powered by CereMetrix BRAIN PERFUSION REPORT · pertaining to traumatic brain injury (TBI) and the...
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Diagnostic Brain Report CereScan powered by CereMetrix ® 720.259.1976, [email protected] | 1 BRAIN PERFUSION REPORT BRAIN PERFUSION REPORT PATIENT CLINICAL FIRST NAME XXX EXAM Quantitative Single Photon Emission Computed Tomography (qSPECT) LAST NAME XXX REFERRING PROVIDER XXX MR # XXX INDICATIONS FOR REFERRAL Diffuse traumatic brain injury without loss of consciousness, sequela (S06.2X0S); Other fatigue (R53.83); Mild cognitive impairment, so stated (G31.84) DOB XXX INTERPRETING PHYSICIAN Reading Radiologist AGE 32 EXAM DATE XXX HANDED Right INTAKE CLINICIAN CereScan Clinician RADIOLOGIC FINDINGS High-resolution, brain SPECT imaging was performed at baseline and with a concentration battery. No abnormal motion or artifact was detected. A blind review of the tomographic images was performed. Images were compared to the results of the patients MRI on 03/19/2019. At rest, the overall cortical activity was slightly reduced. Baseline tomographic images revealed increased perfusion in the anterior cingulate, left thalamic and bilateral basal ganglia areas. CereMetrix z-score cluster analysis reveals focal areas of abnormal cortical hypoperfusion in the bilateral anterior frontal (L>R), right orbitofrontal, left mesial frontal, left anterior temporal, right medial temporal, bilateral lateral parietal, bilateral calcarine portion of occipital and left cerebellar areas. Scattered areas of increased cortical perfusion were noted of uncertain significance. CereMetrix z-score cluster analysis reveal focal areas of abnormally increased subcortical perfusion in the bilateral putamen, bilateral globus pallidi and left amygdala areas. Cortical deactivation is noted with the concentration task on tomographic images. CereMetrix cluster analysis comparisons of the patient’s baseline data to a 1000 patient composite average sample, as well as the 3D/surface-rendered images, revealed abnormalities consistent with those seen on the tomographic images. RADIOLOGIC IMPRESSIONS 1. This is an abnormal brain SPECT study demonstrating focal areas of abnormal cortical hypoperfusion in SAMPLE
Transcript of powered by CereMetrix BRAIN PERFUSION REPORT · pertaining to traumatic brain injury (TBI) and the...
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BRAINPERFUSIONREPORTBRAINPERFUSIONREPORTPATIENT CLINICAL
FIRSTNAMEXXX
EXAMQuantitativeSinglePhotonEmissionComputedTomography(qSPECT)
LASTNAMEXXX
REFERRINGPROVIDERXXX
MR#XXX
INDICATIONSFORREFERRALDiffusetraumaticbraininjurywithoutlossofconsciousness,sequela(S06.2X0S);Otherfatigue(R53.83);Mildcognitiveimpairment,sostated(G31.84)
DOBXXX
INTERPRETINGPHYSICIANReading Radiologist
AGE32
EXAMDATEXXX
HANDEDRight
INTAKECLINICIANCereScan Clinician
RADIOLOGICFINDINGSHigh-resolution,brainSPECTimagingwasperformedatbaselineandwithaconcentrationbattery.Noabnormalmotionorartifactwasdetected.Ablindreviewofthetomographicimageswasperformed.ImageswerecomparedtotheresultsofthepatientsMRIon03/19/2019.
Atrest,theoverallcorticalactivitywasslightlyreduced.Baselinetomographicimagesrevealedincreasedperfusionintheanteriorcingulate,leftthalamicandbilateralbasalgangliaareas.
CereMetrixz-scoreclusteranalysisrevealsfocalareasofabnormalcorticalhypoperfusioninthebilateralanteriorfrontal(L>R),rightorbitofrontal,leftmesialfrontal,leftanteriortemporal,rightmedialtemporal,bilaterallateralparietal,bilateralcalcarineportionofoccipitalandleftcerebellarareas.Scatteredareasofincreasedcorticalperfusionwerenotedofuncertainsignificance.
CereMetrixz-scoreclusteranalysisrevealfocalareasofabnormallyincreasedsubcorticalperfusioninthebilateralputamen,bilateralglobuspallidiandleftamygdalaareas.
Corticaldeactivationisnotedwiththeconcentrationtaskontomographicimages.
CereMetrixclusteranalysiscomparisonsofthepatient’sbaselinedatatoa1000patientcompositeaveragesample,aswellasthe3D/surface-renderedimages,revealedabnormalitiesconsistentwiththoseseenonthetomographicimages.
RADIOLOGICIMPRESSIONS1. ThisisanabnormalbrainSPECTstudydemonstratingfocalareasofabnormalcorticalhypoperfusionin
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thefrontal,temporal,parietal,occipitalandcerebellarlobesaspreviouslydescribed.Scatteredareasofincreasedcorticalperfusionwerenotedofuncertainsignificance.Inaddition,focalareasofabnormallyincreasedsubcorticalhypoperfusionwerenotedinthebasalganglia,thalamicandamygdalaareasaspreviouslydescribed.
Paradoxicalcorticaldeactivationisnotedwiththeconcentrationtask.
Thenature,location,andpatternoftheseabnormalitiesisprimarilyconsistentwiththescientificliteraturepertainingtotraumaticbraininjury(TBI)andthepatient’sclinicalhistory,asobtained,whichwasreceivedaftertheblindreview.Corticaldeactivationwiththeconcentrationtaskisanabnormalfindingassociatedwithanon-specificbraininjuryprocess.Alternativeconsiderationsforthesefindings,suchasneurodegenerative,neurovascularandtoxic/hypoxicprocesseswereconsidered,butwereconsideredtobelesslikelygiventhepatient’sageandspecificclinicalhistory,whichwasobtainedaftertheblindreview.
2. Thefindingoforbito-frontalhypoperfusionhasbeenassociatedbyseveralauthorswithvariousmooddisorders.
3. Thefindingofincreasedactivityinthebasalganglia,alongwiththepatient’sclinicalhistory,hasbeenassociatedbyseveralauthorswithvariousanxietydisorders.
Closeclinicalcorrelationwiththepatient’sentiremedicalhistoryisadvised.
QSPECTBRAINIMAGINGThepatientwasseenforthefollowinghigh-resolutionbrainSPECTimagingstudies,whichwereperformedwithinthecriteria,establishedguidelinesandqualitycontrolsforimagingsetbytheAmericanCollegeofRadiologyincludingtheACR-SPRPracticeParameterforthePerformanceofSinglePhotonEmissionComputedTomography(SPECT)BrainPerfusionImaging,IncludingBrainDeathExaminations.
MethodsDuringthebaselinescan,thepatientisplacedinacomfortablechairandanIVlineisstarted.Thepatientisthenallowedtoacclimatetoaquietsemi-darkenedroomwithsound-dampeningheadphonesonandtheireyesclosedfor15minutes,inaccordancewiththeACRpracticeguidelines.TheTc99-mlabeledHMPAOtraceristheninjectedthroughtheIVlineandflushedwithsaline.Thetraceristhentakenupbythebrainwithinthenext2minutes.Thisresultsinaperfusionpatternthatisanalyzedandinterpreted.Afterinjection,thepatientremainsinthequietsemi-darkenedroomforanadditional5minutes.TheSPECTscanisacquiredaminimumof60minutespostinjection.
Duringtheconcentrationtask,thepatientisplacedinaquietroomandanIVlineisstarted.Thepatientperformsaconcentrationbatteryonatablet.Approximately5minutesintothetask,theTc99-mlabeledHMPAOtraceristheninjectedthroughtheIVlineandflushedwithsaline.Thepatientcompletesthetaskandscanisacquiredaminimumof60minutespostinjection.
ScansareobtainedusingaSiemensE-CamSPECTgammacamerawithalowenergyhighresolution(LEHR)
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parallelholecollimator.Countsarecollectedina128X128matrixwith32stopsof5.625degreeseach,withazoomof1.78.Totalcountsexceeded5million.DataisfilteredusingaButterworthfilterat.25withanorderof5,correctedformotionasneededandattenuationcorrectionisperformed.Thevolumeismaskedtoexcludeasmuchnon-neuralstructureaspossible.Thereisnopost-filtering.Dataispresentedinaxial,sagittalandcoronalviewsin2mmsections.StatisticalanalysisisperformedusingCereMetrixsoftwarerelativetoacompositedatabaseofaverageperfusioncontaining1000individuals.
Date Status TC99-HMPAODose Count
XXX SPECT-Concentration 27.90mCiTc99HMPAO 5.685million
XXX SPECT-Baseline 28.10mCiTc99HMPAO 5.727million
ProceduresTheutilizationofSPECTinthediagnosticevaluationofvariousneurologicaldisordersiswellestablished.TheprocedureandpracticeguidelinesoftheAmericanCollegeofRadiology,theSocietyofNuclearMedicineandtheEuropeanAssociationofNuclearMedicineestablishtheutilityandscientificvalidityofSPECTfunctionalbrainimagingfordetectionandevaluationofcerebrovasculardiseaseandstroke,evaluationofdementiaandAlzheimer’sdisease,pre-surgicallocalizationofepilepticfoci,diagnosticevaluationofencephalitisandevaluationofsuspectedbraintrauma.Researchhasalsodemonstratedregionalperfusionpatternsassociatedwithotherneurologicaldisordersandwithexposuretoneurotoxins,hypoxiaandsubstancesofabuse.
Althoughthereisaverylargebodyofpeer-reviewedscientificarticlesshowingcertainbrainpatternsassociatedwithcertainpsychiatricconditions,theutilizationofSPECTfortheevaluationofpsychiatricdisordersisstillconsideredanemergingscienceandthereforeintheinvestigationalstage.AlthoughwewillreportonbrainpatternsofcertainpsychiatricconditionssuchasAttentionDeficitHyperactivityDisorder,BipolarDisorder,Anxiety,ObsessiveCompulsiveDisorder,etc.,basedonpatternspublishedinpeer-reviewedjournals,suchfindingsarenotconsideredstandaloneordiagnosticperseandshouldalwaysbeconsideredinconjunctionwiththepatient’sclinicalcondition.Thesefindingsshouldonlybeusedasadditionalinformationtoaddtotheclinician’sdiagnosticimpression.
ThebrainSPECTimagingstudieswereperformedunderthegeneralsupervisionofaqualifiedstatelicensedphysician.
Sincerely,
Reading Radiologist
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CLINICALHISTORYREPORTCLINICALHISTORYREPORT
NEUROPSYCHIATRICANDCOGNITIVEASSESSMENTS1. TheMiniInternationalNeuropsychiatricInterviewwasadministeredonXXX.Accordingly,shedid not
meetanydiagnosticcriteria.
2. TheCNSVitalSignsCognitiveAssessmentwasadministeredonXXX.Hercognitivestatusprofile generatedthefollowingresults:
CLINICALOVERVIEWOFCHIEFCOMPLAINTPatientXXXisa32-year-oldrighthandedfemale.
On10/21/17thepatientwasinvolvedinamotorvehicleaccidentasthedriverofhervehicle.Thepatient explainedthatsheandherhusbandwereoutoftownforaweddingandweredrivingtotheirhotel.Theywere stoppedafewcarsbackatatrafficlightwhentheywererear-endedbyanotherdriver.Thepatientremembers hearingtiresscreechingandwaslookinguptoherrear-viewmirrorwhentheimpactoccurred.Thepatientdid nothitherheadorloseconsciousness,butdidexperiencewhiplash.Shereportsfeelinganadrenalinerush andwasinshockwhenapoliceofficershowedupatthescene.Thepoliceofficercalledforanambulanceand oncetheambulancearrived,thepatientreportsdevelopingneckandbackpain.Shewastakentothehospital andaCTofherneckwasperformed.Thepatientwasgivenasoftneckcollarandwasdischarged.Forthe nextfewweeksaftertheaccident,thepatientreportsshedevelopedmoresevereheadaches,spentan excessiveamountoftimesleepingandwasinpain.
Thepatient'sprimarysymptomsofconcernincludecognitivechanges,wordfindingissues,fatigue,andoffand onneckpain.Immediatelyfollowingtheaccident,thepatientdevelopedPTSDandsufferedfromafewpanic attackswhendrivingorbeinginthecar.SheunderwenttraumatherapyandbelievesthePTSDsymptoms haveimproved.Thepatientalsoreportshavingahardertimemanagingstresssincethiscaraccidentandhas noticedmomentsofanxietythatcomeandgowiththestressor.
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BlurredvisionCognitivedeclineorchangesCognitivefunctionproblemsDecreasedjudgementDifficultyfollowinginstructionsDifficultyintegratinginformationDifficultylearningnewthingsDifficultywithconcentrationDisorganizationDistractibilityEmotional-Cryingforlittleornoreason,easilycryExcessiveSadnessFatigueFrequentHeadachesGastrointestinalproblemsGeneralanxietyGriefIrritability
LossofinterestinthingsLossofmotivationLowfrustrationtoleranceMakingcarelessmistakesMusclepainMusclespasmsPanicattacksPhysical-jawclenching/tightnessProblemspayingattentionProblemswithabstractthinkingProblemswithlanguage/wordfindingRacingthoughtsReducedabilitytocopewithstressSensitivitytolightSensitivitytosoundShorttermmemoryproblemsSleepingtoomuchWorry
Thepatienthasparticipatedincognitivetherapy,visiontherapy,andneurofeedbackwhichshebelieveshavehelpedwithsomeofhersymptoms.Shehasalsocompletedtwoneuropsychologicalevaluations.Thepatientishopingtoachieveabetterunderstandingofhowherbrainiscurrentlyfunctioning.
PATIENT’SSELF-REPORTEDSYMPTOMS
MEDICALHISTORY
HistoryofBrainInjuryMotorVehicleAccident(10/21/2017):On10/21/17thepatientwasinvolvedinamotorvehicleaccidentasthedriverofhervehicle.Thepatientexplainedthatsheandherhusbandwereoutoftownforaweddingandweredrivingtotheirhotel.Theywerestoppedafewcarsbackatatrafficlightwhentheywererear-endedbyanotherdriver.Thepatientremembershearingtiresscreechingandwaslookinguptoherrear-viewmirrorwhentheimpactoccurred.Thepatientdidnothitherheadorloseconsciousness,butdidexperiencewhiplash.Shereportsfeelinganadrenalinerushandwasinshockwhenapoliceofficershowedupatthescene.Thepoliceofficercalledforanambulanceandoncetheambulancearrived,thepatientreportsdevelopingneckandbackpain.ShewastakentothehospitalandaCTofherneckwasperformed.Thepatientwasgivenasoftneckcollarandwasdischarged.Forthenextfewweeksaftertheaccident,thepatientreportsshedevelopedmoresevereheadachesandspentanexcessiveamountoftimesleepingandwasinpain.
IncomingDiagnoses
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AnxietyBackinjuriesBraininjury(02/2019)FatigueHeadaches(migraine)
MildCognitiveImpairment(MCI)(2019)Neckinjury(2017)neurovascularsyncopePosttraumaticstressdisorder(04/2018)
AcetylL-CarnitineHCL(500mgtwicedaily)AlphaBase(2twicedaily)D3withK(110mcgthreetimesaweek)DIMDefense(2everyday)GIDetox(1twicedaily)Magnesium(2twicedaily)MetabolicCare(2everyday)optimalliposomalglutathione(1twicedaily)
PectaSol-CProfessional(1everyday)PharmaGABA(1Tabtwicedaily)PQQ-10(1everyday)ProDHA1000(3everyday)ProlamineIodine(1Tabeveryday)PurePC(1everyday)Taurine(500mcgeveryday)
Catdander(Itchy,Wheezing) Sulfa/Septra(GI)
ReplacementBilateralTympanostomy&Tubeplacement(07/1990)
Adenoidectomy/BilateralTympanostomy&Tubeplacement(02/1989)
Father:Headaches(Tension)MaternalGrandmother:Lupus,RheumatoidArthritis,ThyroidProblemsMother:Headaches(Tension)
PaternalCousin:DiabetesPaternalGrandmother:ThyroidProblems,BipolarMoodDisroder
CurrentMedications
PastMedicationsNonereported
Pre-ScanMedicationRecommendationsCertainclassificationsofmedicationsmayhaveanimpactonbloodflowinthebrain.ThepatientwasadvisedtoreviewCereScan’srecommendationsregardingtheuseofstimulants,benzodiazepines,opiatesandbarbiturates,amongothersubstancesandmedications,anddiscussthemwithhis/herphysician.
Allergies
Surgeries/Hospitalizations
FamilyHistoryofMajorMedicalandPsychiatricIllness
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NeuroPsychTesting(Abnormal,12/05/2019),ReportAvailableqEEG(Abnormal,09/06/2019),ReportAvailable
NeuroPsychTesting(Abnormal,04/12/2019),ReportAvailableMRI(Normal,03/19/2019),ReportAvailable
BRAINIMAGINGHISTORY
DEVELOPMENTALHISTORYThepatientthinkshermedicalrecordsaysshehadaforcepsbirth.Shealsosufferedfromchronicearinfectionsinchildhood.
CURRENTUSEOFALCOHOLANDRECREATIONALSUBSTANCESAlcohol:Nonereported
Caffeine:Nonereported
Nicotine:Nonereported
Drugs:Nonereported
PASTHISTORYOFALCOHOLORDRUGABUSE
AlcoholNonereported
DrugsNonereported
EDUCATIONALANDEMPLOYMENTSTATUSThepatient'shighesteducationlevelisMaster'sDegree.Thepatient'semploymentstatusisUnemployed.
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VETERANHISTORYNonereported
Sincerely,
CereScan Clinician
Wearehappytocommunicatewithanyofyourtreatingclinicians.Thankyouforthisopportunitytoparticipate inyourcarewiththisconsultation.
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APPENDIXAPPENDIX
ANNOTATIONS
Id:1543
Tomogramsrevealingincreaasedleftthalamic,anteriorcingulateandbilateralbasalgangliaperfusion.
ChangBrainTomoBaseline-mc_TRA-2020-02-27
Dataset(s):ChangBrainTomoBaseline-mc_TRA-ProcessedVolume
Id:1546
CereMetrixz-scoreclusteranalysisrevealsfocalareasofabnormalcorticalhypoperfusioninthebilateralanteriorfrontal(L>R),rightorbitofrontal,leftmesialfrontal,leftanteriortemporal,rightmedialtemporal,bilaterallateralparietal,bilateralcalcaringportionofoccipitalandleftcerebellarareas.Scatteredareasofincreasedcorticalperfusionwerenotedofuncertainsignificance.
ChangBrainTomoBaseline-mc_TRA-2020-02-27
Dataset(s):CorticalSurface,Medial(Left-Hemisphere),Medial(Right-Hemisphere)
ColoredBy:AverageZ-Score SAMPLE
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Id:1548
CereMetrixz-scoreclusteranalysisrevealfocalareasofabnormallyincreasedsubcorticalperfusioninthebilateralputamena,bilateralglobuspallidiandleftamygdlaareas.
ChangBrainTomoBaseline-mc_TRA-2020-02-27
Dataset(s):Medial(Left-Hemisphere),Sub-Cortical,Medial(Right-Hemisphere)
ColoredBy:AverageZ-Score
Id:1549
Decreasingcorticalperfusionwithconcentrationtask.
ChangBrainTomoBaseline-mc_TRA-2020-02-27
Dataset(s):ChangBrainTomoBaseline-mc_TRA-ProcessedVolume
ChangBrainTomoConcentration-mc_TRA-2020-02-20
Dataset(s):ChangBrainTomoConcentration-mc_TRA-ProcessedVolume
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