Brain and Spine Injury Lawyer & Attorney : Titolo Law Firm : Las Vegas, Nevada

I came across this brief explanation of some of the topics I will be presenting with Dr. Joseph Wu of University of California, Irvine, in next week's Brain Injury Association of America Conference in Las Vegas.  Here Magnetic Resonance Imaging (MRI), Computed Tomography (CT), Functional Magnetic Resonance (fMRI), Positron Emission Tomography (PET) and Single Photon Emission Computed Tomography (SPECT) are discussed.  These diagnostics show us the structure and metabolism of the brain.  EEG (not discussed below) reveals electrical activity of the brain. Dr. Wu is the Director of the Brain Imaging Center and will be discussing advances in Positron Emission Tomography technology and use in brain injury detection. 

This information was derived from Microsoft® Encarta® Online Encyclopedia 2007:

Brain Imaging

Several commonly used diagnostic methods give images of the brain without invading the skull. Some portray anatomy—that is, the structure of the brain—whereas others measure brain function. Two or more methods may be used to complement each other, together providing a more complete picture than would be possible by one method alone.

 

Magnetic Resonance Imaging or MRI

Magnetic resonance imaging (MRI), introduced in the early 1980s, beams high-frequency radio waves into the brain in a highly magnetized field that causes the protons that form the nuclei of hydrogen atoms in the brain to reemit the radio waves. The reemitted radio waves are analyzed by computer to create thin cross-sectional images of the brain. MRI provides the most detailed images of the brain and is safer than imaging methods that use X rays. However, MRI is a lengthy process and also cannot be used with people who have pacemakers or metal implants, both of which are adversely affected by the magnetic field.

Computed Tomography or CT

Computed tomography, also known as CT scans, developed in the early 1970s. This imaging method X-rays the brain from many different angles, feeding the information into a computer that produces a series of cross-sectional images. CT is particularly useful for diagnosing blood clots and brain tumors. It is a much quicker process than magnetic resonance imaging and is therefore advantageous in certain situations—for example, with people who are extremely ill.

Functional Magnetic Resonance Imaging of fMRI

Changes in brain function due to brain disorders can be visualized in several ways. Magnetic resonance spectroscopy measures the concentration of specific chemical compounds in the brain that may change during specific behaviors. Functional magnetic resonance imaging (fMRI) maps changes in oxygen concentration that correspond to nerve cell activity.

Positron Emission Tomography or PET

Positron emission tomography (PET), developed in the mid-1970s, uses computed tomography to visualize radioactive tracers (see Isotopic Tracer), radioactive substances introduced into the brain intravenously or by inhalation. PET can measure such brain functions as cerebral metabolism, blood flow and volume, oxygen use, and the formation of neurotransmitters. Single photon emission computed tomography (SPECT), developed in the 1950s and 1960s, uses radioactive tracers to visualize the circulation and volume of blood in the brain.

Brain-imaging studies have provided new insights into sensory, motor, language, and memory processes, as well as brain disorders such as epilepsy; cerebrovascular disease; Alzheimer's, Parkinson, and Huntington's diseases (see Chorea); and various mental disorders, such as schizophrenia.

 

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Insurance companies are once again trying to preserve their income by cutting health care.  The rising cost of CT and other neuroimaging techniques is prompting insurance companies to look for ways to decrease their use.

There is certainly an argument that doctors have been placed in the unenviable position of having to protect themselves by practicing "defensive medicine."  But more compelling is the information neuroimaging provides in saving lives or prescribing proper care.

It is no wonder that diagnostic tests increase as technology increases.  Moreover, doctors' ability to see and treat disease increases with the use of neuroimaging technology.  Just as the Hubbell telescope  allows us to see things in outer space previously unseen and allows us to create theories of Relativity, we are better informed and able to understand that sun does not evolve around earth but earth around sun.

Fortunately health insurance companies do not dispute such theories and facts - but if they could save money doing it I bet they would!

Read the article in today's Newsday.

To read more click Study by Center for Studying Health System Change http://hschange.org/CONTENT/968/

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60 Minutes just aired an incredible piece on new findings for brain injured people in a minimally conscious state. 

The story describes fireman Don Herbert who was injured when a roof fell on him while making a rescue attempt.  Unconscious for 10 years, Don is shown waking up and being aware of the fact that he was "gone."

The next story is of George Menendez who also sustained brain injury and was minimally conscious.  His mother thought to give him Ambien for sleep one night when he was moaning.  George, for the first time, opened his eyes and was able to communicate with his family.

Experts believe there is a subset of brain injured people who may respond to Ambien.  PET scans were done before and after Ambien was ingested and the results were remarkable.  The brain showed distinctive functioning after Ambien.

This is an exciting discovery and I hope there is more to come.  To see the amazing 12 minute video click here.

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PET is a very uselful procedure in assessing brain function after brain injury.  When procedure results are compared to neuropsychological findings, treatment can be specified to enhance recovery.

Definition
Positron emission tomography (PET) is an imaging test that uses a radioactive substance (called a tracer) to look for disease in the body. Unlike magnetic resonance imaging (MRI) and computed tomography (CT) scans, which reveal the structure of organs, a PET scan shows how the organs and tissues are functioning.

PET scans use a small amount of a radioactive substance injected into a vein, usually on the inside of the elbow. The substance travels through the blood and collects in organs or tissues.

The scan begins approximately 60 minutes after receiving the radioactive substance. The individual then lies on a table that slides into a tunnel-shaped hole in the center of the PET scanner.

The PET machine detects energy given off by the radioactive substance and converts it into 3-dimensional pictures. The images are sent to a computer, where they are displayed on a monitor for the physician to read.

The test takes about 30 minutes.

How to Prepare for the Test
You must sign a consent form before having this test. You will be told not to eat anything for 4 - 6 hours before the PET scan, although you will be able to drink water.

Tell your doctor if you are pregnant or think you might be pregnant.

Also tell your doctor about any prescription and over-the-counter medicines that you are taking, because they may interfere with the test.

Be sure to mention if you have any allergies, or if you've had any recent imaging studies using injected dye (contrast).

During the test, you may need to wear a hospital gown. Take off any jewelry, dentures, and other metal objects because they could affect the scan results.

Why the Test is Performed
A PET scan can reveal the size, shape, position, and function of the brain and other organs.  It is used to diagnose cancer, heart problems, and brain disorders. It can see how far cancer has spread, reveal areas of poor blood flow to the heart, and check brain function.

Normal Results
A normal scan reveals no problems in the size, shape, or position of an organ. An abnormal scan reveals areas in which the radiotracer has abnormally collected.

Risks
The amount of radiation used in a PET scan is low. It is about the same amount of radiation as in most CT scans. Also, the radiation doesn't last for very long in your body.

However, women who are pregnant or are breastfeeding should let their doctor know before having this test. Infants and fetuses are more sensitive to the effects of radiation because their organs are still growing.

It is possible, although very unlikely, to have an allergic reaction to the radioactive tracer. Some people have pain, redness, or swelling at the injection site.

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