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Roberts RM, Mathias JL, Rose SE. Relationship Between Diffusion Tensor Imaging (DTI) Findings and Cognition Following Pediatric TBI: A Meta-Analytic Review. Dev Neuropsychol 2016; 41:176-200. [PMID: 27232263 PMCID: PMC4960507 DOI: 10.1080/87565641.2016.1186167] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
This study meta-analyzed research examining relationships between diffusion tensor imaging and cognition following pediatric traumatic brain injury (TBI). Data from 14 studies that correlated fractional anisotropy (FA) or apparent diffusion coefficient/mean diffusivity with cognition were analyzed. Short-term (<4 weeks post-TBI) findings were inconsistent, but, in the medium to long term, FA values for numerous large white matter tracts and the whole brain were related to cognition. However, the analyses were limited by the diversity of brain regions and cognitive outcomes that have been examined; all in relatively small samples. Moreover, additional data are needed to investigate the impact of age and injury severity on these findings.
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Affiliation(s)
| | - Jane L. Mathias
- School of Psychology, University of Adelaide, Adelaide, Australia
| | - Stephen E. Rose
- CSIRO Health & Biosecurity, The Australian e-Health Research Centre, Royal Brisbane and Women’s Hospital, Herston, Australia
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52
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Mitra J, Shen KK, Ghose S, Bourgeat P, Fripp J, Salvado O, Pannek K, Taylor DJ, Mathias JL, Rose S. Statistical machine learning to identify traumatic brain injury (TBI) from structural disconnections of white matter networks. Neuroimage 2016; 129:247-259. [DOI: 10.1016/j.neuroimage.2016.01.056] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Revised: 12/21/2015] [Accepted: 01/24/2016] [Indexed: 12/13/2022] Open
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53
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Ryan NP, Catroppa C, Beare R, Silk TJ, Crossley L, Beauchamp MH, Yeates KO, Anderson VA. Theory of mind mediates the prospective relationship between abnormal social brain network morphology and chronic behavior problems after pediatric traumatic brain injury. Soc Cogn Affect Neurosci 2016; 11:683-92. [PMID: 26796967 DOI: 10.1093/scan/nsw007] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Accepted: 01/14/2016] [Indexed: 12/21/2022] Open
Abstract
Childhood and adolescence coincide with rapid maturation and synaptic reorganization of distributed neural networks that underlie complex cognitive-affective behaviors. These regions, referred to collectively as the 'social brain network' (SBN) are commonly vulnerable to disruption from pediatric traumatic brain injury (TBI); however, the mechanisms that link morphological changes in the SBN to behavior problems in this population remain unclear. In 98 children and adolescents with mild to severe TBI, we acquired 3D T1-weighted MRIs at 2-8 weeks post-injury. For comparison, 33 typically developing controls of similar age, sex and education were scanned. All participants were assessed on measures of Theory of Mind (ToM) at 6 months post-injury and parents provided ratings of behavior problems at 24-months post-injury. Severe TBI was associated with volumetric reductions in the overall SBN package, as well as regional gray matter structural change in multiple component regions of the SBN. When compared with TD controls and children with milder injuries, the severe TBI group had significantly poorer ToM, which was associated with more frequent behavior problems and abnormal SBN morphology. Mediation analysis indicated that impaired theory of mind mediated the prospective relationship between abnormal SBN morphology and more frequent chronic behavior problems. Our findings suggest that sub-acute alterations in SBN morphology indirectly contribute to long-term behavior problems via their influence on ToM. Volumetric change in the SBN and its putative hub regions may represent useful imaging biomarkers for prediction of post-acute social cognitive impairment, which may in turn elevate risk for chronic behavior problems.
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Affiliation(s)
- Nicholas P Ryan
- Australian Centre for Child Neuropsychological Studies, Murdoch Childrens Research Institute, Melbourne, Australia, Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Australia,
| | - Cathy Catroppa
- Australian Centre for Child Neuropsychological Studies, Murdoch Childrens Research Institute, Melbourne, Australia, Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Australia, Department of Psychology, Royal Children's Hospital, Melbourne, Australia
| | - Richard Beare
- Developmental Imaging, Murdoch Childrens Research Institute, Melbourne, Australia
| | - Timothy J Silk
- Australian Centre for Child Neuropsychological Studies, Murdoch Childrens Research Institute, Melbourne, Australia
| | - Louise Crossley
- Australian Centre for Child Neuropsychological Studies, Murdoch Childrens Research Institute, Melbourne, Australia
| | - Miriam H Beauchamp
- Department of Psychology, University of Montreal, Montreal, Canada, Ste-Justine Research Center, Montreal, Quebec, Canada, and
| | - Keith Owen Yeates
- Department of Psychology, Hotchkiss, Brain Institute, and Alberta Children's Hospital Research Institute, The University of Calgary, Calgary, Alberta, Canada
| | - Vicki A Anderson
- Australian Centre for Child Neuropsychological Studies, Murdoch Childrens Research Institute, Melbourne, Australia, Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Australia, Department of Psychology, Royal Children's Hospital, Melbourne, Australia
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54
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Babikian T, Merkley T, Savage RC, Giza CC, Levin H. Chronic Aspects of Pediatric Traumatic Brain Injury: Review of the Literature. J Neurotrauma 2015; 32:1849-60. [DOI: 10.1089/neu.2015.3971] [Citation(s) in RCA: 144] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Affiliation(s)
- Talin Babikian
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine and Mattel Children's Hospital at UCLA, Los Angeles, California
| | - Tricia Merkley
- Department of Clinical Neuropsychology, Barrow Neurological Institute, Phoenix, Arizona
| | | | - Christopher C. Giza
- Department of Pediatrics and Neurosurgery, David Geffen School of Medicine and Mattel Children's Hospital at UCLA, Los Angeles, California
| | - Harvey Levin
- Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, Texas
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Schertz M, Shiran SI, Myers V, Weinstein M, Fattal-Valevski A, Artzi M, Ben Bashat D, Gordon AM, Green D. Imaging Predictors of Improvement From a Motor Learning-Based Intervention for Children With Unilateral Cerebral Palsy. Neurorehabil Neural Repair 2015; 30:647-60. [PMID: 26564999 DOI: 10.1177/1545968315613446] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Motor-learning interventions may improve hand function in children with unilateral cerebral palsy (UCP) but with inconsistent outcomes across participants. Objective To examine if pre-intervention brain imaging predicts benefit from bimanual intervention. Method Twenty children with UCP with Manual Ability Classification System levels I to III, aged 7-16 years, participated in an intensive bimanual intervention. Assessments included the Assisting Hand Assessment (AHA), Jebsen Taylor Test of Hand Function (JTTHF) and Children's Hand Experience Questionnaire (CHEQ) at baseline (T1), completion (T2) and 8-10 weeks post-intervention (T3). Imaging at baseline included conventional structural (radiological score), functional (fMRI) and diffusion tensor imaging (DTI). Results Improvements were seen across assessments; AHA (P = 0.04), JTTHF (P < .001) and CHEQ (P < 0.001). Radiological score significantly correlated with improvement at T2; AHA (r = .475) and CHEQ (r = .632), but negatively with improvement on unimanual measures at T3 (JTTFH r = -.514). fMRI showed negative correlations between contralesional brain activation when moving the affected hand and AHA improvements (T2: r = -.562, T3: r = -0.479). Fractional Anisotropy in the affected posterior limb of the internal capsule correlated negatively with increased bimanual use on CHEQ at T2 (r = -547) and AHA at T3 (r = -.656). Conclusions Children with greater structural, functional and connective brain damage showed enhanced responses to bimanual intervention. Baseline imaging may identify parameters predicting response to intervention in children with UCP.
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Affiliation(s)
- Mitchell Schertz
- Child Development and Pediatric Neurology Service, Meuhedet-Northern Region, Haifa, Israel Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | | | - Vicki Myers
- Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Maya Weinstein
- Tel Aviv Sourasky Medical Center, Tel Aviv, Israel Bar Ilan University, Ramat Gan, Israel
| | | | - Moran Artzi
- Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Dafna Ben Bashat
- Tel Aviv Sourasky Medical Center, Tel Aviv, Israel Tel Aviv University, Tel Aviv, Israel
| | | | - Dido Green
- Tel Aviv University, Tel Aviv, Israel Oxford Brookes University, Oxford, UK
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56
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Van Beek L, Ghesquière P, Lagae L, De Smedt B. Mathematical Difficulties and White Matter Abnormalities in Subacute Pediatric Mild Traumatic Brain Injury. J Neurotrauma 2015; 32:1567-78. [DOI: 10.1089/neu.2014.3809] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Affiliation(s)
- Leen Van Beek
- Parenting and Special Education Research Unit, University of Leuven, Belgium
| | - Pol Ghesquière
- Parenting and Special Education Research Unit, University of Leuven, Belgium
| | - Lieven Lagae
- Department of Development and Regeneration, University of Leuven, Belgium
| | - Bert De Smedt
- Parenting and Special Education Research Unit, University of Leuven, Belgium
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Ellis MU, DeBoard Marion S, McArthur DL, Babikian T, Giza C, Kernan CL, Newman N, Moran L, Akarakian R, Houshiarnejad A, Mink R, Johnson J, Babbitt CJ, Olsen A, Asarnow RF. The UCLA Study of Children with Moderate-to-Severe Traumatic Brain Injury: Event-Related Potential Measure of Interhemispheric Transfer Time. J Neurotrauma 2015; 33:990-6. [PMID: 26153851 DOI: 10.1089/neu.2015.4023] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Traumatic brain injury (TBI) frequently results in diffuse axonal injury and other white matter damage. The corpus callosum (CC) is particularly vulnerable to injury following TBI. Damage to this white matter tract has been associated with impaired neurocognitive functioning in children with TBI. Event-related potentials can identify stimulus-locked neural activity with high temporal resolution. They were used in this study to measure interhemispheric transfer time (IHTT) as an indicator of CC integrity in 44 children with moderate/severe TBI at 3-5 months post-injury, compared with 39 healthy control children. Neurocognitive performance also was examined in these groups. Nearly half of the children with TBI had IHTTs that were outside the range of the healthy control group children. This subgroup of TBI children with slow IHTT also had significantly poorer neurocognitive functioning than healthy controls-even after correction for premorbid intellectual functioning. We discuss alternative models for the relationship between IHTT and neurocognitive functioning following TBI. Slow IHTT may be a biomarker that identifies children at risk for poor cognitive functioning following moderate/severe TBI.
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Affiliation(s)
- Monica U Ellis
- 1 Department of Psychiatry and Biobehavioral Sciences, University of California , Los Angeles, Los Angeles, California.,2 Fuller Graduate School of Psychology , Pasadena, California
| | | | - David L McArthur
- 3 Department of Neurosurgery, University of California , Los Angeles, Los Angeles, California
| | - Talin Babikian
- 1 Department of Psychiatry and Biobehavioral Sciences, University of California , Los Angeles, Los Angeles, California.,4 Mattel Children's Hospital, University of California , Los Angeles, Los Angeles, California
| | - Christopher Giza
- 3 Department of Neurosurgery, University of California , Los Angeles, Los Angeles, California.,4 Mattel Children's Hospital, University of California , Los Angeles, Los Angeles, California.,5 Steve Tisch BrainSPORT Program, University of California , Los Angeles, Los Angeles, California.,6 Brain Injury Research Center, University of California , Los Angeles, Los Angeles, California.,7 Department of Pediatrics, University of California , Los Angeles, Los Angeles, California
| | - Claudia L Kernan
- 1 Department of Psychiatry and Biobehavioral Sciences, University of California , Los Angeles, Los Angeles, California.,4 Mattel Children's Hospital, University of California , Los Angeles, Los Angeles, California
| | - Nina Newman
- 1 Department of Psychiatry and Biobehavioral Sciences, University of California , Los Angeles, Los Angeles, California
| | - Lisa Moran
- 1 Department of Psychiatry and Biobehavioral Sciences, University of California , Los Angeles, Los Angeles, California.,4 Mattel Children's Hospital, University of California , Los Angeles, Los Angeles, California
| | - Roy Akarakian
- 8 Wayne State University School of Medicine , Detroit, Michigan
| | - Asal Houshiarnejad
- 1 Department of Psychiatry and Biobehavioral Sciences, University of California , Los Angeles, Los Angeles, California
| | - Richard Mink
- 7 Department of Pediatrics, University of California , Los Angeles, Los Angeles, California.,9 Harbor-University of California , Los Angeles Medical Center, Torrance, California
| | - Jeffrey Johnson
- 10 Department of Clinical Pediatrics, University of Southern California ; Department of Pediatrics, Los Angeles County+USC Medical Center, Los Angeles, California
| | | | - Alexander Olsen
- 1 Department of Psychiatry and Biobehavioral Sciences, University of California , Los Angeles, Los Angeles, California.,12 Alexander Olsen Department of Psychology, Norwegian University of Science and Technology; Department of Physical Medicine and Rehabilitation, St. Olavs Hospital, Trondheim University Hospital , Trondheim, Norway
| | - Robert F Asarnow
- 1 Department of Psychiatry and Biobehavioral Sciences, University of California , Los Angeles, Los Angeles, California.,13 Department of Psychology, University of California , Los Angeles, Los Angeles, California
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58
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Transcranial magnetic stimulation facilitates neurorehabilitation after pediatric traumatic brain injury. Sci Rep 2015; 5:14769. [PMID: 26440604 PMCID: PMC4594036 DOI: 10.1038/srep14769] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Accepted: 09/09/2015] [Indexed: 11/08/2022] Open
Abstract
Traumatic brain injury (TBI) is the leading cause of death and disability among children in the United States. Affected children will often suffer from emotional, cognitive and neurological impairments throughout life. In the controlled cortical impact (CCI) animal model of pediatric TBI (postnatal day 16-17) it was demonstrated that injury results in abnormal neuronal hypoactivity in the non-injured primary somatosensory cortex (S1). It materializes that reshaping the abnormal post-injury neuronal activity may provide a suitable strategy to augment rehabilitation. We tested whether high-frequency, non-invasive transcranial magnetic stimulation (TMS) delivered twice a week over a four-week period can rescue the neuronal activity and improve the long-term functional neurophysiological and behavioral outcome in the pediatric CCI model. The results show that TBI rats subjected to TMS therapy showed significant increases in the evoked-fMRI cortical responses (189%), evoked synaptic activity (46%), evoked neuronal firing (200%) and increases expression of cellular markers of neuroplasticity in the non-injured S1 compared to TBI rats that did not receive therapy. Notably, these rats showed less hyperactivity in behavioral tests. These results implicate TMS as a promising approach for reversing the adverse neuronal mechanisms activated post-TBI. Importantly, this intervention could readily be translated to human studies.
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59
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Stamm JM, Koerte IK, Muehlmann M, Pasternak O, Bourlas AP, Baugh CM, Giwerc MY, Zhu A, Coleman MJ, Bouix S, Fritts NG, Martin BM, Chaisson C, McClean MD, Lin AP, Cantu RC, Tripodis Y, Stern RA, Shenton ME. Age at First Exposure to Football Is Associated with Altered Corpus Callosum White Matter Microstructure in Former Professional Football Players. J Neurotrauma 2015. [PMID: 26200068 DOI: 10.1089/neu.2014.3822] [Citation(s) in RCA: 120] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Youth football players may incur hundreds of repetitive head impacts (RHI) in one season. Our recent research suggests that exposure to RHI during a critical neurodevelopmental period prior to age 12 may lead to greater later-life mood, behavioral, and cognitive impairments. Here, we examine the relationship between age of first exposure (AFE) to RHI through tackle football and later-life corpus callosum (CC) microstructure using magnetic resonance diffusion tensor imaging (DTI). Forty retired National Football League (NFL) players, ages 40-65, were matched by age and divided into two groups based on their AFE to tackle football: before age 12 or at age 12 or older. Participants underwent DTI on a 3 Tesla Siemens (TIM-Verio) magnet. The whole CC and five subregions were defined and seeded using deterministic tractography. Dependent measures were fractional anisotropy (FA), trace, axial diffusivity, and radial diffusivity. Results showed that former NFL players in the AFE <12 group had significantly lower FA in anterior three CC regions and higher radial diffusivity in the most anterior CC region than those in the AFE ≥12 group. This is the first study to find a relationship between AFE to RHI and later-life CC microstructure. These results suggest that incurring RHI during critical periods of CC development may disrupt neurodevelopmental processes, including myelination, resulting in altered CC microstructure.
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Affiliation(s)
- Julie M Stamm
- 1 CTE Center, Boston University School of Medicine , Boston, Massachusetts.,2 Department of Anatomy and Neurobiology, Boston University School of Medicine , Boston, Massachusetts.,3 Psychiatry Neuroimaging Laboratory, Harvard Medical School , Boston, Massachusetts
| | - Inga K Koerte
- 3 Psychiatry Neuroimaging Laboratory, Harvard Medical School , Boston, Massachusetts.,4 Department of Child and Adolescent Psychiatry, Psychosomatic, and Psychotherapy, Ludwig-Maximilian-University , Munich, Germany
| | - Marc Muehlmann
- 3 Psychiatry Neuroimaging Laboratory, Harvard Medical School , Boston, Massachusetts.,4 Department of Child and Adolescent Psychiatry, Psychosomatic, and Psychotherapy, Ludwig-Maximilian-University , Munich, Germany
| | - Ofer Pasternak
- 3 Psychiatry Neuroimaging Laboratory, Harvard Medical School , Boston, Massachusetts.,15 Department of Radiology, Brigham and Women's Hospital, Harvard Medical School , Boston, Massachusetts
| | - Alexandra P Bourlas
- 1 CTE Center, Boston University School of Medicine , Boston, Massachusetts.,5 Alzheimer's Disease Center, Boston University School of Medicine , Boston, Massachusetts
| | - Christine M Baugh
- 1 CTE Center, Boston University School of Medicine , Boston, Massachusetts.,6 Interfaculty Initiative in Health Policy, Harvard University , Boston, Massachusetts
| | - Michelle Y Giwerc
- 3 Psychiatry Neuroimaging Laboratory, Harvard Medical School , Boston, Massachusetts
| | - Anni Zhu
- 3 Psychiatry Neuroimaging Laboratory, Harvard Medical School , Boston, Massachusetts
| | - Michael J Coleman
- 3 Psychiatry Neuroimaging Laboratory, Harvard Medical School , Boston, Massachusetts
| | - Sylvain Bouix
- 3 Psychiatry Neuroimaging Laboratory, Harvard Medical School , Boston, Massachusetts
| | - Nathan G Fritts
- 1 CTE Center, Boston University School of Medicine , Boston, Massachusetts
| | - Brett M Martin
- 7 Data Coordinating Center, Boston University School of Public Health , Boston, Massachusetts
| | - Christine Chaisson
- 1 CTE Center, Boston University School of Medicine , Boston, Massachusetts.,5 Alzheimer's Disease Center, Boston University School of Medicine , Boston, Massachusetts.,7 Data Coordinating Center, Boston University School of Public Health , Boston, Massachusetts.,8 Department of Biostatistics, Boston University School of Public Health , Boston, Massachusetts
| | - Michael D McClean
- 9 Department of Environmental Health, Boston University School of Public Health , Boston, Massachusetts
| | - Alexander P Lin
- 3 Psychiatry Neuroimaging Laboratory, Harvard Medical School , Boston, Massachusetts.,10 Center for Clinical Spectroscopy, Harvard Medical School , Boston, Massachusetts
| | - Robert C Cantu
- 1 CTE Center, Boston University School of Medicine , Boston, Massachusetts.,11 Department of Neurosurgery, Boston University School of Medicine , Boston, Massachusetts.,12 Sports Legacy Institute , Waltham, Massachusetts.,13 Department of Neurosurgery, Emerson Hospital , Concord, Massachusetts
| | - Yorghos Tripodis
- 1 CTE Center, Boston University School of Medicine , Boston, Massachusetts.,5 Alzheimer's Disease Center, Boston University School of Medicine , Boston, Massachusetts.,8 Department of Biostatistics, Boston University School of Public Health , Boston, Massachusetts
| | - Robert A Stern
- 1 CTE Center, Boston University School of Medicine , Boston, Massachusetts.,2 Department of Anatomy and Neurobiology, Boston University School of Medicine , Boston, Massachusetts.,5 Alzheimer's Disease Center, Boston University School of Medicine , Boston, Massachusetts.,11 Department of Neurosurgery, Boston University School of Medicine , Boston, Massachusetts.,14 Department of Neurology, Boston University School of Medicine , Boston, Massachusetts
| | - Martha E Shenton
- 3 Psychiatry Neuroimaging Laboratory, Harvard Medical School , Boston, Massachusetts.,15 Department of Radiology, Brigham and Women's Hospital, Harvard Medical School , Boston, Massachusetts.,16 VA Boston Healthcare System , Brockton Division, Brockton, Massachusetts
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60
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Zhuo J, Keledjian K, Xu S, Pampori A, Gerzanich V, Simard JM, Gullapalli RP. Changes in Diffusion Kurtosis Imaging and Magnetic Resonance Spectroscopy in a Direct Cranial Blast Traumatic Brain Injury (dc-bTBI) Model. PLoS One 2015; 10:e0136151. [PMID: 26301778 PMCID: PMC4547765 DOI: 10.1371/journal.pone.0136151] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Accepted: 07/31/2015] [Indexed: 01/27/2023] Open
Abstract
Explosive blast-related injuries are one of the hallmark injuries of veterans returning from recent wars, but the effects of a blast overpressure on the brain are poorly understood. In this study, we used in vivo diffusion kurtosis imaging (DKI) and proton magnetic resonance spectroscopy (MRS) to investigate tissue microstructure and metabolic changes in a novel, direct cranial blast traumatic brain injury (dc-bTBI) rat model. Imaging was performed on rats before injury and 1, 7, 14 and 28 days after blast exposure (~517 kPa peak overpressure to the dorsum of the head). No brain parenchyma abnormalities were visible on conventional T2-weighted MRI, but microstructural and metabolic changes were observed with DKI and proton MRS, respectively. Increased mean kurtosis, which peaked at 21 days post injury, was observed in the hippocampus and the internal capsule. Concomitant increases in myo-Inositol (Ins) and Taurine (Tau) were also observed in the hippocampus, while early changes at 1 day in the Glutamine (Gln) were observed in the internal capsule, all indicating glial abnormality in these regions. Neurofunctional testing on a separate but similarly treated group of rats showed early disturbances in vestibulomotor functions (days 1–14), which were associated with imaging changes in the internal capsule. Delayed impairments in spatial memory and in rapid learning, as assessed by Morris Water Maze paradigms (days 14–19), were associated with delayed changes in the hippocampus. Significant microglial activation and neurodegeneration were observed at 28 days in the hippocampus. Overall, our findings indicate delayed neurofunctional and pathological abnormalities following dc-bTBI that are silent on conventional T2-weighted imaging, but are detectable using DKI and proton MRS.
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Affiliation(s)
- Jiachen Zhuo
- Departments of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD, 21201, United States of America
| | - Kaspar Keledjian
- Department of Neurosurgery, University of Maryland School of Medicine, Baltimore, MD, 21201, United States of America
| | - Su Xu
- Departments of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD, 21201, United States of America
| | - Adam Pampori
- Department of Neurosurgery, University of Maryland School of Medicine, Baltimore, MD, 21201, United States of America
| | - Volodymyr Gerzanich
- Department of Neurosurgery, University of Maryland School of Medicine, Baltimore, MD, 21201, United States of America
| | - J. Marc Simard
- Department of Neurosurgery, University of Maryland School of Medicine, Baltimore, MD, 21201, United States of America
- Department of Pathology, University of Maryland School of Medicine, Baltimore, MD, 21201, United States of America
- Department of Physiology, University of Maryland School of Medicine, Baltimore, MD, 21201, United States of America
- * E-mail: (RGP); (JMS)
| | - Rao P. Gullapalli
- Departments of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD, 21201, United States of America
- * E-mail: (RGP); (JMS)
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61
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Brainstem white matter integrity is related to loss of consciousness and postconcussive symptomatology in veterans with chronic mild to moderate traumatic brain injury. Brain Imaging Behav 2015; 9:500-12. [DOI: 10.1007/s11682-015-9432-2] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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62
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Diffusion tensor imaging and magnetic resonance spectroscopy in traumatic brain injury: a review of recent literature. Brain Imaging Behav 2015; 8:487-96. [PMID: 24449140 DOI: 10.1007/s11682-013-9288-2] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Concussion is the most common form of traumatic brain injury (TBI), but diagnosis remains controversial because the brain appears quite normal in conventional computed tomography and magnetic resonance imaging (MRI). These conventional tools are not sensitive enough to detect diffuse traumatic axonal injury, and cannot depict aberrations in mild TBIs. Advanced MRI modalities including diffusion tensor imaging (DTI), and magnetic resonance spectroscopy (MRS), make it possible to detect brain injuries in TBI. The purpose of this review is to provide the latest information regarding the visualization and quantification of important abnormalities in TBI and new insights into their clinical significance. Advanced imaging modalities allow the discovery of biomarkers of injury and the detection of changes in brain injury over time. Such tools will likely be used to evaluate treatment efficacy in research. Combining multiple imaging modalities would not only provide greater insight into the underlying physiological changes in TBI, but also improve diagnostic accuracy in predicting outcomes. In this review we present evidence of brain abnormalities in TBI based on investigations using MRI, including DTI and MRS. Our review provides a summary of some of the important studies published from 2002 to 2012 on the topic of MRI findings in head trauma. With the growing realization that even mild head injury can lead to neurocognitive deficits, medical imaging has assumed preeminence for detecting abnormalities associated with TBI. Advanced MRI modalities such as DTI and MRS have an important role in the diagnosis of lesions for TBI patients.
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63
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Andronikou S, Ackermann C, Laughton B, Cotton M, Tomazos N, Spottiswoode B, Mauff K, Pettifor JM. Corpus callosum thickness on mid-sagittal MRI as a marker of brain volume: a pilot study in children with HIV-related brain disease and controls. Pediatr Radiol 2015; 45:1016-25. [PMID: 25620244 DOI: 10.1007/s00247-014-3255-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2014] [Revised: 07/24/2014] [Accepted: 11/25/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND Corpus callosum thickness measurement on mid-sagittal MRI may be a surrogate marker of brain volume. This is important for evaluation of diseases causing brain volume gain or loss, such as HIV-related brain disease and HIV encephalopathy. OBJECTIVE To determine if thickness of the corpus callosum on mid-sagittal MRI is a surrogate marker of brain volume in children with HIV-related brain disease and in controls without HIV. MATERIALS AND METHODS A retrospective MRI analysis in children (<5 years old) with HIV-related brain disease and controls used a custom-developed semi-automated tool, which divided the midline corpus callosum and measured its thickness in multiple locations. Brain volume was determined using volumetric analysis. Overall corpus callosum thickness and thickness of segments of the corpus callosum were correlated with overall and segmented (grey and white matter) brain volume. RESULTS Forty-four children (33 HIV-infected patients and 11 controls) were included. Significant correlations included overall corpus callosum (mean) and total brain volume (P = 0.05); prefrontal corpus callosum maximum with white matter volume (P = 0.02); premotor corpus callosum mean with total brain volume (P = 0.04) and white matter volume (P = 0.02), premotor corpus callosum maximum with white matter volume (P = 0.02) and sensory corpus callosum mean with total brain volume (P = 0.02). CONCLUSION Corpus callosum thickness correlates with brain volume both in HIV-infected patients and controls.
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Affiliation(s)
- Savvas Andronikou
- Department of Radiology, Faculty of Health Sciences, University of the Witwatersrand, South Africa, 700 Harbouredge, 10 Hospital Str. Greenpoint, Cape Town, 8005, South Africa,
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64
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Ma L, Steinberg JL, Keyser-Marcus L, Ramesh D, Narayana PA, Merchant RE, Moeller FG, Cifu DX. Altered white matter in cocaine-dependent subjects with traumatic brain injury: A diffusion tensor imaging study. Drug Alcohol Depend 2015; 151:128-34. [PMID: 25841982 PMCID: PMC4447586 DOI: 10.1016/j.drugalcdep.2015.03.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Revised: 03/09/2015] [Accepted: 03/11/2015] [Indexed: 01/22/2023]
Abstract
BACKGROUND Diffusion tensor imaging (DTI) is a useful technique for non-invasively investigating the microstructural organization of white matter (WM), and the most consistent DTI finding regarding cocaine-related WM alterations is in the corpus callosum (CC). WM injury has also been observed in subjects with traumatic brain injury (TBI), including in the CC. METHODS We used DTI to test if the WM microstructure is relatively more impaired in cocaine-dependent subjects who had suffered a mild TBI (mTBI). Fractional anisotropy (FA), which reflects the degree of alignment of cellular structures within fiber tracts and their structural integrity, was compared across cocaine-dependent subjects with mTBI (COCTBI group, n = 9), matched cocaine-dependent subjects without TBI (COC group, n = 12), and matched healthy controls (CTL group, n = 12). RESULTS The COCTBI group had significantly lower FA in the genu, body, and splenium of CC, than the CTL group whenever the education was controlled or not. The COC group had significantly lower FA in the left and right anterior corona radiata than the CTL group only when the education was controlled. There was no significant difference in FA between the COC and COCTBI groups. CONCLUSION Cocaine dependence (or mTBI) related WM impairments in the CC were not detectable in this small subject sample. The significant finding in the CC suggests that the concurrence of cocaine dependence and mTBI might result in more severe damage to the CC, which could even be detected in small sample size.
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Affiliation(s)
- Liangsuo Ma
- Institute for Drug and Alcohol Studies, Virginia Commonwealth University (VCU), Richmond, VA, USA; Department of Radiology, VCU, Richmond, VA, USA.
| | - Joel L. Steinberg
- Institute for Drug and Alcohol Studies, Virginia Commonwealth University (VCU), Richmond, Virginia, USA,Department of Psychiatry, VCU, Richmond, Virginia, USA
| | - Lori Keyser-Marcus
- Institute for Drug and Alcohol Studies, Virginia Commonwealth University (VCU), Richmond, Virginia, USA,Department of Psychiatry, VCU, Richmond, Virginia, USA
| | - Divya Ramesh
- Institute for Drug and Alcohol Studies, Virginia Commonwealth University (VCU), Richmond, Virginia, USA,Department of Psychiatry, VCU, Richmond, Virginia, USA,Department of Pharmacology and Toxicology, VCU, Richmond, Virginia, USA
| | - Ponnada A. Narayana
- Department of Diagnostic and Interventional Imaging, University of Texas Health Science Center, Houston, Texas, USA
| | - Randall E Merchant
- Department of Anatomy and Neurobiology, VCU, Richmond, Virginia, USA,Department of Neurosurgery, VCU, Richmond, Virginia, USA
| | - F. Gerard Moeller
- Institute for Drug and Alcohol Studies, Virginia Commonwealth University (VCU), Richmond, Virginia, USA,Department of Psychiatry, VCU, Richmond, Virginia, USA,Department of Pharmacology and Toxicology, VCU, Richmond, Virginia, USA
| | - David X Cifu
- Department of Physical Medicine and Rehabilitation, VCU, Richmond, Virginia, USA
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White matter disruption in moderate/severe pediatric traumatic brain injury: advanced tract-based analyses. NEUROIMAGE-CLINICAL 2015; 7:493-505. [PMID: 25737958 PMCID: PMC4338205 DOI: 10.1016/j.nicl.2015.02.002] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Revised: 02/06/2015] [Accepted: 02/07/2015] [Indexed: 12/01/2022]
Abstract
Traumatic brain injury (TBI) is the leading cause of death and disability in children and can lead to a wide range of impairments. Brain imaging methods such as DTI (diffusion tensor imaging) are uniquely sensitive to the white matter (WM) damage that is common in TBI. However, higher-level analyses using tractography are complicated by the damage and decreased FA (fractional anisotropy) characteristic of TBI, which can result in premature tract endings. We used the newly developed autoMATE (automated multi-atlas tract extraction) method to identify differences in WM integrity. 63 pediatric patients aged 8–19 years with moderate/severe TBI were examined with cross sectional scanning at one or two time points after injury: a post-acute assessment 1–5 months post-injury and a chronic assessment 13–19 months post-injury. A battery of cognitive function tests was performed in the same time periods. 56 children were examined in the first phase, 28 TBI patients and 28 healthy controls. In the second phase 34 children were studied, 17 TBI patients and 17 controls (27 participants completed both post-acute and chronic phases). We did not find any significant group differences in the post-acute phase. Chronically, we found extensive group differences, mainly for mean and radial diffusivity (MD and RD). In the chronic phase, we found higher MD and RD across a wide range of WM. Additionally, we found correlations between these WM integrity measures and cognitive deficits. This suggests a distributed pattern of WM disruption that continues over the first year following a TBI in children. We examined pediatric traumatic brain injury patients at 2 time points post injury. Cross sectional analyses were completed at the post-acute and chronic stages. We used novel tract-based methods to reveal widespread white matter disruption. White matter disruption chronically was related to cognitive deficits.
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66
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Roberts RM, Mathias JL, Rose SE. Diffusion Tensor Imaging (DTI) findings following pediatric non-penetrating TBI: a meta-analysis. Dev Neuropsychol 2015; 39:600-37. [PMID: 25470224 PMCID: PMC4270261 DOI: 10.1080/87565641.2014.973958] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
This study meta-analyzed research examining Diffusion Tensor Imaging following pediatric non-penetrating traumatic brain injury to identify the location and extent of white matter changes. Fractional anisotropy (FA) and apparent diffusion coefficient (ADC) data from 20 studies were analyzed. FA increased and ADC decreased in most white matter tracts in the short-term (moderate-to-large effects), and FA decreased and ADC increased in the medium- to long-term (moderate-to-very-large effects). Whole brain (short-term), cerebellum and corpus callosum (medium- to long-term) FA values have diagnostic potential, but the impact of age/developmental stage and injury severity on FA/ADC, and the predictive value, is unclear.
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Affiliation(s)
- R M Roberts
- a School of Psychology , University of Adelaide , Adelaide , Australia
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67
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Andronikou S, Pillay T, Gabuza L, Mahomed N, Naidoo J, Hlabangana LT, du Plessis V, Prabhu SP. Corpus callosum thickness in children: an MR pattern-recognition approach on the midsagittal image. Pediatr Radiol 2015; 45:258-72. [PMID: 25173405 DOI: 10.1007/s00247-014-2998-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2013] [Revised: 02/23/2014] [Accepted: 04/03/2014] [Indexed: 11/24/2022]
Abstract
Thickening of the corpus callosum is an important feature of development, whereas thinning of the corpus callosum can be the result of a number of diseases that affect development or cause destruction of the corpus callosum. Corpus callosum thickness reflects the volume of the hemispheres and responds to changes through direct effects or through Wallerian degeneration. It is therefore not only important to evaluate the morphology of the corpus callosum for congenital anomalies but also to evaluate the thickness of specific components or the whole corpus callosum in association with other findings. The goal of this pictorial review is raise awareness that the thickness of the corpus callosum can be a useful feature of pathology in pediatric central nervous system disease and must be considered in the context of the stage of development of a child. Thinning of the corpus callosum can be primary or secondary, and generalized or focal. Primary thinning is caused by abnormal or failed myelination related to the hypomyelinating leukoencephalopathies, metabolic disorders affecting white matter, and microcephaly. Secondary thinning of the corpus callosum can be caused by diffuse injury such as hypoxic-ischemic encephalopathy, human immunodeficiency virus (HIV) encephalopathy, hydrocephalus, dysmyelinating conditions and demyelinating conditions. Focal disturbance of formation or focal injury also causes localized thinning, e.g., callosal dysgenesis, metabolic disorders with localized effects, hypoglycemia, white matter injury of prematurity, HIV-related atrophy, infarction and vasculitis, trauma and toxins. The corpus callosum might be too thick because of a primary disorder in which the corpus callosum finding is essential to diagnosis; abnormal thickening can also be secondary to inflammation, infection and trauma.
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Affiliation(s)
- Savvas Andronikou
- Radiology Department, Faculty of Health Sciences, University of the Witwatersrand, York Road Parktown 2193, Johannesburg, South Africa,
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Lao Y, Law M, Shi J, Gajawelli N, Haas L, Wang Y, Leporé N. A T1 and DTI fused 3D Corpus Callosum analysis in pre- vs. post-season contact sports players. PROCEEDINGS OF SPIE--THE INTERNATIONAL SOCIETY FOR OPTICAL ENGINEERING 2015; 9287:92870O. [PMID: 26412925 PMCID: PMC4580707 DOI: 10.1117/12.2072600] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Sports related traumatic brain injury (TBI) is a worldwide public health issue, and damage to the corpus callosum (CC) has been considered as an important indicator of TBI. However, contact sports players suffer repeated hits to the head during the course of a season even in the absence of diagnosed concussion, and less is known about their effect on callosal anatomy. In addition, T1-weighted and diffusion tensor brain magnetic resonance images (DTI) have been analyzed separately, but a joint analysis of both types of data may increase statistical power and give a more complete understanding of anatomical correlates of subclinical concussions in these athletes. Here, for the first time, we fuse T1 surface-based morphometry and a new DTI analysis on 3D surface representations of the CCs into a single statistical analysis on these subjects. Our new combined method successfully increases detection power in detecting differences between pre- vs. post-season contact sports players. Alterations are found in the ventral genu, isthmus, and splenium of CC. Our findings may inform future health assessments in contact sports players. The new method here is also the first truly multimodal diffusion and T1-weighted analysis of the CC in TBI, and may be useful to detect anatomical changes in the corpus callosum in other multimodal datasets.
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Affiliation(s)
- Yi Lao
- Department of Radiology, Children's Hospital Los Angeles, Los Angeles CA, USA ; Department of Biomedical Engineering, University of Southern California, Los Angeles CA, USA
| | - Meng Law
- Department of Biomedical Engineering, University of Southern California, Los Angeles CA, USA ; Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Jie Shi
- School of Computing, Informatics, and Decision Systems Engineering, Arizona State University, Tempe, AZ, USA
| | - Niharika Gajawelli
- Department of Radiology, Children's Hospital Los Angeles, Los Angeles CA, USA ; Department of Biomedical Engineering, University of Southern California, Los Angeles CA, USA
| | - Lauren Haas
- Department of Biomedical Engineering, University of Southern California, Los Angeles CA, USA
| | - Yalin Wang
- School of Computing, Informatics, and Decision Systems Engineering, Arizona State University, Tempe, AZ, USA
| | - Natasha Leporé
- Department of Radiology, Children's Hospital Los Angeles, Los Angeles CA, USA ; Department of Biomedical Engineering, University of Southern California, Los Angeles CA, USA
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Ashwal S, Tong KA, Ghosh N, Bartnik-Olson B, Holshouser BA. Application of advanced neuroimaging modalities in pediatric traumatic brain injury. J Child Neurol 2014; 29:1704-17. [PMID: 24958007 PMCID: PMC4388155 DOI: 10.1177/0883073814538504] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Neuroimaging is commonly used for the assessment of children with traumatic brain injury and has greatly advanced how children are acutely evaluated. More recently, emphasis has focused on how advanced magnetic resonance imaging methods can detect subtler injuries that could relate to the structural underpinnings of the neuropsychological and behavioral alterations that frequently occur. We examine several methods used for the assessment of pediatric brain injury. Susceptibility-weighted imaging is a sensitive 3-dimensional high-resolution technique in detecting hemorrhagic lesions associated with diffuse axonal injury. Magnetic resonance spectroscopy acquires metabolite information, which serves as a proxy for neuronal (and glial, lipid, etc) structural integrity and provides sensitive assessment of neurochemical alterations. Diffusion-weighted imaging is useful for the early detection of ischemic and shearing injury. Diffusion tensor imaging allows better structural evaluation of white matter tracts. These methods are more sensitive than conventional imaging in demonstrating subtle injury that underlies a child's clinical symptoms. There also is an increasing desire to develop computational methods to fuse imaging data to provide a more integrated analysis of the extent to which components of the neurovascular unit are affected. The future of traumatic brain injury neuroimaging research is promising and will lead to novel approaches to predict and improve outcomes.
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Affiliation(s)
- Stephen Ashwal
- Departments of Pediatrics, Loma Linda University School of Medicine, Loma Linda, CA, USA
| | - Karen A. Tong
- Departments of Radiology, Loma Linda University School of Medicine, Loma Linda, CA, USA
| | - Nirmalya Ghosh
- Departments of Pediatrics, Loma Linda University School of Medicine, Loma Linda, CA, USA
| | - Brenda Bartnik-Olson
- Departments of Radiology, Loma Linda University School of Medicine, Loma Linda, CA, USA
| | - Barbara A. Holshouser
- Departments of Radiology, Loma Linda University School of Medicine, Loma Linda, CA, USA
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Stokum JA, Sours C, Zhuo J, Kane R, Shanmuganathan K, Gullapalli RP. A longitudinal evaluation of diffusion kurtosis imaging in patients with mild traumatic brain injury. Brain Inj 2014; 29:47-57. [PMID: 25259786 DOI: 10.3109/02699052.2014.947628] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PRIMARY OBJECTIVE To investigate longitudinal diffusion tensor imaging (DTI) and diffusion kurtosis imaging (DKI) changes in white and grey matter in patients with mild traumatic brain injury (mTBI). RESEARCH DESIGN A prospective case-control study. METHODS AND PROCEDURES DKI data was obtained from 24 patients with mTBI along with cognitive assessments within 10 days, 1 month and 6 months post-injury and compared with age-matched control (n¼ 24). Fractional anisotropy (FA), mean diffusivity (MD), radial diffusion (l(r)), mean kurtosis (MK) and radial kurtosis (Kr) were extracted from the thalamus, internal capsule and corpus callosum. MAIN OUTCOMES AND RESULTS Results demonstrate reduced Kr and MK in the anterior internal capsule in patients with mTBI across the three visits, and reduced MK in the posterior internal capsule during the 10 day time point. Correlations were observed between the change in MK or Kr between 1–6 months and the improvements in cognition between the 1 and 6 month visits in the thalamus, internal capsule and corpus callosum. CONCLUSIONS These data demonstrate that DKI may be sensitive in tracking pathophysiological changes associated with mTBI and may provide additional information to conventional DTI parameters in evaluating longitudinal changes following TBI.
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Schmidt AT, Hanten G, Li X, Wilde EA, Ibarra AP, Chu ZD, Helbling AR, Shah S, Levin HS. Emotional prosody and diffusion tensor imaging in children after traumatic brain injury. Brain Inj 2014; 27:1528-35. [PMID: 24266795 DOI: 10.3109/02699052.2013.828851] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PRIMARY OBJECTIVE Brain structures and their white matter connections that may contribute to emotion processing and may be vulnerable to disruption by a traumatic brain injury (TBI) occurring in childhood have not been thoroughly explored. RESEARCH DESIGN AND METHODS The current investigation examines the relationship between diffusion tensor imaging (DTI) metrics, including fractional anisotropy (FA) and apparent diffusion coefficient (ADC), and 3-month post-injury performance on a task of emotion prosody recognition and a control task of phonological discrimination in a group of 91 children who sustained either a moderate-to-severe TBI (n = 45) or orthopaedic injury (OI) (n = 46). MAIN OUTCOMES AND RESULTS Brain-behaviour findings within OI participants confirmed relationships between several significant white matter tracts in emotional prosody performance (i.e. the cingulum bundle, genu of the corpus callosum, inferior longitudinal fasciculus (ILF) and the inferior fronto-occipital fasciculus (IFOF). The cingulum and genu were also related to phonological discrimination performance. The TBI group demonstrated few strong brain behaviour relationships, with significant findings emerging only in the cingulum bundle for Emotional Prosody and the genu for Phonological Processing. CONCLUSION The lack of clear relationships in the TBI group is discussed in terms of the likely disruption to cortical networks secondary to significant brain injuries.
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Affiliation(s)
- Adam T Schmidt
- Department of Psychology and Philosophy, Sam Houston State University , Huntsville, TX , USA
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Imagawa KK, Hamilton A, Ceschin R, Tokar E, Pham P, Bluml S, Wisnowski J, Panigrahy A. Characterization of microstructural injury: a novel approach in infant abusive head trauma-initial experience. J Neurotrauma 2014; 31:1632-8. [PMID: 24831582 DOI: 10.1089/neu.2013.3228] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abusive head trauma (AHT) is the leading cause of morbidity and mortality among abused children, yet the neuroanatomical underpinnings of AHT outcome is incompletely understood. The aim of this study was to characterize white matter (WM) abnormalities in infants with AHT using diffusion tensor imaging (DTI) and determine which microstructural abnormalities are associated with poor outcome. Retrospective DTI data from 17 infants (>3 months) with a diagnosis of AHT and a comparison cohort of 34 term infants of similar post-conceptual age (PCA) were compared using a voxel-based DTI analysis of cerebral WM. AHT cases were dichotomously classified into mild/moderate versus severe outcome. Clinical variables and conventional imaging findings were also analyzed in relation to outcome. Outcomes were classified in accordance with the Pediatric Cerebral Performance Category Score (PCPCS). Reduced axial diffusivity (AD) was shown in widespread WM regions in the AHT infants compared with controls as well as in the AHT severe outcome group compared with the AHT mild/moderate outcome group. Reduced mean diffusivity (MD) was also associated with severe outcome. Radial diffusivity (RD), conventional magnetic resonance findings, brain metric measurements, and clinical/laboratory variables (with the exception of Glascow Coma Scale) did not differ among AHT outcome groups. Findings support the unique role of DTI techniques, beyond conventional imaging, in the evaluation of microstructural WM injury of AHT. Reduced AD (likely reflecting axonal damage) and MD were associated with poor clinical outcome. DTI abnormalities may uniquely reflect AHT patterns of axonal injury that are not characterized by conventional imaging, which may have both therapeutic and prognostic implications.
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Affiliation(s)
- Karen Kay Imagawa
- 1 Department of Pediatrics, Children's Hospital Los Angeles , Los Angeles, California
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Roden I, Könen T, Bongard S, Frankenberg E, Friedrich EK, Kreutz G. Effects of Music Training on Attention, Processing Speed and Cognitive Music Abilities-Findings from a Longitudinal Study. APPLIED COGNITIVE PSYCHOLOGY 2014. [DOI: 10.1002/acp.3034] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Ingo Roden
- Department of Music, School of Linguistics and Cultural Studies; Carl von Ossietzky University of Oldenburg; Oldenburg Germany
| | - Tanja Könen
- Department of Education and Human Development; German Institute for International Educational Research; Frankfurt am Main Germany
| | - Stephan Bongard
- Department of Psychology; Goethe-University Frankfurt; Frankfurt am Main Germany
| | - Emily Frankenberg
- Department of Psychology; Goethe-University Frankfurt; Frankfurt am Main Germany
| | | | - Gunter Kreutz
- Department of Music, School of Linguistics and Cultural Studies; Carl von Ossietzky University of Oldenburg; Oldenburg Germany
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Green REA, Colella B, Maller JJ, Bayley M, Glazer J, Mikulis DJ. Scale and pattern of atrophy in the chronic stages of moderate-severe TBI. Front Hum Neurosci 2014; 8:67. [PMID: 24744712 PMCID: PMC3978360 DOI: 10.3389/fnhum.2014.00067] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2012] [Accepted: 01/27/2014] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Moderate-severe traumatic brain injury (TBI) is increasingly being understood as a progressive disorder, with growing evidence of reduced brain volume and white matter (WM) integrity as well as lesion expansion in the chronic phases of injury. The scale of these losses has yet to be investigated, and pattern of change across structures has received limited attention. OBJECTIVES (1) To measure the percentage of patients in our TBI sample showing atrophy from 5 to 20 months post-injury in the whole brain and in structures with known vulnerability to acute TBI, and (2) To examine relative vulnerability and patterns of volume loss across structures. METHODS Fifty-six TBI patients [complicated mild to severe, with mean Glasgow Coma Scale (GCS) in severe range] underwent MRI at, on average, 5 and 20 months post-injury; 12 healthy controls underwent MRI twice, with a mean gap between scans of 25.4 months. Mean monthly percent volume change was computed for whole brain (ventricle-to-brain ratio; VBR), corpus callosum (CC), and right and left hippocampi (HPC). RESULTS (1) Using a threshold of 2 z-scores below controls, 96% of patients showed atrophy across time points in at least one region; 75% showed atrophy in at least 3 of the 4 regions measured. (2) There were no significant differences in the proportion of patients who showed atrophy across structures. For those showing decline in VBR, there was a significant association with both the CC and the right HPC (P < 0.05 for both comparisons). There were also significant associations between those showing decline in (i) right and left HPC (P < 0.05); (ii) all combinations of genu, body and splenium of the CC (P < 0.05), and (iii) head and tail of the right HPC (P < 0.05 all sub-structure comparisons). CONCLUSIONS Atrophy in chronic TBI is robust, and the CC, right HPC and left HPC appear equally vulnerable. Significant associations between the right and left HPC, and within substructures of the CC and right HPC, raise the possibility of common mechanisms for these regions, including transneuronal degeneration. Given the 96% incidence rate of atrophy, a genetic explanation is unlikely to explain all findings. Multiple and possibly synergistic mechanisms may explain findings. Atrophy has been associated with poorer functional outcomes, but recent findings suggest there is potential to offset this. A better, understanding of the underlying mechanisms could permit targeted therapy enabling better long-term outcomes.
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Affiliation(s)
- Robin E. A. Green
- Cognitive Neurorehabilitation Sciences Laboratory, Research Department, Toronto Rehabilitation InstituteToronto, ON, Canada
- Department of Psychiatry, Faculty of Medicine, University of TorontoToronto, ON, Canada
| | - Brenda Colella
- Cognitive Neurorehabilitation Sciences Laboratory, Research Department, Toronto Rehabilitation InstituteToronto, ON, Canada
| | - Jerome J. Maller
- Brain Stimulation and Neuroimaging Laboratory, Monash Alfred Psychiatry Research Centre, Alfred HospitalMelbourne, VIC, Australia
| | - Mark Bayley
- Cognitive Neurorehabilitation Sciences Laboratory, Research Department, Toronto Rehabilitation InstituteToronto, ON, Canada
| | - Joanna Glazer
- Cognitive Neurorehabilitation Sciences Laboratory, Research Department, Toronto Rehabilitation InstituteToronto, ON, Canada
| | - David J. Mikulis
- fMRI Laboratory, Division of Applied and Interventional Research, Toronto Western Research InstituteToronto, ON, Canada
- Department of Medical Imaging, Faculty of Medicine, University of TorontoToronto, ON, Canada
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Keightley ML, Sinopoli KJ, Davis KD, Mikulis DJ, Wennberg R, Tartaglia MC, Chen JK, Tator CH. Is there evidence for neurodegenerative change following traumatic brain injury in children and youth? A scoping review. Front Hum Neurosci 2014; 8:139. [PMID: 24678292 PMCID: PMC3958726 DOI: 10.3389/fnhum.2014.00139] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2012] [Accepted: 02/24/2014] [Indexed: 11/13/2022] Open
Abstract
While generalized cerebral atrophy and neurodegenerative change following traumatic brain injury (TBI) is well recognized in adults, it remains comparatively understudied in the pediatric population, suggesting that research should address the potential for neurodegenerative change in children and youth following TBI. This focused review examines original research findings documenting evidence for neurodegenerative change following TBI of all severities in children and youth. Our relevant inclusion and exclusion criteria identified a total of 16 articles for review. Taken together, the studies reviewed suggest there is evidence for long-term neurodegenerative change following TBI in children and youth. In particular both cross-sectional and longitudinal studies revealed volume loss in selected brain regions including the hippocampus, amygdala, globus pallidus, thalamus, periventricular white matter, cerebellum, and brain stem as well as overall decreased whole brain volume and increased CSF and ventricular space. Diffusion Tensor Imaging (DTI) studies also report evidence for decreased cellular integrity, particularly in the corpus callosum. Sensitivity of the hippocampus and deep limbic structures in pediatric populations are similar to findings in the adult literature and we consider the data supporting these changes as well as the need to investigate the possibility of neurodegenerative onset in childhood associated with mild traumatic brain injury (mTBI).
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Affiliation(s)
- Michelle L Keightley
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital Toronto, ON, Canada ; Department of Occupational Science and Occupational Therapy, University of Toronto Toronto, ON, Canada ; Graduate Department of Rehabilitation Science, University of Toronto ON, Canada ; Department of Psychology, University of Toronto ON, Canada ; Cognitive Neurorehabilitation Sciences, Toronto Rehabilitation Institute Toronto, ON, Canada
| | - Katia J Sinopoli
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital Toronto, ON, Canada ; Department of Psychology and Division of Neurology, Sickids Hospital for Sick Children Toronto, ON, Canada
| | - Karen D Davis
- Division of Brain, Imaging and Behaviour - Systems Neuroscience, Toronto Western Research Institute, University Health Network Toronto, ON, Canada ; Department of Surgery and Institute of Medical Science, University of Toronto Toronto, ON, Canada
| | - David J Mikulis
- Division of Brain, Imaging and Behaviour - Systems Neuroscience, Toronto Western Research Institute, University Health Network Toronto, ON, Canada
| | - Richard Wennberg
- Krembil Neuroscience Centre, Toronto Western Hospital, University Health Network and University of Toronto Toronto, ON, Canada
| | - Maria C Tartaglia
- Krembil Neuroscience Centre, Toronto Western Hospital, University Health Network and University of Toronto Toronto, ON, Canada
| | - Jen-Kai Chen
- Neuropsychology/Cognitive Neuroscience Unit, Montreal Neurological Institute Montreal, QC, Canada
| | - Charles H Tator
- Krembil Neuroscience Centre, Toronto Western Hospital, University Health Network and University of Toronto Toronto, ON, Canada
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Arenth PM, Russell KC, Scanlon JM, Kessler LJ, Ricker JH. Corpus callosum integrity and neuropsychological performance after traumatic brain injury: a diffusion tensor imaging study. J Head Trauma Rehabil 2014; 29:E1-E10. [PMID: 23558829 PMCID: PMC4918513 DOI: 10.1097/htr.0b013e318289ede5] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES (1) Detailed analysis of diffusion tensor imaging (DTI) parameters (fractional anisotropy and radial diffusivity) to evaluate white matter integrity in the corpus callosum (CC), and (2) examine correlations between DTI data and performance on multiple measures of cognitive functioning. PARTICIPANTS Twelve individuals with a history of complicated mild, moderate, or severe traumatic brain injury (TBI) who were an average of 1.7 years postinjury and 12 control participants. MAIN MEASURES Standardized and experimental neuropsychological tests; detailed analysis of DTI parameters. RESULTS The TBI group demonstrated DTI values suggesting decreased white matter integrity and correlations with severity of injury. Both groups showed correlations between DTI parameters and cognitive measures, with more significant correlations observed for the TBI group. White matter changes in the CC were evident chronically and were related to severity of injury. CONCLUSIONS Diffusion tensor imaging parameters suggesting disruptions in white matter in the CC may be implicated in impaired performance, both in terms of cognitive tasks and reaction time, after TBI.
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Affiliation(s)
- Patricia M. Arenth
- University of Pittsburgh Department of Physical Medicine and Rehabilitation, School of Medicine
- University of Pittsburgh Center for the Neural Basis of Cognition
| | - Kathryn C. Russell
- University of Pittsburgh Department of Physical Medicine and Rehabilitation, School of Medicine
- University of Pittsburgh Center for the Neural Basis of Cognition
- University of Pittsburgh Safar Center for Resuscitation Research, School of Medicine
| | - Joelle M. Scanlon
- University of Pittsburgh Department of Physical Medicine and Rehabilitation, School of Medicine
| | - Lauren J. Kessler
- University of Pittsburgh Department of Physical Medicine and Rehabilitation, School of Medicine
| | - Joseph H. Ricker
- University of Pittsburgh Department of Physical Medicine and Rehabilitation, School of Medicine
- University of Pittsburgh Center for the Neural Basis of Cognition
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Treit S, Chen Z, Rasmussen C, Beaulieu C. White matter correlates of cognitive inhibition during development: a diffusion tensor imaging study. Neuroscience 2013; 276:87-97. [PMID: 24355493 DOI: 10.1016/j.neuroscience.2013.12.019] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2013] [Revised: 12/06/2013] [Accepted: 12/09/2013] [Indexed: 11/24/2022]
Abstract
Inhibitory control and cognitive flexibility are two key executive functions that develop in childhood and adolescence, increasing one's capacity to respond dynamically to changing external demands and refrain from impulsive behaviors. These gains evolve in concert with significant brain development. Magnetic resonance imaging studies have identified numerous frontal and cingulate cortical areas associated with performance on inhibition tasks, but less is known about the involvement of the underlying anatomical connectivity, namely white matter. Here we used diffusion tensor imaging (DTI) to examine correlations between a DTI-derived parameter, fractional anisotropy (FA) of white matter, and performance on the NEPSY-II Inhibition test (Naming, Inhibition and Switching conditions) in 49 healthy children aged 5-16years (20 females; 29 males). First, whole brain voxel-based analysis revealed several clusters in the frontal projections of the corpus callosum, where higher FA was associated with worse inhibitory performance, as well as several clusters in posterior brain regions and one in the brainstem where higher FA was associated with better cognitive flexibility (in the Switching task), suggesting a dichotomous relationship between FA and these two aspects of cognitive control. Tractography through these clusters identified several white matter tracts, which were then manual traced in native space. Pearson's correlations confirmed associations between higher FA of frontal projections of the corpus callosum with poorer inhibitory performance (independent of age), though associations with Switching were not significant. Post-hoc evaluation suggested that FA of orbital and anterior frontal projections of the corpus callosum also mediated performance differences across conditions, which may reflect differences in self-monitoring or strategy use. These findings suggest a link between the development of inhibition and cognitive control with that of the underlying white matter, and may help to identify deviations of neurobiology in adolescent psychopathology.
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Affiliation(s)
- S Treit
- Centre for Neuroscience, University of Alberta, Edmonton, AB T6G-2V2, Canada
| | - Z Chen
- Department of Biomedical Engineering, University of Alberta, Edmonton, AB T6G-2V2, Canada
| | - C Rasmussen
- Centre for Neuroscience, University of Alberta, Edmonton, AB T6G-2V2, Canada; Department of Pediatrics, University of Alberta, Edmonton, AB T6G-2V2, Canada
| | - C Beaulieu
- Centre for Neuroscience, University of Alberta, Edmonton, AB T6G-2V2, Canada; Department of Biomedical Engineering, University of Alberta, Edmonton, AB T6G-2V2, Canada.
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Li N, Yang Y, Glover DP, Zhang J, Saraswati M, Robertson C, Pelled G. Evidence for impaired plasticity after traumatic brain injury in the developing brain. J Neurotrauma 2013; 31:395-403. [PMID: 24050267 DOI: 10.1089/neu.2013.3059] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The robustness of plasticity mechanisms during brain development is essential for synaptic formation and has a beneficial outcome after sensory deprivation. However, the role of plasticity in recovery after acute brain injury in children has not been well defined. Traumatic brain injury (TBI) is the leading cause of death and disability among children, and long-term disability from pediatric TBI can be particularly devastating. We investigated the altered cortical plasticity 2-3 weeks after injury in a pediatric rat model of TBI. Significant decreases in neurophysiological responses across the depth of the noninjured, primary somatosensory cortex (S1) in TBI rats, compared to age-matched controls, were detected with electrophysiological measurements of multi-unit activity (86.4% decrease), local field potential (75.3% decrease), and functional magnetic resonance imaging (77.6% decrease). Because the corpus callosum is a clinically important white matter tract that was shown to be consistently involved in post-traumatic axonal injury, we investigated its anatomical and functional characteristics after TBI. Indeed, corpus callosum abnormalities in TBI rats were detected with diffusion tensor imaging (9.3% decrease in fractional anisotropy) and histopathological analysis (14% myelination volume decreases). Whole-cell patch clamp recordings further revealed that TBI results in significant decreases in spontaneous firing rate (57% decrease) and the potential to induce long-term potentiation in neurons located in layer V of the noninjured S1 by stimulation of the corpus callosum (82% decrease). The results suggest that post-TBI plasticity can translate into inappropriate neuronal connections and dramatic changes in the function of neuronal networks.
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Affiliation(s)
- Nan Li
- 1 F.M. Kirby Research Center for Functional Brain Imaging , Kennedy Krieger Institute, Baltimore, Maryland
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79
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Bazeed MF, El-Fatah Ghanem MA, Afif HF, Adib Sunbulli MH, Elsayed Abdelaal AM. Can diffusion tensor imaging predict motor power affection after moderate traumatic brain injury? THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2013. [DOI: 10.1016/j.ejrnm.2013.09.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Centrum Semiovale and Corpus Callosum Integrity in Relation to Information Processing Speed in Patients With Severe Traumatic Brain Injury. J Head Trauma Rehabil 2013; 28:433-41. [DOI: 10.1097/htr.0b013e3182585d06] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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81
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Damage to myelin and oligodendrocytes: a role in chronic outcomes following traumatic brain injury? Brain Sci 2013; 3:1374-94. [PMID: 24961533 PMCID: PMC4061868 DOI: 10.3390/brainsci3031374] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2013] [Revised: 08/23/2013] [Accepted: 09/02/2013] [Indexed: 01/19/2023] Open
Abstract
There is increasing evidence in the experimental and clinical traumatic brain injury (TBI) literature that loss of central myelinated nerve fibers continues over the chronic post-traumatic phase after injury. However, the biomechanism(s) of continued loss of axons is obscure. Stretch-injury to optic nerve fibers in adult guinea-pigs was used to test the hypothesis that damage to the myelin sheath and oligodendrocytes of the optic nerve fibers may contribute to, or facilitate, the continuance of axonal loss. Myelin dislocations occur within internodal myelin of larger axons within 1–2 h of TBI. The myelin dislocations contain elevated levels of free calcium. The volume of myelin dislocations increase with greater survival and are associated with disruption of the axonal cytoskeleton leading to secondary axotomy. Waves of Ca2+ depolarization or spreading depression extend from the initial locus injury for perhaps hundreds of microns after TBI. As astrocytes and oligodendrocytes are connected via gap junctions, it is hypothesized that spreading depression results in depolarization of central glia, disrupt axonal ionic homeostasis, injure axonal mitochondria and allow the onset of axonal degeneration throughout an increasing volume of brain tissue; and contribute toward post-traumatic continued loss of white matter.
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82
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Treble A, Hasan KM, Iftikhar A, Stuebing KK, Kramer LA, Cox CS, Swank PR, Ewing-Cobbs L. Working memory and corpus callosum microstructural integrity after pediatric traumatic brain injury: a diffusion tensor tractography study. J Neurotrauma 2013; 30:1609-19. [PMID: 23627735 DOI: 10.1089/neu.2013.2934] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Deficits in working memory (WM) are a common consequence of pediatric traumatic brain injury (TBI) and are believed to contribute to difficulties in a range of cognitive and academic domains. Reduced integrity of the corpus callosum (CC) after TBI may disrupt the connectivity between bilateral frontoparietal neural networks underlying WM. In the present investigation, diffusion tensor imaging (DTI) tractography of eight callosal subregions (CC1-CC8) was examined in relation to measures of verbal and visuospatial WM in 74 children sustaining TBI and 49 typically developing comparison children. Relative to the comparison group, children with TBI demonstrated poorer visuospatial WM, but comparable verbal WM. Microstructure of the CC was significantly compromised in brain-injured children, with lower fractional anisotropy (FA) and higher axial and radial diffusivity metrics in all callosal subregions. In both groups of children, lower FA and/or higher radial diffusivity in callosal subregions connecting anterior and posterior parietal cortical regions predicted poorer verbal WM, whereas higher radial diffusivity in callosal subregions connecting anterior and posterior parietal, as well as temporal, cortical regions predicted poorer visuospatial WM. DTI metrics, especially radial diffusivity, in predictive callosal subregions accounted for significant variance in WM over and above remaining callosal subregions. Reduced microstructural integrity of the CC, particularly in subregions connecting parietal and temporal cortices, may act as a neuropathological mechanism contributing to long-term WM deficits. The future clinical use of neuroanatomical biomarkers may allow for the early identification of children at highest risk for WM deficits and earlier provision of interventions for these children.
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Affiliation(s)
- Amery Treble
- 1 Department of Psychology, University of Houston , Houston, Texas
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83
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Shin W, Mahmoud SY, Sakaie K, Banks SJ, Lowe MJ, Phillips M, Modic MT, Bernick C. Diffusion measures indicate fight exposure-related damage to cerebral white matter in boxers and mixed martial arts fighters. AJNR Am J Neuroradiol 2013; 35:285-90. [PMID: 23928146 DOI: 10.3174/ajnr.a3676] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Traumatic brain injury is common in fighting athletes such as boxers, given the frequency of blows to the head. Because DTI is sensitive to microstructural changes in white matter, this technique is often used to investigate white matter integrity in patients with traumatic brain injury. We hypothesized that previous fight exposure would predict DTI abnormalities in fighting athletes after controlling for individual variation. MATERIALS AND METHODS A total of 74 boxers and 81 mixed martial arts fighters were included in the analysis and scanned by use of DTI. Individual information and data on fight exposures, including number of fights and knockouts, were collected. A multiple hierarchical linear regression model was used in region-of-interest analysis to test the hypothesis that fight-related exposure could predict DTI values separately in boxers and mixed martial arts fighters. Age, weight, and years of education were controlled to ensure that these factors would not account for the hypothesized effects. RESULTS We found that the number of knockouts among boxers predicted increased longitudinal diffusivity and transversal diffusivity in white matter and subcortical gray matter regions, including corpus callosum, isthmus cingulate, pericalcarine, precuneus, and amygdala, leading to increased mean diffusivity and decreased fractional anisotropy in the corresponding regions. The mixed martial arts fighters had increased transversal diffusivity in the posterior cingulate. The number of fights did not predict any DTI measures in either group. CONCLUSIONS These findings suggest that the history of fight exposure in a fighter population can be used to predict microstructural brain damage.
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Affiliation(s)
- W Shin
- From the Imaging Institute (W.S., S.Y.M., K.S., M.J.L., M.P.)
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84
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Bigler ED. Traumatic brain injury, neuroimaging, and neurodegeneration. Front Hum Neurosci 2013; 7:395. [PMID: 23964217 PMCID: PMC3734373 DOI: 10.3389/fnhum.2013.00395] [Citation(s) in RCA: 135] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2012] [Accepted: 07/05/2013] [Indexed: 12/14/2022] Open
Abstract
Depending on severity, traumatic brain injury (TBI) induces immediate neuropathological effects that in the mildest form may be transient but as severity increases results in neural damage and degeneration. The first phase of neural degeneration is explainable by the primary acute and secondary neuropathological effects initiated by the injury; however, neuroimaging studies demonstrate a prolonged period of pathological changes that progressively occur even during the chronic phase. This review examines how neuroimaging may be used in TBI to understand (1) the dynamic changes that occur in brain development relevant to understanding the effects of TBI and how these relate to developmental stage when the brain is injured, (2) how TBI interferes with age-typical brain development and the effects of aging thereafter, and (3) how TBI results in greater frontotemporolimbic damage, results in cerebral atrophy, and is more disruptive to white matter neural connectivity. Neuroimaging quantification in TBI demonstrates degenerative effects from brain injury over time. An adverse synergistic influence of TBI with aging may predispose the brain injured individual for the development of neuropsychiatric and neurodegenerative disorders long after surviving the brain injury.
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Affiliation(s)
- Erin D Bigler
- Department of Psychology, Brigham Young University Provo, UT, USA ; Neuroscience Center, Brigham Young University Provo, UT, USA ; Department of Psychiatry, University of Utah Salt Lake City, UT, USA ; The Brain Institute of Utah, University of Utah Salt Lake City, UT, USA
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85
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Dinkel J, Drier A, Khalilzadeh O, Perlbarg V, Czernecki V, Gupta R, Gomas F, Sanchez P, Dormont D, Galanaud D, Stevens RD, Puybasset L. Long-term white matter changes after severe traumatic brain injury: a 5-year prospective cohort. AJNR Am J Neuroradiol 2013; 35:23-9. [PMID: 23846796 DOI: 10.3174/ajnr.a3616] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Extensive white matter damage has been documented in patients with severe traumatic brain injury, yet how this damage evolves in the long term is not well understood. We used DTI to study white matter changes at 5 years after traumatic brain injury. MATERIALS AND METHODS There were 8 healthy control participants and 13 patients with severe traumatic brain injury who were enrolled in a prospective observational study, which included clinical assessment and brain MR imaging in the acute setting (< 6 weeks) and 2 years and 5 years after injury. Only subjects with mild to moderate disability or no disability at 1 year were included in this analysis. DTI parameters were measured in 20 different brain regions and were normalized to values obtained in an age-matched control group. RESULTS In the acute setting, fractional anisotropy was significantly lower in the genu and body of the corpus callosum and in the bilateral corona radiata in patients compared with control participants, whereas radial diffusivity was significantly (P < .05) higher in these tracts. At 2 years, fractional anisotropy in these tracts had further decreased and radial diffusivity had increased. No significant changes were detected between 2 and 5 years after injury. The baseline radial diffusivity and fractional anisotropy values in the anterior aspect of the brain stem, genu and body of the corpus callosum, and the right and left corona radiata were significantly (P < .05) associated with neurocognitive sequelae (including amnesia, aphasia, and dyspraxia) at year 5. CONCLUSIONS DTI changes in major white matter tracts persist up to 5 years after severe traumatic brain injury and are most pronounced in the corpus callosum and corona radiata. Limited structural change is noted in the interval between 2 and 5 years.
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Affiliation(s)
- J Dinkel
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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86
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Semple BD, Blomgren K, Gimlin K, Ferriero DM, Noble-Haeusslein LJ. Brain development in rodents and humans: Identifying benchmarks of maturation and vulnerability to injury across species. Prog Neurobiol 2013; 106-107:1-16. [PMID: 23583307 PMCID: PMC3737272 DOI: 10.1016/j.pneurobio.2013.04.001] [Citation(s) in RCA: 1375] [Impact Index Per Article: 125.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2013] [Revised: 04/03/2013] [Accepted: 04/03/2013] [Indexed: 12/13/2022]
Abstract
Hypoxic-ischemic and traumatic brain injuries are leading causes of long-term mortality and disability in infants and children. Although several preclinical models using rodents of different ages have been developed, species differences in the timing of key brain maturation events can render comparisons of vulnerability and regenerative capacities difficult to interpret. Traditional models of developmental brain injury have utilized rodents at postnatal day 7-10 as being roughly equivalent to a term human infant, based historically on the measurement of post-mortem brain weights during the 1970s. Here we will examine fundamental brain development processes that occur in both rodents and humans, to delineate a comparable time course of postnatal brain development across species. We consider the timing of neurogenesis, synaptogenesis, gliogenesis, oligodendrocyte maturation and age-dependent behaviors that coincide with developmentally regulated molecular and biochemical changes. In general, while the time scale is considerably different, the sequence of key events in brain maturation is largely consistent between humans and rodents. Further, there are distinct parallels in regional vulnerability as well as functional consequences in response to brain injuries. With a focus on developmental hypoxic-ischemic encephalopathy and traumatic brain injury, this review offers guidelines for researchers when considering the most appropriate rodent age for the developmental stage or process of interest to approximate human brain development.
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Affiliation(s)
- Bridgette D. Semple
- Department of Neurological Surgery, University of California San Francisco, 513 Parnassus Avenue, Room HSE-722, San Francisco, CA 94143-0112, USA
| | - Klas Blomgren
- Center for Brain Repair and Rehabilitation, Institute of Neuroscience and Physiology, University of Gothenburg, Sweden
- Department of Pediatrics, Queen Silvia's Children's Hospital, University of Gothenburg, Sweden
- Department of Women's and Children's Health, Karolinska Institutet, Q2:07, SE 171 76 Stockholm, Sweden
| | - Kayleen Gimlin
- Department of Neurological Surgery, University of California San Francisco, 513 Parnassus Avenue, Room HSE-722, San Francisco, CA 94143-0112, USA
| | - Donna M. Ferriero
- Department of Pediatrics, University of California San Francisco, San Francisco, CA, USA
| | - Linda J. Noble-Haeusslein
- Department of Neurological Surgery, University of California San Francisco, 513 Parnassus Avenue, Room HSE-722, San Francisco, CA 94143-0112, USA
- Department of Physical Therapy and Rehabilitation Science, University of California San Francisco, San Francisco, CA, USA
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Ho L, Zhao W, Dams-O'Connor K, Tang CY, Gordon W, Peskind ER, Yemul S, Haroutunian V, Pasinetti GM. Elevated plasma MCP-1 concentration following traumatic brain injury as a potential "predisposition" factor associated with an increased risk for subsequent development of Alzheimer's disease. J Alzheimers Dis 2013; 31:301-13. [PMID: 22543850 DOI: 10.3233/jad-2012-120598] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We explored whether changes in the expression profile of peripheral blood plasma proteins may provide a clinical, readily accessible "window" into the brain, reflecting molecular alterations following traumatic brain injury (TBI) that might contribute to TBI complications. We recruited fourteen TBI and ten control civilian participants for the study, and also analyzed banked plasma specimens from 20 veterans with TBI and 20 control cases. Using antibody arrays and ELISA assays, we explored differentially-regulated protein species in the plasma of TBI compared to healthy controls from the two independent cohorts. We found three protein biomarker species, monocyte chemotactic protein-1 (MCP-1), insulin-like growth factor-binding protein-3, and epidermal growth factor receptor, that are differentially regulated in plasma specimens of the TBI cases. A three-biomarker panel using all three proteins provides the best potential criterion for separating TBI and control cases. Plasma MCP-1 contents are correlated with the severity of TBI and the index of compromised axonal fiber integrity in the frontal cortex. Based on these findings, we evaluated postmortem brain specimens from 7 mild cognitive impairment (MCI) and 7 neurologically normal cases. We found elevated MCP-1 expression in the frontal cortex of MCI cases that are at high risk for developing Alzheimer's disease. Our findings suggest that additional application of the three-biomarker panel to current diagnostic criteria may lead to improved TBI detection and more sensitive outcome measures for clinical trials. Induction of MCP-1 in response to TBI might be a potential predisposing factor that may increase the risk for development of Alzheimer's disease.
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Affiliation(s)
- Lap Ho
- Department of Neurology, Mount Sinai School of Medicine, New York, NY 10029, USA
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88
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Kurki TJI, Laalo JP, Oksaranta OM. Diffusion tensor tractography of the uncinate fasciculus: pitfalls in quantitative analysis due to traumatic volume changes. J Magn Reson Imaging 2013; 38:46-53. [PMID: 23733545 DOI: 10.1002/jmri.23901] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2012] [Accepted: 09/18/2012] [Indexed: 11/05/2022] Open
Abstract
PURPOSE To demonstrate the sensitivity of quantitative diffusion tensor tractography to traumatic injury of the uncinate fasciculus (UF), and to evaluate the effect of volume changes on the accuracy of quantitative analysis. MATERIALS AND METHODS Diffusion tensor imaging (DTI) was performed at 3 T for 110 patients with traumatic brain injury (TBI) and 60 control subjects. Volume, mean diffusivity (MD), and mean fractional anisotropy (FA) of the UF were measured by means of tractography. The influence of FA threshold on mean FA values was determined and the values were further related to the tract volume. RESULTS In patients with TBI, 16% of the volumes and 29% of the FA values were decreased and 25% of the MD values were increased (>2 SD from the mean of controls). Small tracts (6% of trajectories) often had normal mean FA, but low volume-related FA values. Large UFs often had decreased mean FA values, but normal volume-related central values (3% of trajectories). CONCLUSION Posttraumatic FA and MD changes and volume reductions are common in the tractography of UF. Trauma-induced volume changes can cause misleading whole-tract mean FA values. Therefore, additional volume-based analysis of the central part is beneficial for clinical assessment.
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89
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Kim N, Branch CA, Kim M, Lipton ML. Whole brain approaches for identification of microstructural abnormalities in individual patients: comparison of techniques applied to mild traumatic brain injury. PLoS One 2013; 8:e59382. [PMID: 23555665 PMCID: PMC3608654 DOI: 10.1371/journal.pone.0059382] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2012] [Accepted: 02/14/2013] [Indexed: 12/11/2022] Open
Abstract
PURPOSE Group-wise analyses of DTI in mTBI have demonstrated evidence of traumatic axonal injury (TAI), associated with adverse clinical outcomes. Although mTBI is likely to have a unique spatial pattern in each patient, group analyses implicitly assume that location of injury will be the same across patients. The purpose of this study was to optimize and validate a procedure for analysis of DTI images acquired in individual patients, which could detect inter-individual differences and be applied in the clinical setting, where patients must be assessed as individuals. MATERIALS AND METHODS After informed consent and in compliance with HIPAA, 34 mTBI patients and 42 normal subjects underwent 3.0 Tesla DTI. Four voxelwise assessment methods (standard Z-score, "one vs. many" t-test, Family-Wise Error Rate control using pseudo t-distribution, EZ-MAP) for use in individual patients, were applied to each patient's fractional anisotropy (FA) maps and tested for its ability to discriminate patients from controls. Receiver Operating Characteristic (ROC) analyses were used to define optimal thresholds (voxel-level significance and spatial extent) for reliable and robust detection of mTBI pathology. RESULTS ROC analyses showed EZ-MAP (specificity 71%, sensitivity 71%), "one vs. many" t-test and standard Z-score (sensitivity 65%, specificity 76% for both methods) resulted in a significant area under the curve (AUC) score for discriminating mTBI patients from controls in terms of the total number of abnormal white matter voxels detected while the FWER test was not significant. EZ-MAP is demonstrated to be robust to assumptions of Gaussian behavior and may serve as an alternative to methods that require strict Gaussian assumptions. CONCLUSION EZ-MAP provides a robust approach for delineation of regional abnormal anisotropy in individual mTBI patients.
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Affiliation(s)
- Namhee Kim
- The Gruss Magnetic Resonance Research Center, Albert Einstein College of Medicine of Yeshiva University, Bronx, New York, United States of America
- Department of Radiology, Albert Einstein College of Medicine of Yeshiva University, Bronx, New York, United States of America
| | - Craig A. Branch
- The Gruss Magnetic Resonance Research Center, Albert Einstein College of Medicine of Yeshiva University, Bronx, New York, United States of America
- Department of Radiology, Albert Einstein College of Medicine of Yeshiva University, Bronx, New York, United States of America
- Department of Physiology and Biophysics, Albert Einstein College of Medicine of Yeshiva University, Bronx, New York, United States of America
| | - Mimi Kim
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine of Yeshiva University, Bronx, New York, United States of America
| | - Michael L. Lipton
- The Gruss Magnetic Resonance Research Center, Albert Einstein College of Medicine of Yeshiva University, Bronx, New York, United States of America
- Department of Radiology, Albert Einstein College of Medicine of Yeshiva University, Bronx, New York, United States of America
- Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine of Yeshiva University, Bronx, New York, United States of America
- The Dominick P. Purpura Department of Neuroscience, Albert Einstein College of Medicine of Yeshiva University, Bronx, New York, United States of America
- Department of Radiology, Montefiore Medical Center, Bronx, New York, United States of America
- * E-mail:
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90
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Detection of white matter lesions in the acute stage of diffuse axonal injury predicts long-term cognitive impairments: a clinical diffusion tensor imaging study. J Trauma Acute Care Surg 2013; 74:242-7. [PMID: 23064612 DOI: 10.1097/ta.0b013e3182684fe8] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND White matter disruption is known to contribute to neurocognitive deficits after diffuse axonal injury (DAI). This study evaluated the relationship between white matter integrity using diffusion tensor imaging in the early stage and cognitions in the chronic stage. METHODS Diffusion tensor imaging was performed in 15 patients with DAI within 7 days of injury and in 15 patients in the control group. Fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (AD), and radial diffusivity (RD) were calculated within regions of interest, including the posterior limb of the internal capsule, uncinate fasciculus (UF), anterior corona radiate (ACR), superior longitudinal fasciculus (SLF), inferior longitudinal fasciculus (ILF), genu of the corpus callosum, body of the corpus callosum, and splenium of the corpus callosum and cingulum bundle (CB). The patients with DAI and the patients in the control group also underwent neuropsychological testing during the chronic stage after DAI. RESULTS The region-of-interest analysis showed significantly reduced FA and AD values in all nine regions within 7 days of injury as well as increased MD values in the corpus callosum among patients in the DAI group. The patients demonstrated significantly poorer performance on the working memory tests and attention test. In patients, working memory function was positively correlated with the AD value in the UF and with the FA value in the CB, UF, SLF, and ILF. Working memory function was inversely correlated with the RD value in the CB, SLF, and ILF and with the MD value in the SLF and ILF. In addition, the attention function demonstrated a positive correlation with the RD value in the ACR, SLF, and ILF and with the MD value in the ACR, SLF, and ILF. In addition, attention was inversely correlated with the FA values for the posterior limb of the internal capsule, ACR, SLF, and ILF. CONCLUSION The results indicated that the presence of white matter changes during the early stage of DAI may be helpful for predicting cognitive dysfunction over the long term. LEVEL OF EVIDENCE Prognostic study, level III.
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Abstract
The potential utility of diffusion tensor (DT) imaging in clinical practice is broad, and new applications continue to evolve as technology advances. Clinical applications of DT imaging and tractography include tissue characterization, lesion localization, and mapping of white matter tracts. DT imaging metrics are sensitive to microstructural changes associated with central nervous system disease; however, further research is needed to enhance specificity so as to facilitate more widespread clinical application. Preoperative tract mapping, with either directionally encoded color maps or tractography, provides useful information to the neurosurgeon and has been shown to improve clinical outcomes.
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92
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Wilde EA, Ayoub KW, Bigler ED, Chu ZD, Hunter JV, Wu TC, McCauley SR, Levin HS. Diffusion tensor imaging in moderate-to-severe pediatric traumatic brain injury: changes within an 18 month post-injury interval. Brain Imaging Behav 2013; 6:404-16. [PMID: 22399284 DOI: 10.1007/s11682-012-9150-y] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Traumatic brain injury (TBI) is a leading cause of death and disability in children, yet little is known regarding the pattern of TBI-related microstructural change and its impact on subsequent development. Diffusion tensor imaging (DTI) was used to examine between-group differences at two time points (planned intervals of 3 months and 18 months post-injury) and within-group longitudinal change in a group of children and adolescents aged 7-17 years with moderate-to-severe TBI (n = 20) and a comparison group of children with orthopedic injury (OI) (n = 21). In the 3- and 18-month cross-sectional analyses, tract-based spatial statistics (TBSS) generally revealed decreased fractional anisotropy (FA) and increased apparent diffusion coefficient (ADC) in the TBI group in regions of frontal, temporal, parietal, and occipital white matter as well as several deep subcortical structures, though areas of FA decrease were more prominent at the 3-month assessment, and areas of ADC increase were more prominent at the 18 month assessment, particularly in the frontal regions. In terms of the within-group changes over time, the OI group demonstrated primarily diffuse increases in FA over time, consistent with previous findings of DTI-measured white matter developmental change. The TBI group demonstrated primarily regions of FA decrease and ADC increase over time, consistent with presumed continued degenerative change, though regions of ADC decrease were also appreciated. These results suggest that TBI-related microstructural changes are dynamic in children and continue until at least 18 months post-injury. Understanding the course of these changes in DTI metrics may be important in TBI for facilitating advances in management and intervention.
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Affiliation(s)
- Elisabeth A Wilde
- Physical Medicine and Rehabilitation Alliance, Baylor College of Medicine and the University of Texas-Houston Medical School, Houston, TX, USA.
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93
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Hulkower MB, Poliak DB, Rosenbaum SB, Zimmerman ME, Lipton ML. A decade of DTI in traumatic brain injury: 10 years and 100 articles later. AJNR Am J Neuroradiol 2013; 34:2064-74. [PMID: 23306011 DOI: 10.3174/ajnr.a3395] [Citation(s) in RCA: 310] [Impact Index Per Article: 28.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
SUMMARY The past decade has seen an increase in the number of articles reporting the use of DTI to detect brain abnormalities in patients with traumatic brain injury. DTI is well-suited to the interrogation of white matter microstructure, the most important location of pathology in TBI. Additionally, studies in animal models have demonstrated the correlation of DTI findings and TBI pathology. One hundred articles met the inclusion criteria for this quantitative literature review. Despite significant variability in sample characteristics, technical aspects of imaging, and analysis approaches, the consensus is that DTI effectively differentiates patients with TBI and controls, regardless of the severity and timeframe following injury. Furthermore, many have established a relationship between DTI measures and TBI outcomes. However, the heterogeneity of specific outcome measures used limits interpretation of the literature. Similarly, few longitudinal studies have been performed, limiting inferences regarding the long-term predictive utility of DTI. Larger longitudinal studies, using standardized imaging, analysis approaches, and outcome measures will help realize the promise of DTI as a prognostic tool in the care of patients with TBI.
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94
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Levine B, Kovacevic N, Nica EI, Schwartz ML, Gao F, Black SE. Quantified MRI and cognition in TBI with diffuse and focal damage ☆. NEUROIMAGE-CLINICAL 2013; 2:534-541. [PMID: 24049744 PMCID: PMC3773881 DOI: 10.1016/j.nicl.2013.03.015] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
In patients with chronic-phase traumatic brain injury (TBI), structural MRI is readily attainable and provides rich anatomical information, yet the relationship between whole-brain structural MRI measures and neurocognitive outcome is relatively unexplored and can be complicated by the presence of combined focal and diffuse injury. In this study, sixty-three patients spanning the full range of TBI severity received high-resolution structural MRI concurrent with neuropsychological testing. Multivariate statistical analysis assessed covariance patterns between volumes of grey matter, white matter, and sulcal/subdural and ventricular CSF across 38 brain regions and neuropsychological test performance. Patients with diffuse and diffuse + focal injury were analyzed both separately and together. Tests of speeded attention, working memory, and verbal learning and memory robustly covaried with a distributed pattern of volume loss over temporal, ventromedial prefrontal, right parietal regions, and cingulate regions. This pattern was modulated by the presence of large focal lesions, but held even when analyses were restricted to those with diffuse injury. Effects were most consistently observed within grey matter. Relative to regional brain volumetric data, clinically defined injury severity (depth of coma at time of injury) showed only weak relation to neuropsychological outcome. The results showed that neuropsychological test performance in patients with TBI is related to a distributed pattern of volume loss in regions mediating mnemonic and attentional processing. This relationship holds for patients with and without focal lesions, indicating that diffuse injury alone is sufficient to cause significant neuropsychological disability in relation to regional volume loss. Quantified structural brain imaging data provides a highly sensitive index of brain integrity that is related to cognitive functioning in chronic phase TBI.
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Affiliation(s)
- Brian Levine
- Rotman Research Institute, Baycrest, Toronto, Canada
- Department of Psychology, University of Toronto, Canada
- Department of Medicine (Neurology), University of Toronto, Canada
- Corresponding author at: The Rotman Research Institute at Baycrest, 3560 Bathurst St., Toronto, ON, M6A 2E1, Canada. Tel.: + 1 416 785 2500x3593; fax: + 1 416 785 2862.
| | | | | | | | - Fuqiang Gao
- L.C. Campbell Cognitive Neurology Research Unit and Heart and Stroke Foundation Center for Stroke Recovery, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Sandra E. Black
- Rotman Research Institute, Baycrest, Toronto, Canada
- Department of Medicine (Neurology), University of Toronto, Canada
- Department of Surgery (Neurosurgery), University of Toronto, Canada
- Department of Medicine (Neurology), Sunnybrook Health Sciences Centre, Toronto, Canada
- L.C. Campbell Cognitive Neurology Research Unit and Heart and Stroke Foundation Center for Stroke Recovery, Sunnybrook Health Sciences Centre, Toronto, Canada
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95
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Jorge RE, Acion L, White T, Tordesillas-Gutierrez D, Pierson R, Crespo-Facorro B, Magnotta VA. White matter abnormalities in veterans with mild traumatic brain injury. Am J Psychiatry 2012; 169:1284-91. [PMID: 23212059 PMCID: PMC4030599 DOI: 10.1176/appi.ajp.2012.12050600] [Citation(s) in RCA: 118] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE It has been estimated that 10%-20% of U.S. veterans of the wars in Iraq and Afghanistan experienced mild traumatic brain injury (TBI), mostly secondary to blast exposure. Diffusion tensor imaging (DTI) may detect subtle white matter changes in both the acute and chronic stages of mild TBI and thus has the potential to detect white matter damage in patients with TBI. The authors used DTI to examine white matter integrity in a relatively large group of veterans with a history of mild TBI. METHOD DTI images from 72 veterans of the wars in Iraq and Afghanistan who had mild TBI were compared with DTI images from 21 veterans with no exposure to TBI during deployment. Conventional voxel-based analysis as well as a method of identifying spatially heterogeneous areas of decreased fractional anisotropy ("potholes") were used. Veterans also underwent psychiatric and neuropsychological assessments. RESULTS Voxel-based analysis did not reveal differences in DTI parameters between the veterans with mild TBI and those with no TBI. However, the veterans with mild TBI had a significantly higher number of potholes than those without TBI. The difference in the number of potholes was not influenced by age, time since trauma, a history of mild TBI unrelated to deployment, or coexisting psychopathology. The number of potholes was correlated with the severity of TBI and with performance in executive functioning tasks. CONCLUSIONS Veterans who had blast-related mild TBI showed evidence of multifocal white matter abnormalities that were associated with severity of the injury and with relevant functional measures. Overall, white matter potholes may constitute a sensitive biomarker of axonal injury that can be identified in mild TBI at acute and chronic stages of its clinical course.
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Affiliation(s)
- Ricardo E Jorge
- Departments of Psychiatry and Radiology, Carver College of Medicine, University of Iowa, Iowa City, Iowa, USA.
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96
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Carter E, Coles JP. Imaging in the diagnosis and prognosis of traumatic brain injury. EXPERT OPINION ON MEDICAL DIAGNOSTICS 2012; 6:541-554. [PMID: 23480836 DOI: 10.1517/17530059.2012.707188] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
INTRODUCTION Traumatic brain injury (TBI) is a major cause of death and disability worldwide. Improved understanding of the impact of head injury and the extent and development of neuronal loss and cognitive dysfunction could lead to improved therapy and outcome for patients. AREAS COVERED This paper reviews the currently available imaging techniques and defines their role in the diagnosis, management and prediction of outcome following traumatic brain injury. These imaging techniques provide delineation of the structural, physiological and functional derangements that result following acute injury, and map their development and association with late functional deficits. Imaging tools also have a role in defining the pathophysiological mechanisms responsible for further neuronal loss following the primary injury. Finally, this paper provides an overview of the role of functional imaging in classifying unresponsive coma and defining functional reorganisation of the brain following injury. EXPERT OPINION Brain imaging is of key importance in TBI management, enabling efficient and accurate diagnoses to be made, informing management decisions and contributing to prognostication. Developments in imaging techniques promise to improve understanding of the structural and functional derangements, improve management and guide the development and implementation of novel neuroprotective strategies following head injury.
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Affiliation(s)
- Eleanor Carter
- Division of Anaesthesia, University of Cambridge, Addenbrooke's Hospital , Cambridge, CB2 0AA , UK +01223 217889 ; +01223 217887 ;
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97
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Diffusion tensor imaging findings are not strongly associated with postconcussional disorder 2 months following mild traumatic brain injury. J Head Trauma Rehabil 2012; 27:188-98. [PMID: 21642855 DOI: 10.1097/htr.0b013e318217f0ad] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To examine the relation between diffusion tensor imaging (DTI) of the corpus callosum and postconcussion symptom reporting following mild traumatic brain injury (MTBI). PARTICIPANTS Sixty patients with MTBI and 34 patients with orthopedic/soft-tissue injuries (Trauma Controls) prospectively enrolled from consecutive admissions to a level 1 trauma center. PROCEDURE Diffusion tensor imaging of the corpus callosum was undertaken using a Phillips 3T scanner at 6 to 8 weeks postinjury. Participants also completed a postconcussion symptom checklist. The MTBI group was divided into 2 subgroups based on the International Classification of Diseases, Tenth Revision symptom criteria for postconcussion disorder (PCD): PCD Present (n = 21), PCD Absent (n = 39). MAIN OUTCOME MEASURES Measures of fractional anisotropy and mean diffusivity for the genu, body, and splenium of the corpus callosum. Participants also completed the British Columbia Post-Concussion Symptom Inventory. RESULTS The MTBI group reported more postconcussion symptoms than the trauma controls. There were no significant differences between MTBI and trauma control groups on all DTI measures. In the MTBI sample, there were no significant differences on all DTI measures between those who did and did not meet the International Classification of Diseases, Tenth Revision research criteria for postconcussion disorder. CONCLUSIONS These data do not support an association between white matter integrity in the corpus callosum and self-reported postconcussion syndrome 6 to 8 weeks post-MTBI.
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98
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Palmer SL, Glass JO, Li Y, Ogg R, Qaddoumi I, Armstrong GT, Wright K, Wetmore C, Broniscer A, Gajjar A, Reddick WE. White matter integrity is associated with cognitive processing in patients treated for a posterior fossa brain tumor. Neuro Oncol 2012; 14:1185-93. [PMID: 22898373 DOI: 10.1093/neuonc/nos154] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Children treated for posterior fossa tumors experience reduced cognitive processing speed and, after imaging, show damage to white matter (WM) tracts in the brain. This study explores relationships between white matter microstructure, assessed by fractional anisotropy (FA), and speed of cognitive processing using tract-based spatial statistics (TBSS). At 36 months after treatment with radiotherapy and chemotherapy, 40 patients completed an MRI examination and neuropsychological evaluation. Patients were matched with healthy control subjects based on age, sex, and race. Individual FA values were extracted from examinations for all voxels identified as having significant association between processing speed and FA using TBSS. The regions were labeled anatomically, and fiber tracts were grouped into larger fiber bundle categories based on their anatomical and functional associations. Analyses were performed between mean skeletal FA values in each of the fiber bundles and each of the cognitive processing scores controlling for age. Children 3 years after treatment for posterior fossa brain tumors demonstrate significantly lower processing speed associated with decreased FA, compared with their healthy peers. Commissural fibers in the corpus callosum were negatively affected by disease and therapy with detrimental consequence on patients' cognitive processing. Diffusion tensor imaging of the white matter tracts in the brain is relevant to determining potential mechanisms underlying clinically meaningful change in cognitive performance. Neuroprotective strategies are needed to preserve critical functions.
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Affiliation(s)
- Shawna L Palmer
- Department of Psychology, St. Jude Children’s Research Hospital, Memphis, TN 38105, USA.
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99
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Tamm L, Barnea-Goraly N, Reiss A. Diffusion tensor imaging reveals white matter abnormalities in Attention-Deficit/Hyperactivity Disorder. Psychiatry Res 2012; 202:150-4. [PMID: 22703620 PMCID: PMC3398227 DOI: 10.1016/j.pscychresns.2012.04.001] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2011] [Revised: 04/05/2012] [Accepted: 04/05/2012] [Indexed: 11/26/2022]
Abstract
The specific brain structures or neural mechanisms underlying dysfunction in individuals with Attention-Deficit/Hyperactivity Disorder (ADHD) are not well established, particularly in regard to white matter (WM). Diffusion tensor imaging (DTI) was used to investigate WM in 12 adolescent males diagnosed with ADHD only and 12 typically developing controls (group matched; mean age=15.64 years, SD=1.15). In addition to fractional anisotropy (FA), we also examined axial and radial diffusivity (AD and RD) in an effort to help elucidate conflicting findings suggesting that both lower and higher FA values are characteristic of ADHD. Tract-based spatial statistics and voxel-wide analyses were conducted on the data utilizing a pre-frontal mask to enable focus on fronto-striatal and prefrontal pathways. Adolescents with ADHD had significantly higher FA and AD values in fronto-striatal pathways compared with controls. No differences were observed for RD. These results contribute to the growing literature implicating prefrontal WM variations in neuropsychiatric disorders, and are consistent with findings suggesting a role for fronto-striatal pathways in ADHD pathophysiology.
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Affiliation(s)
- Leanne Tamm
- Center for ADHD, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA.
| | - Naama Barnea-Goraly
- Center for Interdisciplinary Brain Sciences Research, Stanford University, California, United States
| | - Allan Reiss
- Center for Interdisciplinary Brain Sciences Research, Stanford University, California, United States
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100
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Advanced neuromonitoring and imaging in pediatric traumatic brain injury. Crit Care Res Pract 2012; 2012:361310. [PMID: 22675618 PMCID: PMC3363371 DOI: 10.1155/2012/361310] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2011] [Accepted: 03/22/2012] [Indexed: 12/22/2022] Open
Abstract
While the cornerstone of monitoring following severe pediatric traumatic brain injury is serial neurologic examinations, vital signs, and intracranial pressure monitoring, additional techniques may provide useful insight into early detection of evolving brain injury. This paper provides an overview of recent advances in neuromonitoring, neuroimaging, and biomarker analysis of pediatric patients following traumatic brain injury.
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