The current state-of-the-art of spinal cord imaging: methods.

A first-ever spinal cord imaging meeting was sponsored by the International Spinal Research Trust and the Wings for Life Foundation with the aim of identifying the current state-of-the-art of spinal cord imaging, the current greatest challenges, and greatest needs for future development. This meeting was attended by a small group of invited experts spanning all aspects of spinal cord imaging from basic research to clinical practice. The greatest current challenges for spinal cord imaging were identified as arising from the imaging environment itself; difficult imaging environment created by the bone surrounding the spinal canal, physiological motion of the cord and adjacent tissues, and small cross-sectional dimensions of the spinal cord, exacerbated by metallic implants often present in injured patients. Challenges were also identified as a result of a lack of "critical mass" of researchers taking on the development of spinal cord imaging, affecting both the rate of progress in the field, and the demand for equipment and software to manufacturers to produce the necessary tools. Here we define the current state-of-the-art of spinal cord imaging, discuss the underlying theory and challenges, and present the evidence for the current and potential power of these methods. In two review papers (part I and part II), we propose that the challenges can be overcome with advances in methods, improving availability and effectiveness of methods, and linking existing researchers to create the necessary scientific and clinical network to advance the rate of progress and impact of the research

Traumatic Brain Injury: Nuclear Medicine Neuroimaging

This chapter provides an up-to-date review of nuclear medicine neuroimaging in traumatic brain injury (TBI). 18F-FDG PET will remain a valuable tool in researching complex mechanisms associated with early metabolic dysfunction in TBI. Although evidence-based imaging studies are needed, 18F-FDG PET in the TBI acute phase appeared to be more useful in those patients in whom structural neuroimages fail to show abnormalities explaining their neurological state. 15O2-PET is also a solid technique for research in acute TBI, but in contrast to 18F-FDG PET it is not widely available due to its high cost. In the chronic TBI phase, most 18F-FDG PET studies converge to identify a diffuse cortical–subcortical hypometabolism involving key regions for cognitive function. Recent studies suggest the usefulness of 18F-FDG PET for the evaluation of therapeutic interventions in chronic TBI patients with cognitive deficits. In recent years, interest in studying cell-specific processes is growing. The use of radioligands as markers of neuroinflammation could become attractive for detecting secondary damage and serve for the evaluation of different therapeutic approaches. SPECT advances also make this technique a valid alternative for the study of TBI

PET Imaging in Altered States of Consciousness: Coma, Sleep, and Hypnosis

peer reviewedPositron emission tomography (PET) allows studies of cerebral metabolism and blood flow and has been widely used to investigate physiological mechanisms underlying altered states of consciousness. Consciousness is characterized by two components: wakefulness and awareness. In this chapter, we review the current literature on brain metabolism during pathological loss of consciousness (vegetative/unresponsive or minimally conscious states), sleep (in healthy subjects and in patients with insomnia), and under hypnosis. By identifying brain areas specifically involved in conscious processing, these studies have contributed to our understanding of the underlying physiology of consciousness. The precuneal and cingulate cortices, for example, seem to be key areas for maintaining conscious awareness. FDG-PET further allowed the identification of the minimal energetic requirement for conscious awareness in this population, which corresponds to 42% of normal cortical activity. Up to now, it is the most accurate neuroimaging tool regarding the diagnosis of patients with disorders of consciousness. In the future, its use as part of multimodal assessment could improve diagnosis and prognosis in this challenging population. In sleep, a greater activity of the precuneus/posterior cingulate cortex and the fronto-parietal areas during non rapid eye movement sleep also seems to play a role in disorders such as insomnia. Other areas such as the hypothalamus, amygdala, or temporo-occipital cortex seem to play a role in different states such as rapid eye movement sleep and hypnosis. PET studies permit a better comprehension of the neural correlates of consciousness and to identify the implication of specific neural areas and networks in altered states of consciousness in post-comatose patients, sleep and induced hypnosis