Toward a VA women’s health research agenda: Setting evidence-based priorities to improve the health and health care of women veterans

The expansion of women in the military is reshaping the veteran population, with women now constituting the fastest growing segment of eligible VA health care users. In recognition of the changing demographics and special health care needs of women, the VA Office of Research & Development recently sponsored the first national VA Women’s Health Research Agenda-setting conference to map research priorities to the needs of women veterans and position VA as a national leader in Women’s Health Research. This paper summarizes the process and outcomes of this effort, outlining VA’s research priorities for biomedical, clinical, rehabilitation, and health services research.     

Signal-to-noise ratio effects in quantitative cerebral perfusion using dynamic susceptibility contrast agents.

Theoretical and simulation evidence is presented in support of the idea that the optimal manner of determining blood flow from MR perfusion studies is not necessarily obtained by setting experimental conditions to maximize either the arterial input or the measured tissue concentration level for a particular echo time (TE). The noise power in the contrast concentration curve is associated with its peak because of the nonlinear relationship between the contrast concentration and MR signal intensity curves. The optimum signal-to-noise ratio (SNR), SNR(C), for a particular contrast concentration curve can be obtained when the experimental concentration level and TE are adjusted to produce an MR intensity curve whose signal loss is 63% of the precontrast MR signal intensity. It is demonstrated that the stability of the singular valued decomposition (SVD) deconvolution approach to determine blood flow parameters is increased when the tissue curve maximum signal loss is in the range of 40-80%. The accuracy and stability of the SVD-determined blood flow parameters are affected by deviations from these optimum conditions in a manner that depends on the mean transit time (MTT) associated with the residue function. It is recommended that the experimental TE value be set so that neither the tissue nor the arterial curves are placed a region of rapidly deteriorating SNR(C).     

Removing the effect of SVD algorithmic artifacts present in quantitative MR perfusion studies.

Quantitative cerebral blood flow (CBF) values can be obtained from dynamic susceptibility contrast (DSC) MR perfusion studies using the standard singular value decomposition (sSVD) deconvolution algorithm. Reports in the literature from simulation and in vivo studies suggest that CBF estimates obtained using sSVD deconvolution depend on the arterial-tissue delay (ATD). By contrast, Fourier transform (FT) deconvolution produces CBF estimates that are independent of ATD. The diagnostic reliability of quantitative CBF measurements to define areas of normal tissue flow and tissue at risk is brought into doubt by such gross sensitivity to the specifics of the deconvolution approach. This variation of CBF values with ATD is shown to be an artifact associated with the current implementation of the sSVD deconvolution algorithm. A reformulated version of the SVD deconvolution algorithm (rSVD) is presented and compared to the standard SVD algorithm through simulation and patient case studies.     

Interventions to Increase Multivitamin Use Among Women in the Interconception Period: An IMPLICIT Network Study

Maternal and Child Health Journal - Each year, 3% of infants in the Unites States (US) are born with congenital anomalies, including 3000 with neural tube defects. Multivitamins (MVIs) including...     

In vitro and in vivo comparison of three MR measurement methods for calculating vascular shear stress in the internal carotid artery

BACKGROUND AND PURPOSE: Vascular abnormalities, such as atherosclerosis and the growth and rupture of cerebral aneurysms, result from a derangement in tissue metabolism and injury that are, in part, regulated by hemodynamic stress. The purpose of this study was to establish the feasibility and accuracy of determining wall shear rate in the internal carotid artery from phase-contrast MR data. METHODS: Three algorithms were used to generate shear rate estimates from both ungated and cardiac-gated 2D phase-contrast data. These algorithms were linear extrapolation (LE), linear estimation with correction for wall position (LE*), and quadratic extrapolation (QE). In vitro experiments were conducted by using a phantom under conditions of both nonpulsatile and pulsatile flow. The findings from five healthy volunteers were also studied. MR imaging-derived shear rates were compared with values calculated by solving the fluid flow equations. RESULTS: Findings of in vitro constant-flow experiments indicated that at one or two excitations, QE has the advantage of good accuracy and low variance. Results of in vitro pulsatile flow experiments showed that neither LE* nor QE differed significantly from the predicted value of wall shear stress, despite errors of 17% and 22%, respectively. In vivo data showed that QE did not differ significantly from the predicted value, whereas LE and LE* did. The percentages of errors for QE, LE, and LE* in vivo measurements were 98.5%, 28.5%, and 36.1%, respectively. The average residual of QE was low because the residuals were both above and below baseline whereas, on average, LE* tended to be a more biased overestimator of the shear rate in volunteers. The average and peak wall shear force in five volunteers was approximately 8.10 dyne/cm2 and 13.2 dyne/cm2, respectively. CONCLUSION: Our findings show that LE consistently underestimates the shear rate. Although LE* and QE may be used to estimate shear rate, errors of up to 36% should be expected because of variance above and below the true value for individual measurements.     

3D MR DSA: effects of injection protocol and image masking

The purpose of this study was to investigate the effect on three-dimensional (3D) magnetic resonance digital subtraction angiography (MR DSA) images of various injection protocol parameters (ie, injection order, volume, and rate), as well as image masking. The pelves of 10 normal volunteers were scanned using seven different contrast agent volume/injection rate combinations. Subtraction of a precontrast mask image resulted in vascular image contrast improvements of between 4.0 and 7.7 times. Image quality and smaller vessel image contrast in the masked data decreased with increasing injection number. Data acquired with a high (0.150 mmol kg(-1)) volume yielded the highest quality images, although only small nonsignificant differences in image quality and large vessel conspicuity were found between images obtained using the high and medium (0.075 mmol kg(-1)) volumes. Images acquired with a low (0. 038 mmol kg(-1)) volume, while of lower image contrast, were judged to be of reasonable quality, especially when acquired as the first or second injection. Injection rate (1 ml s(-1), 2 ml s(-1), and 4 ml s(-1)) was not found to affect the images significantly, although selection of an injection rate that gave an injection duration of approximately 10 seconds tended to give better vascular image contrast. Based on these data, a series of escalating volumes for multi-injection examination is proposed. J. Magn. Reson. Imaging 2000;12:476-487.     

Neuroanatomical associations of the Edinburgh cognitive and Behavioural ALS screen (ECAS)

Brain Imaging and Behavior - Cognitive impairment is now recognized in a subset of patients with amyotrophic lateral sclerosis (ALS). The objective of the study was to identify group differences...     

Comparison of pre- and postcontrast 3D time-of-flight MR angiography for the evaluation of distal intracranial branch occlusions in acute ischemic stroke

BACKGROUND AND PURPOSE: Three-dimensional time-of-flight (TOF) MR angiography is used routinely in stroke workup to detect arterial occlusions, but a major drawback is its inadequate depiction of vessels with slow or in-plane flow. We hypothesized that the use of contrast-enhanced MR angiography improves delineation of vessels with diminished or absent flow on precontrast MR angiograms. METHODS: Pre- and postcontrast 3D TOF MR angiograms were acquired in 55 consecutive patients with acute stroke. Patency of 480 intracranial vessels was assessed on both the pre- and postcontrast angiograms. Diffusion-weighted (DW) and perfusion-weighted (PW) imaging data were also obtained and results correlated with those of pre- and postcontrast MR angiography. RESULTS: For 50 abnormal vessel segments seen on precontrast MR angiograms, postcontrast MR angiograms resulted in change in the vascular signal intensity in 70% (35 vessel segments); 94% of these changes showed a greater extent of vessel patency. Venous and soft-tissue contrast enhancement had no effect on assessment in 95% of all 480 vessels examined. Interobserver reliability was moderate, with postcontrast interpretation (kappa = 0.48) showing a slight improvement over precontrast interpretation (kappa = 0.41). Good agreement was found between the TOF results and the pooled DW and PW imaging results. CONCLUSIONS: Compared with precontrast 3D TOF MR angiograms, postcontrast 3D TOF angiograms improve assessment of intracranial vessel patency in acutely ischemic vascular territories. In some patients, an improved understanding of acute ischemic stroke was obtained by viewing the pre- and postcontrast images. Postcontrast MR angiography should be included in the MR evaluation of acute stroke.     

Endovascular treatment of experimental canine aneurysms: feasibility with MR imaging guidance

PURPOSE: To evaluate the feasibility of using magnetic resonance (MR) imaging to guide and monitor endovascular therapeutic procedures. MATERIALS AND METHODS: Endovascular therapeutic procedures were performed with MR imaging guidance in eight dogs by using a 1.5-T MR unit with echo-planar imaging capabilities. Carotid arterial aneurysms were surgically created in four dogs. The ability to depict, track, and position catheters, guide wires, and Guglielmi detachable coils was assessed. Catheters were first positioned with fluoroscopic guidance. Tracking and depiction were achieved with MR imaging by using commercially available catheters filled with a gadopentetate dimeglumine solution and a fast, two-dimensional, time-resolved, variable-rate k-space sampling technique. RESULTS: When either a catheter or the coaxial space between a catheter and a guide wire was filled with a solution of gadopentetate dimeglumine, catheter movement was always depicted. In the animals with aneurysms, it was possible to depict movement of a catheter into and out of the aneurysm. This was achieved by superimposing reconstructed images obtained during catheter movement onto a previously acquired MR angiogram ("road map"). Prototype Guglielmi detachable coils were successfully positioned and detached. Aneurysm obliteration was monitored with the acquisition of new road map images. CONCLUSION: The results demonstrate the feasibility of using MR imaging to guide endovascular therapeutic procedures.