Utility Of Neuroimaging Research Articles

Navigating Neural Landscapes: A Comprehensive Review of Magnetic Resonance Imaging (MRI) and Magnetic Resonance Spectroscopy (MRS) Applications in Epilepsy.

This review comprehensively explores the evolving role of neuroimaging, specifically magnetic resonance imaging (MRI) and magnetic resonance spectroscopy (MRS), in epilepsy research and clinical practice. Beginning with a concise overview of epilepsy, the discussion emphasizes the crucial importance of neuroimaging in diagnosing and managing this complex neurological disorder. The review delves into the applications of advanced MRI techniques, including high-field MRI, resting-state fMRI, and connectomics, highlighting their impact on refining our understanding of epilepsy's structural and functional dimensions. Additionally, it examines the integration of machine learning in the analysis of intricate neuroimaging data. Moving to the clinical domain, the review outlines the utility of neuroimaging in pre-surgical evaluations and the monitoring of treatment responses and disease progression. Despite significant strides, challenges and limitations are discussed in the routine clinical incorporation of neuroimaging. The review explores promising developments in MRI and MRS technology, potential advancements in imaging biomarkers, and the implications for personalized medicine in epilepsy management. The conclusion underscores the transformative potential of neuroimaging and advocates for continued exploration, collaboration, and technological innovation to propel the field toward a future where tailored, effective interventions improve outcomes for individuals with epilepsy.

The utility of neuroimaging in the differential diagnosis of parkinsonian disorders

The utility of neuroimaging in the differential diagnosis of parkinsonian disorders

Functional neuroimaging related to lower urinary tract sensations: Future directions for study designs and selection of patient groups: ICI-RS 2023.

Neuroimaging studies have advanced our understanding of the intricate central nervous system control network governing lower urinary tract (LUT) function, shedding light on mechanisms for urine storage and voiding. However, a lack of consensus in methodological approaches hinders the comparability of results among research groups and limits the translation of this knowledge to clinical applications, emphasizing the need for standardized methodologies and clinical utilization guidelines. This paper reports the discussions of a workshop at the 2023 meeting of the International Consultation on Incontinence Research Society, which reviewed uncertainties and research priorities to progress the field of neuroimaging in LUT control and dysfunction. Neuroimaging holds great potential for improving our understanding of LUT control and pathophysiological conditions. To date, functional neuroimaging techniques have not yet achieved sufficient strength to make a direct clinical impact. Potential approaches that can improve the clinical utilization of neuroimaging were discussed and research questions proposed. Neuroimaging offers a valuable tool for investigating LUT control, but it's essential to acknowledge the potential for oversimplification when interpreting brain activity due to the complex neural processing and filtering of sensory information. Moreover, technical limitations pose challenges in assessing key brain stem and spinal cord centers, particularly in cases of neurological dysfunction, highlighting the need for more reliable imaging of these centers to advance our understanding of LUT function and dysfunction.

Invited Symposium 4: Innovations in Infant, Toddler, and Young Child Neuropsychological Models of Care

Abstract & Learning Objectives:The neuropsychology of babies, toddlers, and young children is a rapidly evolving frontier within our discipline. While there is an inaccurate perception among referral sources that neuropsychological services are not useful before school-age, pediatric neuropsychologists are especially well-suited to identify delay or dysfunction in the years before school entry (Baron and Anderson, 2012). Patterns of neurodevelopmental strengths and weaknesses can be detected very early on in development and used to make inferences about brain-behavior relationships integral for guiding treatment across a number of medical and neurodevelopmental diagnoses. As such, there is a need to foster ongoing clinical interest and expertise and promote the utility of neuropsychological services within this age range. The INS BabIes, ToddlerS, and Young children (BITSY) SIG was recently developed to bring together scientists and clinicians from across the world who conduct research and provide neuropsychological services within this age range to foster collaboration and learning. A priority of the BITSY SIG is not only to promote awareness of the novel needs of this age range, but to consider historical and ongoing disparities in service access, representation in research, and neuropsychological practice. For this inaugural BITSY SIG symposium, four members of the SIG will discuss innovations in infant, toddler, and young child neuropsychological models of care. This topic was developed in direct response to survey results from the first BITSY SIG meeting held during INS 2022, indicating the need for the development and refinement of clinical approaches that incorporate diverse perspectives as well as training opportunities in models of care for very young children. As such, speakers will cover innovations in neuropsychological service models from the prenatal period to formative early years that are inclusive of diverse neurological and neurodevelopmental populations commonly served by neuropsychologists including spina bifida, prematurity, hypoxic-ischemic encephalopathy (HIE), congenital heart disease (CHD), autism (ASD) and attention-deficit/hyperactivity disorder (ADHD). The first talk will highlight the unique role of the neuropsychologist in prenatal and infant consultation, whereas the second talk will focus on the state of the field with regard to the utility of neuroimaging in neonatal populations and the integration of this tool in neuropsychological care. The third talk will discuss early screening and assessment models in a diverse range of conditions within an interdisciplinary setting. The final talk will illustrate a novel neuropsychological intervention designed with and for the empowerment of caregivers for young children impacted by neurological and neurodevelopmental conditions. The unifying theme across the talks is how unplanned discoveries and acute observations of children and families during the critical early years have led to these inclusive care models that prioritize family preferences, values, and culture. Upon conclusion of this course, learners will be able to: 1.Summarize several novel models of neuropsychological care for infants, toddlers, and young children.2.Recognize ways in which neuropsychologists work within interdisciplinary teams to serve infants, toddlers, and young children and their families.3.Apply these models of care to your conceptualization of the scope of neuropsychological services available for infants, toddlers, and young children.

76 More Than One Way to Skin a Cortex: A Meta-Analysis Comparing Neuroimaging and Personality Testing

Objective:Neuroimaging is commonly used in medicine to identify neuropathology and is widely considered to be a reliable and valid diagnostic modality. Personality testing is commonly used to identify psychopathology but is generally perceived to have less clinical efficacy than neuroimaging. The purpose of the current study was to compare the clinical efficacy of personality tests to neuroimaging using meta-analysis.Participants and Methods:Multiple databases were searched for original research utilizing either personality tests or neuroimaging. The search interval covered articles published within the last 10 years. Studies were selected based on the criteria of having a clinical group and a healthy control sample with a reported diagnostic outcome. For this meta-analysis, neuroimaging studies focusing on diagnostic utility for Alzheimer’s dementia were included. Personality testing studies were included if they broadly reported a clinical outcome, due to fewer studies in this area. Studies were coded using a complex multi-comparison, outcome, and subgroup schema, and were analyzed under random-effects modeling.Results:Out of the 240 studies identified for the personality domain, 13 were selected for the meta-analysis. Out of 6522 studies identified for the neuroimaging domain, 21 studies were selected for the meta-analysis. Results indicated a significant difference between the neuroimaging and personality testing effect sizes. Specifically, neuroimaging [Hedge’s g = -1.623, 95% CI = -1.973 to -1.273, p<.001] yielded a greater effect size in comparison to the personality tests effect size [Hedge’s g = -0.658, 95% CI = -0.751 to -0.565, p<.001]. The effect size for clinical utility of neuroimaging was close to double that of the effect for personality tests diagnostic utility.Conclusions:Findings from this meta-analysis showed a significant difference in the effect sizes obtained from neuroimaging studies compared to the studies of personality tests. While both neuroimaging and personality testing demonstrated meaningful clinical utility, neuroimaging studied had a larger effect size.

Multimodal MRI improves diagnostic accuracy and sensitivity to longitudinal change in amyotrophic lateral sclerosis

BackgroundRecent advances in MRI acquisitions and image analysis have increased the utility of neuroimaging in understanding disease-related changes. In this work, we aim to demonstrate increased sensitivity to disease progression as well as improved diagnostic accuracy in Amyotrophic lateral sclerosis (ALS) with multimodal MRI of the brain and cervical spinal cord.MethodsWe acquired diffusion MRI data from the brain and cervical cord, and T1 data from the brain, of 20 participants with ALS and 20 healthy control participants. Ten ALS and 14 control participants, and 11 ALS and 13 control participants were re-scanned at 6-month and 12-month follow-ups respectively. We estimated cross-sectional differences and longitudinal changes in diffusion metrics, cortical thickness, and fixel-based microstructure measures, i.e. fiber density and fiber cross-section.ResultsWe demonstrate improved disease diagnostic accuracy and sensitivity through multimodal analysis of brain and spinal cord metrics. The brain metrics also distinguished lower motor neuron-predominant ALS participants from control participants. Fiber density and cross-section provided the greatest sensitivity to longitudinal change. We demonstrate evidence of progression in a cohort of 11 participants with slowly progressive ALS, including in participants with very slow change in ALSFRS-R. More importantly, we demonstrate that longitudinal change is detectable at a six-month follow-up visit. We also report correlations between ALSFRS-R and the fiber density and cross-section metrics.ConclusionsOur findings suggest that multimodal MRI is useful in improving disease diagnosis, and fixel-based measures may serve as potential biomarkers of disease progression in ALS clinical trials.

Utility of Neuroimaging in Children Presenting to the Emergency Department with Altered Mental Status (P14-9.005)

<h3>Objective:</h3> Describe the utility of neuroimaging and EEG in children who present to a pediatric emergency department (PED) with altered mental status (AMS). <h3>Background:</h3> The differential diagnosis of AMS is wide and ancillary testing is often required to make a definitive diagnosis. The utility of neuroimaging and EEG has not been well studied in AMS. <h3>Design/Methods:</h3> A retrospective chart review of children aged 0–18 years who presented to a PED from 1/1/2018 to 12/31/2021 with AMS. We abstracted patient demographics, presence of comorbidities, laboratory and imaging data, disposition from the PED, and final diagnosis. Neuroimaging (CT and MRI) studies and EEG were classified as normal or abnormal. Abnormal results were further categorized as contributory to the current diagnosis, clinically important but not contributory to the current diagnosis, and incidental. <h3>Results:</h3> We analyzed the charts of 371 patients. The most common etiology of AMS was accidental ingestion (188, 51%). Structural/anatomical neurologic conditions, and seizures as potential etiology were noted in one-tenth (51;13.8%). A conclusive diagnosis could not be reached in 58 patients (16%). Neuroimaging was performed in 159 (43%). The most common was CT (150, 40%) followed by MRI (18, 5%) and 10 patients had both. The breakdown of neuroimaging abnormalities was as follows: contributed to the final diagnosis 18 (4.8%), clinically important but did not contribute to the diagnosis 22 (5.9%), and incidental findings 3 (0.8%). EEG was performed in 65 patients (17.5%) of which 23% had findings that contributed to the final diagnosis. <h3>Conclusions:</h3> Neuroimaging contributed to a definitive diagnosis in a minority of patients, whereas EEG contributed to diagnosis in about one fourth of the patients. Further studies are required to identify subsets of children with AMS who will benefit from directed neurological investigations. <b>Disclosure:</b> Dr. Castellucci has nothing to disclose. Dr. CENTER has received personal compensation for serving as an employee of Detroit Medical Center. Dr. Taskin has nothing to disclose. Ms. Kistou has nothing to disclose. The institution of Dr. Kannikeswaran has received research support from NIH. Dr. Sivaswamy has nothing to disclose.

Trends in Disparities in Advanced Neuroimaging Utilization in Acute Stroke: A Population-Based Study.

Our primary objective was to evaluate if disparities in race, sex, age, and socioeconomic status (SES) exist in utilization of advanced neuroimaging in year 2015 in a population-based study. Our secondary objective was to identify the disparity trends and overall imaging utilization as compared with years 2005 and 2010. This was a retrospective, population-based study that utilized the GCNKSS (Greater Cincinnati/Northern Kentucky Stroke Study) data. Patients with stroke and transient ischemic attack were identified in the years 2005, 2010, and 2015 in a metropolitan population of 1.3 million. The proportion of imaging use within 2 days of stroke/transient ischemic attack onset or hospital admission date was computed. SES determined by the percentage below the poverty level within a given respondent's US census tract of residence was dichotomized. Multivariable logistic regression was used to determine the odds of advanced neuroimaging use (computed tomography angiogram/magnetic resonance imaging/magnetic resonance angiogram) for age, race, gender, and SES. There was a total of 10 526 stroke/transient ischemic attack events in the combined study year periods of 2005, 2010, and 2015. The utilization of advanced imaging progressively increased (48% in 2005, 63% in 2010, and 75% in 2015 [P<0.001]). In the combined study year multivariable model, advanced imaging was associated with age and SES. Younger patients (≤55 years) were more likely to have advanced imaging compared with older patients (adjusted odds ratio, 1.85 [95% CI, 1.62-2.12]; P<0.01), and low SES patients were less likely to have advanced imaging compared with high SES (adjusted odds ratio, 0.83 [95% CI, 0.75-0.93]; P<0.01). A significant interaction was found between age and race. Stratified by age, the adjusted odds of advanced imaging were higher for Black patients compared with White patients among older patients (>55 years; adjusted odds ratio, 1.34 [95% CI, 1.15-1.57]; P<0.01), but no racial differences among the young. Racial, age, and SES-related disparities exist in the utilization of advanced neuroimaging for patients with acute stroke. There was no evidence of a change in trend of these disparities between the study periods.

April 2023 Stroke Highlights.

April 2023 Stroke Highlights.

Patterns of MRI Findings in Patients with Chronic Headache: A Retrospective Study from a Private Diagnostic Center in Addis Ababa, Ethiopia.

Headache is one of the most common complaints that lead the patient to seek medical advice however only a few patients with recurrent headaches have a secondary cause like intracranial mass. The appropriate utilization of neuroimaging is important to rule-out secondary cause of headache in resource-limited regions. The objective of this study is to describe the patterns of MRI findings in the evaluation of patients with chronic headache and to determine the clinical variables helpful in identifying patients with intracranial lesions. This cross sectional study was conducted among 590 selected patients who underwent an MRI scan of the head from September 2016 to January 2018 at Wudassie Diagnostic center in Addis Ababa, Ethiopia. Siemens Magnetom 0.35T MRI was used. Out of 590 patients, 372 (63.1%) were females and 218 (36.9%) were males; 300 (50.8%) patients with the mean age of 38.6 ± 0.5 years and a median of 37 ± 16.7years have normal brain MRI and 290(49.2%) have abnormal brain MRI reports. The abnormal findings further divided into non-significant findings were 166(28%) that did not alter patient management and clinically significant findings were 124 (21%) which included by decreasing order of frequency tumors, infection, hydrocephalus, hemorrhage, and vascular abnormalities. It was 1.3 times higher rate of positive brain MR findings in patients who had headaches plus abnormal neurologic findings as compared to patients without neurologic abnormality (P-value = 0.01). There is a high rate of significant abnormal MRI findings in this study as compared to studies from developed nations.

Neuroimaging in the Acute Psychiatric Setting: Associations With Neuropsychiatric Risk Factors.

The appropriateness and clinical utility of neuroimaging in psychiatric populations has been long debated, and the ambiguity of guideline recommendations is well established. Most of the literature is focused on first-episode psychosis. The investigators aimed to review ordering practices and identify risk factors associated with neuroradiological MRI abnormalities and their clinical utility in a general psychiatric population. A retrospective file review was undertaken for 100 consecutive brain MRI scans for adult psychiatric inpatients who received scanning as part of their clinical care in an Australian hospital. Brain MRI was abnormal in 79.0% of scans; in these cases, 72.2% of patients required further investigation or follow-up, with 17.7% requiring urgent referral within days to weeks, despite only 3.7% of admitted patients undergoing MRI during the study period. Psychiatrically relevant abnormalities were found in 32.0% of scans. Abnormalities were more likely to be found in the presence of cognitive impairment, older age, and longer duration of psychiatric disorder. Psychiatrically relevant abnormalities had further associations with older age at onset of the psychiatric disorder and a weak association with abnormal neurological examination. Multiple indications for imaging were present in 57.0% of patients; the most common indications were physical, neurological, and cognitive abnormalities. Brain MRI is a useful part of psychiatric management in the presence of certain neuropsychiatric risk factors. The present findings suggest that treating teams can judiciously tailor radiological investigations while limiting excessive imaging. Future research in larger cohorts across multiple centers may contribute to shaping more consistent neuroimaging guidelines in psychiatry.

Updated Trends, Disparities, and Clinical Impact of Neuroimaging Utilization in Ischemic Stroke in the Medicare Population: 2012 to 2019.

The purpose of this study was to update trends, investigate sociodemographic disparities, and evaluate the impact on mortality of stroke neuroimaging across the United States from 2012 to2019. Retrospective cohort study using CMS Medicare 5% Research Identifiable Files, representing consecutive ischemic stroke emergency department or hospitalized patients aged ≥65 years. A total of 85,547 stroke episodes with demographic and clinical information were analyzed using Cochran-Mantel-Haenszel tests and logistic regression. Outcome measures were neuroimaging (CT angiography [CTA], CT perfusion [CTP], MRI, MR angiography [MRA]) utilization, acute treatment (endovascular thrombectomy [EVT] and intravenous thrombolysis [IVT]), and mortality while in the hospital and at 30 days and 1 year post discharge. Significantly increasing utilization trends for CTA (250%), CTP (428%) and MRI (18%), and a decreasing trend for MRA (-33%) were observed from 2012 to 2019 (P < .0001). Controlling for covariates in the logistic regression models, CTA and CTP were significantly associated with higher EVT and IVT utilization. Although CTA, MRI, and MRA were associated with lower mortality, CTP was associated with higher mortality post discharge. Less neuroimaging was performed in rural patients; older patients (≥80 years) had lower utilization of CTA, MRI, and MRA; female patients had lower rates of CTA; and Black patients had lower utilization of CTA and CTP. CTA and CTP utilization increased in the Medicare ischemic stroke population from 2012 to 2019 and both were associated with greater EVT and IVT use. However, disparities exist in neuroimaging utilization across all demographic groups, and further understanding of the root causes of these disparities will be crucial to achieving equity in stroke care.

Etiological profile of seizure in children of age group 1 month to 18 years with special reference to neuroimaging in a tertiary care hospital

Background: Seizure is a common cause of childhood hospitalization. Neuroimaging studies help in identifying etiologies, including the rare ones, and planning management. Purpose: The aim of this study is to determine the etiology of seizures in pediatric patients and the utility of neuroimaging in the same. Materials and Methods: A prospective study was carried out on 100 children who were admitted with seizures (including recurrent episodes) in our tertiary care institute. The sociodemographic profile, clinical features, neuroimaging findings, and findings of other investigations were documented and analyzed, to classify the type and etiology of seizures. Results: The male–female ratio among patients was 1.94: 1. Seizures of generalized onset were most common (95%), affecting mostly the age group of 1–5 years (50.53%), followed by the 5–18 years (29.47%) and the 1 month to 1 year (20%) groups. The etiologies were simple febrile seizure (51%), seizure disorder (8%), cerebral palsy (8%), acute viral meningoencephalitis (7%), pyogenic meningitis (6%), and complex febrile seizure (5%). Neuroimaging was carried out in 30 children, in which 14 showed abnormal reports, and abnormal electroencephalogram (EEG) report was found in 6 out of 10 patients. The analysis of the distribution of the types of seizures concerning age, gender, family history of seizure, history of seizure, socioeconomic status, and developmental milestones did not reveal any statistically significant relationships (P &gt; 0.05). Conclusion: Seizure of generalized onset was the most common type, and the most common etiology was a simple febrile seizure. Abnormal neuroimaging/EEG findings were more pronounced in patients with focal seizures.

Striving for Socioeconomic Equity in Ischemic Stroke Care: Imaging and Acute Treatment Utilization From a Comprehensive Stroke Center.

Prior studies have shown socioeconomic disparities in advanced neuroimaging and acute treatment utilization in patients with ischemic stroke. The authors analyzed whether socioeconomic factors were associated with stroke neuroimaging and acute treatment utilization at a comprehensive stroke center. A retrospective study of consecutive acute ischemic stroke discharges from 2012 to 2020 at a comprehensive stroke center was performed. Differences in neuroimaging (CT angiography [CTA], CT perfusion, MRI, and MR angiography [MRA]) and acute treatment (intravenous thrombolysis [IVT] and endovascular thrombectomy [EVT]) utilization were evaluated on the basis of socioeconomic factors of age, sex, race, insurance type, and neighborhood-level median household income. Chi-square tests were used for bivariate analyses. Multivariable logistic regression analyses were performed to determine associations between socioeconomic factors and neuroimaging or treatment utilization while controlling for stroke-specific factors and comorbidities. Among 6,140 ischemic stroke discharges, race and insurance type were not significantly associated with lower utilization of neuroimaging (CTA, CT perfusion, MRI, and MRA) or acute stroke treatment (IVT and EVT) after controlling for stroke-specific factors and comorbidities. However, median household income < $80,000/year was associated with lower IVT use (odds ratio [OR], 0.74; 95% confidence interval [CI], 0.63-0.87). In addition, age ≥ 80 years had lower CTA (OR, 0.62; 95% CI, 0.51-0.75) and EVT (OR, 0.53; 95% CI, 0.39-0.73) utilization, and female sex had lower CTA (OR, 0.78; 95% CI, 0.65-0.93) utilization. Significantly higher utilization was observed for MRI in Asian (OR, 1.33; 95% CI, 1.04-1.69) and uninsured (OR, 1.64; 95% CI, 1.07-2.50) patients and for MRA (OR, 1.24; 95% CI, 1.04-1.49) and EVT (OR, 1.62; 95% CI, 1.20-2.20) in privately insured patients. Once access to a comprehensive stroke center is achieved, socioeconomic disparities in the utilization of health care resources, particularly advanced neuroimaging and acute treatment, may be improved in patients with ischemic stroke.

Trends and variation in repeat neuroimaging for children with traumatic intracranial hemorrhage.

ObjectivesWe aimed to determine trends and institutional variation in repeat neuroimaging in children with traumatic intracranial hemorrhage and to identify factors associated with neuroimaging modality (subsequent magnetic resonance imaging [MRI] vs computed tomography [CT]).MethodsWe conducted a retrospective cross‐sectional study of 35 hospitals in the Pediatric Health Information System database. We included children <18 years of age hospitalized from 2010–2019 with intracranial hemorrhage and who underwent a brain CT. We calculated repeat neuroimaging rates by modality and used regression analyses to examine temporal trends. We used hierarchical logistic regression to identify factors associated with subsequent MRI versus repeat CT, controlling for hospital.ResultsWe identified 12,714 children with intracranial hemorrhage, of which 5072 with repeat neuroimaging were studied. Of the 5072 children with repeat neuroimaging, repeat CT was performed in 67.6% (n = 3429) and subsequent MRI in 32.4% (n = 1643). Overall repeat neuroimaging with either a CT or MRI remained similar from 2010–2019 (P = 0.431); however, repeat CT scans significantly decreased (P = 0.001); whereas, MRIs significantly increased (P < 0.001). Repeat neuroimaging by hospital ranged from 20%–80%. After controlling for institution, subsequent MRI was more likely to be used in younger children and children who did not receive hyperosmotic agents, neurosurgical interventions, or intensive care unit admission (all P‐values <0.001).ConclusionsWe found that repeat neuroimaging rates for children with intracranial hemorrhage vary substantially by institution. We also found that although MRI was increasingly used to re‐image these children, overall repeat neuroimaging rates (CT or MRI) have not decreased over the past decade. Future work to implement optimal utilization of neuroimaging in these children is needed.

Increasing and disparate use of neuroimaging for adults and children with non-traumatic headaches in the US emergency departments: Opportunities for improvement.

Optimization of neuroimaging practices for headache is considered a national priority; however, nationwide patterns and predictors of neuroimaging use for headache in the US emergency departments (EDs) are unknown. To analyze temporal neuroimaging utilization trends for adults and children with non-traumatic headache in the US EDs and identify factors predictive of neuroimaging use in this patient population. Retrospective cross-sectional study using the Healthcare Cost and Utilization Project Nationwide Emergency Department Sample database for administrative encounter-level data analysis of a nationwide group of adult and pediatric patients with primary diagnosis of headache (ICD-9CM codes 784.0x, 339.xx, 346.xx) visited the US EDs between January 1, 2006 and December 31, 2014. Temporal trends and independent predictors of neuroimaging use (e.g., patient and hospital characteristics, primary payment sources) were determined. In 2006-2014, a weighted group of 18,146,302 patients with a primary diagnosis of non-traumatic headache visited US EDs. Advanced neuroimaging utilization increased from 18.6% (n=350,777) to 34.8% (n=756,895) in the total group, from 18.8% (n=314,646) to 36.5% (n=698,080) in the adult subgroup (+94.1%), and from 16.9% (n=36,131) to 22.0% (n=58,815) (+30.2%) in the pediatric subgroup (+87.0%) between 2006 and 2014. The strongest predictors of higher neuroimaging utilization were hospital location in the Northeast (OR 3.17, 95% CI 2.67-3.76) or South (OR 2.42, 95% CI 2.03-2.88) regions. Lower utilization of imaging was associated with weekend ED visits (OR 0.92, 95% CI 0.92-0.93), female gender (OR 0.82, 95% CI 0.81-0.83), and Medicare, Medicaid, or self-pay (vs. private insurance) encounters. Neuroimaging utilization in patients with headache in US EDs nearly doubled in 2006-2014, and was used in 34.8% of all ED encounters in 2014. Utilization was higher and increased at faster rates for adults than children. In US EDs, imaging for headache is preferentially performed on commercially insured and male patients, at urban hospitals, in certain geographic regions, and on weekdays, raising concerns regarding disparate imaging use.

Obsessive-Compulsive Symptoms Among Children in the Adolescent Brain and Cognitive Development Study: Clinical, Cognitive, and Brain Connectivity Correlates

BackgroundChildhood obsessive-compulsive symptoms (OCSs) are common and can be an early risk marker for obsessive-compulsive disorder. The Adolescent Brain and Cognitive Development (ABCD) Study provides a unique opportunity to characterize OCSs in a large normative sample of school-age children and to explore corticostriatal and task-control circuits implicated in pediatric obsessive-compulsive disorder. MethodsThe ABCD Study acquired data from 9- and 10-year-olds (N = 11,876). Linear mixed-effects models probed associations between OCSs (Child Behavior Checklist) and cognition (NIH Toolbox), brain structure (subcortical volume, cortical thickness), white matter (diffusion tensor imaging), and resting-state functional connectivity. ResultsOCS scores showed good psychometric properties and high prevalence, and they were related to familial/parental factors, including family conflict. Higher OCS scores related to better cognitive performance (β = .06, t9966.60 = 6.28, p < .001, ηp2= .01), particularly verbal, when controlling for attention-deficit/hyperactivity disorder, which related to worse performance. OCSs did not significantly relate to brain structure but did relate to lower superior corticostriatal tract fractional anisotropy (β = −.03, t = −3.07, p = .002, ηp2= .02). Higher OCS scores were related to altered functional connectivity, including weaker connectivity within the dorsal attention network (β = −.04, t7262.87 = −3.71, p < .001, ηp2= .002) and weaker dorsal attention–default mode anticorrelation (β = .04, t7251.95 = 3.94, p < .001, ηp2 = .002). Dorsal attention–default mode connectivity predicted OCS scores at 1 year (β = −.04, t2407.61 = −2.23, p = .03, ηp2 = .03). ConclusionsOCSs are common and may persist throughout childhood. Corticostriatal connectivity and attention network connectivity are likely mechanisms in the subclinical-to-clinical spectrum of OCSs. Understanding correlates and mechanisms of OCSs may elucidate their role in childhood psychiatric risk and suggest potential utility of neuroimaging, e.g., dorsal attention–default mode connectivity, for identifying children at increased risk for obsessive-compulsive disorder.

Emergent neuroimaging for seizures in epilepsy: A population study

We determined how often patients with epilepsy presented to the emergency department (ED) for seizure and the frequency and predictors for undergoing emergent neuroimaging during those visits. We conducted a retrospective population-based cohort study using administrative claims' data from 2007 to 2015. Adults with epilepsy were identified based on a diagnosis of epilepsy and an outpatient prescription for an antiepileptic medication. The Bonferroni corrected significance level was 0.0018. We identified 381,362 patients with a mean follow-up period of 1.99 years, of whom 35,015 (9.2%) patients presented to the ED for seizure at least once. Patients with at least one ED visit were younger, more likely to be male, had fewer comorbidities, and had longer follow-up as compared with those with no ED visit (all p < 0.001). Among the 35,015 patients presenting to the ED, 13.6% had neuroimaging, mostly commonly head computed tomography (CT; 95.5%). Patients undergoing neuroimaging were younger (46 versus 48 years) and with higher rates of psychosis (17.4% versus 13.8%) and depression (16.1% versus 12.2%; p < 0.001). This helps to quantify the burden of ED and emergent neuroimaging utilization for patients with epilepsy and can help inform efforts to curtail unnecessary neuroimaging.

MRI characteristics in acute ischemic stroke patients with preceding direct oral anticoagulant therapy as compared to vitamin K antagonists

BackgroundDespite the utility of neuroimaging in the diagnostic and therapeutic management of patients with acute ischemic stroke (AIS), imaging characteristics in patients with preceding direct oral anticoagulants (DOAC) compared to vitamin K antagonists (VKA) have hardly been described. We aimed to determine presence of large vessel occlusion (LVO), thrombus length, infarction diameter, and occurrence of hemorrhagic transformation in AIS patients with preceding DOAC as compared to VKA therapy.MethodsUsing a prospectively collected cohort of AIS patients, we performed univariate and multivariable regression analyses regarding imaging outcomes. Additionally, we provide a sensitivity analysis for the subgroup of patients with confirmed therapeutic anticoagulation.ResultsWe included AIS in patients with preceding DOAC (N = 75) and VKA (N = 61) therapy, median age 79 (IQR 70–83), 39% female. Presence of any LVO between DOAC and VKA patients (29.3% versus 37.7%, P = 0.361), and target LVO for endovascular therapy (26.7% versus 27.9%, P = 1.0) was equal with a similar occlusion pattern. DOAC as compared to VKA were associated with a similar rate of target LVO for EVT (aOR 0.835, 95% CI 0.368–1.898). The presence of multiple lesions and characteristics of the thrombus were similar in DOAC and VKA patients. Acute ischemic lesion diameter in real world patients was equal in patients taking DOAC as compared to VKA. Lesion diameter in VKA patients (median 13 mm, IQR 6–26 versus median 20 mm, IQR 7–36, P = 0.001), but not DOAC patients was smaller in the setting of confirmed therapeutic VKA. The frequency of radiological hemorrhagic transformation and symptomatic intracranial hemorrhage in OAC patients was low. Sensitivity analysis considering only patients with confirmed therapeutic anticoagulation did not change any of the results.ConclusionPreceding DOAC treatment showed equal rates of LVO and infarct size as compared to VKA in AIS patients. This study adds to the knowledge of imaging findings in AIS patients with preceding anticoagulation.

Neuroimaging in the Diagnosis of Chronic Traumatic Encephalopathy: A Systematic Review.

Chronic traumatic encephalopathy (CTE) is a neurodegenerative tauopathy associated with repeated subconcussive and concussive head injury. Clinical features include cognitive, behavioral, mood, and motor impairments. Definitive diagnosis is only possible at postmortem. Here, the utility of neuroimaging in the diagnosis of CTE is evaluated by systematically reviewing recent evidence for changes in neuroimaging biomarkers in suspected cases of CTE compared with controls. Providing an update on a previous systematic review of articles published until December 2014, we searched for articles published between December 2014 and July 2016. We searched PubMed for studies assessing neuroimaging changes in symptomatic suspected cases of CTE with a history of repeated subconcussive or concussive head injury or participation in contact sports involving direct impact to the head. Exclusion criteria were case studies, review articles, and articles focusing on repetitive head trauma from military service, head banging, epilepsy, physical abuse, or animal models. Seven articles met the review criteria, almost all of which studied professional athletes. The range of modalities were categorized into structural magnetic resonance imaging (MRI), diffusion MRI, and radionuclide studies. Biomarkers which differed significantly between suspected CTE and controls were Evans index (P = 0.05), cavum septum pellucidum (CSP) rate (P < 0.0006), length (P < 0.03) and ratio of CSP length to septum length (P < 0.03), regional differences in axial diffusivity (P < 0.05) and free/intracellular water fractions (P < 0.005), single-photon emission computed tomography perfusion abnormalities (P < 0.01), positron emission tomography (PET) signals from tau-binding, glucose-binding, and GABA receptor-binding radionuclides (P < 0.0001, P < 0.005, and P < 0.005, respectively). Important limitations include low specificity in identification of suspected cases of CTE across studies, the need for postmortem validation, and a lack of generalizability to nonprofessional athletes. The most promising biomarker is tau-binding radionuclide PET signal because it is most specific to the underlying neuropathology and differentiated CTE from both controls and patients with Alzheimer disease (P < 0.0001). Multimodal imaging will improve specificity further. Future research should minimize variability in identification of suspected cases of CTE using published clinical criteria.