Bruno Passebon Soares, MD

All Publications

• ACR Appropriateness Criteria Headache: 2022 Update. Journal of the American College of Radiology : JACR Expert Panel on Neurological Imaging, Utukuri, P. S., Shih, R. Y., Ajam, A. A., Callahan, K. E., Chen, D., Dunkle, J. W., Hunt, C. H., Ivanidze, J., Ledbetter, L. N., Lee, R. K., Malu, O., Pannell, J. S., Pollock, J. M., Potrebic, S. X., Setzen, M., Shih, R. D., Soares, B. P., Staudt, M. D., Wang, L. L., Burns, J. 2023; 20 (5S): S70-S93

  Abstract

  Headache is an ancient problem plaguing a large proportion of the population. At present, headache disorders rank third among the global causes of disability, accounting for over $78 billion per year in direct and indirect costs in the United States. Given the prevalence of headache and the wide range of possible etiologies, the goal of this document is to help clarify the most appropriate initial imaging guidelines for headache for eight clinical scenarios/variants, which range from acute onset, life-threatening etiologies to chronic benign scenarios. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.

  View details for DOI 10.1016/j.jacr.2023.02.018

  View details for PubMedID 37236753

• ACR Appropriateness Criteria Seizures-Child. Journal of the American College of Radiology : JACR Expert Panel on Pediatric Imaging, Trofimova, A., Milla, S. S., Ryan, M. E., Pruthi, S., Blount, J. P., Desai, N. K., Glenn, O. A., Islam, M. P., Kadom, N., Mirsky, D. M., Myseros, J. S., Partap, S., Radhakrishnan, R., Rose, E., Soares, B. P., Trout, A. T., Udayasankar, U. K., Whitehead, M. T., Karmazyn, B. 2021; 18 (5S): S199–S211

  Abstract

  In children, seizures represent an extremely heterogeneous group of medical conditions ranging from benign cases, such as a simple febrile seizure, to life-threatening situations, such as status epilepticus. Underlying causes of seizures also represent a wide range of pathologies from idiopathic cases, usually genetic, to a variety of acute and chronic intracranial or systemic abnormalities. This document discusses appropriate utilization of neuroimaging tests in a child with seizures. The clinical scenarios in this document take into consideration different circumstances at the time of a child's presentation including the patient's age, precipitating event (if any), and clinical and electroencephalogram findings and include neonatal seizures, simple and complex febrile seizures, post-traumatic seizures, focal seizures, primary generalized seizures in a neurologically normal child, and generalized seizures in neurologically abnormal child. This practical approach aims to guide clinicians in clinical decision-making and to help identify efficient and appropriate imaging workup. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.

  View details for DOI 10.1016/j.jacr.2021.02.020

  View details for PubMedID 33958113

• Superior Verbal Memory Outcome After Stereotactic Laser Amygdalohippocampotomy. Frontiers in neurology Drane, D. L., Willie, J. T., Pedersen, N. P., Qiu, D., Voets, N. L., Millis, S. R., Soares, B. P., Saindane, A. M., Hu, R., Kim, M. S., Hewitt, K. C., Hakimian, S., Grabowski, T., Ojemann, J. G., Loring, D. W., Meador, K. J., Faught, E. J., Miller, J. W., Gross, R. E. 1800; 12: 779495

  Abstract

  Objective: To evaluate declarative memory outcomes in medically refractory epilepsy patients who underwent either a highly selective laser ablation of the amygdalohippocampal complex or a conventional open temporal lobe resection. Methods: Post-operative change scores were examined for verbal memory outcome in epilepsy patients who underwent stereotactic laser amygdalohippocampotomy (SLAH: n = 40) or open resection procedures (n = 40) using both reliable change index (RCI) scores and a 1-SD change metric. Results: Using RCI scores, patients undergoing open resection (12/40, 30.0%) were more likely to decline on verbal memory than those undergoing SLAH (2/40 [5.0%], p = 0.0064, Fisher's exact test). Patients with language dominant procedures were much more likely to experience a significant verbal memory decline following open resection (9/19 [47.4%]) compared to laser ablation (2/19 [10.5%], p = 0.0293, Fisher's exact test). 1 SD verbal memory decline frequently occurred in the open resection sample of language dominant temporal lobe patients with mesial temporal sclerosis (8/10 [80.0%]), although it rarely occurred in such patients after SLAH (2/14, 14.3%) (p = 0.0027, Fisher's exact test). Memory improvement occurred significantly more frequently following SLAH than after open resection. Interpretation: These findings suggest that while verbal memory function can decline after laser ablation of the amygdalohippocampal complex, it is better preserved when compared to open temporal lobe resection. Our findings also highlight that the dominant hippocampus is not uniquely responsible for verbal memory. While this is at odds with our simple and common heuristic of the hippocampus in memory, it supports the findings of non-human primate studies showing that memory depends on broader medial and lateral TL regions.

  View details for DOI 10.3389/fneur.2021.779495

  View details for PubMedID 34956059

• ACR Appropriateness Criteria Cerebrovascular Disease-Child. Journal of the American College of Radiology : JACR Expert Panel on Pediatric Imaging, Robertson, R. L., Palasis, S., Rivkin, M. J., Pruthi, S., Bartel, T. B., Desai, N. K., Kadom, N., Kulkarni, A. V., Lam, H. F., Maheshwari, M., Milla, S. S., Mirsky, D. M., Myseros, J. S., Partap, S., Radhakrishnan, R., Soares, B. P., Trout, A. T., Udayasankar, U. K., Whitehead, M. T., Karmazyn, B. 2020; 17 (5S): S36–S54

  Abstract

  Stroke is an uncommon but an important and under-recognized cause of morbidity and mortality in children. Strokes may be due to either brain ischemia or intracranial hemorrhage. Common symptoms of pediatric acute stroke include headache, vomiting, focal weakness, numbness, visual disturbance, seizures, and altered consciousness. Most children presenting with an acute neurologic deficit do not have an acute stroke, but have symptoms due to stroke mimics which include complicated migraine, seizures with postictal paralysis, and Bell palsy. Because of frequency of stroke mimics, in children and the common lack of specificity in symptoms, the diagnosis of a true stroke may be delayed. There are a relatively large number of potential causes of stroke mimic and true stroke. Consequently, imaging plays a critical role in the assessment of children with possible stroke and especially in children who present with acute onset of stroke symptoms. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.

  View details for DOI 10.1016/j.jacr.2020.01.036

  View details for PubMedID 32370977

• ACR Appropriateness Criteria Head Trauma-Child. Journal of the American College of Radiology : JACR Expert Panel on Pediatric Imaging, Ryan, M. E., Pruthi, S., Desai, N. K., Falcone, R. A., Glenn, O. A., Joseph, M. M., Maheshwari, M., Marin, J. R., Mazzola, C., Milla, S. S., Mirsky, D. M., Myseros, J. S., Niogi, S. N., Partap, S., Radhakrishnan, R., Robertson, R. L., Soares, B. P., Udayasankar, U. K., Whitehead, M. T., Wright, J. N., Karmazyn, B. 2020; 17 (5S): S125–S137

  Abstract

  Head trauma is a frequent indication for cranial imaging in children. The majority of accidental pediatric head trauma is minor and sustained without intracranial injury. Well-validated pediatric-specific clinical decision guidelines should be used to identify very low-risk children who can safely forgo imaging. In those who require acute imaging, CT is considered the first-line imaging modality for suspected intracranial injury because of the short duration of the examination and its high sensitivity for acute hemorrhage. MRI can accurately detect traumatic complications, but often necessitates sedation in children, owing to the examination length and motion sensitivity, which limits rapid assessment. There is a paucity of literature regarding vascular injuries in pediatric blunt head trauma and imaging is typically guided by clinical suspicion. Advanced imaging techniques have the potential to identify changes that are not seen by standard imaging, but data are currently insufficient to support routine clinical use. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.

  View details for DOI 10.1016/j.jacr.2020.01.026

  View details for PubMedID 32370957

• ACR Appropriateness Criteria Sinusitis-Child. Journal of the American College of Radiology : JACR Expert Panel on Pediatric Imaging:, Tekes, A., Palasis, S., Durand, D. J., Pruthi, S., Booth, T. N., Desai, N. K., Jones, J. Y., Kadom, N., Lam, H. F., Milla, S. S., Mirsky, D. M., Partap, S., Robertson, R. L., Ryan, M. E., Saigal, G., Setzen, G., Soares, B. P., Trout, A. T., Whitehead, M. T., Karmazyn, B. 2018; 15 (11S): S403–S412

  Abstract

  Sinusitis is common in children that usually resolves spontaneously. Imaging is not part of the standard of care for initial diagnosis, however may be necessary in cases with persistent or chronic sinusitis to guide surgical intervention, or to rule out intracranial and vascular complications of sinusitis. Computed tomography (CT) and magnetic resonance imaging (MRI) are the leading imaging modalities. In this article, appropriateness in use of imaging modalities are discussed under common/clinically relevant scenarios. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.

  View details for PubMedID 30392608

• Focal Ablations of the Amygdala and Hippocampus Infrequently Results in Verbal Memory Impairment Drane, D. L., Willie, J., Pedersen, N. P., Soares, B. P., Qiu, D., Millis, S., Saindane, A. M., Loring, D. W., Voets, N. L., Grabowski, T., Ojemann, J. G., Kim, M., Meador, K. J., Faught, E., Miller, J. W., Gross, R. E. WILEY. 2018: S173

  View details for Web of Science ID 000446520900318

• ACR Appropriateness Criteria® Headache-Child. Journal of the American College of Radiology : JACR Hayes, L. L., Palasis, S. n., Bartel, T. B., Booth, T. N., Iyer, R. S., Jones, J. Y., Kadom, N. n., Milla, S. S., Myseros, J. S., Pakalnis, A. n., Partap, S. n., Robertson, R. L., Ryan, M. E., Saigal, G. n., Soares, B. P., Tekes, A. n., Karmazyn, B. K. 2018; 15 (5S): S78–S90

  Abstract

  Headaches in children are not uncommon and have various causes. Proper neuroimaging of these children is very specific to the headache type. Care must be taken to choose and perform the most appropriate initial imaging examination in order to maximize the ability to properly determine the cause with minimum risk to the child. This evidence-based report discusses the different headache types in children and provides appropriate guidelines for imaging these children. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.

  View details for PubMedID 29724429

• Suspected Physical Abuse-Child. Journal of the American College of Radiology Wootton-Gorges, S. L., Soares, B. P., Alazraki, A. L., Anupindi, S. A., Blount, J. P., Booth, T. N., Dempsey, M. E., Falcone, R. A., Hayes, L. L., Kulkarni, A. V., Partap, S., Rigsby, C. K., Ryan, M. E., Safdar, N. M., Trout, A. T., Widmann, R. F., Karmazyn, B. K., Palasis, S. 2017; 14 (5S): S338-S349

  Abstract

  The youngest children, particularly in the first year of life, are the most vulnerable to physical abuse. Skeletal survey is the universal screening examination in children 24 months of age and younger. Fractures occur in over half of abused children. Rib fractures may be the only abnormality in about 30%. A repeat limited skeletal survey after 2 weeks can detect additional fractures and can provide fracture dating information. The type and extent of additional imaging for pediatric patients being evaluated for suspected physical abuse depends on the age of the child, the presence of neurologic signs and symptoms, evidence of thoracic or abdominopelvic injuries, and social considerations. Unenhanced CT of the head is the initial study for suspected intracranial injury. Clinically occult abusive head trauma can occur, especially in young infants. Therefore, head CT should be performed in selected neurologically asymptomatic physical abuse patients. Contrast-enhanced CT of the abdomen/pelvis is utilized for suspected intra-abdominal or pelvic injury. Particular attention should be paid to discrepancies between the patterns of injury and the reported clinical history. Making the diagnosis of child abuse also requires differentiation from anatomical and developmental variants and possible underlying metabolic and genetic conditions. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer-reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.

  View details for DOI 10.1016/j.jacr.2017.01.036

  View details for PubMedID 28473090

• Back Pain-Child. Journal of the American College of Radiology Booth, T. N., Iyer, R. S., Falcone, R. A., Hayes, L. L., Jones, J. Y., Kadom, N., Kulkarni, A. V., Myseros, J. S., Partap, S., Reitman, C., Robertson, R. L., Ryan, M. E., Saigal, G., Soares, B. P., Tekes-Brady, A., Trout, A. T., Zumberge, N. A., Coley, B. D., Palasis, S. 2017; 14 (5S): S13-S24

  Abstract

  It is now generally accepted that nontraumatic back pain in the pediatric population is common. The presence of isolated back pain in a child has previously been an indication for imaging; however, recently a more conservative approach has been suggested using clinical criteria. The presence of constant pain, night pain, and radicular pain, alone or in combination, lasting for 4 weeks or more, constitute clinical red flags that should prompt further imaging. Without these clinical red flags, imaging is likely not indicated. Exceptions include an abnormal neurologic examination or clinical and laboratory findings suggesting an infectious or neoplastic etiology, and when present should prompt immediate imaging. Initial imaging should consist of spine radiographs limited to area of interest, with spine MRI without contrast to evaluate further if needed. CT of the spine, limited to area of interest, and Tc-99m bone scan whole body with single-photon emission computed tomography may be useful in some patients. The addition of intravenous contrast is also recommended for evaluation of a potential neoplastic or infectious process. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.

  View details for DOI 10.1016/j.jacr.2017.01.039

  View details for PubMedID 28473069