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Continuum Postreading Test 29(1) February 2023 (Neuroimaging)

Continuum Postreading Test 29(1) February 2023 (Neuroimaging)

Learning Objectives

Upon completion of this Continuum: Lifelong Learning in Neurology Neuroimaging issue, participants will be able to:
  • Describe governing rules for choosing an imaging modality or a specific imaging protocol in an individual patient, with emphasis on the limitations of predefined protocols and the importance of clinical context
  • Describe the physical and procedural safety risks of MRI and CT, which are essential imaging modalities for the diagnosis of neurologic disease
  • Describe the imaging modalities used in the evaluation of patients presenting with acute ischemic stroke, including technical considerations, interpretation, and clinical utility of each modality
  • Describe the role of neuroimaging in guiding identification of central nervous system hemorrhage, aiding in identification of hemorrhage etiology, and guiding subsequent medical decision making
  • Describe a methodical approach to the integration of neuroimaging in the clinical care of patients with epilepsy
  • Discuss the classic imaging features of common skull base tumors and their implications in surveillance, as well as management of these tumors
  • Describe essential imaging modalities in the treatment of patients with brain tumors and recognize common imaging patterns for tumors and certain clinical scenarios
  • Recognize abnormal findings on conventional clinical imaging in movement disorders and critically evaluate their relationship with pathology, utility, and limitations; and describe some other imaging modalities used in research and recent findings
  • Identify and describe neuroimaging findings in the most common age-related dementias
  • Describe the imaging patterns typical of autoimmune and inflammatory brain and spinal cord diseases, causes of the limbic encephalitis pattern on MRI, and findings on MRI that can help distinguish causes of myelitis
  • Discuss the role of MRI in both the diagnosis and prognosis of multiple sclerosis and antibody-mediated demyelinating diseases such as myelin oligodendrocyte glycoprotein–associated disorder, acquired disseminated encephalomyelitis, and neuromyelitis optica
  • Discuss the technical requirements, applications, and limitations of ultrasonography in central nervous system neurology

CORE COMPETENCIES

This Continuum: Lifelong Learning in Neurology Neuroimaging issue covers the following core competencies
  • Patient Care and Procedural Skills
  • Medical Knowledge
  • Practice-Based Learning and Improvement
  • Interpersonal and Communication Skills
  • Professionalism
  • Systems-Based Practice

Contributorsa

Joshua P. Klein, MD, PhD, FANA, FASN, FAAN, Guest Editor
Vice Chair, Clinical Affairs, and Chief, Division of Hospital Neurology, Department of Neurology, Brigham and Women's Hospital; Associate Professor of Neurology and Radiology, Harvard Medical School, Boston, Massachusetts

Relationship Disclosure: Dr Klein has received personal compensation in the range of $5000 to $9999 for serving as an editor, associate editor, or editorial advisory board member for Oakstone Publishing and in the range of $10,000 to $49,999 for serving as an editor, associate editor, or editorial advisory board member for AudioDigest, McGraw Hill, and SAGE Publications. Dr Klein has received publishing royalties in the range of $10,000 to $49,000 from a publication relating to health care. Dr Klein has received personal compensation in the range of $100,000 to $499,999 for serving as an expert witness for various law firms.

Unlabeled Use of Products/Investigational Use Disclosure: Dr Klein reports no disclosure.

Mohamad Abdalkader, MD
Assistant Professor of Radiology, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts

Relationship Disclosure: Dr Abdalkader reports no disclosure.

Unlabeled Use of Products/Investigational Use Disclosure: Dr Abdalkader reports no disclosure.

Lama Abdel Wahed, MD
Clinical Assistant Professor of Neurology, University of Iowa Carver College of Medicine; Associate Residency Program Director, Associate Clerkship Director, University of Iowa Healthcare, Iowa City, Iowa

Relationship Disclosure: Dr Abdel Wahed has received personal compensation in the range of $0 to $499 for serving as a resident honorary speaker with the Iowa Neurological Association and as an author for MedLink, LLC.

Unlabeled Use of Products/Investigational Use Disclosure: Dr Abdel Wahed discusses the unlabeled use of corticosteroids for the treatment of autoimmune neurologic diseases that have no US Food and Drug Administration–approved medications.

Liana G. Apostolova, MD, MS, FAAN
Indiana University Distinguished Professor, Barbara and Peer Baekgaard Professor in Alzheimer's Disease Research, Indiana University School of Medicine, Indianapolis, Indiana

Relationship Disclosure: Dr Apostolova has received personal compensation in the range of $500 to $4999 for serving as a consultant for Florida Health, General Electric Company, Lilly, the National Institutes of Health (NIH), and NIH Biobank; on a data safety monitoring board for IQVIA Inc; and on advisory boards for Eisai Co, Ltd, F. Hoffman-La Roche Ltd, Genentech, Inc, and TwoLabs, LLC. Dr Apostolova has received personal compensation in the range of $5000 to $9999 for serving on an advisory board for Biogen and in the range of $10,000 to $49,999 for serving as an editor-in-chief for the Alzheimer’s Association. An immediate family member of Dr Apostolova has stock in Cassava Sciences, Inc, Golden Seeds, and Semiring. The institution of Dr Apostolova has received research support from the Alzheimer’s Association, Avid Radiopharmaceuticals, F. Hoffman-La Roche Ltd, Life Molecular Imaging, and the National Institute on Aging.

Unlabeled Use of Products/Investigational Use Disclosure: Dr Apostolova reports no disclosure.

Elsa Azevedo, MD, PhD
Department of Neurology, Centro Hospitalar Universitário de São João; Department of Clinical Neurosciences and Mental Health, Faculty of Medicine of University of Porto, Porto, Portugal

Relationship Disclosure: Dr Azevedo reports no disclosure.

Unlabeled Use of Products/Investigational Use Disclosure: Dr Azevedo reports no disclosure.

Wenya Linda Bi, MD, PhD
Assistant Professor of Neurosurgery, Harvard Medical School, Brigham and Women’s Hospital, Boston, Massachusetts

Relationship Disclosure: Dr Bi reports no disclosure.

Unlabeled Use of Products/Investigational Use Disclosure: Dr Bi reports no disclosure.

Tracey A. Cho, MD, FAAN
Clinical Professor of Neurology, University of Iowa Carver College of Medicine; Director, Neuroimmunology Division, University of Iowa Healthcare, Iowa City, Iowa

Relationship Disclosure: Dr Cho has received personal compensation in the range of $500 to $4999 for serving as a consultant for Horizon Therapeutics plc and on a data safety monitoring board for the National Institutes of Health and has received publishing royalties from a publication relating to health care. The institution of an immediate family member of Dr Cho has received research support from the National Institutes of Health.

Elizabeth R. Gerstner, MD
Associate Professor of Neurology, Harvard Medical School; Associate Neurologist, Massachusetts General Hospital, Boston, Massachusetts

Relationship Disclosure: Dr Gerstner has received personal compensation in the range of $500 to $4999 for serving on a data safety monitoring board for Midatech Pharma PLC and in the range of $50,000 to $99,999 for serving as an officer or member of the board of directors for the Gerstner Family Foundation. The institution of Dr Gerstner has received research support from the National Cancer Institute.

Unlabeled Use of Products/Investigational Use Disclosure: Dr Gerstner discusses the unlabeled/investigational use of mitogen-associated protein kinase (MAPK) pathway with MAP-ERK kinase (MEK) inhibitors for the treatment of MAP kinase-altered tumors and various MRI and positron emission tomography (PET) techniques not approved for the imaging of brain tumors.

Ryan Hakimi, DO, MS, NVS, RPNI, CPB, FNCS, FCCM
Director, Neuro ICU and Transcranial Doppler Ultrasound Services, Prisma Health-Upstate; Professor, Department of Medicine (Neurology Division), University of South Carolina School of Medicine-Greenville, Greenville, South Carolina

Relationship Disclosure: Dr Hakimi has received personal compensation in the range of $0 to $499 for serving as a delegate in the American Medical Association House of Delegates for the American Society of Neuroimaging and in the range of $500 to $4999 for serving as the immediate past president for the South Carolina Osteopathic Medical Society and as a medical reviewer for the Office of Disciplinary Counsel in the South Carolina Department of Labor, Licensing and Regulation and has received publishing royalties from Osler, Hoskin & Harcourt LLP. Dr Hakimi has a noncompensated relationship as an annual meeting course committee member with the Neurocritical Care Society that is relevant to AAN interests or activities.

Unlabeled Use of Products/Investigational Use Disclosure: Dr Hakimi reports no disclosure.

Justin T. Jordan, MD, MPH, FAAN Clinical Director, Stephen E. and Catherine Pappas Center for Neuro-Oncology at Massachusetts General Hospital; Director, Family Center for Neurofibromatosis Massachusetts General Hospital; Assistant Professor of Neurology, Harvard Medical School, Boston, Massachusetts

Relationship Disclosure: Dr Jordan has received personal compensation in the range of $0 to $499 for serving as a consultant for Atheneum Partners, EM Partners, GLG Pharma, and Guidepoint Global, LLC; in the range of $500 to $4999 for serving as a consultant for Creative Educational Concepts, LLC, and Texas Health Resources; and in the range of $5000 to $9999 for serving as a consultant for Children’s Tumor Foundation, Navio Theragnostics, Inc, and Recursion and on a scientific advisory board for Recursion. Dr Jordan has stock in The Doctor Lounge and Navio Theragnostics, Inc, has received publishing royalties from Elsevier, and has noncompensated relationships as a board member with ABA Academy, Neurofibromatosis Northeast, Neurofibromatosis Network, and the United Council for Neurologic Subspecialties that is relevant to AAN interests or activities. The institution of Dr Jordan has received research support from The Burke Foundation, the Department of Defense, and the National Institutes of Health.

Unlabeled Use of Products/Investigational Use Disclosure: Dr Jordan discusses the unlabeled/investigational use of mitogen-associated protein kinase (MAPK) pathway with MAP-ERK kinase (MEK) inhibitors for the treatment of MAP kinase-altered tumors and various MRI and positron emission tomography (PET) techniques not approved for the imaging of brain tumors.

Baijayanta Maiti, MD, PhD
Assistant Professor of Neurology, Washington University in St. Louis School of Medicine, St. Louis, Missouri

Relationship Disclosure: The institution of Dr Maiti has received research support from the National Center for Advancing Translational Sciences and the National Institute of Neurological Disorders and Stroke of the National Institutes of Health.

Unlabeled Use of Products/Investigational Use Disclosure: Dr Maiti reports no disclosure.

Erasmo A. Passaro, MD
Professor of Neurology, University of South Florida, Tampa; Director, Epilepsy Program, Bayfront Health; Medical Director, Epilepsy Surgery, Johns Hopkins All Children’s Hospital; St Petersburg, Florida

Relationship Disclosure: Dr Passaro has received personal compensation in the range of $0 to $499 for serving on a speakers bureau and as a consultant for Neurelis, Inc; in the range of $500 to $4999 for serving on speakers bureaus and as a consultant for Eisai Co, Ltd, and Sunovion Pharmaceuticals, Inc; and in the range of $5000 to $9999 for serving on speakers bureaus and as a consultant for SK Life Science, Inc, and UCB, Inc.

Unlabeled Use of Products/Investigational Use Disclosure: Dr Passaro reports no disclosure.

Joel S. Perlmutter, MD
Elliot Stein Family Professor Neurology; Head of Movement Disorders; Professor of Radiology, Neuroscience, Physical Therapy, Occupational Therapy, Washington University in St. Louis School of Medicine, St. Louis, Missouri

Relationship Disclosure: Dr Perlmutter has received personal compensation in the range of $0 to $499 for serving as an officer or member of the Board of Directors for the Parkinson Study Group, and in the range of $500 to $4999 for serving as an officer or member of the Board of Directors for the CHDI Foundation, as an expert witness for Wood, Cooper and Peterson, LLC, and Simmons and Simmons LLP, as a lecturer for Boston University, as an external advisor for Stanford University, and as a visiting professor with Beth Israel Hospital and the University of Pennsylvania. The institution of Dr Perlmutter has received research support from the American Parkinson Disease Association, the Barnes-Jewish Hospital Foundation, the CHDI Foundation, the Huntington Disease Society of America, The Michael J Fox Foundation, the National Institutes of Health, the University of California San Diego, and the University of Western Toronto.

Unlabeled Use of Products/Investigational Use Disclosure: Dr Perlmutter reports no disclosure.

Nandor K. Pinter, MD
Director, Neuroimaging Research, Dent Neurologic Institute, Amherst; Research Associate Professor, Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York; University of Amsterdam Medical Center, VUmc, Department of Radiology, Amsterdam, The Netherlands

Relationship Disclosure: Dr Pinter has received personal compensation in the range of $5000 to $10,000 for serving as a consultant for Koninklijke Philips N.V. and in the range of $10,000 to $49,000 for serving as a consultant for NeuroNetPro. The institution of Dr Pinter has received research support from the Dent Family Foundation and Koninklijke Philips N.V.

Unlabeled Use of Products/Investigational Use Disclosure: Dr Pinter reports no disclosure.

Shannon L. Risacher, PhD
Associate Professor of Radiology and Imaging Sciences; Neuroimaging Core Leader, Indiana Alzheimer's Disease Research Center, Indiana University School of Medicine, Indianapolis, Indiana

Relationship Disclosure: Dr Risacher has received research support from the Alzheimer’s Association, New Vision Award, and the National Institute on Aging (K01 AG049050, R01 AG061788, P30 AG010133, and P30 AG072976).

Unlabeled Use of Products/Investigational Use Disclosure: Dr Risacher reports no disclosure.

Julie G. Shulman, MD
Assistant Professor of Neurology, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts

Relationship Disclosure: Dr Shulman has received research support from the BU Spivack Neuroscience Pilot Award.

Unlabeled Use of Products/Investigational Use Disclosure: Dr Shulman reports no disclosure.

Jan-Mendelt Tillema, MD
Assistant Professor of Neurology, Mayo Clinic, Rochester, Minnesota

Relationship Disclosure: Dr Tillema reports no disclosure.

Unlabeled Use of Products/Investigational Use Disclosure: Dr Tillema reports no disclosure.

Robert E. Watson, MD, PhD
Professor of Radiology, Department of Radiology, Mayo Clinic, Rochester, Minnesota

Relationship Disclosure: Dr Watson has a noncompensated relationship as a Chair with the American Board of Magnetic Resonance Safety that is relevant to American Academy of Neurology interests or activities.

Unlabeled Use of Products/Investigational Use Disclosure: Dr Watson reports no disclosure.

Lifeng Yu, PhD
Professor of Medical Physics, Mayo Clinic, Rochester, Minnesota

Relationship Disclosure: Dr Yu reports no disclosure.

Unlabeled Use of Products/Investigational Use Disclosure: Dr Yu reports no disclosure.


Self-Assessment and CME Test Writers

Nuri Jacoby, MD
Associate Professor of Clinical Neurology, SUNY Downstate Health Sciences University; Attending Neurologist, Maimonides Medical Center, Brooklyn, New York

Relationship Disclosure: Dr Jacoby has received personal compensation in the range of $500 to $4999 for serving as a multiple-choice question writer for Continuum with the American Academy of Neurology and on a scientific advisory or data safety monitoring board for Alexion Pharmaceuticals, Inc and in the range of $5000 to $9999 for serving as an expert witness. The institution of Dr Jacoby has received research support from the American Board of Psychiatry and Neurology.

Unlabeled Use of Products/Investigational Use Disclosure: Dr Jacoby reports no disclosure.

Allison L. Weathers, MD, FAAN
Associate Chief Medical Information Officer, Cleveland Clinic; Assistant Professor, Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio

Relationship Disclosure: Dr Weathers has a noncompensated relationship as chair of the adult neurosciences specialty steering board for Epic and as co-chair of the neurology leadership council for Cerner Corporation and has received personal compensation in the range of $0 to $499 for serving as a consultant for Dent Neurologic Institute and in the range of $500 to $4999 for serving as an associate editor and as a CME question writer and presenter with the American Academy of Neurology.

Unlabeled Use of Products/Investigational Use Disclosure: Dr Weathers reports no disclosure.

AAll relevant financial relationships have been mitigated.

Accreditation

Accreditation Statement: The American Academy of Neurology Institute is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide CME for physicians. For information on Continuum Audio CME, please visitcontinuum.audio-digest.org.

AMA Credit: The American Academy of Neurology Institute designates this enduring material for a maximum of 20 AMA PRA Category1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Methods of Participation and Instructions for Use

Continuum: Lifelong Learning in Neurology® is designed to help practicing neurologists stay abreast of advances in the field while simultaneously developing lifelong self-directed learning skills. In Continuum, the process of absorbing, integrating, and applying the material presented is as important as, if not more important than, the material itself.

The goals of Continuum include disseminating up-to-date information to the practicing neurologist in a lively, interactive format; fostering self-assessment and lifelong study skills; encouraging critical thinking; and, in the final analysis, strengthening and improving patient care.

Each Continuum issue is prepared by distinguished authors who are acknowledged leaders in their respective fields. Six issues are published annually and are composed of review articles, case-based discussions on ethical and practice issues related to the issue topic, coding information, and comprehensive continuing medical education (CME) and self-assessment offerings.
The review articles emphasize clinical issues emerging in the field in recent years. Case reports and vignettes are used liberally, as are tables and illustrations. Audio interviews with the authors of Continuum articles are published alongside each article, and video material relating to the issue topic accompanies issues when applicable.

The text can be reviewed and digested most effectively by establishing a regular schedule of study in the office or at home, either alone or in an interactive group. If subscribers use such regular and perhaps new study habits, Continuum’s goal of establishing lifelong learning patterns can be met.