With as many as 212,000 servicemembers suffering a TBI over the last decade, military clinicians are searching for the most effective neuroimaging methods to diagnose and treat the injuries.
“Our goal is to improve neuroimaging contribution to the diagnosis and treatment of TBI and PTS,” said Gerard Riedy, MD, the National Intrepid Center of Excellence (NICoE) chief of neuroimaging, during a recent webinar held by DCoE.
The NICoE, opened its doors in Bethesda, MD, to patients in October of 2010 and provides help to patients with complex TBI as well as other psychological health conditions who have not recovered with conventional therapies offered elsewhere in the MHS. NICoE is equipped with advanced imaging equipment, including a Positron Emission Tomography-Computed Tomography (PET-CT), MRI and Magnetoencephalography (MEG), which enables providers to view brain scans and images in multiple dimensions.
“We use all of these modalities in concert to do a full clinical and research evaluation of many of the patients that come to the NICoE here,” he explained.
Clinicians at NICoE are imaging much thinner sections of the brain than would be done in a routine MRI study. In doing so, Riedy said they have been “quite surprised” as to how many abnormalities they are finding in the brains of the 44 patients who underwent an MRI scan there since April.
“We have seen abnormalities related to TBI in about 64% of those of the patients we have imaged. Of those, 82% have had either normal prior imaging or no prior imaging. So it is basically a new imaging diagnosis for the patient,” he said.Center Uses Cutting-Edge Neuroimaging Techniques to Diagnosis, Treat TBI Cont.
While a routine Magnetic Resonance Imaging (MRI) picks up abnormalities in the brain structure of those with moderate and severe TBI, it does not always pick up abnormalities in those with mild TBI cases, Riedy explained. “We are trying here at the NICoE to use more advanced neuroimaging … to not only look at the structure, but also look at brain function, which we know can be disrupted in terms of memory issues, executive function issues and others.”
During the webinar, Riedy showed a comparison of a brain scan in which the standard MRI for microhemorrhage found a possible lesion in the corpus callosum, while NICoE’s advanced sustainability weighted images showed multiple lesions in the brain due to the injury.
As part of their current evaluations, patients also undergo FMRI studies to examine cognitive changes and Diffusion Tensor Imaging.
“Our goal is to eliminate some of these things we are looking at,” he said. “We are going to say, ‘well maybe spectroscopy is not the way to do it, or maybe diffusion tensor is not the way to do it, maybe a combination of susceptibility weighted imaging and functional imaging is the way to do it.’ So we want to look at all of these things, and then we are going to make recommendations to MTFs and VA about how they should be imaging.”
NICoE Offers State of the Art
The 150 patients treated at NICoE so far are active-duty servicemembers, mostly with mild to moderate TBI complicated by other psychological health conditions who are not responding to conventional therapy, officials said.
“Many of the patients we have seen have been in treatment for two, three, five, even seven years since their first injury back in 2003 and 2004, and they have failed to progress,” said Capt. Robert Koffman, NICoE clinical operations deputy director.
Troops stay at the Fisher House for approximately three weeks of evaluation, assessment and treatment planning. In addition to the advanced neuroimaging offered at the center, officials said the center is unique in that it uses an interdisciplinary approach to care.
Clinicians work to address sleep issues, decrease physical pain and decrease polypharmacy use, among other efforts. The center also offers complementary and alternative medicine approaches such as yoga, Tai Chi, breathing, recreational therapy, art therapy, acupuncture and music therapy.
The architecture of the 72,000-square-foot, two-story facility lends itself to healing, Koffman said. An atrium called “Central Park,” is a natural setting with plants, simulated sounds and different surfaces for troops to experience.
“Every aspect of this building has been considered in terms of the healing environment such as how bright it needs to be so that individuals with photo-sensitivity are not aroused,” he said. “The building itself has very graceful curves to it. There is nothing angular; it is very inviting. The colors are very natural and warm.”
NICoE deputy director Thomas DeGraba said the effects of the healing environment are being studied and that elements found to be beneficial could be reproduced at other MTFs.
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