Since 2011, mobile MR imaging has played a surprising and unique role in diagnosing and treating mild traumatic brain injuries (mTBI) and other afflictions suffered by U.S. soldiers in war-torn Afghanistan, according to the presenter of an RSNA 2012 session.
MR imaging is greatly improving care to wounded warriors, many who suffer head injuries from roadside bombs, said Lt. Col. Sean Jersey, M.D., a third-year radiology resident at David Grant Medical Center, Travis Air Force Base, California, who discussed the current and future role of mobile MR imaging in combat and the clinical benefit and types of diseases identified with the modality.
Although he was not able to attend RSNA 2012, Lt. Col. Robert Jesinger, M.D., Task Force Medical East Expeditionary Medical Support Squadron radiology flight commander, deployed to Afghanistan in 2012 and led the project to expand MR imaging in a combat war zone. Maj. Samuel Southam, M.D., also contributed to the project.
In addition to brain injuries, trauma, tumors, infectious/inflammatory diseases and congenital disorders are among the afflictions diagnosed and treated by mobile MR imaging on host nationals, military contractors and Special and U.S./NATO Forces and others who otherwise would not have immediate access to MR technology, Dr. Jersey said.
“While U.S./NATO troops could be removed from the combat zone for MR imaging, more rapid diagnosis of conditions with mobile MR imaging has been value-added in their care,” Dr. Jersey said. “And local nationals—who cannot leave the country—can be considered for MR imaging when under U.S./NATO care and when medically warranted.”
While TBI is a signature injury of war, the ability to peer into the brain and see the injury, diagnose it, and actually examine the injury is relatively new, said Dr. Jersey, who reviewed cases remotely via teleradiology links between Afghanistan and the U.S. “Mobile MR imaging allows us to gather data on mild traumatic brain injury in the combat zone, diagnose mission-changing injuries such as neurological decompression sickness and musculoskeletal injuries in Special Forces troops, diagnose conditions only identifiable with MR imaging and even image military working dogs,” he said.
“Medical people are deployed to the front line with the troops,” Dr. Jersey added. “These guys are getting a lot of stabilization treatments right on the front line. They’re getting a lot better treatment.”
MR imaging has future potential in helping detect possible early signs of TBI, Dr. Jesinger said.
“If you do a CT for TBI, you are usually looking for big problems, such as a head bleed,” Dr. Jesinger said. “MRI is geared to find subtle problems. If someone has had a concussion and we do an MRI and identify brain injury, then that’s a big deal. If we don’t see anything with an MRI, then it may be that there is nothing there, but we hope to find MRI as a helpful distinguishing tool. Treatment guidelines for head injury can be upgraded and more aggressive treatment can be done for someone with a head injury and visible results on an MRI, than if there are no indicators. Knowing that information sooner helps treatment to get initiated sooner.”
Current results and future potential of MR imaging are worth the considerable effort put into buying and transporting the equipment, Drs. Jesinger and Jersey said. The U.S. Congress collaborated with the chairman of the Joint Chiefs of Staff to fund placement of the three mobile 1.5 Tesla MR imaging machines, including the one operated by the U.S. Air Force at Bagram Air Base in Afghanistan.
Physically getting the mobile imaging machine to the Bagram Air Base in Afghanistan was a major undertaking that took weeks, Dr. Jersey said. It was also years in the making, creating a controversy as to whether or not it was worth the millions it cost, he said.
While the main purpose of MR imaging in a combat zone was for research and gathering data on U.S./NATO troops with brain injuries, the modality’s role has been carefully expanded to include medical conditions where results will change mission requirements and/or medical management, Dr. Jersey said.
Examples include the use of MR imaging on a 19-year-old Army specialist who had experienced three weeks of left hip pain, limiting her duties. Her physical exam and radiographs were not diagnostic and after the soldier’s orthopedic surgeon requested an MR, she was diagnosed with an iliac wing sarcoma, Dr. Jersey said.
In another case, MR imaging revealed an unstable T3 burst fracture in a 22-year-old Marine who fell and injured his upper thoracic spine. Toe cellulitis and osteomyelitis were discovered in a Special Forces troop member through MR and an acute biceps tendon tear was detected in a 23-year old Special Forces soldier who injured his elbow during combat.
With MR imaging, an F-16 pilot with an acute right knee chondral injury was deemed unable to safely or effectively fly a combat aircraft, while a U-2 pilot was diagnosed with neurological decompression sickness. A military bomb-sniffing dog that developed leg weakness was diagnosed with a spine tumor. “We take care of our dogs just as we do people,” Dr. Jersey said.
The equipment also aided in treating local nationals. MR imaging detected a radioactive adenopathy from cellulitis infection in an Afghan Army troop member, cortical dysplasia in an Afghan child with seizures and congenital brains cysts, Dr. Jersey said.
In the future, MR imaging in combat zones could provide perfusion imaging applications such as neuroradiology and abdominal imaging as well as cardiovascular MR imaging and a more robust use of military teleradiology networks for MR imaging interpretation including second opinion consults, Dr. Jersey said.
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