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  • Radiology in Public Focus

    July 01, 2014

    Press releases were sent to the medical news media for the following articles appearing in recent issues of Radiology.

    Detection of Central White Matter Injury Underlying Vestibulopathy after Mild Traumatic Brain Injury

    Diffusion tensor imaging (DTI) findings in patients with mild traumatic brain injury (TBI) and vestibulopathy support the hypothesis that posttraumatic vestibulopathy has a central axonal injury component, new research shows.

    Lea M. Alhilali, M.D., of the University of Pittsburgh Medical Center, and colleagues retrospectively reviewed DTI images in 30 patients with mild TBI and vestibular symptoms and 25 patients with mild TBI and ocular convergence insufficiency. Control subjects consisted of 39 patients with mild TBI without vestibular abnormalities and 17 patients with mild TBI and normal ocular convergence.

    Fractional anisotropy (FA) maps were generated as a measure of white matter integrity and were analyzed with tract-based spatial statistics regression analysis by using a general linear model. DTI abnormalities were correlated with symptom severity, neurocognitive test scores and time to recovery with the Pearson correlation coefficient.

    Patients with mild TBI and ocular convergence insufficiency have decreased FA in the right anterior thalamic radiation and right geniculate nucleus optic tracts compared with control subjects (P < .0001), with anterior thalamic radiation injury showing a correlation with decreased processing speed (R = 0.402, P < .05).

    “This has the potential to change the current clinical management of vestibulopathy in mild TBI, which previously lacked both an understanding of the central component of the underlying injury, as well as biomarkers to aid in prognosis,” the authors write.

    Intrinsic Brain Abnormalities in Attention Deficit Hyperactivity Disorder: A Resting-State Functional MR Imaging Study

    Altered regional brain function was detected in the prefrontal cortex and globus pallidus—as well as aberrant functional connectivity (FC) in large-scale networks—in children and adolescents with attention deficit hyperactivity disorder (ADHD), new research shows.

    Fei Li, Ph.D., of West China Hospital of Sichuan University, and colleagues compared resting state functional MR imaging (rfMRI) results in 33 boys with ADHD, ages 6 to 16, with those of 32 similarly aged, healthy controls. Amplitude of low-frequency fluctuation and seed-based FC were calculated to examine regional neural function and functional integration, respectively, and were compared between patients and control subjects using the voxel-based two-sample t test. Pearson correlation analyses were performed to identify neural correlates of executive function.

    Patients with ADHD showed altered structure and function in areas of the brain including the orbitofrontal cortex and the globus pallidus, according to researchers. “Our research suggests that the characteristics of the brain’s resting-state functional architecture are relevant to understanding relationships between neural substrate and executive function in ADHD,” they write.

    Coronary Artery Plaque Volume and Obesity in Patients with Diabetes: The Factor-64 Study

    In asymptomatic diabetic patients, body mass index (BMI) was the primary modifiable risk factor associated with total and soft coronary plaque as assessed with coronary CT angiography (CTA), according to new research.

    In a study by Alan C. Kwan, B.A., National Institutes of Health Clinical Center, Bethesda, Md., and colleagues, 224 asymptomatic diabetic patients underwent coronary CTA. Total coronary artery wall volume in all three vessels was measured by using semiautomated software. Researchers determined the coronary plaque volume index (PVI) by dividing the wall volume by the coronary length.

    Results showed that PVI in the proximal coronary arteries is more closely related to the calcium score than to the total coronary plaque index (r = 0.57 vs 0.47, respectively; P < 001). Major determinants of plaque in diabetic patients in addition to age and sex are BMI (P< .0001) and duration of diabetes (P = .03).

    “This study supports reduction of BMI as a therapeutic goal to reduce cardiovascular risk in diabetic patients,” the authors wrote.

    Effect of Diabetes on Brain Structure: The Action to Control Cardiovascular Risk in Diabetes MR Imaging Baseline Data

    In the diabetic population of an Action to Control Cardiovascular Risk in Diabetes substudy, duration of diabetes and fasting plasma glucose (FPG) were associated with brain atrophy—specifically that of gray matter—but were not associated with greater ischemic lesion volumes, new research shows.

    In a study of 614 patients with type 2 diabetes, R. Nick Bryan, M.D., Ph.D., of the University of Pennsylvania, Philadelphia, and colleagues evaluated baseline severity by testing FPG, hemo-globin A1c levels and duration of diabetes. MR imaging was performed with fluid-attenuated inversion recovery, proton-density and T2-weighted and T1-weighted sequences, which were postprocessed with an automated computer algorithm classifying brain tissue as gray or white matter and as normal or ischemic.

    Longer duration of diabetes was associated with lower gray matter volumes (r = 20.11), possibly reflecting direct neurologic insult; higher FPG levels showed similar associations with lower brain volumes (r = 20.10). Researchers found no association of diabetes characteristics with small vessel ischemic disease in the brain.

    “Our findings raise the possibility that cognitive changes arising in patients with diabetes might not be strongly related to vascular dementia but to neurodegenerative disorders, such as Alzheimer disease,” the authors wrote.

    Media Coverage of RSNA

    In April, 739 RSNA-related news stories were tracked in the media. These stories reached an estimated 245 million people. Coverage included Time, Newsday, The Washington Post, MSN.com, NFL.com, CNN.com, FOXNews.com, CBSNews.com, WebMD, KCAL-TV (Los Angeles) and WGN-TV (Chicago).

    Read coverage of RSNA in these media:

    New on RadiologyInfo.org

    Visit RadiologyInfo.org, the public information website produced by the RSNA and ACR, to read the latest content posted to the Disease/Conditions section on Breast Cancer.

    July Public Information Outreach Activities Focus on Ultrasound

    In July, RSNA’s 60-Second Checkup radio program will focus on the use of ultrasound to detect suspected appendicitis in children.

    Vestibular disturbances correlate with decreased FA in cerebellar regions
    (Click to enlarge) Vestibular disturbances correlate with decreased FA in cerebellar regions responsible for sensorimotor processing and central and/or axial balance as well as fusiform gyrus, which is responsible for visually guided locomotion and stereoscopic vision. Images derived from TBSS results and rendered on T1-weighted images from Montreal Neurologic Institute atlas indicate that significant white matter differences in patients with mild TBI and vestibular symptoms involve lobule VI and vermian lobules VIIIa, VIIIb, and IX, as shown in the axial. Significant voxels were thickened by using TBSS fill function into local tracts (red) and overlaid on white matter skeleton (blue).(Radiology 2014;272;2:InPress) ©RSNA, 2014. All rights reserved. Printed with permission.
    Anatomic replicas show differences of FC between patients with ADHD and healthy control
    (Click to enlarge) Anatomic replicas show differences of FC between patients with ADHD and healthy control subjects. The red nodes represent the seed areas of FC. The yellow nodes and orange lines and blue nodes and green lines represent, respectively, increased and decreased FC in patients with ADHD relative to healthy control subjects. Left: BA8.L = BA8, left; BA8.R = BA8, right; BA10.L = BA10, left; BA10.R = BA10, right; dSFG.R = dorsal superior frontal gyrus, right; GP.L = globus pallidus, left; GP.R = globus pallidus, right; OFC.L = orbitofrontal cortex, left; OFC.R = orbitofrontal cortex, right; vMPFC.L = ventral medial prefrontal cortex, left; vSFG.L = ventral superior frontal gyrus, left. Right: AG.R = angular gyrus, right; CER.L = cerebellum, left; dSFG.R = dorsal superior frontal gyrus, right; OFC.L = orbitofrontal cortex, left; PG.L = precentral gyrus, left; PG.R = precentral gyrus, right; PUT.L = putamen, left; PUT.R = putamen, right; SG.L = supramarginal gyrus, left; SG.R = supramarginal gyrus, right; STG.R = superior temporal gyrus, right; vSFG.L = ventral superior frontal gyrus, left.(Radiology 2014;272;2:InPress) ©RSNA, 2014. All rights reserved. Printed with permission.
    Automated plaque detection
    (Click to enlarge) Automated plaque detection. Red = soft plaque, blue = fibrous plaque, yellow = calcified plaque, green = luminal area. Image in patient with large amounts of calcified plaque. PVI = 20.1 mm2, soft PVI = 2.5 mm2, fibrous PVI = 6.1 mm2, calcified PVI = 11.5 mm2.(Radiology 2014;272;2:InPress) ©RSNA, 2014. All rights reserved. Printed with permission.
    Gray matter volume by duration of diabetes quartiles
    (Click to enlarge) Graph shows least squares means for total gray matter volume by duration of diabetes quartiles (at baseline).(Radiology 2014;272;1:210-216) ©RSNA, 2014. All rights reserved. Printed with permission.
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