patient clinical sample - ceremetrix€¦ · mood swings muscle spasms nausea nightmares obsessive...
TRANSCRIPT
DiagnosticBrainReportCereScanpoweredbyCereMetrix®
720.259.1976,[email protected]|1
BRAINPERFUSIONREPORTBRAINPERFUSIONREPORTPATIENT CLINICAL
FIRSTNAMEXXX
EXAMQuantitativeSinglePhotonEmissionComputedTomography(qSPECT)
LASTNAMEXXX
REFERRINGPROVIDERXXX
MR#XXX
INDICATIONSFORREFERRALDiffusetraumaticbraininjurywithlossofconsciousnessofunspecifiedduration,initialencounter(S06.2X9A)
DOBXXX
INTERPRETINGPHYSICIANXXX
AGEXX
EXAMDATEXXX
HANDEDLeft
XXX
RADIOLOGICFINDINGSHigh-resolution,brainSPECTimagingwasperformedatbaselineandwithaconcentrationbattery.Noabnormalmotionorartifactwasdetected.Ablindreviewofthetomographicimageswasperformed.
Atrest,theoverallcorticalactivitywasslightlyreduced.
Focalareasofabnormalcorticalhypoperfusionwerenotedintherightanteriorfrontal,rightorbitofrontal,bilateralsuperiorparietal,bilateralanterior,medialandposteriortemporal,bilateraloccipitalandbilateralposteriorcerebellarareas.
Focalareasofabnormalsubcorticalhypoperfusionwerenotedinthelefthippocamapalareas.
Focalareasofabnormallyincreasedcorticalperfusionwerenotnoted.
Focalareasofabnormallyincreasedsubcorticalperfusionwerenotedintherightthalamusandbilaterallentiformareas.
Corticaldeactivationisnotedwiththeconcentrationtask.
CereMetrixclusteranalysiscomparisonsofthepatient’sbaselinedatatoa1000patientcompositeaveragesample,aswellasthe3D/surface-renderedimages,revealedabnormalitiesconsistentwiththoseseenonthetomographicimages
RADIOLOGICIMPRESSIONS
SAMPLE
DiagnosticBrainReportCereScanpoweredbyCereMetrix®
720.259.1976,[email protected]|2XXX
1. ThisisanabnormalbrainSPECTstudydemonstratingfocalareasofabnormalcorticalhypoperfusioninthefrontal,temporal,parietal,occipitalandcerebellarareasaspreviouslydescribed.
Thenature,location,andpatternoftheseabnormalitiesisprimarilyconsistentwiththescientificliteraturepertainingtotraumaticbraininjury(TBI)andthepatient’sclinicalhistory,asobtained,whichwasreceivedaftertheblindreview.Corticaldeactivationwiththeconcentrationtaskisanabnormalfindingassociatedwithanon-specificbraininjuryprocess.Alternativeconsiderationsforthesefindings,suchasneurodegenerative,neurovascularandtoxic/hypoxicprocesseswereconsidered,butwereconsideredtobelesslikelygiventhepatient’sageandspecificclinicalhistory,whichwasobtainedaftertheblindreview.
2. Thefindingsofincreasedthalamicactivitycoupledwithorbito-frontalhypoperfusionhasbeenassociatedbyseveralauthorswithvariousmooddisorders.
3. Thefindingofincreasedactivityinthebasalganglia,alongwiththepatient’sclinicalhistoryandresultsofhisstructuredMINIinterviewhere,hasbeenassociatedbyseveralauthorswithvariousanxietydisorders.
Closeclinicalcorrelationwiththepatient’sentiremedicalhistoryisadvised.
QSPECTBRAINIMAGINGThepatientwasseenforthefollowinghigh-resolutionbrainSPECTimagingstudies,whichwereperformedwithinthecriteria,establishedguidelinesandqualitycontrolsforimagingsetbytheAmericanCollegeofRadiologyincludingtheACR-SPRPracticeParameterforthePerformanceofSinglePhotonEmissionComputedTomography(SPECT)BrainPerfusionImaging,IncludingBrainDeathExaminations.
MethodsDuringthebaselinescan,thepatientisplacedinacomfortablerecliningchairinaquietdimlylitroomwitheyesclosed,withambientnoise,andanIVlineisstarted.Thepatientisthenallowedtoacclimatetoaquietsemi-darkenedroomwithsound-dampeningheadphonesonfor15minutes,inaccordancewiththeACRpracticeguidelines.TheTc99-mlabeledHMPAOtraceristheninjectedthroughtheIVlineandflushedwithsaline.Thetraceristhentakenupbythebrainwithinthenext2minutes.Thisresultsinaperfusionpatternthatisanalyzedandinterpreted.Afterinjection,thepatientremainsinthequietsemi-darkenedroomforanadditional5minutes.TheSPECTscanisacquiredaminimumof60minutespostinjection.
Duringtheconcentrationtask,thepatientisplacedinaquietroomandanIVlineisstarted.Thepatientperformsaconcentrationbatteryonatablet.Approximately5minutesintothetask,theTc99-mlabeledHMPAOtraceristheninjectedthroughtheIVlineandflushedwithsaline.Thepatientcompletesthetaskandscanisacquiredaminimumof60minutespostinjection.
ScansareobtainedusingaSiemensSymbiaESPECTgammacamerawithalowenergyhighresolution(LEHR)parallelholecollimator.Countsarecollectedina128X128matrixwith32stopsof5.625degreeseach,withazoomof1.78.Totalcountsexceeded5million.DataisfilteredusingaButterworthfilterat.25withanorderof5,correctedformotionasneededandattenuationcorrectionisperformed.Thevolumeismaskedto
SAMPLE
DiagnosticBrainReportCereScanpoweredbyCereMetrix®
720.259.1976,[email protected]|3
excludeasmuchnon-neuralstructureaspossible.Thereisnopost-filtering.Dataispresentedinaxial,sagittalandcoronalviewsin2mmsections.StatisticalanalysisisperformedusingCereMetrixsoftwarerelativetoacompositedatabaseofaverageperfusioncontaining1000individuals.
Date Status TC99-HMPAODose Count
XXX SPECT-Baseline 30.70mCiTc99HMPAO 5.645million
XXX SPECT-Concentration 31.30mCiTc99HMPAO 5.703million
ProceduresTheutilizationofSPECTinthediagnosticevaluationofvariousneurologicaldisordersiswellestablished.TheprocedureandpracticeguidelinesoftheAmericanCollegeofRadiology,theSocietyofNuclearMedicineandtheEuropeanAssociationofNuclearMedicineestablishtheutilityandscientificvalidityofSPECTfunctionalbrainimagingfordetectionandevaluationofcerebrovasculardiseaseandstroke,evaluationofdementiaandAlzheimer’sdisease,pre-surgicallocalizationofepilepticfoci,diagnosticevaluationofencephalitisandevaluationofsuspectedbraintrauma.Theseprocedureandpracticeguidelinesareadheredtoinallofouracquisitionandprocessingprotocols.Researchhasalsodemonstratedregionalperfusionpatternsassociatedwithotherneurologicaldisordersandwithexposuretoneurotoxins,hypoxiaandsubstancesofabuse.
Althoughthereisaverylargebodyofpeer-reviewedscientificarticlesshowingcertainbrainpatternsassociatedwithcertainpsychiatricconditions,theutilizationofSPECTfortheevaluationofpsychiatricdisordersisstillconsideredanemergingscienceandthereforeintheinvestigationalstage.AlthoughwewillreportonbrainpatternsofcertainpsychiatricconditionssuchasAttentionDeficitHyperactivityDisorder,BipolarDisorder,Anxiety,ObsessiveCompulsiveDisorder,etc.,basedonpatternspublishedinpeer-reviewedjournals,suchfindingsarenotconsideredstandaloneordiagnosticperseandshouldalwaysbeconsideredinconjunctionwiththepatient’sclinicalcondition.Thesedatashouldonlybeusedasadditionalinformationtoaddtotheclinician’sdiagnosticimpression.
ThebrainSPECTimagingstudieswereperformedunderthegeneralsupervisionofaqualifiedstatelicensedphysician.
Sincerely,
Date:XXXTime:XXX
Radiologist SignatureRadiologist License
SAMPLE
DiagnosticBrainReportCereScanpoweredbyCereMetrix®
720.259.1976,[email protected]|4
CLINICALHISTORYREPORTCLINICALHISTORYREPORT
NEUROPSYCHIATRICANDCOGNITIVEASSESSMENTS1. TheMiniInternationalNeuropsychiatricInterviewwasadministeredonXXX.Accordingly,hemetthe
followingdiagnosticcriteria:
GeneralizedAnxietyDisorder2. TheSavonixCognitiveAssessmentwasadministeredonXXX.Hiscognitivestatusprofile
generatedthefollowingresults:
SAMPLE
DiagnosticBrainReportCereScanpoweredbyCereMetrix®
720.259.1976,[email protected]|6
AngermanagementproblemsBalanceproblemsCompulsivebehaviorConfusionDifficultyfollowinginstructionsDifficultylearningnewthingsDifficultywithconcentrationDisorganizationDisorientationtotimeand/orplaceDistractibilityElevatedmoodFatigueFlashbacksoftraumaFrequentHeadachesGeneralanxiety
LossofmotivationLowfrustrationtoleranceMakingcarelessmistakesMoodswingsMusclespasmsNauseaNightmaresObsessivethoughtsPanicattacksParanoiaPerformanceanxietyPersonalitychangesProblemspayingattentionProblemswithlanguage/wordfindingRacingthoughts
CLINICALOVERVIEWOFCHIEFCOMPLAINTPatient XXXisa39yearoldlefthandedmale.
XXX isaretiredAirForceVeteran.Duringhismilitarycareer(bothintheUnitedStatesandalsoin Iraq)thepatientworkedasanExplosiveOrdnanceDisposalOperatorfrom1999-2006.Heperformedandwas subjectedtomultipledetonationsrangingfrom0.5lbofC-4to100,000poundsofhighexplosive.Heestimated thenumberofdetonationstobe50,000.On05/03/2006,whileinIraq,thepatientsustainedanIEDattack duringconvoyoperationsinIraq.Theimpactcausedhisrifletostrikethefrontofhishead.Theblastand impactrequiredhimtobeplacedinamedicallyinducedcomaforthreedays.
Thepatient'sprimarysymptomsofconcernincludetinnitus,balancingissues,wordmisplacementchallenges, headaches,moodswings,episodesofanger,emotionalregulationchallenges,andlowfrustrationtolerance occasionally.Thesechronicsymptomsdevelopedaftertheblastin2006.
PATIENT’SSELF-REPORTEDSYMPTOMSSAMPLE
DiagnosticBrainReportCereScanpoweredbyCereMetrix®
720.259.1976,[email protected]|7
ImpulsecontrolproblemsInsomniaLong-termmemoryproblemsLosingthingsLossofinterestinthings
Restlessness/FidgetinessRinginginearsRiskybehaviorShorttermmemoryproblemsSocialanxiety
ADD/ADHD(07/2010)Anxiety(07/2006)Backinjuries(07/2007)Braininjury(05/03/2006)Headaches(migraine)(08/2006)
Headaches(tension)(08/2018)Hearingproblems(07/2006)Posttraumaticstressdisorder(07/2006)Sleepapnea(10/2009)
Motrin(800mgasneeded) Sumatriptan(asneeded)
Lyrica(300mg) Oxycotin(20mgtwicedaily)
MEDICALHISTORY
HistoryofBrainInjuryBlastWaveInjury:ThepatientworkedasanExplosiveOrdnanceDisposalOperatorfrom1999-2006.Heperformedandwassubjectedtomultipledetonationsrangingfrom0.5lbofC-4to100,000bsofhighexplosive.Heestimatedthenumberofdetonationstobe50,000.CombatInjury(05/03/2006):On05/03/2006,thepatientsustainedanIEDattackduringconvoyoperationsinIraq.AnEFPIEDdetonatedwithin5ftofhisvehicle.Hisweapon"hit[him]intheface,knocked[him]outandblastwavethrew[him]acrossthevehicle."Hewashitonthefrontandrightsideofhisface.Hesaid,"IalsosustainedmassivefacialtraumaandafracturedL5S1duringtheattack."Helostconsciousnessfor30-60secondsandafterregainingconsciousness,herememberedwatchinghisfriendtakehislastbreath.Hewasnotwearinganarmoredhelmet;onlyaplatecarrier.HereportedPTamnesia,confusion,disorientation,headaches,anddizziness.Aftertheexplosion,hewasmedivacedandplacedintoamedicallyinducedcoma.HewasthenseenatLandstuhlMedicalCenter,SentaraNorfolkGeneralHospital,wherehewasdiagnosedwithaconcussion.
IncomingDiagnoses
CurrentMedications
PastMedications
Pre-ScanMedicationRecommendationsCertainclassificationsofmedicationsmayhaveanimpactonbloodflowinthebrain.ThepatientwasadvisedtoreviewCereScan’srecommendationsregardingtheuseofstimulants,benzodiazepines,opiatesandbarbiturates,amongothersubstancesandmedications,anddiscussthemwithhis/herphysician.
SAMPLE
DiagnosticBrainReportCereScanpoweredbyCereMetrix®
720.259.1976,[email protected]|8
He hashad59+surgeriestohis face,rightarm, uppermandible,etc.associatedwithhisblast injuryinIraq
Father:Melanoma PaternalUncle:Schizophrenia
MRI(Unknown,05/05/2018),ReportUnavailable CT(Unknown,05/15/2006),ReportUnavailable
AllergiesNonereported
Surgeries/Hospitalizations
FamilyHistoryofMajorMedicalandPsychiatricIllness
BRAINIMAGINGHISTORY
DEVELOPMENTALHISTORYThepatientdeniesanyknownhistoryofbirthtraumaordevelopmentaldelays.
CURRENTUSEOFALCOHOLANDRECREATIONALSUBSTANCESAlcohol:Nonereported
Caffeine:Nonereported
Nicotine:Nonereported
Drugs:Nonereported
Thepatientreportsthathequitusingnicotinesevenyearsago.
PASTHISTORYOFALCOHOLORDRUGABUSE
AlcoholNonereported
SAMPLE
DiagnosticBrainReportCereScanpoweredbyCereMetrix®
720.259.1976,[email protected]|9
DrugsThepatientusedmarijuanaoccasionallyinhispast.Hedoesnotcurrentlyusemarijuana.
EDUCATIONALANDEMPLOYMENTSTATUSThepatient'shighesteducationlevelisBachelor'sDegree.Thepatient'semploymentstatusisEmployedPart-Time.
VETERANHISTORYThepatientisadischargedAirForceveteran.Hehadanon-combatdeploymentinKuwait.
Sincerely,
Date:XXXTime:XXX
Clinician Signature
Clinician License
Wearehappytocommunicatewithanyofyourtreatingclinicians.Thankyouforthisopportunitytoparticipate inyourcarewiththisconsultation. SAMPLE
DiagnosticBrainReportCereScanpoweredbyCereMetrix®
720.259.1976,[email protected]|10
APPENDIXAPPENDIX
ANNOTATIONS
Anteriorview:bilateralanteriorfrontal(rightgreaterthanleft),bilateralanteriortemporalhypoperfusion
Inferiorview:rightorbitofrontal,bilateralanteriorandmedialtemporalareasofhypoperfusion,bilateralposteriorcerebellarhypoperfusion
Superiorview:bilateralsuperiorparietalhypoperfusion
Leftview:leftlateralfrontalhypoperfusion,leftanteriorandposteriortemporalhypoperfusion
Posteriorview:bilateraloccipitalhypoperfusion
SAMPLE
DiagnosticBrainReportCereScanpoweredbyCereMetrix®
720.259.1976,[email protected]|11
Rightlateral:rightanteriorandposteriortemporalhypoperfusion,rightlateralfrontalhypoperfusion
Limbicview:increasedrightthalamusandbilaterallentiformperfusiondecreasedlefthippocampalperfusion
SAMPLE