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Rahmani F, Batson RD, Zimmerman A, Reddigari S, Bigler ED, Lanning SC, Ilasa E, Grafman JH, Lu H, Lin AP, Raji CA. Rate of abnormalities in quantitative MR neuroimaging of persons with chronic traumatic brain injury. BMC Neurol 2024; 24:235. [PMID: 38969967 PMCID: PMC11225195 DOI: 10.1186/s12883-024-03745-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Accepted: 06/26/2024] [Indexed: 07/07/2024] Open
Abstract
BACKGROUND Mild traumatic brain injury (mTBI) can result in lasting brain damage that is often too subtle to detect by qualitative visual inspection on conventional MR imaging. Although a number of FDA-cleared MR neuroimaging tools have demonstrated changes associated with mTBI, they are still under-utilized in clinical practice. METHODS We investigated a group of 65 individuals with predominantly mTBI (60 mTBI, 48 due to motor-vehicle collision, mean age 47 ± 13 years, 27 men and 38 women) with MR neuroimaging performed in a median of 37 months post-injury. We evaluated abnormalities in brain volumetry including analysis of left-right asymmetry by quantitative volumetric analysis, cerebral perfusion by pseudo-continuous arterial spin labeling (PCASL), white matter microstructure by diffusion tensor imaging (DTI), and neurometabolites via magnetic resonance spectroscopy (MRS). RESULTS All participants demonstrated atrophy in at least one lobar structure or increased lateral ventricular volume. The globus pallidi and cerebellar grey matter were most likely to demonstrate atrophy and asymmetry. Perfusion imaging revealed significant reductions of cerebral blood flow in both occipital and right frontoparietal regions. Diffusion abnormalities were relatively less common though a subset analysis of participants with higher resolution DTI demonstrated additional abnormalities. All participants showed abnormal levels on at least one brain metabolite, most commonly in choline and N-acetylaspartate. CONCLUSION We demonstrate the presence of coup-contrecoup perfusion injury patterns, widespread atrophy, regional brain volume asymmetry, and metabolic aberrations as sensitive markers of chronic mTBI sequelae. Our findings expand the historic focus on quantitative imaging of mTBI with DTI by highlighting the complementary importance of volumetry, arterial spin labeling perfusion and magnetic resonance spectroscopy neurometabolite analyses in the evaluation of chronic mTBI.
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Affiliation(s)
- Farzaneh Rahmani
- Department of Radiology, Washington University School of Medicine, Saint Louis, MO, USA
| | - Richard D Batson
- Endocrine & Brain Injury Research Alliance, Neurevolution Medicine, PLLC, NUNM Helfgott Research Institute, Portland, Oregon, USA
| | | | | | - Erin D Bigler
- Department of Neurology, Department of Psychiatry, University of Utah, Salt Lake City, UT, USA
| | | | | | - Jordan H Grafman
- Departments of Physical Medicine & Rehabilitation, Neurology, Cognitive Neurology and Alzheimer's Center, Department of Psychiatry, Feinberg School of Medicine, Department of Psychology, Weinberg College of Arts and Sciences, Northwestern University, Chicago, IL, USA
| | - Hanzhang Lu
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Alexander P Lin
- Center for Clinical Spectroscopy, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Cyrus A Raji
- Department of Radiology, Washington University School of Medicine, Saint Louis, MO, USA.
- Department of Neurology, Washington University School of Medicine, Saint Louis, MO, USA.
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Shahim P, Pham DL, van der Merwe AJ, Moore B, Chou Y, Lippa SM, Kenney K, Diaz‐Arrastia R, Chan L. Serum NfL and GFAP as biomarkers of progressive neurodegeneration in TBI. Alzheimers Dement 2024; 20:4663-4676. [PMID: 38805359 PMCID: PMC11247683 DOI: 10.1002/alz.13898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 04/01/2024] [Accepted: 04/12/2024] [Indexed: 05/30/2024]
Abstract
BACKGROUND We examined spatial patterns of brain atrophy after mild, moderate, and severe traumatic brain injury (TBI), the relationship between progression of brain atrophy with initial traumatic axonal injury (TAI), cognitive outcome, and with serum biomarkers of brain injury. METHODS A total of 143 patients with TBI and 43 controls were studied cross-sectionally and longitudinally up to 5 years with multiple assessments, which included brain magnetic resonance imaging, cognitive testing, and serum biomarkers. RESULTS TBI patients showed progressive volume loss regardless of injury severity over several years, and TAI was independently associated with accelerated brain atrophy. Cognitive performance improved over time. Higher baseline serum neurofilament light (NfL) and glial fibrillary acidic protein (GFAP) were associated with greater rate of brain atrophy over 5 years. DISCUSSSION Spatial patterns of atrophy differ by injury severity and TAI is associated with the progression of brain atrophy. Serum NfL and GFAP show promise as non-invasive prognostic biomarkers of progressive neurodegeneration in TBI. HIGHLIGHTS In this longitudinal study of patient with mild, moderate, and severe traumatic brain injury (TBI) who were assessed with paired magnetic resonance imaging (MRI), blood biomarkers, and cognitive assessments, we found that brain atrophy after TBI is progressive and continues for many years even after a mild head trauma without signs of brain injury on conventional MRI. We found that spatial pattern of brain atrophy differs between mild, moderate, and severe TBI, where in patients with mild TBI , atrophy is mainly seen in the gray matter, while in those with moderate to severe brain injury atrophy is predominantly seen in the subcortical gray matter and whiter matter. Cognitive performance improves over time after a TBI. Serum measures of neurofilament light or glial fibrillary acidic protein are associated with progression of brain atrophy after TBI.
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Affiliation(s)
- Pashtun Shahim
- Rehabilitation Medicine DepartmentNational Institutes of Health (NIH) Clinical CenterBethesdaMarylandUSA
- National Institutes of Neurological Disorders and Stroke, NIHBethesdaMarylandUSA
- Department of NeurologyMedStar Georgetown University Hospital, Pasquerilla Healthcare CenterWashingtonDistrict of ColumbiaUSA
- The Military Traumatic Brain Injury Initiative (MTBI2)BethesdaMarylandUSA
- The Henry M. Jackson Foundation for the Advancement of Military MedicineBethesdaMarylandUSA
| | - Dzung L. Pham
- The Military Traumatic Brain Injury Initiative (MTBI2)BethesdaMarylandUSA
- Uniformed Services University of the Health SciencesBethesdaMarylandUSA
| | - Andre J. van der Merwe
- Rehabilitation Medicine DepartmentNational Institutes of Health (NIH) Clinical CenterBethesdaMarylandUSA
- The Military Traumatic Brain Injury Initiative (MTBI2)BethesdaMarylandUSA
- The Henry M. Jackson Foundation for the Advancement of Military MedicineBethesdaMarylandUSA
| | - Brian Moore
- Rehabilitation Medicine DepartmentNational Institutes of Health (NIH) Clinical CenterBethesdaMarylandUSA
- The Military Traumatic Brain Injury Initiative (MTBI2)BethesdaMarylandUSA
- The Henry M. Jackson Foundation for the Advancement of Military MedicineBethesdaMarylandUSA
| | - Yi‐Yu Chou
- The Military Traumatic Brain Injury Initiative (MTBI2)BethesdaMarylandUSA
- The Henry M. Jackson Foundation for the Advancement of Military MedicineBethesdaMarylandUSA
| | - Sara M. Lippa
- Uniformed Services University of the Health SciencesBethesdaMarylandUSA
- National Intrepid Center of Excellence, Walter Reed National Military Medical CenterBethesdaMarylandUSA
| | - Kimbra Kenney
- Uniformed Services University of the Health SciencesBethesdaMarylandUSA
- National Intrepid Center of Excellence, Walter Reed National Military Medical CenterBethesdaMarylandUSA
| | - Ramon Diaz‐Arrastia
- Department of NeurologyUniversity of Pennsylvania Perelman School of MedicinePhiladelphiaPennsylvaniaUSA
| | - Leighton Chan
- Rehabilitation Medicine DepartmentNational Institutes of Health (NIH) Clinical CenterBethesdaMarylandUSA
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Freeman HJ, Atalay AS, Li J, Sobczak E, Snider SB, Carrington H, Selmanovic E, Pruyser A, Bura L, Sheppard D, Hunt D, Seifert AC, Bodien YG, Hoffman JM, Donald CLM, Dams-O'Connor K, Edlow BL. Longitudinal Lesion Expansion in Chronic Traumatic Brain Injury. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.06.24.24309307. [PMID: 38978662 PMCID: PMC11230300 DOI: 10.1101/2024.06.24.24309307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/10/2024]
Abstract
Traumatic brain injury (TBI) is a risk factor for neurodegeneration and cognitive decline, yet the underlying pathophysiologic mechanisms are incompletely understood. This gap in knowledge is in part related to the lack of analytic methods to account for cortical lesions in prior neuroimaging studies. The objective of this study was to develop a lesion detection tool and apply it to an investigation of longitudinal changes in brain structure among individuals with chronic TBI. We identified 24 individuals with chronic moderate-to-severe TBI enrolled in the Late Effects of TBI (LETBI) study who had cortical lesions detected by T1-weighted MRI at two time points. Initial MRI scans were performed more than 1-year post-injury and follow-up scans were performed 3.1 (IQR=1.7) years later. We leveraged FreeSurfer parcellations of T1-weighted MRI volumes and a recently developed super-resolution technique, SynthSR, to identify cortical lesions in this longitudinal dataset. Trained raters received the data in a randomized order and manually corrected the automated lesion segmentation, yielding a final lesion mask for each scan at each timepoint. Lesion volume significantly increased between the two time points with a median volume change of 3.2 (IQR=5.9) mL (p<0.001), and the increases significantly exceeded the possible variance in lesion volume changes due to manual tracing errors (p < 0.001). Lesion volume significantly expanded longitudinally in 23 of 24 subjects, with all FDR corrected p-values ≤ 0.02. Inter-scan duration was not associated with the magnitude of lesion growth. We also demonstrated that the semi-automated tool showed a high level of accuracy compared to "ground truth" manual lesion segmentation. Semi-automated lesion segmentation is feasible in TBI studies and creates opportunities to elucidate mechanisms of post-traumatic neurodegeneration.
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4
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Chan ST, Mercaldo N, Figueiro Longo MG, Welt J, Avesta A, Lee J, Lev MH, Ratai EM, Wenke MR, Parry BA, Drake L, Anderson RR, Rauch T, Diaz-Arrastia R, Kwong KK, Hamblin M, Vakoc BJ, Gupta R, Panzer A. Effects of Low-Level Light Therapy on Resting-State Connectivity Following Moderate Traumatic Brain Injury: Secondary Analyses of a Double-blinded Placebo-controlled Study. Radiology 2024; 311:e230999. [PMID: 38805733 PMCID: PMC11140530 DOI: 10.1148/radiol.230999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Revised: 02/28/2024] [Accepted: 04/08/2024] [Indexed: 05/30/2024]
Abstract
Background Low-level light therapy (LLLT) has been shown to modulate recovery in patients with traumatic brain injury (TBI). However, the impact of LLLT on the functional connectivity of the brain when at rest has not been well studied. Purpose To use functional MRI to assess the effect of LLLT on whole-brain resting-state functional connectivity (RSFC) in patients with moderate TBI at acute (within 1 week), subacute (2-3 weeks), and late-subacute (3 months) recovery phases. Materials and Methods This is a secondary analysis of a prospective single-site double-blinded sham-controlled study conducted in patients presenting to the emergency department with moderate TBI from November 2015 to July 2019. Participants were randomized for LLLT and sham treatment. The primary outcome of the study was to assess structural connectivity, and RSFC was collected as the secondary outcome. MRI was used to measure RSFC in 82 brain regions in participants during the three recovery phases. Healthy individuals who did not receive treatment were imaged at a single time point to provide control values. The Pearson correlation coefficient was estimated to assess the connectivity strength for each brain region pair, and estimates of the differences in Fisher z-transformed correlation coefficients (hereafter, z differences) were compared between recovery phases and treatment groups using a linear mixed-effects regression model. These analyses were repeated for all brain region pairs. False discovery rate (FDR)-adjusted P values were computed to account for multiple comparisons. Quantile mixed-effects models were constructed to quantify the association between the Rivermead Postconcussion Symptoms Questionnaire (RPQ) score, recovery phase, and treatment group. Results RSFC was evaluated in 17 LLLT-treated participants (median age, 50 years [IQR, 25-67 years]; nine female), 21 sham-treated participants (median age, 50 years [IQR, 43-59 years]; 11 female), and 23 healthy control participants (median age, 42 years [IQR, 32-54 years]; 13 male). Seven brain region pairs exhibited a greater change in connectivity in LLLT-treated participants than in sham-treated participants between the acute and subacute phases (range of z differences, 0.37 [95% CI: 0.20, 0.53] to 0.45 [95% CI: 0.24, 0.67]; FDR-adjusted P value range, .010-.047). Thirteen different brain region pairs showed an increase in connectivity in sham-treated participants between the subacute and late-subacute phases (range of z differences, 0.17 [95% CI: 0.09, 0.25] to 0.26 [95% CI: 0.14, 0.39]; FDR-adjusted P value range, .020-.047). There was no evidence of a difference in clinical outcomes between LLLT-treated and sham-treated participants (range of differences in medians, -3.54 [95% CI: -12.65, 5.57] to -0.59 [95% CI: -7.31, 8.49]; P value range, .44-.99), as measured according to RPQ scores. Conclusion Despite the small sample size, the change in RSFC from the acute to subacute phases of recovery was greater in LLLT-treated than sham-treated participants, suggesting that acute-phase LLLT may have an impact on resting-state neuronal circuits in the early recovery phase of moderate TBI. ClinicalTrials.gov Identifier: NCT02233413 © RSNA, 2024 Supplemental material is available for this article.
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Affiliation(s)
| | | | - Maria G. Figueiro Longo
- From the Athinoula A. Martinos Center for Biomedical Imaging (S.T.C.,
E.M.R., K.K.K.), Department of Radiology (S.T.C., N.M., M.G.F.L., A.A., M.H.L.,
E.M.R., K.K.K., R.G.), Wellman Center for Photomedicine (L.D., R.R.A., M.H.,
B.J.V.), Department of Emergency Medicine (J.L., B.A.P.), and Department of
Surgery (J.L.), Massachusetts General Hospital, 55 Fruit St, Boston, MA 02129;
Department of Anesthesiology and Perioperative Care, University of California
Irvine, Orange, Calif (J.W.); Department of Radiology, Yale School of Medicine,
New Haven, Conn (A.A.); Neuroscience Institute, Huck Institutes of the Life
Sciences, Pennsylvania State University, State College, Pa (M.R.W.);
Pennsylvania State College of Medicine, Milton S. Hershey Medical Center,
Hershey, Pa (M.R.W.); Office of Secretary of Defense, Department of Defense,
Washington, DC (T.R.); and Department of Neurology, University of Pennsylvania,
Philadelphia, Pa (R.D.A.)
| | - Jonathan Welt
- From the Athinoula A. Martinos Center for Biomedical Imaging (S.T.C.,
E.M.R., K.K.K.), Department of Radiology (S.T.C., N.M., M.G.F.L., A.A., M.H.L.,
E.M.R., K.K.K., R.G.), Wellman Center for Photomedicine (L.D., R.R.A., M.H.,
B.J.V.), Department of Emergency Medicine (J.L., B.A.P.), and Department of
Surgery (J.L.), Massachusetts General Hospital, 55 Fruit St, Boston, MA 02129;
Department of Anesthesiology and Perioperative Care, University of California
Irvine, Orange, Calif (J.W.); Department of Radiology, Yale School of Medicine,
New Haven, Conn (A.A.); Neuroscience Institute, Huck Institutes of the Life
Sciences, Pennsylvania State University, State College, Pa (M.R.W.);
Pennsylvania State College of Medicine, Milton S. Hershey Medical Center,
Hershey, Pa (M.R.W.); Office of Secretary of Defense, Department of Defense,
Washington, DC (T.R.); and Department of Neurology, University of Pennsylvania,
Philadelphia, Pa (R.D.A.)
| | - Arman Avesta
- From the Athinoula A. Martinos Center for Biomedical Imaging (S.T.C.,
E.M.R., K.K.K.), Department of Radiology (S.T.C., N.M., M.G.F.L., A.A., M.H.L.,
E.M.R., K.K.K., R.G.), Wellman Center for Photomedicine (L.D., R.R.A., M.H.,
B.J.V.), Department of Emergency Medicine (J.L., B.A.P.), and Department of
Surgery (J.L.), Massachusetts General Hospital, 55 Fruit St, Boston, MA 02129;
Department of Anesthesiology and Perioperative Care, University of California
Irvine, Orange, Calif (J.W.); Department of Radiology, Yale School of Medicine,
New Haven, Conn (A.A.); Neuroscience Institute, Huck Institutes of the Life
Sciences, Pennsylvania State University, State College, Pa (M.R.W.);
Pennsylvania State College of Medicine, Milton S. Hershey Medical Center,
Hershey, Pa (M.R.W.); Office of Secretary of Defense, Department of Defense,
Washington, DC (T.R.); and Department of Neurology, University of Pennsylvania,
Philadelphia, Pa (R.D.A.)
| | - Jarone Lee
- From the Athinoula A. Martinos Center for Biomedical Imaging (S.T.C.,
E.M.R., K.K.K.), Department of Radiology (S.T.C., N.M., M.G.F.L., A.A., M.H.L.,
E.M.R., K.K.K., R.G.), Wellman Center for Photomedicine (L.D., R.R.A., M.H.,
B.J.V.), Department of Emergency Medicine (J.L., B.A.P.), and Department of
Surgery (J.L.), Massachusetts General Hospital, 55 Fruit St, Boston, MA 02129;
Department of Anesthesiology and Perioperative Care, University of California
Irvine, Orange, Calif (J.W.); Department of Radiology, Yale School of Medicine,
New Haven, Conn (A.A.); Neuroscience Institute, Huck Institutes of the Life
Sciences, Pennsylvania State University, State College, Pa (M.R.W.);
Pennsylvania State College of Medicine, Milton S. Hershey Medical Center,
Hershey, Pa (M.R.W.); Office of Secretary of Defense, Department of Defense,
Washington, DC (T.R.); and Department of Neurology, University of Pennsylvania,
Philadelphia, Pa (R.D.A.)
| | - Michael H. Lev
- From the Athinoula A. Martinos Center for Biomedical Imaging (S.T.C.,
E.M.R., K.K.K.), Department of Radiology (S.T.C., N.M., M.G.F.L., A.A., M.H.L.,
E.M.R., K.K.K., R.G.), Wellman Center for Photomedicine (L.D., R.R.A., M.H.,
B.J.V.), Department of Emergency Medicine (J.L., B.A.P.), and Department of
Surgery (J.L.), Massachusetts General Hospital, 55 Fruit St, Boston, MA 02129;
Department of Anesthesiology and Perioperative Care, University of California
Irvine, Orange, Calif (J.W.); Department of Radiology, Yale School of Medicine,
New Haven, Conn (A.A.); Neuroscience Institute, Huck Institutes of the Life
Sciences, Pennsylvania State University, State College, Pa (M.R.W.);
Pennsylvania State College of Medicine, Milton S. Hershey Medical Center,
Hershey, Pa (M.R.W.); Office of Secretary of Defense, Department of Defense,
Washington, DC (T.R.); and Department of Neurology, University of Pennsylvania,
Philadelphia, Pa (R.D.A.)
| | - Eva-Maria Ratai
- From the Athinoula A. Martinos Center for Biomedical Imaging (S.T.C.,
E.M.R., K.K.K.), Department of Radiology (S.T.C., N.M., M.G.F.L., A.A., M.H.L.,
E.M.R., K.K.K., R.G.), Wellman Center for Photomedicine (L.D., R.R.A., M.H.,
B.J.V.), Department of Emergency Medicine (J.L., B.A.P.), and Department of
Surgery (J.L.), Massachusetts General Hospital, 55 Fruit St, Boston, MA 02129;
Department of Anesthesiology and Perioperative Care, University of California
Irvine, Orange, Calif (J.W.); Department of Radiology, Yale School of Medicine,
New Haven, Conn (A.A.); Neuroscience Institute, Huck Institutes of the Life
Sciences, Pennsylvania State University, State College, Pa (M.R.W.);
Pennsylvania State College of Medicine, Milton S. Hershey Medical Center,
Hershey, Pa (M.R.W.); Office of Secretary of Defense, Department of Defense,
Washington, DC (T.R.); and Department of Neurology, University of Pennsylvania,
Philadelphia, Pa (R.D.A.)
| | - Michael R. Wenke
- From the Athinoula A. Martinos Center for Biomedical Imaging (S.T.C.,
E.M.R., K.K.K.), Department of Radiology (S.T.C., N.M., M.G.F.L., A.A., M.H.L.,
E.M.R., K.K.K., R.G.), Wellman Center for Photomedicine (L.D., R.R.A., M.H.,
B.J.V.), Department of Emergency Medicine (J.L., B.A.P.), and Department of
Surgery (J.L.), Massachusetts General Hospital, 55 Fruit St, Boston, MA 02129;
Department of Anesthesiology and Perioperative Care, University of California
Irvine, Orange, Calif (J.W.); Department of Radiology, Yale School of Medicine,
New Haven, Conn (A.A.); Neuroscience Institute, Huck Institutes of the Life
Sciences, Pennsylvania State University, State College, Pa (M.R.W.);
Pennsylvania State College of Medicine, Milton S. Hershey Medical Center,
Hershey, Pa (M.R.W.); Office of Secretary of Defense, Department of Defense,
Washington, DC (T.R.); and Department of Neurology, University of Pennsylvania,
Philadelphia, Pa (R.D.A.)
| | - Blair A. Parry
- From the Athinoula A. Martinos Center for Biomedical Imaging (S.T.C.,
E.M.R., K.K.K.), Department of Radiology (S.T.C., N.M., M.G.F.L., A.A., M.H.L.,
E.M.R., K.K.K., R.G.), Wellman Center for Photomedicine (L.D., R.R.A., M.H.,
B.J.V.), Department of Emergency Medicine (J.L., B.A.P.), and Department of
Surgery (J.L.), Massachusetts General Hospital, 55 Fruit St, Boston, MA 02129;
Department of Anesthesiology and Perioperative Care, University of California
Irvine, Orange, Calif (J.W.); Department of Radiology, Yale School of Medicine,
New Haven, Conn (A.A.); Neuroscience Institute, Huck Institutes of the Life
Sciences, Pennsylvania State University, State College, Pa (M.R.W.);
Pennsylvania State College of Medicine, Milton S. Hershey Medical Center,
Hershey, Pa (M.R.W.); Office of Secretary of Defense, Department of Defense,
Washington, DC (T.R.); and Department of Neurology, University of Pennsylvania,
Philadelphia, Pa (R.D.A.)
| | - Lynn Drake
- From the Athinoula A. Martinos Center for Biomedical Imaging (S.T.C.,
E.M.R., K.K.K.), Department of Radiology (S.T.C., N.M., M.G.F.L., A.A., M.H.L.,
E.M.R., K.K.K., R.G.), Wellman Center for Photomedicine (L.D., R.R.A., M.H.,
B.J.V.), Department of Emergency Medicine (J.L., B.A.P.), and Department of
Surgery (J.L.), Massachusetts General Hospital, 55 Fruit St, Boston, MA 02129;
Department of Anesthesiology and Perioperative Care, University of California
Irvine, Orange, Calif (J.W.); Department of Radiology, Yale School of Medicine,
New Haven, Conn (A.A.); Neuroscience Institute, Huck Institutes of the Life
Sciences, Pennsylvania State University, State College, Pa (M.R.W.);
Pennsylvania State College of Medicine, Milton S. Hershey Medical Center,
Hershey, Pa (M.R.W.); Office of Secretary of Defense, Department of Defense,
Washington, DC (T.R.); and Department of Neurology, University of Pennsylvania,
Philadelphia, Pa (R.D.A.)
| | - Richard R. Anderson
- From the Athinoula A. Martinos Center for Biomedical Imaging (S.T.C.,
E.M.R., K.K.K.), Department of Radiology (S.T.C., N.M., M.G.F.L., A.A., M.H.L.,
E.M.R., K.K.K., R.G.), Wellman Center for Photomedicine (L.D., R.R.A., M.H.,
B.J.V.), Department of Emergency Medicine (J.L., B.A.P.), and Department of
Surgery (J.L.), Massachusetts General Hospital, 55 Fruit St, Boston, MA 02129;
Department of Anesthesiology and Perioperative Care, University of California
Irvine, Orange, Calif (J.W.); Department of Radiology, Yale School of Medicine,
New Haven, Conn (A.A.); Neuroscience Institute, Huck Institutes of the Life
Sciences, Pennsylvania State University, State College, Pa (M.R.W.);
Pennsylvania State College of Medicine, Milton S. Hershey Medical Center,
Hershey, Pa (M.R.W.); Office of Secretary of Defense, Department of Defense,
Washington, DC (T.R.); and Department of Neurology, University of Pennsylvania,
Philadelphia, Pa (R.D.A.)
| | - Terry Rauch
- From the Athinoula A. Martinos Center for Biomedical Imaging (S.T.C.,
E.M.R., K.K.K.), Department of Radiology (S.T.C., N.M., M.G.F.L., A.A., M.H.L.,
E.M.R., K.K.K., R.G.), Wellman Center for Photomedicine (L.D., R.R.A., M.H.,
B.J.V.), Department of Emergency Medicine (J.L., B.A.P.), and Department of
Surgery (J.L.), Massachusetts General Hospital, 55 Fruit St, Boston, MA 02129;
Department of Anesthesiology and Perioperative Care, University of California
Irvine, Orange, Calif (J.W.); Department of Radiology, Yale School of Medicine,
New Haven, Conn (A.A.); Neuroscience Institute, Huck Institutes of the Life
Sciences, Pennsylvania State University, State College, Pa (M.R.W.);
Pennsylvania State College of Medicine, Milton S. Hershey Medical Center,
Hershey, Pa (M.R.W.); Office of Secretary of Defense, Department of Defense,
Washington, DC (T.R.); and Department of Neurology, University of Pennsylvania,
Philadelphia, Pa (R.D.A.)
| | - Ramon Diaz-Arrastia
- From the Athinoula A. Martinos Center for Biomedical Imaging (S.T.C.,
E.M.R., K.K.K.), Department of Radiology (S.T.C., N.M., M.G.F.L., A.A., M.H.L.,
E.M.R., K.K.K., R.G.), Wellman Center for Photomedicine (L.D., R.R.A., M.H.,
B.J.V.), Department of Emergency Medicine (J.L., B.A.P.), and Department of
Surgery (J.L.), Massachusetts General Hospital, 55 Fruit St, Boston, MA 02129;
Department of Anesthesiology and Perioperative Care, University of California
Irvine, Orange, Calif (J.W.); Department of Radiology, Yale School of Medicine,
New Haven, Conn (A.A.); Neuroscience Institute, Huck Institutes of the Life
Sciences, Pennsylvania State University, State College, Pa (M.R.W.);
Pennsylvania State College of Medicine, Milton S. Hershey Medical Center,
Hershey, Pa (M.R.W.); Office of Secretary of Defense, Department of Defense,
Washington, DC (T.R.); and Department of Neurology, University of Pennsylvania,
Philadelphia, Pa (R.D.A.)
| | - Kenneth K. Kwong
- From the Athinoula A. Martinos Center for Biomedical Imaging (S.T.C.,
E.M.R., K.K.K.), Department of Radiology (S.T.C., N.M., M.G.F.L., A.A., M.H.L.,
E.M.R., K.K.K., R.G.), Wellman Center for Photomedicine (L.D., R.R.A., M.H.,
B.J.V.), Department of Emergency Medicine (J.L., B.A.P.), and Department of
Surgery (J.L.), Massachusetts General Hospital, 55 Fruit St, Boston, MA 02129;
Department of Anesthesiology and Perioperative Care, University of California
Irvine, Orange, Calif (J.W.); Department of Radiology, Yale School of Medicine,
New Haven, Conn (A.A.); Neuroscience Institute, Huck Institutes of the Life
Sciences, Pennsylvania State University, State College, Pa (M.R.W.);
Pennsylvania State College of Medicine, Milton S. Hershey Medical Center,
Hershey, Pa (M.R.W.); Office of Secretary of Defense, Department of Defense,
Washington, DC (T.R.); and Department of Neurology, University of Pennsylvania,
Philadelphia, Pa (R.D.A.)
| | - Michael Hamblin
- From the Athinoula A. Martinos Center for Biomedical Imaging (S.T.C.,
E.M.R., K.K.K.), Department of Radiology (S.T.C., N.M., M.G.F.L., A.A., M.H.L.,
E.M.R., K.K.K., R.G.), Wellman Center for Photomedicine (L.D., R.R.A., M.H.,
B.J.V.), Department of Emergency Medicine (J.L., B.A.P.), and Department of
Surgery (J.L.), Massachusetts General Hospital, 55 Fruit St, Boston, MA 02129;
Department of Anesthesiology and Perioperative Care, University of California
Irvine, Orange, Calif (J.W.); Department of Radiology, Yale School of Medicine,
New Haven, Conn (A.A.); Neuroscience Institute, Huck Institutes of the Life
Sciences, Pennsylvania State University, State College, Pa (M.R.W.);
Pennsylvania State College of Medicine, Milton S. Hershey Medical Center,
Hershey, Pa (M.R.W.); Office of Secretary of Defense, Department of Defense,
Washington, DC (T.R.); and Department of Neurology, University of Pennsylvania,
Philadelphia, Pa (R.D.A.)
| | | | | | - Ariane Panzer
- From the Athinoula A. Martinos Center for Biomedical Imaging (S.T.C.,
E.M.R., K.K.K.), Department of Radiology (S.T.C., N.M., M.G.F.L., A.A., M.H.L.,
E.M.R., K.K.K., R.G.), Wellman Center for Photomedicine (L.D., R.R.A., M.H.,
B.J.V.), Department of Emergency Medicine (J.L., B.A.P.), and Department of
Surgery (J.L.), Massachusetts General Hospital, 55 Fruit St, Boston, MA 02129;
Department of Anesthesiology and Perioperative Care, University of California
Irvine, Orange, Calif (J.W.); Department of Radiology, Yale School of Medicine,
New Haven, Conn (A.A.); Neuroscience Institute, Huck Institutes of the Life
Sciences, Pennsylvania State University, State College, Pa (M.R.W.);
Pennsylvania State College of Medicine, Milton S. Hershey Medical Center,
Hershey, Pa (M.R.W.); Office of Secretary of Defense, Department of Defense,
Washington, DC (T.R.); and Department of Neurology, University of Pennsylvania,
Philadelphia, Pa (R.D.A.)
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5
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Kadaba Sridhar S, Dysterheft Robb J, Gupta R, Cheong S, Kuang R, Samadani U. Structural neuroimaging markers of normal pressure hydrocephalus versus Alzheimer's dementia and Parkinson's disease, and hydrocephalus versus atrophy in chronic TBI-a narrative review. Front Neurol 2024; 15:1347200. [PMID: 38576534 PMCID: PMC10991762 DOI: 10.3389/fneur.2024.1347200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 02/07/2024] [Indexed: 04/06/2024] Open
Abstract
Introduction Normal Pressure Hydrocephalus (NPH) is a prominent type of reversible dementia that may be treated with shunt surgery, and it is crucial to differentiate it from irreversible degeneration caused by its symptomatic mimics like Alzheimer's Dementia (AD) and Parkinson's Disease (PD). Similarly, it is important to distinguish between (normal pressure) hydrocephalus and irreversible atrophy/degeneration which are among the chronic effects of Traumatic Brain Injury (cTBI), as the former may be reversed through shunt placement. The purpose of this review is to elucidate the structural imaging markers which may be foundational to the development of accurate, noninvasive, and accessible solutions to this problem. Methods By searching the PubMed database for keywords related to NPH, AD, PD, and cTBI, we reviewed studies that examined the (1) distinct neuroanatomical markers of degeneration in NPH versus AD and PD, and atrophy versus hydrocephalus in cTBI and (2) computational methods for their (semi-) automatic assessment on Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) scans. Results Structural markers of NPH and those that can distinguish it from AD have been well studied, but only a few studies have explored its structural distinction between PD. The structural implications of cTBI over time have been studied. But neuroanatomical markers that can predict shunt response in patients with either symptomatic idiopathic NPH or post-traumatic hydrocephalus have not been reliably established. MRI-based markers dominate this field of investigation as compared to CT, which is also reflected in the disproportionate number of MRI-based computational methods for their automatic assessment. Conclusion Along with an up-to-date literature review on the structural neurodegeneration due to NPH versus AD/PD, and hydrocephalus versus atrophy in cTBI, this article sheds light on the potential of structural imaging markers as (differential) diagnostic aids for the timely recognition of patients with reversible (normal pressure) hydrocephalus, and opportunities to develop computational tools for their objective assessment.
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Affiliation(s)
- Sharada Kadaba Sridhar
- Department of Bioinformatics and Computational Biology, University of Minnesota, Minneapolis, MN, United States
- Neurotrauma Research Lab, Center for Veterans Research and Education, Minneapolis, MN, United States
| | - Jen Dysterheft Robb
- Neurotrauma Research Lab, Center for Veterans Research and Education, Minneapolis, MN, United States
| | - Rishabh Gupta
- Neurotrauma Research Lab, Center for Veterans Research and Education, Minneapolis, MN, United States
- University of Minnesota Twin Cities Medical School, Minneapolis, MN, United States
| | - Scarlett Cheong
- Department of Bioinformatics and Computational Biology, University of Minnesota, Minneapolis, MN, United States
- Neurotrauma Research Lab, Center for Veterans Research and Education, Minneapolis, MN, United States
| | - Rui Kuang
- Department of Bioinformatics and Computational Biology, University of Minnesota, Minneapolis, MN, United States
- Department of Computer Science and Engineering, University of Minnesota, Minneapolis, MN, United States
| | - Uzma Samadani
- Department of Bioinformatics and Computational Biology, University of Minnesota, Minneapolis, MN, United States
- Neurotrauma Research Lab, Center for Veterans Research and Education, Minneapolis, MN, United States
- University of Minnesota Twin Cities Medical School, Minneapolis, MN, United States
- Department of Computer Science and Engineering, University of Minnesota, Minneapolis, MN, United States
- Division of Neurosurgery, Department of Surgery, Minneapolis Veterans Affairs Health Care System, Minneapolis, MN, United States
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6
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Domínguez D JF, Stewart A, Burmester A, Akhlaghi H, O'Brien K, Bollmann S, Caeyenberghs K. Improving quantitative susceptibility mapping for the identification of traumatic brain injury neurodegeneration at the individual level. Z Med Phys 2024:S0939-3889(24)00001-1. [PMID: 38336583 DOI: 10.1016/j.zemedi.2024.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 12/19/2023] [Accepted: 01/07/2024] [Indexed: 02/12/2024]
Abstract
BACKGROUND Emerging evidence suggests that traumatic brain injury (TBI) is a major risk factor for developing neurodegenerative disease later in life. Quantitative susceptibility mapping (QSM) has been used by an increasing number of studies in investigations of pathophysiological changes in TBI. However, generating artefact-free quantitative susceptibility maps in brains with large focal lesions, as in the case of moderate-to-severe TBI (ms-TBI), is particularly challenging. To address this issue, we utilized a novel two-pass masking technique and reconstruction procedure (two-pass QSM) to generate quantitative susceptibility maps (QSMxT; Stewart et al., 2022, Magn Reson Med.) in combination with the recently developed virtual brain grafting (VBG) procedure for brain repair (Radwan et al., 2021, NeuroImage) to improve automated delineation of brain areas. We used QSMxT and VBG to generate personalised QSM profiles of individual patients with reference to a sample of healthy controls. METHODS Chronic ms-TBI patients (N = 8) and healthy controls (N = 12) underwent (multi-echo) GRE, and anatomical MRI (MPRAGE) on a 3T Siemens PRISMA scanner. We reconstructed the magnetic susceptibility maps using two-pass QSM from QSMxT. We then extracted values of magnetic susceptibility in grey matter (GM) regions (following brain repair via VBG) across the whole brain and determined if they deviate from a reference healthy control group [Z-score < -3.43 or > 3.43, relative to the control mean], with the aim of obtaining personalised QSM profiles. RESULTS Using two-pass QSM, we achieved susceptibility maps with a substantial increase in quality and reduction in artefacts irrespective of the presence of large focal lesions, compared to single-pass QSM. In addition, VBG minimised the loss of GM regions and exclusion of patients due to failures in the region delineation step. Our findings revealed deviations in magnetic susceptibility measures from the HC group that differed across individual TBI patients. These changes included both increases and decreases in magnetic susceptibility values in multiple GM regions across the brain. CONCLUSIONS We illustrate how to obtain magnetic susceptibility values at the individual level and to build personalised QSM profiles in ms-TBI patients. Our approach opens the door for QSM investigations in more severely injured patients. Such profiles are also critical to overcome the inherent heterogeneity of clinical populations, such as ms-TBI, and to characterize the underlying mechanisms of neurodegeneration at the individual level more precisely. Moreover, this new personalised QSM profiling could in the future assist clinicians in assessing recovery and formulating a neuroscience-guided integrative rehabilitation program tailored to individual TBI patients.
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Affiliation(s)
- Juan F Domínguez D
- Cognitive Neuroscience Unit, School of Psychology, Deakin University, Geelong, Australia.
| | - Ashley Stewart
- School of Information Technology and Electrical Engineering, Faculty of Engineering, Architecture, and Information Technology, The University of Queensland, Brisbane, Australia
| | - Alex Burmester
- Cognitive Neuroscience Unit, School of Psychology, Deakin University, Geelong, Australia
| | - Hamed Akhlaghi
- Cognitive Neuroscience Unit, School of Psychology, Deakin University, Geelong, Australia; Department of Emergency Medicine, St. Vincent's Hospital, Melbourne, Australia
| | - Kieran O'Brien
- Siemens Healthcare Pty Ltd, Brisbane, Queensland, Australia
| | - Steffen Bollmann
- School of Information Technology and Electrical Engineering, Faculty of Engineering, Architecture, and Information Technology, The University of Queensland, Brisbane, Australia; Centre for Advanced Imaging, The University of Queensland, Brisbane, Australia
| | - Karen Caeyenberghs
- Cognitive Neuroscience Unit, School of Psychology, Deakin University, Geelong, Australia
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7
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Donnelly RR, Ugbolue UC, Gao Y, Gu Y, Dutheil F, Baker JS. A Systematic Review and Meta-Analysis Investigating Head Trauma in Boxing. Clin J Sport Med 2023; 33:658-674. [PMID: 37862081 PMCID: PMC10597432 DOI: 10.1097/jsm.0000000000001195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 05/22/2023] [Indexed: 10/21/2023]
Abstract
OBJECTIVES Although physical trauma has been reported in boxing since its inception, boxing still appeals to athletes and spectators. This systematic review and meta-analysis assess both acute and chronic neurological and neuropsychological effects that boxing has on the brain. Further assessments in terms of comparisons of the concussion ratio in boxing to other combat sports, as well as the efficiency of wearing headguards, are also performed. DATA SOURCES This systematic review and meta-analysis used the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. The outcomes incorporated included physical chronic abnormalities of the brain, neuropsychiatric, and neurological disorders sustained in amateur or professional boxing, in addition to the safety benefits of boxing headguards. Odds ratios, descriptive statistics, and inferential statistics are also reported. MAIN RESULTS From the 84 articles reviewed, the 35 included articles suggested that boxers have a significantly elevated risk of sustaining a concussion compared with other combat sports (risk ratio [RR]: 0.253 vs RR: 0.065, P < 0.001). From the 631 amateur and professional boxers analyzed, 147 (23.30%) had cavum septum pellucidum, whereas 125 of 411 amateur and professional boxers (30.41%) presented with some form of brain atrophy. Dementia or amnesia was observed in 46 of 71 boxers (61.79%), 36 of 70 (51.43%) had various forms and severities of cognitive disorders, and 57 of 109 (52.29%) displayed abnormal computed tomography or electroencephalogram scan results. Utilization of headguards significantly increased the risk for stoppages in amateur bouts, compared with boxers not wearing a headguard (OR: 1.75 vs 0.53, P < 0.050). CONCLUSIONS Boxing is a hazardous sport that has the potential to have fatal and negative life-changing results. Because of the limited reliable data regarding the efficiency of boxing headguards, future research should focus on the overall significance that headguards may have for reducing head trauma.
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Affiliation(s)
- Robert R. Donnelly
- Faculty of Sports Science, Ningbo University, Ningbo, China
- School of Health and Life Sciences, Institute for Clinical Exercise & Health Science, University of the West of Scotland, South Lanarkshire, Scotland, United Kingdom
| | - Ukadike Chris Ugbolue
- Faculty of Sports Science, Ningbo University, Ningbo, China
- School of Health and Life Sciences, Institute for Clinical Exercise & Health Science, University of the West of Scotland, South Lanarkshire, Scotland, United Kingdom
| | - Yang Gao
- Centre for Health and Exercise Science Research, Department of Sport, Physical Education and Health, Hong Kong Baptist University, Kowloon Tong, Hong Kong; and
| | - Yaodong Gu
- School of Health and Life Sciences, Institute for Clinical Exercise & Health Science, University of the West of Scotland, South Lanarkshire, Scotland, United Kingdom
| | - Frédéric Dutheil
- CNRS, LaPSCo, Physiological and Psychosocial Stress, University Hospital of Clermont-Ferrand, CHU Clermont-Ferrand, Preventive and Occupational Medicine, WittyFit, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Julien S. Baker
- Centre for Health and Exercise Science Research, Department of Sport, Physical Education and Health, Hong Kong Baptist University, Kowloon Tong, Hong Kong; and
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8
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Zhou F, Wu L, Qian L, Kuang H, Zhan J, Li J, Cheung GL, Ding A, Gong H. The Relationship Between Cortical Morphological and Functional Topological Properties and Clinical Manifestations in Patients with Posttraumatic Diffuse Axonal Injury: An Individual Brain Network Study. Brain Topogr 2023; 36:936-945. [PMID: 37615797 DOI: 10.1007/s10548-023-00964-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 04/15/2023] [Indexed: 08/25/2023]
Abstract
To evaluate the altered network topological properties and their clinical relevance in patients with posttraumatic diffuse axonal injury (DAI). Forty-seven participants were recruited in this study, underwent 3D T1-weighted and resting-state functional MRI, and had single-subject morphological brain networks (MBNs) constructed by Kullback-Leibler divergence and functional brain networks (FBNs) constructed by Pearson correlation measurement interregional similarity. The global and regional properties were analyzed and compared using graph theory and network-based statistics (NBS), and the relationship with clinical manifestations was assessed. Compared with those of the healthy subjects, MBNs of patients with DAI showed a higher path length ([Formula: see text]: P = 0.021, [Formula: see text]: P = 0.011), lower clustering ([Formula: see text]: P = 0.002) and less small-worldness ([Formula: see text]: P = 0.002), but there was no significant difference in the global properties of FBNs (P: 0.161-0.216). For nodal properties of MBNs and FBNs, several regions showed significant differences between patients with DAI and healthy controls (HCs) (P < 0.05, FDR corrected). NBS analysis revealed that MBNs have more altered morphological connections in the frontal parietal control network and interhemispheric connections (P < 0.05). DAI-related global or nodal properties of MBNs were correlated with physical disability or dyscognition (P < 0.05/7, with Bonferroni correction), and the alteration of functional topology properties mediates this relationship. Our results suggested that disrupted morphological topology properties, which are mediated by FBNs and correlated with clinical manifestations of DAI, play a critical role in the short-term and medium-term phases after trauma.
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Affiliation(s)
- Fuqing Zhou
- Department of Radiology, The First Affiliated Hospital, Nanchang University, 17 Yongwaizheng Street, Nanchang, 330006, Jiangxi, China
- Neuroimaging Laboratory, Jiangxi Medical Imaging Research Institute, Nanchang, 330006, China
| | - Lin Wu
- Department of Radiology, The First Affiliated Hospital, Nanchang University, 17 Yongwaizheng Street, Nanchang, 330006, Jiangxi, China
- Neuroimaging Laboratory, Jiangxi Medical Imaging Research Institute, Nanchang, 330006, China
| | - Long Qian
- Department of Biomedical Engineering, College of Engineering, Peking University, No.60 Yannan Yuan, Beijing, 100871, China
| | - Hongmei Kuang
- Department of Radiology, The First Affiliated Hospital, Nanchang University, 17 Yongwaizheng Street, Nanchang, 330006, Jiangxi, China
- Neuroimaging Laboratory, Jiangxi Medical Imaging Research Institute, Nanchang, 330006, China
| | - Jie Zhan
- Department of Radiology, The First Affiliated Hospital, Nanchang University, 17 Yongwaizheng Street, Nanchang, 330006, Jiangxi, China
- Neuroimaging Laboratory, Jiangxi Medical Imaging Research Institute, Nanchang, 330006, China
| | - Jian Li
- Department of Radiology, The First Affiliated Hospital, Nanchang University, 17 Yongwaizheng Street, Nanchang, 330006, Jiangxi, China
- Neuroimaging Laboratory, Jiangxi Medical Imaging Research Institute, Nanchang, 330006, China
| | - Gerald L Cheung
- Spin Imaging Technology Co., Ltd, No.6 Fengxin Road, Nanjing, 210012, China
| | - Aimin Ding
- Department of Radiology, The First People's Hospital of Fuzhou and The Fifth Affiliated Hospital, Nanchang University, Fuzhou, 344000, China.
| | - Honghan Gong
- Department of Radiology, The First Affiliated Hospital, Nanchang University, 17 Yongwaizheng Street, Nanchang, 330006, Jiangxi, China.
- Neuroimaging Laboratory, Jiangxi Medical Imaging Research Institute, Nanchang, 330006, China.
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9
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Davidson CG, Woodford SJ, Mathur S, Valle DB, Foster D, Kioutchoukova I, Mahmood A, Lucke-Wold B. Investigation into the vascular contributors to dementia and the associated treatments. EXPLORATION OF NEUROSCIENCE 2023; 2:224-237. [PMID: 37981945 PMCID: PMC10655228 DOI: 10.37349/en.2023.00023] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 09/20/2023] [Indexed: 11/21/2023]
Abstract
As the average lifespan has increased, memory disorders have become a more pressing public health concern. However, dementia in the elderly population is often neglected in light of other health priorities. Therefore, expanding the knowledge surrounding the pathology of dementia will allow more informed decision-making regarding treatment within elderly and older adult populations. An important emerging avenue in dementia research is understanding the vascular contributors to dementia. This review summarizes potential causes of vascular cognitive impairment like stroke, microinfarction, hypertension, atherosclerosis, blood-brain-barrier dysfunction, and cerebral amyloid angiopathy. Also, this review address treatments that target these vascular impairments that also show promising results in reducing patient's risk for and experience of dementia.
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Affiliation(s)
| | | | - Shreya Mathur
- College of Medicine, University of Florida, Gainesville, FL 32610, USA
| | | | - Devon Foster
- University of Central Florida, Orlando, FL 32816, USA
| | | | - Arman Mahmood
- College of Medicine, University of Florida, Gainesville, FL 32610, USA
| | - Brandon Lucke-Wold
- Department of Neurosurgery, University of Florida, Gainesville, FL 32610, USA
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10
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Merkley TL, Halter C, Graul B, Gale SD, Junge C, Reading M, Jarvis S, Greer K, Squires C, Bigler ED, Taylor HG, Vannatta K, Gerhardt CA, Rubin KH, Stancin T, Yeates KO, Cobia D. Regional Cortical Thickness Correlates of Intellectual Abilities Differ in Children With Traumatic Brain Injury Versus Those With Orthopedic Injury in the Chronic Post-Injury Phase. J Neurotrauma 2023; 40:2063-2072. [PMID: 37294204 PMCID: PMC10623066 DOI: 10.1089/neu.2022.0524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023] Open
Abstract
A decline in intellectual functioning (intelligence quotient [IQ]) is often observed following more severe forms of traumatic brain injury (TBI) and is a useful index for long-term outcome. Identifying brain correlates of IQ can serve to inform developmental trajectories of behavior in this population. Using magnetic resonance imaging (MRI), we examined the relationship between intellectual abilities and patterns of cortical thickness in children with a history of TBI or with orthopedic injury (OI) in the chronic phase of injury recovery. Participants were 47 children with OI and 58 children with TBI, with TBI severity ranging from complicated-mild to severe. Ages ranged from 8 to 14 years old, with an average age of 10.47 years, and an injury-to-test range of ∼1-5 years. The groups did not differ in age or sex. The intellectual ability estimate (full-scale [FS]IQ-2) was derived from a two-form (Vocabulary and Matrix Reasoning subtests) Wechsler Abbreviated Scale of Intelligence (WASI). MRI data were processed using the FreeSurfer toolkit and harmonized across data collection sites using neuroComBat procedures, while holding demographic features (i.e., sex, socioeconomic status [SES]), TBI status, and FSIQ-2 constant. Separate general linear models per group (TBI and OI) and a single interaction model with all participants were conducted with all significant results withstanding correction for multiple comparisons via permutation testing. Intellectual ability was higher (p < 0.001) in the OI group (FSIQ-2 = 110.81) than in the TBI group (FSIQ-2 = 99.81). In children with OI, bi-hemispheric regions, including the right pre-central gyrus and precuneus and bilateral inferior temporal and left occipital areas were related to IQ, such that higher IQ was associated with thicker cortex in these regions. In contrast, only cortical thickness in the right pre-central gyrus and bilateral cuneus positively related to IQ in children with TBI. Significant interaction effects were found in the bilateral temporal, parietal, and occipital lobes and left frontal regions, indicating that the relationship between IQ and cortical thickness differed between groups in these regions. Changes in cortical associations with IQ after TBI may reflect direct injury effects and/or adaptation in cortical structure and intellectual functioning, particularly in the bilateral posterior parietal and inferior temporal regions. This suggests that the substrates of intellectual ability are particularly susceptible to acquired injury in the integrative association cortex. Longitudinal work is needed to account for normal developmental changes and to investigate how cortical thickness and intellectual functioning and their association change over time following TBI. Improved understanding of how TBI-related cortical thickness alterations relate to cognitive outcome could lead to improved predictions of outcome following brain injury.
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Affiliation(s)
- Tricia L. Merkley
- Department of Psychology and Brigham Young University, Provo, Utah, USA
- Neuroscience Center, Brigham Young University, Provo, Utah, USA
| | - Colt Halter
- Department of Psychology and Brigham Young University, Provo, Utah, USA
| | - Benjamin Graul
- Neuroscience Center, Brigham Young University, Provo, Utah, USA
| | - Shawn D. Gale
- Department of Psychology and Brigham Young University, Provo, Utah, USA
- Neuroscience Center, Brigham Young University, Provo, Utah, USA
| | - Chase Junge
- Neuroscience Center, Brigham Young University, Provo, Utah, USA
| | - Madeleine Reading
- Department of Psychology and Brigham Young University, Provo, Utah, USA
| | - Sierra Jarvis
- Department of Psychology and Brigham Young University, Provo, Utah, USA
| | - Kaitlyn Greer
- Department of Psychology and Brigham Young University, Provo, Utah, USA
| | - Chad Squires
- Department of Psychology and Brigham Young University, Provo, Utah, USA
| | - Erin D. Bigler
- Department of Psychology and Brigham Young University, Provo, Utah, USA
- Neuroscience Center, Brigham Young University, Provo, Utah, USA
| | - H. Gerry Taylor
- Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Kathryn Vannatta
- Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio, USA
- Departments of Pediatrics and Psychology, The Ohio State University, Columbus, Ohio, USA
| | - Cynthia A. Gerhardt
- Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio, USA
- Departments of Pediatrics and Psychology, The Ohio State University, Columbus, Ohio, USA
| | - Kenneth H. Rubin
- Department of Human Development and Quantitative Methodology, University of Maryland, College Park, Maryland, USA
| | - Terry Stancin
- MetroHealth System, Case Western Reserve University, Cleveland, Ohio, USA
| | - Keith Owen Yeates
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada
| | - Derin Cobia
- Department of Psychology and Brigham Young University, Provo, Utah, USA
- Neuroscience Center, Brigham Young University, Provo, Utah, USA
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11
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Hansson MJ, Elmér E. Cyclosporine as Therapy for Traumatic Brain Injury. Neurotherapeutics 2023; 20:1482-1495. [PMID: 37561274 PMCID: PMC10684836 DOI: 10.1007/s13311-023-01414-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/19/2023] [Indexed: 08/11/2023] Open
Abstract
Drug development in traumatic brain injury (TBI) has been impeded by the complexity and heterogeneity of the disease pathology, as well as limited understanding of the secondary injury cascade that follows the initial trauma. As a result, patients with TBI have an unmet need for effective pharmacological therapies. One promising drug candidate is cyclosporine, a polypeptide traditionally used to achieve immunosuppression in transplant recipients. Cyclosporine inhibits mitochondrial permeability transition, thereby reducing secondary brain injury, and has shown neuroprotective effects in multiple preclinical models of TBI. Moreover, the cyclosporine formulation NeuroSTAT® displayed positive effects on injury biomarker levels in patients with severe TBI enrolled in the Phase Ib/IIa Copenhagen Head Injury Ciclosporin trial (NCT01825044). Future research on neuroprotective compounds such as cyclosporine should take advantage of recent advances in fluid-based biomarkers and neuroimaging to select patients with similar disease pathologies for clinical trials. This would increase statistical power and allow for more accurate assessment of long-term outcomes.
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Affiliation(s)
- Magnus J Hansson
- Abliva AB, Lund, Sweden.
- Department of Clinical Sciences, Mitochondrial Medicine, Lund University, Lund, Sweden.
| | - Eskil Elmér
- Abliva AB, Lund, Sweden
- Department of Clinical Sciences, Mitochondrial Medicine, Lund University, Lund, Sweden
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12
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Pugazenthi S, Hernandez-Rovira MA, Mitha R, Rogers JL, Lavadi RS, Kann MR, Cardozo MR, Hardi A, Elsayed GA, Joseph J, Housley SN, Agarwal N. Evaluating the state of non-invasive imaging biomarkers for traumatic brain injury. Neurosurg Rev 2023; 46:232. [PMID: 37682375 DOI: 10.1007/s10143-023-02085-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 07/03/2023] [Accepted: 07/07/2023] [Indexed: 09/09/2023]
Abstract
Non-invasive imaging biomarkers are useful for prognostication in patients with traumatic brain injury (TBI) at high risk for morbidity with invasive procedures. The authors present findings from a scoping review discussing the pertinent biomarkers. Embase, Ovid-MEDLINE, and Scopus were queried for original research on imaging biomarkers for prognostication of TBI in adult patients. Two reviewers independently screened articles, extracted data, and evaluated risk of bias. Data was synthesized and confidence evaluated with the linked evidence according to the Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) approach. Our search yielded 3104 unique citations, 44 of which were included in this review. Study populations varied in TBI severity, as defined by Glasgow Coma Scale (GCS), including: mild (n=9), mild and moderate (n=3), moderate and severe (n=7), severe (n=6), and all GCS scores (n=17). Diverse imaging modalities were used for prognostication, predominantly computed tomography (CT) only (n=11), magnetic resonance imaging (MRI) only (n=9), and diffusion tensor imaging (DTI) (N=9). The biomarkers included diffusion coefficient mapping, metabolic characteristics, optic nerve sheath diameter, T1-weighted signal changes, cortical cerebral blood flow, axial versus extra-axial lesions, T2-weighted gradient versus spin echo, translocator protein levels, and trauma imaging of brainstem areas. The majority (93%) of studies identified that the imaging biomarker of interest had a statistically significant prognostic value; however, these are based on a very low to low level of quality of evidence. No study directly compared the effects on specific TBI treatments on the temporal course of imaging biomarkers. The current literature is insufficient to make a strong recommendation about a preferred imaging biomarker for TBI, especially considering GRADE criteria revealing low quality of evidence. Rigorous prospective research of imaging biomarkers of TBI is warranted to improve the understanding of TBI severity.
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Affiliation(s)
- Sangami Pugazenthi
- Department of Neurosurgery, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | | | - Rida Mitha
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, 15213, USA
| | - James L Rogers
- Vanderbilt University School of Medicine, Nashville, TN, 37235, USA
| | - Raj Swaroop Lavadi
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, 15213, USA
| | - Michael R Kann
- Department of Neurosurgery, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - Miguel Ruiz Cardozo
- Department of Neurosurgery, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - Angela Hardi
- Becker Medical Library, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - Galal A Elsayed
- Och Spine, Weill Cornell Medicine, New-York Presbyterian Hospital, New York City, NY, USA
| | - Jacob Joseph
- Department of Neurosurgery, University of Michigan Medical School, Ann Arbor, MI, 48109, USA
| | - Stephen N Housley
- School of Applied Physiology, Georgia Institute of Technology, Atlanta, GA, 30332, USA
- Integrated Cancer Research Center, Parker H. Petit Institute for Bioengineering and Bioscience, Georgia Institute of Technology, Atlanta, GA, 30332, USA
| | - Nitin Agarwal
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, 15213, USA.
- Department of Neurological Surgery, University of Pittsburgh Medical Center, 200 Lothrop Street, Pittsburgh, PA, 15213, USA.
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Brennan DJ, Duda J, Ware JB, Whyte J, Choi JY, Gugger J, Focht K, Walter AE, Bushnik T, Gee JC, Diaz‐Arrastia R, Kim JJ. Spatiotemporal profile of atrophy in the first year following moderate-severe traumatic brain injury. Hum Brain Mapp 2023; 44:4692-4709. [PMID: 37399336 PMCID: PMC10400790 DOI: 10.1002/hbm.26410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 06/04/2023] [Accepted: 06/12/2023] [Indexed: 07/05/2023] Open
Abstract
Traumatic brain injury (TBI) triggers progressive neurodegeneration resulting in brain atrophy that continues months-to-years following injury. However, a comprehensive characterization of the spatial and temporal evolution of TBI-related brain atrophy remains incomplete. Utilizing a sensitive and unbiased morphometry analysis pipeline optimized for detecting longitudinal changes, we analyzed a sample consisting of 37 individuals with moderate-severe TBI who had primarily high-velocity and high-impact injury mechanisms. They were scanned up to three times during the first year after injury (3 months, 6 months, and 12 months post-injury) and compared with 33 demographically matched controls who were scanned once. Individuals with TBI already showed cortical thinning in frontal and temporal regions and reduced volume in the bilateral thalami at 3 months post-injury. Longitudinally, only a subset of cortical regions in the parietal and occipital lobes showed continued atrophy from 3 to 12 months post-injury. Additionally, cortical white matter volume and nearly all deep gray matter structures exhibited progressive atrophy over this period. Finally, we found that disproportionate atrophy of cortex along sulci relative to gyri, an emerging morphometric marker of chronic TBI, was present as early as 3 month post-injury. In parallel, neurocognitive functioning largely recovered during this period despite this pervasive atrophy. Our findings demonstrate msTBI results in characteristic progressive neurodegeneration patterns that are divergent across regions and scale with the severity of injury. Future clinical research using atrophy during the first year of TBI as a biomarker of neurodegeneration should consider the spatiotemporal profile of atrophy described in this study.
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Affiliation(s)
- Daniel J. Brennan
- CUNY Neuroscience Collaborative, The Graduate CenterCity University of New YorkNew YorkNew YorkUnited States
- Department of Molecular, Cellular, and Biomedical SciencesCUNY School of Medicine, The City College of New YorkNew YorkNew YorkUnited States
| | - Jeffrey Duda
- Department of RadiologyUniversity of Pennsylvania Perelman School of MedicinePhiladelphiaPennsylvaniaUnited States
- Penn Image Computing and Science LaboratoryUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUnited States
| | - Jeffrey B. Ware
- Department of RadiologyUniversity of Pennsylvania Perelman School of MedicinePhiladelphiaPennsylvaniaUnited States
| | - John Whyte
- Moss Rehabilitation Research Institute, Einstein Healthcare NetworkElkins ParkPennsylvaniaUnited States
| | - Joon Yul Choi
- Department of Molecular, Cellular, and Biomedical SciencesCUNY School of Medicine, The City College of New YorkNew YorkNew YorkUnited States
- Department of Biomedical EngineeringYonsei UniversityWonjuRepublic of Korea
| | - James Gugger
- Department of NeurologyUniversity of Pennsylvania Perelman School of MedicinePhiladelphiaPennsylvaniaUnited States
| | - Kristen Focht
- Widener University School for Graduate Clinical PsychologyChesterPennsylvaniaUnited States
| | - Alexa E. Walter
- Department of NeurologyUniversity of Pennsylvania Perelman School of MedicinePhiladelphiaPennsylvaniaUnited States
| | - Tamara Bushnik
- NYU Grossman School of MedicineNew YorkNew YorkUnited States
| | - James C. Gee
- Department of RadiologyUniversity of Pennsylvania Perelman School of MedicinePhiladelphiaPennsylvaniaUnited States
- Penn Image Computing and Science LaboratoryUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUnited States
| | - Ramon Diaz‐Arrastia
- Department of NeurologyUniversity of Pennsylvania Perelman School of MedicinePhiladelphiaPennsylvaniaUnited States
| | - Junghoon J. Kim
- CUNY Neuroscience Collaborative, The Graduate CenterCity University of New YorkNew YorkNew YorkUnited States
- Department of Molecular, Cellular, and Biomedical SciencesCUNY School of Medicine, The City College of New YorkNew YorkNew YorkUnited States
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14
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Shida AF, Massett RJ, Imms P, Vegesna RV, Amgalan A, Irimia A. Significant Acceleration of Regional Brain Aging and Atrophy After Mild Traumatic Brain Injury. J Gerontol A Biol Sci Med Sci 2023; 78:1328-1338. [PMID: 36879433 PMCID: PMC10395568 DOI: 10.1093/gerona/glad079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Indexed: 03/08/2023] Open
Abstract
Brain regions' rates of age-related volumetric change after traumatic brain injury (TBI) are unknown. Here, we quantify these rates cross-sectionally in 113 persons with recent mild TBI (mTBI), whom we compare against 3 418 healthy controls (HCs). Regional gray matter (GM) volumes were extracted from magnetic resonance images. Linear regression yielded regional brain ages and the annualized average rates of regional GM volume loss. These results were compared across groups after accounting for sex and intracranial volume. In HCs, the steepest rates of volume loss were recorded in the nucleus accumbens, amygdala, and lateral orbital sulcus. In mTBI, approximately 80% of GM structures had significantly steeper rates of annual volume loss than in HCs. The largest group differences involved the short gyri of the insula and both the long gyrus and central sulcus of the insula. No significant sex differences were found in the mTBI group, regional brain ages being the oldest in prefrontal and temporal structures. Thus, mTBI involves significantly steeper regional GM loss rates than in HCs, reflecting older-than-expected regional brain ages.
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Affiliation(s)
- Alexander F Shida
- Ethel Percy Andrus Gerontology Center, Leonard Davis School of Gerontology, University of Southern California, Los Angeles, California, USA
| | - Roy J Massett
- Ethel Percy Andrus Gerontology Center, Leonard Davis School of Gerontology, University of Southern California, Los Angeles, California, USA
| | - Phoebe Imms
- Ethel Percy Andrus Gerontology Center, Leonard Davis School of Gerontology, University of Southern California, Los Angeles, California, USA
| | - Ramanand V Vegesna
- Ethel Percy Andrus Gerontology Center, Leonard Davis School of Gerontology, University of Southern California, Los Angeles, California, USA
| | - Anar Amgalan
- Ethel Percy Andrus Gerontology Center, Leonard Davis School of Gerontology, University of Southern California, Los Angeles, California, USA
| | - Andrei Irimia
- Ethel Percy Andrus Gerontology Center, Leonard Davis School of Gerontology, University of Southern California, Los Angeles, California, USA
- Corwin D. Denney Research Center, Department of Biomedical Engineering, Viterbi School of Engineering, University of Southern California, Los Angeles, California, USA
- Department of Quantitative & Computational Biology, Dana and David Dornsife College of Arts & Sciences, University of Southern California, Los Angeles, California, USA
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15
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Hurtubise JM, Gorbet DJ, Hynes L, Macpherson AK, Sergio LE. Cortical and cerebellar structural correlates of cognitive-motor integration performance in females with and without persistent concussion symptoms. Brain Inj 2023; 37:397-411. [PMID: 36548113 DOI: 10.1080/02699052.2022.2158231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Fifteen percent of individuals who sustain a concussion develop persistent concussion symptoms (PCS). Recent literature has demonstrated atrophy of the frontal, parietal, and cerebellar regions following acute concussive injury. The frontoparietal-cerebellar network is essential for the performance of visuomotor transformation tasks requiring cognitive-motor integration (CMI), important for daily function. PURPOSE We investigated cortical and subcortical structural differences and how these differences are associated with CMI performance in those with PCS versus healthy controls. METHODS Twenty-six age-matched female participants (13 PCS, 13 healthy) completed four visuomotor tasks. Additionally, MR-images were analyzed for cortical thickness and volume, and cerebellar lobule volume. RESULTS No statistically significant group differences were found in CMI performance. However, those with PCS demonstrated a significantly thicker and larger precuneus, and significantly smaller cerebellar lobules (VIIIa, VIIIb, X) compared to controls. When groups were combined, volumes of both the cerebellar lobules and cortical regions were associated with CMI task performance. CONCLUSION The lack of behavioral differences combined with the structural differences may reflect a compensatory mechanism for those with PCS. In addition, this study highlights the effectiveness of CMI tasks in estimating the structural integrity of the frontoparietal-cerebellar network and is among the first to demonstrate structural correlates of PCS.
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Affiliation(s)
- Johanna M Hurtubise
- School of Kinesiology and Health Science, York University, Toronto, Canada
- Centre for Sport and Exercise Education, Camosun College, Victoria, Canada
| | - Diana J Gorbet
- School of Kinesiology and Health Science, York University, Toronto, Canada
| | - Loriann Hynes
- School of Kinesiology and Health Science, York University, Toronto, Canada
| | | | - Lauren E Sergio
- School of Kinesiology and Health Science, York University, Toronto, Canada
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16
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A model for estimating the brainstem volume in normal healthy individuals and its application to diffuse axonal injury patients. Sci Rep 2023; 13:33. [PMID: 36593347 PMCID: PMC9807567 DOI: 10.1038/s41598-022-27202-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 12/28/2022] [Indexed: 01/03/2023] Open
Abstract
Diffuse axonal injury (DAI) is a subtype of traumatic brain injury that causes acute-phase consciousness disorders and widespread chronic-phase brain atrophy. Considering the importance of brainstem damage in DAI, a valid method for evaluating brainstem volume is required. We obtained volume measurements from 182 healthy adults by analyzing T1-weighted magnetic resonance images, and created an age-/sex-/intracranial volume-based quantitative model to estimate the normal healthy volume of the brainstem and cerebrum. We then applied this model to the volume measurements of 22 DAI patients, most of whom were in the long-term chronic phase and had no gross focal injury, to estimate the percentage difference in volume from the expected normal healthy volume in different brain regions, and investigated its association with the duration of posttraumatic amnesia (which is an early marker of injury severity). The average loss of the whole brainstem was 13.9%. Moreover, the percentage loss of the whole brainstem, and particularly of the pons and midbrain, was significantly negatively correlated with the duration of posttraumatic amnesia. Our findings suggest that injury severity, as denoted by the duration of posttraumatic amnesia, is among the factors affecting the chronic-phase brainstem volume in patients with DAI.
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17
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Grasset L, Power MC, Crivello F, Tzourio C, Chêne G, Dufouil C. How Traumatic Brain Injury History Relates to Brain Health MRI Markers and Dementia Risk: Findings from the 3C Dijon Cohort. J Alzheimers Dis 2023; 92:183-193. [PMID: 36710672 PMCID: PMC10041415 DOI: 10.3233/jad-220658] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND The long-term effects of traumatic brain injury (TBI) with loss of consciousness (LOC) on magnetic resonance imaging (MRI) markers of brain health and on dementia risk are still debated. OBJECTIVE To investigate the associations of history of TBI with LOC with incident dementia and neuroimaging markers of brain structure and small vessel disease lesions. METHODS The analytical sample consisted in 4,144 participants aged 65 and older who were dementia-free at baseline from the Three City -Dijon study. History of TBI with LOC was self-reported at baseline. Clinical Dementia was assessed every two to three years, up to 12 years of follow-up. A subsample of 1,675 participants <80 years old underwent a brain MRI at baseline. We investigated the associations between history of TBI with LOC and 1) incident all cause and Alzheimer's disease (AD) dementia using illness-death models, and 2) neuroimaging markers at baseline. RESULTS At baseline, 8.3% of the participants reported a history of TBI with LOC. In fully-adjusted models, participants with a history of TBI with LOC had no statistically significant differences in dementia risk (HR = 0.90, 95% CI = 0.60-1.36) or AD risk (HR = 1.03, 95% CI = 0.69-1.52), compared to participants without TBI history. History of TBI with LOC was associated with lower white matter volume (β= -4.58, p = 0.048), but not with other brain volumes, white matter hyperintensities volume, nor covert brain infarct. CONCLUSION This study did not find evidence of an association between history of TBI with LOC and dementia or AD dementia risks over 12-year follow-up, brain atrophy, or markers of small vessel disease.
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Affiliation(s)
- Leslie Grasset
- University of Bordeaux, Inserm, Bordeaux Population Health Research Center, UMR 1219; CIC1401-EC, Bordeaux, France
| | - Melinda C Power
- Department of Epidemiology, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | | | - Christophe Tzourio
- University of Bordeaux, Inserm, Bordeaux Population Health Research Center, UMR 1219; Bordeaux, France
| | - Geneviève Chêne
- University of Bordeaux, Inserm, Bordeaux Population Health Research Center, UMR 1219; CIC1401-EC, Bordeaux, France.,Pole de sante publique Centre Hospitalier Universitaire (CHU) de Bordeaux, Bordeaux, France
| | - Carole Dufouil
- University of Bordeaux, Inserm, Bordeaux Population Health Research Center, UMR 1219; CIC1401-EC, Bordeaux, France.,Pole de sante publique Centre Hospitalier Universitaire (CHU) de Bordeaux, Bordeaux, France
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18
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Kosaraju S, Galatzer-Levy I, Schultebraucks K, Winters S, Hinrichs R, Reddi PJ, Maples-Keller JL, Hudak L, Michopoulos V, Jovanovic T, Ressler KJ, Allen JW, Stevens JS. Associations among civilian mild traumatic brain injury with loss of consciousness, posttraumatic stress disorder symptom trajectories, and structural brain volumetric data. J Trauma Stress 2022; 35:1521-1534. [PMID: 35776892 DOI: 10.1002/jts.22858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 05/14/2022] [Accepted: 05/16/2022] [Indexed: 11/08/2022]
Abstract
Posttraumatic stress disorder (PTSD) is prevalent and associated with significant morbidity. Mild traumatic brain injury (mTBI) concurrent with psychiatric trauma may be associated with PTSD. Prior studies of PTSD-related structural brain alterations have focused on military populations. The current study examined correlations between PTSD, acute mTBI, and structural brain alterations longitudinally in civilian patients (N = 504) who experienced a recent Criterion A traumatic event. Participants who reported loss of consciousness (LOC) were characterized as having mTBI; all others were included in the control group. PTSD symptoms were assessed at enrollment and over the following year; a subset of participants (n = 89) underwent volumetric brain MRI (M = 53 days posttrauma). Classes of PTSD symptom trajectories were modeled using latent growth mixture modeling. Associations between PTSD symptom trajectories and cortical thicknesses or subcortical volumes were assessed using a moderator-based regression. mTBI with LOC during trauma was positively correlated with the likelihood of developing a chronic PTSD symptom trajectory. mTBI showed significant interactions with cortical thickness in the rostral anterior cingulate cortex (rACC) in predicting PTSD symptoms, r = .461-.463. Bilateral rACC thickness positively predicted PTSD symptoms but only among participants who endorsed LOC, p < .001. The results demonstrate positive correlations between mTBI with LOC and PTSD symptom trajectories, and findings related to mTBI with LOC and rACC thickness interactions in predicting subsequent chronic PTSD symptoms suggest the importance of further understanding the role of mTBI in the context of PTSD to inform intervention and risk stratification.
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Affiliation(s)
- Siddhartha Kosaraju
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Isaac Galatzer-Levy
- Department of Psychiatry, New York University School of Medicine, New York, New York, USA
| | - Katharina Schultebraucks
- Department of Emergency Medicine, Vagelos School of Physicians and Surgeons, Columbia University Medical Center, New York, New York, USA
| | - Sterling Winters
- Department of Psychiatry, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Rebecca Hinrichs
- Department of Psychiatry, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Preethi J Reddi
- Department of Biology, Emory University School of Medicine, Atlanta, Georgia, USA
| | | | - Lauren Hudak
- Department of Emergency Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Vasiliki Michopoulos
- Department of Psychiatry, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Tanja Jovanovic
- Department of Psychiatry, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Kerry J Ressler
- Department of Psychiatry, McLean Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Jason W Allen
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Jennifer S Stevens
- Department of Psychiatry, New York University School of Medicine, New York, New York, USA
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19
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Macruz FBDC, Feltrin FS, Zaninotto A, Guirado VMDP, Otaduy MCG, Tsunemi MH, Nucci MP, Rimkus C, Andrade CS, Leite CDC. Longitudinal assessment of magnetization transfer ratio, brain volume, and cognitive functions in diffuse axonal injury. Brain Behav 2022; 12:e2490. [PMID: 35103410 PMCID: PMC8933768 DOI: 10.1002/brb3.2490] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 11/08/2021] [Accepted: 12/29/2021] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Diffuse axonal injury (DAI) is a frequent mechanism of traumatic brain injury (TBI) that triggers a sequence of parenchymal changes that progresses from focal axonal shear injuries up to inflammatory response and delayed axonal disconnection. OBJECTIVE The main purpose of this study is to evaluate changes in the axonal/myelinic content and the brain volume up to 12 months after TBI and to correlate these changes with neuropsychological results. METHODS Patients with DAI (n = 25) were scanned at three time points after trauma (2, 6, and 12 months), and the total brain volume (TBV), gray matter volume, and white matter volume (WMV) were calculated in each time point. The magnetization transfer ratio (MTR) for the total brain (TB MTR), gray matter (GM MTR), and white matter (WM MTR) was also quantified. In addition, Hopkins verbal learning test (HVLT), Trail Making Test (TMT), and Rey-Osterrieth Complex Figure test were performed at 6 and 12 months after the trauma. RESULTS There was a significant reduction in the mean TBV, WMV, TB MTR, GM MTR, and WM MTR between time points 1 and 3 (p < .05). There was also a significant difference in HVLT-immediate, TMT-A, and TMT-B scores between time points 2 and 3. The MTR decline correlated more with the cognitive dysfunction than the volume reduction. CONCLUSION A progressive axonal/myelinic rarefaction and volume loss were characterized, especially in the white matter (WM) up to 1 year after the trauma. Despite that, specific neuropsychological tests revealed that patients' episodic verbal memory, attention, and executive function improved during the study. The current findings may be valuable in developing long-term TBI rehabilitation management programs.
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Affiliation(s)
| | - Fabrício Stewan Feltrin
- Department of Radiology and Oncology, Hospital das Clínicas, Faculdade de Medicina da USP, São Paulo, Brazil
| | - Ana Zaninotto
- Neuropsychology Division, Department of Neurology, Hospital das Clínicas, Faculdade de Medicina da USP, São Paulo, Brazil
| | | | | | - Miriam Harumi Tsunemi
- Department of Biostatistics, Universidade Estadual Paulista, Botucatu, São Paulo, Brazil
| | - Mariana Penteado Nucci
- Department of Radiology and Oncology, Hospital das Clínicas, Faculdade de Medicina da USP, São Paulo, Brazil
| | - Carolina Rimkus
- Department of Radiology and Oncology, Hospital das Clínicas, Faculdade de Medicina da USP, São Paulo, Brazil
| | - Celi Santos Andrade
- Department of Radiology and Oncology, Hospital das Clínicas, Faculdade de Medicina da USP, São Paulo, Brazil
| | - Claudia da Costa Leite
- Department of Radiology and Oncology, Hospital das Clínicas, Faculdade de Medicina da USP, São Paulo, Brazil
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20
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Adamson MM, Main K, Harris OA, Kang X. Sex differences in cortical thickness and diffusion properties in patients with traumatic brain injury: a pilot study. Brain Inj 2022; 36:488-502. [PMID: 35113752 DOI: 10.1080/02699052.2022.2034046] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
OBJECTIVE Cortical thickness and diffusion properties are important measures of gray and white matter integrity in those with traumatic brain injury (TBI). Many studies show that healthy adult females have greater cortical thickness than males across numerous brain sites. In this study, we explored this sex difference in patients with TBI. METHOD Participants consisted of 32 patients with TBI and 21 neurologically healthy controls. All were scanned by magnetic resonance imaging (MRI). Differences in cortical thickness and diffusion properties were examined between groups (i.e., TBI/control, male/female). RESULTS Patients with TBI had more cortical thinning (both hemispheres) compared to controls. They also showed decreased fractional anisotropy (FA) for several major white matter tracts. Healthy females had significantly greater cortical thickness compared to healthy males. However, this difference was smaller among the patients with TBI. We found no sex differences in diffusion properties. There were moderate correlations between cortical thickness, diffusion properties, and cognitive performance, as measured by the Trail Making Test B. CONCLUSION These findings contribute to a growing discussion on sex differences in cortical thickness and diffusion properties. Sexual dimorphism could necessitate different clinical profiles, targets, and rehabilitation strategies in patients with TBI.
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Affiliation(s)
- Maheen M Adamson
- Rehabilitation Service, VA Palo Alto Health Care System, Palo Alto, California, USA.,Department of Neurosurgery, Stanford University School of Medicine, Palo Alto, California, USA
| | - Keith Main
- Research Division, Traumatic Brain Injury Center of Excellence, Silver Spring, Maryland, USA.,General Dynamics Information Technology, Falls Church, Virginia, USA
| | - Odette A Harris
- Rehabilitation Service, VA Palo Alto Health Care System, Palo Alto, California, USA.,Department of Neurosurgery, Stanford University School of Medicine, Palo Alto, California, USA
| | - Xiaojian Kang
- Rehabilitation Service, VA Palo Alto Health Care System, Palo Alto, California, USA
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21
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Xu H, Tao Y, Zhu P, Li D, Zhang M, Bai G, Yin B. Restoration of aberrant shape of caudate sub-regions associated with cognitive function improvement in mild traumatic brain injury. J Neurotrauma 2022; 39:348-357. [PMID: 35019763 DOI: 10.1089/neu.2021.0426] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Mild traumatic brain injury (mTBI) is an important but less recognized public health concern. Research shows that altered subcortical structures mediate cognitive impairment in patients with mTBI. This has been performed mostly using voxel-based morphometry methods and traditional volume measurement methods, which have certain limitations. In this study, we conducted a vertex-wise shape analysis to understand the aberrant patterns of caudate sub-regions and recovery from mTBI. The study involved 36 mTBI patients and 34 matched healthy controls (HCs) observed at seven-days (acute phase) and followed-up for one-month (subacute phase) post-injury. Different aberrant shapes of the caudate sub-regions were observed at acute phase, which revealed atrophy in the bilateral dorsal medial caudate, and increase in the size of the right ventral anterior caudate in mTBI patients related to HCs. Moreover, specific and significant shape restoration of right dorsal medial caudate in mTBI was observed at subacute phase, which significantly associated with the cognitive function improvement of the patients. These findings suggest that the restoration of the aberrant shape atrophy of right dorsal medial caudate plays a vital role in the improvement of cognitive function of mTBI patients, providing an alternative clinical target for these patients.
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Affiliation(s)
- Hui Xu
- The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Department of Neurosurgery, Wenzhou, China.,McMaster University, 3710, Department of Psychiatry and Behavioural Neurosciences,, Hamilton, Ontario, Canada;
| | - Yin Tao
- McMaster University, 3710, Department of Psychiatry and Behavioural Neurosciences,, Hamilton, Ontario, Canada.,Xi'an Jiaotong University School of Life Science and Technology, 529492, he Key Laboratory of Biomedical Information Engineering, Ministry of Education, Department of Biomedical Engineering, Xi'an, Shaanxi, China;
| | - Pingyi Zhu
- The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Department of Radiology, Wenzhou, China;
| | - Dandong Li
- The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Department of Neurosurgery, Wenzhou, China;
| | - Ming Zhang
- Xi'an Jiaotong University Medical College First Affiliated Hospital Department of Medical Imaging, 535072, Xi'an, Shaanxi, China;
| | - Guanghui Bai
- The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Department of Radiology, Wenzhou, China;
| | - Bo Yin
- The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Department of Neurosurgery, Wenzhou, China;
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22
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Greer KM, Snyder A, Junge C, Reading M, Jarvis S, Squires C, Bigler ED, Popuri K, Beg MF, Taylor HG, Vannatta K, Gerhardt CA, Rubin K, Yeates KO, Cobia D. Surface-based abnormalities of the executive frontostriatial circuit in pediatric TBI. NEUROIMAGE: CLINICAL 2022; 35:103136. [PMID: 36002959 PMCID: PMC9421496 DOI: 10.1016/j.nicl.2022.103136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 07/25/2022] [Accepted: 07/27/2022] [Indexed: 11/28/2022] Open
Abstract
Cortical thickness of the dorsolateral prefrontal cortex is reduced in pediatric TBI. Shape abnormalities of the caudate and mediodorsal nucleus of the thalamus are a feature of pediatric TBI. Surface-based abnormalities of the dorsolateral prefrontal loop do not appear to relate to executive functioning.
Childhood traumatic brain injury (TBI) is one of the most common causes of acquired disability and has significant implications for executive functions (EF), such as impaired attention, planning, and initiation that are predictive of everyday functioning. Evidence has suggested attentional features of executive functioning require behavioral flexibility that is dependent on frontostriatial circuitry. The purpose of this study was to evaluate surface-based deformation of a specific frontostriatial circuit in pediatric TBI and its role in EF. Regions of interest included: the dorsolateral prefrontal cortex (DLPFC), caudate nucleus, globus pallidus, and the mediodorsal nucleus of the thalamus (MD). T1-weighted magnetic resonance images were obtained in a sample of children ages 8–13 with complicated mild, moderate, or severe TBI (n = 32) and a group of comparison children with orthopedic injury (OI; n = 30). Brain regions were characterized using high-dimensional surface-based brain mapping procedures. Aspects of EF were assessed using select subtests from the Test of Everyday Attention for Children (TEA-Ch). General linear models tested group and hemisphere differences in DLPFC cortical thickness and subcortical shape of deep-brain regions; Pearson correlations tested relationships with EF. Main effects for group were found in both cortical thickness of the DLPFC (F1,60 = 4.30, p = 0.042) and MD mean deformation (F1,60 = 6.50, p = 0.01) all with lower values in the TBI group. Statistical surface maps revealed significant inward deformation on ventral-medial aspects of the caudate in TBI relative to OI, but null results in the globus pallidus. No significant relationships between EF and any region of interest were observed. Overall, findings revealed abnormalities in multiple aspects of a frontostriatial circuit in pediatric TBI, which may reflect broader pathophysiological mechanisms. Increased consideration for the role of deep-brain structures in pediatric TBI can aid in the clinical characterization of anticipated long-term developmental effects of these individuals.
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23
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Mazaharally M, Stojanovski S, Trossman R, Szulc-Lerch K, Chakravarty MM, Colella B, Glazer J, E Green R, Wheeler AL. Patterns of change in cortical morphometry following traumatic brain injury in adults. Hum Brain Mapp 2021; 43:1882-1894. [PMID: 34953011 PMCID: PMC8933328 DOI: 10.1002/hbm.25761] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 12/01/2021] [Accepted: 12/13/2021] [Indexed: 01/18/2023] Open
Abstract
Progressive cortical volumetric loss following moderate–severe traumatic brain injury (TBI) has been observed; however, regionally specific changes in the structural determinants of cortical volume, namely, cortical thickness (CT) and cortical surface area (CSA), are unknown and may inform the patterns and neural substrates of neurodegeneration and plasticity following injury. We aimed to (a) assess differences in CT and CSA between TBI participants and controls in the early chronic stage post‐injury, (b) describe longitudinal changes in cortical morphometry following TBI, and (c) examine how regional changes in CT and CSA are associated. We acquired magnetic resonance images for 67 participants with TBI at up to 4 time‐points spanning 5 months to 7 years post‐injury, and 18 controls at 2 time‐points. In the early chronic stage, TBI participants displayed thinner cortices than controls, predominantly in frontal regions, but no CSA differences. Throughout the chronic period, TBI participants showed widespread CT reductions in posterior cingulate/precuneus regions and moderate CT increase in frontal regions. Additionally, CSA showed a significant decrease in the orbitofrontal cortex and circumscribed increase in posterior regions. No changes were identified in controls. Relationships between regional cortical changes in the same morphological measure revealed coordinated patterns within participants, whereas correlations between regions with CT and CSA change yielded bi‐directional relationships. This suggests that these measures may be differentially affected by neurodegenerative mechanisms such as transneuronal degeneration following TBI and that degeneration may be localized to the depths of cortical sulci. These findings emphasize the importance of dissecting morphometric contributions to cortical volume change.
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Affiliation(s)
- Maria Mazaharally
- Program in Neuroscience and Mental Health, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Sonja Stojanovski
- Program in Neuroscience and Mental Health, Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Physiology, University of Toronto, Toronto, Ontario, Canada
| | - Rebecca Trossman
- Program in Neuroscience and Mental Health, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Kamila Szulc-Lerch
- Wellcome Centre for Integrative Neuroimaging, FMRIB, Nuffield Department of Clinical Neuroscience, The University of Oxford, Oxford, UK
| | - M Mallar Chakravarty
- Cerebral Imaging Centre, Douglas Mental Health University Institute, Montreal, Canada.,Department of Psychiatry, McGill University, Montreal, Canada.,Department of Biomedical Engineering, McGill University, Montreal, Canada
| | - Brenda Colella
- Cognitive Neurorehabilitation Sciences Laboratory, Research Department, Toronto Rehabilitation Institute, Toronto, Ontario, Canada
| | - Joanna Glazer
- Cognitive Neurorehabilitation Sciences Laboratory, Research Department, Toronto Rehabilitation Institute, Toronto, Ontario, Canada
| | - Robin E Green
- Cognitive Neurorehabilitation Sciences Laboratory, Research Department, Toronto Rehabilitation Institute, Toronto, Ontario, Canada.,Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Anne L Wheeler
- Program in Neuroscience and Mental Health, Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Physiology, University of Toronto, Toronto, Ontario, Canada
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24
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Chan ST, Ordway C, Calvanio RJ, Buonanno FS, Rosen BR, Kwong KK. Cerebrovascular Responses to O 2-CO 2 Exchange Ratio under Brief Breath-Hold Challenge in Patients with Chronic Mild Traumatic Brain Injury. J Neurotrauma 2021; 38:2851-2861. [PMID: 34210158 PMCID: PMC8820289 DOI: 10.1089/neu.2021.0166] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Breath-by-breath oxygen-carbon dioxide (O2-CO2) exchange ratio (bER) is a respiratory gas exchange (RGE) metric, which is the ratio of the changes in the partial pressure of O2 (ΔPO2) to CO2 (ΔPCO2) between end-inspiration and end-expiration, has been demonstrated to characterize the cerebrovascular responses to breath-hold challenge in healthy individuals. We aimed to explore whether bER could characterize cerebrovascular responses in patients with chronic mild traumatic brain injury (mTBI) under breath-hold challenge. We also investigated the correlation between bER and the severity of post-concussion symptoms. Blood-oxygenation-level-dependent (BOLD) images were acquired using functional magnetic resonance imaging (fMRI) on 10 patients with chronic mTBI and 10 controls without brain injury history when performing a breath-hold task. Time series of RGE metrics of ΔPO2, ΔPCO2, and bER were computed, and their cross-correlation with regional change in BOLD (ΔBOLD) was calculated. Symptom burden was assessed using the Rivermead Post Concussion Questionnaire (RPQ), and its correlation with RGE changes was also measured. Compared with controls, a diffuse decrease in the correlation between regional ΔBOLD and bER was found in the brain of patients with mTBI (pfdr < 0.05). No significant difference was found between patients and controls for the correlation of regional ΔBOLD with ΔPO2 and ΔPCO2. Symptom severity indicated by RPQ scores increased with a decrease in the averaged changes of bER (ρ = 0.79, p = 0.01) and ΔPO2 (ρ = 0.70, p = 0.03) in breath-hold epochs. Our imaging and symptom severity findings suggest that bER can be used to characterize cerebrovascular responses to breath hold in patients with mTBI. The RGE may contribute to the post-concussive symptom severity.
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Affiliation(s)
- Suk-Tak Chan
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, Massachusetts, USA
| | - Cora Ordway
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, Massachusetts, USA
| | - Ronald J. Calvanio
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | | | - Bruce R. Rosen
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, Massachusetts, USA
| | - Kenneth K. Kwong
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, Massachusetts, USA
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25
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Sandry J, Dobryakova E. Global hippocampal and selective thalamic nuclei atrophy differentiate chronic TBI from Non-TBI. Cortex 2021; 145:37-56. [PMID: 34689031 DOI: 10.1016/j.cortex.2021.08.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 05/04/2021] [Accepted: 08/12/2021] [Indexed: 12/27/2022]
Abstract
Traumatic brain injury (TBI) may increase susceptibility to neurodegenerative diseases later in life. One neurobiological parallel between chronic TBI and neurodegeneration may be accelerated aging and the nature of atrophy across subcortical gray matter structures. The main aim of the present investigation is to evaluate and rank the degree that subcortical gray matter atrophy differentiates chronic moderate-severe TBI from non-TBI participants by evaluating morphometric differences between groups. Forty individuals with moderate-severe chronic TBI (9.23 yrs from injury) and 33 healthy controls (HC) underwent high resolution 3D T1-weighted structural magnetic resonance imaging. Whole brain volume was classified into white matter, cortical and subcortical gray matter structures with hippocampi and thalami further segmented into subfields and nuclei, respectively. Extensive atrophy was observed across nearly all brain regions for chronic TBI participants. A series of multivariate logistic regression models identified subcortical gray matter structures of the hippocampus and thalamus as the most sensitive to differentiating chronic TBI from non-TBI participants (McFadden R2 = .36, p < .001). Further analyses revealed the pattern of hippocampal atrophy to be global, occurring across nearly all subfields. The pattern of thalamic atrophy appeared to be much more selective and non-uniform, with largest between-group differences evident for nuclei bordering the ventricles. Subcortical gray matter was negatively correlated with time since injury (r = -.31, p = .054), while white matter and cortical gray matter were not. Cognitive ability was lower in the chronic TBI group (Cohen's d = .97, p = .003) and correlated with subcortical structures including the pallidum (r2 = .23, p = .038), thalamus (r2 = .36, p = .007) and ventral diencephalon (r2 = .23, p = .036). These data may support an accelerated aging hypothesis in chronic moderate-severe TBI that coincides with a similar neuropathological profile found in neurodegenerative diseases.
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Affiliation(s)
- Joshua Sandry
- Psychology Department, Montclair State University, Montclair, NJ, USA.
| | - Ekaterina Dobryakova
- Center for Traumatic Brain Injury Research, Kessler Foundation, East Hanover, NJ, USA; Department of Physical Medicine and Rehabilitation, Rutgers-New Jersey Medical School Newark, NJ, USA
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26
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Haber M, Amyot F, Lynch CE, Sandsmark DK, Kenney K, Werner JK, Moore C, Flesher K, Woodson S, Silverman E, Chou Y, Pham D, Diaz-Arrastia R. Imaging biomarkers of vascular and axonal injury are spatially distinct in chronic traumatic brain injury. J Cereb Blood Flow Metab 2021; 41:1924-1938. [PMID: 33444092 PMCID: PMC8327117 DOI: 10.1177/0271678x20985156] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 10/07/2020] [Accepted: 12/06/2020] [Indexed: 11/17/2022]
Abstract
Traumatic Brain Injury (TBI) is associated with both diffuse axonal injury (DAI) and diffuse vascular injury (DVI), which result from inertial shearing forces. These terms are often used interchangeably, but the spatial relationships between DAI and DVI have not been carefully studied. Multimodal magnetic resonance imaging (MRI) can help distinguish these injury mechanisms: diffusion tensor imaging (DTI) provides information about axonal integrity, while arterial spin labeling (ASL) can be used to measure cerebral blood flow (CBF), and the reactivity of the Blood Oxygen Level Dependent (BOLD) signal to a hypercapnia challenge reflects cerebrovascular reactivity (CVR). Subjects with chronic TBI (n = 27) and healthy controls (n = 14) were studied with multimodal MRI. Mean values of mean diffusivity (MD), fractional anisotropy (FA), CBF, and CVR were extracted for pre-determined regions of interest (ROIs). Normalized z-score maps were generated from the pool of healthy controls. Abnormal ROIs in one modality were not predictive of abnormalities in another. Approximately 9-10% of abnormal voxels for CVR and CBF also showed an abnormal voxel value for MD, while only 1% of abnormal CVR and CBF voxels show a concomitant abnormal FA value. These data indicate that DAI and DVI represent two distinct TBI endophenotypes that are spatially independent.
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Affiliation(s)
- Margalit Haber
- Department of Neurology, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA
| | - Franck Amyot
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Cillian E Lynch
- Department of Neurology, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA
| | - Danielle K Sandsmark
- Department of Neurology, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA
| | - Kimbra Kenney
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD, USA
- Department of Neurology, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - John K Werner
- Department of Neurology, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Carol Moore
- Department of Neurology, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Kelley Flesher
- Department of Neurology, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Sarah Woodson
- Department of Neurology, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA
| | - Erika Silverman
- Department of Neurology, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA
| | - Yiyu Chou
- Center for Neuroscience and Regenerative Medicine, Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| | - Dzung Pham
- Center for Neuroscience and Regenerative Medicine, Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| | - Ramon Diaz-Arrastia
- Department of Neurology, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA
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27
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Karlsson M, Yang Z, Chawla S, Delso N, Pukenas B, Elmér E, Hugerth M, Margulies SS, Ehinger J, Hansson MJ, Wang KKW, Kilbaugh TJ. Evaluation of Diffusion Tensor Imaging and Fluid Based Biomarkers in a Large Animal Trial of Cyclosporine in Focal Traumatic Brain Injury. J Neurotrauma 2021; 38:1870-1878. [PMID: 33191835 DOI: 10.1089/neu.2020.7317] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
All phase III trials evaluating medical treatments for traumatic brain injury (TBI), performed to date, have failed. To facilitate future success there is a need for novel outcome metrics that can bridge pre-clinical studies to clinical proof of concept trials. Our objective was to assess diffusion tensor imaging (DTI) and biofluid-based biomarkers as efficacy outcome metrics in a large animal study evaluating the efficacy of cyclosporine in TBI. This work builds on our previously published study that demonstrated a reduced volume of injury by 35% with cyclosporine treatment based on magnetic resonance imaging (MRI) results. A focal contusion injury was induced in piglets using a controlled cortical impact (CCI) device. Cyclosporine in a novel Cremophor/Kolliphor EL-free lipid emulsion, NeuroSTAT, was administered by continuous intravenous infusion for 5 days. The animals underwent DTI on day 5. Glial fibrillary acidic protein (GFAP), as a measure of astroglia injury, and neurofilament light (NF-L), as a measure of axonal injury, were measured in blood on days 1, 2, and 5, and in cerebrospinal fluid (CSF) on day 5 post-injury. Normalized fractional anisotropy (FA) was significantly (p = 0.027) higher in in the treatment group, indicating preserved tissue integrity with treatment. For the biomarkers, we observed a statistical trend of a decreased level of NF-L in CSF (p = 0.051), in the treatment group relative to placebo, indicating less axonal injury. Our findings suggest that DTI, and possibly CSF NF-L, may be feasible as translational end-points assessing neuroprotective drugs in TBI.
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Affiliation(s)
- Michael Karlsson
- Department of Neurosurgery, Rigshospitalet, Copenhagen, Denmark.,Mitochondrial Medicine, Department of Clinical Sciences, Lund University, Lund, Sweden.,Department of Anesthesiology and Critical Care, Children's Hospital of Philadelphia, Perelman School of Medicine at University of Pennsylvania, Philadelphia, USA
| | - Zhihui Yang
- Program for Neurotrauma, Neuroproteomics, and Biomarkers Research, Department of Emergency Medicine, University of Florida, Gainesville, Florida, USA
| | - Sanjeev Chawla
- Department of Radiology, Perelman School of Medicine at University of Pennsylvania, Philadelphia, USA
| | - Nile Delso
- Department of Anesthesiology and Critical Care, Children's Hospital of Philadelphia, Perelman School of Medicine at University of Pennsylvania, Philadelphia, USA
| | - Bryan Pukenas
- Department of Radiology, Perelman School of Medicine at University of Pennsylvania, Philadelphia, USA
| | - Eskil Elmér
- Mitochondrial Medicine, Department of Clinical Sciences, Lund University, Lund, Sweden.,Abliva AB, Lund, Sweden
| | | | - Susan S Margulies
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, Georgia, USA
| | - Johannes Ehinger
- Mitochondrial Medicine, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Magnus J Hansson
- Mitochondrial Medicine, Department of Clinical Sciences, Lund University, Lund, Sweden.,Abliva AB, Lund, Sweden
| | - Kevin K W Wang
- Program for Neurotrauma, Neuroproteomics, and Biomarkers Research, Department of Emergency Medicine, University of Florida, Gainesville, Florida, USA
| | - Todd J Kilbaugh
- Department of Anesthesiology and Critical Care, Children's Hospital of Philadelphia, Perelman School of Medicine at University of Pennsylvania, Philadelphia, USA
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28
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Ondek K, Pevzner A, Tercovich K, Schedlbauer AM, Izadi A, Ekstrom AD, Cowen SL, Shahlaie K, Gurkoff GG. Recovery of Theta Frequency Oscillations in Rats Following Lateral Fluid Percussion Corresponds With a Mild Cognitive Phenotype. Front Neurol 2020; 11:600171. [PMID: 33343499 PMCID: PMC7746872 DOI: 10.3389/fneur.2020.600171] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 10/21/2020] [Indexed: 01/31/2023] Open
Abstract
Whether from a fall, sports concussion, or even combat injury, there is a critical need to identify when an individual is able to return to play or work following traumatic brain injury (TBI). Electroencephalogram (EEG) and local field potentials (LFP) represent potential tools to monitor circuit-level abnormalities related to learning and memory: specifically, theta oscillations can be readily observed and play a critical role in cognition. Following moderate traumatic brain injury in the rat, lasting changes in theta oscillations coincide with deficits in spatial learning. We hypothesized, therefore, that theta oscillations can be used as an objective biomarker of recovery, with a return of oscillatory activity corresponding with improved spatial learning. In the current study, LFP were recorded from dorsal hippocampus and anterior cingulate in awake, behaving adult Sprague Dawley rats in both a novel environment on post-injury days 3 and 7, and Barnes maze spatial navigation on post-injury days 8–11. Theta oscillations, as measured by power, theta-delta ratio, peak theta frequency, and phase coherence, were significantly altered on day 3, but had largely recovered by day 7 post-injury. Injured rats had a mild behavioral phenotype and were not different from shams on the Barnes maze, as measured by escape latency. Injured rats did use suboptimal search strategies. Combined with our previous findings that demonstrated a correlation between persistent alterations in theta oscillations and spatial learning deficits, these new data suggest that neural oscillations, and particularly theta oscillations, have potential as a biomarker to monitor recovery of brain function following TBI. Specifically, we now demonstrate that oscillations are depressed following injury, but as oscillations recover, so does behavior.
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Affiliation(s)
- Katelynn Ondek
- Department of Neurological Surgery, University of California, Davis, Davis, CA, United States.,Center for Neuroscience, University of California, Davis, Davis, CA, United States
| | - Aleksandr Pevzner
- Department of Neurological Surgery, University of California, Davis, Davis, CA, United States
| | - Kayleen Tercovich
- Department of Neurological Surgery, University of California, Davis, Davis, CA, United States.,Center for Neuroscience, University of California, Davis, Davis, CA, United States
| | - Amber M Schedlbauer
- Department of Neurological Surgery, University of California, Davis, Davis, CA, United States.,Center for Neuroscience, University of California, Davis, Davis, CA, United States
| | - Ali Izadi
- Department of Neurological Surgery, University of California, Davis, Davis, CA, United States.,Center for Neuroscience, University of California, Davis, Davis, CA, United States
| | - Arne D Ekstrom
- Department of Psychology, The University of Arizona, Tucson, AZ, United States.,McKnight Brain Institute, The University of Arizona, Tucson, AZ, United States
| | - Stephen L Cowen
- Department of Psychology, The University of Arizona, Tucson, AZ, United States.,McKnight Brain Institute, The University of Arizona, Tucson, AZ, United States
| | - Kiarash Shahlaie
- Department of Neurological Surgery, University of California, Davis, Davis, CA, United States
| | - Gene G Gurkoff
- Department of Neurological Surgery, University of California, Davis, Davis, CA, United States.,Center for Neuroscience, University of California, Davis, Davis, CA, United States
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29
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LoBue C, Munro C, Schaffert J, Didehbani N, Hart J, Batjer H, Cullum CM. Traumatic Brain Injury and Risk of Long-Term Brain Changes, Accumulation of Pathological Markers, and Developing Dementia: A Review. J Alzheimers Dis 2020; 70:629-654. [PMID: 31282414 DOI: 10.3233/jad-190028] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Traumatic brain injuries (TBI) have received widespread media attention in recent years as being a risk factor for the development of dementia and chronic traumatic encephalopathy (CTE). This has sparked fears about the potential long-term effects of TBI of any severity on cognitive aging, leading to a public health concern. This article reviews the evidence surrounding TBI as a risk factor for the later development of changes in brain structure and function, and an increased risk of neurodegenerative disorders. A number of studies have shown evidence of long-term brain changes and accumulation of pathological biomarkers (e.g., amyloid and tau proteins) related to a history of moderate-to-severe TBI, and research has also demonstrated that individuals with moderate-to-severe injuries have an increased risk of dementia. While milder injuries have been found to be associated with an increased risk for dementia in some recent studies, reports on long-term brain changes have been mixed and often are complicated by factors related to injury exposure (i.e., number of injuries) and severity/complications, psychiatric conditions, and opioid use disorder. CTE, although often described as a neurodegenerative disorder, remains a neuropathological condition that is poorly understood. Future research is needed to clarify the significance of CTE pathology and determine whether that can explain any clinical symptoms. Overall, it is clear that most individuals who sustain a TBI (particularly milder injuries) do not experience worse outcomes with aging, as the incidence for dementia is found to be less than 7% across the literature.
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Affiliation(s)
- Christian LoBue
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA.,Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Catherine Munro
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Jeffrey Schaffert
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Nyaz Didehbani
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - John Hart
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA.,School of Behavioral and Brain Sciences, University of Texas at Dallas, Dallas, TX, USA.,Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Hunt Batjer
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - C Munro Cullum
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA.,Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA.,Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas, TX, USA
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30
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Östberg A, Ledig C, Katila A, Maanpää HR, Posti JP, Takala R, Tallus J, Glocker B, Rueckert D, Tenovuo O. Volume Change in Frontal Cholinergic Structures After Traumatic Brain Injury and Cognitive Outcome. Front Neurol 2020; 11:832. [PMID: 32903569 PMCID: PMC7438550 DOI: 10.3389/fneur.2020.00832] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 07/03/2020] [Indexed: 01/02/2023] Open
Abstract
The cholinergic nuclei in the basal forebrain innervate frontal cortical structures regulating attention. Our aim was to investigate if cognitive test results measuring attention relate to the longitudinal volume change of cholinergically innervated structures following traumatic brain injury (TBI). During the prospective, observational TBIcare project patients with all severities of TBI (n = 114) and controls with acute orthopedic injuries (n = 17) were recruited. Head MRI was obtained in both acute (mean 2 weeks post-injury) and late (mean 8 months) time points. T1-weighted 3D MR images were analyzed with an automatic segmentation method to evaluate longitudinal, structural brain volume change. The cognitive outcome was assessed with the Cambridge Neuropsychological Test Automated Battery (CANTAB). Analyses included 16 frontal cortical structures, of which four showed a significant correlation between post-traumatic volume change and the CANTAB test results. The strongest correlation was found between the volume loss of the supplementary motor cortex and motor screening task results (R-sq 0.16, p < 0.0001), where poorer test results correlated with greater atrophy. Of the measured sum structures, greater cortical gray matter atrophy rate showed a significant correlation with the poorer CANTAB test results. TBI caused volume loss of frontal cortical structures that are heavily innervated by cholinergic neurons is associated with neuropsychological test results measuring attention.
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Affiliation(s)
- Anna Östberg
- Division of Clinical Neurosciences, Turku Brain Injury Centre, Turku University Hospital, Turku, Finland.,Department of Neurology, Institute of Clinical Medicine, University of Turku, Turku, Finland.,Department of Neurosurgery, Neurocenter, Turku University Hospital, Turku, Finland
| | - Christian Ledig
- Department of Computing, Imperial College London, London, United Kingdom
| | - Ari Katila
- Department of Perioperative Services, Intensive Care and Pain Medicine, Turku University Hospital, Turku, Finland
| | - Henna-Riikka Maanpää
- Department of Neurology, Institute of Clinical Medicine, University of Turku, Turku, Finland.,Department of Neurosurgery, Neurocenter, Turku University Hospital, Turku, Finland
| | - Jussi P Posti
- Division of Clinical Neurosciences, Turku Brain Injury Centre, Turku University Hospital, Turku, Finland.,Department of Neurology, Institute of Clinical Medicine, University of Turku, Turku, Finland.,Department of Neurosurgery, Neurocenter, Turku University Hospital, Turku, Finland
| | - Riikka Takala
- Department of Perioperative Services, Intensive Care and Pain Medicine, Turku University Hospital, Turku, Finland
| | - Jussi Tallus
- Department of Neurology, Institute of Clinical Medicine, University of Turku, Turku, Finland
| | - Ben Glocker
- Department of Computing, Imperial College London, London, United Kingdom
| | - Daniel Rueckert
- Department of Computing, Imperial College London, London, United Kingdom
| | - Olli Tenovuo
- Division of Clinical Neurosciences, Turku Brain Injury Centre, Turku University Hospital, Turku, Finland.,Department of Neurology, Institute of Clinical Medicine, University of Turku, Turku, Finland
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31
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Diamond BR, Donald CLM, Frau-Pascual A, Snider SB, Fischl B, Dams-O'Connor K, Edlow BL. Optimizing the accuracy of cortical volumetric analysis in traumatic brain injury. MethodsX 2020; 7:100994. [PMID: 32760659 PMCID: PMC7393399 DOI: 10.1016/j.mex.2020.100994] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 07/08/2020] [Indexed: 01/21/2023] Open
Abstract
Cortical volumetric analysis is widely used to study the anatomic basis of neurological deficits in patients with traumatic brain injury (TBI). However, patients with TBI-related lesions are often excluded from MRI analyses because cortical lesions may compromise the accuracy of reconstructed surfaces upon which volumetric measurements are based. We developed a FreeSurfer-based lesion correction method and tested its impact on cortical volume measures in 87 patients with chronic moderate-to-severe TBI. We reconstructed cortical surfaces from T1-weighted MRI scans, then manually labeled and removed vertices on the cortical surfaces where lesions caused inaccuracies. Next, we measured the surface area of lesion overlap with seven canonical brain networks and the percent volume of each network affected by lesions.The lesion correction method revealed that cortical lesions in patients with TBI are preferentially located in the limbic and default mode networks (95.7% each), with the limbic network also having the largest average surface area (4.4+/−3.7%) and percent volume affected by lesions (12.7+/−9.7%). The method has the potential to improve the accuracy of cortical volumetric measurements and permit inclusion of patients with lesioned brains in MRI analyses. The method also provides new opportunities to elucidate network-based mechanisms of neurological deficits in patients with TBI.
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Affiliation(s)
- Bram R Diamond
- Center for Neurotechnology and Neurorecovery, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA.,Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA
| | | | - Aina Frau-Pascual
- Center for Neurotechnology and Neurorecovery, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA.,Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA
| | - Samuel B Snider
- Center for Neurotechnology and Neurorecovery, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Bruce Fischl
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA.,Harvard-MIT Health Sciences and Technology, Computer Science and Artificial Intelligence Laboratory, Massachusetts Institute of Technology, Cambridge, MA
| | - Kristen Dams-O'Connor
- Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, NY.,Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Brian L Edlow
- Center for Neurotechnology and Neurorecovery, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA.,Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA
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32
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Kinzel P, Marx CE, Sollmann N, Hartl E, Guenette JP, Kaufmann D, Bouix S, Pasternak O, Rathi Y, Coleman MJ, van der Kouwe A, Helmer K, Kilts JD, Naylor JC, Morey RA, Shutter L, Andaluz N, Coimbra R, Lang AJ, George MS, McAllister TW, Zafonte R, Stein MB, Shenton ME, Koerte IK. Serum Neurosteroid Levels Are Associated With Cortical Thickness in Individuals Diagnosed With Posttraumatic Stress Disorder and History of Mild Traumatic Brain Injury. Clin EEG Neurosci 2020; 51:285-299. [PMID: 32186207 DOI: 10.1177/1550059420909676] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Posttraumatic stress disorder (PTSD) co-occurring with mild traumatic brain injury (mTBI) is common in veterans. Worse clinical outcome in those with PTSD has been associated with decreased serum neurosteroid levels. Furthermore, decreased cortical thickness has been associated with both PTSD and mTBI. However, it is not known whether decreased neurosteroids are associated with decreased cortical thickness in PTSD co-occurring with mTBI. This study included 141 individuals divided into the following groups: (a) mTBI group (n = 32 [10 female, 22 male] veterans with a history of mTBI); (b) PTSD + mTBI group (n = 41 [6 female, 35 male] veterans with current PTSD with a history of mTBI); and (c) control group (n = 68 [35 female, 33 male] control participants), which were acquired through the Injury and Traumatic Stress (INTRuST) Clinical Consortium. Subjects underwent clinical assessment, magnetic resonance imaging at 3 T, and serum neurosteroid quantifications of allopregnanolone (ALLO) and pregnenolone (PREGN). Group differences in cortical thickness and associations between serum neurosteroid levels and cortical thickness were investigated. Cortical thickness was decreased in the PTSD + mTBI group compared with the other groups. In the PTSD + mTBI group, decreased cortical thickness was also associated with lower serum ALLO (right superior frontal cortex) and lower serum PREGN (left middle temporal and right orbitofrontal cortex). Cortical thickness in the middle temporal and orbitofrontal cortex was associated with PTSD symptom severity. There were no significant associations between neurosteroids and cortical thickness in the mTBI or control groups. Decreased cortical thickness in individuals with PTSD + mTBI is associated with decreased serum neurosteroid levels and greater PTSD symptom severity. Causality is unclear. However, future studies might investigate whether treatment with neurosteroids could counteract stress-induced neural atrophy in PTSD + mTBI by potentially preserving cortical thickness.
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Affiliation(s)
- Philipp Kinzel
- Department of Psychiatry, Psychiatry Neuroimaging Laboratory, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,cBRAIN, Department of Child and Adolescent Psychiatry, Psychosomatic and Psychotherapy, Ludwig-Maximilians-Universität, Munich, Germany
| | - Christine E Marx
- VA Mid-Atlantic Mental Illness Research and Clinical Center (MIRECC) and Durham VA Medical Center, Durham, NC, USA.,Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Nico Sollmann
- Department of Psychiatry, Psychiatry Neuroimaging Laboratory, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,cBRAIN, Department of Child and Adolescent Psychiatry, Psychosomatic and Psychotherapy, Ludwig-Maximilians-Universität, Munich, Germany.,Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.,TUM-Neuroimaging Center, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Elisabeth Hartl
- Department of Psychiatry, Psychiatry Neuroimaging Laboratory, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,cBRAIN, Department of Child and Adolescent Psychiatry, Psychosomatic and Psychotherapy, Ludwig-Maximilians-Universität, Munich, Germany.,Department of Neurology, Epilepsy Center, University Hospital Munich, Munich, Germany
| | - Jeffrey P Guenette
- Department of Psychiatry, Psychiatry Neuroimaging Laboratory, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - David Kaufmann
- Department of Psychiatry, Psychiatry Neuroimaging Laboratory, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,cBRAIN, Department of Child and Adolescent Psychiatry, Psychosomatic and Psychotherapy, Ludwig-Maximilians-Universität, Munich, Germany.,Department of Radiology, Charité Universitätsmedizin, Berlin, Germany
| | - Sylvain Bouix
- Department of Psychiatry, Psychiatry Neuroimaging Laboratory, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Ofer Pasternak
- Department of Psychiatry, Psychiatry Neuroimaging Laboratory, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Yogesh Rathi
- Department of Psychiatry, Psychiatry Neuroimaging Laboratory, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Michael J Coleman
- Department of Psychiatry, Psychiatry Neuroimaging Laboratory, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Andre van der Kouwe
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.,Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA, USA
| | - Karl Helmer
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.,Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA, USA
| | - Jason D Kilts
- VA Mid-Atlantic Mental Illness Research and Clinical Center (MIRECC) and Durham VA Medical Center, Durham, NC, USA.,Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Jennifer C Naylor
- VA Mid-Atlantic Mental Illness Research and Clinical Center (MIRECC) and Durham VA Medical Center, Durham, NC, USA.,Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Rajendra A Morey
- VA Mid-Atlantic Mental Illness Research and Clinical Center (MIRECC) and Durham VA Medical Center, Durham, NC, USA.,Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA.,Duke-UNC Brain Imaging and Analysis Center, Duke University, Durham, NC, USA
| | - Lori Shutter
- Departments of Critical Care Medicine, Neurology and Neurosurgery, UPMC Health System/University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Norberto Andaluz
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA.,Mayfield Brain & Spine, Cincinnati, OH, USA
| | - Raul Coimbra
- Department of General Surgery, Riverside University Health System Medical Center, Moreno Valley, CA, USA
| | - Ariel J Lang
- VA San Diego Center of Excellence for Stress and Mental Health (CESAMH), San Diego, CA, USA.,Department of Psychiatry, University of California San Diego, La Jolla, CA, USA.,Department of Family Medicine and Public Health, University of California San Diego, La Jolla, CA, USA
| | - Mark S George
- Psychiatry Department, Medical University of South Carolina, Charleston, SC, USA.,Ralph H. Johnson VA Medical Center, Charleston, SC, USA
| | | | - Ross Zafonte
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Charlestown, MA, USA.,Department of Physical Medicine and Rehabilitation, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Murray B Stein
- VA San Diego Center of Excellence for Stress and Mental Health (CESAMH), San Diego, CA, USA.,Department of Psychiatry, University of California San Diego, La Jolla, CA, USA.,Department of Family Medicine and Public Health, University of California San Diego, La Jolla, CA, USA
| | - Martha E Shenton
- Department of Psychiatry, Psychiatry Neuroimaging Laboratory, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,VA Boston Healthcare System, Brockton Division, Brockton, MA, USA
| | - Inga K Koerte
- Department of Psychiatry, Psychiatry Neuroimaging Laboratory, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,cBRAIN, Department of Child and Adolescent Psychiatry, Psychosomatic and Psychotherapy, Ludwig-Maximilians-Universität, Munich, Germany.,Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.,Graduate School of Systemic Neuroscience, Ludwig-Maximilians-Universität, Munich, Germany
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Ware JB, Dolui S, Duda J, Gaggi N, Choi R, Detre J, Whyte J, Diaz-Arrastia R, Kim JJ. Relationship of Cerebral Blood Flow to Cognitive Function and Recovery in Early Chronic Traumatic Brain Injury. J Neurotrauma 2020; 37:2180-2187. [PMID: 32349614 DOI: 10.1089/neu.2020.7031] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Traumatic brain injury (TBI) is a leading cause of morbidity worldwide, for which biomarkers are needed to better understand the underlying pathophysiology. Microvascular injury represents a subset of pathological mechanisms contributing to cognitive dysfunction after TBI, which may also impair subsequent neural repair thereby inhibiting cognitive recovery. Magnetic resonance imaging (MRI)-based measurement of cerebral blood flow (CBF) by arterial spin labeling (ASL) provides an appealing means of assessing microvascular disruption in TBI; however, the relationship between CBF alterations in the early chronic post-TBI setting and cognitive dysfunction as well as subsequent cognitive recovery remain poorly understood. Structural MRI and ASL were performed in 42 TBI subjects 3 months post-injury and 35 matched healthy controls. Neuropsychological testing was performed in each subject, as well as in a subset of TBI patients (n = 33) at 6 and/or 12 months post-injury. TBI and control subject CBF data were compared between groups in a voxel-wise fashion while controlling for the effects of structural atrophy. A region-of-interest approach was then used to compare CBF to clinical and neuropsychological measures within the TBI group in a cross-sectional fashion, as well as to the degree of subsequent cognitive recovery among subjects with follow-up testing. At 3 months post-injury, the TBI group demonstrated lower performance in each cognitive domain (p < 0.05), as well as widespread reductions in gray matter CBF independent of structural atrophy (p < 0.05). Within the TBI group, CBF was moderately correlated with injury severity (r = -0.43; p = 0.009) and executive function (r = 0.43; p = 0.01). In the longitudinal analysis, there was a positive correlation between initial CBF and processing speed recovery (r = 0.43; p = 0.015) independent of age, education level, and initial test score. Early chronic TBI is associated with widespread gray matter CBF deficits, which are correlated with injury severity and cognitive dysfunction. CBF may predict subsequent recovery in some cognitive domains.
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Affiliation(s)
- Jeffrey B Ware
- Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Sudipto Dolui
- Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jeffrey Duda
- Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Naomi Gaggi
- Department of Neurology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Robin Choi
- Department of Molecular, Cellular, and Biomedical Sciences, City University of New York School of Medicine, New York, New York, USA
| | - John Detre
- Moss Rehabilitation Research Institute, Philadelphia, Pennsylvania, USA
| | - John Whyte
- Department of Molecular, Cellular, and Biomedical Sciences, City University of New York School of Medicine, New York, New York, USA
| | | | - Junghoon J Kim
- Department of Neurology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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34
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Katsumoto A, Takeuchi H, Tanaka F. Tau Pathology in Chronic Traumatic Encephalopathy and Alzheimer's Disease: Similarities and Differences. Front Neurol 2019; 10:980. [PMID: 31551922 PMCID: PMC6748163 DOI: 10.3389/fneur.2019.00980] [Citation(s) in RCA: 83] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 08/28/2019] [Indexed: 12/14/2022] Open
Abstract
Traumatic brain injury (TBI) has been associated with the development of Alzheimer's disease (AD) because these conditions share common pathological hallmarks: amyloid-β and hyperphosphorylated tau accumulation. However, given recent data it is uncertain if a history of TBI leads to the development of AD. Moreover, chronic traumatic encephalopathy (CTE), caused by repetitive mild TBI and characterized by progressive neurodegeneration with hyperphosphorylated tau, has come to be recognized as distinct from AD. Therefore, it is important to elucidate the clinical outcomes and molecular mechanisms underlying tau pathology following TBI. We summarize the histopathological features and clinical course of TBI in CTE, comparing the tau pathology with that in AD. Following brain injury, diffuse axonal injury, and hyperphosphorylated tau aggregates are observed within a shorter period than in AD. Hyperphosphorylated tau deposition usually begins in the perivascular area of the sulci in the cerebral cortex, then spreads unevenly in the cortex in CTE, while AD shows diffuse distribution of hyperphosphorylated tau in the cortical areas. We also highlight the molecular profile of tau and the implications of tau progression throughout the brain in both diseases. Tau contains phosphorylation sites common to both conditions. In particular, phosphorylation at Thr231 triggers a conformational change to the toxic cis form of tau, which is suggested to drive neurodegeneration. Although the mechanism of rapid tau accumulation remains unknown, the structural diversity of tau might result in these different outcomes. Finally, future perspectives on CTE in terms of tau reduction are discussed.
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Affiliation(s)
- Atsuko Katsumoto
- Department of Neurology and Stroke Medicine, Graduate School of Medicine, Yokohama City University, Yokohama, Japan
| | - Hideyuki Takeuchi
- Department of Neurology and Stroke Medicine, Graduate School of Medicine, Yokohama City University, Yokohama, Japan
| | - Fumiaki Tanaka
- Department of Neurology and Stroke Medicine, Graduate School of Medicine, Yokohama City University, Yokohama, Japan
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35
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Harris TC, de Rooij R, Kuhl E. The Shrinking Brain: Cerebral Atrophy Following Traumatic Brain Injury. Ann Biomed Eng 2019; 47:1941-1959. [PMID: 30341741 PMCID: PMC6757025 DOI: 10.1007/s10439-018-02148-2] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 10/01/2018] [Indexed: 11/29/2022]
Abstract
Cerebral atrophy in response to traumatic brain injury is a well-documented phenomenon in both primary investigations and review articles. Recent atrophy studies focus on exploring the region-specific patterns of cerebral atrophy; yet, there is no study that analyzes and synthesizes the emerging atrophy patterns in a single comprehensive review. Here we attempt to fill this gap in our current knowledge by integrating the current literature into a cohesive theory of preferential brain tissue loss and by identifying common risk factors for accelerated atrophy progression. Our review reveals that observations for mild traumatic brain injury remain inconclusive, whereas observations for moderate-to-severe traumatic brain injury converge towards robust patterns: brain tissue loss is on the order of 5% per year, and occurs in the form of generalized atrophy, across the entire brain, or focal atrophy, in specific brain regions. The most common regions of focal atrophy are the thalamus, hippocampus, and cerebellum in gray matter and the corpus callosum, corona radiata, and brainstem in white matter. We illustrate the differences of generalized and focal gray and white matter atrophy on emerging deformation and stress profiles across the whole brain using computational simulation. The characteristic features of our atrophy simulations-a widening of the cortical sulci, a gradual enlargement of the ventricles, and a pronounced cortical thinning-agree well with clinical observations. Understanding region-specific atrophy patterns in response to traumatic brain injury has significant implications in modeling, simulating, and predicting injury outcomes. Computational modeling of brain atrophy could open new strategies for physicians to make informed decisions for whom, how, and when to administer pharmaceutical treatment to manage the chronic loss of brain structure and function.
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36
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Volume and shape analysis of the Hippocampus and amygdala in veterans with traumatic brain injury and posttraumatic stress disorder. Brain Imaging Behav 2019; 14:1850-1864. [DOI: 10.1007/s11682-019-00127-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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37
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Cole JH, Jolly A, de Simoni S, Bourke N, Patel MC, Scott G, Sharp DJ. Spatial patterns of progressive brain volume loss after moderate-severe traumatic brain injury. Brain 2019; 141:822-836. [PMID: 29309542 PMCID: PMC5837530 DOI: 10.1093/brain/awx354] [Citation(s) in RCA: 94] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Accepted: 11/08/2017] [Indexed: 12/14/2022] Open
Abstract
Traumatic brain injury leads to significant loss of brain volume, which continues into the chronic stage. This can be sensitively measured using volumetric analysis of MRI. Here we: (i) investigated longitudinal patterns of brain atrophy; (ii) tested whether atrophy is greatest in sulcal cortical regions; and (iii) showed how atrophy could be used to power intervention trials aimed at slowing neurodegeneration. In 61 patients with moderate-severe traumatic brain injury (mean age = 41.55 years ± 12.77) and 32 healthy controls (mean age = 34.22 years ± 10.29), cross-sectional and longitudinal (1-year follow-up) brain structure was assessed using voxel-based morphometry on T1-weighted scans. Longitudinal brain volume changes were characterized using a novel neuroimaging analysis pipeline that generates a Jacobian determinant metric, reflecting spatial warping between baseline and follow-up scans. Jacobian determinant values were summarized regionally and compared with clinical and neuropsychological measures. Patients with traumatic brain injury showed lower grey and white matter volume in multiple brain regions compared to controls at baseline. Atrophy over 1 year was pronounced following traumatic brain injury. Patients with traumatic brain injury lost a mean (± standard deviation) of 1.55% ± 2.19 of grey matter volume per year, 1.49% ± 2.20 of white matter volume or 1.51% ± 1.60 of whole brain volume. Healthy controls lost 0.55% ± 1.13 of grey matter volume and gained 0.26% ± 1.11 of white matter volume; equating to a 0.22% ± 0.83 reduction in whole brain volume. Atrophy was greatest in white matter, where the majority (84%) of regions were affected. This effect was independent of and substantially greater than that of ageing. Increased atrophy was also seen in cortical sulci compared to gyri. There was no relationship between atrophy and time since injury or age at baseline. Atrophy rates were related to memory performance at the end of the follow-up period, as well as to changes in memory performance, prior to multiple comparison correction. In conclusion, traumatic brain injury results in progressive loss of brain tissue volume, which continues for many years post-injury. Atrophy is most prominent in the white matter, but is also more pronounced in cortical sulci compared to gyri. These findings suggest the Jacobian determinant provides a method of quantifying brain atrophy following a traumatic brain injury and is informative in determining the long-term neurodegenerative effects after injury. Power calculations indicate that Jacobian determinant images are an efficient surrogate marker in clinical trials of neuroprotective therapeutics.
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Affiliation(s)
- James H Cole
- Computational, Cognitive and Clinical Neuroimaging Laboratory, Imperial College London, Division of Brain Sciences, Hammersmith Hospital, London, UK
| | - Amy Jolly
- Computational, Cognitive and Clinical Neuroimaging Laboratory, Imperial College London, Division of Brain Sciences, Hammersmith Hospital, London, UK
| | - Sara de Simoni
- Computational, Cognitive and Clinical Neuroimaging Laboratory, Imperial College London, Division of Brain Sciences, Hammersmith Hospital, London, UK
| | - Niall Bourke
- Computational, Cognitive and Clinical Neuroimaging Laboratory, Imperial College London, Division of Brain Sciences, Hammersmith Hospital, London, UK
| | - Maneesh C Patel
- Computational, Cognitive and Clinical Neuroimaging Laboratory, Imperial College London, Division of Brain Sciences, Hammersmith Hospital, London, UK
| | - Gregory Scott
- Computational, Cognitive and Clinical Neuroimaging Laboratory, Imperial College London, Division of Brain Sciences, Hammersmith Hospital, London, UK
| | - David J Sharp
- Computational, Cognitive and Clinical Neuroimaging Laboratory, Imperial College London, Division of Brain Sciences, Hammersmith Hospital, London, UK
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38
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Thalamic atrophy and dysfunction in patients with mild-to-moderate traumatic diffuse axonal injury: a short-term and mid-term MRI study. Neuroreport 2019; 29:1282-1287. [PMID: 30080741 PMCID: PMC6143221 DOI: 10.1097/wnr.0000000000001106] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Disrupted white matter structure has been established in patients with diffuse axonal injury (DAI), but morphological changes in gray matter and local intrinsic activity in the short and midterm (before 6 months) have not been documented in DAI patients. We hypothesized that regionally selective atrophy observed in deep gray matter in the short-term and mid-term periods in patients with mild-to-moderate DAI, local atrophy, and/or dysfunction would be related to clinical characteristics. We evaluated the changes in regional density and synchronization in 18 DAI patients separately using Diffeomorphic Anatomical Registration through Exponentiated Lie algebra-enhanced voxel-based morphometry and regional homogeneity (ReHo). Compared with the controls, DAI patients showed a decreased density in the bilateral thalami and decreased ReHo values in the ventral anterior and ventral lateral nuclei of the bilateral thalami. Pearson's correlation analysis showed that decreased density in the bilateral thalami was correlated negatively with time since injury and decreased ReHo values in the ventral anterior and ventral lateral nuclei of the bilateral thalami were associated with a worsened motor assessment scale. These findings suggest that mild-to-moderate traumatic DAI within the short and midterm could lead to thalamic atrophy and that dysfunction in the bilateral thalami is associated with declining motor function. This study could potentially provide complementary evidence as an important element in longitudinal studies.
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39
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Catharine VL, Helena V, Ellen D, Guy V, Karel D, Karen C. Exploration of gray matter correlates of cognitive training benefit in adolescents with chronic traumatic brain injury. Neuroimage Clin 2019; 23:101827. [PMID: 31005776 PMCID: PMC6477162 DOI: 10.1016/j.nicl.2019.101827] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 03/19/2019] [Accepted: 04/13/2019] [Indexed: 12/23/2022]
Abstract
Sustaining a traumatic brain injury (TBI) during adolescence has a profound effect on brain development and can result in persistent executive functioning deficits in daily life. Cognitive recovery from pediatric-TBI relies on the potential of neuroplasticity, which can be fostered by restorative training-programs. However the structural mechanisms underlying cognitive recovery in the immature brain are poorly understood. This study investigated gray matter plasticity following 2 months of cognitive training in young patients with TBI. Sixteen adolescents in the chronic stage of moderate-severe-TBI (9 male, mean age = 15y8m ± 1y7m) were enrolled in a cognitive computerized training program for 8 weeks (5 times/week, 40 min/session). Pre-and post-intervention, and 6 months after completion of the training, participants underwent a comprehensive neurocognitive test-battery and anatomical Magnetic Resonance Imaging scans. We selected 9 cortical-subcortical Regions-Of-Interest associated with Executive Functioning (EF-ROIs) and 3 control regions from the Desikan-Killiany atlas. Baseline analyses showed significant decreased gray matter density in the superior frontal gyri p = 0.033, superior parietal gyri p = 0.015 and thalamus p = 0.006 in adolescents with TBI compared to age and gender matched controls. Linear mixed model analyses of longitudinal volumetric data of the EF-ROI revealed no strong evidence of training-related changes in the group with TBI. However, compared to the change over time in the control regions between post-intervention and 6 months follow-up, the change in the EF-ROIs showed a significant difference. Exploratory analyses revealed a negative correlation between the change on the Digit Symbol Substitution test and the change in volume of the putamen (r = -0.596, p = 0.015). This preliminary study contributes to the insights of training-related plasticity mechanisms after pediatric-TBI.
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Affiliation(s)
- Vander Linden Catharine
- Ghent University Hospital, Child Rehabilitation Centre K7, Corneel Heymanslaan 10, 9000 Ghent, Belgium.
| | - Verhelst Helena
- Ghent University, Department of Experimental Psychology, Faculty of Psychology and Educational Sciences, Henri Dunantlaan 2, 9000 Ghent, Belgium.
| | - Deschepper Ellen
- Ghent University, Biostatistics Unit, Department of Public Health, Corneel Heymanslaan 10, 9000 Ghent, Belgium.
| | - Vingerhoets Guy
- Ghent University, Department of Experimental Psychology, Faculty of Psychology and Educational Sciences, Henri Dunantlaan 2, 9000 Ghent, Belgium.
| | - Deblaere Karel
- Ghent University Hospital, Department of Neuroradiology, Corneel Heymanslaan 10, 9000 Ghent, Belgium.
| | - Caeyenberghs Karen
- Australian Catholic University, Mary McKillop Institute for Health Research Level 5, 215 Spring Street, Melbourne, VIC 3000, Australia.
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40
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Ubukata S, Oishi N, Sugihara G, Aso T, Fukuyama H, Murai T, Ueda K. Transcallosal Fiber Disruption and its Relationship with Corresponding Gray Matter Alteration in Patients with Diffuse Axonal Injury. J Neurotrauma 2019; 36:1106-1114. [DOI: 10.1089/neu.2018.5823] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Shiho Ubukata
- Department of Psychiatry, Center for the Promotion of Interdisciplinary Education and Research, Kyoto University, Kyoto, Japan
- Medical Innovation Center, Center for the Promotion of Interdisciplinary Education and Research, Kyoto University, Kyoto, Japan
| | - Naoya Oishi
- Medical Innovation Center, Center for the Promotion of Interdisciplinary Education and Research, Kyoto University, Kyoto, Japan
| | - Genichi Sugihara
- Department of Psychiatry, Center for the Promotion of Interdisciplinary Education and Research, Kyoto University, Kyoto, Japan
| | - Toshihiko Aso
- Department of Psychiatry, Center for the Promotion of Interdisciplinary Education and Research, Kyoto University, Kyoto, Japan
- Human Brain Research Center, Graduate School of Medicine, and Center for the Promotion of Interdisciplinary Education and Research, Kyoto University, Kyoto, Japan
| | - Hidenao Fukuyama
- Beijing Institute of Technology, Beijing, China
- Research and Educational Unit of Leaders for Integrated Medical System, Center for the Promotion of Interdisciplinary Education and Research, Kyoto University, Kyoto, Japan
| | - Toshiya Murai
- Department of Psychiatry, Center for the Promotion of Interdisciplinary Education and Research, Kyoto University, Kyoto, Japan
| | - Keita Ueda
- Department of Psychiatry, Center for the Promotion of Interdisciplinary Education and Research, Kyoto University, Kyoto, Japan
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41
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Development of a Stand-Alone Independent Graphical User Interface for Neurological Disease Prediction with Automated Extraction and Segmentation of Gray and White Matter in Brain MRI Images. JOURNAL OF HEALTHCARE ENGINEERING 2019; 2019:9610212. [PMID: 30906515 PMCID: PMC6393878 DOI: 10.1155/2019/9610212] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Accepted: 09/16/2018] [Indexed: 11/29/2022]
Abstract
This research presents an independent stand-alone graphical computational tool which functions as a neurological disease prediction framework for diagnosis of neurological disorders to assist neurologists or researchers in the field to perform automatic segmentation of gray and white matter regions in brain MRI images. The tool was built in collaboration with neurologists and neurosurgeons and many of the features are based on their feedback. This tool provides the user automatized functionality to perform automatic segmentation and extract the gray and white matter regions of patient brain image data using an algorithm called adapted fuzzy c-means (FCM) membership-based clustering with preprocessing using the elliptical Hough transform and postprocessing using connected region analysis. Dice coefficients for several patient brain MRI images were calculated to measure the similarity between the manual tracings by experts and automatic segmentations obtained in this research. The average Dice coefficients are 0.86 for gray matter, 0.88 for white matter, and 0.87 for total cortical matter. Dice coefficients of the proposed algorithm were also the highest when compared with previously published standard state-of-the-art brain MRI segmentation algorithms in terms of accuracy in segmenting the gray matter, white matter, and total cortical matter.
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42
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Konstantinou N, Pettemeridou E, Stamatakis EA, Seimenis I, Constantinidou F. Altered Resting Functional Connectivity Is Related to Cognitive Outcome in Males With Moderate-Severe Traumatic Brain Injury. Front Neurol 2019; 9:1163. [PMID: 30687219 PMCID: PMC6335280 DOI: 10.3389/fneur.2018.01163] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Accepted: 12/17/2018] [Indexed: 12/30/2022] Open
Abstract
TBI results in significant cognitive impairments and in altered brain functional connectivity. However, no studies explored so far, the relationship between global functional connectivity and cognitive outcome in chronic moderate-severe TBI. This proof of principle study employed the intrinsic connectivity contrast, an objective voxel-based metric of global functional connectivity, in a small sample of chronic moderate-severe TBI participants and a group of healthy controls matched on gender (males), age, and education. Cognitive tests assessing executive functions, verbal memory, visual memory, attention/organization, and cognitive reserve were administered. Group differences in terms of global functional connectivity maps were assessed and the association between performance on the cognitive measures and global functional connectivity was examined. Next, we investigated the spatial extent of functional connectivity in the brain regions found to be associated with cognitive performance, using traditional seed-based analyses. Global functional connectivity of the TBI group was altered, compared to the controls. Moreover, the strength of global functional connectivity in affected brain areas was associated with cognitive outcome. These findings indicate that impaired global functional connectivity is a significant consequence of TBI suggesting that cognitive impairments following TBI may be partly attributed to altered functional connectivity between brain areas involved in the specific cognitive functions.
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Affiliation(s)
- Nikos Konstantinou
- Department of Rehabilitation Sciences, Cyprus University of Technology, Limassol, Cyprus
| | - Eva Pettemeridou
- Center for Applied Neuroscience, University of Cyprus, Nicosia, Cyprus.,Department of Psychology, University of Cyprus, Nicosia, Cyprus
| | | | - Ioannis Seimenis
- Medical Physics Laboratory, Medical School, Democritus University of Thrace, Alexandroupoli, Greece
| | - Fofi Constantinidou
- Center for Applied Neuroscience, University of Cyprus, Nicosia, Cyprus.,Department of Psychology, University of Cyprus, Nicosia, Cyprus
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43
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Ferraro S, Nigri A, Nava S, Rosazza C, Sattin D, Sebastiano DR, Porcu L, Bruzzone MG, Marotta G, Benti R, Redolfi A, Matilde L, D'Incerti L. Interhemispherical Anatomical Disconnection in Disorders of Consciousness Patients. J Neurotrauma 2019; 36:1535-1543. [PMID: 30520674 DOI: 10.1089/neu.2018.5820] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
In patients with disorder of consciousness (DOC), the corpus callosum (CC) and subcortical white matter (SWM) integrity were shown to discriminate between diagnostic categories. The aims of the study were: (1) to clarify the link between the integrity of CC and of SWM and the clinical status in DOC patients, disentangling the role played by the different brain injuries (traumatic or hemorrhagic brain injury); (2) to investigate the relationship between the CC integrity and the brain metabolism. We assessed the diagnostic accuracy of the CC and SWM integrity, using diffusion tensor imaging (DTI) and structural magnetic resonance imaging (sMRI), in a sample of DOC individuals, well balanced for diagnosis and etiology. The CC DTI-derived measures were correlated with the brain metabolism, computed with fluorodeoxyglucose positron emission tomography. Our results showed that the CC macrostructural DTI-derived measures discriminate between diagnosis and correlate with the clinical status of DOC patients irrespective of the etiology. Moreover, the CC DTI-derived measures strongly correlate with the metabolism of the right hemisphere. No significant diagnostic accuracy emerged for the CC sMRI evaluation and the SWM measures. Our results indicate that: (1) the degree of the interhemispherical anatomical disconnection is a marker of the level of consciousness independent from the type of brain injury; (2) CC alterations might be the consequence of the reduced brain metabolism. Remarkably, our results suggest that the functional interplay between the two hemispheres is linked tightly to the level of consciousness.
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Affiliation(s)
| | - Anna Nigri
- 1 Neuroradiology Department, " Milan, Italy
| | | | | | - Davide Sattin
- 3 Neurology, Public Health, Disability Unit, and " Milan, Italy
| | - Davide Rossi Sebastiano
- 4 Neurophysiology Department of Fondazione IRCCS Istituto Neurologico "Carlo Besta," Milan, Italy
| | - Luca Porcu
- 5 Laboratory of Methodology for Clinical Research, Oncology Department, IRCCS Istituto di Ricerche Farmacologiche "Mario Negri," Milan, Italy
| | | | - Giorgio Marotta
- 6 Department of Nuclear Medicine, Fondazione IRCCS Ca' Granda Ospedale Maggiore, Milan, Italy
| | - Riccardo Benti
- 6 Department of Nuclear Medicine, Fondazione IRCCS Ca' Granda Ospedale Maggiore, Milan, Italy
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44
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Affiliation(s)
- Lee Goldstein
- Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts
- Department of Neurology, Boston University School of Medicine, Boston, Massachusetts
- Department of Radiology, Boston University School of Medicine, Boston, Massachusetts
- Department of Pathology, Boston University School of Medicine, Boston, Massachusetts
- Boston University College of Engineering, Boston, Massachusetts
- Boston University Alzheimer's Disease and CTE Center, Boston University School of Medicine, Boston, Massachusetts
| | - Ramon Diaz-Arrastia
- Department of Neurology, University of Pennsylvania Perelman School of Medicine, Philadelphia
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45
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Stewan Feltrin F, Zaninotto AL, Guirado VMP, Macruz F, Sakuno D, Dalaqua M, Magalhães LGA, Paiva WS, Andrade AFD, Otaduy MCG, Leite CC. Longitudinal changes in brain volumetry and cognitive functions after moderate and severe diffuse axonal injury. Brain Inj 2018; 32:1208-1217. [PMID: 30024781 DOI: 10.1080/02699052.2018.1494852] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND AND OBJECTIVE Diffuse axonal injury (DAI) induces a long-term process of brain atrophy and cognitive deficits. The goal of this study was to determine whether there are correlations between brain volume loss, microhaemorrhage load (MHL) and neuropsychological performance during the first year after DAI. METHODS Twenty-four patients with moderate or severe DAI were evaluated at 2, 6 and 12 months post-injury. MHL was evaluated at 3 months, and brain volumetry was evaluated at 3, 6 and 12 months. The trail making test (TMT) was used to evaluate executive function (EF), and the Hopkins verbal learning test (HVLT) was used to evaluate episodic verbal memory (EVM) at 6 and 12 months. RESULTS There were significant white matter volume (WMV), subcortical grey matter volume and total brain volume (TBV) reductions during the study period (p < 0.05). MHL was correlated only with WMV reduction. EF and EVM were not correlated with MHL but were, in part, correlated with WMV and TBV reductions. CONCLUSIONS Our findings suggest that MHL may be a predictor of WMV reduction but cannot predict EF or EVM in DAI. Brain atrophy progresses over time, but patients showed better EF and EVM in some of the tests, which could be due to neuroplasticity.
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Affiliation(s)
- Fabrício Stewan Feltrin
- a Laboratory of Magnetic Resonance, LIM44, Department of Radiology , Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo , Sao Paulo , SP , Brazil
| | - Ana Luiza Zaninotto
- b Division of Psychology , Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo , Sao Paulo , SP , Brazil
| | - Vinícius M P Guirado
- c Division of Neurosurgery , Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo , Sao Paulo , SP , Brazil
| | - Fabiola Macruz
- a Laboratory of Magnetic Resonance, LIM44, Department of Radiology , Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo , Sao Paulo , SP , Brazil
| | - Daniel Sakuno
- d Department of Radiology , Hospital Universitário HU-UEPG, Universidade Estadual de Ponta Grossa , Ponta Grossa , Brazil
| | - Mariana Dalaqua
- e Department of Radiology , Hospital Israelita Albert Einstein , São Paulo , Brazil
| | | | - Wellingson Silva Paiva
- c Division of Neurosurgery , Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo , Sao Paulo , SP , Brazil
| | - Almir Ferreira de Andrade
- c Division of Neurosurgery , Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo , Sao Paulo , SP , Brazil
| | - Maria C G Otaduy
- a Laboratory of Magnetic Resonance, LIM44, Department of Radiology , Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo , Sao Paulo , SP , Brazil
| | - Claudia C Leite
- a Laboratory of Magnetic Resonance, LIM44, Department of Radiology , Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo , Sao Paulo , SP , Brazil
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46
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Diffuse axonal injury (DAI) in moderate to severe head injured patients: Pure DAI vs. non-pure DAI. Clin Neurol Neurosurg 2018; 171:116-123. [PMID: 29909182 DOI: 10.1016/j.clineuro.2018.06.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Revised: 06/01/2018] [Accepted: 06/09/2018] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Diffuse axonal injury (DAI) is known to be associated with poor outcome. DAI often associates with other intracranial injuries but their distinct features have not been established. In this retrospective cohort study, we compared clinical outcomes between pure and non-pure DAI patients. PATIENTS AND METHODS Total of 1047 traumatic brain injury (TBI) patients visited our institute between 2011 and 2017. Age ranged between 15-85 years old and Glasgow coma scale (GCS) score less than 13 were included. DAI was diagnosed in 45 patients using CT and MRI and their clinical features and outcomes were compared depending on their associated cranial injury; 20 patients without evidence of associated injury (Pure DAI group) and other 25 patients with associated injury (Non-pure DAI group). DAI stage was adopted using Gentry, L.R. CLASSIFICATION Glasgow outcome scale (GOS) was measured at least 6 months after trauma to evaluate their functional outcome. RESULTS The mean age and follow-up period were 45.36 years and 15.09 months, respectively. There were no significant differences between pure and non-pure DAI groups regarding demographic data and clinical findings on their admission. Logistic regression model was used to examine the association between GOS and clinical factors. In this analysis, pure DAI was no significantly different to non-pure DAI (p = 0.607). However, DAI Stage, transfusion, and hypotension on admission were strongly related to poor outcome. Stage III showed sevenfold higher risk when compared to Stage I (p = 0.010). The risk was also high when Stage III was compare to Stage I and II (p = 0.002). Interestingly, no significant difference was observed between Stage I and II (p = 0.847). CONCLUSIONS Unfavorable outcome was observed in 14 patients (31.11%) which was lower than we expected. Interestingly, non-pure DAI was no worse than pure DAI on their functional outcome. However, DAI Stage III was independently associated with poor outcome when compared to Stage I or I and II. Finally, we concluded that Stage II is clinically more related to Stage I, rather than Stage III.
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47
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Ruet A, Joyeux F, Segobin S, Jokic C, Desgranges B, Eustache F, Pitel AL. Severe Traumatic Brain Injury Patients without Focal Lesion but with Behavioral Disorders: Shrinkage of Gray Matter Nuclei and Thalamus Revealed in a Pilot Voxel-Based MRI Study. J Neurotrauma 2018; 35:1552-1556. [PMID: 29648977 DOI: 10.1089/neu.2017.5242] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
After a traumatic brain injury (TBI), behavioral disorders can occur without major focal brain lesion, and in these situations, their pathophysiology remains unclear. The aim of this study is to examine whether TBI patients with behavioral disorders but without any focal damage, as observed from an initial clinical CT scan, present subtle volumetric alterations that could be measured voxel-by-voxel in the whole brain with MRI. Eight male adults with severe TBI who had behavioral sequela but not major focal cerebral lesion and 17 age-matched controls underwent a volumetric T1-weighted 1.5T MRI. A two step analysis was performed. First, gray matter (GM) and white matter (WM) volumes were compared between groups using voxel-based morphometry. Second, we examined brain regions systematically damaged using the sum of the individual binary maps obtained from z-maps thresholded at -1.75 for significant GM and WM atrophy. TBI patients had lower GM volume than controls (p < 0.001, uncorrected) in the right parahippocampal gyrus; left and right superior, middle, and inferior temporal gyri; left superior frontal gyrus; right middle frontal gyrus; thalami; mammillary bodies; caudate nuclei; insulae; cerebellar cortex; and vermis. WM volume was lower (p < 0.001, uncorrected) in the TBI group than in controls in the periventricular area and around the basal nuclei. We found shrinkage in the dorsomedial thalami in each of the TBI patients, and in the posterior part of the right putamen and caudate nuclei in seven TBI patients. Shrinkage in the dorsomedial thalami and in the posterior part of the right putamen and caudate nuclei may be a common effect of the disseminated microscopic lesions, and be associated with behavioral issues in severe TBI patients without major focal lesions.
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Affiliation(s)
- Alexis Ruet
- 1 CHU de Caen, Service de Médecine Physique et de Réadaptation, Caen, France .,2 INSERM; EPHE, Neuropsychologie et Imagerie de la Mémoire Humaine, UNICAEN, PSL Research University , Normandie Université, Caen, France .,3 CH Aunay Bayeux, Service de Médecine Physique et de Réadaptation, Aunay/Odon, France
| | - Françoise Joyeux
- 2 INSERM; EPHE, Neuropsychologie et Imagerie de la Mémoire Humaine, UNICAEN, PSL Research University , Normandie Université, Caen, France .,3 CH Aunay Bayeux, Service de Médecine Physique et de Réadaptation, Aunay/Odon, France
| | - Shailendra Segobin
- 2 INSERM; EPHE, Neuropsychologie et Imagerie de la Mémoire Humaine, UNICAEN, PSL Research University , Normandie Université, Caen, France
| | - Corine Jokic
- 3 CH Aunay Bayeux, Service de Médecine Physique et de Réadaptation, Aunay/Odon, France
| | - Béatrice Desgranges
- 2 INSERM; EPHE, Neuropsychologie et Imagerie de la Mémoire Humaine, UNICAEN, PSL Research University , Normandie Université, Caen, France
| | - Francis Eustache
- 2 INSERM; EPHE, Neuropsychologie et Imagerie de la Mémoire Humaine, UNICAEN, PSL Research University , Normandie Université, Caen, France
| | - Anne-Lise Pitel
- 2 INSERM; EPHE, Neuropsychologie et Imagerie de la Mémoire Humaine, UNICAEN, PSL Research University , Normandie Université, Caen, France
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48
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Annen J, Heine L, Ziegler E, Frasso G, Bahri M, Di Perri C, Stender J, Martial C, Wannez S, D'ostilio K, Amico E, Antonopoulos G, Bernard C, Tshibanda F, Hustinx R, Laureys S. Function-structure connectivity in patients with severe brain injury as measured by MRI-DWI and FDG-PET. Hum Brain Mapp 2018; 37:3707-3720. [PMID: 27273334 DOI: 10.1002/hbm.23269] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Revised: 04/12/2016] [Accepted: 05/16/2016] [Indexed: 02/05/2023] Open
Abstract
A vast body of literature exists showing functional and structural dysfunction within the brains of patients with disorders of consciousness. However, the function (fluorodeoxyglucose FDG-PET metabolism)-structure (MRI-diffusion-weighted images; DWI) relationship and how it is affected in severely brain injured patients remains ill-defined. FDG-PET and MRI-DWI in 25 severely brain injured patients (19 Disorders of Consciousness of which 7 unresponsive wakefulness syndrome, 12 minimally conscious; 6 emergence from minimally conscious state) and 25 healthy control subjects were acquired here. Default mode network (DMN) function-structure connectivity was assessed by fractional anisotropy (FA) and metabolic standardized uptake value (SUV). As expected, a profound decline in regional metabolism and white matter integrity was found in patients as compared with healthy subjects. Furthermore, a function-structure relationship was present in brain-damaged patients between functional metabolism of inferior-parietal, precuneus, and frontal regions and structural integrity of the frontal-inferiorparietal, precuneus-inferiorparietal, thalamo-inferioparietal, and thalamofrontal tracts. When focusing on patients, a stronger relationship between structural integrity of thalamo-inferiorparietal tracts and thalamic metabolism in patients who have emerged from the minimally conscious state as compared with patients with disorders of consciousness was found. The latter finding was in line with the mesocircuit hypothesis for the emergence of consciousness. The findings showed a positive function-structure relationship within most regions of the DMN. Hum Brain Mapp 37:3707-3720, 2016. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- J Annen
- Cyclotron Research Centre, University of Liège, Liège, Belgium.,Coma Science Group, GIGA Consciousness, University of Liège, Liège, Belgium.,University Hospital of Liège, Liège, Belgium
| | - L Heine
- Cyclotron Research Centre, University of Liège, Liège, Belgium.,Coma Science Group, GIGA Consciousness, University of Liège, Liège, Belgium.,University Hospital of Liège, Liège, Belgium
| | - E Ziegler
- Cyclotron Research Centre, University of Liège, Liège, Belgium
| | - G Frasso
- Faculty of Social Sciences, Quantitative Methods for Social Sciences, University of Liège, Liège, Belgium
| | - M Bahri
- Cyclotron Research Centre, University of Liège, Liège, Belgium
| | - C Di Perri
- Cyclotron Research Centre, University of Liège, Liège, Belgium.,Coma Science Group, GIGA Consciousness, University of Liège, Liège, Belgium
| | - J Stender
- University of Copenhagen, Copenhagen, Denmark
| | - C Martial
- Cyclotron Research Centre, University of Liège, Liège, Belgium.,Coma Science Group, GIGA Consciousness, University of Liège, Liège, Belgium.,University Hospital of Liège, Liège, Belgium
| | - S Wannez
- Cyclotron Research Centre, University of Liège, Liège, Belgium.,Coma Science Group, GIGA Consciousness, University of Liège, Liège, Belgium.,University Hospital of Liège, Liège, Belgium
| | - K D'ostilio
- Headache Research Unit, University of Liège, Liège, Belgium
| | - E Amico
- Cyclotron Research Centre, University of Liège, Liège, Belgium.,Coma Science Group, GIGA Consciousness, University of Liège, Liège, Belgium
| | - G Antonopoulos
- Cyclotron Research Centre, University of Liège, Liège, Belgium.,Coma Science Group, GIGA Consciousness, University of Liège, Liège, Belgium
| | - C Bernard
- University Hospital of Liège, Liège, Belgium
| | - F Tshibanda
- University Hospital of Liège, Liège, Belgium
| | - R Hustinx
- University Hospital of Liège, Liège, Belgium
| | - S Laureys
- Cyclotron Research Centre, University of Liège, Liège, Belgium. .,Coma Science Group, GIGA Consciousness, University of Liège, Liège, Belgium. .,University Hospital of Liège, Liège, Belgium.
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49
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Almeida Vieira RDC, Paiva WS, de Oliveira DV, de Paula Guirado VM, Caetano Lança EDF, de Sousa RMC. Recovery of Patients with Pure Diffuse Axonal Injury Who Remained in a Coma for 6 Hours or More. World Neurosurg 2018; 109:140-146. [DOI: 10.1016/j.wneu.2017.09.101] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Revised: 09/14/2017] [Accepted: 09/15/2017] [Indexed: 02/06/2023]
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50
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The Prognostic Value of MRI in Moderate and Severe Traumatic Brain Injury: A Systematic Review and Meta-Analysis. Crit Care Med 2017; 45:e1280-e1288. [PMID: 29028764 DOI: 10.1097/ccm.0000000000002731] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVES Traumatic brain injury is a major cause of death and disability, yet many predictors of outcome are not precise enough to guide initial clinical decision-making. Although increasingly used in the early phase following traumatic brain injury, the prognostic utility of MRI remains uncertain. We thus undertook a systematic review and meta-analysis of studies evaluating the predictive value of acute MRI lesion patterns for discriminating clinical outcome in traumatic brain injury. DATA SOURCES MEDLINE, EMBASE, BIOSIS, and CENTRAL from inception to November 2015. STUDY SELECTION Studies of adults who had MRI in the acute phase following moderate or severe traumatic brain injury. Our primary outcomes were all-cause mortality and the Glasgow Outcome Scale. DATA EXTRACTION Two authors independently performed study selection and data extraction. We calculated pooled effect estimates with a random effects model, evaluated the risk of bias using a modified version of Quality in Prognostic Studies and determined the strength of evidence with the Grading of Recommendations, Assessment, Development, and Evaluation. DATA SYNTHESIS We included 58 eligible studies, of which 27 (n = 1,652) contributed data to meta-analysis. Brainstem lesions were associated with all-cause mortality (risk ratio, 1.78; 95% CI, 1.01-3.15; I = 43%) and unfavorable Glasgow Outcome Scale (risk ratio, 2.49; 95% CI, 1.72-3.58; I = 81%) at greater than or equal to 6 months. Diffuse axonal injury patterns were associated with an increased risk of unfavorable Glasgow Outcome Scale (risk ratio, 2.46; 95% CI, 1.06-5.69; I = 74%). MRI scores based on lesion depth demonstrated increasing risk of unfavorable neurologic outcome as more caudal structures were affected. Most studies were at high risk of methodological bias. CONCLUSIONS MRI following traumatic brain injury yields important prognostic information, with several lesion patterns significantly associated with long-term survival and neurologic outcome. Given the high risk of bias in the current body of literature, large well-controlled studies are necessary to better quantify the prognostic role of early MRI in moderate and severe traumatic brain injury.
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