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A new study published in Proceedings of the National Academy of Sciences (PNAS) promises to improve diagnosis and monitoring of Alzheimer's disease.  Scientists at the University of California, San Diego have developed a fast and accurate method for quantifying subtle, sub-regional brain volume loss using magnetic resonance imaging (MRI). 

The general pattern of brain atrophy resulting from Alzheimer's disease has long been known through autopsy studies, but exploiting this knowledge toward accurate diagnosis and monitoring of the disease has only recently been made possible by improvements in computational algorithms that automate identification of brain structures with MRI. The new methods described in the study provide rapid identification of brain sub-regions combined with measures of change in these regions across time. The methods require at least two brain scans to be performed on the same MRI scanner over a period of several months. The new research shows that changes in the brain's memory regions, in particular a region of the temporal lobe called the entorhinal cortex, offer sensitive measures of the early stages of the disease.
 

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Hospitals that make greater use of inpatient diagnostic imaging exams achieve lower in-hospital mortality rates with little or no impact on costs, according to a peer-reviewed study of more than 1 million patient outcomes in more than 100 hospitals nationwide published in the November issue of the Journal of the American College of Radiology (JACR).

"The results of our in-depth study would indicate that greater use of imaging does, in fact, lead to better patient outcomes in terms of lower in-hospital death rates with no significant impact on overall cost," said David W. Lee, Ph.D., lead author of the article and Senior Director, Health Economics and Outcome Research at GE Healthcare. "This study dealt only with imaging provided in hospitals, but would seem to confirm what many have long suspected - that medical imaging exams save lives."

Read the full article here.

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I am a firm believer in the use of Tesla 3 MRI machines for the detection of microscopic lesions on the brain.  While Tesla 3 MRI has been around for use in detecting such lesions from brain injury, the technology is frequently overlooked. 

In my practice I see neurologists hired by worker's compensation and insurance companies citing the "normal" results of MRI in mild and moderate brain injury cases in their effort to show the patient is faking injury.  While this is statistically consistent - that normal MRI is found in mild and moderate cases - the use of Tesla 3 MRI digs deeper, so to speak, to reveal the microscopic changes in the brain.  This helps not only the lawyer trying to prove a case, but the medical provider in diagnosing and treating a patient.

I found this recent article supporting Tesla 3 MRI. "Reports outline magnetic resonance imaging study results from University of Bonn." Science Letter. NewsRX. 2009. HighBeam Research. 21 Oct. 2009 <http://www.highbeam.com>.

In this recent report published in the Journal of Magnetic Resonance Imaging, researchers in Bonn, Germany conducted a study "To evaluate the feasibility of automatic planning and scanning of brain MR imaging (MRI) protocols on a clinical 3 Tesla system in tumor patients before and after neurosurgical intervention. Twenty-nine patients with intra-axial lesions were examined with automated planscan software pre- and postoperatively."

The researchers concluded: "These results are promising to minimize interscan variability in longitudinal studies."

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 The belief that healthy older brains are substantially smaller than younger brains may stem from studies that did not screen out people whose undetected, slowly developing brain disease was killing off cells in key areas, according to new research. As a result, previous findings may have overestimated atrophy and underestimated normal size for the older brain.
 

The seeming age-related atrophy in gray matter more likely reflected pathological changes in the brain that underlie significant cognitive decline than aging itself, the authors wrote. As long as people stay cognitively healthy, the researchers believe that the gray matter of areas supporting cognition might not shrink much at all.

"The Prevalence of Cortical Gray Matter Atrophy May Be Overestimated In the Healthy Aging Brain,"
Saartje Burgmans, PhD student, Martin P. J. van Boxtel, PhD, MD, Eric F. P. M. Vuurman, PhD, Floortje Smeets, PhD student, and Ed H. B. M. Gronenschild, PhD, Maastricht University; Harry B. M. Uylings, PhD, Maastricht University and VU University Medical Center Amsterdam; and Jelle Jolles, PhD, Maastricht University;
Neuropsychology, Vol. 23, No. 5.
 

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Advance in neuroimaging are always exciting as they assist doctors and clinicians in treating patients with traumatic brain injury. 

Functional magnetic resonance imaging (fMRI) is a technique widely used in studying the human brain. However, it has long been unclear exactly how fMRI signals are generated at brain cell level. This information is crucially important to interpreting these imaging signals. Scientists from the Academy of Finland's Neuroscience Research Programme (NEURO) have discovered that astrocytes, support cells in brain tissue, play a key role in the generation of fMRI signals.

Functional magnetic imaging has become a highly popular method in basic neurobiological research, psychology, medicine as well as in areas of study that interface with the social sciences and economics, such as neuroeconomics. fMRI imaging does not directly measure the activity of nerve cells or neural networks, but local changes in cerebrovascular circulation during the execution of certain functions. Interpretation of the measurement data obtained with this method therefore requires a close knowledge of the cell-level mechanisms that are responsible for these local changes in cerebrovascular circulation.
 

Read morehere.

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Wikipedia defines Diffuse axonal injury (DAI) as

one of the most common and devastating types of traumatic brain injury, , meaning that damage occurs over a more widespread area than in focal brain injury. DAI, which refers to extensive lesions in white matter tracts, is one of the major causes of unconsciousness and persistent vegetative state after head trauma. It occurs in about half of all cases of severe head trauma and also occurs in moderate and mild brain injury.

The outcome is frequently coma, with over 90% of patients with severe DAI never regaining consciousness. Those who do wake up often remain significantly impaired.

Nowadays, other authors state that DAI can occur in every degree of severity from (very) mild or moderate to (very) severe. Concussion may be a milder type of diffuse axonal injury.

DAI is not easily detected by physicians in mild and moderate cases. Imaging studies and neuropsychological evaluations in addition to observations of relatives, friends and co-workers are some of the devices used when diagnosing DAI. Cases involving mild to moderate brain injuries are harder to tackle than cases in which there is objectively discernible injury such as loss of consciousness, skull fracture, or intracranial bleeding on imaging studies. Often such cases involve allegations of diffuse axonal injury (DAI), an injury to the brain that can occur at the microscopic level and not be detectable even by computerized tomography or magnetic resonance imaging.

Nonetheless, DAI can cause significant changes in personality or cognition which can create significant life change.
 

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During my law school experience in the mid 1980s I was chosen to participate in a nationwide, seminar called "Right to Die."  This was an interdisciplinary exercise of law, medicine, nursing, theology and others.  All of us were students in out respective fields brought together to consider whether an individual should or can possess the right to die with dignity.

In cases of undeniably fatal illness, can someone decide to end their life?  Over 30 students from around the country met in San Francisco, paid for entirely with grant money, to participate.  The notion and experience never left me.

In now appears that science can read desires of comatose patients with functional MRI.  The ethical dilemma again comes to mind.  Here are some excerpts from a recent article.

A British researcher claims that he has devised a way to communicate with people who, though can't move their limbs, are consciously aware.

While making a presentation at the Organisation for Human Brain Mapping Conference, Dr. Martin Monti of the Medical Research Council's Cognition and Brain Science Unit in Cambridge said that his work might have implications for the medical diagnosis of people in a vegetative state, and for determining whether to discontinue feeding.

Dr. Monti said that the study had a 100 per cent success rate in determining the right answer.

He said that the research might help, in the long term, reconnect patients with their families.

It might also be helpful in providing a solution to legal battles over whether to discontinue feeding a patient.

"There will be a lot of ramifications from this technology. The medical system needs to understand how to use it and at some point we have to look at the ethical and legal ramifications," he said.

"If you had a patient (in a coma-like state) who you could reliably see they do not want to live, how would you react to that?" he added.

Published by HT Syndication with permission from Asian News International.

Copyright © HT Media Ltd. All Rights Reserved. Provided by ProQuest LLC.

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In a medical era governed by managed health care and scientific advances, physicians have increasingly emphasized disease prevention and early diagnosis. Such a strategy both reduces costs, as it is generally much more cost-effective to prevent a disease than it is to treat its manifestations, and increases treatment efficacy, as most diseases are more easily cured or ameliorated earlier in their progression.

The premise is doing MRI scans BEFORE symptoms arise.  MRI is being offered to the public for as low as $200.

The pros and cons are discussed in an article entitled Brain Magnetic Resonance Imaging Scans for Asymptomatic Patients: Role in Medical Screening.

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

Brain Imaging

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.

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