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Wintermark M, Allen JW, Anzai Y, Das T, Flanders AE, Galanaud D, Gean A, Haller S, Lv H, Hirvonen J, Jordan JE, Lee R, Lui YW, Sundgren PC, Mukherjee P, Moen KG, Muto M, Ng K, Niogi SN, Rovira A, de Bruxellas NL, Smits M, Tsiouris AJ, Van Goethem J, Vyvere TV, Whitlow C, Wiesmann M, Yamada K, Zakharova N, Parizel PM. Standardized reporting for Head CT Scans in patients suspected of traumatic brain injury (TBI): An international expert endeavor. Neuroradiology 2024:10.1007/s00234-024-03410-2. [PMID: 38963424 DOI: 10.1007/s00234-024-03410-2] [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: 04/07/2024] [Accepted: 06/20/2024] [Indexed: 07/05/2024]
Abstract
BACKGROUND AND PURPOSE Traumatic brain injury (TBI) is a major source of health loss and disability worldwide. Accurate and timely diagnosis of TBI is critical for appropriate treatment and management of the condition. Neuroimaging plays a crucial role in the diagnosis and characterization of TBI. Computed tomography (CT) is the first-line diagnostic imaging modality typically utilized in patients with suspected acute mild, moderate and severe TBI. Radiology reports play a crucial role in the diagnostic process, providing critical information about the location and extent of brain injury, as well as factors that could prevent secondary injury. However, the complexity and variability of radiology reports can make it challenging for healthcare providers to extract the necessary information for diagnosis and treatment planning. METHODS/RESULTS/CONCLUSION In this article, we report the efforts of an international group of TBI imaging experts to develop a clinical radiology report template for CT scans obtained in patients suspected of TBI and consisting of fourteen different subdivisions (CT technique, mechanism of injury or clinical history, presence of scalp injuries, fractures, potential vascular injuries, potential injuries involving the extra-axial spaces, brain parenchymal injuries, potential injuries involving the cerebrospinal fluid spaces and the ventricular system, mass effect, secondary injuries, prior or coexisting pathology).
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Affiliation(s)
- Max Wintermark
- Department of Neuroradiology, The University of Teas MD Anderson Center, Houston, TX, USA.
| | - Jason W Allen
- Department of Radiology, University of Indiana, Indianapolis, IN, USA
| | - Yoshimi Anzai
- Department of Radiology, University of Utah, Salt Lake City, UT, USA
| | - Tilak Das
- Department of Radiology, Cambridge University Hospitals, Cambridge, UK
| | - Adam E Flanders
- Department of Radiology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Damien Galanaud
- Department of Neuroradiology, Pitie Salpetrière Hospital & Sorbonne, Universite, Paris, France
| | - Alisa Gean
- Department of Radiology, University of California San Francisco, San Francisco, CA, USA
| | - Sven Haller
- Department of Imaging and Medical Informatics, University Hospitals of Geneva and Faculty of Medicine of the University of Geneva, Geneva, Switzerland
| | - Han Lv
- Department of Radiology, Capital Medical University Affiliated Beijing Friendship Hospital, Beijing, 100050, China
| | - Jussi Hirvonen
- Department of Radiology, Tampere University, Faculty of Medicine and Health Technology, and Tampere University Hospital, Tampere, Finland
| | - John E Jordan
- Providence Little Company of Mary Medical Center-Torrance, Torrance, CA, USA
| | - Roland Lee
- Radiology Department, San Diego VA Healthcare System, University of California San Diego, San Diego, CA, USA
| | - Yvonne W Lui
- FACR, Department of Radiology, NYU Langone Health / Grossman School of Medicine, New York, NY, USA
| | - Pia C Sundgren
- Diagnostic Radiology, Department of Clinical Sciences, Lund University, Lund, Sweden
- Department of Medcial Imaging and Physiology, Skåne University Hospital, Lund, Sweden
| | - Pratik Mukherjee
- Department of Veterans Affairs, San Francisco VA Health Care System, San Francisco, CA, U.S.A
- University of California, San Francisco, CA, USA
| | - Kent Gøran Moen
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
| | - Mario Muto
- Chief Diagnostic and Interventional Neuroradiology, Cardarelli Hospital Naples, Naples, Italy
| | - Karelys Ng
- Section of Neuroradiology, Department of Radiology, University Hospital Vall d'Hebron, Barcelona, Spain
| | - Sumit N Niogi
- Weill Cornell Medicine, Department of Radiology, New York, NY, USA
| | - Alex Rovira
- Section of Neuroradiology, Department of Radiology, University Hospital Vall d'Hebron, Barcelona, Spain
| | | | - Marion Smits
- Department of Radiology & Nuclear Medicine, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
- Medical Delta, Delft, The Netherlands
| | - A John Tsiouris
- Associate Professor of Clinical RadiologyDirector of MRIDepartment of Radiology, Section Chief, Weill Cornell Medicine, NeuroradiologyNew York, NY, USA
| | - Johan Van Goethem
- Department of Medical and Molecular Imaging, University Hospital of Antwerp, Antwerp, Belgium
| | - Thijs Vande Vyvere
- Department of Rehabilitation Sciences and Physiotherapy, MOVANT, University of Antwerp, Antwerp, Belgium
- Pain in Motion International Research Group, Brussels, Belgium
- Department of Radiology, Antwerp University Hospital, Antwerp, Belgium
| | - Chris Whitlow
- Department of Radiology, Wake Forest University, Winston-Salem, USA
| | - Martin Wiesmann
- Department of Neuroradiology, University Hospital Aachen, Aachen, Germany
| | - Kei Yamada
- Department of Radiology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Natalia Zakharova
- N.N. Burdenko National Medical Research Center of Neurosurgery, Federal State Autonomous Institution, Moscow, Russian Federation
| | - Paul M Parizel
- FRANZCR Dept of Radiology, Royal Perth Hospital (RPH), Medical School, University of Western Australia (UWA), Perth, WA, Australia
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Moen KG, Flusund AMH, Moe HK, Andelic N, Skandsen T, Håberg A, Kvistad KA, Olsen Ø, Saksvoll EH, Abel-Grüner S, Anke A, Follestad T, Vik A. The prognostic importance of traumatic axonal injury on early MRI: the Trondheim TAI-MRI grading and quantitative models. Eur Radiol 2024:10.1007/s00330-024-10841-1. [PMID: 38896232 DOI: 10.1007/s00330-024-10841-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Revised: 03/25/2024] [Accepted: 04/06/2024] [Indexed: 06/21/2024]
Abstract
OBJECTIVES We analysed magnetic resonance imaging (MRI) findings after traumatic brain injury (TBI) aiming to improve the grading of traumatic axonal injury (TAI) to better reflect the outcome. METHODS Four-hundred sixty-three patients (8-70 years) with mild (n = 158), moderate (n = 129), or severe (n = 176) TBI and early MRI were prospectively included. TAI presence, numbers, and volumes at predefined locations were registered on fluid-attenuated inversion recovery (FLAIR) and diffusion-weighted imaging, and presence and numbers on T2*GRE/SWI. Presence and volumes of contusions were registered on FLAIR. We assessed the outcome with the Glasgow Outcome Scale Extended. Multivariable logistic and elastic-net regression analyses were performed. RESULTS The presence of TAI differed between mild (6%), moderate (70%), and severe TBI (95%). In severe TBI, bilateral TAI in mesencephalon or thalami and bilateral TAI in pons predicted worse outcomes and were defined as the worst grades (4 and 5, respectively) in the Trondheim TAI-MRI grading. The Trondheim TAI-MRI grading performed better than the standard TAI grading in severe TBI (pseudo-R2 0.19 vs. 0.16). In moderate-severe TBI, quantitative models including both FLAIR volume of TAI and contusions performed best (pseudo-R2 0.19-0.21). In patients with mild TBI or Glasgow Coma Scale (GCS) score 13, models with the volume of contusions performed best (pseudo-R2 0.25-0.26). CONCLUSIONS We propose the Trondheim TAI-MRI grading (grades 1-5) with bilateral TAI in mesencephalon or thalami, and bilateral TAI in pons as the worst grades. The predictive value was highest for the quantitative models including FLAIR volume of TAI and contusions (GCS score <13) or FLAIR volume of contusions (GCS score ≥ 13), which emphasise artificial intelligence as a potentially important future tool. CLINICAL RELEVANCE STATEMENT The Trondheim TAI-MRI grading reflects patient outcomes better in severe TBI than today's standard TAI grading and can be implemented after external validation. The prognostic importance of volumetric models is promising for future use of artificial intelligence technologies. KEY POINTS Traumatic axonal injury (TAI) is an important injury type in all TBI severities. Studies demonstrating which MRI findings that can serve as future biomarkers are highly warranted. This study proposes the most optimal MRI models for predicting patient outcome at 6 months after TBI; one updated pragmatic model and a volumetric model. The Trondheim TAI-MRI grading, in severe TBI, reflects patient outcome better than today's standard grading of TAI and the prognostic importance of volumetric models in all severities of TBI is promising for future use of AI.
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Affiliation(s)
- Kent Gøran Moen
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), 7491, Trondheim, Norway.
- Department of Radiology, Vestre Viken Hospital Trust, Drammen Hospital, 3004, Drammen, Norway.
- Department of Radiology and Nuclear Medicine, St. Olavs Hospital, Trondheim University Hospital, 7006, Trondheim, Norway.
- Department of Neurosurgery, St. Olavs Hospital, Trondheim University Hospital, 7006, Trondheim, Norway.
| | - Anne-Mari Holte Flusund
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), 7491, Trondheim, Norway
- Department of Radiology, Møre and Romsdal Hospital Trust, Molde Hospital, 6412, Molde, Norway
| | - Hans Kristian Moe
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), 7491, Trondheim, Norway
- Department of Neurosurgery, Oslo University Hospital, Rikshospitalet, P.O. Box 4950 Nydalen, 0424, Oslo, Norway
| | - Nada Andelic
- Institute of Health and Society, Research Centre for Habilitation and Rehabilitation Models and Services (CHARM), Faculty of Medicine, University of Oslo, P.O. Box 1130 Blindern, 0318, Oslo, Norway
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Ullevål Hospital, P.O. Box 4956 Nydalen, 0424, Oslo, Norway
| | - Toril Skandsen
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), 7491, Trondheim, Norway
- Department of Physical Medicine and Rehabilitation, St. Olavs Hospital, Trondheim University Hospital, 7006, Trondheim, Norway
| | - Asta Håberg
- Department of Radiology and Nuclear Medicine, St. Olavs Hospital, Trondheim University Hospital, 7006, Trondheim, Norway
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), 7491, Trondheim, Norway
- MI Lab and Department of Circulation and Medical Imaging, Norwegian University of Science and Technology (NTNU), 7491, Trondheim, Norway
| | - Kjell Arne Kvistad
- Department of Radiology and Nuclear Medicine, St. Olavs Hospital, Trondheim University Hospital, 7006, Trondheim, Norway
| | - Øystein Olsen
- Department of Radiology, Nord-Trøndelag Hospital Trust, Levanger Hospital, 7600, Levanger, Norway
| | - Elin Hildrum Saksvoll
- Department of Radiology, Nord-Trøndelag Hospital Trust, Levanger Hospital, 7600, Levanger, Norway
| | - Sebastian Abel-Grüner
- Department of Radiology and Nuclear Medicine, St. Olavs Hospital, Trondheim University Hospital, 7006, Trondheim, Norway
| | - Audny Anke
- Department of Rehabilitation, University Hospital of North Norway, 9038, Tromsø, Norway
- Faculty of Health Sciences, Department of Clinical Medicine, UiT- The Arctic University of Norway, 9038, Tromsø, Norway
| | - Turid Follestad
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, 7491, Trondheim, Norway
- Clinical Research Unit Central Norway, St. Olavs Hospital, Trondheim University Hospital, 7006, Trondheim, Norway
| | - Anne Vik
- Department of Neurosurgery, St. Olavs Hospital, Trondheim University Hospital, 7006, Trondheim, Norway
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), 7491, Trondheim, Norway
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Vande Vyvere T, Pisică D, Wilms G, Claes L, Van Dyck P, Snoeckx A, van den Hauwe L, Pullens P, Verheyden J, Wintermark M, Dekeyzer S, Mac Donald CL, Maas AIR, Parizel PM. Imaging Findings in Acute Traumatic Brain Injury: a National Institute of Neurological Disorders and Stroke Common Data Element-Based Pictorial Review and Analysis of Over 4000 Admission Brain Computed Tomography Scans from the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) Study. J Neurotrauma 2024. [PMID: 38482818 DOI: 10.1089/neu.2023.0553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/20/2024] Open
Abstract
In 2010, the National Institute of Neurological Disorders and Stroke (NINDS) created a set of common data elements (CDEs) to help standardize the assessment and reporting of imaging findings in traumatic brain injury (TBI). However, as opposed to other standardized radiology reporting systems, a visual overview and data to support the proposed standardized lexicon are lacking. We used over 4000 admission computed tomography (CT) scans of patients with TBI from the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) study to develop an extensive pictorial overview of the NINDS TBI CDEs, with visual examples and background information on individual pathoanatomical lesion types, up to the level of supplemental and emerging information (e.g., location and estimated volumes). We documented the frequency of lesion occurrence, aiming to quantify the relative importance of different CDEs for characterizing TBI, and performed a critical appraisal of our experience with the intent to inform updating of the CDEs. In addition, we investigated the co-occurrence and clustering of lesion types and the distribution of six CT classification systems. The median age of the 4087 patients in our dataset was 50 years (interquartile range, 29-66; range, 0-96), including 238 patients under 18 years old (5.8%). Traumatic subarachnoid hemorrhage (45.3%), skull fractures (37.4%), contusions (31.3%), and acute subdural hematoma (28.9%) were the most frequently occurring CT findings in acute TBI. The ranking of these lesions was the same in patients with mild TBI (baseline Glasgow Coma Scale [GCS] score 13-15) compared with those with moderate-severe TBI (baseline GCS score 3-12), but the frequency of occurrence was up to three times higher in moderate-severe TBI. In most TBI patients with CT abnormalities, there was co-occurrence and clustering of different lesion types, with significant differences between mild and moderate-severe TBI patients. More specifically, lesion patterns were more complex in moderate-severe TBI patients, with more co-existing lesions and more frequent signs of mass effect. These patients also had higher and more heterogeneous CT score distributions, associated with worse predicted outcomes. The critical appraisal of the NINDS CDEs was highly positive, but revealed that full assessment can be time consuming, that some CDEs had very low frequencies, and identified a few redundancies and ambiguity in some definitions. Whilst primarily developed for research, implementation of CDE templates for use in clinical practice is advocated, but this will require development of an abbreviated version. In conclusion, with this study, we provide an educational resource for clinicians and researchers to help assess, characterize, and report the vast and complex spectrum of imaging findings in patients with TBI. Our data provides a comprehensive overview of the contemporary landscape of TBI imaging pathology in Europe, and the findings can serve as empirical evidence for updating the current NINDS radiologic CDEs to version 3.0.
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Affiliation(s)
- Thijs Vande Vyvere
- Department of Radiology, Antwerp University Hospital, Antwerp, Belgium
- Department of Molecular Imaging and Radiology (MIRA), Faculty of Medicine and Health Science, University of Antwerp, Antwerp, Belgium
| | - Dana Pisică
- Department of Neurosurgery, Erasmus MC - University Medical Center Rotterdam, Rotterdam, the Netherlands
- Department of Public Health, Erasmus MC - University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Guido Wilms
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium
| | - Lene Claes
- icometrix, Research and Development, Leuven, Belgium
| | - Pieter Van Dyck
- Department of Radiology, Antwerp University Hospital, Antwerp, Belgium
- Department of Molecular Imaging and Radiology (MIRA), Faculty of Medicine and Health Science, University of Antwerp, Antwerp, Belgium
| | - Annemiek Snoeckx
- Department of Radiology, Antwerp University Hospital, Antwerp, Belgium
- Department of Molecular Imaging and Radiology (MIRA), Faculty of Medicine and Health Science, University of Antwerp, Antwerp, Belgium
| | - Luc van den Hauwe
- Department of Radiology, Antwerp University Hospital, Antwerp, Belgium
| | - Pim Pullens
- Department of Imaging, University Hospital Ghent; IBITech/MEDISIP, Engineering and Architecture, Ghent University; Ghent Institute for Functional and Metabolic Imaging, Ghent University, Belgium
| | - Jan Verheyden
- icometrix, Research and Development, Leuven, Belgium
| | - Max Wintermark
- Department of Neuroradiology, University of Texas MD Anderson Center, Houston, Texas, USA
| | - Sven Dekeyzer
- Department of Radiology, Antwerp University Hospital, Antwerp, Belgium
- Department of Radiology, University Hospital Ghent, Belgium
| | - Christine L Mac Donald
- Department of Neurological Surgery, School of Medicine, Harborview Medical Center, Seattle, Washington, USA
- Department of Neurological Surgery, School of Medicine, University of Washington, Seattle, Washington, USA
| | - Andrew I R Maas
- Department of Neurosurgery, Antwerp University Hospital, Antwerp, Belgium
- Department of Translational Neuroscience, Faculty of Medicine and Health Science, University of Antwerp, Antwerp, Belgium
| | - Paul M Parizel
- Department of Radiology, Royal Perth Hospital (RPH) and University of Western Australia (UWA), Perth, Australia; Western Australia National Imaging Facility (WA NIF) node, Australia
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Villarreal-Haro JL, Gardier R, Canales-Rodríguez EJ, Fischi-Gomez E, Girard G, Thiran JP, Rafael-Patiño J. CACTUS: a computational framework for generating realistic white matter microstructure substrates. Front Neuroinform 2023; 17:1208073. [PMID: 37603781 PMCID: PMC10434236 DOI: 10.3389/fninf.2023.1208073] [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: 04/18/2023] [Accepted: 07/13/2023] [Indexed: 08/23/2023] Open
Abstract
Monte-Carlo diffusion simulations are a powerful tool for validating tissue microstructure models by generating synthetic diffusion-weighted magnetic resonance images (DW-MRI) in controlled environments. This is fundamental for understanding the link between micrometre-scale tissue properties and DW-MRI signals measured at the millimetre-scale, optimizing acquisition protocols to target microstructure properties of interest, and exploring the robustness and accuracy of estimation methods. However, accurate simulations require substrates that reflect the main microstructural features of the studied tissue. To address this challenge, we introduce a novel computational workflow, CACTUS (Computational Axonal Configurator for Tailored and Ultradense Substrates), for generating synthetic white matter substrates. Our approach allows constructing substrates with higher packing density than existing methods, up to 95% intra-axonal volume fraction, and larger voxel sizes of up to 500μm3 with rich fibre complexity. CACTUS generates bundles with angular dispersion, bundle crossings, and variations along the fibres of their inner and outer radii and g-ratio. We achieve this by introducing a novel global cost function and a fibre radial growth approach that allows substrates to match predefined targeted characteristics and mirror those reported in histological studies. CACTUS improves the development of complex synthetic substrates, paving the way for future applications in microstructure imaging.
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Affiliation(s)
- Juan Luis Villarreal-Haro
- Signal Processing Laboratory (LTS5), École Polytechnique Frale de Lausanne (EPFL), Lausanne, Switzerland
| | - Remy Gardier
- Signal Processing Laboratory (LTS5), École Polytechnique Frale de Lausanne (EPFL), Lausanne, Switzerland
| | - Erick J. Canales-Rodríguez
- Signal Processing Laboratory (LTS5), École Polytechnique Frale de Lausanne (EPFL), Lausanne, Switzerland
| | - Elda Fischi-Gomez
- Signal Processing Laboratory (LTS5), École Polytechnique Frale de Lausanne (EPFL), Lausanne, Switzerland
- CIBM Center for Biomedical Imaging, Lausanne, Switzerland
- Radiology Department, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Lausanne, Switzerland
| | - Gabriel Girard
- Signal Processing Laboratory (LTS5), École Polytechnique Frale de Lausanne (EPFL), Lausanne, Switzerland
- CIBM Center for Biomedical Imaging, Lausanne, Switzerland
- Radiology Department, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Lausanne, Switzerland
- Department of Computer Science, University of Sherbrooke, Sherbrooke, QC, Canada
| | - Jean-Philippe Thiran
- Signal Processing Laboratory (LTS5), École Polytechnique Frale de Lausanne (EPFL), Lausanne, Switzerland
- CIBM Center for Biomedical Imaging, Lausanne, Switzerland
- Radiology Department, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Lausanne, Switzerland
| | - Jonathan Rafael-Patiño
- Signal Processing Laboratory (LTS5), École Polytechnique Frale de Lausanne (EPFL), Lausanne, Switzerland
- Radiology Department, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Lausanne, Switzerland
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Mohamed M, Alamri A, Mohamed M, Khalid N, O'Halloran P, Staartjes V, Uff C. Prognosticating outcome using magnetic resonance imaging in patients with moderate to severe traumatic brain injury: a machine learning approach. Brain Inj 2022; 36:353-358. [PMID: 35129403 DOI: 10.1080/02699052.2022.2034184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
INTRODUCTION Over the last decade advancements in computer processing have enabled the application of machine learning (ML) to complex medical problems. Convolutional neural networks (CNN), a type of ML, have been used to interrogate medical images for variety of purposes. In this study, we aimed to investigate the potential application of CNN in prognosticating patients with traumatic brain injury (TBI). METHODS Patients with moderate to severe TBI and evidence of diffuse axonal injury (DAI) were selected retrospectively. A CNN model was developed using a training subgroup and a holdout subgroup was used as a testing dataset. We reported the model characteristics including area under the receiver operating characteristic curve (AUC). RESULTS We included a total of 38 patient, of which we generated 725 MRI sections. We developed a CNN model based on a modified AlexNet architecture that interpreted the brain stem injury to generate outcome predictions. The model was able to predict GOS outcomes with a specificity of 0.43 and a sensitivity of 0.997. It showed an AUC of 0.917. CONCLUSION The utilization of machine learning MRI analysis for prognosticating patients with TBI is a valued method that require further investigation. This will require multicentre collaboration to generate large datasets.
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Affiliation(s)
- Moumin Mohamed
- Department of Neurosurgery, Royal London Hospital, London, UK.,Neurosurgery Department, The London Neuro-Machine Learning Institute, Barts Health NHS Trust, London, UK
| | - A Alamri
- Department of Neurosurgery, Royal London Hospital, London, UK.,Neurosurgery Department, The London Neuro-Machine Learning Institute, Barts Health NHS Trust, London, UK
| | - M Mohamed
- Department of Neurosurgery, Royal London Hospital, London, UK.,Neurosurgery Department, The London Neuro-Machine Learning Institute, Barts Health NHS Trust, London, UK
| | - N Khalid
- Department of Neurosurgery, Royal London Hospital, London, UK
| | - Pj O'Halloran
- Department of Neurosurgery, Royal London Hospital, London, UK.,Neurosurgery Department, The London Neuro-Machine Learning Institute, Barts Health NHS Trust, London, UK.,Department of Physiology & Medical Physics, Royal College of Surgeons in Ireland, Ireland
| | - Ve Staartjes
- Clinical Neuroscience Department, Machine Intelligence in Clinical Neuroscience (Micn) Laboratory, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - C Uff
- Department of Neurosurgery, Royal London Hospital, London, UK.,Neurosurgery Department, The London Neuro-Machine Learning Institute, Barts Health NHS Trust, London, UK
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Moe HK, Vik A, Flusund AMH, Stenberg J, Skandsen T, Moen KG. Letter to the editor: Grading of traumatic axonal injury on clinical MRI and functional outcome. Acta Neurochir (Wien) 2021; 163:1443-1444. [PMID: 33630141 DOI: 10.1007/s00701-021-04759-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Accepted: 02/04/2021] [Indexed: 01/03/2023]
Affiliation(s)
- Hans Kristian Moe
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.
| | - Anne Vik
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Department of Neurosurgery, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Anne-Mari Holte Flusund
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Department of Radiology, Molde Hospital, Molde, Norway
| | - Jonas Stenberg
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Toril Skandsen
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Department of Physical Medicine and Rehabilitation, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Kent Gøran Moen
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Department of Radiology, Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
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Dekeyzer S, van den Hauwe L, Vande Vyvere T, Parizel PM. Traumatic Brain Injury: Imaging Strategy. Clin Neuroradiol 2021. [DOI: 10.1007/978-3-319-61423-6_27-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Moe HK, Limandvik Myhr J, Moen KG, Håberg AK, Skandsen T, Vik A. Association of cause of injury and traumatic axonal injury: a clinical MRI study of moderate and severe traumatic brain injury. J Neurosurg 2020; 133:1559-1567. [PMID: 31604329 DOI: 10.3171/2019.6.jns191040] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Accepted: 06/25/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The authors investigated the association between the cause of injury and the occurrence and grade of traumatic axonal injury (TAI) on clinical MRI in patients with moderate or severe traumatic brain injury (TBI). METHODS Data for a total of 396 consecutive patients, aged 7-70 years, with moderate or severe TBI admitted to a level 1 trauma center were prospectively registered. Data were included for analysis from the 219 patients who had MRI performed within 35 days (median 8, IQR 4-17 days) and for whom cause of injury was known. Cause of injury was registered as road traffic accident (RTA) or fall (both with respective subcategories), alpine skiing or snowboarding accident, or violence. The MRI protocol consisted of T2*-weighted gradient echo, FLAIR, and diffusion-weighted imaging scans. TAI lesions were evaluated in a blinded manner and categorized into 3 grades, hemispheric/cerebellar white matter (grade 1), corpus callosum (grade 2), and brainstem (grade 3). The absence of TAI was analyzed as grade 0. Contusions and mass lesions on CT were also registered. RESULTS Cause of injury did not differ between included and nonincluded patients. TAI was found in 83% of patients in the included group after RTAs and 62% after falls (p < 0.001). Observed TAI grades differed between the subcategories of both RTAs (p = 0.004) and falls (p = 0.006). Pedestrians in RTAs, car drivers/passengers in RTAs, and alpine skiers had the highest prevalence of TAI (89%-100%) and the highest TAI grades (70%-82% TAI grades 2-3). TAI was found in 76% of patients after falls from > own height (45% TAI grade 2-3), 63% after falls down the stairs (26% TAI grade 2-3), and 31% after falls from ≤ own height (12% TAI grade 2-3). Moreover, 53% of patients with TAI after RTAs and 68% with TAI after falls had cortical contusions or mass lesions on CT. CONCLUSIONS This prospective study of moderate and severe TBI is to the authors' knowledge the first clinical MRI study to demonstrate both the high prevalence and grade of TAI after most of the different types of RTAs, alpine skiing accidents, and falls from a height. Importantly, TAI was also common following more low-energy trauma such as falls down the stairs or from own height. Physicians managing TBI patients in the acute phase should be aware of the possibility of TAI no matter the cause of injury and also when the CT scan shows cortical contusions or mass lesions.
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Affiliation(s)
- Hans Kristian Moe
- 1Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology (NTNU), Trondheim
| | - Janne Limandvik Myhr
- 1Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology (NTNU), Trondheim
| | - Kent Gøran Moen
- 1Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology (NTNU), Trondheim
- 2Department of Radiology, Nord-Trøndelag Hospital Trust, Levanger; and
| | - Asta Kristine Håberg
- 1Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology (NTNU), Trondheim
- Departments of3Radiology and Nuclear Medicine
| | - Toril Skandsen
- 1Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology (NTNU), Trondheim
- 4Physical Medicine and Rehabilitation, and
| | - Anne Vik
- 1Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology (NTNU), Trondheim
- 5Neurosurgery, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
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9
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Vande Vyvere T, De La Rosa E, Wilms G, Nieboer D, Steyerberg E, Maas AIR, Verheyden J, van den Hauwe L, Parizel PM. Prognostic Validation of the NINDS Common Data Elements for the Radiologic Reporting of Acute Traumatic Brain Injuries: A CENTER-TBI Study. J Neurotrauma 2020; 37:1269-1282. [PMID: 31813313 DOI: 10.1089/neu.2019.6710] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
The aim of this study is to investigate the prognostic value of using the National Institute of Neurological Disorders and Stroke (NINDS) standardized imaging-based pathoanatomic descriptors for the evaluation and reporting of acute traumatic brain injury (TBI) lesions. For a total of 3392 patients (2244 males and 1148 females, median age = 51 years) enrolled in the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) study, we extracted 96 Common Data Elements (CDEs) from the structured reports, spanning all three levels of pathoanatomic information (i.e., 20 "basic," 60 "descriptive," and 16 "advanced" CDE variables per patient). Six-month clinical outcome scores were dichotomized into favorable (Glasgow Outcome Scale Extended [GOS-E] = 5-8) versus unfavorable (GOS-E = 1-4). Regularized logistic regression models were constructed and compared using the optimism-corrected area under the curve (AUC). An abnormality was reported for the majority of patients (64.51%). In 79.11% of those patients, there was at least one coexisting pathoanatomic lesion or associated finding. An increase in lesion severity, laterality, and volume was associated with more unfavorable outcomes. Compared with the full set of pathoanatomic descriptors (i.e., all three categories of information), reporting "basic" CDE information provides at least equal discrimination between patients with favorable versus unfavorable outcome (AUC = 0.8121 vs. 0.8155, respectively). Addition of a selected subset of "descriptive" detail to the basic CDEs could improve outcome prediction (AUC = 0.8248). Addition of "advanced" or "emerging/exploratory" information had minimal prognostic value. Our results show that the NINDS standardized-imaging based pathoanatomic descriptors can be used in large-scale studies and provide important insights into acute TBI lesion patterns. When used in clinical predictive models, they can provide excellent discrimination between patients with favorable and unfavorable 6-month outcomes. If further validated, our findings could support the development of structured and itemized templates in routine clinical radiology.
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Affiliation(s)
- Thijs Vande Vyvere
- Department of Radiology, University Hospital and University of Antwerp, Antwerp, Belgium.,Icometrix, Research and Development, Leuven, Belgium
| | | | - Guido Wilms
- Icometrix, Research and Development, Leuven, Belgium.,Department of Radiology, University Hospital Leuven and Catholic University of Leuven, Leuven, Belgium
| | - Daan Nieboer
- Center for Medical Decision Making, Department of Public Health, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Ewout Steyerberg
- Center for Medical Decision Making, Department of Public Health, Erasmus Medical Center, Rotterdam, the Netherlands.,Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands
| | - Andrew I R Maas
- Department of Neurosurgery, Antwerp University Hospital and University of Antwerp, Antwerp, Belgium
| | - Jan Verheyden
- Icometrix, Research and Development, Leuven, Belgium
| | - Luc van den Hauwe
- Department of Radiology, University Hospital and University of Antwerp, Antwerp, Belgium
| | - Paul M Parizel
- Department of Radiology, University Hospital and University of Antwerp, Antwerp, Belgium
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10
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Traumatic Neuroemergency: Imaging Patients with Traumatic Brain Injury—An Introduction. ACTA ACUST UNITED AC 2020. [DOI: 10.1007/978-3-030-38490-6_7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register]
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11
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Einarsen CE, Moen KG, Håberg AK, Eikenes L, Kvistad KA, Xu J, Moe HK, Tollefsen MH, Vik A, Skandsen T. Patients with Mild Traumatic Brain Injury Recruited from Both Hospital and Primary Care Settings: A Controlled Longitudinal Magnetic Resonance Imaging Study. J Neurotrauma 2019; 36:3172-3182. [PMID: 31280698 PMCID: PMC6818486 DOI: 10.1089/neu.2018.6360] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
With an emphasis on traumatic axonal injury (TAI), frequency and evolution of traumatic intracranial lesions on 3T clinical magnetic resonance imaging (MRI) were assessed in a combined hospital and community-based study of patients with mild traumatic brain injury (mTBI). The findings were related to post-concussion symptoms (PCS) at 3 and 12 months. Prospectively, 194 patients (16–60 years of age) were recruited from the emergency departments at a level 1 trauma center and a municipal outpatient clinic into the Trondheim mTBI follow-up study. MRI was acquired within 72 h (n = 194) and at 3 (n = 165) and 12 months (n = 152) in patients and community controls (n = 78). The protocol included T2, diffusion weighted imaging, fluid attenuated inversion recovery (FLAIR), and susceptibility weighted imaging (SWI). PCS was assessed with British Columbia Post Concussion Symptom Inventory in patients and controls. Traumatic lesions were present in 12% on very early MRI, and in 5% when computed tomography (CT) was negative. TAI was found in 6% and persisted for 12 months on SWI, whereas TAI lesions on FLAIR disappeared or became less conspicuous on follow-up. PCS occurred in 33% of patients with lesions on MRI and in 19% in patients without lesions at 3 months (p = 0.12) and in 21% with lesions and 14% without lesions at 12 months (p = 0.49). Very early MRI depicted cases of TAI in patients with mTBI with microbleeds persisting for 12 months. Patients with traumatic lesions may have a more protracted recovery, but the study was underpowered to detect significant differences for PCS because of the low frequency of trauma-related MRI lesions.
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Affiliation(s)
- Cathrine Elisabeth Einarsen
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway.,Department of Physical Medicine and Rehabilitation, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Kent Gøran Moen
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway.,Department of Radiology, Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
| | - Asta Kristine Håberg
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway.,Department of Radiology and Nuclear Medicine, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Live Eikenes
- Department of Circulation and Medical Imaging Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Kjell Arne Kvistad
- Department of Radiology and Nuclear Medicine, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Jian Xu
- Department of Radiology and Nuclear Medicine, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Hans Kristian Moe
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - Marie Hexeberg Tollefsen
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - Anne Vik
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway.,Department of Neurosurgery, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Toril Skandsen
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway.,Department of Physical Medicine and Rehabilitation, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
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12
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Zakharova NE, Danilov GV, Potapov AA, Pronin IN, Alexandrova EV, Kravchuk AD, Oshorov AV, Sychev AA, Polupan AA, Savin IA. [The prognostic value of mri-classification of traumatic brain lesions level and localization depending on neuroimaging timing]. ZHURNAL VOPROSY NEIROKHIRURGII IMENI N. N. BURDENKO 2019; 83:46-55. [PMID: 31577269 DOI: 10.17116/neiro20198304146] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
OBJECTIVE The aim of this study was to estimate the prognostic value of magnetic resonance imaging (MRI) classification of traumatic brain lesion localization and levels in patients with a brain injury of various severity in a few days to three weeks after the injury. MATERIAL AND METHODS The cohort of 278 patients with traumatic brain injury (TBI) of various severity aged 8-74 y.o. (average -31.4±13.8, median - 29 (21.3; 37.0) was included in the analysis. The severity of TBI at admission varied from 3 to 15 Glasgow coma scores (GCS) (average - 8±4, median - 7 (5; 12). The main indications and conditions for MRI were: inconsistency between computed tomography (CT) data and neurological status, the necessity to clarify the location and type of brain damage, the absence of metal implants, the stabilization of the patient's vital functions, etc. MRI was performed during the first three weeks after the injury using T1, T2, T2-FLAIR, DWI, T2*GRE, SWAN sequences. The damage to the brain was classified according to 8 grades depending on the lesion levels (cortical-subcortical level, corpus callosum, basal ganglia and/or thalamus, and/or internal, and/or external capsules, uni- or bilateral brain stem injury at a different level). Outcomes were assessed by the Glasgow outcome scale (GOS) 6 months after injury. RESULTS The significant correlations were found for the entire cohort between MRI grading and TBI severity (by GCS) and outcome (by GOS) of the injury (R=-0.66; p<0.0001; R=-0.69; p<0.0001, respectively). A high accuracy (77%), sensitivity (77%) and specificity (76%) of the proposed MRI classification in predicting injury outcomes (AUC=0.85) were confirmed using the logistic regression and ROC analysis. The assessment of MRI-classification prognostic value in subgroups of patients examined during the first, second, and third weeks after injury showed significant correlations between the GCS and the GOS as well as between MRI-grading and GCS, and GOS in all three subgroups. In the subgroup of patients examined during the first 14 days after the injury, the correlation coefficients were higher compared with those obtained in a subgroup examined 15-21 days after the injury. The highest correlations between MRI grading, TBI severity, and the outcome were found in the subgroup of patients who underwent MRI in the first three days after the injury (n=58). CONCLUSION The proposed MRI classification of traumatic brain lesion levels and localization based on the use of different MR sequences reliably correlated with the clinical estimate of TBI severity by GCS and the outcomes by GOS in patients examined during the first three weeks after injury. The strongest correlation was observed for patients examined during the first three days after the injury.
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Affiliation(s)
| | - G V Danilov
- Burdenko Neurosurgery Center, Moscow, Russia
| | - A A Potapov
- Burdenko Neurosurgery Center, Moscow, Russia
| | - I N Pronin
- Burdenko Neurosurgery Center, Moscow, Russia
| | | | | | - A V Oshorov
- Burdenko Neurosurgery Center, Moscow, Russia
| | - A A Sychev
- Burdenko Neurosurgery Center, Moscow, Russia
| | - A A Polupan
- Burdenko Neurosurgery Center, Moscow, Russia
| | - I A Savin
- Burdenko Neurosurgery Center, Moscow, Russia
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13
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Dekeyzer S, van den Hauwe L, Vande Vyvere T, Parizel PM. Traumatic Brain Injury: Imaging Strategy. Clin Neuroradiol 2019. [DOI: 10.1007/978-3-319-68536-6_27] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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14
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Dekeyzer S, van den Hauwe L, Vande Vyvere T, Parizel PM. Traumatic Brain Injury: Imaging Strategy. Clin Neuroradiol 2019. [DOI: 10.1007/978-3-319-61423-6_27-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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15
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Vande Vyvere T, Wilms G, Claes L, Martin Leon F, Nieboer D, Verheyden J, van den Hauwe L, Pullens P, Maas AIR, Parizel PM. Central versus Local Radiological Reading of Acute Computed Tomography Characteristics in Multi-Center Traumatic Brain Injury Research. J Neurotrauma 2018; 36:1080-1092. [PMID: 30259789 DOI: 10.1089/neu.2018.6061] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Observer variability in local radiological reading is a major concern in large-scale multi-center traumatic brain injury (TBI) studies. A central review process has been advocated to minimize this variability. The aim of this study is to compare central with local reading of TBI imaging datasets and to investigate the added value of central review. A total of 2050 admission computed tomography (CT) scans from subjects enrolled in the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) study were analyzed for seven main CT characteristics. Kappa statistics were used to calculate agreement between central and local evaluations and a center-specific analysis was performed. The McNemar test was used to detect whether discordances were significant. Central interobserver and intra-observer agreement was calculated in a subset of patients. Good agreement was found between central and local assessment for the presence or absence of structural pathology (CT+, CT-, κ = 0.73) and most CT characteristics (κ = 0.62 to 0.71), except for traumatic axonal injury lesions (κ = 0.37). Despite good kappa values, discordances were significant in four of seven CT characteristics (i.e., midline shift, contusion, traumatic subarachnoid hemorrhage, and cisternal compression; p = 0.0005). Central reviewers showed substantial to excellent interobserver and intra-observer agreement (κ = 0.73 to κ = 0.96), contrasted by considerable variability in local radiological reading. Compared with local evaluation, a central review process offers a more consistent radiological reading of acute CT characteristics in TBI. It generates reliable, reproducible data and should be recommended for use in multi-center TBI studies.
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Affiliation(s)
- Thijs Vande Vyvere
- 1 Department of Radiology, Antwerp University Hospital and University of Antwerp, Antwerp, Belgium
| | - Guido Wilms
- 2 icometrix, Research and Development, Leuven, Belgium.,3 Department of Radiology, University Hospital Leuven and Catholic University of Leuven, Leuven, Belgium
| | - Lene Claes
- 2 icometrix, Research and Development, Leuven, Belgium
| | | | - Daan Nieboer
- 4 Department of Public Health, Erasmus University Rotterdam, Rotterdam, the Netherlands
| | - Jan Verheyden
- 2 icometrix, Research and Development, Leuven, Belgium
| | - Luc van den Hauwe
- 1 Department of Radiology, Antwerp University Hospital and University of Antwerp, Antwerp, Belgium.,2 icometrix, Research and Development, Leuven, Belgium
| | - Pim Pullens
- 6 Department of Radiology, Ghent University Hospital, Ghent, Belgium
| | - Andrew I R Maas
- 5 Department of Neurosurgery, Antwerp University Hospital and University of Antwerp, Antwerp, Belgium
| | - Paul M Parizel
- 1 Department of Radiology, Antwerp University Hospital and University of Antwerp, Antwerp, Belgium
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16
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Bratt M, Skandsen T, Hummel T, Moen KG, Vik A, Nordgård S, Helvik AS. Frequency and prognostic factors of olfactory dysfunction after traumatic brain injury. Brain Inj 2018; 32:1021-1027. [DOI: 10.1080/02699052.2018.1469043] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- Mette Bratt
- Department of Otorhinolaryngology, St. Olavs University Hospital, Trondheim, Norway
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology (NTNU), Faculty of Medicine and Health Sciences (MH), Trondheim, Norway
| | - Toril Skandsen
- Department of Physical Medicine and Rehabilitation, St. Olavs University Hospital, Trondheim, Norway
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology (NTNU), Faculty of Medicine and Health Sciences (MH), Trondheim, Norway
| | - Thomas Hummel
- Department of Otorhinolaryngology, Smell & Taste Clinic, Dresden, Germany
| | - Kent G. Moen
- Clinic of Radiology and Nuclear Medicine, St. Olavs University Hospital, Trondheim, Norway
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology (NTNU), Faculty of Medicine and Health Sciences (MH), Trondheim, Norway
| | - Anne Vik
- Department of Neurosurgery, St. Olavs University Hospital, Trondheim, Norway
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology (NTNU), Faculty of Medicine and Health Sciences (MH), Trondheim, Norway
| | - Ståle Nordgård
- Department of Otorhinolaryngology, St. Olavs University Hospital, Trondheim, Norway
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology (NTNU), Faculty of Medicine and Health Sciences (MH), Trondheim, Norway
| | - Anne-S. Helvik
- Department of Otorhinolaryngology, St. Olavs University Hospital, Trondheim, Norway
- Department of Public Health and Nursing, NTNU, Faculty of MH, Trondheim, Norway
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17
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Moe HK, Moen KG, Skandsen T, Kvistad KA, Laureys S, Håberg A, Vik A. The Influence of Traumatic Axonal Injury in Thalamus and Brainstem on Level of Consciousness at Scene or Admission: A Clinical Magnetic Resonance Imaging Study. J Neurotrauma 2018; 35:975-984. [PMID: 29334825 PMCID: PMC5865618 DOI: 10.1089/neu.2017.5252] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
The aim of this study was to investigate how traumatic axonal injury (TAI) lesions in the thalamus, basal ganglia, and brainstem on clinical brain magnetic resonance imaging (MRI) are associated with level of consciousness in the acute phase in patients with moderate to severe traumatic brain injury (TBI). There were 158 patients with moderate to severe TBI (7-70 years) with early 1.5T MRI (median 7 days, range 0-35) without mass lesion included prospectively. Glasgow Coma Scale (GCS) scores were registered before intubation or at admission. The TAI lesions were identified in T2*gradient echo, fluid attenuated inversion recovery, and diffusion weighted imaging scans. In addition to registering TAI lesions in hemispheric white matter and the corpus callosum, TAI lesions in the thalamus, basal ganglia, and brainstem were classified as uni- or bilateral. Twenty percent of patients had TAI lesions in the thalamus (7% bilateral), 18% in basal ganglia (2% bilateral), and 29% in the brainstem (9% bilateral). One of 26 bilateral lesions in the thalamus or brainstem was found on computed tomography. The GCS scores were lower in patients with bilateral lesions in the thalamus (median four) and brainstem (median five) than in those with corresponding unilateral lesions (median six and eight, p = 0.002 and 0.022). The TAI locations most associated with low GCS scores in univariable ordinal regression analyses were bilateral TAI lesions in the thalamus (odds ratio [OR] 35.8; confidence interval [CI: 10.5-121.8], p < 0.001), followed by bilateral lesions in basal ganglia (OR 13.1 [CI: 2.0-88.2], p = 0.008) and bilateral lesions in the brainstem (OR 11.4 [CI: 4.0-32.2], p < 0.001). This Trondheim TBI study showed that patients with bilateral TAI lesions in the thalamus, basal ganglia, or brainstem had particularly low consciousness at admission. We suggest these bilateral lesions should be evaluated further as possible biomarkers in a new TAI-MRI classification as a worst grade, because they could explain low consciousness in patients without mass lesions.
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Affiliation(s)
- Hans Kristian Moe
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Kent Gøran Moen
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Department of Medical Imaging, Levanger Hospital, Levanger, Norway
| | - Toril Skandsen
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Department of Physical Medicine and Rehabilitation, St. Olavs University Hospital, Trondheim, Norway
| | - Kjell Arne Kvistad
- Department of Radiology and Nuclear Medicine, St. Olavs University Hospital, Trondheim, Norway
| | - Steven Laureys
- Coma Science Group, Cyclotron Research Center and University Hospital of Liège, University of Liège, Liège, Belgium
| | - Asta Håberg
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Department of Radiology and Nuclear Medicine, St. Olavs University Hospital, Trondheim, Norway
| | - Anne Vik
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Department of Neurosurgery, St. Olavs University Hospital, Trondheim, Norway
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18
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Diffuse Axonal Injury and Oxidative Stress: A Comprehensive Review. Int J Mol Sci 2017; 18:ijms18122600. [PMID: 29207487 PMCID: PMC5751203 DOI: 10.3390/ijms18122600] [Citation(s) in RCA: 86] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2017] [Revised: 11/17/2017] [Accepted: 11/28/2017] [Indexed: 12/14/2022] Open
Abstract
Traumatic brain injury (TBI) is one of the world’s leading causes of morbidity and mortality among young individuals. TBI applies powerful rotational and translational forces to the brain parenchyma, which results in a traumatic diffuse axonal injury (DAI) responsible for brain swelling and neuronal death. Following TBI, axonal degeneration has been identified as a progressive process that starts with disrupted axonal transport causing axonal swelling, followed by secondary axonal disconnection and Wallerian degeneration. These modifications in the axonal cytoskeleton interrupt the axoplasmic transport mechanisms, causing the gradual gathering of transport products so as to generate axonal swellings and modifications in neuronal homeostasis. Oxidative stress with consequent impairment of endogenous antioxidant defense mechanisms plays a significant role in the secondary events leading to neuronal death. Studies support the role of an altered axonal calcium homeostasis as a mechanism in the secondary damage of axon, and suggest that calcium channel blocker can alleviate the secondary damage, as well as other mechanisms implied in the secondary injury, and could be targeted as a candidate for therapeutic approaches. Reactive oxygen species (ROS)-mediated axonal degeneration is mainly caused by extracellular Ca2+. Increases in the defense mechanisms through the use of exogenous antioxidants may be neuroprotective, particularly if they are given within the neuroprotective time window. A promising potential therapeutic target for DAI is to directly address mitochondria-related injury or to modulate energetic axonal energy failure.
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19
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Tsitsopoulos PP, Abu Hamdeh S, Marklund N. Current Opportunities for Clinical Monitoring of Axonal Pathology in Traumatic Brain Injury. Front Neurol 2017; 8:599. [PMID: 29209266 PMCID: PMC5702013 DOI: 10.3389/fneur.2017.00599] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Accepted: 10/25/2017] [Indexed: 01/14/2023] Open
Abstract
Traumatic brain injury (TBI) is a multidimensional and highly complex disease commonly resulting in widespread injury to axons, due to rapid inertial acceleration/deceleration forces transmitted to the brain during impact. Axonal injury leads to brain network dysfunction, significantly contributing to cognitive and functional impairments frequently observed in TBI survivors. Diffuse axonal injury (DAI) is a clinical entity suggested by impaired level of consciousness and coma on clinical examination and characterized by widespread injury to the hemispheric white matter tracts, the corpus callosum and the brain stem. The clinical course of DAI is commonly unpredictable and it remains a challenging entity with limited therapeutic options, to date. Although axonal integrity may be disrupted at impact, the majority of axonal pathology evolves over time, resulting from delayed activation of complex intracellular biochemical cascades. Activation of these secondary biochemical pathways may lead to axonal transection, named secondary axotomy, and be responsible for the clinical decline of DAI patients. Advances in the neurocritical care of TBI patients have been achieved by refinements in multimodality monitoring for prevention and early detection of secondary injury factors, which can be applied also to DAI. There is an emerging role for biomarkers in blood, cerebrospinal fluid, and interstitial fluid using microdialysis in the evaluation of axonal injury in TBI. These biomarker studies have assessed various axonal and neuroglial markers as well as inflammatory mediators, such as cytokines and chemokines. Moreover, modern neuroimaging can detect subtle or overt DAI/white matter changes in diffuse TBI patients across all injury severities using magnetic resonance spectroscopy, diffusion tensor imaging, and positron emission tomography. Importantly, serial neuroimaging studies provide evidence for evolving axonal injury. Since axonal injury may be a key risk factor for neurodegeneration and dementias at long-term following TBI, the secondary injury processes may require prolonged monitoring. The aim of the present review is to summarize the clinical short- and long-term monitoring possibilities of axonal injury in TBI. Increased knowledge of the underlying pathophysiology achieved by advanced clinical monitoring raises hope for the development of novel treatment strategies for axonal injury in TBI.
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Affiliation(s)
- Parmenion P Tsitsopoulos
- Section of Neurosurgery, Department of Neuroscience, Uppsala University, Uppsala, Sweden.,Hippokratio General Hospital, Aristotle University, Thessaloniki, Greece
| | - Sami Abu Hamdeh
- Section of Neurosurgery, Department of Neuroscience, Uppsala University, Uppsala, Sweden
| | - Niklas Marklund
- Section of Neurosurgery, Department of Neuroscience, Uppsala University, Uppsala, Sweden.,Department of Clinical Sciences Lund, Neurosurgery, Skåne University Hospital, Lund University, Lund, Sweden
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20
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Ahmed OH, Loosemore M, Hornby K, Kumar B, Sylvester R, Makalanda HL, Rogers T, Edwards D, de Medici A. Moving concussion care to the next level: The emergence and role of concussion clinics in the UK. PROGRESS IN BRAIN RESEARCH 2017; 234:205-220. [PMID: 29031464 DOI: 10.1016/bs.pbr.2017.06.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Concussion is a worldwide issue in sports medicine at present, and in recent years has evolved into a major consideration for sports in the United Kingdom (UK). Governing bodies, sports clinicians, and indeed athletes themselves are dealing with the implications that this injury brings. In parallel with this, innovative means of managing this condition are emerging. The creation of specialized concussion clinics (which mirror those present in the United States and Canada) is one means of enhancing concussion care in the UK. In this chapter, the emergence of concussion clinics in the UK will be discussed. The specific roles of the multidisciplinary teams working in these clinics will be outlined (including the disciplines of sports medicine, radiology, neurology, physiotherapy, and psychology/psychiatry), and the approaches used in the management of concussion in this setting will be explored. Future recommendations for the growth and development of clinic-based concussion care in the UK will also be discussed.
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Affiliation(s)
- Osman H Ahmed
- Faculty of Health and Social Sciences, Bournemouth University, Bournemouth, United Kingdom; The FA Centre for Disability Football Research, St George's Park, Burton-Upon-Trent, United Kingdom.
| | - Mike Loosemore
- Institute of Sport and Exercise Health, University College London, London, United Kingdom
| | - Katy Hornby
- Institute of Sport and Exercise Health, University College London, London, United Kingdom
| | - Bhavesh Kumar
- Institute of Sport and Exercise Health, University College London, London, United Kingdom
| | - Richard Sylvester
- Institute of Sport and Exercise Health, University College London, London, United Kingdom; National Hospital of Neurology and Neurosurgery, London, United Kingdom
| | | | | | - David Edwards
- Cognacity, London, United Kingdom; University of Zululand, KwaDlangezwa, South Africa
| | - Akbar de Medici
- Institute of Sport and Exercise Health, University College London, London, United Kingdom
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Zhang J, Wei RL, Peng GP, Zhou JJ, Wu M, He FP, Pan G, Gao J, Luo BY. Correlations between diffusion tensor imaging and levels of consciousness in patients with traumatic brain injury: a systematic review and meta-analysis. Sci Rep 2017; 7:2793. [PMID: 28584256 PMCID: PMC5459858 DOI: 10.1038/s41598-017-02950-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Accepted: 04/26/2017] [Indexed: 12/19/2022] Open
Abstract
Traumatic brain injury (TBI) often leads to impaired consciousness. Recent diffusion tensor imaging studies associated consciousness with imaging metrics including fractional anisotropy (FA) and apparent diffusion coefficient (ADC). We evaluated their correlations and determined the best index in candidate regions. Six databases were searched, including PubMed and Embase, and 16 studies with 701 participants were included. Data from region-of-interest and whole-brain analysis methods were meta-analysed separately. The FA-consciousness correlation was marginal in the whole-brain white matter (r = 0.63, 95% CI [0.47, 0.79], p = 0.000) and the corpus callosum (CC) (r = 0.60, 95% CI [0.48, 0.71], p = 0.000), and moderate in the internal capsule (r = 0.48, 95% CI [0.24, 0.72], p = 0.000). Correlations with ADC trended negative and lacked significance. Further subgroup analysis revealed that consciousness levels correlated strongly with FA in the CC body (r = 0.66, 95% CI [0.43, 0.89]), moderately in the splenium (r = 0.58, 95% CI [0.38, 0.78]), but insignificantly in the genu. In conclusion, FA correlates better with consciousness levels than ADC in TBI. The degree of correlation varies among brain regions. The CC (especially its splenium and body) is a reliable candidate region to quantitatively reflect consciousness levels.
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Affiliation(s)
- Jie Zhang
- Department of Neurology & Brain Medical Centre, The First Affiliated Hospital, Zhejiang University, Hangzhou, China
| | - Rui-Li Wei
- Department of Neurology & Brain Medical Centre, The First Affiliated Hospital, Zhejiang University, Hangzhou, China
| | - Guo-Ping Peng
- Department of Neurology & Brain Medical Centre, The First Affiliated Hospital, Zhejiang University, Hangzhou, China
| | - Jia-Jia Zhou
- Department of Neurology & Brain Medical Centre, The First Affiliated Hospital, Zhejiang University, Hangzhou, China
| | - Min Wu
- Department of Neurology & Brain Medical Centre, The First Affiliated Hospital, Zhejiang University, Hangzhou, China
| | - Fang-Ping He
- Department of Neurology & Brain Medical Centre, The First Affiliated Hospital, Zhejiang University, Hangzhou, China
| | - Gang Pan
- Department of Computer Science, Zhejiang University, Hangzhou, China
| | - Jian Gao
- Department of Rehabilitation, Hangzhou Hospital of Zhejiang CAPR, Hangzhou, China
| | - Ben-Yan Luo
- Department of Neurology & Brain Medical Centre, The First Affiliated Hospital, Zhejiang University, Hangzhou, China.
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Hashim E, Caverzasi E, Papinutto N, Lewis CE, Jing R, Charles O, Zhang S, Lin A, Graham SJ, Schweizer TA, Bharatha A, Cusimano MD. Investigating Microstructural Abnormalities and Neurocognition in Sub-Acute and Chronic Traumatic Brain Injury Patients with Normal-Appearing White Matter: A Preliminary Diffusion Tensor Imaging Study. Front Neurol 2017; 8:97. [PMID: 28373856 PMCID: PMC5357974 DOI: 10.3389/fneur.2017.00097] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Accepted: 02/28/2017] [Indexed: 11/23/2022] Open
Abstract
For a significant percentage of subjects, with chronic traumatic brain injury (TBI), who report persisting cognitive impairment and functional loss, the diagnosis is often impeded by the fact that routine neuroimaging often does not reveal any abnormalities. In this paper, we used diffusion tensor imaging (DTI) to investigate the apparently normal white matter (as assessed by routine magnetic resonance imaging) in the brains of 19 subjects with sub-acute (9) and chronic (10) TBI. We also assessed memory, executive function, and visual-motor coordination in these subjects. Using a voxel-wise approach, we investigated if parameters of diffusion were significantly different between TBI subjects and 17 healthy controls (HC), who were demographically matched to the TBI group. We also investigated if changes in DTI parameters were associated with neuropsychological performance in either group. Our results indicate significantly increased mean and axial diffusivity (MD and AD, respectively) values in widespread brain locations in TBI subjects, while controlling for age, sex, and time since injury. HC performed significantly better than the TBI subjects on tests of memory and executive function, indicating the persisting functional loss in chronic TBI. We found no correlation between diffusion parameters and performance on test of executive function in either group. We found negative correlation between FA and composite memory scores, and positive correlation between RD and visuomotor coordination test scores, in various tracts in both groups. Our study suggests that changes in MD and AD can indicate persisting micro-structure abnormalities in normal-appearing white matter in the brains of subjects with chronic TBI. Our results also suggest that FA in major white matter tracts is correlated with memory in health and in disease, alike; larger and longitudinal studies are needed to discern potential differences in these correlations in the two groups.
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Affiliation(s)
- Eyesha Hashim
- Department of Neurosurgery, St. Michael's Hospital , Toronto, ON , Canada
| | - Eduardo Caverzasi
- Department of Neurology, University of California at San Francisco, San Francisco, CA, USA; Department of Brain and Behavioral Sciences, University of Pavia, Italy
| | - Nico Papinutto
- Department of Neurology, University of California at San Francisco , San Francisco, CA , USA
| | - Caroline E Lewis
- Department of Neurosurgery, St. Michael's Hospital , Toronto, ON , Canada
| | - Ruiwei Jing
- Department of Neurosurgery, St. Michael's Hospital , Toronto, ON , Canada
| | - Onella Charles
- Department of Neurosurgery, St. Michael's Hospital , Toronto, ON , Canada
| | - Shudong Zhang
- Department of Neurosurgery, St. Michael's Hospital , Toronto, ON , Canada
| | - Amy Lin
- Department of Radiology, St. Michael's Hospital , Toronto, ON , Canada
| | - Simon J Graham
- Sunnybrook Research Institute, University of Toronto , Toronto, ON , Canada
| | - Tom A Schweizer
- Department of Neurosurgery, St. Michael's Hospital , Toronto, ON , Canada
| | - Aditya Bharatha
- Department of Medical Imaging, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada; Department of Medical Imaging and Neurosurgery at the University of Toronto, Toronto, ON, Canada
| | - Michael D Cusimano
- Department of Neurosurgery, St. Michael's Hospital, Toronto, ON, Canada; Faculty of Medicine, Department of Surgery, Division of Neurosurgery, University of Toronto, Toronto, ON, Canada
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Elliott CA, Ramaswamy V, Jacob FD, Sankar T, Mehta V. Early diffusion restriction of white matter in infants with small subdural hematomas is associated with delayed atrophy. Childs Nerv Syst 2017; 33:289-295. [PMID: 27766468 DOI: 10.1007/s00381-016-3271-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Accepted: 10/05/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND Traumatic brain injury (TBI) is a major cause of infant morbidity and mortality. In these patients, magnetic resonance imaging (MRI) including diffusion-weighted imaging (DWI) is the test of choice to describe the extent of microstructural injury. CASE PRESENTATION AND DISCUSSION In this case series, we describe novel acute and chronic MRI findings in four infants (6-19 months) with small, unilateral subdural hematomas in whom the etiology of head injury was suspicious for non-accidental trauma (NAT). Acute (<1-week post-injury) DWI revealed extensive areas of restricted diffusion isolated to the cerebral white matter predominantly ipsilateral to the subdural hematoma. After prolonged pediatric intensive care treatment including subdural evacuation (n = 2) or decompressive craniectomy (n = 1), all patients survived albeit with significant motor and cognitive deficits. Delayed structural MRI (6-9-year post-injury) demonstrated cortical and subcortical atrophy well-correlated with areas of acute restricted diffusion. CONCLUSION These four cases highlight that relatively small subdural hematomas can be associated with extensive white matter injury-detectable only by early DWI-which have long-term structural and functional consequences.
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Affiliation(s)
- Cameron A Elliott
- Division of Neurosurgery, University of Alberta, Edmonton, Alberta, Canada
| | - Vijay Ramaswamy
- Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Francois D Jacob
- Division of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Tejas Sankar
- Division of Neurosurgery, University of Alberta, Edmonton, Alberta, Canada
| | - Vivek Mehta
- Division of Neurosurgery, University of Alberta, Edmonton, Alberta, Canada.
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Yeh P, Guan Koay C, Wang B, Morissette J, Sham E, Senseney J, Joy D, Kubli A, Yeh C, Eskay V, Liu W, French LM, Oakes TR, Riedy G, Ollinger J. Compromised Neurocircuitry in Chronic Blast-Related Mild Traumatic Brain Injury. Hum Brain Mapp 2017; 38:352-369. [PMID: 27629984 PMCID: PMC6867097 DOI: 10.1002/hbm.23365] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Revised: 08/16/2016] [Accepted: 08/23/2016] [Indexed: 12/20/2022] Open
Abstract
The aim of this study was to apply recently developed automated fiber segmentation and quantification methods using diffusion tensor imaging (DTI) and DTI-based deterministic and probabilistic tractography to access local and global diffusion changes in blast-induced mild traumatic brain injury (bmTBI). Two hundred and two (202) male active US service members who reported persistent post-concussion symptoms for more than 6 months after injury were recruited. An additional forty (40) male military controls were included for comparison. DTI results were examined in relation to post-concussion and post-traumatic stress disorder (PTSD) symptoms. No significant group difference in DTI metrics was found using voxel-wise analysis. However, group comparison using tract profile analysis and tract specific analysis, as well as single subject analysis using tract profile analysis revealed the most prominent white matter microstructural injury in chronic bmTBI patients over the frontal fiber tracts, that is, the front-limbic projection fibers (cingulum bundle, uncinate fasciculus), the fronto-parieto-temporal association fibers (superior longitudinal fasciculus), and the fronto-striatal pathways (anterior thalamic radiation). Effects were noted to be sensitive to the number of previous blast exposures, with a negative association between fractional anisotropy (FA) and time since most severe blast exposure in a subset of the multiple blast-exposed group. However, these patterns were not observed in the subgroups classified using macrostructural changes (T2 white matter hyperintensities). Moreover, post-concussion symptoms and PTSD symptoms, as well as neuropsychological function were associated with low FA in the major nodes of compromised neurocircuitry. Hum Brain Mapp 38:352-369, 2017. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Ping‐Hong Yeh
- Henry Jackson Foundation for the Advancement of Military MedicineRockledgeMaryland
- National Intrepid Center of Excellence (NICoE)Walter Reed National Military Medical CenterBethesdaMaryland
| | - Cheng Guan Koay
- National Intrepid Center of Excellence (NICoE)Walter Reed National Military Medical CenterBethesdaMaryland
| | - Binquan Wang
- Henry Jackson Foundation for the Advancement of Military MedicineRockledgeMaryland
| | - John Morissette
- National Intrepid Center of Excellence (NICoE)Walter Reed National Military Medical CenterBethesdaMaryland
| | - Elyssa Sham
- National Intrepid Center of Excellence (NICoE)Walter Reed National Military Medical CenterBethesdaMaryland
| | - Justin Senseney
- National Intrepid Center of Excellence (NICoE)Walter Reed National Military Medical CenterBethesdaMaryland
| | - David Joy
- National Intrepid Center of Excellence (NICoE)Walter Reed National Military Medical CenterBethesdaMaryland
| | - Alex Kubli
- National Intrepid Center of Excellence (NICoE)Walter Reed National Military Medical CenterBethesdaMaryland
| | - Chen‐Haur Yeh
- National Intrepid Center of Excellence (NICoE)Walter Reed National Military Medical CenterBethesdaMaryland
| | - Victora Eskay
- National Intrepid Center of Excellence (NICoE)Walter Reed National Military Medical CenterBethesdaMaryland
| | - Wei Liu
- National Intrepid Center of Excellence (NICoE)Walter Reed National Military Medical CenterBethesdaMaryland
| | - Louis M. French
- National Intrepid Center of Excellence (NICoE)Walter Reed National Military Medical CenterBethesdaMaryland
- Center for Neuroscience and Regenerative Medicine (CNRM)Uniformed Services University of the Health Sciences (USUHS)BethesdaMaryland
| | - Terrence R. Oakes
- National Intrepid Center of Excellence (NICoE)Walter Reed National Military Medical CenterBethesdaMaryland
| | - Gerard Riedy
- National Intrepid Center of Excellence (NICoE)Walter Reed National Military Medical CenterBethesdaMaryland
- Center for Neuroscience and Regenerative Medicine (CNRM)Uniformed Services University of the Health Sciences (USUHS)BethesdaMaryland
| | - John Ollinger
- National Intrepid Center of Excellence (NICoE)Walter Reed National Military Medical CenterBethesdaMaryland
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Matsumura H, Fujimori H, Sato N, Matsumura A. Paraplegia caused by cerebral contusions in the bilateral precentral gyri. Surg Neurol Int 2016; 7:S752-S755. [PMID: 27904755 PMCID: PMC5114859 DOI: 10.4103/2152-7806.193726] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2015] [Accepted: 05/03/2016] [Indexed: 11/22/2022] Open
Abstract
Background: Paraplegia is mainly caused by spinal cord disease and rarely occurs due to head trauma. In this report, we describe a case of paraplegia caused by cerebral contusions in the bilateral precentral gyri. Case Description: A 72-year-old man was admitted to our hospital with mildly impaired consciousness and severe pure motor paralysis in both legs. He was healthy until the morning of the day, but his wife found him injured in front of his house upon returning home. He had a subcutaneous hematoma in his occipital region, and seemed to have slipped by accident. Computed tomography of the brain and magnetic resonance imaging (MRI) of his spinal cord revealed no apparent cause of the paraplegia, although an MRI of his brain clearly revealed cerebral contusions in the bilateral precentral gyri. The cerebral contusion was diagnosed as the cause of pure motor paralysis of lower extremities. He received rehabilitation, and manual muscle testing of his legs revealed improvements. In the subacute phase, the precentral gyrus lesion disappeared on MRI. Conclusion: We must emphasize that cerebral contusion can be a differential diagnosis for paraplegia. In the acute phase, fluid-attenuated inversion recovery (FLAIR) MRI coronal and sagittal images are useful for identifying precentral gyri contusions. Paraplegia caused by a cerebral contusion may be misdiagnosed as a spinal concussion due to the disappearance of the precentral gyrus lesion on FLAIR MRI in the subacute phase.
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Affiliation(s)
- Hideaki Matsumura
- Department of Neurosurgery, Kobari General Hospital, Yokouchi, Noda, Chiba, Japan; Department of Neurosurgery, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Hiroyuki Fujimori
- Department of Neurosurgery, Kobari General Hospital, Yokouchi, Noda, Chiba, Japan
| | - Naoaki Sato
- Department of Neurosurgery, Kobari General Hospital, Yokouchi, Noda, Chiba, Japan
| | - Akira Matsumura
- Department of Neurosurgery, University of Tsukuba, Tsukuba, Ibaraki, Japan
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27
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Imaging Techniques in Emergency Surgeries. Int Anesthesiol Clin 2016; 54:22-38. [PMID: 26655507 DOI: 10.1097/aia.0000000000000086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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28
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Moen KG, Vik A, Olsen A, Skandsen T, Håberg AK, Evensen KAI, Eikenes L. Traumatic axonal injury: Relationships between lesions in the early phase and diffusion tensor imaging parameters in the chronic phase of traumatic brain injury. J Neurosci Res 2016; 94:623-35. [PMID: 26948154 DOI: 10.1002/jnr.23728] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2015] [Revised: 01/24/2016] [Accepted: 02/11/2016] [Indexed: 11/06/2022]
Abstract
This prospective study of traumatic brain injury (TBI) patients investigates fractional anisotropy (FA) from chronic diffusion tensor imaging (DTI) in areas corresponding to persistent and transient traumatic axonal injury (TAI) lesions detected in clinical MRI from the early phase. Thirty-eight patients (mean 24.7 [range 13-63] years of age) with moderate-to-severe TBI and 42 age- and sex-matched healthy controls were included. Patients underwent 1.5-T clinical MRI in the early phase (median 7 days), including fluid-attenuated inversion recovery (FLAIR) and T2* gradient echo (T2*GRE) sequences. TAI lesions from the early phase were characterized as nonhemorrhagic or microhemorrhagic. In the chronic phase (median 3 years), patients and controls were imaged at 3 T with FLAIR, T2*GRE, T1, and DTI sequences. TAI lesions were classified as transient or persistent. The FLAIR/T2*GRE images from the early phase were linearly registered to the FA images from the chronic phase and lesions manually segmented on the FA-registered FLAIR/T2*GRE images. For regions of interest (ROIs) from both nonhemorrhagic and microhemorrhagic lesion, we found a significant linear trend of lower mean FA from ROIs in healthy controls to ROIs in patients without either nonhemorrhagic or microhemorrhagic lesions and further to transient and finally persistent lesion ROIs (P < 0.001). Histogram analyses showed lower FA in persistent compared with transient nonhemorrhagic lesion ROIs (P < 0.001), but this was not found in microhemorrhagic lesion ROIs (P = 0.08-0.55). The demonstrated linear trend of lower FA values from healthy controls to persistent lesion ROIs was found in both nonhemorrhagic and microhemorrhagic lesions and indicates a gradual increasing disruption of the microstructure. Lower FA values in persistent compared with transient lesions were found only in nonhemorrhagic lesions. Thus, clinical MRI techniques are able to depict important aspects of white matter pathology across the stages of TBI. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Kent Gøran Moen
- Department of Neuroscience, Norwegian University of Science and Technology, Trondheim, Norway.,Department of Medical Imaging, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Anne Vik
- Department of Neuroscience, Norwegian University of Science and Technology, Trondheim, Norway.,Department of Neurosurgery, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Alexander Olsen
- Department of Physical Medicine and Rehabilitation, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.,Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
| | - Toril Skandsen
- Department of Neuroscience, Norwegian University of Science and Technology, Trondheim, Norway.,Department of Physical Medicine and Rehabilitation, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Asta Kristine Håberg
- Department of Neuroscience, Norwegian University of Science and Technology, Trondheim, Norway.,Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
| | - Kari Anne I Evensen
- Department of Public Health and General Practice and Department of Laboratory Medicine, Children's and Women's Health, Norwegian University of Science and Technology, Trondheim, Norway.,Department of Physiotherapy, Trondheim Municipality, Trondheim, Norway
| | - Live Eikenes
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
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29
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Morgan CD, Zuckerman SL, King LE, Beaird SE, Sills AK, Solomon GS. Post-concussion syndrome (PCS) in a youth population: defining the diagnostic value and cost-utility of brain imaging. Childs Nerv Syst 2015; 31:2305-9. [PMID: 26419243 DOI: 10.1007/s00381-015-2916-y] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Accepted: 09/18/2015] [Indexed: 11/27/2022]
Abstract
PURPOSE Approximately 90% of concussions are transient, with symptoms resolving within 10-14 days. However, a minority of patients remain symptomatic several months post-injury, a condition known as post-concussion syndrome (PCS). The treatment of these patients can be challenging. The goal of our study was to assess the utility and cost-effectiveness of neurologic imaging two or more weeks post-injury in a cohort of youth with PCS. METHODS We conducted a retrospective study of 52 pediatric patients with persistent post-concussion symptoms after 3 months. We collected demographics and neuroimaging results obtained greater than 2 weeks post-concussion. Neuroimaging ordered in the first 2 weeks post-concussion was excluded, except to determine the rate of re-imaging. Descriptive statistics and corresponding cost data were collected. RESULTS Of 52 patients with PCS, 23/52 (44%) had neuroimaging at least 2 weeks after the initial injury, for a total of 32 diagnostic studies. In summary, 1/19 MRIs (5.3%), 1/8 CTs (13%), and 0/5 x-rays (0%) yielded significant positive findings, none of which altered clinical management. Chronic phase neuroimaging estimated costs from these 52 pediatric patients totaled $129,025. We estimate the cost to identify a single positive finding was $21,000 for head CT and $104,500 for brain MRI. CONCLUSIONS In this cohort of pediatric PCS patients, brain imaging in the chronic phase (defined as more than 2 weeks after concussion) was pursued in almost half the study sample, had low diagnostic yield, and had poor cost-effectiveness. Based on these results, outpatient management of pediatric patients with long-term post-concussive symptoms should rarely include repeat neuroimaging beyond the acute phase.
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Affiliation(s)
- Clinton D Morgan
- Department of Neurological Surgery, Vanderbilt Sports Concussion Center, Vanderbilt University School of Medicine, Medical Center North T-4224, 37212, Nashville, TN, USA
| | - Scott L Zuckerman
- Department of Neurological Surgery, Vanderbilt Sports Concussion Center, Vanderbilt University School of Medicine, Medical Center North T-4224, 37212, Nashville, TN, USA.
| | - Lauren E King
- Division of Pediatric Neurology, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Susan E Beaird
- Division of Pediatric Neurology, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Allen K Sills
- Department of Neurological Surgery, Vanderbilt Sports Concussion Center, Vanderbilt University School of Medicine, Medical Center North T-4224, 37212, Nashville, TN, USA
| | - Gary S Solomon
- Department of Neurological Surgery, Vanderbilt Sports Concussion Center, Vanderbilt University School of Medicine, Medical Center North T-4224, 37212, Nashville, TN, USA
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30
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Van Beek L, Ghesquière P, Lagae L, De Smedt B. Mathematical Difficulties and White Matter Abnormalities in Subacute Pediatric Mild Traumatic Brain Injury. J Neurotrauma 2015; 32:1567-78. [DOI: 10.1089/neu.2014.3809] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Affiliation(s)
- Leen Van Beek
- Parenting and Special Education Research Unit, University of Leuven, Belgium
| | - Pol Ghesquière
- Parenting and Special Education Research Unit, University of Leuven, Belgium
| | - Lieven Lagae
- Department of Development and Regeneration, University of Leuven, Belgium
| | - Bert De Smedt
- Parenting and Special Education Research Unit, University of Leuven, Belgium
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31
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Buttram SDW, Garcia-Filion P, Miller J, Youssfi M, Brown SD, Dalton HJ, Adelson PD. Computed tomography vs magnetic resonance imaging for identifying acute lesions in pediatric traumatic brain injury. Hosp Pediatr 2015; 5:79-84. [PMID: 25646200 DOI: 10.1542/hpeds.2014-0094] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND AND OBJECTIVE Pediatric traumatic brain injury (TBI) is a leading cause of morbidity and mortality in children. Computed tomography (CT) is the modality of choice to screen for brain injuries. MRI may provide more clinically relevant information. The purpose of this study was to compare lesion detection between CT and MRI after TBI. METHODS Retrospective cohort of children (0-21 years) with TBI between 2008 and 2010 at a Level 1 pediatric trauma center with a head CT scan on day of injury and a brain MRI scan within 2 weeks of injury. Agreement between CT and MRI was determined by κ statistic and stratified by injury mechanism. RESULTS One hundred five children were studied. Of these, 78% had mild TBI. The MRI scan was obtained a median of 1 day (interquartile range, 1-2) after CT. Overall, CT and MRI demonstrated poor agreement (κ=-0.083; P=.18). MRI detected a greater number of intraparenchymal lesions (n=36; 34%) compared with CT (n=16; 15%) (P<.001). Among patients with abusive head trauma, MRI detected intraparenchymal lesions in 16 (43%), compared with only 4 (11%) lesions with CT (P=.03). Of 8 subjects with a normal CT scan, 6 out of 8 had abnormal lesions on MRI. CONCLUSIONS Compared with CT, MRI identified significantly more intraparenchymal lesions in pediatric TBI, particularly in children with abusive head trauma. The prognostic value of identification of intraparenchymal lesions by MRI is unknown but warrants additional inquiry. Risks and benefits from early MRI (including sedation, time, and lack of radiation exposure) compared with CT should be weighed by clinicians.
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Affiliation(s)
- Sandra D W Buttram
- Divisions of Critical Care Medicine, Department of Child Health, University of Arizona College of Medicine Phoenix, Phoenix, Arizona
| | - Pamela Garcia-Filion
- Department of Child Health, University of Arizona College of Medicine Phoenix, Phoenix, Arizona Trauma, Phoenix Children's Hospital, Phoenix, Arizona
| | - Jeffrey Miller
- Department of Child Health, University of Arizona College of Medicine Phoenix, Phoenix, Arizona Radiology and
| | - Mostafa Youssfi
- Department of Child Health, University of Arizona College of Medicine Phoenix, Phoenix, Arizona Radiology and
| | - S Danielle Brown
- Division of Neurosurgery, Barrow Neurological Institute at Phoenix Children's Hospital, Phoenix, Arizona; and
| | - Heidi J Dalton
- Divisions of Critical Care Medicine, Department of Child Health, University of Arizona College of Medicine Phoenix, Phoenix, Arizona
| | - P David Adelson
- Department of Child Health, University of Arizona College of Medicine Phoenix, Phoenix, Arizona Division of Neurosurgery, Barrow Neurological Institute at Phoenix Children's Hospital, Phoenix, Arizona; and
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Potapov AA, Krylov VV, Gavrilov AG, Kravchuk AD, Likhterman LB, Petrikov SS, Talypov AE, Zakharova NE, Oshorov AV, Solodov AA. Guidelines for the management of severe head injury. Part 1. Neurotrauma system and neuroimaging. ZHURNAL VOPROSY NEIROKHIRURGII IMENI N. N. BURDENKO 2015; 79:100-106. [PMID: 26977800 DOI: 10.17116/neiro2015796100-106] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Traumatic brain injury is one of the main causes of mortality and disability in young and middle-aged individuals. The patients with severe traumatic brain injury who are in coma are the most difficult to deal with. Appropriate diagnosis of the primary brain injuries and early prevention and treatment of secondary damage mechanisms largely determine the possibility of reducing mortality and severe disabling consequences. The authors compiled these guidelines based on their experience in development of international and Russian recommendations on the diagnosis and treatment of mild traumatic brain injury, penetrating gunshot injury of the skull and brain, severe traumatic brain injury, and severe consequences of brain injuries, including a vegetative state. In addition, we used the materials of international and Russian recommendations on the diagnosis, intensive care, and surgical treatment of severe traumatic brain injury published in recent years. The proposed recommendations are related to organization of medical care and diagnosis of severe traumatic brain injury in adults and are primarily addressed to neurosurgeons, neurologists, neuroradiologists, anesthesiologists, and emergency room doctors, who are routinely involved in management of these patients.
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Affiliation(s)
- A A Potapov
- Burdenko Neurosurgical Institute, Moscow, Russia
| | - V V Krylov
- Sklifosovsky Research Institute for Emergency Medicine, Moscow
| | - A G Gavrilov
- Burdenko Neurosurgical Institute, Moscow, Russia
| | - A D Kravchuk
- Burdenko Neurosurgical Institute, Moscow, Russia
| | | | - S S Petrikov
- Sklifosovsky Research Institute for Emergency Medicine, Moscow
| | - A E Talypov
- Sklifosovsky Research Institute for Emergency Medicine, Moscow
| | | | - A V Oshorov
- Burdenko Neurosurgical Institute, Moscow, Russia
| | - A A Solodov
- Sklifosovsky Research Institute for Emergency Medicine, Moscow
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Moen KG, Brezova V, Skandsen T, Håberg AK, Folvik M, Vik A. Traumatic axonal injury: the prognostic value of lesion load in corpus callosum, brain stem, and thalamus in different magnetic resonance imaging sequences. J Neurotrauma 2014; 31:1486-96. [PMID: 24773587 DOI: 10.1089/neu.2013.3258] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The aim of this study was to explore the prognostic value of visible traumatic axonal injury (TAI) loads in different MRI sequences from the early phase after adjusting for established prognostic factors. Likewise, we sought to explore the prognostic role of early apparent diffusion coefficient (ADC) values in normal-appearing corpus callosum. In this prospective study, 128 patients (mean age, 33.9 years; range, 11-69) with moderate (n = 64) and severe traumatic brain injury (TBI) were examined with MRI at a median of 8 days (range, 0-28) postinjury. TAI lesions in fluid-attenuated inversion recovery (FLAIR), diffusion-weighted imaging (DWI), and T2*-weighted gradient echo (T2*GRE) sequences were counted and FLAIR lesion volumes estimated. In patients and 47 healthy controls, mean ADC values were computed in 10 regions of interests in the normal-appearing corpus callosum. Outcome measure was the Glasgow Outcome Scale-Extended (GOS-E) at 12 months. In patients with severe TBI, number of DWI lesions and volume of FLAIR lesions in the corpus callosum, brain stem, and thalamus predicted outcome in analyses with adjustment for age, Glasgow Coma Scale score, and pupillary dilation (odds ratio, 1.3-6.9; p = <0.001-0.017). The addition of Rotterdam CT score and DWI lesions in the corpus callosum yielded the highest R2 (0.24), compared to all other MRI variables, including brain stem lesions. For patients with moderate TBI only the number of cortical contusions (p = 0.089) and Rotterdam CT score (p = 0.065) tended to predict outcome. Numbers of T2*GRE lesions did not affect outcome. Mean ADC values in the normal-appearing corpus callosum did not differ from controls. In conclusion, the loads of visible TAI lesions in the corpus callosum, brain stem, and thalamus in DWI and FLAIR were independent prognostic factors in patients with severe TBI. DWI lesions in the corpus callosum were the most important predictive MRI variable. Interestingly, number of cortical contusions in MRI and CT findings seemed more important for patients with moderate TBI.
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Affiliation(s)
- Kent G Moen
- 1 Department of Neuroscience, Norwegian University of Science and Technology , Trondheim, Norway
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Association between peripheral oxidative stress and white matter damage in acute traumatic brain injury. BIOMED RESEARCH INTERNATIONAL 2014; 2014:340936. [PMID: 24804213 PMCID: PMC3996315 DOI: 10.1155/2014/340936] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Accepted: 02/11/2014] [Indexed: 11/17/2022]
Abstract
The oxidative stress is believed to be one of the mechanisms involved in the neuronal damage after acute traumatic brain injury (TBI). However, the disease severity correlation between oxidative stress biomarker level and deep brain microstructural changes in acute TBI remains unknown. In present study, twenty-four patients with acute TBI and 24 healthy volunteers underwent DTI. The peripheral blood oxidative biomarkers, like serum thiol and thiobarbituric acid-reactive substances (TBARS) concentrations, were also obtained. The DTI metrics of the deep brain regions, as well as the fractional anisotropy (FA) and apparent diffusion coefficient, were measured and correlated with disease severity, serum thiol, and TBARS levels. We found that patients with TBI displayed lower FAs in deep brain regions with abundant WMs and further correlated with increased serum TBARS level. Our study has shown a level of anatomic detail to the relationship between white matter (WM) damage and increased systemic oxidative stress in TBI which suggests common inflammatory processes that covary in both the peripheral and central reactions after TBI.
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Bazeed MF, El-Fatah Ghanem MA, Afif HF, Adib Sunbulli MH, Elsayed Abdelaal AM. Can diffusion tensor imaging predict motor power affection after moderate traumatic brain injury? THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2013. [DOI: 10.1016/j.ejrnm.2013.09.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Yeh PH, Wang B, Oakes TR, French LM, Pan H, Graner J, Liu W, Riedy G. Postconcussional disorder and PTSD symptoms of military-related traumatic brain injury associated with compromised neurocircuitry. Hum Brain Mapp 2013; 35:2652-73. [PMID: 24038816 DOI: 10.1002/hbm.22358] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2013] [Revised: 04/23/2013] [Accepted: 06/13/2013] [Indexed: 11/09/2022] Open
Abstract
Traumatic brain injury (TBI) is a common combat injury, often through explosive blast, and produces heterogeneous brain changes due to various mechanisms of injury. It is unclear whether the vulnerability of white matter differs between blast and impact injury, and the consequences of microstructural changes on neuropsychological function are poorly understood in military TBI patients. Diffusion tensor imaging (DTI) techniques were used to assess the neurocircuitry in 37 U.S. service members (29 mild, 7 moderate, 1 severe; 17 blast and 20 nonblast), who sustained a TBI while deployed, compared to 14 nondeployed, military controls. High-dimensional deformable registration of MRI diffusion tensor data was followed by fiber tracking and tract-specific analysis along with region-of-interest analysis. DTI results were examined in relation to post-concussion and post-traumatic stress disorder (PTSD) symptoms. The most prominent white matter microstructural injury for both blast and nonblast patients was in the frontal fibers within the fronto-striatal (corona radiata, internal capsule) and fronto-limbic circuits (fornix, cingulum), the fronto-parieto-occipital association fibers, in brainstem fibers, and in callosal fibers. Subcortical superior-inferiorly oriented tracts were more vulnerable to blast injury than nonblast injury, while direct impact force had more detrimental effects on anterior-posteriorly oriented tracts, which tended to cause heterogeneous left and right hemispheric asymmetries of white matter connectivity. The tractography using diffusion anisotropy deficits revealed the cortico-striatal-thalamic-cerebellar-cortical (CSTCC) networks, where increased post-concussion and PTSD symptoms were associated with low fractional anisotropy in the major nodes of compromised CSTCC neurocircuitry, and the consequences on cognitive function were explored as well.
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Affiliation(s)
- Ping-Hong Yeh
- Traumatic Brain Injury Image Analysis Lab, Department of Radiology, Henry Jackson Foundation for the Advancement of Military Medicine, Rockville, Maryland
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Hayempour BJ, Alavi A. RETRACTED ARTICLE: Neuroradiological advances detect abnormal neuroanatomy underlying neuropsychological impairments: the power of PET imaging. Eur J Nucl Med Mol Imaging 2013; 40:1462-8. [DOI: 10.1007/s00259-013-2401-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2012] [Accepted: 03/19/2013] [Indexed: 11/24/2022]
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Structural integrity and postconcussion syndrome in mild traumatic brain injury patients. Brain Imaging Behav 2012; 6:283-92. [PMID: 22477019 DOI: 10.1007/s11682-012-9159-2] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
The presence of a postconcussion syndrome (PCS) induces substantial socio-professional troubles in mild traumatic brain injury (mTBI) patients. Although the exact origin of these disorders is not known, they may be the consequence of diffuse axonal injury (DAI) impacting structural integrity. In the present study, we compared structural integrity at the subacute and late stages after mTBI and in case of PCS, using diffusion-weighted imaging (DWI). Fifty-three mTBI patients were investigated and compared with 40 healthy controls. All patients underwent a DWI examination at the subacute (8-21 days) and late (6 months) phases after injury. MTBI patients with PCS were detected at the subacute phase using the ICD-10 classification. Groupwise differences in structural integrity were investigated using Tract-Based Spatial Statistics (TBSS). A loss of structural integrity was found in mTBI patients at the subacute phase but partially resolved over time. Moreover, we observed that mTBI patients with PCS had greater and wider structural impairment than patients without PCS. These damages persisted over time for PCS patients, while mTBI patients without PCS partly recovered. In conclusion, our results strengthen the relationship between structural integrity and PCS.
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Gonzalez PG, Walker MT. Imaging modalities in mild traumatic brain injury and sports concussion. PM R 2012; 3:S413-24. [PMID: 22035684 DOI: 10.1016/j.pmrj.2011.08.536] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2011] [Accepted: 08/25/2011] [Indexed: 12/26/2022]
Abstract
Mild traumatic brain injury is a significant public health issue that has been gaining considerable attention over the past few years. After injury, a large percentage of patients experience postconcussive symptoms that affect work and school performance and that carry significant medicolegal implications. Conventional imaging modalities (computed tomography and magnetic resonance imaging) are insensitive to microstructural changes and underestimate the degree of diffuse axonal injury and metabolic changes. Newer imaging techniques have attempted to better diagnose and characterize diffuse axonal injury and the metabolic and functional aspects of traumatic brain injury. The following review article summarizes the currently available imaging studies and describes the novel and more investigational techniques available for mild traumatic brain injury. A suggested algorithm is offered.
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Affiliation(s)
- Peter G Gonzalez
- Department of Physical Medicine and Rehabilitation, Eastern Virginia Medical School, 721 Fairfax Ave, Norfolk, VA 23507, USA.
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Pinto PS, Meoded A, Poretti A, Tekes A, Huisman TAGM. The unique features of traumatic brain injury in children. review of the characteristics of the pediatric skull and brain, mechanisms of trauma, patterns of injury, complications, and their imaging findings--part 2. J Neuroimaging 2012; 22:e18-41. [PMID: 22303964 DOI: 10.1111/j.1552-6569.2011.00690.x] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Traumatic brain injury (TBI) is a major cause of morbidity and mortality in children. The unique biomechanical, hemodynamical, and functional characteristics of the developing brain and the age-dependent variance in trauma mechanisms result in a wide range of age specific traumas and patterns of brain injuries. Detailed knowledge of the main primary and secondary pediatric injuries, which enhance sensitivity and specificity of diagnosis, will guide therapy and may give important information about the prognosis. In recent years, anatomical but also functional imaging methods have revolutionized neuroimaging of pediatric TBI. The purpose of this article is (1) to comprehensively review frequent primary and secondary brain injuries and (2) to give a short overview of two special types of pediatric TBI: birth related and nonaccidental injuries.
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Affiliation(s)
- Pedro S Pinto
- Division of Pediatric Radiology, Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins Hospital, Baltimore, MD, USA
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Pinto PS, Poretti A, Meoded A, Tekes A, Huisman TAGM. The unique features of traumatic brain injury in children. Review of the characteristics of the pediatric skull and brain, mechanisms of trauma, patterns of injury, complications and their imaging findings--part 1. J Neuroimaging 2012; 22:e1-e17. [PMID: 22273264 DOI: 10.1111/j.1552-6569.2011.00688.x] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Traumatic head/brain injury (TBI) is a leading cause of death and life-long disability in children. The biomechanical properties of the child's brain and skull, the size of the child, the age-specific activity pattern, and higher degree of brain plasticity result in a unique distribution, degree, and quality of TBI compared to adult TBI. A detailed knowledge about the various types of primary and secondary pediatric head injuries is essential to better identify and understand pediatric TBI. The goals of this review article are (1) to discuss the unique epidemiology, mechanisms, and characteristics of TBI in children, and (2) to review the anatomical and functional imaging techniques that can be used to study common and rare pediatric traumatic brain injuries and their complications.
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Affiliation(s)
- Pedro S Pinto
- Division of Pediatric Radiology, Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins Hospital, Baltimore, MD, USA
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Yeh PH, Oakes TR, Riedy G. Diffusion Tensor Imaging and Its Application to Traumatic Brain Injury: Basic Principles and Recent Advances. ACTA ACUST UNITED AC 2012. [DOI: 10.4236/ojmi.2012.24025] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Sanjith S. Traumatic axonal injury in mild to moderate head injury — an illustrated review. INDIAN JOURNAL OF NEUROTRAUMA 2011. [DOI: 10.1016/s0973-0508(11)80003-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Hayempour BJ, Rushing SE, Alavi A. The Role of Neuroimaging in Assessing Neuropsychological Deficits following Traumatic Brain Injury. ACTA ACUST UNITED AC 2011. [DOI: 10.1177/009318531103900403] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Neuroimaging enables highly accurate and specific identification of treatable brain injuries for the purposes of preventing secondary damage as well as providing useful prognostic information. This article addresses the range of currently employed neuroimaging techniques and their utility in assessing legal claims involving the presence of brain damage.
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Matsukawa H, Shinoda M, Fujii M, Takahashi O, Yamamoto D, Murakata A, Ishikawa R. Genu of corpus callosum in diffuse axonal injury induces a worse 1-year outcome in patients with traumatic brain injury. Acta Neurochir (Wien) 2011; 153:1687-93; discussion 1693-4. [PMID: 21479582 DOI: 10.1007/s00701-011-1002-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2010] [Accepted: 03/17/2011] [Indexed: 10/18/2022]
Abstract
BACKGROUND Previous studies have shown a relationship between diffuse axonal injury (DAI) and unfavorable clinical outcome in patients with traumatic brain injury (TBI), but it remains unclear whether the type of DAI lesion influences outcome after TBI. The aim of the present study was to investigate whether 1-year outcome after TBI differed between patients with different types of lesions. METHODS A retrospective, single-institution study involving 261 patients with TBI was carried out between April 2003 and December 2009. Outcome was measured using the Glasgow Outcome Scale (GOS) 1 year after TBI. DAI lesions occurred in the lobar region, corpus callosum (CC), and brainstem. CC lesions were subdivided into three types: genu, body, and splenium. Univariate and multivariate logistic regression analyses were performed to evaluate the relationships between clinical characteristics and outcome for each type of DAI lesion and each type of CC lesion in patients with TBI. FINDINGS Sixty-nine patients had DAI lesions: 34 in the lobar region, 30 in the CC, and five in the brainstem. Of the 30 patients with CC lesions, ten each were found in the genu, body, and splenium. Each DAI, CC, and genu lesion was significantly associated with unfavorable outcome 1 year after TBI by multivariate analysis using variables that were significantly associated with unfavorable outcome as determined by univariate analysis after adjustment for age. CONCLUSIONS CC lesions, especially those in the genu, were related to unfavorable 1-year outcome in patients with TBI.
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Skandsen T, Kvistad KA, Solheim O, Lydersen S, Strand IH, Vik A. Prognostic value of magnetic resonance imaging in moderate and severe head injury: a prospective study of early MRI findings and one-year outcome. J Neurotrauma 2011; 28:691-9. [PMID: 21401308 DOI: 10.1089/neu.2010.1590] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The clinical benefit of early magnetic resonance imaging (MRI) in severe and moderate head injury is unclear. We sought to explore the prognostic value of the depth of lesions depicted with early MRI, and also to describe the prevalence and impact of traumatic brainstem lesions. In a cohort of 159 consecutive patients with moderate to severe head injury (age 5-65 years and surviving the acute phase) admitted to a regional level 1 trauma center, 106 (67%) were examined with MRI within 4 weeks post-injury. Depth of lesions in MRI was categorized as: hemisphere level, central level, and brainstem injury (BSI). The outcome measure was Glasgow Outcome Scale Extended (GOSE) 12 months post-injury. Forty-six percent of patients with severe injuries and 14% of patients with moderate injuries had BSI. In severe head injury, central or brainstem lesions in MRI, together with higher Rotterdam CT score, pupillary dilation, and secondary adverse events were significantly associated with a worse outcome in age-adjusted analyses. Bilateral BSI was strongly associated with a poor outcome in severe injury, with positive and negative predictive values of 0.86 and 0.88, respectively. In moderate injury, only age was significantly associated with outcome in multivariable analyses. Limitations of the current study include lack of blinded outcome evaluations and insufficient statistical power to assess the added prognostic value of MRI when combined with clinical information. We conclude that in patients with severe head injury surviving the acute phase, depth of lesion on the MRI was associated with outcome, and in particular, bilateral brainstem injury was strongly associated with poor outcomes. In moderate head injury, surprisingly, there was no association between MRI findings and outcome when using the GOSE score as outcome measure.
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Affiliation(s)
- Toril Skandsen
- Department of Neuroscience, Norwegian University of Science and Technology, Trondheim, Norway.
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Gasparetto EL, Rueda Lopes FC, Domingues RC, Domingues RC. Diffusion Imaging in Traumatic Brain Injury. Neuroimaging Clin N Am 2011; 21:115-25, viii. [DOI: 10.1016/j.nic.2011.02.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Evangelopoulos DS, Deyle S, Zimmermann H, Exadaktylos AK. Full-body radiography (LODOX Statscan) in trauma and emergency medicine: a report from the first European installation site. TRAUMA-ENGLAND 2011. [DOI: 10.1177/1460408610382493] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Lodox Statscan is a whole-body, skeletal and soft-tissue, low-dose X-ray scanner with digital enhancement and enlargement capabilities. Ten years ago it was introduced as a screening device for the examination of trauma patients. Its incorporation into the Emergency Room enabled anterior-posterior and lateral thoraco-abdominal studies to be performed in 3—5 min with only about one-third of the radiation required for conventional radiography. Since its approval by the Food and Drug Administration in the USA, several trauma centres have incorporated this technology into their Advanced Trauma Life Support protocols. This review provides an overview of the system, and reports on the authors’ own experience with the system and that of others over the past 10 years, based on a literature search for all review articles, original articles, conference proceedings, case reports and short reports related to the Lodox Statscan device.
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Affiliation(s)
| | - Simone Deyle
- Department of Emergency Medicine, University Hospital Bern, Switzerland
| | - Heinz Zimmermann
- Department of Emergency Medicine, University Hospital Bern, Switzerland
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Messé A, Caplain S, Paradot G, Garrigue D, Mineo JF, Soto Ares G, Ducreux D, Vignaud F, Rozec G, Desal H, Pélégrini-Issac M, Montreuil M, Benali H, Lehéricy S. Diffusion tensor imaging and white matter lesions at the subacute stage in mild traumatic brain injury with persistent neurobehavioral impairment. Hum Brain Mapp 2010; 32:999-1011. [PMID: 20669166 DOI: 10.1002/hbm.21092] [Citation(s) in RCA: 159] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2009] [Revised: 04/08/2010] [Accepted: 04/12/2010] [Indexed: 11/09/2022] Open
Abstract
Mild traumatic brain injury (mTBI) can induce long-term behavioral and cognitive disorders. Although the exact origin of these mTBI-related disorders is not known, they may be the consequence of diffuse axonal injury (DAI). Here, we investigated whether MRI at the subacute stage can detect lesions that are associated with poor functional outcome in mTBI by using anatomical images (T(1) ) and diffusion tensor imaging (DTI). Twenty-three patients with mTBI were investigated and compared with 23 healthy volunteers. All patients underwent an MRI investigation and clinical tests between 7 and 28 days (D15) and between 3 and 4 months (M3) after injury. Patients were divided in two groups of poor outcome (PO) and good outcome (GO), based on their complaints at M3. Groupwise differences in gray matter partial volume between PO patients, GO patients and controls were analyzed using Voxel-Based Morphometry (VBM) from T(1) data at D15. Differences in microstructural architecture were investigated using Tract-Based Spatial Statistics (TBSS) and the diffusion images obtained from DTI data at D15. Permutation-based non-parametric testing was used to assess cluster significance at p < 0.05, corrected for multiple comparisons. Twelve GO patients and 11 PO patients were identified on the basis of their complaints. In PO patients, gray matter partial volume was significantly lower in several cortical and subcortical regions compared with controls, but did not differ from that of GO patients. No difference in diffusion variables was found between GO and controls. PO patients showed significantly higher mean diffusivity values than both controls and GO patients in the corpus callosum, the right anterior thalamic radiations and the superior longitudinal fasciculus, the inferior longitudinal fasciculus and the fronto-occipital fasciculus bilaterally. In conclusion, PO patients differed from GO patients by the presence of diffusion changes in long association white matter fiber tracts but not by gray matter partial volume. These results suggest that DTI at the subacute stage may be a predictive marker of poor outcome in mTBI.
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Affiliation(s)
- Arnaud Messé
- Inserm, UPMC Univ Paris 06, UMR_S 678, Laboratoire d'Imagerie Fonctionnelle, Paris F-75013, France.
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