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Urbanik A, Guz W, Brożyna M, Ostrogórska M. Changes in the central nervous system in football players: an MRI study. Acta Radiol 2024:2841851241248410. [PMID: 38767036 DOI: 10.1177/02841851241248410] [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: 05/22/2024]
Abstract
BACKGROUND Football (soccer) is the world's most popular team sport. PURPOSE To comprehensively examine the brain in football (soccer) players, with the use of magnetic resonance imaging (MRI) techniques. MATERIAL AND METHODS The study involved 65 football players and 62 controls. The MR examinations were performed using MR 1.5-T system (Optima MR 360; GE Medical Systems). The examinations were carried out in the 3D Bravo, CUBE, FSEpropeller, and diffusion-weighted imaging (DWI) sequences. The 1HMRS signal was obtained from the volume of interest in the frontal and occipital lobes on both sides. RESULTS The present study, based on structural MRI, shows some changes in the brains of the group of football players. The findings show asymmetry of the ventricular system in four football players, arachnoid cysts in the parieto-occipital region, and pineal cysts. NAA/Cr concentration in the right frontal lobe was lower in the football players than in the controls, and the Glx/Cr concentration in the right occipital lobe was higher. The apparent diffusion coefficient value is lower in football players in the occipital lobes. CONCLUSION Playing football can cause measurable changes in the brain, known to occur in patients diagnosed with traumatic brain injury. The present findings fill the gap in the literature by contributing evidence showing that playing football may lead to changes in the brain, without clinical symptoms of concussion.
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Affiliation(s)
- Andrzej Urbanik
- Department of Radiology, Collegium Medicum, Jagiellonian University, Krakow, Poland
| | - Wiesław Guz
- Institute of Medical Sciences, College of Medical Sciences, University of Rzeszów, Rzeszów, Poland
| | - Maciej Brożyna
- Institute of Physical Culture Sciences, College of Medical Sciences, University of Rzeszów, Rzeszów, Poland
| | - Monika Ostrogórska
- Department of Radiology, Collegium Medicum, Jagiellonian University, Krakow, Poland
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2
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Devoto C, Vorn R, Mithani S, Meier TB, Lai C, Broglio SP, McAllister T, Giza CC, Huber D, Harezlak J, Cameron KL, McGinty G, Jackson J, Guskiewicz K, Mihalik JP, Brooks A, Duma S, Rowson S, Nelson LD, Pasquina P, Turtzo C, Latour L, McCrea MA, Gill JM. Plasma phosphorylated tau181 as a biomarker of mild traumatic brain injury: findings from THINC and NCAA-DoD CARE Consortium prospective cohorts. Front Neurol 2023; 14:1202967. [PMID: 37662031 PMCID: PMC10470112 DOI: 10.3389/fneur.2023.1202967] [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: 04/09/2023] [Accepted: 07/18/2023] [Indexed: 09/05/2023] Open
Abstract
Objective The aim of this study was to investigate phosphorylated tau (p-tau181) protein in plasma in a cohort of mild traumatic brain injury (mTBI) patients and a cohort of concussed athletes. Methods This pilot study comprised two independent cohorts. The first cohort-part of a Traumatic Head Injury Neuroimaging Classification (THINC) study-with a mean age of 46 years was composed of uninjured controls (UIC, n = 30) and mTBI patients (n = 288) recruited from the emergency department with clinical computed tomography (CT) and research magnetic resonance imaging (MRI) findings. The second cohort-with a mean age of 19 years-comprised 133 collegiate athletes with (n = 112) and without (n = 21) concussions. The participants enrolled in the second cohort were a part of a multicenter, prospective, case-control study conducted by the NCAA-DoD Concussion Assessment, Research and Education (CARE) Consortium at six CARE Advanced Research Core (ARC) sites between 2015 and 2019. Blood was collected within 48 h of injury for both cohorts. Plasma concentration (pg/ml) of p-tau181 was measured using the Single Molecule Array ultrasensitive assay. Results Concentrations of plasma p-tau181 in both cohorts were significantly elevated compared to controls within 48 h of injury, with the highest concentrations of p-tau181 within 18 h of injury, with an area under the curve (AUC) of 0.690-0.748, respectively, in distinguishing mTBI patients and concussed athletes from controls. Among the mTBI patients, the levels of plasma p-tau181 were significantly higher in patients with positive neuroimaging (either CT+/MRI+, n = 74 or CT-/MRI+, n = 89) compared to mTBI patients with negative neuroimaging (CT-/MRI-, n = 111) findings and UIC (P-values < 0.05). Conclusion These findings indicate that plasma p-tau181 concentrations likely relate to brain injury, with the highest levels in patients with neuroimaging evidence of injury. Future research is needed to replicate and validate this protein assay's performance as a possible early diagnostic biomarker for mTBI/concussions.
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Affiliation(s)
- Christina Devoto
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, United States
| | - Rany Vorn
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, United States
- School of Nursing, Johns Hopkins University, Baltimore, MD, United States
| | - Sara Mithani
- School of Nursing, University of Texas Health at San Antonio, San Antonio, TX, United States
| | - Timothy B. Meier
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Chen Lai
- Center for Neuroscience and Regenerative Medicine, Uniformed Services University and Health Science, Bethesda, MD, United States
| | - Steven P. Broglio
- Michigan Concussion Center, University of Michigan, Ann Arbor, MI, United States
| | - Thomas McAllister
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Christopher C. Giza
- Departments of Pediatrics and Neurosurgery, UCLA Steve Tisch BrainSPORT Program, University of California, Los Angeles, Los Angeles, CA, United States
| | - Daniel Huber
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Jaroslaw Harezlak
- Department of Epidemiology and Biostatistics School of Public Health-Bloomington, Indiana University, Bloomington, IN, United States
| | - Kenneth L. Cameron
- John A. Feagin Sports Medicine Fellowship, Keller Army Hospital, West Point, NY, United States
| | - Gerald McGinty
- United States Air Force Academy, Colorado Springs, CO, United States
| | - Jonathan Jackson
- United States Air Force Academy, Colorado Springs, CO, United States
| | - Kevin Guskiewicz
- Matthew Gfeller Center, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Jason P. Mihalik
- Matthew Gfeller Center, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Alison Brooks
- Department of Orthopedics and Sports Medicine, University of Wisconsin, Madison, WI, United States
| | - Stefan Duma
- Department of Biomedical Engineering, Virginia Tech, Blacksburg, VA, United States
| | - Steven Rowson
- Department of Biomedical Engineering, Virginia Tech, Blacksburg, VA, United States
| | - Lindsay D. Nelson
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Paul Pasquina
- Center for Neuroscience and Regenerative Medicine, Uniformed Services University and Health Science, Bethesda, MD, United States
| | - Christine Turtzo
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, United States
| | - Lawrence Latour
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, United States
| | - Michael A. McCrea
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Jessica M. Gill
- School of Nursing, Johns Hopkins University, Baltimore, MD, United States
- Department of Neurology, Johns Hopkins University, Baltimore, MD, United States
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Berger L, Holshouser B, Nichols JG, Pivonka-Jones J, Ashwal S, Bartnik-Olson B. White Matter Metabolite Ratios Predict Cognitive Outcome in Pediatric Traumatic Brain Injury. Metabolites 2023; 13:778. [PMID: 37512485 PMCID: PMC10385309 DOI: 10.3390/metabo13070778] [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: 04/29/2023] [Revised: 06/15/2023] [Accepted: 06/17/2023] [Indexed: 07/30/2023] Open
Abstract
The prognostic ability of global white matter and gray matter metabolite ratios following pediatric traumatic brain injury (TBI) and their relationship to 12-month neuropsychological assessments of intelligence quotient (IQ), attention, and memory is presented. Three-dimensional proton magnetic resonance spectroscopic imaging (MRSI) in pediatric subjects with complicated mild (cMild), moderate, and severe TBI was acquired acutely (6-18 days) and 12 months post-injury and compared to age-matched typically developing adolescents. A global linear regression model, co-registering MRSI metabolite maps with 3D high-resolution magnetic resonance images, was used to identify longitudinal white matter and gray matter metabolite ratio changes. Acutely, gray matter NAA/Cr, white matter NAA/Cr, and white matter NAA/Cho ratios were significantly lower in TBI groups compared to controls. Gray matter NAA/Cho was reduced only in the severe TBI group. At 12 months, all metabolite ratios normalized to control levels in each of the TBI groups. Acute gray matter and white matter NAA ratios were significantly correlated to 12-month assessments of IQ, attention, and memory. These findings suggest that whole brain gray matter and white matter metabolite ratios reflect longitudinal changes in neuronal metabolism following TBI, which can be used to predict neuropsychological outcomes in pediatric subjects.
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Affiliation(s)
- Luke Berger
- School of Medicine, Loma Linda University, Loma Linda, CA 92354, USA
| | - Barbara Holshouser
- Department of Radiology, Loma Linda University Health, Loma Linda, CA 92354, USA
| | - Joy G Nichols
- Department of Pediatrics, Loma Linda University Health, Loma Linda, CA 92354, USA
| | - Jamie Pivonka-Jones
- Department of Pediatrics, Loma Linda University Health, Loma Linda, CA 92354, USA
| | - Stephen Ashwal
- Department of Pediatrics, Loma Linda University Health, Loma Linda, CA 92354, USA
- Division of Child Neurology, Loma Linda University Health, Loma Linda, CA 92354, USA
| | - Brenda Bartnik-Olson
- Department of Radiology, Loma Linda University Health, Loma Linda, CA 92354, USA
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4
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La PL, Joyce JM, Bell TK, Mauthner M, Craig W, Doan Q, Beauchamp MH, Zemek R, Yeates KO, Harris AD. Brain metabolites measured with magnetic resonance spectroscopy in pediatric concussion and orthopedic injury: An Advancing Concussion Assessment in Pediatrics (A-CAP) study. Hum Brain Mapp 2023; 44:2493-2508. [PMID: 36763547 PMCID: PMC10028643 DOI: 10.1002/hbm.26226] [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: 08/16/2022] [Revised: 11/18/2022] [Accepted: 01/25/2023] [Indexed: 02/11/2023] Open
Abstract
Millions of children sustain a concussion annually. Concussion disrupts cellular signaling and neural pathways within the brain but the resulting metabolic disruptions are not well characterized. Magnetic resonance spectroscopy (MRS) can examine key brain metabolites (e.g., N-acetyl Aspartate (tNAA), glutamate (Glx), creatine (tCr), choline (tCho), and myo-Inositol (mI)) to better understand these disruptions. In this study, we used MRS to examine differences in brain metabolites between children and adolescents with concussion versus orthopedic injury. Children and adolescents with concussion (n = 361) or orthopedic injury (OI) (n = 184) aged 8 to 17 years were recruited from five emergency departments across Canada. MRS data were collected from the left dorsolateral prefrontal cortex (L-DLPFC) using point resolved spectroscopy (PRESS) at 3 T at a mean of 12 days post-injury (median 10 days post-injury, range 2-33 days). Univariate analyses for each metabolite found no statistically significant metabolite differences between groups. Within each analysis, several covariates were statistically significant. Follow-up analyses designed to account for possible confounding factors including age, site, scanner, vendor, time since injury, and tissue type (and interactions as appropriate) did not find any metabolite group differences. In the largest sample of pediatric concussion studied with MRS to date, we found no metabolite differences between concussion and OI groups in the L-DLPFC. We suggest that at 2 weeks post-injury in a general pediatric concussion population, brain metabolites in the L-DLPFC are not specifically affected by brain injury.
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Affiliation(s)
- Parker L La
- Department of Radiology, University of Calgary, Calgary, Alberta, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Julie M Joyce
- Department of Radiology, University of Calgary, Calgary, Alberta, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Tiffany K Bell
- Department of Radiology, University of Calgary, Calgary, Alberta, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Micaela Mauthner
- Department of Radiology, University of Calgary, Calgary, Alberta, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - William Craig
- Department of Pediatrics, University of Alberta and Stollery Children's Hospital, Edmonton, Alberta, Canada
| | - Quynh Doan
- Department of Pediatrics, University of British Columbia and BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada
| | - Miriam H Beauchamp
- Department of Psychology, University of Montreal and Ste Justine Hospital Research Center, Montreal, Quebec, Canada
| | - Roger Zemek
- Department of Pediatrics and Emergency Medicine, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada
- Childrens' Hospital of Eastern Ontario Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Keith Owen Yeates
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Ashley D Harris
- Department of Radiology, University of Calgary, Calgary, Alberta, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
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5
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Chen AM, Gerhalter T, Dehkharghani S, Peralta R, Gajdošík M, Gajdošík M, Tordjman M, Zabludovsky J, Sheriff S, Ahn S, Babb JS, Bushnik T, Zarate A, Silver JM, Im BS, Wall SP, Madelin G, Kirov II. Replicability of proton MR spectroscopic imaging findings in mild traumatic brain injury: Implications for clinical applications. Neuroimage Clin 2023; 37:103325. [PMID: 36724732 PMCID: PMC9898311 DOI: 10.1016/j.nicl.2023.103325] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 11/06/2022] [Accepted: 01/16/2023] [Indexed: 01/20/2023]
Abstract
PURPOSE Proton magnetic resonance spectroscopy (1H MRS) offers biomarkers of metabolic damage after mild traumatic brain injury (mTBI), but a lack of replicability studies hampers clinical translation. In a conceptual replication study design, the results reported in four previous publications were used as the hypotheses (H1-H7), specifically: abnormalities in patients are diffuse (H1), confined to white matter (WM) (H2), comprise low N-acetyl-aspartate (NAA) levels and normal choline (Cho), creatine (Cr) and myo-inositol (mI) (H3), and correlate with clinical outcome (H4); additionally, a lack of findings in regional subcortical WM (H5) and deep gray matter (GM) structures (H6), except for higher mI in patients' putamen (H7). METHODS 26 mTBI patients (20 female, age 36.5 ± 12.5 [mean ± standard deviation] years), within two months from injury and 21 age-, sex-, and education-matched healthy controls were scanned at 3 Tesla with 3D echo-planar spectroscopic imaging. To test H1-H3, global analysis using linear regression was used to obtain metabolite levels of GM and WM in each brain lobe. For H4, patients were stratified into non-recovered and recovered subgroups using the Glasgow Outcome Scale Extended. To test H5-H7, regional analysis using spectral averaging estimated metabolite levels in four GM and six WM structures segmented from T1-weighted MRI. The Mann-Whitney U test and weighted least squares analysis of covariance were used to examine mean group differences in metabolite levels between all patients and all controls (H1-H3, H5-H7), and between recovered and non-recovered patients and their respectively matched controls (H4). Replicability was defined as the support or failure to support the null hypotheses in accordance with the content of H1-H7, and was further evaluated using percent differences, coefficients of variation, and effect size (Cohen's d). RESULTS Patients' occipital lobe WM Cho and Cr levels were 6.0% and 4.6% higher than controls', respectively (Cho, d = 0.37, p = 0.04; Cr, d = 0.63, p = 0.03). The same findings, i.e., higher patients' occipital lobe WM Cho and Cr (both p = 0.01), but with larger percent differences (Cho, 8.6%; Cr, 6.3%) and effect sizes (Cho, d = 0.52; Cr, d = 0.88) were found in the comparison of non-recovered patients to their matched controls. For the lobar WM Cho and Cr comparisons without statistical significance (frontal, parietal, temporal), unidirectional effect sizes were observed (Cho, d = 0.07 - 0.37; Cr, d = 0.27 - 0.63). No differences were found in any metabolite in any lobe in the comparison between recovered patients and their matched controls. In the regional analyses, no differences in metabolite levels were found in any GM or WM region, but all WM regions (posterior, frontal, corona radiata, and the genu, body, and splenium of the corpus callosum) exhibited unidirectional effect sizes for Cho and Cr (Cho, d = 0.03 - 0.34; Cr, d = 0.16 - 0.51). CONCLUSIONS We replicated findings of diffuse WM injury, which correlated with clinical outcome (supporting H1-H2, H4). These findings, however, were among the glial markers Cho and Cr, not the neuronal marker NAA (not supporting H3). No differences were found in regional GM and WM metabolite levels (supporting H5-H6), nor in putaminal mI (not supporting H7). Unidirectional effect sizes of higher patients' Cho and Cr within all WM analyses suggest widespread injury, and are in line with the conclusion from the previous publications, i.e., that detection of WM injury may be more dependent upon sensitivity of the 1H MRS technique than on the selection of specific regions. The findings lend further support to the corollary that clinic-ready 1H MRS biomarkers for mTBI may best be achieved by using high signal-to-noise-ratio single-voxels placed anywhere within WM. The biochemical signature of the injury, however, may differ and therefore absolute levels, rather than ratios may be preferred. Future replication efforts should further test the generalizability of these findings.
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Affiliation(s)
- Anna M Chen
- Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology, New York University Grossman School of Medicine, New York, NY, USA
| | - Teresa Gerhalter
- Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology, New York University Grossman School of Medicine, New York, NY, USA
| | - Seena Dehkharghani
- Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology, New York University Grossman School of Medicine, New York, NY, USA; Department of Neurology, New York University Grossman School of Medicine, New York, NY, USA
| | - Rosemary Peralta
- Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology, New York University Grossman School of Medicine, New York, NY, USA
| | - Mia Gajdošík
- Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology, New York University Grossman School of Medicine, New York, NY, USA
| | - Martin Gajdošík
- Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology, New York University Grossman School of Medicine, New York, NY, USA
| | - Mickael Tordjman
- Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology, New York University Grossman School of Medicine, New York, NY, USA; Department of Radiology, Hôpital Cochin, Paris, France
| | - Julia Zabludovsky
- Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology, New York University Grossman School of Medicine, New York, NY, USA
| | - Sulaiman Sheriff
- Department of Radiology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Sinyeob Ahn
- Siemens Medical Solutions USA Inc., Malvern, PA, USA
| | - James S Babb
- Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology, New York University Grossman School of Medicine, New York, NY, USA
| | - Tamara Bushnik
- Department of Rehabilitation Medicine, New York University Grossman School of Medicine, New York, NY, USA
| | - Alejandro Zarate
- Department of Rehabilitation Medicine, New York University Grossman School of Medicine, New York, NY, USA
| | - Jonathan M Silver
- Department of Psychiatry, New York University Grossman School of Medicine, New York, NY, USA
| | - Brian S Im
- Department of Rehabilitation Medicine, New York University Grossman School of Medicine, New York, NY, USA
| | - Stephen P Wall
- Ronald O. Perelman Department of Emergency Medicine, New York University Grossman School of Medicine, New York, NY, USA
| | - Guillaume Madelin
- Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology, New York University Grossman School of Medicine, New York, NY, USA
| | - Ivan I Kirov
- Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology, New York University Grossman School of Medicine, New York, NY, USA; Department of Neurology, New York University Grossman School of Medicine, New York, NY, USA; Center for Advanced Imaging Innovation and Research, Department of Radiology, New York University Grossman School of Medicine, New York, NY, USA.
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Hebert JR, Filley CM. Multisensory integration and white matter pathology: Contributions to cognitive dysfunction. Front Neurol 2022; 13:1051538. [PMID: 36408503 PMCID: PMC9668060 DOI: 10.3389/fneur.2022.1051538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 10/18/2022] [Indexed: 11/23/2022] Open
Abstract
The ability to simultaneously process and integrate multiple sensory stimuli is paramount to effective daily function and essential for normal cognition. Multisensory management depends critically on the interplay between bottom-up and top-down processing of sensory information, with white matter (WM) tracts acting as the conduit between cortical and subcortical gray matter (GM) regions. White matter tracts and GM structures operate in concert to manage both multisensory signals and cognition. Altered sensory processing leads to difficulties in reweighting and modulating multisensory input during various routine environmental challenges, and thus contributes to cognitive dysfunction. To examine the specific role of WM in altered sensory processing and cognitive dysfunction, this review focuses on two neurologic disorders with diffuse WM pathology, multiple sclerosis and mild traumatic brain injury, in which persistently altered sensory processing and cognitive impairment are common. In these disorders, cognitive dysfunction in association with altered sensory processing may develop initially from slowed signaling in WM tracts and, in some cases, GM pathology secondary to WM disruption, but also because of interference with cognitive function by the added burden of managing concurrent multimodal primary sensory signals. These insights promise to inform research in the neuroimaging, clinical assessment, and treatment of WM disorders, and the investigation of WM-behavior relationships.
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Affiliation(s)
- Jeffrey R. Hebert
- Physical Performance Laboratory, Marcus Institute for Brain Health, University of Colorado School of Medicine, Aurora, CO, United States,*Correspondence: Jeffrey R. Hebert
| | - Christopher M. Filley
- Behavorial Neurology Section, Department of Neurology and Psychiatry, Marcus Institute for Brain Health, University of Colorado School of Medicine, Aurora, CO, United States
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7
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Joyce JM, La PL, Walker R, Harris A. Magnetic resonance spectroscopy of traumatic brain injury and subconcussive hits: A systematic review and meta-analysis. J Neurotrauma 2022; 39:1455-1476. [PMID: 35838132 DOI: 10.1089/neu.2022.0125] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Magnetic resonance spectroscopy (MRS) is a non-invasive technique used to study metabolites in the brain. MRS findings in traumatic brain injury (TBI) and subconcussive hit literature have been mixed. The most common observation is a decrease in N-acetyl-aspartate (NAA), traditionally considered a marker of neuronal integrity. Other metabolites, however, such as creatine (Cr), choline (Cho), glutamate+glutamine (Glx) and myo-inositol (mI) have shown inconsistent changes in these populations. The objective of this systematic review and meta-analysis was to synthesize MRS literature in head injury and explore factors (brain region, injury severity, time since injury, demographic, technical imaging factors, etc.) that may contribute to differential findings. One hundred and thirty-eight studies met inclusion criteria for the systematic review and of those, 62 NAA, 24 Cr, 49 Cho, 18 Glx and 21 mI studies met inclusion criteria for meta-analysis. A random effects model was used for meta-analyses with brain region as a subgroup for each of the five metabolites studied. Meta-regression was used to examine the influence of potential moderators including injury severity, time since injury, age, sex, tissue composition and methodological factors. In this analysis of 1428 unique head-injured subjects and 1132 controls, the corpus callosum was identified as a brain region highly susceptible to metabolite alteration. NAA was consistently decreased in TBI of all severity, but not in subconcussive hits. Cho and mI were found to be increased in moderate-to-severe TBI but not mild TBI. Glx and Cr were largely unaffected, however did show alterations in certain conditions.
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Affiliation(s)
- Julie Michele Joyce
- University of Calgary, 2129, Radiology, Calgary, Alberta, Canada.,Hotchkiss Brain Institute, 157742, Calgary, Alberta, Canada.,Alberta Children's Hospital Research Institute, 157744, Calgary, Alberta, Canada.,Integrated Concussion Research Program, Calgary, Alberta, Canada;
| | - Parker L La
- University of Calgary, 2129, Radiology, Calgary, Alberta, Canada.,Hotchkiss Brain Institute, 157742, Calgary, Alberta, Canada.,Alberta Children's Hospital Research Institute, 157744, Calgary, Alberta, Canada.,Integrated Concussion Research Program, Calgary, Alberta, Canada;
| | - Robyn Walker
- University of Calgary, 2129, Radiology, Calgary, Alberta, Canada.,Hotchkiss Brain Institute, 157742, Calgary, Alberta, Canada.,Alberta Children's Hospital Research Institute, 157744, Calgary, Alberta, Canada.,Integrated Concussion Research Program, Calgary, Alberta, Canada;
| | - Ashley Harris
- University of Calgary, Radiology, Calgary, Alberta, Canada.,Hotchkiss Brain Institute, 157742, Calgary, Alberta, Canada.,Alberta Children's Hospital Research Institute, 157744, Calgary, Alberta, Canada.,Integrated Concussion Research Program, Calgary, Alberta, Canada;
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8
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Associations Between Neurochemistry and Gait Performance Following Concussion in Collegiate Athletes. J Head Trauma Rehabil 2021; 35:342-353. [PMID: 32881768 DOI: 10.1097/htr.0000000000000616] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
OBJECTIVE To evaluate the strength of associations between single-task and dual-task gait measures and posterior cingulate gyrus (PCG) neurochemicals in acutely concussed collegiate athletes. SETTING Participants were recruited from an NCAA Division 1 University. PARTICIPANTS Nineteen collegiate athletes acutely (<4 days) following sports-related concussion. DESIGN We acquired magnetic resonance spectroscopy (MRS) in the PCG and gait performance measurements in the participants, acutely following concussion. Linear mixed-effects models were constructed to measure the effect of gait performance, in the single- and dual-task settings, and sex on the 6 neurochemicals quantified with MRS in mmol. Correlation coefficients were also calculated to determine the direction and strength of the relationship between MRS neurochemicals and gait performance, postconcussion symptom score, and number of previous concussions. MAIN MEASURES Average gait speed, average cadence, N-acetyl aspartate, choline, myo-inositol, glutathione, glutamate plus glutamine, and creatine. RESULTS Single-task gait speed (P = .0056) and cadence (P = .0065) had significant effects on myo-inositol concentrations in the PCG, independent of sex, in concussed collegiate athletes. Single-task cadence (P = .047) also had a significant effect on glutathione in the PCG. No significant effects were observed between dual-task gait performance and PCG neurochemistry. CONCLUSIONS These findings indicate that increased concentrations of neuroinflammatory markers in the PCG are associated with slower single-task gait performance within 4 days of sports-related concussion.
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9
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Ueda R, Hara H, Hata J, Senoo A. White matter degeneration in diffuse axonal injury and mild traumatic brain injury observed with automatic tractography. Neuroreport 2021; 32:936-941. [PMID: 34132707 DOI: 10.1097/wnr.0000000000001688] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
A better understanding of white matter tract damage in patients with diffuse axonal injury (DAI) and mild traumatic brain injury (MTBI) is important to obtain an objective basis for sequelae. The purpose of this study was to clarify the characteristics of white matter tract degeneration in DAI and MTBI using automated tractography. T1-weighted and diffusion tensor imaging (DTI) was performed on seven DAI and seven MTBI patients as well as on nine healthy subjects. Automated probabilistic tractography analysis was performed using FreeSurfer and TRACULA (tracts constrained by underlying anatomy) for the reconstruction of major nerve fibers. We investigated the difference between DTI quantitative values in each white matter nerve fiber between groups and attempted to evaluate the classification accuracy of DAI and MTBI using receiver operator curve analysis. Both DAI and MTBI appeared to exhibit axonal degeneration along the nerve fiber tract in a scattered manner. The mean diffusivity of the ampulla of the corpus callosum was significantly higher in DAI than that in MTBI patients, suggesting axonal degeneration of the corpus callosum in DAI patients. Using mean diffusivity of the right cingulum-angular bundle, DAI and MTBI could be discriminated with an area under the curve of 94%. Both DAI and MTBI exhibited scattered axonal degeneration; however, DAI appeared to exhibit more pronounced axonal degeneration in the ampulla of the corpus callosum than MTBI. Our results suggest that DAI and MTBI can be accurately distinguished using DTI.
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Affiliation(s)
- Ryo Ueda
- Office of Radiation Technology, Keio University Hospital, Tokyo
| | - Hiroyoshi Hara
- Neurorehabilitation Center, Ainomiyako Neurosurgery Hospital, Osaka
| | - Junichi Hata
- Division of Regenerative Medicine, Jikei University Graduate School of Medicine
| | - Atsushi Senoo
- Department of Radiological Sciences, Graduate School of Human Health Sciences, Tokyo Metropolitan University, Tokyo, Japan
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10
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Kulpanovich A, Tal A. What is the optimal schedule for multiparametric MRS? A magnetic resonance fingerprinting perspective. NMR IN BIOMEDICINE 2021; 34:e4196. [PMID: 31814197 PMCID: PMC9244865 DOI: 10.1002/nbm.4196] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 09/09/2019] [Accepted: 09/09/2019] [Indexed: 05/09/2023]
Abstract
Clinical magnetic resonance spectroscopy (MRS) mainly concerns itself with the quantification of metabolite concentrations. Metabolite relaxation values, which reflect the microscopic state of specific cellular and sub-cellular environments, could potentially hold additional valuable information, but are rarely acquired within clinical scan times. By varying the flip angle, repetition time and echo time in a preset way (termed a schedule), and matching the resulting signals to a pre-generated dictionary - an approach dubbed magnetic resonance fingerprinting - it is possible to encode the spins' relaxation times into the acquired signal, simultaneously quantifying multiple tissue parameters for each metabolite. Herein, we optimized the schedule to minimize the averaged root mean square error (RMSE) across all estimated parameters: concentrations, longitudinal and transverse relaxation time, and transmitter inhomogeneity. The optimal schedules were validated in phantoms and, subsequently, in a cohort of healthy volunteers, in a 4.5 mL parietal white matter single voxel and an acquisition time under 5 minutes. The average intra-subject, inter-scan coefficients of variation (CVs) for metabolite concentrations, T1 and T2 relaxation times were found to be 3.4%, 4.6% and 4.7% in-vivo, respectively, averaged over all major singlets. Coupled metabolites were quantified using the short echo time schedule entries and spectral fitting, and reliable estimates of glutamate+glutamine, glutathione and myo-inositol were obtained.
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Affiliation(s)
- Alexey Kulpanovich
- Department of Chemical Physics, Weizmann Institute of Science, 234 Herzel St., Rehovot 7610001, Israel
| | - Assaf Tal
- Department of Chemical Physics, Weizmann Institute of Science, 234 Herzel St., Rehovot 7610001, Israel
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11
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Zulazmi NA, Arulsamy A, Ali I, Zainal Abidin SA, Othman I, Shaikh MF. The utilization of small non-mammals in traumatic brain injury research: A systematic review. CNS Neurosci Ther 2021; 27:381-402. [PMID: 33539662 PMCID: PMC7941175 DOI: 10.1111/cns.13590] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Revised: 12/07/2020] [Accepted: 12/14/2020] [Indexed: 12/20/2022] Open
Abstract
Traumatic brain injury (TBI) is the leading cause of death and disability worldwide and has complicated underlying pathophysiology. Numerous TBI animal models have been developed over the past decade to effectively mimic the human TBI pathophysiology. These models are of mostly mammalian origin including rodents and non-human primates. However, the mammalian models demanded higher costs and have lower throughput often limiting the progress in TBI research. Thus, this systematic review aims to discuss the potential benefits of non-mammalian TBI models in terms of their face validity in resembling human TBI. Three databases were searched as follows: PubMed, Scopus, and Embase, for original articles relating to non-mammalian TBI models, published between January 2010 and December 2019. A total of 29 articles were selected based on PRISMA model for critical appraisal. Zebrafish, both larvae and adult, was found to be the most utilized non-mammalian TBI model in the current literature, followed by the fruit fly and roundworm. In conclusion, non-mammalian TBI models have advantages over mammalian models especially for rapid, cost-effective, and reproducible screening of effective treatment strategies and provide an opportunity to expedite the advancement of TBI research.
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Affiliation(s)
- Nurul Atiqah Zulazmi
- Neuropharmacology Research LaboratoryJeffrey Cheah School of Medicine and Health SciencesMonash University MalaysiaSelangor Darul EhsanMalaysia
| | - Alina Arulsamy
- Neuropharmacology Research LaboratoryJeffrey Cheah School of Medicine and Health SciencesMonash University MalaysiaSelangor Darul EhsanMalaysia
| | - Idrish Ali
- Department of NeuroscienceCentral Clinical SchoolThe Alfred HospitalMonash UniversityMelbourneVic.Australia
| | - Syafiq Asnawi Zainal Abidin
- Neuropharmacology Research LaboratoryJeffrey Cheah School of Medicine and Health SciencesMonash University MalaysiaSelangor Darul EhsanMalaysia
- Liquid Chromatography Mass Spectrometry (LCMS) PlatformJeffrey Cheah School of Medicine and Health SciencesMonash University MalaysiaSelangor Darul EhsanMalaysia
| | - Iekhsan Othman
- Neuropharmacology Research LaboratoryJeffrey Cheah School of Medicine and Health SciencesMonash University MalaysiaSelangor Darul EhsanMalaysia
- Liquid Chromatography Mass Spectrometry (LCMS) PlatformJeffrey Cheah School of Medicine and Health SciencesMonash University MalaysiaSelangor Darul EhsanMalaysia
| | - Mohd. Farooq Shaikh
- Neuropharmacology Research LaboratoryJeffrey Cheah School of Medicine and Health SciencesMonash University MalaysiaSelangor Darul EhsanMalaysia
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12
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Bartnik-Olson BL, Alger JR, Babikian T, Harris AD, Holshouser B, Kirov II, Maudsley AA, Thompson PM, Dennis EL, Tate DF, Wilde EA, Lin A. The clinical utility of proton magnetic resonance spectroscopy in traumatic brain injury: recommendations from the ENIGMA MRS working group. Brain Imaging Behav 2021; 15:504-525. [PMID: 32797399 PMCID: PMC7882010 DOI: 10.1007/s11682-020-00330-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Proton (1H) magnetic resonance spectroscopy provides a non-invasive and quantitative measure of brain metabolites. Traumatic brain injury impacts cerebral metabolism and a number of research groups have successfully used this technique as a biomarker of injury and/or outcome in both pediatric and adult TBI populations. However, this technique is underutilized, with studies being performed primarily at centers with access to MR research support. In this paper we present a technical introduction to the acquisition and analysis of in vivo 1H magnetic resonance spectroscopy and review 1H magnetic resonance spectroscopy findings in different injury populations. In addition, we propose a basic 1H magnetic resonance spectroscopy data acquisition scheme (Supplemental Information) that can be added to any imaging protocol, regardless of clinical magnetic resonance platform. We outline a number of considerations for study design as a way of encouraging the use of 1H magnetic resonance spectroscopy in the study of traumatic brain injury, as well as recommendations to improve data harmonization across groups already using this technique.
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Affiliation(s)
| | - Jeffry R Alger
- Departments of Neurology and Radiology, University of California Los Angeles, Los Angeles, CA, USA
- NeuroSpectroScopics LLC, Sherman Oaks, Los Angeles, CA, USA
- Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Talin Babikian
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, UCLA, Los Angeles, CA, USA
- UCLA Steve Tisch BrainSPORT Program, Los Angeles, CA, USA
| | - Ashley D Harris
- Department of Radiology, University of Calgary, Calgary, Canada
- Child and Adolescent Imaging Research Program, Alberta Children's Hospital Research Institute and the Hotchkiss Brain Institute, University of Calgary, Calgary, Canada
| | - Barbara Holshouser
- Department of Radiology, Loma Linda University Medical Center, Loma Linda, CA, USA
| | - Ivan I Kirov
- Bernard and Irene Schwartz Center for Biomedical Imaging, Center for Advanced Imaging Innovation and Research (CAI2R), Department of Radiology, New York University School of Medicine, New York, NY, USA
| | - Andrew A Maudsley
- Department of Radiology, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Paul M Thompson
- Imaging Genetics Center, Stevens Neuroimaging & Informatics Institute, Keck School of Medicine of USC, Marina del Rey, Los Angeles, CA, USA
- Departments of Neurology, Pediatrics, Psychiatry, Radiology, Engineering, and Ophthalmology, USC, Los Angeles, CA, USA
| | - Emily L Dennis
- Imaging Genetics Center, Stevens Neuroimaging & Informatics Institute, Keck School of Medicine of USC, Marina del Rey, Los Angeles, CA, USA
- Department of Neurology, University of Utah, Salt Lake City, UT, USA
- Psychiatry Neuroimaging Laboratory, Brigham & Women's Hospital, Boston, MA, USA
| | - David F Tate
- Department of Neurology, University of Utah, Salt Lake City, UT, USA
- George E. Wahlen Veterans Affairs Medical Center, Salt Lake City, UT, USA
| | - Elisabeth A Wilde
- Department of Neurology, University of Utah, Salt Lake City, UT, USA
- George E. Wahlen Veterans Affairs Medical Center, Salt Lake City, UT, USA
- H. Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX, USA
| | - Alexander Lin
- Center for Clinical Spectroscopy, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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13
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Scooping Rice Into a Glass and Putting a Cell Phone in the Refrigerator: Action Slips in an Individual With a Diffuse Axonal Injury. Cogn Behav Neurol 2020; 33:259-265. [PMID: 33264153 DOI: 10.1097/wnn.0000000000000246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
A 39-year-old man with a diffuse axonal injury self-presented to the cognitive function clinic of the Ashikaga Red Cross Hospital complaining of behavioral errors in his daily life, such as scooping hot rice into a glass instead of a bowl or forgetting to turn off the gas stove after cooking. This type of error has been referred to as an action slip-a form of unintentional behavioral error that occurs when an individual attempts to perform an automatic and/or familiar task. In this case, action slips occurred nine times a day on average and had a serious and long-term impact on the man's daily quality of life. To reduce the impact of action slips, we created a one-on-one cognitive intervention that used a combination of mnemonic strategies, such as verbalizing his actions as he carried them out, and external aids, including a waist pouch, a voice-controlled artificial intelligence (AI) speaker, and an AI key finder. After 3 years of intervention, the man reported some improvement in his daily activities and a reduction in the number of action slips. Thus, intervention strategies for individuals with a diffuse axonal injury may benefit from targeting action slips. To our knowledge, this is the first detailed description of action slips in an individual with a diffuse axonal injury.
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Acute damage to the blood–brain barrier and perineuronal net integrity in a clinically-relevant rat model of traumatic brain injury. Neuroreport 2020; 31:1167-1174. [PMID: 32991524 DOI: 10.1097/wnr.0000000000001531] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Closed-head, frontal impacts in which the brain undergoes both lateral and rotational acceleration comprise the majority of human traumatic brain injury (TBI). Here, we utilize a clinically relevant model to examine the effects of a single concussion on aspects of brain integrity: the blood-brain barrier, the perineuronal nets (PNNs), and diffuse axonal injury. Adult, male Sprague-Dawley rats received either a frontal, closed-head concussive TBI, or no injury and were evaluated at 1- or 7-day post-injury. Using immunolabeling for albumin, we observed a significant increase in the permeability of the blood-brain barrier at 1-, but not 7-day post-injury. Breakdown of the PNN, as measured by the binding of wisteria floribunda, was observed at 1-day post-injury in the dorsal, lateral, and ventral cortices. This difference was resolved at 7-day. Finally, axonal injury was identified at both 1- and 7-day post-injury. This preclinical model of closed-head, frontal TBI presents a useful tool with which to understand better the acute pathophysiology of a single, frontal TBI.
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15
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Elenberger J, Kim B, de Castro-Abeger A, Rex TS. Connections between intrinsically photosensitive retinal ganglion cells and TBI symptoms. Neurology 2020; 95:826-833. [PMID: 32934170 DOI: 10.1212/wnl.0000000000010830] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 08/12/2020] [Indexed: 12/15/2022] Open
Abstract
The majority of patients with traumatic brain injury (TBI) are classified as having a mild TBI. Despite being categorized as mild, these individuals report ongoing and complex symptoms, which negatively affect their ability to complete activities of daily living and overall quality of life. Some of the major symptoms include anxiety, depression, sleep problems, headaches, light sensitivity, and difficulty reading. The root cause for these symptoms is under investigation by many in the field. Of interest, several of these symptoms such as headaches, ocular pain, light sensitivity, and sleep disturbances may overlap and share underlying circuitry influenced by the intrinsically photosensitive retinal ganglion cells (ipRGCs). These cells are light sensing, but non-image forming, and they influence corneal function, pupillary constriction, and circadian rhythm. In this review, we discuss these symptoms and propose a role of the ipRGCs as at least one underlying and unifying cause for such symptoms.
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Affiliation(s)
- Jason Elenberger
- From the Department of Ophthalmology & Visual Sciences (J.E., B.K., T.S.R.), Vanderbilt University; and Vanderbilt Eye Institute (A.d.C.-A., T.S.R.), Vanderbilt University Medical Center, Nashville, TN
| | - Bohan Kim
- From the Department of Ophthalmology & Visual Sciences (J.E., B.K., T.S.R.), Vanderbilt University; and Vanderbilt Eye Institute (A.d.C.-A., T.S.R.), Vanderbilt University Medical Center, Nashville, TN
| | - Alexander de Castro-Abeger
- From the Department of Ophthalmology & Visual Sciences (J.E., B.K., T.S.R.), Vanderbilt University; and Vanderbilt Eye Institute (A.d.C.-A., T.S.R.), Vanderbilt University Medical Center, Nashville, TN
| | - Tonia S Rex
- From the Department of Ophthalmology & Visual Sciences (J.E., B.K., T.S.R.), Vanderbilt University; and Vanderbilt Eye Institute (A.d.C.-A., T.S.R.), Vanderbilt University Medical Center, Nashville, TN.
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16
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Eisele A, Hill-Strathy M, Michels L, Rauen K. Magnetic Resonance Spectroscopy following Mild Traumatic Brain Injury: A Systematic Review and Meta-Analysis on the Potential to Detect Posttraumatic Neurodegeneration. NEURODEGENER DIS 2020; 20:2-11. [PMID: 32610337 DOI: 10.1159/000508098] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Accepted: 04/11/2020] [Indexed: 02/03/2023] Open
Abstract
INTRODUCTION Traumatic brain injury (TBI) is the most relevant external risk factor for dementia and a major global health burden. Mild TBI (mTBI) contributes to up to 90% of all TBIs, and the classification "mild" often misrepresents the patient's burden who suffer from neuropsychiatric long-term sequelae. Magnetic resonance spectroscopy (MRS) allows in vivo detection of compromised brain metabolism although it is not routinely used after TBI. OBJECTIVE Thus, we performed a systematic review and meta-analysis to elucidate if MRS has the potential to identify changes in brain metabolism in adult patients after a single mTBI with a negative routine brain scan (CCT and/or MRI scan) compared to aged- and sex-matched healthy controls (HC) during the acute or subacute postinjury phase (≤90 days after mTBI). METHODS A comprehensive literature search was conducted from the first edition of electronic databases until January 31, 2020. Group analyses were performed per metabolite using a random-effects model. RESULTS Four and 2 out of 5,417 articles met the inclusion criteria for the meta-analysis and systematic review, respectively. For the meta-analysis, 50 mTBI patients and 51 HC with a mean age of 31 and 30 years, respectively, were scanned using N-acetyl-aspartate (NAA), a marker for neuronal integrity. Glutamate (Glu), a marker for disturbed brain metabolism, choline (Cho), a marker for increased cell membrane turnover, and creatine (Cr) were used in 2 out of the 4 included articles. Regions of interests were the frontal lobe, the white matter around 1 cm above the lateral ventricles, or the whole brain. NAA was decreased in patients compared to HC with an effect size (ES) of -0.49 (95% CI -1.08 to 0.09), primarily measured in the frontal lobe. Glu was increased in the white matter in 22 mTBI patients compared to 22 HC (ES 0.79; 95% CI 0.17-1.41). Cho was decreased in 31 mTBI patients compared to 31 HC (ES -0.31; 95% CI -0.81 to 0.19). Cr was contradictory and, therefore, potentially not suitable as a reference marker after mTBI. CONCLUSIONS MRS pinpoints changes in posttraumatic brain metabolism that correlate with cognitive dysfunction and, thus, might possibly help to detect mTBI patients at risk for unfavorable outcome or posttraumatic neurodegeneration early.
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Affiliation(s)
- Amanda Eisele
- Department of Geriatric Psychiatry, Psychiatric Hospital Zurich, University of Zurich, Zurich, Switzerland.,Department of Neurology, University Hospital Zurich, Zurich, Switzerland
| | - MaryJane Hill-Strathy
- Department of Geriatric Psychiatry, Psychiatric Hospital Zurich, University of Zurich, Zurich, Switzerland.,School of Psychology and Neuroscience, University of St Andrews, St Andrews, United Kingdom
| | - Lars Michels
- Department of Neuroradiology, University Hospital Zurich, Zurich, Switzerland
| | - Katrin Rauen
- Department of Geriatric Psychiatry, Psychiatric Hospital Zurich, University of Zurich, Zurich, Switzerland, .,Institute for Regenerative Medicine, University of Zurich, Schlieren, Switzerland,
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Davitz MS, Gonen O, Tal A, Babb JS, Lui YW, Kirov II. Quantitative multivoxel proton MR spectroscopy for the identification of white matter abnormalities in mild traumatic brain injury: Comparison between regional and global analysis. J Magn Reson Imaging 2019; 50:1424-1432. [PMID: 30868703 PMCID: PMC6744359 DOI: 10.1002/jmri.26718] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 02/26/2019] [Accepted: 02/27/2019] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND 3D brain proton MR spectroscopic imaging (1 H MRSI) facilitates simultaneous metabolic profiling of multiple loci, at higher, sub-1 cm3 , spatial resolution than single-voxel 1 H MRS with the ability to separate tissue-type partial volume contribution(s). PURPOSE To determine if: 1) white matter (WM) damage in mild traumatic brain injury (mTBI) is homogeneously diffuse, or if specific regions are more affected; 2) partial-volume-corrected, structure-specific 1 H MRSI voxel averaging is sensitive to regional WM metabolic abnormalities. STUDY TYPE Retrospective cross-sectional cohort study. POPULATION Twenty-seven subjects: 15 symptomatic mTBI patients, 12 matched controls. FIELD STRENGTH/SEQUENCE 3T using 3D 1 H MRSI over a 360-cm3 volume of interest (VOI) centered over the corpus callosum, partitioned into 480 voxels, each 0.75 cm3 . ASSESSMENT N-acetyl-aspartate (NAA), creatine, choline, and myo-inositol concentrations estimated in predominantly WM regions: body, genu, and splenium of the corpus callosum, corona radiata, frontal, and occipital WM. STATISTICAL TESTS Analysis of covariance (ANCOVA) to compare patients with controls in terms of regional concentrations. The effect sizes (Cohen's d) of the mean differences were compared across regions and with previously published global data obtained with linear regression of the WM over the entire VOI in the same dataset. RESULTS Despite patients' global VOI WM NAA being significantly lower than the controls', no regional differences were observed for any metabolite. Regional NAA comparisons, however, were all unidirectional (patients' NAA concentrations < controls') within a narrow range: 0.3 ≤ Cohen's d ≤ 0.6. DATA CONCLUSION Since the patient group was symptomatic and exhibiting global WM NAA deficits, these findings suggest: 1) diffuse axonal mTBI damage; that is 2) below the 1 H MRSI detection threshold in small regions. Therefore, larger, ie, more sensitive, single-voxel 1 H MRS, placed anywhere in WM regions, may be well suited for mTBI 1 H MRS studies, given that these results are confirmed in other cohorts. LEVEL OF EVIDENCE 2 Technical Efficacy: Stage 3 J. Magn. Reson. Imaging 2019;50:1424-1432.
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Affiliation(s)
- Matthew S. Davitz
- Center for Advanced Imaging Innovation and Research (CAIR), Bernard and Irene Schwartz Center for Biomedical Imaging, New York University School of Medicine, Department of Radiology, 660 1 Avenue, New York, NY 10016, USA
| | - Oded Gonen
- Center for Advanced Imaging Innovation and Research (CAIR), Bernard and Irene Schwartz Center for Biomedical Imaging, New York University School of Medicine, Department of Radiology, 660 1 Avenue, New York, NY 10016, USA
| | - Assaf Tal
- Department of Chemical Physics, Weizmann Institute of Science, Rehovot 7610001, Israel
| | - James S. Babb
- Center for Advanced Imaging Innovation and Research (CAIR), Bernard and Irene Schwartz Center for Biomedical Imaging, New York University School of Medicine, Department of Radiology, 660 1 Avenue, New York, NY 10016, USA
| | - Yvonne W. Lui
- Center for Advanced Imaging Innovation and Research (CAIR), Bernard and Irene Schwartz Center for Biomedical Imaging, New York University School of Medicine, Department of Radiology, 660 1 Avenue, New York, NY 10016, USA
| | - Ivan I. Kirov
- Center for Advanced Imaging Innovation and Research (CAIR), Bernard and Irene Schwartz Center for Biomedical Imaging, New York University School of Medicine, Department of Radiology, 660 1 Avenue, New York, NY 10016, USA
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Lan YL, Li S, Lou JC, Ma XC, Zhang B. The potential roles of dopamine in traumatic brain injury: a preclinical and clinical update. Am J Transl Res 2019; 11:2616-2631. [PMID: 31217842 PMCID: PMC6556629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 03/20/2019] [Indexed: 06/09/2023]
Abstract
Traumatic brain injury (TBI) is one of the leading causes of death and disability, particularly among the young and the elderly. Several therapeutic options have been investigated, including drug interventions or combinational therapies. Although many drugs have shown promising results in the preclinical stage, all have failed in large clinical trials. Targeting the dopamine system is a novel TBI approach that provides benefits to functional outcomes. TBI could damage the dopaminergic system. Alterations in dopamine levels can impact cellular dysfunction and central nervous system (CNS) inflammation. Experimental evidence suggests that dopamine should be considered a first-line treatment to protect cerebral autoregulation and promote cerebral outcomes in TBI. Furthermore, investigation of dopamine-related genetic factors in relation to injury severity could also be of great significance for promoting TBI treatment. Importantly, various clinical lines of evidence have indicated that many dopamine agonists are beneficial when administered following injury in TBI patients. However, side effects of dopamine treatment prevent their use in TBI treatment, and there is a need for ongoing large, prospective, double-blind randomized controlled trials (RCTs) with these medications by the use of standardized criteria and outcomes to fully understand their effectiveness in this patient group. Here, we review the roles of dopamine in TBI and discuss the role that dopaminergic therapies have in neuroprotective strategies.
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Affiliation(s)
- Yu-Long Lan
- Department of Neurosurgery, The Second Affiliated Hospital of Dalian Medical UniversityDalian, China
- Department of Neurosurgery, Shenzhen People’s HospitalShenzhen, China
- Department of Pharmacy, Dalian Medical UniversityDalian, China
- Department of Physiology, Dalian Medical UniversityDalian, China
| | - Shao Li
- Department of Physiology, Dalian Medical UniversityDalian, China
| | - Jia-Cheng Lou
- Department of Neurosurgery, The Second Affiliated Hospital of Dalian Medical UniversityDalian, China
- Department of Neurosurgery, Shenzhen People’s HospitalShenzhen, China
| | - Xiao-Chi Ma
- Department of Pharmacy, Dalian Medical UniversityDalian, China
| | - Bo Zhang
- Department of Neurosurgery, The Second Affiliated Hospital of Dalian Medical UniversityDalian, China
- Department of Neurosurgery, Shenzhen People’s HospitalShenzhen, China
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McGuire SA, Ryan MC, Sherman PM, Sladky JH, Rowland LM, Wijtenburg SA, Hong LE, Kochunov PV. White matter and hypoxic hypobaria in humans. Hum Brain Mapp 2019; 40:3165-3173. [PMID: 30927318 DOI: 10.1002/hbm.24587] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 03/05/2019] [Accepted: 03/18/2019] [Indexed: 12/18/2022] Open
Abstract
Occupational exposure to hypobaria (low atmospheric pressure) is a risk factor for reduced white matter integrity, increased white matter hyperintensive burden, and decline in cognitive function. We tested the hypothesis that a discrete hypobaric exposure will have a transient impact on cerebral physiology. Cerebral blood flow, fractional anisotropy of water diffusion in cerebral white matter, white matter hyperintensity volume, and concentrations of neurochemicals were measured at baseline and 24 hr and 72 hr postexposure in N = 64 healthy aircrew undergoing standard US Air Force altitude chamber training and compared to N = 60 controls not exposed to hypobaria. We observed that hypobaric exposure led to a significant rise in white matter cerebral blood flow (CBF) 24 hr postexposure that remained elevated, albeit not significantly, at 72 hr. No significant changes were observed in structural measurements or gray matter CBF. Subjects with higher baseline concentrations of neurochemicals associated with neuroprotection and maintenance of normal white matter physiology (glutathione, N-acetylaspartate, glutamate/glutamine) showed proportionally less white matter CBF changes. Our findings suggest that discrete hypobaric exposure may provide a model to study white matter injury associated with occupational hypobaric exposure.
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Affiliation(s)
- Stephen A McGuire
- Department of Neurology, University of Texas Health Science Center, San Antonio, Texas
| | - Meghann C Ryan
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, Maryland
| | - Paul M Sherman
- U.S. Air Force School of Aerospace Medicine, 59MDW-USAFSAM/FHOH, San Antonio, Texas
| | - John H Sladky
- U.S. Air Force School of Aerospace Medicine, 59MDW-USAFSAM/FHOH, San Antonio, Texas
| | - Laura M Rowland
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, Maryland
| | - S Andrea Wijtenburg
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, Maryland
| | - L Elliot Hong
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, Maryland
| | - Peter V Kochunov
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, Maryland
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20
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Lawrence TP, Steel A, Ezra M, Speirs M, Pretorius PM, Douaud G, Sotiropoulos S, Cadoux-Hudson T, Emir UE, Voets NL. MRS and DTI evidence of progressive posterior cingulate cortex and corpus callosum injury in the hyper-acute phase after Traumatic Brain Injury. Brain Inj 2019; 33:854-868. [PMID: 30848964 PMCID: PMC6619394 DOI: 10.1080/02699052.2019.1584332] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
The posterior cingulate cortex (PCC) and corpus callosum (CC) are susceptible to trauma, but injury often evades detection. PCC Metabolic disruption may predict CC white matter tract injury and the secondary cascade responsible for progression. While the time frame for the secondary cascade remains unclear in humans, the first 24 h (hyper-acute phase) are crucial for life-saving interventions. Objectives: To test whether Magnetic Resonance Imaging (MRI) markers are detectable in the hyper-acute phase and progress after traumatic brain injury (TBI) and whether alterations in these parameters reflect injury severity. Methods: Spectroscopic and diffusion-weighted MRI data were collected in 18 patients with TBI (within 24 h and repeated 7–15 days following injury) and 18 healthy controls (scanned once). Results: Within 24 h of TBI N-acetylaspartate was reduced (F = 11.43, p = 0.002) and choline increased (F = 10.67, p = 0.003), the latter driven by moderate-severe injury (F = 5.54, p = 0.03). Alterations in fractional anisotropy (FA) and axial diffusivity (AD) progressed between the two time-points in the splenium of the CC (p = 0.029 and p = 0.013). Gradual reductions in FA correlated with progressive increases in choline (p = 0.029). Conclusions: Metabolic disruption and structural injury can be detected within hours of trauma. Metabolic and diffusion parameters allow identification of severity and provide evidence of injury progression.
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Affiliation(s)
- Tim P Lawrence
- a FMRIB Centre, Wellcome Centre for Integrative Neuroimaging, Nuffield Department of Clinical Neurosciences , University of Oxford , Oxford , United Kingdom.,b Department of Neuroscience , Oxford University Hospitals NHS Foundation Trust , Oxford , United Kingdom
| | - Adam Steel
- a FMRIB Centre, Wellcome Centre for Integrative Neuroimaging, Nuffield Department of Clinical Neurosciences , University of Oxford , Oxford , United Kingdom.,c Laboratory of Brain and Cognition , National Institute of Mental Health, National Institutes of Health , Bethesda , MD , USA
| | - Martyn Ezra
- a FMRIB Centre, Wellcome Centre for Integrative Neuroimaging, Nuffield Department of Clinical Neurosciences , University of Oxford , Oxford , United Kingdom
| | - Mhairi Speirs
- b Department of Neuroscience , Oxford University Hospitals NHS Foundation Trust , Oxford , United Kingdom
| | - Pieter M Pretorius
- b Department of Neuroscience , Oxford University Hospitals NHS Foundation Trust , Oxford , United Kingdom
| | - Gwenaelle Douaud
- a FMRIB Centre, Wellcome Centre for Integrative Neuroimaging, Nuffield Department of Clinical Neurosciences , University of Oxford , Oxford , United Kingdom
| | - Stamatios Sotiropoulos
- a FMRIB Centre, Wellcome Centre for Integrative Neuroimaging, Nuffield Department of Clinical Neurosciences , University of Oxford , Oxford , United Kingdom.,d Sir Peter Mansfield Imaging Centre, School of Medicine, University of Nottingham , Nottingham , UK.,e National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Queens Medical Centre , Nottingham , UK
| | - Tom Cadoux-Hudson
- b Department of Neuroscience , Oxford University Hospitals NHS Foundation Trust , Oxford , United Kingdom
| | - Uzay E Emir
- a FMRIB Centre, Wellcome Centre for Integrative Neuroimaging, Nuffield Department of Clinical Neurosciences , University of Oxford , Oxford , United Kingdom.,f School of Health Sciences , Purdue University , West Lafayette , IN , USA
| | - Natalie L Voets
- a FMRIB Centre, Wellcome Centre for Integrative Neuroimaging, Nuffield Department of Clinical Neurosciences , University of Oxford , Oxford , United Kingdom.,b Department of Neuroscience , Oxford University Hospitals NHS Foundation Trust , Oxford , United Kingdom
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21
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Panchal H, Sollmann N, Pasternak O, Alosco ML, Kinzel P, Kaufmann D, Hartl E, Forwell LA, Johnson AM, Skopelja EN, Shenton ME, Koerte IK, Echlin PS, Lin AP. Neuro-Metabolite Changes in a Single Season of University Ice Hockey Using Magnetic Resonance Spectroscopy. Front Neurol 2018; 9:616. [PMID: 30177905 PMCID: PMC6109794 DOI: 10.3389/fneur.2018.00616] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Accepted: 07/09/2018] [Indexed: 01/13/2023] Open
Abstract
Background: Previous research has shown evidence for transient neuronal loss after repetitive head impacts (RHI) as demonstrated by a decrease in N-acetylaspartate (NAA). However, few studies have investigated other neuro-metabolites that may be altered in the presence of RHI; furthermore, the relationship of neuro-metabolite changes to neurocognitive outcome and potential sex differences remain largely unknown. Objective: The aim of this study was to identify alterations in brain metabolites and their potential association with neurocognitive performance over time as well as to characterize sex-specific differences in response to RHI. Methods: 33 collegiate ice hockey players (17 males and 16 females) underwent 3T magnetic resonance spectroscopy (MRS) and neurocognitive evaluation before and after the Canadian Interuniversity Sports (CIS) ice hockey season 2011–2012. The MRS voxel was placed in the corpus callosum. Pre- and postseason neurocognitive performances were assessed using the Immediate Post-Concussion Assessment and Cognitive Test (ImPACT). Absolute neuro-metabolite concentrations were then compared between pre- and postseason MRS were (level of statistical significance after correction for multiple comparisons: p < 0.007) and correlated to ImPACT scores for both sexes. Results: A significant decrease in NAA was observed from preseason to postseason (p = 0.001). Furthermore, a trend toward a decrease in total choline (Cho) was observed (p = 0.044). Although no overall effect was observed for glutamate (Glu) over the season, a difference was observed with females showing a decrease in Glu and males showing an increase in Glu, though this was not statistically significant (p = 0.039). In both males and females, a negative correlation was observed between changes in Glu and changes in verbal memory (p = 0.008). Conclusion: The results of this study demonstrate changes in absolute concentrations of neuro-metabolites following exposure to RHI. Results suggest that changes in Glu are correlated with changes in verbal memory. Future studies need to investigate further the association between brain metabolites and clinical outcome as well as sex-specific differences in the brain's response to RHI.
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Affiliation(s)
- Hemali Panchal
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States.,Center for Clinical Spectroscopy, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
| | - Nico Sollmann
- Psychiatry Neuroimaging Laboratory, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States.,Department of Neuroradiology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.,TUM-Neuroimaging Center, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.,Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Ofer Pasternak
- Psychiatry Neuroimaging Laboratory, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States.,Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Michael L Alosco
- Boston University Alzheimer's Disease and CTE Center, Boston University School of Medicine, Boston, MA, United States.,Department of Neurology, Boston University School of Medicine, Boston, MA, United States
| | - Philipp Kinzel
- Psychiatry Neuroimaging Laboratory, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States.,Department of Child and Adolescent Psychiatry, Psychosomatic and Psychotherapy, Ludwig-Maximilians-Universität, Munich, Germany
| | - David Kaufmann
- Psychiatry Neuroimaging Laboratory, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States.,Department of Child and Adolescent Psychiatry, Psychosomatic and Psychotherapy, Ludwig-Maximilians-Universität, Munich, Germany
| | - Elisabeth Hartl
- Psychiatry Neuroimaging Laboratory, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States.,Department of Neurology, Ludwig-Maximilians-Universität, Munich, Germany
| | - Lorie A Forwell
- 3M Centre, The University of Western Ontario, London, ON, Canada
| | - Andrew M Johnson
- School of Health Studies, The University of Western Ontario, London, ON, Canada
| | - Elaine N Skopelja
- Ruth Lilly Medical Library, Indiana University, Indianapolis, IN, United States
| | - Martha E Shenton
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States.,Psychiatry Neuroimaging Laboratory, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States.,Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States.,VA Boston Healthcare System, Brockton, MA, United States
| | - Inga K Koerte
- Psychiatry Neuroimaging Laboratory, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States.,Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States.,Department of Child and Adolescent Psychiatry, Psychosomatic and Psychotherapy, Ludwig-Maximilians-Universität, Munich, Germany
| | - Paul S Echlin
- Elliott Sports Medicine Clinic, Burlington, ON, Canada
| | - Alexander P Lin
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States.,Center for Clinical Spectroscopy, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States.,Psychiatry Neuroimaging Laboratory, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
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22
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Raikes AC, Bajaj S, Dailey NS, Smith RS, Alkozei A, Satterfield BC, Killgore WDS. Diffusion Tensor Imaging (DTI) Correlates of Self-Reported Sleep Quality and Depression Following Mild Traumatic Brain Injury. Front Neurol 2018; 9:468. [PMID: 29973910 PMCID: PMC6019466 DOI: 10.3389/fneur.2018.00468] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 05/31/2018] [Indexed: 12/12/2022] Open
Abstract
Background: Mild traumatic brain injuries (mTBIs) are a significant social, sport, and military health issue. In spite of advances in the clinical management of these injuries, the underlying pathophysiology is not well-understood. There is a critical need to advance objective biomarkers, allowing the identification and tracking of the long-term evolution of changes resulting from mTBI. Diffusion-weighted imaging (DWI) allows for the assessment of white-matter properties in the brain and shows promise as a suitable biomarker of mTBI pathophysiology. Methods: 34 individuals within a year of an mTBI (age: 24.4 ± 7.4) and 18 individuals with no history of mTBI (age: 23.2 ± 3.4) participated in this study. Participants completed self-report measures related to functional outcomes, psychological health, post-injury symptoms, and sleep, and underwent a neuroimaging session that included DWI. Whole-brain white matter was skeletonized using tract-based spatial statistics (TBSS) and compared between groups as well as correlated within-group with the self-report measures. Results: There were no statistically significant anatomical differences between the two groups. After controlling for time since injury, fractional anisotropy (FA) demonstrated a negative correlation with sleep quality scores (higher FA was associated with better sleep quality) and increasing depressive symptoms in the mTBI participants. Conversely, mean (MD) and radial diffusivity (RD) demonstrated positive correlations with sleep quality scores (higher RD was associated with worse sleep quality) and increasing depressive symptoms. These correlations were observed bilaterally in the internal capsule (anterior and posterior limbs), corona radiata (anterior and superior), fornix, and superior fronto-occipital fasciculi. Conclusion: The results of this study indicate that the clinical presentation of mTBI, particularly with respect to depression and sleep, is associated with reduced white-matter integrity in multiple areas of the brain, even after controlling for time since injury. These areas are generally associated not only with sleep and emotion regulation but also cognition. Consequently, the onset of depression and sleep dysfunction as well as cognitive impairments following mTBI may be closely related to each other and to white-matter integrity throughout the brain.
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Affiliation(s)
- Adam C Raikes
- Social, Cognitive, and Affective Neuroscience Laboratory, Department of Psychiatry, College of Medicine, University of Arizona, Tucson, AZ, United States
| | - Sahil Bajaj
- Social, Cognitive, and Affective Neuroscience Laboratory, Department of Psychiatry, College of Medicine, University of Arizona, Tucson, AZ, United States
| | - Natalie S Dailey
- Social, Cognitive, and Affective Neuroscience Laboratory, Department of Psychiatry, College of Medicine, University of Arizona, Tucson, AZ, United States
| | - Ryan S Smith
- Social, Cognitive, and Affective Neuroscience Laboratory, Department of Psychiatry, College of Medicine, University of Arizona, Tucson, AZ, United States
| | - Anna Alkozei
- Social, Cognitive, and Affective Neuroscience Laboratory, Department of Psychiatry, College of Medicine, University of Arizona, Tucson, AZ, United States
| | - Brieann C Satterfield
- Social, Cognitive, and Affective Neuroscience Laboratory, Department of Psychiatry, College of Medicine, University of Arizona, Tucson, AZ, United States
| | - William D S Killgore
- Social, Cognitive, and Affective Neuroscience Laboratory, Department of Psychiatry, College of Medicine, University of Arizona, Tucson, AZ, United States
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23
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Magnetic resonance spectroscopy abnormalities in traumatic brain injury: A meta-analysis. J Neuroradiol 2018; 45:123-129. [DOI: 10.1016/j.neurad.2017.09.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Revised: 07/28/2017] [Accepted: 09/05/2017] [Indexed: 11/22/2022]
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24
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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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25
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Stovell MG, Yan JL, Sleigh A, Mada MO, Carpenter TA, Hutchinson PJA, Carpenter KLH. Assessing Metabolism and Injury in Acute Human Traumatic Brain Injury with Magnetic Resonance Spectroscopy: Current and Future Applications. Front Neurol 2017; 8:426. [PMID: 28955291 PMCID: PMC5600917 DOI: 10.3389/fneur.2017.00426] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Accepted: 08/07/2017] [Indexed: 11/25/2022] Open
Abstract
Traumatic brain injury (TBI) triggers a series of complex pathophysiological processes. These include abnormalities in brain energy metabolism; consequent to reduced tissue pO2 arising from ischemia or abnormal tissue oxygen diffusion, or due to a failure of mitochondrial function. In vivo magnetic resonance spectroscopy (MRS) allows non-invasive interrogation of brain tissue metabolism in patients with acute brain injury. Nuclei with “spin,” e.g., 1H, 31P, and 13C, are detectable using MRS and are found in metabolites at various stages of energy metabolism, possessing unique signatures due to their chemical shift or spin–spin interactions (J-coupling). The most commonly used clinical MRS technique, 1H MRS, uses the great abundance of hydrogen atoms within molecules in brain tissue. Spectra acquired with longer echo-times include N-acetylaspartate (NAA), creatine, and choline. NAA, a marker of neuronal mitochondrial activity related to adenosine triphosphate (ATP), is reported to be lower in patients with TBI than healthy controls, and the ratio of NAA/creatine at early time points may correlate with clinical outcome. 1H MRS acquired with shorter echo times produces a more complex spectrum, allowing detection of a wider range of metabolites.31 P MRS detects high-energy phosphate species, which are the end products of cellular respiration: ATP and phosphocreatine (PCr). ATP is the principal form of chemical energy in living organisms, and PCr is regarded as a readily mobilized reserve for its replenishment during periods of high utilization. The ratios of high-energy phosphates are thought to represent a balance between energy generation, reserve and use in the brain. In addition, the chemical shift difference between inorganic phosphate and PCr enables calculation of intracellular pH.13 C MRS detects the 13C isotope of carbon in brain metabolites. As the natural abundance of 13C is low (1.1%), 13C MRS is typically performed following administration of 13C-enriched substrates, which permits tracking of the metabolic fate of the infused 13C in the brain over time, and calculation of metabolic rates in a range of biochemical pathways, including glycolysis, the tricarboxylic acid cycle, and glutamate–glutamine cycling. The advent of new hyperpolarization techniques to transiently boost signal in 13C-enriched MRS in vivo studies shows promise in this field, and further developments are expected.
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Affiliation(s)
- Matthew G Stovell
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom
| | - Jiun-Lin Yan
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom.,Department of Neurosurgery, Keelung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Alison Sleigh
- Wolfson Brain Imaging Centre, Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom.,National Institute for Health Research/Wellcome Trust Clinical Research Facility, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Marius O Mada
- Wolfson Brain Imaging Centre, Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom
| | - T Adrian Carpenter
- Wolfson Brain Imaging Centre, Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom
| | - Peter J A Hutchinson
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom.,Wolfson Brain Imaging Centre, Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom
| | - Keri L H Carpenter
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom.,Wolfson Brain Imaging Centre, Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom
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26
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Hoch SE, Kirov II, Tal A. When are metabolic ratios superior to absolute quantification? A statistical analysis. NMR IN BIOMEDICINE 2017; 30:10.1002/nbm.3710. [PMID: 28272763 PMCID: PMC6411280 DOI: 10.1002/nbm.3710] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Revised: 12/31/2016] [Accepted: 01/20/2017] [Indexed: 06/06/2023]
Abstract
Metabolite levels measured using magnetic resonance spectroscopy (MRS) are often expressed as ratios rather than absolute concentrations. However, the inter-subject variability of the denominator metabolite can introduce uncertainty into a metabolite ratio. In a clinical setting, there are no guidelines on whether ratios or absolute quantification should be used for a more accurate classification of normal versus abnormal results based on their statistical properties. In a research setting, the choice of one over the other can have significant implications on sample size, which must be factored in at the study design stage. Herein, we derive the probability distribution function for the ratio of two normally distributed random variables, and present analytical expressions for the comparison of ratios with absolute quantification in terms of both sample size and area under the receiver operator characteristic curve. The two approaches are compared for typical metabolite values found in the literature, and their respective merits are illustrated using previously acquired clinical MRS data in two pathologies: mild traumatic brain injury and multiple sclerosis. Our analysis shows that the decision between ratios and absolute quantification is non-trivial: in some cases, ratios might offer a reduction in sample size, whereas, in others, absolute quantification might prove more desirable for individual (i.e. clinical) use. The decision is straightforward and exact guidelines are provided in the text, given that population means and standard deviations of numerator and denominator can be reliably estimated.
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Affiliation(s)
- Sarah E. Hoch
- Department of Diagnostic Imaging, Sheba Medical Center, Ramat Gan, 5262100, Israel
| | - Ivan I. Kirov
- Bernard and Irene Schwartz Center for Biomedical Imaging and Center for Advanced Imaging Innovation and Research (CAIR), Department of Radiology, New York University School of Medicine, 660 1 Avenue, New York, NY 10016, USA
| | - Assaf Tal
- Department of Chemical Physics, Weizmann Institute of Science, 234 Herzel St., Rehovot 7610001, Israel
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27
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Narayana PA. White matter changes in patients with mild traumatic brain injury: MRI perspective. Concussion 2017; 2:CNC35. [PMID: 30202576 PMCID: PMC6093760 DOI: 10.2217/cnc-2016-0028] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2016] [Accepted: 02/10/2017] [Indexed: 12/20/2022] Open
Abstract
This review focuses on white matter (WM) changes in mild traumatic brain injury (mTBI) as assessed by multimodal MRI. All the peer reviewed publications on WM changes in mTBI from January 2011 through September 2016 are included in this review. This review is organized as follows: introduction to mTBI, the basics of multimodal MRI techniques that are potentially useful for probing the WM integrity, summary and critical evaluation of the published literature on the application of multimodal MRI techniques to assess the changes of WM in mTBI, and correlation of MRI measures with behavioral deficits. The MRI–pathology correlation studies based on preclinical models of mTBI are also reviewed. Finally, the author's perspective of future research directions is described.
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Affiliation(s)
- Ponnada A Narayana
- Department of Diagnostic & Interventional Imaging, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX 77030, USA
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28
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Ainsley Dean PJ, Arikan G, Opitz B, Sterr A. Potential for use of creatine supplementation following mild traumatic brain injury. ACTA ACUST UNITED AC 2017; 2:CNC34. [PMID: 30202575 PMCID: PMC6094347 DOI: 10.2217/cnc-2016-0016] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2016] [Accepted: 02/07/2017] [Indexed: 01/27/2023]
Abstract
There is significant overlap between the neuropathology of mild traumatic brain injury (mTBI) and the cellular role of creatine, as well as evidence of neural creatine alterations after mTBI. Creatine supplementation has not been researched in mTBI, but shows some potential as a neuroprotective when administered prior to or after TBI. Consistent with creatine’s cellular role, supplementation reduced neuronal damage, protected against the effects of cellular energy crisis and improved cognitive and somatic symptoms. A variety of factors influencing the efficacy of creatine supplementation are highlighted, as well as avenues for future research into the potential of supplementation as an intervention for mTBI. In particular, the slow neural uptake of creatine may mean that greater effects are achieved by pre-emptive supplementation in at-risk groups.
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Affiliation(s)
- Philip John Ainsley Dean
- School of Psychology, Faculty of Health and Medical Sciences, University of Surrey, Guildford, Surrey, GU2 7XH, UK
| | - Gozdem Arikan
- School of Psychology, Faculty of Health and Medical Sciences, University of Surrey, Guildford, Surrey, GU2 7XH, UK
| | - Bertram Opitz
- School of Psychology, Faculty of Health and Medical Sciences, University of Surrey, Guildford, Surrey, GU2 7XH, UK
| | - Annette Sterr
- School of Psychology, Faculty of Health and Medical Sciences, University of Surrey, Guildford, Surrey, GU2 7XH, UK
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29
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Wu X, Kirov II, Gonen O, Ge Y, Grossman RI, Lui YW. MR Imaging Applications in Mild Traumatic Brain Injury: An Imaging Update. Radiology 2016; 279:693-707. [PMID: 27183405 DOI: 10.1148/radiol.16142535] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Mild traumatic brain injury (mTBI), also commonly referred to as concussion, affects millions of Americans annually. Although computed tomography is the first-line imaging technique for all traumatic brain injury, it is incapable of providing long-term prognostic information in mTBI. In the past decade, the amount of research related to magnetic resonance (MR) imaging of mTBI has grown exponentially, partly due to development of novel analytical methods, which are applied to a variety of MR techniques. Here, evidence of subtle brain changes in mTBI as revealed by these techniques, which are not demonstrable by conventional imaging, will be reviewed. These changes can be considered in three main categories of brain structure, function, and metabolism. Macrostructural and microstructural changes have been revealed with three-dimensional MR imaging, susceptibility-weighted imaging, diffusion-weighted imaging, and higher order diffusion imaging. Functional abnormalities have been described with both task-mediated and resting-state blood oxygen level-dependent functional MR imaging. Metabolic changes suggesting neuronal injury have been demonstrated with MR spectroscopy. These findings improve understanding of the true impact of mTBI and its pathogenesis. Further investigation may eventually lead to improved diagnosis, prognosis, and management of this common and costly condition. (©) RSNA, 2016.
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Affiliation(s)
- Xin Wu
- From the Center for Biomedical Imaging, Department of Radiology, New York University School of Medicine, 660 First Ave, 4th Floor, New York, NY 10016
| | - Ivan I Kirov
- From the Center for Biomedical Imaging, Department of Radiology, New York University School of Medicine, 660 First Ave, 4th Floor, New York, NY 10016
| | - Oded Gonen
- From the Center for Biomedical Imaging, Department of Radiology, New York University School of Medicine, 660 First Ave, 4th Floor, New York, NY 10016
| | - Yulin Ge
- From the Center for Biomedical Imaging, Department of Radiology, New York University School of Medicine, 660 First Ave, 4th Floor, New York, NY 10016
| | - Robert I Grossman
- From the Center for Biomedical Imaging, Department of Radiology, New York University School of Medicine, 660 First Ave, 4th Floor, New York, NY 10016
| | - Yvonne W Lui
- From the Center for Biomedical Imaging, Department of Radiology, New York University School of Medicine, 660 First Ave, 4th Floor, New York, NY 10016
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30
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Abstract
Magnetic resonance spectroscopy (MRS) provides a noninvasive tool to assess metabolic change in the brain following head injury. Observable metabolites reflect neuronal density and viability, glial density, membrane injury, and hypoxia or ischemia. MRS has been used in traumatic brain injury (TBI) research for nearly 20 years and this article reviews the MRS findings in the adult TBI population.Although MRS observations are heterogeneous, there are consistent patterns in TBI with the neuronal metabolite N-acetyl-aspartate (NAA) significantly reduced in the vast majority of studies, while the membrane related choline signal (Cho) is almost equally found to be elevated. The glial metabolites myo-inositol is often observed to be increased postinjury and this elevation persists into the chronic phase, which is interpreted as revealing gliosis. Observation of elevated lactate levels are sporadic and mainly in acute studies in severely injured subjects. In general, these spectral changes show a dependency on injury severity and acute changes relate to both neuropsychological deficits and to long-term outcome.
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31
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Hyper-connectivity of the thalamus during early stages following mild traumatic brain injury. Brain Imaging Behav 2016; 9:550-63. [PMID: 26153468 DOI: 10.1007/s11682-015-9424-2] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
The thalamo-cortical resting state functional connectivity of seven sub-thalamic regions were examined in a prospectively recruited population of 77 acute mild TBI (mTBI) patients within the first 10 days (mean 6 ± 3 days) of injury and 35 neurologically intact control subjects using the Oxford thalamic connectivity atlas. Neuropsychological assessments were conducted using the Automated Neuropsychological Assessment Metrics (ANAM). A subset of participants received a magentic resonance spectroscopy (MRS) exam to determine metabolite concentrations in the thalamus and the posterior cingulate cortex. Results show that patients performed worse than the control group on various subtests of ANAM and the weighted throughput score, suggesting reduced cognitive performance at this early stage of injury. Both voxel and region of interest based analysis of the resting state fMRI data demonstrated that acute mTBI patients have increased functional connectivity between the various sub-thalamic regions and cortical regions associated with sensory processing and the default mode network (DMN). In addition, a significant reduction in NAA/Cr was observed in the thalamus in the mTBI patients. Furthermore, an increase in Cho/Cr ratio specific to mTBI patients with self-reported sensory symptoms was observed compared to those without self-reported sensory symptoms. These results provide novel insights into the neural mechanisms of the brain state related to internal rumination and arousal, which have implications for new interventions for mTBI patients with persistent symptoms. Furthermore, an understanding of heightened sensitivity to sensory related inputs during early stages of injury may facilitate enhanced prediction of safe return to work.
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Advanced neuroimaging applied to veterans and service personnel with traumatic brain injury: state of the art and potential benefits. Brain Imaging Behav 2016; 9:367-402. [PMID: 26350144 DOI: 10.1007/s11682-015-9444-y] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Traumatic brain injury (TBI) remains one of the most prevalent forms of morbidity among Veterans and Service Members, particularly for those engaged in the conflicts in Iraq and Afghanistan. Neuroimaging has been considered a potentially useful diagnostic and prognostic tool across the spectrum of TBI generally, but may have particular importance in military populations where the diagnosis of mild TBI is particularly challenging, given the frequent lack of documentation on the nature of the injuries and mixed etiologies, and highly comorbid with other disorders such as post-traumatic stress disorder, depression, and substance misuse. Imaging has also been employed in attempts to understand better the potential late effects of trauma and to evaluate the effects of promising therapeutic interventions. This review surveys the use of structural and functional neuroimaging techniques utilized in military studies published to date, including the utilization of quantitative fluid attenuated inversion recovery (FLAIR), susceptibility weighted imaging (SWI), volumetric analysis, diffusion tensor imaging (DTI), magnetization transfer imaging (MTI), positron emission tomography (PET), magnetoencephalography (MEG), task-based and resting state functional MRI (fMRI), arterial spin labeling (ASL), and magnetic resonance spectroscopy (MRS). The importance of quality assurance testing in current and future research is also highlighted. Current challenges and limitations of each technique are outlined, and future directions are discussed.
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Chiara Ricciardi M, Bokkers RPH, Butman JA, Hammoud DA, Pham DL, Warach S, Latour LL. Trauma-Specific Brain Abnormalities in Suspected Mild Traumatic Brain Injury Patients Identified in the First 48 Hours after Injury: A Blinded Magnetic Resonance Imaging Comparative Study Including Suspected Acute Minor Stroke Patients. J Neurotrauma 2016; 34:23-30. [PMID: 27215444 DOI: 10.1089/neu.2015.4338] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
We assessed the utility of a brief MRI protocol, appropriate for the acute setting, to detect acute traumatic brain injury (TBI) in patients with suspected mild TBI (mTBI) and distinguish traumatic from nontraumatic brain injury by comparing trauma with nontrauma patients. Twenty-two patients with suspected mTBI were included in this exploratory study over a period of 9 months. Median time from injury to MR scanning was 5.4 h (interquartile range 3.6-15.3). To determine the specificity of certain findings for TBI, 61 patients presenting with suspected minor acute stroke were included as a comparative group using the same MRI methods. A selected series of MRI sequences (diffusion-weighted imaging, fluid attenuated inversion recovery [FLAIR], and T2* weighted) were independently evaluated by two neuroradiologists blinded to clinical diagnosis, for presence of specific findings. In a separate session, all cases in which at least one MRI sequence above was positive were classified as TBI, stroke, or indeterminate. Intracranial MRI abnormalities were observed in 47 (57%) of the 83 studied patients. Based on findings on MRI, 12 (55%) of 22 suspected mTBI patients were classified as having traumatic injury. Nine (47%) of the 19 suspected mTBI patients with a negative CT had findings on MRI. Abnormalities on MRI consistent with trauma were observed most frequently on postcontrast FLAIR (83%) and T2*-weighted (58%) sequences. We demonstrated the ability of a fast MRI protocol to identify trauma-related abnormalities not seen on CT, and differentiate acute trauma from nonspecific chronic disease in a blinded cohort of mTBI patients.
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Affiliation(s)
- Maria Chiara Ricciardi
- 1 Stroke Diagnostics and Therapeutics Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health , Bethesda, Maryland.,2 Center for Neuroscience and Regenerative Medicine , Bethesda, Maryland
| | - Reinoud P H Bokkers
- 3 Department of Radiology, University Medical Center Groningen , Groningen, The Netherlands
| | - John A Butman
- 2 Center for Neuroscience and Regenerative Medicine , Bethesda, Maryland.,4 Diagnostic Radiology Department, Clinical Center, National Institutes of Health , Bethesda, Maryland
| | - Dima A Hammoud
- 5 Center for Infectious Disease Imaging (CIDI), Radiology and Imaging Sciences, Clinical Center, National Institutes of Health , Bethesda, Maryland
| | - Dzung L Pham
- 2 Center for Neuroscience and Regenerative Medicine , Bethesda, Maryland
| | - Steven Warach
- 6 Seton Dell Medical School Stroke Institute, University of Texas , Austin, Texas
| | - Lawrence L Latour
- 1 Stroke Diagnostics and Therapeutics Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health , Bethesda, Maryland.,2 Center for Neuroscience and Regenerative Medicine , Bethesda, Maryland
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34
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Mayer AR, Ling JM, Dodd AB, Gasparovic C, Klimaj SD, Meier TB. A Longitudinal Assessment of Structural and Chemical Alterations in Mixed Martial Arts Fighters. J Neurotrauma 2015; 32:1759-67. [PMID: 26096140 DOI: 10.1089/neu.2014.3833] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Growing evidence suggests that temporally proximal acute concussions and repetitive subconcussive head injuries may lead to long-term neurological deficits. However, the underlying mechanisms of injury and their relative time-scales are not well documented in human injury models. The current study therefore investigated whether biomarkers of brain chemistry (magnetic resonance [MR] spectroscopy: N-acetylaspartate [NAA], combined glutamate and glutamine [Glx], total creatine [Cre], choline compounds [Cho], and myo-inositol [mI]) and structure (cortical thickness, white matter [WM]/subcortical volume) differed between mixed martial artists (MMA; n = 13) and matched healthy controls (HC) without a history of contact sport participation (HC; n = 14). A subset of participants (MMA = 9; HC = 10) returned for follow-up visits, with MMA (n = 3) with clinician-documented acute concussions also scanned serially. As expected, MMA self-reported a higher incidence of previous concussions and significantly more cognitive symptoms during prior concussion recovery. Fighters also exhibited reduced memory and processing speed relative to controls on neuropsychological testing coupled with cortical thinning in the left posterior cingulate gyrus and right occipital cortex at baseline assessment. Over a 1-year follow-up period, MMA experienced a significant decrease in both WM volume and NAA concentration, as well as relative thinning in the left middle and superior frontal gyri. These longitudinal changes did not correlate with self-reported metrics of injury (i.e., fight diary). In contrast, HC did not exhibit significant longitudinal changes over a 4-month follow-up period (p > 0.05). Collectively, current results provide preliminary evidence of progressive changes in brain chemistry and structure over a relatively short time period in individuals with high exposure to repetitive head hits. These findings require replication in independent samples.
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Affiliation(s)
- Andrew R Mayer
- 1 The Mind Research Network/Lovelace Biomedical and Environmental Research Institute , Albuquerque, New Mexico.,2 Neurology Department, School of Medicine, University of New Mexico , Albuquerque, New Mexico.,3 Department of Psychology, University of New Mexico , Albuquerque, New Mexico
| | - Josef M Ling
- 1 The Mind Research Network/Lovelace Biomedical and Environmental Research Institute , Albuquerque, New Mexico
| | - Andrew B Dodd
- 1 The Mind Research Network/Lovelace Biomedical and Environmental Research Institute , Albuquerque, New Mexico
| | - Charles Gasparovic
- 1 The Mind Research Network/Lovelace Biomedical and Environmental Research Institute , Albuquerque, New Mexico
| | - Stefan D Klimaj
- 1 The Mind Research Network/Lovelace Biomedical and Environmental Research Institute , Albuquerque, New Mexico
| | - Timothy B Meier
- 1 The Mind Research Network/Lovelace Biomedical and Environmental Research Institute , Albuquerque, New Mexico
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Grossman EJ, Kirov II, Gonen O, Novikov DS, Davitz MS, Lui YW, Grossman RI, Inglese M, Fieremans E. N-acetyl-aspartate levels correlate with intra-axonal compartment parameters from diffusion MRI. Neuroimage 2015; 118:334-43. [PMID: 26037050 PMCID: PMC4651014 DOI: 10.1016/j.neuroimage.2015.05.061] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Revised: 04/19/2015] [Accepted: 05/22/2015] [Indexed: 11/27/2022] Open
Abstract
Diffusion MRI combined with biophysical modeling allows for the description of a white matter (WM) fiber bundle in terms of compartment specific white matter tract integrity (WMTI) metrics, which include intra-axonal diffusivity (Daxon), extra-axonal axial diffusivity (De||), extra-axonal radial diffusivity (De┴), axonal water fraction (AWF), and tortuosity (α) of extra-axonal space. Here we derive these parameters from diffusion kurtosis imaging to examine their relationship to concentrations of global WM N-acetyl-aspartate (NAA), creatine (Cr), choline (Cho) and myo-Inositol (mI), as measured with proton MR spectroscopy ((1)H-MRS), in a cohort of 25 patients with mild traumatic brain injury (MTBI). We found statistically significant (p<0.05) positive correlations between NAA and Daxon, AWF, α, and fractional anisotropy; negative correlations between NAA and De,┴ and the overall radial diffusivity (D┴). These correlations were supported by similar findings in regional analysis of the genu and splenium of the corpus callosum. Furthermore, a positive correlation in global WM was noted between Daxon and Cr, as well as a positive correlation between De|| and Cho, and a positive trend between De|| and mI. The specific correlations between NAA, an endogenous probe of the neuronal intracellular space, and WMTI metrics related to the intra-axonal space, combined with the specific correlations of De|| with mI and Cho, both predominantly present extra-axonally, corroborate the overarching assumption of many advanced modeling approaches that diffusion imaging can disentangle between the intra- and extra-axonal compartments in WM fiber bundles. Our findings are also generally consistent with what is known about the pathophysiology of MTBI, which appears to involve both intra-axonal injury (as reflected by a positive trend between NAA and Daxon) as well as axonal shrinkage, demyelination, degeneration, and/or loss (as reflected by correlations between NAA and De┴, AWF, and α).
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Affiliation(s)
- Elan J Grossman
- Center for Biomedical Imaging, Department of Radiology, New York University School of Medicine, New York, NY, USA; Department of Physiology and Neuroscience, New York University School of Medicine, New York, NY, USA.
| | - Ivan I Kirov
- Center for Biomedical Imaging, Department of Radiology, New York University School of Medicine, New York, NY, USA.
| | - Oded Gonen
- Center for Biomedical Imaging, Department of Radiology, New York University School of Medicine, New York, NY, USA; Department of Physiology and Neuroscience, New York University School of Medicine, New York, NY, USA.
| | - Dmitry S Novikov
- Center for Biomedical Imaging, Department of Radiology, New York University School of Medicine, New York, NY, USA.
| | - Matthew S Davitz
- College of Arts and Sciences, New York University, New York, NY, USA.
| | - Yvonne W Lui
- Center for Biomedical Imaging, Department of Radiology, New York University School of Medicine, New York, NY, USA.
| | - Robert I Grossman
- Center for Biomedical Imaging, Department of Radiology, New York University School of Medicine, New York, NY, USA.
| | - Matilde Inglese
- Center for Biomedical Imaging, Department of Radiology, New York University School of Medicine, New York, NY, USA; Department of Neurology, Radiology, and Neuroscience, Mount Sinai School of Medicine, New York, NY, USA; Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, and Maternal and Child Health, University of Genoa, Genoa, Italy.
| | - Els Fieremans
- Center for Biomedical Imaging, Department of Radiology, New York University School of Medicine, New York, NY, USA.
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Urban KJ, Barlow KM, Jimenez JJ, Goodyear BG, Dunn JF. Functional near-infrared spectroscopy reveals reduced interhemispheric cortical communication after pediatric concussion. J Neurotrauma 2015; 32:833-40. [PMID: 25387354 PMCID: PMC4449632 DOI: 10.1089/neu.2014.3577] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Concussion, or mild traumatic brain injury (mTBI), is a growing concern, especially among the pediatric population. By age 25, as many as 30% of the population are likely to have had a concussion. Many result in long-term disability, with some evolving to postconcussion syndrome. Treatments are being developed, but are difficult to assess given the lack of measures to quantitatively monitor concussion. There is no accepted quantitative imaging metric for monitoring concussion. We hypothesized that because cognitive function and fiber tracks are often impacted in concussion, interhemispheric brain communication may be impaired. We used functional near-infrared spectroscopy (fNIRS) to quantify functional coherence between the left and right motor cortex as a marker of interhemispheric communication. Studies were undertaken during the resting state and with a finger-tapping task to activate the motor cortex. Pediatric patients (ages 12-18) had symptoms for 31-473 days, compared to controls, who have not had reported a previous concussion. We detected differences between patients and controls in coherence between the contralateral motor cortices using measurements of total hemoglobin and oxy-hemoglobin with a p<0.01 (n=8, control; n=12 mTBI). Given the critical need for a quantitative biomarker for recovery after a concussion, we present these data to highlight the potential of fNIRS coupled with interhemispheric coherence analysis as a biomarker of concussion injury.
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Affiliation(s)
- Karolina J. Urban
- Department of Radiology, University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
- Experimental Imaging Center, University of Calgary, Calgary, Alberta, Canada
| | - Karen M. Barlow
- Department of Pediatrics and Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
| | - Jon J. Jimenez
- Experimental Imaging Center, University of Calgary, Calgary, Alberta, Canada
| | - Bradley G. Goodyear
- Department of Radiology, University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Jeff F. Dunn
- Department of Radiology, University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
- Experimental Imaging Center, University of Calgary, Calgary, Alberta, Canada
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37
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Carpenter KLH, Czosnyka M, Jalloh I, Newcombe VFJ, Helmy A, Shannon RJ, Budohoski KP, Kolias AG, Kirkpatrick PJ, Carpenter TA, Menon DK, Hutchinson PJ. Systemic, local, and imaging biomarkers of brain injury: more needed, and better use of those already established? Front Neurol 2015; 6:26. [PMID: 25741315 PMCID: PMC4332345 DOI: 10.3389/fneur.2015.00026] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Accepted: 01/30/2015] [Indexed: 02/02/2023] Open
Abstract
Much progress has been made over the past two decades in the treatment of severe acute brain injury, including traumatic brain injury and subarachnoid hemorrhage, resulting in a higher proportion of patients surviving with better outcomes. This has arisen from a combination of factors. These include improvements in procedures at the scene (pre-hospital) and in the hospital emergency department, advances in neuromonitoring in the intensive care unit, both continuously at the bedside and intermittently in scans, evolution and refinement of protocol-driven therapy for better management of patients, and advances in surgical procedures and rehabilitation. Nevertheless, many patients still experience varying degrees of long-term disabilities post-injury with consequent demands on carers and resources, and there is room for improvement. Biomarkers are a key aspect of neuromonitoring. A broad definition of a biomarker is any observable feature that can be used to inform on the state of the patient, e.g., a molecular species, a feature on a scan, or a monitoring characteristic, e.g., cerebrovascular pressure reactivity index. Biomarkers are usually quantitative measures, which can be utilized in diagnosis and monitoring of response to treatment. They are thus crucial to the development of therapies and may be utilized as surrogate endpoints in Phase II clinical trials. To date, there is no specific drug treatment for acute brain injury, and many seemingly promising agents emerging from pre-clinical animal models have failed in clinical trials. Large Phase III studies of clinical outcomes are costly, consuming time and resources. It is therefore important that adequate Phase II clinical studies with informative surrogate endpoints are performed employing appropriate biomarkers. In this article, we review some of the available systemic, local, and imaging biomarkers and technologies relevant in acute brain injury patients, and highlight gaps in the current state of knowledge.
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Affiliation(s)
- Keri L. H. Carpenter
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK,Wolfson Brain Imaging Centre, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK,*Correspondence: Keri L. H. Carpenter, Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Box 167, Cambridge Biomedical Campus, Cambridge CB2 0QQ, UK e-mail:
| | - Marek Czosnyka
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Ibrahim Jalloh
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Virginia F. J. Newcombe
- Wolfson Brain Imaging Centre, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK,Division of Anaesthesia, Department of Medicine, University of Cambridge, Cambridge, UK
| | - Adel Helmy
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Richard J. Shannon
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Karol P. Budohoski
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Angelos G. Kolias
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Peter J. Kirkpatrick
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Thomas Adrian Carpenter
- Wolfson Brain Imaging Centre, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - David K. Menon
- Wolfson Brain Imaging Centre, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK,Division of Anaesthesia, Department of Medicine, University of Cambridge, Cambridge, UK
| | - Peter J. Hutchinson
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK,Wolfson Brain Imaging Centre, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
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38
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Soher BJ, Wu WE, Tal A, Storey P, Zhang K, Babb JS, Lui YW, Gonen O. Automated whole-brain N-acetylaspartate proton MRS quantification. NMR IN BIOMEDICINE 2014; 27:1275-84. [PMID: 25196714 PMCID: PMC4212831 DOI: 10.1002/nbm.3185] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Revised: 07/16/2014] [Accepted: 07/18/2014] [Indexed: 06/03/2023]
Abstract
Concentration of the neuronal marker, N-acetylaspartate (NAA), a quantitative metric for the health and density of neurons, is currently obtained by integration of the manually defined peak in whole-head proton ((1) H)-MRS. Our goal was to develop a full spectral modeling approach for the automatic estimation of the whole-brain NAA concentration (WBNAA) and to compare the performance of this approach with a manual frequency-range peak integration approach previously employed. MRI and whole-head (1) H-MRS from 18 healthy young adults were examined. Non-localized, whole-head (1) H-MRS obtained at 3 T yielded the NAA peak area through both manually defined frequency-range integration and the new, full spectral simulation. The NAA peak area was converted into an absolute amount with phantom replacement and normalized for brain volume (segmented from T1 -weighted MRI) to yield WBNAA. A paired-sample t test was used to compare the means of the WBNAA paradigms and a likelihood ratio test used to compare their coefficients of variation. While the between-subject WBNAA means were nearly identical (12.8 ± 2.5 mm for integration, 12.8 ± 1.4 mm for spectral modeling), the latter's standard deviation was significantly smaller (by ~50%, p = 0.026). The within-subject variability was 11.7% (±1.3 mm) for integration versus 7.0% (±0.8 mm) for spectral modeling, i.e., a 40% improvement. The (quantifiable) quality of the modeling approach was high, as reflected by Cramer-Rao lower bounds below 0.1% and vanishingly small (experimental - fitted) residuals. Modeling of the whole-head (1) H-MRS increases WBNAA quantification reliability by reducing its variability, its susceptibility to operator bias and baseline roll, and by providing quality-control feedback. Together, these enhance the usefulness of the technique for monitoring the diffuse progression and treatment response of neurological disorders.
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Affiliation(s)
- Brian J. Soher
- Department of Radiology, Duke University Medical Center, Durham NC, 27710, USA
| | - William E. Wu
- Department of Radiology, New York University School of Medicine, New York, NY 10016, USA
| | - Assaf Tal
- Department of Radiology, New York University School of Medicine, New York, NY 10016, USA
| | - Pippa Storey
- Department of Radiology, New York University School of Medicine, New York, NY 10016, USA
| | - Ke Zhang
- Department of Radiology, New York University School of Medicine, New York, NY 10016, USA
| | - James. S. Babb
- Department of Radiology, New York University School of Medicine, New York, NY 10016, USA
| | - Yvonne W. Lui
- Department of Radiology, New York University School of Medicine, New York, NY 10016, USA
| | - Oded Gonen
- Department of Radiology, New York University School of Medicine, New York, NY 10016, USA
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39
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Stocker RPJ, Cieply MA, Paul B, Khan H, Henry L, Kontos AP, Germain A. Combat-related blast exposure and traumatic brain injury influence brain glucose metabolism during REM sleep in military veterans. Neuroimage 2014; 99:207-14. [PMID: 24893322 PMCID: PMC4112017 DOI: 10.1016/j.neuroimage.2014.05.067] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Revised: 04/30/2014] [Accepted: 05/24/2014] [Indexed: 12/01/2022] Open
Abstract
Traumatic brain injury (TBI), a signature wound of Operations Enduring and Iraqi Freedom, can result from blunt head trauma or exposure to a blast/explosion. While TBI affects sleep, the neurobiological underpinnings between TBI and sleep are largely unknown. To examine the neurobiological underpinnings of this relationship in military veterans, [(18)F]-fluorodeoxyglucose positron emission tomography (FDG PET) was used to compare mTBI-related changes in relative cerebral metabolic rate of glucose (rCMRglc) during wakefulness, Rapid Eye Movement (REM) sleep, and non-REM (NREM) sleep, after adjusting for the effects of posttraumatic stress (PTS). Fourteen veterans with a history of blast exposure and/or mTBI (B/mTBI) (age 27.5±3.9) and eleven veterans with no history (No B/mTBI) (age 28.1±4.3) completed FDG PET studies during wakefulness, REM sleep, and NREM sleep. Whole-brain analyses were conducted using Statistical Parametric Mapping (SPM8). Between group comparisons revealed that B/mTBI was associated with significantly lower rCMRglc during wakefulness and REM sleep in the amygdala, hippocampus, parahippocampal gyrus, thalamus, insula, uncus, culmen, visual association cortices, and midline medial frontal cortices. These results suggest that alterations in neurobiological networks during wakefulness and REM sleep subsequent to B/mTBI exposure may contribute to chronic sleep disturbances and differ in individuals with acute symptoms.
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Affiliation(s)
- Ryan P J Stocker
- University of Pittsburgh Medical Center, Pittsburgh, PA, USA; Department of Counseling Psychology, Chatham University, Pittsburgh, PA, USA
| | | | - Benjamin Paul
- School of Social Work, University of Pittsburgh, Pittsburgh, PA, USA
| | - Hassen Khan
- University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Luke Henry
- Department of Orthopaedic Surgery, Pittsburgh, PA, USA
| | | | - Anne Germain
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
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40
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Bigler ED. Effort, symptom validity testing, performance validity testing and traumatic brain injury. Brain Inj 2014; 28:1623-38. [PMID: 25215453 PMCID: PMC4673569 DOI: 10.3109/02699052.2014.947627] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2014] [Revised: 05/09/2014] [Accepted: 07/20/2014] [Indexed: 11/22/2022]
Abstract
BACKGROUND To understand the neurocognitive effects of brain injury, valid neuropsychological test findings are paramount. REVIEW This review examines the research on what has been referred to a symptom validity testing (SVT). Above a designated cut-score signifies a 'passing' SVT performance which is likely the best indicator of valid neuropsychological test findings. Likewise, substantially below cut-point performance that nears chance or is at chance signifies invalid test performance. Significantly below chance is the sine qua non neuropsychological indicator for malingering. However, the interpretative problems with SVT performance below the cut-point yet far above chance are substantial, as pointed out in this review. This intermediate, border-zone performance on SVT measures is where substantial interpretative challenges exist. Case studies are used to highlight the many areas where additional research is needed. Historical perspectives are reviewed along with the neurobiology of effort. Reasons why performance validity testing (PVT) may be better than the SVT term are reviewed. CONCLUSIONS Advances in neuroimaging techniques may be key in better understanding the meaning of border zone SVT failure. The review demonstrates the problems with rigidity in interpretation with established cut-scores. A better understanding of how certain types of neurological, neuropsychiatric and/or even test conditions may affect SVT performance is needed.
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Affiliation(s)
- Erin D. Bigler
- Department of Psychology
- Neuroscience Center
- Magnetic Resonance Imaging Research Facility, Brigham Young University
Provo, UTUSA
- Department of Psychiatry
- The Brain Institute of Utah, University of Utah
Salt Lake City, UTUSA
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41
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Long J, Cai L, Li J, Zhang L, Yang H, Wang T. JNK3 involvement in nerve cell apoptosis and neurofunctional recovery after traumatic brain injury. Neural Regen Res 2014; 8:1491-9. [PMID: 25206445 PMCID: PMC4107806 DOI: 10.3969/j.issn.1673-5374.2013.16.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2012] [Accepted: 03/08/2013] [Indexed: 12/21/2022] Open
Abstract
Increasing evidence has revealed that the activation of the JNK pathway participates in apoptosis of nerve cells and neurological function recovery after traumatic brain injury. However, which genes in the JNK family are activated and their role in traumatic brain injury remain unclear. Therefore, in this study, in situ end labeling, reverse transcription-PCR and neurological function assessment were adopted to investigate the alteration of JNK1, JNK2 and JNK3 gene expression in cerebral injured rats, and their role in cell apoptosis and neurological function restoration. Results showed that JNK3 expression significantly decreased at 1 and 6 hours and 1 and 7 days post injury, but that JNK1 and JNK2 expression remained unchanged. In addition, the number of apoptotic nerve cells surrounding the injured cerebral cortex gradually reduced over time post injury. The Neurological Severity Scores gradually decreased over 1, 3, 5, 14 and 28 days post injury. These findings suggested that JNK3 expression was downregulated at early stages of brain injury, which may be associated with apoptosis of nerve cells. Downregulation of JNK3 expression may promote the recovery of neurological function following traumatic brain injury.
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Affiliation(s)
- Jiang Long
- Department of Neurosurgery, First Affiliated Hospital of Kunming Medical University, Kunming 650032, Yunnan Province, China
| | - Li Cai
- Department of Neurosurgery, First Affiliated Hospital of Kunming Medical University, Kunming 650032, Yunnan Province, China
| | - Jintao Li
- Neuroscience Institute of Kunming Medical University, Kunming 650500, Yunnan Province, China
| | - Lei Zhang
- Department of Neurosurgery, First Affiliated Hospital of Kunming Medical University, Kunming 650032, Yunnan Province, China
| | - Haiyang Yang
- Department of Neurosurgery, First Affiliated Hospital of Kunming Medical University, Kunming 650032, Yunnan Province, China
| | - Tinghua Wang
- Neuroscience Institute of Kunming Medical University, Kunming 650500, Yunnan Province, China
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Neselius S, Brisby H, Marcusson J, Zetterberg H, Blennow K, Karlsson T. Neurological assessment and its relationship to CSF biomarkers in amateur boxers. PLoS One 2014; 9:e99870. [PMID: 24941067 PMCID: PMC4062456 DOI: 10.1371/journal.pone.0099870] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Accepted: 05/20/2014] [Indexed: 12/14/2022] Open
Abstract
Background Mild traumatic brain injury (TBI) or concussion is common in many sports. Today, neuropsychological evaluation is recommended in the monitoring of a concussion and in return-to-play considerations. To investigate the sensitivity of neuropsychological assessment, we tested amateur boxers post bout and compared with controls. Further the relationship between neuropsychological test results and brain injury biomarkers in the cerebrospinal fluid (CSF) were investigated. Method Thirty amateur boxers on high elite level with a minimum of 45 bouts and 25 non-boxing matched controls were included. Memory tests (Rey Osterrieth Complex Figure, Listening Span, Digit Span, Controlled Word Association Test, and computerized testing of episodic memory), tests of processing speed and executive functions (Trail Making, Reaction Time, and Finger Tapping) were performed and related to previously published CSF biomarker results for the axonal injury marker neurofilament light (NFL). Results The neurological assessment showed no significant differences between boxers and controls, although elevated CSF NFL, as a sign of axonal injury, was detected in about 80% of the boxers 1–6 days post bout. The investigation of the relationship between neuropsychological evaluation and CSF NFL concentrations revealed that boxers with persisting NFL concentration elevation after at least 14 days resting time post bout, had a significantly poorer performance on Trail Making A (p = 0.041) and Simple Reaction Time (p = 0.042) compared to other boxers. Conclusion This is the first study showing traumatic axonal brain injury can be present without measureable cognitive impairment. The repetitive, subconcussive head trauma in amateur boxing causes axonal injury that can be detected with analysis of CSF NFL, but is not sufficient to produce impairment in memory tests, tests of processing speed, or executive functions. The association of prolonged CSF NFL increase in boxers with impairment of processing speed is an interesting observation, which needs to be verified in larger studies.
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Affiliation(s)
- Sanna Neselius
- Department of Orthopaedics, Sahlgrenska University Hospital, Gothenburg, Sweden
- Institute for Clinical Sciences, the Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
- * E-mail:
| | - Helena Brisby
- Department of Orthopaedics, Sahlgrenska University Hospital, Gothenburg, Sweden
- Institute for Clinical Sciences, the Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Jan Marcusson
- Geriatric Section, University Hospital in Linköping, Linköping, Sweden
- Institution of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Henrik Zetterberg
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
- Institute of Neuroscience and Physiology, Department of Psychiatry and Neurochemistry, the Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
- UCL Institute of Neurology, Queen Square, London, United Kingdom
| | - Kaj Blennow
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
- Institute of Neuroscience and Physiology, Department of Psychiatry and Neurochemistry, the Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Thomas Karlsson
- Disability Research, Department of Behavioral Sciences and Learning, Linköping University, Linköping, Sweden
- Linnaeus Centre HEAD, Linköping University, Linköping, Sweden
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George EO, Roys S, Sours C, Rosenberg J, Zhuo J, Shanmuganathan K, Gullapalli RP. Longitudinal and Prognostic Evaluation of Mild Traumatic Brain Injury: A 1H-Magnetic Resonance Spectroscopy Study. J Neurotrauma 2014; 31:1018-28. [DOI: 10.1089/neu.2013.3224] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Elijah O. George
- Magnetic Resonance Research Center, Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, Maryland
- Fischell Department of Bioengineering, University of Maryland, College Park, Maryland
| | - Steve Roys
- Magnetic Resonance Research Center, Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | - Chandler Sours
- Magnetic Resonance Research Center, Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, Maryland
- Program in Neuroscience, University of Maryland School of Medicine, Baltimore, Maryland
| | - Joseph Rosenberg
- Magnetic Resonance Research Center, Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | - Jiachen Zhuo
- Magnetic Resonance Research Center, Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | - Kathirkamanthan Shanmuganathan
- Magnetic Resonance Research Center, Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | - Rao P. Gullapalli
- Magnetic Resonance Research Center, Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, Maryland
- Fischell Department of Bioengineering, University of Maryland, College Park, Maryland
- Program in Neuroscience, University of Maryland School of Medicine, Baltimore, Maryland
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Nisenbaum EJ, Novikov DS, Lui YW. The presence and role of iron in mild traumatic brain injury: an imaging perspective. J Neurotrauma 2014; 31:301-7. [PMID: 24295521 DOI: 10.1089/neu.2013.3102] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Mild traumatic brain injury (mTBI), although often presenting without the gross structural abnormalities seen in more severe forms of brain trauma, can nonetheless result in lingering cognitive and behavioral problems along with subtle alterations in brain structure and function. Repeated injuries are associated with brain atrophy and dementia in the form of chronic traumatic encephalopathy (CTE). The mechanisms underlying these dysfunctions are poorly understood. There is a growing body of evidence that brain iron is abnormal after TBI, and brain iron has also been implicated in a host of neurodegenerative disorders. The purpose of this article is to review evidence about the function of iron in the pathophysiology of mTBI and the role that advanced imaging modalities can play in further elucidating said function. MRI techniques sensitive to field inhomogeneities provide supporting evidence for both deep gray matter non-heme iron accumulation as well as focal microhemorrhage resulting from mTBI. In addition, there is evidence that iron may contribute to pathology after mTBI through a number of mechanisms, including generation of reactive oxygen species (ROS), exacerbation of oxidative stress from other sources, and encouragement of tau phosphorylation and the formation of neurofibrillary tangles. Finally, recent animal studies suggest that iron may serve as a therapeutic target in mitigating the effects of mTBI. However, research on the presence and role of iron in mTBI and CTE is still relatively sparse, and further work is necessary to elucidate issues such as the sources of increased iron and the chain of secondary injury.
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Affiliation(s)
- Eric J Nisenbaum
- Department of Radiology, NYU Langone Medical Center , New York, New York
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45
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Kierans AS, Kirov II, Gonen O, Haemer G, Nisenbaum E, Babb JS, Grossman RI, Lui YW. Myoinositol and glutamate complex neurometabolite abnormality after mild traumatic brain injury. Neurology 2014; 82:521-8. [PMID: 24401686 DOI: 10.1212/wnl.0000000000000105] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE To obtain quantitative neurometabolite measurements, specifically myoinositol (mI) and glutamate plus glutamine (Glx), markers of glial and neuronal excitation, in deep gray matter structures after mild traumatic brain injury (mTBI) using proton magnetic resonance spectroscopy ((1)H-MRS) and to compare these measurements against normal healthy control subjects. METHODS This study approved by the institutional review board is Health Insurance Portability and Accountability Act compliant. T1-weighted MRI and multi-voxel (1)H-MRS imaging were acquired at 3 tesla from 26 patients with mTBI an average of 22 days postinjury and from 13 age-matched healthy controls. Two-way analysis of variance was used to compare patients and controls for mean N-acetylaspartate, choline, creatine (Cr), Glx, and mI levels as well as the respective ratios to Cr within the caudate, globus pallidus, putamen, and thalamus. RESULTS Quantitative putaminal mI was higher in patients with mTBI compared with controls (p = 0.02). Quantitative neurometabolite ratios of putaminal mI and Glx relative to Cr, mI/Cr, and Glx/Cr were also higher among patients with mTBI compared with controls (p = 0.01 and 0.02, respectively). No other differences in neurometabolite levels or ratios were observed in any other brain region evaluated. CONCLUSION Increased putaminal mI, mI/Cr, and Glx/Cr in patients after mTBI compared with control subjects supports the notion of a complex glial and excitatory response to injury without concomitant neuronal loss, evidenced by preserved N-acetylaspartate levels in this region.
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Affiliation(s)
- Andrea S Kierans
- From the Department of Radiology, New York University School of Medicine, NY
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46
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Gardner A, Iverson GL, Stanwell P. A Systematic Review of Proton Magnetic Resonance Spectroscopy Findings in Sport-Related Concussion. J Neurotrauma 2014; 31:1-18. [DOI: 10.1089/neu.2013.3079] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Andrew Gardner
- Centre for Translational Neuroscience and Mental Health, School of Medicine and Public Health, Faculty of Health, University of Newcastle, Callaghan, New South Wales, Australia
| | - Grant L. Iverson
- Department of Physical Medicine and Rehabilitation, Harvard Medical School; Red Sox Foundation and Massachusetts General Hospital Home Base Program, Boston, Massachusetts
| | - Peter Stanwell
- Centre for Translational Neuroscience and Mental Health, School of Medicine and Public Health, Faculty of Health, University of Newcastle, Callaghan, New South Wales, Australia
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Sivák Š, Bittšanský M, Grossmann J, Nosál' V, Kantorová E, Siváková J, Demková A, Hnilicová P, Dobrota D, Kurča E. Clinical correlations of proton magnetic resonance spectroscopy findings in acute phase after mild traumatic brain injury. Brain Inj 2013; 28:341-6. [DOI: 10.3109/02699052.2013.865270] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Ramadan S, Lin A, Stanwell P. Glutamate and glutamine: a review of in vivo MRS in the human brain. NMR IN BIOMEDICINE 2013; 26:1630-46. [PMID: 24123328 PMCID: PMC3849600 DOI: 10.1002/nbm.3045] [Citation(s) in RCA: 179] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2012] [Revised: 08/08/2013] [Accepted: 09/08/2013] [Indexed: 05/21/2023]
Abstract
Our understanding of the roles that the amino acids glutamate (Glu) and glutamine (Gln) play in the mammalian central nervous system has increased rapidly in recent times. Many conditions are known to exhibit a disturbance in Glu-Gln equilibrium, and the exact relationships between these changed conditions and these amino acids are not fully understood. This has led to increased interest in Glu/Gln quantitation in the human brain in an array of conditions (e.g. mental illness, tumor, neuro-degeneration) as well as in normal brain function. Accordingly, this review has been undertaken to describe the increasing number of in vivo techniques available to study Glu and Gln separately, or pooled as 'Glx'. The present MRS methods used to assess Glu and Gln vary in approach, complexity, and outcome, thus the focus of this review is on a description of MRS acquisition approaches, and an indication of relative utility of each technique rather than brain pathologies associated with Glu and/or Gln perturbation. Consequently, this review focuses particularly on (1) one-dimensional (1)H MRS, (2) two-dimensional (1)H MRS, and (3) one-dimensional (13)C MRS techniques.
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Affiliation(s)
- Saadallah Ramadan
- School of Health Sciences, Faculty of Health, Hunter Building, University of Newcastle, Callaghan NSW 2308, Australia
| | - Alexander Lin
- Alexander Lin: Center for Clinical Spectroscopy, Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, 4 Blackfan Street, HIM-820, Boston MA 02115
| | - Peter Stanwell
- School of Health Sciences, Faculty of Health, Hunter Building, University of Newcastle, Callaghan NSW 2308, Australia
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Lippi G, Cervellin G, Lui YW. Role of biomarkers in the diagnosis of mild traumatic brain injury. Radiology 2013; 268:611-2. [PMID: 23882101 DOI: 10.1148/radiol.13130643] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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50
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Kirov II, Tal A, Babb JS, Reaume J, Bushnik T, Ashman TA, Flanagan S, Grossman RI, Gonen O. Proton MR spectroscopy correlates diffuse axonal abnormalities with post-concussive symptoms in mild traumatic brain injury. J Neurotrauma 2013; 30:1200-4. [PMID: 23339670 PMCID: PMC3700460 DOI: 10.1089/neu.2012.2696] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
There are no established biomarkers for mild traumatic brain injury (mTBI), in part because post-concussive symptoms (PCS) are subjective and conventional imaging is typically unremarkable. To test whether diffuse axonal abnormalities quantified with three-dimensional (3D) proton magnetic resonance spectroscopic imaging (¹H-MRSI) correlated with patients' PCS, we retrospectively studied 26 mTBI patients (mean Glasgow Coma Scale [GCS] score of 14.7), 18- to 56-year-olds and 13 controls three to 55 days post-injury. All were scanned at 3 Tesla with T1- and T2-weighted MRI and 3D ¹H-MRSI (480 voxels over 360 cm³, ∼30% of the brain). On scan day, patients completed a symptom questionnaire, and those who indicated at least one of the most common subacute mTBI symptoms (headache, dizziness, sleep disturbance, memory deficits, blurred vision) were grouped as PCS-positive. Global gray matter and white matter (GM/WM) absolute concentrations of N-acetylaspartate (NAA), choline (Cho), creatine (Cr) and myo-inositol (mI) in PCS-positive and PCS-negative patients were compared to age- and gender-matched controls using two-way analysis of variance. The results showed that the PCS-negative group (n=11) and controls (n=8) did not differ in any GM or WM metabolite level. The PCS-positive patients (n=15) had lower WM NAA than the controls (n=12; 7.0 ± 0.6 versus 7.9 ± 0.5mM; p=0.0007). Global WM NAA, therefore, showed sensitivity to the TBI sequelae associated with common PCS in patients with mostly normal neuroimaging, as well as GCS scores. This suggests a potential biomarker role in a patient population in which objective measures of injury and symptomatology are currently lacking.
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Affiliation(s)
- Ivan I. Kirov
- Department of Radiology, New York University School of Medicine, New York, New York
| | - Assaf Tal
- Department of Radiology, New York University School of Medicine, New York, New York
| | - James S. Babb
- Department of Radiology, New York University School of Medicine, New York, New York
| | - Joseph Reaume
- Department of Radiology, New York University School of Medicine, New York, New York
| | - Tamara Bushnik
- Rusk Institute of Rehabilitation Medicine, New York University School of Medicine, New York, New York
| | - Teresa A. Ashman
- Rusk Institute of Rehabilitation Medicine, New York University School of Medicine, New York, New York
| | - Steven Flanagan
- Rusk Institute of Rehabilitation Medicine, New York University School of Medicine, New York, New York
| | - Robert I. Grossman
- Department of Radiology, New York University School of Medicine, New York, New York
| | - Oded Gonen
- Department of Radiology, New York University School of Medicine, New York, New York
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