1
|
Rahmani F, Batson RD, Zimmerman A, Reddigari S, Bigler ED, Lanning SC, Ilasa E, Grafman JH, Lu H, Lin AP, Raji CA. Rate of abnormalities in quantitative MR neuroimaging of persons with chronic traumatic brain injury. BMC Neurol 2024; 24:235. [PMID: 38969967 PMCID: PMC11225195 DOI: 10.1186/s12883-024-03745-6] [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] [Received: 02/21/2024] [Accepted: 06/26/2024] [Indexed: 07/07/2024] Open
Abstract
BACKGROUND Mild traumatic brain injury (mTBI) can result in lasting brain damage that is often too subtle to detect by qualitative visual inspection on conventional MR imaging. Although a number of FDA-cleared MR neuroimaging tools have demonstrated changes associated with mTBI, they are still under-utilized in clinical practice. METHODS We investigated a group of 65 individuals with predominantly mTBI (60 mTBI, 48 due to motor-vehicle collision, mean age 47 ± 13 years, 27 men and 38 women) with MR neuroimaging performed in a median of 37 months post-injury. We evaluated abnormalities in brain volumetry including analysis of left-right asymmetry by quantitative volumetric analysis, cerebral perfusion by pseudo-continuous arterial spin labeling (PCASL), white matter microstructure by diffusion tensor imaging (DTI), and neurometabolites via magnetic resonance spectroscopy (MRS). RESULTS All participants demonstrated atrophy in at least one lobar structure or increased lateral ventricular volume. The globus pallidi and cerebellar grey matter were most likely to demonstrate atrophy and asymmetry. Perfusion imaging revealed significant reductions of cerebral blood flow in both occipital and right frontoparietal regions. Diffusion abnormalities were relatively less common though a subset analysis of participants with higher resolution DTI demonstrated additional abnormalities. All participants showed abnormal levels on at least one brain metabolite, most commonly in choline and N-acetylaspartate. CONCLUSION We demonstrate the presence of coup-contrecoup perfusion injury patterns, widespread atrophy, regional brain volume asymmetry, and metabolic aberrations as sensitive markers of chronic mTBI sequelae. Our findings expand the historic focus on quantitative imaging of mTBI with DTI by highlighting the complementary importance of volumetry, arterial spin labeling perfusion and magnetic resonance spectroscopy neurometabolite analyses in the evaluation of chronic mTBI.
Collapse
Affiliation(s)
- Farzaneh Rahmani
- Department of Radiology, Washington University School of Medicine, Saint Louis, MO, USA
| | - Richard D Batson
- Endocrine & Brain Injury Research Alliance, Neurevolution Medicine, PLLC, NUNM Helfgott Research Institute, Portland, Oregon, USA
| | | | | | - Erin D Bigler
- Department of Neurology, Department of Psychiatry, University of Utah, Salt Lake City, UT, USA
| | | | | | - Jordan H Grafman
- Departments of Physical Medicine & Rehabilitation, Neurology, Cognitive Neurology and Alzheimer's Center, Department of Psychiatry, Feinberg School of Medicine, Department of Psychology, Weinberg College of Arts and Sciences, Northwestern University, Chicago, IL, USA
| | - Hanzhang Lu
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Alexander P Lin
- Center for Clinical Spectroscopy, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Cyrus A Raji
- Department of Radiology, Washington University School of Medicine, Saint Louis, MO, USA.
- Department of Neurology, Washington University School of Medicine, Saint Louis, MO, USA.
| |
Collapse
|
2
|
Huang W, Ma L, Yan J, Hu W, Liu G, Wang R, Zhang J. Neurite orientation dispersion and density imaging reveals abnormal white matter and glymphatic function in active young boxers. Eur J Sport Sci 2024; 24:975-986. [PMID: 38956796 PMCID: PMC11235717 DOI: 10.1002/ejsc.12113] [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] [Received: 11/02/2023] [Revised: 02/23/2024] [Accepted: 04/08/2024] [Indexed: 07/04/2024]
Abstract
The neurological effects and underlying pathophysiological mechanisms of sports-related concussion (SRC) in active young boxers remain poorly understood. This study aims to investigate the impairment of white matter microstructure and assess changes in glymphatic function following SRC by utilizing neurite orientation dispersion and density imaging (NODDI) on young boxers who have sustained SRC. A total of 60 young participants were recruited, including 30 boxers diagnosed with SRC and 30 healthy individuals engaging in regular exercise. The assessment of whole-brain white matter damage was conducted using diffusion metrics, while the evaluation of glymphatic function was performed through diffusion tensor imaging (DTI) analysis along the perivascular space (DTI-ALPS) index. A two-sample t-test was utilized to examine group differences in DTI and NODDI metrics. Spearman correlation and generalized linear mixed models were employed to investigate the relationship between clinical assessments of SRC and NODDI measurements. Significant alterations were observed in DTI and NODDI metrics among young boxers with SRC. Additionally, the DTI-ALPS index in the SRC group exhibited a significantly higher value than that of the control group (left side: 1.58 vs. 1.48, PFDR = 0.009; right side: 1.61 vs. 1.51, PFDR = 0.02). Moreover, it was observed that the DTI-ALPS index correlated with poorer cognitive test results among boxers in this study population. Repetitive SRC in active young boxers is associated with diffuse white matter injury and glymphatic dysfunction, highlighting the detrimental impact on brain health. These findings highlight the importance of long-term monitoring of the neurological health of boxers.
Collapse
Affiliation(s)
- Wenjing Huang
- Department of Magnetic ResonanceLanzhou University Second HospitalLanzhouChina
- Second Clinical SchoolLanzhou UniversityLanzhouChina
| | - Laiyang Ma
- Department of Magnetic ResonanceLanzhou University Second HospitalLanzhouChina
- Second Clinical SchoolLanzhou UniversityLanzhouChina
| | - Jiahao Yan
- Department of Magnetic ResonanceLanzhou University Second HospitalLanzhouChina
- Second Clinical SchoolLanzhou UniversityLanzhouChina
| | - Wanjun Hu
- Department of Magnetic ResonanceLanzhou University Second HospitalLanzhouChina
- Second Clinical SchoolLanzhou UniversityLanzhouChina
| | - Guangyao Liu
- Department of Magnetic ResonanceLanzhou University Second HospitalLanzhouChina
| | - Rui Wang
- Department of Magnetic ResonanceLanzhou University Second HospitalLanzhouChina
| | - Jing Zhang
- Department of Magnetic ResonanceLanzhou University Second HospitalLanzhouChina
| |
Collapse
|
3
|
Koochaki F, Najafizadeh L. A Siamese Convolutional Neural Network for Identifying Mild Traumatic Brain Injury and Predicting Recovery. IEEE Trans Neural Syst Rehabil Eng 2024; 32:1779-1786. [PMID: 38635385 DOI: 10.1109/tnsre.2024.3391067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/20/2024]
Abstract
Timely diagnosis of mild traumatic brain injury (mTBI) remains challenging due to the rapid recovery of acute symptoms and the absence of evidence of injury in static neuroimaging scans. Furthermore, while longitudinal tracking of mTBI is essential in understanding how the diseases progresses/regresses over time for enhancing personalized patient care, a standardized approach for this purpose is not yet available. Recent functional neuroimaging studies have provided evidence of brain function alterations following mTBI, suggesting mTBI-detection models can be built based on these changes. Most of these models, however, rely on manual feature engineering, but the optimal set of features for detecting mTBI may be unknown. Data-driven approaches, on the other hand, may uncover hidden relationships in an automated manner, making them suitable for the problem of mTBI detection. This paper presents a data-driven framework based on Siamese Convolutional Neural Network (SCNN) to detect mTBI and to monitor the recovery state from mTBI over time. The proposed framework is tested on the cortical images of Thy1-GCaMP6s mice, obtained via widefield calcium imaging, acquired in a longitudinal study. Results show that the proposed model achieves a classification accuracy of 96.5%. To track the state of the injured brain over time, a reference distance map is constructed, which together with the SCNN model, are employed to assess the recovery state in subsequent sessions after injury, revealing that the recovery progress varies among subjects. The promising results of this work suggest that a similar approach could be potentially applicable for monitoring recovery from mTBI, in humans.
Collapse
|
4
|
Chen J, Chung S, Li T, Fieremans E, Novikov DS, Wang Y, Lui YW. Identifying relevant diffusion MRI microstructure biomarkers relating to exposure to repeated head impacts in contact sport athletes. Neuroradiol J 2023; 36:693-701. [PMID: 37212469 PMCID: PMC10649530 DOI: 10.1177/19714009231177396] [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: 05/23/2023] Open
Abstract
PURPOSE Repeated head impacts (RHI) without concussion may cause long-term sequelae. A growing array of diffusion MRI metrics exist, both empiric and modeled and it is hard to know which are potentially important biomarkers. Common conventional statistical methods fail to consider interactions between metrics and rely on group-level comparisons. This study uses a classification pipeline as a means towards identifying important diffusion metrics associated with subconcussive RHI. METHODS 36 collegiate contact sport athletes and 45 non-contact sport controls from FITBIR CARE were included. Regional/whole brain WM statistics were computed from 7 diffusion metrics. Wrapper-based feature selection was applied to 5 classifiers representing a range of learning capacities. Best 2 classifiers were interpreted to identify the most RHI-related diffusion metrics. RESULTS Mean diffusivity (MD) and mean kurtosis (MK) are found to be the most important metrics for discriminating between athletes with and without RHI exposure history. Regional features outperformed global statistics. Linear approaches outperformed non-linear approaches with good generalizability (test AUC 0.80-0.81). CONCLUSION Feature selection and classification identifies diffusion metrics that characterize subconcussive RHI. Linear classifiers yield the best performance and mean diffusion, tissue microstructure complexity, and radial extra-axonal compartment diffusion (MD, MK, De,⊥) are found to be the most influential metrics. This work provides proof of concept that applying such approach to small, multidimensional dataset can be successful given attention to optimizing learning capacity without overfitting and serves an example of methods that lead to better understanding of the myriad of diffusion metrics as they relate to injury and disease.
Collapse
Affiliation(s)
- Junbo Chen
- Department of Electrical and Computer Engineering, New York University Tandon School of Engineering, Brooklyn, NY, USA
| | - Sohae Chung
- Center for Advanced Imaging Innovation and Research (CAI2R), Department of Radiology, New York University Grossman School of Medicine, New York, NY, USA
- Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology, New York University Grossman School of Medicine, New York, NY, USA
| | - Tianhao Li
- Department of Electrical and Computer Engineering, New York University Tandon School of Engineering, Brooklyn, NY, USA
| | - Els Fieremans
- Center for Advanced Imaging Innovation and Research (CAI2R), Department of Radiology, New York University Grossman School of Medicine, New York, NY, USA
- Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology, New York University Grossman School of Medicine, New York, NY, USA
| | - Dmitry S Novikov
- Center for Advanced Imaging Innovation and Research (CAI2R), Department of Radiology, New York University Grossman School of Medicine, New York, NY, USA
- Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology, New York University Grossman School of Medicine, New York, NY, USA
| | - Yao Wang
- Department of Electrical and Computer Engineering, New York University Tandon School of Engineering, Brooklyn, NY, USA
| | - Yvonne W Lui
- Center for Advanced Imaging Innovation and Research (CAI2R), Department of Radiology, New York University Grossman School of Medicine, New York, NY, USA
- Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology, New York University Grossman School of Medicine, New York, NY, USA
| |
Collapse
|
5
|
Du Q, Liu C, Liu Y, Li J, Gong X, Zhang Q, Li K. Investigation of long-term symptoms and influencing factors in patients with mild traumatic brain injury: A cross-sectional study. Int Emerg Nurs 2023; 69:101313. [PMID: 37348243 DOI: 10.1016/j.ienj.2023.101313] [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: 07/14/2022] [Revised: 05/11/2023] [Accepted: 05/25/2023] [Indexed: 06/24/2023]
Abstract
BACKGROUND Traumatic brain injury is the leading cause of death and disability in individuals under the age of 45, which places a heavy disease burden on patients and society. However, the prevalence of long-term symptoms in individuals who suffered from mild traumatic brain injury and how psychosocial factors affect their long-term symptoms remain unclear. OBJECTIVE To determine howpsychosocial factors influence long-term symptomsin individuals who suffered from mild traumatic brain injury as well as the prevalence of long-term symptoms. METHODS A demographic characteristics questionnaire, adapted self-report questionnaire of family relationship quality, revised Chinese version of the disease perception questionnaire, Rivermead postconcussion syndrome symptom questionnaire, Glasgow Outcome Scale-Extended, and Brief Symptoms Inventory 18 were used to collect data anonymously. Psychosocial factors associated with long-term symptoms in individuals who suffered from mild traumatic brain injury weremeasuredusingmultiple linear regression. RESULTS More than half of individuals who suffered from mild traumatic brain injury showed at least 1 long-term symptom after injury. Our results indicated that family relationship quality, disease perception, and demographic characteristics were related to the long-term symptoms of individuals who suffered from mild traumatic brain injury. CONCLUSIONS Our study shows that theprevalence of long-term symptomsfollowingmild traumatic brain injuryishigh. Psychosocial factors are related to patients' long-term symptoms. The findings indicate that healthcare administrators ought to adopt a robust health promotion strategy that prioritizes familial support and health education of diseases to ameliorate long-term symptoms in individuals who suffered from mild traumatic brain injury.
Collapse
Affiliation(s)
- Qiujing Du
- West China Hospital, Sichuan University/ West China School of Nursing, Sichuan University, Chengdu 610041, China
| | - Changqing Liu
- West China Hospital, Sichuan University/ West China School of Nursing, Sichuan University, Chengdu 610041, China
| | - Yuwei Liu
- West China Hospital, Sichuan University/ West China School of Nursing, Sichuan University, Chengdu 610041, China
| | - Jiafei Li
- West China Hospital, Sichuan University/ West China School of Nursing, Sichuan University, Chengdu 610041, China
| | - Xiaotong Gong
- West China Hospital, Sichuan University/ West China School of Nursing, Sichuan University, Chengdu 610041, China
| | - Qi Zhang
- West China Hospital, Sichuan University/ West China School of Nursing, Sichuan University, Chengdu 610041, China
| | - Ka Li
- West China Hospital, Sichuan University/ West China School of Nursing, Sichuan University, Chengdu 610041, China.
| |
Collapse
|
6
|
Abstract
Traumatic brain injury disrupts the complex anatomy of the afferent and efferent visual pathways. Injury to the afferent pathway can result in vision loss, visual field deficits, and photophobia. Injury to the efferent pathway primarily causes eye movement abnormalities resulting in ocular misalignment and double vision. Injury to both the afferent and efferent systems can result in significant visual disability.
Collapse
Affiliation(s)
- Mary D Maher
- Division of Neuroradiology, Department of Radiology, Perelman School of Medicine at the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA
| | - Mohit Agarwal
- Division of Neuroradiology, Department of Radiology, Medical College of Wisconsin, 9200 W Wisconsin Avenue, Milwaukee, WI 53226, USA
| | - Madhura A Tamhankar
- Division of Neuro-Ophthalmology, Department of Ophthalmology, Perelman School of Medicine at the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA
| | - Suyash Mohan
- Division of Neuroradiology, Department of Radiology, Perelman School of Medicine at the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA; Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA.
| |
Collapse
|
7
|
Irimia A, Ngo V, Chaudhari NN, Zhang F, Joshi SH, Penkova AN, O'Donnell LJ, Sheikh-Bahaei N, Zheng X, Chui HC. White matter degradation near cerebral microbleeds is associated with cognitive change after mild traumatic brain injury. Neurobiol Aging 2022; 120:68-80. [PMID: 36116396 PMCID: PMC9759713 DOI: 10.1016/j.neurobiolaging.2022.08.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 08/17/2022] [Accepted: 08/20/2022] [Indexed: 11/28/2022]
Abstract
To explore how cerebral microbleeds (CMBs) accompanying mild traumatic brain injury (mTBI) reflect white matter (WM) degradation and cognitive decline, magnetic resonance images were acquired from 62 mTBI adults (imaged ∼7 days and ∼6 months post-injury) and 203 matched healthy controls. On average, mTBI participants had a count of 2.7 ± 2.6 traumatic CMBs in WM, located 6.1 ± 4.4 mm from cortex. At ∼6-month follow-up, 97% of CMBs were associated with significant reductions (34% ± 11%, q < 0.05) in the fractional anisotropy of WM streamlines within ∼1 cm of CMB locations. Male sex and older age were significant risk factors for larger reductions (q < 0.05). For CMBs in the corpus callosum, cingulum bundle, inferior and middle longitudinal fasciculi, fractional anisotropy changes were significantly and positively associated with changes in cognitive functions mediated by these structures (q < 0.05). Our findings distinguish traumatic from non-traumatic CMBs by virtue of surrounding WM alterations and challenge the assumption that traumatic CMBs are neurocognitively silent. Thus, mTBI with CMB findings can be described as a clinical endophenotype warranting longitudinal cognitive assessment.
Collapse
Affiliation(s)
- Andrei Irimia
- Ethel Percy Andrus Gerontology Center, Leonard Davis School of Gerontology, University of Southern California, Los Angeles, CA, USA; Denney Research Center, Department of Biomedical Engineering, Viterbi School of Engineering, University of Southern California, Los Angeles, CA, USA.
| | - Van Ngo
- Ethel Percy Andrus Gerontology Center, Leonard Davis School of Gerontology, University of Southern California, Los Angeles, CA, USA
| | - Nikhil N Chaudhari
- Ethel Percy Andrus Gerontology Center, Leonard Davis School of Gerontology, University of Southern California, Los Angeles, CA, USA
| | - Fan Zhang
- Laboratory of Mathematics in Imaging, Department of Radiology, Brigham & Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Shantanu H Joshi
- Ahmanson Lovelace Brain Mapping Center, Department of Neurology, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Anita N Penkova
- Department of Aerospace and Mechanical Engineering, Viterbi School of Engineering, University of Southern California, Los Angeles, CA, USA
| | - Lauren J O'Donnell
- Laboratory of Mathematics in Imaging, Department of Radiology, Brigham & Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Nasim Sheikh-Bahaei
- Department of Neurology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA; Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Xiaoyu Zheng
- Department of Materials Science & Engineering, University of California, Berkeley, CA, USA
| | - Helena C Chui
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| |
Collapse
|
8
|
Mahoney SO, Chowdhury NF, Ngo V, Imms P, Irimia A. Mild Traumatic Brain Injury Results in Significant and Lasting Cortical Demyelination. Front Neurol 2022; 13:854396. [PMID: 35812106 PMCID: PMC9262516 DOI: 10.3389/fneur.2022.854396] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 05/23/2022] [Indexed: 11/13/2022] Open
Abstract
Despite contributing to neurocognitive deficits, intracortical demyelination after traumatic brain injury (TBI) is understudied. This study uses magnetic resonance imaging (MRI) to map intracortical myelin and its change in healthy controls and after mild TBI (mTBI). Acute mTBI involves reductions in relative myelin content primarily in lateral occipital regions. Demyelination mapped ~6 months post-injury is significantly more severe than that observed in typical aging (p < 0.05), with temporal, cingulate, and insular regions losing more myelin (30%, 20%, and 16%, respectively) than most other areas, although occipital regions experience 22% less demyelination. Thus, occipital regions may be more susceptible to primary injury, whereas temporal, cingulate and insular regions may be more susceptible to later manifestations of injury sequelae. The spatial profiles of aging- and mTBI-related chronic demyelination overlap substantially; exceptions include primary motor and somatosensory cortices, where myelin is relatively spared post-mTBI. These features resemble those of white matter demyelination and cortical thinning during Alzheimer's disease, whose risk increases after mTBI.
Collapse
Affiliation(s)
- Sean O. Mahoney
- Ethel Percy Andrus Gerontology Center, Leonard Davis School of Gerontology, University of Southern California, Los Angeles, CA, United States
| | - Nahian F. Chowdhury
- Ethel Percy Andrus Gerontology Center, Leonard Davis School of Gerontology, University of Southern California, Los Angeles, CA, United States
| | - Van Ngo
- Ethel Percy Andrus Gerontology Center, Leonard Davis School of Gerontology, University of Southern California, Los Angeles, CA, United States
| | - Phoebe Imms
- Ethel Percy Andrus Gerontology Center, Leonard Davis School of Gerontology, University of Southern California, Los Angeles, CA, United States
| | - Andrei Irimia
- Ethel Percy Andrus Gerontology Center, Leonard Davis School of Gerontology, University of Southern California, Los Angeles, CA, United States
- Corwin D. Denney Research Center, Department of Biomedical Engineering, Andrew and Edna Viterbi School of Engineering, University of Southern California, Los Angeles, CA, United States
- *Correspondence: Andrei Irimia
| |
Collapse
|
9
|
Huang CX, Li YH, Lu W, Huang SH, Li MJ, Xiao LZ, Liu J. Positron emission tomography imaging for the assessment of mild traumatic brain injury and chronic traumatic encephalopathy: recent advances in radiotracers. Neural Regen Res 2022; 17:74-81. [PMID: 34100430 PMCID: PMC8451552 DOI: 10.4103/1673-5374.314285] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
A chronic phase following repetitive mild traumatic brain injury can present as chronic traumatic encephalopathy in some cases, which requires a neuropathological examination to make a definitive diagnosis. Positron emission tomography (PET) is a molecular imaging modality that has high sensitivity for detecting even very small molecular changes, and can be used to quantitatively measure a range of molecular biological processes in the brain using different radioactive tracers. Functional changes have also been reported in patients with different forms of traumatic brain injury, especially mild traumatic brain injury and subsequent chronic traumatic encephalopathy. Thus, PET provides a novel approach for the further evaluation of mild traumatic brain injury at molecular levels. In this review, we discuss the recent advances in PET imaging with different radiotracers, including radioligands for PET imaging of glucose metabolism, tau, amyloid-beta, γ-aminobutyric acid type A receptors, and neuroinflammation, in the identification of altered neurological function. These novel radiolabeled ligands are likely to have widespread clinical application, and may be helpful for the treatment of mild traumatic brain injury. Moreover, PET functional imaging with different ligands can be used in the future to perform large-scale and sequential studies exploring the time-dependent changes that occur in mild traumatic brain injury.
Collapse
Affiliation(s)
- Chu-Xin Huang
- Department of Radiology; Department of Neurology, the Second Xiangya Hospital of Central South University, Changsha, Hunan Province, China
| | - Yan-Hui Li
- Department of Radiology, the Second Xiangya Hospital of Central South University, Changsha, Hunan Province, China
| | - Wei Lu
- Department of Neurology, the Second Xiangya Hospital of Central South University, Changsha, Hunan Province, China
| | - Si-Hong Huang
- Department of Radiology, the Second Xiangya Hospital of Central South University, Changsha, Hunan Province, China
| | - Meng-Jun Li
- Department of Radiology, the Second Xiangya Hospital of Central South University, Changsha, Hunan Province, China
| | - Li-Zhi Xiao
- PET-CT Center, the Second Xiangya Hospital of Central South University, Changsha, Hunan Province, China
| | - Jun Liu
- Department of Radiology, the Second Xiangya Hospital of Central South University, Changsha, Hunan Province, China
| |
Collapse
|
10
|
The Global Reading Room: Imaging of Posttraumatic Headache. AJR Am J Roentgenol 2021; 218:382-383. [PMID: 34319161 DOI: 10.2214/ajr.21.26587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
|
11
|
Amir J, Nair JKR, Del Carpio-O'Donovan R, Ptito A, Chen JK, Chankowsky J, Tinawi S, Lunkova E, Saluja RS. Atypical resting state functional connectivity in mild traumatic brain injury. Brain Behav 2021; 11:e2261. [PMID: 34152089 PMCID: PMC8413771 DOI: 10.1002/brb3.2261] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 06/08/2021] [Accepted: 06/08/2021] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES This study aimed to investigate changes in three intrinsic functional connectivity networks (IFCNs; default mode network [DMN], salience network [SN], and task-positive network [TPN]) in individuals who had sustained a mild traumatic brain injury (mTBI). METHODS Resting-state functional magnetic resonance imaging (rs-fMRI) data were acquired from 27 mTBI patients with persistent postconcussive symptoms, along with 26 age- and sex-matched controls. These individuals were recruited from a Level-1 trauma center, at least 3 months after a traumatic episode. IFCNs were established based on seed-to-voxel, region-of-interest (ROI) to ROI, and independent component analyses (ICA). Subsequently, we analyzed the relationship between functional connectivity and postconcussive symptoms. RESULTS Seed-to-voxel analysis of rs-fMRI demonstrated decreased functional connectivity in the right lateral parietal lobe, part of the DMN, and increased functional connectivity in the supramarginal gyrus, part of the SN. Our TPN showed both hypo- and hyperconnectivity dependent on seed location. Within network hypoconnectivity was observed in the visual network also using group comparison. Using an ICA, we identified altered network functional connectivity in regions within four IFCNs (sensorimotor, visual, DMN, and dorsal attentional). A significant negative correlation between dorsal attentional network connectivity and behavioral symptoms score was also found. CONCLUSIONS Our findings indicate that rs-fMRI may be of use clinically in order to assess disrupted functional connectivity among IFCNs in mTBI patients. Improved mTBI diagnostic and prognostic information could be especially relevant for athletes looking to safely return to play, as well for individuals from the general population with persistent postconcussive symptoms months after injury, who hope to resume activity.
Collapse
Affiliation(s)
- Joelle Amir
- Department of Neurology and Neurosurgery, McGill University, Montreal, Quebec, Canada
| | | | | | - Alain Ptito
- Department of Neurology and Neurosurgery, McGill University, Montreal, Quebec, Canada.,Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Jen-Kai Chen
- Department of Neurology and Neurosurgery, McGill University, Montreal, Quebec, Canada
| | - Jeffrey Chankowsky
- Department of Radiology, McGill University Health Centre, Montreal, Quebec, Canada
| | - Simon Tinawi
- Department of Rehabilitation Medicine, McGill University Health Centre, Montreal, Quebec, Canada
| | - Ekaterina Lunkova
- Department of Neurology and Neurosurgery, McGill University, Montreal, Quebec, Canada
| | - Rajeet Singh Saluja
- Department of Radiology, McGill University Health Centre, Montreal, Quebec, Canada.,Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| |
Collapse
|
12
|
Tan XG, Sajja VSSS, D'Souza MM, Gupta RK, Long JB, Singh AK, Bagchi A. A Methodology to Compare Biomechanical Simulations With Clinical Brain Imaging Analysis Utilizing Two Blunt Impact Cases. Front Bioeng Biotechnol 2021; 9:654677. [PMID: 34277581 PMCID: PMC8280347 DOI: 10.3389/fbioe.2021.654677] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Accepted: 04/06/2021] [Indexed: 12/03/2022] Open
Abstract
According to the US Defense and Veterans Brain Injury Center (DVBIC) and Centers for Disease Control and Prevention (CDC), mild traumatic brain injury (mTBI) is a common form of head injury. Medical imaging data provides clinical insight into tissue damage/injury and injury severity, and helps medical diagnosis. Computational modeling and simulation can predict the biomechanical characteristics of such injury, and are useful for development of protective equipment. Integration of techniques from computational biomechanics with medical data assessment modalities (e.g., magnetic resonance imaging or MRI) has not yet been used to predict injury, support early medical diagnosis, or assess effectiveness of personal protective equipment. This paper presents a methodology to map computational simulations with clinical data for interpreting blunt impact TBI utilizing two clinically different head injury case studies. MRI modalities, such as T1, T2, diffusion-weighted imaging (DWI) and apparent diffusion coefficient (ADC), were used for simulation comparisons. The two clinical cases have been reconstructed using finite element analysis to predict head biomechanics based on medical reports documented by a clinician. The findings are mapped to simulation results using image-based clinical analyses of head impact injuries, and modalities that could capture simulation results have been identified. In case 1, the MRI results showed lesions in the brain with skull indentation, while case 2 had lesions in both coup and contrecoup sides with no skull deformation. Simulation data analyses show that different biomechanical measures and thresholds are needed to explain different blunt impact injury modalities; specifically, strain rate threshold corresponds well with brain injury with skull indentation, while minimum pressure threshold corresponds well with coup–contrecoup injury; and DWI has been found to be the most appropriate modality for MRI data interpretation. As the findings from these two cases are substantiated with additional clinical studies, this methodology can be broadly applied as a tool to support injury assessment in head trauma events and to improve countermeasures (e.g., diagnostics and protective equipment design) to mitigate these injuries.
Collapse
Affiliation(s)
- X Gary Tan
- U.S. Naval Research Laboratory, Washington, DC, United States
| | | | - Maria M D'Souza
- Institute of Nuclear Medicine and Allied Sciences, New Delhi, India
| | - Raj K Gupta
- U.S. Army Medical Research and Development Command, Fort Detrick, MD, United States
| | - Joseph B Long
- Walter Reed Army Institute of Research, Silver Spring, MD, United States
| | - Ajay K Singh
- Life Sciences Directorate, Defence Research and Development Organisation (DRDO), New Delhi, India
| | - Amit Bagchi
- U.S. Naval Research Laboratory, Washington, DC, United States
| |
Collapse
|
13
|
Hemachandran N, Meena S, Kumar A, Sharma R, Gupta D, Gamanagatti S. Utility of admission perfusion CT for the prediction of suboptimal outcome following uncomplicated minor traumatic brain injury. Emerg Radiol 2021; 28:541-548. [PMID: 33420847 DOI: 10.1007/s10140-020-01876-0] [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: 10/22/2020] [Accepted: 11/25/2020] [Indexed: 11/24/2022]
Abstract
PURPOSE To compare the perfusion parameters of patients with uncomplicated mild traumatic brain injury (mTBI) with healthy controls and to assess whether admission perfusion CT parameters can be used to predict outcome at 6 months post-injury in patients with uncomplicated mTBI. METHODS Institute ethical committee approval was obtained for this prospective cohort study and informed written consent obtained from all subjects. Patients who sustained mTBI and had no abnormalities on non-contrast CT from June 2010 to January 2012 (20 months) and 10 healthy controls were included and underwent perfusion CT at admission. Outcome was determined at 6 months follow-up using the extended Glasgow Coma Outcome Scale score. RESULTS Forty-nine patients were included, of which 16 (32.7%) had symptoms at 6 months post-injury (suboptimal outcome). The mean cerebral blood flow and volume were lower in both the gray and white matter of all three arterial territories in the study group than in the control group (p value < 0.05). In the study group, these values were lower in those with suboptimal outcome than in those with optimal outcome (no symptoms). Cerebral blood flow showed higher area under the curve for predicting the outcome. CONCLUSION Perfusion parameters are altered even in patients with uncomplicated mTBI. A single ROI (region of interest) evaluation of the gray matter in the posterior cerebral artery territory on admission perfusion CT could provide a quick and efficient way to predict patients who would have a suboptimal outcome at 6 months post-injury.
Collapse
Affiliation(s)
| | | | - Atin Kumar
- All India Institute of Medical Sciences, New Delhi, India
| | - Raju Sharma
- All India Institute of Medical Sciences, New Delhi, India
| | - Deepak Gupta
- All India Institute of Medical Sciences, New Delhi, India
| | - Shivanand Gamanagatti
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Room no. 81b, 110029, New Delhi, India.
| |
Collapse
|
14
|
Calvillo M, Irimia A. Neuroimaging and Psychometric Assessment of Mild Cognitive Impairment After Traumatic Brain Injury. Front Psychol 2020; 11:1423. [PMID: 32733322 PMCID: PMC7358255 DOI: 10.3389/fpsyg.2020.01423] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Accepted: 05/27/2020] [Indexed: 12/13/2022] Open
Abstract
Traumatic brain injury (TBI) can be serious partly due to the challenges of assessing and treating its neurocognitive and affective sequelae. The effects of a single TBI may persist for years and can limit patients’ activities due to somatic complaints (headaches, vertigo, sleep disturbances, nausea, light or sound sensitivity), affective sequelae (post-traumatic depressive symptoms, anxiety, irritability, emotional instability) and mild cognitive impairment (MCI, including social cognition disturbances, attention deficits, information processing speed decreases, memory degradation and executive dysfunction). Despite a growing amount of research, study comparison and knowledge synthesis in this field are problematic due to TBI heterogeneity and factors like injury mechanism, age at or time since injury. The relative lack of standardization in neuropsychological assessment strategies for quantifying sequelae adds to these challenges, and the proper administration of neuropsychological testing relative to the relationship between TBI, MCI and neuroimaging has not been reviewed satisfactorily. Social cognition impairments after TBI (e.g., disturbed emotion recognition, theory of mind impairment, altered self-awareness) and their neuroimaging correlates have not been explored thoroughly. This review consolidates recent findings on the cognitive and affective consequences of TBI in relation to neuropsychological testing strategies, to neurobiological and neuroimaging correlates, and to patient age at and assessment time after injury. All cognitive domains recognized by the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) are reviewed, including social cognition, complex attention, learning and memory, executive function, language and perceptual-motor function. Affect and effort are additionally discussed owing to their relationships to cognition and to their potentially confounding effects. Our findings highlight non-negligible cognitive and affective impairments following TBI, their gravity often increasing with injury severity. Future research should study (A) language, executive and perceptual-motor function (whose evolution post-TBI remains under-explored), (B) the effects of age at and time since injury, and (C) cognitive impairment severity as a function of injury severity. Such efforts should aim to develop and standardize batteries for cognitive subdomains—rather than only domains—with high ecological validity. Additionally, they should utilize multivariate techniques like factor analysis and related methods to clarify which cognitive subdomains or components are indeed measured by standardized tests.
Collapse
Affiliation(s)
- Maria Calvillo
- Ethel Percy Andrus Gerontology Center, Leonard Davis School of Gerontology, University of Southern California, Los Angeles, CA, United States
| | - Andrei Irimia
- Ethel Percy Andrus Gerontology Center, Leonard Davis School of Gerontology, University of Southern California, Los Angeles, CA, United States.,Denney Research Center, Department of Biomedical Engineering, Viterbi School of Engineering, University of Southern California, Los Angeles, CA, United States
| |
Collapse
|
15
|
Menshchikov P, Ivantsova A, Manzhurtsev A, Ublinskiy M, Yakovlev A, Melnikov I, Kupriyanov D, Akhadov T, Semenova N. Separate N-acetyl aspartyl glutamate, N-acetyl aspartate, aspartate, and glutamate quantification after pediatric mild traumatic brain injury in the acute phase. Magn Reson Med 2020; 84:2918-2931. [PMID: 32544309 DOI: 10.1002/mrm.28332] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 04/27/2020] [Accepted: 05/01/2020] [Indexed: 12/19/2022]
Abstract
PURPOSE To separately measure N-acetyl aspartul glutamate (NAAG), N-acetyl aspartate (NAA), aspartate (Asp), and glutamate (Glu) concentrations in white matter (WM) using J-editing techniques in patients with mild traumatic brain injury (mTBI) in the acute phase. METHODS Twenty-four patients with closed concussive head injury and 29 healthy volunteers were enrolled in the current study. For extended 1 H MRS examination, patients and controls were equally divided into two subgroups. In subgroup 1 (12 patients/15 controls), NAAG and NAA concentrations were measured in WM separately with MEGA-PRESS (echo time/repetition time [TE/TR] = 140/2000 ms; δ ON NAA / δ OFF NAA = 4.84/4.38 ppm, δ ON NAAG / δ OFF NAAG = 4.61/4.15 ppm). In subgroup 2 (12 patients/14 controls), Asp and Glu concentrations were acquired with MEGA-PRESS (TE/TR = 90/2000 ms; δ ON Asp / δ OFF Asp = 3.89/5.21 ppm) and TE-averaged PRESS (TE from 35 ms to 185 ms with 2.5-ms increments; TR = 2000 ms) pulse sequences, respectively. RESULTS tNAA and NAAG concentrations were found to be reduced, while NAA concentrations were unchanged, after mild mTBI. Reduced Asp and elevated myo-inositol (mI) concentrations were also found. CONCLUSION The main finding of the study is that the tNAA signal reduction in WM after mTBI is associated with a decrease in the NAAG concentration rather than a decrease in the NAA concentration, as was thought previously. This finding highlights the importance of separating these signals, at least for WM studies, to avoid misinterpretation of the results. NAAG plays an important role in selectively activating mGluR3 receptors, thus providing neuroprotective and neuroreparative functions immediately after mTBI. NAAG shows potential for the development of new therapeutic strategies for patients with injuries of varying severity.
Collapse
Affiliation(s)
- Petr Menshchikov
- Semenov Institute of Chemical Physics, Russian Academy of Sciences, Moscow, Russian Federation.,Emanuel Institute of Biochemical Physics, Russian Academy of Sciences, Moscow, Russian Federation.,Clinical and Research Institute of Emergency Paediatric Surgery and Traumatology, Moscow, Russian Federation
| | - Anna Ivantsova
- Clinical and Research Institute of Emergency Paediatric Surgery and Traumatology, Moscow, Russian Federation
| | - Andrei Manzhurtsev
- Emanuel Institute of Biochemical Physics, Russian Academy of Sciences, Moscow, Russian Federation.,Clinical and Research Institute of Emergency Paediatric Surgery and Traumatology, Moscow, Russian Federation
| | - Maxim Ublinskiy
- Emanuel Institute of Biochemical Physics, Russian Academy of Sciences, Moscow, Russian Federation.,Clinical and Research Institute of Emergency Paediatric Surgery and Traumatology, Moscow, Russian Federation
| | - Alexey Yakovlev
- Semenov Institute of Chemical Physics, Russian Academy of Sciences, Moscow, Russian Federation.,Emanuel Institute of Biochemical Physics, Russian Academy of Sciences, Moscow, Russian Federation.,Clinical and Research Institute of Emergency Paediatric Surgery and Traumatology, Moscow, Russian Federation
| | - Ilya Melnikov
- Clinical and Research Institute of Emergency Paediatric Surgery and Traumatology, Moscow, Russian Federation
| | | | - Tolib Akhadov
- Clinical and Research Institute of Emergency Paediatric Surgery and Traumatology, Moscow, Russian Federation
| | - Natalia Semenova
- Semenov Institute of Chemical Physics, Russian Academy of Sciences, Moscow, Russian Federation.,Emanuel Institute of Biochemical Physics, Russian Academy of Sciences, Moscow, Russian Federation.,Clinical and Research Institute of Emergency Paediatric Surgery and Traumatology, Moscow, Russian Federation
| |
Collapse
|
16
|
Brooks BL, Virani S, Khetani A, Carlson H, Jadavji Z, Mauthner M, Low TA, Plourde V, MacMaster FP, Bray S, Harris AD, Lebel C, Lebel RM, Esser MJ, Yeates KO, Barlow KM. Functional magnetic resonance imaging study of working memory several years after pediatric concussion. Brain Inj 2020; 34:895-904. [PMID: 32396403 DOI: 10.1080/02699052.2020.1753240] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
PRIMARY OBJECTIVE The neurophysiological effects of pediatric concussion several years after injury remain inadequately characterized. The objective of this study was to determine if a history of concussion was associated with BOLD response differences during an n-back working memory task in youth. RESEARCH DESIGN Observational, cross-sectional. METHODS AND PROCEDURES Participants include 52 children and adolescents (M = 15.1 years, 95%CI = 14.4-15.8, range = 9-19) with past concussion (n = 33) or orthopedic injury (OI; n = 19). Mean time since injury was 2.5 years (95%CI = 2.0-3.0). Measures included postconcussion symptom ratings, neuropsychological testing, and blood-oxygen-dependent-level (BOLD) functional magnetic resonance imaging (fMRI) during an n-back working memory task. MAIN OUTCOMES AND RESULTS Groups did not differ on accuracy or speed during the three n-back conditions. They also did not differ in BOLD signal change for the 1- vs. 0-back or 2- vs. 0-back contrasts (controlling for task performance). CONCLUSIONS This study does not support group differences in BOLD response during an n-back working memory task in youth who are on average 2.5 years post-concussion. The findings are encouraging from the perspective of understanding recovery after pediatric concussion.
Collapse
Affiliation(s)
- Brian L Brooks
- Neurosciences Program, Alberta Children's Hospital , Calgary, Alberta, Canada.,Alberta Children's Hospital Research Institute, University of Calgary , Calgary, Alberta, Canada.,Departments of Paediatrics, Clinical Neurosciences, and Psychology, University of Calgary , Calgary, Alberta, Canada
| | - Shane Virani
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary , Calgary, Alberta, Canada.,Vi Riddell Pain and Rehabilitation Program, Alberta Children's Hospital Research Institute , Calgary, Alberta, Canada
| | - Aneesh Khetani
- Department of Neurosciences, University of Calgary , Calgary, Alberta, Canada
| | - Helen Carlson
- Alberta Children's Hospital Research Institute, University of Calgary , Calgary, Alberta, Canada.,Department of Pediatrics, University of Calgary , Calgary, Alberta, Canada.,Hotchkiss Brain Institute, University of Calgary , Calgary, Alberta, Canada
| | - Zeanna Jadavji
- Alberta Children's Hospital Research Institute, University of Calgary , Calgary, Alberta, Canada.,Department of Neurosciences, University of Calgary , Calgary, Alberta, Canada
| | - Micaela Mauthner
- Department of Neurosciences, University of Calgary , Calgary, Alberta, Canada
| | - Trevor A Low
- Department of Neurosciences, University of Calgary , Calgary, Alberta, Canada
| | - Vickie Plourde
- École de Psychologie, Faculté des sciences de la santé et des services communautaires, Université de Moncton, Monton, New Brunswick, Canada; Faculty Saint-Jean, University of Alberta , Edmonton, AB, Canada
| | - Frank P MacMaster
- Alberta Children's Hospital Research Institute, University of Calgary , Calgary, Alberta, Canada.,Departments of Psychiatry and Paediatrics, University of Calgary , Calgary, Alberta, Canada.,Mathison Centre for Mental Health Research and Education, Hotchkiss Brain Institute , Calgary, Alberta, Canada.,Strategic Clinical Network for Addictions and Mental Health, Alberta Health Services , Edmonton, Alberta, Canada
| | - Signe Bray
- Alberta Children's Hospital Research Institute, University of Calgary , Calgary, Alberta, Canada.,Hotchkiss Brain Institute, University of Calgary , Calgary, Alberta, Canada
| | - Ashley D Harris
- Alberta Children's Hospital Research Institute, University of Calgary , Calgary, Alberta, Canada.,Department of Radiology, University of Calgary , Calgary, Alberta, Canada
| | - Catherine Lebel
- Alberta Children's Hospital Research Institute, University of Calgary , Calgary, Alberta, Canada.,Hotchkiss Brain Institute, University of Calgary , Calgary, Alberta, Canada.,Department of Radiology, University of Calgary , Calgary, Alberta, Canada
| | - R Marc Lebel
- Alberta Children's Hospital Research Institute, University of Calgary , Calgary, Alberta, Canada.,Departments of Radiology and Biomedical Engineering, University of Calgary , Calgary, Alberta, Canada.,MR Applications and Workflow, GE Healthcare , Calgary, Alberta, Canada
| | - Michael J Esser
- Alberta Children's Hospital Research Institute, University of Calgary , Calgary, Alberta, Canada.,Department of Pediatrics, University of Calgary , Calgary, Alberta, Canada.,Hotchkiss Brain Institute, University of Calgary , Calgary, Alberta, Canada
| | - Keith Owen Yeates
- Alberta Children's Hospital Research Institute, University of Calgary , Calgary, Alberta, Canada.,Departments of Paediatrics, Clinical Neurosciences, and Psychology, University of Calgary , Calgary, Alberta, Canada.,Hotchkiss Brain Institute, University of Calgary , Calgary, Alberta, Canada
| | - Karen M Barlow
- Departments of Paediatrics and Clinical Neurosciences, University of Calgary , Calgary, Alberta, Canada.,Faculty of Medicine, University of Queensland , Brisbane, Australia
| |
Collapse
|
17
|
Lee RK, Burns J, Ajam AA, Broder JS, Chakraborty S, Chong ST, Kendi AT, Ledbetter LN, Liebeskind DS, Pannell JS, Pollock JM, Rosenow JM, Shaines MD, Shih RY, Slavin K, Utukuri PS, Corey AS. ACR Appropriateness Criteria® Seizures and Epilepsy. J Am Coll Radiol 2020; 17:S293-S304. [PMID: 32370973 DOI: 10.1016/j.jacr.2020.01.037] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 01/30/2020] [Indexed: 12/31/2022]
Abstract
Seizures and epilepsy are a set of conditions that can be challenging to diagnose, treat, and manage. This document summarizes recommendations for imaging in different clinical scenarios for a patient presenting with seizures and epilepsy. MRI of the brain is usually appropriate for each clinical scenario described with the exception of known seizures and unchanged semiology (Variant 3). In this scenario, it is unclear if any imaging would provide a benefit to patients. In the emergent situation, a noncontrast CT of the head is also usually appropriate as it can diagnose or exclude emergent findings quickly and is an alternative to MRI of the brain in these clinical scenarios. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
Collapse
Affiliation(s)
- Ryan K Lee
- Einstein Healthcare Network, Philadelphia, Pennsylvania.
| | - Judah Burns
- Panel Chair, Montefiore Medical Center, Bronx, New York
| | | | - Joshua S Broder
- Duke University School of Medicine, Durham, North Carolina; American College of Emergency Physicians
| | - Santanu Chakraborty
- Ottawa Hospital Research Institute and the Department of Radiology, The University of Ottawa, Ottawa, Ontario, Canada; Canadian Association of Radiologists
| | | | | | | | - David S Liebeskind
- University of California Los Angeles, Los Angeles, California; American Academy of Neurology
| | - Jeffrey S Pannell
- University of California San Diego Medical Center, San Diego, California
| | | | - Joshua M Rosenow
- Northwestern University Feinberg School of Medicine, Chicago, Illinois; Neurosurgery expert
| | - Matthew D Shaines
- Albert Einstein College of Medicine Montefiore Medical Center, Bronx, New York; Primary care physician
| | - Robert Y Shih
- Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Konstantin Slavin
- University of Illinois at Chicago College of Medicine, Chicago, Illinois; Neurosurgery expert
| | | | - Amanda S Corey
- Specialty Chair, Atlanta VA Health Care System and Emory University, Atlanta, Georgia
| |
Collapse
|
18
|
Baker JG, Willer BS, Dwyer MG, Leddy JJ. A preliminary investigation of cognitive intolerance and neuroimaging among adolescents returning to school after concussion. Brain Inj 2020; 34:818-827. [PMID: 32324445 DOI: 10.1080/02699052.2020.1749932] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PRIMARY OBJECTIVE To introduce the concept of cognitive intolerance. A test is proposed to measure this concept and pilot data are presented to support this measure and future research to develop this concept into a construct. Research design: Three-group comparison to protect larger study blinding. Methods and procedures: Two groups of student athletes (n = 13, n = 13) between 13 and 17 (mean 15.1 ± 1.1 years; 58% male) who sustained a sport-related concussion within 10 days and one group (n = 13) of age-matched healthy controls were recruited for a comparison of correlations between self and observer ratings of cognitive difficulties and DTI fractional anisotropy (FA) using tract-based spatial statistics (TBSS) analysis at two time points. Main outcomes and results: Significant negative only associations (higher cognitive difficulty and lower FA) with DTI FA were found in white matter tracts. These included the anterior corpus callosum, frontal-parietal longitudinal fasciculi, and cortical-subcortical pathways at only the second time point. Several working memory networks would likely involve connections using the above-identified white matter tracts. Conclusions: Cognitive intolerance can be defined as symptom exacerbation from prolonged cognitive activity. Cognitive intolerance could be measured by the n-back working memory task and time to symptom exacerbation.
Collapse
Affiliation(s)
- John G Baker
- Departments of UBMD Orthopedics and Sports Medicine and Nuclear Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo , Buffalo, New York, USA
| | - Barry S Willer
- Department of Psychiatry, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo , Buffalo, New York, USA
| | - Michael G Dwyer
- Department of Neurology, Buffalo Neuroimaging Analysis Center, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo , Buffalo, New York, USA
| | - John J Leddy
- Department of Orthopaedics and Sports Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo , Buffalo, New York, USA
| |
Collapse
|
19
|
van der Kleij LA, De Vis JB, Restivo MC, Turtzo LC, Hendrikse J, Latour LL. Subarachnoid Hemorrhage and Cerebral Perfusion Are Associated with Brain Volume Decrease in a Cohort of Predominantly Mild Traumatic Brain Injury Patients. J Neurotrauma 2020; 37:600-607. [PMID: 31642407 PMCID: PMC7045349 DOI: 10.1089/neu.2019.6514] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Biomarkers are needed to identify traumatic brain injury (TBI) patients at risk for accelerated brain volume loss and its associated functional impairment. Subarachnoid hemorrhage (SAH) has been shown to affect cerebral volume and perfusion, possibly by induction of inflammation and vasospasm. The purpose of this study was to assess the impact of SAH due to trauma on cerebral perfusion and brain volume. For this, magnetic resonance imaging (MRI) was performed <48 h and at 90 days after TBI. The <48-h scan was used to assess SAH presence and perfusion. Brain volume changes were assessed quantitatively over time. Differences in brain volume change and perfusion were compared between SAH and non-SAH patients. A linear regression analysis with clinical and imaging variables was used to identify predictors of brain volume change. All patients had a relatively good status on admission, and 83% presented with the maximum Glasgow Coma Scale (GCS) score. Brain volume decrease was greater in the 11 SAH patients (-3.2%, interquartile range [IQR] -4.8 to -1.3%) compared with the 46 non-SAH patients (-0.4%, IQR -1.8 to 0.9%; p < 0.001). Brain perfusion was not affected by SAH, but it was correlated with brain volume change (ρ = 0.39; p < 0.01). Forty-three percent of brain volume change was explained by SAH (β -0.40, p = 0.001), loss of consciousness (β -0.24, p = 0.035), and peak perfusion curve signal intensity height (0.27, p = 0.012). SAH and lower perfusion in the acute phase may identity TBI patients at increased risk for accelerated brain volume loss, in addition to loss of consciousness occurrence. Future studies should determine whether the findings apply to TBI patients with worse clinical status on admission. SAH predicts brain volume decrease independent of brain perfusion. This indicates the adverse effects of SAH extend beyond vasoconstriction, and that hypoperfusion also occurs separately from SAH.
Collapse
Affiliation(s)
- Lisa A. van der Kleij
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
- Acute Cerebrovascular Diagnostics Unit, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland
| | - Jill B. De Vis
- Acute Cerebrovascular Diagnostics Unit, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland
| | - Matthew C. Restivo
- Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - L. Christine Turtzo
- Acute Cerebrovascular Diagnostics Unit, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland
- Acute Studies Core, Center for Neuroscience and Regenerative Medicine, Bethesda, Maryland
| | - Jeroen Hendrikse
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Lawrence L. Latour
- Acute Cerebrovascular Diagnostics Unit, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland
- Acute Studies Core, Center for Neuroscience and Regenerative Medicine, Bethesda, Maryland
| |
Collapse
|
20
|
Poznanski P, Lesniak A, Korostynski M, Sacharczuk M. Ethanol consumption following mild traumatic brain injury is related to blood-brain barrier permeability. Addict Biol 2020; 25:e12683. [PMID: 30334599 DOI: 10.1111/adb.12683] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 09/12/2018] [Accepted: 09/14/2018] [Indexed: 12/21/2022]
Abstract
Several preclinical and clinical studies that deal with the neuropathological consequences of mild traumatic brain injury (mTBI) have focused on unraveling its effect on ethanol drinking behavior. Previous reports describe changes in ethanol consumption, both in animal models of mTBI as well as in patients, after concussive brain injury. However, the neurobiological mechanisms underlying this phenomenon are still poorly understood. In the present study, we used a unique model of mouse lines divergently selected for high (HA) or low (LA) swim stress-induced analgesia to examine the effect of mTBI on ethanol drinking behavior. In comparison with LA mice, their HA counterparts exhibited increased blood-brain barrier (BBB) permeability, lower basal alcohol preference, and lower level of stress-induced ethanol intake. Here, we showed that mTBI attenuates voluntary ethanol intake in LA, but not in HA mice. Interestingly, BBB disruption after mannitol infusion also decreases the level of ethanol drinking behavior in this line. We conclude that in alcohol-preferring LA mice, BBB disruption as a consequence of mTBI attenuates ethanol consumption. Our results suggest that the innate level of BBB integrity plays a pivotal role in regulation of ethanol consumption in mice showing differential endogenous opioid system activity.
Collapse
Affiliation(s)
- Piotr Poznanski
- Laboratory of NeurogenomicsInstitute of Genetics and Animal Breeding, Polish Academy of Sciences Magdalenka Poland
| | - Anna Lesniak
- Department of Pharmacodynamics, Centre for Preclinical Research and TechnologyMedical University of Warsaw Warsaw Poland
| | - Michal Korostynski
- Department of Molecular NeuropharmacologyInstitute of Pharmacology Krakow Poland
| | - Mariusz Sacharczuk
- Laboratory of NeurogenomicsInstitute of Genetics and Animal Breeding, Polish Academy of Sciences Magdalenka Poland
- Department of Pharmacodynamics, Centre for Preclinical Research and TechnologyMedical University of Warsaw Warsaw Poland
- Department of Internal Medicine, Hypertension and Vascular DiseasesMedical University of Warsaw Warsaw Poland
| |
Collapse
|
21
|
Patel JB, Wilson SH, Oakes TR, Santhanam P, Weaver LK. Structural and Volumetric Brain MRI Findings in Mild Traumatic Brain Injury. AJNR Am J Neuroradiol 2020; 41:92-99. [PMID: 31896572 DOI: 10.3174/ajnr.a6346] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 10/16/2019] [Indexed: 01/05/2023]
Abstract
BACKGROUND AND PURPOSE Routine MR imaging findings are frequently normal following mild traumatic brain injury and have a limited role in diagnosis and management. Advanced MR imaging can assist in detecting pathology and prognostication but is not readily available outside research settings. However, 3D isotropic sequences with ∼1-mm3 voxel size are available on community MR imaging scanners. Using such sequences, we compared radiologists' findings and quantified regional brain volumes between a mild traumatic brain injury cohort and non-brain-injured controls to describe structural imaging findings associated with mild traumatic brain injury. MATERIALS AND METHODS Seventy-one military personnel with persistent symptoms and 75 controls underwent 3T MR imaging. Three neuroradiologists interpreted the scans using common data elements. FreeSurfer was used to quantify regional gray and white matter volumes. RESULTS WM hyperintensities were seen in 81% of the brain-injured group versus 60% of healthy controls. The odds of ≥1 WM hyperintensity in the brain-injured group was about 3.5 times the odds for healthy controls (95% CI, 1.58-7.72; P = .002) after adjustment for age. A frontal lobe-only distribution of WM hyperintensities was more commonly seen in the mild traumatic brain injury cohort. Furthermore, 7 gray matter, 1 white matter, and 2 subcortical gray matter regions demonstrated decreased volumes in the brain-injured group after multiple-comparison correction. The mild traumatic brain injury cohort showed regional parenchymal volume loss. CONCLUSIONS White matter findings are nonspecific and therefore a clinical challenge. Our results suggest that prior trauma should be considered in the differential diagnosis of multifocal white matter abnormalities with a clinical history of mild traumatic brain injury, particularly when a frontal predilection is observed.
Collapse
Affiliation(s)
- J B Patel
- From Lovelace Biomedical Research (J.B.P., T.R.O., P.S.), Albuquerque, New Mexico
- VA Maryland Health Care System (J.B.P.), Baltimore, Maryland
| | | | - T R Oakes
- From Lovelace Biomedical Research (J.B.P., T.R.O., P.S.), Albuquerque, New Mexico
- University of Wisconsin-Madison (T.R.O.), Madison, Wisconsin
| | - P Santhanam
- From Lovelace Biomedical Research (J.B.P., T.R.O., P.S.), Albuquerque, New Mexico
| | - L K Weaver
- Division of Hyperbaric Medicine (L.K.W.), Intermountain Medical Center, Murray, Utah, and Intermountain LDS Hospital, Salt Lake City, Utah
- University of Utah School of Medicine (L.K.W.), Salt Lake City, Utah
| |
Collapse
|
22
|
Raji CA, Ly M, Benzinger TLS. Overview of MR Imaging Volumetric Quantification in Neurocognitive Disorders. Top Magn Reson Imaging 2019; 28:311-315. [PMID: 31794503 DOI: 10.1097/rmr.0000000000000224] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
This review article provides a general overview on the various methodologies for quantifying brain structure on magnetic resonance images of the human brain. This overview is followed by examples of applications in Alzheimer dementia and mild cognitive impairment. Other examples will include traumatic brain injury and other neurodegenerative dementias. Finally, an overview of general principles for protocol acquisition of magnetic resonance imaging for volumetric quantification will be discussed along with the current choices of FDA cleared algorithms for use in clinical practice.
Collapse
Affiliation(s)
- Cyrus A Raji
- Division of Neuroradiology, Department of Radiology, Mallinckrodt Institute of Radiology at Washington University, St. Louis, MO
| | - Maria Ly
- University of Pittsburgh Medical Scientist Training Program, Pittsburgh, PA
| | - Tammie L S Benzinger
- Division of Neuroradiology, Department of Radiology, Mallinckrodt Institute of Radiology at Washington University, St. Louis, MO
| |
Collapse
|
23
|
Wood T, Nance E. Disease-directed engineering for physiology-driven treatment interventions in neurological disorders. APL Bioeng 2019; 3:040901. [PMID: 31673672 PMCID: PMC6811362 DOI: 10.1063/1.5117299] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Accepted: 10/02/2019] [Indexed: 02/06/2023] Open
Abstract
Neurological disease is killing us. While there have long been attempts to develop therapies for both acute and chronic neurological diseases, no current treatments are curative. Additionally, therapeutic development for neurological disease takes 15 years and often costs several billion dollars. More than 96% of these therapies will fail in late stage clinical trials. Engineering novel treatment interventions for neurological disease can improve outcomes and quality of life for millions; however, therapeutics should be designed with the underlying physiology and pathology in mind. In this perspective, we aim to unpack the importance of, and need to understand, the physiology of neurological disease. We first dive into the normal physiological considerations that should guide experimental design, and then assess the pathophysiological factors of acute and chronic neurological disease that should direct treatment design. We provide an analysis of a nanobased therapeutic intervention that proved successful in translation due to incorporation of physiology at all stages of the research process. We also provide an opinion on the importance of keeping a high-level view to designing and administering treatment interventions. Finally, we close with an implementation strategy for applying a disease-directed engineering approach. Our assessment encourages embracing the complexity of neurological disease, as well as increasing efforts to provide system-level thinking in our development of therapeutics for neurological disease.
Collapse
|
24
|
Electrophysiological Markers of Visuospatial Attention Recovery after Mild Traumatic Brain Injury. Brain Sci 2019; 9:brainsci9120343. [PMID: 31783501 PMCID: PMC6956036 DOI: 10.3390/brainsci9120343] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 11/21/2019] [Accepted: 11/22/2019] [Indexed: 11/17/2022] Open
Abstract
Objective: Attentional problems are amongst the most commonly reported complaints following mild traumatic brain injury (mTBI), including difficulties orienting and disengaging attention, sustaining it over time, and dividing attentional resources across multiple simultaneous demands. The objective of this study was to track, using a single novel electrophysiological task, various components associated with the deployment of visuospatial selective attention. Methods: A paradigm was designed to evoke earlier visual evoked potentials (VEPs), as well as attention-related and visuocognitive ERPs. Data from 36 individuals with mTBI (19 subacute, 17 chronic) and 22 uninjured controls are presented. Postconcussion symptoms (PCS), anxiety (BAI), depression (BDI-II) and visual attention (TEA Map Search, DKEFS Trail Making Test) were also assessed. Results: Earlier VEPs (P1, N1), as well as processes related to visuospatial orientation (N2pc) and encoding in visual short-term memory (SPCN), appear comparable in mTBI and control participants. However, there appears to be a disruption in the spatiotemporal dynamics of attention (N2pc-Ptc, P2) in subacute mTBI, which recovers within six months. This is also reflected in altered neuropsychological performance (information processing speed, attentional shifting). Furthermore, orientation of attention (P3a) and working memory processes (P3b) are also affected and remain as such in the chronic post-mTBI period, in co-occurrence with persisting postconcussion symptomatology. Conclusions: This study adds original findings indicating that such a sensitive and rigorous ERP task implemented at diagnostic and follow-up levels could allow for the identification of subtle but complex brain activation and connectivity deficits that can occur following mTBI.
Collapse
|
25
|
Tan XG, D'Souza MM, Khushu S, Gupta RK, DeGiorgi VG, Singh AK, Bagchi A. Computational Modeling of Blunt Impact to Head and Correlation of Biomechanical Measures With Medical Images. ACTA ACUST UNITED AC 2019. [DOI: 10.1115/1.4045253] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Abstract
Mild traumatic brain injury (TBI) is a common injury to service members in recent conflicts. We attempt to correlate simulation results with clinical data from advanced imaging techniques to identify TBI-related subtle alterations in brain morphology, function, and metabolism. Magnetic resonance image (MRI) data were obtained for a young adult male, after a concussive head injury caused by a road traffic accident. A similar fall of a pedestrian using an articulated human body biodynamics model was integrated with the finite element (FE) analysis using a high-resolution human head model to investigate TBI from an accident. The hyper-viscoelastic model was used to represent the strain rate dependence in brain tissues. The bone structure was simulated using an elastoplastic model to capture the focal permanent deformation. Enhanced tetrahedral elements were used in modeling nearly incompressible tissues. The localized large deformation in the head was simulated and compared with those from the MRI images. Biomechanical measures, such as stresses and strains, were correlated with postaccident medical images with respect to injury location and severity in the brain. The correspondence between model results and MRI findings shows a new way to relate computational simulation response of human head to blunt impacts with clinical data from such incidents and thus enhances our understanding of the mechanism, extent, and effects of TBI.
Collapse
Affiliation(s)
- X. Gary Tan
- U.S. Naval Research Laboratory, Washington, DC 20375
| | - Maria M. D'Souza
- Institute of Nuclear Medicine and Allied Sciences, Delhi 110054, India
| | - Subhash Khushu
- Institute of Nuclear Medicine and Allied Sciences, Delhi 110054, India
| | - Raj K. Gupta
- U.S. Army Medical Research and Development Command, Fort Detrick, MD 21702
| | | | - Ajay K. Singh
- Institute of Nuclear Medicine and Allied Sciences, Delhi 110054, India
| | - Amit Bagchi
- U.S. Naval Research Laboratory, Washington, DC 20375
| |
Collapse
|
26
|
Minaee S, Wang Y, Aygar A, Chung S, Wang X, Lui YW, Fieremans E, Flanagan S, Rath J. MTBI Identification From Diffusion MR Images Using Bag of Adversarial Visual Features. IEEE TRANSACTIONS ON MEDICAL IMAGING 2019; 38:2545-2555. [PMID: 30892204 PMCID: PMC6751027 DOI: 10.1109/tmi.2019.2905917] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
In this paper, we propose bag of adversarial features (BAFs) for identifying mild traumatic brain injury (MTBI) patients from their diffusion magnetic resonance images (MRIs) (obtained within one month of injury) by incorporating unsupervised feature learning techniques. MTBI is a growing public health problem with an estimated incidence of over 1.7 million people annually in USA. Diagnosis is based on clinical history and symptoms, and accurate, concrete measures of injury are lacking. Unlike most of the previous works, which use hand-crafted features extracted from different parts of brain for MTBI classification, we employ feature learning algorithms to learn more discriminative representation for this task. A major challenge in this field thus far is the relatively small number of subjects available for training. This makes it difficult to use an end-to-end convolutional neural network to directly classify a subject from MRIs. To overcome this challenge, we first apply an adversarial auto-encoder (with convolutional structure) to learn patch-level features, from overlapping image patches extracted from different brain regions. We then aggregate these features through a bag-of-words approach. We perform an extensive experimental study on a dataset of 227 subjects (including 109 MTBI patients, and 118 age and sex-matched healthy controls) and compare the bag-of-deep-features with several previous approaches. Our experimental results show that the BAF significantly outperforms earlier works relying on the mean values of MR metrics in selected brain regions.
Collapse
|
27
|
Wooten DW, Ortiz-Terán L, Zubcevik N, Zhang X, Huang C, Sepulcre J, Atassi N, Johnson KA, Zafonte RD, El Fakhri G. Multi-Modal Signatures of Tau Pathology, Neuronal Fiber Integrity, and Functional Connectivity in Traumatic Brain Injury. J Neurotrauma 2019; 36:3233-3243. [PMID: 31210098 DOI: 10.1089/neu.2018.6178] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
[18F]AV-1451 (aka 18F-Flortaucipir, [18F]T807) was developed for positron-emission tomography (PET) imaging of paired helical filaments of hyperphosphorylated tau, which are of interest in a range of neuropathologies, including traumatic brain injury (TBI). Magnetic resonance imaging (MRI) techniques like diffusion tensor imaging (DTI) and resting state functional connectivity assess structural and functional characteristics of the brain, complementing the molecular information that can be obtained by PET. The goal herein was to explore the utility of such multi-modal imaging in a case series based on a population of TBI subjects. This study probes the interrelationship between tau deposition, white matter integrity, and gray matter functional connectivity across the spectrum of TBI. Nineteen subjects (11 controls, five former contact sports athletes, one automotive accident, and two with military-related injury) underwent [18F]AV-1451 PET and magnetic resonance scanning procedures. [18F]AV-1451 distribution volume ratio (DVR) was estimated using the Logan method and the cerebellum as a reference region. Diffusion tractography images and fractional anisotropy (FA) images were generated using diffusion toolkit and FSL. Resting-state functional MRI (fMRI) analysis was based on a graph theory metric, namely weighted degree centrality. TBI subjects showed greater heterogeneity in [18F]AV-1451 DVR when compared with control subjects. In a subset of TBI subjects, areas with high [18F]AV-1451 binding corresponded with increased FA and diminished white matter tract density in DTI. Functional MRI results exhibited an increase in functional connectivity, particularly among local connections, in the areas where tau aggregates were more prevalent. In a case series of a diverse group of TBI subjects, brain regions with elevated tau burden exhibited increased functional connectivity as well as decreased white matter integrity. These findings portray molecular, microstructural, and functional corollaries of TBI that spatially coincide and can be measured in the living human brain using noninvasive neuroimaging techniques.
Collapse
Affiliation(s)
- Dustin W Wooten
- Gordon Center for Medical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Laura Ortiz-Terán
- Gordon Center for Medical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Nevena Zubcevik
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Massachusetts General Hospital, Brigham and Women's Hospital Harvard Medical School, Charlestown, Massachusetts
| | - Xiaomeng Zhang
- Gordon Center for Medical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Chuan Huang
- Gordon Center for Medical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Jorge Sepulcre
- Gordon Center for Medical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Nazem Atassi
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Keith A Johnson
- Gordon Center for Medical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.,Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Ross D Zafonte
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Massachusetts General Hospital, Brigham and Women's Hospital Harvard Medical School, Charlestown, Massachusetts
| | - Georges El Fakhri
- Gordon Center for Medical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| |
Collapse
|
28
|
Einarsen CE, Moen KG, Håberg AK, Eikenes L, Kvistad KA, Xu J, Moe HK, Tollefsen MH, Vik A, Skandsen T. Patients with Mild Traumatic Brain Injury Recruited from Both Hospital and Primary Care Settings: A Controlled Longitudinal Magnetic Resonance Imaging Study. J Neurotrauma 2019; 36:3172-3182. [PMID: 31280698 PMCID: PMC6818486 DOI: 10.1089/neu.2018.6360] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
With an emphasis on traumatic axonal injury (TAI), frequency and evolution of traumatic intracranial lesions on 3T clinical magnetic resonance imaging (MRI) were assessed in a combined hospital and community-based study of patients with mild traumatic brain injury (mTBI). The findings were related to post-concussion symptoms (PCS) at 3 and 12 months. Prospectively, 194 patients (16–60 years of age) were recruited from the emergency departments at a level 1 trauma center and a municipal outpatient clinic into the Trondheim mTBI follow-up study. MRI was acquired within 72 h (n = 194) and at 3 (n = 165) and 12 months (n = 152) in patients and community controls (n = 78). The protocol included T2, diffusion weighted imaging, fluid attenuated inversion recovery (FLAIR), and susceptibility weighted imaging (SWI). PCS was assessed with British Columbia Post Concussion Symptom Inventory in patients and controls. Traumatic lesions were present in 12% on very early MRI, and in 5% when computed tomography (CT) was negative. TAI was found in 6% and persisted for 12 months on SWI, whereas TAI lesions on FLAIR disappeared or became less conspicuous on follow-up. PCS occurred in 33% of patients with lesions on MRI and in 19% in patients without lesions at 3 months (p = 0.12) and in 21% with lesions and 14% without lesions at 12 months (p = 0.49). Very early MRI depicted cases of TAI in patients with mTBI with microbleeds persisting for 12 months. Patients with traumatic lesions may have a more protracted recovery, but the study was underpowered to detect significant differences for PCS because of the low frequency of trauma-related MRI lesions.
Collapse
Affiliation(s)
- Cathrine Elisabeth Einarsen
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway.,Department of Physical Medicine and Rehabilitation, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Kent Gøran Moen
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway.,Department of Radiology, Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
| | - Asta Kristine Håberg
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway.,Department of Radiology and Nuclear Medicine, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Live Eikenes
- Department of Circulation and Medical Imaging Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Kjell Arne Kvistad
- Department of Radiology and Nuclear Medicine, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Jian Xu
- Department of Radiology and Nuclear Medicine, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Hans Kristian Moe
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - Marie Hexeberg Tollefsen
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - Anne Vik
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway.,Department of Neurosurgery, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Toril Skandsen
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway.,Department of Physical Medicine and Rehabilitation, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| |
Collapse
|
29
|
Schweser F, Kyyriäinen J, Preda M, Pitkänen A, Toffolo K, Poulsen A, Donahue K, Levy B, Poulsen D. Visualization of thalamic calcium influx with quantitative susceptibility mapping as a potential imaging biomarker for repeated mild traumatic brain injury. Neuroimage 2019; 200:250-258. [PMID: 31201986 DOI: 10.1016/j.neuroimage.2019.06.024] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 06/03/2019] [Accepted: 06/11/2019] [Indexed: 11/17/2022] Open
Abstract
A key event in the pathophysiology of traumatic brain injury (TBI) is the influx of substantial amounts of Ca2+ into neurons, particularly in the thalamus. Detection of this calcium influx in vivo would provide a window into the biochemical mechanisms of TBI with potentially significant clinical implications. In the present work, our central hypothesis was that the Ca2+ influx could be imaged in vivo with the relatively recent MRI technique of quantitative susceptibility mapping (QSM). Wistar rats were divided into five groups: naive controls, sham-operated experimental controls, single mild TBI, repeated mild TBI, and single severe TBI. We employed the lateral fluid percussion injury (FPI) model, which replicates clinical TBI without skull fracture, performed 9.4 Tesla MRI with a 3D multi-echo gradient-echo sequence at weeks 1 and 4 post-injury, computed susceptibility maps using V-SHARP and the QUASAR-HEIDI technique, and performed histology. Sham, experimental controls animals, and injured animals did not demonstrate calcifications at 1 week after the injury. At week 4, calcifications were found in the ipsilateral thalamus of 25-50% of animals after a single TBI and 83% of animals after repeated mild TBI. The location and appearance of calcifications on stained sections was consistent with the appearance on the in vivo susceptibility maps (correlation of volumes: r = 0.7). Our findings suggest that persistent calcium deposits represent a primary pathology of repeated injury and that FPI-QSM has the potential to become a sensitive tool for studying pathophysiology related to mild TBI in vivo.
Collapse
Affiliation(s)
- Ferdinand Schweser
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo, The State University of New York, Buffalo, NY, USA; Center for Biomedical Imaging, Clinical and Translational Science Institute, University at Buffalo, The State University of New York, Buffalo, NY, USA.
| | - Jenni Kyyriäinen
- Epilepsy Research Laboratory, A. I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, PO Box 1627, FI, 70211, Kuopio, Finland
| | - Marilena Preda
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo, The State University of New York, Buffalo, NY, USA; Center for Biomedical Imaging, Clinical and Translational Science Institute, University at Buffalo, The State University of New York, Buffalo, NY, USA
| | - Asla Pitkänen
- Epilepsy Research Laboratory, A. I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, PO Box 1627, FI, 70211, Kuopio, Finland
| | - Kathryn Toffolo
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo, The State University of New York, Buffalo, NY, USA
| | - Austin Poulsen
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo, The State University of New York, Buffalo, NY, USA
| | - Kaitlynn Donahue
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo, The State University of New York, Buffalo, NY, USA
| | - Benett Levy
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo, The State University of New York, Buffalo, NY, USA
| | - David Poulsen
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo, The State University of New York, Buffalo, NY, USA
| |
Collapse
|
30
|
Kao YCJ, Lui YW, Lu CF, Chen HL, Hsieh BY, Chen CY. Behavioral and Structural Effects of Single and Repeat Closed-Head Injury. AJNR Am J Neuroradiol 2019; 40:601-608. [PMID: 30923084 DOI: 10.3174/ajnr.a6014] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 02/16/2019] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE The effects of multiple head impacts, even without detectable primary injury, on subsequent behavioral impairment and structural abnormality is yet well explored. Our aim was to uncover the dynamic changes and long-term effects of single and repetitive head injury without focal contusion on tissue microstructure and macrostructure. MATERIALS AND METHODS We introduced a repetitive closed-head injury rodent model (n = 70) without parenchymal lesions. We performed a longitudinal MR imaging study during a 50-day study period (T2-weighted imaging, susceptibility-weighted imaging, and diffusion tensor imaging) as well as sequential behavioral assessment. Immunohistochemical staining for astrogliosis was examined in a subgroup of animals. Paired and independent t tests were used to evaluate the outcome change after injury and the cumulative effects of impact load, respectively. RESULTS There was no gross morphologic evidence for head injury such as skull fracture, contusion, or hemorrhage on micro-CT and MR imaging. A significant decrease of white matter fractional anisotropy from day 21 on and an increase of gray matter fractional anisotropy from day 35 on were observed. Smaller mean cortical volume in the double-injury group was shown at day 50 compared with sham and single injury (P < .05). Behavioral deficits (P < .05) in neurologic outcome, balance, and locomotor activity were also aggravated after double injury. Histologic analysis showed astrogliosis 24 hours after injury, which persisted throughout the study period. CONCLUSIONS There are measurable and dynamic changes in microstructure, cortical volume, behavior, and histopathology after both single and double injury, with more severe effects seen after double injury. This work bridges cross-sectional evidence from human subject and pathologic studies using animal models with a multi-time point, longitudinal research paradigm.
Collapse
Affiliation(s)
- Y-C J Kao
- From the Neuroscience Research Center (Y.-C.J.K., C.-Y.C.).,Translational Imaging Research Center (Y.-C.J.K., C.-Y.C.), Taipei Medical University, Taipei, Taiwan.,Department of Radiology (Y.-C.J.K., C.-Y.C.), School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.,Radiogenomic Research Center (Y.-C.J.K., C.-Y.C.), Taipei Medical University Hospital, Taipei, Taiwan
| | - Y W Lui
- Department of Radiology (Y.W.L.), NYU School of Medicine/NYU Langone Health, New York, New York
| | - C-F Lu
- Department of Biomedical Imaging and Radiological Sciences (C.-F.L.), National Yang-Ming University, Taipei, Taiwan
| | - H-L Chen
- Departments of Medical Research (H.-L.C.)
| | - B-Y Hsieh
- Department of Biomedical Imaging and Radiological Science (B.-Y.H.), China Medical University, Taichung, Taiwan
| | - C-Y Chen
- From the Neuroscience Research Center (Y.-C.J.K., C.-Y.C.) .,Translational Imaging Research Center (Y.-C.J.K., C.-Y.C.), Taipei Medical University, Taipei, Taiwan.,Department of Radiology (Y.-C.J.K., C.-Y.C.), School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.,Medical Imaging (C.-Y.C.).,Radiogenomic Research Center (Y.-C.J.K., C.-Y.C.), Taipei Medical University Hospital, Taipei, Taiwan
| |
Collapse
|
31
|
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.
Collapse
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.
| |
Collapse
|
32
|
Raji CA, Henderson TA. PET and Single-Photon Emission Computed Tomography in Brain Concussion. Neuroimaging Clin N Am 2018; 28:67-82. [PMID: 29157854 DOI: 10.1016/j.nic.2017.09.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
This article offers an overview of the application of PET and single photon emission computed tomography brain imaging to concussion, a type of mild traumatic brain injury and traumatic brain injury, in general. The article reviews the application of these neuronuclear imaging modalities in cross-sectional and longitudinal studies. Additionally, this article frames the current literature with an overview of the basic physics and radiation exposure risks of each modality.
Collapse
Affiliation(s)
- Cyrus A Raji
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, UCSF China Basin, 185 Berry Street, Suite 350, San Francisco, CA 94158, USA
| | - Theodore A Henderson
- The Synaptic Space Inc, Neuro-Laser Foundation, Neuro-Luminance Brain Health Centers Inc, Dr. Theodore Henderson Inc, 3979 East Arapahoe Road, Suite 200, Centennial, CO 80122, USA.
| |
Collapse
|
33
|
McGuire JA, Sherman PM, Dean E, Bernot JM, Rowland LM, McGuire SA, Kochunov PV. Utilization of MRI for Cerebral White Matter Injury in a Hypobaric Swine Model-Validation of Technique. Mil Med 2018; 182:e1757-e1764. [PMID: 29087921 DOI: 10.7205/milmed-d-16-00188] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Repetitive hypobaric exposure in humans induces subcortical white matter change, observable on magnetic resonance imaging (MRI) and associated with cognitive impairment. Similar findings occur in traumatic brain injury (TBI). We are developing a swine MRI-driven model to understand the pathophysiology and to develop treatment interventions. METHODS Five miniature pigs (Sus scrofa domestica) were repetitively exposed to nonhypoxic hypobaria (30,000 feet/FIO2 100%/transcutaneous PO2 >90%) while under general anesthesia. Three pigs served as controls. Pre-exposure and postexposure MRIs were obtained that included structural sequences, dynamic contrast perfusion, and diffusion tensor quantification. Statistical comparison of individual subject and group change was performed utilizing a two-tailed t test. FINDINGS No structural imaging change was noted on T2-weighted or three-dimensional fluid-attenuated inversion recovery imaging between MRI 1 and MRI 2. No absolute difference in dynamic contrast perfusion was observed. A trend (p = 0.084) toward increase in interstitial extra-axonal fluid was noted. When individual subjects were examined, this trend toward increased extra-axonal fluid paralleled a decrease in contrast perfusion rate. DISCUSSION/IMPACT/RECOMMENDATIONS This study demonstrates high reproducibility of quantitative noninvasive MRI, suggesting MRI is an appropriate assessment tool for TBI and hypobaric-induced injury research in swine. The lack of fluid-attenuated inversion recovery change may be multifactorial and requires further investigation. A trend toward increased extra-axonal water content that negatively correlates with dynamic contrast perfusion implies generalized axonal injury was induced. This study suggests this is a potential model for hypobaric-induced injury as well as potentially other axonal injuries such as TBI in which similar subcortical white matter change occurs. Further development of this model is necessary.
Collapse
Affiliation(s)
- Jennifer A McGuire
- Conte Center, Maryland Psychiatric Research Center, University of Maryland School of Medicine, 55 Wade Avenue, Catonsville, MD 21228
| | - Paul M Sherman
- U.S. Air Force School of Aerospace Medicine, Aeromedical Research Department, 2510 5th Street, Building 840, Wright-Patterson AFB, OH 45433-7913
| | - Erica Dean
- U.S. Air Force School of Aerospace Medicine, Aeromedical Research Department, 2510 5th Street, Building 840, Wright-Patterson AFB, OH 45433-7913
| | - Jeremy M Bernot
- Department of Neuroradiology, 59th Medical Wing, 2200 Bergquist Drive, Suite 1, Room 7A45, Joint Base San Antonio-Lackland AFB, TX 78236
| | - Laura M Rowland
- Conte Center, Maryland Psychiatric Research Center, University of Maryland School of Medicine, 55 Wade Avenue, Catonsville, MD 21228
| | - Stephen A McGuire
- U.S. Air Force School of Aerospace Medicine, Aeromedical Research Department, 2510 5th Street, Building 840, Wright-Patterson AFB, OH 45433-7913
| | - Peter V Kochunov
- Conte Center, Maryland Psychiatric Research Center, University of Maryland School of Medicine, 55 Wade Avenue, Catonsville, MD 21228
| |
Collapse
|
34
|
Lyons DN, Vekaria H, Macheda T, Bakshi V, Powell DK, Gold BT, Lin AL, Sullivan PG, Bachstetter AD. A Mild Traumatic Brain Injury in Mice Produces Lasting Deficits in Brain Metabolism. J Neurotrauma 2018; 35:2435-2447. [PMID: 29808778 PMCID: PMC6196750 DOI: 10.1089/neu.2018.5663] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Metabolic uncoupling has been well-characterized during the first minutes-to-days after a traumatic brain injury (TBI), yet mitochondrial bioenergetics during the weeks-to-months after a brain injury is poorly defined, particularly after a mild TBI. We hypothesized that a closed head injury (CHI) would be associated with deficits in mitochondrial bioenergetics at one month after the injury. A significant decrease in state-III (adenosine triphosphate production) and state-V (complex-I) driven mitochondrial respiration was found at one month post-injury in adult C57Bl/6J mice. Isolation of synaptic mitochondria demonstrated that the deficit in state-III and state-V was primarily neuronal. Injured mice had a temporally consistent deficit in memory recall at one month post-injury. Using proton magnetic resonance spectroscopy (1H MRS) at 7-Tesla, we found significant decreases in phosphocreatine, N-Acetylaspartic acid, and total choline. We also found regional variations in cerebral blood flow, including both hypo- and hyperperfusion, as measured by a pseudocontinuous arterial spin labeling MR sequence. Our results highlight a chronic deficit in mitochondrial bioenergetics associated with a CHI that may lead toward a novel approach for neurorestoration after a mild TBI. MRS provides a potential biomarker for assessing the efficacy of candidate treatments targeted at improving mitochondrial bioenergetics.
Collapse
Affiliation(s)
- Danielle N Lyons
- 1 Spinal Cord & Brain Injury Research Center, University of Kentucky , Lexington Kentucky.,2 Department of Neuroscience, University of Kentucky , Lexington Kentucky
| | - Hemendra Vekaria
- 1 Spinal Cord & Brain Injury Research Center, University of Kentucky , Lexington Kentucky.,2 Department of Neuroscience, University of Kentucky , Lexington Kentucky
| | - Teresa Macheda
- 1 Spinal Cord & Brain Injury Research Center, University of Kentucky , Lexington Kentucky.,2 Department of Neuroscience, University of Kentucky , Lexington Kentucky
| | - Vikas Bakshi
- 4 Sanders-Brown Center on Aging, University of Kentucky , Lexington Kentucky.,5 Department of Pharmacology and Nutritional Sciences, University of Kentucky , Lexington Kentucky
| | - David K Powell
- 2 Department of Neuroscience, University of Kentucky , Lexington Kentucky.,3 Department of Biomedical Engineering, University of Kentucky , Lexington Kentucky
| | - Brian T Gold
- 2 Department of Neuroscience, University of Kentucky , Lexington Kentucky
| | - Ai-Ling Lin
- 4 Sanders-Brown Center on Aging, University of Kentucky , Lexington Kentucky.,5 Department of Pharmacology and Nutritional Sciences, University of Kentucky , Lexington Kentucky
| | - Patrick G Sullivan
- 1 Spinal Cord & Brain Injury Research Center, University of Kentucky , Lexington Kentucky.,2 Department of Neuroscience, University of Kentucky , Lexington Kentucky
| | - Adam D Bachstetter
- 1 Spinal Cord & Brain Injury Research Center, University of Kentucky , Lexington Kentucky.,2 Department of Neuroscience, University of Kentucky , Lexington Kentucky
| |
Collapse
|
35
|
Nolan A, Hennessy E, Krukowski K, Guglielmetti C, Chaumeil MM, Sohal VS, Rosi S. Repeated Mild Head Injury Leads to Wide-Ranging Deficits in Higher-Order Cognitive Functions Associated with the Prefrontal Cortex. J Neurotrauma 2018; 35:2425-2434. [PMID: 29732949 DOI: 10.1089/neu.2018.5731] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Traumatic brain injury (TBI) has long been identified as a precipitating risk factor for higher-order cognitive deficits associated with the frontal and prefrontal cortices (PFC). In addition, mild repetitive TBI (rTBI), in particular, is being steadily recognized to increase the risk of neurodegenerative disease. Thus, further understanding of how mild rTBI changes the pathophysiology of the brain to lead to cognitive impairment is warranted. The current models of rTBI lack knowledge regarding chronic higher-order cognitive functions and the underlying neuronal physiology, especially functions involving the PFC. Here, we establish that five repeated mild hits, allowing rotational acceleration of the head, lead to chronic deficits in PFC-dependent functions such as social behavior, spatial working memory, and environmental response with concomitant microgliosis and a small decrease in the adaptation rate of layer V pyramidal neurons in the medial PFC (mPFC). However, structural damage is not seen on in vivo T2-weighted magnetic resonance imaging (MRI), and extensive intrinsic excitability changes in layer V pyramidal neurons of the mPFC are not observed. Thus, this rTBI animal model can recapitulate chronic higher-order cognitive impairments without structural damage on MR imaging as observed in humans.
Collapse
Affiliation(s)
- Amber Nolan
- 1 Brain and Spinal Injury Center, University of California , San Francisco, San Francisco, California.,2 Department of Physical Therapy and Rehabilitation Science, University of California , San Francisco, San Francisco, California.,3 Department of Anatomic Pathology, University of California , San Francisco, San Francisco, California
| | - Edel Hennessy
- 1 Brain and Spinal Injury Center, University of California , San Francisco, San Francisco, California.,2 Department of Physical Therapy and Rehabilitation Science, University of California , San Francisco, San Francisco, California
| | - Karen Krukowski
- 1 Brain and Spinal Injury Center, University of California , San Francisco, San Francisco, California.,2 Department of Physical Therapy and Rehabilitation Science, University of California , San Francisco, San Francisco, California
| | - Caroline Guglielmetti
- 2 Department of Physical Therapy and Rehabilitation Science, University of California , San Francisco, San Francisco, California.,4 Surbeck Laboratory of Advanced Imaging, Department of Radiology and Biomedical Imaging, University of California , San Francisco, San Francisco, California
| | - Myriam M Chaumeil
- 2 Department of Physical Therapy and Rehabilitation Science, University of California , San Francisco, San Francisco, California.,4 Surbeck Laboratory of Advanced Imaging, Department of Radiology and Biomedical Imaging, University of California , San Francisco, San Francisco, California
| | - Vikaas S Sohal
- 5 Department of Psychiatry, University of California , San Francisco, San Francisco, California
| | - Susanna Rosi
- 1 Brain and Spinal Injury Center, University of California , San Francisco, San Francisco, California.,2 Department of Physical Therapy and Rehabilitation Science, University of California , San Francisco, San Francisco, California.,6 Department of Neurological Surgery, University of California , San Francisco, San Francisco, California.,7 Weill Institute for Neuroscience, University of California , San Francisco, San Francisco, California.,8 Kavli Institute of Fundamental Neuroscience, University of California , San Francisco, San Francisco, California
| |
Collapse
|
36
|
Crider T, Eng D, Sarkar PR, Cordero J, Krusz JC, Sarkar SN. Microvascular and large vein abnormalities in young patients after mild head trauma and associated fatigue: A brain SPECT evaluation and posture dependence modeling. Clin Neurol Neurosurg 2018; 170:159-164. [DOI: 10.1016/j.clineuro.2018.05.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Revised: 04/28/2018] [Accepted: 05/17/2018] [Indexed: 10/16/2022]
|
37
|
|
38
|
Rajesh A, Cooke GE, Monti JM, Jahn A, Daugherty AM, Cohen NJ, Kramer AF. Differences in Brain Architecture in Remote Mild Traumatic Brain Injury. J Neurotrauma 2017; 34:3280-3287. [PMID: 28726543 PMCID: PMC6913796 DOI: 10.1089/neu.2017.5047] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Mild traumatic brain injury (mTBI) is brain trauma from an external impact with a loss of consciousness less than 30 min. Mild TBI results in several biopsychosocial impairments, with pronounced cognitive deficits thought to resolve within 3 months of injury. Previous research suggests that these impairments are due to a temporary inability to appropriately allocate neural resources in response to cognitive demands. Our study questioned this assumption and instead hypothesized that mTBI was associated with long-term neural disruptions and compromised brain structure integrity. By extension, we investigated the likelihood that functional restitution and cognitive resolution following mTBI may be due to some form of neurofunctional reorganization. To this end, we examined abnormalities in resting state functional connectivity and structure (volume, thickness, and fractional anisotropy) in two groups of mTBI-those with 1-10 years time post-injury (mTBI1-10), and those with 20-65 years time post-injury, relative to age-, sex-, and education-matched controls. We observed abnormalities in brain architecture only in the mTBI1-10 group, characterized by functional hypo-activation in the right frontal pole, smaller frontal pole volume, and lesser fractional anisotropy in the genu of the corpus callosum that extended near the right frontal pole. This frontal region is laterally specialized to regulate function specific to socio-emotional processes. Collectively, neural disruptions and structural insult in mTBI may persist up to 10 years following injury, but injury-related pathology may resolve with longer recovery time. Disruption to frontal-dependent function that supports socio-emotional processes also may interfere with cognitive functioning, as in the case of chronic mTBI.
Collapse
Affiliation(s)
- Aishwarya Rajesh
- Department of Psychology, University of Illinois at Urbana-Champaign, Champaign, Illinois
| | - Gillian E. Cooke
- Department of Psychology, University of Illinois at Urbana-Champaign, Champaign, Illinois
| | - Jim M. Monti
- Department of Psychology, University of Illinois at Urbana-Champaign, Champaign, Illinois
| | - Andrew Jahn
- Haskins Laboratories, New Haven, Connecticut
| | - Ana M. Daugherty
- Department of Psychology, University of Illinois at Urbana-Champaign, Champaign, Illinois
| | - Neal J. Cohen
- Department of Psychology, University of Illinois at Urbana-Champaign, Champaign, Illinois
| | - Arthur F. Kramer
- Department of Psychology, University of Illinois at Urbana-Champaign, Champaign, Illinois
- Departments of Psychology and Engineering, Northeastern University, Boston, Massachusetts
| |
Collapse
|
39
|
Stovell MG, Yan JL, Sleigh A, Mada MO, Carpenter TA, Hutchinson PJA, Carpenter KLH. Assessing Metabolism and Injury in Acute Human Traumatic Brain Injury with Magnetic Resonance Spectroscopy: Current and Future Applications. Front Neurol 2017; 8:426. [PMID: 28955291 PMCID: PMC5600917 DOI: 10.3389/fneur.2017.00426] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Accepted: 08/07/2017] [Indexed: 11/25/2022] Open
Abstract
Traumatic brain injury (TBI) triggers a series of complex pathophysiological processes. These include abnormalities in brain energy metabolism; consequent to reduced tissue pO2 arising from ischemia or abnormal tissue oxygen diffusion, or due to a failure of mitochondrial function. In vivo magnetic resonance spectroscopy (MRS) allows non-invasive interrogation of brain tissue metabolism in patients with acute brain injury. Nuclei with “spin,” e.g., 1H, 31P, and 13C, are detectable using MRS and are found in metabolites at various stages of energy metabolism, possessing unique signatures due to their chemical shift or spin–spin interactions (J-coupling). The most commonly used clinical MRS technique, 1H MRS, uses the great abundance of hydrogen atoms within molecules in brain tissue. Spectra acquired with longer echo-times include N-acetylaspartate (NAA), creatine, and choline. NAA, a marker of neuronal mitochondrial activity related to adenosine triphosphate (ATP), is reported to be lower in patients with TBI than healthy controls, and the ratio of NAA/creatine at early time points may correlate with clinical outcome. 1H MRS acquired with shorter echo times produces a more complex spectrum, allowing detection of a wider range of metabolites.31 P MRS detects high-energy phosphate species, which are the end products of cellular respiration: ATP and phosphocreatine (PCr). ATP is the principal form of chemical energy in living organisms, and PCr is regarded as a readily mobilized reserve for its replenishment during periods of high utilization. The ratios of high-energy phosphates are thought to represent a balance between energy generation, reserve and use in the brain. In addition, the chemical shift difference between inorganic phosphate and PCr enables calculation of intracellular pH.13 C MRS detects the 13C isotope of carbon in brain metabolites. As the natural abundance of 13C is low (1.1%), 13C MRS is typically performed following administration of 13C-enriched substrates, which permits tracking of the metabolic fate of the infused 13C in the brain over time, and calculation of metabolic rates in a range of biochemical pathways, including glycolysis, the tricarboxylic acid cycle, and glutamate–glutamine cycling. The advent of new hyperpolarization techniques to transiently boost signal in 13C-enriched MRS in vivo studies shows promise in this field, and further developments are expected.
Collapse
Affiliation(s)
- Matthew G Stovell
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom
| | - Jiun-Lin Yan
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom.,Department of Neurosurgery, Keelung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Alison Sleigh
- Wolfson Brain Imaging Centre, Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom.,National Institute for Health Research/Wellcome Trust Clinical Research Facility, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Marius O Mada
- Wolfson Brain Imaging Centre, Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom
| | - T Adrian Carpenter
- Wolfson Brain Imaging Centre, Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom
| | - Peter J A Hutchinson
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom.,Wolfson Brain Imaging Centre, Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom
| | - Keri L H Carpenter
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom.,Wolfson Brain Imaging Centre, Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom
| |
Collapse
|
40
|
The association between microhaemorrhages and post - traumatic functional outcome in the chronic phase after mild traumatic brain injury. Neuroradiology 2017; 59:963-969. [PMID: 28785801 DOI: 10.1007/s00234-017-1898-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Accepted: 07/27/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE In the chronic phase after mild traumatic brain injury (mTBI), microhaemorrhages are frequently detected on magnetic resonance imaging (MRI). It is however unclear whether microhaemorrhages are associated with functional outcome and which MRI sequence is most appropriate to address this association. We aimed to determine the association between microhaemorrhages and functional outcome in the chronic posttraumatic phase after injury with the most suitable MRI sequence to address this association. METHODS One hundred twenty-seven patients classified with mTBI admitted to the outpatient clinic from 2008 to 2015 for persisting posttraumatic complaints were stratified according to the presence of MRI abnormalities (n = 63 (MRI+ group) and n = 64 without abnormalities (MRI- group)). For the detection of microhaemorrhages, susceptibility-weighted imaging (SWI) and T2* gradient recalled echo (T2*GRE) were used. The relation between the functional outcome (dichotomized Glasgow Outcome Scale Extended scores) and the number and localization of microhaemorrhages was analysed using binary logistic regression. RESULTS SWI detected twice as many microhaemorrhages compared to T2*GRE: 341 vs. 179. Lesions were predominantly present in the frontal and temporal lobes. Unfavourable outcome was present in 67% of the MRI+ group with a significant association of total number of microhaemorrhages in the temporal cortical area on SWI (OR 0.43 (0.21-0.90) p = 0.02), with an explained variance of 44%. The number of microhaemorrhages was not correlated with the number of posttraumatic complaints. CONCLUSION An unfavourable outcome in the chronic posttraumatic phase is associated with the presence and number of microhaemorrhages in the temporal cortical area. SWI is preferably used to detect these microhaemorrhages.
Collapse
|
41
|
Narayana PA. White matter changes in patients with mild traumatic brain injury: MRI perspective. Concussion 2017; 2:CNC35. [PMID: 30202576 PMCID: PMC6093760 DOI: 10.2217/cnc-2016-0028] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2016] [Accepted: 02/10/2017] [Indexed: 12/20/2022] Open
Abstract
This review focuses on white matter (WM) changes in mild traumatic brain injury (mTBI) as assessed by multimodal MRI. All the peer reviewed publications on WM changes in mTBI from January 2011 through September 2016 are included in this review. This review is organized as follows: introduction to mTBI, the basics of multimodal MRI techniques that are potentially useful for probing the WM integrity, summary and critical evaluation of the published literature on the application of multimodal MRI techniques to assess the changes of WM in mTBI, and correlation of MRI measures with behavioral deficits. The MRI–pathology correlation studies based on preclinical models of mTBI are also reviewed. Finally, the author's perspective of future research directions is described.
Collapse
Affiliation(s)
- Ponnada A Narayana
- Department of Diagnostic & Interventional Imaging, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX 77030, USA
| |
Collapse
|
42
|
Shah RN, Allen JW. Advances in Mild Traumatic Brain Injury Imaging Biomarkers. CURRENT RADIOLOGY REPORTS 2017. [DOI: 10.1007/s40134-017-0210-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
|
43
|
Snyder VS, Hansen LA. A Conceptual Overview of Axonopathy in Infants and Children with Allegedly Inflicted Head Trauma. Acad Forensic Pathol 2016; 6:608-621. [PMID: 31239934 PMCID: PMC6474503 DOI: 10.23907/2016.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 10/14/2016] [Accepted: 11/12/2016] [Indexed: 11/12/2022]
Abstract
Fatal, allegedly inflicted pediatric head trauma remains a controversial topic in forensic pathology. Recommendations for systematic neuropathologic evaluation of the brains of supposedly injured infants and children usually include the assessment of long white matter tracts in search of axonopathy - specifically, diffuse axonal injury. The ability to recognize, document, and interpret injuries to axons has significant academic and medicolegal implications. For example, more than two decades of inconsistent nosology have resulted in confusion about the definition of diffuse axonal injury between various medical disciplines including radiology, neurosurgery, pediatrics, neuropathology, and forensic pathology. Furthermore, in the pediatric setting, acceptance that "pure" shaking can cause axonal shearing in infants and young children is not widespread. Additionally, controversy abounds whether or not axonal trauma can be identified within regions of white matter ischemia - a debate with very significant implications. Immunohistochemistry is often used not only to document axonal injury, but also to estimate the time since injury. As a result, the estimated post-injury interval may then be used by law enforcement officers and prosecutors to narrow "exclusive opportunity" and thus, identify potential suspects. Fundamental to these highly complicated and controversial topics is a philosophical understanding of the diffuse axonal injury spectrum disorders.
Collapse
|
44
|
Zhou Y. Small world properties changes in mild traumatic brain injury. J Magn Reson Imaging 2016; 46:518-527. [PMID: 27902865 DOI: 10.1002/jmri.25548] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Accepted: 10/26/2016] [Indexed: 11/10/2022] Open
Abstract
PURPOSE To investigate local and global efficiency changes characterized by small-world properties based on resting-state functional MRI, such as centrality and clustering coefficient, in mild traumatic brain injury (MTBI) patients; and to associate these findings with axonal injury as measured by diffusion tensor imaging (DTI) as well as with post-concussive symptom (PCS). MATERIALS AND METHODS Thirty patients (mean age 35 ± 13 years) with clinically defined MTBI and 45 age-matched healthy controls (mean age 37 ± 10 years) participated in the experiments. Resting-state functional MRI was performed using gradient echo planar imaging sequence with 3 Tesla MRI scanner to obtain functional small-world networks. Out of all participants, 20 MTBI patients and 20 controls had available DTI data with three b-values (0, 500, 1000) s/mm2 and 30 directions for diffuse axonal injury analyses. RESULTS Compared with controls, MTBI patients showed lower relative betweenness centrality (P = 0.01), but significantly higher clustering coefficient (P = 0.04), and these two metrics correlated negatively in patients (r = -0.77; P < 0.001). Regions with lower betweenness centrality (e.g., frontal and occipital) corresponded with the regions of reduced FA in patients, while global FA reduction correlated with betweenness centrality (r = 0.48; P = 0.03) and clustering coefficient (r = -0.46; P = 0.04) in MTBI patients. In addition, there was significantly higher thalamocortical connectivity that correlated with clustering coefficient (r = 0.39; P = 0.03) in patients. Also, patients with higher clustering coefficient tended to have less PCS score with negative correlation (r = -0.4; P = 0.04). CONCLUSION Our results demonstrated significant functional small-world properties changes in patients with MTBI, and suggest decreased global efficiency, possibly due to diffuse axonal injury and local network upregulation including increased thalamo-cortical connectivity. LEVEL OF EVIDENCE 2 Technical Efficacy: Stage 2 J. MAGN. RESON. IMAGING 2017;46:518-527.
Collapse
Affiliation(s)
- Yongxia Zhou
- Department of Radiology / Center for Biomedical Imaging, NYU Langone Medical Center, New York, New York
| |
Collapse
|
45
|
Zhou Y. Abnormal structural and functional hypothalamic connectivity in mild traumatic brain injury. J Magn Reson Imaging 2016; 45:1105-1112. [PMID: 27467114 DOI: 10.1002/jmri.25413] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2016] [Accepted: 07/19/2016] [Indexed: 11/09/2022] Open
Abstract
PURPOSE To investigate whether there is imaging evidence of hypothalamic injury in patients with mild traumatic brain injury (MTBI), which is a major public health problem due to the high prevalence and difficulty in diagnosis and treatment. MATERIALS AND METHODS Twenty-four patients (mean age 34.2, range, 18-56 years) with symptomatic MTBI and 22 age-matched healthy controls (mean age 37.0, range 20-61 years) participated in the study. Diffusion kurtosis imaging was performed with diffusion-weighted images acquired along 30 gradient directions and three b-values (b = 0, 1000, 2000 s/mm2 ) based on a twice-refocused spin-echo sequence with a 3T magnetic resonance imaging (MRI) scanner. Resting-state functional (f)MRI with standard echo planar imaging (EPI) were performed to localize the resting-state networks (RSN) and hypothalamic functional connectivity. RESULTS There were significantly reduced mean kurtosis (P = 0.0092) and radial kurtosis (P = 0.0078) in patients as compared to controls in the hypothalamus. Furthermore, there was a significant negative correlation (r = -0.675, P = 0.0007) between radial kurtosis in the hypothalamus and fatigue severity scale in patients. The MTBI group also showed disrupted hypothalamic RSNs, with significantly decreased positive connectivity in medial prefrontal cortex, inferior posterior parietal, and cingulate regions but increased connectivity in the peri-hypothalamic regions and cerebellum, together with significantly decreased negative RSNs in visual and bilateral premotor areas (cluster corrected P < 0.05). CONCLUSION Our results show disruption of functional and structural hypothalamic connectivity in patients with MTBI, and might further the understanding of an array of clinical symptoms in MTBI such as sleep disturbance and fatigue. LEVEL OF EVIDENCE 2 J. Magn. Reson. Imaging 2017;45:1105-1112.
Collapse
Affiliation(s)
- Yongxia Zhou
- Department of Radiology / Center for Biomedical Imaging, NYU Langone Medical Center, New York, New York, USA
| |
Collapse
|