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Hernadi G, Perlaki G, Kovacs M, Pinter D, Orsi G, Janszky J, Kovacs N. White matter hyperintensities associated with impulse control disorders in Parkinson's Disease. Sci Rep 2023; 13:10594. [PMID: 37391475 PMCID: PMC10313834 DOI: 10.1038/s41598-023-37054-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 06/15/2023] [Indexed: 07/02/2023] Open
Abstract
Impulse control disorders (ICDs) in Parkinson's disease (PD) are increasingly recognized as clinically significant non-motor features that potentially impair the quality of life. White matter hyperintensities (WMHs), detected by magnetic resonance imaging, are frequently observed in PD and can be associated with both motor- and certain non-motor symptoms. Given the limited number of non-motor features studied in this context, our aim was to reveal the potential association between the severity of WMHs and ICDs in PD. Fluid-attenuated inversion recovery magnetic resonance images were retrospectively evaluated in 70 patients with PD (48 males; 59.3 ± 10.1 years). The severity of WMHs was assessed by Fazekas scores and by the volume and number of supratentorial WMHs. ICDs were evaluated using the modified Minnesota Impulsive Disorders Interview. Significant interaction between age and the severity of WMHs was present for ICDs. In our younger patients (< 60.5 years), severity of WMHs was positively associated with ICDs (p = 0.004, p = 0.021, p < 0.001 and p < 0.001, respectively for periventricular white matter and total Fazekas scores and the volume and number of WMHs). Our study supports the hypothesis that WMHs of presumed vascular origin may contribute to ICDs in PD. Future prospective studies are needed to assess the prognostic relevance of this finding.
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Affiliation(s)
| | - Gabor Perlaki
- Pecs Diagnostic Centre, Pecs, Hungary
- ELKH-PTE Clinical Neuroscience MR Research Group, Pecs, Hungary
- Department of Neurology, Medical School, University of Pecs, Pecs, Hungary
- Department of Neurosurgery, Medical School, University of Pecs, Pecs, Hungary
| | - Marton Kovacs
- Department of Neurology, Medical School, University of Pecs, Pecs, Hungary.
| | - David Pinter
- ELKH-PTE Clinical Neuroscience MR Research Group, Pecs, Hungary
- Department of Neurology, Medical School, University of Pecs, Pecs, Hungary
| | - Gergely Orsi
- Pecs Diagnostic Centre, Pecs, Hungary
- ELKH-PTE Clinical Neuroscience MR Research Group, Pecs, Hungary
- Department of Neurology, Medical School, University of Pecs, Pecs, Hungary
- Department of Neurosurgery, Medical School, University of Pecs, Pecs, Hungary
| | - Jozsef Janszky
- ELKH-PTE Clinical Neuroscience MR Research Group, Pecs, Hungary
- Department of Neurology, Medical School, University of Pecs, Pecs, Hungary
| | - Norbert Kovacs
- ELKH-PTE Clinical Neuroscience MR Research Group, Pecs, Hungary
- Department of Neurology, Medical School, University of Pecs, Pecs, Hungary
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2
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Dahl J, Tenovuo O, Posti JP, Hirvonen J, Katila AJ, Frantzén J, Maanpää HR, Takala R, Löyttyniemi E, Tallus J, Newcombe V, Menon DK, Hutchinson PJ, Mohammadian M. Cerebral Microbleeds and Structural White Matter Integrity in Patients With Traumatic Brain Injury-A Diffusion Tensor Imaging Study. Front Neurol 2022; 13:888815. [PMID: 35711272 PMCID: PMC9194845 DOI: 10.3389/fneur.2022.888815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 05/05/2022] [Indexed: 11/13/2022] Open
Abstract
Diffuse axonal injury (DAI) is a common neuropathological manifestation of traumatic brain injury (TBI), presenting as traumatic alterations in the cerebral white matter (WM) microstructure and often leading to long-term neurocognitive impairment. These WM alterations can be assessed using diffusion tensor imaging (DTI). Cerebral microbleeds (CMBs) are a common finding on head imaging in TBI and are often considered a visible sign of DAI, although they represent diffuse vascular injury. It is poorly known how they associate with long-term white matter integrity. This study included 20 patients with TBI and CMBs, 34 patients with TBI without CMBs, and 11 controls with orthopedic injuries. DTI was used to assess microstructural WM alterations. CMBs were detected using susceptibility-weighted imaging (SWI) and graded according to their location in the WM and total lesion load was counted. Patients underwent SWI within 2 months after injury. DTI and clinical outcome assessment were performed at an average of eight months after injury. Outcome was assessed using the extended Glasgow Outcome Scale (GOSe). The Glasgow Coma Scale (GCS) and length of post-traumatic amnesia (PTA) were used to assess clinical severity of the injury. We found that CMB grading and total lesion load were negatively associated with fractional anisotropy (FA) and positively associated with mean diffusivity (MD). Patients with TBI and CMBs had decreased FA and increased MD compared with patients with TBI without CMBs. CMBs were also associated with worse clinical outcome. When adjusting for the clinical severity of the injury, none of the mentioned associations were found. Thus, the difference in FA and MD is explained by patients with TBI and CMBs having more severe injuries. Our results suggest that CMBs are not associated with greater WM alterations when adjusting for the clinical severity of TBI. Thus, CMBs and WM alterations may not be strongly associated pathologies in TBI.
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Affiliation(s)
- Juho Dahl
- Turku Brain Injury Center, Turku University Hospital, University of Turku, Turku, Finland
| | - Olli Tenovuo
- Turku Brain Injury Center, Turku University Hospital, University of Turku, Turku, Finland
| | - Jussi P Posti
- Neurocenter, Department of Neurosurgery, Turku Brain Injury Center, Turku University Hospital, University of Turku, Turku, Finland
| | - Jussi Hirvonen
- Department of Diagnostic Radiology, Turku University Hospital, University of Turku, Turku, Finland
| | - Ari J Katila
- Perioperative Services, Intensive Care Medicine and Pain Management, Department of Anesthesiology and Intensive Care, Turku University Hospital, University of Turku, Turku, Finland
| | - Janek Frantzén
- Neurocenter, Department of Neurosurgery, Turku Brain Injury Center, Turku University Hospital, University of Turku, Turku, Finland
| | - Henna-Riikka Maanpää
- Neurocenter, Department of Neurosurgery, Turku Brain Injury Center, Turku University Hospital, University of Turku, Turku, Finland
| | - Riikka Takala
- Perioperative Services, Intensive Care Medicine and Pain Management, Department of Anesthesiology and Intensive Care, Turku University Hospital, University of Turku, Turku, Finland
| | | | - Jussi Tallus
- Turku Brain Injury Center, Turku University Hospital, University of Turku, Turku, Finland
| | - Virginia Newcombe
- Division of Anaesthesia, Addenbrooke's Hospital, University of Cambridge, Cambridge, United Kingdom
| | - David K Menon
- Division of Anaesthesia, Addenbrooke's Hospital, University of Cambridge, Cambridge, United Kingdom
| | - Peter J Hutchinson
- Neurosurgery Unit, Department of Clinical Neurosciences, Addenbrooke's Hospital, University of Cambridge, Cambridge, United Kingdom
| | - Mehrbod Mohammadian
- Turku Brain Injury Center, Turku University Hospital, University of Turku, Turku, Finland
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Környei BS, Szabó V, Perlaki G, Balogh B, Szabó Steigerwald DK, Nagy SA, Tóth L, Büki A, Dóczi T, Bogner P, Schwarcz A, Tóth A. Cerebral Microbleeds May Be Less Detectable by Susceptibility Weighted Imaging MRI From 24 to 72 Hours After Traumatic Brain Injury. Front Neurosci 2021; 15:711074. [PMID: 34658762 PMCID: PMC8514822 DOI: 10.3389/fnins.2021.711074] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 08/12/2021] [Indexed: 01/26/2023] Open
Abstract
Purpose: A former rodent study showed that cerebral traumatic microbleeds (TMBs) may temporarily become invisible shortly after injury when detected by susceptibility weighted imaging (SWI). The present study aims to validate this phenomenon in human SWI. Methods: In this retrospective study, 46 traumatic brain injury (TBI) patients in various forms of severity were included and willingly complied with our strict selection criteria. Clinical parameters potentially affecting TMB count, Rotterdam and Marshall CT score, Mayo Clinic Classification, contusion number, and total volume were registered. The precise time between trauma and MRI [5 h 19 min to 141 h 54 min, including SWI and fluid-attenuated inversion recovery (FLAIR)] was individually recorded; TMB and FLAIR lesion counts were assessed. Four groups were created based on elapsed time between the trauma and MRI: 0–24, 24–48, 48–72, and >72 h. Kruskal–Wallis, ANOVA, Chi-square, and Fisher’s exact tests were used to reveal differences among the groups within clinical and imaging parameters; statistical power was calculated retrospectively for each comparison. Results: The Kruskal–Wallis ANOVA with Conover post hoc analysis showed significant (p = 0.01; 1−β > 0.9) median TMB number differences in the subacute period: 0–24 h = 4.00 (n = 11); 24–48 h = 1 (n = 14); 48–72 h = 1 (n = 11); and 72 h ≤ 7.5 (n = 10). Neither clinical parameters nor FLAIR lesions depicted significant differences among the groups. Conclusion: Our results demonstrate that TMBs on SWI MRI may temporarily become less detectable at 24–72 h following TBI.
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Affiliation(s)
- Bálint S Környei
- Department of Medical Imaging, Medical School, University of Pécs, Pécs, Hungary
| | - Viktor Szabó
- Department of Neurosurgery, Medical School, University of Pécs, Pécs, Hungary
| | - Gábor Perlaki
- Department of Neurosurgery, Medical School, University of Pécs, Pécs, Hungary.,MTA-PTE Clinical Neuroscience MR Research Group, Pécs Diagnostic Center, Pécs, Hungary
| | - Bendegúz Balogh
- Department of Medical Imaging, Medical School, University of Pécs, Pécs, Hungary
| | | | - Szilvia A Nagy
- MTA-PTE Clinical Neuroscience MR Research Group, Pécs Diagnostic Center, Pécs, Hungary.,Neurobiology of Stress Research Group, Szentágothai Research Centre, University of Pécs, Pécs, Hungary.,Department of Laboratory Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Luca Tóth
- Department of Neurosurgery, Medical School, University of Pécs, Pécs, Hungary
| | - András Büki
- Department of Neurosurgery, Medical School, University of Pécs, Pécs, Hungary
| | - Tamás Dóczi
- Department of Neurosurgery, Medical School, University of Pécs, Pécs, Hungary
| | - Péter Bogner
- Department of Medical Imaging, Medical School, University of Pécs, Pécs, Hungary
| | - Attila Schwarcz
- Department of Neurosurgery, Medical School, University of Pécs, Pécs, Hungary
| | - Arnold Tóth
- Department of Medical Imaging, Medical School, University of Pécs, Pécs, Hungary.,MTA-PTE Clinical Neuroscience MR Research Group, Pécs, Hungary
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Castaño-Leon AM, Cicuendez M, Navarro-Main B, Paredes I, Munarriz PM, Hilario A, Ramos A, Gomez PA, Lagares A. Traumatic axonal injury: is the prognostic information produced by conventional MRI and DTI complementary or supplementary? J Neurosurg 2021; 136:242-256. [PMID: 34214979 DOI: 10.3171/2020.11.jns203124] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 11/09/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE A traumatic axonal injury (TAI) diagnosis has traditionally been based on conventional MRI, especially on those sequences with a higher sensitivity to edema and blood degradation products. A more recent technique, diffusion tensor imaging (DTI), can infer the microstructure of white matter (WM) due to the restricted diffusion of water in organized tissues. However, there is little information regarding the correlation of the findings obtained by both methods and their use for outcome prognosis. The main objectives of this study were threefold: 1) study the correlation between DTI metrics and conventional MRI findings; 2) evaluate whether the prognostic information provided by the two techniques is supplementary or complementary; and 3) determine the incremental value of the addition of these variables compared to a traditional prognostic model. METHODS The authors studied 185 patients with moderate to severe traumatic brain injury (TBI) who underwent MRI with DTI study during the subacute stage. The number and volume of lesions in hemispheric subcortical WM, corpus callosum (CC), basal ganglia, thalamus, and brainstem in at least four conventional MRI sequences (T1-weighted, T2-weighted, FLAIR, T2* gradient recalled echo, susceptibility-weighted imaging, and diffusion-weighted imaging) were determined. Fractional anisotropy (FA) was measured in 28 WM bundles using the region of interest method. Nonparametric tests were used to evaluate the colocalization of macroscopic lesions and FA. A multivariate logistic regression analysis was performed to assess the independent prognostic value of each neuroimaging modality after adjustment for relevant clinical covariates, and the internal validation of the model was evaluated in a contemporary cohort of 92 patients. RESULTS Differences in the lesion load between patients according to their severity and outcome were found. Colocalization of macroscopic nonhemorrhagic TAI lesions (not microbleeds) and lower FA was limited to the internal and external capsule, corona radiata, inferior frontooccipital fasciculus, CC, and brainstem. However, a significant association between the FA value and the identification of macroscopic lesions in distant brain regions was also detected. Specifically, lower values of FA of some hemispheric WM bundles and the splenium of the CC were related to a higher number and volume of hyperintensities in the brainstem. The regression analysis revealed that age, motor score, hypoxia, FA of the genu of the CC, characterization of TAI lesions in the CC, and the presence of thalamic/basal ganglia lesions were independent prognostic factors. The performance of the proposed model was higher than that of the IMPACT (International Mission on Prognosis and Analysis of Clinical Trials in TBI) model in the validation cohort. CONCLUSIONS Very limited colocalization of hyperintensities (none for microbleeds) with FA values was discovered. DTI and conventional MRI provide complementary prognostic information, and their combination can improve the performance of traditional prognostic models.
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Affiliation(s)
| | - Marta Cicuendez
- 2Department of Neurosurgery, Hospital Universitario Vall d'Hebron, Universidad de Barcelona, Passeig de la Vall d'Hebron, Barcelona, Spain
| | | | - Igor Paredes
- 1Department of Neurosurgery and Research Institute i+12-CIBERESP, and
| | - Pablo M Munarriz
- 1Department of Neurosurgery and Research Institute i+12-CIBERESP, and
| | - Amaya Hilario
- 3Department of Radiology, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Avda de Cordoba SN, Madrid; and
| | - Ana Ramos
- 3Department of Radiology, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Avda de Cordoba SN, Madrid; and
| | - Pedro A Gomez
- 1Department of Neurosurgery and Research Institute i+12-CIBERESP, and
| | - Alfonso Lagares
- 1Department of Neurosurgery and Research Institute i+12-CIBERESP, and
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5
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van der Eerden AW, van den Heuvel TL, Perlbarg V, Vart P, Vos PE, Puybasset L, Galanaud D, Platel B, Manniesing R, Goraj BM. Traumatic Cerebral Microbleeds in the Subacute Phase Are Practical and Early Predictors of Abnormality of the Normal-Appearing White Matter in the Chronic Phase. AJNR Am J Neuroradiol 2021; 42:861-867. [PMID: 33632731 DOI: 10.3174/ajnr.a7028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 11/16/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND PURPOSE In the chronic phase after traumatic brain injury, DTI findings reflect WM integrity. DTI interpretation in the subacute phase is less straightforward. Microbleed evaluation with SWI is straightforward in both phases. We evaluated whether the microbleed concentration in the subacute phase is associated with the integrity of normal-appearing WM in the chronic phase. MATERIALS AND METHODS Sixty of 211 consecutive patients 18 years of age or older admitted to our emergency department ≤24 hours after moderate to severe traumatic brain injury matched the selection criteria. Standardized 3T SWI, DTI, and T1WI were obtained 3 and 26 weeks after traumatic brain injury in 31 patients and 24 healthy volunteers. At baseline, microbleed concentrations were calculated. At follow-up, mean diffusivity (MD) was calculated in the normal-appearing WM in reference to the healthy volunteers (MDz). Through linear regression, we evaluated the relation between microbleed concentration and MDz in predefined structures. RESULTS In the cerebral hemispheres, MDz at follow-up was independently associated with the microbleed concentration at baseline (left: B = 38.4 [95% CI 7.5-69.3], P = .017; right: B = 26.3 [95% CI 5.7-47.0], P = .014). No such relation was demonstrated in the central brain. MDz in the corpus callosum was independently associated with the microbleed concentration in the structures connected by WM tracts running through the corpus callosum (B = 20.0 [95% CI 24.8-75.2], P < .000). MDz in the central brain was independently associated with the microbleed concentration in the cerebral hemispheres (B = 25.7 [95% CI 3.9-47.5], P = .023). CONCLUSIONS SWI-assessed microbleeds in the subacute phase are associated with DTI-based WM integrity in the chronic phase. These associations are found both within regions and between functionally connected regions.
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Affiliation(s)
- A W van der Eerden
- From the Department of Radiology and Nuclear Medicine (A.W.v.d.E., T.L.v.d.H., B.P., R.M., B.M.G.), Radboud University Medical Center, Nijmegen, The Netherlands .,Erasmus Medical Center, Department of Radiology & Nuclear Medicine (A.W.v.d.E.), Rotterdam, The Netherlands
| | - T L van den Heuvel
- From the Department of Radiology and Nuclear Medicine (A.W.v.d.E., T.L.v.d.H., B.P., R.M., B.M.G.), Radboud University Medical Center, Nijmegen, The Netherlands
| | - V Perlbarg
- Inserm, Sorbonne Université (V.P.), CNRS, Laboratoire d'Imagerie Biomédicale, Paris, France.,BrainTale SAS (V.P.), Paris, France
| | - P Vart
- Department of Epidemiology and Biostatistics (P.V.), Radboud University Nijmegen, Nijmegen, The Netherlands
| | - P E Vos
- Department of Neurology (P.E.V.), Santiz-Slingeland Hospital, Doetinchem, The Netherlands
| | - L Puybasset
- Department of Neurosurgical ICU (L.P.), Pitié Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - D Galanaud
- Department of Neuroradiology (D.G.), Pitié Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - B Platel
- From the Department of Radiology and Nuclear Medicine (A.W.v.d.E., T.L.v.d.H., B.P., R.M., B.M.G.), Radboud University Medical Center, Nijmegen, The Netherlands
| | - R Manniesing
- From the Department of Radiology and Nuclear Medicine (A.W.v.d.E., T.L.v.d.H., B.P., R.M., B.M.G.), Radboud University Medical Center, Nijmegen, The Netherlands
| | - B M Goraj
- From the Department of Radiology and Nuclear Medicine (A.W.v.d.E., T.L.v.d.H., B.P., R.M., B.M.G.), Radboud University Medical Center, Nijmegen, The Netherlands.,Department of Diagnostic Imaging (B.M.G.), Medical Centre of Postgraduate Education, Warsaw, Poland
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6
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Hütter BO, Altmeppen J, Kraff O, Maderwald S, Theysohn JM, Ringelstein A, Wrede KH, Dammann P, Quick HH, Schlamann M, Moenninghoff C. Higher sensitivity for traumatic cerebral microbleeds at 7 T ultra-high field MRI: is it clinically significant for the acute state of the patients and later quality of life? Ther Adv Neurol Disord 2020; 13:1756286420911295. [PMID: 32313555 PMCID: PMC7155239 DOI: 10.1177/1756286420911295] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 02/03/2020] [Indexed: 01/14/2023] Open
Abstract
Background The present study evaluates the possible prognostic benefits of 7 T susceptibility weighted imaging (SWI) of traumatic cerebral microbleeds (TMBs) over 3 T SWI to predict the acute clinical state and subjective impairments, including health-related quality of life (HRQOL), after closed head injury (CHI). Methods The study group comprised 10 participants with known TMBs All subjects underwent 3 T magnetic resonance imaging (MRI) and 7 T MRI, respectively. Location and count of TMBs were independently evaluated by two neuroradiologists. The initial Glasgow Coma Scale (GCS), the duration of coma and further clinical data were taken from the patients records. HRQOL was assessed by means of a questionnaire. Memory complaints and neurological symptoms were inquired at the time of the MRI examinations. Results SWI revealed a total of 485 TMBs at 3 T, 584 TMBs at 7 T with similar spatial resolution, and 684 TMBs at 7 T with a factor of 10 higher spatial resolution. The TMBs depicted by 7 T high-resolution SWI were correlated with the duration of coma (Spearman's rho of 0.77). The corresponding association with TMBs in 3 T MRI SWI showed a Spearman's rho of 0.71. The initial GCS score and TMBs correlated with a Spearman's rho of -0.35 at 3 T SWI MRI and a rho of -0.33 at 7 T high-resolution SWI, respectively. The physical aspect of HRQOL correlated substantially with the count of TMBs (rho = 0.44 for 3 T SWI and rho = 0.35 for both 7 T SWI sequences, respectively). Conclusions The number of TMBs showed a substantial association with indicators of the acute clinical state and chronic neurobehavioral parameters after CHI, but there was no additional advantage of 7 T MRI. These preliminary findings warrant a larger prospective study for the future.
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Affiliation(s)
- Bernd-Otto Hütter
- Department of Neurosurgery, University Hospital Essen, Hufelandstr. 55, Essen, 45147, Germany
| | - Jan Altmeppen
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Oliver Kraff
- Erwin L. Hahn Institute for Magnetic Resonance Imaging, University Duisburg-Essen, Essen, Germany
| | - Stefan Maderwald
- Erwin L. Hahn Institute for Magnetic Resonance Imaging, University Duisburg-Essen, Essen, Germany
| | - Jens M Theysohn
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Adrian Ringelstein
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Karsten H Wrede
- Department of Neurosurgery, University Hospital Essen, Essen, Germany
| | - Philipp Dammann
- Department of Neurosurgery, University Hospital Essen, Essen, Germany
| | - Harald H Quick
- Erwin L. Hahn Institute for Magnetic Resonance Imaging, University Duisburg-Essen, Essen, Germany
| | - Marc Schlamann
- Department of Neuroradiology, University Hospital Giessen, Giessen, Germany
| | - Christoph Moenninghoff
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
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Rizk T, Turtzo LC, Cota M, Van Der Merwe AJ, Latour L, Whiting MD, Chan L. Traumatic microbleeds persist for up to five years following traumatic brain injury despite resolution of other acute findings on MRI. Brain Inj 2020; 34:773-781. [PMID: 32228304 DOI: 10.1080/02699052.2020.1725835] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE The primary objective of this study was to track the incidence and progression of traumatic microbleeds (TMBs) for up to five years following traumatic brain injury (TBI). METHODS Thirty patients with mild, moderate, or severe TBI received initial MRI within 48 h of injury and continued in a longitudinal study for up to five years. The incidence and progression of MRI findings was assessed across the five year period. In addition to TMBs, we noted the presence of other imaging findings including diffusion weighted imaging (DWI) lesions, extra-axial and intraventricular hemorrhage, hematoma, traumatic meningeal enhancement (TME), fluid-attenuated inversion recovery (FLAIR) hyperintensities, and encephalomalacia. RESULTS TMBs were observed in 60% of patients at initial presentation. At one-year follow-up, TMBs were more persistent than other neuroimaging findings, with 83% remaining visible on MRI. In patients receiving serial MRI 2-5 years post-injury, acute TMBs were visible on all follow-up scans. In contrast, most other imaging markers of TBI had either resolved or evolved into ambiguous abnormalities on imaging by one year post-injury. CONCLUSIONS These findings suggest that TMBs may serve as a uniquely persistent indicator of TBI and reinforce the importance of acute post-injury imaging for accurate characterization of persistent imaging findings.
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Affiliation(s)
- Theresa Rizk
- Department of Rehabilitation Medicine, National Institutes of Health Clinical Center , Bethesda, MD, USA
| | - L Christine Turtzo
- National Institutes of Neurological Disorders and Stroke, National Institutes of Health , Bethesda, MD, USA
| | - Martin Cota
- Center for Neuroscience and Regenerative Medicine , Rockville, MD, USA
| | | | - Lawrence Latour
- National Institutes of Neurological Disorders and Stroke, National Institutes of Health , Bethesda, MD, USA.,Center for Neuroscience and Regenerative Medicine , Rockville, MD, USA
| | - Mark D Whiting
- Center for Neuroscience and Regenerative Medicine , Rockville, MD, USA
| | - Leighton Chan
- Department of Rehabilitation Medicine, National Institutes of Health Clinical Center , Bethesda, MD, USA.,Center for Neuroscience and Regenerative Medicine , Rockville, MD, USA
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8
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Zheng T, Du J, Yuan Y, Wu S, Jin Y, Wang Z, Liu D, Shi Q, Wang X, Liu L. Neuroprotective Effect of Low-Intensity Transcranial Ultrasound Stimulation in Moderate Traumatic Brain Injury Rats. Front Neurosci 2020; 14:172. [PMID: 32218720 PMCID: PMC7078644 DOI: 10.3389/fnins.2020.00172] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 02/17/2020] [Indexed: 01/30/2023] Open
Abstract
Traumatic brain injury (TBI) is a kind of severe brain injury characterized with a high incidence rate and a high disability rate. Low-intensity transcranial ultrasound stimulation (LITUS) is a promising neuroprotective method for improving the functional prognosis of TBI. The fractional anisotropy (FA) value and mean diffusivity (MD) value can be sensitive to abnormal brain structure and function and can thus be used to evaluate the effect of LITUS on TBI. Our purpose was to evaluate the therapeutic effect of LITUS in a moderate TBI rat model with FA and MD values. For our method, we used 45 male Sprague Dawley rats (15 sham normal, 15 TBI, and 15 LITUS treatment rats). We used single-shot spin echo echo-planar imaging sequences at 3.0T to obtain the DTI parameters. Parameters of FA and MD on the treated side of the injury cortex were measured to evaluate the therapeutic effect of LITUS in a TBI rat model. For FA and MD values, groups were compared by using a two-way analysis of variance for repeated measures, and this was followed by Tukey's post hoc test. Differences were considered significant at P < 0.05. The results were that the FA value in the LITUS treatment group at 1 day after TBI was significantly higher than that in the control group (adjusted P = 0.0422) and significantly lower than that in the TBI group at 14, 21, and 35 days after TBI (adjusted P = 0.0015, 0.0064, and 0.0173, respectively). At the end of the scan time point, the differences between the two groups were not significant (adjusted P = 0.3242). The MD values in the LITUS treatment group were significantly higher in the early stage than that in the TBI group (adjusted P = 0.0167) and significantly lower at the following time points than in the TBI group. In conclusion, daily treatment with LITUS for 10 min effectively improved the brain damage in the Controlled Cortical Impact (CCI)-caused TBI model. FA and MD values can serve as evaluation indicators for the neuro-protective effect of LITUS.
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Affiliation(s)
- Tao Zheng
- Department of Magnetic Resonance Imaging, Qinhuangdao Municipal No. 1 Hospital, Qinhuangdao, China
| | - Juan Du
- Department of Magnetic Resonance Imaging, Qinhuangdao Municipal No. 1 Hospital, Qinhuangdao, China
| | - Yi Yuan
- Institute of Electrical Engineering, Yanshan University, Qinhuangdao, China
| | - Shuo Wu
- Department of Magnetic Resonance Imaging, Qinhuangdao Municipal No. 1 Hospital, Qinhuangdao, China
| | - Yinglan Jin
- Peking University Health Science Center, Beijing, China
| | - Zhanqiu Wang
- Department of Magnetic Resonance Imaging, Qinhuangdao Municipal No. 1 Hospital, Qinhuangdao, China
| | - Defeng Liu
- Department of Magnetic Resonance Imaging, Qinhuangdao Municipal No. 1 Hospital, Qinhuangdao, China
| | | | - Xiaohan Wang
- Department of Magnetic Resonance Imaging, Qinhuangdao Municipal No. 1 Hospital, Qinhuangdao, China
| | - Lanxiang Liu
- Department of Magnetic Resonance Imaging, Qinhuangdao Municipal No. 1 Hospital, Qinhuangdao, China
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9
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Taylor PN, Moreira da Silva N, Blamire A, Wang Y, Forsyth R. Early deviation from normal structural connectivity: A novel intrinsic severity score for mild TBI. Neurology 2020; 94:e1021-e1026. [PMID: 31937623 PMCID: PMC7238920 DOI: 10.1212/wnl.0000000000008902] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 09/03/2020] [Indexed: 11/21/2022] Open
Abstract
Objective Studies of outcome after traumatic brain injury (TBI) are hampered by the lack of robust injury severity measures that can accommodate spatial-anatomical and mechanistic heterogeneity. In this study we introduce a Mahalanobis distance measure (M) as an intrinsic injury severity measure that combines in a single score the many ways a given injured brain's connectivity can vary from that of healthy controls. Our objective is to test the hypotheses that M is superior to univariate measures in (1) discriminating patients and controls and (2) correlating with cognitive assessment. Methods Sixty-five participants (34 with mild TBI, 31 controls) underwent diffusion tensor MRI and extensive neuropsychological testing. Structural connectivity was inferred for all participants for 22 major white matter connections. Twenty-two univariate measures (1 per connection) and 1 multivariate measure (M), capturing and summarizing all connectivity change in a single score, were computed. Results Our multivariate measure (M) was able to better discriminate between patients and controls (area under the curve 0.81) than any individual univariate measure. M significantly correlated with cognitive outcome (Spearman ρ = 0.31; p < 0.05). No univariate measure showed significant correlation after correction for multiple comparisons. Conclusions Heterogeneity in the severity and distribution of injuries after TBI has traditionally complicated the understanding of outcomes after TBI. Our approach provides a single, continuous variable that can fully capture individual heterogeneity. M's ability to distinguish even mildly injured patients from controls and its correlation with cognitive assessment suggest utility as an imaging-based marker of intrinsic injury severity.
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Affiliation(s)
- Peter Neal Taylor
- From the Interdisciplinary Complex Systems Group, School of Computing (P.N.T., N.M.d.S., Y.W.), Institute of Neuroscience, Faculty of Medical Sciences (P.N.T., Y.W., R.F.), and Institute of Cellular Medicine & Newcastle MR Centre (A.B.), Newcastle University, Newcastle Upon Tyne; and Institute of Neurology (P.N.T., Y.W.), University College London, UK.
| | - Nádia Moreira da Silva
- From the Interdisciplinary Complex Systems Group, School of Computing (P.N.T., N.M.d.S., Y.W.), Institute of Neuroscience, Faculty of Medical Sciences (P.N.T., Y.W., R.F.), and Institute of Cellular Medicine & Newcastle MR Centre (A.B.), Newcastle University, Newcastle Upon Tyne; and Institute of Neurology (P.N.T., Y.W.), University College London, UK
| | - Andrew Blamire
- From the Interdisciplinary Complex Systems Group, School of Computing (P.N.T., N.M.d.S., Y.W.), Institute of Neuroscience, Faculty of Medical Sciences (P.N.T., Y.W., R.F.), and Institute of Cellular Medicine & Newcastle MR Centre (A.B.), Newcastle University, Newcastle Upon Tyne; and Institute of Neurology (P.N.T., Y.W.), University College London, UK
| | - Yujiang Wang
- From the Interdisciplinary Complex Systems Group, School of Computing (P.N.T., N.M.d.S., Y.W.), Institute of Neuroscience, Faculty of Medical Sciences (P.N.T., Y.W., R.F.), and Institute of Cellular Medicine & Newcastle MR Centre (A.B.), Newcastle University, Newcastle Upon Tyne; and Institute of Neurology (P.N.T., Y.W.), University College London, UK
| | - Rob Forsyth
- From the Interdisciplinary Complex Systems Group, School of Computing (P.N.T., N.M.d.S., Y.W.), Institute of Neuroscience, Faculty of Medical Sciences (P.N.T., Y.W., R.F.), and Institute of Cellular Medicine & Newcastle MR Centre (A.B.), Newcastle University, Newcastle Upon Tyne; and Institute of Neurology (P.N.T., Y.W.), University College London, UK
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10
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Andreasen SH, Andersen KW, Conde V, Dyrby TB, Puonti O, Kammersgaard LP, Madsen CG, Madsen KH, Poulsen I, Siebner HR. Limited Colocalization of Microbleeds and Microstructural Changes after Severe Traumatic Brain Injury. J Neurotrauma 2019; 37:581-592. [PMID: 31588844 DOI: 10.1089/neu.2019.6608] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Severe traumatic brain injury (TBI) produces shearing forces on long-range axons and brain vessels, causing axonal and vascular injury. To examine whether microbleeds and axonal injury colocalize after TBI, we performed whole-brain susceptibility-weighted imaging (SWI) and diffusion tensor imaging (DTI) in 14 patients during the subacute phase after severe TBI. SWI was used to determine the number and volumes of microbleeds in five brain regions: the frontotemporal lobe; parieto-occipital lobe; midsagittal region (cingular cortex, parasagittal white matter, and corpus callosum); deep nuclei (basal ganglia and thalamus); and brainstem. Averaged fractional anisotropy (FA) and mean diffusivity (MD) were measured to assess microstructural changes in the normal appearing white matter attributed to axonal injury in the same five regions. Regional expressions of microbleeds and microstructure were used in a partial least-squares model to predict the impairment of consciousness in the subacute stage after TBI as measured with the Coma Recovery Scale-Revised (CRS-R). Only in the midsagittal region, the expression of microbleeds was correlated with regional changes in microstructure as revealed by DTI. Microbleeds and microstructural DTI-based metrics of deep, but not superficial, brain regions were able to predict individual CRS-R. Our results suggest that microbleeds are not strictly related to axonal pathology in other than the midsagittal region. While each measure alone was predictive, the combination of both metrics scaled best with individual CRS-R. Structural alterations in deep brain structures are relevant in terms of determining the severity of impaired consciousness in the acute stage after TBI.
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Affiliation(s)
- Sara H Andreasen
- Danish Research Centre for Magnetic Resonance (DRCMR), Centre for Functional and Diagnostic Imaging Research, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark.,Research Unit on Brain Injury Rehabilitation Copenhagen (RUBRIC), Department of Neurorehabilitation, Traumatic Brain Injury, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.,Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Kasper W Andersen
- Danish Research Centre for Magnetic Resonance (DRCMR), Centre for Functional and Diagnostic Imaging Research, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - Virginia Conde
- Danish Research Centre for Magnetic Resonance (DRCMR), Centre for Functional and Diagnostic Imaging Research, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark.,Clinical Neuroscience Laboratory, Institute of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
| | - Tim B Dyrby
- Danish Research Centre for Magnetic Resonance (DRCMR), Centre for Functional and Diagnostic Imaging Research, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark.,Department of Applied Mathematics and Computer Science, Technical University of Denmark, Kgs. Lyngby, Denmark
| | - Oula Puonti
- Danish Research Centre for Magnetic Resonance (DRCMR), Centre for Functional and Diagnostic Imaging Research, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark.,Department of Applied Mathematics and Computer Science, Technical University of Denmark, Kgs. Lyngby, Denmark
| | - Lars Peter Kammersgaard
- Research Unit on Brain Injury Rehabilitation Copenhagen (RUBRIC), Department of Neurorehabilitation, Traumatic Brain Injury, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.,Department of Neurology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Camilla G Madsen
- Danish Research Centre for Magnetic Resonance (DRCMR), Centre for Functional and Diagnostic Imaging Research, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark.,Department of Radiology, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - Kristoffer H Madsen
- Danish Research Centre for Magnetic Resonance (DRCMR), Centre for Functional and Diagnostic Imaging Research, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark.,Department of Applied Mathematics and Computer Science, Technical University of Denmark, Kgs. Lyngby, Denmark
| | - Ingrid Poulsen
- Research Unit on Brain Injury Rehabilitation Copenhagen (RUBRIC), Department of Neurorehabilitation, Traumatic Brain Injury, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.,Department of Nursing Science, Faculty of Health, Aarhus University, Aarhus, Denmark
| | - Hartwig R Siebner
- Danish Research Centre for Magnetic Resonance (DRCMR), Centre for Functional and Diagnostic Imaging Research, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark.,Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Department for Neurology, Copenhagen University Hospital Bispebjerg, Copenhagen, Denmark
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11
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Moe HK, Limandvik Myhr J, Moen KG, Håberg AK, Skandsen T, Vik A. Association of cause of injury and traumatic axonal injury: a clinical MRI study of moderate and severe traumatic brain injury. J Neurosurg 2019; 133:1559-1567. [PMID: 31604329 DOI: 10.3171/2019.6.jns191040] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Accepted: 06/25/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The authors investigated the association between the cause of injury and the occurrence and grade of traumatic axonal injury (TAI) on clinical MRI in patients with moderate or severe traumatic brain injury (TBI). METHODS Data for a total of 396 consecutive patients, aged 7-70 years, with moderate or severe TBI admitted to a level 1 trauma center were prospectively registered. Data were included for analysis from the 219 patients who had MRI performed within 35 days (median 8, IQR 4-17 days) and for whom cause of injury was known. Cause of injury was registered as road traffic accident (RTA) or fall (both with respective subcategories), alpine skiing or snowboarding accident, or violence. The MRI protocol consisted of T2*-weighted gradient echo, FLAIR, and diffusion-weighted imaging scans. TAI lesions were evaluated in a blinded manner and categorized into 3 grades, hemispheric/cerebellar white matter (grade 1), corpus callosum (grade 2), and brainstem (grade 3). The absence of TAI was analyzed as grade 0. Contusions and mass lesions on CT were also registered. RESULTS Cause of injury did not differ between included and nonincluded patients. TAI was found in 83% of patients in the included group after RTAs and 62% after falls (p < 0.001). Observed TAI grades differed between the subcategories of both RTAs (p = 0.004) and falls (p = 0.006). Pedestrians in RTAs, car drivers/passengers in RTAs, and alpine skiers had the highest prevalence of TAI (89%-100%) and the highest TAI grades (70%-82% TAI grades 2-3). TAI was found in 76% of patients after falls from > own height (45% TAI grade 2-3), 63% after falls down the stairs (26% TAI grade 2-3), and 31% after falls from ≤ own height (12% TAI grade 2-3). Moreover, 53% of patients with TAI after RTAs and 68% with TAI after falls had cortical contusions or mass lesions on CT. CONCLUSIONS This prospective study of moderate and severe TBI is to the authors' knowledge the first clinical MRI study to demonstrate both the high prevalence and grade of TAI after most of the different types of RTAs, alpine skiing accidents, and falls from a height. Importantly, TAI was also common following more low-energy trauma such as falls down the stairs or from own height. Physicians managing TBI patients in the acute phase should be aware of the possibility of TAI no matter the cause of injury and also when the CT scan shows cortical contusions or mass lesions.
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Affiliation(s)
- Hans Kristian Moe
- 1Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology (NTNU), Trondheim
| | - Janne Limandvik Myhr
- 1Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology (NTNU), Trondheim
| | - Kent Gøran Moen
- 1Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology (NTNU), Trondheim
- 2Department of Radiology, Nord-Trøndelag Hospital Trust, Levanger; and
| | - Asta Kristine Håberg
- 1Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology (NTNU), Trondheim
- Departments of3Radiology and Nuclear Medicine
| | - Toril Skandsen
- 1Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology (NTNU), Trondheim
- 4Physical Medicine and Rehabilitation, and
| | - Anne Vik
- 1Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology (NTNU), Trondheim
- 5Neurosurgery, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
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12
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Tóth A, Berente Z, Bogner P, Környei B, Balogh B, Czeiter E, Amrein K, Dóczi T, Büki A, Schwarcz A. Cerebral Microbleeds Temporarily Become Less Visible or Invisible in Acute Susceptibility Weighted Magnetic Resonance Imaging: A Rat Study. J Neurotrauma 2019; 36:1670-1677. [PMID: 30421664 PMCID: PMC6531906 DOI: 10.1089/neu.2018.6004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Previously, we reported human traumatic brain injury cases demonstrating acute to subacute microbleed appearance changes in susceptibility-weighted imaging (SWI—magnetic resonance imaging [MRI]). This study aims to confirm and characterize such temporal microbleed appearance alterations in an experimental model. To elicit microbleed formation, brains of male Sprague Dawley rats were pierced in a depth of 4 mm, in a parasagittal position bilaterally using 159 μm and 474 μm needles, without the injection of autologous blood or any agent. Rats underwent 4.7 T MRI immediately, then at multiple time points until 125 h. Volumes of hypointensities consistent with microbleeds in SWI were measured using an intensity threshold-based approach. Microbleed volumes across time points were compared using repeated measures analysis of variance. Microbleeds were assessed by Prussian blue histology at different time points. Hypointensity volumes referring to microbleeds were significantly decreased (corrected p < 0.05) at 24 h compared with the immediate or the 125 h time points. By visual inspection, microbleeds were similarly detectable at the immediate and 125 h imaging but were decreased in extent or completely absent at 24 h or 48 h. Histology confirmed the presence of microbleeds at all time points and in all animals. This study confirmed a general temporary reduction in visibility of microbleeds in the acute phase in SWI. Such short-term appearance dynamics of microbleeds should be considered when using SWI as a diagnostic tool for microbleeds in traumatic brain injury and various diseases.
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Affiliation(s)
- Arnold Tóth
- 1 Department of Neurosurgery, Pécs Medical School, Pécs, Hungary.,2 Department of Radiology, Pécs Medical School, Pécs, Hungary.,3 MTA-PTE Clinical Neuroscience MR Research Group, Pécs, Hungary
| | - Zoltán Berente
- 4 Department of Biochemistry and Medical Chemistry, Pécs Medical School, Pécs, Hungary.,5 János Szentágothai Research Centre, University of Pécs, Pécs, Hungary.,6 Research Group for Experimental Diagnostic Imaging, Pécs Medical School, Pécs, Hungary
| | - Péter Bogner
- 2 Department of Radiology, Pécs Medical School, Pécs, Hungary
| | - Bálint Környei
- 1 Department of Neurosurgery, Pécs Medical School, Pécs, Hungary
| | - Bendegúz Balogh
- 2 Department of Radiology, Pécs Medical School, Pécs, Hungary
| | - Endre Czeiter
- 1 Department of Neurosurgery, Pécs Medical School, Pécs, Hungary.,3 MTA-PTE Clinical Neuroscience MR Research Group, Pécs, Hungary.,5 János Szentágothai Research Centre, University of Pécs, Pécs, Hungary
| | - Krisztina Amrein
- 1 Department of Neurosurgery, Pécs Medical School, Pécs, Hungary.,5 János Szentágothai Research Centre, University of Pécs, Pécs, Hungary
| | - Tamás Dóczi
- 1 Department of Neurosurgery, Pécs Medical School, Pécs, Hungary.,3 MTA-PTE Clinical Neuroscience MR Research Group, Pécs, Hungary.,7 Diagnostic Center of Pécs, Pécs, Hungary
| | - András Büki
- 1 Department of Neurosurgery, Pécs Medical School, Pécs, Hungary.,5 János Szentágothai Research Centre, University of Pécs, Pécs, Hungary
| | - Attila Schwarcz
- 1 Department of Neurosurgery, Pécs Medical School, Pécs, Hungary
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13
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Vander Linden C, Verhelst H, Genbrugge E, Deschepper E, Caeyenberghs K, Vingerhoets G, Deblaere K. Is diffuse axonal injury on susceptibility weighted imaging a biomarker for executive functioning in adolescents with traumatic brain injury? Eur J Paediatr Neurol 2019; 23:525-536. [PMID: 31023628 DOI: 10.1016/j.ejpn.2019.04.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 03/23/2019] [Accepted: 04/09/2019] [Indexed: 01/07/2023]
Abstract
Traumatic brain injury (TBI) is a heterogeneous disorder in which diffuse axonal injury (DAI) is an important component contributing to executive dysfunction. During adolescence, developing brain networks are especially vulnerable to acceleration-deceleration forces. We aimed to examine the correlation between DAI (number and localization) and executive functioning in adolescents with TBI. We recruited 18 adolescents with a mean age of 15y8m (SD = 1y7m), averaging 2.5 years after sustaining a moderate-to-severe TBI with documented DAI. Susceptibility Weighted Imaging sequence was administered to localize the DAI lesions. The adolescents performed a neurocognitive test-battery, addressing different aspects of executive functioning (working memory, attention, processing speed, planning ability) and their parents completed the Behavior Rating Inventory of Executive Function (BRIEF) - questionnaire. Executive performance of the TBI-group was compared with an age and gender matched control group of typically developing peers. Based on these results we focused on the Stockings of Cambridge test and the BRIEF to correlate with the total number and location of DAI. Results revealed that the anatomical distribution of DAI, especially in the corpus callosum and the deep brain nuclei, may have more implications for executive functioning than the total amount of DAI in adolescents. Results of this study may help guide targeted rehabilitation to redirect the disturbed development of executive function in adolescents with TBI.
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Affiliation(s)
- Catharine Vander Linden
- Ghent University Hospital, Child Rehabilitation Center K7, Corneel Heymanslaan 10, 9000, Ghent, Belgium.
| | - Helena Verhelst
- Ghent University, Department of Experimental Psychology, Faculty of Psychology and Educational Sciences, Henri Dunantlaan 2, 9000, Ghent, Belgium.
| | - Eva Genbrugge
- Ghent University Hospital, Department of Neuroradiology, Corneel Heymanslaan 10, 9000, Ghent, Belgium.
| | - Ellen Deschepper
- Ghent University, Biostatistics Unit, Department of Public Health, Corneel Heymanslaan 10, 9000, Ghent, Belgium.
| | - Karen Caeyenberghs
- Australian Catholic University, Mary McKillop Institute for Health Research, Level 5, 215 Spring Street, Melbourne, VIC, 3000, Australia.
| | - Guy Vingerhoets
- Ghent University, Department of Experimental Psychology, Faculty of Psychology and Educational Sciences, Henri Dunantlaan 2, 9000, Ghent, Belgium.
| | - Karel Deblaere
- Ghent University Hospital, Department of Neuroradiology, Corneel Heymanslaan 10, 9000, Ghent, Belgium.
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14
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Stewan Feltrin F, Zaninotto AL, Guirado VMP, Macruz F, Sakuno D, Dalaqua M, Magalhães LGA, Paiva WS, Andrade AFD, Otaduy MCG, Leite CC. Longitudinal changes in brain volumetry and cognitive functions after moderate and severe diffuse axonal injury. Brain Inj 2018; 32:1208-1217. [PMID: 30024781 DOI: 10.1080/02699052.2018.1494852] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND AND OBJECTIVE Diffuse axonal injury (DAI) induces a long-term process of brain atrophy and cognitive deficits. The goal of this study was to determine whether there are correlations between brain volume loss, microhaemorrhage load (MHL) and neuropsychological performance during the first year after DAI. METHODS Twenty-four patients with moderate or severe DAI were evaluated at 2, 6 and 12 months post-injury. MHL was evaluated at 3 months, and brain volumetry was evaluated at 3, 6 and 12 months. The trail making test (TMT) was used to evaluate executive function (EF), and the Hopkins verbal learning test (HVLT) was used to evaluate episodic verbal memory (EVM) at 6 and 12 months. RESULTS There were significant white matter volume (WMV), subcortical grey matter volume and total brain volume (TBV) reductions during the study period (p < 0.05). MHL was correlated only with WMV reduction. EF and EVM were not correlated with MHL but were, in part, correlated with WMV and TBV reductions. CONCLUSIONS Our findings suggest that MHL may be a predictor of WMV reduction but cannot predict EF or EVM in DAI. Brain atrophy progresses over time, but patients showed better EF and EVM in some of the tests, which could be due to neuroplasticity.
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Affiliation(s)
- Fabrício Stewan Feltrin
- a Laboratory of Magnetic Resonance, LIM44, Department of Radiology , Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo , Sao Paulo , SP , Brazil
| | - Ana Luiza Zaninotto
- b Division of Psychology , Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo , Sao Paulo , SP , Brazil
| | - Vinícius M P Guirado
- c Division of Neurosurgery , Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo , Sao Paulo , SP , Brazil
| | - Fabiola Macruz
- a Laboratory of Magnetic Resonance, LIM44, Department of Radiology , Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo , Sao Paulo , SP , Brazil
| | - Daniel Sakuno
- d Department of Radiology , Hospital Universitário HU-UEPG, Universidade Estadual de Ponta Grossa , Ponta Grossa , Brazil
| | - Mariana Dalaqua
- e Department of Radiology , Hospital Israelita Albert Einstein , São Paulo , Brazil
| | | | - Wellingson Silva Paiva
- c Division of Neurosurgery , Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo , Sao Paulo , SP , Brazil
| | - Almir Ferreira de Andrade
- c Division of Neurosurgery , Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo , Sao Paulo , SP , Brazil
| | - Maria C G Otaduy
- a Laboratory of Magnetic Resonance, LIM44, Department of Radiology , Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo , Sao Paulo , SP , Brazil
| | - Claudia C Leite
- a Laboratory of Magnetic Resonance, LIM44, Department of Radiology , Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo , Sao Paulo , SP , Brazil
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15
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Lotan E, Morley C, Newman J, Qian M, Abu-Amara D, Marmar C, Lui YW. Prevalence of Cerebral Microhemorrhage following Chronic Blast-Related Mild Traumatic Brain Injury in Military Service Members Using Susceptibility-Weighted MRI. AJNR Am J Neuroradiol 2018; 39:1222-1225. [PMID: 29794235 PMCID: PMC7655437 DOI: 10.3174/ajnr.a5688] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2018] [Accepted: 04/04/2018] [Indexed: 01/14/2023]
Abstract
BACKGROUND AND PURPOSE Cerebral microhemorrhages are a known marker of mild traumatic brain injury. Blast-related mild traumatic brain injury relates to a propagating pressure wave, and there is evidence that the mechanism of injury in blast-related mild traumatic brain injury may be different from that in blunt head trauma. Two recent reports in mixed cohorts of blunt and blast-related traumatic brain injury in military personnel suggest that the prevalence of cerebral microhemorrhages is lower than in civilian head injury. In this study, we aimed to characterize the prevalence of cerebral microhemorrhages in military service members specifically with chronic blast-related mild traumatic brain injury. MATERIALS AND METHODS Participants were prospectively recruited and underwent 3T MR imaging. Susceptibility-weighted images were assessed by 2 neuroradiologists independently for the presence of cerebral microhemorrhages. RESULTS Our cohort included 146 veterans (132 men) who experienced remote blast-related mild traumatic brain injury (mean, 9.4 years; median, 9 years after injury). Twenty-one (14.4%) reported loss of consciousness for <30 minutes. Seventy-seven subjects (52.7%) had 1 episode of blast-related mild traumatic brain injury; 41 (28.1%) had 2 episodes; and 28 (19.2%) had >2 episodes. No cerebral microhemorrhages were identified in any subject, as opposed to the frequency of SWI-detectable cerebral microhemorrhages following blunt-related mild traumatic brain injury in the civilian population, which has been reported to be as high as 28% in the acute and subacute stages. CONCLUSIONS Our results may reflect differences in pathophysiology and the mechanism of injury between blast- and blunt-related mild traumatic brain injury. Additionally, the chronicity of injury may play a role in the detection of cerebral microhemorrhages.
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Affiliation(s)
- E Lotan
- From the Departments of Radiology (E.L., C.M., Y.W.L.)
- Sackler Faculty of Medicine (E.L.), Tel Aviv University, Tel Aviv, Israel
| | - C Morley
- From the Departments of Radiology (E.L., C.M., Y.W.L.)
- Psychiatry (J.N., M.Q., D.A.-A., C.M.), Steven and Alexandra Cohen Veterans Center for Posttraumatic Stress and Traumatic Brain Injury, New York University Langone Medical Center, New York, New York
| | - J Newman
- Psychiatry (J.N., M.Q., D.A.-A., C.M.), Steven and Alexandra Cohen Veterans Center for Posttraumatic Stress and Traumatic Brain Injury, New York University Langone Medical Center, New York, New York
| | - M Qian
- Psychiatry (J.N., M.Q., D.A.-A., C.M.), Steven and Alexandra Cohen Veterans Center for Posttraumatic Stress and Traumatic Brain Injury, New York University Langone Medical Center, New York, New York
| | - D Abu-Amara
- Psychiatry (J.N., M.Q., D.A.-A., C.M.), Steven and Alexandra Cohen Veterans Center for Posttraumatic Stress and Traumatic Brain Injury, New York University Langone Medical Center, New York, New York
| | - C Marmar
- From the Departments of Radiology (E.L., C.M., Y.W.L.)
| | - Y W Lui
- From the Departments of Radiology (E.L., C.M., Y.W.L.)
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16
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Goodrich-Hunsaker NJ, Abildskov TJ, Black G, Bigler ED, Cohen DM, Mihalov LK, Bangert BA, Taylor HG, Yeates KO. Age- and sex-related effects in children with mild traumatic brain injury on diffusion magnetic resonance imaging properties: A comparison of voxelwise and tractography methods. J Neurosci Res 2018; 96:626-641. [PMID: 28984377 PMCID: PMC5803411 DOI: 10.1002/jnr.24142] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Revised: 07/28/2017] [Accepted: 07/28/2017] [Indexed: 12/27/2022]
Abstract
Although there are several techniques to analyze diffusion-weighted imaging, any technique must be sufficiently sensitive to detect clinical abnormalities. This is especially critical in disorders like mild traumatic brain injury (mTBI), where pathology is likely to be subtle. mTBI represents a major public health concern, especially for youth under 15 years of age. However, the developmental period from birth to 18 years is also a time of tremendous brain changes. Therefore, it is important to establish the degree of age- and sex-related differences. Participants were children aged 8-15 years with mTBI or mild orthopedic injuries. Imaging was obtained within 10 days of injury. We performed tract-based spatial statistics (TBSS), deterministic tractography using Automated Fiber Quantification (AFQ), and probabilistic tractography using TRACULA (TRActs Constrained by UnderLying Anatomy) to evaluate whether any method provided improved sensitivity at identifying group, developmental, and/or sex-related differences. Although there were no group differences from any of the three analyses, many of the tracts, but not all, revealed increases of fractional anisotropy and decreases of axial, radial, and mean diffusivity with age. TBSS analyses resulted in age-related changes across all white matter tracts. AFQ and TRACULA revealed age-related changes within the corpus callosum, cingulum cingulate, corticospinal tract, inferior and superior longitudinal fasciculus, and uncinate fasciculus. The results are in many ways consistent across all three methods. However, results from the tractography methods provided improved sensitivity and better tract-specific results for identifying developmental and sex-related differences within the brain.
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Affiliation(s)
| | | | - Garrett Black
- Ohio State University Fisher College of Business, Columbus, OH, USA
| | - Erin D. Bigler
- Department of Psychology, Brigham Young University, Provo, UT
| | - Daniel M. Cohen
- Division of Emergency Medicine, Nationwide Children’s Hospital, Columbus, OH
| | - Leslie K. Mihalov
- Division of Emergency Medicine, Nationwide Children’s Hospital, Columbus, OH
| | - Barbara A. Bangert
- Department of Radiology, Case Western Reserve University School of Medicine, Cleveland, OH
| | - H. Gerry Taylor
- Department of Pediatrics, Rainbow Babies and Children’s Hospital, Case Western Reserve University, Cleveland, OH
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O'Phelan KH, Otoshi CK, Ernst T, Chang L. Common Patterns of Regional Brain Injury Detectable by Diffusion Tensor Imaging in Otherwise Normal-Appearing White Matter in Patients with Early Moderate to Severe Traumatic Brain Injury. J Neurotrauma 2018; 35:739-749. [PMID: 29228858 PMCID: PMC5831746 DOI: 10.1089/neu.2016.4944] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Traumatic brain injury (TBI) alters the lives of millions of people every year. Although mortality rates have improved, attributed to better pre-hospital care and reduction of secondary injury in the critical care setting, improvements in functional outcomes post-TBI have been difficult to achieve. Diffusion-tensor imaging (DTI) allows detailed measurement of microstructural damage in regional brain tissue post-TBI, thus improving our understanding of the extent and severity of TBI. Twenty subjects were recruited from a neurological intensive care unit and compared to 18 healthy control subjects. Magnetic resonance imaging (MRI) scanning was performed on a 3.0-Tesla Siemens TIM Trio Scanner (Siemens Medical Solutions, Erlangen, Germany) including T1- and T2-weighted sequences and DTI. Images were processed using DTIStudio software. SAS (SAS Institute Inc., Cary, NC) was used for statistical analysis of group differences in 14 brain regions (25 regions of interests [ROIs]). Seventeen TBI subjects completed scanning. TBI and control subjects did not differ in age or sex. All TBI subjects had visible lesions on structural MRI. TBI subjects had seven brain regions (nine ROIs) that showed significant group differences on DTI metrics (fractional anisotropy, radial diffusion, or mean diffusion) compared to noninjured subjects, including the corpus callosum (genu and splenium), superior longitudinal fasciculus, internal capsule, right retrolenticular internal capsule, posterior corona radiata, and thalamus. However, 16 ROIs showed relatively normal DTI measures. Quantitative DTI demonstrates multiple areas of microstructual injury in specific normal-appearing white matter brain regions. DTI may be useful for assessing the extent of brain injury in patients with early moderate to severe TBI.
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Affiliation(s)
- Kristine H. O'Phelan
- Department of Neurology, Miller School of Medicine, University of Miami, Miami, Florida
| | - Chad K. Otoshi
- Department of Medicine, Neuroscience and MRI Research Program, John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu, Hawaii
| | - Thomas Ernst
- Department of Medicine, Neuroscience and MRI Research Program, John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu, Hawaii
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | - Linda Chang
- Department of Medicine, Neuroscience and MRI Research Program, John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu, Hawaii
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, Maryland
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de Haan S, de Groot JC, Jacobs B, van der Naalt J. The association between microhaemorrhages and post - traumatic functional outcome in the chronic phase after mild traumatic brain injury. Neuroradiology 2017; 59:963-9. [PMID: 28785801 DOI: 10.1007/s00234-017-1898-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [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.
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