Citations

Objectives Often, persistent post-traumatic headache and migraine are phenotypically similar. However, the similarities and differences in the neuropathological underpinnings of persistent post-traumatic headache and migraine require further understanding. We used diffusion tensor imaging (DTI) and a novel method for detecting subtle changes in fibertract integrity by measuring node-by-node parameters along each tract to compare fibertract profiles between those with migraine and those with persistent post-traumatic headache, and compared both cohorts to a group of controls. Methods Eighteen fibertracts were reconstructed for 131 subjects, including 49 patients with persistent post-traumatic headache attributed to mild traumatic brain injury, 41 with migraine, and 41 controls. Node-by-node diffusion parameters of mean diffusivity and radial diffusivity were calculated along each tract. Mean diffusivity and radial diffusivity measurements were averaged along quartiles of each tract for statistical interpretation and group comparison. Using a post-hoc analysis, correlations between tract quartile measurements and headache frequency were calculated. Results There were significant differences between migraine and persistent post-traumatic headache cohorts for quartile measurements of mean diffusivity or radial diffusivity in the bilateral anterior thalamic radiations, cingulum (angular bundles and cingulate gyri), inferior longitudinal fasciculi, and uncinate fasciculi, the left corticospinal tract, and the right superior longitudinal fasciculi-parietal portion. For migraine patients, there was a significant positive correlation between headache frequency and forceps major mean diffusivity, whereas for persistent post-traumatic headache there was a positive correlation between headache frequency and cingulum angular bundle mean diffusivity and radial diffusivity. Conclusions Quartile measurements of radial diffusivity and mean diffusivity indicate unique differences in fibertract profiles between those with migraine vs. persistent post-traumatic headache. Although for both migraine and persistent post-traumatic headache there was a positive relationship between fibertract alterations and headache frequency, there were disease-specific differences between headache frequency and fibertract injury patterns. These findings might suggest potential differences in the neuropathological mechanisms underlying migraine and persistent post-traumatic headache.

Abstract Objective The American College of Surgeons (ACS) encourages clinicians to provide training to laypeople on tourniquet application. It is unclear whether clinicians are confident in their abilities and equipped with adequate knowledge, skills, and resources. This study aimed to determine surgical trainee knowledge and attitudes regarding tourniquet application and compare the effectiveness of instructions. Methods Thirty surgical trainees performed a tourniquet application simulation using a Combat Application Tourniquet and one of the three instructions sets developed by ACS, Department of Homeland Security, and the tourniquet manufacturer. Participants reported tourniquet knowledge, attitudes, and confidence and discussed the instructions. One instruction set was updated and compared to the original set with 20 new trainees. Results Participants with ACS instructions passed the greatest number of steps (p < 0.01) and completed the task significantly faster compared to those with manufacturer instructions (p < 0.01). Participants (80%) reported favorable views toward tourniquets but 30–60% did not align with to ACS tourniquet guidelines. Focus group participants suggested revisions to the ACS instructions. Comparing the original and revised version of these instructions resulted in no significant improvements. Conclusions ACS instructions provide guidance; however, improvements to tourniquet instruction are needed for success in controlling exsanguinating hemorrhage.

BackgroundThe 3D breast magnetic resonance fingerprinting (MRF) technique enables T1 and T2 mapping in breast tissues. Combined repeatability and reproducibility studies on breast T1 and T2 relaxometry are lacking.PurposeTo assess test–retest and two‐visit repeatability and interscanner reproducibility of the 3D breast MRF technique in a single‐institution setting.Study TypeProspective.SubjectsEighteen women (median age 29 years, range, 22–33 years) underwent Visit 1 scans on scanner 1. Ten of these women underwent test–retest scan repositioning after a 10‐minute interval. Thirteen women had Visit 2 scans within 7–15 days in same menstrual cycle. The remaining five women had Visit 2 scans in the same menstrual phase in next menstrual cycle. Five women were also scanned on scanner 2 at both visits for interscanner reproducibility.Field Strength/SequenceTwo 3T MR scanners with the 3D breast MRF technique.AssessmentT1 and T2 MRF maps of both breasts.Statistical TestsMean T1 and T2 values for normal fibroglandular tissues were quantified at all scans. For variability, between and within‐subjects coefficients of variation (bCV and wCV, respectively) were assessed. Repeatability was assessed with Bland–Altman analysis and coefficient of repeatability (CR). Reproducibility was assessed with interscanner coefficient of variation (CoV) and Wilcoxon signed‐rank test.ResultsThe bCV at test–retest scans was 9–12% for T1, 7–17% for T2, wCV was <4% for T1, and <7% for T2. For two visits in same menstrual cycle, bCV was 10–15% for T1, 13–17% for T2, wCV was <7% for T1 and <5% for T2. For two visits in the same menstrual phase, bCV was 6–14% for T1, 15–18% for T2, wCV was <7% for T1, and <9% for T2. For test–retest scans, CR for T1 and T2 were 130 msec and 11 msec. For two visit scans, CR was <290 msec for T1 and 10–14 msec for T2. Interscanner CoV was 3.3–3.6% for T1 and 5.1–6.6% for T2, with no differences between interscanner measurements (P = 1.00 for T1, P = 0.344 for T2).Data Conclusion3D breast MRF measurements are repeatable across scan timings and scanners and may be useful in clinical applications in breast imaging.Level of Evidence: 2Technical Efficacy: Stage 2J. Magn. Reson. Imaging 2019;50:1133–1143.