis of the subgroups 1.5 and 3 Tesla, more discriminating features were found. CONCLUSION Texture-based analysis is a useful tool in the discrimination of benign and malignant tumors when performed on one scanner with the same protocol. We cannot recommend this technique for the use of multicenter studies with clinical data. KEY POINTS 2 D/3 D texture-based analysis can be performed in head and neck tumors. Texture-based analysis can differentiate between benign and malignant masses. Analyzed MR images should originate from one scanner with an identical protocol.
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Affiliation(s)
- J Fruehwald-Pallamar
- Department of Biomedical Imaging und Image-guided Therapy, Subdivision of Neuroradiology and Musculoskeletal Radiology, Medical University of Vienna, Austria
| | - J R Hesselink
- Department of Radiology, UCSD Medical Center, San Diego, United States
| | - M F Mafee
- Department of Radiology, UCSD Medical Center, San Diego, United States
| | - L Holzer-Fruehwald
- Department of Biomedical Imaging und Image-guided Therapy, Medical University of Vienna, Austria
| | - C Czerny
- Department of Biomedical Imaging und Image-guided Therapy, Subdivision of Neuroradiology and Musculoskeletal Radiology, Medical University of Vienna, Austria
| | - M E Mayerhoefer
- Department of Biomedical Imaging und Image-guided Therapy, Medical University of Vienna, Austria
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13
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Hesselink JR, Barkovich MJ, Seibert TM, Farid N, Muller KA, Murphy KT, Kesari S. Bevacizumab: radiation combination produces restricted diffusion on brain MRI. CNS Oncol 2015; 3:329-35. [PMID: 25363005 DOI: 10.2217/cns.14.35] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [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: 11/21/2022] Open
Abstract
AIMS The purpose of this paper is to investigate the effect of bevacizumab (BEV) on the diffusion properties of irradiated brain gliomas. MATERIALS & METHODS Neuroimaging studies and medical records of 44 patients undergoing treatment for cerebral gliomas were reviewed. MRIs were analyzed for presence of restricted diffusion, time to onset, pattern/location, duration of restriction, and persistence of restriction post-treatment with BEV. RESULTS Patchy confluent areas of diffusion restriction on MRI were found in 12 patients. All 12 patients received radiation therapy followed by BEV therapy. Diffusion restriction appeared 3 to 21 months after onset of radiation and 1 to 6 months after starting BEV therapy, increased in size over time, and persisted up to 23 months while on BEV. Restricted diffusion was observed in areas that received 60 Gy or more of radiation. Areas of restricted diffusion showed low T1 and increased T2 signal intensity, minimal or no contrast enhancement, and low cerebral blood volume. A thin perimeter of susceptibility outlined the restricted areas on susceptibility-weighted images in nine patients (75%). Small focal areas of tumor recurrence within larger regions of restricted diffusion were evident in only four patients (33%). In seven patients (58%) the area of restricted diffusion showed necrosis or radiation change on histology or no metabolic activity on MR spectroscopy or PET. CONCLUSION Restricted diffusion associated with BEV-treated cerebral gliomas occurs in regions of high-dose radiation and does not indicate high-cellularity of tumor recurrence.
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Affiliation(s)
- John R Hesselink
- Department of Radiology, UCSD Medical Center, 200 West Arbor Drive, San Diego, CA 92103-8749, USA
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14
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Malatt C, Zawaideh M, Chao C, Hesselink JR, Lee RR, Chen JY. Head computed tomography in the emergency department: a collection of easily missed findings that are life-threatening or life-changing. J Emerg Med 2014; 47:646-59. [PMID: 25260346 DOI: 10.1016/j.jemermed.2014.06.042] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [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: 11/22/2013] [Revised: 04/01/2014] [Accepted: 06/30/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND The use of noncontrast head computed tomography (CT) has become commonplace in the emergency department (ED) as a means of screening for a wide variety of pathologies. Approximately 1 in 14 ED patients receives a head CT scan, and analyzing and interpreting this high volume of images in a timely manner is a daily challenge. OBJECTIVES Minimizing interpretation error is of paramount importance in the context of life-threatening and time-sensitive diagnoses. Therefore, it is prudent for the physician to recognize particular pitfalls in head CT interpretation and establish search patterns and practices that minimize such errors. In this article, we discuss a collection of common ED cases with easily missed findings, and identify time-effective practices and patterns to minimize interpretation error. DISCUSSION There are numerous reasons for false-negative interpretations, including, but not limited to, incomplete or misleading clinical history, failure to review prior studies, suboptimal windowing and leveling, and failure to utilize multiple anatomic views via multi-planar reconstructions and scout views. We illustrate this in four specific clinical scenarios: stroke, trauma, headache, and altered mental status. CONCLUSION Accurate and timely interpretation in the emergent setting is a daily challenge for emergency physicians. Knowledge of easily overlooked yet critical findings is a first step in minimizing interpretation error.
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Affiliation(s)
- Camille Malatt
- University of California, San Diego School of Medicine, San Diego, California
| | - Mazen Zawaideh
- University of California, San Diego School of Medicine, San Diego, California
| | - Cherng Chao
- Department of Radiology, UC San Diego Health System, San Diego, California
| | - John R Hesselink
- Department of Radiology, UC San Diego Health System, San Diego, California
| | - Roland R Lee
- Department of Radiology, UC San Diego Health System, San Diego, California; Department of Radiology, San Diego VA Medical Center, San Diego, California
| | - James Y Chen
- Department of Radiology, UC San Diego Health System, San Diego, California; Department of Radiology, San Diego VA Medical Center, San Diego, California
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15
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16
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Abstract
We studied the rare case of an older adult with dementia following herpes zoster encephalitis (HZE). This 71-year-old woman presented to us approximately 1 year following resolution of a rapid-onset episode of HZE, and subsequently underwent neuropsychological and neuroimaging examinations. Cognitive assessment revealed impairments in general cognitive functioning, verbal and nonverbal memory, executive functions, speed of information processing, attention/working memory, and motor skills. The patient's neuroimaging data, when compared to a demographically similar healthy control sample (n = 9), demonstrated moderate central and perisylvian brain volume loss, several subcortical lesions in the white matter, and resting state whole brain and hippocampal hypoperfusion. These findings highlight neuropsychological changes evident in a dementia syndrome of this type, and they suggest that early identification and treatment of HZE has implications for the preservation of long-term cognitive functioning.
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Affiliation(s)
- Katherine J Bangen
- San Diego State University/University of California-San Diego, La Jolla, CA, USA
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17
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Cianfoni A, da Graca Morais Martin M, Luigetti M, Pettorini BL, Hesselink JR. Spontaneous regression of a midbrain lesion in a patient with chronic transtentorial herniation: is it a pre-syrinx? J Neurol 2010; 257:848-50. [PMID: 20140446 DOI: 10.1007/s00415-010-5460-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2009] [Revised: 01/05/2010] [Accepted: 01/11/2010] [Indexed: 11/29/2022]
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18
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Hesselink JR. Myelin Maturation and White Matter Development: An Embryologic Eye View. Neuroradiol J 2009. [DOI: 10.1177/19714009090220s104] [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] [Indexed: 11/16/2022] Open
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19
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Hesselink JR. Concepts of Myelin and Myelination in MRI. Neuroradiol J 2009. [DOI: 10.1177/19714009090220s105] [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] [Indexed: 11/16/2022] Open
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20
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Petry M, Brown MA, Hesselink JR, Imbesi SG. Multifocal intravascular papillary endothelial hyperplasia in the retroperitoneum and spine: A case report and review of the literature. J Magn Reson Imaging 2009; 29:957-61. [DOI: 10.1002/jmri.21724] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
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21
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Atkinson JH, Heaton RK, Patterson TL, Wolfson T, Deutsch R, Brown SJ, Summers J, Sciolla A, Gutierrez R, Ellis RJ, Abramson I, Hesselink JR, McCutchan JA, Grant I. Two-year prospective study of major depressive disorder in HIV-infected men. J Affect Disord 2008; 108:225-34. [PMID: 18045694 PMCID: PMC2494949 DOI: 10.1016/j.jad.2007.10.017] [Citation(s) in RCA: 84] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2007] [Accepted: 10/24/2007] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The risks and factors contributing to major depressive episodes in HIV infection remain unclear. This 2-year prospective study compared cumulative rates and predictors of a major depressive episode in HIV-infected (HIV+) men (N=297) and uninfected (HIV-) risk-group controls (N=90). METHODS By design participants at entry were without current major depression, substance dependence or major anxiety disorder. Standardized neuromedical, neuropsychological, neuroimaging, life events, and psychiatric assessments (Structured Clinical Interview for DSM III-R) were conducted semi-annually for those with AIDS, and annually for all others. RESULTS Lifetime prevalence of major depression or other psychiatric disorder did not differ at baseline between HIV+ men and controls. On a two-year follow-up those with symptomatic HIV disease were significantly more likely to experience a major depressive episode than were asymptomatic HIV+ individuals and HIV-controls (p<0.05). Episodes were as likely to be first onset as recurrent depression. After baseline disease stage and medical variables associated with HIV infection were controlled, a lifetime history of major depression, or of lifetime psychiatric comorbidity (two or more psychiatric disorders), predicted subsequent major depressive episode (p<0.05). Neither HIV disease progression during follow-up, nor the baseline presence of neurocognitive impairment, clinical brain imaging abnormality, or marked life adversity predicted a later major depressive episode. LIMITATIONS Research cohort of men examined before era of widespread use of advanced anti-HIV therapies. CONCLUSIONS Symptomatic HIV disease, but not HIV infection itself, increases intermediate-term risk of major depression. Prior psychiatric history most strongly predicted future vulnerability.
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Affiliation(s)
- J Hampton Atkinson
- Department of Psychiatry, University of California San Diego, School of Medicine, La Jolla, California 92093, USA.
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22
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Phuttharak W, Galassi W, Laopaiboon V, Laopaiboon M, Hesselink JR. Abnormal diffusivity of normal appearing brain tissue in multiple sclerosis: a diffusion-weighted MR imaging study. J Med Assoc Thai 2007; 90:2689-2694. [PMID: 18386722] [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] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
OBJECTIVE To assess whether water diffusivity in normal appearing brain tissue including white and gray matter of multiple sclerosis (MS) patients shown by diffusion-weighted imaging (DWI) differs from normal individuals. MATERIAL AND METHOD Conventional MRI and DWI were performed in 37 multiple sclerosis patients and 31 control subjects, matched for age and sex. Quantitative diffusivity values were obtained from variable locations of normal appearing white and gray matter from both hemispheres by using a standardized region of interest template. +/- 2. 9 x 10(-5) mm2/s and 85.90 x 10(-5) +/- 2.45 x 10(-5) mm2/s) than normal control subjects (NAWM: 73.46 x 10(-5) +/- 1.77 x 10(-5) mm2/s and NAGM: 82.90 x 10(-5) +/- 0.91 x 10(-5) mm2/s) with p-value < 0.0001. CONCLUSION Water diffusivity was higher in all NAWM regions, deep gray matter regions, and some cortical gray matter region of MS patients than normal controls. DWI can quantify the presence and extent of MRI-undetectable pathology in the normal appearing brain tissue that were the disease burden.
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23
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O'Charoen P, Hesselink JR, Healy JF. Cerebral aneurysmal arteriopathy in an adult patient with acquired immunodeficiency syndrome. AJNR Am J Neuroradiol 2007; 28:938-9. [PMID: 17494674 PMCID: PMC8134320] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
In adult patients with acquired immunodeficiency syndrome (AIDS), cerebral arteritis usually takes the form of arterial wall thickening, stenosis, and occlusion, leading to cerebral ischemia and infarction. Aneurysms and intracranial hemorrhage are much less commonly associated with cerebral vasculitis. For reasons not entirely clear, this form is seen more often in pediatric patients infected with human immunodeficiency virus. We report an adult patient with cerebral aneurysmal arteriopathy who presented shortly after his AIDS-defining illness in a setting of severe immune suppression and high viral load.
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Affiliation(s)
- P O'Charoen
- Radiology Section, Bangkok Metropolitan Administration General Hospital, Department of Medical Services, Bangkok Metropolitan Administration, Thailand
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24
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Hazany S, Hesselink JR, Healy JF, Imbesi SG. Utilization of glutamate/creatine ratios for proton spectroscopic diagnosis of meningiomas. Neuroradiology 2006; 49:121-7. [PMID: 17086406 DOI: 10.1007/s00234-006-0167-z] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.7] [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: 06/22/2006] [Accepted: 09/18/2006] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Our purpose was to determine the potential of metabolites other than alanine to diagnose intracranial meningiomas on proton magnetic resonance spectroscopy (MRS). METHODS Using a 1.5-T MR system the lesions were initially identified on FLAIR, and T1- and T2-weighted images. Employing standard point-resolved spectroscopy (PRESS) for single voxel proton MRS (TR 1500 ms, TE 30 ms, 128 acquisitions, voxel size 2 x 2 x 2 cm, acquisition time 3.12 min), MR spectra were obtained from 5 patients with meningiomas, from 20 with other intracranial lesions, and from 4 normal controls. Peak heights of nine resonances, including lipid, lactate, alanine, NAA (N-acetylaspartate), beta/gamma-Glx (glutamate + glutamine), creatine, choline, myo-inositol, and alpha-Glx/glutathione, were measured in all spectra. The relative quantity of each metabolite was measured as the ratio of its peak height to the peak height of creatine. RESULTS Relative quantities of alpha-Glx/glutathione, beta/gamma-Glx, and total Glx/glutathione were significantly elevated in meningiomas compared to the 20 other intracranial lesions and the normal control brains. Alanine was found in four of five meningiomas, but lactate partially masked the alanine in three meningiomas. None of the other lesions or control brains showed an alanine peak. The one meningioma with no alanine and the three others with lactate had elevated Glx. CONCLUSION While alanine is a relatively unique marker for meningioma, our results support the hypothesis that the combination of glutamate/creatine ratios and alanine on proton MRS is more specific and reliable for the diagnosis of meningiomas than alanine alone.
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Affiliation(s)
- Saman Hazany
- School of Medicine, University of California, San Diego, CA, USA
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25
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Abstract
OBJECTIVES The purpose of this article is to explore the magnetic resonance (MR) imaging features and the advanced MR techniques for differential diagnosis of white matter diseases of the brain. RESULTS Magnetic resonance imaging is exquisitely sensitive for detecting brain abnormalities. Particularly in the evaluation of white matter diseases, MR far outperforms any other imaging technique. Lesions that may be quite subtle or even invisible on computed tomography are often clearly seen on the MR scan. The MR signal characteristics of white matter lesions are similar and relatively nonspecific, but other distinguishing features are often present to assist in diagnosis, such as the pattern of the abnormality, location, signal intensities, and enhancement features. Advanced MR techniques, such as diffusion-weighted imaging, MR spectroscopy, and perfusion imaging, provide additional specificity to the diagnosis of demyelinating diseases. CONCLUSIONS Conventional MR images and advanced MR techniques are very helpful in distinguishing various types of white matter disease, for assessing disease burden, and for separating acute and chronic lesions.
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Affiliation(s)
- John R Hesselink
- Department of Radiology, UCSD Medical Center, 200 West Arbor Dr, San Diego, CA 92103-8756, USA.
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26
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Cianfoni A, Martin MGM, Du J, Hesselink JR, Imbesi SG, Bradley WG, Bydder GM. Artifact simulating subarachnoid and intraventricular hemorrhage on single-shot, fast spin-echo fluid-attenuated inversion recovery images caused by head movement: A trap for the unwary. AJNR Am J Neuroradiol 2006; 27:843-9. [PMID: 16611776 PMCID: PMC8133968] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
BACKGROUND AND PURPOSE Single-shot, fast spin-echo, fluid attenuated inversion recovery (SS-FSE-FLAIR) images are frequently used to detect disease in the brain and subarachnoid space in confused or uncooperative patients who may move during the examination. In some of these patients, high signal intensity areas are seen on good-quality images in the subarachnoid space and ventricular system in locations not associated with high CSF flow. These artifacts may simulate hemorrhage or leptomeningeal disease. The purpose of this article was to determine the cause of these artifacts, describe ways to recognize them, and find methods to reduce or eliminate them. METHODS Healthy volunteers were studied on 6 occasions with conventional multisection FSE-FLAIR images and SS-FSE-FLAIR images while at rest and while nodding and rotating their heads at different speeds. In addition, SS-FSE-FLAIR images with different section widths of the initial inverting pulse and a non-section-selective initial inversion pulse were performed with the subjects moving their heads in the same way. The scans of 30 successive patients with acute neurologic syndromes who had been studied with SS-FSE-FLAIR sequences were reviewed for evidence of high signal intensity in the CSF in regions not associated with high CSF flow. RESULTS Each of the volunteers showed areas of increased signal intensity in CSF at sites apart from those associated with rapid pulsatile CSF flow on SS-FSE-FLAIR images acquired during head motion. The images were otherwise virtually free of motion artifact. The use of a wider initial inversion pulse section and a non-section-selected initial inversion pulse reduced the extent of these artifacts. Nineteen of the 30 patients showed areas of high signal intensity in the CSF in regions not associated with highly pulsatile CSF flow. Six of these patients had negative lumbar punctures for blood and xanthochromia and normal CSF protein levels. CONCLUSION High signal intensity artifacts may be seen in CSF as a result of head movement on otherwise artifact-free images when imaging uncooperative patients with SS-FSE-FLAIR sequences. These artifacts have a different mechanism and distribution from those caused by CSF pulsation and may simulate subarachnoid and intraventricular hemorrhage. Artifact recognition is aided by signs of patient motion during the examination. The artifacts can be reduced by use of increased section width and non-section-selective initial inversion pulses. Recognition of these artifacts is important, because the circumstances in which the SS-FSE-FLAIR sequence is used and the particular properties of the sequence may conspire to produce a trap for the unwary.
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Affiliation(s)
- A Cianfoni
- Department of Radiology, University of California, San Diego, CA 92103-8756, USA
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27
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Abstract
The educational objectives for this self-assessment module on imaging of the pineal region and spine are for the participant to exercise, self-assess, and improve his or her understanding of the evaluation of patients with brain tumors, particularly solid masses of the pineal region; gain familiarity with the clinical entity of chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) and its radiologic appearance; and gain familiarity with the clinical entity of spinal dural arteriovenous fistula (DAVF) and its radiologic appearance.
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Affiliation(s)
- Catherine C Roberts
- Department of Radiology, Mayo Clinic College of Medicine, Scottsdale, AZ, USA
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28
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Phuttharak W, Galassi W, Laopaiboon V, Laopaiboon M, Hesselink JR. ADC measurements in various patterns of multiple sclerosis lesions. J Med Assoc Thai 2006; 89:196-204. [PMID: 16579006] [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] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
OBJECTIVE To determine the difference of mean apparent diffusion coefficients (ADC) among different patterns of focal multiple sclerosis (MS) lesions, to compare mean lesion ADC between 2 clinical subgroups and to correlate mean lesion ADC with disability. MATERIAL AND METHOD Thirty seven patients (26 with relapsing-remitting multiple sclerosis (MS) and 11 with secondary-progressive MS) underwent both conventional and diffusion-weighted MR imaging of the brain. After creating ADC maps, region identification was done by using b = 0 images and T2-weighted images. ADC values were measured for MS lesions and (NAWM). RESULTS A total of 288 lesions were identified on the images. The mean ADC for the lesions was significantly higher than that of NAWM Hypointense T1 lesions (n = 221) had a significantly higher mean ADC than isointense T1 lesions (n = 67) in both nonenhancing lesions (n = 250) and enhancing lesions (n = 38). The enhanced rim of ring-enhancing lesions (n = 18) had lower ADC than the central nonenhanced portions. Confluent lesions (n = 62) had a substantially higher mean ADC than discrete lesion (n = 226). Mean lesion ADC of secondary progressive MS was significantly higher than relapsing remitting MS. No correlation between mean lesion ADC and (EDSS) score was found CONCLUSION Quantitative diffusion-weighted imaging is useful to elucidate the heterogeneous pathological substrate of MS in different patterns of MS lesions, to differentiate 2 major clinical subgroups.
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Affiliation(s)
- Warinthorn Phuttharak
- Department of Radiology, Srinagarind Hospital, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand.
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Phuttharak W, Hesselink JR, Wixom C. MR features of cerebral aspergillosis in an immunocompetent patient: correlation with histology and elemental analysis. AJNR Am J Neuroradiol 2005; 26:835-8. [PMID: 15814930 PMCID: PMC7977097] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
We report an unusual case of cerebral aspergillosis in a young immunocompetent patient who also had dissemination to other end organs. The patient presented with a large mass in the left cerebral hemisphere. Elemental analysis of biopsy specimens revealed elevated levels of iron, magnesium, zinc, calcium, chromium, and nickel that correlated with a peripheral rim of hypointensity on T2-weighted images.
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Affiliation(s)
- Warinthorn Phuttharak
- Department of Radiology, University of California, San Diego, San Diego, CA 92103-8756, USA
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Galassi W, Phuttharak W, Hesselink JR, Healy JF, Dietrich RB, Imbesi SG. Intracranial meningeal disease: comparison of contrast-enhanced MR imaging with fluid-attenuated inversion recovery and fat-suppressed T1-weighted sequences. AJNR Am J Neuroradiol 2005; 26:553-9. [PMID: 15760865 PMCID: PMC7976502] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
BACKGROUND AND PURPOSE Contrast-enhanced fluid-attenuated inversion recovery (FLAIR) imaging has been reported to have higher sensitivity for detecting leptomeningeal disease compared with contrast-enhanced T1-weighted MR imaging. The purpose of this study was to compare contrast-enhanced T1-weighted MR images with fat suppression to contrast-enhanced FLAIR images to determine which sequence was superior for depicting meningeal disease. METHODS We reviewed MR images of 24 patients (35 studies) with a variety of meningeal diseases. The MR imaging protocol included contrast-enhanced T1-weighted MR images with fat suppression (FS) and contrast-enhanced fluid-attenuated inversion recovery (FLAIR) images that were reviewed by three neuroradiologists and were assigned a rating of positive, equivocal, or negative for abnormal meningeal enhancement. The two sequences were compared side by side to determine which better depicted meningeal disease. RESULTS Abnormal meningeal enhancement was positive in 35 contrast-enhanced T1-weighted MR images with FS and in 33 contrast-enhanced FLAIR studies. In the first group, which had the T1-weighted sequence acquired first (21 of 33 studies), contrast-enhanced T1-weighted images with FS showed superior contrast enhancement in 11 studies (52%), inferior contrast enhancement in six studies (29%), and equal contrast enhancement in four studies (19%) compared with the contrast-enhanced FLAIR images. In the second group, which had the FLAIR sequence acquired first (12 of 33), contrast-enhanced T1-weighted images with FS showed superior contrast enhancement in seven studies (58%), inferior contrast enhancement in two studies (17%), and equal contrast enhancement in three studies (25%). CONCLUSION Contrast-enhanced T1-weighted MR imaging with FS is superior to contrast-enhanced FLAIR imaging in most cases for depicting intracranial meningeal diseases.
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Affiliation(s)
- Waneerat Galassi
- Department of Radiology, University of California, San Diego, Medical Center, San Diego, California 92103-8756, USA
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Kimura S, Hesselink JR, Garfin SR, Kawaji Y, Hasegawa K, Hargens AR. Axial load—dependent cervical spinal alterations during simulated upright posture: a comparison of healthy controls and patients with cervical degenerative disease. J Neurosurg Spine 2005; 2:137-44. [PMID: 15739524 DOI: 10.3171/spi.2005.2.2.0137] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [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: 11/06/2022]
Abstract
Object. The objectives of this study were to simulate the upright loading condition in the cervical spine by applying a new compression device during supine posture and to assess intervertebral angles and cross-sectional areas of the spinal cord and dural tube before and during axial compression.
Methods. A magnetic resonance (MR) imaging-compatible device was developed to create axial compression with the patient in the supine position. Lateral radiographs were obtained in upright and supine positions with an axial load of 0% (supine) and by applying a cervical compression device at 7, 10, and 13% of body weight (BW) in 18 control individuals and seven symptomatic patients with cervical degenerative disc disease (DDD). Additionally, cervical MR images acquired in 17 controls and 12 patients were compared before and during an axial load of 8.4% BW in terms of anteroposterior diameter and cross-sectional area of the dural sac.
The supine intervertebral angles with loads of 0, 7, 10, and 13% of the individuals' BW relative to upright posture were −8.1 ± 1.3, −2.3 ± 1.4, 1.3 ± 1.9, and 2.8 ± 2°, respectively. Subsequent axial force was interpolated as 8.9% of BW to simulate upright cervical spine alignment. Under an axial loading similar to that created by the upright posture, the dural sac narrowed at the C5–6 interspace in asymptomatic individuals and at the C6–7 interspace in patients with cervical DDD.
Conclusions. This cervical compression device may be a useful tool to simulate upright cervical spinal alignment. The results of this study help in understanding the pathophysiology of symptoms related to cervical degenerative disorders in upright posture.
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Affiliation(s)
- Shinji Kimura
- Department of Orthopedic Surgery, University of California, San Diego, California 92103-8894, USA
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Danchaivijitr N, Hesselink JR, Aryan HE, Herndier B. Cerebello-Pontine angle (CPA) lymphoma with perineural extension into the middle fossa: case report. ACTA ACUST UNITED AC 2004; 62:80-5. [PMID: 15226085 DOI: 10.1016/j.surneu.2003.07.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [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: 04/25/2003] [Accepted: 07/21/2003] [Indexed: 10/26/2022]
Abstract
BACKGROUND Tumors of the cerebello-pontine angle are most commonly schwannoma and meningioma. Primary central nervous system (CNS) lymphoma usually presents deep within the cerebral hemispheres, occasionally is found in the cerebellum, and rarely occurs in the cerebello-pontine angle. We report a rare case of primary CNS lymphoma involving the right cerebello-pontine angle and the middle cranial fossa mimicking a tentorial meningioma. METHODS A 21-year-old woman presented with right sided hearing loss and a facial droop. Computed tomography (CT) and magnetic resonance imaging (MRI) were performed, followed by cerebral angiography to assess vascularity. RESULTS Imaging revealed a bilobed mass involving the right cerebello-pontine angle and middle fossa. The labyrinthine segment of the facial nerve canal was enlarged, and some bony erosion was seen along the petrous bone anteriorly. The mass was hypointense on both T1 and T2-weighted MRI and exhibited heterogenous enhancement. It was distinctly hypovascular on angiography. At surgery, a B-cell lymphoblastic lymphona was found that infiltrated along the 7(th) and 8(th) nerve complexes into the internal auditory canal. CONCLUSION Imaging and surgery disclosed a cerebello-pontine lymphoma with perineural extension along the 7(th) nerve to reach the middle cranial fossa. Because of the unusual imaging characteristics of this tumor, as well as special considerations with respect to treatment, preoperative consideration of this entity is important in planning direct surgical biopsy rather than an extensive resection.
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Jernigan TL, Archibald SL, Fennema-Notestine C, Gamst AC, Stout JC, Bonner J, Hesselink JR. Effects of age on tissues and regions of the cerebrum and cerebellum. Neurobiol Aging 2001; 22:581-94. [PMID: 11445259 DOI: 10.1016/s0197-4580(01)00217-2] [Citation(s) in RCA: 695] [Impact Index Per Article: 30.2] [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] [Indexed: 10/17/2022]
Abstract
Normal volunteers, aged 30 to 99 years, were studied with MRI. Age was related to estimated volumes of: gray matter, white matter, and CSF of the cerebrum and cerebellum; gray matter, white matter, white matter abnormality, and CSF within each cerebral lobe; and gray matter of eight subcortical structures. The results were: 1) Age-related losses in the hippocampus were significantly accelerated relative to gray matter losses elsewhere in the brain. 2) Among the cerebral lobes, the frontal lobes were disproportionately affected by cortical volume loss and increased white matter abnormality. 3) Loss of cerebral and cerebellar white matter occurred later than, but was ultimately greater than, loss of gray matter. It is estimated that between the ages of 30 and 90 volume loss averages 14% in the cerebral cortex, 35% in the hippocampus, and 26% in the cerebral white matter. Separate analyses were conducted in which genetic risk associated with the Apolipoprotein E epsilon4 allele was either overrepresented or underrepresented among elderly participants. Accelerated loss of hippocampal volume was observed with both analyses and thus does not appear to be due to the presence of at-risk subjects. MR signal alterations in the tissues of older individuals pose challenges to the validity of current methods of tissue segmentation, and should be considered in the interpretation of the results.
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Affiliation(s)
- T L Jernigan
- Veterans Affairs San Diego Healthcare System, San Diego, CA, USA.
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Lizerbram EK, Hesselink JR. Neuroimaging of AIDS. I. Viral infections. Neuroimaging Clin N Am 1997; 7:261-80. [PMID: 9113690] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Viral infections of the brain and spinal cord cause significant morbidity and mortality in patients afflicted with AIDS. Debate continues over the specific mechanisms and pathways of how HIV-1 manifests itself in the brain and spinal cord. Attempts to predict which seropositive patients develop neurocognitive deficits caused by HIV-1 and how soon these deficits will occur in the course of disease have had limited success. The neuropathologic changes of HIV-1 must be distinguished from other viral infections, such as cytomegalovirus, JC papovavirus (progressive multifocal leukoencephalopathy), herpes simplex virus type 1, and varicella-zoster virus. In addition to cerebral spinal fluid sampling and serum testing, some specific features are seen with contrast-enhanced CT, MR imaging, proton MR spectroscopy, SPECT, and PET.
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Affiliation(s)
- E K Lizerbram
- Division of Magnetic Resonance Imaging, University of California at San Diego Medical Center, San Diego, California 92103-8756, USA
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Hesselink JR. In the area of MR imaging, do we still need to teach our residents in neuroradiology how to perform the lateral cervical C1-C2 puncture to reach the intrathecal space? AJR Am J Roentgenol 1996; 167:1338-9. [PMID: 8911209 DOI: 10.2214/ajr.167.5.8911209] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- J R Hesselink
- University of California Medical Center, San Diego 92103-8756, USA
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Georgy BA, Hesselink JR, Middleton MS. Quantitative analysis of signal intensities and contrast after fat suppression in contrast-enhanced magnetic resonance imaging of the spine. Acad Radiol 1996; 3:731-4. [PMID: 8883513 DOI: 10.1016/s1076-6332(96)80411-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [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: 02/02/2023]
Abstract
RATIONALE AND OBJECTIVES We studied the effect of fat suppression on signal intensity and contrast on contrast-enhanced magnetic resonance (MR) images of the spine. METHODS Contrast-enhanced T1-weighted MR images were obtained at identical levels with and without fat suppression. Signal intensity and contrast were measured in regions of interest in fat, muscle, spinal bone marrow, and enhancing lesions. The differences in the mean values of these signal intensities and the mean values of contrast between enhanced tissues and bone marrow, fat, and muscle were subjected to statistical validation. RESULTS Mean signal intensity of the extraspinal fat and bone marrow was lower after fat suppression (70% and 46% reduction, p < .001 and p < .05, respectively), whereas the signal intensity of muscle showed no significant change (p < .9). Enhancing spinal lesions showed a difference in mean signal intensity after fat suppression (22% increase, p < .2). Contrast between enhanced lesions and bone marrow and fat was higher after fat suppression (78% increase, p < .01 for bone marrow; 8% increase, p < .001 for fat). CONCLUSION In contrast-enhanced MR examinations of the spine, the use of fat suppression may increase the signal intensity of the enhancing lesion by expanding the dynamic gray scale of the image and increases the contrast between the lesion and adjacent bone marrow and suppressed fat.
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Affiliation(s)
- B A Georgy
- Department of Radiology, School of Medicine, University of California, San Diego, USA
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Hesselink JR, Karampekios S. Normal computed tomography and magnetic resonance imaging anatomy of the globe, orbit, and visual pathways. Neuroimaging Clin N Am 1996; 6:15-27. [PMID: 8919132] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The presence of bone and fat in the orbit provide high contrast with normal structures on both CT and MR images. In patients with visual deficits or oculomotor paralysis, imaging studies should include the intracranial cavity to evaluate the visual pathways back to the occipital cortex and the cranial nerves within the cavernous sinuses and brainstem. Magnetic resonance images display the intracranial anatomy in exquisite detail. Fat-suppressed magnetic resonance sequences should be used in conjunction with gadolinium enhancement.
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Affiliation(s)
- J R Hesselink
- Department of Radiology, University of California, San Diego, Medical Center, USA
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Abstract
The purpose of this report was to review the MR techniques, contrast enhancement patterns, and MR imaging findings for the spinal nerve roots. The phenomenon of contrast enhancement of the nerve roots and its relationship to disk disease and failed-back-surgery syndrome are discussed. The MR imaging findings for various inflammatory and neoplastic disorders affecting the spinal nerve roots are described and illustrated.
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Affiliation(s)
- B A Georgy
- Department of Radiology, University of South Alabama, Mobile 36617, USA
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Croutch KL, Wong WH, Coufal F, Georgy B, Hesselink JR. En plaque meningioma of the basilar meninges and Meckel's cave: MR appearance. AJNR Am J Neuroradiol 1995; 16:949-51. [PMID: 7611082 PMCID: PMC8332266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- K L Croutch
- Department of Radiology, University of California San Diego Medical Center 92103-8756, USA
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Abstract
We examined 25 patients with recurrent pain after lumbar disk surgery with MRI to evaluate the usefulness of gadolinium (Gd)-enhanced fat-suppression (FS) imaging in patients with failed back surgery. Pulse sequences included T1-weighted (T1W) images, Gd-enhanced T1W images, and Gd-enhanced T1W images with FS. The addition of FS to Gd-enhanced T1W images improved visualization of enhancing scar in all cases, helped distinguish scar from recurrent herniated disk, and showed more clearly the relationship of scar to the nerve roots and thecal sac. The images also demonstrated enhancement of the facet joints and theca in 23 and 11 cases, respectively. Intradural nerve roots were more conspicuous with FS in 21 cases. The combination of unenhanced and Gd-enhanced T1W images with FS is recommended for routine examination of the postoperative back.
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Affiliation(s)
- B A Georgy
- Department of Radiology, School of Medicine, University of California, San Diego 92103-8756
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Affiliation(s)
- B A Georgy
- Department of Radiology, School of Medicine, University of California, San Diego, La Jolla 92103-8756
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Olson EM, Healy JF, Wong WH, Youmans DC, Hesselink JR. MR detection of white matter disease of the brain in patients with HIV infection: fast spin-echo vs conventional spin-echo pulse sequences. AJR Am J Roentgenol 1994; 162:1199-204. [PMID: 8166010 DOI: 10.2214/ajr.162.5.8166010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [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: 01/29/2023]
Abstract
OBJECTIVE Although fast spin-echo images and slower spin-echo images have similar contrast characteristics, the two techniques have not yet been shown to be equivalent in all aspects of brain imaging. To determine if the two sequences are equivalent, we compared detection of white matter lesions, image quality, and artifact degradation on fast spin-echo and spin-echo proton density-weighted and T2-weighted MR images of the brain in prospectively selected patients who were seropositive for HIV. SUBJECTS AND METHODS Fast spin-echo and spin-echo MR images of the brain were obtained in 153 consecutive subjects. The images were reviewed independently by three experienced neuroradiologists. The size, number, and location of white matter lesions were compared for the two techniques. Image quality, motion artifact, CSF flow artifact, and gray-white matter differentiation were graded on a five-point scale. RESULTS No statistical difference was found in gray-white matter differentiation. Overall image quality, CSF flow artifacts, and motion artifacts were slightly worse on the fast spin-echo images (p < .05). Although some variability existed in the detection of lesions less than 5 mm in diameter, the differences was small, and all larger lesions were detected by both techniques. Agreement between fast spin-echo and conventional spin-echo techniques was nearly exact with respect to characterizing findings in brain as either normal or abnormal. CONCLUSIONS Fast spin-echo and spin-echo MR of the brain produce images of similar quality and show white matter lesions equally well. These results support the replacement of slower, conventional spin-echo pulse sequences with faster fast spin-echo sequences.
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Affiliation(s)
- E M Olson
- Department of Radiology, University of California, San Diego Medical Center 92103-8756
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Abstract
A number of new techniques have been developed to enhance MR imaging of the spine. Fat-suppression techniques used in conjunction with gadolinium-based contrast material improve visualization of enhancing inflammatory and neoplastic diseases. Fast spin-echo (FSE) sequences can be used to decrease imaging times, to increase resolution, or to improve signal-to-noise ratios on T2-weighted images. In general, FSE images provide a better myelographic effect with reduced magnetic susceptibility compared with gradient-recalled echo (GRE) techniques. With volume GRE sequences, thin contiguous sections can be obtained, and images can be reformatted into multiple planes from a single data set. High-contrast imaging can be accomplished by using three-dimensional (3D) turbo-fast low-angle shot (FLASH) or magnetization prepared rapid acquisition gradient-echo (MP RAGE) techniques with gadolinium contrast enhancement. Finally, CSF flow dynamics within the subarachnoid space and within cystic lesions can be elucidated with phase-contrast techniques. Judicious selection of these methods and other innovative MR techniques is necessary to maximize the potential of MR in diagnosis of spinal disease.
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Affiliation(s)
- B A Georgy
- Department of Radiology, School of Medicine, University of California, San Diego 92103-8756
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Chong BW, Kerber CW, Buxton RB, Frank LR, Hesselink JR. Blood flow dynamics in the vertebrobasilar system: correlation of a transparent elastic model and MR angiography. AJNR Am J Neuroradiol 1994; 15:733-45. [PMID: 8010277 PMCID: PMC8334205] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
PURPOSE To describe the flow patterns in a model of the vertebrobasilar artery and use these observations to explain the appearance of the flow on the MR images. METHODS We created an anatomically precise, transparent elastic model of the human vertebrobasilar artery containing a basilar tip aneurysm and perfused the model with non-Newtonian fluid which has similar rheologic properties to blood. Flow patterns in the vessels were directly observed. MR angiogram images were obtained with commercially available two-dimensional time-of-flight, three-dimensional time-of-flight, and 3-D phase-contrast MR angiographic pulse sequences, and they were correlated with the directly seen flow patterns. Quantitative flow velocity measurements were performed with 2-D cine phase-contrast MR angiography and correlated with the flow measured with an electromagnetic flow meter. RESULTS Visualization studies showed the dye stream patterns in the vertebrobasilar arteries to be extremely complex and variable. During the MR experiments we found that often the same segment of a vessel could appear very different depending on the pulse sequence. In some instances, the model experiments helped to explain the MR appearance of the vessels. Flow profiles measured with 2-D cine phase contrast were found to be consistent with those measured directly with an electromagnetic flow meter. CONCLUSION Clear elastic models can be used to duplicate the flow in human cranial vessels and thus provide a unique means to observe these flow patterns directly. The flow patterns helped to explain the variation in appearance of the vessels and the artifacts with different MR angiography pulse sequences. The artifacts depend on both the geometry of the vessel and the flow pattern within it. Two-dimensional cine phase-contrast MR provides temporal flow field information that is directly related to physiological information about flow volumes and velocity patterns.
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Affiliation(s)
- B W Chong
- Department of Radiology, University of California San Diego Medical Center
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Georgy BA, Hesselink JR. Evaluation of fat suppression in contrast-enhanced MR of neoplastic and inflammatory spine disease. AJNR Am J Neuroradiol 1994; 15:409-17. [PMID: 8197935 PMCID: PMC8334296] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
PURPOSE To determine the benefit of fat suppression in conjunction with gadolinium enhancement for evaluating neoplastic and inflammatory diseases of the spine. METHODS Contrast-enhanced T1-weighted images were compared with the corresponding contrast-enhanced T1-weighted images with fat suppression in 14 patients with various neoplastic and inflammatory spine diseases. RESULTS Contrast-enhanced T1-weighted images with fat suppression showed enhancing lesions in all cases of vertebral disease (five cases), but in one case some metastases did not enhance. Paravertebral (nine lesions), epidural (seven lesions), and intradural-extramedullary (six lesions) were delineated better with contrast-enhanced fat suppression. In the 14 cases (29 lesions), nine lesions were seen only on contrast-enhanced images with fat suppression. Integrity of the vertebral end plates was assessed more accurately on fat-suppressed images. CONCLUSION Although noncontrast T1-weighted images are sufficient to screen for vertebral disease, contrast-enhanced images with fat suppression may detect additional lesions. Fat suppression should be used in conjunction with gadolinium for evaluating epidural, paravertebral, and intradural-extramedullary spinal lesions.
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Affiliation(s)
- B A Georgy
- Department of Radiology, School of Medicine, University of California, San Diego 92103-8756
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Abstract
Surface-coil MR imaging of the spine is one of the most commonly performed MR imaging procedures. As the spine is the region of interest in these studies, extraspinal abnormalities may be overlooked. Such lesions can be difficult to perceive because they are out of the area of interest or distant from the surface coil. MR studies may be interpreted without other radiographic studies for comparison, as the other studies often have been performed elsewhere. Consequently, it is important for radiologists to be aware of the extraspinal anatomy and the appearances of extraspinal abnormalities. We describe the appearances of some common extraspinal diseases and normal variants detected with surface-coil MR imaging of the spine.
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Affiliation(s)
- E M Olson
- Department of Radiology, University of California, San Diego Medical Center 92103-8756
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Georgy BA, Chong B, Chamberlain M, Hesselink JR, Cheung G. MR of the spine in Guillain-Barré syndrome. AJNR Am J Neuroradiol 1994; 15:300-1. [PMID: 8192076 PMCID: PMC8334612] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
MR examination of the spine after injection of gadopentetate dimeglumine showed enhancement of the cauda equina in a case of Guillain-Barré syndrome. These MR observations may help confirm the diagnosis of Guillain-Barré syndrome.
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Affiliation(s)
- B A Georgy
- Department of Radiology, School of Medicine, University of California, San Diego
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Sewell DD, Jeste DV, Atkinson JH, Heaton RK, Hesselink JR, Wiley C, Thal L, Chandler JL, Grant I. HIV-associated psychosis: a study of 20 cases. San Diego HIV Neurobehavioral Research Center Group. Am J Psychiatry 1994; 151:237-42. [PMID: 8296896 DOI: 10.1176/ajp.151.2.237] [Citation(s) in RCA: 58] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
OBJECTIVE Psychosis is an uncommon but serious complication of infection with HIV. This article presents the results of a study of HIV-infected individuals with psychosis. METHOD The authors evaluated 20 HIV-infected men who had noniatrogenic new-onset psychosis without delirium, current substance abuse, or previous psychotic episodes. Clinical, neuropsychological, CSF, magnetic resonance imaging, and neuropathologic assessments were made. A comparison group consisting of 20 nonpsychotic HIV-infected men matched to the psychotic subjects with respect to age, race, years of education, and Centers for Disease Control HIV stage was also evaluated. RESULTS The psychotic patients differed from the nonpsychotic comparison subjects in having significantly higher rates of past stimulant and sedative/hypnotic abuse or dependence and, at follow-up, a significantly higher rate of mortality. They also showed a trend toward greater global neuropsychological impairment. CONCLUSIONS New-onset psychosis may be, at least in part, a manifestation of an HIV-associated encephalopathy.
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Affiliation(s)
- D D Sewell
- Department of Psychiatry, School of Medicine, University of California, San Diego
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Simpson IA, Maciel BC, Moises V, Shandas R, Elias W, Valdes-Cruz L, Hesselink JR, Chung KJ, Sahn DJ. Cine magnetic resonance imaging and color Doppler flow mapping displays of flow velocity, spatial acceleration, and jet formation: a comparative in vitro study. Am Heart J 1993; 126:1165-74. [PMID: 8237761 DOI: 10.1016/0002-8703(93)90670-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [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: 01/29/2023]
Abstract
To study the effects of flow acceleration and high-velocity jets on the display characteristics of cine magnetic resonance imaging compared with color Doppler flow mapping, a custom-designed in vitro flow model was developed. This model consisted of a funnel segment tapering to an orifice (0.78 cm2) that leads into a confined receiving chamber with a second, discrete orifice (0.78 cm2) at its distal end. Cine magnetic resonance images obtained at varying flow rates (1.5 to 27.2 L/min) demonstrated loss of signal intensity throughout the tapering zone of spatial acceleration and a small zone of more marked signal loss immediately proximal to the second orifice (always < 50% of the signal intensity within the tapering funnel zone) associated with more rapid spatial acceleration. A formed jet was imaged distal to the first orifice, and the turbulence area surrounding the laminar central jet core correlated well with flow rate (r = 0.98), as did the distance from the orifice to the subsequent onset of flow relaminarization (r = 0.96). A turbulent spray area was always seen distal to the second, discrete orifice. Comparative observations with color Doppler flow mapping and continuous wave Doppler demonstrated that signal intensity on cine magnetic resonance imaging is reduced by both spatial acceleration, and the high-velocity and turbulent jets associated with obstructive and regurgitant lesions. In vitro evaluation of cine magnetic resonance imaging allows comparative observations to be made about the flow characteristics of cine magnetic resonance imaging and color Doppler flow mapping and provides a more rational basis for the interpretation of cine magnetic resonance imaging in the clinical setting.
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Affiliation(s)
- I A Simpson
- Division of Pediatric Cardiology, University of California, San Diego
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