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Amyot F, Arciniegas DB, Brazaitis MP, Curley KC, Diaz-Arrastia R, Gandjbakhche A, Herscovitch P, Hinds SR, Manley GT, Pacifico A, Razumovsky A, Riley J, Salzer W, Shih R, Smirniotopoulos JG, Stocker D. A Review of the Effectiveness of Neuroimaging Modalities for the Detection of Traumatic Brain Injury. J Neurotrauma 2015; 32:1693-721. [PMID: 26176603 PMCID: PMC4651019 DOI: 10.1089/neu.2013.3306] [Citation(s) in RCA: 114] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
The incidence of traumatic brain injury (TBI) in the United States was 3.5 million cases in 2009, according to the Centers for Disease Control and Prevention. It is a contributing factor in 30.5% of injury-related deaths among civilians. Additionally, since 2000, more than 260,000 service members were diagnosed with TBI, with the vast majority classified as mild or concussive (76%). The objective assessment of TBI via imaging is a critical research gap, both in the military and civilian communities. In 2011, the Department of Defense (DoD) prepared a congressional report summarizing the effectiveness of seven neuroimaging modalities (computed tomography [CT], magnetic resonance imaging [MRI], transcranial Doppler [TCD], positron emission tomography, single photon emission computed tomography, electrophysiologic techniques [magnetoencephalography and electroencephalography], and functional near-infrared spectroscopy) to assess the spectrum of TBI from concussion to coma. For this report, neuroimaging experts identified the most relevant peer-reviewed publications and assessed the quality of the literature for each of these imaging technique in the clinical and research settings. Although CT, MRI, and TCD were determined to be the most useful modalities in the clinical setting, no single imaging modality proved sufficient for all patients due to the heterogeneity of TBI. All imaging modalities reviewed demonstrated the potential to emerge as part of future clinical care. This paper describes and updates the results of the DoD report and also expands on the use of angiography in patients with TBI.
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Affiliation(s)
- Franck Amyot
- The Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland
- Center for Neuroscience and Regenerative Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - David B. Arciniegas
- Beth K. and Stuart C. Yudofsky Division of Neuropsychiatry, Baylor College of Medicine, Houston, Texas
- Brain Injury Research, TIRR Memorial Hermann, Houston, Texas
| | | | - Kenneth C. Curley
- Combat Casualty Care Directorate (RAD2), U.S. Army Medical Research and Materiel Command, Fort Detrick, Maryland
| | - Ramon Diaz-Arrastia
- Center for Neuroscience and Regenerative Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Amir Gandjbakhche
- The Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland
| | - Peter Herscovitch
- Positron Emission Tomography Department, National Institutes of Health Clinical Center, Bethesda, Maryland
| | - Sidney R. Hinds
- Defense and Veterans Brain Injury Center, Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury Silver Spring, Maryland
| | - Geoffrey T. Manley
- Brain and Spinal Injury Center, Department of Neurological Surgery, University of California, San Francisco, San Francisco, California
| | - Anthony Pacifico
- Congressionally Directed Medical Research Programs, Fort Detrick, Maryland
| | | | - Jason Riley
- Queens University, Kingston, Ontario, Canada
- ArcheOptix Inc., Picton, Ontario, Canada
| | - Wanda Salzer
- Congressionally Directed Medical Research Programs, Fort Detrick, Maryland
| | - Robert Shih
- Walter Reed National Military Medical Center, Bethesda, Maryland
| | - James G. Smirniotopoulos
- Department of Radiology, Neurology, and Biomedical Informatics, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Derek Stocker
- Walter Reed National Military Medical Center, Bethesda, Maryland
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Smith JM, Fox CJ, Brazaitis MP, Via K, Garcia R, Feuerstein IM. Sixty-four-slice CT angiography to determine the three dimensional relationships of vascular and soft tissue wounds in lower extremity war time injuries. Mil Med 2010; 175:65-7. [PMID: 20108845 DOI: 10.7205/milmed-d-00-04509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
This article analyzes the use and benefits of the 64-slice CT scanner in determining the 3D relationships of vascular and soft tissue wounds in lower extremity war time injuries. A brief overview of CT scanning is given as well as the techniques used to produce the images needed for diagnosis. The series follows two similar cases of war time injury patients at the Walter Reed Army Medical Center. The first case is a 30-year-old active duty male, who presented with multiple trauma from a motor vehicle accident because of an improvised explosive device (IED) blast, sustaining substantial lower extremity injuries. The second case is a 34-year-old active duty male, who presented with multiple trauma blast injuries. Both cases were of interest because the vasculature was found to be very close to the surface of the wound, which put the arteries at risk for rupture and for iatrogenic injury during repeated debridements.
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Affiliation(s)
- Jennifer M Smith
- California University of Pennsylvania, California, PA 15419, USA
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Smith JM, Fox CJ, Brazaitis MP, Via K, Garcia R, Feuerstein IM. Sixty-Four-Slice CT Angiography to Determine the Three Dimensional Relationships of Vascular and Soft Tissue Wounds in Lower Extremity War Time Injuries. Mil Med 2010. [DOI: 10.7205/milmed-d-00-4509] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Feuerstein IM, Brazaitis MP, Zoltick JM, Barko WF, Vaitkus MA, Combs JJ, Burger LM, Blanck RR. Electron beam computed tomography screening of the coronary arteries: experience with 3,263 patients at Walter Reed Army Medical Center. Mil Med 2001; 166:432-42. [PMID: 11370209] [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: 04/16/2023] Open
Abstract
The U.S. Department of Defense desires to reduce the impact of coronary atherosclerosis on its active duty, retired, and dependent populations. Electron beam computed tomography (EBCT) is currently the best way to noninvasively image the coronary arteries directly. Between August 1997 and February 1999, a total of 3,263 patients were scanned by EBCT in the Radiology Department at Walter Reed Army Medical Center. Scans were performed on 2,415 men (74%) and 848 women (26%). The most common age group was 50 to 54 years (25%). Coronary calcification was found in approximately half of the patients (46%), and the magnitude of the score was strongly associated with age and male gender. Average scores increased exponentially with age, doubling every 7 years. In men, average scores ranged from 17 units in those aged 35 to 39 years to 842 in those older than 70 years old. In women, average scores ranged from 1 in those 35 to 39 years to 162 in those older than 70 years. Significant numbers of patients fell into the high-risk categories, with 8% of men in their 40s, 20% of men in their 50s, 33% of men in their 60s, and 49% of men in their 70s with high scores. Scores of more than 400 units were seen in 368 patients (8%) overall. There is a large amount of coronary calcium present in military personnel and their dependents, in patterns that are consistent with previous studies. Many patients had very high scores that are consistent with advanced coronary artery disease. EBCT should play a central role in the identification of occult calcific atherosclerosis of the coronary arteries in military, retired, and dependent patients.
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Affiliation(s)
- I M Feuerstein
- Department of Radiology, Room 1X05B, Building 2 (Heaton Pavilion), Walter Reed Army Medical Center, 3900 Georgia Avenue NW, Washington, DC 20307, USA.
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Irwin M. F, Brazaitis MP, Zoltick JM, Barko WF, Vaitkus MA, Combs JJ, Burger LM, Blanck RR. Electron Beam Computed Tomography Screening of the Coronary Arteries: Experience with 3,263 Patients at Walter Reed Army Medical Center. Mil Med 2001. [DOI: 10.1093/milmed/166.5.432] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Feuerstein Irwin M.
- Electron Beam Computed Tomography, Department of Radiology, Walter Reed Army Medical Center, Washington, DC 20307; and Department of Radiology, Uniformed Services University for the Health Sciences, Bethesda, MD
| | | | - Jerel M. Zoltick
- Office of the Surgeon General (U.S. Army), U.S. Army Health Clinic, The Pentagon, Washington, DC 20310
| | - William F. Barko
- Army Physical Fitness Research Institute, U.S. Army War College, Carlisle, PA 17013
| | - Mark A. Vaitkus
- Army Physical Fitness Research Institute, U.S. Army War College, Carlisle, PA 17013
| | - John J. Combs
- Department of Radiology, Walter Reed Army Medical Center, Washington, DC 20307
| | - Leslie M. Burger
- Building One, Walter Reed Army Medical Center, Washington, DC 20307
| | - Ronald R. Blanck
- U.S. Army, Office of the Surgeon General, Falls Church, VA 22041-3258
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Abstract
The patient with acute abdominal pain presents the attending physician with a wide and varied gamut of diagnostic possibilities. Prompt and accurate diagnosis is essential for the proper care and management of these acutely ill patients. Diagnostic radiology is often an integral part of the emergent evaluation of these patients. This article focuses on some of the key plain-film findings in the patients suffering from acute abdominal pain of intestinal causes and reviews the radiologic evaluation of several major abdominal conditions such as acute appendicitis, diverticulitis, inflammatory bowel disease, bowel ischemia, and infarction.
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Affiliation(s)
- M P Brazaitis
- Diagnostic Radiology Service, Walter Reed Army Medical Center, Washington, DC
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