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Peattie ARD, Manktelow AE, Sahakian BJ, Menon DK, Stamatakis EA. Methylphenidate Ameliorates Behavioural and Neurobiological Deficits in Executive Function for Patients with Chronic Traumatic Brain Injury. J Clin Med 2024; 13:771. [PMID: 38337465 PMCID: PMC10856064 DOI: 10.3390/jcm13030771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 01/18/2024] [Accepted: 01/23/2024] [Indexed: 02/12/2024] Open
Abstract
(1) Background: Traumatic brain injury (TBI) often results in cognitive impairments, including in visuospatial planning and executive function. Methylphenidate (MPh) demonstrates potential improvements in several cognitive domains in patients with TBI. The Tower of London (TOL) is a visuospatial planning task used to assess executive function. (2) Methods: Volunteers with a history of TBI (n = 16) participated in a randomised, double-blinded, placebo-controlled, fMRI study to investigate the neurobiological correlates of visuospatial planning and executive function, on and off MPh. (3) Results: Healthy controls (HCs) (n = 18) and patients on placebo (TBI-placebo) differed significantly in reaction time (p < 0.0005) and accuracy (p < 0.0001) when considering all task loads, but especially for high cognitive loads for reaction time (p < 0.001) and accuracy (p < 0.005). Across all task loads, TBI-MPh were more accurate than TBI-placebo (p < 0.05) but remained less accurate than HCs (p < 0.005). TBI-placebo substantially improved in accuracy with MPh administration (TBI-MPh) to a level statistically comparable to HCs at low (p = 0.443) and high (p = 0.175) cognitive loads. Further, individual patients that performed slower on placebo at low cognitive loads were faster with MPh (p < 0.05), while individual patients that performed less accurately on placebo were more accurate with MPh at both high and low cognitive loads (p < 0.005). TBI-placebo showed reduced activity in the bilateral inferior frontal gyri (IFG) and insulae versus HCs. MPh normalised these regional differences. MPh enhanced within-network connectivity (between parietal, striatal, insula, and cerebellar regions) and enhanced beyond-network connectivity (between parietal, thalamic, and cerebellar regions). Finally, individual changes in cerebellar-thalamic (p < 0.005) and cerebellar-parietal (p < 0.05) connectivity with MPh related to individual changes in accuracy with MPh. (4) Conclusions: This work highlights behavioural and neurofunctional differences between HCs and patients with chronic TBI, and that adverse differences may benefit from MPh treatment.
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Affiliation(s)
- Alexander R. D. Peattie
- Division of Anaesthesia, University of Cambridge, Addenbrooke’s Hospital, Box 93, Hills Road, Cambridge CB2 0QQ, UK; (A.E.M.); (D.K.M.)
- Department of Clinical Neurosciences, University of Cambridge, Addenbrooke’s Hospital, Box 165, Hills Road, Cambridge CB2 0QQ, UK
| | - Anne E. Manktelow
- Division of Anaesthesia, University of Cambridge, Addenbrooke’s Hospital, Box 93, Hills Road, Cambridge CB2 0QQ, UK; (A.E.M.); (D.K.M.)
- Department of Clinical Neurosciences, University of Cambridge, Addenbrooke’s Hospital, Box 165, Hills Road, Cambridge CB2 0QQ, UK
| | - Barbara J. Sahakian
- Department of Psychiatry, University of Cambridge, Herchel Smith Building for Brain and Mind Sciences, Forvie Site, Robinson Way, Cambridge CB2 0SZ, UK;
| | - David K. Menon
- Division of Anaesthesia, University of Cambridge, Addenbrooke’s Hospital, Box 93, Hills Road, Cambridge CB2 0QQ, UK; (A.E.M.); (D.K.M.)
- Wolfson Brain Imaging Centre, University of Cambridge, Cambridge Biomedical Campus, Box 65, Cambridge CB2 0QQ, UK
| | - Emmanuel A. Stamatakis
- Division of Anaesthesia, University of Cambridge, Addenbrooke’s Hospital, Box 93, Hills Road, Cambridge CB2 0QQ, UK; (A.E.M.); (D.K.M.)
- Department of Clinical Neurosciences, University of Cambridge, Addenbrooke’s Hospital, Box 165, Hills Road, Cambridge CB2 0QQ, UK
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Pugazenthi S, Hernandez-Rovira MA, Mitha R, Rogers JL, Lavadi RS, Kann MR, Cardozo MR, Hardi A, Elsayed GA, Joseph J, Housley SN, Agarwal N. Evaluating the state of non-invasive imaging biomarkers for traumatic brain injury. Neurosurg Rev 2023; 46:232. [PMID: 37682375 DOI: 10.1007/s10143-023-02085-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 07/03/2023] [Accepted: 07/07/2023] [Indexed: 09/09/2023]
Abstract
Non-invasive imaging biomarkers are useful for prognostication in patients with traumatic brain injury (TBI) at high risk for morbidity with invasive procedures. The authors present findings from a scoping review discussing the pertinent biomarkers. Embase, Ovid-MEDLINE, and Scopus were queried for original research on imaging biomarkers for prognostication of TBI in adult patients. Two reviewers independently screened articles, extracted data, and evaluated risk of bias. Data was synthesized and confidence evaluated with the linked evidence according to the Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) approach. Our search yielded 3104 unique citations, 44 of which were included in this review. Study populations varied in TBI severity, as defined by Glasgow Coma Scale (GCS), including: mild (n=9), mild and moderate (n=3), moderate and severe (n=7), severe (n=6), and all GCS scores (n=17). Diverse imaging modalities were used for prognostication, predominantly computed tomography (CT) only (n=11), magnetic resonance imaging (MRI) only (n=9), and diffusion tensor imaging (DTI) (N=9). The biomarkers included diffusion coefficient mapping, metabolic characteristics, optic nerve sheath diameter, T1-weighted signal changes, cortical cerebral blood flow, axial versus extra-axial lesions, T2-weighted gradient versus spin echo, translocator protein levels, and trauma imaging of brainstem areas. The majority (93%) of studies identified that the imaging biomarker of interest had a statistically significant prognostic value; however, these are based on a very low to low level of quality of evidence. No study directly compared the effects on specific TBI treatments on the temporal course of imaging biomarkers. The current literature is insufficient to make a strong recommendation about a preferred imaging biomarker for TBI, especially considering GRADE criteria revealing low quality of evidence. Rigorous prospective research of imaging biomarkers of TBI is warranted to improve the understanding of TBI severity.
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Affiliation(s)
- Sangami Pugazenthi
- Department of Neurosurgery, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | | | - Rida Mitha
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, 15213, USA
| | - James L Rogers
- Vanderbilt University School of Medicine, Nashville, TN, 37235, USA
| | - Raj Swaroop Lavadi
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, 15213, USA
| | - Michael R Kann
- Department of Neurosurgery, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - Miguel Ruiz Cardozo
- Department of Neurosurgery, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - Angela Hardi
- Becker Medical Library, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - Galal A Elsayed
- Och Spine, Weill Cornell Medicine, New-York Presbyterian Hospital, New York City, NY, USA
| | - Jacob Joseph
- Department of Neurosurgery, University of Michigan Medical School, Ann Arbor, MI, 48109, USA
| | - Stephen N Housley
- School of Applied Physiology, Georgia Institute of Technology, Atlanta, GA, 30332, USA
- Integrated Cancer Research Center, Parker H. Petit Institute for Bioengineering and Bioscience, Georgia Institute of Technology, Atlanta, GA, 30332, USA
| | - Nitin Agarwal
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, 15213, USA.
- Department of Neurological Surgery, University of Pittsburgh Medical Center, 200 Lothrop Street, Pittsburgh, PA, 15213, USA.
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Taran S, Gros P, Gofton T, Boyd G, Briard JN, Chassé M, Singh JM. The reticular activating system: a narrative review of discovery, evolving understanding, and relevance to current formulations of brain death. Can J Anaesth 2023; 70:788-795. [PMID: 37155119 PMCID: PMC10203024 DOI: 10.1007/s12630-023-02421-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 08/24/2022] [Accepted: 08/25/2022] [Indexed: 05/10/2023] Open
Abstract
A series of landmark experiments conducted throughout the 20th century progressively localized the regions involved in consciousness to the reticular activating system (RAS) and its ascending projections. The first description of the RAS emerged in 1949 through seminal experiments performed by Moruzzi and Magoun in feline brainstems; additional experiments in the 1950s revealed connections between the RAS and the thalamus and neocortical structures. This knowledge has allowed for the explanation of disorders of consciousness with exquisite anatomic precision. The clinical relevance of the RAS is further apparent in modern definitions of brain death/death by neurologic criteria (BD/DNC), which require demonstration of the complete and permanent loss of capacity for consciousness as one of their core criteria. BD/DNC is currently understood across jurisdictions in terms of "whole brain" and "brainstem" formulations. Although their clinical examination between formulations is indistinguishable, policies for BD/DNC declaration may differ in the rare scenario of patients with isolated infratentorial brain injuries, in which ancillary testing is advised in the whole brain formulation but not the brainstem formulation. Canadian guidelines acknowledge that the distinction between whole brain and brainstem formulations is unclear with respect to clinical implications for patients with isolated infratentorial injuries. This has led to variability in Canadian clinicians' use of ancillary testing when the mechanism of BD/DNC is suspected to be an isolated infratentorial injury. The present narrative review highlights these concepts and explores implications for determination of BD/DNC in Canada, with specific emphasis on the RAS and its relevance to both formulations.
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Affiliation(s)
- Shaurya Taran
- Department of Medicine, University Health Network, Toronto, ON, Canada
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
- Toronto Western Hospital, Office 411-L, 2nd Floor McLaughlin, 399 Bathurst St., Toronto, ON, M5T 2S8, Canada
| | - Priti Gros
- Department of Medicine, University Health Network, Toronto, ON, Canada
- Division of Neurology, University Health Network, Toronto, ON, Canada
| | - Teneille Gofton
- Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Gordon Boyd
- Department of Medicine (Neurology) and Critical Care Medicine, Queen's University, Kingston, ON, Canada
| | - Joel Neves Briard
- Department of Neuroscience, Université de Montréal, Montreal, QC, Canada
| | - Michaël Chassé
- Department of Medicine, Université de Montréal, Montreal, QC, Canada
- Université de Montréal Hospital Research Centre, Montreal, QC, Canada
| | - Jeffrey M Singh
- Department of Medicine, University Health Network, Toronto, ON, Canada
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
- Ontario Health - Trillium Gift of Life Network, Toronto, ON, Canada
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Laic RAG, Verheyden J, Bruyninckx D, Lebegge P, Sloten JV, Depreitere B. Profound prospective assessment of radiological and functional outcome 6 months after TBI in elderly. Acta Neurochir (Wien) 2023; 165:849-864. [PMID: 36922467 DOI: 10.1007/s00701-023-05546-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 03/02/2023] [Indexed: 03/18/2023]
Abstract
BACKGROUND Recovery after traumatic brain injury (TBI) in older adults is usually affected by the presence of comorbidities, leading to more severe sequelae in this age group than in younger patients. However, there are only few reports that prospectively perform in-depth assessment of outcome following TBI in elderly. OBJECTIVE This study aims at documenting structural brain characteristics and functional outcome and quality of life in elderly patients 6 months after TBI and comparing these data with healthy volunteers undergoing the same assessments. METHODS Thirteen TBI patients ≥ 65 years old, admitted to the University Hospitals Leuven (Belgium), between 2019 and 2022 due to TBI, including all injury severities, and a group of 13 healthy volunteers with similar demographic characteristics were prospectively included in the study. At admission, demographic, injury, and CT scan data were collected in our database. Six months after the accident, a brain MRI scan and standardized assessments of frailty, sleep quality, cognitive function, motor function, and quality of life were conducted. RESULTS A total of 13 patients and 13 volunteers were included in the study, with a median age of 74 and 73 years, respectively. Nine out of the 13 patients presented with a mild TBI. The patient group had a significantly higher level of frailty than the control group, presenting a mean Reported Edmonton Frailty Scale score of 5.8 (SD 2.7) vs 0.7 (SD 1.1) (p < 0.01). No statistically significant differences were found between patient and control brain volumes, fluid attenuated inversion recovery white matter hyperintensity volumes, number of lesions and blackholes, and fractional anisotropy values. Patients demonstrated a significantly higher median reaction time in the One Touch Stockings of Cambridge (22.3 s vs 17.6, p = 0.03) and Reaction Time (0.5 s vs 0.4 s, p < 0.01) subtests in the Cambridge Neuropsychological Test Automated Battery. Furthermore, patients had a lower mean score on the first Box and Blocks test with the right hand (46.6 vs 61.7, p < 0.01) and a significantly higher mean score in the Timed-Up & Go test (13.1 s vs 6.2 s, p = 0.02) and Timed Up & Go with cognitive dual task (16.0 s vs 10.2 s, p < 0.01). Substantially lower QOLIBRI total score (60.4 vs 85.4, p < 0.01) and QOLIBRI-OS total score (53.8 vs 88.5, p < 0.01) were also observed in the patients' group. CONCLUSION In this prospective study, TBI patients ≥ 65 years old when compared with elder controls showed slightly worse cognitive performance and poorer motor function, higher fall risk, but a substantially reduced QoL at 6 months FU, as well as significantly higher frailty, even when the TBI is classified as mild. No statistically significant differences were found in structural brain characteristics on MRI. Future studies with larger sample sizes are needed to refine the impact of TBI versus frailty on function and QoL in elderly.
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Diffusion-Weighted Imaging in Mild Traumatic Brain Injury: A Systematic Review of the Literature. Neuropsychol Rev 2023; 33:42-121. [PMID: 33721207 DOI: 10.1007/s11065-021-09485-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Accepted: 02/09/2021] [Indexed: 12/14/2022]
Abstract
There is evidence that diffusion-weighted imaging (DWI) is able to detect tissue alterations following mild traumatic brain injury (mTBI) that may not be observed on conventional neuroimaging; however, findings are often inconsistent between studies. This systematic review assesses patterns of differences in DWI metrics between those with and without a history of mTBI. A PubMed literature search was performed using relevant indexing terms for articles published prior to May 14, 2020. Findings were limited to human studies using DWI in mTBI. Articles were excluded if they were not full-length, did not contain original data, if they were case studies, pertained to military populations, had inadequate injury severity classification, or did not report post-injury interval. Findings were reported independently for four subgroups: acute/subacute pediatric mTBI, acute/subacute adult mTBI, chronic adult mTBI, and sport-related concussion, and all DWI acquisition and analysis methods used were included. Patterns of findings between studies were reported, along with strengths and weaknesses of the current state of the literature. Although heterogeneity of sample characteristics and study methods limited the consistency of findings, alterations in DWI metrics were most commonly reported in the corpus callosum, corona radiata, internal capsule, and long association pathways. Many acute/subacute pediatric studies reported higher FA and lower ADC or MD in various regions. In contrast, acute/subacute adult studies most commonly indicate lower FA within the context of higher MD and RD. In the chronic phase of recovery, FA may remain low, possibly indicating overall demyelination or Wallerian degeneration over time. Longitudinal studies, though limited, generally indicate at least a partial normalization of DWI metrics over time, which is often associated with functional improvement. We conclude that DWI is able to detect structural mTBI-related abnormalities that may persist over time, although future DWI research will benefit from larger samples, improved data analysis methods, standardized reporting, and increasing transparency.
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Rapid Prediction and Accurate Location Selection of Mild Traumatic Brain Injury (mTBI) by Using Multiple Parameter Analysis of Diffusion Tensor Imaging (DTI): Integrating Correlational and Clinical Approaches. BIOMED RESEARCH INTERNATIONAL 2023; 2023:7467479. [PMID: 36700239 PMCID: PMC9870681 DOI: 10.1155/2023/7467479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 11/25/2022] [Accepted: 12/23/2022] [Indexed: 01/19/2023]
Abstract
Background Mild traumatic brain injury (mTBI) is a widespread and serious public health problem which also causes physical and psychological suffering to patients and their families and imposes a significant economic burden on society. But it is usually very difficult to detect and provide warning of mTBI in early stage. Therefore, a novel method is urgent for the increasing demands on the accurate and rapid prediction and feature selection of mTBI. Objectives To establish a better idea of the performance of neuroimage biomarker in the acute phase of mTBI, our study adopts diffusion tensor imaging (DTI) which could present the pathophysiological changes of white matter through several parameters noninvasively and combined with behavioral experiments such as intelligence quotient test, memory, executive function, and motion function to find the relationship between DTI abnormal brain regions and behavioral abnormalities. Then, provide new method for rapid prediction and feature selection of mTBI. Methods 77 mTBI patients were admitted to the Emergency and Neurosurgery Departments of the Third Xiangya Hospital of Central South University from August 2019 to July 2021; the patients (41 males and 36 females) suffered mTBI because of car accident (36), assault (11), and fall (30). All the mTBI patients were examined through MRI scan and behavioral psychology test within 3 days after injury. MRI images and behavioral psychology tests were also collected; the correlation between the DTI biomarker and the cognitive psychological outcome was analyzed. A series of integration and computational methods were also used for fusion arithmetic and result analysis. Results Compared with the healthy control group, the patients in the acute stage of mTBI presented lower scores in the digit symbol substitution test (DSST), suggesting that mTBI patients in the acute stage had decline in information processing speed and associative learning. The difference of DTI parameters in acute stage mTBI patients was mainly manifested as increased AD and MD values in multiple brain regions, while RD and FA values have no significant difference. The most significant brain regions were bilateral corticospinal tracts (CST), bilateral posterior internal capsule lentiform nucleus, bilateral superior longitudinal fasciculus, left terminal striae, and left sagittal plane with right posterior thalamic radiation. The Pearson correlation coefficient was significantly positive correlation between AD and MD elevation in the left sagittal layer and the results of DSST and digit span in acute stage mTBI patients. Conclusions The acute phase mTBI patients performed lower score on the DSST than those in the normal control group. This neuropsychological change was associated with increased AD value and MD value in the left sagittal layer, which indicated reduction of information processing speed in mTBI patients in the acute phase. It might be related to abnormal AD value and MD value in the upper longitudinal tract, lower longitudinal tract, lower frontal occipital tract, and sagittal layer. In this study, combined with neuropsychological test and increase of the AD value and MD value in certain brain region, neurosurgeon should pay more attention to the abnormal of the upper longitudinal tract and the patients' information processing speed in the diagnosis and treatment of the acute phase mTBI patients. The study offers a much more secure and integrated method for rapid prediction and feature selection of mTBI, which could have broader clinical approaches and application prospects.
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Nakuci J, McGuire M, Schweser F, Poulsen D, Muldoon SF. Differential Patterns of Change in Brain Connectivity Resulting from Severe Traumatic Brain Injury. Brain Connect 2022; 12:799-811. [PMID: 35302399 PMCID: PMC9805864 DOI: 10.1089/brain.2021.0168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Background: Traumatic brain injury (TBI) damages white matter tracts, disrupting brain network structure and communication. There exists a wide heterogeneity in the pattern of structural damage associated with injury, as well as a large heterogeneity in behavioral outcomes. However, little is known about the relationship between changes in network connectivity and clinical outcomes. Materials and Methods: We utilize the rat lateral fluid-percussion injury model of severe TBI to study differences in brain connectivity in 8 animals that received the insult and 11 animals that received only a craniectomy. Diffusion tensor imaging is performed 5 weeks after the injury and network theory is used to investigate changes in white matter connectivity. Results: We find that (1) global network measures are not able to distinguish between healthy and injured animals; (2) injury induced alterations predominantly exist in a subset of connections (subnetworks) distributed throughout the brain; and (3) injured animals can be divided into subgroups based on changes in network motifs-measures of local structural connectivity. In addition, alterations in predicted functional connectivity indicate that the subgroups have different propensities to synchronize brain activity, which could relate to the heterogeneity of clinical outcomes. Discussion: These results suggest that network measures can be used to quantify progressive changes in brain connectivity due to injury and differentiate among subpopulations with similar injuries, but different pathological trajectories.
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Affiliation(s)
- Johan Nakuci
- Neuroscience Program, University at Buffalo, SUNY, Buffalo, New York, USA
| | - Matthew McGuire
- Neuroscience Program, University at Buffalo, SUNY, Buffalo, New York, USA
- Department of Neurosurgery, University at Buffalo, SUNY, Buffalo, New York, USA
| | - Ferdinand Schweser
- Buffalo Neuroimaging Analysis Center, Department of Neurology, School of Medicine and Biomedical Sciences, University at Buffalo, SUNY, Buffalo, New York, USA
- Center for Biomedical Imaging, Clinical and Translational Science Institute, University at Buffalo, SUNY, Buffalo, New York, USA
| | - David Poulsen
- Department of Neurosurgery, University at Buffalo, SUNY, Buffalo, New York, USA
| | - Sarah F. Muldoon
- Neuroscience Program, University at Buffalo, SUNY, Buffalo, New York, USA
- Department of Mathematics and CDSE Program, University at Buffalo, SUNY, Buffalo, New York, USA
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Osmanlıoğlu Y, Parker D, Alappatt JA, Gugger JJ, Diaz-Arrastia RR, Whyte J, Kim JJ, Verma R. Connectomic assessment of injury burden and longitudinal structural network alterations in moderate-to-severe traumatic brain injury. Hum Brain Mapp 2022; 43:3944-3957. [PMID: 35486024 PMCID: PMC9374876 DOI: 10.1002/hbm.25894] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 04/08/2022] [Accepted: 04/14/2022] [Indexed: 11/14/2022] Open
Abstract
Traumatic brain injury (TBI) is a major public health problem. Caused by external mechanical forces, a major characteristic of TBI is the shearing of axons across the white matter, which causes structural connectivity disruptions between brain regions. This diffuse injury leads to cognitive deficits, frequently requiring rehabilitation. Heterogeneity is another characteristic of TBI as severity and cognitive sequelae of the disease have a wide variation across patients, posing a big challenge for treatment. Thus, measures assessing network-wide structural connectivity disruptions in TBI are necessary to quantify injury burden of individuals, which would help in achieving personalized treatment, patient monitoring, and rehabilitation planning. Despite TBI being a disconnectivity syndrome, connectomic assessment of structural disconnectivity has been relatively limited. In this study, we propose a novel connectomic measure that we call network normality score (NNS) to capture the integrity of structural connectivity in TBI patients by leveraging two major characteristics of the disease: diffuseness of axonal injury and heterogeneity of the disease. Over a longitudinal cohort of moderate-to-severe TBI patients, we demonstrate that structural network topology of patients is more heterogeneous and significantly different than that of healthy controls at 3 months postinjury, where dissimilarity further increases up to 12 months. We also show that NNS captures injury burden as quantified by posttraumatic amnesia and that alterations in the structural brain network is not related to cognitive recovery. Finally, we compare NNS to major graph theory measures used in TBI literature and demonstrate the superiority of NNS in characterizing the disease.
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Affiliation(s)
- Yusuf Osmanlıoğlu
- Department of Computer Science, College of Computing and Informatics, Drexel University, Philadelphia, Pennsylvania, USA
| | - Drew Parker
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jacob A Alappatt
- Speech and hearing, bioscience and technology program, Harvard Medical School, Harvard University, Boston, MA, USA
| | - James J Gugger
- Department of Neurology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ramon R Diaz-Arrastia
- Department of Neurology, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Center for Brain Injury and Repair, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - John Whyte
- Moss Rehabilitation Research Institute, TBI Rehabilitation Research LaboratoryEinstein Medical Center, Elkins Park, Pennsylvania, USA
| | - Junghoon J Kim
- Department of Molecular, Cellular, and Biomedical Sciences, CUNY School of Medicine, The City College of New York, New York, New York, USA
| | - Ragini Verma
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Center for Brain Injury and Repair, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Department of Neurosurgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, USA
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Baragi VM, Gattu R, Trifan G, Woodard JL, Meyers K, Halstead TS, Hipple E, Haacke EM, Benson RR. Neuroimaging Markers for Determining Former American Football Players at Risk for Alzheimer's Disease. Neurotrauma Rep 2022; 3:398-414. [PMID: 36204386 PMCID: PMC9531889 DOI: 10.1089/neur.2022.0020] [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: 11/26/2022] Open
Abstract
NFL players, by virtue of their exposure to traumatic brain injury (TBI), are at higher risk of developing dementia and Alzheimer's disease (AD) than the general population. Early recognition and intervention before the onset of clinical symptoms could potentially avert/delay the long-term consequences of these diseases. Given that AD is thought to have a long pre-clinical incubation period, the aim of the current research was to determine whether former NFL players show evidence of incipient dementia in their structural imaging before diagnosis of AD. To identify neuroimaging markers of AD, against which former NFL players would be compared, we conducted a whole-brain volumetric analysis using a cohort of AD patients (ADNI clinical database) to produce a set of brain regions demonstrating sensitivity to early AD pathology (i.e., the “AD fingerprint”). A group of 46 former NFL players' brain magnetic resonance images were then interrogated using the AD fingerprint, that is, the former NFL subjects were compared volumetrically to AD patients using a T1-weighted magnetization-prepared rapid gradient echo sequence. The FreeSurfer image analysis suite (version 6.0) was used to obtain volumetric and cortical thickness data. The Automated Neuropsychological Assessment Metric-Version 4 was used to assess current cognitive functioning. A total of 55 brain regions demonstrated significant atrophy or ex vacuo dilatation bilaterally in AD patients versus controls. Of the 46 former NFL players, 41% demonstrated a greater than expected number of atrophied/dilated AD regions compared with age-matched controls, presumably reflecting AD pathology.
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Affiliation(s)
| | - Ramtilak Gattu
- Center for Neurological Studies, Dearborn, Michigan, USA
| | | | | | | | | | | | - Ewart Mark Haacke
- HUH-MR Research/Radiology, Wayne State University/Detroit Receiving Hospital, Detroit, Michigan, USA
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10
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Li L, Kumar U, You J, Zhou Y, Weiss SA, Engel J, Bragin A. Spatial and temporal profile of high-frequency oscillations in posttraumatic epileptogenesis. Neurobiol Dis 2021; 161:105544. [PMID: 34742877 PMCID: PMC9075674 DOI: 10.1016/j.nbd.2021.105544] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 10/18/2021] [Accepted: 11/02/2021] [Indexed: 12/18/2022] Open
Abstract
We studied the role of temporal and spatial changes in high-frequency oscillation (HFO, 80-500 Hz) generation in epileptogenesis following traumatic brain injury (TBI). Experiments were conducted on adult male Sprague Dawley rats. For the TBI group, fluid percussion injury (FPI) on the left sensorimotor area was performed to induce posttraumatic epileptogenesis. For the sham control group, only the craniotomy was performed. After TBI, 8 bipolar micro-electrodes were implanted bilaterally in the prefrontal cortex, perilesional area and homotopic contralateral site, striatum, and hippocampus. Long-term video/local field potential (LFP) recordings were performed for up to 21 weeks to identify and characterize seizures and capture HFOs. The electrode tip locations and the volume of post TBI brain lesions were further estimated by ex-vivo MRI scans. HFOs were detected during slow-wave sleep and categorized as ripple (80-200 Hz) and fast ripple (FR, 250-500 Hz) events. HFO rates and the HFO peak frequencies were compared in the 8 recording locations and across 8-weeks following TBI. Data from 48 rats (8 sham controls and 40 TBI rats) were analyzed. Within the TBI group, 22 rats (55%) developed recurrent spontaneous seizures (E+ group), at an average of 62.2 (+17.1) days, while 18 rats (45%) did not (E- group). We observed that the HFOs in the E+ group had a higher mean peak frequency than the E- group and the sham group (P < 0.05). Furthermore, the FR rate of the E+ group showed a significant increase compared to the E-group (P < 0.01) and sham control group (P < 0.01), specifically in the perilesional area, homotopic contralateral site, bilateral hippocampus, and to a lesser degree bilateral striatum. When compared across time, the increased FR rate in the E+ group occurred immediately after the insult and remained stable across the duration of the experiment. In addition, lesion size was not statistically different in the E+ and E- group and was not correlated with HFO rates. Our results suggest that TBI results in the formation of a widespread epileptogenic network. FR rates serve as a biomarker of network formation and predict the future development of epilepsy, however FR are not a temporally specific biomarker of TBI sequelae responsible for epileptogenesis. These results suggest that in patients, future risk of post-TBI epilepsy can be predicted early using FR.
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Affiliation(s)
- Lin Li
- Department of Neurology, University of California Los Angeles, CA 90095, USA; Department of Biomedical Engineering, University of North Texas, TX 76207, USA.
| | - Udaya Kumar
- Department of Neurology, University of California Los Angeles, CA 90095, USA
| | - Jing You
- Department of Biomedical Engineering, University of North Texas, TX 76207, USA
| | - Yufeng Zhou
- Department of Biomedical Engineering, University of North Texas, TX 76207, USA
| | - Shennan A Weiss
- Depts. of Neurology, Dept. of Physiology and Pharmacology, State University of New York Downstate, Brooklyn, New York 11203, USA; Department of Neurology, New York City Health + Hospitals/Kings County, Brooklyn, NY 11203, USA
| | - Jerome Engel
- Department of Neurology, University of California Los Angeles, CA 90095, USA; Brain Research Institute, University of California, Los Angeles, CA 90095, USA; Department of Neurobiology, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA; Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA
| | - Anatol Bragin
- Department of Neurology, University of California Los Angeles, CA 90095, USA; Brain Research Institute, University of California, Los Angeles, CA 90095, USA.
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11
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Enciso-Olivera CO, Ordóñez-Rubiano EG, Casanova-Libreros R, Rivera D, Zarate-Ardila CJ, Rudas J, Pulido C, Gómez F, Martínez D, Guerrero N, Hurtado MA, Aguilera-Bustos N, Hernández-Torres CP, Hernandez J, Marín-Muñoz JH. Structural and functional connectivity of the ascending arousal network for prediction of outcome in patients with acute disorders of consciousness. Sci Rep 2021; 11:22952. [PMID: 34824383 PMCID: PMC8617304 DOI: 10.1038/s41598-021-98506-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 07/20/2021] [Indexed: 11/24/2022] Open
Abstract
To determine the role of early acquisition of blood oxygen level-dependent (BOLD) signals and diffusion tensor imaging (DTI) for analysis of the connectivity of the ascending arousal network (AAN) in predicting neurological outcomes after acute traumatic brain injury (TBI), cardiopulmonary arrest (CPA), or stroke. A prospective analysis of 50 comatose patients was performed during their ICU stay. Image processing was conducted to assess structural and functional connectivity of the AAN. Outcomes were evaluated after 3 and 6 months. Nineteen patients (38%) had stroke, 18 (36%) CPA, and 13 (26%) TBI. Twenty-three patients were comatose (44%), 11 were in a minimally conscious state (20%), and 16 had unresponsive wakefulness syndrome (32%). Univariate analysis demonstrated that measurements of diffusivity, functional connectivity, and numbers of fibers in the gray matter, white matter, whole brain, midbrain reticular formation, and pontis oralis nucleus may serve as predictive biomarkers of outcome depending on the diagnosis. Multivariate analysis demonstrated a correlation of the predicted value and the real outcome for each separate diagnosis and for all the etiologies together. Findings suggest that the above imaging biomarkers may have a predictive role for the outcome of comatose patients after acute TBI, CPA, or stroke.
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Affiliation(s)
- Cesar O Enciso-Olivera
- Department of Critical Care and Intensive Care Unit, Fundación Universitaria de Ciencias de La Salud (FUCS), Hospital Infantil Universitario de San José, Bogotá, Colombia
| | - Edgar G Ordóñez-Rubiano
- Department of Neurological Surgery, Fundación Universitaria de Ciencias de La Salud (FUCS), Hospital de San José, Bogotá, Colombia
| | - Rosángela Casanova-Libreros
- Division of Clinical Research, Fundación Universitaria de Ciencias de La Salud (FUCS), Hospital de San José, Hospital Infantil Universitario de San José, Bogotá, Colombia
| | - Diana Rivera
- Division of Clinical Research, Fundación Universitaria de Ciencias de La Salud (FUCS), Hospital de San José, Hospital Infantil Universitario de San José, Bogotá, Colombia
| | - Carol J Zarate-Ardila
- Division of Clinical Research, Fundación Universitaria de Ciencias de La Salud (FUCS), Hospital de San José, Hospital Infantil Universitario de San José, Bogotá, Colombia
| | - Jorge Rudas
- Department of Biotechnology, Universidad Nacional de Colombia, Bogotá, Colombia
| | - Cristian Pulido
- Department of Mathematics, Universidad Nacional de Colombia, Bogotá, Colombia
| | - Francisco Gómez
- Department of Computer Science, Universidad Nacional de Colombia, Bogotá, Colombia
| | - Darwin Martínez
- Department of Computer Science, Universidad Central, Bogotá, Colombia
| | - Natalia Guerrero
- Department of Radiology, Fundación Universitaria de Ciencias de La Salud (FUCS), Hospital Infantil Universitario de San José, Bogotá, Colombia
| | - Mayra A Hurtado
- Department of Critical Care and Intensive Care Unit, Fundación Universitaria de Ciencias de La Salud (FUCS), Hospital Infantil Universitario de San José, Bogotá, Colombia
| | - Natalia Aguilera-Bustos
- Division of Clinical Research, Fundación Universitaria de Ciencias de La Salud (FUCS), Hospital de San José, Hospital Infantil Universitario de San José, Bogotá, Colombia
| | - Clara P Hernández-Torres
- Department of Psychology, Fundación Universitaria de Ciencias de La Salud (FUCS), Hospital Infantil Universitario de San José, Bogotá, Colombia
| | - José Hernandez
- Department of Neurology, Fundación Universitaria de Ciencias de La Salud (FUCS), Hospital Infantil Universitario de San José, Bogotá, Colombia
| | - Jorge H Marín-Muñoz
- Department of Radiology, Fundación Universitaria de Ciencias de La Salud (FUCS), Hospital Infantil Universitario de San José, Bogotá, Colombia. .,Innovation and Research Division, Imaging Experts and Healthcare Services (ImexHS), Street 92 # 11-51, Of 202, Bogotá, Colombia.
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12
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Shenoy Handiru V, Alivar A, Hoxha A, Saleh S, Suviseshamuthu ES, Yue GH, Allexandre D. Graph-theoretical analysis of EEG functional connectivity during balance perturbation in traumatic brain injury: A pilot study. Hum Brain Mapp 2021; 42:4427-4447. [PMID: 34312933 PMCID: PMC8410544 DOI: 10.1002/hbm.25554] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 05/08/2021] [Accepted: 05/27/2021] [Indexed: 12/13/2022] Open
Abstract
Traumatic brain injury (TBI) often results in balance impairment, increasing the risk of falls, and the chances of further injuries. However, the underlying neural mechanisms of postural control after TBI are not well understood. To this end, we conducted a pilot study to explore the neural mechanisms of unpredictable balance perturbations in 17 chronic TBI participants and 15 matched healthy controls (HC) using the EEG, MRI, and diffusion tensor imaging (DTI) data. As quantitative measures of the functional integration and segregation of the brain networks during the postural task, we computed the global graph-theoretic network measures (global efficiency and modularity) of brain functional connectivity derived from source-space EEG in different frequency bands. We observed that the TBI group showed a lower balance performance as measured by the center of pressure displacement during the task, and the Berg Balance Scale (BBS). They also showed reduced brain activation and connectivity during the balance task. Furthermore, the decrease in brain network segregation in alpha-band from baseline to task was smaller in TBI than HC. The DTI findings revealed widespread structural damage. In terms of the neural correlates, we observed a distinct role played by different frequency bands: theta-band modularity during the task was negatively correlated with the BBS in the TBI group; lower beta-band network connectivity was associated with the reduction in white matter structural integrity. Our future studies will focus on how postural training will modulate the functional brain networks in TBI.
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Affiliation(s)
- Vikram Shenoy Handiru
- Center for Mobility and Rehabilitation Engineering Research, Kessler Foundation, West Orange, New Jersey, USA.,Department of Physical Medicine and Rehabilitation, Rutgers University New Jersey Medical School, Newark, New Jersey, USA
| | - Alaleh Alivar
- Center for Mobility and Rehabilitation Engineering Research, Kessler Foundation, West Orange, New Jersey, USA.,Department of Physical Medicine and Rehabilitation, Rutgers University New Jersey Medical School, Newark, New Jersey, USA
| | - Armand Hoxha
- Center for Mobility and Rehabilitation Engineering Research, Kessler Foundation, West Orange, New Jersey, USA
| | - Soha Saleh
- Center for Mobility and Rehabilitation Engineering Research, Kessler Foundation, West Orange, New Jersey, USA.,Department of Physical Medicine and Rehabilitation, Rutgers University New Jersey Medical School, Newark, New Jersey, USA
| | - Easter S Suviseshamuthu
- Center for Mobility and Rehabilitation Engineering Research, Kessler Foundation, West Orange, New Jersey, USA.,Department of Physical Medicine and Rehabilitation, Rutgers University New Jersey Medical School, Newark, New Jersey, USA
| | - Guang H Yue
- Center for Mobility and Rehabilitation Engineering Research, Kessler Foundation, West Orange, New Jersey, USA.,Department of Physical Medicine and Rehabilitation, Rutgers University New Jersey Medical School, Newark, New Jersey, USA
| | - Didier Allexandre
- Center for Mobility and Rehabilitation Engineering Research, Kessler Foundation, West Orange, New Jersey, USA.,Department of Physical Medicine and Rehabilitation, Rutgers University New Jersey Medical School, Newark, New Jersey, USA
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13
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Shokri-Kojori E, Bennett IJ, Tomeldan ZA, Krawczyk DC, Rypma B. Estimates of brain age for gray matter and white matter in younger and older adults: Insights into human intelligence. Brain Res 2021; 1763:147431. [PMID: 33737067 PMCID: PMC8428193 DOI: 10.1016/j.brainres.2021.147431] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 02/01/2021] [Accepted: 03/10/2021] [Indexed: 12/18/2022]
Abstract
Aging entails a multifaceted complex of changes in macro- and micro-structural properties of human brain gray matter (GM) and white matter (WM) tissues, as well as in intellectual abilities. To better capture tissue-specific brain aging, we combined volume and distribution properties of diffusivity indices to derive subject-specific age scores for each tissue. We compared age-related variance between younger and older adults for GM and WM age scores, and tested whether tissue-specific age scores could explain different effects of aging on fluid (Gf) and crystalized (Gc) intelligence in younger and older adults. Chronological age was strongly associated with GM (R2 = 0.73) and WM (R2 = 0.57) age scores. The GM age score accounted for significantly more variance in chronological age in younger relative to older adults (p < 0.001), whereas the WM age score accounted for significantly more variance in chronological age in older compared to younger adults (p < 0.025). Consistent with existing literature, younger adults outperformed older adults in Gf while older adults outperformed younger adults in Gc. The GM age score was negatively associated with Gf in younger adults (p < 0.02), whereas the WM age score was negatively associated with Gc in older adults (p < 0.02). Our results provide evidence for differences in the effects of age on GM and WM in younger versus older adults that may contribute to age-related differences in Gf and Gc.
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Affiliation(s)
- Ehsan Shokri-Kojori
- Center for BrainHealth®, School of Behavioral and Brain Sciences, The University of Texas at Dallas, Dallas, TX, USA.
| | - Ilana J Bennett
- Center for BrainHealth®, School of Behavioral and Brain Sciences, The University of Texas at Dallas, Dallas, TX, USA; Department of Psychology, University of California, Riverside, Riverside, CA, USA
| | - Zuri A Tomeldan
- Center for BrainHealth®, School of Behavioral and Brain Sciences, The University of Texas at Dallas, Dallas, TX, USA
| | - Daniel C Krawczyk
- Center for BrainHealth®, School of Behavioral and Brain Sciences, The University of Texas at Dallas, Dallas, TX, USA; Department of Psychiatry, The University of Texas Southwestern Medical Center at Dallas, Dallas, TX, USA
| | - Bart Rypma
- Center for BrainHealth®, School of Behavioral and Brain Sciences, The University of Texas at Dallas, Dallas, TX, USA; Department of Psychiatry, The University of Texas Southwestern Medical Center at Dallas, Dallas, TX, USA
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14
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White matter changes following experimental pediatric traumatic brain injury: an advanced diffusion-weighted imaging investigation. Brain Imaging Behav 2021; 15:2766-2774. [PMID: 33411159 DOI: 10.1007/s11682-020-00433-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 10/24/2020] [Accepted: 12/17/2020] [Indexed: 12/13/2022]
Abstract
Pediatric traumatic brain injury (pTBI) is a major community health concern. Due to ongoing maturation, injury to the brain at a young age can have devastating consequences in later life. However, how pTBI affects brain development, including white matter maturation, is still poorly understood. Here, we used advanced diffusion weighted imaging (DWI) to assess chronic white matter changes after experimental pTBI. Mice at post-natal day 21 sustained a TBI using the controlled cortical impact model and magnetic resonance imaging (MRI) was performed at 6 months post-injury using a 4.7 T Bruker scanner. Four diffusion shells with 81 directions and b-values of 1000, 3000, 5000, and 7000s/mm2 were acquired and analyzed using MRtrix3 software. Advanced DWI metrics, including fiber density, fiber cross-section and a combined fiber density and cross-section measure, were investigated together with three track-weighted images (TWI): the average pathlength map, mean curvature and the track density image. These advanced metrics were compared to traditional diffusion tensor imaging (DTI) metrics which indicated that TBI injured mice had reduced fractional anisotropy and increased radial diffusivity in the white matter when compared to age-matched sham controls. Consistent with previous findings, fiber density and TWI metrics appeared to be more sensitive to white matter changes than DTI metrics, revealing widespread reductions in fiber density and TWI metrics in pTBI mice compared to sham controls. These results provide additional support for the use of advanced DWI metrics in assessing white matter degeneration following injury and highlight the chronic outcomes that can follow pTBI.
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15
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Mahan MY, Rafter DJ, Truwit CL, Oswood M, Samadani U. Evaluation of diffusion measurements reveals radial diffusivity indicative of microstructural damage following acute, mild traumatic brain injury. Magn Reson Imaging 2020; 77:137-147. [PMID: 33359428 DOI: 10.1016/j.mri.2020.12.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Revised: 10/25/2020] [Accepted: 12/20/2020] [Indexed: 01/07/2023]
Abstract
PURPOSE Mild TBI, characterized by microstructural damage, often undetectable on conventional imaging techniques, is a pervasive condition that disturbs brain function and can potentially result in long-term deficits. Deciphering the underlying microstructural damage in mild TBI is crucial for establishing a reliable diagnosis and enabling effective therapeutics. Efforts to capture this damage have been extensive, but results have been inconsistent and incomplete. METHODS To that effect, we set out to examine the shape of the diffusion tensor in mild TBI during the acute phase of injury. We inspected diffusivity and geometric measurements describing the diffusion tensor's shape and compared mild TBI (N = 34, 20.4-66.6 yo) measurements with those from healthy control (N = 42, 20.7-67.2 yo) participants using voxelwise tract-based spatial statistics. Subsequently, to explore associations between the diffusion measurements in mild TBI, we performed nonparametric statistics and machine learning techniques. RESULTS Overall, mild TBI displayed a diffuse increase in Dλ2, Dλ3, Dradial, Dmean, and Cspherical, with a diffuse decrease in Afractional, Amode, and Clinear, in addition to no change in Daxial or Cplanar. Most notably, our results provide evidence for Dradial as a potential biomarker for microstructural damage, specifically its main component Dλ2, based on their performance in discriminating between mild TBI and control groups. Afractional was also found to be important for discriminating between groups. CONCLUSION Our results revealed the importance of a diffusion measurement often overlooked, Dradial, in assessing TBI and suggest differentiating diffusion measurements has the potential utility to detect variations in the underlying pathophysiology after injury.
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Affiliation(s)
- Margaret Y Mahan
- Department of Biomedical Informatics and Computational Biology, University of Minnesota, 101 Pleasant St SE, Minneapolis, MN 55455, USA.
| | - Daniel J Rafter
- Department of Biomedical Informatics and Computational Biology, University of Minnesota, 101 Pleasant St SE, Minneapolis, MN 55455, USA
| | - Charles L Truwit
- Diagnostic Imaging, Philips Global, 6655 Wedgwood Rd N #105, Maple Grove, MN 55311, USA; Department of Radiology, Hennepin Healthcare, 701 Park Ave, Minneapolis, MN 55415, USA.
| | - Mark Oswood
- Department of Radiology, University of Minnesota, 420 Delaware Street SE, Minneapolis, MN 55455, USA; Department of Radiology, Hennepin Healthcare, 701 Park Ave, Minneapolis, MN 55415, USA.
| | - Uzma Samadani
- Department of Biomedical Informatics and Computational Biology, University of Minnesota, 101 Pleasant St SE, Minneapolis, MN 55455, USA; Department of Neurosurgery, Minneapolis VA Medical Center, 1 Veterans Drive, Minneapolis, MN 55417, USA.
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16
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Levy-Lamdan O, Zifman N, Sasson E, Efrati S, Hack DC, Tanne D, Dolev I, Fogel H. Evaluation of White Matter Integrity Utilizing the DELPHI (TMS-EEG) System. Front Neurosci 2020; 14:589107. [PMID: 33408607 PMCID: PMC7779791 DOI: 10.3389/fnins.2020.589107] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 11/16/2020] [Indexed: 01/18/2023] Open
Abstract
Objective The aim of this study was to evaluate brain white matter (WM) fibers connectivity damage in stroke and traumatic brain injury (TBI) subjects by direct electrophysiological imaging (DELPHI) that analyzes transcranial magnetic stimulation (TMS)-evoked potentials (TEPs). Methods The study included 123 participants, out of which 53 subjects with WM-related pathologies (39 stroke, 14 TBI) and 70 healthy age-related controls. All subjects underwent DELPHI brain network evaluations of TMS-electroencephalogram (EEG)-evoked potentials and diffusion tensor imaging (DTI) scans for quantification of WM microstructure fractional anisotropy (FA). Results DELPHI output measures show a significant difference between the healthy and stroke/TBI groups. A multidimensional approach was able to classify healthy from unhealthy with a balanced accuracy of 0.81 ± 0.02 and area under the curve (AUC) of 0.88 ± 0.01. Moreover, a multivariant regression model of DELPHI output measures achieved prediction of WM microstructure changes measured by FA with the highest correlations observed for fibers proximal to the stimulation area, such as frontal corpus callosum (r = 0.7 ± 0.02), anterior internal capsule (r = 0.7 ± 0.02), and fronto-occipital fasciculus (r = 0.65 ± 0.03). Conclusion These results indicate that features of TMS-evoked response are correlated to WM microstructure changes observed in pathological conditions, such as stroke and TBI, and that a multidimensional approach combining these features in supervised learning methods serves as a strong indicator for abnormalities and changes in WM integrity.
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Affiliation(s)
| | - Noa Zifman
- QuantalX Neuroscience, Beer-Yaacov, Israel
| | - Efrat Sasson
- Sagol Center for Hyperbaric Medicine and Research, Shamir Medical Center, Zerifin, Israel
| | - Shai Efrati
- Sagol Center for Hyperbaric Medicine and Research, Shamir Medical Center, Zerifin, Israel.,Sackler School of Medicine and Sagol School of Neuroscience, Tel-Aviv University, Tel-Aviv, Israel
| | - Dallas C Hack
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, VA, United States
| | - David Tanne
- Sackler School of Medicine and Sagol School of Neuroscience, Tel-Aviv University, Tel-Aviv, Israel.,Stroke and Cognition Institute, Rambam Healthcare Campus, Haifa, Israel
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17
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Mohammadian M, Roine T, Hirvonen J, Kurki T, Posti JP, Katila AJ, Takala RSK, Tallus J, Maanpää HR, Frantzén J, Hutchinson PJ, Newcombe VF, Menon DK, Tenovuo O. Alterations in Microstructure and Local Fiber Orientation of White Matter Are Associated with Outcome after Mild Traumatic Brain Injury. J Neurotrauma 2020; 37:2616-2623. [PMID: 32689872 DOI: 10.1089/neu.2020.7081] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Mild traumatic brain injury (mTBI) can have long-lasting consequences. We investigated white matter (WM) alterations at 6-12 months following mTBI using diffusion tensor imaging (DTI) and assessed if the alterations associate with outcome. Eighty-five patients with mTBI underwent diffusion-weighted magnetic resonance imaging (MRI) on average 8 months post-injury and patients' outcome was assessed at the time of imaging using the Glasgow Outcome Scale-Extended (GOS-E). Additionally, 30 age-matched patients with extracranial orthopedic injuries were used as control subjects. Voxel-wise analysis of the data was performed using a tract-based spatial statistics (TBSS) approach and differences in microstructural metrics between groups were investigated. Further, the susceptibility of the abnormalities to specific fiber orientations was investigated by analyzing the first eigenvector of the diffusion tensor in the voxels with significant differences. We found significantly lower fractional anisotropy (FA) and higher mean diffusivity (MD) and radial diffusivity (RD) in patients with mTBI compared with control subjects, whereas no significant differences were observed in axial diffusivity (AD) between the groups. The differences were present bilaterally in several WM regions and correlated with outcome. Moreover, multiple clusters were found in the principal fiber orientations of the significant voxels in anisotropy, and similar orientation patterns were found for the diffusivity metrics. These directional clusters correlated with patients' functional outcome. Our study showed that mTBI is associated with WM changes at the chronic stage and these alterations occur in several WM regions. In addition, several significant clusters of WM alterations in specific fiber orientations were found and these clusters were associated with outcome.
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Affiliation(s)
- Mehrbod Mohammadian
- Department of Clinical Neurosciences, Intensive Care, Emergency Care and Pain Medicine, University of Turku, Turku, Finland.,Turku Brain Injury Center, Intensive Care Medicine and Pain Management, Turku University Hospital, Turku, Finland
| | - Timo Roine
- Turku Brain and Mind Center, Intensive Care, Emergency Care and Pain Medicine, University of Turku, Turku, Finland.,Department of Neuroscience and Biomedical Engineering, Aalto University School of Science, Espoo, Finland
| | - Jussi Hirvonen
- Department of Radiology, Intensive Care, Emergency Care and Pain Medicine, University of Turku, Turku, Finland
| | - Timo Kurki
- Department of Clinical Neurosciences, Intensive Care, Emergency Care and Pain Medicine, University of Turku, Turku, Finland.,Turku Brain Injury Center, Intensive Care Medicine and Pain Management, Turku University Hospital, Turku, Finland.,Department of Radiology, Intensive Care, Emergency Care and Pain Medicine, University of Turku, Turku, Finland
| | - Jussi P Posti
- Department of Clinical Neurosciences, Intensive Care, Emergency Care and Pain Medicine, University of Turku, Turku, Finland.,Turku Brain Injury Center, Intensive Care Medicine and Pain Management, Turku University Hospital, Turku, Finland.,Department of Neurosurgery, Division of Clinical Neurosciences, Intensive Care Medicine and Pain Management, Turku University Hospital, Turku, Finland
| | - Ari J Katila
- Perioperative Services, Intensive Care Medicine and Pain Management, Turku University Hospital, Turku, Finland.,Anesthesiology, Intensive Care, Emergency Care and Pain Medicine, University of Turku, Turku, Finland
| | - Riikka S K Takala
- Perioperative Services, Intensive Care Medicine and Pain Management, Turku University Hospital, Turku, Finland.,Anesthesiology, Intensive Care, Emergency Care and Pain Medicine, University of Turku, Turku, Finland
| | - Jussi Tallus
- Department of Clinical Neurosciences, Intensive Care, Emergency Care and Pain Medicine, University of Turku, Turku, Finland.,Turku Brain Injury Center, Intensive Care Medicine and Pain Management, Turku University Hospital, Turku, Finland
| | - Henna-Riikka Maanpää
- Turku Brain Injury Center, Intensive Care Medicine and Pain Management, Turku University Hospital, Turku, Finland.,Department of Neurosurgery, Division of Clinical Neurosciences, Intensive Care Medicine and Pain Management, Turku University Hospital, Turku, Finland
| | - Janek Frantzén
- Department of Clinical Neurosciences, Intensive Care, Emergency Care and Pain Medicine, University of Turku, Turku, Finland.,Department of Neurosurgery, Division of Clinical Neurosciences, Intensive Care Medicine and Pain Management, Turku University Hospital, Turku, Finland
| | - Peter J Hutchinson
- Department of Clinical Neurosciences, Neurosurgery Unit, Addenbrooke's Hospital, Cambridge, United Kingdom
| | | | - David K Menon
- Division of Anesthesia, Addenbrooke's Hospital, Cambridge, United Kingdom
| | - Olli Tenovuo
- Department of Clinical Neurosciences, Intensive Care, Emergency Care and Pain Medicine, University of Turku, Turku, Finland.,Turku Brain Injury Center, Intensive Care Medicine and Pain Management, Turku University Hospital, Turku, Finland
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18
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Yoen H, Yoo RE, Choi SH, Kim E, Oh BM, Yang D, Hwang I, Kang KM, Yun TJ, Kim JH, Sohn CH. Blood-Brain Barrier Disruption in Mild Traumatic Brain Injury Patients with Post-Concussion Syndrome: Evaluation with Region-Based Quantification of Dynamic Contrast-Enhanced MR Imaging Parameters Using Automatic Whole-Brain Segmentation. Korean J Radiol 2020; 22:118-130. [PMID: 32783413 PMCID: PMC7772380 DOI: 10.3348/kjr.2020.0016] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 05/05/2020] [Accepted: 05/24/2020] [Indexed: 12/29/2022] Open
Abstract
Objective This study aimed to investigate the blood-brain barrier (BBB) disruption in mild traumatic brain injury (mTBI) patients with post-concussion syndrome (PCS) using dynamic contrast-enhanced (DCE) magnetic resonance (MR) imaging and automatic whole brain segmentation. Materials and Methods Forty-two consecutive mTBI patients with PCS who had undergone post-traumatic MR imaging, including DCE MR imaging, between October 2016 and April 2018, and 29 controls with DCE MR imaging were included in this retrospective study. After performing three-dimensional T1-based brain segmentation with FreeSurfer software (Laboratory for Computational Neuroimaging), the mean Ktrans and vp from DCE MR imaging (derived using the Patlak model and extended Tofts and Kermode model) were analyzed in the bilateral cerebral/cerebellar cortex, bilateral cerebral/cerebellar white matter (WM), and brainstem. Ktrans values of the mTBI patients and controls were calculated using both models to identify the model that better reflected the increased permeability owing to mTBI (tendency toward higher Ktrans values in mTBI patients than in controls). The Mann-Whitney U test and Spearman rank correlation test were performed to compare the mean Ktrans and vp between the two groups and correlate Ktrans and vp with neuropsychological tests for mTBI patients. Results Increased permeability owing to mTBI was observed in the Patlak model but not in the extended Tofts and Kermode model. In the Patlak model, the mean Ktrans in the bilateral cerebral cortex was significantly higher in mTBI patients than in controls (p = 0.042). The mean vp values in the bilateral cerebellar WM and brainstem were significantly lower in mTBI patients than in controls (p = 0.009 and p = 0.011, respectively). The mean Ktrans of the bilateral cerebral cortex was significantly higher in patients with atypical performance in the auditory continuous performance test (commission errors) than in average or good performers (p = 0.041). Conclusion BBB disruption, as reflected by the increased Ktrans and decreased vp values from the Patlak model, was observed throughout the bilateral cerebral cortex, bilateral cerebellar WM, and brainstem in mTBI patients with PCS.
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Affiliation(s)
- Heera Yoen
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Roh Eul Yoo
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.
| | - Seung Hong Choi
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.,Center for Nanoparticle Research, Institute for Basic Science (IBS), Seoul National University, Seoul, Korea.,School of Chemical and Biological Engineering, Seoul National University, Seoul, Korea
| | - Eunkyung Kim
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Byung Mo Oh
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.,Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul, Korea.,National Traffic Injury Rehabilitation Hospital, Yangpyeong, Korea.,Neuroscience Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Dongjin Yang
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Inpyeong Hwang
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Koung Mi Kang
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Tae Jin Yun
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Ji Hoon Kim
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Chul Ho Sohn
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
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19
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Raizman R, Tavor I, Biegon A, Harnof S, Hoffmann C, Tsarfaty G, Fruchter E, Tatsa-Laur L, Weiser M, Livny A. Traumatic Brain Injury Severity in a Network Perspective: A Diffusion MRI Based Connectome Study. Sci Rep 2020; 10:9121. [PMID: 32499553 PMCID: PMC7272462 DOI: 10.1038/s41598-020-65948-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 05/11/2020] [Indexed: 11/08/2022] Open
Abstract
Traumatic brain injury (TBI) is often characterized by alterations in brain connectivity. We explored connectivity alterations from a network perspective, using graph theory, and examined whether injury severity affected structural connectivity and modulated the association between brain connectivity and cognitive deficits post-TBI. We performed diffusion imaging network analysis on chronic TBI patients, with different injury severities and healthy subjects. From both global and local perspectives, we found an effect of injury severity on network strength. In addition, regions which were considered as hubs differed between groups. Further exploration of graph measures in the determined hub regions showed that efficiency of six regions differed between groups. An association between reduced efficiency in the precuneus and nonverbal abstract reasoning deficits (calculated using actual pre-injury scores) was found in the controls but was lost in TBI patients. Our results suggest that disconnection of network hubs led to a less efficient network, which in turn may have contributed to the cognitive impairments manifested in TBI patients. We conclude that injury severity modulates the disruption of network organization, reflecting a "dose response" relationship and emphasize the role of efficiency as an important diagnostic tool to detect subtle brain injury specifically in mild TBI patients.
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Affiliation(s)
- Reut Raizman
- Division of Diagnostic Imaging, Sheba Medical Center, Tel-Hashomer, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Ido Tavor
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- Sagol School of neuroscience, Tel-Aviv University, Tel-Aviv, Israel
| | - Anat Biegon
- Department of Radiology and Neurology, Stony Brook University School of Medicine, Stony Brook, NY, USA
| | - Sagi Harnof
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- Department of Neurosurgery, Rabin Medical Center, Belinson, Israel
| | - Chen Hoffmann
- Division of Diagnostic Imaging, Sheba Medical Center, Tel-Hashomer, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Galia Tsarfaty
- Division of Diagnostic Imaging, Sheba Medical Center, Tel-Hashomer, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Eyal Fruchter
- Department of Mental Health, Israel Defense Forces, Medical Corps, Tel Hashomer, Israel
| | - Lucian Tatsa-Laur
- Department of Mental Health, Israel Defense Forces, Medical Corps, Tel Hashomer, Israel
| | - Mark Weiser
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- Department of Psychiatry, Sheba Medical Center, Tel Hashomer, Israel
| | - Abigail Livny
- Division of Diagnostic Imaging, Sheba Medical Center, Tel-Hashomer, Israel.
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
- The Joseph Sagol Neuroscience Center, Sheba Medical Center, Tel Hashomer, Israel.
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20
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Höller Y, Versace V, Trinka E, Nardone R. Functional connectivity after hemispherectomy. Quant Imaging Med Surg 2020; 10:1174-1178. [PMID: 32489942 DOI: 10.21037/qims.2020.03.17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- Yvonne Höller
- Faculty of Psychology, University of Akureyri, Akureyri, Iceland
| | - Viviana Versace
- Department of Neurorehabilitation, Hospital of Vipiteno, Vipiteno, Italy.,Research Unit for Neurorehabilitation South Tyrol, Bolzano, Italy
| | - Eugen Trinka
- Department of Neurology, Paracelsus Medical University Salzburg, Salzburg, Austria.,Centre for Cognitive Neurosciences Salzburg, Salzburg, Austria.,University for Medical Informatics and Health Technology, UMIT, Hall in Tirol, Austria
| | - Raffaele Nardone
- Franz Tappeiner Hospital, Merano, Italy.,Spinal Cord Injury and Tissue Regeneration Center Salzburg, Salzburg, Austria.,Department of Neurology, Paracelsus Medical University Salzburg, Salzburg, Austria
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21
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Sanchez E, El-Khatib H, Arbour C, Bedetti C, Blais H, Marcotte K, Baril AA, Descoteaux M, Gilbert D, Carrier J, Gosselin N. Brain white matter damage and its association with neuronal synchrony during sleep. Brain 2020; 142:674-687. [PMID: 30698667 DOI: 10.1093/brain/awy348] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Revised: 10/22/2018] [Accepted: 11/19/2018] [Indexed: 02/04/2023] Open
Abstract
The restorative function of sleep partly relies on its ability to deeply synchronize cerebral networks to create large slow oscillations observable with EEG. However, whether a brain can properly synchronize and produce a restorative sleep when it undergoes massive and widespread white matter damage is unknown. Here, we answer this question by testing 23 patients with various levels of white matter damage secondary to moderate to severe traumatic brain injuries (ages 18-56; 17 males, six females, 11-39 months post-injury) and compared them to 27 healthy subjects of similar age and sex. We used MRI and diffusion tensor imaging metrics (e.g. fractional anisotropy as well as mean, axial and radial diffusivities) to characterize voxel-wise white matter damage. We measured the following slow wave characteristics for all slow waves detected in N2 and N3 sleep stages: peak-to-peak amplitude, negative-to-positive slope, negative and positive phase durations, oscillation frequency, and slow wave density. Correlation analyses were performed in traumatic brain injury and control participants separately, with age as a covariate. Contrary to our hypotheses, we found that greater white matter damage mainly over the frontal and temporal brain regions was strongly correlated with a pattern of higher neuronal synchrony characterized by slow waves of larger amplitudes and steeper negative-to-positive slopes during non-rapid eye movement sleep. The same pattern of associations with white matter damage was also observed with markers of high homeostatic sleep pressure. More specifically, higher white matter damage was associated with higher slow-wave activity power, as well as with more severe complaints of cognitive fatigue. These associations between white matter damage and sleep were found only in our traumatic brain injured participants, with no such correlation in controls. Our results suggest that, contrary to previous observations in healthy controls, white matter damage does not prevent the expected high cerebral synchrony during sleep. Moreover, our observations challenge the current line of hypotheses that white matter microstructure deterioration reduces cerebral synchrony during sleep. Our results showed that the relationship between white matter and the brain's ability to synchronize during sleep is neither linear nor simple.
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Affiliation(s)
- Erlan Sanchez
- Research center of the Hôpital du Sacré-Coeur de Montréal, Qc, Canada.,Department of Neuroscience, Université de Montréal, Qc, Canada
| | - Héjar El-Khatib
- Research center of the Hôpital du Sacré-Coeur de Montréal, Qc, Canada.,Department of Psychology, Université de Montréal, Qc, Canada
| | - Caroline Arbour
- Research center of the Hôpital du Sacré-Coeur de Montréal, Qc, Canada.,Faculty of Nursing, Université de Montréal, Qc, Canada
| | - Christophe Bedetti
- Research center of the Hôpital du Sacré-Coeur de Montréal, Qc, Canada.,Research center of the Institut universitaire de gériatrie de Montréal, Qc, Canada
| | - Hélène Blais
- Research center of the Hôpital du Sacré-Coeur de Montréal, Qc, Canada
| | - Karine Marcotte
- Research center of the Hôpital du Sacré-Coeur de Montréal, Qc, Canada.,School of Speech Therapy and Audiology, Université de Montréal, Qc, Canada
| | - Andrée-Ann Baril
- Research center of the Hôpital du Sacré-Coeur de Montréal, Qc, Canada.,Department of Psychiatry, Université de Montréal, Qc, Canada
| | | | - Danielle Gilbert
- Research center of the Hôpital du Sacré-Coeur de Montréal, Qc, Canada
| | - Julie Carrier
- Research center of the Hôpital du Sacré-Coeur de Montréal, Qc, Canada.,Department of Psychology, Université de Montréal, Qc, Canada
| | - Nadia Gosselin
- Research center of the Hôpital du Sacré-Coeur de Montréal, Qc, Canada.,Department of Psychology, Université de Montréal, Qc, Canada
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22
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Bolton-Hall AN, Hubbard WB, Saatman KE. Experimental Designs for Repeated Mild Traumatic Brain Injury: Challenges and Considerations. J Neurotrauma 2019; 36:1203-1221. [PMID: 30351225 PMCID: PMC6479246 DOI: 10.1089/neu.2018.6096] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Mild traumatic brain injury (mild TBI) is a growing public concern, as evidence mounts that even brain injuries classified as "mild" can result in persistent neurological dysfunction. Multiple brain injuries heighten the likelihood of worsened or more prolonged symptomatology and may trigger long-term neurodegeneration. Animal models provide a logical platform to identify key parameters, such as loading forces, duration between injuries, and number of injuries, which contribute to additive or synergistic damage after repeated mild TBI. Despite the tremendous increase in research productivity in the field of repeated mild TBI, relatively few studies have been designed in such a way as to provide experimental-based insights into the dependence of cellular and functional outcomes on the prescribed parameters of mild TBI. In this review, we summarize how standard models of TBI have been adapted to produce mild TBI and highlight commonly observed aspects of neuropathology replicated in rodent models of mild TBI. The complexity of designing studies of repeated TBI is discussed, including challenges of incorporating appropriate control groups, informative experimental design, and relevant outcome measures. We then feature studies that provide a well-controlled, within-study design varying either the number of injuries or the interinjury interval. Harnessing the power of experimental models of TBI to elucidate which injury parameters are critical contributors to acute and chronic damage after repeated injury can further efforts at prevention and provide improved models for testing mechanisms and therapeutic interventions.
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Affiliation(s)
- Amanda N. Bolton-Hall
- Spinal Cord and Brain Injury Research Center, University of Kentucky College of Medicine, Lexington, Kentucky
- Department of Physiology, University of Kentucky College of Medicine, Lexington, Kentucky
- Department of Neurosurgery, Wayne State University School of Medicine, Detroit, Michigan
| | - W. Brad Hubbard
- Spinal Cord and Brain Injury Research Center, University of Kentucky College of Medicine, Lexington, Kentucky
- Department of Physiology, University of Kentucky College of Medicine, Lexington, Kentucky
- Department of Neuroscience, University of Kentucky College of Medicine, Lexington, Kentucky
| | - Kathryn E. Saatman
- Spinal Cord and Brain Injury Research Center, University of Kentucky College of Medicine, Lexington, Kentucky
- Department of Physiology, University of Kentucky College of Medicine, Lexington, Kentucky
- Department of Neurosurgery, University of Kentucky College of Medicine, Lexington, Kentucky
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23
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Abstract
Over 1.4 million people in the United States experience traumatic brain injury (TBI) each year and approximately 52,000 people die annually due to complications related to TBI. Traditionally, TBI has been viewed as a static injury with significant consequences for frontal lobe functioning that plateaus after some window of recovery, remaining relatively stable thereafter. However, over the past decade there has been growing consensus that the consequences of TBI are dynamic, with unique characteristics expressed at the individual level and over the life span. This chapter first discusses the pathophysiology of TBI in order to understand its dynamic process and then describes the behavioral changes that are the result of injury with focus on frontal lobe functions. It integrates a historical perspective on structural and functional brain-imaging approaches used to understand how TBI impacts the frontal lobes, as well as more recent approaches to examine large-scale network changes after TBI. The factors most useful for outcome prediction are surveyed, along with how the theoretical frameworks used to predict recovery have developed over time. In this chapter, the authors argue for the need to understand outcome after TBI as a dynamic process with individual trajectories, taking a network theory perspective to understand the consequences of disrupting frontal systems in TBI. Within this framework, understanding frontal lobe dysfunction within a larger coordinated neural network to study TBI may provide a novel perspective in outcome prediction and in developing individualized treatments.
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Affiliation(s)
- Rachel A Bernier
- Department of Psychology, Pennsylvania State University, University Park, State College, PA, United States
| | - Frank G Hillary
- Department of Psychology, Pennsylvania State University, University Park, State College, PA, United States.
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24
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Hanks R, Millis S, Scott S, Gattu R, O’Hara NB, Haacke M, Kou Z. The relation between cognitive dysfunction and diffusion tensor imaging parameters in traumatic brain injury. Brain Inj 2018; 33:355-363. [DOI: 10.1080/02699052.2018.1553073] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Robin Hanks
- Department of Physical Medicine and Rehabilitation, Wayne State University School of Medicine, Detroit, MI, USA
| | - Scott Millis
- Department of Physical Medicine and Rehabilitation, Wayne State University School of Medicine, Detroit, MI, USA
| | - Selena Scott
- Department of Rehabilitation Psychology and Neuropsychology, Rehabilitation Institute of Michigan, Detroit, MI, USA
| | - Ramtilak Gattu
- Department of Radiology, Wayne State University School of Medicine, Detroit, MI, USA
| | | | - Mark Haacke
- Department of Radiology, Wayne State University School of Medicine, Detroit, MI, USA
- Department of Biomedical Engineering, College of Engineering, Wayne State University, Detroit, MI, USA
| | - Zhifeng Kou
- Department of Radiology, Wayne State University School of Medicine, Detroit, MI, USA
- Department of Biomedical Engineering, College of Engineering, Wayne State University, Detroit, MI, USA
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25
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Santos JGRPD, Casto JPSD, Teixeira MJ, Andrade AFD, Paiva WS. Diffuse axonal injury: diffusion tensor imaging and cognitive outcome. ARQUIVOS DE NEURO-PSIQUIATRIA 2018; 76:724-725. [PMID: 30427516 DOI: 10.1590/0004-282x20180113] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 08/08/2018] [Indexed: 11/22/2022]
Affiliation(s)
| | - João Paulo Souza de Casto
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Neurocirurgia, São Paulo SP, Brasil
| | - Manoel Jacobsen Teixeira
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Neurocirurgia, São Paulo SP, Brasil
| | - Almir Ferreira de Andrade
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Neurocirurgia, São Paulo SP, Brasil
| | - Wellingson Silva Paiva
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Neurocirurgia, São Paulo SP, Brasil
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26
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Hutchinson EB, Schwerin SC, Radomski KL, Sadeghi N, Komlosh ME, Irfanoglu MO, Juliano SL, Pierpaoli C. Detection and Distinction of Mild Brain Injury Effects in a Ferret Model Using Diffusion Tensor MRI (DTI) and DTI-Driven Tensor-Based Morphometry (D-TBM). Front Neurosci 2018; 12:573. [PMID: 30174584 PMCID: PMC6107703 DOI: 10.3389/fnins.2018.00573] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 07/30/2018] [Indexed: 12/25/2022] Open
Abstract
Mild traumatic brain injury (mTBI) is highly prevalent but lacks both research tools with adequate sensitivity to detect cellular alterations that accompany mild injury and pre-clinical models that are able to robustly mimic hallmark features of human TBI. To address these related challenges, high-resolution diffusion tensor MRI (DTI) analysis was performed in a model of mild TBI in the ferret - a species that, unlike rodents, share with humans a gyrencephalic cortex and high white matter (WM) volume. A set of DTI image analysis tools were optimized and implemented to explore key features of DTI alterations in ex vivo adult male ferret brains (n = 26), evaluated 1 day to 16 weeks after mild controlled cortical impact (CCI). Using template-based ROI analysis, lesion overlay mapping and DTI-driven tensor-based morphometry (D-TBM) significant differences in DTI and morphometric values were found and their dependence on time after injury evaluated. These observations were also qualitatively compared with immunohistochemistry staining of neurons, astrocytes, and microglia in the same tissue. Focal DTI abnormalities including reduced cortical diffusivity were apparent in 12/13 injured brains with greatest lesion extent found acutely following CCI by ROI overlay maps and reduced WM FA in the chronic period was observed near to the CCI site (ANOVA for FA in focal WM: time after CCI p = 0.046, brain hemisphere p = 0.0012) often in regions without other prominent MRI abnormalities. Global abnormalities were also detected, especially for WM regions, which demonstrated reduced diffusivity (ANOVA for Trace: time after CCI p = 0.007) and atrophy that appeared to become more extensive and bilateral with longer time after injury (ANOVA for D-TBM Log of the Jacobian values: time after CCI p = 0.007). The findings of this study extend earlier work in rodent models especially by evaluation of focal WM abnormalities that are not influenced by partial volume effects in the ferret. There is also substantial overlap between DTI and morphometric findings in this model and those from human studies of mTBI implying that the combination of DTI tools with a human-similar model system can provide an advantageous and informative approach for mTBI research.
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Affiliation(s)
- Elizabeth B. Hutchinson
- Section on Quantitative Medical Imaging, National Institute of Biomedical Imaging and Bioengineering, National Institutes of Health, Bethesda, MD, United States
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, United States
| | - Susan C. Schwerin
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, United States
- Department of Anatomy, Physiology, and Genetics, Uniformed Services University of the Health Sciences, Bethesda, MD, United States
| | - Kryslaine L. Radomski
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, United States
- Department of Anatomy, Physiology, and Genetics, Uniformed Services University of the Health Sciences, Bethesda, MD, United States
| | - Neda Sadeghi
- Section on Quantitative Imaging and Tissue Sciences, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, United States
| | - Michal E. Komlosh
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, United States
- Section on Quantitative Imaging and Tissue Sciences, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, United States
| | - M. O. Irfanoglu
- Section on Quantitative Medical Imaging, National Institute of Biomedical Imaging and Bioengineering, National Institutes of Health, Bethesda, MD, United States
| | - Sharon L. Juliano
- Department of Anatomy, Physiology, and Genetics, Uniformed Services University of the Health Sciences, Bethesda, MD, United States
| | - Carlo Pierpaoli
- Section on Quantitative Medical Imaging, National Institute of Biomedical Imaging and Bioengineering, National Institutes of Health, Bethesda, MD, United States
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27
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Song M, Zhang Y, Cui Y, Yang Y, Jiang T. Brain Network Studies in Chronic Disorders of Consciousness: Advances and Perspectives. Neurosci Bull 2018; 34:592-604. [PMID: 29916113 PMCID: PMC6060221 DOI: 10.1007/s12264-018-0243-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Accepted: 05/07/2018] [Indexed: 02/06/2023] Open
Abstract
Neuroimaging has opened new opportunities to study the neural correlates of consciousness, and provided additional information concerning diagnosis, prognosis, and therapeutic interventions in patients with disorders of consciousness. Here, we aim to review neuroimaging studies in chronic disorders of consciousness from the viewpoint of the brain network, focusing on positron emission tomography, functional MRI, functional near-infrared spectroscopy, electrophysiology, and diffusion MRI. To accelerate basic research on disorders of consciousness and provide a panoramic view of unconsciousness, we propose that it is urgent to integrate different techniques at various spatiotemporal scales, and to merge fragmented findings into a uniform "Brainnetome" (Brain-net-ome) research framework.
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Affiliation(s)
- Ming Song
- National Laboratory of Pattern Recognition, Institute of Automation, The Chinese Academy of Sciences, Beijing, 100190, China
- Brainnetome Center, Institute of Automation, The Chinese Academy of Sciences, Beijing, 100190, China
| | - Yujin Zhang
- National Laboratory of Pattern Recognition, Institute of Automation, The Chinese Academy of Sciences, Beijing, 100190, China
- Brainnetome Center, Institute of Automation, The Chinese Academy of Sciences, Beijing, 100190, China
| | - Yue Cui
- National Laboratory of Pattern Recognition, Institute of Automation, The Chinese Academy of Sciences, Beijing, 100190, China
- Brainnetome Center, Institute of Automation, The Chinese Academy of Sciences, Beijing, 100190, China
- University of Chinese Academy of Sciences, Beijing, 100190, China
| | - Yi Yang
- Department of Neurosurgery, PLA Army General Hospital, Beijing, 100700, China
| | - Tianzi Jiang
- National Laboratory of Pattern Recognition, Institute of Automation, The Chinese Academy of Sciences, Beijing, 100190, China.
- Brainnetome Center, Institute of Automation, The Chinese Academy of Sciences, Beijing, 100190, China.
- University of Chinese Academy of Sciences, Beijing, 100190, China.
- CAS Center for Excellence in Brain Science and Intelligence Technology, Chinese Academy of Sciences, Beijing, 100190, China.
- Key Laboratory for Neuroinformation of the Ministry of Education, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, 625014, China.
- The Queensland Brain Institute, University of Queensland, Brisbane, QLD, 4072, Australia.
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28
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Abstract
PURPOSE OF REVIEW Headache is a frequent and debilitating symptom after mild traumatic brain injury, yet little is known about its pathophysiology and most effective treatments. The goal of this review is to summarize findings from imaging studies used during the clinical evaluation and research investigation of post-traumatic headache (PTH). RECENT FINDINGS There are no published recommendations or guidelines for when to acquire imaging studies of the head or neck in patients with PTH. Clinical acumen is required to determine if imaging is needed to assess for a secondary cause of headache which may have been precipitated or unmasked by the trauma. Several guidelines for when to image the patient with mild traumatic brain injury (mTBI) in the emergency setting consider headache among the deciding factors. In the research arena, imaging techniques including proton spectroscopy magnetic resonance imaging, diffusion tensor imaging, magnetic resonance morphometry, and functional neck x-rays have been employed with the goal of identifying diagnostic and prognostic factors for PTH and to help understand its underlying pathophysiologic mechanisms. Results indicate that changes in regional cortical thickness and damage to specific white matter tracts warrant further research. Future research should interrogate whether these imaging findings contribute to the classification and prognosis of PTH. Current research provides evidence that imaging findings associated with PTH may be distinct from those attributable to mTBI. A variety of imaging techniques have potential to further our understanding of the pathophysiologic processes underlying PTH as well as to provide diagnostic and prognostic indicators. However, considerable work must be undertaken for this to be realized.
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Affiliation(s)
- Jill C Rau
- Mayo Clinic Arizona, 5777 East Mayo Boulevard, Phoenix, AZ, 85054, USA
| | - Gina M Dumkrieger
- Mayo Clinic Arizona, 5777 East Mayo Boulevard, Phoenix, AZ, 85054, USA
| | - Catherine D Chong
- Mayo Clinic Arizona, 5777 East Mayo Boulevard, Phoenix, AZ, 85054, USA
| | - Todd J Schwedt
- Mayo Clinic Arizona, 5777 East Mayo Boulevard, Phoenix, AZ, 85054, USA.
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29
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Manivannan S, Makwana M, Ahmed AI, Zaben M. Profiling biomarkers of traumatic axonal injury: From mouse to man. Clin Neurol Neurosurg 2018; 171:6-20. [PMID: 29803093 DOI: 10.1016/j.clineuro.2018.05.017] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2018] [Revised: 05/05/2018] [Accepted: 05/14/2018] [Indexed: 12/20/2022]
Abstract
Traumatic brain injury (TBI) poses a major public health problem on a global scale. Its burden results from high mortality and significant morbidity in survivors. This stems, in part, from an ongoing inadequacy in diagnostic and prognostic indicators despite significant technological advances. Traumatic axonal injury (TAI) is a key driver of the ongoing pathological process following TBI, causing chronic neurological deficits and disability. The science underpinning biomarkers of TAI has been a subject of many reviews in recent literature. However, in this review we provide a comprehensive account of biomarkers from animal models to clinical studies, bridging the gap between experimental science and clinical medicine. We have discussed pathogenesis, temporal kinetics, relationships to neuro-imaging, and, most importantly, clinical applicability in order to provide a holistic perspective of how this could improve TBI diagnosis and predict clinical outcome in a real-life setting. We conclude that early and reliable identification of axonal injury post-TBI with the help of body fluid biomarkers could enhance current care of TBI patients by (i) increasing speed and accuracy of diagnosis, (ii) providing invaluable prognostic information, (iii) allow efficient allocation of rehabilitation services, and (iv) provide potential therapeutic targets. The optimal model for assessing TAI is likely to involve multiple components, including several blood biomarkers and neuro-imaging modalities, at different time points.
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Affiliation(s)
- Susruta Manivannan
- Department of Neurosurgery, University Hospital of Wales, Heath Park, Cardiff, CF14 4XN, United Kingdom
| | - Milan Makwana
- Department of Neurosurgery, University Hospital of Wales, Heath Park, Cardiff, CF14 4XN, United Kingdom
| | - Aminul Islam Ahmed
- Clinical Neurosciences, University of Southampton, Southampton, SO16 6YD, United Kingdom; Wessex Neurological Centre, University Hospitals Southampton, Southampton, SO16 6YD, United Kingdom
| | - Malik Zaben
- Department of Neurosurgery, University Hospital of Wales, Heath Park, Cardiff, CF14 4XN, United Kingdom; Brain Repair & Intracranial Neurotherapeutics (BRAIN) Unit, Cardiff University, Hadyn Ellis Building, Maindy Road, Cardiff, CF24 4HQ, United Kingdom.
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30
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van Eijck MM, Schoonman GG, van der Naalt J, de Vries J, Roks G. Diffuse axonal injury after traumatic brain injury is a prognostic factor for functional outcome: a systematic review and meta-analysis. Brain Inj 2018; 32:395-402. [PMID: 29381396 DOI: 10.1080/02699052.2018.1429018] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To determine the prognosis of adult patients with traumatic brain injury (TBI) and diffuse axonal injury (DAI). METHODS Online search (PubMed, Embase and Ovid Science Direct) of articles providing information about outcome in (1) patients with DAI in general, (2) DAI vs. non-DAI, (3) related to magnetic resonance imaging (MRI) classification and (4) related to lesion location/load. A reference check and quality assessment were performed. RESULTS A total of 32 articles were included. TBI patients with DAI had a favourable outcome in 62%. The risk of unfavourable outcome in TBI with DAI was three times higher than in TBI without DAI. Odds ratio (OR) for unfavourable outcome was 2.9 per increase of DAI grade on MRI. Lesions located in the corpus callosum were associated with an unfavourable outcome. Other specific lesion locations and lesions count showed inconsistent results regarding outcome. Lesion volume was predictive for outcome only on apparent diffusion coefficient and fluid attenuation inversion recovery MRI sequences. CONCLUSIONS Presence of DAI on MRI in patients with TBI results in a higher chance of unfavourable outcome. With MRI grading, OR for unfavourable outcome increases threefold with every grade. Lesions in the corpus callosum in particular are associated with an unfavourable outcome.
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Affiliation(s)
- Marleen Maria van Eijck
- a Department of Neurology , Elisabeth-TweeSteden Hospital , Tilburg , The Netherlands.,b Trauma TopCare , Elisabeth-TweeSteden Hospital , Tilburg , The Netherlands
| | - Guus Geurt Schoonman
- a Department of Neurology , Elisabeth-TweeSteden Hospital , Tilburg , The Netherlands.,b Trauma TopCare , Elisabeth-TweeSteden Hospital , Tilburg , The Netherlands
| | - Joukje van der Naalt
- c Department of Neurology , University of Groningen, University Medical Center Groningen , Groningen , The Netherlands
| | - Jolanda de Vries
- b Trauma TopCare , Elisabeth-TweeSteden Hospital , Tilburg , The Netherlands.,d Department of Medical Psychology , Elisabeth-TweeSteden Hospital , Tilburg , The Netherlands.,e CoRPS, Department of Medical and Clinical Psychology , Tilburg University , Tilburg , The Netherlands
| | - Gerwin Roks
- a Department of Neurology , Elisabeth-TweeSteden Hospital , Tilburg , The Netherlands.,b Trauma TopCare , Elisabeth-TweeSteden Hospital , Tilburg , The Netherlands
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31
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Yang A, Xiao XH, Liu ZH, Wan ZL, Wang ZY. A Multimodal Magnetic Resonance Imaging Study of Recovery of Consciousness in Severe Traumatic Brain Injury: Preliminary Results. J Neurotrauma 2018; 35:308-313. [PMID: 29141511 DOI: 10.1089/neu.2017.5335] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Ang Yang
- Department of MR, Affiliated Zhongshan City Hospital of Sun Yat-sen University, Sun Yat-sen University, Zhonshan, China
| | - Xue Hong Xiao
- Department of MR, Affiliated Zhongshan City Hospital of Sun Yat-sen University, Sun Yat-sen University, Zhonshan, China
| | - Zhong Hua Liu
- Department of Neurology and Neurological Rehabilitation, Affiliated Zhongshan City Hospital of Sun Yat-sen University, Sun Yat-sen University, Zhonshan, China
| | - Zhi Long Wan
- Department of MR, Affiliated Zhongshan City Hospital of Sun Yat-sen University, Sun Yat-sen University, Zhonshan, China
| | - Ze Yan Wang
- Department of MR, Affiliated Zhongshan City Hospital of Sun Yat-sen University, Sun Yat-sen University, Zhonshan, China
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32
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Dollé JP, Jaye A, Anderson SA, Ahmadzadeh H, Shenoy VB, Smith DH. Newfound sex differences in axonal structure underlie differential outcomes from in vitro traumatic axonal injury. Exp Neurol 2017; 300:121-134. [PMID: 29104114 DOI: 10.1016/j.expneurol.2017.11.001] [Citation(s) in RCA: 74] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Revised: 10/27/2017] [Accepted: 11/02/2017] [Indexed: 12/29/2022]
Abstract
Since traumatic axonal injury (TAI) is implicated as a prominent pathology of concussion, we examined potential sex differences in axon structure and responses to TAI. Rat and human neurons were used to develop micropatterned axon tracts in vitro that were genetically either male or female. Ultrastructural analysis revealed for the first time that female axons were consistently smaller with fewer microtubules than male axons. Computational modeling of TAI showed that these structural differences place microtubules in female axons at greater risk of failure during trauma under the same applied loads than in male axons. Likewise, in an in vitro model of TAI, dynamic stretch-injury to axon tracts induced greater pathophysiology of female axons than male axons, including more extensive undulation formations resulting from mechanical breaking of microtubules, and greater calcium influx shortly after the same level of injury. At 24h post-injury, female axons exhibited significantly more swellings and greater loss of calcium signaling function than male axons. Accordingly, sexual dimorphism of axon structure in the brain may also contribute to more extensive axonal pathology in females compared to males exposed to the same mechanical injury.
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Affiliation(s)
- Jean-Pierre Dollé
- Penn Center for Brain Injury and Repair, Department of Neurosurgery, University of Pennsylvania, 220 South 33rd Street, 283 Towne Building, Philadelphia, PA 19104, USA.
| | - Andrew Jaye
- Penn Center for Brain Injury and Repair, Department of Neurosurgery, University of Pennsylvania, 220 South 33rd Street, 283 Towne Building, Philadelphia, PA 19104, USA.
| | - Stewart A Anderson
- Department of Psychiatry, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA.
| | - Hossein Ahmadzadeh
- Department of Materials Science and Engineering, 3231 Walnut Street, Room 309, The Laboratory for Research on the Structure of Matter, University of Pennsylvania, Philadelphia, PA 19104, USA.
| | - Vivek B Shenoy
- Department of Materials Science and Engineering, 3231 Walnut Street, Room 309, The Laboratory for Research on the Structure of Matter, University of Pennsylvania, Philadelphia, PA 19104, USA.
| | - Douglas H Smith
- Penn Center for Brain Injury and Repair, Department of Neurosurgery, University of Pennsylvania, 3320 Smith Walk Hayden Hall 105, Philadelphia, PA 19104, USA.
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33
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Tsitsopoulos PP, Abu Hamdeh S, Marklund N. Current Opportunities for Clinical Monitoring of Axonal Pathology in Traumatic Brain Injury. Front Neurol 2017; 8:599. [PMID: 29209266 PMCID: PMC5702013 DOI: 10.3389/fneur.2017.00599] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Accepted: 10/25/2017] [Indexed: 01/14/2023] Open
Abstract
Traumatic brain injury (TBI) is a multidimensional and highly complex disease commonly resulting in widespread injury to axons, due to rapid inertial acceleration/deceleration forces transmitted to the brain during impact. Axonal injury leads to brain network dysfunction, significantly contributing to cognitive and functional impairments frequently observed in TBI survivors. Diffuse axonal injury (DAI) is a clinical entity suggested by impaired level of consciousness and coma on clinical examination and characterized by widespread injury to the hemispheric white matter tracts, the corpus callosum and the brain stem. The clinical course of DAI is commonly unpredictable and it remains a challenging entity with limited therapeutic options, to date. Although axonal integrity may be disrupted at impact, the majority of axonal pathology evolves over time, resulting from delayed activation of complex intracellular biochemical cascades. Activation of these secondary biochemical pathways may lead to axonal transection, named secondary axotomy, and be responsible for the clinical decline of DAI patients. Advances in the neurocritical care of TBI patients have been achieved by refinements in multimodality monitoring for prevention and early detection of secondary injury factors, which can be applied also to DAI. There is an emerging role for biomarkers in blood, cerebrospinal fluid, and interstitial fluid using microdialysis in the evaluation of axonal injury in TBI. These biomarker studies have assessed various axonal and neuroglial markers as well as inflammatory mediators, such as cytokines and chemokines. Moreover, modern neuroimaging can detect subtle or overt DAI/white matter changes in diffuse TBI patients across all injury severities using magnetic resonance spectroscopy, diffusion tensor imaging, and positron emission tomography. Importantly, serial neuroimaging studies provide evidence for evolving axonal injury. Since axonal injury may be a key risk factor for neurodegeneration and dementias at long-term following TBI, the secondary injury processes may require prolonged monitoring. The aim of the present review is to summarize the clinical short- and long-term monitoring possibilities of axonal injury in TBI. Increased knowledge of the underlying pathophysiology achieved by advanced clinical monitoring raises hope for the development of novel treatment strategies for axonal injury in TBI.
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Affiliation(s)
- Parmenion P Tsitsopoulos
- Section of Neurosurgery, Department of Neuroscience, Uppsala University, Uppsala, Sweden.,Hippokratio General Hospital, Aristotle University, Thessaloniki, Greece
| | - Sami Abu Hamdeh
- Section of Neurosurgery, Department of Neuroscience, Uppsala University, Uppsala, Sweden
| | - Niklas Marklund
- Section of Neurosurgery, Department of Neuroscience, Uppsala University, Uppsala, Sweden.,Department of Clinical Sciences Lund, Neurosurgery, Skåne University Hospital, Lund University, Lund, Sweden
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34
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Tal S, Hadanny A, Sasson E, Suzin G, Efrati S. Hyperbaric Oxygen Therapy Can Induce Angiogenesis and Regeneration of Nerve Fibers in Traumatic Brain Injury Patients. Front Hum Neurosci 2017; 11:508. [PMID: 29097988 PMCID: PMC5654341 DOI: 10.3389/fnhum.2017.00508] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Accepted: 10/06/2017] [Indexed: 01/01/2023] Open
Abstract
Background: Recent clinical studies in stroke and traumatic brain injury (TBI) victims suffering chronic neurological injury present evidence that hyperbaric oxygen therapy (HBOT) can induce neuroplasticity. Objective: To assess the neurotherapeutic effect of HBOT on prolonged post-concussion syndrome (PPCS) due to TBI, using brain microstructure imaging. Methods: Fifteen patients afflicted with PPCS were treated with 60 daily HBOT sessions. Imaging evaluation was performed using Dynamic Susceptibility Contrast-Enhanced (DSC) and Diffusion Tensor Imaging (DTI) MR sequences. Cognitive evaluation was performed by an objective computerized battery (NeuroTrax). Results: HBOT was initiated 6 months to 27 years (10.3 ± 3.2 years) from injury. After HBOT, DTI analysis showed significantly increased fractional anisotropy values and decreased mean diffusivity in both white and gray matter structures. In addition, the cerebral blood flow and volume were increased significantly. Clinically, HBOT induced significant improvement in the memory, executive functions, information processing speed and global cognitive scores. Conclusions: The mechanisms by which HBOT induces brain neuroplasticity can be demonstrated by highly sensitive MRI techniques of DSC and DTI. HBOT can induce cerebral angiogenesis and improve both white and gray microstructures indicating regeneration of nerve fibers. The micro structural changes correlate with the neurocognitive improvements.
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Affiliation(s)
- Sigal Tal
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Radiology Department, Assaf Harofeh Medical Center, Zerifin, Israel
| | - Amir Hadanny
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Sagol Center for Hyperbaric Medicine and Research, Assaf Harofeh Medical Center, Zerifin, Israel.,Faculty of Medicine, Bar-Ilan University, Ramat Gan, Israel
| | | | - Gil Suzin
- Sagol Center for Hyperbaric Medicine and Research, Assaf Harofeh Medical Center, Zerifin, Israel
| | - Shai Efrati
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Sagol Center for Hyperbaric Medicine and Research, Assaf Harofeh Medical Center, Zerifin, Israel.,Research and Development Unit, Assaf Harofeh Medical Center, Zerifin, Israel.,Sagol School of Neuroscience, Tel-Aviv University, Tel-Aviv, Israel
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35
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Zhang H, Wang W, Jiang S, Zhang Y, Heo HY, Wang X, Peng Y, Wang J, Zhou J. Amide proton transfer-weighted MRI detection of traumatic brain injury in rats. J Cereb Blood Flow Metab 2017; 37:3422-3432. [PMID: 28128026 PMCID: PMC5624391 DOI: 10.1177/0271678x17690165] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
The purpose of this study was to explore the capability and uniqueness of amide proton transfer-weighted (APTw) imaging in the detection of primary and secondary injury after controlled cortical impact (CCI)-induced traumatic brain injury (TBI) in rats. Eleven adult rats had craniotomy plus CCI surgery under isoflurane anesthesia. Multi-parameter MRI data were acquired at 4.7 T, at eight time points (1, 6 h, and 1, 2, 3, 7, 14, and 28 days after TBI). At one and six hours post-injury, average APTw signal intensities decreased significantly in the impacted and peri-lesional areas due to tissue acidosis. A slightly high APTw signal was seen in the core lesion area with respect to the peri-lesional area, which was due to hemorrhage, as shown by T2*w. After the initial drop, the APTw signals dramatically increased in some peri-lesional areas at two and three days post-injury, likely due to the secondary inflammatory response. The use of APTw MRI has the potential to introduce a novel molecular neuroimaging approach for the simultaneous detection of ischemia, hemorrhage, and neuroinflammation in TBI.
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Affiliation(s)
- Hong Zhang
- 1 Division of MR Research, Department of Radiology, Johns Hopkins University, Baltimore, MD, USA.,2 Department of Radiology, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Wenzhu Wang
- 3 Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, MD, USA.,4 Department of Integrated Chinese and West Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Shanshan Jiang
- 1 Division of MR Research, Department of Radiology, Johns Hopkins University, Baltimore, MD, USA
| | - Yi Zhang
- 1 Division of MR Research, Department of Radiology, Johns Hopkins University, Baltimore, MD, USA
| | - Hye-Young Heo
- 1 Division of MR Research, Department of Radiology, Johns Hopkins University, Baltimore, MD, USA
| | - Xianlong Wang
- 1 Division of MR Research, Department of Radiology, Johns Hopkins University, Baltimore, MD, USA
| | - Yun Peng
- 2 Department of Radiology, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Jian Wang
- 3 Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Jinyuan Zhou
- 1 Division of MR Research, Department of Radiology, Johns Hopkins University, Baltimore, MD, USA
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36
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Atlan LS, Smith C, Margulies SS. Improved prediction of direction-dependent, acute axonal injury in piglets. J Neurosci Res 2017; 96:536-544. [PMID: 28833411 DOI: 10.1002/jnr.24108] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Revised: 05/23/2017] [Accepted: 06/14/2017] [Indexed: 01/25/2023]
Abstract
To guide development of safety equipment that reduces sports-related head injuries, we sought to enhance predictive relationships between head movement and acute axonal injury severity. The severity of traumatic brain injury (TBI) is influenced by the magnitude and direction of head kinematics. Previous studies have demonstrated correlation between rotational head kinematics and symptom severity in the adult. More recent studies have demonstrated brain injury age- and direction-dependence, relating head kinematics to white matter tract-oriented strains. We have recently developed and assessed novel rotational head kinematic parameters as predictors of white matter damage in the female immature piglet. We show that many previously published rotational kinematic injury predictor metrics poorly predict acute axonal pathology induced by rapid, non-impact head rotations and that inclusion of cerebral moments of inertia (MOI) in rotational head injury metrics refines prediction of diffuse axonal injury following rapid head rotations for two immature age groups. Rotational Work (RotWork) was the best significant predictor of traumatic axonal injury in both newborn and pre-adolescent piglets following head rotations in the axial, coronal, and sagittal planes. An improvement over current metrics, we find that RotWork, which incorporates head rotation rate, direction, and brain shape, significantly enhanced acute traumatic axonal injury prediction. For similar injury extent, the RotWork threshold is lower for the newborn piglet than the pre-adolescent.
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Affiliation(s)
- Lorre S Atlan
- Bioengineering, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Colin Smith
- Academic Department of Neuropathology, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, Scotland, United Kingdom
| | - Susan S Margulies
- Bioengineering, University of Pennsylvania, Philadelphia, PA, 19104, USA
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37
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Yu K, Seal ML, Reyes J, Godfrey C, Anderson V, Adamson C, Ryan NP, Hearps SJC, Catroppa C. Brain volumetric correlates of inhibition and cognitive flexibility 16 years following childhood traumatic brain injury. J Neurosci Res 2017; 96:642-651. [PMID: 28675465 DOI: 10.1002/jnr.24087] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Revised: 04/06/2017] [Accepted: 05/01/2017] [Indexed: 01/08/2023]
Abstract
Executive functions (EFs), such as inhibition and cognitive flexibility, are essential for everyday functioning, including regulation of socially appropriate emotional responses. These skills develop during childhood and continue maturing into early adulthood. The current study aimed to investigate the very long-term impact of childhood traumatic brain injury (TBI) on inhibition and cognitive flexibility, and to examine whether global white matter is associated with these abilities. Twenty-eight young adult survivors of childhood TBI (mean age at 16-year follow-up = 21.67 years, SD = 2.70) and 16 typically developing controls (TDCs), group-matched for age, sex, and socioeconomic status, completed tests of inhibition and cognitive flexibility and underwent structural MRI. Survivors of childhood TBI did not significantly differ from TDCs on EF or white matter volume. However, the relationship between EF and white matter volume differed between survivors of TBI and TDCs. Survivors of TBI did not mimic the brain behavior relationship that characterized EF in TDCs. The inverse brain behavior relationship, exhibited by childhood TBI survivors, suggests disruptions in the whole brain underpinning EF following childhood TBI.
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Affiliation(s)
- Kelleynne Yu
- Clinical Sciences, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
| | - Marc L Seal
- Clinical Sciences, Murdoch Childrens Research Institute, Parkville, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
| | - Jonathan Reyes
- Clinical Sciences, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
| | - Celia Godfrey
- Clinical Sciences, Murdoch Childrens Research Institute, Parkville, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
| | - Vicki Anderson
- Clinical Sciences, Murdoch Childrens Research Institute, Parkville, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia.,Department of Psychology, Royal Children's Hospital, Parkville, Victoria, Australia.,Melbourne School of Psychological Sciences (MSPS), University of Melbourne, Parkville, Victoria, Australia
| | - Chris Adamson
- Clinical Sciences, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
| | - Nicholas P Ryan
- Clinical Sciences, Murdoch Childrens Research Institute, Parkville, Victoria, Australia.,Melbourne School of Psychological Sciences (MSPS), University of Melbourne, Parkville, Victoria, Australia
| | - Stephen J C Hearps
- Clinical Sciences, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
| | - Cathy Catroppa
- Clinical Sciences, Murdoch Childrens Research Institute, Parkville, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia.,Department of Psychology, Royal Children's Hospital, Parkville, Victoria, Australia.,Melbourne School of Psychological Sciences (MSPS), University of Melbourne, Parkville, Victoria, Australia
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38
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Ivleva EI, Clementz BA, Dutcher AM, Arnold SJ, Jeon-Slaughter H, Aslan S, Witte B, Poudyal G, Lu H, Meda SA, Pearlson GD, Sweeney JA, Keshavan MS, Tamminga CA. Brain Structure Biomarkers in the Psychosis Biotypes: Findings From the Bipolar-Schizophrenia Network for Intermediate Phenotypes. Biol Psychiatry 2017; 82:26-39. [PMID: 27817844 PMCID: PMC6501573 DOI: 10.1016/j.biopsych.2016.08.030] [Citation(s) in RCA: 102] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Revised: 08/17/2016] [Accepted: 08/17/2016] [Indexed: 11/27/2022]
Abstract
BACKGROUND The current definitions of psychotic illness lack biological validity, motivating alternative biomarker-driven disease entities. Building on experimental constructs-Biotypes-that were previously developed from cognitive and neurophysiologic measures, we contrast brain anatomy characteristics across Biotypes alongside conventional diagnoses, examining gray matter density (GMD) as an independent validator for the Biotypes. METHODS Whole brain GMD measures were examined in probands, their relatives, and healthy subjects organized by Biotype and then by DSM-IV-TR diagnosis (n = 1409) using voxel-based morphometry with subsequent subject-level regional characterization and distribution analyses. RESULTS Probands grouped by Biotype versus healthy controls showed a stepwise pattern of GMD reductions as follows: Biotype1, extensive and diffusely distributed GMD loss, with the largest effects in frontal, anterior/middle cingulate cortex, and temporal regions; Biotype2, intermediate and more localized reductions, with the largest effects in insula and frontotemporal regions; and Biotype3, small reductions localized to anterior limbic regions. Relatives showed regionally distinct GMD reductions versus healthy controls, with primarily anterior (frontotemporal) effects in Biotype1; posterior (temporo-parieto-cerebellar) in Biotype2; and normal GMD in Biotype3. Schizophrenia and schizoaffective probands versus healthy controls showed overlapping GMD reductions, with the largest effects in frontotemporal and parietal regions; psychotic bipolar probands had small reductions, primarily in frontal regions. GMD changes in relatives followed regional patterns observed in probands, albeit less extensive. Biotypes showed stronger between-group separation based on GMD than the conventional diagnoses and were the strongest predictor of GMD change. CONCLUSIONS GMD biomarkers depicted unique brain structure characteristics within Biotypes, consistent with their cognitive and sensorimotor profiles, and provided stronger discrimination for biologically driven biotypes than symptom-based diagnoses.
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Affiliation(s)
| | | | | | | | | | - Sina Aslan
- Advance MRI, LLC, Frisco,University of Texas at Dallas, Richardson, Texas
| | - Bradley Witte
- University of Texas Southwestern Medical Center, Dallas
| | | | - Hanzhang Lu
- University of Texas Southwestern Medical Center, Dallas,Johns Hopkins University, Baltimore, Maryland
| | | | - Godfrey D. Pearlson
- Institute of Living/Hartford Hospital, Hartford,Yale School of Medicine, New Haven, Connecticut
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39
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Zhang J, Wei RL, Peng GP, Zhou JJ, Wu M, He FP, Pan G, Gao J, Luo BY. Correlations between diffusion tensor imaging and levels of consciousness in patients with traumatic brain injury: a systematic review and meta-analysis. Sci Rep 2017; 7:2793. [PMID: 28584256 PMCID: PMC5459858 DOI: 10.1038/s41598-017-02950-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Accepted: 04/26/2017] [Indexed: 12/19/2022] Open
Abstract
Traumatic brain injury (TBI) often leads to impaired consciousness. Recent diffusion tensor imaging studies associated consciousness with imaging metrics including fractional anisotropy (FA) and apparent diffusion coefficient (ADC). We evaluated their correlations and determined the best index in candidate regions. Six databases were searched, including PubMed and Embase, and 16 studies with 701 participants were included. Data from region-of-interest and whole-brain analysis methods were meta-analysed separately. The FA-consciousness correlation was marginal in the whole-brain white matter (r = 0.63, 95% CI [0.47, 0.79], p = 0.000) and the corpus callosum (CC) (r = 0.60, 95% CI [0.48, 0.71], p = 0.000), and moderate in the internal capsule (r = 0.48, 95% CI [0.24, 0.72], p = 0.000). Correlations with ADC trended negative and lacked significance. Further subgroup analysis revealed that consciousness levels correlated strongly with FA in the CC body (r = 0.66, 95% CI [0.43, 0.89]), moderately in the splenium (r = 0.58, 95% CI [0.38, 0.78]), but insignificantly in the genu. In conclusion, FA correlates better with consciousness levels than ADC in TBI. The degree of correlation varies among brain regions. The CC (especially its splenium and body) is a reliable candidate region to quantitatively reflect consciousness levels.
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Affiliation(s)
- Jie Zhang
- Department of Neurology & Brain Medical Centre, The First Affiliated Hospital, Zhejiang University, Hangzhou, China
| | - Rui-Li Wei
- Department of Neurology & Brain Medical Centre, The First Affiliated Hospital, Zhejiang University, Hangzhou, China
| | - Guo-Ping Peng
- Department of Neurology & Brain Medical Centre, The First Affiliated Hospital, Zhejiang University, Hangzhou, China
| | - Jia-Jia Zhou
- Department of Neurology & Brain Medical Centre, The First Affiliated Hospital, Zhejiang University, Hangzhou, China
| | - Min Wu
- Department of Neurology & Brain Medical Centre, The First Affiliated Hospital, Zhejiang University, Hangzhou, China
| | - Fang-Ping He
- Department of Neurology & Brain Medical Centre, The First Affiliated Hospital, Zhejiang University, Hangzhou, China
| | - Gang Pan
- Department of Computer Science, Zhejiang University, Hangzhou, China
| | - Jian Gao
- Department of Rehabilitation, Hangzhou Hospital of Zhejiang CAPR, Hangzhou, China
| | - Ben-Yan Luo
- Department of Neurology & Brain Medical Centre, The First Affiliated Hospital, Zhejiang University, Hangzhou, China.
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40
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Ware JB, Hart T, Whyte J, Rabinowitz A, Detre JA, Kim J. Inter-Subject Variability of Axonal Injury in Diffuse Traumatic Brain Injury. J Neurotrauma 2017; 34:2243-2253. [PMID: 28314375 DOI: 10.1089/neu.2016.4817] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Traumatic brain injury (TBI) is a leading cause of cognitive morbidity worldwide for which reliable biomarkers are needed. Diffusion tensor imaging (DTI) is a promising biomarker of traumatic axonal injury (TAI); however, existing studies have been limited by a primary reliance on group-level analytic methods not well suited to account for inter-subject variability. In this study, 42 adults with TBI of at least moderate severity were examined 3 months following injury and compared with 35 healthy controls. DTI data were used for both traditional group-level comparison and subject-specific analysis using the distribution-corrected Z-score (DisCo-Z) approach. Inter-subject variation in TAI was assessed in a threshold-invariant manner using a threshold-weighted overlap map derived from subject-specific analysis. Receiver operator curve analysis was used to examine the ability of subject-specific DTI analysis to identify TBI subjects with significantly impaired processing speed in comparison with region of interest-based fractional anisotropy (FA) measurements and clinical characteristics. Traditional group-wise analysis demonstrated widespread reductions of white matter FA within the TBI group (voxel-wise p < 0.05, corrected), despite relatively low consistency of subject-level effects secondary to widespread variation in the spatial distribution of TAI. Subject-specific mapping of TAI with the DisCo-Z approach was the best predictor of impaired processing speed, achieving high classification accuracy (area under the curve [AUC] = 0.94). In moderate-to-severe TBI, there is substantial inter-subject variation in TAI, with extent strongly correlated to post-traumatic deficits in processing speed. Significant group-level effects do not necessarily represent consistent effects at the individual level. Better accounting for inter-subject variability in neurobiological manifestations of TBI may substantially improve the ability to detect and classify patterns of injury.
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Affiliation(s)
- Jeffrey B Ware
- 1 Department of Radiology, Hospital of the University of Pennsylvania , Philadelphia, Pennsylvania
| | - Tessa Hart
- 2 Moss Rehabilitation Research Institute , Philadelphia, Pennsylvania
| | - John Whyte
- 2 Moss Rehabilitation Research Institute , Philadelphia, Pennsylvania
| | - Amanda Rabinowitz
- 2 Moss Rehabilitation Research Institute , Philadelphia, Pennsylvania
| | - John A Detre
- 3 Department of Neurology, Hospital of the University of Pennsylvania , Philadelphia, Pennsylvania
| | - Junghoon Kim
- 2 Moss Rehabilitation Research Institute , Philadelphia, Pennsylvania.,4 Department of Physiology, Pharmacology, and Neuroscience, City University of New York School of Medicine , New York, New York
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Gardner AJ, Shih SL, Adamov EV, Zafonte RD. Research Frontiers in Traumatic Brain Injury. Phys Med Rehabil Clin N Am 2017; 28:413-431. [DOI: 10.1016/j.pmr.2016.12.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Solmaz B, Tunç B, Parker D, Whyte J, Hart T, Rabinowitz A, Rohrbach M, Kim J, Verma R. Assessing connectivity related injury burden in diffuse traumatic brain injury. Hum Brain Mapp 2017; 38:2913-2922. [PMID: 28294464 DOI: 10.1002/hbm.23561] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Revised: 02/08/2017] [Accepted: 02/28/2017] [Indexed: 01/01/2023] Open
Abstract
Many of the clinical and behavioral manifestations of traumatic brain injury (TBI) are thought to arise from disruption to the structural network of the brain due to diffuse axonal injury (DAI). However, a principled way of summarizing diffuse connectivity alterations to quantify injury burden is lacking. In this study, we developed a connectome injury score, Disruption Index of the Structural Connectome (DISC), which summarizes the cumulative effects of TBI-induced connectivity abnormalities across the entire brain. Forty patients with moderate-to-severe TBI examined at 3 months postinjury and 35 uninjured healthy controls underwent magnetic resonance imaging with diffusion tensor imaging, and completed behavioral assessment including global clinical outcome measures and neuropsychological tests. TBI patients were selected to maximize the likelihood of DAI in the absence of large focal brain lesions. We found that hub-like regions, with high betweenness centrality, were most likely to be impaired as a result of diffuse TBI. Clustering of participants revealed a subgroup of TBI patients with similar connectivity abnormality profiles who exhibited relatively poor cognitive performance. Among TBI patients, DISC was significantly correlated with post-traumatic amnesia, verbal learning, executive function, and processing speed. Our experiments jointly demonstrated that assessing structural connectivity alterations may be useful in development of patient-oriented diagnostic and prognostic tools. Hum Brain Mapp 38:2913-2922, 2017. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- Berkan Solmaz
- Center for Biomedical Image Computing and Analytics, Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Birkan Tunç
- Center for Biomedical Image Computing and Analytics, Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Drew Parker
- Center for Biomedical Image Computing and Analytics, Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - John Whyte
- Moss Rehabilitation Research Institute, Elkins Park, Pennsylvania
| | - Tessa Hart
- Moss Rehabilitation Research Institute, Elkins Park, Pennsylvania
| | | | - Morgan Rohrbach
- Moss Rehabilitation Research Institute, Elkins Park, Pennsylvania
| | - Junghoon Kim
- Moss Rehabilitation Research Institute, Elkins Park, Pennsylvania.,CUNY School of Medicine, The City College of New York, New York, New York
| | - Ragini Verma
- Center for Biomedical Image Computing and Analytics, Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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Iranmahboob AK, Kierans AS, Huang C, Ream JM, Rosenkrantz AB. Preliminary investigation of whole-pancreas 3D histogram ADC metrics for predicting progression of acute pancreatitis. Clin Imaging 2017; 42:172-177. [DOI: 10.1016/j.clinimag.2016.12.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 11/23/2016] [Accepted: 12/14/2016] [Indexed: 12/24/2022]
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Ljungqvist J, Nilsson D, Ljungberg M, Esbjörnsson E, Eriksson-Ritzén C, Skoglund T. Longitudinal changes in diffusion tensor imaging parameters of the corpus callosum between 6 and 12 months after diffuse axonal injury. Brain Inj 2017; 31:344-350. [PMID: 28128655 DOI: 10.1080/02699052.2016.1256500] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND Magnetic resonance diffusion tensor imaging (MR-DTI) is used increasingly to detect diffuse axonal injury (DAI) after traumatic brain injury (TBI). PRIMARY OBJECTIVE To investigate changes in the diffusion tensor imaging parameters of the corpus callosum 6 and 12 months after TBI, to optimize the timing of follow-up DTI investigations. A secondary goal was to study the relationship between DTI parameters and outcome. RESEARCH DESIGN Longitudinal prospective study. METHODS AND PROCEDURES MR-DTI was performed in 15 patients with suspected DAI, 6 and 12 months post-injury. Sixteen controls were also examined. Fractional anisotropy (FA) and diffusivity (trace) in the corpus callosum were analysed. The outcome measures were the extended Glasgow Outcome Scale and the Barrow Neurological Institute Screen for Higher Cerebral Functions, assessed at 6 and 12 months. MAIN OUTCOMES AND RESULTS FA decreased and trace increased at 6 and 12 months compared to controls. Trace continued to increase even further between 6 and 12 months, while FA remained unchanged. Patients with the worst outcomes had lower FA and higher trace compared to patients with better outcomes. CONCLUSIONS DTI parameters have not reached a stable level at 6 months after DAI, but continue to change, probably reflecting an incessant microstructural alteration of the white matter.
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Affiliation(s)
| | | | | | - Eva Esbjörnsson
- c Department of Clinical Neuroscience and Rehabilitation , Sahlgrenska University Hospital , Goteborg , Sweden
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Kuhn AW, Zuckerman SL, Solomon GS, Casson IR, Viano DC. Interrelationships Among Neuroimaging Biomarkers, Neuropsychological Test Data, and Symptom Reporting in a Cohort of Retired National Football League Players. Sports Health 2016; 9:30-40. [PMID: 30043690 PMCID: PMC5315257 DOI: 10.1177/1941738116674006] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Background: Structural brain changes, potentially resulting from repetitive brain trauma (RBT), have been correlated with neurocognitive decline and increased symptom reporting in retired athletes. Hypothesis: In a cohort of retired National Football League (NFL) players, the relationships between 3 neuroimaging parameters, neuropsychological testing, and symptom scores will be significantly correlated. Study Design: Cross-sectional study. Level of Evidence: Level 3. Methods: Comprehensive magnetic resonance imaging was performed in 45 retired NFL players. Three neuroanatomical parameters were assessed by board-certified radiologists blinded to the purpose of the study: (1) the absence or presence of small or large cavum septum pellucidum, (2) a global mean score of fractional anisotropy (FA), and (3) the presence or absence of microhemorrhages. The subjects underwent a battery of 9 paper-and-pencil neuropsychological tests, a computerized neurocognitive test, and multiple symptom and depression scales. The associations among the neuroimaging results with these outcome measures were assessed utilizing Pearson, Spearman rank, and point-biserial correlations. Results: The 45 subjects (mean age, 46.7 ± 9.1 years) reported a mean 6.9 (±6.2) concussions and 13.0 (±7.9) “dings” in the NFL. Ten (22%) did not have a cavum septum pellucidum, while 32 (71%) had a small and 3 (7%) had a large one. Four (9%) had microhemorrhages. Global FA mean was 0.459 (±0.035). The majority (50.8%) of correlations among the neuroimaging parameters and neurocognitive/symptom scores fell below the threshold of “small” effect size (r < 0.10). The remaining (49.2%) correlations were between “small” and “medium” effect sizes (0.1 < r < 0.3). However, all correlations were statistically nonsignificant. Conclusion: There were minimal and statistically nonsignificant correlations among the neuroimaging, neurocognitive, and symptom scores examined in this cohort of NFL retirees. Clinical Relevance: Associating the severity of structural brain changes to neurocognitive performance and symptom burden after RBT is complex may involve other moderating variables or biomarkers, and demands further study.
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Affiliation(s)
- Andrew W Kuhn
- Vanderbilt Sports Concussion Center, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Scott L Zuckerman
- Vanderbilt Sports Concussion Center, Vanderbilt University School of Medicine, Nashville, Tennessee.,Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Gary S Solomon
- Vanderbilt Sports Concussion Center, Vanderbilt University School of Medicine, Nashville, Tennessee.,Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Ira R Casson
- Department of Neurology, Hofstra North Shore-LIJ School of Medicine, Hempstead, New York
| | - David C Viano
- ProBiomechanics LLC, Bloomfield Hills, Michigan.,Department of Biomedical Engineering and Radiology, Wayne State University, Detroit, Michigan
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Li W, Long JA, Watts L, Shen Q, Liu Y, Jiang Z, Duong TQ. Spatiotemporal changes in diffusion, T2 and susceptibility of white matter following mild traumatic brain injury. NMR IN BIOMEDICINE 2016; 29:896-903. [PMID: 27149577 PMCID: PMC4909565 DOI: 10.1002/nbm.3536] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Revised: 03/09/2016] [Accepted: 03/16/2016] [Indexed: 06/05/2023]
Abstract
Impaired white matter integrity in traumatic brain injury (TBI) can lead to deficits in various neurological functions. The differentiation of the underlying pathological processes, e.g. edema, demyelination, axonal damage, to name a few, is of key clinical interest for the assessment of white matter injury. In this study, a combination of T2 , diffusion and susceptibility MRI was used to study the spatiotemporal changes in white matter at 1 h, 3 h, and 1, 2, 7 and 14 days following TBI, using a rat controlled cortical impact (CCI) model. Based on radial diffusivity (RD), the rats were divided into two groups: group 1 showed widespread increases in RD along the corpus callosum of the ipsilesional hemisphere at day 2, and group 2 showed normal RD. Based on this group separation, group 1 also showed similar widespread changes in fractional anisotropy (FA) and T2 at day 2, and group 2 showed normal FA and T2 . The widespread changes in RD and T2 in group 1 on day 2 were apparently dominated by edema, which obscured possible myelin and axonal damage. In contrast, the susceptibility of group 1 showed more localized increases near the impact site on day 2, and otherwise similar contrast to the contralesional hemisphere. The localized susceptibility increase is probably a result of demyelination and axonal injury. The extent of brain damage between the two groups revealed by MRI was consistent with behavioral results, with the first group showing significantly increased forelimb asymmetry and increased forelimb foot fault deficits. Our results suggest that the combination of T2 , diffusion and susceptibility MRI may provide an opportunity for the differential assessment of edema and axonal damage in TBI. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Wei Li
- Research Imaging Institute, University of Texas Health Science Center at San Antonio, TX 78229, USA
- Department of Ophthalmology, University of Texas Health Science Center at San Antonio, TX 78229, USA
| | - Justin Alexander Long
- Research Imaging Institute, University of Texas Health Science Center at San Antonio, TX 78229, USA
| | | | | | | | - Zhao Jiang
- Research Imaging Institute, University of Texas Health Science Center at San Antonio, TX 78229, USA
| | - Timothy Q. Duong
- Research Imaging Institute, University of Texas Health Science Center at San Antonio, TX 78229, USA
- Department of Ophthalmology, University of Texas Health Science Center at San Antonio, TX 78229, USA
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Delic J, Alhilali LM, Hughes MA, Gumus S, Fakhran S. White Matter Injuries in Mild Traumatic Brain Injury and Posttraumatic Migraines: Diffusion Entropy Analysis. Radiology 2016; 279:859-66. [DOI: 10.1148/radiol.2015151388] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Herweh C, Hess K, Meyding-Lamadé U, Bartsch AJ, Stippich C, Jost J, Friedmann-Bette B, Heiland S, Bendszus M, Hähnel S. Reduced white matter integrity in amateur boxers. Neuroradiology 2016; 58:911-20. [PMID: 27230917 DOI: 10.1007/s00234-016-1705-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Accepted: 05/13/2016] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Professional boxing can lead to chronic traumatic encephalopathy, a variant of traumatic brain injury (TBI). Its occurrence in amateur boxers is a matter of debate since amateur boxing is considered to be less harmful due to more strict regulations. However, several studies using different methodological approaches have revealed subtle signs of TBI even in amateurs. Diffusion tensor imaging (DTI) is sensitive to microscopic white matter changes and has been proven useful in TBI when routine MR imaging often is unrevealing. METHODS DTI, with tract-based spatial statistics (TBSS) together with neuropsychological examination of executive functions and memory, was used to investigate a collective of 31 male amateur boxers and 31 age-matched controls as well as a subgroup of 19 individuals, respectively, who were additionally matched for intellectual performance (IQ). RESULTS All participants had normal findings in neurological examination and conventional MR. Amateur boxers did not show deficits in neuropsychological tests when their IQ was taken into account. Fractional anisotropy was significantly reduced, while diffusivity measures were increased along central white matter tracts in the boxers group. These changes were in part associated with the number of fights. CONCLUSIONS TBSS revealed widespread white matter disturbance partially related to the individual fighting history in amateur boxers. These findings closely resemble those in patients with accidental TBI and indicate similar histological changes in amateur boxers.
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Affiliation(s)
- Christian Herweh
- Department of Neuroradiology, University of Heidelberg Medical School, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.
| | - Klaus Hess
- Department of Neurology, University of Heidelberg Medical School, Heidelberg, Germany
| | | | - Andreas J Bartsch
- Department of Neuroradiology, University of Heidelberg Medical School, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Christoph Stippich
- Department of Neuroradiology, University Hospital Basel, Basel, Switzerland
| | - Joachim Jost
- National Training Center for Boxing, Heidelberg, Germany
| | - Birgit Friedmann-Bette
- Department of Sports Medicine, University of Heidelberg Medical School, Heidelberg, Germany
| | - Sabine Heiland
- Department of Neuroradiology, University of Heidelberg Medical School, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Martin Bendszus
- Department of Neuroradiology, University of Heidelberg Medical School, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Stefan Hähnel
- Department of Neuroradiology, University of Heidelberg Medical School, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
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Solomon GS, Kuhn AW, Zuckerman SL, Casson IR, Viano DC, Lovell MR, Sills AK. Participation in Pre-High School Football and Neurological, Neuroradiological, and Neuropsychological Findings in Later Life: A Study of 45 Retired National Football League Players. Am J Sports Med 2016; 44:1106-15. [PMID: 26888877 DOI: 10.1177/0363546515626164] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND A recent study found that an earlier age of first exposure (AFE) to tackle football was associated with long-term neurocognitive impairment in retired National Football League (NFL) players. PURPOSE To assess the association between years of exposure to pre-high school football (PreYOE) and neuroradiological, neurological, and neuropsychological outcome measures in a different sample of retired NFL players. STUDY DESIGN Cross-sectional study; Level of evidence, 3. METHODS Forty-five former NFL players were included in this study. All participants prospectively completed extensive history taking, a neurological examination, brain magnetic resonance imaging, and a comprehensive battery of neuropsychological tests. To measure the associations between PreYOE and these outcome measures, multiple regression models were utilized while controlling for several covariates. RESULTS After applying a Bonferroni correction for multiple comparisons, none of the neurological, neuroradiological, or neuropsychological outcome measures yielded a significant relationship with PreYOE. A second Bonferroni-corrected analysis of a subset of these athletes with self-reported learning disability yielded no significant relationships on paper-and-pencil neurocognitive tests but did result in a significant association between learning disability and computerized indices of visual motor speed and reaction time. CONCLUSION The current study failed to replicate the results of a prior study, which concluded that an earlier AFE to tackle football might result in long-term neurocognitive deficits. In 45 retired NFL athletes, there were no associations between PreYOE and neuroradiological, neurological, and neuropsychological outcome measures.
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Affiliation(s)
- Gary S Solomon
- Department of Neurological Surgery, Vanderbilt Sports Concussion Center, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Andrew W Kuhn
- MedSport-Sports Medicine and Physical Therapy, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Scott L Zuckerman
- Department of Neurological Surgery, Vanderbilt Sports Concussion Center, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Ira R Casson
- Department of Neurology, Hofstra North Shore-LIJ School of Medicine, Hofstra University, Hempstead, New York, USA
| | - David C Viano
- ProBiomechanics LLC, Bloomfield Hills, Michigan, USA Department of Biomedical Engineering and Radiology, Wayne State University, Detroit, Michigan, USA
| | - Mark R Lovell
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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