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Wallace EJ, Mathias JL, Ward L. Diffusion tensor imaging changes following mild, moderate and severe adult traumatic brain injury: a meta-analysis. Brain Imaging Behav 2019; 12:1607-1621. [PMID: 29383621 DOI: 10.1007/s11682-018-9823-2] [Citation(s) in RCA: 78] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Diffusion tensor imaging quantifies the asymmetry (fractional anisotropy; FA) and amount of water diffusion (mean diffusivity/apparent diffusion coefficient; MD/ADC) and has been used to assess white matter damage following traumatic brain injury (TBI). In healthy brains, diffusion is constrained by the organization of axons, resulting in high FA and low MD/ADC. Following a TBI, diffusion may be altered; however the exact nature of these changes has yet to be determined. A meta-analysis was therefore conducted to determine the location and extent of changes in DTI following adult TBI. The data from 44 studies that compared the FA and/or MD/ADC data from TBI and Control participants in different regions of interest (ROIs) were analyzed. The impact of injury severity, post-injury interval (acute: ≤ 1 week, subacute: 1 week-3 months, chronic: > 3 months), scanner details and acquisition parameters were investigated in subgroup analyses, with the findings indicating that mild TBI should be examined separately to that of moderate to severe injuries. Lower FA values were found in 88% of brain regions following mild TBI and 92% following moderate-severe TBI, compared to Controls. MD/ADC was higher in 95% and 100% of brain regions following mild and moderate-severe TBI, respectively. Moderate to severe TBI resulted in larger changes in FA and MD/ADC than mild TBI. Overall, changes to FA and MD/ADC were widespread, reflecting more symmetric and a higher amount of diffusion, indicative of white matter damage.
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Affiliation(s)
- Erica J Wallace
- School of Psychology, Faculty of Medical & Health Sciences, University of Adelaide, Adelaide, Australia
| | - Jane L Mathias
- School of Psychology, Faculty of Medical & Health Sciences, University of Adelaide, Adelaide, Australia.
| | - Lynn Ward
- School of Psychology, Faculty of Medical & Health Sciences, University of Adelaide, Adelaide, Australia
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Douglas DB, Ro T, Toffoli T, Krawchuk B, Muldermans J, Gullo J, Dulberger A, Anderson AE, Douglas PK, Wintermark M. Neuroimaging of Traumatic Brain Injury. Med Sci (Basel) 2018; 7:E2. [PMID: 30577545 PMCID: PMC6358760 DOI: 10.3390/medsci7010002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 12/12/2018] [Accepted: 12/14/2018] [Indexed: 12/15/2022] Open
Abstract
The purpose of this article is to review conventional and advanced neuroimaging techniques performed in the setting of traumatic brain injury (TBI). The primary goal for the treatment of patients with suspected TBI is to prevent secondary injury. In the setting of a moderate to severe TBI, the most appropriate initial neuroimaging examination is a noncontrast head computed tomography (CT), which can reveal life-threatening injuries and direct emergent neurosurgical intervention. We will focus much of the article on advanced neuroimaging techniques including perfusion imaging and diffusion tensor imaging and discuss their potentials and challenges. We believe that advanced neuroimaging techniques may improve the accuracy of diagnosis of TBI and improve management of TBI.
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Affiliation(s)
- David B Douglas
- Department of Neuroradiology, Stanford University, Palo Alto, CA 94301, USA.
- Department of Radiology, David Grant Medical Center, Travis AFB, CA 94535, USA.
| | - Tae Ro
- Department of Radiology, David Grant Medical Center, Travis AFB, CA 94535, USA.
| | - Thomas Toffoli
- Department of Radiology, David Grant Medical Center, Travis AFB, CA 94535, USA.
| | - Bennet Krawchuk
- Department of Radiology, David Grant Medical Center, Travis AFB, CA 94535, USA.
| | - Jonathan Muldermans
- Department of Radiology, David Grant Medical Center, Travis AFB, CA 94535, USA.
| | - James Gullo
- Department of Radiology, David Grant Medical Center, Travis AFB, CA 94535, USA.
| | - Adam Dulberger
- Department of Radiology, David Grant Medical Center, Travis AFB, CA 94535, USA.
| | - Ariana E Anderson
- Department of Psychiatry and Biobehavioral Sciences, UCLA, Los Angeles, CA 90095, USA.
| | - Pamela K Douglas
- Department of Psychiatry and Biobehavioral Sciences, UCLA, Los Angeles, CA 90095, USA.
- Institute for Simulation and Training, University of Central Florida, Orlando, FL 32816, USA.
| | - Max Wintermark
- Department of Neuroradiology, Stanford University, Palo Alto, CA 94301, USA.
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Soni N, Mohamed AZ, Kurniawan ND, Borges K, Nasrallah F. Diffusion Magnetic Resonance Imaging Unveils the Spatiotemporal Microstructural Gray Matter Changes following Injury in the Rodent Brain. J Neurotrauma 2018; 36:1306-1317. [PMID: 30381993 DOI: 10.1089/neu.2018.5972] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Traumatic brain injury (TBI) is associated with gray and white matter alterations in brain tissue. Gray matter alterations are not yet as well studied as those of the white matter counterpart. This work utilized T2-weighted structural imaging, diffusion tensor imaging (DTI), and diffusion kurtosis imaging to unveil the gray matter changes induced in a controlled cortical impact (CCI) mouse model of TBI at 5 h, 1 day, 3 days, 7 days, 14 days, and 30 days post-CCI. A cross-sectional histopathology approach was used to confer validity of the magnetic resonance imaging (MRI) data by performing cresyl violet staining and glial fibrillary acidic protein (GFAP) immunohistochemistry. The results demonstrated a significant increase in lesion volume up to 3 days post-injury followed by a significant decrease in the cavity volume for the period of 1 month. GFAP signals peaked on Day 7 and persisted until Day 30 in both ipsilateral and contralateral hippocampus, ipsilateral cortex, and thalamic areas. An increase in fractional anisotropy (FA) was seen at Day 7 in the pericontusional area but decreased FA in the contralateral cortex, hippocampus, and thalamus. Mean diffusivity (MD) was significantly lower in the pericontusional cortex. Increased MD and decreased mean kurtosis were limited to the injury site on Days 7 to 30 and to the contralateral hippocampus and thalamus on Days 3 and 7. This work is one of the few cross-sectional studies to demonstrate a link between MRI measures and histopathological readings to track gray matter changes in the progression of TBI.
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Affiliation(s)
- Neha Soni
- 1 Queensland Brain Institute, University of Queensland, Brisbane, Australia
| | - Abdalla Z Mohamed
- 1 Queensland Brain Institute, University of Queensland, Brisbane, Australia
| | - Nyoman D Kurniawan
- 3 Center for Advanced Imaging, University of Queensland, Brisbane, Australia
| | - Karin Borges
- 2 School of Biomedical Sciences, University of Queensland, Brisbane, Australia
| | - Fatima Nasrallah
- 1 Queensland Brain Institute, University of Queensland, Brisbane, Australia
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Hunter LE, Lubin N, Glassman NR, Xue X, Spira M, Lipton ML. Comparing Region of Interest versus Voxel-Wise Diffusion Tensor Imaging Analytic Methods in Mild and Moderate Traumatic Brain Injury: A Systematic Review and Meta-Analysis. J Neurotrauma 2018; 36:1222-1230. [PMID: 30375271 DOI: 10.1089/neu.2018.5838] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Diffusion tensor imaging is a magnetic resonance imaging technique that is uniquely capable of detecting microstructural tissue damage in mild and moderate traumatic brain injuries (TBIs). To date, it remains unknown if two common analytic techniques, region of interest (ROI) versus voxel-wise (VW) analyses, detect injury in similar locations. The purpose of this systematic review and meta-analysis was to directly compare the regions of abnormality elucidated by each method. Twenty-seven ROI and 11 VW studies met our inclusion criteria. Our ROI meta-analysis identified 11 regions, including the splenium of the corpus callosum, where fractional anisotropy (FA) was significantly decreased in TBI patients, compared with controls. Likewise, we identified higher mean diffusivity/apparent diffusivity constant in the genu, body, and splenium of the corpus callosum. Alternatively, our VW analysis identified one region of high FA in the right superior longitudinal fasciculus and seven regions of low FA, with the two largest located in the corpus callosum. High mean diffusivity and high radial diffusivity, both in the right inferior longitudinal fasciculus, also was revealed by our VW analysis. Moreover, we have shown that the magnitude of damage in the corpus callosum revealed by ROI analysis (z = -3.15) is greater than that demonstrated by VW analysis (z = -1.41). Overall, this study indicates that both ROI and VW analytic methods are sensitive to low FA in the corpus callosum; however, the ROI method has more power to detect the full extent of tissue abnormality in the corpus callosum. More research utilizing standardized methods and reporting is essential to fully characterize the extent to which ROI and VW analyses can concordantly detect other locations of pathology in mild and moderate TBI patients.
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Affiliation(s)
- Liane E Hunter
- 1 Gruss Magnetic Resonance Imaging Center, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York
| | - Naomi Lubin
- 1 Gruss Magnetic Resonance Imaging Center, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York
| | - Nancy R Glassman
- 2 Samuel Gottesman Library, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York
| | - Xiaonan Xue
- 3 Department of Epidemiology and Population Health, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York
| | - Moshe Spira
- 1 Gruss Magnetic Resonance Imaging Center, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York
| | - Michael L Lipton
- 1 Gruss Magnetic Resonance Imaging Center, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York.,4 Department of Radiology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York.,5 Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York.,6 Department of Neurology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York.,7 Dominick P. Purpura Department of Neuroscience, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York
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Klimova A, Korgaonkar MS, Whitford T, Bryant RA. Diffusion Tensor Imaging Analysis of Mild Traumatic Brain Injury and Posttraumatic Stress Disorder. BIOLOGICAL PSYCHIATRY: COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2018; 4:81-90. [PMID: 30616750 DOI: 10.1016/j.bpsc.2018.10.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2018] [Revised: 09/13/2018] [Accepted: 09/13/2018] [Indexed: 12/28/2022]
Abstract
BACKGROUND Debate exists over the extent to which dysfunctions arising from mild traumatic brain injury (mTBI) are distinct from posttraumatic stress disorder (PTSD). METHODS This study investigated 1) the white matter integrity of participants with either mTBI or PTSD, and 2) the relationship between white matter integrity and postconcussive syndrome. The sample comprised 110 civilians (mTBI group = 40; PTSD group = 32; age- and sex-matched trauma-exposed control subjects = 38) recruited from community advertising. Indicators of white matter abnormalities were fractional anisotropy, mean diffusivity, axial diffusivity, and radial diffusivity. PTSD symptoms were indexed by the Clinician-Administered PTSD Scale, and postconcussive symptoms were assessed using the Somatic and Psychological Health Report measure. RESULTS Fractional anisotropy was reduced in mTBI participants in the corpus callosum, tracts of the brainstem, projection fibers, association fibers, and limbic fibers compared with both PTSD and trauma-exposed control subjects. This decrease in fractional anisotropy was observed in the context of concurrent changes in radial diffusivity, axial diffusivity, and mean diffusivity. Postconcussive symptoms were largely explained by PTSD severity rather than by changes in brain white matter. mTBI appears to be characterized by distinct reductions in white matter integrity, and this cannot be attributed to PTSD. CONCLUSIONS PTSD symptoms appear to be more strongly associated with postconcussive syndrome than with white matter compromise. These findings extend epidemiological evidence of the relative associations of PTSD and mTBI with postconcussive syndrome.
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Affiliation(s)
- Aleksandra Klimova
- School of Psychology, University of New South Wales, Sydney, Australia; Brain Dynamics Centre, Westmead Institute for Medical Research, Westmead, Australia
| | | | - Thomas Whitford
- School of Psychology, University of New South Wales, Sydney, Australia
| | - Richard A Bryant
- School of Psychology, University of New South Wales, Sydney, Australia; Brain Dynamics Centre, Westmead Institute for Medical Research, Westmead, Australia.
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Wu YC, Mustafi SM, Harezlak J, Kodiweera C, Flashman LA, McAllister TW. Hybrid Diffusion Imaging in Mild Traumatic Brain Injury. J Neurotrauma 2018; 35:2377-2390. [PMID: 29786463 PMCID: PMC6196746 DOI: 10.1089/neu.2017.5566] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Mild traumatic brain injury (mTBI) is an important public health problem. Although conventional medical imaging techniques can detect moderate-to-severe injuries, they are relatively insensitive to mTBI. In this study, we used hybrid diffusion imaging (HYDI) to detect white matter alterations in 19 patients with mTBI and 23 other trauma control patients. Within 15 days (standard deviation = 10) of brain injury, all subjects underwent magnetic resonance HYDI and were assessed with a battery of neuropsychological tests of sustained attention, memory, and executive function. Tract-based spatial statistics (TBSS) was used for voxel-wise statistical analyses within the white matter skeleton to study between-group differences in diffusion metrics, within-group correlations between diffusion metrics and clinical outcomes, and between-group interaction effects. The advanced diffusion imaging techniques, including neurite orientation dispersion and density imaging (NODDI) and q-space analyses, appeared to be more sensitive then classic diffusion tensor imaging. Only NODDI-derived intra-axonal volume fraction (Vic) demonstrated significant group differences (i.e., 5–9% lower in the injured brain). Within the mTBI group, Vic and a q-space measure, P0, correlated with 6 of 10 neuropsychological tests, including measures of attention, memory, and executive function. In addition, the direction of correlations differed significantly between groups (R2 > 0.71 and pinteration < 0.03). Specifically, in the control group, higher Vic and P0 were associated with better performances on clinical assessments, whereas in the mTBI group, higher Vic and P0 were associated with worse performances with correlation coefficients >0.83. In summary, the NODDI-derived axonal density index and q-space measure for tissue restriction demonstrated superior sensitivity to white matter changes shortly after mTBI. These techniques hold promise as a neuroimaging biomarker for mTBI.
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Affiliation(s)
- Yu-Chien Wu
- 1 Department of Radiology and Imaging Sciences, Indiana University School of Medicine , Indianapolis, Indiana
| | - Sourajit M Mustafi
- 1 Department of Radiology and Imaging Sciences, Indiana University School of Medicine , Indianapolis, Indiana
| | - Jaroslaw Harezlak
- 2 Department of Epidemiology and Biostatistics, School of Public Health, Indiana University , Bloomington, Indiana
| | - Chandana Kodiweera
- 3 Dartmouth Brain Imaging Center, Dartmouth College , Hanover, New Hampshire
| | - Laura A Flashman
- 4 Department of Psychiatry, Geisel School of Medicine at Dartmouth and Dartmouth-Hitchcock Medical Center , Lebanon, New Hampshire
| | - Thomas W McAllister
- 5 Department of Psychiatry, Indiana University School of Medicine , Indianapolis, Indiana
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58
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Lepage C, de Pierrefeu A, Koerte IK, Coleman MJ, Pasternak O, Grant G, Marx CE, Morey RA, Flashman LA, George MS, McAllister TW, Andaluz N, Shutter L, Coimbra R, Zafonte RD, Stein MB, Shenton ME, Bouix S. White matter abnormalities in mild traumatic brain injury with and without post-traumatic stress disorder: a subject-specific diffusion tensor imaging study. Brain Imaging Behav 2018; 12:870-881. [PMID: 28676987 PMCID: PMC5756136 DOI: 10.1007/s11682-017-9744-5] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Mild traumatic brain injuries (mTBIs) are often associated with posttraumatic stress disorder (PTSD). In cases of chronic mTBI, accurate diagnosis can be challenging due to the overlapping symptoms this condition shares with PTSD. Furthermore, mTBIs are heterogeneous and not easily observed using conventional neuroimaging tools, despite the fact that diffuse axonal injuries are the most common injury. Diffusion tensor imaging (DTI) is sensitive to diffuse axonal injuries and is thus more likely to detect mTBIs, especially when analyses account for the inter-individual variability of these injuries. Using a subject-specific approach, we compared fractional anisotropy (FA) abnormalities between groups with a history of mTBI (n = 35), comorbid mTBI and PTSD (mTBI + PTSD; n = 22), and healthy controls (n = 37). We compared all three groups on the number of abnormal FA clusters derived from subject-specific injury profiles (i.e., individual z-score maps) along a common white matter skeleton. The mTBI + PTSD group evinced a greater number of abnormally low FA clusters relative to both the healthy controls and the mTBI group without PTSD (p < .05). Across the groups with a history of mTBI, increased numbers of abnormally low FA clusters were significantly associated with PTSD symptom severity, depression, post-concussion symptoms, and reduced information processing speed (p < .05). These findings highlight the utility of subject-specific microstructural analyses when searching for mTBI-related brain abnormalities, particularly in patients with PTSD. This study also suggests that patients with a history of mTBI and comorbid PTSD, relative to those without PTSD, are at increased risk of FA abnormalities.
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Affiliation(s)
- Christian Lepage
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, 1249 Boylston St, Boston, MA, 02215, USA
- Department of Psychology, University of Ottawa, Ottawa, Canada
| | - Amicie de Pierrefeu
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, 1249 Boylston St, Boston, MA, 02215, USA
- School of Life Sciences, École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Inga K Koerte
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, 1249 Boylston St, Boston, MA, 02215, USA
- Department of Child and Adolescent Psychiatry, Psychosomatic, and Psychotherapy, Ludwig-Maximilian-University, Munich, Germany
| | - Michael J Coleman
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, 1249 Boylston St, Boston, MA, 02215, USA
| | - Ofer Pasternak
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, 1249 Boylston St, Boston, MA, 02215, USA
| | - Gerald Grant
- Stanford University Medical Center, Palo Alto, CA, USA
- Duke University, Durham, NC, USA
| | - Christine E Marx
- Duke University Medical Center and VA Mid-Atlantic MIRECC, Durham, NC, USA
| | - Rajendra A Morey
- Duke University Medical Center and VA Mid-Atlantic MIRECC, Durham, NC, USA
| | | | - Mark S George
- Medical University of South Carolina, Ralph H. Johnson VA Medical Center, Charleston, SC, USA
| | - Thomas W McAllister
- Geisel School of Medicine at Dartmouth, Hanover, NH, USA
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - Norberto Andaluz
- Department of Neurosurgery, Mayfield Clinic, University of Cincinnati (UC) College of Medicine, Neurotrauma Center at UC Neuroscience Institute, Cincinnati, OH, USA
| | - Lori Shutter
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- University of Cincinnati, Pittsburgh, PA, USA
| | - Raul Coimbra
- Department of Surgery, University of California, San Diego, CA, USA
| | - Ross D Zafonte
- Spaulding Rehabilitation Hospital, Massachusetts General Hospital, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Murray B Stein
- Department of Psychiatry and Department of Family Medicine & Public Health, University of California, San Diego, La Jolla, CA, USA
| | - Martha E Shenton
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, 1249 Boylston St, Boston, MA, 02215, USA
- Department of Radiology, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA, USA
- VA Boston Healthcare System, Brockton Division, Brockton, MA, USA
| | - Sylvain Bouix
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, 1249 Boylston St, Boston, MA, 02215, USA.
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Schmidt J, Hayward KS, Brown KE, Zwicker JG, Ponsford J, van Donkelaar P, Babul S, Boyd LA. Imaging in Pediatric Concussion: A Systematic Review. Pediatrics 2018; 141:peds.2017-3406. [PMID: 29678928 DOI: 10.1542/peds.2017-3406] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/12/2018] [Indexed: 11/24/2022] Open
Abstract
CONTEXT Pediatric mild traumatic brain injury (mTBI) is a common and poorly understood injury. Neuroimaging indexes brain injury and outcome after pediatric mTBI, but remains largely unexplored. OBJECTIVE To investigate the differences in neuroimaging findings in children/youth with mTBI. Measures of behavior, symptoms, time since injury, and age at injury were also considered. DATA SOURCES A systematic review was conducted up to July 6, 2016. STUDY SELECTION Studies were independently screened by 2 authors and included if they met predetermined eligibility criteria: (1) children/youth (5-18 years of age), (2) diagnosis of mTBI, and (3) use of neuroimaging. DATA EXTRACTION Two authors independently appraised study quality and extracted demographic and outcome data. RESULTS Twenty-two studies met the eligibility criteria, involving 448 participants with mTBI (mean age = 12.7 years ± 2.8). Time postinjury ranged from 1 day to 5 years. Seven different neuroimaging methods were investigated in included studies. The most frequently used method, diffusion tensor imaging (41%), had heterogeneous findings with respect to the specific regions and tracts that showed group differences. However, group differences were observed in many regions containing the corticospinal tract, portions of the corpus callosum, or frontal white-matter regions; fractional anisotropy was increased in 88% of the studies. LIMITATIONS This review included a heterogeneous sample with regard to participant ages, time since injury, symptoms, and imaging methods which prevented statistical pooling/modelling. CONCLUSIONS These data highlight essential priorities for future research (eg, common data elements) that are foundational to progress the understanding of pediatric concussion.
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Affiliation(s)
- Julia Schmidt
- Department of Physical Therapy, The University of British Columbia, Vancouver, Canada; .,School of Allied Health, College of Science, Health and Engineering, La Trobe University, Melbourne, Australia
| | - Kathryn S Hayward
- Department of Physical Therapy, The University of British Columbia, Vancouver, Canada.,Florey Institute of Neuroscience and Mental Health, National Health and Medical Research Council and University of Melbourne, Parkville, Australia.,Centre for Research Excellence in Stroke Rehabilitation and Brain Recovery, Melbourne, Australia
| | - Katlyn E Brown
- Department of Physical Therapy, The University of British Columbia, Vancouver, Canada
| | - Jill G Zwicker
- Department of Physical Therapy, The University of British Columbia, Vancouver, Canada.,BC Children's Hospital Research Institute, Vancouver, Canada; and
| | | | - Paul van Donkelaar
- Department of Physical Therapy, The University of British Columbia, Vancouver, Canada
| | - Shelina Babul
- Department of Physical Therapy, The University of British Columbia, Vancouver, Canada.,BC Children's Hospital Research Institute, Vancouver, Canada; and
| | - Lara A Boyd
- Department of Physical Therapy, The University of British Columbia, Vancouver, Canada
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When light hurts: Comparative Morphometry of Human Brainstem in Traumatic Photalgia. Sci Rep 2018; 8:6256. [PMID: 29674712 PMCID: PMC5908841 DOI: 10.1038/s41598-018-24386-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Accepted: 12/01/2017] [Indexed: 11/29/2022] Open
Abstract
Traumatic brain injury is an increasingly common affliction, although many of its serious repercussions are still underappreciated. A frequent consequence is the development of light-induced pain, or ‘photalgia’, which can often lead to prolonged debilitation. The mechanism underlying the sensitivity to light, however, remains unresolved. Since tissue oedema (swelling) is a common feature of traumatic brain injury, we propose that the brainstem oedema, in particular, might sensitize the brainstem trigeminal complex to signals from ocular mechanisms activated in bright light. To assess this hypothesis, we ran high-resolution Magnetic Resonance Imaging of the brainstems of concussion groups with mild and severe photalgia, without photalgia, and healthy controls. The 3D configuration of the brainstem was determined by Tensor-Based Morphometry (TBM) for each participant. The TBM revealed significant deviations in the brainstem morphology of all concussion groups, with a characteristic signature for each group. In particular, concussion without photalgia showed bilateral expansion at the pontine/medulla junction, whereas concussion with photalgia showed mid-pontine shrinkage, consistent with degeneration of nuclei of the trigeminal complex. These results support the hypothesis that brainstem shrinkage/degeneration represents a morphological substrate of the photalgic sensitization of the trigeminal pathway.
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Vergara VM, Mayer AR, Kiehl KA, Calhoun VD. Dynamic functional network connectivity discriminates mild traumatic brain injury through machine learning. NEUROIMAGE-CLINICAL 2018; 19:30-37. [PMID: 30034999 PMCID: PMC6051314 DOI: 10.1016/j.nicl.2018.03.017] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/29/2017] [Revised: 02/22/2018] [Accepted: 03/14/2018] [Indexed: 12/20/2022]
Abstract
Mild traumatic brain injury (mTBI) can result in symptoms that affect a person's cognitive and social abilities. Improvements in diagnostic methodologies are necessary given that current clinical techniques have limited accuracy and are solely based on self-reports. Recently, resting state functional network connectivity (FNC) has shown potential as an important imaging modality for the development of mTBI biomarkers. The present work explores the use of dynamic functional network connectivity (dFNC) for mTBI detection. Forty eight mTBI patients (24 males) and age-gender matched healthy controls were recruited. We identified a set of dFNC states and looked at the possibility of using each state to classify subjects in mTBI patients and healthy controls. A linear support vector machine was used for classification and validated using leave-one-out cross validation. One of the dFNC states achieved a high classification performance of 92% using the area under the curve method. A series of t-test analysis revealed significant dFNC increases between cerebellum and sensorimotor networks. This significant increase was detected in the same dFNC state useful for classification. Results suggest that dFNC can be used to identify optimal dFNC states for classification excluding those that does not contain useful features. Dynamic functional connectivity and support vector machine classified traumatic brain injury patients and healthy controls. Out of 4 dynamic brain states, we identified 1 state useful for classification. Classification performance of the dynamic state of interest achieved a performance of 92% area under the curve method.
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Affiliation(s)
- Victor M Vergara
- The Mind Research Network and Lovelace Biomedical and Environmental Research Institute, 1101 Yale Blvd. NE, Albuquerque, NM 87106, United States.
| | - Andrew R Mayer
- The Mind Research Network and Lovelace Biomedical and Environmental Research Institute, 1101 Yale Blvd. NE, Albuquerque, NM 87106, United States; Department of Psychology, University of New Mexico, Albuquerque, NM 87131, United States; Department of Neurology, University of New Mexico School of Medicine, Albuquerque, NM 87131, United States; Department of Psychiatry and Behavioral Sciences, University of New Mexico School of Medicine, Albuquerque, NM 87131, United States.
| | - Kent A Kiehl
- The Mind Research Network and Lovelace Biomedical and Environmental Research Institute, 1101 Yale Blvd. NE, Albuquerque, NM 87106, United States; Department of Psychology, University of New Mexico, Albuquerque, NM 87131, United States.
| | - Vince D Calhoun
- The Mind Research Network and Lovelace Biomedical and Environmental Research Institute, 1101 Yale Blvd. NE, Albuquerque, NM 87106, United States; Dept of ECE, University of New Mexico, Albuquerque, NM 87131, United States.
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62
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Chong CD, Schwedt TJ. Research Imaging of Brain Structure and Function After Concussion. Headache 2018; 58:827-835. [DOI: 10.1111/head.13269] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Revised: 12/13/2017] [Accepted: 12/20/2017] [Indexed: 11/30/2022]
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Badea A, Kamnaksh A, Anderson RJ, Calabrese E, Long JB, Agoston DV. Repeated mild blast exposure in young adult rats results in dynamic and persistent microstructural changes in the brain. NEUROIMAGE-CLINICAL 2018; 18:60-73. [PMID: 29868442 PMCID: PMC5984602 DOI: 10.1016/j.nicl.2018.01.007] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Revised: 01/08/2018] [Accepted: 01/09/2018] [Indexed: 11/19/2022]
Abstract
A history of mild traumatic brain injury (mTBI), particularly repeated mTBI (rmTBI), has been identified as a risk factor for late-onset neurodegenerative conditions. The mild and transient nature of early symptoms often impedes diagnosis in young adults who are disproportionately affected by mTBIs. A proportion of the affected population will incur long-term behavioral and cognitive consequences but the underlying pathomechanism is currently unknown. Diffusion tensor imaging (DTI) provides sensitive and quantitative assessment of TBI-induced structural changes, including white matter injury, and may be used to predict long-term outcome. We used DTI in an animal model of blast rmTBI (rmbTBI) to quantify blast-induced structural changes at 7 and 90 days post-injury, and their evolution between the two time points. Young adult male rats (~P65 at injury) were exposed to repeated mild blast overpressure, or anesthetized as shams, and their fixed brains were imaged using high-field (7 T) MRI. We found that whole brain volumes similarly increased in injured and sham rats from 7 to 90 days. However, we detected localized volume increases in blast-exposed animals 7 days post-injury, mainly ipsilateral to incident blast waves. Affected regions included gray matter of the frontal association, cingulate, and motor cortex, thalamus, substantia nigra, and raphe nuclei (median and dorsal), as well as white matter of the internal capsule and cerebral peduncle. Conversely, we measured volume reductions in these and other regions, including the hippocampus and cerebellum, at 90 days post-injury. DTI also detected both transient and persistent microstructural changes following injury, with some changes showing distinct ipsilateral versus contralateral side differences relative to blast impact. Early changes in fractional anisotropy (FA) were subtle, becoming more prominent at 90 days in the cerebral and inferior cerebellar peduncles, and cerebellar white matter. Widespread increases in radial diffusivity (RD) and axial diffusivity (primary eigenvalue or E1) at 7 days post-injury largely subsided by 90 days, although RD was more sensitive than E1 at detecting white matter changes. E1 effects in gray and white matter, which paralleled increases in apparent diffusion, were likely more indicative of dysregulated water homeostasis than pathologic structural changes. Importantly, we found evidence for a different developmental trajectory following rmbTBI, as indicated by significant injury x age interactions on volume. Our findings demonstrate that rmbTBI initiates dynamic pathobiological processes that may negatively alter the course of late-stage neurodevelopment and adversely affect long-term cognitive and behavioral outcomes. Young adult rats exposed to mild blast show lasting microstructural brain changes. The evolution of mTBI pathology was reflected by temporal changes in DTI measures. Regional volume changes captured significant injury × age interactions. DTI measures differentially captured injury effects in white and gray matter. Significant interaction effects suggest an altered developmental trajectory.
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Affiliation(s)
- Alexandra Badea
- Center for In Vivo Microscopy, Department of Radiology, Duke University Medical Center, Durham, NC, USA.
| | - Alaa Kamnaksh
- Department of Anatomy, Physiology and Genetics, Uniformed Services University, Bethesda, MD, USA
| | - Robert J Anderson
- Center for In Vivo Microscopy, Department of Radiology, Duke University Medical Center, Durham, NC, USA
| | - Evan Calabrese
- Center for In Vivo Microscopy, Department of Radiology, Duke University Medical Center, Durham, NC, USA
| | - Joseph B Long
- Blast-Induced Neurotrauma Branch, Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | - Denes V Agoston
- Department of Anatomy, Physiology and Genetics, Uniformed Services University, Bethesda, MD, USA.
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64
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Bajaj S, Vanuk JR, Smith R, Dailey NS, Killgore WDS. Blue-Light Therapy following Mild Traumatic Brain Injury: Effects on White Matter Water Diffusion in the Brain. Front Neurol 2017; 8:616. [PMID: 29213254 PMCID: PMC5702646 DOI: 10.3389/fneur.2017.00616] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2017] [Accepted: 11/06/2017] [Indexed: 11/13/2022] Open
Abstract
Mild traumatic brain injury (mTBI) is a common and often inconspicuous wound that is frequently associated with chronic low-grade symptoms and cognitive dysfunction. Previous evidence suggests that daily blue wavelength light therapy may be effective at reducing fatigue and improving sleep in patients recovering from mTBI. However, the effects of light therapy on recovering brain structure remain unexplored. In this study, we analyzed white matter diffusion properties, including generalized fractional anisotropy, and the quantity of water diffusion in isotropic (i.e., isotropic diffusion) and anisotropic fashion (i.e., quantitative anisotropy, QA) for fibers crossing 11 brain areas known to be significantly affected following mTBI. Specifically, we investigated how 6 weeks of daily morning blue light exposure therapy (compared to an amber-light placebo condition) impacted changes in white matter diffusion in individuals with mTBI. We observed a significant impact of the blue light treatment (relative to the placebo) on the amount of water diffusion (QA) for multiple brain areas, including the corpus callosum, anterior corona radiata, and thalamus. Moreover, many of these changes were associated with improvements in sleep latency and delayed memory. These findings suggest that blue wavelength light exposure may serve as one of the potential non-pharmacological treatments for facilitating structural and functional recovery following mTBI; they also support the use of QA as a reliable neuro-biomarker for mTBI therapies.
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Affiliation(s)
- Sahil Bajaj
- Social, Cognitive and Affective Neuroscience Laboratory (SCAN Lab), Department of Psychiatry, College of Medicine, University of Arizona, Tucson, AZ, United States
| | - John R Vanuk
- Social, Cognitive and Affective Neuroscience Laboratory (SCAN Lab), Department of Psychiatry, College of Medicine, University of Arizona, Tucson, AZ, United States
| | - Ryan Smith
- Social, Cognitive and Affective Neuroscience Laboratory (SCAN Lab), Department of Psychiatry, College of Medicine, University of Arizona, Tucson, AZ, United States
| | - Natalie S Dailey
- Social, Cognitive and Affective Neuroscience Laboratory (SCAN Lab), Department of Psychiatry, College of Medicine, University of Arizona, Tucson, AZ, United States
| | - William D S Killgore
- Social, Cognitive and Affective Neuroscience Laboratory (SCAN Lab), Department of Psychiatry, College of Medicine, University of Arizona, Tucson, AZ, United States
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Abstract
There is a long history linking traumatic brain injury (TBI) with the development of dementia. Despite significant reservations, such as recall bias or concluding causality for TBI, a summary of recent research points to several conclusions on the TBI-dementia relationship. 1) Increasing severity of a single moderate-to-severe TBI increases the risk of subsequent Alzheimer's disease (AD), the most common type of dementia. 2) Repetitive, often subconcussive, mild TBIs increases the risk for chronic traumatic encephalopathy (CTE), a degenerative neuropathology. 3) TBI may be a risk factor for other neurodegenerative disorders that can be associated with dementia. 4) TBI appears to lower the age of onset of TBI-related neurocognitive syndromes, potentially adding "TBI cognitive-behavioral features". The literature further indicates several specific risk factors for TBI-associated dementia: 5) any blast or blunt physical force to the head as long as there is violent head displacement; 6) decreased cognitive and/or neuronal reserve and the related variable of older age at TBI; and 7) the presence of apolipoprotein E ɛ4 alleles, a genetic risk factor for AD. Finally, there are neuropathological features relating TBI with neurocognitive syndromes: 8) acute TBI results in amyloid pathology and other neurodegenerative proteinopathies; 9) CTE shares features with neurodegenerative dementias; and 10) TBI results in white matter tract and neural network disruptions. Although further research is needed, these ten findings suggest that dose-dependent effects of violent head displacement in vulnerable brains predispose to dementia; among several potential mechanisms is the propagation of abnormal proteins along damaged white matter networks.
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Affiliation(s)
- Mario F Mendez
- Department of Neurology, David Geffen School of Medicine, University of California Los Angeles (UCLA), Los Angeles, CA, USA.,Department of Neurology, Neurobehavior Unit, V.A. Greater Los Angeles Healthcare System, Los Angeles, CA, USA
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66
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Wright DK, Johnston LA, Kershaw J, Ordidge R, O'Brien TJ, Shultz SR. Changes in Apparent Fiber Density and Track-Weighted Imaging Metrics in White Matter following Experimental Traumatic Brain Injury. J Neurotrauma 2017; 34:2109-2118. [DOI: 10.1089/neu.2016.4730] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
- David K. Wright
- Anatomy and Neuroscience, The University of Melbourne, Parkville, VIC, Australia
- The Florey Institute of Neuroscience and Mental Health, Parkville, VIC, Australia
| | - Leigh A. Johnston
- The Florey Institute of Neuroscience and Mental Health, Parkville, VIC, Australia
- Department of Electrical & Electronic Engineering, The University of Melbourne, Parkville, VIC, Australia
| | - Jeff Kershaw
- Applied MRI Research, National Institute of Radiological Sciences, QST, Chiba, Japan
| | - Roger Ordidge
- Anatomy and Neuroscience, The University of Melbourne, Parkville, VIC, Australia
| | - Terence J. O'Brien
- Department of Medicine, The Royal Melbourne Hospital, The University of Melbourne, Parkville, VIC, Australia
| | - Sandy R. Shultz
- Department of Medicine, The Royal Melbourne Hospital, The University of Melbourne, Parkville, VIC, Australia
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67
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Main KL, Soman S, Pestilli F, Furst A, Noda A, Hernandez B, Kong J, Cheng J, Fairchild JK, Taylor J, Yesavage J, Wesson Ashford J, Kraemer H, Adamson MM. DTI measures identify mild and moderate TBI cases among patients with complex health problems: A receiver operating characteristic analysis of U.S. veterans. Neuroimage Clin 2017; 16:1-16. [PMID: 28725550 PMCID: PMC5503837 DOI: 10.1016/j.nicl.2017.06.031] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Revised: 06/10/2017] [Accepted: 06/23/2017] [Indexed: 01/10/2023]
Abstract
Standard MRI methods are often inadequate for identifying mild traumatic brain injury (TBI). Advances in diffusion tensor imaging now provide potential biomarkers of TBI among white matter fascicles (tracts). However, it is still unclear which tracts are most pertinent to TBI diagnosis. This study ranked fiber tracts on their ability to discriminate patients with and without TBI. We acquired diffusion tensor imaging data from military veterans admitted to a polytrauma clinic (Overall n = 109; Age: M = 47.2, SD = 11.3; Male: 88%; TBI: 67%). TBI diagnosis was based on self-report and neurological examination. Fiber tractography analysis produced 20 fiber tracts per patient. Each tract yielded four clinically relevant measures (fractional anisotropy, mean diffusivity, radial diffusivity, and axial diffusivity). We applied receiver operating characteristic (ROC) analyses to identify the most diagnostic tract for each measure. The analyses produced an optimal cutpoint for each tract. We then used kappa coefficients to rate the agreement of each cutpoint with the neurologist's diagnosis. The tract with the highest kappa was most diagnostic. As a check on the ROC results, we performed a stepwise logistic regression on each measure using all 20 tracts as predictors. We also bootstrapped the ROC analyses to compute the 95% confidence intervals for sensitivity, specificity, and the highest kappa coefficients. The ROC analyses identified two fiber tracts as most diagnostic of TBI: the left cingulum (LCG) and the left inferior fronto-occipital fasciculus (LIF). Like ROC, logistic regression identified LCG as most predictive for the FA measure but identified the right anterior thalamic tract (RAT) for the MD, RD, and AD measures. These findings are potentially relevant to the development of TBI biomarkers. Our methods also demonstrate how ROC analysis may be used to identify clinically relevant variables in the TBI population.
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Key Words
- AD, axial diffusivity
- Axon degeneration
- CC, corpus callosum
- Concussion
- DAI, diffuse axonal injury
- DTI, diffusion tensor imaging
- FA, fractional anisotropy
- GN, genu
- Imaging
- LAT, left anterior thalamic tract
- LCG, left cingulum
- LCH, left cingulum – hippocampus
- LCS, left cortico-spinal tract
- LIF, left inferior fronto-occipital fasciculus
- LIL, left inferior longitudinal fasciculus
- LSL, left superior longitudinal fasciculus
- LST, left superior longitudinal fasciculus – temporal
- LUN, left uncinate
- MD, mean diffusivity
- Neurodegeneration
- PTSD, post-traumatic stress disorder
- RAT, right anterior thalamic tract
- RCG, right cingulum
- RCH, right cingulum – Hippocampus
- RCS, right cortico-spinal tract
- RD, radial diffusivity
- RIF, right inferior fronto-occipital fasciculus
- RIL, right inferior longitudinal fasciculus
- ROC, receiver operating characteristic
- RSL, right superior longitudinal fasciculus
- RST, right superior longitudinal fasciculus – temporal
- RUN, right uncinate
- SP, splenium
- TBI, traumatic brain injury
- Traumatic brain injury
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Affiliation(s)
- Keith L. Main
- War Related Illness and Injury Study Center, Veterans Affairs, Palo Alto Health Care System (VAPAHCS), Palo Alto, CA, United States
- Defense and Veterans Brain Injury Center (DVBIC), Silver Spring, MD, United States
- General Dynamics Health Solutions (GDHS), Fairfax, VA, United States
| | - Salil Soman
- War Related Illness and Injury Study Center, Veterans Affairs, Palo Alto Health Care System (VAPAHCS), Palo Alto, CA, United States
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, United States
- Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | - Franco Pestilli
- Department of Psychological and Brain Sciences, Indiana University, Bloomington, IN, United States
| | - Ansgar Furst
- War Related Illness and Injury Study Center, Veterans Affairs, Palo Alto Health Care System (VAPAHCS), Palo Alto, CA, United States
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, United States
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, United States
| | - Art Noda
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, United States
| | - Beatriz Hernandez
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, United States
| | - Jennifer Kong
- War Related Illness and Injury Study Center, Veterans Affairs, Palo Alto Health Care System (VAPAHCS), Palo Alto, CA, United States
| | - Jauhtai Cheng
- War Related Illness and Injury Study Center, Veterans Affairs, Palo Alto Health Care System (VAPAHCS), Palo Alto, CA, United States
| | - Jennifer K. Fairchild
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, United States
| | - Joy Taylor
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, United States
| | - Jerome Yesavage
- War Related Illness and Injury Study Center, Veterans Affairs, Palo Alto Health Care System (VAPAHCS), Palo Alto, CA, United States
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, United States
| | - J. Wesson Ashford
- War Related Illness and Injury Study Center, Veterans Affairs, Palo Alto Health Care System (VAPAHCS), Palo Alto, CA, United States
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, United States
| | - Helena Kraemer
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, United States
| | - Maheen M. Adamson
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, United States
- Department of Neurosurgery, Stanford School of Medicine, Stanford, CA, United States
- Defense and Veterans Brain Injury Center (DVBIC), Veterans Affairs, Palo Alto Health Care System (VAPAHCS), Palo Alto, CA, United States
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68
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Thomas AW, Watts R, Filippi CG, Nickerson JP, Andrews T, Lieberman G, Naylor MR, Eppstein MJ, Freeman K. Dynamic changes in diffusion measures improve sensitivity in identifying patients with mild traumatic brain injury. PLoS One 2017; 12:e0178360. [PMID: 28604837 PMCID: PMC5467843 DOI: 10.1371/journal.pone.0178360] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Accepted: 05/11/2017] [Indexed: 12/03/2022] Open
Abstract
The goal of this study was to investigate patterns of axonal injury in the first week after mild traumatic brain injury (mTBI). We performed a prospective cohort study of 20 patients presenting to the emergency department with mTBI, using 3.0T diffusion tensor MRI immediately after injury and again at 1 week post-injury. Corresponding data were acquired from 16 controls over a similar time interval. Fractional anisotropy (FA) and other diffusion measures were calculated from 11 a priori selected axon tracts at each time-point, and the change across time in each region was quantified for each subject. Clinical outcomes were determined by standardized neurocognitive assessment. We found that mTBI subjects were significantly more likely to have changes in FA in those 11 regions of interest across the one week time period, compared to control subjects whose FA measurements were stable across time. Longitudinal imaging was more sensitive to these subtle changes in white matter integrity than cross-sectional assessments at either of two time points, alone. Analyzing the sources of variance in our control population, we show that this increased sensitivity is likely due to the smaller within-subject variability obtained by longitudinal analysis with each subject as their own control. This is in contrast to the larger between-subject variability obtained by cross-sectional analysis of each individual subject to normalized data from a control group. We also demonstrated that inclusion of all a priori ROIs in an analytic model as opposed to measuring individual ROIs improves detection of white matter changes by overcoming issues of injury heterogeneity. Finally, we employed genetic programming (a bio-inspired computational method for model estimation) to demonstrate that longitudinal changes in FA have utility in predicting the symptomatology of patients with mTBI. We conclude concussive brain injury caused acute, measurable changes in the FA of white matter tracts consistent with evolving axonal injury and/or edema, which may contribute to post-concussive symptoms.
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Affiliation(s)
- Alexander W. Thomas
- Department of Surgery, University of Vermont, Burlington, Vermont, United States of America
| | - Richard Watts
- Department of Radiology, University of Vermont, Burlington, Vermont, United States of America
| | - Christopher G. Filippi
- Department of Neurology, University of Vermont, Burlington, Vermont, United States of America
- Hofstra North Shore LIJ School of Medicine; Hempstead, New York, United States of America
| | - Joshua P. Nickerson
- Department of Radiology, University of Vermont, Burlington, Vermont, United States of America
| | - Trevor Andrews
- Department of Radiology, University of Vermont, Burlington, Vermont, United States of America
- Philips HealthTech, Cleveland, Ohio, United States of America
| | - Gregory Lieberman
- Department of Psychiatry, University of Vermont, Burlington, Vermont, United States of America
- U.S. Army Research Laboratory, Human Research and Engineering Directorate, Aberdeen Proving Ground, Aberdeen, Maryland, United States of America
| | - Magdalena R. Naylor
- Department of Psychiatry, University of Vermont, Burlington, Vermont, United States of America
| | - Margaret J. Eppstein
- Department of Computer Science, University of Vermont, Burlington, Vermont, United States of America
| | - Kalev Freeman
- Department of Surgery, University of Vermont, Burlington, Vermont, United States of America
- * E-mail:
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69
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Mayer AR, Ling JM, Dodd AB, Meier TB, Hanlon FM, Klimaj SD. A prospective microstructure imaging study in mixed-martial artists using geometric measures and diffusion tensor imaging: methods and findings. Brain Imaging Behav 2017; 11:698-711. [PMID: 27071950 PMCID: PMC5889053 DOI: 10.1007/s11682-016-9546-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Although diffusion magnetic resonance imaging (dMRI) has been widely used to characterize the effects of repetitive mild traumatic brain injury (rmTBI), to date no studies have investigated how novel geometric models of microstructure relate to more typical diffusion tensor imaging (DTI) sequences. Moreover, few studies have evaluated the sensitivity of different registration pipelines (non-linear, linear and tract-based spatial statistics) for detecting dMRI abnormalities in clinical populations. Results from single-subject analyses in healthy controls (HC) indicated a strong negative relationship between fractional anisotropy (FA) and orientation dispersion index (ODI) in both white and gray matter. Equally important, only moderate relationships existed between all other estimates of free/intracellular water volume fractions and more traditional DTI metrics (FA, mean, axial and radial diffusivity). These findings suggest that geometric measures provide differential information about the cellular microstructure relative to traditional DTI measures. Results also suggest greater sensitivity for non-linear registration pipelines that maximize the anatomical information available in T1-weighted images. Clinically, rmTBI resulted in a pattern of decreased FA and increased ODI, largely overlapping in space, in conjunction with increased intracellular and free water fractions, highlighting the potential role of edema following repeated head trauma. In summary, current results suggest that geometric models of diffusion can provide relatively unique information regarding potential mechanisms of pathology that contribute to long-term neurological damage.
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Affiliation(s)
- Andrew R Mayer
- The Mind Research Network/Lovelace Biomedical and Environmental Research Institute, Albuquerque, NM, 87106, USA.
- Neurology and Psychiatry Departments, University of New Mexico School of Medicine, Albuquerque, NM, 87131, USA.
- Department of Psychology, University of New Mexico, Albuquerque, NM, 87131, USA.
| | - Josef M Ling
- The Mind Research Network/Lovelace Biomedical and Environmental Research Institute, Albuquerque, NM, 87106, USA
| | - Andrew B Dodd
- The Mind Research Network/Lovelace Biomedical and Environmental Research Institute, Albuquerque, NM, 87106, USA
| | - Timothy B Meier
- The Mind Research Network/Lovelace Biomedical and Environmental Research Institute, Albuquerque, NM, 87106, USA
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, 53226, USA
| | - Faith M Hanlon
- The Mind Research Network/Lovelace Biomedical and Environmental Research Institute, Albuquerque, NM, 87106, USA
| | - Stefan D Klimaj
- The Mind Research Network/Lovelace Biomedical and Environmental Research Institute, Albuquerque, NM, 87106, USA
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70
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Dall'Acqua P, Johannes S, Mica L, Simmen HP, Glaab R, Fandino J, Schwendinger M, Meier C, Ulbrich EJ, Müller A, Baetschmann H, Jäncke L, Hänggi J. Functional and Structural Network Recovery after Mild Traumatic Brain Injury: A 1-Year Longitudinal Study. Front Hum Neurosci 2017; 11:280. [PMID: 28611614 PMCID: PMC5447750 DOI: 10.3389/fnhum.2017.00280] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Accepted: 05/15/2017] [Indexed: 01/17/2023] Open
Abstract
Brain connectivity after mild traumatic brain injury (mTBI) has not been investigated longitudinally with respect to both functional and structural networks together within the same patients, crucial to capture the multifaceted neuropathology of the injury and to comprehensively monitor the course of recovery and compensatory reorganizations at macro-level. We performed a prospective study with 49 mTBI patients at an average of 5 days and 1 year post-injury and 49 healthy controls. Neuropsychological assessments as well as resting-state functional and diffusion-weighted magnetic resonance imaging were obtained. Functional and structural connectome analyses were performed using network-based statistics. They included a cross-sectional group comparison and a longitudinal analysis with the factors group and time. The latter tracked the subnetworks altered at the early phase and, in addition, included a whole-brain group × time interaction analysis. Finally, we explored associations between the evolution of connectivity and changes in cognitive performance. The early phase of mTBI was characterized by a functional hypoconnectivity in a subnetwork with a large overlap of regions involved within the classical default mode network. In addition, structural hyperconnectivity in a subnetwork including central hub areas such as the cingulate cortex was found. The impaired functional and structural subnetworks were strongly correlated and revealed a large anatomical overlap. One year after trauma and compared to healthy controls we observed a partial normalization of both subnetworks along with a considerable compensation of functional and structural connectivity subsequent to the acute phase. Connectivity changes over time were correlated with improvements in working memory, divided attention, and verbal recall. Neuroplasticity-induced recovery or compensatory processes following mTBI differ between brain regions with respect to their time course and are not fully completed 1 year after trauma.
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Affiliation(s)
- Patrizia Dall'Acqua
- Bellikon Rehabilitation ClinicBellikon, Switzerland.,Division Neuropsychology, Department of Psychology, University of ZurichZurich, Switzerland
| | | | - Ladislav Mica
- Division of Trauma Surgery, University Hospital ZurichZurich, Switzerland
| | - Hans-Peter Simmen
- Division of Trauma Surgery, University Hospital ZurichZurich, Switzerland
| | - Richard Glaab
- Department of Surgery, Division of Traumatology, Kantonsspital AarauAarau, Switzerland
| | - Javier Fandino
- Department of Neurosurgery, Kantonsspital AarauAarau, Switzerland
| | - Markus Schwendinger
- Interdisciplinary Emergency Centre, Baden Cantonal HospitalBaden, Switzerland
| | - Christoph Meier
- Department of Surgery, Waid Hospital ZurichZurich, Switzerland
| | - Erika J Ulbrich
- Institute of Diagnostic and Interventional Radiology, University Hospital ZurichZurich, Switzerland
| | | | - Hansruedi Baetschmann
- Division Neuropsychology, Department of Psychology, University of ZurichZurich, Switzerland
| | - Lutz Jäncke
- Division Neuropsychology, Department of Psychology, University of ZurichZurich, Switzerland.,International Normal Aging and Plasticity Imaging Center, University of ZurichZurich, Switzerland.,University Research Priority Program, Dynamic of Healthy Aging, University of ZurichZurich, Switzerland
| | - Jürgen Hänggi
- Division Neuropsychology, Department of Psychology, University of ZurichZurich, Switzerland
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71
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Leh SE, Schroeder C, Chen JK, Mallar Chakravarty M, Park MTM, Cheung B, Huntgeburth SC, Gosselin N, Hock C, Ptito A, Petrides M. Microstructural Integrity of Hippocampal Subregions Is Impaired after Mild Traumatic Brain Injury. J Neurotrauma 2017; 34:1402-1411. [DOI: 10.1089/neu.2016.4591] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Affiliation(s)
- Sandra E. Leh
- Institute for Regenerative Medicine, University of Zurich, Switzerland
| | - Clemens Schroeder
- Institute for Regenerative Medicine, University of Zurich, Switzerland
| | - Jen-Kai Chen
- Cognitive Neuroscience Unit, Montreal Neurological Institute, Montreal, Quebec, Canada
- Department of Psychology, McGill University Health Centre, Montreal, Quebec, Canada
| | - M. Mallar Chakravarty
- Cerebral Imaging Centre, Douglas Mental Health University Institute, McGill University, Montreal, Quebec, Canada
- Departments of Psychiatry and Biomedical Engineering, McGill University, Montreal, Quebec, Canada
| | - Min Tae M. Park
- Cerebral Imaging Centre, Douglas Mental Health University Institute, McGill University, Montreal, Quebec, Canada
- Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Bob Cheung
- Defense Research and Development Canada (DRDC) Toronto, Ontario, Canada
| | - Sonja C. Huntgeburth
- Cognitive Neuroscience Unit, Montreal Neurological Institute, Montreal, Quebec, Canada
- Department of Psychology, McGill University, Montreal, Quebec, Canada
| | - Nadia Gosselin
- Research Center, Hôpital du Sacré-Coeur de Montréal, Montreal, Quebec, Canada
| | - Christoph Hock
- Institute for Regenerative Medicine, University of Zurich, Switzerland
| | - Alain Ptito
- Cognitive Neuroscience Unit, Montreal Neurological Institute, Montreal, Quebec, Canada
- Department of Psychology, McGill University Health Centre, Montreal, Quebec, Canada
| | - Michael Petrides
- Cognitive Neuroscience Unit, Montreal Neurological Institute, Montreal, Quebec, Canada
- Department of Psychology, McGill University, Montreal, Quebec, Canada
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72
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Asken BM, DeKosky ST, Clugston JR, Jaffee MS, Bauer RM. Diffusion tensor imaging (DTI) findings in adult civilian, military, and sport-related mild traumatic brain injury (mTBI): a systematic critical review. Brain Imaging Behav 2017; 12:585-612. [DOI: 10.1007/s11682-017-9708-9] [Citation(s) in RCA: 75] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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73
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Clark AL, Bangen KJ, Sorg SF, Schiehser DM, Evangelista ND, McKenna B, Liu TT, Delano-Wood L. Dynamic association between perfusion and white matter integrity across time since injury in Veterans with history of TBI. Neuroimage Clin 2016; 14:308-315. [PMID: 28210542 PMCID: PMC5299206 DOI: 10.1016/j.nicl.2016.12.017] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Revised: 12/14/2016] [Accepted: 12/16/2016] [Indexed: 01/01/2023]
Abstract
OBJECTIVE Cerebral blood flow (CBF) plays a critical role in the maintenance of neuronal integrity, and CBF alterations have been linked to deleterious white matter changes. Although both CBF and white matter microstructural alterations have been observed within the context of traumatic brain injury (TBI), the degree to which these pathological changes relate to one another and whether this association is altered by time since injury have not been examined. The current study therefore sought to clarify associations between resting CBF and white matter microstructure post-TBI. METHODS 37 veterans with history of mild or moderate TBI (mmTBI) underwent neuroimaging and completed health and psychiatric symptom questionnaires. Resting CBF was measured with multiphase pseudocontinuous arterial spin labeling (MPPCASL), and white matter microstructural integrity was measured with diffusion tensor imaging (DTI). The cingulate cortex and cingulum bundle were selected as a priori regions of interest for the ASL and DTI data, respectively, given the known vulnerability of these regions to TBI. RESULTS Regression analyses controlling for age, sex, and posttraumatic stress disorder (PTSD) symptoms revealed a significant time since injury × resting CBF interaction for the left cingulum (p < 0.005). Decreased CBF was significantly associated with reduced cingulum fractional anisotropy (FA) in the chronic phase; however, no such association was observed for participants with less remote TBI. CONCLUSIONS Our results showed that reduced CBF was associated with poorer white matter integrity in those who were further removed from their brain injury. Findings provide preliminary evidence of a possible dynamic association between CBF and white matter microstructure that warrants additional consideration within the context of the negative long-term clinical outcomes frequently observed in those with history of TBI. Additional cross-disciplinary studies integrating multiple imaging modalities (e.g., DTI, ASL) and refined neuropsychiatric assessment are needed to better understand the nature, temporal course, and dynamic association between brain changes and clinical outcomes post-injury.
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Affiliation(s)
- Alexandra L. Clark
- San Diego State University/University of California, San Diego (SDSU/UCSD) Joint Doctoral Program in Clinical Psychology, United States
- VA San Diego Healthcare System (VASDHS), United States
| | - Katherine J. Bangen
- VA San Diego Healthcare System (VASDHS), United States
- University of California San Diego, School of Medicine, Department of Psychiatry, United States
| | - Scott F. Sorg
- VA San Diego Healthcare System (VASDHS), United States
- University of California San Diego, School of Medicine, Department of Psychiatry, United States
| | - Dawn M. Schiehser
- VA San Diego Healthcare System (VASDHS), United States
- Center of Excellence for Stress and Mental Health, VASDHS, United States
- University of California San Diego, School of Medicine, Department of Psychiatry, United States
| | - Nicole D. Evangelista
- VA San Diego Healthcare System (VASDHS), United States
- University of California San Diego, School of Medicine, Department of Psychiatry, United States
| | - Benjamin McKenna
- VA San Diego Healthcare System (VASDHS), United States
- University of California San Diego, School of Medicine, Department of Psychiatry, United States
| | - Thomas T. Liu
- University of California San Diego, Department of Radiology, Keck Center for Functional MRI, United States
| | - Lisa Delano-Wood
- VA San Diego Healthcare System (VASDHS), United States
- Center of Excellence for Stress and Mental Health, VASDHS, United States
- University of California San Diego, School of Medicine, Department of Psychiatry, United States
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Vergara VM, Mayer AR, Damaraju E, Kiehl KA, Calhoun V. Detection of Mild Traumatic Brain Injury by Machine Learning Classification Using Resting State Functional Network Connectivity and Fractional Anisotropy. J Neurotrauma 2016; 34:1045-1053. [PMID: 27676221 DOI: 10.1089/neu.2016.4526] [Citation(s) in RCA: 82] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Traumatic brain injury (TBI) may adversely affect a person's thinking, memory, personality, and behavior. While mild TBI (mTBI) diagnosis is challenging, there is a risk for long-term psychiatric, neurologic, and psychosocial problems in some patients that motivates the search for new and better biomarkers. Recently, diffusion magnetic resonance imaging (dMRI) has shown promise in detecting mTBI, but its validity is still being investigated. Resting state functional network connectivity (rsFNC) is another approach that is emerging as a promising option for the diagnosis of mTBI. The present work investigated the use of rsFNC for mTBI detection compared with dMRI results on the same cohort. Fifty patients with mTBI (25 males) and age-sex matched healthy controls were recruited. Features from dMRI were obtained using all voxels, the enhanced Z-score microstructural assessment for pathology, and the distribution corrected Z-score. Features based on rsFNC were obtained through group independent component analysis and correlation between pairs of resting state networks. A linear support vector machine was used for classification and validated using leave-one-out cross validation. Classification achieved a maximum accuracy of 84.1% for rsFNC and 75.5% for dMRI and 74.5% for both combined. A t test analysis revealed significant increase in rsFNC between cerebellum versus sensorimotor networks and between left angular gyrus versus precuneus in subjects with mTBI. These outcomes suggest that inclusion of both common and unique information is important for classification of mTBI. Results also suggest that rsFNC can yield viable biomarkers that might outperform dMRI and points to connectivity to the cerebellum as an important region for the detection of mTBI.
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Affiliation(s)
- Victor M Vergara
- 1 The Mind Research Network and Lovelace Biomedical and Environmental Research Institute , Albuquerque, New Mexico
| | - Andrew R Mayer
- 1 The Mind Research Network and Lovelace Biomedical and Environmental Research Institute , Albuquerque, New Mexico .,2 Department of Neurology, University of New Mexico School of Medicine , Albuquerque, New Mexico
| | - Eswar Damaraju
- 1 The Mind Research Network and Lovelace Biomedical and Environmental Research Institute , Albuquerque, New Mexico .,3 Department of ECE, University of New Mexico , Albuquerque, New Mexico
| | - Kent A Kiehl
- 1 The Mind Research Network and Lovelace Biomedical and Environmental Research Institute , Albuquerque, New Mexico .,4 Department of Psychology, University of New Mexico , Albuquerque, New Mexico
| | - Vince Calhoun
- 1 The Mind Research Network and Lovelace Biomedical and Environmental Research Institute , Albuquerque, New Mexico .,3 Department of ECE, University of New Mexico , Albuquerque, New Mexico
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Loss of Consciousness Is Related to White Matter Injury in Mild Traumatic Brain Injury. J Neurotrauma 2016; 33:2000-2010. [DOI: 10.1089/neu.2015.4212] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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In-vivo Dynamics of the Human Hippocampus across the Menstrual Cycle. Sci Rep 2016; 6:32833. [PMID: 27713470 PMCID: PMC5054394 DOI: 10.1038/srep32833] [Citation(s) in RCA: 81] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Accepted: 08/11/2016] [Indexed: 12/31/2022] Open
Abstract
Sex hormones fluctuate during the menstrual cycle. Evidence from animal studies suggests similar subtle fluctuations in hippocampal structure, predominantly linked to estrogen. Hippocampal abnormalities have been observed in several neuropsychiatric pathologies with prominent sexual dimorphism. Yet, the potential impact of subtle sex-hormonal fluctuations on human hippocampal structure in health is unclear. We tested the feasibility of longitudinal neuroimaging in conjunction with rigorous menstrual cycle monitoring to evaluate potential changes in hippocampal microstructure associated with physiological sex-hormonal changes. Thirty longitudinal diffusion weighted imaging scans of a single healthy female subject were acquired across two full menstrual cycles. We calculated hippocampal fractional anisotropy (FA), a measure sensitive to changes in microstructural integrity, and investigated potential correlations with estrogen. We observed a significant positive correlation between FA values and estrogen in the hippocampus bilaterally, revealing a peak in FA closely paralleling ovulation. This exploratory, single-subject study demonstrates the feasibility of a longitudinal DWI scanning protocol across the menstrual cycle and is the first to link subtle endogenous hormonal fluctuations to changes in FA in vivo. In light of recent attempts to neurally phenotype single humans, our findings highlight menstrual cycle monitoring in parallel with highly sampled individual neuroimaging data to address fundamental questions about the dynamics of plasticity in the adult brain.
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Kimura-Ohba S, Yang Y, Thompson J, Kimura T, Salayandia VM, Cosse M, Yang Y, Sillerud LO, Rosenberg GA. Transient increase of fractional anisotropy in reversible vasogenic edema. J Cereb Blood Flow Metab 2016; 36:1731-1743. [PMID: 26865662 PMCID: PMC5076788 DOI: 10.1177/0271678x16630556] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Accepted: 01/11/2016] [Indexed: 11/17/2022]
Abstract
Brain vasogenic edema, involving disruption of the blood-brain barrier, is a common pathological condition in several neurological diseases, with a heterogeneous prognosis. It is sometimes reversible, as in posterior reversible encephalopathy syndrome, but often irreversible and our current clinical tools are insufficient to reveal its reversibility. Here, we show that increased fractional anisotropy in magnetic resonance imaging is associated with the reversibility of vasogenic edema. Spontaneously, hypertensive rats-stroke prone demonstrated posterior reversible encephalopathy syndrome-like acute encephalopathy in response to high-dose cyclosporine A treatment; the deteriorating neurological symptoms and worsening scores in behavioral tests, which were seen in acute phase, dissappered after recovery by cessation of cyclosporine A. In the acute phase of encephalopathy, the fractional anisotropy and apparent diffusion coefficient increased in areas with IgG leakage. This increase of fractional anisotropy occurred in the absence of demyelination: fluid leakage into the myelinated space increased the axial, but not the radial, diffusivity, resulting in the increased fractional anisotropy. This increased fractional anisotropy returned to pre-encephalopathy values in the recovery phase. Our results highlight the importance of the fractional anisotropy increase as a marker for the reversibility of brain edema, which can delineate the brain areas for which recovery is possible.
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Affiliation(s)
| | - Yi Yang
- Department of Neurology, University of New Mexico, Albuquerque, USA
| | - Jeffrey Thompson
- Department of Neurology, University of New Mexico, Albuquerque, USA
| | - Tomonori Kimura
- Department of Molecular Genetics and Microbiology, University of New Mexico, Albuquerque, USA
| | | | - Melissa Cosse
- Department of Neurology, University of New Mexico, Albuquerque, USA
| | - Yirong Yang
- BRaIN Imaging Center and College of Pharmacy, University of New Mexico, Albuquerque, USA
| | - Laurel O Sillerud
- Department of Neurology, University of New Mexico, Albuquerque, USA BRaIN Imaging Center and College of Pharmacy, University of New Mexico, Albuquerque, USA
| | - Gary A Rosenberg
- Department of Neurology, University of New Mexico, Albuquerque, USA Department of Neurosciences, University of New Mexico, Albuquerque, USA Department of Cell Biology and Physiology, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
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Affiliation(s)
- Graham Martin
- Accident Compensation Corporation of New Zealand, Wellington, New Zealand
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79
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Abstract
There is a paucity of accurate and reliable biomarkers to detect traumatic brain injury, grade its severity, and model post-traumatic brain injury (TBI) recovery. This gap could be addressed via advances in brain mapping which define injury signatures and enable tracking of post-injury trajectories at the individual level. Mapping of molecular and anatomical changes and of modifications in functional activation supports the conceptual paradigm of TBI as a disorder of large-scale neural connectivity. Imaging approaches with particular relevance are magnetic resonance techniques (diffusion weighted imaging, diffusion tensor imaging, susceptibility weighted imaging, magnetic resonance spectroscopy, functional magnetic resonance imaging, and positron emission tomographic methods including molecular neuroimaging). Inferences from mapping represent unique endophenotypes which have the potential to transform classification and treatment of patients with TBI. Limitations of these methods, as well as future research directions, are highlighted.
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Strauss S, Hulkower M, Gulko E, Zampolin RL, Gutman D, Chitkara M, Zughaft M, Lipton ML. Current Clinical Applications and Future Potential of Diffusion Tensor Imaging in Traumatic Brain Injury. Top Magn Reson Imaging 2016; 24:353-62. [PMID: 26636640 DOI: 10.1097/rmr.0000000000000071] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
In the setting of acute central nervous system (CNS) emergencies, computed tomography (CT) and conventional magnetic resonance imaging (MRI) play an important role in the identification of life-threatening intracranial injury. However, the full extent or even presence of brain damage frequently escapes detection by conventional CT and MRI. Advanced MRI techniques such as diffusion tensor imaging (DTI) are emerging as important adjuncts in the diagnosis of microstructural white matter injury in the acute and postacute brain-injured patient. Although DTI aids in detection of brain injury pathology, which has been repeatedly associated with typical adverse clinical outcomes, the evolution of acute changes and their long-term prognostic implications are less clear and the subject of much active research. A major aim of current research is to identify imaging-based biomarkers that can identify the subset of TBI patients who are at risk for adverse outcome and can therefore most benefit from ongoing care and rehabilitation as well as future therapeutic interventions.The aim of this study is to introduce the current methods used to obtain DTI in the clinical setting, describe a set of common interpretation strategies with their associated advantages and pitfalls, as well as illustrate the clinical utility of DTI through a set of specific patient scenarios. We conclude with a discussion of future potential for the management of TBI.
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Affiliation(s)
- Sara Strauss
- *Department of Radiology of Montefiore Medical Center, Bronx, NY †Radiology Ltd., Tuscon, AZ ‡The Gruss Magnetic Resonance Research Center of Albert Einstein College of Medicine, Bronx, NY §Department of Radiology of Albert Einstein College of Medicine, Bronx, NY
- Department of Psychiatry and Behavioral Sciences of Albert Einstein College of Medicine, Bronx, NY ¶Dominick P. Purpura Department of Neuroscience of Albert Einstein College of Medicine, Bronx, NY
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Abstract
OBJECTIVES To examine the effect of pre-injury alcohol use, acute alcohol intoxication, and post-injury alcohol use on outcome from mild to moderate traumatic brain injury (TBI). METHODS Prospective inception cohort of patients who presented to the Emergency Department with mild to moderate TBI and had a blood alcohol level (BAL) taken for clinical purposes. Those who completed the 1-year outcome assessment were eligible for this study (N=91). Outcomes of interest were the count of post-concussion symptoms (British Columbia Post-Concussion Symptom Inventory), low neuropsychological test scores (Neuropsychological Assessment Battery), and abnormal regions of interest on diffusion tensor imaging (low fractional anisotropy). The main predictors were pre-injury alcohol consumption (Cognitive Lifetime Drinking History interview), BAL, and post-injury alcohol use. RESULTS The alcohol use variables were moderately to strongly inter-correlated. None of the alcohol use variables (whether continuous or categorical) were related to 1-year TBI outcomes in generalized linear modeling. Participants in this cohort generally had a good clinical outcome, regardless of their pre-, peri-, and post-injury alcohol use. CONCLUSIONS Alcohol may not significantly alter long-term outcome from mild to moderate TBI. (JINS, 2016, 22, 816-827).
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82
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Abstract
Neuroimaging plays a critical role in the setting in traumatic brain injury (TBI). Diffusion tensor imaging (DTI) is an advanced magnetic resonance imaging technique that is capable of providing rich information on the brain's neuroanatomic connectome. The purpose of this article is to systematically review the role of DTI and advanced diffusion techniques in the setting of TBI, including diffusion kurtosis imaging (DKI), neurite orientation dispersion and density imaging, diffusion spectrum imaging, and q-ball imaging. We discuss clinical applications of DTI and review the DTI literature as it pertains to TBI. Despite the continued advancements in DTI and related diffusion techniques over the past 20 years, DTI techniques are sensitive for TBI at the group level only and there is insufficient evidence that DTI plays a role at the individual level. We conclude by discussing future directions in DTI research in TBI including the role of machine learning in the pattern classification of TBI.
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83
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Harris NG, Verley DR, Gutman BA, Sutton RL. Bi-directional changes in fractional anisotropy after experiment TBI: Disorganization and reorganization? Neuroimage 2016; 133:129-143. [PMID: 26975556 PMCID: PMC4889542 DOI: 10.1016/j.neuroimage.2016.03.012] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2015] [Revised: 03/02/2016] [Accepted: 03/03/2016] [Indexed: 11/26/2022] Open
Abstract
The current dogma to explain the extent of injury-related changes following rodent controlled cortical impact (CCI) injury is a focal injury with limited axonal pathology. However, there is in fact good, published histologic evidence to suggest that axonal injury is far more widespread in this model than generally thought. One possibility that might help to explain this is the often-used region-of-interest data analysis approach taken by experimental traumatic brain injury (TBI) diffusion tensor imaging (DTI) or histologic studies that might miss more widespread damage, when compared to the whole brain, statistically robust method of tract-based analysis used more routinely in clinical research. To determine the extent of DTI changes in this model, we acquired in vivo DTI data before and at 1 and 4weeks after CCI injury in 17 adult male rats and analyzed parametric maps of fractional anisotropy (FA), axial, radial, and mean diffusivity (AD, RD, MD), tensor mode (MO), and fiber tract density (FTD) using tract-based spatial statistics. Contusion volume was used as a surrogate marker of injury severity and as a covariate for investigating severity dependence of the data. Mean fiber tract length was also computed from seeds in the cortical spinal tract regions. In parallel experiments (n=3-5/group), we investigated corpus callosum neurofilaments and demyelination using immunohistochemistry (IHC) at 3days and 6weeks, callosal tract patency using dual-label retrograde tract tracing at 5weeks, and the contribution of gliosis to DTI parameter maps using GFAP IHC at 4weeks post-injury. The data show widespread ipsilateral regions of significantly reduced FA at 1week post-injury, driven by temporally changing values of AD, RD, and MD that persist to 4weeks. Demyelination, retrograde label tract loss, and reductions in MO (tract degeneration) and FTD were shown to underpin these data. Significant FA increases occurred in subcortical and corticospinal tract regions that were spatially distinct from regions of FA decrease, grossly affected gliotic areas, and MO changes. However, there was good spatial correspondence between regions of increased FA and areas of increased FTD and mean fiber length. We discuss these widespread changes in DTI parameters in terms of axonal degeneration and potential reorganization, with reference to a resting state fMRI companion paper (Harris et al., 2016, Exp. Neurol. 227:124-138) that demonstrated altered functional connectivity data acquired from the same rats used in this study.
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Affiliation(s)
- N G Harris
- UCLA Brain injury Research Center, Department of Neurosurgery, University of California, Los Angeles, Los Angeles, USA.
| | - D R Verley
- UCLA Brain injury Research Center, Department of Neurosurgery, University of California, Los Angeles, Los Angeles, USA
| | - B A Gutman
- Department of Neurology, Imaging Genetics Center, Keck/USC School of Medicine, Institute for Neuroimaging and Informatics, University of Southern California, Los Angeles, CA, USA
| | - R L Sutton
- UCLA Brain injury Research Center, Department of Neurosurgery, University of California, Los Angeles, Los Angeles, USA
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85
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A voxel-based meta-analysis of diffusion tensor imaging in mild traumatic brain injury. Neurosci Biobehav Rev 2016; 66:119-26. [PMID: 27133211 DOI: 10.1016/j.neubiorev.2016.04.021] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2015] [Revised: 03/31/2016] [Accepted: 04/27/2016] [Indexed: 12/22/2022]
Abstract
Microstructural damage to white matter and resultant abnormal structural connectivity are a potential underlying pathophysiological mechanism of mild traumatic brain injury (mTBI). Many Tract-Based Spatial Statics studies have investigated the pathophysiology of mTBI, but they yielded inconsistent results potentially due to insufficient statistical power in spite of methodological homogeneity. We used anisotropic effect size signed differential mapping (AES-SDM) to integrate previous studies that recruited patients without a psychiatric history. AES-SDM revealed that fractional anisotropy values were significantly lower in mTBI patients than in control in three clusters. The peak of the largest cluster was in the left thalamus and the cluster extended to the splenium of the corpus callosum and to the anterior thalamic radiation. The second largest cluster was situated in the left forceps minor, and the third largest cluster was in the right superior longitudinal fasciculus III. These results suggest that the pathophysiology of mTBI includes abnormal structural connectivity between the thalamus and the prefrontal cortex, and abnormal intra- and inter-hemispheric structural connectivity involving the prefrontal cortex.
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86
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Lu C, Xia J, Bin W, Wu Y, Liu X, Zhang Y. Advances in diagnosis, treatments, and molecular mechanistic studies of traumatic brain injury. Biosci Trends 2016; 9:138-48. [PMID: 26166367 DOI: 10.5582/bst.2015.01066] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Traumatic brain injury (TBI) is a main cause of death and disability around the world especially in soldiers, children, and young men. Since its clinical diagnosis and treatment cannot predict its prognosis, novel diagnostic techniques need to be developed, insight into its molecular mechanisms needs to be gleaned, and alternative and complementary medicine (ACM) approaches to its treatment need to be developed. This review summarizes the new diagnostic methods used in clinical practice, such as imaging of structural abnormalities after TBI and measurement of prognosis-related biomarkers. This review also describes the cellular mechanisms of traditional Chinese medicine in terms of intracellular signaling pathways, the extracellular microenvironment, and stem cells. This review concludes by describing experimental and clinical studies of the use of traditional Chinese medicine as a form of ACM to treat TBI. This review helps to understand advances in the field of TBI diagnosis and treatment.
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Affiliation(s)
- Chunyu Lu
- Department of Neurosurgery, The People's Hospital of Huaibei
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87
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Tu TW, Williams RA, Lescher JD, Jikaria N, Turtzo LC, Frank JA. Radiological-pathological correlation of diffusion tensor and magnetization transfer imaging in a closed head traumatic brain injury model. Ann Neurol 2016; 79:907-20. [PMID: 27230970 DOI: 10.1002/ana.24641] [Citation(s) in RCA: 74] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Revised: 03/13/2016] [Accepted: 03/14/2016] [Indexed: 12/27/2022]
Abstract
OBJECTIVE Metrics of diffusion tensor imaging (DTI) and magnetization transfer imaging (MTI) can detect diffuse axonal injury in traumatic brain injury (TBI). The relationship between the changes in these imaging measures and the underlying pathologies is still relatively unknown. This study investigated the radiological-pathological correlation between these imaging techniques and immunohistochemistry using a closed head rat model of TBI. METHODS TBI was performed on female rats followed longitudinally by magnetic resonance imaging (MRI) out to 30 days postinjury, with a subset of animals selected for histopathological analyses. A MRI-based finite element analysis was generated to characterize the pattern of the mechanical insult and estimate the extent of brain injury to direct the pathological correlation with imaging findings. RESULTS DTI axial diffusivity and fractional anisotropy (FA) were sensitive to axonal integrity, whereas radial diffusivity showed significant correlation to the myelin compactness. FA was correlated with astrogliosis in the gray matter, whereas mean diffusivity was correlated with increased cellularity. Secondary inflammatory responses also partly affected the changes of these DTI metrics. The magnetization transfer ratio (MTR) at 3.5ppm demonstrated a strong correlation with both axon and myelin integrity. Decrease in MTR at 20ppm correlated with the extent of astrogliosis in both gray and white matter. INTERPRETATION Although conventional T2-weighted MRI did not detect abnormalities following TBI, DTI and MTI afforded complementary insight into the underlying pathologies reflecting varying injury states over time, and thus may substitute for histology to reveal diffusive axonal injury pathologies in vivo. This correlation of MRI and histology furthers understanding of the microscopic pathology underlying DTI and MTI changes in TBI. Ann Neurol 2016;79:907-920.
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Affiliation(s)
- Tsang-Wei Tu
- Frank Laboratory, Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, MD
| | - Rashida A Williams
- Frank Laboratory, Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, MD
| | - Jacob D Lescher
- Frank Laboratory, Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, MD
| | - Neekita Jikaria
- Frank Laboratory, Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, MD
| | - L Christine Turtzo
- Frank Laboratory, Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, MD.,Center for Neuroscience and Regenerative Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD
| | - Joseph A Frank
- Frank Laboratory, Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, MD.,National Institute of Biomedical Imaging and Bioengineering, National Institutes of Health, Bethesda, MD
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Dall'Acqua P, Johannes S, Mica L, Simmen HP, Glaab R, Fandino J, Schwendinger M, Meier C, Ulbrich EJ, Müller A, Jäncke L, Hänggi J. Connectomic and Surface-Based Morphometric Correlates of Acute Mild Traumatic Brain Injury. Front Hum Neurosci 2016; 10:127. [PMID: 27065831 PMCID: PMC4809899 DOI: 10.3389/fnhum.2016.00127] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Accepted: 03/09/2016] [Indexed: 02/01/2023] Open
Abstract
Reduced integrity of white matter (WM) pathways and subtle anomalies in gray matter (GM) morphology have been hypothesized as mechanisms in mild traumatic brain injury (mTBI). However, findings on structural brain changes in early stages after mTBI are inconsistent and findings related to early symptoms severity are rare. Fifty-one patients were assessed with multimodal neuroimaging and clinical methods exclusively within 7 days following mTBI and compared to 53 controls. Whole-brain connectivity based on diffusion tensor imaging was subjected to network-based statistics, whereas cortical surface area, thickness, and volume based on T1-weighted MRI scans were investigated using surface-based morphometric analysis. Reduced connectivity strength within a subnetwork of 59 edges located predominantly in bilateral frontal lobes was significantly associated with higher levels of self-reported symptoms. In addition, cortical surface area decreases were associated with stronger complaints in five clusters located in bilateral frontal and postcentral cortices, and in the right inferior temporal region. Alterations in WM and GM were localized in similar brain regions and moderately-to-strongly related to each other. Furthermore, the reduction of cortical surface area in the frontal regions was correlated with poorer attentive-executive performance in the mTBI group. Finally, group differences were detected in both the WM and GM, especially when focusing on a subgroup of patients with greater complaints, indicating the importance of classifying mTBI patients according to severity of symptoms. This study provides evidence that mTBI affects not only the integrity of WM networks by means of axonal damage but also the morphology of the cortex during the initial post-injury period. These anomalies might be greater in the acute period than previously believed and the involvement of frontal brain regions was consistently pronounced in both findings. The dysconnected subnetwork suggests that mTBI can be conceptualized as a dysconnection syndrome. It remains unclear whether reduced WM integrity is the trigger for changes in cortical surface area or whether tissue deformations are the direct result of mechanical forces acting on the brain. The findings suggest that rapid identification of high-risk patients with the use of clinical scales should be assessed acutely as part of the mTBI protocol.
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Affiliation(s)
- Patrizia Dall'Acqua
- Bellikon Rehabilitation ClinicBellikon, Switzerland; Division Neuropsychology, Department of Psychology, University of ZurichZurich, Switzerland
| | | | - Ladislav Mica
- Division of Trauma Surgery, University Hospital Zurich Zurich, Switzerland
| | - Hans-Peter Simmen
- Division of Trauma Surgery, University Hospital Zurich Zurich, Switzerland
| | - Richard Glaab
- Department of Traumatology, Cantonal Hospital Aarau Aarau, Switzerland
| | - Javier Fandino
- Department of Neurosurgery, Cantonal Hospital Aarau Aarau, Switzerland
| | - Markus Schwendinger
- Interdisciplinary Emergency Centre, Baden Cantonal Hospital Baden, Switzerland
| | - Christoph Meier
- Department of Surgery, Waid Hospital Zurich Zurich, Switzerland
| | - Erika J Ulbrich
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich Zurich, Switzerland
| | | | - Lutz Jäncke
- Division Neuropsychology, Department of Psychology, University of ZurichZurich, Switzerland; International Normal Aging and Plasticity Imaging Center, University of ZurichZurich, Switzerland; Center for Integrative Human Physiology, University of ZurichZurich, Switzerland; University Research Priority Program, Dynamic of Healthy Aging, University of ZurichZurich, Switzerland
| | - Jürgen Hänggi
- Division Neuropsychology, Department of Psychology, University of Zurich Zurich, Switzerland
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Kawa L, Barde S, Arborelius UP, Theodorsson E, Agoston D, Risling M, Hökfelt T. Expression of galanin and its receptors are perturbed in a rodent model of mild, blast-induced traumatic brain injury. Exp Neurol 2016; 279:159-167. [PMID: 26928087 DOI: 10.1016/j.expneurol.2016.02.019] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Revised: 02/22/2016] [Accepted: 02/24/2016] [Indexed: 01/05/2023]
Abstract
The symptomatology, mood and cognitive disturbances seen in post-traumatic stress disorder (PTSD) and mild blast-induced traumatic brain injury (mbTBI) overlap considerably. However the pathological mechanisms underlying the two conditions are currently unknown. The neuropeptide galanin has been suggested to play a role in the development of stress and mood disorders. Here we applied bio- and histochemical methods with the aim to elucidate the nature of any changes in the expression of galanin and its receptors in a rodent model of mbTBI. In situ hybridization and quantitative polymerase chain reaction studies revealed significant, injury-induced changes, in some cases lasting at least for one week, in the mRNA levels of galanin and/or its three receptors, galanin receptor 1-3 (GalR1-3). Such changes were seen in several forebrain regions, and the locus coeruleus. In the ventral periaqueductal gray GalR1 mRNA levels were increased, while GalR2 were decreased. Analysis of galanin peptide levels using radioimmunoassay demonstrated an increase in several brain regions including the locus coeruleus, dorsal hippocampal formation and amygdala. These findings suggest a role for the galanin system in the endogenous response to mbTBI, and that pharmacological studies of the effects of activation or inhibition of different galanin receptors in combination with functional assays of behavioral recovery may reveal promising targets for new therapeutic strategies in mbTBI.
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Affiliation(s)
- Lizan Kawa
- Department of Neuroscience, Karolinska Institutet, Retzius väg 8, SE 171 77 Stockholm, Sweden.
| | - Swapnali Barde
- Department of Neuroscience, Karolinska Institutet, Retzius väg 8, SE 171 77 Stockholm, Sweden
| | - Ulf P Arborelius
- Department of Neuroscience, Karolinska Institutet, Retzius väg 8, SE 171 77 Stockholm, Sweden
| | - Elvar Theodorsson
- Department of Clinical Chemistry, Linköping University, Linköping, Sweden
| | - Denes Agoston
- Department of Neuroscience, Karolinska Institutet, Retzius väg 8, SE 171 77 Stockholm, Sweden; Department of Anatomy, Physiology and Genetics, The Uniformed Services University, 4301 Jones Bridge Road, Bethesda, MD 20814, United States
| | - Mårten Risling
- Department of Neuroscience, Karolinska Institutet, Retzius väg 8, SE 171 77 Stockholm, Sweden.
| | - Tomas Hökfelt
- Department of Neuroscience, Karolinska Institutet, Retzius väg 8, SE 171 77 Stockholm, Sweden
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90
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Abstract
OBJECTIVES Recent advances in neuroimaging methodologies sensitive to axonal injury have made it possible to assess in vivo the extent of traumatic brain injury (TBI) -related disruption in neural structures and their connections. The objective of this paper is to review studies examining connectivity in TBI with an emphasis on structural and functional MRI methods that have proven to be valuable in uncovering neural abnormalities associated with this condition. METHODS We review studies that have examined white matter integrity in TBI of varying etiology and levels of severity, and consider how findings at different times post-injury may inform underlying mechanisms of post-injury progression and recovery. Moreover, in light of recent advances in neuroimaging methods to study the functional connectivity among brain regions that form integrated networks, we review TBI studies that use resting-state functional connectivity MRI methodology to examine neural networks disrupted by putative axonal injury. RESULTS The findings suggest that TBI is associated with altered structural and functional connectivity, characterized by decreased integrity of white matter pathways and imbalance and inefficiency of functional networks. These structural and functional alterations are often associated with neurocognitive dysfunction and poor functional outcomes. CONCLUSIONS TBI has a negative impact on distributed brain networks that lead to behavioral disturbance.
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91
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Edlow BL, Copen WA, Izzy S, Bakhadirov K, van der Kouwe A, Glenn MB, Greenberg SM, Greer DM, Wu O. Diffusion tensor imaging in acute-to-subacute traumatic brain injury: a longitudinal analysis. BMC Neurol 2016; 16:2. [PMID: 26754948 PMCID: PMC4707723 DOI: 10.1186/s12883-015-0525-8] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Accepted: 12/31/2015] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Diffusion tensor imaging (DTI) may have prognostic utility in patients with traumatic brain injury (TBI), but the optimal timing of DTI data acquisition is unknown because of dynamic changes in white matter water diffusion during the acute and subacute stages of TBI. We aimed to characterize the direction and magnitude of early longitudinal changes in white matter fractional anisotropy (FA) and to determine whether acute or subacute FA values correlate more reliably with functional outcomes after TBI. METHODS From a prospective TBI outcomes database, 11 patients who underwent acute (≤7 days) and subacute (8 days to rehabilitation discharge) DTI were retrospectively analyzed. Longitudinal changes in FA were measured in 11 white matter regions susceptible to traumatic axonal injury. Correlations were assessed between acute FA, subacute FA and the disability rating scale (DRS) score, which was ascertained at discharge from inpatient rehabilitation. RESULTS FA declined from the acute-to-subacute period in the genu of the corpus callosum (0.70 ± 0.02 vs. 0.55 ± 0.11, p < 0.05) and inferior longitudinal fasciculus (0.54+/-0.07 vs. 0.49+/-0.07, p < 0.01). Acute correlations between FA and DRS score were variable: higher FA in the body (R = -0.78, p = 0.02) and splenium (R = -0.83, p = 0.003) of the corpus callosum was associated with better outcomes (i.e. lower DRS scores), whereas higher FA in the genu of the corpus callosum (R = 0.83, p = 0.02) corresponded with worse outcomes (i.e. higher DRS scores). In contrast, in the subacute period higher FA in the splenium correlated with better outcomes (R = -0.63, p < 0.05) and no inverse correlations were observed. CONCLUSIONS White matter FA declined during the acute-to-subacute stages of TBI. Variability in acute FA correlations with outcome suggests that the optimal timing of DTI for TBI prognostication may be in the subacute period.
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Affiliation(s)
- Brian L Edlow
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA. .,Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, USA.
| | - William A Copen
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
| | - Saef Izzy
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
| | - Khamid Bakhadirov
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
| | - Andre van der Kouwe
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, USA.
| | - Mel B Glenn
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, USA.
| | - Steven M Greenberg
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
| | - David M Greer
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA. .,Department of Neurology, Yale-New Haven Hospital, Yale School of Medicine, New Haven, CT, USA.
| | - Ona Wu
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA. .,Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, USA.
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92
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Astafiev SV, Zinn KL, Shulman GL, Corbetta M. Exploring the physiological correlates of chronic mild traumatic brain injury symptoms. NEUROIMAGE-CLINICAL 2016; 11:10-19. [PMID: 26909324 PMCID: PMC4732189 DOI: 10.1016/j.nicl.2016.01.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Revised: 12/31/2015] [Accepted: 01/04/2016] [Indexed: 12/14/2022]
Abstract
We report on the results of a multimodal imaging study involving behavioral assessments, evoked and resting-state BOLD fMRI, and DTI in chronic mTBI subjects. We found that larger task-evoked BOLD activity in the MT+/LO region in extra-striate visual cortex correlated with mTBI and PTSD symptoms, especially light sensitivity. Moreover, higher FA values near the left optic radiation (OR) were associated with both light sensitivity and higher BOLD activity in the MT+/LO region. The MT+/LO region was localized as a region of abnormal functional connectivity with central white matter regions previously found to have abnormal physiological signals during visual eye movement tracking (Astafiev et al., 2015). We conclude that mTBI symptoms and light sensitivity may be related to excessive responsiveness of visual cortex to sensory stimuli. This abnormal sensitivity may be related to chronic remodeling of white matter visual pathways acutely injured. We report a multimodal imaging study of symptoms in chronic mTBI. Higher BOLD activity in the MT +/LO region correlated with mTBI symptoms. Higher FA near the left optic radiation was associated with light sensitivity.
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Affiliation(s)
- Serguei V Astafiev
- Department of Neurology, Washington University in St. Louis, 660 S. Euclid Ave, Campus Box 8225, St. Louis, MO 63110, USA.
| | - Kristina L Zinn
- Department of Neurology, Washington University in St. Louis, 660 S. Euclid Ave, Campus Box 8225, St. Louis, MO 63110, USA.
| | - Gordon L Shulman
- Department of Neurology, Washington University in St. Louis, 660 S. Euclid Ave, Campus Box 8225, St. Louis, MO 63110, USA.
| | - Maurizio Corbetta
- Department of Neurology, Washington University in St. Louis, 660 S. Euclid Ave, Campus Box 8225, St. Louis, MO 63110, USA.
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93
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Delouche A, Attyé A, Heck O, Grand S, Kastler A, Lamalle L, Renard F, Krainik A. Diffusion MRI: Pitfalls, literature review and future directions of research in mild traumatic brain injury. Eur J Radiol 2016; 85:25-30. [PMID: 26724645 DOI: 10.1016/j.ejrad.2015.11.004] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Revised: 10/06/2015] [Accepted: 11/01/2015] [Indexed: 12/27/2022]
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94
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Abstract
Imaging is an indispensable part of the initial assessment and subsequent management of patients with head trauma. Initially, it is important for diagnosing the extent of injury and the prompt recognition of treatable injuries to reduce mortality. Subsequently, imaging is useful in following the sequelae of trauma. In this chapter, we review indications for neuroimaging and typical computed tomography (CT) and magnetic resonance imaging (MRI) protocols used in the evaluation of a patient with head trauma. We review the role of CT), the imaging modality of choice in the acute setting, and the role of MRI in the evaluation of patients with head trauma. We describe an organized and consistent approach to the interpretation of imaging of these patients. Important topics in head trauma, including fundamental concepts related to skull fractures, intracranial hemorrhage, parenchymal injury, penetrating trauma, cerebrovascular injuries, and secondary effects of trauma, are reviewed. The chapter concludes with advanced neuroimaging techniques for the evaluation of traumatic brain injury, including use of diffusion tensor imaging (DTI), functional MRI (fMRI), and MR spectroscopy (MRS), techniques which are still under development.
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Affiliation(s)
- Sandra Rincon
- Division of Neuroradiology, Massachusetts General Hospital, Boston, MA, USA.
| | - Rajiv Gupta
- Division of Neuroradiology, Massachusetts General Hospital, Boston, MA, USA; Division of Neuroradiology and Cardiac Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Thomas Ptak
- Division of Neuroradiology, Massachusetts General Hospital, Boston, MA, USA; Division of Emergency Radiology, Massachusetts General Hospital, Boston, MA, USA
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95
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Miller DR, Hayes JP, Lafleche G, Salat DH, Verfaellie M. White matter abnormalities are associated with chronic postconcussion symptoms in blast-related mild traumatic brain injury. Hum Brain Mapp 2016; 37:220-9. [PMID: 26497829 PMCID: PMC4760357 DOI: 10.1002/hbm.23022] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Revised: 08/10/2015] [Accepted: 10/04/2015] [Indexed: 01/07/2023] Open
Abstract
Blast-related mild traumatic brain injury (mTBI) is a common injury among Iraq and Afghanistan military veterans due to the frequent use of improvised explosive devices. A significant minority of individuals with mTBI report chronic postconcussion symptoms (PCS), which include physical, emotional, and cognitive complaints. However, chronic PCS are nonspecific and are also associated with mental health disorders such as posttraumatic stress disorder (PTSD). Identifying the mechanisms that contribute to chronic PCS is particularly challenging in blast-related mTBI, where the incidence of comorbid PTSD is high. In this study, we examined whether blast-related mTBI is associated with diffuse white matter changes, and whether these neural changes are associated with chronic PCS. Ninety Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) veterans were assigned to one of three groups including a blast-exposed no--TBI group, a blast-related mTBI without loss of consciousness (LOC) group (mTBI--LOC), and a blast-related mTBI with LOC group (mTBI + LOC). PCS were measured with the Rivermead Postconcussion Questionnaire. Results showed that participants in the mTBI + LOC group had more spatially heterogeneous white matter abnormalities than those in the no--TBI group. These white matter abnormalities were significantly associated with physical PCS severity even after accounting for PTSD symptoms, but not with cognitive or emotional PCS severity. A mediation analysis revealed that mTBI + LOC significantly influenced physical PCS severity through its effect on white matter integrity. These results suggest that white matter abnormalities are associated with chronic PCS independent of PTSD symptom severity and that these abnormalities are an important mechanism explaining the relationship between mTBI and chronic physical PCS.
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Affiliation(s)
- Danielle R. Miller
- Department of Anatomy and NeurobiologyBoston University School of MedicineBostonMassachusetts
- Memory Disorders Research CenterVA Boston Healthcare SystemBostonMassachusetts
| | - Jasmeet P. Hayes
- National Center for PTSDVA Boston Healthcare SystemBostonMassachusetts
- Department of PsychiatryBoston University School of MedicineBostonMassachusetts
- Neuroimaging Research for Veterans Center, VA Boston Healthcare SystemBostonMassachusetts
| | - Ginette Lafleche
- Memory Disorders Research CenterVA Boston Healthcare SystemBostonMassachusetts
- Department of PsychiatryBoston University School of MedicineBostonMassachusetts
| | - David H. Salat
- Neuroimaging Research for Veterans Center, VA Boston Healthcare SystemBostonMassachusetts
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General HospitalCharlestownMassachusetts
- Harvard Medical School, Harvard UniversityBostonMassachusetts
| | - Mieke Verfaellie
- Memory Disorders Research CenterVA Boston Healthcare SystemBostonMassachusetts
- Department of PsychiatryBoston University School of MedicineBostonMassachusetts
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96
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Meier TB, Bergamino M, Bellgowan PSF, Teague TK, Ling JM, Jeromin A, Mayer AR. Longitudinal assessment of white matter abnormalities following sports-related concussion. Hum Brain Mapp 2015; 37:833-45. [PMID: 26663463 DOI: 10.1002/hbm.23072] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Accepted: 11/23/2015] [Indexed: 01/08/2023] Open
Abstract
There is great interest in developing physiological-based biomarkers such as diffusion tensor imaging to aid in the management of concussion, which is currently entirely dependent on clinical judgment. However, the time course for recovery of white matter abnormalities following sports-related concussion (SRC) is unknown. We collected diffusion tensor imaging and behavioral data in forty concussed collegiate athletes on average 1.64 days (T1; n = 33), 8.33 days (T2; n = 30), and 32.15 days post-concussion (T3; n = 26), with healthy collegiate contact-sport athletes (HA) serving as controls (n = 46). We hypothesized that fractional anisotropy (FA) would be increased acutely and partially recovered by one month post-concussion. Mood symptoms were assessed using structured interviews. FA differences were assessed using both traditional and subject-specific analyses. An exploratory analysis of tau plasma levels was conducted in a subset of participants. Results indicated that mood symptoms improved over time post-concussion, but remained elevated at T3 relative to HA. Across both group and subject-specific analyses, concussed athletes exhibited increased FA in several white matter tracts at each visit post-concussion with no longitudinal evidence of recovery. Increased FA at T1 and T3 was significantly associated with an independent, real-world outcome measure for return-to-play. Finally, we observed a nonsignificant trend for reduced tau in plasma of concussed athletes at T1 relative to HA, with tau significantly increasing by T2. These results suggest white matter abnormalities following SRC may persist beyond one month and have potential as an objective biomarker for concussion outcome. Hum Brain Mapp 37:833-845, 2016. © 2015 Wiley Periodicals, Inc.
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Affiliation(s)
- Timothy B Meier
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin.,The Mind Research Network/Lovelace Biomedical and Environmental Research Institute, Albuquerque, New Mexico.,Laureate Institute for Brain Research, Tulsa, Oklahoma
| | | | - Patrick S F Bellgowan
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, North Bethesda, Maryland
| | - T K Teague
- Departments of Surgery and Psychiatry, University of Oklahoma College of Medicine, Tulsa, Oklahoma.,Department of Pharmaceutical Sciences, University of Oklahoma College of Pharmacy, Tulsa, Oklahoma.,Department of Biochemistry and Microbiology, Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma
| | - Josef M Ling
- The Mind Research Network/Lovelace Biomedical and Environmental Research Institute, Albuquerque, New Mexico
| | | | - Andrew R Mayer
- The Mind Research Network/Lovelace Biomedical and Environmental Research Institute, Albuquerque, New Mexico.,Neurology Department, University of New Mexico School of Medicine, Albuquerque, New Mexico.,Department of Psychology, University of New Mexico, Albuquerque, New Mexico
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97
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Winkler EA, Yue JK, McAllister TW, Temkin NR, Oh SS, Burchard EG, Hu D, Ferguson AR, Lingsma HF, Burke JF, Sorani MD, Rosand J, Yuh EL, Barber J, Tarapore PE, Gardner RC, Sharma S, Satris GG, Eng C, Puccio AM, Wang KKW, Mukherjee P, Valadka AB, Okonkwo DO, Diaz-Arrastia R, Manley GT. COMT Val 158 Met polymorphism is associated with nonverbal cognition following mild traumatic brain injury. Neurogenetics 2015; 17:31-41. [PMID: 26576546 DOI: 10.1007/s10048-015-0467-8] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Accepted: 10/22/2015] [Indexed: 11/28/2022]
Abstract
Mild traumatic brain injury (mTBI) results in variable clinical outcomes, which may be influenced by genetic variation. A single-nucleotide polymorphism in catechol-o-methyltransferase (COMT), an enzyme which degrades catecholamine neurotransmitters, may influence cognitive deficits following moderate and/or severe head trauma. However, this has been disputed, and its role in mTBI has not been studied. Here, we utilize the Transforming Research and Clinical Knowledge in Traumatic Brain Injury Pilot (TRACK-TBI Pilot) study to investigate whether the COMT Val (158) Met polymorphism influences outcome on a cognitive battery 6 months following mTBI--Wechsler Adult Intelligence Test Processing Speed Index Composite Score (WAIS-PSI), Trail Making Test (TMT) Trail B minus Trail A time, and California Verbal Learning Test, Second Edition Trial 1-5 Standard Score (CVLT-II). All patients had an emergency department Glasgow Coma Scale (GCS) of 13-15, no acute intracranial pathology on head CT, and no polytrauma as defined by an Abbreviated Injury Scale (AIS) score of ≥3 in any extracranial region. Results in 100 subjects aged 40.9 (SD 15.2) years (COMT Met (158) /Met (158) 29 %, Met (158) /Val (158) 47 %, Val (158) /Val (158) 24 %) show that the COMT Met (158) allele (mean 101.6 ± SE 2.1) associates with higher nonverbal processing speed on the WAIS-PSI when compared to Val (158) /Val (158) homozygotes (93.8 ± SE 3.0) after controlling for demographics and injury severity (mean increase 7.9 points, 95 % CI [1.4 to 14.3], p = 0.017). The COMT Val (158) Met polymorphism did not associate with mental flexibility on the TMT or with verbal learning on the CVLT-II. Hence, COMT Val (158) Met may preferentially modulate nonverbal cognition following uncomplicated mTBI.Registry: ClinicalTrials.gov Identifier NCT01565551.
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Affiliation(s)
- Ethan A Winkler
- Department of Neurological Surgery, University of California, San Francisco, 1001 Potrero Avenue, Building 1, Room 101, San Francisco, CA, 94110, USA.,Brain and Spinal Injury Center, San Francisco General Hospital, San Francisco, CA, USA
| | - John K Yue
- Department of Neurological Surgery, University of California, San Francisco, 1001 Potrero Avenue, Building 1, Room 101, San Francisco, CA, 94110, USA.,Brain and Spinal Injury Center, San Francisco General Hospital, San Francisco, CA, USA
| | - Thomas W McAllister
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Nancy R Temkin
- Departments of Neurological Surgery and Biostatistics, University of Washington, Seattle, WA, USA
| | - Sam S Oh
- Department of Bioengineering and Therapeutic Sciences, University of California, San Francisco, San Francisco, CA, USA
| | - Esteban G Burchard
- Department of Bioengineering and Therapeutic Sciences, University of California, San Francisco, San Francisco, CA, USA
| | - Donglei Hu
- Department of Bioengineering and Therapeutic Sciences, University of California, San Francisco, San Francisco, CA, USA
| | - Adam R Ferguson
- Department of Neurological Surgery, University of California, San Francisco, 1001 Potrero Avenue, Building 1, Room 101, San Francisco, CA, 94110, USA.,Brain and Spinal Injury Center, San Francisco General Hospital, San Francisco, CA, USA
| | - Hester F Lingsma
- Department of Public Health, Erasmus Medical Center, Rotterdam, The Netherlands
| | - John F Burke
- Department of Neurological Surgery, University of California, San Francisco, 1001 Potrero Avenue, Building 1, Room 101, San Francisco, CA, 94110, USA.,Brain and Spinal Injury Center, San Francisco General Hospital, San Francisco, CA, USA
| | - Marco D Sorani
- Department of Neurological Surgery, University of California, San Francisco, 1001 Potrero Avenue, Building 1, Room 101, San Francisco, CA, 94110, USA.,Brain and Spinal Injury Center, San Francisco General Hospital, San Francisco, CA, USA
| | - Jonathan Rosand
- Department of Neurology, Harvard Medical School, Boston, MA, USA.,Program in Medical and Population Genetics, The Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Esther L Yuh
- Brain and Spinal Injury Center, San Francisco General Hospital, San Francisco, CA, USA.,Department of Radiology, University of California, San Francisco, San Francisco, CA, USA
| | - Jason Barber
- Departments of Neurological Surgery and Biostatistics, University of Washington, Seattle, WA, USA
| | - Phiroz E Tarapore
- Department of Neurological Surgery, University of California, San Francisco, 1001 Potrero Avenue, Building 1, Room 101, San Francisco, CA, 94110, USA.,Brain and Spinal Injury Center, San Francisco General Hospital, San Francisco, CA, USA
| | - Raquel C Gardner
- Department of Neurology, Harvard Medical School, Boston, MA, USA.,Department of Neurology, San Francisco Veterans Administration Medical Center, San Francisco, CA, USA
| | - Sourabh Sharma
- Department of Neurological Surgery, University of California, San Francisco, 1001 Potrero Avenue, Building 1, Room 101, San Francisco, CA, 94110, USA.,Brain and Spinal Injury Center, San Francisco General Hospital, San Francisco, CA, USA
| | - Gabriela G Satris
- Department of Neurological Surgery, University of California, San Francisco, 1001 Potrero Avenue, Building 1, Room 101, San Francisco, CA, 94110, USA.,Brain and Spinal Injury Center, San Francisco General Hospital, San Francisco, CA, USA
| | - Celeste Eng
- Department of Bioengineering and Therapeutic Sciences, University of California, San Francisco, San Francisco, CA, USA
| | - Ava M Puccio
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Kevin K W Wang
- Center for Neuroproteomics and Biomarkers Research, Departments of Psychiatry and Neuroscience, University of Florida, Gainesville, FL, USA
| | - Pratik Mukherjee
- Brain and Spinal Injury Center, San Francisco General Hospital, San Francisco, CA, USA.,Department of Radiology, University of California, San Francisco, San Francisco, CA, USA
| | | | - David O Okonkwo
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Ramon Diaz-Arrastia
- Department of Neurology, Uniformed Services University of the Health Sciences, Bethesda, MD, USA.,Center for Neuroscience and Regenerative Medicine, Bethesda, MD, USA
| | - Geoffrey T Manley
- Department of Neurological Surgery, University of California, San Francisco, 1001 Potrero Avenue, Building 1, Room 101, San Francisco, CA, 94110, USA. .,Brain and Spinal Injury Center, San Francisco General Hospital, San Francisco, CA, USA.
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98
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Van Beek L, Vanderauwera J, Ghesquière P, Lagae L, De Smedt B. Longitudinal changes in mathematical abilities and white matter following paediatric mild traumatic brain injury. Brain Inj 2015; 29:1701-10. [DOI: 10.3109/02699052.2015.1075172] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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99
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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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100
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Meier TB, Bellgowan PSF, Bergamino M, Ling JM, Mayer AR. Thinner Cortex in Collegiate Football Players With, but not Without, a Self-Reported History of Concussion. J Neurotrauma 2015; 33:330-8. [PMID: 26061068 DOI: 10.1089/neu.2015.3919] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Emerging evidence suggests that a history of sports-related concussions can lead to long-term neuroanatomical changes. The extent to which similar changes are present in young athletes is undetermined at this time. Here, we tested the hypothesis that collegiate football athletes with (n = 25) and without (n = 24) a self-reported history of concussion would have cortical thickness differences and altered white matter integrity relative to healthy controls (n = 27) in fronto-temporal regions that appear particularly susceptible to traumatic brain injury. Freesurfer software was used to estimate cortical thickness, fractional anisotropy was calculated in a priori white matter tracts, and behavior was assessed using a concussion behavioral battery. Groups did not differ in self-reported symptoms (p > 0.10) or cognitive performance (p > 0.10). Healthy controls reported significantly higher happiness levels than both football groups (all p < 0.01). Contrary to our hypothesis, no differences in fractional anisotropy were observed between our groups (p > 0.10). However, football athletes with a history of concussion had significantly thinner cortex in the left anterior cingulate cortex, orbital frontal cortex, and medial superior frontal cortex relative to healthy controls (p = 0.02, d = -0.69). Further, football athletes with a history of concussion had significantly thinner cortex in the right central sulcus and precentral gyrus relative to football athletes without a history of concussion (p = 0.03, d = -0.71). No differences were observed between football athletes without a history of concussion and healthy controls. These results suggest that previous concussions, but not necessarily football exposure, may be associated with cortical thickness differences in collegiate football athletes.
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Affiliation(s)
- Timothy B Meier
- 1 The Mind Research Network/Lovelace Biomedical and Environmental Research Institute , Albuquerque, New Mexico .,2 Laureate Institute for Brain Research , Tulsa, Oklahoma
| | - Patrick S F Bellgowan
- 3 National Institute of Neurological Disorders and Stroke, National Institute of Health , North Bethesda, Maryland
| | | | - Josef M Ling
- 1 The Mind Research Network/Lovelace Biomedical and Environmental Research Institute , Albuquerque, New Mexico
| | - Andrew R Mayer
- 1 The Mind Research Network/Lovelace Biomedical and Environmental Research Institute , Albuquerque, New Mexico .,4 Neurology Department, University of New Mexico School of Medicine , Albuquerque, New Mexico .,5 Department of Psychology, University of New Mexico , Albuquerque, New Mexico
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