﻿ Diagnostic Testing | NorthShore

When it comes to quickly delivering effective treatments for brain and spine conditions, it’s crucial to get the correct diagnosis the first time from highly trained neurological specialists. The NorthShore Neurological Institute uses the most sophisticated equipment and technology available to diagnose our patients. Our highly qualified team of neuroradiologists and neurophysiologists are expert in reading and interpreting neurological exams (or studies). These subspecialists work closely with NorthShore’s neurologists, neurosurgeons and physiatrists to ensure the most accurate interpretation of diagnostic imaging tests critical to developing appropriate care plans.

Neuroimaging Exams

NorthShore’s neuroradiology team features subspecialty trained neuroradiologists, who are certified by the American Board of Radiology. Additionally, all have earned the prestigious Certificate of Added Qualification in diagnostic neuroradiology. These skilled specialists provide the highest level of subspecialty interpretation for brain, spine and head/neck neuroradiological examinations that include magnetic resonance imaging (MRI), computed tomography (CT) and nuclear medicine studies.

MRI is the primary imaging tool used to optimally evaluate the soft tissues of the brain, neck and spine. Providing high resolution details without radiation, MR imaging is used for initial diagnosis or follow up for neurological conditions, including brain tumors, stroke, multiple sclerosis, infections, dementia and neck masses. Our MR imaging studies include:

  • MR Angiography (MRA) and MR Venography (MRV) for noninvasively assessing blood vessels of the brain and neck.
  • Time-resolved MRA for visualizing the “real time” flow of blood through the blood vessel. It provides an alternative to traditional but more invasive catheter angiograms.
  • MR Perfusion for determining blood flow in the brain. Often used in the assessment and follow up of patients with brain tumors and other masses as well as with carotid stenosis (blockage) or acute stroke episodes.
  • MR Spectroscopy for detecting brain abnormalities at the molecular level.
  • MR Diffusion Tensor Imaging for detecting subtle neurodegenerative changes that can occur in dementia and more recently, mild traumatic brain injury or concussion. A critical observation tool for safe and effective pre-operative planning and tumor removal.
  • fMRI (functional MRI) for identifying areas of the brain and matching them to specific tasks ranging from language and motor movement centers to hearing localization and skin sensation.
  • MR CSF Flow for determining the state of cerebrospinal fluid flow around the brain and spinal cord to identify abnormal neurological conditions.

At NorthShore, we offer a full complement of the most advanced 1.5 and 3.0T high field strength MR scanners with contemporary software and hardware essential to performing leading-edge neuroimaging. Most importantly, the Neurological Institute has the professional expertise to execute and interpret these MR studies. Our multiple 1.5T Espree magnets provide a “virtual open” MRI experience that makes MR scanning more comfortable for patients who have problems with enclosed spaces while still maintaining quality high resolution imaging.

Computed tomography (CT) scanning is utilized in a variety of acute neurological conditions, including rapid assessment of trauma, stroke and for mass effect from tumors and other intracranial lesions. Our specialists use state-of-the-art dose reduction software and techniques to obtain high quality images at the safest possible dose to patients. CT angiography/venography, a specialized contrast-enhanced CT technique, provides high-resolution imaging of the blood vessels in the neck and head. This exam is used for vascular conditions including intracranial aneurysms, vascular malformations (AVM, dural AV fistula), stroke, carotid disease and arterial dissection. This technique can also assist in the diagnosis of blood clots in the veins of the head and neck.

PET and PET/CT imaging involves the use of radiolabelled pharmaceuticals such as glucose or beta-amyloid plaque to determine glucose metabolism, perfusion or plaque deposition. PET/CT imaging is invaluable in the initial work-up and follow up of patients with head and neck cancer. Brain perfusion and glucose metabolism also can be helpful in assessing dementia patients. More recently, Amyvid, a specific Alzheimer’s plaque agent, has been used to evaluate the degree of amyloid plaque buildup in the brain, which has been implicated in the development of Alzheimer’s disease. For the diagnosis and assessment of movement disorders, PET/CT imaging can be useful in identifying dopamine (a neurotransmitter) transport molecules that disrupt motor movement in diseases such as Parkinson’s.

Not only using the latest neuroimaging techniques to detect neurological disorders, Neurological Institute specialists are conducting novel research to develop new diagnostic techniques. Chairman of neurosurgery at NorthShore and co-director of the Neurological Institute Julian Bailes, MD, and colleagues are investigating the use of PET imaging coupled with a special radioactively tagged tracer to diagnosis—for the first time—chronic traumatic encephalopathy (CTE) in living patients. Previously, an autopsy was the only way to diagnose CTE, a degenerative neurological disease related to repeated head trauma or multiple concussions. The radioactive compound is bound to a specific protein, tau, which in people with pre-CTE or CTE symptoms such as former athletes or military personnel becomes damaged and forms neurofibrillary tangles that lead to dementia, memory loss and behavior changes. Using the amyloid imaging tracer, FDDNP, researchers are able to look at the degree of tau protein deposits in the brain.

A renowned traumatic brain injury (sports concussion) expert, Dr. Bailes' research focuses on NFL players but the findings of his work have implications for the diagnosis of other brain trauma as well as conditions such as dementia and Alzheimer’s disease. 

Neurophysiology Testing

Your nervous system communicates by passing electrical signals between nerve cells to parts of the body. Stimulating those nerve cells and muscles and recording their electrical activity allows keen insight into the function of the nervous system itself. 

NorthShore offers a variety of neurophysiology tests:

  • EEG (electroencephalogram) for measuring the brain’s electrical activity.
  • EMG (electromyogram) for measuring electrical activity of the muscles.
  • NCV (nerve conduction velocity) for measuring nerve function.
  • EP (evoked potential) for testing the sensory (hearing, vision, somatosensory or touch, movement and pain) pathways of the nervous system.

Our neurology and physiatry team also provides EMG testing for the diagnosis of such physical impairments as pain, numbness or weakness that can stem from a variety of disorders.  Our specialists provide appropriate recommendations and treatment options, including physical, occupational or speech therapies.

EEG monitoring has proven to be a crucial analytical tool for epilepsy management. NorthShore offers an Epilepsy Monitoring Unit (EMU), a specialized, state-of-the-art inpatient unit designed to characterize epileptic patterns and localize seizures to develop a comprehensive treatment plan. Patients discontinue their anti-epileptic medication and are monitored day and night in an attempt to record seizures. The Command Center is staffed 24 hours a day, seven days a week by EEG techs. The length of stay typically ranges from five to seven days.

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