Bruno Passebon Soares, MD

All Publications

• Comprehensive segmentation of focal cortical dysplasia by combining surface-based and whole-brain MRI deep learning algorithms: a proof-of-concept study. Biomedical physics & engineering express Kravutske, Y., A Esmeraldo, M., Chambers, S., Reis, E. P., Haider, L., Kasprian, G., Soares, B. P. 2026

  Abstract

  Focal cortical dysplasia type II (FCD II) is a significant cause of drug-resistant epilepsy, and the full surgical resection of the lesion is linked with excellent disease-free outcomes. Its imaging hallmark is the white matter hyperintense funnel-shaped transmantle sign on T2-FLAIR magnetic resonance imaging (MRI). Manual delineation of this abnormality is challenging and inconsistent. Most current artificial intelligence (AI) segmentation tools focus on cortical features and do not fully evaluate the white matter component. We tested whether integrating an algorithm trained on white matter lesions may improve FCD II segmentation. Methods: We evaluated the combination of two AI algorithms, MELD Graph (surface-based FCD segmentation) and MindGlide (whole-brain/white-matter lesion segmentation tool) in 49 FCD cases with a radiologically confirmed transmantle sign. Segmentation accuracy was assessed against expert manual annotations using the Dice similarity coefficient and segmentation volumes. Results: MELD Graph detected the lesion in 31 cases, 22 of which had the transmantle sign included in the expert lesion mask. Among these, MindGlide detected the transmantle sign in eight cases (36%). The mean added Dice score was 0.033 (95% CI, 0.013-0.056). Overall Dice values of MELD Graph were 0.321 and increased to 0.354 with the addition of MindGlide. It also contributed additional lesion volume in these eight cases, ranging from 0.028 to 4.18 cm³, with a mean added volume of 0.77 cm³. Discussion: Despite not being trained on FCD data, MindGlide, when combined with MELD Graph, provided a modest improvement in FCD II segmentation, including the deep white matter component of the lesion that is not captured by MELD Graph.These findings provide preliminary evidence supporting the consideration of a sequential cortical and white matter segmentation approach in FCD II, which may guide further epilepsy-specific AI model development.

  View details for DOI 10.1088/2057-1976/ae3d3e

  View details for PubMedID 41587495

• Prenatal Diagnosis of VLDLR-associated Cerebellar Hypoplasia via Fetal MRI. Neuropediatrics Povlow, M. R., Esmeraldo, M. A., Dahmoush, H. M., Halverson, M. R., Barsh, G. R., Soares, B. P. 2025

  View details for DOI 10.1055/a-2736-4758

  View details for PubMedID 41213595

• Prenatal Diagnosis of ANKLE2-Related Microcephaly Mimicking Zika Infection. Neuropediatrics Barsh, G. R., Smith, C. M., Matalon, D. R., Soares, B. P. 2025

  View details for DOI 10.1055/a-2695-7275

  View details for PubMedID 40940024

• Characterizing pre- and post-operative cerebral blood flow and transit time in pediatric moyamoya patients using multi-delay ASL and DSC MRI. Journal of cerebral blood flow and metabolism : official journal of the International Society of Cerebral Blood Flow and Metabolism Zhao, M. Y., Alexander, S., Lopez, C. A., Zhang, H., Morton, G., Armindo, R. D., Yeom, K. W., Tong, E., Soares, B. P., Lee, S., Moseley, M., Steinberg, G. K. 2025: 271678X251358979

  Abstract

  Cerebral blood flow (CBF) and transit time are essential biomarkers for assessing brain health. While dynamic susceptibility contrast (DSC) MRI has been widely applied to measure these metrics, it is limited in the pediatric population due to the need for contrast agents. Arterial spin labeling is a non-invasive and quantitative MR modality, and multi-delay ASL can measure CBF and transit time simultaneously. Although multi-delay ASL has been used in adult neuroimaging studies, its application in children requires investigation. Moyamoya disease, a progressive steno-occlusive cerebrovascular disorder, often manifests in childhood. In this work, we present a cohort study that examines multi-delay ASL and DSC MRI to characterize vascular hemodynamics in 22 pediatric patients. We evaluate CBF and transit time in different brain regions before and after revascularization surgeries. Results show that revascularization significantly increased CBF by 24% and 7.6%, respectively, as measured by ASL and DSC; it also significantly decreased transit time by 12% and 15%, indicating improved hemodynamics and metabolism. ASL and DSC results also showed significantly positive correlations in all brain regions. Thus, revascularization improved hemodynamics in pediatric moyamoya patients and shows that multi-delay ASL can effectively characterize CBF and transit time in the pediatric population.

  View details for DOI 10.1177/0271678X251358979

  View details for PubMedID 40665679

• Fistulograms for the management of recurrent and atypical congenital neck anomalies. International journal of pediatric otorhinolaryngology Penaranda, D., Qian, J., Hasnie, S., Bertino, F., Soares, B., Dahmoush, H. M., Taufique, Z., Truong, M. T. 2025; 196: 112457

  Abstract

  Fistulous and cystic neck lesions that cannot be categorized into traditional classification schemes at presentation are challenging to manage and often manifest as recurrently draining fistulas after primary surgery. Work up with traditional cross-sectional imaging techniques with computed tomography (CT) or magnetic resonance imaging (MRI) may not provide adequate fine details of small channels. Characterization of fistula tracts is necessary for identification and definitive management of atypical or recurrent congenital neck anomalies.A retrospective review of the electronic medical record from 2 institutions between 2016 and 2023 identifying cases of atypical or recurrent congenital neck anomalies for which CT and MR fistulogram, a novel interventional imaging technique, identified and characterized atypical fistula tracts. Imaging protocol, fistulogram technique, imaging-anatomic correlation, and follow up are reported.We identified 5 patients aged 8-14 years who presented with a draining pit in the head and neck who underwent CT or MRI fistulograms. Diagnoses include first branchial cleft anomalies (n = 3), deep branchial cleft fistula containing ectopic salivary tissue (n = 1), and a recurrent thyroglossal duct cyst (n = 1). Three patients had prior surgery to address these anomalies with recurrences, and one patient had an associated Kabuki syndrome. Complete resection was performed in all cases, with no recurrence to date.CT and MRI fistulograms are minimally invasive, safe, efficacious, and feasible techniques that can be performed before surgery and facilitated on the same day in a single anesthesia encounter. The technique allows for complete visualization of atypical and/or recurrent cystic and fistulous neck anomalies. It facilitates preoperative planning and aids in the characterization of the lesion so that a complete surgical excision can be executed.

  View details for DOI 10.1016/j.ijporl.2025.112457

  View details for PubMedID 40633270

• ACR Appropriateness Criteria® Dementia: 2024 Update. Journal of the American College of Radiology : JACR Soderlund, K. A., Austin, M. J., Ben-Haim, S., Chu, S., Ivanidze, J., Joshi, P., Kalnins, A., Kennedy, M., Kulshreshtha, A., Kuo, P. H., Masdeu, J. C., Nikumbh, T., Soares, B. P., Thaker, A. A., Wang, L. L., Yasar, S., Shih, R. Y. 2025; 22 (5S): S202-S233

  Abstract

  Dementia is defined by significant chronic or acquired impairment in a single domain or loss of two or more cognitive functions by brain disease or injury. It is a common chronic syndrome in adults and constitutes the fifth leading cause of death in patients >65 years of age. Multiple etiologies of dementia exist, most notably Alzheimer disease, frontotemporal dementia, and dementia with Lewy bodies, as well as other neurologic diseases such as vascular dementia and normal pressure hydrocephalus. In addition to aiding clinicians in selecting the most appropriate imaging test for patients suspected of one of these dementia syndromes, this document highlights the most appropriate initial imaging tests for patients with suspected mild cognitive impairment and rapidly progressive dementia, as well as the most appropriate pre- and posttreatment imaging tests for patients undergoing therapy with antiamyloid monoclonal antibodies. 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.2025.02.031

  View details for PubMedID 40409878

• ACR Appropriateness Criteria® Brain Tumors. Journal of the American College of Radiology : JACR Ivanidze, J., Shih, R. Y., Utukuri, P. S., Ajam, A. A., Auron, M., Chang, S. M., Jordan, J. T., Kalnins, A., Kuo, P. H., Ledbetter, L. N., Pannell, J. S., Pollock, J. M., Sheehan, J., Soares, B. P., Soderlund, K. A., Wang, L. L., Burns, J. 2025; 22 (5S): S108-S135

  Abstract

  Brain tumors represent a complex and clinically diverse disease group, whose management is particularly dependent on neuroimaging given the wide range of differential diagnostic considerations and clinical scenarios. The introduction of advanced brain imaging tools into clinical practice makes it paramount for all treating physicians to recognize the range and understand the appropriate application of various conventional and advanced imaging modalities. The imaging recommendations for neuro-oncologic clinical scenarios involving screening in patients with increased genetic risk, screening in patients with systemic malignancy, pretreatment evaluation in patients with intra- and extraaxial brain tumors, posttreatment-surveillance in patients with known brain tumors after completion of therapy, and subsequent workup in the context of suspected radiographic progression are encompassed by this document. 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.2025.02.036

  View details for PubMedID 40409872

• ACR Appropriateness Criteria® Altered Mental Status, Coma, Delirium, and Psychosis: 2024 Update. Journal of the American College of Radiology : JACR Soares, B. P., Shih, R. Y., Utukuri, P. S., Adamson, M., Austin, M. J., Brown, R. K., Burns, J., Cacic, K., Chu, S., Crone, C., Ivanidze, J., Jackson, C. D., Kalnins, A., Potter, C. A., Rosen, S., Soderlund, K. A., Thaker, A. A., Wang, L. L., Policeni, B. 2024; 21 (11S): S372-S383

  Abstract

  Altered mental status (AMS) and coma are terms used to describe disorders of arousal and content of consciousness. AMS may account for up to 4% to 10% of chief complaints in the emergency department setting and is a common accompanying symptom for other presentations. AMS is not a diagnosis, but rather a term for symptoms of acute or chronic disordered mentation, including confusion, disorientation, lethargy, drowsiness, somnolence, unresponsiveness, agitation, altered behavior, inattention, hallucinations, delusions, and psychosis. Some of the most common disorders associated with AMS are underlying medical conditions, substance use, and mental disorders. This document focuses on the appropriateness of neuroimaging in adult patients presenting with AMS changes including new onset delirium or new onset psychosis. In these cases, imaging is often expedited for initial stabilization and to exclude an intracranial process requiring intervention. 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.2024.08.018

  View details for PubMedID 39488349

• Response assessment in pediatric neurooncology (RAPNO) criteria revisited: a practical navigation guide for neuroradiologists. Neuroradiology Geraldo, A. F., Maldonado, F., Severino, M., Mankad, K., Dahmoush, H., Soares, B., Rugilo, C., Rossi, A. 2024

  Abstract

  The Response Assessment in Pediatric Neuro-Oncology (RAPNO) Working Group is an international, collaborative network of experts dedicated to pediatric central nervous system (CNS) tumors that was created in 2011. Since then, six RAPNO articles with imaging guidelines for response assessment in diverse pediatric tumor subgroups have been published, namely: 1) medulloblastomas and leptomeningeal seeding tumors (2018), 2) pediatric high-grade gliomas (2020), 3) pediatric low-grade gliomas (2020), 4) diffuse intrinsic pontine gliomas (2020), 5) pediatric intracranial ependymomas (2022) and 6) pediatric craniopharyngiomas (2023). The purpose of this article is to review all current available RAPNO criteria using a systematized and comparative approach centered on the role of neuroradiologists and supported by neuroimaging examples. Special emphasis will be placed on clarification of core concepts as well as practical adoption aspects of the RAPNO guidelines, namely how and when to image the brain and/or the spine; how to interpret the imaging findings; which other clinical, therapeutic and laboratory variables to consider; and finally how to apply the information to attribute the final appropriate response assessment classification.

  View details for DOI 10.1007/s00234-024-03493-x

  View details for PubMedID 39446196

• Brain Magnetic Resonance Imaging of Neonatal Hypoglycemia: Assessing Injury Extent and Potential Cause. Neuropediatrics Alvi, Z., Dahmoush, H. M., Soares, B. P. 2024

  View details for DOI 10.1055/s-0044-1788975

  View details for PubMedID 39134034

• ACR Appropriateness Criteria® Cerebrovascular Diseases-Stroke and Stroke-Related Conditions. Journal of the American College of Radiology : JACR Pannell, J. S., Corey, A. S., Shih, R. Y., Austin, M. J., Chu, S., Davis, M. A., Ducruet, A. F., Hunt, C. H., Ivanidze, J., Kalnins, A., Lacy, M. E., Lo, B. M., Setzen, G., Shaines, M. D., Soares, B. P., Soderlund, K. A., Thaker, A. A., Wang, L. L., Burns, J. 2024; 21 (6S): S21-S64

  Abstract

  Cerebrovascular disease encompasses a vast array of conditions. The imaging recommendations for stroke-related conditions involving noninflammatory steno-occlusive arterial and venous cerebrovascular disease including carotid stenosis, carotid dissection, intracranial large vessel occlusion, and cerebral venous sinus thrombosis are encompassed by this document. Additional imaging recommendations regarding complications of these conditions including intraparenchymal hemorrhage and completed ischemic strokes are also discussed. 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.2024.02.015

  View details for PubMedID 38823945

• ACR Appropriateness Criteria<SUP>®</SUP> Dizziness and Ataxia: 2023 Update JOURNAL OF THE AMERICAN COLLEGE OF RADIOLOGY Wang, L. L., Thompson, T. A., Shih, R. Y., Ajam, A. A., Bulsara, K., Burns, J., Davis, M. A., Ivanidze, J., Kalnins, A., Kuo, P. H., Ledbetter, L. N., Pannell, J. S., Pollock, J. M., Shakkottai, V. G., Shih, R. D., Soares, B. P., Soderlund, K. A., Utukuri, P. S., Woolsey, S., Policeni, B., Expert Panel Neurological Imaging 2024; 21 (6): S100-S125

  Abstract

  Diagnostic evaluation of a patient with dizziness or vertigo is complicated by a lack of standardized nomenclature, significant overlap in symptom descriptions, and the subjective nature of the patient's symptoms. Although dizziness is an imprecise term often used by patients to describe a feeling of being off-balance, in many cases dizziness can be subcategorized based on symptomatology as vertigo (false sense of motion or spinning), disequilibrium (imbalance with gait instability), presyncope (nearly fainting or blacking out), or lightheadedness (nonspecific). As such, current diagnostic paradigms focus on timing, triggers, and associated symptoms rather than subjective descriptions of dizziness type. Regardless, these factors complicate the selection of appropriate diagnostic imaging in patients presenting with dizziness or vertigo. This document serves to aid providers in this selection by using a framework of definable clinical variants. 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.2024.02.018

  View details for Web of Science ID 001302055100006

  View details for PubMedID 38823940

• 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

• Arch and Great Vessel Geometry From a Transradial Angiographic Approach. Stroke (Hoboken, N.J.) Zerebiec, K. W., Heidari, P., D'Agostino, E., Soares, B. P., Johnson, D. M., Raymond, S. B. 2023; 3 (1): e000470

  Abstract

  Neuroendovascular practices are transitioning from transfemoral to a radial-first approach for cerebral angiography. Developing radial-specific devices requires a comprehensive understanding of vessel size and geometry encountered from a right radial approach. We developed a database of aortic arch and vessel measurements relevant for radial-specific device development.The database contained 100 consecutive neck computed tomographic angiograms conducted on a 256-slice emergency department computed tomographic scanner. Arch characteristics and measurements obtained from 1-cm maximum intensity projection reformats included arch type and diameter, bifurcation angles, and distances from the arch to vessel origins. Statistical analysis was conducted using Excel and R.The database contained 56 female and 44 male patients; the average age was 62 years. A total of 46% had type 2 or 3 arch configuration, 19% had bovine configuration, and 5% had a left vertebral artery originating directly from the arch. Median angles at the arch from the innominate ranged from 20° to 47° and at branch vessels from 16° to 63° with large variation. The left carotid bifurcation was ≈8 cm further than the right carotid bifurcation. The left vertebral artery origin was median 3.8 cm from the arch.We cataloged aortic arch and vessel geometries that have implications for catheter and device performance from a transradial approach. For example, a standard guide catheter that is adequate length for the right anterior circulation must be at least 8 cm longer for comparable distal support on the left because of the difference in distance from the right to the left. Catheter tip shape may be further optimized to improve vessel selection. Currently used catheters make a reverse curve angle of ≈15°, although most great vessels are at between 15° and 45°. Finally, the length of the distal arm of reverse curve catheters is just >4 cm, frequently inadequate to easily reach the left vertebral artery origin (median distance, 3.8 cm in this study). Transradial devices should be developed with these constraints in mind. This database provides benchmarks for future catheter design.

  View details for DOI 10.1161/SVIN.122.000470

  View details for PubMedID 41585747

  View details for PubMedCentralID PMC12778588

• Alteration of brain function and systemic inflammatory tone in older adults by decreasing the dietary palmitic acid intake AGING BRAIN Dumas, J. A., Bunn, J. Y., Lamantia, M. A., Mcisaac, C., Miller, A., Nop, O., Testo, A., Soares, B. P., Mank, M. M., Poynter, M. E., Kien, C. 2023; 3: 100072

  Abstract

  Prior studies in younger adults showed that reducing the normally high intake of the saturated fatty acid, palmitic acid (PA), in the North American diet by replacing it with the monounsaturated fatty acid, oleic acid (OA), decreased blood concentrations and secretion by peripheral blood mononuclear cells (PBMCs) of interleukin (IL)-1β and IL-6 and changed brain activation in regions of the working memory network. We examined the effects of these fatty acid manipulations in the diet of older adults. Ten subjects, aged 65-75 years, participated in a randomized, cross-over trial comparing 1-week high PA versus low PA/high OA diets. We evaluated functional magnetic resonance imaging (fMRI) using an N-back test of working memory and a resting state scan, cytokine secretion by lipopolysaccharide (LPS)-stimulated PBMCs, and plasma cytokine concentrations. During the low PA compared to the high PA diet, we observed increased activation for the 2-back minus 0-back conditions in the right dorsolateral prefrontal cortex (Broadman Area (BA) 9; p < 0.005), but the effect of diet on working memory performance was not significant (p = 0.09). We observed increased connectivity between anterior regions of the salience network during the low PA/high OA diet (p < 0.001). The concentrations of IL-1β (p = 0.026), IL-8 (p = 0.013), and IL-6 (p = 0.009) in conditioned media from LPS-stimulated PBMCs were lower during the low PA/high OA diet. This study suggests that lowering the dietary intake of PA down-regulated pro-inflammatory cytokine secretion and altered working memory, task-based activation and resting state functional connectivity in older adults.

  View details for DOI 10.1016/j.nbas.2023.100072

  View details for Web of Science ID 001134552400001

  View details for PubMedID 37408793

  View details for PubMedCentralID PMC10318304

• Arch and Great Vessel Geometry From a Transradial Angiographic Approach STROKE-VASCULAR AND INTERVENTIONAL NEUROLOGY Zerebiec, K. W., Heidari, P., D'Agostino, E., Soares, B. P., Johnson, D. M., Raymond, S. B. 2023; 3 (1)

  View details for DOI 10.1161/SVIN.122.000470

  View details for Web of Science ID 001157345000011

• Neurosarcoidosis: Phenotypes, Approach to Diagnosis and Treatment CURRENT RHEUMATOLOGY REPORTS Gosselin, J., Roy-Hewitson, C., Bullis, S. S. M., DeWitt, J. C., Soares, B. P., Dasari, S., Nevares, A. 2022; 24 (12): 371-382

  Abstract

  The aim of this review is to provide an update of clinical presentation, diagnosis, differential diagnoses, and treatment according to recent evidence.Neurosarcoidosis remains a diagnosis of exclusion, with infectious and malignant etiologies recognized as important mimickers. Corticosteroids remain as first-line therapy. In recent years, however, studies have demonstrated the effectiveness of anti-tumor necrosis factor (anti-TNF) therapy in the treatment of neurosarcoidosis, leading to improved outcomes. Neurosarcoidosis is a granulomatous disease with protean manifestations that may affect any part of the central and peripheral nervous system. It has many mimickers, and potentially devastating complications necessitating long-term follow-up. Early initiation of treatment, particularly with anti-TNF therapy, may lead to better outcomes and fewer relapses. There is an unmet need for randomized controlled trials that provide robust data to guide therapy and the long-term management of neurosarcoidosis patients.

  View details for DOI 10.1007/s11926-022-01089-z

  View details for Web of Science ID 000866317500001

  View details for PubMedID 36223002

  View details for PubMedCentralID 6114796

• Development of a composite diffusion tensor imaging score correlating with short-term neurological status in neonatal hypoxic-ischemic encephalopathy FRONTIERS IN NEUROSCIENCE Onda, K., Catenaccio, E., Chotiyanonta, J., Chavez-Valdez, R., Meoded, A., Soares, B. P., Tekes, A., Spahic, H., Miller, S. C., Parker, S., Parkinson, C., Vaidya, D. M., Graham, E. M., Stafstrom, C. E., Everett, A. D., Northington, F. J., Oishi, K. 2022; 16: 931360

  Abstract

  Hypoxic-ischemic encephalopathy (HIE) is the most common cause of neonatal acquired brain injury. Although conventional MRI may predict neurodevelopmental outcomes, accurate prognostication remains difficult. As diffusion tensor imaging (DTI) may provide an additional diagnostic and prognostic value over conventional MRI, we aimed to develop a composite DTI (cDTI) score to relate to short-term neurological function. Sixty prospective neonates treated with therapeutic hypothermia (TH) for HIE were evaluated with DTI, with a voxel size of 1 × 1 × 2 mm. Fractional anisotropy (FA) and mean diffusivity (MD) from 100 neuroanatomical regions (FA/MD *100 = 200 DTI parameters in total) were quantified using an atlas-based image parcellation technique. A least absolute shrinkage and selection operator (LASSO) regression was applied to the DTI parameters to generate the cDTI score. Time to full oral nutrition [short-term oral feeding (STO) score] was used as a measure of short-term neurological function and was correlated with extracted DTI features. Seventeen DTI parameters were selected with LASSO and built into the final unbiased regression model. The selected factors included FA or MD values of the limbic structures, the corticospinal tract, and the frontotemporal cortices. While the cDTI score strongly correlated with the STO score (rho = 0.83, p = 2.8 × 10-16), it only weakly correlated with the Sarnat score (rho = 0.27, p = 0.035) and moderately with the NICHD-NRN neuroimaging score (rho = 0.43, p = 6.6 × 10-04). In contrast to the cDTI score, the NICHD-NRN score only moderately correlated with the STO score (rho = 0.37, p = 0.0037). Using a mixed-model analysis, interleukin-10 at admission to the NICU (p = 1.5 × 10-13) and tau protein at the end of TH/rewarming (p = 0.036) and after rewarming (p = 0.0015) were significantly associated with higher cDTI scores, suggesting that high cDTI scores were related to the intensity of the early inflammatory response and the severity of neuronal impairment after TH. In conclusion, a data-driven unbiased approach was applied to identify anatomical structures associated with some aspects of neurological function of HIE neonates after cooling and to build a cDTI score, which was correlated with the severity of short-term neurological functions.

  View details for DOI 10.3389/fnins.2022.931360

  View details for Web of Science ID 000841009900001

  View details for PubMedID 35983227

  View details for PubMedCentralID PMC9379310

• MOG Antibody Disease Presenting as Multiphasic Disseminated Encephalomyelitis NEUROPEDIATRICS Nguyen, K., Bazylewicz, M. P., Soares, B. P. 2022; 53 (04): 303-304

  View details for DOI 10.1055/a-1784-0219

  View details for Web of Science ID 000822577500001

  View details for PubMedID 35231947

• 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

• Wavelet Autoregulation Monitoring Identifies Blood Pressures Associated With Brain Injury in Neonatal Hypoxic-Ischemic Encephalopathy FRONTIERS IN NEUROLOGY Liu, X., Tekes, A., Perin, J., Chen, M. W., Soares, B. P., Massaro, A. N., Govindan, R. B., Parkinson, C., Chavez-Valdez, R., Northington, F. J., Brady, K. M., Lee, J. K. 2021; 12: 662839

  Abstract

  Dysfunctional cerebrovascular autoregulation may contribute to neurologic injury in neonatal hypoxic-ischemic encephalopathy (HIE). Identifying the optimal mean arterial blood pressure (MAPopt) that best supports autoregulation could help identify hemodynamic goals that support neurologic recovery. In neonates who received therapeutic hypothermia for HIE, we hypothesized that the wavelet hemoglobin volume index (wHVx) would identify MAPopt and that blood pressures closer to MAPopt would be associated with less brain injury on MRI. We also tested a correlation-derived hemoglobin volume index (HVx) and single- and multi-window data processing methodology. Autoregulation was monitored in consecutive 3-h periods using near infrared spectroscopy in an observational study. The neonates had a mean MAP of 54 mmHg (standard deviation: 9) during hypothermia. Greater blood pressure above the MAPopt from single-window wHVx was associated with less injury in the paracentral gyri (p = 0.044; n = 63), basal ganglia (p = 0.015), thalamus (p = 0.013), and brainstem (p = 0.041) after adjustments for sex, vasopressor use, seizures, arterial carbon dioxide level, and a perinatal insult score. Blood pressure exceeding MAPopt from the multi-window, correlation HVx was associated with less injury in the brainstem (p = 0.021) but not in other brain regions. We conclude that applying wavelet methodology to short autoregulation monitoring periods may improve the identification of MAPopt values that are associated with brain injury. Having blood pressure above MAPopt with an upper MAP of ~50-60 mmHg may reduce the risk of brain injury during therapeutic hypothermia. Though a cause-and-effect relationship cannot be inferred, the data support the need for randomized studies of autoregulation and brain injury in neonates with HIE.

  View details for DOI 10.3389/fneur.2021.662839

  View details for Web of Science ID 000649102300001

  View details for PubMedID 33995258

  View details for PubMedCentralID PMC8113412

• Neurocutaneous Melanosis: Prenatal Presentation as a Posterior Fossa Cyst NEUROPEDIATRICS East, J. E., Soares, B. P. 2021; 52 (06): 504-505

  View details for DOI 10.1055/s-0040-1722676

  View details for Web of Science ID 000607582700003

  View details for PubMedID 33445188

• 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

• Pediatric Posterior Fossa Medulloblastoma: The Role of Diffusion Imaging in Identifying Molecular Groups JOURNAL OF NEUROIMAGING Reddy, N., Ellison, D. W., Soares, B. P., Carson, K. A., Huisman, T. M., Patay, Z. 2020; 30 (4): 503-511

  Abstract

  The molecular groups WNT activated (WNT), Sonic hedgehog activated (SHH), group 3, and group 4 are biologically and clinically distinct forms of medulloblastoma. We evaluated apparent diffusion coefficient (ADC) values' utility in differentiating/predicting medulloblastoma groups at the initial diagnostic imaging evaluation and prior to surgery.We retrospectively measured the ADC values of the enhancing, solid portion of the tumor (EST) and of the whole tumor (WT) and performed Kruskal-Wallis testing to compare the absolute tumor ADC values and cerebellar and thalamic ratios of three medulloblastoma groups (WNT, SHH, and group 3/group 4 combined).Ninety-three children (65 males) were included. Fifty-seven children had group 3/group 4, 27 had SHH, and 9 had WNT medulloblastomas. The median absolute ADC values in the EST and WT were .719 × 10-3 and .864 × 10-3 mm2 /s for group 3/group 4; .660 × 10-3 and .965 × 10-3 mm2 /s for SHH; and .594 × 10-3 and .728 × 10-3 mm2 /s for WNT medulloblastomas (P = .02 and .13). The median ratio of ADC values in the EST or the WT to normal cerebellar tissue was highest for group 3/group 4 and lowest for WNT medulloblastomas (P = .03 and .09), with similar results in pairwise comparisons of the corresponding thalamic ADC values (P = .02 and .06).ADC analysis of a tumor's contrast-enhancing solid portion may aid preoperative molecular classification/prediction of pediatric medulloblastomas and may facilitate optimal surgical treatment planning, reducing surgery-induced morbidity.

  View details for DOI 10.1111/jon.12704

  View details for Web of Science ID 000539620000001

  View details for PubMedID 32529709

• 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

• Early neurodevelopmental outcome in preterm posthemorrhagic ventricular dilatation and hydrocephalus: Neonatal ICU Network Neurobehavioral Scale and imaging predict 3-6-month motor quotients and Capute Scales JOURNAL OF NEUROSURGERY-PEDIATRICS Dorner, R. A., Allen, M. C., Robinson, S., Soares, B. P., Perin, J., Ramos, E., Gerner, G., Burton, V. 2020; 25 (3): 217-227

  Abstract

  Brain injury remains a serious complication of prematurity. Almost half of infants with severe intraventricular hemorrhage (IVH) develop posthemorrhagic ventricular dilatation (PHVD) and 20% need surgery for posthemorrhagic hydrocephalus (PHH). This population is associated with an increased risk of later neurodevelopmental disability, but there is uncertainty about which radiological and examination features predict later disability. In this study the authors sought to devise and describe a novel combination of neurobehavioral examination and imaging for prediction of neurodevelopmental disability among preterm infants with PHVD and PHH.The study patients were preterm infants (< 36 weeks gestation) with IVH and PHVD, with or without PHH. Ventricular index (VI), anterior horn width (AHW), thalamooccipital distance (TOD), ventricle/brain (V/B) ratio, and resistive indices (RIs) were recorded on the head ultrasound (HUS) just prior to surgery, or the HUS capturing the worst PHVD when surgery was not indicated. The posterior fossa was assessed with MRI. Neonatal ICU Network Neurobehavioral Scale (NNNS) examinations were performed at term age equivalent for each infant. A neurodevelopmental assessment using the Capute Scales (Capute Cognitive Adaptive Test [CAT] scores and Capute Clinical Linguistic Auditory Milestone Scale [CLAMS] scores) and a motor quotient (MQ) assessment were performed between 3 and 6 months of age corrected for degree of prematurity (corrected age). MQs < 50 reflect moderate to severe delays in early motor milestone attainment, CAT scores < 85 reflect delays in early visual and problem-solving abilities, and CLAMS scores < 85 reflect delays in early language.Twenty-one infants underwent assessments that included imaging and NNNS examinations, Capute Scales assessments, and MQs. NNNS nonoptimal reflexes (NOR) and hypertonicity subscores and AHW were associated with MQs < 50: NOR subscore OR 2.46 (95% CI 1.15-37.6, p = 0.034), hypertonicity subscore OR 1.68 (95% CI 1.04-3.78, p = 0.037), and AHW OR 1.13 (95% CI 1.01-1.39, p = 0.041). PVHI, cystic changes, and neurosurgical intervention were associated with CAT scores < 85: PVHI OR 9.2 (95% CI 1.2-73.2, p = 0.037); cystic changes OR 12.0 (95% CI 1.0-141.3, p = 0.048), and neurosurgical intervention OR 11.2 (95% CI 1.0-120.4, p = 0.046). Every 1-SD increase in the NOR subscore was associated with an increase in odds of a CAT score < 85, OR 4.0 (95% CI 1.0-15.0, p = 0.044). Worse NNNS NOR subscores were associated with early language delay: for a 1-SD increase in NOR subscore, there was an increase in the odds of a CLAMS score < 85, OR 19.5 (95% CI 1.3-303, p = 0.034).In former preterm children with severe IVH and PHVD, neonatal neurological examination findings and imaging features are associated with delays at 3-6 months in motor milestones, visual and problem-solving abilities, and language.

  View details for DOI 10.3171/2019.9.PEDS19438

  View details for Web of Science ID 000518390100003

  View details for PubMedID 31860810

  View details for PubMedCentralID PMC7305038

• Meet in the middle: a technique for resecting nasocranial dermoids-technical note and review of the literature CHILDS NERVOUS SYSTEM Hidalgo, J., Redett, R. J., Soares, B. P., Cohen, A. R. 2020; 36 (3): 477-484

  Abstract

  Nasal dermoids with intracranial extension are benign lesions that can have life-threatening consequences, as a nasal punctum may serve as a portal of entry for infection into the central nervous system. The surgical management of these lesions can be challenging, as the extracranial and intracranial cysts and sinus tract must be resected to prevent recurrence, and the surgery must be carried out with an acceptable esthetic result.The authors present a technique for the resection of nasocranial dermoids that eliminates the need to remove and replace the frontonasal segment. Working through a small frontal craniotomy enables the surgeon to drill out the sinus tract through the foramen cecum and inferiorly into the nose. This exposure eliminates the need to enter the frontal sinus, if it is present.The extracranial punctum and tract are resected from below in a minimally invasive fashion that permits removal of the lesion without a disfiguring scar.

  View details for DOI 10.1007/s00381-020-04499-5

  View details for Web of Science ID 000514537800006

  View details for PubMedID 31925508

• Peering Into Peer Review: <i>AJR</i> Neuroradiology Reviewers Discuss Their Approaches to Assessing a Manuscript AMERICAN JOURNAL OF ROENTGENOLOGY Provenzale, J. M., Buch, K., Filippi, C. G., Gaskill-Shipley, M., Hacein-Bey, L., Soares, B. P. 2020; 214 (1): 45-49

  Abstract

  OBJECTIVE. This article provides comments from a small group of highly qualified reviewers of the American Journal of Roentgenology (AJR) regarding their approach to assessing manuscripts. The objective is to educate authors about the issues to which reviewers particularly attend and about errors that will decrease the likelihood of publication. CONCLUSION. By following the advice provided in this article, authors should be able to compose better manuscripts and reviewers should be able to generate better reviews.

  View details for DOI 10.2214/AJR.19.21999

  View details for Web of Science ID 000503833500018

  View details for PubMedID 31670589

• Congenital Oral Masses: An Anatomic Approach to Diagnosis RADIOGRAPHICS Chapman, M. C., Soares, B. P., Li, Y., Shum, D. J., Glenn, O. A., Glastonbury, C. M., Courtier, J. L. 2019; 39 (4): 1143-1160

  Abstract

  Although congenital oral masses are rare, they are readily detectable during fetal US screening. Most congenital oral masses are benign, but some may cause mechanical airway obstruction, resulting in poor outcomes at delivery. The radiologist's ability to describe these abnormalities and their physiologic sequelae accurately can have a substantial effect on perinatal treatment. Furthermore, despite being rare, congenital oral lesions encountered at screening and at follow up fetal MRI provide the opportunity to make a specific diagnosis by following a simple anatomic approach. This article describes an anatomic algorithm as the framework for accurate diagnosis of congenital oral lesions. The imaging appearance of the most common congenital oral cavity neoplasms is outlined, including vascular anomalies, epulides, choristomas, congenital lingual thyroid anomalies, lingual hamartomas, and epignathi, and other conditions that mimic these at US. Also reviewed are perinatal management of masses that affect the fetal airway and the imaging features key to optimizing delivery outcomes. Online supplemental material is available for this article. ©RSNA, 2019.

  View details for DOI 10.1148/rg.2019180128

  View details for Web of Science ID 000474437100017

  View details for PubMedID 31283464

• ACR Appropriateness Criteria® Scoliosis-Child JOURNAL OF THE AMERICAN COLLEGE OF RADIOLOGY Jones, J. Y., Saigal, G., Palasis, S., Booth, T. N., Hayes, L. L., Iyer, R. S., Kadom, N., V. Kulkarni, A., Milla, S. S., Myseros, J. S., Reitman, C., Robertson, R. L., Ryan, M. E., Schulz, J., Soares, B. P., Tekes, A., Trout, A. T., Karmazyn, B., Expert Panel Pediat Imaging 2019; 16 (5): S244-S251

  Abstract

  Scoliosis is frequently encountered in childhood, with prevalence of 2%. The majority is idiopathic, without vertebral segmentation anomaly, dysraphism, neuromuscular abnormality, skeletal dysplasia, tumor, or infection. As a complement to clinical assessment, radiography is the primary imaging modality used to classify scoliosis and subsequently monitor its progression and response to treatment. MRI is utilized selectively to assess for neural axis abnormalities in those at higher risk, including those with congenital scoliosis, early onset idiopathic scoliosis, and adolescent idiopathic scoliosis with certain risk factors. CT, although not routinely employed in the initial evaluation of scoliosis, may have a select role in characterizing the bone anomalies of congenital scoliosis and in perioperative planning. 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.2019.02.018

  View details for Web of Science ID 001602835000023

  View details for PubMedID 31054751

• ACR Appropriateness Criteria® Suspected Spine Trauma-Child JOURNAL OF THE AMERICAN COLLEGE OF RADIOLOGY Kadom, N., Palasis, S., Pruthi, S., Bif, W. L., Booth, T. N., Desai, N. K., Falcone Jr, R. A., Jones, J. Y., Joseph, M. M., Kulkarni, A. V., Marin, J. R., Milla, S. S., Mirsky, D. M., Myseros, J. S., Reitman, C., Robertson, R. L., Ryan, M. E., Saigal, G., Schulz, J., Soares, B. P., Tekes, A., Trout, A. T., Whitehead, M. T., Karmazyn, B., Expert Panel Pediat Imaging 2019; 16 (5): S286-S299

  Abstract

  Choosing the appropriate imaging in children with accidental traumatic spine injuries can be challenging because the recommendations based on scientific evidence at this time differ from those applied in adults. This differentiation is due in part to differences in anatomy and physiology of the developing spine. This publication uses scientific evidence and a panel of pediatric experts to summarize best current imaging practices for children with accidental spine trauma. 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.2019.02.003

  View details for Web of Science ID 001602835000026

  View details for PubMedID 31054755

• The Relationship Between Clinical Imaging and Neurobehavioral Assessment in Posthemorrhagic Ventricular Dilation of Prematurity FRONTIERS IN PHYSIOLOGY Dorner, R. A., Soares, B. P., Robinson, S., Allen, M. C., Perin, J., Burton, V. 2019; 10: 64

  Abstract

  Introduction: Neonatal intraventricular hemorrhage (IVH) and subsequent posthemorrhagic ventricular dilation and hydrocephalus of prematurity are associated with brain injury and neurodevelopmental impairment in the preterm population. Neuroimaging assesses cerebral injury and guides neurosurgical intervention; however, the relationship of head ultrasound (HUS) and magnetic resonance imaging (MRI) parameters to neonatal exams in this group has not been well described. The NICU Network Neurobehavioral Scale (NNNS) is a reproducible, highly reliable battery with motor and cognitive domain scores. Objective: To evaluate the relationship between neonatal neurobehavioral findings on the NNNS and measures of ventricular dilation and associated brain injury on HUS and MRI. Materials and Methods: Neonates with IVH and ventricular dilatation with and without posthemorrhagic hydrocephalus were enrolled. NNNS exams were performed at approximately term age equivalent. HUS indices were measured on the last HUS before initial neurosurgical procedure or that with worst ventriculomegaly if no intervention. The posterior fossa was assessed with MRI at term. Descriptive statistics including medians, interquartile ranges, means, and percentages were performed. Correlations were estimated using Pearson's method. Results: 28 patients had NNNS and HUS, and 18 patients also had an MRI. Ventricle size measures for the cohort were significantly above normal. Motor and cognitive subscores on the NNNS exam varied from established baseline scores for postmenstrual age. Children who required neurosurgical intervention had higher ventricle/brain ratios and worse NNNS habituation scores. Ventricle sizes were modestly correlated with motor abnormalities (0.24-0.59); larger anterior horn width correlated with nonoptimal reflexes, hypertonicity and hypotonicity. Ventricle sizes were modestly correlated with cognitive scores (-0.44 to 0.27); larger ventricular index correlated with worse attention. Periventricular hemorrhagic infarction correlated with worse habituation. Conclusion: For this cohort of preterm infants with IVH, surgical intervention for posthemorrhagic hydrocephalus correlated with both larger degrees of ventriculomegaly and worse NNNS exams. Findings on both HUS and MRI correlated with motor and cognitive abnormalities on neonatal neurobehavioral exam, suggesting that larger neonatal ventricle sizes and white matter injury have detectable correlates on exam. The NNNS exam provides important additional information when assessing posthemorrhagic ventricular dilation and hydrocephalus of prematurity.

  View details for DOI 10.3389/fphys.2019.00064

  View details for Web of Science ID 000458264100001

  View details for PubMedID 30804803

  View details for PubMedCentralID PMC6378306

• Cerebral Diffusivity Changes in Fetuses with Chiari II Malformation FETAL DIAGNOSIS AND THERAPY Shrot, S., Soares, B. P., Whitehead, M. T. 2019; 45 (4): 268-274

  Abstract

  Chiari II malformation is a congenital abnormality characterized by a small posterior fossa with downward displacement of the hindbrain into the foramen magnum. Diffusion-weighted imaging (DWI) can be used to quantitatively characterize brain injury and physiological maturation. We aim to evaluate DWI parameters of the infra- and supratentorial brain in fetuses with Chiari II malformation.MRI and US studies of 26 fetuses with Chiari II malformation and 15 controls were evaluated for the presence/severity of hydrocephalus, myelomeningocele level, and brain apparent diffusion coefficient (ADC) values. Cerebral flow impedance parameters (resistance and pulsatile indexes, resistance index [RI], and pulsatility index [PI] respectively) from concurrently preformed fetal US were also evaluated.Of the Chiari II group, 16 fetuses had hydrocephalus. There was increasing severity of lateral ventriculomegaly in the high compared to low spinal dysraphism subgroups. There were significant lower ADC values in the frontal (p = 0.01) and temporal lobes (p = 0.05) in Chiari II group compared with normal, regardless of the presence or severity of hydrocephalus. Fetuses with Chiari II showed significantly lower RI and PI values.Abnormal ADC values indicate supratentorial microstructural changes in fetuses with Chiari II malformation. Further investigation of the role of diffusion imaging metrics in evaluating abnormal brain development, parenchymal damage and efficacy of fetal surgery is needed.

  View details for DOI 10.1159/000490102

  View details for Web of Science ID 000464377100008

  View details for PubMedID 30121678

• Preschool Language Outcomes following Perinatal Hypoxic-Ischemic Encephalopathy in the Age of Therapeutic Hypothermia Chin, E. M., Jayakumar, S., Ramos, E., Gerner, G., Soares, B. P., Cristofalo, E., Leppert, M., Allen, M., Parkinson, C., Johnston, M., Northington, F., Burton, V. KARGER. 2019: 627-637

  Abstract

  Early studies following perinatal hypoxic-ischemic encephalopathy (HIE) suggested expressive language deficits and academic difficulties, but there is only limited detailed study of language development in this population since the widespread adoption of therapeutic hypothermia (TH). Expressive and receptive language testing was performed as part of a larger battery with 45 children with a mean age of 26 months following perinatal HIE treated with TH. Overall cohort outcomes as well as the effects of gender, estimated household income, initial pH and base excess, and pattern of injury on neonatal brain MRI were assessed. The cohort overall demonstrated expressive language subscore, visual-reception subscore, and early learning composite scores significantly below test norms, with relative sparing of receptive language subscores. Poorer expressive language manifested as decreased vocabulary size and shorter utterances. Expressive language subscores showed a significant gender effect, and estimated socioeconomic status showed a significant effect on both receptive and expressive language subscores. Initial blood gas markers and modified Sarnat scoring did not show a significant effect on language subscores. Binarized MRI abnormality predicted a significant effect on both receptive and expressive language subscores; the presence of specific cortical/subcortical abnormalities predicted receptive language deficits. Overall, the language development profile of children following HIE in the era of hypothermia shows a relative strength in receptive language. Gender and socioeconomic status predominantly predict expressive language deficits; abnormalities detectable on MRI predominantly predict receptive language deficits.

  View details for DOI 10.1159/000499562

  View details for Web of Science ID 000477586900020

  View details for PubMedID 31167188

  View details for PubMedCentralID PMC6893079

• Use of gadolinium contrast agents in paediatric population: Donald Rumsfeld meets Hippocrates! BRITISH JOURNAL OF RADIOLOGY Shah, R., D'Arco, F., Soares, B., Cooper, J., Brierley, J. 2019; 92 (1094): 20180746

  Abstract

  Gadolinium is a contrast agent that is used in MRI. There is new evidence that gadolinium accumulates in a patient's body and the effects of this accumulation is unknown. This has resulted in different advice being given by European Medicine Agency and U.S. Food and Drug Administration. The European Medicine Agency recommended stopping the use of linear Gadolinium agents (requiring more proof of safety) while the Food and Drug Administration continues to permit its use (requiring more proof of harm). Gadolinium should be used if deemed clinically necessary. Children and parents should be informed of the benefits and potential harm of using gadolinium-based contrast. It is up for debate whether those imaged before with gadolinium will benefit from being informed of new evidence.

  View details for DOI 10.1259/bjr.20180746

  View details for Web of Science ID 000456614000039

  View details for PubMedID 30412428

  View details for PubMedCentralID PMC6404820

• The Rare Neurocutaneous Disorders: Update on Clinical, Molecular, and Neuroimaging Features. Topics in magnetic resonance imaging : TMRI Barros, F. S., Marussi, V. H., Amaral, L. L., da Rocha, A. J., Campos, C. M., Freitas, L. F., Huisman, T. A., Soares, B. P. 2018; 27 (6): 433-462

  Abstract

  Phakomatoses, also known as neurocutaneous disorders, comprise a vast number of entities that predominantly affect structures originated from the ectoderm such as the central nervous system and the skin, but also the mesoderm, particularly the vascular system. Extensive literature exists about the most common phakomatoses, namely neurofibromatosis, tuberous sclerosis, von Hippel-Lindau and Sturge-Weber syndrome. However, recent developments in the understanding of the molecular underpinnings of less common phakomatoses have sparked interest in these disorders. In this article, we review the clinical features, current pathogenesis, and modern neuroimaging findings of melanophakomatoses, vascular phakomatoses, and other rare neurocutaneous syndromes that may also include tissue overgrowth or neoplastic predisposition.

  View details for DOI 10.1097/RMR.0000000000000185

  View details for PubMedID 30516694

• Thalamic and dentate nucleus abnormalities in the brain of children with Gaucher disease NEURORADIOLOGY Perucca, G., Soares, B. P., Stagliano, S., Davison, J., Chakrapani, A., D'Arco, F. 2018; 60 (12): 1353-1356

  Abstract

  Gaucher disease (GD) represents the most common lysosomal storage defect. It is classified into three phenotypes: type 1 non-neuronopathic, type 2 acute neuronopathic, and type 3 subacute/chronic neuronopathic. Although children affected by GD may present with a broad spectrum of neurological signs, brain magnetic resonance imaging (MRI) findings are usually normal or non-specific. We report three cases of GD with previously undescribed brain MRI changes mainly affecting the thalami and/or the dentate nuclei. We discuss the possible etiopathogenesis of these abnormalities. Correlation between brain MRI abnormalities, neurological symptoms, and treatment efficacy is still unclear.

  View details for DOI 10.1007/s00234-018-2116-z

  View details for Web of Science ID 000450656500013

  View details for PubMedID 30328501

• 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

• ST3GAL5-Related Disorders: A Deficiency in Ganglioside Metabolism and a Genetic Cause of Intellectual Disability and Choreoathetosis JOURNAL OF CHILD NEUROLOGY Gordon-Lipkin, E., Cohen, J. S., Srivastava, S., Soares, B. P., Levey, E., Fatemi, A. 2018; 33 (13): 825-831

  Abstract

  GM3 synthase deficiency is due to biallelic pathogenic variants in ST3GAL5, which encodes a sialyltransferase that synthesizes ganglioside GM3. Key features of this rare autosomal recessive condition include profound intellectual disability, failure to thrive and infantile onset epilepsy. We expand the phenotypic spectrum with 3 siblings who were found by whole exome sequencing to have a homozygous pathogenic variant in ST3GAL5, and we compare these cases to those previously described in the literature. The siblings had normal birth history, subsequent developmental stagnation, profound intellectual disability, choreoathetosis, failure to thrive, and visual and hearing impairment. Ichthyosis and self-injurious behavior are newly described in our patients and may influence clinical management. We conclude that GM3 synthase deficiency is a neurodevelopmental disorder with consistent features of profound intellectual disability, choreoathetosis, and deafness. Other phenotypic features have variable expressivity, including failure to thrive, epilepsy, regression, vision impairment, and skin findings. Our analysis demonstrates a broader phenotypic range of this potentially under-recognized disorder.

  View details for DOI 10.1177/0883073818791099

  View details for Web of Science ID 000447509800003

  View details for PubMedID 30185102

  View details for PubMedCentralID PMC6188822

• Preterm neuroimaging and neurodevelopmental outcome: a focus on intraventricular hemorrhage, post-hemorrhagic hydrocephalus, and associated brain injury JOURNAL OF PERINATOLOGY Dorner, R. A., Burton, V., Allen, M. C., Robinson, S., Soares, B. P. 2018; 38 (11): 1431-1443

  Abstract

  Intraventricular hemorrhage in the setting of prematurity remains the most common cause of acquired hydrocephalus. Neonates with progressive post-hemorrhagic hydrocephalus are at risk for adverse neurodevelopmental outcomes. The goal of this review is to describe the distinct and often overlapping types of brain injury in the preterm neonate, with a focus on neonatal hydrocephalus, and to connect injury on imaging to neurodevelopmental outcome risk. Head ultrasound and magnetic resonance imaging findings are described separately. The current state of the literature is imprecise and we end the review with recommendations for future radiologic and neurodevelopmental research.

  View details for DOI 10.1038/s41372-018-0209-5

  View details for Web of Science ID 000449174800001

  View details for PubMedID 30166622

  View details for PubMedCentralID PMC6215507

• 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

• Vanishing Act: Gorham-Stout Disease Leading to Dynamic Cerebrospinal Fluid Abnormalities JOURNAL OF NEURO-OPHTHALMOLOGY Peragallo, J. H., Soares, B. P. 2018; 38 (3): 419-421

  View details for DOI 10.1097/WNO.0000000000000577

  View details for Web of Science ID 000451239400025

  View details for PubMedID 29016411

  View details for PubMedCentralID PMC5889366

• Neuroradiological findings of trisomy 13 in a rare long-term survivor NEURORADIOLOGY JOURNAL Goff, R. D., Soares, B. P. 2018; 31 (4): 412-414

  Abstract

  Patau syndrome remains a difficult diagnosis for parents and a challenging conversation for clinicians due to the overall poor prognosis. Previous population-based reports have documented the sobering life expectancies of these patients, with few surviving to 1 year of age. Despite the high mortality rate in infants born with trisomy 13, there are several reports of survival into late childhood and early adulthood. While clinical outcomes have been well documented, there has been a paucity of literature describing postnatal imaging findings in long-term survivors. We present a case report of a 2-year-old girl with trisomy 13 who underwent brain magnetic resonance imaging examination at our institution to evaluate for possible structural abnormalities contributing to central sleep apnea. We describe the clinical and postnatal neuroimaging findings of this rare patient with trisomy 13. Understanding the spectrum of neuroradiological findings in long-term survivors with trisomy 13, in combination with other organ system abnormalities, could add important clinical information and help better predict patient outcomes and expectations among parents.

  View details for DOI 10.1177/1971400916689575

  View details for Web of Science ID 000439966200013

  View details for PubMedID 28195512

  View details for PubMedCentralID PMC6111439

• Clinical and Neuroimaging Spectrum of Peroxisomal Disorders. Topics in magnetic resonance imaging : TMRI Tan, A. P., Goncalves, F. G., Almehdar, A., Soares, B. P. 2018; 27 (4): 241-257

  Abstract

  Peroxisomes play vital roles in a broad spectrum of cellular metabolic pathways. Defects in genes encoding peroxisomal proteins can result in a wide array of disorders, depending upon the metabolic pathways affected. These disorders can be broadly classified into 2 main groups; peroxisome biogenesis disorders (PBDs) and single peroxisomal enzyme deficiencies. Peroxisomal enzyme deficiencies are result of dysfunction of a specific metabolic pathway, while PBDs are due to generalized peroxisomal dysfunction. Mutations in PEX1 gene are the most common cause of PBDs, accounting for two-thirds of cases. Peroxisomal fission defects is a recently recognized entity, included under the subgroup of PBDs. The aim of this article is to provide a comprehensive review on the clinical and neuroimaging spectrum of peroxisomal disorders.

  View details for DOI 10.1097/RMR.0000000000000172

  View details for PubMedID 30086110

• Intracranial dural chondroma in a childconventional and advanced neuroimaging characteristics and differential diagnosis NEURORADIOLOGY JOURNAL Shrot, S., Cohen, A. R., Rodriguez, F. J., Berkowitz, F., Soares, B. P., Huisman, T. M. 2018; 31 (4): 386-389

  Abstract

  Intracranial chondromas are rare tumors, especially in the pediatric population. We describe the conventional and advanced neuroimaging characteristics of this rare convexity dura-based chondroma in a young adolescent. In particular we demonstrate that diffusion-weighted imaging (DWI) facilitates differentiation between a dura-based chondroma and the more frequent classical meningioma. Chondromas are typically DWI hypointense with high apparent diffusion coefficient (ADC) values while meningiomas are typically DWI hyperintense with low ADC values. We also discuss the relevant additional differential diagnoses of dura based focal lesions for the pediatric population as well as the diagnostic significance of additional imaging modalities, including computed tomography, magnetic resonance imaging and cerebral angiography.

  View details for DOI 10.1177/1971400917712268

  View details for Web of Science ID 000439966200008

  View details for PubMedID 28631961

  View details for PubMedCentralID PMC6111435

• Spontaneous epidural hematoma secondary to bone infarction in sickle cell anemia: case report JOURNAL OF NEUROSURGERY-PEDIATRICS Komarla, R., Soares, B. P., Chern, J. J., Mills, S. S. 2018; 22 (1): 18-21

  Abstract

  Spontaneous epidural hematoma (EDH) is a rare occurrence in patients with sickle cell disease, with a small number of cases reported. Appropriate diagnosis is critical, because rapid neurosurgical intervention may be required. This unique case illustrates clinical and MRI features of an 18-year-old woman presenting with a headache and subsequent progression to severe focal neurological symptoms. Imaging demonstrated a large EDH of mixed signal characteristics and underlying calvarial infarction, requiring emergency decompression and evacuation. A second companion case is also presented. The authors discuss proposed pathophysiology of the formation of EDHs in sickle cell anemia.

  View details for DOI 10.3171/2018.1.PEDS17407

  View details for Web of Science ID 000437425100003

  View details for PubMedID 29676678

• Bottom-of-sulcus focal cortical dysplasia presenting as <i>epilepsia partialis continua</i> multimodality characterization including 7T MRI CHILDS NERVOUS SYSTEM Kelley, S. A., Robinson, S., Crone, N. E., Soares, B. P. 2018; 34 (6): 1267-1269

  Abstract

  Bottom-of-sulcus focal cortical dysplasias are an under recognized, surgically treatable cause of focal epilepsy. Resection can dramatically reduce the seizure burden for children with refractory epilepsy, or eliminate seizures altogether.We report the case and present the results of multimodality evaluation of a 15-year-old young man who presented with long-standing partial epilepsy affecting his right leg, which over the years became refractory to therapy.High-resolution 3T MRI images acquired as a dedicated epilepsyprotocol were initially interpreted as unremarkable. On further review by an experienced specialist aware of clinical and electroencephalographic findings, a subtle focal cortical dysplasia was identified at the bottom of a sulcus near the medial aspect of the left precentral gyrus. After confirmation of the extent of the lesion with PET and ultra-high field 7T MRI, the patient underwent cortical mapping and focal resection and remains free of seizures.This case emphasizes the need for a multidisciplinary approach to the evaluation of refractory focal epilepsy in children and highlights the potential role of ultra-high field 7T MRI in identifying the often subtle causative anatomic abnormalities.

  View details for DOI 10.1007/s00381-018-3749-2

  View details for Web of Science ID 000433025700029

  View details for PubMedID 29445916

• Spatial orientation of the adult cochlea: rotation, tilt, and angle theta 3 SURGICAL AND RADIOLOGIC ANATOMY Deshpande, A., Soares, B., Todd, N. 2018; 40 (6): 697-704

  Abstract

  Quantitative description in adult crania of (1) angular orientation of the basal turn of the cochlea relative to the sagittal (termed "rotation") and Frankfort horizontal (termed "tilt") planes, and angle theta 3 [angular relationship of the line defined by the cochlea's spiral center and cochlear (round) window, to the cochlear window]; (2) orientation of the cochlea relative to the plane defined by the horizontal and vertical portions of the facial nerve; (3) orientation of the basal turn of the cochlea relative to the plane of the posterior semicircular canal; and (4) the association of these orientations with the extent of mastoid pneumatization.Postmortem material analysis. From 41 bequeathed anatomical ear-normal cadaveric cranial, high-resolution CT scans were performed of the five crania with the largest and the five with the smallest mastoids. Eleven points in three-dimensional Cartesian space were appointed and studied with the software program FIJI.The median angle values (and ranges) for right ears were: "rotation" 52° (range 47-61); and, "tilt" 84° (79-89). The planes of the cochlear basal turn and facial nerve approximated superimposition: median 15° (2-19). Angle theta 3 for right ears was median 40° (28-44). Bilateral symmetry was found for the relationships between the planes. However, no association of any planar relationship with mastoid pneumatization was suggested.Considering the range of angles found in clinically normal adult specimens, spatial orientation of the cochlea may explain some of the difficulties in implantation.

  View details for DOI 10.1007/s00276-018-2017-1

  View details for Web of Science ID 000432598500012

  View details for PubMedID 29700594

• Extracranial congenital malignant rhabdoid tumor in infant with disseminated disease: An uncommon entity and diagnostic challenge. JAAD case reports Dunn, E. A., Soares, B. P., Pearl, M. S., Redett, R., Alexander, C. J., Puttgen, K. B. 2018; 4 (4): 368-372

  View details for DOI 10.1016/j.jdcr.2017.11.009

  View details for PubMedID 29693073

• Neuroimaging Findings of Organic Acidemias and Aminoacidopathies Reddy, N., Calloni, S. F., Vernon, H. J., Boltshauser, E., Huisman, T. M., Soares, B. P. RADIOLOGICAL SOC NORTH AMERICA. 2018: 912-931

  Abstract

  Although individual cases of inherited metabolic disorders are rare, overall they account for a substantial number of disorders affecting the central nervous system. Organic acidemias and aminoacidopathies include a variety of inborn errors of metabolism that are caused by defects in the intermediary metabolic pathways of carbohydrates, amino acids, and fatty acid oxidation. These defects can lead to the abnormal accumulation of organic acids and amino acids in multiple organs, including the brain. Early diagnosis is mandatory to initiate therapy and prevent permanent long-term neurologic impairments or death. Neuroimaging findings can be nonspecific, and metabolism- and genetics-based laboratory investigations are needed to confirm the diagnosis. However, neuroimaging has a key role in guiding the diagnostic workup. The findings at conventional and advanced magnetic resonance imaging may suggest the correct diagnosis, help narrow the differential diagnosis, and consequently facilitate early initiation of targeted metabolism- and genetics-based laboratory investigations and treatment. Neuroimaging may be especially helpful for distinguishing organic acidemias and aminoacidopathies from other more common diseases with similar manifestations, such as hypoxic-ischemic injury and neonatal sepsis. Therefore, it is important that radiologists, neuroradiologists, pediatric neuroradiologists, and clinicians are familiar with the neuroimaging findings of organic acidemias and aminoacidopathies. ©RSNA, 2018.

  View details for DOI 10.1148/rg.2018170042

  View details for Web of Science ID 000432395200018

  View details for PubMedID 29757724

• ACR Appropriateness Criteria® Headache-Child JOURNAL OF THE AMERICAN COLLEGE OF RADIOLOGY Hayes, L. L., Palasis, S., Bartel, T. B., Booth, T. N., Iyer, R. S., Jones, J. Y., Kadom, N., Milla, S. S., Myseros, J. S., Pakalnis, A., Partap, S., Robertson, R. L., Ryan, M. E., Saigal, G., Soares, B. P., Tekes, A., Karmazyn, B. K. 2018; 15 (5): 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 DOI 10.1016/j.jacr.2018.03.017

  View details for Web of Science ID 001602788100008

  View details for PubMedID 29724429

• Mandibular condylar hypoplasia in children with isolated unilateral congenital aural atresia Halle, T. R., Todd, N., Soares, B. P. WILEY. 2018: 1191-1195

  Abstract

  We hypothesized that children with isolated nonsyndromic unilateral congenital aural atresia have subclinical mandibular condylar hypoplasia ipsilateral to the atretic ear, and that the Jahrsdoerfer score is associated with the degree of condylar hypoplasia.Retrospective self-controlled case series.We reviewed high-resolution computed tomography scans of the temporal bones of 68 children with isolated nonsyndromic unilateral congenital aural atresia. Images were viewed in the transverse (axial) plane perpendicular to the axis of the mandibular ramus and scanned from the mandibular notch to the condylar top. The slice where the condyle had the largest cross-sectional area was measured and checked for correlation with atresia status, age, and sex. The Jahrsdoerfer score of the atretic ear was calculated and correlated with condyle cross-sectional area, age, and sex.Cross-sectional area of the condyle ipsilateral to the atretic ear was, on average, 8.41 mm2 smaller than the contralateral condyle (P < .0001). The Jahrsdoerfer score was not associated with the condylar cross-sectional area, age, or sex.Isolated nonsyndromic unilateral congenital aural atresia is associated with mild hypoplasia of the mandibular condyle ipsilateral to the atretic ear. This is consistent with the hypothesis that congenital aural atresia is a variant of craniofacial (hemifacial) microsomia.4. Laryngoscope, 128:1191-1195, 2018.

  View details for DOI 10.1002/lary.26732

  View details for Web of Science ID 000430472200037

  View details for PubMedID 28671284

• The Child With Macrocephaly: Differential Diagnosis and Neuroimaging Findings AMERICAN JOURNAL OF ROENTGENOLOGY Orru, E., Calloni, S. F., Tekes, A., Huisman, T. M., Soares, B. P. 2018; 210 (4): 848-859

  Abstract

  The purpose of this article is to offer a systematic approach to the imaging of children with macrocephaly and to illustrate key neuroimaging features of common and rare but important disorders.Macrocephaly is a common clinical finding in children. Increased volume of one of the intracranial compartments can enlarge the head either prenatally or postnatally while the cranial sutures are open. Imaging plays a central role in establishing a diagnosis and guiding management.

  View details for DOI 10.2214/AJR.17.18693

  View details for Web of Science ID 000428041400031

  View details for PubMedID 29470161

• Stereotactic laser amygdalohippocampotomy for mesial temporal lobe epilepsy ANNALS OF NEUROLOGY Gross, R. E., Stern, M. A., Willie, J. T., Fasano, R. E., Saindane, A. M., Soares, B. P., Pedersen, N. P., Drane, D. L. 2018; 83 (3): 575-587

  Abstract

  To evaluate the outcomes 1 year and longer following stereotactic laser amygdalohippocampotomy for mesial temporal lobe epilepsy in a large series of patients treated over a 5-year period since introduction of this novel technique.Surgical outcomes of a consecutive series of 58 patients with mesial temporal lobe epilepsy who underwent the surgery at our institution with at least 12 months of follow-up were retrospectively evaluated. A subgroup analysis was performed comparing patients with and without mesial temporal sclerosis.One year following stereotactic laser amygdalohippocampotomy, 53.4% (95% confidence interval [CI] = 40.8-65.7%) of all patients were free of disabling seizures (Engel I). Three of 9 patients became seizure-free following repeat ablation. Subgroup analysis showed that 60.5% (95% CI = 45.6-73.7%) of patients with mesial temporal sclerosis were free of disabling seizures as compared to 33.3% (95% CI = 15.0-58.5%) of patients without mesial temporal sclerosis. Quality of Life in Epilepsy-31 scores significantly improved at the group level, few procedure-related complications were observed, and verbal memory outcome was better than historical open resection data.In an unselected consecutive series of patients, stereotactic laser amygdalohippocampotomy yielded seizure-free rates for patients with mesial temporal lobe epilepsy lower than, but comparable to, the outcomes typically associated with open temporal lobe surgery. Analogous to results from open surgery, patients without mesial temporal sclerosis fared less well. This novel procedure is an effective minimally invasive alternative to resective surgery. In the minority of patients not free of disabling seizures, laser ablation presents no barrier to additional open surgery. Ann Neurol 2018;83:575-587.

  View details for DOI 10.1002/ana.25180

  View details for Web of Science ID 000428350800016

  View details for PubMedID 29420840

  View details for PubMedCentralID PMC5877322

• Orbital infantile hemangioma and rhabdomyosarcoma in children: differentiation using diffusion-weighted magnetic resonance imaging JOURNAL OF AAPOS Kralik, S. F., Haider, K. M., Lobo, R. R., Supakul, N., Calloni, S. F., Soares, B. P. 2018; 22 (1): 27-31

  Abstract

  To evaluate differences in magnetic resonance imaging (MRI) appearance between infantile hemangiomas and rhabdomyosarcomas of the orbit in pediatric patients using diffusion-weighted imaging.A multicenter retrospective review of MRIs of pediatric patients with infantile hemangiomas and rhabdomyosarcomas of the orbit was performed. MRI examinations from a total of 21 patients with infantile hemangiomas and 12 patients with rhabdomyosarcomas of the orbit were independently reviewed by two subspecialty board-certified neuroradiologists masked to the diagnosis. A freehand region of interest was placed in the mass to obtain the mean apparent diffusion coefficient (ADC) value of the mass as well as within the medulla to obtain a ratio of the ADC mass to the medulla. A t test was used to compare mean ADC and ADC ratios between the two groups. Receiver operating characteristic analysis was performed to determine ADC value and ADC ratio thresholds for differentiation of infantile hemangioma and rhabdomyosarcoma.There was a statistically significant difference in the mean ADC value of infantile hemangiomas compared to rhabdomyosarcomas (1527 × 10-6 mm2/s vs 782 × 10-6 mm2/s; P = 0.0001) and the ADC ratio of the lesion to the medulla (1.77 vs 0.92; P = 0.0001). An ADC threshold of <1159 × 10-6 mm2/sec and an ADC ratio of <1.38 differentiated rhabdomyosarcoma from infantile hemangioma (sensitivity 100% and 100%; specificity 100% and 100%) with area under the curve of 1.0 and 1.0, respectively.In conjunction with conventional MRI sequences, ADC values obtained from diffusion-weighted MRI are useful to differentiate orbital infantile hemangiomas from rhabdomyosarcomas in pediatric patients.

  View details for DOI 10.1016/j.jaapos.2017.09.002

  View details for Web of Science ID 000426537900008

  View details for PubMedID 29113884

• Dysplasia and overgrowth: magnetic resonance imaging of pediatric brain abnormalities secondary to alterations in the mechanistic target of rapamycin pathway NEURORADIOLOGY Shrot, S., Hwang, M., Stafstrom, C. E., Huisman, T. M., Soares, B. P. 2018; 60 (2): 137-150

  Abstract

  The current classification of malformations of cortical development is based on the type of disrupted embryological process (cell proliferation, migration, or cortical organization/post-migrational development) and the resulting morphological anomalous pattern of findings. An ideal classification would include knowledge of biological pathways. It has recently been demonstrated that alterations affecting the mechanistic target of rapamycin (mTOR) signaling pathway result in diverse abnormalities such as dysplastic megalencephaly, hemimegalencephaly, ganglioglioma, dysplastic cerebellar gangliocytoma, focal cortical dysplasia type IIb, and brain lesions associated with tuberous sclerosis. We review the neuroimaging findings in brain abnormalities related to alterations in the mTOR pathway, following the emerging trend from morphology towards genetics in the classification of malformations of cortical development. This approach improves the understanding of anomalous brain development and allows precise diagnosis and potentially targeted therapies that may regulate mTOR pathway function.

  View details for DOI 10.1007/s00234-017-1961-5

  View details for Web of Science ID 000419777600005

  View details for PubMedID 29279945

• 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

• Retinopathy and optic atrophy: Expanding the phenotypic spectrum of pathogenic variants in the <i>AARS2</i> gene OPHTHALMIC GENETICS Peragallo, J. H., Keller, S., van der Knaap, M. S., Soares, B. P., Shankar, S. P. 2018; 39 (1): 99-102

  Abstract

  Optic atrophy may be the sequela of optic nerve injury due to any insult, including isolated and syndromic genetic diseases. Alanyl-tRNA synthetase 2 (AARS2) pathogenic variants have been reported to cause leukodystrophy with ovarian failure, and cardiomyopathy (#615889) as well as combined oxidative phosphorylation deficiency-8 (#614096). We report a young child who presented with decreased vision due to optic atrophy and was found to harbor missense variants in the AARS2 gene expanding the phenotypic expression of the AARS2 gene.Single observational case report with genetic testing, laboratory testing, neurologic and ophthalmic clinical examinations, and neuroimaging performed at a tertiary academic medical center.An 18-month old Korean boy was noted to have a progressive decline in visual function. The physical exam revealed bilateral optic atrophy, peripheral retinal bone spicule pigmentation, and absent patellar reflexes. Electromyography was consistent with demyelinating polyneuropathy. Magnetic resonance imaging (MRI) of the brain and spine showed cerebellar and supratentorial white matter multifocal changes with areas of restricted diffusion, and dorsal column signal abnormalities. Whole exome sequencing revealed two missense variants in the AARS2 gene [c.1519G>C (p.V507L) and c.2165G>A (p.R722Q)], found to be in trans on parental testing.Missense variants in the AARS2 gene are the likely cause of the retinopathy and optic atrophy in this patient. This finding expands the phenotypic spectrum of the AARS2 gene.

  View details for DOI 10.1080/13816810.2017.1350723

  View details for Web of Science ID 000428520500019

  View details for PubMedID 28820624

  View details for PubMedCentralID PMC6104516

• Ultrasound and CT of the posterior fossa in neonates. Handbook of clinical neurology Snyder, E., Hwang, M., Soares, B. P., Tekes, A. 2018; 154: 205-217

  Abstract

  Ultrasound, CT and MRI may all be used in the evaluation of the posterior fossa in neonates depending on the clinical scenario. Ultrasonography is particularly valuable for the evaluation of the neonatal brain because of the lack of ionizing radiation and the ability to perform exams at the bedside and, importantly, advancements in ultrasound technology now allow for diagnostic-quality imaging. While CT is still the initial imaging modality of choice in most neurologic emergencies, in the neonate, ultrasound is the first line in nontraumatic emergencies. The goal of this chapter is to discuss the ultrasound technique for evaluation of the cerebellum, to describe the normal sonographic and CT appearance of posterior fossa and to provide the classical findings of the most common cerebellar abnormalities. While ultrasound is able to accurately diagnosis a majority of cerebellar abnormalities in neonates, subsequent MR imaging remains essential to confirm findings and to detect associated abnormalities.

  View details for DOI 10.1016/B978-0-444-63956-1.00012-6

  View details for PubMedID 29903440

• Novel Contrast-Enhanced Ultrasound Evaluation in Neonatal Hypoxic Ischemic Injury: Clinical Application and Future Directions JOURNAL OF ULTRASOUND IN MEDICINE Hwang, M., De Jong, R. M., Herman, S., Boss, R., Riggs, B., Tekes-Brady, A., Spevak, M., Poretti, A., Soares, B. P., Bailey, C. R., Dunn, E., Shin, S. S., Shrot, S., Huisman, T. M. 2017; 36 (11): 2379-2386

  Abstract

  Sensitive, specific, and safe bedside evaluation of brain perfusion is key to the early diagnosis, treatment, and improved survival of neonates with hypoxic ischemic injury. Contrast-enhanced ultrasound (US) imaging is a novel imaging technique in which intravenously injected gas-filled microbubbles generate enhanced US echoes from an acoustic impedance mismatch. This article describes contrast-enhanced US imaging in 2 neonates with hypoxic ischemic injury and future directions on developing quantitative contrast-enhanced US techniques for improved characterization of perfusion abnormalities. The importance of studying the temporal evolution of brain perfusion in neonatal hypoxic ischemic injury is also highlighted.

  View details for DOI 10.1002/jum.14289

  View details for Web of Science ID 000413168000023

  View details for PubMedID 28649730

• Does the Addition of a "Black Bone" Sequence to a Fast Multisequence Trauma MR Protocol Allow MRI to Replace CT after Traumatic Brain Injury in Children? AMERICAN JOURNAL OF NEURORADIOLOGY Dremmen, M. G., Wagner, M. W., Bosemani, T., Tekes, A., Agostino, D., Day, E., Soares, B. P., Huisman, T. M. 2017; 38 (11): 2187-2192

  Abstract

  Head CT is the current neuroimaging tool of choice in acute evaluation of pediatric head trauma. The potential cancer risks of CT-related ionizing radiation should limit its use in children. We evaluated the role of MR imaging, including a "black bone" sequence, compared with CT in detecting skull fractures and intracranial hemorrhages in children with acute head trauma.We performed a retrospective evaluation of 2D head CT and brain MR imaging studies including the black bone sequence of children with head trauma. Two experienced pediatric neuroradiologists in consensus created the standard of reference. Another pediatric neuroradiologist blinded to the diagnosis evaluated brain MR images and head CT images in 2 separate sessions. The presence of skull fractures and intracranial posttraumatic hemorrhages was evaluated. We calculated the sensitivity and specificity of CT and MR imaging with the black bone sequence in the diagnosis of skull fractures and intracranial hemorrhages.Twenty-eight children (24 boys; mean age, 4.89 years; range, 0-15.5 years) with head trauma were included. MR imaging with the black bone sequence revealed lower sensitivity (66.7% versus 100%) and specificity (87.5% versus 100%) in identifying skull fractures. Four of 6 incorrectly interpreted black bone MR imaging studies showed cranial sutures being misinterpreted as skull fractures and vice versa.Our preliminary results show that brain MR imaging complemented by a black bone sequence is a promising nonionizing alternative to head CT for the assessment of skull fractures in children. However, accuracy in the detection of linear fractures in young children and fractures of aerated bone remains limited.

  View details for DOI 10.3174/ajnr.A5405

  View details for Web of Science ID 000415996600034

  View details for PubMedID 28970241

  View details for PubMedCentralID PMC7963587

• Safety of Contrast Material Use in Children MAGNETIC RESONANCE IMAGING CLINICS OF NORTH AMERICA Soares, B. P., Lequin, M. H., Huisman, T. M. 2017; 25 (4): 779-+

  Abstract

  Iodinated and gadolinium-based contrast materials have excellent safety profiles for use in pediatric computed tomography and MR imaging. The rate of acute adverse reactions and contrast-induced nephropathy is lower than in adults. The relationship between nephrogenic systemic fibrosis and gadolinium administration is well established and only a small number of children suffer from this debilitating disorder. The recent finding of gadolinium deposition in the brain of patients with normal renal function has renewed concerns regarding its long-term toxicity. The necessity of gadolinium-based contrast agent use in children should be considered carefully for each examination, and more stable macrocyclic agents should be the primary choice.

  View details for DOI 10.1016/j.mric.2017.06.009

  View details for Web of Science ID 000414382600012

  View details for PubMedID 28964467

• Lesions in the Splenium of the Corpus Callosum on MRI in Children: A Review JOURNAL OF NEUROIMAGING Kontzialis, M., Soares, B. P., Huisman, T. M. 2017; 27 (6): 549-561

  Abstract

  A wide variety of conditions may involve the splenium of the corpus callosum on magnetic resonance imaging in children. A single cause may present with different patterns of splenial involvement, and multiple diseases may have similar imaging findings. Keeping this limitation in mind, the goal of this text is to assist in the diagnostic process of pediatric neurological diseases that are characterized by prominent involvement of the splenium of the corpus callosum on imaging. The various pathologies will be reviewed and categorized based on etiology, reversibility, and pattern of additional or associated findings. Transient splenial lesions in children are an uncommon radiologic finding of unknown etiology in a long list of conditions that may present with altered consciousness, and it usually carries a favorable prognosis. The discussion continues with the presentation of diseases inflicting irreversible damage on the splenium. Familiarity with the various causes implicated in splenial injury may assist in the formulation of differential diagnosis in the appropriate clinical setting using an easily recognizable imaging finding.

  View details for DOI 10.1111/jon.12455

  View details for Web of Science ID 000414175800001

  View details for PubMedID 28654166

• MR Imaging of Acute Cerebellar Involvement in Pediatric Anti-N-Methyl-D-Aspartate Receptor Encephalitis NEUROPEDIATRICS Soares, B. P., Calloni, S. F., Shrot, S., Poretti, A. 2017; 48 (5): 398-399

  View details for DOI 10.1055/s-0037-1600111

  View details for Web of Science ID 000409555300016

  View details for PubMedID 28255964

• Back pain and scoliosis in children: When to image, what to consider NEURORADIOLOGY JOURNAL Calloni, S. F., Huisman, T. M., Poretti, A., Soares, B. P. 2017; 30 (5): 393-404

  Abstract

  Back pain and scoliosis in children most commonly present as benign and self-limited entities. However, persistent back pain and/or progressive scoliosis should always be taken seriously in children. Dedicated diagnostic work-up should exclude etiologies that may result in significant morbidity. Clinical evaluation and management require a comprehensive history and physical and neurological examination. A correct imaging approach is important to define a clear diagnosis and should be reserved for children with persistent symptoms or concerning clinical and laboratory findings. This article reviews the role of different imaging techniques in the diagnostic approach to back pain and scoliosis, and offers a comprehensive review of the main imaging findings associated with common and uncommon causes of back pain and scoliosis in the pediatric population.

  View details for DOI 10.1177/1971400917697503

  View details for Web of Science ID 000418537100001

  View details for PubMedID 28786774

  View details for PubMedCentralID PMC5602330

• Ventricular pseudodiverticula from intraparenchymal cerebrospinal fluid dissection secondary to high-grade obstructive hydrocephalus in children: magnetic resonance imaging findings NEURORADIOLOGY JOURNAL Calloni, S. F., Soares, B. P., Huisman, T. M. 2017; 30 (5): 425-428

  Abstract

  We report on a series of three children who presented with a focal cerebrospinal fluid collection within the periventricular white matter of the temporal and occipital lobes in the setting of high-grade obstructive hydrocephalus. Magnetic resonance imaging showed a focal defect within the ventricular wall associated with leakage of cerebrospinal fluid into the adjacent white matter. The white matter tracts appeared primarily displaced. This entity should be referred to as ventricular pseudodiverticulum, not lined by ependymal cells, in contrast to a true ventricular diverticulum in which the cerebrospinal fluid is contained by a focal outpouching of the intact ventricular wall lined by a dilated and prolapsed layer of ependymal cells. Correct interpretation and classification of the findings may be helpful in predicting prognosis and outcome.

  View details for DOI 10.1177/1971400917712530

  View details for Web of Science ID 000418537100005

  View details for PubMedID 28644065

  View details for PubMedCentralID PMC5602336

• Concurrent myeloid sarcoma, atypical teratoid/rhabdoid tumor, and hypereosinophilia in an infant with a germline <i>SMARCB1</i> mutation PEDIATRIC BLOOD & CANCER Metts, J. L., Park, S. I., Soares, B. P., Fong, C., Biegel, J. A., Goldsmith, K. C. 2017; 64 (9)

  Abstract

  We report a 1-year-old female child presenting with hypereosinophilia who was found to have concurrent myeloid sarcoma and a central nervous system (CNS) atypical teratoid/rhabdoid tumor (AT/RT). She was later found to have a germline mutation in SMARCB1. Concurrent hematologic malignancy and CNS AT/RT have not previously been described in the context of a SMARCB1 loss-of-function germline mutation.

  View details for DOI 10.1002/pbc.26460

  View details for Web of Science ID 000406248200005

  View details for PubMedID 28111898

• Magnetic resonance imaging to diagnose leptomeningeal spread of medulloblastoma in children: Decreasing diagnostic uncertainty, moving in new directions PEDIATRIC BLOOD & CANCER Soares, B. P., Poretti, A., Huisman, T. M. 2017; 64 (8)

  View details for DOI 10.1002/pbc.26514

  View details for Web of Science ID 000403320600043

  View details for PubMedID 28333414

• MAGNETIC RESONANCE IMAGING FINDINGS IN CHILDREN WITH SPASMUS NUTANS REPLY JOURNAL OF AAPOS Peragallo, J. H., Bowen, M., Kralik, S. F., Huisman, T. M., Soares, B. P. 2017; 21 (4): 345-346

  View details for DOI 10.1016/j.jaapos.2017.07.003

  View details for Web of Science ID 000409565500028

  View details for PubMedID 28716737

• 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

• Magnetic resonance imaging findings in children with spasmus nutans JOURNAL OF AAPOS Bowen, M., Peragallo, J. H., Kralik, S. F., Poretti, A., Huisman, T. M., Soares, B. P. 2017; 21 (2): 127-130

  Abstract

  Spasmus nutans (SN) is a rare pediatric ophthalmologic syndrome characterized by nystagmus, head bobbing, and abnormal head positioning. Historically, SN has been associated with underlying optic pathway gliomas (OPG); however, evidence of this association is based primarily on a small number of isolated case reports. Prior retrospective analyses have found the rate of OPG to be <2%, but these studies only intermittently used neuroimaging with computed tomography, which has limited sensitivity for detection of small lesions in the optic pathway. The purpose of this study was to investigate the association of SN with intracranial abnormalities, particularly OPG, using magnetic resonance imaging of the brain and orbits.Neuroradiology databases at three institutions spanning January 2010 to May 2016 were queried for examinations ordered for evaluation of SN; MRI examinations of the brain and/or orbits were included and evaluated for OPG and other structural abnormalities. Medical records were reviewed to confirm a diagnosis of SN, presence of other underlying neurological disease, or preexisting diagnoses.A total of 40 patients with eligible MRI examinations were identified. None had optic nerve pathway gliomas. Two children had optic nerve hypoplasia; no other patients had optic pathway abnormalities. None had intracranial or orbital masses. MRI examinations were normal in 25 patients.This series represents the largest collection of MRI examinations for SN in the literature to date and shows no association between OPG and SN. In children presenting with SN but no other findings suggesting OPG or neurological abnormalities, neuroimaging may not be required.

  View details for DOI 10.1016/j.jaapos.2017.03.001

  View details for Web of Science ID 000401309700009

  View details for PubMedID 28284856

• Inner ear anomalies in children with isolated unilateral congenital aural atresia INTERNATIONAL JOURNAL OF PEDIATRIC OTORHINOLARYNGOLOGY Halle, T. R., Soares, B. R., Todd, N. 2017; 95: 5-8

  Abstract

  We aim to define the frequencies of anomalies of the inner ear, oval window, and round window ipsilateral to isolated non-syndromic unilateral aural atresia.Retrospective case series. We reviewed high resolution computed tomography scans of the temporal bones of 70 children with isolated non-syndromic unilateral congenital aural atresia. Scans were reviewed according to the Jahrsdoerfer criteria and further evaluated for anomalies of the vestibule, semi-circular canals, cochlea, internal auditory canal and vestibulocochlear nerve.Inner ear dysplasia was seen in two of 70 atretic ears: one with a dysmorphic lateral semicircular canal and another with a large vestibule assimilating the lateral semicircular canal. Abnormalities of the oval window and round window ipsilateral to the atresia were identified in 21% (15) and 7% (5), respectively, of the atretic ears. Oval window and round window abnormalities were associated with disproportionately lower Jahrsdoerfer scores compared to aural atresia patients without these abnormalities (P < 0.001 and P = 0.04, respectively).Compared to studies that included syndromic or bilateral atresia cases, we found inner ear and oval window abnormalities less common in children with isolated non-syndromic unilateral aural atresia. However, round window anomalies seem to occur at about the same frequency.

  View details for DOI 10.1016/j.ijporl.2017.01.028

  View details for Web of Science ID 000404317300002

  View details for PubMedID 28576532

• Acute brain injury following illicit drug abuse in adolescent and young adult patients: spectrum of neuroimaging findings NEURORADIOLOGY JOURNAL Shrot, S., Poretti, A., Tucker, E. W., Soares, B. P., Huisman, T. M. 2017; 30 (2): 144-150

  Abstract

  The use of illicit drugs is currently a major medical problem among adolescents. Several illicit drugs have a high abuse potential and can be neurotoxic causing high morbidity and mortality. The clinical manifestation of adolescents with acute drug-induced neurotoxicity is often characterized by non-specific symptoms and findings. Early diagnosis is important to prevent death and permanent long-term neurological impairments. We report on clinical and neuroimaging findings in five adolescents with acute brain imaging following illicit drug intoxication to highlight the role of neuroimaging findings in the diagnostic work-up of pediatric acute drug-induced neurotoxicity. Our patients reveal two main neuroimaging patterns of brain injury: diffuse symmetric subcortical white matter injury with preferential cerebellar involvement (leukoencephalopathy pattern) or multiple foci of ischemic infarctions in a non-arterial territory distribution (ischemic pattern). Familiarity with these two neuroimaging patterns of findings in the evaluation of magnetic resonance imaging studies in adolescents with acutely altered mental status may suggest the correct diagnosis, narrow the differential diagnosis, and consequently allow early initiation of targeted laboratory investigations and treatment, potentially improving outcome.

  View details for DOI 10.1177/1971400917691994

  View details for Web of Science ID 000399924100005

  View details for PubMedID 28424016

  View details for PubMedCentralID PMC5433593

• Imaging Features of Idiopathic Intracranial Hypertension in Children JOURNAL OF CHILD NEUROLOGY Hartmann, A. W., Soares, B. P., Bruce, B. B., Saindane, A. M., Newman, N. J., Biousse, V., Peragallo, J. H. 2017; 32 (1): 120-126

  Abstract

  Magnetic resonance imaging (MRI) signs of elevated intracranial pressure and idiopathic intracranial hypertension have been well characterized in adults but not in children. The MRIs of 50 children with idiopathic intracranial hypertension and 46 adults with idiopathic intracranial hypertension were reviewed for optic nerve head protrusion, optic nerve head enhancement, posterior scleral flattening, increased perioptic cerebrospinal fluid, optic nerve tortuosity, empty or partially empty sella, tonsillar herniation, enlargement of Meckel's cave meningoceles, and transverse venous sinus stenosis(TSS). Compared to adolescents (11-17 years, n = 40) and adults (>17 years, n = 46), prepubescent children (<11 years, n = 10) had lower frequencies of scleral flattening (50% vs 89% and 85%, P = .02), increased perioptic cerebrospinal fluid (60% vs 84% and 89%, P = .08), optic nerve tortuosity (20% vs 46% and 59%, P = .07), empty or partially empty sella (56% vs 78% and 93%, P = .007), and TSS (67% vs 93% and 96%, P = .04). Children with idiopathic intracranial hypertension have similar MRI findings as adults, but they are less frequent in prepubescent children.

  View details for DOI 10.1177/0883073816671855

  View details for Web of Science ID 000397213000016

  View details for PubMedID 28195748

• Human Papillomavirus Genotype Distribution among Cervical Cancer Patients prior to Brazilian National HPV Immunization Program JOURNAL OF ENVIRONMENTAL AND PUBLIC HEALTH de Almeida, L. M., Martins, L. L., Pontes, V. B., Correa, F. M., Montenegro, R. C., Pinto, L. C., Soares, B. M., Vidal, J. B., Felix, S. P., Bertoni, N., Szklo, M., Moreira, M. M. 2017; 2017: 1645074

  Abstract

  To evaluate the impact of HPV immunization and possible changes in virus type-specific prevalence associated with cervical cancer, it is important to obtain baseline information based on socioeconomic, educational, and environmental characteristics in human populations. We describe these characteristics and the type-specific HPV distribution in 1,183 women diagnosed with cervical cancer in two Brazilian healthcare institutions located at the Southeastern (Rio de Janeiro/RJ) and the Amazonian (Belém/PA) regions. Large differences were observed between women in these regions regarding economic, educational, and reproductive characteristics. The eight most frequent HPV types found in tumor samples were the following: 16, 18, 31, 33, 35, 45, 52, and 58. Some HPV types classified as unknown or low risk were found in tumor samples with single infections, HPV 83 in RJ and HPV 11, 61, and 69 in PA. The proportion of squamous cervical cancer was lower in RJ than in PA (76.3% versus 87.3%, p < 0.001). Adenocarcinoma was more frequent in RJ than in PA (13.5% versus 6.9%, p < 0.001). The frequency of HPV 16 in PA was higher in younger women (p < 0.05). The success of a cervical cancer control program should consider HPV types, local health system organization, and sociodemographic diversity of Brazilian regions.

  View details for DOI 10.1155/2017/1645074

  View details for Web of Science ID 000399761900001

  View details for PubMedID 28512474

  View details for PubMedCentralID PMC5420420

• Retinopathy and optic atrophy: expanding phenotypic spectrum of <i>AARS2</i> gene mutations Peragallo, J. H., Keller, S., Cornell, K., van der Knaap, M. S., Soares, B., Shankar, S. P. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2016

  View details for Web of Science ID 000394174002068

• TMJ IMAGING: BRIDGING THE GAP REPLY JOURNAL OF ORAL AND MAXILLOFACIAL SURGERY Moe, J. S., Desai, N. K., Aiken, A. H., Soares, B. P., Kang, J., Abramowicz, S. 2016; 74 (9): 1711-1712

  View details for DOI 10.1016/j.joms.2016.05.003

  View details for Web of Science ID 000382240700003

  View details for PubMedID 27288841

• Magnetic Resonance Imaging of Temporomandibular Joints of Children JOURNAL OF ORAL AND MAXILLOFACIAL SURGERY Moe, J. S., Desai, N. K., Aiken, A. H., Soares, B. P., Kang, J., Abramowicz, S. 2016; 74 (9): 1723-1727

  Abstract

  To identify magnetic resonance imaging (MRI) findings of temporomandibular joints (TMJs) in healthy children.This was a retrospective study of children younger than 18 years undergoing MRI of the head for non-autoimmune indications at Children's Healthcare of Atlanta (Atlanta, GA). Patients with congenital or acquired conditions associated with potential TMJ pathology were excluded. Medical records and MRIs were reviewed to document demographic data. Three neuroradiologists independently recorded specific predetermined MRI findings of the TMJ. The outcome variable was the presence or absence of TMJ findings at MRI. Descriptive and bivariate statistics were used to identify associations (significant at P ≤ .05).Eighty-seven patients (54 boys, 33 girls; mean age, 11.2 yr) met the inclusion criteria. Seventy percent of TMJs had condylar enhancement, 64% of joints had glenoid marginal synovial enhancement, 56% had condylar margin synovial enhancement, and 19% had condylar T1 hyperintense signal. There were no joints with condylar erosion, condylar volume loss, or effusion. Findings of normal marrow development were decreased condylar enhancement and greater condylar T1 signal with increased age.This study found a greater than 60% prevalence of synovial enhancement in healthy children. In a healthy child, MRI findings of TMJ synovial enhancement should be carefully correlated with a clinical evaluation.

  View details for DOI 10.1016/j.joms.2016.03.022

  View details for Web of Science ID 000382240700008

  View details for PubMedID 27102922

• IMAGES IN EMERGENCY MEDICINE <i>Penetrating neck and chest trauma with a pencil</i>, <i>with right lung contusion</i> ANNALS OF EMERGENCY MEDICINE Soares, B., Golden, E. T. 2016; 67 (5): 577-+

  View details for DOI 10.1016/j.annemergmed.2015.11.017

  View details for Web of Science ID 000375373200006

  View details for PubMedID 27106366

• Imaging Features of Idiopathic Intracranial Hypertension (IIH) in Children Hartmann, A., Soares, B., Bruce, B., Saindane, A., Newman, N., Biousse, V., Peragallo, J. LIPPINCOTT WILLIAMS & WILKINS. 2016

  View details for Web of Science ID 000411328602416

• Pictorial Review of CT and MRI in Pediatric Accidental Traumatic Head Injury JOURNAL OF PEDIATRIC NEURORADIOLOGY Golden, E. T., Soares, B. P. 2016; 5 (1): 7-12

  View details for DOI 10.1055/s-0036-1584242

  View details for Web of Science ID 000417692800003

• Baffling brain MRI findings in a patient with Gaucher disease Long, V., Soares, B., Shankar, S. ACADEMIC PRESS INC ELSEVIER SCIENCE. 2016: S74-S75

  View details for DOI 10.1016/j.ymgme.2015.12.342

  View details for Web of Science ID 000370888100185

• Utility of double inversion recovery MRI in paediatric epilepsy BRITISH JOURNAL OF RADIOLOGY Soares, B. P., Porter, S. G., Saindane, A. M., Dehkharghani, S., Desai, N. K. 2016; 89 (1057): 20150325

  Abstract

  Detecting focal abnormalities in MRI examinations of children with epilepsy can be a challenging task given the frequently subtle appearance of cortical dysplasia, mesial temporal sclerosis and similar lesions. In this report, we demonstrate the utility of double inversion recovery MRI in the detection of paediatric epileptogenic abnormalities, promoted primarily by increased lesion conspicuity due to complementary suppression of both cerebrospinal fluid and normal white matter signal.

  View details for DOI 10.1259/bjr.20150325

  View details for Web of Science ID 000368418500009

  View details for PubMedID 26529229

  View details for PubMedCentralID PMC4985945

• Imaging of Herpesvirus Infections of the CNS AMERICAN JOURNAL OF ROENTGENOLOGY Soares, B. P., Provenzale, J. M. 2016; 206 (1): 39-48

  Abstract

  Herpesviridae are a family of DNA viruses remarkable for their ability to both promote acute infection and enter a latent phase with potential of reactivation. Herpes infections are ubiquitous throughout the human life span, regardless of the degree of immunocompetence.We review the virology and clinical manifestations of each herpesvirus, with emphasis on recent advances in knowledge and characteristic neuroimaging findings important for diagnosis and appropriate clinical management.

  View details for DOI 10.2214/AJR.15.15314

  View details for Web of Science ID 000367181400018

  View details for PubMedID 26700334

• The anthelmintic drug mebendazole inhibits growth, migration and invasion in gastric cancer cell model TOXICOLOGY IN VITRO Pinto, L., Soares, B., Viana Pinheiro, J., Riggins, G. J., Assumpcao, P., Rodriguez Burbano, R., Montenegro, R. 2015; 29 (8): 2038-2044

  Abstract

  The present study aimed to investigate the effects of MBZ on a human malignant ascites cell line derived from a primary gastric cancer tumor. Our data reveal that MBZ showed high cytotoxicity in vitro, displaying an IC50 of 0.39 μM and 1.25 μM in ACP-02 and ACP-03, respectively. The association between MBZ and 5-FU increased slightly the cytotoxicity when compared to MBZ and 5-FU alone. Furthermore, MBZ disrupted the microtubule structure of AGP-01 cells and inhibited significantly the invasion and migration of these cells. Activity of active MMP-2 significantly decreased at all tested concentration of MBZ compared to negative control. These results support the indication of MBZ in combination with chemotherapeutic agents as a possible adjuvant therapy for the management/treatment of patients with advanced gastric cancer since MBZ is a drug of low cost with acceptable safety profile and reduced toxicity to normal cells. However, clinical trials must be performed in o to evaluate its efficacy in gastric cancer patients.

  View details for DOI 10.1016/j.tiv.2015.08.007

  View details for Web of Science ID 000364892000010

  View details for PubMedID 26315676

• Longitudinally Extensive Optic Neuritis in Pediatric Patients JOURNAL OF CHILD NEUROLOGY Graves, J., Kraus, V., Soares, B. P., Hess, C. P., Waubant, E. 2015; 30 (1): 120-123

  Abstract

  Extensive optic nerve demyelinating lesions on magnetic resonance imaging (MRI) in adults could indicate a diagnosis other than multiple sclerosis with worse prognosis such as neuromyelitis optica. We report the frequency of longitudinally extensive lesions in children with first events of optic neuritis. Subjects had brain or orbit MRI within 3 months of onset and were evaluated at the University of California, San Francisco, Pediatric Multiple Sclerosis Center. Lesion length, determined by T2 hyperintensity or contrast enhancement, was blindly graded as absent, focal or longitudinally extensive (at least 2 contiguous segments of optic nerve). Of 25 subjects, 9 (36%) had longitudinally extensive optic neuritis. Extensive lesions were not associated with non-multiple sclerosis versus multiple sclerosis diagnosis (P = 1.00). No association between age and lesion extent was observed (P = .26). Prospective studies are needed to determine if longitudinally extensive optic neuritis can predict visual outcome.

  View details for DOI 10.1177/0883073813520500

  View details for Web of Science ID 000346908500022

  View details for PubMedID 24563470

• A pain in the…ventricle. Journal of general internal medicine Tran, M. C., Baxi, S. M., Soares, B. P. 2014; 29 (5): 816-7

  View details for DOI 10.1007/s11606-013-2606-y

  View details for PubMedID 24113804

  View details for PubMedCentralID PMC4000329

• Radiation dose reduction in pediatric CT-guided musculoskeletal procedures PEDIATRIC RADIOLOGY Patel, A. S., Soares, B., Courtier, J., MacKenzie, J. D. 2013; 43 (10): 1303-1308

  Abstract

  Computed-tomography-guided interventions are attractive for tissue sampling of pediatric bone lesions; however, it comes with exposure to ionizing radiation, inherent to CT and magnified by multiple passes during needle localization.We evaluate a method of CT-guided bone biopsy that minimizes ionizing radiation exposure by lowering CT scanner tube current (mAs) and voltage (kVp) during each localization scan.We retrospectively reviewed all CT-guided bone biopsies (n = 13) over a 1-year period in 12 children. Three blinded readers identified the needle tip on the reduced-dose CT images (mAs = 50, kVp = 80) during the final localization scan at biopsy and rated the image quality as high, moderate or low.The image quality of the reduced-dose scans during biopsy was rated as either high or moderate, with needle tip visualized in 12 out of 13 biopsies. Twelve of 13 biopsies also returned sufficient sample for a pathological diagnosis. The average savings in exposure using the dose-reduction technique was 87%.Our results suggest that a low mAs and kVp strategy for needle localization during CT-guided bone biopsy yields a large dose reduction and produces acceptable image quality without sacrificing yield for biopsy diagnosis.

  View details for DOI 10.1007/s00247-013-2691-4

  View details for Web of Science ID 000324643600009

  View details for PubMedID 23624510

  View details for PubMedCentralID PMC3769501

• Clinical Risk Factors and CT Imaging Features of Carotid Atherosclerotic Plaques as Predictors of New Incident Carotid Ischemic Stroke: A Retrospective Cohort Study AMERICAN JOURNAL OF NEURORADIOLOGY Magge, R., LAU, B. C., Soares, B. P., Fischette, S., Arora, S., Tong, E., Cheng, S., Wintermark, M. 2013; 34 (2): 402-409

  Abstract

  Parameters other than luminal narrowing are needed to predict the risk of stroke more reliably, particularly in patients with <70% stenosis. The goal of our study was to identify clinical risk factors and CT features of carotid atherosclerotic plaques, in a retrospective cohort of patients free of stroke at baseline, that are independent predictors of incident stroke on follow-up.We identified a retrospective cohort of patients admitted to our emergency department with suspected stroke between 2001-2007 who underwent a stroke work-up including a CTA of the carotid arteries that was subsequently negative for acute stroke. All patients also had to receive a follow-up brain study at least 2 weeks later. From a random sample, we reviewed charts and imaging studies of patients with subsequent new stroke on follow-up as well as those who remained stroke-free. All patients were classified either as "new carotid infarct patients" or "no-new carotid infarct patients" based on the Causative Classification for Stroke. Independently, the baseline CTA studies were processed using a custom, CT-based automated computer classifier algorithm that quantitatively assesses a set of carotid CT features (wall thickness, plaque ulcerations, fibrous cap thickness, lipid-rich necrotic core, and calcifications). Univariate and multivariate statistical analyses were used to identify any significant differences in CT features between the patient groups in the sample. Subsequent ROC analysis allowed comparison to the classic NASCET stenosis rule in identifying patients with incident stroke on follow-up.We identified a total of 315 patients without a new carotid stroke between baseline and follow-up, and 14 with a new carotid stroke between baseline and follow-up, creating the main comparison groups for the study. Statistical analysis showed age and use of antihypertensive drugs to be the most significant clinical variables, and maximal carotid wall thickness was the most relevant imaging variable. The use of age ≥ 75 years, antihypertensive medication use, and a maximal carotid wall thickness of at least 4 mm was able to successfully identify 10 of the 14 patients who developed a new incident infarct on follow-up. ROC analysis showed an area under the ROC curve of 0.706 for prediction of new stroke with this new model.Our new paradigm of using age ≥ 75 years, history of hypertension, and carotid maximal wall thickness of >4 mm identified most of the patients with subsequent new carotid stroke in our study. It is simple and may help clinicians choose the patients at greatest risk of developing a carotid infarct, warranting validation with a prospective observational study.

  View details for DOI 10.3174/ajnr.A3228

  View details for Web of Science ID 000329210300029

  View details for PubMedID 22859283

• Perfusion-CT assessment of blood-brain barrier permeability in patients with aneurysmal subarachnoid hemorrhage JOURNAL OF NEURORADIOLOGY Kishore, S., Ko, N., Soares, B. P., Higashida, R. T., Tong, E., Bhogal, S., Bredno, J., Cheng, S., Wintermark, M. 2012; 39 (5): 317-325

  Abstract

  The goal of this study was to determine which clinical and radiographic variables in patients with subarachnoid hemorrhage (SAH) are associated with in vivo blood-brain barrier permeability (BBBP) assessments obtained using perfusion-CT (PCT) technology.SAH patients with confirmed aneurysm etiology and with PCT and angiogram within 24 hours of each other were included, and relationships between clinical and imaging variables were analyzed using random-effects generalized linear models.One thousand one hundred and sixty two vascular territories from 83 patients were evaluated in this study. The mean BBBP increased by severity of vasospasm on DSA, however, in multivariate analysis, only mean transit time (MTT), cerebral blood volume (CBV), and severity of hydrocephalus were significantly associated with BBBP. Increased BBBP was not associated with angiographic vasospasm severity in multivariate analysis.Perfusion-CT assessment of BBBP may serve as a unique and useful biomarker in conjunction with angiography, additional perfusion-CT parameters, and clinical assessments, especially in characterizing microvascular dysfunction, or even in targeting treatments. However, future prospective studies will be required to definitively establish its clinical utility in the care of SAH patients.

  View details for DOI 10.1016/j.neurad.2011.11.004

  View details for Web of Science ID 000313298800006

  View details for PubMedID 22197406

• Primary mixed malignant tumor of bone in an 18-year-old male: Report of a case with radiologic-pathologic correlation JOURNAL OF BONE ONCOLOGY Courtier, J., Robbins, E., Soares, B., Horvai, A., Mackenzie, J. D. 2012; 1 (3): 101-105

  Abstract

  We report a case of primary malignant mixed tumor (MMT) of bone in an 18-year-old boy with X-ray, CT, MR, scintigraphic, FDG PET, and pathologic correlation. Primary MMT of bone is a highly aggressive tumor and presents both a diagnostic and clinical treatment challenge. This tumor is extremely rare and to the best of our knowledge, this is the first report of the diagnostic imaging findings for primary MMT arising from bone in a patient of this age group.

  View details for DOI 10.1016/j.jbo.2012.10.002

  View details for Web of Science ID 000209277200007

  View details for PubMedID 26909264

  View details for PubMedCentralID PMC4723350

• A Pictorial Essay of Brain Perfusion-CT: Not Every Abnormality Is a Stroke! JOURNAL OF NEUROIMAGING Keedy, A., Soares, B., Wintermark, M. 2012; 22 (4): E20-E33

  Abstract

  Perfusion-CT (PCT) of the brain is a rapidly evolving imaging technique used to assess blood supply to the brain parenchyma. PCT is readily available at most imaging centers, resulting in steadily increasing use of this imaging technique. Though PCT was initially introduced and still most widely used to evaluate patients with acute ischemic stroke, a wide variety of other pathologic processes demonstrate abnormal perfusion maps. Therefore, it is important for the radiologist to recognize altered perfusion patterns observed in diseases other than typical ischemic stroke. The goal of this article is to show the perfusion maps and review the perfusion patterns observed in some subtypes of atypical stroke and in neurological entities other than stroke, so that they are recognized and not confused with the PCT patterns observed in patients with typical ischemic stroke.

  View details for DOI 10.1111/j.1552-6569.2012.00716.x

  View details for Web of Science ID 000310563200001

  View details for PubMedID 22985169

• Type IV intestinal atresia, congenital bilateral perisylvian syndrome, and chronic pulmonary hypertension secondary to multiple vascular disruption syndrome in a monochorionic twin JOURNAL OF PEDIATRIC SURGERY Shue, E. H., Soares, B., Courtier, J., Hogue, J., Shimotake, T., MacKenzie, T. C. 2012; 47 (10): 1938-1942

  Abstract

  We describe a rare case of multiple intestinal atresias, congenital bilateral perisylvian polymicrogyria, and chronic pulmonary hypertension in a surviving monochorionic twin with co-twin demise. This constellation of congenital anomalies represents a multiple vascular disruption syndrome due to intrauterine vascular compromise in the setting of possible twin-to-twin transfusion syndrome.

  View details for DOI 10.1016/j.jpedsurg.2012.08.021

  View details for Web of Science ID 000310777300043

  View details for PubMedID 23084212

• Contrast Delay on Perfusion CT as a Predictor of New, Incident Infarct A Retrospective Cohort Study STROKE Keedy, A. W., Fischette, S., Soares, B. P., Arora, S., Lau, B. C., Magge, R., Bredno, J., Cheng, S., Wintermark, M. 2012; 43 (5): 1295-1301

  Abstract

  The purpose of this study was to determine if the assessment of intracranial collateral circulation by CT angiography and/or perfusion CT (PCT) can predict the risk of future ischemic stroke in a large, retrospective cohort study.We identified 135 consecutive patients who underwent CT angiography of the head and neck and PCT of the brain at baseline and with subsequent follow-up brain imaging. Clinical and demographic information and carotid wall features were collected. Collateral circulation was assessed anatomically at CT angiography and functionally by measuring the mean transit time delay at PCT. The clinical, carotid, CT angiography, and PCT variables were compared between those with and without new incident infarct at follow-up imaging using mixed effect logistic statistical models.During the follow-up period, 15 patients developed a new infarct and 120 patients did not. Clinical features associated with the stroke risk were age, hypertension, hyperlipidemia, and atrial fibrillation. The carotid features associated with stroke risk were wall thickness. Anatomic assessment of collaterals on CT angiography was not associated with stroke risk, whereas the functional assessment of collaterals (mean transit time delay on PCT) was associated with stroke risk. In a multivariate model, age, atrial fibrillation, and mean transit time delay (OR, 22.8; P<0.001) were the only covariates that were independent predictors of future ischemic stroke.The mean transit time delay on PCT contains important physiological information and should not be discarded. Along with age and atrial fibrillation, this functional assessment of intracranial collateral circulation predicts the risk of future hemispheric infarct.

  View details for DOI 10.1161/STROKEAHA.111.639229

  View details for Web of Science ID 000303602700029

  View details for PubMedID 22363062

• Blood-Brain Barrier Permeability Assessed by Perfusion CT Predicts Symptomatic Hemorrhagic Transformation and Malignant Edema in Acute Ischemic Stroke AMERICAN JOURNAL OF NEURORADIOLOGY Hom, J., Dankbaar, J. W., Soares, B. P., Schneider, T., Cheng, S., Bredno, J., LAU, B. C., Smith, W., Dillon, W. P., Wintermark, M. 2011; 32 (1): 41-48

  Abstract

  SHT and ME are feared complications in patients with acute ischemic stroke. They occur >10 times more frequently in tPA-treated versus placebo-treated patients. Our goal was to evaluate the sensitivity and specificity of admission BBBP measurements derived from PCT in predicting the development of SHT and ME in patients with acute ischemic stroke.We retrospectively analyzed a dataset consisting of 32 consecutive patients with acute ischemic stroke with appropriate admission and follow-up imaging. We calculated admission BBBP by using delayed-acquisition PCT data and the Patlak model. Collateral flow was assessed on the admission CTA, while recanalization and reperfusion were assessed on the follow-up CTA and PCT, respectively. SHT and ME were defined according to ECASS III criteria. Clinical data were obtained from chart review. In our univariate and forward selection-based multivariate analysis for predictors of SHT and ME, we incorporated both clinical and imaging variables, including age, admission NIHSS score, admission blood glucose level, admission blood pressure, time from symptom onset to scanning, treatment type, admission PCT-defined infarct volume, admission BBBP, collateral flow, recanalization, and reperfusion. Optimal sensitivity and specificity for SHT and ME prediction were calculated by using ROC analysis.In our sample of 32 patients, 3 developed SHT and 3 developed ME. Of the 3 patients with SHT, 2 received IV tPA, while 1 received IA tPA and treatment with the Merci device; of the 3 patients with ME, 2 received IV tPA, while 1 received IA tPA and treatment with the Merci device. Admission BBBP measurements above the threshold were 100% sensitive and 79% specific in predicting SHT and ME. Furthermore, all patients with SHT and ME--and only those with SHT and ME--had admission BBBP measurements above the threshold, were older than 65 years of age, and received tPA. Admission BBBP, age, and tPA were the independent predictors of SHT and ME in our forward selection-based multivariate analysis. Of these 3 variables, only BBBP measurements and age were known before making the decision of administering tPA and thus are clinically meaningful.Admission BBBP, a pretreatment measurement, was 100% sensitive and 79% specific in predicting SHT and ME.

  View details for DOI 10.3174/ajnr.A2244

  View details for Web of Science ID 000287016200008

  View details for PubMedID 20947643

• Perfusion-CT of developmental venous anomalies: typical and atypical hemodynamic patterns JOURNAL OF NEURORADIOLOGY Kroll, H., Soares, B. P., Saloner, D., Dillon, W. P., Wintermark, M. 2010; 37 (4): 239-242

  Abstract

  This article reports perfusion-CT patterns that can be observed in patients with DVAs. In atypical DVAs, an abnormal venous congestion pattern with increased CBV, CBF and MTT can be observed in the vicinity of a DVA, and needs to be recognized and differentiated from other entities such as cerebral neoplasms or stroke. This pattern might help to stratify risks of associated complications such as hemorrhage.

  View details for DOI 10.1016/j.neurad.2009.09.002

  View details for Web of Science ID 000283706500005

  View details for PubMedID 19959233

  View details for PubMedCentralID PMC2950208

• Carotid Atheroma Rupture Observed In Vivo and FSI-Predicted Stress Distribution Based on Pre-rupture Imaging ANNALS OF BIOMEDICAL ENGINEERING Leach, J. R., Rayz, V. L., Soares, B., Wintermark, M., Mofrad, M. R., Saloner, D. 2010; 38 (8): 2748-2765

  Abstract

  Atherosclerosis at the carotid bifurcation is a major risk factor for stroke. As mechanical forces may impact lesion stability, finite element studies have been conducted on models of diseased vessels to elucidate the effects of lesion characteristics on the stresses within plaque materials. It is hoped that patient-specific biomechanical analyses may serve clinically to assess the rupture potential for any particular lesion, allowing better stratification of patients into the most appropriate treatments. Due to a sparsity of in vivo plaque rupture data, the relationship between various mechanical descriptors such as stresses or strains and rupture vulnerability is incompletely known, and the patient-specific utility of biomechanical analyses is unclear. In this article, we present a comparison between carotid atheroma rupture observed in vivo and the plaque stress distribution from fluid-structure interaction analysis based on pre-rupture medical imaging. The effects of image resolution are explored and the calculated stress fields are shown to vary by as much as 50% with sub-pixel geometric uncertainty. Within these bounds, we find a region of pronounced elevation in stress within the fibrous plaque layer of the lesion with a location and extent corresponding to that of the observed site of plaque rupture.

  View details for DOI 10.1007/s10439-010-0004-8

  View details for Web of Science ID 000279682000023

  View details for PubMedID 20232151

  View details for PubMedCentralID PMC2900591

• Reperfusion Is a More Accurate Predictor of Follow-Up Infarct Volume Than Recanalization A Proof of Concept Using CT in Acute Ischemic Stroke Patients STROKE Soares, B. P., Tong, E., Hom, J., Cheng, S., Bredno, J., Boussel, L., Smith, W. S., Wintermark, M. 2010; 41 (1): E34-E40

  Abstract

  The purpose of this study was to compare recanalization and reperfusion in terms of their predictive value for imaging outcomes (follow-up infarct volume, infarct growth, salvaged penumbra) and clinical outcome in acute ischemic stroke patients. Material andTwenty-two patients admitted within 6 hours of stroke onset were retrospectively included in this study. These patients underwent a first stroke CT protocol including CT-angiography (CTA) and perfusion-CT (PCT) on admission, and similar imaging after treatment, typically around 24 hours, to assess recanalization and reperfusion. Recanalization was assessed by comparing arterial patency on admission and posttreatment CTAs; reperfusion, by comparing the volumes of CBV, CBF, and MTT abnormality on admission and posttreatment PCTs. Collateral flow was graded on the admission CTA. Follow-up infarct volume was measured on the discharge noncontrast CT. The groups of patients with reperfusion, no reperfusion, recanalization, and no recanalization were compared in terms of imaging and clinical outcomes.Reperfusion (using an MTT reperfusion index >75%) was a more accurate predictor of follow-up infarct volume than recanalization. Collateral flow and recanalization were not accurate predictors of follow-up infarct volume. An interaction term was found between reperfusion and the volume of the admission penumbra >50 mL.Our study provides evidence that reperfusion is a more accurate predictor of follow-up infarct volume in acute ischemic stroke patients than recanalization. We recommend an MTT reperfusion index >75% to assess therapy efficacy in future acute ischemic stroke trials that use perfusion-CT.

  View details for DOI 10.1161/STROKEAHA.109.568766

  View details for Web of Science ID 000273093400042

  View details for PubMedID 19910542

  View details for PubMedCentralID PMC2909663

• Difference in Disease Burden and Activity in Pediatric Patients on Brain Magnetic Resonance Imaging at Time of Multiple Sclerosis Onset vs Adults ARCHIVES OF NEUROLOGY Waubant, E., Chabas, D., Okuda, D. T., Glenn, O., Mowry, E., Henry, R. G., Strober, J. B., Soares, B., Wintermark, M., Pelletier, D. 2009; 66 (8): 967-971

  Abstract

  To compare initial brain magnetic resonance imaging (MRI) characteristics of children and adults at multiple sclerosis (MS) onset.Retrospective analysis of features of first brain MRI available at MS onset in patients with pediatric-onset and adult-onset MS.A pediatric and an adult MS center.Patients with pediatric-onset <18 years) and adult-onset (> or =18 years) MS.We evaluated initial and second (when available) brain MRI scans obtained at the time of first MS symptoms for lesions that were T2-bright, ovoid and well defined, large (> or =1cm), or enhancing.We identified 41 patients with pediatric-onset MS and 35 patients with adult-onset MS. Children had a higher number of total T2- (median, 21 vs 6; P < .001) and large T2-bright areas (median, 4 vs 0; P < .001) than adults. Children more frequently had T2-bright foci in the posterior fossa (68.3% vs 31.4%; P = .001) and enhancing lesions (68.4% vs 21.2%; P < .001) than adults. On the second brain MRI, children had more new T2-bright (median, 2.5 vs 0; P < .001) and gadolinium-enhancing foci (P < .001) than adults. Except for corpus callosum involvement, race/ethnicity was not strongly associated with disease burden or lesion location on the first scan, although other associations cannot be excluded because of the width of the confidence intervals.While it is unknown whether the higher disease burden, posterior fossa involvement, and rate of new lesions in pediatric-onset MS are explained by age alone, these characteristics have been associated with worse disability progression in adults.

  View details for DOI 10.1001/archneurol.2009.135

  View details for Web of Science ID 000268848100007

  View details for PubMedID 19667217

• Automated versus manual post-processing of perfusion-CT data in patients with acute cerebral ischemia: influence on interobserver variability NEURORADIOLOGY Soares, B. P., Dankbaar, J. W., Bredno, J., Cheng, S., Bhogal, S., Dillon, W. P., Wintermark, M. 2009; 51 (7): 445-451

  Abstract

  The purpose of this study is to compare the variability of PCT results obtained by automatic selection of the arterial input function (AIF), venous output function (VOF) and symmetry axis versus manual selection.Imaging data from 30 PCT studies obtained as part of standard clinical stroke care at our institution in patients with suspected acute hemispheric ischemic stroke were retrospectively reviewed. Two observers performed the post-processing of 30 CTP datasets. Each observer processed the data twice, the first time employing manual selection of AIF, VOF and symmetry axis, and a second time using automated selection of these same parameters, with the user being allowed to adjust them whenever deemed appropriate. The volumes of infarct core and of total perfusion defect were recorded. The cerebral blood volume (CBV), cerebral blood flow (CBF), mean transit time (MTT) and blood-brain barrier permeability (BBBP) values in standardized regions of interest were recorded. Interobserver variability was quantified using the Bland and Altman's approach.Automated post-processing yielded lower coefficients of variation for the volume of the infarct core and the volume of the total perfusion defect (15.7% and 5.8%, respectively) compared to manual post-processing (31.0% and 12.2%, respectively). Automated post-processing yielded lower coefficients of variation for PCT values (11.3% for CBV, 9.7% for CBF, and 9.5% for MTT) compared to manual post-processing (23.7% for CBV, 32.8% for CBF, and 16.7% for MTT).Automated post-processing of PCT data improves interobserver agreement in measurements of CBV, CBF and MTT, as well as volume of infarct core and penumbra.

  View details for DOI 10.1007/s00234-009-0516-9

  View details for Web of Science ID 000266927000002

  View details for PubMedID 19274457

  View details for PubMedCentralID PMC2694925

• MR and CT Monitoring of Recanalization, Reperfusion, and Penumbra Salvage Everything That Recanalizes Does Not Necessarily Reperfuse! STROKE Soares, B. P., Chien, J. D., Wintermark, M. 2009; 40 (3): S24-S27

  Abstract

  Revascularization therapies for acute stroke patients aim to rescue the ischemic penumbra by restoring the patency of the occluded artery ("recanalization") and the downstream capillary blood flow ("reperfusion"). This article reviews the definition of recanalization and reperfusion used in stroke clinical trials and their limitations and proposes a study design to determine the relative importance of recanalization, reperfusion, and collateral flow in evaluating the efficacy of revascularization therapies for acute ischemic stroke.

  View details for DOI 10.1161/STROKEAHA.108.526814

  View details for Web of Science ID 000263594200008

  View details for PubMedID 19064812