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Beard K, Gauff AK, Pennington AM, Marion DW, Smith J, Sloley S. Biofluid, Imaging, Physiological, and Functional Biomarkers of Mild Traumatic Brain Injury and Subconcussive Head Impacts. J Neurotrauma 2024. [PMID: 38943278 DOI: 10.1089/neu.2024.0136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/01/2024] Open
Abstract
Post-concussive symptoms are frequently reported by individuals who sustain mild traumatic brain injuries (mTBIs) and subconcussive head impacts, even when evidence of intracranial pathology is lacking. Current strategies used to evaluate head injuries, which primarily rely on self-report, have a limited ability to predict the incidence, severity, and duration of post-concussive symptoms that will develop in an individual patient. In addition, these self-report measures have little association with the underlying mechanisms of pathology that may contribute to persisting symptoms, impeding advancement in precision treatment for TBI. Emerging evidence suggests that biofluid, imaging, physiological, and functional biomarkers associated with mTBI and subconcussive head impacts may address these shortcomings by providing more objective measures of injury severity and underlying pathology. Interest in the use of biomarker data has rapidly accelerated, which is reflected by the recent efforts of organizations such as the National Institute of Neurological Disorders and Stroke and the National Academies of Sciences, Engineering, and Medicine to prioritize the collection of biomarker data during TBI characterization in acute-care settings. Thus, this review aims to describe recent progress in the identification and development of biomarkers of mTBI and subconcussive head impacts and to discuss important considerations for the implementation of these biomarkers in clinical practice.
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Affiliation(s)
- Kryshawna Beard
- General Dynamics Information Technology Fairfax, Falls Church, Virginia, USA
- Traumatic Brain Injury Center of Excellence, Silver Spring, Maryland, USA
| | - Amina K Gauff
- Traumatic Brain Injury Center of Excellence, Silver Spring, Maryland, USA
- Xynergie Federal, LLC, San Juan, United States Minor Outlying Islands
| | - Ashley M Pennington
- Traumatic Brain Injury Center of Excellence, Silver Spring, Maryland, USA
- Xynergie Federal, LLC, San Juan, United States Minor Outlying Islands
| | - Donald W Marion
- General Dynamics Information Technology Fairfax, Falls Church, Virginia, USA
- Traumatic Brain Injury Center of Excellence, Silver Spring, Maryland, USA
| | - Johanna Smith
- Traumatic Brain Injury Center of Excellence, Silver Spring, Maryland, USA
| | - Stephanie Sloley
- Traumatic Brain Injury Center of Excellence, Silver Spring, Maryland, USA
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Domínguez D JF, Stewart A, Burmester A, Akhlaghi H, O'Brien K, Bollmann S, Caeyenberghs K. Improving quantitative susceptibility mapping for the identification of traumatic brain injury neurodegeneration at the individual level. Z Med Phys 2024:S0939-3889(24)00001-1. [PMID: 38336583 DOI: 10.1016/j.zemedi.2024.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 12/19/2023] [Accepted: 01/07/2024] [Indexed: 02/12/2024]
Abstract
BACKGROUND Emerging evidence suggests that traumatic brain injury (TBI) is a major risk factor for developing neurodegenerative disease later in life. Quantitative susceptibility mapping (QSM) has been used by an increasing number of studies in investigations of pathophysiological changes in TBI. However, generating artefact-free quantitative susceptibility maps in brains with large focal lesions, as in the case of moderate-to-severe TBI (ms-TBI), is particularly challenging. To address this issue, we utilized a novel two-pass masking technique and reconstruction procedure (two-pass QSM) to generate quantitative susceptibility maps (QSMxT; Stewart et al., 2022, Magn Reson Med.) in combination with the recently developed virtual brain grafting (VBG) procedure for brain repair (Radwan et al., 2021, NeuroImage) to improve automated delineation of brain areas. We used QSMxT and VBG to generate personalised QSM profiles of individual patients with reference to a sample of healthy controls. METHODS Chronic ms-TBI patients (N = 8) and healthy controls (N = 12) underwent (multi-echo) GRE, and anatomical MRI (MPRAGE) on a 3T Siemens PRISMA scanner. We reconstructed the magnetic susceptibility maps using two-pass QSM from QSMxT. We then extracted values of magnetic susceptibility in grey matter (GM) regions (following brain repair via VBG) across the whole brain and determined if they deviate from a reference healthy control group [Z-score < -3.43 or > 3.43, relative to the control mean], with the aim of obtaining personalised QSM profiles. RESULTS Using two-pass QSM, we achieved susceptibility maps with a substantial increase in quality and reduction in artefacts irrespective of the presence of large focal lesions, compared to single-pass QSM. In addition, VBG minimised the loss of GM regions and exclusion of patients due to failures in the region delineation step. Our findings revealed deviations in magnetic susceptibility measures from the HC group that differed across individual TBI patients. These changes included both increases and decreases in magnetic susceptibility values in multiple GM regions across the brain. CONCLUSIONS We illustrate how to obtain magnetic susceptibility values at the individual level and to build personalised QSM profiles in ms-TBI patients. Our approach opens the door for QSM investigations in more severely injured patients. Such profiles are also critical to overcome the inherent heterogeneity of clinical populations, such as ms-TBI, and to characterize the underlying mechanisms of neurodegeneration at the individual level more precisely. Moreover, this new personalised QSM profiling could in the future assist clinicians in assessing recovery and formulating a neuroscience-guided integrative rehabilitation program tailored to individual TBI patients.
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Affiliation(s)
- Juan F Domínguez D
- Cognitive Neuroscience Unit, School of Psychology, Deakin University, Geelong, Australia.
| | - Ashley Stewart
- School of Information Technology and Electrical Engineering, Faculty of Engineering, Architecture, and Information Technology, The University of Queensland, Brisbane, Australia
| | - Alex Burmester
- Cognitive Neuroscience Unit, School of Psychology, Deakin University, Geelong, Australia
| | - Hamed Akhlaghi
- Cognitive Neuroscience Unit, School of Psychology, Deakin University, Geelong, Australia; Department of Emergency Medicine, St. Vincent's Hospital, Melbourne, Australia
| | - Kieran O'Brien
- Siemens Healthcare Pty Ltd, Brisbane, Queensland, Australia
| | - Steffen Bollmann
- School of Information Technology and Electrical Engineering, Faculty of Engineering, Architecture, and Information Technology, The University of Queensland, Brisbane, Australia; Centre for Advanced Imaging, The University of Queensland, Brisbane, Australia
| | - Karen Caeyenberghs
- Cognitive Neuroscience Unit, School of Psychology, Deakin University, Geelong, Australia
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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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Echemendia RJ, Burma JS, Bruce JM, Davis GA, Giza CC, Guskiewicz KM, Naidu D, Black AM, Broglio S, Kemp S, Patricios JS, Putukian M, Zemek R, Arango-Lasprilla JC, Bailey CM, Brett BL, Didehbani N, Gioia G, Herring SA, Howell D, Master CL, Valovich McLeod TC, Meehan WP, Premji Z, Salmon D, van Ierssel J, Bhathela N, Makdissi M, Walton SR, Kissick J, Pardini J, Schneider KJ. Acute evaluation of sport-related concussion and implications for the Sport Concussion Assessment Tool (SCAT6) for adults, adolescents and children: a systematic review. Br J Sports Med 2023; 57:722-735. [PMID: 37316213 DOI: 10.1136/bjsports-2022-106661] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/25/2023] [Indexed: 06/16/2023]
Abstract
OBJECTIVES To systematically review the scientific literature regarding the acute assessment of sport-related concussion (SRC) and provide recommendations for improving the Sport Concussion Assessment Tool (SCAT6). DATA SOURCES Systematic searches of seven databases from 2001 to 2022 using key words and controlled vocabulary relevant to concussion, sports, SCAT, and acute evaluation. ELIGIBILITY CRITERIA (1) Original research articles, cohort studies, case-control studies, and case series with a sample of >10; (2) ≥80% SRC; and (3) studies using a screening tool/technology to assess SRC acutely (<7 days), and/or studies containing psychometric/normative data for common tools used to assess SRC. DATA EXTRACTION Separate reviews were conducted involving six subdomains: Cognition, Balance/Postural Stability, Oculomotor/Cervical/Vestibular, Emerging Technologies, and Neurological Examination/Autonomic Dysfunction. Paediatric/Child studies were included in each subdomain. Risk of Bias and study quality were rated by coauthors using a modified SIGN (Scottish Intercollegiate Guidelines Network) tool. RESULTS Out of 12 192 articles screened, 612 were included (189 normative data and 423 SRC assessment studies). Of these, 183 focused on cognition, 126 balance/postural stability, 76 oculomotor/cervical/vestibular, 142 emerging technologies, 13 neurological examination/autonomic dysfunction, and 23 paediatric/child SCAT. The SCAT discriminates between concussed and non-concussed athletes within 72 hours of injury with diminishing utility up to 7 days post injury. Ceiling effects were apparent on the 5-word list learning and concentration subtests. More challenging tests, including the 10-word list, were recommended. Test-retest data revealed limitations in temporal stability. Studies primarily originated in North America with scant data on children. CONCLUSION Support exists for using the SCAT within the acute phase of injury. Maximal utility occurs within the first 72 hours and then diminishes up to 7 days after injury. The SCAT has limited utility as a return to play tool beyond 7 days. Empirical data are limited in pre-adolescents, women, sport type, geographical and culturally diverse populations and para athletes. PROSPERO REGISTRATION NUMBER CRD42020154787.
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Affiliation(s)
- Ruben J Echemendia
- Concussion Care Clinic, University Orthopedics, State College, Pennsylvania, USA
- University of Missouri Kansas City, Kansas City, Missouri, USA
| | - Joel S Burma
- Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Jared M Bruce
- Biomedical and Health Informatics, University of Missouri - Kansas City, Kansas City, Missouri, USA
| | - Gavin A Davis
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Cabrini Health, Malvern, Victoria, Australia
| | - Christopher C Giza
- Neurosurgery, UCLA Steve Tisch BrainSPORT Program, Los Angeles, California, USA
- Pediatrics/Pediatric Neurology, Mattel Children's Hospital UCLA, Los Angeles, California, USA
| | - Kevin M Guskiewicz
- Matthew Gfeller Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Dhiren Naidu
- Medicine, University of Alberta, Edmonton, Alberta, Canada
| | | | - Steven Broglio
- Michigan Concussion Center, University of Michigan, Ann Arbor, Michigan, USA
| | - Simon Kemp
- Sports Medicine, Rugby Football Union, London, UK
| | - Jon S Patricios
- Wits Sport and Health (WiSH), School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg-Braamfontein, South Africa
| | | | - Roger Zemek
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
- Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada
| | | | - Christopher M Bailey
- Neurology, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
- Neurology, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Benjamin L Brett
- Neurosurgery/ Neurology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | | | - Gerry Gioia
- Depts of Pediatrics and Psychiatry & Behavioral Sciences, Children's National Health System, Washington, District of Columbia, USA
| | - Stanley A Herring
- Department of Rehabilitation Medicine, Orthopaedics and Sports Medicine, and Neurological Surgery, University of Washington, Seattle, Washington, USA
| | - David Howell
- Orthopedics, Sports Medicine Center, Children's Hospital Colorado, Aurora, Colorado, USA
| | | | - Tamara C Valovich McLeod
- Department of Athletic Training and School of Osteopathic Medicine in Arizona, A.T. Still University, Mesa, Arizona, USA
| | - William P Meehan
- Sports Medicine, Children's Hospital Boston, Boston, Massachusetts, USA
- Emergency Medicine, Children's Hospital Boston, Boston, Massachusetts, USA
| | - Zahra Premji
- Libraries, University of Victoria, Victoria, British Columbia, Canada
| | | | | | - Neil Bhathela
- UCLA Health Steve Tisch BrainSPORT Program, Los Angeles, California, USA
| | - Michael Makdissi
- Florey Institute of Neuroscience and Mental Health - Austin Campus, Heidelberg, Victoria, Australia
- La Trobe Sport and Exercise Medicine Research Centre, Melbourne, Victoria, Australia
| | - Samuel R Walton
- Department of Physical Medicine and Rehabilitation, School of Medicine, Richmond, Virginia, USA
| | - James Kissick
- Dept of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Jamie Pardini
- Departments of Internal Medicine and Neurology, University of Arizona College of Medicine, Phoenix, Arizona, USA
| | - Kathryn J Schneider
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
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Sader N, Gobbi D, Goodyear B, Frayne R, Ware AL, Beauchamp MH, Craig WR, Doan Q, Zemek R, Riva-Cambrin J, Yeates KO. Can quantitative susceptibility mapping help diagnose and predict recovery of concussion in children? An A-CAP study. J Neurol Neurosurg Psychiatry 2023; 94:227-235. [PMID: 36517039 DOI: 10.1136/jnnp-2022-329487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 11/16/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Quantitative susceptibility mapping (QSM) is an MRI technique that is a potential biomarker for concussion. We performed QSM in children following concussion or orthopaedic injury (OI), to assess QSM performance as a diagnostic and prognostic biomarker. METHODS Children aged 8-17 years with either concussion (N=255) or OI (N=116) were recruited from four Canadian paediatric emergency departments and underwent QSM postacutely (2-33 days postinjury) using 3 Tesla MRI. QSM Z-scores within nine regions of interest (ROI) were compared between groups. QSM Z-scores were also compared with the 5P score, the current clinical benchmark for predicting persistent postconcussion symptoms (PPCS), at 4 weeks postinjury, with PPCS defined using reliable change methods based on both participant and parent reports. RESULTS Concussion and OI groups did not differ significantly in QSM Z-scores for any ROI. Higher QSM Z-scores within frontal white matter (WM) independently predicted PPCS based on parent ratings of cognitive symptoms (p=0.001). The combination of frontal WM QSM Z-score and 5P score was better at predicting PPCS than 5P score alone (p=0.004). The area under the curve was 0.72 (95% CI 0.63 to 0.81) for frontal WM susceptibility, 0.69 (95% CI 0.59 to 0.79) for the 5P score and 0.74 (95% CI 0.65 to 0.83) for both. CONCLUSION The findings suggest that QSM is a potential MRI biomarker that can help predict PPCS in children with concussion, over and above the current clinical benchmark, and thereby aid in clinical management. They also suggest a frontal lobe substrate for PPCS, highlighting the potential for QSM to clarify the neurophysiology of paediatric concussion.
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Affiliation(s)
- Nicholas Sader
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
| | - David Gobbi
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada.,Department of Radiology, University of Calgary, Calgary, Alberta, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.,Seaman Family MR Research Centre and Calgary Image Processing and Analysis Centre (CIPAC), Foothills Medical Centre, Alberta Health Services, Calgary, Alberta, Canada
| | - Brad Goodyear
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada.,Department of Radiology, University of Calgary, Calgary, Alberta, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.,Seaman Family MR Research Centre and Calgary Image Processing and Analysis Centre (CIPAC), Foothills Medical Centre, Alberta Health Services, Calgary, Alberta, Canada
| | - Richard Frayne
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada.,Department of Radiology, University of Calgary, Calgary, Alberta, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.,Seaman Family MR Research Centre and Calgary Image Processing and Analysis Centre (CIPAC), Foothills Medical Centre, Alberta Health Services, Calgary, Alberta, Canada.,Department of Neuroscience, University of Calgary, Calgary, Alberta, Canada
| | - Ashley L Ware
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.,Department of Psychology, Georgia State University, Atlanta, Georgia, USA.,Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada.,Department of Psychology, University of Calgary, Calgary, Alberta, Canada
| | - Miriam H Beauchamp
- Department of Psychology, University of Montreal & CHU Sainte-Justine Hospital Research Center, Montreal, Quebec, Canada
| | - William R Craig
- Department of Pediatrics, University of Alberta, Stollery Children's Hospital, Edmonton, Alberta, Canada
| | - Quynh Doan
- Department of Pediatrics, University of British Columbia, BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada
| | - Roger Zemek
- Department of Pediatrics and Emergency Medicine, University of Ottawa, Ottawa, Ontario, Canada.,Children's Hospital of Eastern Ontario Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Jay Riva-Cambrin
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada.,Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
| | - Keith Owen Yeates
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada .,Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada.,Department of Psychology, University of Calgary, Calgary, Alberta, Canada
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6
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Johnson-Kerner BL, Colao K, Evanson NK, Taylor JM. Attitudes and practices of specialty physicians regarding the return to school process after pediatric acquired brain injury. J Pediatr Rehabil Med 2023; 16:497-505. [PMID: 36847024 DOI: 10.3233/prm-210130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/23/2023] Open
Abstract
PURPOSE More than 50,000 children are hospitalized yearly in the U.S. for acquired brain injury (ABI) with no established standards or protocols for school re-entry and limited resources for hospital-school communication. While ultimately the school has autonomy over curricula and services, specialty physicians were asked about their participation and perception of barriers in the school re-entry process. METHODS Approximately 545 specialty physicians were sent an electronic survey. RESULTS 84 responses (43% neurologists and 37% physiatrists) were obtained with a response rate of ∼15%. Thirty-five percent reported that specialty clinicians currently make the plan for school re-entry. The biggest challenge for school re-entry noted by physicians was cognitive difficulties (63%). The biggest gaps perceived by physicians were a lack of hospital-school liaisons to help design and implement a school re-entry plan (27%), schools' inability to implement a school re-entry plan (26%), and an evidence-based cognitive rehab curriculum (26%). Forty-seven percent of physicians reported that they did not have adequate medical personnel to support school re-entry. The most commonly used outcome measure was family satisfaction. Ideal outcome measures included satisfaction (33%) and formal assessment of quality of life (26%). CONCLUSION These data suggest that specialty physicians identify a lack of school liaisons in the medical setting as an important gap in hospital-school communication. Satisfaction and formal assessment of quality of life are meaningful outcomes for this provider group.
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Affiliation(s)
- Bethany L Johnson-Kerner
- Department of Neurology and Pediatrics, University of California San Francisco, San Francisco, CA, USA
| | - Kathleen Colao
- Department of Neurology and Pediatrics, University of California San Francisco, San Francisco, CA, USA
| | - Nathan K Evanson
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
- Division of Pediatric Rehabilitation Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - J Michael Taylor
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
- Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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7
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Chen X, Schädelin S, Lu PJ, Ocampo-Pineda M, Weigel M, Barakovic M, Ruberte E, Cagol A, Marechal B, Kober T, Kuhle J, Kappos L, Melie-Garcia L, Granziera C. Personalized maps of T1 relaxometry abnormalities provide correlates of disability in multiple sclerosis patients. Neuroimage Clin 2023; 37:103349. [PMID: 36801600 PMCID: PMC9958406 DOI: 10.1016/j.nicl.2023.103349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Revised: 02/08/2023] [Accepted: 02/10/2023] [Indexed: 02/16/2023]
Abstract
OBJECTIVES AND AIMS Quantitative MRI (qMRI) has greatly improved the sensitivity and specificity of microstructural brain pathology in multiple sclerosis (MS) when compared to conventional MRI (cMRI). More than cMRI, qMRI also provides means to assess pathology within the normal-appearing and lesion tissue. In this work, we further developed a method providing personalized quantitative T1 (qT1) abnormality maps in individual MS patients by modeling the age dependence of qT1 alterations. In addition, we assessed the relationship between qT1 abnormality maps and patients' disability, in order to evaluate the potential value of this measurement in clinical practice. METHODS We included 119 MS patients (64 relapsing-remitting MS (RRMS), 34 secondary progressive MS (SPMS), 21 primary progressive MS (PPMS)), and 98 Healthy Controls (HC). All individuals underwent 3T MRI examinations, including Magnetization Prepared 2 Rapid Acquisition Gradient Echoes (MP2RAGE) for qT1 maps and High-Resolution 3D Fluid Attenuated Inversion Recovery (FLAIR) imaging. To calculate personalized qT1 abnormality maps, we compared qT1 in each brain voxel in MS patients to the average qT1 obtained in the same tissue (grey/white matter) and region of interest (ROI) in healthy controls, hereby providing individual voxel-based Z-score maps. The age dependence of qT1 in HC was modeled using linear polynomial regression. We computed the average qT1 Z-scores in white matter lesions (WMLs), normal-appearing white matter (NAWM), cortical grey matter lesions (GMcLs) and normal-appearing cortical grey matter (NAcGM). Lastly, a multiple linear regression (MLR) model with the backward selection including age, sex, disease duration, phenotype, lesion number, lesion volume and average Z-score (NAWM/NAcGM/WMLs/GMcLs) was used to assess the relationship between qT1 measures and clinical disability (evaluated with EDSS). RESULTS The average qT1 Z-score was higher in WMLs than in NAWM. (WMLs: 1.366 ± 0.409, NAWM: -0.133 ± 0.288, [mean ± SD], p < 0.001). The average Z-score in NAWM in RRMS patients was significantly lower than in PPMS patients (p = 0.010). The MLR model showed a strong association between average qT1 Z-scores in white matter lesions (WMLs) and EDSS (R2 = 0.549, β = 0.178, 97.5 % CI = 0.030 to 0.326, p = 0.019). Specifically, we measured a 26.9 % increase in EDSS per unit of qT1 Z-score in WMLs in RRMS patients (R2 = 0.099, β = 0.269, 97.5 % CI = 0.078 to 0.461, p = 0.007). CONCLUSIONS We showed that personalized qT1 abnormality maps in MS patients provide measures related to clinical disability, supporting the use of those maps in clinical practice.
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Affiliation(s)
- Xinjie Chen
- Translational Imaging in Neurology (ThINK) Basel, Department of Biomedical Engineering, Faculty of Medicine, University Hospital Basel and University of Basel, Basel, Switzerland; Department of Neurology, University Hospital Basel, Switzerland; Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel and University of Basel, Basel, Switzerland
| | - Sabine Schädelin
- Translational Imaging in Neurology (ThINK) Basel, Department of Biomedical Engineering, Faculty of Medicine, University Hospital Basel and University of Basel, Basel, Switzerland; Department of Neurology, University Hospital Basel, Switzerland; Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel and University of Basel, Basel, Switzerland
| | - Po-Jui Lu
- Translational Imaging in Neurology (ThINK) Basel, Department of Biomedical Engineering, Faculty of Medicine, University Hospital Basel and University of Basel, Basel, Switzerland; Department of Neurology, University Hospital Basel, Switzerland; Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel and University of Basel, Basel, Switzerland
| | - Mario Ocampo-Pineda
- Translational Imaging in Neurology (ThINK) Basel, Department of Biomedical Engineering, Faculty of Medicine, University Hospital Basel and University of Basel, Basel, Switzerland; Department of Neurology, University Hospital Basel, Switzerland; Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel and University of Basel, Basel, Switzerland
| | - Matthias Weigel
- Translational Imaging in Neurology (ThINK) Basel, Department of Biomedical Engineering, Faculty of Medicine, University Hospital Basel and University of Basel, Basel, Switzerland; Department of Neurology, University Hospital Basel, Switzerland; Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel and University of Basel, Basel, Switzerland; Division of Radiological Physics, Department of Radiology, University Hospital Basel, Basel, Switzerland
| | - Muhamed Barakovic
- Translational Imaging in Neurology (ThINK) Basel, Department of Biomedical Engineering, Faculty of Medicine, University Hospital Basel and University of Basel, Basel, Switzerland; Department of Neurology, University Hospital Basel, Switzerland; Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel and University of Basel, Basel, Switzerland
| | - Esther Ruberte
- Translational Imaging in Neurology (ThINK) Basel, Department of Biomedical Engineering, Faculty of Medicine, University Hospital Basel and University of Basel, Basel, Switzerland; Department of Neurology, University Hospital Basel, Switzerland; Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel and University of Basel, Basel, Switzerland
| | - Alessandro Cagol
- Translational Imaging in Neurology (ThINK) Basel, Department of Biomedical Engineering, Faculty of Medicine, University Hospital Basel and University of Basel, Basel, Switzerland; Department of Neurology, University Hospital Basel, Switzerland; Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel and University of Basel, Basel, Switzerland
| | - Benedicte Marechal
- Advanced Clinical Imaging Technology, Siemens Healthineers International AG, Lausanne, Switzerland
| | - Tobias Kober
- Advanced Clinical Imaging Technology, Siemens Healthineers International AG, Lausanne, Switzerland
| | - Jens Kuhle
- Department of Neurology, University Hospital Basel, Switzerland; Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel and University of Basel, Basel, Switzerland
| | - Ludwig Kappos
- Translational Imaging in Neurology (ThINK) Basel, Department of Biomedical Engineering, Faculty of Medicine, University Hospital Basel and University of Basel, Basel, Switzerland; Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel and University of Basel, Basel, Switzerland
| | - Lester Melie-Garcia
- Translational Imaging in Neurology (ThINK) Basel, Department of Biomedical Engineering, Faculty of Medicine, University Hospital Basel and University of Basel, Basel, Switzerland; Department of Neurology, University Hospital Basel, Switzerland; Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel and University of Basel, Basel, Switzerland
| | - Cristina Granziera
- Translational Imaging in Neurology (ThINK) Basel, Department of Biomedical Engineering, Faculty of Medicine, University Hospital Basel and University of Basel, Basel, Switzerland; Department of Neurology, University Hospital Basel, Switzerland; Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel and University of Basel, Basel, Switzerland.
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Sub-acute Changes on MRI Measures of Cerebral Blood Flow and Venous Oxygen Saturation in Concussed Australian Rules Footballers. SPORTS MEDICINE - OPEN 2022; 8:45. [PMID: 35362855 PMCID: PMC8975948 DOI: 10.1186/s40798-022-00435-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 03/17/2022] [Indexed: 12/03/2022]
Abstract
Background Sports-related concussion (SRC) is common in collision sport athletes. There is growing evidence that repetitive SRC can have serious neurological consequences, particularly when the repetitive injuries occur when the brain has yet to fully recover from the initial injury. Hence, there is a need to identify biomarkers that are capable of determining SRC recovery so that they can guide clinical decisions pertaining to return-to-play. Cerebral venous oxygen saturation (SvO2) and cerebral blood flow (CBF) can be measured using magnetic resonance imaging (MRI) and may provide insights into changing energy demands and recovery following SRC. Results In this study we therefore investigated SvO2 and CBF in a cohort of concussed amateur Australian Football athletes (i.e., Australia’s most participated collision sport). Male and female Australian footballers (n = 13) underwent MRI after being cleared to return to play following a mandatory 13-day recovery period and were compared to a group of control Australian footballers (n = 16) with no recent history of SRC (i.e., > 3 months since last SRC). Despite the concussed Australian footballers being cleared to return to play at the time of MRI, we found evidence of significantly increased susceptibility in the global white matter (p = 0.020) and a trend (F5,21 = 2.404, p = 0.071) for reduced relative CBF (relCBF) compared to the control group. Further, there was evidence of an interaction between sex and injury in straight sinus susceptibility values (F1,25 = 3.858, p = 0.061) which were decreased in female SRC athletes (p = 0.053). Of note, there were significant negative correlations between straight sinus susceptibility and relCBF suggesting impaired metabolic function after SRC. Conclusions These findings support the use of quantitative susceptibility mapping (QSM) and relCBF as sensitive indicators of SRC, and raise further concerns related to SRC guidelines that allow for return-to-play in less than two weeks.
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Lunkova E, Guberman GI, Ptito A, Saluja RS. Noninvasive magnetic resonance imaging techniques in mild traumatic brain injury research and diagnosis. Hum Brain Mapp 2021; 42:5477-5494. [PMID: 34427960 PMCID: PMC8519871 DOI: 10.1002/hbm.25630] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 08/06/2021] [Accepted: 08/07/2021] [Indexed: 12/13/2022] Open
Abstract
Mild traumatic brain injury (mTBI), frequently referred to as concussion, is one of the most common neurological disorders. The underlying neural mechanisms of functional disturbances in the brains of concussed individuals remain elusive. Novel forms of brain imaging have been developed to assess patients postconcussion, including functional magnetic resonance imaging (fMRI), susceptibility-weighted imaging (SWI), diffusion MRI (dMRI), and perfusion MRI [arterial spin labeling (ASL)], but results have been mixed with a more common utilization in the research environment and a slower integration into the clinical setting. In this review, the benefits and drawbacks of the methods are described: fMRI is an effective method in the diagnosis of concussion but it is expensive and time-consuming making it difficult for regular use in everyday practice; SWI allows detection of microhemorrhages in acute and chronic phases of concussion; dMRI is primarily used for the detection of white matter abnormalities, especially axonal injury, specific for mTBI; and ASL is an alternative to the BOLD method with its ability to track cerebral blood flow alterations. Thus, the absence of a universal diagnostic neuroimaging method suggests a need for the adoption of a multimodal approach to the neuroimaging of mTBI. Taken together, these methods, with their underlying functional and structural features, can contribute from different angles to a deeper understanding of mTBI mechanisms such that a comprehensive diagnosis of mTBI becomes feasible for the clinician.
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Affiliation(s)
- Ekaterina Lunkova
- Department of Neurology & NeurosurgeryMcGill UniversityMontrealQuebecCanada
| | - Guido I. Guberman
- Department of Neurology & NeurosurgeryMcGill UniversityMontrealQuebecCanada
| | - Alain Ptito
- Department of Neurology & NeurosurgeryMcGill UniversityMontrealQuebecCanada
- Montreal Neurological InstituteMontrealQuebecCanada
- Department of PsychologyMcGill University Health CentreMontrealQuebecCanada
| | - Rajeet Singh Saluja
- Department of Neurology & NeurosurgeryMcGill UniversityMontrealQuebecCanada
- McGill University Health Centre Research InstituteMontrealQuebecCanada
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