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Churchill NW, Hutchison MG, Graham SJ, Schweizer TA. Baseline vs. cross-sectional MRI of concussion: distinct brain patterns in white matter and cerebral blood flow. Sci Rep 2020; 10:1643. [PMID: 32015365 PMCID: PMC6997378 DOI: 10.1038/s41598-020-58073-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Accepted: 01/08/2020] [Indexed: 12/14/2022] Open
Abstract
Neuroimaging has been used to describe the pathophysiology of sport-related concussion during early injury, with effects that may persist beyond medical clearance to return-to-play (RTP). However, studies are typically cross-sectional, comparing groups of concussed and uninjured athletes. It is important to determine whether these findings are consistent with longitudinal change at the individual level, relative to their own pre-injury baseline. A cohort of N = 123 university-level athletes were scanned with magnetic resonance imaging (MRI). Of this group, N = 12 acquired a concussion and were re-scanned at early symptomatic injury and at RTP. A sub-group of N = 44 uninjured athletes were also re-imaged, providing a normative reference group. Among concussed athletes, abnormalities were identified for white matter fractional anisotropy and mean diffusivity, along with grey matter cerebral blood flow, using both cross-sectional (CS) and longitudinal (LNG) approaches. The spatial patterns of abnormality for CS and LNG were distinct, with median fractional overlap below 0.10 and significant differences in the percentage of abnormal voxels. However, the analysis methods did not differ in the amount of change from symptomatic injury to RTP and in the direction of observed abnormalities. These results highlight the impact of using pre-injury baseline data when evaluating concussion-related brain abnormalities at the individual level.
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Affiliation(s)
- Nathan W Churchill
- Neuroscience Research Program, St. Michael's Hospital, Toronto ON, M5B 1M8, Canada. .,Keenan Research Centre for Biomedical Science of St. Michael's Hospital, Toronto ON, M5B 1M8, Canada.
| | - Michael G Hutchison
- Neuroscience Research Program, St. Michael's Hospital, Toronto ON, M5B 1M8, Canada.,Keenan Research Centre for Biomedical Science of St. Michael's Hospital, Toronto ON, M5B 1M8, Canada.,Faculty of Kinesiology and Physical Education, University of Toronto, Toronto ON, M5S 2C9, Canada
| | - Simon J Graham
- Department of Medical Biophysics, University of Toronto, Toronto ON, M5G 1L7, Canada.,Sunnybrook Research Institute, Sunnybrook Hospital, Toronto ON, M4N 3M5, Canada
| | - Tom A Schweizer
- Neuroscience Research Program, St. Michael's Hospital, Toronto ON, M5B 1M8, Canada.,Keenan Research Centre for Biomedical Science of St. Michael's Hospital, Toronto ON, M5B 1M8, Canada.,Faculty of Medicine (Neurosurgery), University of Toronto, Toronto ON, M5T 1P5, Canada
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2
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Patel JB, Wilson SH, Oakes TR, Santhanam P, Weaver LK. Structural and Volumetric Brain MRI Findings in Mild Traumatic Brain Injury. AJNR Am J Neuroradiol 2020; 41:92-99. [PMID: 31896572 DOI: 10.3174/ajnr.a6346] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 10/16/2019] [Indexed: 01/05/2023]
Abstract
BACKGROUND AND PURPOSE Routine MR imaging findings are frequently normal following mild traumatic brain injury and have a limited role in diagnosis and management. Advanced MR imaging can assist in detecting pathology and prognostication but is not readily available outside research settings. However, 3D isotropic sequences with ∼1-mm3 voxel size are available on community MR imaging scanners. Using such sequences, we compared radiologists' findings and quantified regional brain volumes between a mild traumatic brain injury cohort and non-brain-injured controls to describe structural imaging findings associated with mild traumatic brain injury. MATERIALS AND METHODS Seventy-one military personnel with persistent symptoms and 75 controls underwent 3T MR imaging. Three neuroradiologists interpreted the scans using common data elements. FreeSurfer was used to quantify regional gray and white matter volumes. RESULTS WM hyperintensities were seen in 81% of the brain-injured group versus 60% of healthy controls. The odds of ≥1 WM hyperintensity in the brain-injured group was about 3.5 times the odds for healthy controls (95% CI, 1.58-7.72; P = .002) after adjustment for age. A frontal lobe-only distribution of WM hyperintensities was more commonly seen in the mild traumatic brain injury cohort. Furthermore, 7 gray matter, 1 white matter, and 2 subcortical gray matter regions demonstrated decreased volumes in the brain-injured group after multiple-comparison correction. The mild traumatic brain injury cohort showed regional parenchymal volume loss. CONCLUSIONS White matter findings are nonspecific and therefore a clinical challenge. Our results suggest that prior trauma should be considered in the differential diagnosis of multifocal white matter abnormalities with a clinical history of mild traumatic brain injury, particularly when a frontal predilection is observed.
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Affiliation(s)
- J B Patel
- From Lovelace Biomedical Research (J.B.P., T.R.O., P.S.), Albuquerque, New Mexico
- VA Maryland Health Care System (J.B.P.), Baltimore, Maryland
| | | | - T R Oakes
- From Lovelace Biomedical Research (J.B.P., T.R.O., P.S.), Albuquerque, New Mexico
- University of Wisconsin-Madison (T.R.O.), Madison, Wisconsin
| | - P Santhanam
- From Lovelace Biomedical Research (J.B.P., T.R.O., P.S.), Albuquerque, New Mexico
| | - L K Weaver
- Division of Hyperbaric Medicine (L.K.W.), Intermountain Medical Center, Murray, Utah, and Intermountain LDS Hospital, Salt Lake City, Utah
- University of Utah School of Medicine (L.K.W.), Salt Lake City, Utah
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3
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Kaltiainen H, Helle L, Liljeström M, Renvall H, Forss N. Theta-Band Oscillations as an Indicator of Mild Traumatic Brain Injury. Brain Topogr 2018; 31:1037-1046. [PMID: 30097835 PMCID: PMC6182433 DOI: 10.1007/s10548-018-0667-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2017] [Accepted: 07/28/2018] [Indexed: 11/30/2022]
Abstract
Mild traumatic brain injury (mTBI) patients continue to pose a diagnostic challenge due to their diverse symptoms without trauma-specific changes in structural imaging. We addressed here the possible early changes in spontaneous oscillatory brain activity after mTBI, and their feasibility as an indicator of injury in clinical evaluation. We recorded resting-state magnetoencephalography (MEG) data in both eyes-open and eyes-closed conditions from 26 patients (11 females and 15 males, aged 20–59) with mTBI 6 days–6 months after the injury, and compared their spontaneous oscillatory activity to corresponding data from 139 healthy controls. Twelve of the patients underwent a follow-up measurement at 6 months. Ten of all patients were without structural lesions in MRI. At single-subject level, aberrant 4–7 Hz (theta) band activity exceeding the + 2 SD limit of the healthy subjects was visible in 7 out of 26 patients; three out of the seven patients with abnormal theta activity were without any detectable lesions in MRI. Of the patients that participated in the follow-up measurements, five showed abnormal theta activity in the first recording, but only two in the second measurement. Our results suggest that aberrant theta-band oscillatory activity can provide an early objective sign of brain dysfunction after mTBI. In 3/7 patients, the slow-wave activity was transient and visible only in the first recording, urging prompt timing for the measurements in clinical settings.
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Affiliation(s)
- Hanna Kaltiainen
- Department of Neuroscience and Biomedical Engineering, School of Science, Aalto University, P.O. Box 12200, 00076, Aalto, Espoo, Finland.
- Aalto Neuroimaging, MEG Core, Aalto University, Espoo, Finland.
- Department of Neurology, Lohja District Hospital, Sairaalatie 8, 08200, Lohja, Finland.
- Clinical Neurosciences and Department of Neurology, University of Helsinki and Helsinki University Central Hospital, P.O. Box 340, 00029, HUS, Helsinki, Finland.
| | - Liisa Helle
- Department of Neuroscience and Biomedical Engineering, School of Science, Aalto University, P.O. Box 12200, 00076, Aalto, Espoo, Finland
- Aalto Neuroimaging, MEG Core, Aalto University, Espoo, Finland
- Elekta Oy, P.O. Box 34, 00531, Helsinki, Finland
| | - Mia Liljeström
- Department of Neuroscience and Biomedical Engineering, School of Science, Aalto University, P.O. Box 12200, 00076, Aalto, Espoo, Finland
- Aalto Neuroimaging, MEG Core, Aalto University, Espoo, Finland
| | - Hanna Renvall
- Department of Neuroscience and Biomedical Engineering, School of Science, Aalto University, P.O. Box 12200, 00076, Aalto, Espoo, Finland
- Aalto Neuroimaging, MEG Core, Aalto University, Espoo, Finland
- Clinical Neurosciences and Department of Neurology, University of Helsinki and Helsinki University Central Hospital, P.O. Box 340, 00029, HUS, Helsinki, Finland
| | - Nina Forss
- Department of Neuroscience and Biomedical Engineering, School of Science, Aalto University, P.O. Box 12200, 00076, Aalto, Espoo, Finland
- Aalto Neuroimaging, MEG Core, Aalto University, Espoo, Finland
- Clinical Neurosciences and Department of Neurology, University of Helsinki and Helsinki University Central Hospital, P.O. Box 340, 00029, HUS, Helsinki, Finland
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4
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Lehto LJ, Sierra A, Gröhn O. Magnetization transfer SWIFT MRI consistently detects histologically verified myelin loss in the thalamocortical pathway after a traumatic brain injury in rat. NMR IN BIOMEDICINE 2017; 30:e3678. [PMID: 27982487 DOI: 10.1002/nbm.3678] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Revised: 10/24/2016] [Accepted: 11/06/2016] [Indexed: 06/06/2023]
Abstract
Traumatic brain injury (TBI) is associated with various neurocognitive deficits, and rapid assessment of the damage is potentially important for the prevention and treatment of these deficits. Imaging assessment of mild or moderate damage outside the primary lesion area after TBI, however, remains challenging. Magnetization transfer (MT) has clearly been underutilized in imaging the damage caused by TBI. Here, we applied the MT ratio (MTR) using sweep imaging with Fourier transformation (SWIFT) to study microstructural tissue damage in the thalamocortical pathway outside the primary lesion in a lateral fluid percussion injury rat model of TBI, 5 months after injury. MTR was decreased in layers VIb-IV of the barrel cortex and related subcortical areas, mainly indicating demyelination, which was verified by histology. The largest MTR change in the cortex was in layer VIb (-8.2%, pFDR = 0.01), and the largest MTR change in the subcortical areas was in the caudal-most portion of the internal capsule (-11.0%, pFDR < 0.005). These areas exhibited the greatest demyelination and substantial cellularity attributed to gliosis. Correlation analysis of group-averaged results from the subcortical areas revealed an excellent correlation of MTR with myelin (r2 = 0.94, p < 0.001), but no correlation with increased cellularity as detected by Nissl staining. Thus, MTR using SWIFT can be a valuable tool for the assessment of subtle changes after TBI in both cortical and subcortical areas.
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Affiliation(s)
- Lauri Juhani Lehto
- A. I. Virtanen Institute for Molecular Sciences, Department of Neurobiology, University of Eastern Finland, Kuopio, Finland
| | - Alejandra Sierra
- A. I. Virtanen Institute for Molecular Sciences, Department of Neurobiology, University of Eastern Finland, Kuopio, Finland
| | - Olli Gröhn
- A. I. Virtanen Institute for Molecular Sciences, Department of Neurobiology, University of Eastern Finland, Kuopio, Finland
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5
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Diffusion tensor imaging and magnetic resonance spectroscopy in traumatic brain injury: a review of recent literature. Brain Imaging Behav 2015; 8:487-96. [PMID: 24449140 DOI: 10.1007/s11682-013-9288-2] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Concussion is the most common form of traumatic brain injury (TBI), but diagnosis remains controversial because the brain appears quite normal in conventional computed tomography and magnetic resonance imaging (MRI). These conventional tools are not sensitive enough to detect diffuse traumatic axonal injury, and cannot depict aberrations in mild TBIs. Advanced MRI modalities including diffusion tensor imaging (DTI), and magnetic resonance spectroscopy (MRS), make it possible to detect brain injuries in TBI. The purpose of this review is to provide the latest information regarding the visualization and quantification of important abnormalities in TBI and new insights into their clinical significance. Advanced imaging modalities allow the discovery of biomarkers of injury and the detection of changes in brain injury over time. Such tools will likely be used to evaluate treatment efficacy in research. Combining multiple imaging modalities would not only provide greater insight into the underlying physiological changes in TBI, but also improve diagnostic accuracy in predicting outcomes. In this review we present evidence of brain abnormalities in TBI based on investigations using MRI, including DTI and MRS. Our review provides a summary of some of the important studies published from 2002 to 2012 on the topic of MRI findings in head trauma. With the growing realization that even mild head injury can lead to neurocognitive deficits, medical imaging has assumed preeminence for detecting abnormalities associated with TBI. Advanced MRI modalities such as DTI and MRS have an important role in the diagnosis of lesions for TBI patients.
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6
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Laalo JP, Kurki TJ, Tenovuo OS. Interpretation of magnetic resonance imaging in the chronic phase of traumatic brain injury: what is missed in the original reports? Brain Inj 2014; 28:66-70. [PMID: 24328801 DOI: 10.3109/02699052.2013.857791] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PRIMARY OBJECTIVE To find eventual differences in detecting the late stage TBI findings in MRI between two neuroradiologists and to compare the results with the original reports. METHODS AND PROCEDURE Two neuroradiologists with different levels of experience (R1 and R2) reviewed 89 cranial 1.5 T MRI examinations of patients with clinically evident TBI. They recorded the nature, location and side of the finding and stated their view of traumatic axonal injury (TAI). The original reports were reviewed accordingly. MAIN OUTCOMES AND RESULTS TAI was reported as being evident or possible in 51 patients with TBI. However, only 30 (76%) of these concerned the same patients. R1 reported more contusion findings, but both found the same number of spot-like haemorrhages. The most striking difference was in the reporting of localized atrophy. R1 reported atrophy in 51/178 (29%) frontal lobes, whereas R2 in 14/178 (8%). Many of the findings were missed in the original reports. CONCLUSIONS The interpretation of TBI findings in late stage MRI yields significant variability between neuroradiologists. This may endanger diagnostics and lead to false treatment decisions and medico-legal problems. Standardized quantitative imaging analysis programs and advances in MRI technology should be utilized to improve radiological TBI diagnosis.
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Affiliation(s)
- Jussi P Laalo
- Suomen Terveystalo Medical Imaging , Turku , Finland
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7
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Eierud C, Craddock RC, Fletcher S, Aulakh M, King-Casas B, Kuehl D, LaConte SM. Neuroimaging after mild traumatic brain injury: review and meta-analysis. NEUROIMAGE-CLINICAL 2014; 4:283-94. [PMID: 25061565 PMCID: PMC4107372 DOI: 10.1016/j.nicl.2013.12.009] [Citation(s) in RCA: 330] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/04/2013] [Revised: 12/02/2013] [Accepted: 12/22/2013] [Indexed: 11/28/2022]
Abstract
This paper broadly reviews the study of mild traumatic brain injury (mTBI), across the spectrum of neuroimaging modalities. Among the range of imaging methods, however, magnetic resonance imaging (MRI) is unique in its applicability to studying both structure and function. Thus we additionally performed meta-analyses of MRI results to examine 1) the issue of anatomical variability and consistency for functional MRI (fMRI) findings, 2) the analogous issue of anatomical consistency for white-matter findings, and 3) the importance of accounting for the time post injury in diffusion weighted imaging reports. As we discuss, the human neuroimaging literature consists of both small and large studies spanning acute to chronic time points that have examined both structural and functional changes with mTBI, using virtually every available medical imaging modality. Two key commonalities have been used across the majority of imaging studies. The first is the comparison between mTBI and control populations. The second is the attempt to link imaging results with neuropsychological assessments. Our fMRI meta-analysis demonstrates a frontal vulnerability to mTBI, demonstrated by decreased signal in prefrontal cortex compared to controls. This vulnerability is further highlighted by examining the frequency of reported mTBI white matter anisotropy, in which we show a strong anterior-to-posterior gradient (with anterior regions being more frequently reported in mTBI). Our final DTI meta-analysis examines a debated topic arising from inconsistent anisotropy findings across studies. Our results support the hypothesis that acute mTBI is associated with elevated anisotropy values and chronic mTBI complaints are correlated with depressed anisotropy. Thus, this review and set of meta-analyses demonstrate several important points about the ongoing use of neuroimaging to understand the functional and structural changes that occur throughout the time course of mTBI recovery. Based on the complexity of mTBI, however, much more work in this area is required to characterize injury mechanisms and recovery factors and to achieve clinically-relevant capabilities for diagnosis. mTBI neuroimaging literature review and meta-analyses of fMRI and DTI. fMRI meta-analysis revealed differences between mTBI and controls in 13 regions. mTBI anisotropy findings are statistically more frequently reported in anterior regions. Anisotropy is elevated in acute mTBI, but depressed in chronic mTBI. We hypothesize a statistical interaction between anisotropy, cognitive score, and time.
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Affiliation(s)
- Cyrus Eierud
- Virginia Tech Carilion Research Institute, 2 Riverside Circle, Roanoke, VA, USA ; Structural and Computational Biology & Molecular Biophysics Graduate Program, Baylor College of Medicine, Houston, TX 77030, USA
| | - R Cameron Craddock
- Child Mind Institute, 445 Park Avenue, New York, NY, USA ; Nathan S. Kline Institute for Psychiatric Research, Orangeburg, NY, USA
| | - Sean Fletcher
- Virginia Tech Carilion School of Medicine, 2 Riverside Circle, Roanoke, VA, USA
| | - Manek Aulakh
- Virginia Tech Carilion School of Medicine, 2 Riverside Circle, Roanoke, VA, USA
| | - Brooks King-Casas
- Virginia Tech Carilion Research Institute, 2 Riverside Circle, Roanoke, VA, USA ; Department of Psychology, Virginia Tech, Blacksburg, VA, USA
| | - Damon Kuehl
- School of Biomedical Engineering and Sciences, Virginia Polytechnic Institute and State University, Blacksburg, VA, USA
| | - Stephen M LaConte
- Virginia Tech Carilion Research Institute, 2 Riverside Circle, Roanoke, VA, USA ; Structural and Computational Biology & Molecular Biophysics Graduate Program, Baylor College of Medicine, Houston, TX 77030, USA ; School of Biomedical Engineering and Sciences, Virginia Polytechnic Institute and State University, Blacksburg, VA, USA ; Department of Emergency Medicine, Virginia Tech Carilion School of Medicine, Roanoke, VA, USA ; Department of Emergency Radiology, Virginia Tech Carilion School of Medicine, Roanoke, VA, USA
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8
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Embracing chaos: the scope and importance of clinical and pathological heterogeneity in mTBI. Brain Imaging Behav 2012; 6:255-82. [DOI: 10.1007/s11682-012-9162-7] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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9
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Lull N, Noé E, Lull JJ, García-Panach J, Chirivella J, Ferri J, López-Aznar D, Sopena P, Robles M. Voxel-based statistical analysis of thalamic glucose metabolism in traumatic brain injury: Relationship with consciousness and cognition. Brain Inj 2010; 24:1098-107. [DOI: 10.3109/02699052.2010.494592] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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10
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Metabolismo talámico y situación neurológica tras un traumatismo craneoencefálico. Estudio mediante PET-FDG y morfometría basada en vóxel. Neurologia 2010. [DOI: 10.1016/s0213-4853(10)70006-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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11
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Lull N, Noé E, Lull J, García-Panach J, García-Martí G, Chirivella J, Ferri J, Sopena R, de La Cueva L, Robles M. Thalamic metabolism and neurological outcome after traumatic brain injury. A voxel-based morphometric FDG-PET study. NEUROLOGÍA (ENGLISH EDITION) 2010. [DOI: 10.1016/s2173-5808(10)70034-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022] Open
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Laalo JP, Kurki TJ, Sonninen PH, Tenovuo OS. Reliability of Diagnosis of Traumatic Brain Injury by Computed Tomography in the Acute Phase. J Neurotrauma 2009; 26:2169-78. [DOI: 10.1089/neu.2009.1011] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Jussi P. Laalo
- Medical Imaging Centre, Turku University Central Hospital, Turku, Finland
| | | | - Pirkko H. Sonninen
- Medical Imaging Centre, Turku University Central Hospital, Turku, Finland
- Pulssi Medical Imaging Centre, Turku, Finland
| | - Olli S. Tenovuo
- Department of Neurology, Turku University Central Hospital, Turku, Finland
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Hiekkanen H, Kurki T, Brandstack N, Kairisto V, Tenovuo O. MRI changes and ApoE genotype, a prospective 1-year follow-up of traumatic brain injury: A pilot study. Brain Inj 2009; 21:1307-14. [DOI: 10.1080/02699050701739549] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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14
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Hiekkanen H, Kurki T, Brandstack N, Kairisto V, Tenovuo O. Association of injury severity, MRI-results and ApoE genotype with 1-year outcome in mainly mild TBI: A preliminary study. Brain Inj 2009; 23:396-402. [DOI: 10.1080/02699050902926259] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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15
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Orrison WW, Hanson EH, Alamo T, Watson D, Sharma M, Perkins TG, Tandy RD. Traumatic Brain Injury: A Review and High-Field MRI Findings in 100 Unarmed Combatants Using a Literature-Based Checklist Approach. J Neurotrauma 2009; 26:689-701. [DOI: 10.1089/neu.2008.0636] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- William W. Orrison
- Nevada Imaging Centers, Las Vegas, Nevada
- Amigenics (Advanced Medical Imaging and Genetics), Inc., Las Vegas, Nevada
- Touro University Nevada College of Osteopathic Medicine, Henderson, Nevada
| | - Eric H. Hanson
- Amigenics (Advanced Medical Imaging and Genetics), Inc., Las Vegas, Nevada
- Touro University Nevada College of Osteopathic Medicine, Henderson, Nevada
| | | | - David Watson
- Nevada State Athletic Commission, Las Vegas, Nevada
| | - Mythri Sharma
- Touro University Nevada College of Osteopathic Medicine, Henderson, Nevada
| | | | - Richard D. Tandy
- Department of Kinesiology, University of Nevada, Las Vegas, Nevada
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Weiss N, Galanaud D, Carpentier A, Naccache L, Puybasset L. Clinical review: Prognostic value of magnetic resonance imaging in acute brain injury and coma. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2008; 11:230. [PMID: 17980050 PMCID: PMC2556735 DOI: 10.1186/cc6107] [Citation(s) in RCA: 104] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Progress in management of critically ill neurological patients has led to improved survival rates. However, severe residual neurological impairment, such as persistent coma, occurs in some survivors. This raises concerns about whether it is ethically appropriate to apply aggressive care routinely, which is also associated with burdensome long-term management costs. Adapting the management approach based on long-term neurological prognosis represents a major challenge to intensive care. Magnetic resonance imaging (MRI) can show brain lesions that are not visible by computed tomography, including early cytotoxic oedema after ischaemic stroke, diffuse axonal injury after traumatic brain injury and cortical laminar necrosis after cardiac arrest. Thus, MRI increases the accuracy of neurological diagnosis in critically ill patients. In addition, there is some evidence that MRI may have potential in terms of predicting outcome. Following a brief description of the sequences used, this review focuses on the prognostic value of MRI in patients with traumatic brain injury, anoxic/hypoxic encephalopathy and stroke. Finally, the roles played by the main anatomical structures involved in arousal and awareness are discussed and avenues for future research suggested.
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Affiliation(s)
- Nicolas Weiss
- Department of Anesthesiology and Critical Care, Pitié-Salpêtrière Teaching Hospital, Assistance Publique-Hopitaux de Paris and Pierre et Marie Curie University, Bd de l'hôpital, 75013, Paris, France
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