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Beard K, Gauff A, Pennington A, Marion D, Smith J, Sloley S. Biofluid, Imaging, Physiological and Functional Biomarkers of Mild Traumatic Brain Injury and Subconcussive Head Impacts. J Neurotrauma 2024. [PMID: 38943278 DOI: 10.1089/neu.2024.0136] [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: 07/01/2024] Open
Abstract
Post-concussive symptoms are frequently reported by individuals who sustain mild traumatic brain injuries (mTBIs) and subconcussive head impacts, even when evidence of intracranial pathology is lacking. Current strategies used to evaluate head injuries, which primarily rely on self-report, have a limited ability to predict the incidence, severity, and duration of post-concussive symptoms that will develop in an individual patient. Additionally, these self-report measures have little association with the underlying mechanisms of pathology that may contribute to persisting symptoms, impeding advancement in precision treatment for TBI. Emerging evidence suggests that biofluid, imaging, physiological, and functional biomarkers associated with mTBI and subconcussive head impacts may address these shortcomings by providing more objective measures of injury severity and underlying pathology. Interest in the use of biomarker data has rapidly accelerated, which is reflected by the recent efforts of organizations such as the National Institute of Neurological Disorders and Stroke and the National Academy of Sciences, Engineering, and Medicine to prioritize the collection of biomarker data during TBI characterization in acute care settings. Thus, this review aims to describe recent progress in the identification and development of biomarkers of mTBI and subconcussive head impacts and to discuss important considerations for the implementation of these biomarkers in clinical practice.
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Affiliation(s)
- Kryshawna Beard
- Traumatic Brain Injury Center of Excellence, Research , Silver Spring, Maryland, United States
- General Dynamics Information Technology Inc, Falls Church, Virginia, United States;
| | - Amina Gauff
- Traumatic Brain Injury Center of Excellence, Silver Spring, Maryland, United States
- Xynergie Federal, LLC, San Juan , Puerto Rico, United States Minor Outlying Islands;
| | - Ashley Pennington
- Traumatic Brain Injury Center of Excellence, Silver Spring, Maryland, United States
- Xynergie Federal, LLC, San Juan , Puerto Rico, United States Minor Outlying Islands;
| | - Donald Marion
- Traumatic Brain Injury Center of Excellence, Silver Spring, Maryland, United States
- General Dynamics Information Technology Inc, Falls Church, Virginia, United States;
| | - Johanna Smith
- Traumatic Brain Injury Center of Excellence, Silver Spring , Maryland, United States;
| | - Stephanie Sloley
- Traumatic Brain Injury Center of Excellence, Silver Spring, Maryland, United States;
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2
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Cade A, Turnbull PRK. Classification of short and long term mild traumatic brain injury using computerized eye tracking. Sci Rep 2024; 14:12686. [PMID: 38830966 PMCID: PMC11148176 DOI: 10.1038/s41598-024-63540-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Accepted: 05/29/2024] [Indexed: 06/05/2024] Open
Abstract
Accurate, and objective diagnosis of brain injury remains challenging. This study evaluated useability and reliability of computerized eye-tracker assessments (CEAs) designed to assess oculomotor function, visual attention/processing, and selective attention in recent mild traumatic brain injury (mTBI), persistent post-concussion syndrome (PPCS), and controls. Tests included egocentric localisation, fixation-stability, smooth-pursuit, saccades, Stroop, and the vestibulo-ocular reflex (VOR). Thirty-five healthy adults performed the CEA battery twice to assess useability and test-retest reliability. In separate experiments, CEA data from 55 healthy, 20 mTBI, and 40 PPCS adults were used to train a machine learning model to categorize participants into control, mTBI, or PPCS classes. Intraclass correlation coefficients demonstrated moderate (ICC > .50) to excellent (ICC > .98) reliability (p < .05) and satisfactory CEA compliance. Machine learning modelling categorizing participants into groups of control, mTBI, and PPCS performed reasonably (balanced accuracy control: 0.83, mTBI: 0.66, and PPCS: 0.76, AUC-ROC: 0.82). Key outcomes were the VOR (gaze stability), fixation (vertical error), and pursuit (total error, vertical gain, and number of saccades). The CEA battery was reliable and able to differentiate healthy, mTBI, and PPCS patients reasonably well. While promising, the diagnostic model accuracy should be improved with a larger training dataset before use in clinical environments.
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Affiliation(s)
- Alice Cade
- School of Optometry and Vision Science, The University of Auckland, Private Bag 92019, Auckland, 1023, New Zealand.
- New Zealand College of Chiropractic, Auckland, New Zealand.
| | - Philip R K Turnbull
- School of Optometry and Vision Science, The University of Auckland, Private Bag 92019, Auckland, 1023, New Zealand
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3
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Esopenko C, Sollmann N, Bonke EM, Wiegand TLT, Heinen F, de Souza NL, Breedlove KM, Shenton ME, Lin AP, Koerte IK. Current and Emerging Techniques in Neuroimaging of Sport-Related Concussion. J Clin Neurophysiol 2023; 40:398-407. [PMID: 36930218 PMCID: PMC10329721 DOI: 10.1097/wnp.0000000000000864] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023] Open
Abstract
SUMMARY Sport-related concussion (SRC) affects an estimated 1.6 to 3.8 million Americans each year. Sport-related concussion results from biomechanical forces to the head or neck that lead to a broad range of neurologic symptoms and impaired cognitive function. Although most individuals recover within weeks, some develop chronic symptoms. The heterogeneity of both the clinical presentation and the underlying brain injury profile make SRC a challenging condition. Adding to this challenge, there is also a lack of objective and reliable biomarkers to support diagnosis, to inform clinical decision making, and to monitor recovery after SRC. In this review, the authors provide an overview of advanced neuroimaging techniques that provide the sensitivity needed to capture subtle changes in brain structure, metabolism, function, and perfusion after SRC. This is followed by a discussion of emerging neuroimaging techniques, as well as current efforts of international research consortia committed to the study of SRC. Finally, the authors emphasize the need for advanced multimodal neuroimaging to develop objective biomarkers that will inform targeted treatment strategies after SRC.
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Affiliation(s)
- Carrie Esopenko
- Department of Rehabilitation and Movement Sciences, Rutgers Biomedical and Health Sciences, Newark, NJ, USA
| | - Nico Sollmann
- cBRAIN, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Ludwig-Maximilians-Universität, Munich, Germany
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
- TUM-Neuroimaging Center, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Elena M. Bonke
- cBRAIN, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Ludwig-Maximilians-Universität, Munich, Germany
- Graduate School of Systemic Neurosciences, Ludwig-Maximilians-Universität, Munich, Germany
| | - Tim L. T. Wiegand
- cBRAIN, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Ludwig-Maximilians-Universität, Munich, Germany
| | - Felicitas Heinen
- cBRAIN, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Ludwig-Maximilians-Universität, Munich, Germany
| | - Nicola L. de Souza
- School of Graduate Studies, Biomedical Sciences, Rutgers Biomedical and Health Sciences, Newark, NJ, USA
| | - Katherine M. Breedlove
- Center for Clinical Spectroscopy, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
- Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Martha E. Shenton
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
- Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
- VA Boston Healthcare System, Brockton Division, Brockton, MA, USA
| | - Alexander P. Lin
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
- Center for Clinical Spectroscopy, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
- Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Inga K. Koerte
- cBRAIN, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Ludwig-Maximilians-Universität, Munich, Germany
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, 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: 2] [Impact Index Per Article: 2.0] [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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6
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Abstract
OBJECTIVE Depression is among the most pervasive and debilitating neuropsychiatric sequelae experienced by patients following a traumatic brain injury (TBI). While the individual mechanisms underlying depression and TBI have been widely studied, the neurobiological bases of depression after TBI remain largely unknown. This article highlights the potential mechanisms of action implicated in depression after TBI. RESULTS We review putative mechanisms of action including neuroinflammation, neuroendocrine dysregulation, metabolic abnormalities, and neurotransmitter and circuitry dysfunction. We also identify the current limitations in the field and propose directions for future research. CONCLUSION An improved understanding of the underlying mechanisms will aid the development of precision-guided and personalized treatments for patients suffering from depression after TBI.
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Affiliation(s)
- Aava Bushra Jahan
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, US.,Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, US
| | - Kaloyan Tanev
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, US
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7
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Abstract
Imaging of mild traumatic brain injury (TBI) using conventional techniques such as CT or MRI often results in no specific imaging correlation that would explain cognitive and clinical symptoms. Molecular imaging of mild TBI suggests that secondary events after injury can be detected using PET. However, no single specific pattern emerges that can aid in diagnosing the injury or determining the prognosis of the long-term behavioral profiles, indicating the heterogeneous and diffuse nature of TBI. Chronic traumatic encephalopathy, a primary tauopathy, has been shown to be strongly associated with repetitive TBI. In vivo data on the available tau PET tracers, however, have produced mixed results and overall low retention profiles in athletes with a history of repetitive mild TBI. Here, we emphasize that the lack of a mechanistic understanding of chronic TBI has posed a challenge when interpreting the results of molecular imaging biomarkers. We advocate for better target identification, improved analysis techniques such as machine learning or artificial intelligence, and novel tracer development.
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Affiliation(s)
- Gérard N. Bischof
- Department of Nuclear Medicine, University of Cologne, Cologne, Germany;,Institute for Neuroscience and Medicine II–Molecular Organization of the Brain, Research Center Juelich, Juelich, Germany; and
| | - Donna J. Cross
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, Utah
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8
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Sun CC, Zhang YW, Xing XX, Yang Q, Cao LY, Cheng YF, Zhao JW, Zhou ST, Cheng DD, Zhang Y, Hua XY, Wang H, Xu DS. Modified constraint-induced movement therapy enhances cortical plasticity in a rat model of traumatic brain injury: a resting-state functional MRI study. Neural Regen Res 2023; 18:410-415. [PMID: 35900438 PMCID: PMC9396520 DOI: 10.4103/1673-5374.344832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Modified constraint-induced movement therapy (mCIMT) has shown beneficial effects on motor function improvement after brain injury, but the exact mechanism remains unclear. In this study, amplitude of low frequency fluctuation (ALFF) metrics measured by resting-state functional magnetic resonance imaging was obtained to investigate the efficacy and mechanism of mCIMT in a control cortical impact (CCI) rat model simulating traumatic brain injury. At 3 days after control cortical impact model establishment, we found that the mean ALFF (mALFF) signals were decreased in the left motor cortex, somatosensory cortex, insula cortex and the right motor cortex, and were increased in the right corpus callosum. After 3 weeks of an 8-hour daily mCIMT treatment, the mALFF values were significantly increased in the bilateral hemispheres compared with those at 3 days postoperatively. The mALFF signal values of left corpus callosum, left somatosensory cortex, right medial prefrontal cortex, right motor cortex, left postero dorsal hippocampus, left motor cortex, right corpus callosum, and right somatosensory cortex were increased in the mCIMT group compared with the control cortical impact group. Finally, we identified brain regions with significantly decreased mALFF values at 3 days postoperatively. Pearson correlation coefficients with the right forelimb sliding score indicated that the improvement in motor function of the affected upper limb was associated with an increase in mALFF values in these brain regions. Our findings suggest that functional cortical plasticity changes after brain injury, and that mCIMT is an effective method to improve affected upper limb motor function by promoting bilateral hemispheric cortical remodeling. mALFF values correlate with behavioral changes and can potentially be used as biomarkers to assess dynamic cortical plasticity after traumatic brain injury.
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9
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Muacevic A, Adler JR. Management and Treatment of Traumatic Brain Injuries. Cureus 2022; 14:e30617. [PMID: 36426314 PMCID: PMC9681696 DOI: 10.7759/cureus.30617] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Accepted: 10/23/2022] [Indexed: 01/25/2023] Open
Abstract
Traumatic brain injuries (TBI) are one of the main reasons for death in recent years worldwide or globally. They are the number one cause of death for both civilians and military members. It affects how the brain functions and is currently one of the crucial concerns of global public health issues. TBI is increasing worldwide because of the increasing dependency on motorized vehicles and machinery. One of the reasons for TBI is the expanding human population. It is the major cause of death and disability in the world. In young adults around the world, it is the main cause of mortality and morbidity. Its complicated etiology and pathogenesis include primarily primary and secondary injury types. Neuroinflammation is also focused on TBI to be cured. The neuroprotection of the injured brain has received tremendous attention during TBI treatment. In this review, we will first discuss the definition of traumatic brain injury, its causes, and the symptoms experienced by patients of various age groups. Finally, treatment methods and advances in treatment will be discussed. In this review, the aftereffects of traumatic brain damage are also covered. Ferroptosis and choline phospholipids are also emphasized as important components of the treatment of traumatic brain damage in this review.
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10
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Rauchman SH, Albert J, Pinkhasov A, Reiss AB. Mild-to-Moderate Traumatic Brain Injury: A Review with Focus on the Visual System. Neurol Int 2022; 14:453-470. [PMID: 35736619 PMCID: PMC9227114 DOI: 10.3390/neurolint14020038] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 05/23/2022] [Accepted: 05/25/2022] [Indexed: 02/01/2023] Open
Abstract
Traumatic Brain Injury (TBI) is a major global public health problem. Neurological damage from TBI may be mild, moderate, or severe and occurs both immediately at the time of impact (primary injury) and continues to evolve afterwards (secondary injury). In mild (m)TBI, common symptoms are headaches, dizziness and fatigue. Visual impairment is especially prevalent. Insomnia, attentional deficits and memory problems often occur. Neuroimaging methods for the management of TBI include computed tomography and magnetic resonance imaging. The location and the extent of injuries determine the motor and/or sensory deficits that result. Parietal lobe damage can lead to deficits in sensorimotor function, memory, and attention span. The processing of visual information may be disrupted, with consequences such as poor hand-eye coordination and balance. TBI may cause lesions in the occipital or parietal lobe that leave the TBI patient with incomplete homonymous hemianopia. Overall, TBI can interfere with everyday life by compromising the ability to work, sleep, drive, read, communicate and perform numerous activities previously taken for granted. Treatment and rehabilitation options available to TBI sufferers are inadequate and there is a pressing need for new ways to help these patients to optimize their functioning and maintain productivity and participation in life activities, family and community.
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Affiliation(s)
- Steven H. Rauchman
- The Fresno Institute of Neuroscience, Fresno, CA 93730, USA
- Correspondence:
| | - Jacqueline Albert
- Department of Medicine, Biomedical Research Institute, NYU Long Island School of Medicine, Mineola, NY 11501, USA; (J.A.); (A.B.R.)
| | - Aaron Pinkhasov
- Department of Psychiatry, NYU Long Island School of Medicine, Mineola, NY 11501, USA;
| | - Allison B. Reiss
- Department of Medicine, Biomedical Research Institute, NYU Long Island School of Medicine, Mineola, NY 11501, USA; (J.A.); (A.B.R.)
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11
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Vike NL, Bari S, Susnjar A, Lee T, Lycke RJ, Auger J, Music J, Nauman E, Talavage TM, Rispoli J. American football position-specific neurometabolic changes in high school athletes - a magnetic resonance spectroscopic study. J Neurotrauma 2022; 39:1168-1182. [PMID: 35414265 DOI: 10.1089/neu.2021.0186] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Reports estimate between 1.6-3.8 million sports-related concussions occur annually, with 30% occurring in youth male American football athletes. Many studies report neurophysiological changes in these athletes, but the exact reasons for these changes remain elusive. Investigation of injury mechanics highlights a need to address how player position might impact these changes. Here, 55 high school American football athletes (20 linemen; 35 non-linemen) underwent magnetic resonance spectroscopy four times over the course of a football season (once prior to the season (Pre), twice during (In1, In2), and once following (Post)) to quantify metabolites (N-acetyl aspartate, choline, creatine, myo-inositol, and glutamate/glutamine) in the dorsolateral prefrontal cortex (DLPFC) and primary motor cortex (M1). Head acceleration events (HAEs) were monitored at each practice and game. Spectroscopic and HAE data were analyzed by imaging session and player position. Linear regression analyses were conducted between metabolite levels and HAEs, and metabolite levels in football athletes were compared to age-and gender-matched non-contact athletes. Across-season (i.e., between Pre and In1, In2, Post), different DLPFC and M1 metabolites decreased (p<0.05) according to player position (i.e., linemen vs. non-linemen). The majority of regression results involved DLPFC metabolites in linemen, where metabolite levels were higher, from Pre to Post, with increasing HAE load. Comparisons with control athletes revealed higher metabolite levels in football athletes both before and after the season. This study highlights the importance of player position when conducting analyses on American football athletes and demonstrates elevated DLPFC and M1 brain metabolites in football athletes compared to control athletes at both Pre and Post, suggesting potential HAE-related neurocompensatory mechanisms.
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Affiliation(s)
- Nicole L Vike
- Northwestern University, 3270, Chicago, Illinois, United States.,Purdue University, 311308, West Lafayette, Indiana, United States;
| | - Sumra Bari
- Northwestern University, 3270, Chicago, Illinois, United States.,Purdue University, 311308, West Lafayette, Indiana, United States;
| | - Antonia Susnjar
- Purdue University, 311308, West Lafayette, Indiana, United States;
| | - Taylor Lee
- Purdue University, 311308, West Lafayette, Indiana, United States;
| | - Roy J Lycke
- Purdue University, 311308, Weldon School of Biomedical Engineering, West Lafayette, Indiana, United States;
| | - Joshua Auger
- Purdue University, 311308, West Lafayette, Indiana, United States;
| | - Jacob Music
- Purdue University, 311308, West Lafayette, Indiana, United States;
| | - Eric Nauman
- Purdue University, School of Mechanical Engineering, West Lafayette, Indiana, United States.,University of Cincinnati, 2514, Cincinnati, Ohio, United States;
| | - Thomas M Talavage
- Purdue University, 311308, West Lafayette, Indiana, United States.,University of Cincinnati, 2514, Cincinnati, Ohio, United States;
| | - Joseph Rispoli
- Purdue University, 311308, West Lafayette, Indiana, United States;
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12
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Parvaz MA, Rabin RA, Adams F, Goldstein RZ. Structural and functional brain recovery in individuals with substance use disorders during abstinence: A review of longitudinal neuroimaging studies. Drug Alcohol Depend 2022; 232:109319. [PMID: 35077955 PMCID: PMC8885813 DOI: 10.1016/j.drugalcdep.2022.109319] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 01/17/2022] [Indexed: 01/26/2023]
Abstract
BACKGROUND Neuroimaging studies reveal structural and functional including neurochemical brain abnormalities in individuals with substance use disorders compared to healthy controls. However, whether and to what extent such dysfunction is reversible with abstinence remains unclear, and a review of studies with longitudinal within-subject designs is lacking. We performed a systematic review of longitudinal neuroimaging studies to explore putative brain changes associated with abstinence in treatment-seeking individuals with substance use disorders. METHODS Following PRISMA guidelines, we examined articles published up to May 2021 that employed a neuroimaging technique and assessed neurobiological recovery in treatment-seeking participants at a minimum of two time-points separated by a period of abstinence (longer than 24 h apart) or significant reduction in drug use. RESULTS Forty-five studies met inclusion criteria. Encouragingly, in this limited but growing literature, the majority of studies demonstrated at least partial neurobiological recovery with abstinence. Structural recovery appeared to occur predominantly in frontal cortical regions, the insula, hippocampus, and cerebellum. Functional and neurochemical recovery was similarly observed in prefrontal cortical regions but also in subcortical structures. The onset of structural recovery appears to precede neurochemical recovery, which begins soon after cessation (particularly for alcohol); functional recovery may require longer periods of abstinence. CONCLUSIONS The literature is still growing and more studies are warranted to better understand abstinence-mediated neural recovery in individuals with substance use disorders. Elucidating the temporal dynamics between neuronal recovery and abstinence will enable evidence-based planning for more effective and targeted treatment of substance use disorders, potentially pre-empting relapse.
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Affiliation(s)
- Muhammad A Parvaz
- Department of Pyschiatry, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA.
| | - Rachel A. Rabin
- Department of Psychiatry, McGill University and The Douglas Mental Health University Institute, Montreal, Quebec H4H 1R3
| | - Faith Adams
- Department of Pyschiatry, Icahn School of Medicine at Mount Sinai, New York, NY 10029,Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY 10029
| | - Rita Z. Goldstein
- Department of Pyschiatry, Icahn School of Medicine at Mount Sinai, New York, NY 10029,Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY 10029
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13
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Diaz-Pacheco V, Vargas-Medrano J, Tran E, Nicolas M, Price D, Patel R, Tonarelli S, Gadad BS. Prognosis and Diagnostic Biomarkers of Mild Traumatic Brain Injury: Current Status and Future Prospects. J Alzheimers Dis 2022; 86:943-959. [PMID: 35147534 DOI: 10.3233/jad-215158] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Mild traumatic brain injury (mTBI) is the most prevalent type of TBI (80-90%). It is characterized by a loss consciousness for less than 30 minutes, post-traumatic amnesia for less than 24 hours, and Glasgow Coma Score of 13-15. Accurately diagnosing mTBIs can be a challenge because the majority of these injuries do not show noticeable or visible changes on neuroimaging studies. Appropriate determination of mTBI is tremendously important because it might lead in some cases to post-concussion syndrome, cognitive impairments including attention, memory, and speed of information processing problems. The scientists have studied different methods to improve mTBI diagnosis and enhanced approaches that would accurately determine the severity of the trauma. The present review focuses on discussing the role of biomarkers as potential key factors in diagnosing mTBI. The present review focuses on 1) protein based peripheral and CNS markers, 2) genetic biomarkers, 3) imaging biomarkers, 4) neurophysiological biomarkers, and 5) the studies and clinical trials in mTBI. Each section provides information and characteristics on different biomarkers for mTBI.
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Affiliation(s)
- Valeria Diaz-Pacheco
- Department of Psychiatry, Paul L. Foster School of Medicine, Texas Tech University Health Science Center, El Paso, TX, USA.,Southwest Brain Bank, Texas Tech University Health Science Center, El Paso, TX, USA
| | - Javier Vargas-Medrano
- Department of Psychiatry, Paul L. Foster School of Medicine, Texas Tech University Health Science Center, El Paso, TX, USA.,Southwest Brain Bank, Texas Tech University Health Science Center, El Paso, TX, USA
| | - Eric Tran
- Paul L. Foster School of Medicine, Texas Tech University Health Science Center, El Paso, TX, USA
| | - Meza Nicolas
- Paul L. Foster School of Medicine, Texas Tech University Health Science Center, El Paso, TX, USA
| | - Diamond Price
- The Chicago School of Professional Psychology, Irvine, CA, USA
| | - Richa Patel
- Department of Psychiatry, Paul L. Foster School of Medicine, Texas Tech University Health Science Center, El Paso, TX, USA
| | - Silvina Tonarelli
- Department of Psychiatry, Paul L. Foster School of Medicine, Texas Tech University Health Science Center, El Paso, TX, USA
| | - Bharathi S Gadad
- Department of Psychiatry, Paul L. Foster School of Medicine, Texas Tech University Health Science Center, El Paso, TX, USA.,Southwest Brain Bank, Texas Tech University Health Science Center, El Paso, TX, USA
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14
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Daisy CC, Varinos S, Howell DR, Kaplan K, Mannix R, Meehan WP, Wang F, Berkstresser B, Lee RS, Froehlich JW, Zurakowski D, Moses MA. Proteomic Discovery of Noninvasive Biomarkers Associated With Sport-Related Concussions. Neurology 2022; 98:e186-e198. [PMID: 34675105 PMCID: PMC8762586 DOI: 10.1212/wnl.0000000000013001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 10/14/2021] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Sport-related concussions affect millions of individuals across the United States each year, and current techniques to diagnose and monitor them rely largely on subjective measures. Our goal was to discover and validate objective, quantifiable noninvasive biomarkers with the potential to be used in sport-related concussion diagnosis. METHODS Urine samples from a convenience series of healthy control collegiate athletes who had not sustained a concussion and athletes who sustained a concussion as diagnosed by a sports medicine physician within 7 days were collected prospectively and studied. Participants also completed an instrumented single-task gait analysis as a functional measure. Participants were recruited from a single collegiate athletic program and were ≥18 years of age and were excluded if they had a concomitant injury, active psychiatric conditions, or preexisting neurologic disorders. Using Tandem Mass Tags (TMT) mass spectroscopy and ELISA, we identified and validated urinary biomarkers of concussion. RESULTS Forty-eight control and 47 age- and sex-matched athletes with concussion were included in the study (51.6% female, 48.4% male, average age 19.6 years). Participants represented both contact and noncontact sports. All but 1 of the postconcussion participants reported experiencing symptoms at the time of data collection. Insulin-like growth factor 1 (IGF-1) and IGF binding protein 5 (IGFBP5) were downregulated in the urine of athletes with concussions compared to healthy controls. Multivariable risk algorithms developed to predict the probability of sport-related concussion showed that IGF-1 multiplexed with single-task gait velocity predicts concussion risk across a range of postinjury time points (area under the curve [AUC] 0.786, 95% confidence interval [CI] 0.690-0.884). When IGF-1 and IGFBP5 are multiplexed with single-task gait velocity, they accurately distinguish between healthy controls and individuals with concussion at acute time points (AUC 0.835, 95% CI 0.701-0.968, p < 0.001). DISCUSSION These noninvasive biomarkers, discovered in an objective and validated manner, may be useful in diagnosing and monitoring sport-related concussions in both acute phases of injury and several days after injury. TRIAL REGISTRATION INFORMATION ClinicalTrials.gov Identifier: NCT02354469 (submitted February 2015, first patient enrolled August 2015). CLASSIFICATION OF EVIDENCE This study provides Class III evidence that urinary IGF-1 and IGFBP5 multiplexed with single-task gait velocity may be useful in diagnosing sport-related concussion.
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Affiliation(s)
- Cassandra C Daisy
- From the Vascular Biology Program (C.C.D., S.V., K.K., M.A.M.), Division of Sports Medicine (D.R.H., W.P.M.), Department of Orthopaedics, Brain Injury Center (D.R.H., R.M., W.P.M.), Sports Concussion Clinic (R.M.), Division of Sports Medicine, Division of Emergency Medicine (R.M.), Department of Urology (R.S.L., J.W.F.), Department of Anesthesia (D.Z.), and Department of Surgery (M.A.M.), Boston Children's Hospital; The Micheli Center for Sports Injury Prevention (D.R.H., R.M., W.P.M.), Waltham, MA; Sports Medicine Center (D.R.H.), Children's Hospital Colorado; Department of Orthopedics (D.R.H.), University of Colorado School of Medicine, Aurora; Departments of Pediatrics (W.P.M.), and Orthopaedic Surgery (W.P.M.), and Surgery (R.S.L., J.W.F., D.Z., M.A.M.), Harvard Medical School; and Harvard Sports Medicine (F.W., B.B.), Boston, MA
| | - Speros Varinos
- From the Vascular Biology Program (C.C.D., S.V., K.K., M.A.M.), Division of Sports Medicine (D.R.H., W.P.M.), Department of Orthopaedics, Brain Injury Center (D.R.H., R.M., W.P.M.), Sports Concussion Clinic (R.M.), Division of Sports Medicine, Division of Emergency Medicine (R.M.), Department of Urology (R.S.L., J.W.F.), Department of Anesthesia (D.Z.), and Department of Surgery (M.A.M.), Boston Children's Hospital; The Micheli Center for Sports Injury Prevention (D.R.H., R.M., W.P.M.), Waltham, MA; Sports Medicine Center (D.R.H.), Children's Hospital Colorado; Department of Orthopedics (D.R.H.), University of Colorado School of Medicine, Aurora; Departments of Pediatrics (W.P.M.), and Orthopaedic Surgery (W.P.M.), and Surgery (R.S.L., J.W.F., D.Z., M.A.M.), Harvard Medical School; and Harvard Sports Medicine (F.W., B.B.), Boston, MA
| | - David R Howell
- From the Vascular Biology Program (C.C.D., S.V., K.K., M.A.M.), Division of Sports Medicine (D.R.H., W.P.M.), Department of Orthopaedics, Brain Injury Center (D.R.H., R.M., W.P.M.), Sports Concussion Clinic (R.M.), Division of Sports Medicine, Division of Emergency Medicine (R.M.), Department of Urology (R.S.L., J.W.F.), Department of Anesthesia (D.Z.), and Department of Surgery (M.A.M.), Boston Children's Hospital; The Micheli Center for Sports Injury Prevention (D.R.H., R.M., W.P.M.), Waltham, MA; Sports Medicine Center (D.R.H.), Children's Hospital Colorado; Department of Orthopedics (D.R.H.), University of Colorado School of Medicine, Aurora; Departments of Pediatrics (W.P.M.), and Orthopaedic Surgery (W.P.M.), and Surgery (R.S.L., J.W.F., D.Z., M.A.M.), Harvard Medical School; and Harvard Sports Medicine (F.W., B.B.), Boston, MA
| | - Katherine Kaplan
- From the Vascular Biology Program (C.C.D., S.V., K.K., M.A.M.), Division of Sports Medicine (D.R.H., W.P.M.), Department of Orthopaedics, Brain Injury Center (D.R.H., R.M., W.P.M.), Sports Concussion Clinic (R.M.), Division of Sports Medicine, Division of Emergency Medicine (R.M.), Department of Urology (R.S.L., J.W.F.), Department of Anesthesia (D.Z.), and Department of Surgery (M.A.M.), Boston Children's Hospital; The Micheli Center for Sports Injury Prevention (D.R.H., R.M., W.P.M.), Waltham, MA; Sports Medicine Center (D.R.H.), Children's Hospital Colorado; Department of Orthopedics (D.R.H.), University of Colorado School of Medicine, Aurora; Departments of Pediatrics (W.P.M.), and Orthopaedic Surgery (W.P.M.), and Surgery (R.S.L., J.W.F., D.Z., M.A.M.), Harvard Medical School; and Harvard Sports Medicine (F.W., B.B.), Boston, MA
| | - Rebekah Mannix
- From the Vascular Biology Program (C.C.D., S.V., K.K., M.A.M.), Division of Sports Medicine (D.R.H., W.P.M.), Department of Orthopaedics, Brain Injury Center (D.R.H., R.M., W.P.M.), Sports Concussion Clinic (R.M.), Division of Sports Medicine, Division of Emergency Medicine (R.M.), Department of Urology (R.S.L., J.W.F.), Department of Anesthesia (D.Z.), and Department of Surgery (M.A.M.), Boston Children's Hospital; The Micheli Center for Sports Injury Prevention (D.R.H., R.M., W.P.M.), Waltham, MA; Sports Medicine Center (D.R.H.), Children's Hospital Colorado; Department of Orthopedics (D.R.H.), University of Colorado School of Medicine, Aurora; Departments of Pediatrics (W.P.M.), and Orthopaedic Surgery (W.P.M.), and Surgery (R.S.L., J.W.F., D.Z., M.A.M.), Harvard Medical School; and Harvard Sports Medicine (F.W., B.B.), Boston, MA
| | - William P Meehan
- From the Vascular Biology Program (C.C.D., S.V., K.K., M.A.M.), Division of Sports Medicine (D.R.H., W.P.M.), Department of Orthopaedics, Brain Injury Center (D.R.H., R.M., W.P.M.), Sports Concussion Clinic (R.M.), Division of Sports Medicine, Division of Emergency Medicine (R.M.), Department of Urology (R.S.L., J.W.F.), Department of Anesthesia (D.Z.), and Department of Surgery (M.A.M.), Boston Children's Hospital; The Micheli Center for Sports Injury Prevention (D.R.H., R.M., W.P.M.), Waltham, MA; Sports Medicine Center (D.R.H.), Children's Hospital Colorado; Department of Orthopedics (D.R.H.), University of Colorado School of Medicine, Aurora; Departments of Pediatrics (W.P.M.), and Orthopaedic Surgery (W.P.M.), and Surgery (R.S.L., J.W.F., D.Z., M.A.M.), Harvard Medical School; and Harvard Sports Medicine (F.W., B.B.), Boston, MA
| | - Francis Wang
- From the Vascular Biology Program (C.C.D., S.V., K.K., M.A.M.), Division of Sports Medicine (D.R.H., W.P.M.), Department of Orthopaedics, Brain Injury Center (D.R.H., R.M., W.P.M.), Sports Concussion Clinic (R.M.), Division of Sports Medicine, Division of Emergency Medicine (R.M.), Department of Urology (R.S.L., J.W.F.), Department of Anesthesia (D.Z.), and Department of Surgery (M.A.M.), Boston Children's Hospital; The Micheli Center for Sports Injury Prevention (D.R.H., R.M., W.P.M.), Waltham, MA; Sports Medicine Center (D.R.H.), Children's Hospital Colorado; Department of Orthopedics (D.R.H.), University of Colorado School of Medicine, Aurora; Departments of Pediatrics (W.P.M.), and Orthopaedic Surgery (W.P.M.), and Surgery (R.S.L., J.W.F., D.Z., M.A.M.), Harvard Medical School; and Harvard Sports Medicine (F.W., B.B.), Boston, MA
| | - Brant Berkstresser
- From the Vascular Biology Program (C.C.D., S.V., K.K., M.A.M.), Division of Sports Medicine (D.R.H., W.P.M.), Department of Orthopaedics, Brain Injury Center (D.R.H., R.M., W.P.M.), Sports Concussion Clinic (R.M.), Division of Sports Medicine, Division of Emergency Medicine (R.M.), Department of Urology (R.S.L., J.W.F.), Department of Anesthesia (D.Z.), and Department of Surgery (M.A.M.), Boston Children's Hospital; The Micheli Center for Sports Injury Prevention (D.R.H., R.M., W.P.M.), Waltham, MA; Sports Medicine Center (D.R.H.), Children's Hospital Colorado; Department of Orthopedics (D.R.H.), University of Colorado School of Medicine, Aurora; Departments of Pediatrics (W.P.M.), and Orthopaedic Surgery (W.P.M.), and Surgery (R.S.L., J.W.F., D.Z., M.A.M.), Harvard Medical School; and Harvard Sports Medicine (F.W., B.B.), Boston, MA
| | - Richard S Lee
- From the Vascular Biology Program (C.C.D., S.V., K.K., M.A.M.), Division of Sports Medicine (D.R.H., W.P.M.), Department of Orthopaedics, Brain Injury Center (D.R.H., R.M., W.P.M.), Sports Concussion Clinic (R.M.), Division of Sports Medicine, Division of Emergency Medicine (R.M.), Department of Urology (R.S.L., J.W.F.), Department of Anesthesia (D.Z.), and Department of Surgery (M.A.M.), Boston Children's Hospital; The Micheli Center for Sports Injury Prevention (D.R.H., R.M., W.P.M.), Waltham, MA; Sports Medicine Center (D.R.H.), Children's Hospital Colorado; Department of Orthopedics (D.R.H.), University of Colorado School of Medicine, Aurora; Departments of Pediatrics (W.P.M.), and Orthopaedic Surgery (W.P.M.), and Surgery (R.S.L., J.W.F., D.Z., M.A.M.), Harvard Medical School; and Harvard Sports Medicine (F.W., B.B.), Boston, MA
| | - John W Froehlich
- From the Vascular Biology Program (C.C.D., S.V., K.K., M.A.M.), Division of Sports Medicine (D.R.H., W.P.M.), Department of Orthopaedics, Brain Injury Center (D.R.H., R.M., W.P.M.), Sports Concussion Clinic (R.M.), Division of Sports Medicine, Division of Emergency Medicine (R.M.), Department of Urology (R.S.L., J.W.F.), Department of Anesthesia (D.Z.), and Department of Surgery (M.A.M.), Boston Children's Hospital; The Micheli Center for Sports Injury Prevention (D.R.H., R.M., W.P.M.), Waltham, MA; Sports Medicine Center (D.R.H.), Children's Hospital Colorado; Department of Orthopedics (D.R.H.), University of Colorado School of Medicine, Aurora; Departments of Pediatrics (W.P.M.), and Orthopaedic Surgery (W.P.M.), and Surgery (R.S.L., J.W.F., D.Z., M.A.M.), Harvard Medical School; and Harvard Sports Medicine (F.W., B.B.), Boston, MA
| | - David Zurakowski
- From the Vascular Biology Program (C.C.D., S.V., K.K., M.A.M.), Division of Sports Medicine (D.R.H., W.P.M.), Department of Orthopaedics, Brain Injury Center (D.R.H., R.M., W.P.M.), Sports Concussion Clinic (R.M.), Division of Sports Medicine, Division of Emergency Medicine (R.M.), Department of Urology (R.S.L., J.W.F.), Department of Anesthesia (D.Z.), and Department of Surgery (M.A.M.), Boston Children's Hospital; The Micheli Center for Sports Injury Prevention (D.R.H., R.M., W.P.M.), Waltham, MA; Sports Medicine Center (D.R.H.), Children's Hospital Colorado; Department of Orthopedics (D.R.H.), University of Colorado School of Medicine, Aurora; Departments of Pediatrics (W.P.M.), and Orthopaedic Surgery (W.P.M.), and Surgery (R.S.L., J.W.F., D.Z., M.A.M.), Harvard Medical School; and Harvard Sports Medicine (F.W., B.B.), Boston, MA
| | - Marsha A Moses
- From the Vascular Biology Program (C.C.D., S.V., K.K., M.A.M.), Division of Sports Medicine (D.R.H., W.P.M.), Department of Orthopaedics, Brain Injury Center (D.R.H., R.M., W.P.M.), Sports Concussion Clinic (R.M.), Division of Sports Medicine, Division of Emergency Medicine (R.M.), Department of Urology (R.S.L., J.W.F.), Department of Anesthesia (D.Z.), and Department of Surgery (M.A.M.), Boston Children's Hospital; The Micheli Center for Sports Injury Prevention (D.R.H., R.M., W.P.M.), Waltham, MA; Sports Medicine Center (D.R.H.), Children's Hospital Colorado; Department of Orthopedics (D.R.H.), University of Colorado School of Medicine, Aurora; Departments of Pediatrics (W.P.M.), and Orthopaedic Surgery (W.P.M.), and Surgery (R.S.L., J.W.F., D.Z., M.A.M.), Harvard Medical School; and Harvard Sports Medicine (F.W., B.B.), Boston, MA.
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15
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Dennis EL, Baron D, Bartnik‐Olson B, Caeyenberghs K, Esopenko C, Hillary FG, Kenney K, Koerte IK, Lin AP, Mayer AR, Mondello S, Olsen A, Thompson PM, Tate DF, Wilde EA. ENIGMA brain injury: Framework, challenges, and opportunities. Hum Brain Mapp 2022; 43:149-166. [PMID: 32476212 PMCID: PMC8675432 DOI: 10.1002/hbm.25046] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 04/23/2020] [Accepted: 05/03/2020] [Indexed: 12/19/2022] Open
Abstract
Traumatic brain injury (TBI) is a major cause of disability worldwide, but the heterogeneous nature of TBI with respect to injury severity and health comorbidities make patient outcome difficult to predict. Injury severity accounts for only some of this variance, and a wide range of preinjury, injury-related, and postinjury factors may influence outcome, such as sex, socioeconomic status, injury mechanism, and social support. Neuroimaging research in this area has generally been limited by insufficient sample sizes. Additionally, development of reliable biomarkers of mild TBI or repeated subconcussive impacts has been slow, likely due, in part, to subtle effects of injury and the aforementioned variability. The ENIGMA Consortium has established a framework for global collaboration that has resulted in the largest-ever neuroimaging studies of multiple psychiatric and neurological disorders. Here we describe the organization, recent progress, and future goals of the Brain Injury working group.
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Affiliation(s)
- Emily L. Dennis
- Department of NeurologyUniversity of Utah School of MedicineSalt Lake CityUtahUSA
- George E. Wahlen Veterans Affairs Medical CenterSalt Lake CityUtahUSA
- Imaging Genetics CenterStevens Neuroimaging & Informatics Institute, Keck School of Medicine of USCMarina del ReyCaliforniaUSA
| | - David Baron
- Western University of Health SciencesPomonaCaliforniaUSA
| | - Brenda Bartnik‐Olson
- Department of RadiologyLoma Linda University Medical CenterLoma LindaCaliforniaUSA
| | - Karen Caeyenberghs
- Cognitive Neuroscience Unit, School of PsychologyDeakin UniversityBurwoodVictoriaAustralia
| | - Carrie Esopenko
- Department of Rehabilitation and Movement SciencesRutgers Biomedical Health SciencesNewarkNew JerseyUSA
| | - Frank G. Hillary
- Department of PsychologyPennsylvania State UniversityUniversity ParkPennsylvaniaUSA
- Social Life and Engineering Sciences Imaging CenterUniversity ParkPennsylvaniaUSA
| | - Kimbra Kenney
- Department of NeurologyUniformed Services University of the Health SciencesBethesdaMarylandUSA
- National Intrepid Center of ExcellenceWalter Reed National Military Medical CenterBethesdaMarylandUSA
| | - Inga K. Koerte
- Psychiatry Neuroimaging LaboratoryBrigham and Women's HospitalBostonMassachusettsUSA
- Department of Child and Adolescent Psychiatry, Psychosomatics and PsychotherapyLudwig‐Maximilians‐UniversitätMunichGermany
| | - Alexander P. Lin
- Center for Clinical SpectroscopyBrigham and Women's Hospital, Harvard Medical SchoolBostonMassachusettsUSA
| | - Andrew R. Mayer
- Mind Research NetworkAlbuquerqueNew MexicoUSA
- Department of Neurology and PsychiatryUniversity of New Mexico School of MedicineAlbuquerqueNew MexicoUSA
| | - Stefania Mondello
- Department of Biomedical and Dental Sciences and Morphofunctional ImagingUniversity of MessinaMessinaItaly
| | - Alexander Olsen
- Department of PsychologyNorwegian University of Science and TechnologyTrondheimNorway
- Department of Physical Medicine and RehabilitationSt. Olavs Hospital, Trondheim University HospitalTrondheimNorway
| | - Paul M. Thompson
- Imaging Genetics CenterStevens Neuroimaging & Informatics Institute, Keck School of Medicine of USCMarina del ReyCaliforniaUSA
- Department of Neurology, Pediatrics, Psychiatry, Radiology, Engineering, and OphthalmologyUniversity of Southern California (USC)Los AngelesCaliforniaUSA
| | - David F. Tate
- Department of NeurologyUniversity of Utah School of MedicineSalt Lake CityUtahUSA
- George E. Wahlen Veterans Affairs Medical CenterSalt Lake CityUtahUSA
| | - Elisabeth A. Wilde
- Department of NeurologyUniversity of Utah School of MedicineSalt Lake CityUtahUSA
- George E. Wahlen Veterans Affairs Medical CenterSalt Lake CityUtahUSA
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16
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Javaid S, Farooq T, Rehman Z, Afzal A, Ashraf W, Rasool MF, Alqahtani F, Alsanea S, Alasmari F, Alanazi MM, Alharbi M, Imran I. Dynamics of Choline-Containing Phospholipids in Traumatic Brain Injury and Associated Comorbidities. Int J Mol Sci 2021; 22:ijms222111313. [PMID: 34768742 PMCID: PMC8583393 DOI: 10.3390/ijms222111313] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 10/12/2021] [Accepted: 10/15/2021] [Indexed: 01/01/2023] Open
Abstract
The incidences of traumatic brain injuries (TBIs) are increasing globally because of expanding population and increased dependencies on motorized vehicles and machines. This has resulted in increased socio-economic burden on the healthcare system, as TBIs are often associated with mental and physical morbidities with lifelong dependencies, and have severely limited therapeutic options. There is an emerging need to identify the molecular mechanisms orchestrating these injuries to life-long neurodegenerative disease and a therapeutic strategy to counter them. This review highlights the dynamics and role of choline-containing phospholipids during TBIs and how they can be used to evaluate the severity of injuries and later targeted to mitigate neuro-degradation, based on clinical and preclinical studies. Choline-based phospholipids are involved in maintaining the structural integrity of the neuronal/glial cell membranes and are simultaneously the essential component of various biochemical pathways, such as cholinergic neuronal transmission in the brain. Choline or its metabolite levels increase during acute and chronic phases of TBI because of excitotoxicity, ischemia and oxidative stress; this can serve as useful biomarker to predict the severity and prognosis of TBIs. Moreover, the effect of choline-replenishing agents as a post-TBI management strategy has been reviewed in clinical and preclinical studies. Overall, this review determines the theranostic potential of choline phospholipids and provides new insights in the management of TBI.
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Affiliation(s)
- Sana Javaid
- Department of Pharmacology, Faculty of Pharmacy, Bahauddin Zakariya University, Multan 60800, Pakistan; (S.J.); (T.F.); (Z.R.); (A.A.); (W.A.); (I.I.)
- Department of Pharmacy, The Women University, Multan 60000, Pakistan
| | - Talha Farooq
- Department of Pharmacology, Faculty of Pharmacy, Bahauddin Zakariya University, Multan 60800, Pakistan; (S.J.); (T.F.); (Z.R.); (A.A.); (W.A.); (I.I.)
| | - Zohabia Rehman
- Department of Pharmacology, Faculty of Pharmacy, Bahauddin Zakariya University, Multan 60800, Pakistan; (S.J.); (T.F.); (Z.R.); (A.A.); (W.A.); (I.I.)
| | - Ammara Afzal
- Department of Pharmacology, Faculty of Pharmacy, Bahauddin Zakariya University, Multan 60800, Pakistan; (S.J.); (T.F.); (Z.R.); (A.A.); (W.A.); (I.I.)
| | - Waseem Ashraf
- Department of Pharmacology, Faculty of Pharmacy, Bahauddin Zakariya University, Multan 60800, Pakistan; (S.J.); (T.F.); (Z.R.); (A.A.); (W.A.); (I.I.)
| | - Muhammad Fawad Rasool
- Department of Pharmacy Practice, Faculty of Pharmacy, Bahauddin Zakariya University, Multan 60800, Pakistan;
| | - Faleh Alqahtani
- Department of Pharmacology and Toxicology, College of Pharmacy, King Saud University, Riyadh 11451, Saudi Arabia; (S.A.); (F.A.); (M.M.A.); (M.A.)
- Correspondence: ; Tel.: +966-114697749
| | - Sary Alsanea
- Department of Pharmacology and Toxicology, College of Pharmacy, King Saud University, Riyadh 11451, Saudi Arabia; (S.A.); (F.A.); (M.M.A.); (M.A.)
| | - Fawaz Alasmari
- Department of Pharmacology and Toxicology, College of Pharmacy, King Saud University, Riyadh 11451, Saudi Arabia; (S.A.); (F.A.); (M.M.A.); (M.A.)
| | - Mohammed Mufadhe Alanazi
- Department of Pharmacology and Toxicology, College of Pharmacy, King Saud University, Riyadh 11451, Saudi Arabia; (S.A.); (F.A.); (M.M.A.); (M.A.)
| | - Metab Alharbi
- Department of Pharmacology and Toxicology, College of Pharmacy, King Saud University, Riyadh 11451, Saudi Arabia; (S.A.); (F.A.); (M.M.A.); (M.A.)
| | - Imran Imran
- Department of Pharmacology, Faculty of Pharmacy, Bahauddin Zakariya University, Multan 60800, Pakistan; (S.J.); (T.F.); (Z.R.); (A.A.); (W.A.); (I.I.)
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17
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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: 24] [Impact Index Per Article: 8.0] [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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18
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Wiegand TLT, Sollmann N, Bonke EM, Umeasalugo KE, Sobolewski KR, Plesnila N, Shenton ME, Lin AP, Koerte IK. Translational neuroimaging in mild traumatic brain injury. J Neurosci Res 2021; 100:1201-1217. [PMID: 33789358 DOI: 10.1002/jnr.24840] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 03/09/2021] [Accepted: 03/17/2021] [Indexed: 01/26/2023]
Abstract
Traumatic brain injuries (TBIs) are common with an estimated 27.1 million cases per year. Approximately 80% of TBIs are categorized as mild TBI (mTBI) based on initial symptom presentation. While in most individuals, symptoms resolve within days to weeks, in some, symptoms become chronic. Advanced neuroimaging has the potential to characterize brain morphometric, microstructural, biochemical, and metabolic abnormalities following mTBI. However, translational studies are needed for the interpretation of neuroimaging findings in humans with respect to the underlying pathophysiological processes, and, ultimately, for developing novel and more targeted treatment options. In this review, we introduce the most commonly used animal models for the study of mTBI. We then summarize the neuroimaging findings in humans and animals after mTBI and, wherever applicable, the translational aspects of studies available today. Finally, we highlight the importance of translational approaches and outline future perspectives in the field of translational neuroimaging in mTBI.
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Affiliation(s)
- Tim L T Wiegand
- cBRAIN, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Ludwig-Maximilians-Universität, Munich, Germany
| | - Nico Sollmann
- cBRAIN, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Ludwig-Maximilians-Universität, Munich, Germany
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
- TUM-Neuroimaging Center, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
- Department of Diagnostic and Interventional Radiology, University Hospital Ulm, Ulm, Germany
| | - Elena M Bonke
- cBRAIN, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Ludwig-Maximilians-Universität, Munich, Germany
- Graduate School of Systemic Neurosciences, Ludwig-Maximilians-Universität, Munich, Germany
| | - Kosisochukwu E Umeasalugo
- cBRAIN, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Ludwig-Maximilians-Universität, Munich, Germany
- Graduate School of Systemic Neurosciences, Ludwig-Maximilians-Universität, Munich, Germany
- Institute for Stroke and Dementia Research, Ludwig-Maximilians-Universität, Munich, Germany
| | - Kristen R Sobolewski
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Center for Clinical Spectroscopy, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Nikolaus Plesnila
- Institute for Stroke and Dementia Research, Ludwig-Maximilians-Universität, Munich, Germany
- Munich Cluster for Systems Neurology (Synergy), Munich, Germany
| | - Martha E Shenton
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Psychiatry Neuroimaging Laboratory, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Alexander P Lin
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Center for Clinical Spectroscopy, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Psychiatry Neuroimaging Laboratory, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Inga K Koerte
- cBRAIN, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Ludwig-Maximilians-Universität, Munich, Germany
- Psychiatry Neuroimaging Laboratory, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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19
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Li L, Chopp M, Ding G, Davoodi-Bojd E, Zhang L, Li Q, Zhang Y, Xiong Y, Jiang Q. MRI detection of impairment of glymphatic function in rat after mild traumatic brain injury. Brain Res 2020; 1747:147062. [PMID: 32818526 PMCID: PMC9419050 DOI: 10.1016/j.brainres.2020.147062] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 08/02/2020] [Accepted: 08/14/2020] [Indexed: 12/19/2022]
Abstract
We investigated the effect of mild traumatic brain injury (mTBI) on the glymphatic pathway using contrast-enhanced magnetic resonance imaging (CE-MRI) and quantified with kinetic parameters obtained from an advanced two-compartment model. mTBI was induced in male Wistar rats using a closed head impact. Animals with and without mTBI (n = 7/group) underwent the identical MRI protocol 10-weeks post-injury, including T2-weighted imaging and 3D T1-weighted imaging with intra-cisterna magna injection of contrast agent (Gd-DTPA). The parameters of infusion rate, clearance rate and clearance time constant, characterizing the kinetic features of glymphatic tracer transport in a living brain, were quantified in multiple brain tissue regions. In the majority of examined regions, our quantification demonstrated significantly reduced infusion and clearance rates, and significantly increased clearance time constant in the mTBI animals compared to the healthy controls. These data indicate that mTBI induces chronic changes in influx and efflux of contrast agent and glymphatic pathway dysfunction. While the reduced efficiency of glymphatic function after mTBI was apparent in brain, regional evaluation revealed heterogeneous glymphatic effects of the mTBI in different anatomical regions. The suppression of glymphatic function, rather than the presence of focal lesions, indicates a persistent injury of the brain after mTBI. Thus, dynamic CE-MRI in conjunction with advanced kinetic analysis may offer a useful methodology for an objective assessment and confirmatory diagnosis of mTBI.
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Affiliation(s)
- Lian Li
- Department of Neurology, Henry Ford Health System, Detroit, MI 48202, USA.
| | - Michael Chopp
- Department of Neurology, Henry Ford Health System, Detroit, MI 48202, USA; Department of Physics, Oakland University, Rochester, MI 48309, USA.
| | - Guangliang Ding
- Department of Neurology, Henry Ford Health System, Detroit, MI 48202, USA.
| | | | - Li Zhang
- Department of Neurology, Henry Ford Health System, Detroit, MI 48202, USA.
| | - Qingjiang Li
- Department of Neurology, Henry Ford Health System, Detroit, MI 48202, USA.
| | - Yanlu Zhang
- Department of Neurosurgery, Henry Ford Health System, Detroit, MI 48208, USA.
| | - Ye Xiong
- Department of Neurosurgery, Henry Ford Health System, Detroit, MI 48208, USA.
| | - Quan Jiang
- Department of Neurology, Henry Ford Health System, Detroit, MI 48202, USA.
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20
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Abstract
After a concussion, a series of complex, overlapping, and disruptive events occur within the brain, leading to symptoms and behavioral dysfunction. These events include ionic shifts, damaged neuronal architecture, higher concentrations of inflammatory chemicals, increased excitatory neurotransmitter release, and cerebral blood flow disruptions, leading to a neuronal crisis. This review summarizes the translational aspects of the pathophysiologic cascade of postconcussion events, focusing on the role of excitatory neurotransmitters and ionic fluxes, and their role in neuronal disruption. We review the relationship between physiologic disruption and behavioral alterations, and proposed treatments aimed to restore the balance of disrupted processes.
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Affiliation(s)
- David R Howell
- Sports Medicine Center, Children's Hospital Colorado, 13123 East 16th Avenue, B060, Aurora, CO 80045, USA; Department of Orthopedics, University of Colorado School of Medicine, Aurora, CO, USA.
| | - Julia Southard
- Sports Medicine Center, Children's Hospital Colorado, 13123 East 16th Avenue, B060, Aurora, CO 80045, USA; Department of Psychology and Neuroscience, Regis University, 3333 Regis Boulevard, Denver, CO 80221, USA
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21
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Alosco ML, Tripodis Y, Rowland B, Chua AS, Liao H, Martin B, Jarnagin J, Chaisson CE, Pasternak O, Karmacharya S, Koerte IK, Cantu RC, Kowall NW, McKee AC, Shenton ME, Greenwald R, McClean M, Stern RA, Lin A. A magnetic resonance spectroscopy investigation in symptomatic former NFL players. Brain Imaging Behav 2020; 14:1419-1429. [PMID: 30848432 PMCID: PMC6994233 DOI: 10.1007/s11682-019-00060-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The long-term neurologic consequences of exposure to repetitive head impacts (RHI) are not well understood. This study used magnetic resonance spectroscopy (MRS) to examine later-life neurochemistry and its association with RHI and clinical function in former National Football League (NFL) players. The sample included 77 symptomatic former NFL players and 23 asymptomatic individuals without a head trauma history. Participants completed cognitive, behavior, and mood measures. N-acetyl aspartate, glutamate/glutamine, choline, myo-inositol, creatine, and glutathione were measured in the posterior (PCG) and anterior (ACG) cingulate gyrus, and parietal white matter (PWM). A cumulative head impact index (CHII) estimated RHI. In former NFL players, a higher CHII correlated with lower PWM creatine (r = -0.23, p = 0.02). Multivariate mixed-effect models examined neurochemical differences between the former NFL players and asymptomatic individuals without a history of head trauma. PWM N-acetyl aspartate was lower among the former NFL players (mean diff. = 1.02, p = 0.03). Between-group analyses are preliminary as groups were recruited based on symptomatic status. The ACG was the only region associated with clinical function, including positive correlations between glutamate (r = 0.32, p = 0.004), glutathione (r = 0.29, p = 0.02), and myo-inositol (r = 0.26, p = 0.01) with behavioral/mood symptoms. Other positive correlations between ACG neurochemistry and clinical function emerged (i.e., behavioral/mood symptoms, cognition), but the positive directionality was unexpected. All analyses controlled for age, body mass index, and education (for analyses examining clinical function). In this sample of symptomatic former NFL players, there was a direct effect between RHI and reduced cellular energy metabolism (i.e., lower creatine). MRS neurochemicals associated with neuroinflammation also correlated with behavioral/mood symptoms.
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Affiliation(s)
- Michael L Alosco
- Boston University Alzheimer's Disease and CTE Centers, Department of Neurology, Boston University School of Medicine, Boston, MA, USA
| | - Yorghos Tripodis
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Benjamin Rowland
- Center for Clinical Spectroscopy, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 4 Blackfan Street HIM-820, Boston, MA, 02115, USA
| | - Alicia S Chua
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Huijun Liao
- Center for Clinical Spectroscopy, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 4 Blackfan Street HIM-820, Boston, MA, 02115, USA
| | - Brett Martin
- Boston University Alzheimer's Disease and CTE Center, Boston University School of Medicine, Boston, MA, USA
- Biostatistics & Epidemiology Data Analytics Center, Boston University School of Public Health, Boston, MA, USA
| | - Johnny Jarnagin
- Boston University Alzheimer's Disease and CTE Centers, Department of Neurology, Boston University School of Medicine, Boston, MA, USA
| | - Christine E Chaisson
- Boston University Alzheimer's Disease and CTE Centers, Department of Neurology, Boston University School of Medicine, Boston, MA, USA
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
- Biostatistics & Epidemiology Data Analytics Center, Boston University School of Public Health, Boston, MA, USA
| | - Ofer Pasternak
- Departments of Psychiatry and Radiology, Psychiatry Neuroimaging Laboratory, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Sarina Karmacharya
- Department of Psychiatry, Psychiatry Neuroimaging Laboratory, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Inga K Koerte
- Department of Psychiatry, Psychiatry Neuroimaging Laboratory, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Department of Child and Adolescent Psychiatry, Psychosomatic, and Psychotherapy, Ludwig-Maximilian-University, Munich, Germany
| | - Robert C Cantu
- Boston University Alzheimer's Disease and CTE Center, Departments of Neurology and Neurosurgery, Boston University School of Medicine, Boston, MA, USA
- Concussion Legacy Foundation, Boston, MA, USA
| | - Neil W Kowall
- Boston University Alzheimer's Disease and CTE Center, Departments of Neurology, and Pathology and Laboratory Medicine, Boston University School of Medicine, Boston, MA, USA
- Neurology Service, VA Boston Healthcare System, U.S. Department of Veteran Affairs, Boston, MA, USA
| | - Ann C McKee
- Boston University Alzheimer's Disease and CTE Center, Departments of Neurology, and Pathology and Laboratory Medicine, Boston University School of Medicine, Boston, MA, USA
- VA Boston Healthcare System, U.S. Department of Veteran Affairs, Boston, MA, USA
- Department of Veterans Affairs Medical Center, Bedford, MA, USA
| | - Martha E Shenton
- Departments of Psychiatry and Radiology, Psychiatry Neuroimaging Laboratory, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- VA Boston Healthcare System, U.S. Department of Veteran Affairs, Boston, MA, USA
| | - Richard Greenwald
- Simbex, Lebanon, NH, USA
- Thayer School of Engineering, Dartmouth College, Hanover, NH, USA
| | - Michael McClean
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, USA
| | - Robert A Stern
- Boston University Alzheimer's Disease and CTE Center, Departments of Neurology, Neurosurgery, and Anatomy & Neurobiology, Boston University School of Medicine, Boston, MA, USA
| | - 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, USA.
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22
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Churchill NW, Hutchison MG, Graham SJ, Schweizer TA. Neurometabolites and sport-related concussion: From acute injury to one year after medical clearance. Neuroimage Clin 2020; 27:102258. [PMID: 32388345 PMCID: PMC7215245 DOI: 10.1016/j.nicl.2020.102258] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 03/25/2020] [Accepted: 04/09/2020] [Indexed: 01/21/2023]
Abstract
Sport-related concussion is associated with acute disturbances in neurometabolic function, with effects that may last weeks to months after injury. However, is presently unknown whether these disturbances resolve at medical clearance to return to play (RTP) or continue to evolve over longer time intervals. Moreover, little is known about how these neurometabolic changes correlate with other measures of brain physiology. In this study, these gaps were addressed by evaluating ninety-nine (99) university-level athletes, including 33 with sport-related concussion and 66 without recent injury, using multi-parameter magnetic resonance imaging (MRI), which included single-voxel spectroscopy (SVS), diffusion tensor imaging (DTI) and resting-state functional MRI (fMRI). The concussed athletes were scanned at the acute phase of injury (27/33 imaged), medical clearance to RTP (25/33 imaged), one month post-RTP (25/33 imaged) and one year post-RTP (13/33 imaged). We measured longitudinal changes in N-acetyl aspartate (NAA) and myo-inositol (Ins), over the course of concussion recovery. Concussed athletes showed no significant abnormalities or longitudinal change in NAA values, whereas Ins was significantly elevated at RTP and one month later. Interestingly, Ins response was attenuated by a prior history of concussion. Subsequent analyses identified significant associations between Ins values, DTI measures of white matter microstructure and fMRI measures of functional connectivity. These associations varied over the course of concussion recovery, suggesting that elevated Ins values at RTP and beyond reflect distinct changes in brain physiology, compared to acute injury. These findings provide novel information about neurometabolic recovery after a sport-related concussion, with evidence of disturbances that persist beyond medical clearance to RTP.
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Affiliation(s)
- Nathan W Churchill
- Keenan Research Centre of the Li Ka Shing Knowledge Institute at St. Michael's Hospital, Toronto, ON, Canada; Neuroscience Research Program, St. Michael's Hospital, Toronto, ON, Canada.
| | - Michael G Hutchison
- Keenan Research Centre of the Li Ka Shing Knowledge Institute at St. Michael's Hospital, Toronto, ON, Canada; Faculty of Kinesiology and Physical Education, University of Toronto, ON, Canada
| | - Simon J Graham
- Department of Medical Biophysics, University of Toronto, Toronto, ON, Canada; Physical Sciences Platform, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Tom A Schweizer
- Keenan Research Centre of the Li Ka Shing Knowledge Institute at St. Michael's Hospital, Toronto, ON, Canada; Neuroscience Research Program, St. Michael's Hospital, Toronto, ON, Canada; Faculty of Medicine (Neurosurgery) University of Toronto, Toronto, ON, Canada; The Institute of Biomaterials & Biomedical Engineering (IBBME) at the University of Toronto, Toronto, ON, Canada
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23
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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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24
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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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25
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Komura A, Kawasaki T, Yamada Y, Uzuyama S, Asano Y, Shinoda J. Cerebral Glucose Metabolism in Patients with Chronic Mental and Cognitive Sequelae after a Single Blunt Mild Traumatic Brain Injury without Visible Brain Lesions. J Neurotrauma 2019; 36:641-649. [DOI: 10.1089/neu.2018.5641] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
- Akifumi Komura
- Department of Clinical Brain Sciences, Gifu University Graduate School of Medicine, Minokamo, Japan
- Department of Rehabilitation, Heisei College of Health Sciences, Gifu, Japan
| | - Tomohiro Kawasaki
- Department of Clinical Brain Sciences, Gifu University Graduate School of Medicine, Minokamo, Japan
- Chubu Medical Center for Prolonged Traumatic Brain Dysfunction, Kizawa Memorial Hospital, Minokamo, Japan
| | - Yuichi Yamada
- Department of Clinical Brain Sciences, Gifu University Graduate School of Medicine, Minokamo, Japan
- Chubu Medical Center for Prolonged Traumatic Brain Dysfunction, Kizawa Memorial Hospital, Minokamo, Japan
| | - Shiho Uzuyama
- Chubu Medical Center for Prolonged Traumatic Brain Dysfunction, Kizawa Memorial Hospital, Minokamo, Japan
| | - Yoshitaka Asano
- Department of Clinical Brain Sciences, Gifu University Graduate School of Medicine, Minokamo, Japan
- Chubu Medical Center for Prolonged Traumatic Brain Dysfunction, Kizawa Memorial Hospital, Minokamo, Japan
| | - Jun Shinoda
- Department of Clinical Brain Sciences, Gifu University Graduate School of Medicine, Minokamo, Japan
- Chubu Medical Center for Prolonged Traumatic Brain Dysfunction, Kizawa Memorial Hospital, Minokamo, Japan
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26
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Quadrelli S, Tosh N, Urquhart A, Trickey K, Tremewan R, Galloway G, Rich L, Lea R, Malycha P, Mountford C. Post-traumatic stress disorder affects fucose-α(1-2)-glycans in the human brain: preliminary findings of neuro deregulation using in vivo two-dimensional neuro MR spectroscopy. Transl Psychiatry 2019; 9:27. [PMID: 30659168 PMCID: PMC6338732 DOI: 10.1038/s41398-018-0365-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2018] [Revised: 10/06/2018] [Accepted: 12/09/2018] [Indexed: 11/19/2022] Open
Abstract
Post-traumatic stress disorder (PTSD) is triggered by experiencing terrifying event(s) for which there is currently no objective test for a definitive diagnosis. We report a pilot study where two-dimensional (2D) neuro magnetic resonance spectroscopy (MRS), collected at 3 T in a clinical scanner with a 64-channel head coil, identifies neuro deregulation in the PTSD cohort. The control subjects (n = 10) were compared with PTSD participants with minimal co-morbidities (n = 10). The 2D MRS identified statistically significant increases in the total spectral region containing both free substrate fucose and fucosylated glycans of 31% (P = 0.0013), two of multiple fucosylated glycans (Fuc IV and VI) were elevated by 48% (P = 0.002), and 41% (P = 0.02), respectively, imidazole was increased by 12% (P = 0.002), and lipid saturation was increased by 12.5% (P = 0.009). This is the first evidence of fucosylated glycans, reported in animals to be involved in learning and memory, to be affected in humans with PTSD.
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Affiliation(s)
- Scott Quadrelli
- 0000000406180938grid.489335.0Translational Research Institute, Woolloongabba, QLD 4024 Australia ,0000 0000 8831 109Xgrid.266842.cCenter for MR in Health, University of Newcastle, Newcastle, NSW 2308 Australia ,0000000089150953grid.1024.7Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, QLD 4000 Australia ,0000 0004 0380 2017grid.412744.0Radiology Department, Princess Alexandra Hospital, Woolloongabba, QLD 4024 Australia
| | - Nathan Tosh
- 0000000406180938grid.489335.0Translational Research Institute, Woolloongabba, QLD 4024 Australia ,0000000089150953grid.1024.7Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, QLD 4000 Australia
| | - Aaron Urquhart
- 0000000406180938grid.489335.0Translational Research Institute, Woolloongabba, QLD 4024 Australia
| | - Katie Trickey
- 0000000406180938grid.489335.0Translational Research Institute, Woolloongabba, QLD 4024 Australia
| | - Rosanna Tremewan
- 0000000406180938grid.489335.0Translational Research Institute, Woolloongabba, QLD 4024 Australia
| | - Graham Galloway
- 0000000406180938grid.489335.0Translational Research Institute, Woolloongabba, QLD 4024 Australia
| | - Lisa Rich
- 0000000406180938grid.489335.0Translational Research Institute, Woolloongabba, QLD 4024 Australia
| | - Rodney Lea
- 0000000089150953grid.1024.7Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, QLD 4000 Australia
| | - Peter Malycha
- 0000000406180938grid.489335.0Translational Research Institute, Woolloongabba, QLD 4024 Australia
| | - Carolyn Mountford
- Translational Research Institute, Woolloongabba, QLD, 4024, Australia. .,Center for MR in Health, University of Newcastle, Newcastle, NSW, 2308, Australia.
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27
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Alosco ML, Stern RA. The long-term consequences of repetitive head impacts: Chronic traumatic encephalopathy. HANDBOOK OF CLINICAL NEUROLOGY 2019; 167:337-355. [PMID: 31753141 DOI: 10.1016/b978-0-12-804766-8.00018-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Chronic traumatic encephalopathy (CTE) is a neurodegenerative disease associated with exposure to repetitive head impacts (RHI). Although described in boxers for almost a century, scientific and public interest in CTE grew tremendously following a report of postmortem evidence of CTE in the first former professional American football player in 2005. Neuropathologic diagnostic criteria for CTE have been defined, with abnormal perivascular deposition of hyperphosphorylated tau at the sulcal depths as the pathognomonic feature. CTE can currently only be diagnosed postmortem, but clinical research criteria for the in vivo diagnosis of CTE have been proposed. The clinical phenotype of CTE is still ill-defined and there are currently no validated biomarkers to support an in-life diagnosis of "Probable CTE." Many knowledge gaps remain regarding the neuropathologic and clinical make-up of CTE. An increased understanding of CTE is critical given the millions that could potentially be impacted by this disease. This chapter describes the state of the literature on CTE. The historical origins of CTE are first presented, followed by a comprehensive description of the neuropathologic and clinical features. The chapter concludes with discussion on future research directions, emphasizing the importance of diagnosing CTE during life to facilitate development of preventative and intervention strategies.
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Affiliation(s)
- Michael L Alosco
- Boston University Alzheimer's Disease and CTE Centers, Department of Neurology, Boston University School of Medicine, Boston, MA, United States
| | - Robert A Stern
- Boston University Alzheimer's Disease and CTE Centers, Department of Neurology, Boston University School of Medicine, Boston, MA, United States; Departments of Neurosurgery, and Anatomy & Neurobiology, Boston University School of Medicine, Boston, MA, United States.
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28
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Proton Magnetic Resonance Spectroscopy (H1-MRS) Study of the Ketogenic Diet on Repetitive Mild Traumatic Brain Injury in Adolescent Rats and Its Effect on Neurodegeneration. World Neurosurg 2018; 120:e1193-e1202. [DOI: 10.1016/j.wneu.2018.09.037] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 08/31/2018] [Accepted: 09/05/2018] [Indexed: 11/21/2022]
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29
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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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30
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Raji CA, Henderson TA. PET and Single-Photon Emission Computed Tomography in Brain Concussion. Neuroimaging Clin N Am 2018; 28:67-82. [PMID: 29157854 DOI: 10.1016/j.nic.2017.09.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
This article offers an overview of the application of PET and single photon emission computed tomography brain imaging to concussion, a type of mild traumatic brain injury and traumatic brain injury, in general. The article reviews the application of these neuronuclear imaging modalities in cross-sectional and longitudinal studies. Additionally, this article frames the current literature with an overview of the basic physics and radiation exposure risks of each modality.
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Affiliation(s)
- Cyrus A Raji
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, UCSF China Basin, 185 Berry Street, Suite 350, San Francisco, CA 94158, USA
| | - Theodore A Henderson
- The Synaptic Space Inc, Neuro-Laser Foundation, Neuro-Luminance Brain Health Centers Inc, Dr. Theodore Henderson Inc, 3979 East Arapahoe Road, Suite 200, Centennial, CO 80122, USA.
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31
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Abstract
Conventional neuroimaging examinations are typically normal in concussed young athletes. A current focus of research is the characterization of subtle abnormalities after concussion using advanced neuroimaging techniques. These techniques have the potential to identify biomarkers of concussion. In the future, such biomarkers will likely provide important clinical information regarding the appropriate time interval before return to play, as well as the risk for prolonged postconcussive symptoms and long-term cognitive impairment. This article discusses results from advanced imaging techniques and emphasizes imaging modalities that will likely become available in the near future for the clinical evaluation of concussed young athletes.
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Affiliation(s)
- Jeffrey P Guenette
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA; Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, 1249 Boylston Street, Boston, MA 02215, USA
| | - Martha E Shenton
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA; Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, 1249 Boylston Street, Boston, MA 02215, USA; VA Boston Healthcare System, Brockton Division, 940 Belmont Street, Brockton, MA 02301, USA; Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA
| | - Inga K Koerte
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, 1249 Boylston Street, Boston, MA 02215, USA; Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA; Department of Child and Adolescent Psychiatry, Psychosomatic, and Psychotherapy, Ludwig-Maximilian-Universität, Nußbaumstr 5a, Munich 80336, Germany.
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32
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Salat DH, Robinson ME, Miller DR, Clark DC, McGlinchey RE. Neuroimaging of deployment-associated traumatic brain injury (TBI) with a focus on mild TBI (mTBI) since 2009. Brain Inj 2018; 31:1204-1219. [PMID: 28981347 DOI: 10.1080/02699052.2017.1327672] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVES A substantial body of recent research has aimed to better understand the clinical sequelae of military trauma through the application of advanced brain imaging procedures in Veteran populations. The primary objective of this review was to highlight a portion of these recent studies to demonstrate how imaging tools can be used to understand military-associated brain injury. METHODS We focus here on the phenomenon of mild traumatic brain injury (mTBI) given its high prevalence in the Veteran population and current recognition of the need to better understand the clinical implications of this trauma. This is intended to provide readers with an initial exposure to the field of neuroimaging of mTBI with a brief introduction to the concept of traumatic brain injury, followed by a summary of the major imaging techniques that have been applied to the study of mTBI. RESULTS Taken together, the collection of studies reviewed demonstrates a clear role for neuroimaging towards understanding the various neural consequences of mTBI as well as the clinical complications of such brain changes. CONCLUSIONS This information must be considered in the larger context of research into mTBI, including the potentially unique nature of blast exposure and the long-term consequences of mTBI.
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Affiliation(s)
- David H Salat
- a Neuroimaging Research for Veterans (NeRVe) Center , VA Boston Healthcare System , Boston , MA , USA.,b Athinoula A. Martinos Center for Biomedical Imaging , Massachusetts General Hospital Department of Radiology , Charlestown , MA , USA.,c Translational Research Center for TBI and Stress Disorders (TRACTS) , VA Boston Healthcare System , Boston , MA , USA
| | - Meghan E Robinson
- a Neuroimaging Research for Veterans (NeRVe) Center , VA Boston Healthcare System , Boston , MA , USA.,c Translational Research Center for TBI and Stress Disorders (TRACTS) , VA Boston Healthcare System , Boston , MA , USA.,d Department of Neurology , Boston University School of Medicine , Boston , MA , USA
| | - Danielle R Miller
- e National Center for PTSD , VA Boston Healthcare System , Boston , MA , USA.,f Department of Psychiatry , Boston University School of Medicine , Boston , MA , USA
| | - Dustin C Clark
- a Neuroimaging Research for Veterans (NeRVe) Center , VA Boston Healthcare System , Boston , MA , USA
| | - Regina E McGlinchey
- c Translational Research Center for TBI and Stress Disorders (TRACTS) , VA Boston Healthcare System , Boston , MA , USA.,g Geriatric Research , Education and Clinical Center (GRECC) , Boston , MA , USA.,h Department of Psychiatry , Harvard Medical School , Boston , MA , USA
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33
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Kamins J, Charles A. Posttraumatic Headache: Basic Mechanisms and Therapeutic Targets. Headache 2018; 58:811-826. [DOI: 10.1111/head.13312] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2018] [Revised: 03/28/2018] [Accepted: 03/29/2018] [Indexed: 12/16/2022]
Affiliation(s)
- Joshua Kamins
- UCLA Goldberg Migraine Program; David Geffen School of Medicine at UCLA; Los Angeles CA USA
- Tisch Brainsport Program; David Geffen School of Medicine at UCLA; Los Angeles CA USA
| | - Andrew Charles
- UCLA Goldberg Migraine Program; David Geffen School of Medicine at UCLA; Los Angeles CA USA
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34
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Gut metabolome meets microbiome: A methodological perspective to understand the relationship between host and microbe. Methods 2018; 149:3-12. [PMID: 29715508 DOI: 10.1016/j.ymeth.2018.04.029] [Citation(s) in RCA: 99] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Revised: 03/06/2018] [Accepted: 04/22/2018] [Indexed: 02/06/2023] Open
Abstract
It is well established that gut microbes and their metabolic products regulate host metabolism. The interactions between the host and its gut microbiota are highly dynamic and complex. In this review we present and discuss the metabolomic strategies to study the gut microbial ecosystem. We highlight the metabolic profiling approaches to study faecal samples aimed at deciphering the metabolic product derived from gut microbiota. We also discuss how metabolomics data can be integrated with metagenomics data derived from gut microbiota and how such approaches may lead to better understanding of the microbial functions. Finally, the emerging approaches of genome-scale metabolic modelling to study microbial co-metabolism and host-microbe interactions are highlighted.
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35
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Kirov II, Whitlow CT, Zamora C. Susceptibility-Weighted Imaging and Magnetic Resonance Spectroscopy in Concussion. Neuroimaging Clin N Am 2018; 28:91-105. [DOI: 10.1016/j.nic.2017.09.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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36
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Miletich RS. Positron Emission Tomography and Single-Photon Emission Computed Tomography in Neurology. Continuum (Minneap Minn) 2018; 22:1636-1654. [PMID: 27740992 DOI: 10.1212/con.0000000000000389] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE OF REVIEW Positron emission tomography (PET) and single-photon emission computed tomography (SPECT) are now available for routine clinical applications in neurology. This article discusses their diagnostic use in dementia, brain tumors, epilepsy, parkinsonism, cerebrovascular disease, and traumatic brain injury. RECENT FINDINGS Neuromolecular imaging, also known as nuclear neurology, involves clinical imaging of both basal regional physiology (perfusion, metabolism, and transport mechanisms) and specific neurochemical physiology (currently, only the dopamine transporter). This article serves as an introduction to neuromolecular imaging, reviewing the literature supplemented by the author's experience. SUMMARY Neurologic PET and SPECT are no longer restricted to the research realm. These modalities have high diagnostic accuracy.
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37
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Tu TW, Ibrahim WG, Jikaria N, Munasinghe JP, Witko JA, Hammoud DA, Frank JA. On the detection of cerebral metabolic depression in experimental traumatic brain injury using Chemical Exchange Saturation Transfer (CEST)-weighted MRI. Sci Rep 2018; 8:669. [PMID: 29330386 PMCID: PMC5766554 DOI: 10.1038/s41598-017-19094-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Accepted: 12/21/2017] [Indexed: 12/13/2022] Open
Abstract
Metabolic abnormalities are commonly observed in traumatic brain injury (TBI) patients exhibiting long-term neurological deficits. This study investigated the feasibility and reproducibility of using chemical exchange saturation transfer (CEST) MRI to detect cerebral metabolic depression in experimental TBI. Phantom and in vivo CEST experiments were conducted at 9.4 Tesla to optimize the selective saturation for enhancing the endogenous contrast-weighting of the proton exchanges over the range of glucose proton chemical shifts (glucoCEST) in the resting rat brain. The optimized glucoCEST-weighted imaging was performed on a closed-head model of diffuse TBI in rats with 2-deoxy-D-[14C]-glucose (2DG) autoradiography validation. The results demonstrated that saturation duration of 1‒2 seconds at pulse powers 1.5‒2µT resulted in an improved contrast-to-noise ratio between the gray and white matter comparable to 2DG autoradiographs. The intrasubject (n = 4) and intersubject (n = 3) coefficient of variations for repeated glucoCEST acquisitions (n = 4) ranged between 8‒16%. Optimization for the TBI study revealed that glucoCEST-weighted images with 1.5μT power and 1 s saturation duration revealed the greatest changes in contrast before and after TBI, and positively correlated with 2DG autoradiograph (r = 0.78, p < 0.01, n = 6) observations. These results demonstrate that glucoCEST-weighted imaging may be useful in detecting metabolic abnormalities following TBI.
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Affiliation(s)
- Tsang-Wei Tu
- Frank Laboratory, Radiology & Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, MD, United States. .,Center for Neuroscience and Regenerative Medicine, Henry Jackson Foundation, Bethesda, MD, United States. .,Molecular Imaging Laboratory, Department of Radiology, Howard University, Washington, DC, United States.
| | - Wael G Ibrahim
- Center for Infectious Disease Imaging, Radiology & Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, MD, United States
| | - Neekita Jikaria
- Frank Laboratory, Radiology & Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, MD, United States.,Center for Neuroscience and Regenerative Medicine, Henry Jackson Foundation, Bethesda, MD, United States.,Acute Stroke Research Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, United States
| | - Jeeva P Munasinghe
- Mouse Imaging Facility, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, United States
| | - Jaclyn A Witko
- Frank Laboratory, Radiology & Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, MD, United States.,Center for Neuroscience and Regenerative Medicine, Henry Jackson Foundation, Bethesda, MD, United States
| | - Dima A Hammoud
- Center for Infectious Disease Imaging, Radiology & Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, MD, United States
| | - Joseph A Frank
- Frank Laboratory, Radiology & Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, MD, United States.,National Institute of Biomedical Imaging and Bioengineering, National Institutes of Health, Bethesda, MD, United States
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38
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Fidan E, Foley LM, New LA, Alexander H, Kochanek PM, Hitchens TK, Bayır H. Metabolic and Structural Imaging at 7 Tesla After Repetitive Mild Traumatic Brain Injury in Immature Rats. ASN Neuro 2018; 10:1759091418770543. [PMID: 29741097 PMCID: PMC5944144 DOI: 10.1177/1759091418770543] [Citation(s) in RCA: 12] [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: 10/27/2017] [Revised: 03/03/2018] [Accepted: 03/20/2018] [Indexed: 11/15/2022] Open
Abstract
Mild traumatic brain injury (mTBI) in children is a common and serious public health problem. Traditional neuroimaging findings in children who sustain mTBI are often normal, putting them at risk for repeated mTBI (rmTBI). There is a need for more sensitive imaging techniques capable of detecting subtle neurophysiological alterations after injury. We examined neurochemical and white matter changes using diffusion tensor imaging of the whole brain and proton magnetic resonance spectroscopy of the hippocampi at 7 Tesla in 18-day-old male rats at 7 days after mTBI and rmTBI. Traumatic axonal injury was assessed by beta-amyloid precursor protein accumulation using immunohistochemistry. A significant decrease in fractional anisotropy and increase in axial and radial diffusivity were observed in several brain regions, especially in white matter regions, after a single mTBI versus sham and more prominently after rmTBI. In addition, we observed accumulation of beta-amyloid precursor protein in the external capsule after mTBI and rmTBI. mTBI and rmTBI reduced the N-acetylaspartate/creatine ratio (NAA/Cr) and increased the myoinositol/creatine ratio (Ins/Cr) versus sham. rmTBI exacerbated the reduction in NAA/Cr versus mTBI. The choline/creatine (Cho/Cr) and (lipid/Macro Molecule 1)/creatine (Lip/Cr) ratios were also decreased after rmTBI versus sham. Diffusion tensor imaging findings along with the decrease in Cho and Lip after rmTBI may reflect damage to axonal membrane. NAA and Ins are altered at 7 days after mTBI and rmTBI likely reflecting neuro-axonal damage and glial response, respectively. These findings may be relevant to understanding the extent of disability following mTBI and rmTBI in the immature brain and may identify possible therapeutic targets.
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Affiliation(s)
- Emin Fidan
- Safar Center for Resuscitation Research, Department of Critical Care Medicine, University of Pittsburgh, PA, USA
| | - Lesley M. Foley
- Pittsburgh NMR Center for Biomedical Research, Carnegie Mellon University, PA, USA
- Animal Imaging Center, University of Pittsburgh, PA, USA
| | - Lee Ann New
- Safar Center for Resuscitation Research, Department of Critical Care Medicine, University of Pittsburgh, PA, USA
| | - Henry Alexander
- Safar Center for Resuscitation Research, Department of Critical Care Medicine, University of Pittsburgh, PA, USA
| | - Patrick M. Kochanek
- Safar Center for Resuscitation Research, Department of Critical Care Medicine, University of Pittsburgh, PA, USA
| | - T. Kevin Hitchens
- Pittsburgh NMR Center for Biomedical Research, Carnegie Mellon University, PA, USA
- Animal Imaging Center, University of Pittsburgh, PA, USA
| | - Hülya Bayır
- Safar Center for Resuscitation Research, Department of Critical Care Medicine, University of Pittsburgh, PA, USA
- Children's Neuroscience Institute
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Abstract
Computed tomography (CT) and magnetic resonance imaging (MRI) have revolutionized the assessment of traumatic brain injury (TBI) by permitting rapid detection and localization of acute intracranial injuries. In concussion, the most common presentation of sports-related head trauma, CT and MRI are unrevealing. This normal appearance of the brain on standard neuroimaging, however, belies the structural and functional pathology that underpins concussion-related symptoms and dysfunction. Advances in neuroimaging have expanded our ability to gain insight into this microstructural and functional brain pathology. This chapter will present both conventional and more advanced imaging approaches (e.g., diffusion tensor imaging, magnetization transfer imaging, magnetic resonance spectroscopy, functional MRI, arterial spin labeling, magnetoencephalography) to the assessment of TBI in sports and discuss some of the current and potential future roles of brain imaging in the assessment of injured athletes.
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40
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Xiao Y, Fu Y, Zhou Y, Xia J, Wang L, Hu C. Proton Magnetic Resonance Spectroscopy (¹H-MRS) Study of Early Traumatic Brain Injury in Rabbits. Med Sci Monit 2017; 23:2365-2372. [PMID: 28524120 PMCID: PMC5445900 DOI: 10.12659/msm.904788] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Background The aim of this study was to investigate the relationship between dynamic changes of cerebral metabolism and degree of trauma in rabbit models of traumatic brain injury (TBI) by using proton magnetic resonance spectroscopy (1H-MRS). Material/Methods Thirty-five Chinese rabbits were randomly divided into control, mild, moderate, and severe TBI groups. 1H-MRS was performed 1, 6, and 24 h after trauma. The concentrations of NAA, Cr, Cho, and Lac, and NAA/Cr and Cho/Cr ratios in each group, were estimated. Results Compared with the control group, NAA, Cr, and Cho peaks were decreased. NAA/Cr ratio in the ipsilateral cortex was reduced in the mild, moderate, and severe TBI groups by 12.79%, 28.90%, and 45.02% at 1 h, and decreased by 25.11%, 39.81%, and 51.18% at 24 h after trauma, respectively. There were significant negative correlations between NAA/Cr ratio and severity of attack. Cho/Cr ratio in the ipsilateral cortex in the mild, moderate, and severe TBI groups was decreased by 10.86%, 15.94%, and 34.78% at 1 h, and reduced by 24.63%, 29.71%, and 42.02% at 6 h, respectively, and increased slightly at 24 h after trauma. The Lac/Cr ratio in the injured side was increased, most obviously in the severe TBI group. NAA/Cr ratio and Cho/Cr ratio showed significant changes between each group at the same time point. Conclusions 1H-MRS can noninvasively and dynamically detect metabolic changes in early TBI. The NAA/Cr ratio is most sensitive, and has positive significance for early diagnosis and prognosis assessment of TBI.
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Affiliation(s)
- Yong Xiao
- The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China (mainland).,Yancheng First People's Hospital, Yancheng, Jiangsu, China (mainland)
| | - Yigang Fu
- Yancheng First People's Hospital, Yancheng, Jiangsu, China (mainland)
| | - Yi Zhou
- Yancheng First People's Hospital, Yancheng, Jiangsu, China (mainland)
| | - Jianguo Xia
- Taizhou People's Hospital, Taizhou, Zhejiang, China (mainland)
| | - Lina Wang
- Jiangsu Vocational College of Medicine, Yancheng, Jiangsu, China (mainland)
| | - Chunhong Hu
- The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China (mainland)
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Dobson JL, Yarbrough MB, Perez J, Evans K, Buckley T. Sport-related concussion induces transient cardiovascular autonomic dysfunction. Am J Physiol Regul Integr Comp Physiol 2017; 312:R575-R584. [DOI: 10.1152/ajpregu.00499.2016] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Revised: 01/30/2017] [Accepted: 01/30/2017] [Indexed: 12/14/2022]
Abstract
Recent evidence suggests that concussions may disrupt autonomic cardiovascular control. This study investigated the initial effects of concussion on cardiovascular function using three autonomic reflex tests. Twenty-three recreational athletes (12 women, 11 men) were divided into concussed ( n = 12) and control ( n = 11) groups. Concussed participants performed forced breathing, standing, and Valsalva autonomic tests four times: 1) within 48 h of injury; 2) 24 h later; 3) 1 wk after injury; and 4) 2 wk after injury. The controls performed the same tests on the same schedule. Differences in heart rate (HR), systolic blood pressure (SBP), and diastolic blood pressure (DBP) responses to the tests were continuously measured using finger photoplethysmography and were analyzed using repeated-measures multivariate ANOVAs and ANOVAs. Within 48 h of injury, the concussed group had significantly greater resting SBP ( t21= 2.44, P = 0.02, d = 1.03), HR ( t21= 2.33, P = 0.03, d = 1.01), and SBP responses to standing ( t21= 2.98, P = 0.01, d = 1.24), and 90% SBP normalization times ( t21= 2.64, P = 0.02, d = 1.10) after the Valsalva, but those group differences subsided 24 h later. There was also a significant interaction with the HR responses to forced breathing ( F3,60= 4.13, P = 0.01, ηp2= 0.17), indicating the concussed responses declined relative to the control’s over time. The results demonstrate that concussion disrupted autonomic cardiovascular control, and that autonomic reflex tests are practical means by which to evaluate that dysfunction.
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Affiliation(s)
- John L. Dobson
- School of Health and Kinesiology, Georgia Southern University, Statesboro, Georgia
| | - Mary Beth Yarbrough
- School of Health and Kinesiology, Georgia Southern University, Statesboro, Georgia
| | - Jose Perez
- School of Health and Kinesiology, Georgia Southern University, Statesboro, Georgia
| | - Kelsey Evans
- School of Health and Kinesiology, Georgia Southern University, Statesboro, Georgia
| | - Thomas Buckley
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, Delaware; and
- Interdisciplinary Program in Biomechanics and Movement Science, University of Delaware, Newark, Delaware
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42
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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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43
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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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44
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Van Horn JD, Bhattrai A, Irimia A. Multimodal Imaging of Neurometabolic Pathology due to Traumatic Brain Injury. Trends Neurosci 2016; 40:39-59. [PMID: 27939821 DOI: 10.1016/j.tins.2016.10.007] [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] [Received: 07/09/2016] [Revised: 10/21/2016] [Accepted: 10/25/2016] [Indexed: 12/28/2022]
Abstract
The impact of traumatic brain injury (TBI) involves a combination of complex biochemical processes beginning with the initial insult and lasting for days, months and even years post-trauma. These changes range from neuronal integrity losses to neurotransmitter imbalance and metabolite dysregulation, leading to the release of pro- or anti-apoptotic factors which mediate cell survival or death. Such dynamic processes affecting the brain's neurochemistry can be monitored using a variety of neuroimaging techniques, whose combined use can be particularly useful for understanding patient-specific clinical trajectories. Here, we describe how TBI changes the metabolism of essential neurochemical compounds, summarize how neuroimaging approaches facilitate the study of such alterations, and highlight promising ways in which neuroimaging can be used to investigate post-TBI changes in neurometabolism.
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Affiliation(s)
- John Darrell Van Horn
- USC Mark and Mary Stevens Neuroimaging and Informatics Institute, 2025 Zonal Avenue, Keck School of Medicine of USC, University of Southern California, Los Angeles, California 90033, USA.
| | - Avnish Bhattrai
- USC Mark and Mary Stevens Neuroimaging and Informatics Institute, 2025 Zonal Avenue, Keck School of Medicine of USC, University of Southern California, Los Angeles, California 90033, USA
| | - Andrei Irimia
- USC Mark and Mary Stevens Neuroimaging and Informatics Institute, 2025 Zonal Avenue, Keck School of Medicine of USC, University of Southern California, Los Angeles, California 90033, USA
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45
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Singh K, Trivedi R, Haridas S, Manda K, Khushu S. Study of neurometabolic and behavioral alterations in rodent model of mild traumatic brain injury: a pilot study. NMR IN BIOMEDICINE 2016; 29:1748-1758. [PMID: 27779341 DOI: 10.1002/nbm.3627] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Revised: 08/05/2016] [Accepted: 08/23/2016] [Indexed: 06/06/2023]
Abstract
Mild traumatic brain injury (mTBI) is the most common form of TBI (70-90%) with consequences of anxiety-like behavioral alterations in approximately 23% of mTBI cases. This study aimed to assess whether mTBI-induced anxiety-like behavior is a consequence of neurometabolic alterations. mTBI was induced using a weight drop model to simulate mild human brain injury in rodents. Based on injury induction and dosage of anesthesia, four animal groups were included in this study: (i) injury with anesthesia (IA); (ii) sham1 (injury only, IO); (iii) sham2 (only anesthesia, OA); and (iv) control rats. After mTBI, proton magnetic resonance spectroscopy (1 H-MRS) and neurobehavioral analysis were performed in these groups. At day 5, reduced taurine (Tau)/total creatine (tCr, creatine and phosphocreatine) levels in cortex were observed in the IA and IO groups relative to the control. These groups showed mTBI-induced anxiety-like behavior with normal cognition at day 5 post-injury. An anxiogenic effect of repeated dosage of anesthesia in OA rats was observed with normal Tau/tCr levels in rat cortex, which requires further examination. In conclusion, this mTBI model closely mimics human concussion injury with anxiety-like behavior and normal cognition. Reduced cortical Tau levels may provide a putative neurometabolic basis of anxiety-like behavior following mTBI.
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Affiliation(s)
- Kavita Singh
- NMR Research Center, Institute of Nuclear Medicine and Allied Sciences, Delhi, India
| | - Richa Trivedi
- NMR Research Center, Institute of Nuclear Medicine and Allied Sciences, Delhi, India
| | - Seenu Haridas
- Neurobehavior Laboratory, Institute of Nuclear Medicine and Allied Sciences, Delhi, India
| | - Kailash Manda
- Neurobehavior Laboratory, Institute of Nuclear Medicine and Allied Sciences, Delhi, India
| | - Subash Khushu
- NMR Research Center, Institute of Nuclear Medicine and Allied Sciences, Delhi, India
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46
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Abstract
Traumatic brain injury (TBI) is a major cause of morbidity and mortality worldwide. Imaging plays an important role in the evaluation, diagnosis, and triage of patients with TBI. Recent studies suggest that it also helps predict patient outcomes. TBI consists of multiple pathoanatomic entities. This article reviews the current state of TBI imaging including its indications, benefits and limitations of the modalities, imaging protocols, and imaging findings for each of these pathoanatomic entities. Also briefly surveyed are advanced imaging techniques, which include several promising areas of TBI research.
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Affiliation(s)
- Christopher A Mutch
- Department of Radiology, University of California, San Francisco, 505 Parnassus Avenue, M391, San Francisco, CA 94143, USA
| | - Jason F Talbott
- Department of Radiology, San Francisco General Hospital, University of California, San Francisco, 1001 Potrero Avenue, San Francisco, CA 94110, USA.
| | - Alisa Gean
- Department of Radiology, San Francisco General Hospital, University of California, San Francisco, 1001 Potrero Avenue, San Francisco, CA 94110, USA
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47
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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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49
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Bertrand R. H, Thor D. S, Michael L. A, Ann C. M. Potential Long-Term Consequences of Concussive and Subconcussive Injury. Phys Med Rehabil Clin N Am 2016; 27:503-11. [PMID: 27154859 PMCID: PMC4866819 DOI: 10.1016/j.pmr.2015.12.007] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Repeated concussive and subconcussive trauma is associated with the later development of chronic traumatic encephalopathy (CTE), a neurodegenerative disease associated with clinical symptoms in multiple domains and a unique pattern of pathologic changes. CTE has been linked to boxing and American football; CTE has also been identified in soccer, ice hockey, baseball, rugby, and military service. To date, most large studies of CTE have come from enriched cohorts associated with brain bank donations for traumatic brain injury, although several recent studies re-examining neurodegenerative disease brain banks suggest that CTE is more common than is currently appreciated.
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Affiliation(s)
- Huber Bertrand R.
- VA Boston HealthCare System 150 South Huntington Ave, Boston, MA 02130, USA
- Department of Neurology, Boston University School of Medicine, 72 East Concord Street, B-7800, Boston, MA 02118, USA
| | - Stein Thor D.
- VA Boston HealthCare System 150 South Huntington Ave, Boston, MA 02130, USA
- Chronic Traumatic Encephalopathy Program, Boston University School of Medicine,72 East Concord Street, B-7800, Boston, MA 02118, USA
- Department of Pathology, Boston University School of Medicine, 72 East Concord Street, B-7800, Boston, MA 02118, USA
- Bedford Veterans Affairs Medical Center, 200 Springs Road, Building 18, Room 118, Bedford, MA 01730, USA
| | - Alosco Michael L.
- Chronic Traumatic Encephalopathy Program, Boston University School of Medicine,72 East Concord Street, B-7800, Boston, MA 02118, USA
| | - McKee Ann C.
- VA Boston HealthCare System 150 South Huntington Ave, Boston, MA 02130, USA
- Department of Neurology, Boston University School of Medicine, 72 East Concord Street, B-7800, Boston, MA 02118, USA
- Chronic Traumatic Encephalopathy Program, Boston University School of Medicine,72 East Concord Street, B-7800, Boston, MA 02118, USA
- Department of Pathology, Boston University School of Medicine, 72 East Concord Street, B-7800, Boston, MA 02118, USA
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50
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Pan J, Connolly ID, Dangelmajer S, Kintzing J, Ho AL, Grant G. Sports-related brain injuries: connecting pathology to diagnosis. Neurosurg Focus 2016; 40:E14. [DOI: 10.3171/2016.1.focus15607] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Brain injuries are becoming increasingly common in athletes and represent an important diagnostic challenge. Early detection and management of brain injuries in sports are of utmost importance in preventing chronic neurological and psychiatric decline. These types of injuries incurred during sports are referred to as mild traumatic brain injuries, which represent a heterogeneous spectrum of disease. The most dramatic manifestation of chronic mild traumatic brain injuries is termed chronic traumatic encephalopathy, which is associated with profound neuropsychiatric deficits. Because chronic traumatic encephalopathy can only be diagnosed by postmortem examination, new diagnostic methodologies are needed for early detection and amelioration of disease burden. This review examines the pathology driving changes in athletes participating in high-impact sports and how this understanding can lead to innovations in neuroimaging and biomarker discovery.
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Affiliation(s)
| | | | | | - James Kintzing
- 3Bioengineering, Stanford University School of Medicine, Stanford, California
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