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Introduction to Neuroimaging
Introduction to Neuroimaging Aaron S. Field, MD, PhD Assistant Professor of Radiology Neuroradiology Section University of Wisconsin–Madison Updated 7/17/07 Neuroimaging Modalities Radiography (X-Ray) Magnetic Resonance (MR) Fluoroscopy (guided procedures) • MR Angiography/Venography (MRA/MRV) • Angiography • Diffusion and Diffusion Tensor • Diagnostic MR • Interventional • Perfusion MR • Myelography • MR Spectroscopy (MRS) Ultrasound (US) • Functional MR (fMRI) • Gray-Scale Nuclear Medicine ―Duplex‖ • Color Doppler • Single Photon Emission Computed Tomography (SPECT) Computed Tomography (CT) • Positron Emission Tomography • CT Angiography (CTA) (PET) • Perfusion CT • CT Myelography Radiography (X-Ray) Radiography (X-Ray) Primarily used for spine: • Trauma • Degenerative Dz • Post-op Fluoroscopy (Real-Time X-Ray) Fluoro-guided procedures: • Angiography • Myelography Fluoroscopy (Real-Time X-Ray) Fluoroscopy (Real-Time X-Ray) Digital Subtraction Angiography Fluoroscopy (Real-Time X-Ray) Digital Subtraction Angiography Digital Subtraction Angiography Indications: • Aneurysms, vascular malformations and fistulae • Vessel stenosis, thrombosis, dissection, pseudoaneurysm • Stenting, embolization, thrombolysis (mechanical and pharmacologic) Advantages: • Ability to intervene • Time-resolved blood flow dynamics (arterial, capillary, venous phases) • High spatial and temporal resolution Disadvantages: • Invasive, risk of vascular injury and stroke • Iodinated contrast and ionizing radiation Fluoroscopy (Real-Time X-Ray) Myelography Lumbar or -
Myelography in the Assessment of Degenerative Lumbar Scoliosis And
https://doi.org/10.14245/kjs.2017.14.4.133 KJS Print ISSN 1738-2262 On-line ISSN 2093-6729 CLINICAL ARTICLE Korean J Spine 14(4):133-138, 2017 www.e-kjs.org Myelography in the Assessment of Degenerative Lumbar Scoliosis and Its Influence on Surgical Management George McKay, Objective: Myelography has been shown to highlight foraminal and lateral recess stenosis more Peter Alexander Torrie, readily than computed tomography (CT) or magnetic resonance imaging (MRI). It also has the Wendy Bertram, advantage of providing dynamic assessment of stenosis in the loaded spine. The advent of weight-bearing MRI may go some way towards improving assessment of the loaded spine Priyan Landham, and is less invasive, however availability remains limited. This study evaluates the potential Stephen Morris, role of myelography and its impact upon surgical decision making. John Hutchinson, Methods: Of 270 patients undergoing myelography during 2006-2009, a period representing Roland Watura, peak utilisation of this imaging modality in our unit, we identified 21 patients with degenerative Ian Harding scoliosis who fulfilled our inclusion criteria. An operative plan was formulated by our senior author based initially on interpretation of an MRI scan. Subsequent myelogram and CT myelogram Department of Spinal Surgery, investigations were scrutinised, with any additional abnormalities noted and whether these im- Southmead Hospital, Bristol, United pacted upon the operative plan. Kingdom Results: From our 21 patients, 18 (85.7%) had myelographic findings not identified on MRI. Of Corresponding Author: note, in 4 patients, supine CT myelography yielded additional information when compared to George McKay supine MRI in the same patients. -
Neurological Critical Care: the Evolution of Cerebrovascular Critical Care Cherylee W
50TH ANNIVERSARY ARTICLE Neurological Critical Care: The Evolution of Cerebrovascular Critical Care Cherylee W. J. Chang, MD, FCCM, KEY WORDS: acute ischemic stroke; cerebrovascular disease; critical FACP, FNCS1 care medicine; history; intracerebral hemorrhage; neurocritical care; Jose Javier Provencio, MD, FCCM, subarachnoid hemorrhage FNCS2 Shreyansh Shah, MD1 n 1970, when 29 physicians first met in Los Angeles, California, to found the Society of Critical Care Medicine (SCCM), there was little to offer for the acute management of a patient suffering from an acute cerebrovascular Icondition except supportive care. Stroke patients were not often found in the ICU. Poliomyelitis, and its associated neuromuscular respiratory failure, cre- ated a natural intersection of neurology with critical care; such was not the case for stroke patients. Early textbooks describe that the primary decision in the emergency department was to ascertain whether a patient could swallow. If so, the patient was discharged with the advice that nothing could be done for the stroke. If unable to swallow, a nasogastric tube was inserted and then the patient was discharged with the same advice. In the 50 intervening years, many advances in stroke care have been made. Now, acute cerebrovascular patients are not infrequent admissions to an ICU for neurologic monitoring, observa- tion, and aggressive therapy (Fig. 1). HISTORY Over 50 years ago, stroke, previously called “apoplexy” which means “struck down with violence” or “to strike suddenly,” was a clinical diagnosis that was confirmed by autopsy as a disease of the CNS of vascular origin (1). In the 1960s, approximately 25% of stroke patients died within 24 hours and nearly half died within 2 to 3 weeks. -
Intracranial Cerebrovascular Evaluations: Transcranial Doppler
VASCULAR TECHNOLOGY PROFESSIONAL PERFORMANCE GUIDELINES Intracranial Cerebrovascular Evaluations: Transcranial Doppler Ultrasound and Transcranial Color Duplex Imaging This Guideline was prepared by the Professional Guidelines Subcommittee of the Society for Vascular Ultrasound (SVU) as a template to aid the vascular technologist/sonographer and other interested parties. It implies a consensus of those substantially concerned with its scope and provisions. The guidelines contain recommendations only and should not be used as a sole basis to make medical practice decisions. This SVU Guideline may be revised or withdrawn at any time. The procedures of SVU require that action be taken to reaffirm, revise, or withdraw this Guideline no later than three years from the date of publication. Suggestions for improvement of this guideline are welcome and should be sent to the Executive Director of the Society for Vascular Ultrasound. No part of this guideline may be reproduced in any form, in an electronic retrieval system or otherwise, without the prior written permission of the publisher. Sponsored and published by: Society for Vascular Ultrasound 4601 Presidents Drive, Suite 260 Lanham, MD 20706-4831 Tel.: 301-459-7550 Fax: 301-459-5651 E-mail: [email protected] Internet: www.svunet.org Copyright © by the Society for Vascular Ultrasound, 2019 ALL RIGHTS RESERVED. PRINTED IN THE UNITED STATES OF AMERICA. VASCULAR PROFESSIONAL PERFOMANCE GUIDELINE Updated January 2019 Intracranial Cerebrovascular Evaluation s: TCD and TCDI 01/2019 PURPOSE Transcranial Doppler ultrasound (TCD) and transcranial color duplex imaging (TCDI) studies measure blood flow velocities and direction within portions of the intracranial arteries. TCD and TCDI evaluate the anterior and posterior circulation territories to assess and manage patients with cerebrovascular disease. -
Study Guide Medical Terminology by Thea Liza Batan About the Author
Study Guide Medical Terminology By Thea Liza Batan About the Author Thea Liza Batan earned a Master of Science in Nursing Administration in 2007 from Xavier University in Cincinnati, Ohio. She has worked as a staff nurse, nurse instructor, and level department head. She currently works as a simulation coordinator and a free- lance writer specializing in nursing and healthcare. All terms mentioned in this text that are known to be trademarks or service marks have been appropriately capitalized. Use of a term in this text shouldn’t be regarded as affecting the validity of any trademark or service mark. Copyright © 2017 by Penn Foster, Inc. All rights reserved. No part of the material protected by this copyright may be reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, or by any information storage and retrieval system, without permission in writing from the copyright owner. Requests for permission to make copies of any part of the work should be mailed to Copyright Permissions, Penn Foster, 925 Oak Street, Scranton, Pennsylvania 18515. Printed in the United States of America CONTENTS INSTRUCTIONS 1 READING ASSIGNMENTS 3 LESSON 1: THE FUNDAMENTALS OF MEDICAL TERMINOLOGY 5 LESSON 2: DIAGNOSIS, INTERVENTION, AND HUMAN BODY TERMS 28 LESSON 3: MUSCULOSKELETAL, CIRCULATORY, AND RESPIRATORY SYSTEM TERMS 44 LESSON 4: DIGESTIVE, URINARY, AND REPRODUCTIVE SYSTEM TERMS 69 LESSON 5: INTEGUMENTARY, NERVOUS, AND ENDOCRINE S YSTEM TERMS 96 SELF-CHECK ANSWERS 134 © PENN FOSTER, INC. 2017 MEDICAL TERMINOLOGY PAGE III Contents INSTRUCTIONS INTRODUCTION Welcome to your course on medical terminology. You’re taking this course because you’re most likely interested in pursuing a health and science career, which entails proficiencyincommunicatingwithhealthcareprofessionalssuchasphysicians,nurses, or dentists. -
Treatment of Spinal Cord Vascular Malformations by Surgical Excision
J. Neurosurg. / Volume 30 / April, 1969 Treatment of Spinal Cord Vascular Malformations by Surgical Excision H. KRAYENBOHL, M. G. YA~ARGIL, M.D., AND H. G. McCLINTOCK* Section v] Neurosurgery, Kantonsspital, The University o] Ziirich, Ziirich, Switzerland ECENT developments have now made called attention to an increase in symptoms direct surgical attack the treatment during pregnancy with subsidence after of choice for spinal cord vascular delivery, z~ Newman has stated that he be- malformations. We are reporting 17 cases lieves the increase in symptoms in such cases treated with surgical excision, the last 11 of may be due to "venous congestion" from the which were operated on under the operating distended uterus and interestingly suggests microscope. the possibility of some "hormonal factor act- There is much confusion in the literature ing on the vessel walls. ''22 Although none of concerning the histological nomenclature our cases was a child, several authors have used to describe varieties of spinal vascular reported the occurrence in children and even malformations. This confusion is partly the in infants?, ~, 10,22,23 result of the lack of opportunity for ade- quate microscopic study of the entire lesion. Clinical Picture We prefer to follow the classification of History. The clinical history is usually one Bergstrand, et al.2 who divided these malfor- of three types. There can be 1) a slow mations into: 1) angioma cavernosum, 2) progression of neurological symptoms and angioma racemosum, and 3) angioreticu- signs, 2) progression followed with regres- loma. Some vascular malformations will sion or a stationary period, or 3) a sudden show characteristics of more than one group, apoplectic onset. -
2Nd Quarter 2001 Medicare Part a Bulletin
In This Issue... From the Intermediary Medical Director Medical Review Progressive Corrective Action ......................................................................... 3 General Information Medical Review Process Revision to Medical Record Requests ................................................ 5 General Coverage New CLIA Waived Tests ............................................................................................................. 8 Outpatient Hospital Services Correction to the Outpatient Services Fee Schedule ................................................................. 9 Skilled Nursing Facility Services Fee Schedule and Consolidated Billing for Skilled Nursing Facility (SNF) Services ............. 12 Fraud and Abuse Justice Recovers Record $1.5 Billion in Fraud Payments - Highest Ever for One Year Period ........................................................................................... 20 Bulletin Medical Policies Use of the American Medical Association’s (AMA’s) Current Procedural Terminology (CPT) Codes on Contractors’ Web Sites ................................................................................. 21 Outpatient Prospective Payment System January 2001 Update: Coding Information for Hospital Outpatient Prospective Payment System (OPPS) ......................................................................................................................... 93 he Medicare A Bulletin Providers Will Be Asked to Register Tshould be shared with all to Receive Medicare Bulletins and health care -
Esotropia: Unusual Complication of Myelography and Pneumoencephalography
278 Esotropia: Unusual Complication of Myelography and Pneumoencephalography Harris Newmark 111,1 Norman Levin,2 Richard K. APV and Jack D. Wax2 Myelography and pneumoencephalography are invasive years later showed occasional diplopia on left gaze. The patient procedures with many complications. We report two cases was asymptomatic 10 years later. of esotropia that developed 8 and 7 days after a Pantopaque myelogram and a pneumoencephalogram, respectively. For Discussion tunately, the esotropia was temporary in both cases. This rare complication, of which very few radiologists are aware, These cases are interesting in that they illustrate that was presumably secondary to the lumbar puncture per esotropia can be a complication of myelography and pneu formed for the procedure. moencephalography, although it is extremely rare. It has been reported to be a complication in 0.25%-1.00% of lumbar punctures [1 , 2], but we believe it is much rarer Case Reports since none of us, or any of our colleagues, could recall a Case 1 similar episode. The probable pathogenesis is that cerebrospinal fluid A 27-year-old man had a lumbar myelogram for a suspected leaks through the dura at the puncture site. The cerebro herniated nucleus pulposus at L5-S1 which caused right-sided leg spinal fluid pressure is less in the lumbar region than in the pain . The lumbar puncture was performed with ease on the first attempt with an 18 gauge spinal needle. The cerebrospinal fluid intracranial area after this procedure. Subsequently the was clear and the laboratory test results were normal except for a brain stem shifts caudally and the cranial nerves are slightly slight elevation of protein. -
Magnetic Resonance Imaging (MRI) in the Evaluation of Spinal Cord Injured Children and Adolescents
Paraplegia 25 (1987) 92-99 1987 International Medical Society of Paraplegia Magnetic Resonance Itnaging (MRI) in the Evaluation of Spinal Cord Injured Children and Adolescents R. R. Betz, M.D.,! A. J. Gelman, 0.0.,2 G. J. DeFilipp, M.D.,3 M. Mesgarzadeh, M.D.,3 M. Clancy, M.D.,! H. H. Steel, M.D.! ! Shriners Hospital for Crippled Children, 8400 Roosevelt Boulevard, Philadelphia, Pennsylvania, U.S.A., 2 Department of Orthopaedic Surgery, Albert Einstein Medical Center, Philadelphia, Pennsylvania, U.S.A., 3 Department of Radiology, Temple University Hospital, Philadelphia, Pennsylvania, U.S.A. Summary In order to determine the indications and usefulness of MRI scanning in evaluating spinal cord trauma, MRIs on 43 subacute and chronic spinal cord injured children were compared with CT myelograms and other diagnostic tests. MRI scans were superior to CT myelograms in evaluating post-traumatic syrinx, disc pathology and the physiological status of the cord. CT myelogram remains an essential study before considering spinal cord decompression. The presence of internal fixation is not a contraindication to MRI scanning. Key words: Magnetic resonance imaging; CT myelogram; Spinal cord injury; Children and adolescents. Introduction Over the past decade, medical imaging has advanced dramatically, with com puterised axial tomography (CT) now used routinely in the evaluation of spinal cord trauma. Among the more intriguing of these advances has been the de velopment of magnetic resonance imaging (MRI). This modality, which evolved from the work of Damadian (1971) and Lauterbur (1973), is being used more frequently for the diagnosis of spine problems. Modic (1983, 1984) has written on some of the uses in the spine, but the true value of MRI as a diagnostic test in spinal cord injury has yet to be established. -
Intraocular Haemorrhage As a Complication of Pneumoencephalography
J Neurol Neurosurg Psychiatry: first published as 10.1136/jnnp.39.4.375 on 1 April 1976. Downloaded from Journal ofNeurology, Neurosurgery, and Psychiatry, 1976, 39, 375-380 Intraocular haemorrhage as a complication of pneumoencephalography I. F. MOSELEY AND J. B. PILLING' From the Lysholm Radiological Department, National Hospital for Nervous Diseases, Queen Square, London SYNOPSIS The ocular fundi of 20 patients were examined before and after pneumoencephalo- graphy. In four of these, fresh venous retinal haemorrhages were seen, and a further patient had developed an exudate. Possible reasons for a rise in retinal venous pressure include bodily inverting the patient, compression of the thorax, the use of positive pressure respiration, and the air injection itself. It may be advisable to take steps to limit the effects of such possible causative factors. In 1973, Simon and colleagues published an neuroradiologists or neuro-ophthalmologists account of several cases of intraocular haemor- seem to have encountered individual cases. It Protected by copyright. rhage resulting from air myelography carried out therefore seemed desirable to examine systema- under general anaesthesia. They described three tically a series of patients undergoing pneumo- cases of symptomatic haemorrhage occurring in encephalography in order to detect subclinical an uncontrolled series of 480 gas myelographies, retinal or preretinal haemorrhage, since, if this while in a pilot series of 19 patients examined were occurring, the possibility of a more serious before -
June-July 2000 Part a Bulletin
In This Issue... Disclosure of Itemized Statement Providers Must Furnish an Itemmized Statement when Requested in Writing by the Beneficiary .................................................................................................... 6 Prospective Payment System The Outpatient Code Editor Software Has Been Modified in Preparation for the Implementation of Outpatient Prospective Payment System ........................... 8 Reclassification of Certain Urban Hospitals Certain Urban Hospitals in the State of Florida May Be Permitted to Be Reclassified as Rural Hospitals................................................................................ 13 ulletin Final Medical Review Policies 33216, 53850, 70541, 82108, 83735, 87621, 93303, 94010, 95004, A0320, J0207, J2430, J2792, J3240, J7190, and J9999 .......................................... 15 B Payment of Skilled Nursing Facility Claims Involving a Terminating Medicare+Choice Plan Payment of Skilled Nursing Facility Care for Beneficiaries Involuntarily Disenrolling from M+C plans Who Have Not Met the 3-Day Stay Requirement ........................................................................................... 67 Features From the Medical Director 3 Administrative 4 lease share the Medicare A roviders PBulletin with appropriate General Information 5 members of your organization. Outpatient Prospective Payment System 7 Routing Suggestions: General Coverage 12 o Medicare Manager Hospital Services 13 o Reimbursement Director Local and Focused Medical Policies 15 o Chief Financial -
Brain Spect with Tl-201 Ddc
BRAIN SPECT WITH TL-201 DDC INIS-mf —11361 BRAIN SPECT WITH TL-201 DDC BRAIN SPECT WITH TL-201 DDC ACADEMISCH PROEFSCHRIFT ter verkrijging van de graad van doctor aan de Universiteit van Amsterdam, op gezag van de Rector Magnificus Prof, dr S.K. Thoden van Velzen, in het openbaar te verdedigen in de Aula der Universiteit (Oude Lutherse Kerk, ingang Singel 411, hoek Spui), op donderdag 21 april 1988 te 13.30 uur door Johan Frederik de Brume geboren te 's Gravenhage AMSTERDAM 1988 Promotor : Prof, dr J.B. van der Schoot Copromotor : Dr E.A. van Royen To my parents Joey, Joost and Duco The publication of this thesis was financially supported by: The Netherlands Heart Foundation CIL, BV, Mallinckrodt General Electric Medical Systems Printed in the Netherlands Rodopi B.V., Amsterdam ISBN: 90-900-2127-2 Contents Chapter 1: Introduction 1 Chapter 2: Current methods in neuroimaging and cerebral blood flow measurements 5 2.1. Angiography and digital subtraction angiography 5 2.2. Duplex sonography 7 2.3. Technetium-99m pertechnetate brainscintigraphy 8 2.4. Regional cerebral blood flow measurements with Xenon-133 8 2.5. Computed tomography and Xenon-enhanced computed tomography 9 2.6. Nuclear magnetic resonance imaging 13 2.7. Positron emission tomography 15 2.8. Single-photon emission computed tomography 16 2.9. Regional cerebral blood flow imaging and blood- brain barrier 25 2.10. Cerebral blood flow tracers for SPECT 27 2.11. Possible applications of SPECT brain studies 32 Chapter 3: Functional brain imaging with 1-123 amphetamine First experience in the Netherlands 53 Chapter 4: Thallium-201 diethyldithiocarbamate 69 4.1.