Seizures In Babies: Cutting-Edge Imaging Technique To Improve Diagnosis

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Main Category: Pediatrics / Children's Health
Article Date: 03 Aug 2012 - 10:00 PDT Current ratings for:
Seizures In Babies: Cutting-Edge Imaging Technique To Improve Diagnosis

A cutting-edge technique, combining brain imaging and monitoring of its electrical activity, could improve early diagnosis and treatment of babies who suffer seizures.

Researchers at The Rosie Hospital, Cambridge, are investigating the new technique with funding from children's charity Action Medical Research.

In the UK over 2,000 newborn babies suffer seizures each year.1 Early diagnosis and treatment is vital, as seizures may cause lasting brain damage. However, seizures sometimes go unnoticed, as babies can have no obvious symptoms.

Dr Topun Austin at The Rosie Hospital was awarded £131,150 by Action Medical Research for the two year project. "Seizures remain a major challenge when caring for newborn babies," explains Dr Austin, "but can be difficult to diagnose as abnormal movements of the baby may be subtle or not even present."

Around two or three babies in every 1,000 born alive also suffer from seizures within a month of birth.2,3 Babies born very prematurely are especially vulnerable, as are babies who suffer from a lack of oxygen during birth.

Babies who are suspected of suffering from seizures are normally referred for specialist tests. "The current diagnostic test is an electroencephalogram (EEG), which measures electrical activity within the brain," explains Dr Austin. "EEG has limitations though, as it can only detect seizures occurring near the surface of the brain. It cannot detect abnormalities deeper within the brain."

Dr Austin is developing a new way to diagnose seizures, which combines existing EEG technology with a new optical imaging system. The technique could also help other people with seizures or epilepsy.

"When babies have a seizure, there is a large amount of electrical activity in the brain, which we are measuring with EEG," explains Dr Austin. "The amount of oxygen in the brain also changes, which we are measuring with the new optical system. This system works by shining near-infrared light into the brain, which is harmless and non-invasive."

Dr Austin hopes the new combined technique will boost understanding of what's happening inside the brain during seizures: "The ultimate aim is to develop the new system for routine use at the cot-side."

This project brings together a team of clinicians and scientists with a proven track record in developing new technologies to study the infant brain. Most of the work is being carried out in a new neonatal unit - one of the largest in the country - at the Rosie Maternity Hospital, Cambridge.

Article adapted by Medical News Today from original press release. Click 'references' tab above for source.
Visit our pediatrics / children's health section for the latest news on this subject. 1. Rennie JM, Hagmann CF, Robertson NJ. Neonatal cerebral investigation. (2008) Cambridge University Press.

2. Panayiotopoulos CP. Chapter 5. Neonatal seizures and neonatal syndromes. The Epilepsies: Seizures, Syndromes and Management. Bladon Medical Publishing (Oxfordshire UK) 2005.

3. Davis AS et al. Seizures in extremely low birth weight infants are associated with adverse outcome. J Pediatr 2010; 157: 720-5.

Source: Action Medical Research

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SPECT/CT Imaging Agent Solves The Problem Of Difficult To Diagnose Cases Of Infectious Endocarditis

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Main Category: Heart Disease
Also Included In: Radiology / Nuclear Medicine;  Infectious Diseases / Bacteria / Viruses
Article Date: 03 Aug 2012 - 1:00 PDT Current ratings for:
SPECT/CT Imaging Agent Solves The Problem Of Difficult To Diagnose Cases Of Infectious Endocarditis

When combined with standard diagnostic tests, functional imaging procedures have been shown to reduce the rate of misdiagnosed cases of infectious endocarditis. According to new research published in the August issue of The Journal of Nuclear Medicine, single photon emission computed tomography (SPECT)/computed tomography (CT) with 99mTc-hexamethylpropleneamine oxime-labeled white blood cells (99mTc-HMPAO-WBC) can improve the diagnosis of infectious endocarditis in hard-to-diagnose cases.

Infectious endocarditis is an infection of the lining of the heart chambers and heart valves that is caused by bacteria, fungi or other infectious substances. It affects 2-4 people per 100,000 each year, with 25-50 percent of the cases occurring in patients older than 60 years. Mortality from infectious endocarditis remains high when this condition is undiagnosed and, therefore, not adequately treated.

The diagnosis of infectious endocarditis is becoming progressively more challenging in the past years because of a variety of factors: the indiscriminate use of antimicrobial agents in some clinical settings, the increased number of individuals with predisposing or underlying conditions (i.e., frail and elderly, immune-suppressed persons), and the increasing number of interventional cardiovascular procedures and placement of valve prostheses, intravascular devices and cardiac devices.

"SPECT/CT with 99mT-HMPAO-WBC is a nuclear medicine technique currently used for the management of patients with infection; its application in infectious endocarditis has been restricted to few reports," said Paola A. Erba, MD, lead author of the study. "With this work we aimed to open new perspective for the application of this technique."

Researchers conducted 99mTc-HMPAO-WBC SPECT/CT scans on 131 consecutive patients with suspected infectious endocarditis. Patients with permanent cardiac devices were excluded from the research as the devices might have introduced the infection. Results from the scans were compared to diagnostic tests for standard infectious endocarditis - transthoracic or transesophageal echocardiography, blood cultures and the modified Duke Endocarditis Service criteria, which are recommended for classification.

Of the 131 patients, 97 were found to have uptake indicating infection.The 99mTc-HMPAO-WBC SPECT/CT scan was true-positive in 46 of 51 patients and false negative in 5 of 51 cases (90 percent sensitivity, 94 percent negative predictive value and 100 percent specificity and positive predictor value). In addition, septic embolism was detected in 41 percent of the patients.

"When the results of the 99mTc-HMPAO-WBC SPECT/CT scan were associated with either positive echocardiography or a positive blood culture, no cases of infectious endocarditis went undiagnosed," noted Erba. "This demonstrates the added value that 99mTc-HMPAO-WBC SPECT/CT scans can provide to assist physicians in their diagnosis and treatment decisions. Cardiologists and infectivologists dealing with infectious endocarditis should consider using 99mT-HMPAO-WBC when they are facing difficult situation."

Article adapted by Medical News Today from original press release. Click 'references' tab above for source.
Visit our heart disease section for the latest news on this subject. Authors of the article “Added Value of 99mTc-HMPAO-Labeled Leukocyte SPECT/CT in Characterization and Management of Patients with Infectious Endocarditis”include Paola A. Erba, Elena Lazzeri, Martina Sollini and Giuliano Mariani, Regional Center of Nuclear Medicine, University of Pisa Medical School, Pisa, Italy; Umberto Conti, Laboratory of Echocardiography, Cardiology Unit, Azienda Ospaedaliero-Universitaria Pisana, Pisa, Italy; Roberta Doria, Carlo Tascini and Francesco Menichetti, Infectious Disease Department, Azienda Ospaedaliero-Universitaria Pisana, Pisa, Italy; Salvatore M. De Tommasi, Cardiology Department, Azienda Ospaedaliero-Universitaria Pisana, Pisa, Italy; Francesco Bandera, Cardiovascular Department “E Malan,” IRCCS Policlinico San Donato Milanese, Milan, Italy; A.J.O. Dierckx, Nuclear Medicine and Molecular Imaging Department, University Medical Center Groningen, The Netherlands; and Alberto Signore, Nuclear Medicine and Molecular Imaging Department, University Medical Center Groningen, The Netherlands and Nuclear Medicine Unit, S. Andrea Hospital, University of Rome, Rome, Italy.
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Increasing Number Of Imaging Visits Faced By Breast Cancer Patients Before Surgery

Main Category: Breast Cancer
Also Included In: MRI / PET / Ultrasound;  Radiology / Nuclear Medicine
Article Date: 13 Dec 2011 - 1:00 PST

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Breast cancer patients frequently undergo imaging like mammograms or ultrasounds between their first breast cancer-related doctor visit and surgery to remove the tumor. Evaluations of these scans help physicians understand a person's disease and determine the best course of action. In recent years, however, imaging has increased in dramatic and significant ways, say researchers from Fox Chase Cancer Center. More patients have repeat visits for imaging than they did 20 years ago, and single imaging appointments increasingly include multiple types of imaging.

The researchers, led by Richard Bleicher, M.D., surgical oncologist at Fox Chase, found that between 1992 and 2005, the percentage of patients who had multiple (2+) imaging visits nearly quadrupled. Bleicher says additional visits present a burden to patients, many of whom are elderly, but the stress may be alleviated through better coordination and evaluation by physicians. Bleicher presented his group's findings at the 2011 CTRC-AACR San Antonio Breast Cancer Symposium.

"The burden to the patient is increasing substantially," Bleicher says. "The number of days patients are having mammograms, MRIs, and ultrasounds is going up steadily year by year. They're having imaging done more frequently on separate dates during the preoperative interval than ever before. It's surprising."

The preoperative interval begins when a patient first reports to a doctor with a breast complaint and ends when the patient undergoes therapeutic surgery to resect a tumor. For the more than 65,000 patients involved in the study, the preoperative interval lasted 37 days on average. The Fox Chase researchers found that in 1992, roughly one in 20 cancer patients (4.9 percent) diagnosed with invasive, non-metastatic cancer underwent imaging twice or more during the preoperative interval. By 2005, that portion had climbed to about one in 5 (19.4 percent). In the extreme case, a small subset of 20 patients underwent mammograms on five or more visits during the preoperative interval.

The researchers also found that a single imaging visit increasingly includes multiple imaging types. In 1992, 4.3 percent of patients underwent multiple types of imaging; in 2005, that rate rose to 27.1 percent.

With the increased use of imaging, Bleicher says that for physicians, "the question becomes, 'How are we affecting patients overall with what we're ordering nowadays?'"

Previous studies have examined patient burden in terms of cost, but Bleicher says he hasn't seen studies that focus on the patient burden in terms of the patient's time. "I wanted to take a look at how things have been changing for patients and how many times they have to travel back and forth to get more imaging," he says. "Physicians need to keep in mind that it's hard enough for working people to take off from work and trek back and forth to appointments, but older people have infirmities, and it's harder to get around. The coordination of care is very important. We need to focus more on the burden to the patient."

Other studies have shown an increase in the cost of breast cancer care - but the cost of imaging is rising even faster. "We know the costs are going up, but we don't know why," he says. "One reason might be the frequency and amount of imaging."

He points out that when more than one set of imaging is done on the same day, "There are perversities of the reimbursement system that may foster these separate visits, although I don't know if that's why we're seeing this phenomenon."

The researchers discovered the climbing trend after studying data on Medicare patients from the National Cancer Institute's Surveillance Epidemiology and End Results (SEER) program. Their results came from the records of 67,751 women who were treated for invasive, non-metastatic breast cancer with surgery and lymph node staging. The researchers omitted patients diagnosed with either metastatic disease or DCIS because those types of breast cancer require different approaches to imaging and treatment. The median age of the study participants was 75.

Bleicher says the patient's burden may be reduced if patients ask their providers why imaging is being done, and work together to make the process smoother. "If they do need imaging, then they might ask their physician, especially if they're of an older age, whether or not they think they're going to need additional types of imaging and if those can be scheduled together," he says.

The researchers are now diving deeper into their data to understand the trend and look for a better way to help breast cancer patients with imaging, Bleicher says. "We want to see whether or not there is a more efficient method of imaging the patients so that we're improving outcomes without increasing costs."

Article adapted by Medical News Today from original press release. Click 'references' tab above for source.
Visit our breast cancer section for the latest news on this subject. Co-authors include Karen Ruth, Elin R. Sigurdson, Kathryn Evers, Yu-Ning Wong, Marcia Boraas, and Brian L. Egleston from Fox Chase.
The study was supported, in part, by a US Public Health Services grant, an appropriation from the Commonwealth of Pennsylvania, an American Cancer Society grant, and by generous private donor support.
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Long-Term Imaging Reveals Intriguing Patterns Of Human Brain Maturation

Main Category: Neurology / Neuroscience
Article Date: 09 Dec 2011 - 0:00 PST

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Neuroimaging has provided fascinating insight into the dynamic nature of human brain maturation. However, most studies of developmental changes in brain anatomy have considered individual locations in relative isolation from all others and have not characterized relationships between structural changes in different parts of the developing brain. Now, new research describes the first comprehensive study of coordinated anatomical maturation within the developing human brain. The study, published by Cell Press in the December 8 issue of the journal Neuron, reveals that functionally connected brain regions mature together and uncovers fascinating sex-specific differences in brain development.

"Understanding patterns of structural change in the developing human brain is a challenge because the types of change that we can detect using neuroimaging unfold rather slowly," explains lead study author, Dr. Armin Raznahan, from the National Institutes of Mental Health in Bethesda, Maryland. "So, we drew from the largest and longest-running longitudinal neuroimaging study of human brain maturation, where brain changes were tracked for over several years in the same set of individuals, to analyze patterns of correlated anatomical change across the sensitive developmental window of late childhood, adolescence, and early adulthood."

Dr. Raznahan and colleagues examined the thickness of the cortex because it can be reliably measured and its developmental changes have been described in detail. The cortex is a sheet of neural tissue that covers the surface of the brain and plays a key role in thought, language, memory and consciousness.

The researchers discovered that rates of structural maturation were highly coordinated in the cortex and that regions which were functionally connected to each other also exhibited tightly coupled patterns of maturation. Interestingly, the researchers also observed that maturational coupling within the brain regions crucial for complex decision making differed between males and females.

"Our study represents the first ever investigation of correlated anatomical maturation in the developing human brain and shows that rates of structural cortical development in different cortical regions are highly organized with respect to one another," concludes Dr. Raznahan. "By providing the first link between cortical connectivity and the coordination of cortical development, we reveal a previously unseen property of healthy brain maturation, which may represent a target for neurodevelopmental disease processes and a substrate for sexually dimorphic behavior in adolescence."

Article adapted by Medical News Today from original press release. Click 'references' tab above for source.
Visit our neurology / neuroscience section for the latest news on this subject. Please use one of the following formats to cite this article in your essay, paper or report:

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Cell Press. "Long-Term Imaging Reveals Intriguing Patterns Of Human Brain Maturation." Medical News Today. MediLexicon, Intl., 9 Dec. 2011. Web.
9 Dec. 2011. APA

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