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Loo BKG, Fyffe A, Lam LTM, Browne G. The Effect of Impact Seizure on the Recovery of Children and Adolescents With Concussion: A Matched Case-Control Study. Clin J Sport Med 2024; 34:273-279. [PMID: 37706664 DOI: 10.1097/jsm.0000000000001192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 08/09/2023] [Indexed: 09/15/2023]
Abstract
OBJECTIVE Management of sport-related and recreation-related concussions (SRCs) in children and adolescents is challenging as brain maturation affects prognosis. However, impact seizure was removed as a prognosis modifying factor in children and adolescents with SRCs in the 2017 consensus statement on concussion in sport, based mostly on adult literature. Therefore, this study evaluates the association of impact seizure on the recovery in children and adolescents with SRCs. DESIGN Retrospective matched case-control study. SETTING Tertiary pediatric sports medicine service, from January 1, 2015, to June 30, 2022. PATIENTS A cohort of 452 patients, aged 7 to 18 years, with new episode of SRC was seen. From this cohort, 396 patients were included in the analysis, including 22 with impact seizures. Controls were generated using the propensity score matching approach. Patients with moderate or severe traumatic brain injury or incomplete treatment were excluded. INDEPENDENT VARIABLE Impact seizure during SRC. MAIN OUTCOME MEASURES Primary outcome was recovery duration in number of days. RESULTS The median recovery duration was longer in the cases (73 days, interquartile range [IQR] = 38-143 days) as compared with controls (49.5 days, IQR = 30.5-93.5 days). There was no difference in patients with prolonged recovery (ie >28 days) between both groups (OR 1.6, 95% CI, 0.4-6.6, P = 0.505). CONCLUSIONS Impact seizures prolonged the recovery duration in children and adolescents with SRCs and therefore have a potential concussion modifying prognostic role. These findings could help provide evidence-based management principles for children and adolescents with SRCs in subsequent concussion consensus statements.
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Affiliation(s)
- Benny Kai Guo Loo
- Sport and Exercise Medicine Service, KK Women's and Children's Hospital, Singapore
| | - Andrew Fyffe
- Children's Hospital Institute of Sports Medicine, The Children's Hospital at Westmead, Sydney, Australia; and
| | | | - Gary Browne
- Children's Hospital Institute of Sports Medicine, The Children's Hospital at Westmead, Sydney, Australia; and
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Hazwani T, Khalifa AM, Azzubi M, Alhammad A, Aloboudi A, Jorya A, Alkhuraiji A, Alhelabi S, Shaheen N. Diffuse axonal injury on magnetic resonance imaging and its relation to neurological outcomes in pediatric traumatic brain injury. Clin Neurol Neurosurg 2024; 237:108166. [PMID: 38364490 DOI: 10.1016/j.clineuro.2024.108166] [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: 10/12/2023] [Revised: 02/04/2024] [Accepted: 02/05/2024] [Indexed: 02/18/2024]
Abstract
OBJECTIVE Diffuse axonal injury (DAI), a frequent consequence of pediatric traumatic brain injury (TBI), presents challenges in predicting long-term recovery. This study investigates the relationship between the severity of DAI and neurological outcomes in children. METHODS We conducted a retrospective analysis of 51 pediatric TBI patients diagnosed with DAI using Adam's classification. Neurological function was assessed at 2, 3, and 6 weeks, and 12 months post-injury using the Pediatric Glasgow Outcome Scale-Extended (PGOSE). RESULTS PGOSE scores significantly improved over time across all DAI grades, suggesting substantial recovery potential even in initially severe cases. Despite indicating extensive injury, patients with DAI grades II and III demonstrated significant improvement, achieving a good recovery by 12 months. Although the initial Glasgow Coma Scale (GCS) score did not show a statistically significant association with long-term outcomes in our limited sample, these findings suggest that the severity of DAI alone may not fully predict eventual recovery. CONCLUSIONS Our study highlights the potential for significant neurological recovery in pediatric patients with DAI, emphasizing the importance of long-term follow-up and individualized rehabilitation programs. Further research with larger cohorts and extended follow-up periods is crucial to refine our understanding of the complex relationships between DAI severity, injury mechanisms, and long-term neurological outcomes in children.
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Affiliation(s)
- Tarek Hazwani
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia; College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; Department of Pediatrics, Ministry of National Guard - Health Affairs, Riyadh, Saudi Arabia
| | - Ahmed M Khalifa
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia; Department of Pediatrics, Ministry of National Guard - Health Affairs, Riyadh, Saudi Arabia.
| | - Moutasem Azzubi
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia; Division of Neurosurgery, Department of Pediatric Surgery, Ministry of National Guard - Health Affairs, Riyadh, Saudi Arabia
| | - Abdullah Alhammad
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia; Department of Medical Imaging, Ministry of National Guard - Health Affairs, Riyadh, Saudi Arabia
| | - Abdullah Aloboudi
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia; Department of Medical Imaging, Ministry of National Guard - Health Affairs, Riyadh, Saudi Arabia
| | - Ahmad Jorya
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia; Department of Pediatrics, Ministry of National Guard - Health Affairs, Riyadh, Saudi Arabia
| | - Arwa Alkhuraiji
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Sarah Alhelabi
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Naila Shaheen
- King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; Department of Biostatistics and Bioinformatics, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
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Di Ieva A. Computational Fractal-Based Analysis of MR Susceptibility-Weighted Imaging (SWI) in Neuro-Oncology and Neurotraumatology. ADVANCES IN NEUROBIOLOGY 2024; 36:445-468. [PMID: 38468047 DOI: 10.1007/978-3-031-47606-8_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/13/2024]
Abstract
Susceptibility-weighted imaging (SWI) is a magnetic resonance imaging (MRI) technique able to depict the magnetic susceptibility produced by different substances, such as deoxyhemoglobin, calcium, and iron. The main application of SWI in clinical neuroimaging is detecting microbleedings and venous vasculature. Quantitative analyses of SWI have been developed over the last few years, aimed to offer new parameters, which could be used as neuroimaging biomarkers. Each technique has shown pros and cons, but no gold standard exists yet. The fractal dimension (FD) has been investigated as a novel potential objective parameter for monitoring intratumoral space-filling properties of SWI patterns. We showed that SWI patterns found in different tumors or different glioma grades can be represented by a gradient in the fractal dimension, thereby enabling each tumor to be assigned a specific SWI fingerprint. Such results were especially relevant in the differentiation of low-grade versus high-grade gliomas, as well as from high-grade gliomas versus lymphomas.Therefore, FD has been suggested as a potential image biomarker to analyze intrinsic neoplastic architecture in order to improve the differential diagnosis within clinical neuroimaging, determine appropriate therapy, and improve outcome in patients.These promising preliminary findings could be extended into the field of neurotraumatology, by means of the application of computational fractal-based analysis for the qualitative and quantitative imaging of microbleedings in traumatic brain injury patients. In consideration of some evidences showing that SWI signals are correlated with trauma clinical severity, FD might offer some objective prognostic biomarkers.In conclusion, fractal-based morphometrics of SWI could be further investigated to be used in a complementary way with other techniques, in order to form a holistic understanding of the temporal evolution of brain tumors and follow-up response to treatment, with several further applications in other fields, such as neurotraumatology and cerebrovascular neurosurgery as well.
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Affiliation(s)
- Antonio Di Ieva
- Computational NeuroSurgery (CNS) Lab & Macquarie Neurosurgery, Macquarie Medical School, Faculty of Medicine, Human and Health Sciences, Macquarie University, Sydney, NSW, Australia.
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Janas AM, Miller KR, Stence NV, Wyrwa JM, Ruzas CM, Messer R, Mourani PM, Fink EL, Maddux AB. Utility of Early Magnetic Resonance Imaging to Enhance Outcome Prediction in Critically Ill Children with Severe Traumatic Brain Injury. Neurocrit Care 2023:10.1007/s12028-023-01898-9. [PMID: 38148435 DOI: 10.1007/s12028-023-01898-9] [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: 08/04/2023] [Accepted: 11/16/2023] [Indexed: 12/28/2023]
Abstract
BACKGROUND Many children with severe traumatic brain injury (TBI) receive magnetic resonance imaging (MRI) during hospitalization. There are insufficient data on how different patterns of injury on early MRI inform outcomes. METHODS Children (3-17 years) admitted in 2010-2021 for severe TBI (Glasgow Coma Scale [GCS] score < 9) were identified using our site's trauma registry. We used multivariable modeling to determine whether the hemorrhagic diffuse axonal injury (DAI) grade and the number of regions with restricted diffusion (subcortical white matter, corpus callosum, deep gray matter, and brainstem) on MRI obtained within 7 days of injury were independently associated with time to follow commands and with Functional Independence Measure for Children (WeeFIM) scores at the time of discharge from inpatient rehabilitation. We controlled for the clinical variables age, preadmission cardiopulmonary resuscitation, pupil reactivity, motor GCS score, and fever (> 38 °C) in the first 12 h. RESULTS Of 260 patients, 136 (52%) underwent MRI within 7 days of injury at a median of 3 days (interquartile range [IQR] 2-4). Patients with early MRI were a median age of 11 years (IQR 7-14), 8 (6%) patients received cardiopulmonary resuscitation, 19 (14%) patients had bilateral unreactive pupils, the median motor GCS score was 1 (IQR 1-4), and 82 (60%) patients had fever. Grade 3 DAI was present in 46 (34%) patients, and restricted diffusion was noted in the corpus callosum in 75 (55%) patients, deep gray matter in 29 (21%) patients, subcortical white matter in 23 (17%) patients, and the brainstem in 20 (15%) patients. After controlling for clinical variables, an increased number of regions with restricted diffusion, but not hemorrhagic DAI grade, was independently associated with longer time to follow commands (hazard ratio 0.68, 95% confidence interval 0.53-0.89) and worse WeeFIM scores (estimate β - 4.67, 95% confidence interval - 8.33 to - 1.01). CONCLUSIONS Regional restricted diffusion on early MRI is independently associated with short-term outcomes in children with severe TBI. Multicenter cohort studies are needed to validate these findings and elucidate the association of early MRI features with long-term outcomes in children with severe TBI.
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Affiliation(s)
- Anna M Janas
- Section of Critical Care, Department of Pediatrics, University of Colorado School of Medicine and Children's Hospital of Colorado, University of Colorado Anschutz Medical Campus, 13121 E. 17th Avenue, Ed2S, MS8414, Aurora, CO, 80045, USA.
| | - Kristen R Miller
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA
| | - Nicholas V Stence
- Section of Neuroradiology, Department of Radiology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Jordan M Wyrwa
- Department of Physical Medicine and Rehabilitation, University of Colorado School of Medicine and Children's Hospital of Colorado, Aurora, CO, USA
| | - Christopher M Ruzas
- Section of Critical Care, Department of Pediatrics, University of Colorado School of Medicine and Children's Hospital of Colorado, University of Colorado Anschutz Medical Campus, 13121 E. 17th Avenue, Ed2S, MS8414, Aurora, CO, 80045, USA
| | - Ricka Messer
- Section of Child Neurology, Department of Pediatrics, University of Colorado School of Medicine and Children's Hospital of Colorado, Aurora, CO, USA
| | - Peter M Mourani
- Section of Critical Care, Department of Pediatrics, University of Arkansas for Medical Sciences and Arkansas Children's Hospital, Little Rock, AR, USA
| | - Ericka L Fink
- Department of Critical Care Medicine, University of Pittsburgh Medical Center Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
- Safar Center for Resuscitation Research, University of Pittsburgh, Pittsburgh, PA, USA
| | - Aline B Maddux
- Section of Critical Care, Department of Pediatrics, University of Colorado School of Medicine and Children's Hospital of Colorado, University of Colorado Anschutz Medical Campus, 13121 E. 17th Avenue, Ed2S, MS8414, Aurora, CO, 80045, USA
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5
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de Souza DN, Jarmol M, Bell CA, Marini C, Balcer LJ, Galetta SL, Grossman SN. Precision Concussion Management: Approaches to Quantifying Head Injury Severity and Recovery. Brain Sci 2023; 13:1352. [PMID: 37759953 PMCID: PMC10526525 DOI: 10.3390/brainsci13091352] [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: 08/18/2023] [Revised: 09/18/2023] [Accepted: 09/19/2023] [Indexed: 09/29/2023] Open
Abstract
Mitigating the substantial public health impact of concussion is a particularly difficult challenge. This is partly because concussion is a highly prevalent condition, and diagnosis is predominantly symptom-based. Much of contemporary concussion management relies on symptom interpretation and accurate reporting by patients. These types of reports may be influenced by a variety of factors for each individual, such as preexisting mental health conditions, headache disorders, and sleep conditions, among other factors. This can all be contributory to non-specific and potentially misleading clinical manifestations in the aftermath of a concussion. This review aimed to conduct an examination of the existing literature on emerging approaches for objectively evaluating potential concussion, as well as to highlight current gaps in understanding where further research is necessary. Objective assessments of visual and ocular motor concussion symptoms, specialized imaging techniques, and tissue-based concentrations of specific biomarkers have all shown promise for specifically characterizing diffuse brain injuries, and will be important to the future of concussion diagnosis and management. The consolidation of these approaches into a comprehensive examination progression will be the next horizon for increased precision in concussion diagnosis and treatment.
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Affiliation(s)
- Daniel N. de Souza
- Department of Neurology, New York University Grossman School of Medicine, New York, NY 10017, USA; (D.N.d.S.); (M.J.); (C.A.B.); (C.M.); (L.J.B.); (S.L.G.)
| | - Mitchell Jarmol
- Department of Neurology, New York University Grossman School of Medicine, New York, NY 10017, USA; (D.N.d.S.); (M.J.); (C.A.B.); (C.M.); (L.J.B.); (S.L.G.)
| | - Carter A. Bell
- Department of Neurology, New York University Grossman School of Medicine, New York, NY 10017, USA; (D.N.d.S.); (M.J.); (C.A.B.); (C.M.); (L.J.B.); (S.L.G.)
| | - Christina Marini
- Department of Neurology, New York University Grossman School of Medicine, New York, NY 10017, USA; (D.N.d.S.); (M.J.); (C.A.B.); (C.M.); (L.J.B.); (S.L.G.)
| | - Laura J. Balcer
- Department of Neurology, New York University Grossman School of Medicine, New York, NY 10017, USA; (D.N.d.S.); (M.J.); (C.A.B.); (C.M.); (L.J.B.); (S.L.G.)
- Department of Ophthalmology, New York University Grossman School of Medicine, New York, NY 10017, USA
- Department of Population Health, New York University Grossman School of Medicine, New York, NY 10017, USA
| | - Steven L. Galetta
- Department of Neurology, New York University Grossman School of Medicine, New York, NY 10017, USA; (D.N.d.S.); (M.J.); (C.A.B.); (C.M.); (L.J.B.); (S.L.G.)
- Department of Ophthalmology, New York University Grossman School of Medicine, New York, NY 10017, USA
| | - Scott N. Grossman
- Department of Neurology, New York University Grossman School of Medicine, New York, NY 10017, USA; (D.N.d.S.); (M.J.); (C.A.B.); (C.M.); (L.J.B.); (S.L.G.)
- Department of Ophthalmology, New York University Grossman School of Medicine, New York, NY 10017, USA
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6
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von Steinbuechel N, Krenz U, Bockhop F, Koerte IK, Timmermann D, Cunitz K, Zeldovich M, Andelic N, Rojczyk P, Bonfert MV, Berweck S, Kieslich M, Brockmann K, Roediger M, Lendt M, Buchheim A, Muehlan H, Holloway I, Olabarrieta-Landa L. A Multidimensional Approach to Assessing Factors Impacting Health-Related Quality of Life after Pediatric Traumatic Brain Injury. J Clin Med 2023; 12:3895. [PMID: 37373590 DOI: 10.3390/jcm12123895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 05/25/2023] [Accepted: 06/02/2023] [Indexed: 06/29/2023] Open
Abstract
In the field of pediatric traumatic brain injury (TBI), relationships between pre-injury and injury-related characteristics and post-TBI outcomes (functional recovery, post-concussion depression, anxiety) and their impact on disease-specific health-related quality of life (HRQoL) are under-investigated. Here, a multidimensional conceptual model was tested using a structural equation model (SEM). The final SEM evaluates the associations between these four latent variables. We retrospectively investigated 152 children (8-12 years) and 148 adolescents (13-17 years) after TBI at the recruiting clinics or online. The final SEM displayed a fair goodness-of-fit (SRMR = 0.09, RMSEA = 0.08 with 90% CI [0.068, 0.085], GFI = 0.87, CFI = 0.83), explaining 39% of the variance across the four latent variables and 45% of the variance in HRQoL in particular. The relationships between pre-injury and post-injury outcomes and between post-injury outcomes and TBI-specific HRQoL were moderately strong. Especially, pre-injury characteristics (children's age, sensory, cognitive, or physical impairments, neurological and chronic diseases, and parental education) may aggravate post-injury outcomes, which in turn may influence TBI-specific HRQoL negatively. Thus, the SEM comprises potential risk factors for developing negative post-injury outcomes, impacting TBI-specific HRQoL. Our findings may assist healthcare providers and parents in the management, therapy, rehabilitation, and care of pediatric individuals after TBI.
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Affiliation(s)
- Nicole von Steinbuechel
- Institute of Medical Psychology and Medical Sociology, University Medical Center Göttingen, Waldweg 37A, 37073 Göttingen, Germany
| | - Ugne Krenz
- Institute of Medical Psychology and Medical Sociology, University Medical Center Göttingen, Waldweg 37A, 37073 Göttingen, Germany
| | - Fabian Bockhop
- Institute of Medical Psychology and Medical Sociology, University Medical Center Göttingen, Waldweg 37A, 37073 Göttingen, Germany
| | - Inga K Koerte
- cBRAIN/Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, LMU University Hospital, Ludwig-Maximilian University, Nussbaumstrasse 5, 80336 Munich, Germany
| | - Dagmar Timmermann
- Institute of Medical Psychology and Medical Sociology, University Medical Center Göttingen, Waldweg 37A, 37073 Göttingen, Germany
| | - Katrin Cunitz
- Institute of Medical Psychology and Medical Sociology, University Medical Center Göttingen, Waldweg 37A, 37073 Göttingen, Germany
| | - Marina Zeldovich
- Institute of Medical Psychology and Medical Sociology, University Medical Center Göttingen, Waldweg 37A, 37073 Göttingen, Germany
| | - Nada Andelic
- Research Centre for Habilitation and Rehabilitation Models and Services (CHARM), Department of Health and Society, University of Oslo, 0316 Oslo, Norway
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, 0424 Oslo, Norway
| | - Philine Rojczyk
- cBRAIN/Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, LMU University Hospital, Ludwig-Maximilian University, Nussbaumstrasse 5, 80336 Munich, Germany
| | - Michaela Veronika Bonfert
- Department of Pediatric Neurology and Developmental Medicine, LMU Center for Development and Children with Medical Complexity, Dr. von Hauner Children's Hospital, LMU University Hospital, Haydnstr. 5, 80336 Munich, Germany
| | - Steffen Berweck
- Specialist Center for Paediatric Neurology, Neurorehabilitation and Epileptology, Schoen Klinik, Krankenhausstraße 20, 83569 Vogtareuth, Germany
| | - Matthias Kieslich
- Department of Paediatric Neurology, Hospital of Goethe University, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
| | - Knut Brockmann
- Interdisciplinary Pediatric Center for Children with Developmental Disabilities and Severe Chronic Disorders, Department of Pediatrics and Adolescent Medicine, University Medical Center, Robert-Koch-Str. 40, 37075 Göttingen, Germany
| | - Maike Roediger
- Department of Pediatric Intensive Care Medicine and Neonatology, University Hospital Muenster, Albert-Schweitzer-Campus 1, 48149 Muenster, Germany
| | - Michael Lendt
- Neuropediatrics, St. Mauritius Therapeutic Clinic, Strümper Straße 111, 40670 Meerbusch, Germany
| | - Anna Buchheim
- Institut für Psychologie, Universität Innsbruck, Innrain 52 f, 6020 Innsbruck, Austria
| | - Holger Muehlan
- Department of Health and Prevention, University of Greifswald, Robert-Blum-Str. 13, 17487 Greifswald, Germany
| | - Ivana Holloway
- Institute of Medical Psychology and Medical Sociology, University Medical Center Göttingen, Waldweg 37A, 37073 Göttingen, Germany
| | - Laiene Olabarrieta-Landa
- Departamento de Ciencias de la Salud, Universidad Pública de Navarra, Campus de Arrosadía, 31006 Pamplona, Spain
- Instituto de Investigación Sanitaria de Navarra (IdiSNA), 31008 Pamplona, Spain
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7
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Joyce JM, La PL, Walker R, Harris A. Magnetic resonance spectroscopy of traumatic brain injury and subconcussive hits: A systematic review and meta-analysis. J Neurotrauma 2022; 39:1455-1476. [PMID: 35838132 DOI: 10.1089/neu.2022.0125] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Magnetic resonance spectroscopy (MRS) is a non-invasive technique used to study metabolites in the brain. MRS findings in traumatic brain injury (TBI) and subconcussive hit literature have been mixed. The most common observation is a decrease in N-acetyl-aspartate (NAA), traditionally considered a marker of neuronal integrity. Other metabolites, however, such as creatine (Cr), choline (Cho), glutamate+glutamine (Glx) and myo-inositol (mI) have shown inconsistent changes in these populations. The objective of this systematic review and meta-analysis was to synthesize MRS literature in head injury and explore factors (brain region, injury severity, time since injury, demographic, technical imaging factors, etc.) that may contribute to differential findings. One hundred and thirty-eight studies met inclusion criteria for the systematic review and of those, 62 NAA, 24 Cr, 49 Cho, 18 Glx and 21 mI studies met inclusion criteria for meta-analysis. A random effects model was used for meta-analyses with brain region as a subgroup for each of the five metabolites studied. Meta-regression was used to examine the influence of potential moderators including injury severity, time since injury, age, sex, tissue composition and methodological factors. In this analysis of 1428 unique head-injured subjects and 1132 controls, the corpus callosum was identified as a brain region highly susceptible to metabolite alteration. NAA was consistently decreased in TBI of all severity, but not in subconcussive hits. Cho and mI were found to be increased in moderate-to-severe TBI but not mild TBI. Glx and Cr were largely unaffected, however did show alterations in certain conditions.
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Affiliation(s)
- Julie Michele Joyce
- University of Calgary, 2129, Radiology, Calgary, Alberta, Canada.,Hotchkiss Brain Institute, 157742, Calgary, Alberta, Canada.,Alberta Children's Hospital Research Institute, 157744, Calgary, Alberta, Canada.,Integrated Concussion Research Program, Calgary, Alberta, Canada;
| | - Parker L La
- University of Calgary, 2129, Radiology, Calgary, Alberta, Canada.,Hotchkiss Brain Institute, 157742, Calgary, Alberta, Canada.,Alberta Children's Hospital Research Institute, 157744, Calgary, Alberta, Canada.,Integrated Concussion Research Program, Calgary, Alberta, Canada;
| | - Robyn Walker
- University of Calgary, 2129, Radiology, Calgary, Alberta, Canada.,Hotchkiss Brain Institute, 157742, Calgary, Alberta, Canada.,Alberta Children's Hospital Research Institute, 157744, Calgary, Alberta, Canada.,Integrated Concussion Research Program, Calgary, Alberta, Canada;
| | - Ashley Harris
- University of Calgary, Radiology, Calgary, Alberta, Canada.,Hotchkiss Brain Institute, 157742, Calgary, Alberta, Canada.,Alberta Children's Hospital Research Institute, 157744, Calgary, Alberta, Canada.,Integrated Concussion Research Program, Calgary, Alberta, Canada;
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8
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Baker CM, Cox AP, Hunsaker JC, Scoville J, Bollo RJ. Postoperative magnetic resonance imaging may predict poor outcome in children with severe traumatic brain injuries who undergo cranial surgery. J Neurosurg Pediatr 2022; 29:407-411. [PMID: 35061988 DOI: 10.3171/2021.11.peds21486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 11/19/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Multiple studies have evaluated the use of MRI for prognostication in pediatric patients with severe traumatic brain injury (TBI) and have found a correlation between diffuse axonal injury (DAI)-type lesions and outcome. However, there remains a limited understanding about the use of MRI for prognostication after severe TBI in children who have undergone cranial surgery. METHODS Children with severe TBI who underwent craniectomy or craniotomy at Primary Children's Hospital in Salt Lake City, Utah, between 2010 and 2019 were identified retrospectively. Of these 92 patients, 43 underwent postoperative brain MRI within 4 months of surgery. Susceptibility-weighted imaging (SWI) and FLAIR sequences were used to designate areas of hemorrhagic and nonhemorrhagic cerebral lesions related to DAI. Patients were then stratified based on the location of the DAI as read by a neuroradiologist as superficial, deep, or brainstem. The location of the DAI and other variables associated with poor outcome, including Glasgow Coma Scale (GCS) score, pediatric trauma score, mechanism of injury, and time to surgery, were analyzed for correlation with poor outcome. Outcomes were reported using the King's Outcome Scale for Childhood Head Injury (KOSCHI). RESULTS In the 43 children with severe TBI who underwent postoperative brain MRI, the median GCS score on arrival was 4. The most common cause of injury was falls (14 patients, 33%). The most common primary intracranial pathology was subdural hematoma in 26 patients (60%), followed by epidural hematoma in 9 (21%). Fifteen patients (35%) had cerebral herniation and 31 (72%) had evidence of contusion. Variables associated with poor outcome included cerebral herniation (r = 0.338, p = 0.027) and location of DAI (r = 0.319, p = 0.037). In a separate analysis, brainstem DAI was shown to predict poor outcome, whereas location (no, superficial, or deep DAI) did not. Logistic regression showed that brainstem DAI (OR 22.3, p = 0.020) had a higher odds ratio than cerebral herniation (OR 10.5, p = 0.044) for poor outcome. Thirty-six children (84%) had a satisfactory outcome at last follow-up; 3 (7%) children died. CONCLUSIONS The majority of children in this series who presented with a severe TBI and underwent craniectomy or craniotomy made a satisfactory recovery. In patients in whom there is a concern for poor outcome, the location of DAI-type lesions with SWI and FLAIR may assist in prognostication. The authors' results revealed that DAI-type lesions in the brainstem and evidence of cerebral herniation may indicate a poorer prognosis; however, more studies with larger cohorts are needed to make definitive conclusions.
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9
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Hansen C, Waller LC, Brady D, Teramoto M. Relationship Between CT Head Findings and Long-term Recovery in Children with Complicated Mild Traumatic Brain Injury. Brain Inj 2022; 36:77-86. [PMID: 35129405 DOI: 10.1080/02699052.2022.2034947] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
PRIMARY OBJECTIVE Complicated mild traumatic brain injury (C-mTBI) refers to CT positive patients with clinically mild TBI. This study investigates the association between CT head findings at time of injury and recovery of paediatric patients with C-mTBI. RESEARCH DESIGN Retrospective survey and chart review. METHODS For paediatric patients with C-mTBI (N = 77), CT findings associated with corresponding degree and lengths of recovery from C-mTBI using logistic regression analysis. RESULTS There was a trend that the odds of incomplete recovery at the time of survey was higher for older children than for younger children (OR = 1.14, 95% CI = 0.98-1.32, p = 0.072). There was a trend that the odds of incomplete recovery (OR = 6.26, 95% CI = 0.97-40.57, p = 0.054) and longer duration for recovery (OR = 8.14, 95% CI = 0.78-84.46, p = 0.079) was higher for children with multiple haemorrhagic contusions than those with single haemorrhagic contusion. No other imaging patterns predicted degree or length of recovery with statistical significance (p > 0.05). CONCLUSIONS Other than the presence of multiple haemorrhagic contusions, no other pattern of imaging abnormality in paediatric C-mTBI appears to be associated with degree or length of recovery. Further studies with larger cohorts are encouraged.
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Affiliation(s)
- Colby Hansen
- Department of Physical Medicine & Rehabilitation, University of Utah, Salt Lake City, Utah, USA
| | - Laura C Waller
- Department of Rehabilitation Medicine, Essentia Health, Duluth, Minnesota, USA
| | - Dalton Brady
- Department of Physical Medicine & Rehabilitation, University of Utah, Salt Lake City, Utah, USA
| | - Masaru Teramoto
- Department of Physical Medicine & Rehabilitation, University of Utah, Salt Lake City, Utah, USA
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10
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Bohyn C, Vyvere TV, Keyzer FD, Sima DM, Demaerel P. Morphometric evaluation of traumatic axonal injury and the correlation with post-traumatic cerebral atrophy and functional outcome. Neuroradiol J 2021; 35:468-476. [PMID: 34643120 PMCID: PMC9437508 DOI: 10.1177/19714009211049714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Imaging plays a crucial role in the diagnosis, prognosis and follow-up of traumatic brain injury. Whereas computed tomography plays a pivotal role in the acute setting, magnetic resonance imaging is best suited to detect the true extent of traumatic brain injury, and more specifically diffuse axonal injury. Post-traumatic brain atrophy is a well-known complication of traumatic brain injury. PURPOSE This study investigated the correlation between diffuse axonal injury detected with fluid-attenuated inversion recovery and susceptibility-weighted imaging magnetic resonance imaging, post-traumatic brain atrophy and functional outcome (Glasgow outcome scale - extended). MATERIALS AND METHODS Twenty patients with a closed head injury and diffuse axonal injury detected with fluid-attenuated inversion recovery and susceptibility-weighted imaging were included. The total volumes of the diffuse axonal injury fluid-attenuated inversion recovery lesions were determined for each subject's initial (<14 days) and follow-up magnetic resonance scan (average: day 303 ± 83 standard deviation). The different brain volumes were automatically quantified using a validated and both US Food and Drug Administration-cleared and CE-marked machine learning algorithm (icobrain). The number of susceptibility-weighted imaging lesions and functional outcome scores (Glasgow outcome scale - extended) were retrieved from the Collaborative European NeuroTrauma Effectiveness Research Traumatic Brain Injury dataset. RESULTS The volumetric fluid-attenuated inversion recovery diffuse axonal injury lesion load showed a significant inverse correlation with functional outcome (Glasgow outcome scale - extended) (r = -0.57; P = 0.0094) and white matter volume change (r = -0.50; P = 0.027). In addition, white matter volume change correlated significantly with the Glasgow outcome scale - extended score (P = 0.0072; r = 0.58). Moreover, there was a strong inverse correlation between longitudinal fluid-attenuated inversion recovery lesion volume change and whole brain volume change (r = -0.63; P = 0.0028). No significant correlation existed between the number of diffuse axonal injury susceptibility-weighted imaging lesions, brain atrophy and functional outcome. CONCLUSIONS Volumetric analysis of diffuse axonal injury on fluid-attenuated inversion recovery imaging and automated brain atrophy calculation are potentially useful tools in the clinical management and follow-up of traumatic brain injury patients with diffuse axonal injury.
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Affiliation(s)
- Cedric Bohyn
- Department of Radiology, University Hospital Leuven, Belgium
| | | | - Frederik De Keyzer
- Department of Medical Physics and Quality Control, University Hospital Leuven, Belgium
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11
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Virani S, Barton A, Goodyear BG, Yeates KO, Brooks BL. Susceptibility-Weighted Magnetic Resonance Imaging (MRI) of Microbleeds in Pediatric Concussion. J Child Neurol 2021; 36:867-874. [PMID: 33966537 PMCID: PMC8438780 DOI: 10.1177/08830738211002946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The long-term consequences of pediatric concussion on brain structure are poorly understood. This study aimed to evaluate the presence and clinical significance of cerebral microbleeds several years after pediatric concussion. METHODS Children and adolescents 8-19 years of age with either a history of concussion (n = 35), or orthopedic injury (n = 20) participated. Mean time since injury for the sample was 30.4 months (SD = 19.6). Participants underwent susceptibility-weighted imaging, rated their depression and postconcussion symptoms, and completed cognitive testing. Parents of participants also completed symptom ratings for their child. Hypointensities in susceptibility-weighted images indicative of cerebral microbleeds were calculated as a measure of hypointensity burden. RESULTS Hypointensity burden did not differ significantly between participants with a history of concussion and those with a history of orthopedic injury. Depression ratings (self and parent report), postconcussion symptom ratings (self and parent report), and cognitive performance did not significantly correlate with hypointensity burden in the concussion group. CONCLUSIONS These findings suggest that at approximately 2.5 years postinjury, children and adolescents with prior concussion do not have a greater amount of cerebral microbleeds compared to those with orthopedic injury. Future research should use longitudinal study designs and investigate children with persistent postconcussive symptoms to gain better insight into the long-term effects of concussion on cerebral microbleeds.
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Affiliation(s)
- Shane Virani
- Department of Pediatrics, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada,Department of Pediatrics, Neurosciences Program, Alberta Children’s Hospital, Calgary, Alberta, Canada
| | - Alexander Barton
- Department of Radiology, University of Calgary, Calgary, Alberta, Canada
| | - Bradley G. Goodyear
- Department of Radiology, University of Calgary, Calgary, Alberta, Canada,Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada,Hotchkiss Brain Institute, Calgary, Alberta, Canada,Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
| | - Keith Owen Yeates
- Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada,Hotchkiss Brain Institute, Calgary, Alberta, Canada,Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada,Department of Psychology, University of Calgary, Calgary, Alberta, Canada,Alberta Children’s Hospital Research Institute, Calgary, Alberta, Canada
| | - Brian L. Brooks
- Department of Pediatrics, Neurosciences Program, Alberta Children’s Hospital, Calgary, Alberta, Canada,Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada,Hotchkiss Brain Institute, Calgary, Alberta, Canada,Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada,Department of Psychology, University of Calgary, Calgary, Alberta, Canada,Alberta Children’s Hospital Research Institute, Calgary, Alberta, Canada,Brian L. Brooks, PhD, Alberta Children’s Hospital, 28 Oki Drive NW, Calgary, Alberta, Canada T3B 6A8.
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12
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Janas AM, Qin F, Hamilton S, Jiang B, Baier N, Wintermark M, Threlkeld Z, Lee S. Diffuse Axonal Injury Grade on Early MRI is Associated with Worse Outcome in Children with Moderate-Severe Traumatic Brain Injury. Neurocrit Care 2021; 36:492-503. [PMID: 34462880 PMCID: PMC8405042 DOI: 10.1007/s12028-021-01336-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 08/16/2021] [Indexed: 01/15/2023]
Abstract
Background Traumatic brain injury (TBI) is the leading cause of death and disability in children, but effective tools for predicting outcome remain elusive. Although many pediatric patients receive early magnetic resonance imaging (MRI), data on its utility in prognostication are lacking. Diffuse axonal injury (DAI) is a hallmark of TBI detected on early MRI and was shown previously to improve prognostication in adult patients with TBI. In this exploratory study, we investigated whether DAI grade correlates with functional outcome and improves prognostic accuracy when combined with core clinical variables and computed tomography (CT) biomarkers in pediatric patients with moderate-severe TBI (msTBI). Methods Pediatric patients (≤ 19 years) who were admitted to two regional level one trauma centers with a diagnosis of msTBI (Glasgow Coma Scale [GCS] score < 13) between 2011 and 2019 were identified through retrospective chart review. Patients who underwent brain MRI within 30 days of injury and had documented clinical follow-up after discharge were included. Age, pupil reactivity, and initial motor GCS score were collected as part of the International Mission for Prognosis and Analysis of Clinical Trials in TBI (IMPACT) model. Imaging was reviewed to calculate the Rotterdam score (CT) and DAI grade (MRI) and to evaluate for presence of hypoxic-ischemic injury (MRI). The primary outcome measure was the Pediatric Cerebral Performance Category Scale (PCPCS) score at 6 months after TBI, with favorable outcome defined as PCPCS scores 1–3 and unfavorable outcome defined as PCPCS scores 4–6. The secondary outcome measure was discharge disposition to home versus to an inpatient rehabilitation facility. Result Of 55 patients included in the study, 45 (82%) had severe TBI. The most common mechanism of injury was motor vehicle collision (71%). Initial head CT scans showed acute hemorrhage in 84% of patients. MRI was acquired a median of 5 days after injury, and hemorrhagic DAI lesions were detected in 87% of patients. Each 1-point increase in DAI grade increased the odds of unfavorable functional outcome by 2.4-fold. When controlling for core IMPACT clinical variables, neither the DAI grade nor the Rotterdam score was independently correlated with outcome and neither significantly improved outcome prediction over the IMPACT model alone. Conclusions A higher DAI grade on early MRI is associated with worse 6-month functional outcome and with discharge to inpatient rehabilitation in children with acute msTBI in a univariate analysis but does not independently correlate with outcome when controlling for the GCS score. Addition of the DAI grade to the core IMPACT model does not significantly improve prediction of poor neurological outcome. Further study is needed to elucidate the utility of early MRI in children with msTBI. Supplementary Information The online version contains supplementary material available at 10.1007/s12028-021-01336-8.
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Affiliation(s)
- Anna M Janas
- Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA, USA. .,Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
| | - FeiFei Qin
- Quantitative Science Unit, Department of Medicine, Stanford University, Stanford, CA, USA
| | - Scott Hamilton
- Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA, USA
| | - Bin Jiang
- Department of Radiology, Stanford University, Stanford, CA, USA
| | - Nicole Baier
- Department of Pediatrics, Santa Clara Valley Medical Center, San Jose, CA, USA
| | - Max Wintermark
- Department of Radiology, Stanford University, Stanford, CA, USA
| | - Zachary Threlkeld
- Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA, USA
| | - Sarah Lee
- Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA, USA
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13
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Zamani A, Ryan NP, Wright DK, Caeyenberghs K, Semple BD. The Impact of Traumatic Injury to the Immature Human Brain: A Scoping Review with Insights from Advanced Structural Neuroimaging. J Neurotrauma 2021; 37:724-738. [PMID: 32037951 DOI: 10.1089/neu.2019.6895] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Traumatic brain injury (TBI) during critical periods of early-life brain development can affect the normal formation of brain networks responsible for a range of complex social behaviors. Because of the protracted nature of brain and behavioral development, deficits in cognitive and socioaffective behaviors may not become evident until late adolescence and early adulthood, when such skills are expected to reach maturity. In addition, multiple pre- and post-injury factors can interact with the effects of early brain insult to influence long-term outcomes. In recent years, with advancements in magnetic-resonance-based neuroimaging techniques and analysis, studies of the pediatric population have revealed a link between neurobehavioral deficits, such as social dysfunction, with white matter damage. In this review, in which we focus on contributions from Australian researchers to the field, we have highlighted pioneering longitudinal studies in pediatric TBI, in relation to social deficits specifically. We also discuss the use of advanced neuroimaging and novel behavioral assays in animal models of TBI in the immature brain. Together, this research aims to understand the relationship between injury consequences and ongoing brain development after pediatric TBI, which promises to improve prediction of the behavioral deficits that emerge in the years subsequent to early-life injury.
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Affiliation(s)
- Akram Zamani
- Department of Neuroscience, Monash University, Melbourne, Victoria, Australia
| | - Nicholas P Ryan
- Cognitive Neuroscience Unit, School of Psychology, Deakin University, Melbourne, Victoria, Australia.,Brain & Mind Research, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - David K Wright
- Department of Neuroscience, Monash University, Melbourne, Victoria, Australia
| | - Karen Caeyenberghs
- Cognitive Neuroscience Unit, School of Psychology, Deakin University, Melbourne, Victoria, Australia
| | - Bridgette D Semple
- Department of Neuroscience, Monash University, Melbourne, Victoria, Australia.,Department of Medicine, Royal Melbourne Hospital, The University of Melbourne, Parkville, Victoria, Australia
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14
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Aker L, Abandeh L, Abdelhady M, Aboughalia H, Vattoth S. Susceptibility-weighted Imaging in Neuroradiology: Practical Imaging Principles, Pearls and Pitfalls. Curr Probl Diagn Radiol 2021; 51:568-578. [PMID: 34210556 DOI: 10.1067/j.cpradiol.2021.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 05/10/2021] [Indexed: 01/13/2023]
Abstract
Susceptibility-weighted imaging (SWI) was one of the recent and helpful advancement in magnetic resonance imaging. Its utilization -provided valuable information for the radiologists in multiple fields, including neuroradiology. SWI was able to demonstrate cerebral paramagnetic and diamagnetic substances. Therefore, the applications of this imaging technique were diverse in research and clinical neuroradiology. This article reviewed the basic technical steps, various clinical applications of SWI, and potential limitations. The practicing radiologist needs to be oriented about using SWI and phase images in the right- and left-handed MRI systems to demonstrate different brain pathologies, including neurovascular diseases, traumatic brain injuries, brain tumors, infectious and inflammatory, and neurodegenerative diseases.
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Affiliation(s)
- Loai Aker
- Department of Clinical Imaging, Hamad Medical Corporation,Doha,Qatar.
| | - Laith Abandeh
- Department of Radiology, University of Washington, Seattle,WA
| | | | - Hassan Aboughalia
- Radiology Department, Seattle Children's Hospital, University of Washington Medical Center,Seattle,WA
| | - Surjith Vattoth
- Neuroradiology Section, University of Arkansas for Medical Sciences (UAMS),Little Rock,AR
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15
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Cognitive impairment after focal brain lesions is better predicted by damage to structural than functional network hubs. Proc Natl Acad Sci U S A 2021; 118:2018784118. [PMID: 33941692 DOI: 10.1073/pnas.2018784118] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Hubs are highly connected brain regions important for coordinating processing in brain networks. It is unclear, however, which measures of network "hubness" are most useful in identifying brain regions critical to human cognition. We tested how closely two measures of hubness-edge density and participation coefficient, derived from white and gray matter, respectively-were associated with general cognitive impairment after brain damage in two large cohorts of patients with focal brain lesions (N = 402 and 102, respectively) using cognitive tests spanning multiple cognitive domains. Lesions disrupting white matter regions with high edge density were associated with cognitive impairment, whereas lesions damaging gray matter regions with high participation coefficient had a weaker, less consistent association with cognitive outcomes. Similar results were observed with six other gray matter hubness measures. This suggests that damage to densely connected white matter regions is more cognitively impairing than similar damage to gray matter hubs, helping to explain interindividual differences in cognitive outcomes after brain damage.
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16
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Puy L, Pasi M, Rodrigues M, van Veluw SJ, Tsivgoulis G, Shoamanesh A, Cordonnier C. Cerebral microbleeds: from depiction to interpretation. J Neurol Neurosurg Psychiatry 2021; 92:jnnp-2020-323951. [PMID: 33563804 DOI: 10.1136/jnnp-2020-323951] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 12/22/2020] [Accepted: 01/04/2021] [Indexed: 11/04/2022]
Abstract
Cerebral microbleeds (CMBs) are defined as hypointense foci visible on T2*-weighted and susceptible-weighted MRI sequences. CMBs are increasingly recognised with the widespread use of MRI in healthy individuals as well as in the context of cerebrovascular disease or dementia. They can also be encountered in major critical medical conditions such as in patients requiring extracorporeal mechanical oxygenation. The advent of MRI-guided postmortem neuropathological examinations confirmed that, in the context of cerebrovascular disease, the vast majority of CMBs correspond to recent or old microhaemorrhages. Detection of CMBs is highly influenced by MRI parameters, in particular field strength, postprocessing methods used to enhance T2* contrast and three dimensional sequences. Despite recent progress, harmonising imaging parameters across research studies remains necessary to improve cross-study comparisons. CMBs are helpful markers to identify the nature and the severity of the underlying chronic small vessel disease. In daily clinical practice, presence and numbers of CMBs often trigger uncertainty for clinicians especially when antithrombotic treatments and acute reperfusion therapies are discussed. In the present review, we discuss those clinical dilemmas and address the value of CMBs as diagnostic and prognostic markers for future vascular events.
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Affiliation(s)
- Laurent Puy
- Department of Neurology, U1172 - LilNCog - Lille Neuroscience & Cognition, Univ. Lille, Inserm, CHU Lille, F-59000 Lille, France
| | - Marco Pasi
- Department of Neurology, U1172 - LilNCog - Lille Neuroscience & Cognition, Univ. Lille, Inserm, CHU Lille, F-59000 Lille, France
| | - Mark Rodrigues
- Centre for Clinical Brain Sciences, The University of Edinburgh College of Medicine and Veterinary Medicine, Edinburgh, Midlothian, UK
| | - Susanne J van Veluw
- Neurology Department, Hemorrhagic Stroke Research Program, Department of Neurology, Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Georgios Tsivgoulis
- Second Department of Neurology, "Attikon" University Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Ashkan Shoamanesh
- Department of Medicine (Neurology), McMaster University and Population Health Research Institute, Hamilton, Ontario, Canada
| | - Charlotte Cordonnier
- Department of Neurology, U1172 - LilNCog - Lille Neuroscience & Cognition, Univ. Lille, Inserm, CHU Lille, F-59000 Lille, France
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17
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Chary K, Nissi MJ, Nykänen O, Manninen E, Rey RI, Shmueli K, Sierra A, Gröhn O. Quantitative susceptibility mapping of the rat brain after traumatic brain injury. NMR IN BIOMEDICINE 2021; 34:e4438. [PMID: 33219598 DOI: 10.1002/nbm.4438] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2019] [Revised: 10/13/2020] [Accepted: 10/14/2020] [Indexed: 06/11/2023]
Abstract
The primary lesion arising from the initial insult after traumatic brain injury (TBI) triggers a cascade of secondary tissue damage, which may also progress to connected brain areas in the chronic phase. The aim of this study was, therefore, to investigate variations in the susceptibility distribution related to these secondary tissue changes in a rat model after severe lateral fluid percussion injury. We compared quantitative susceptibility mapping (QSM) and R2 * measurements with histological analyses in white and grey matter areas outside the primary lesion but connected to the lesion site. We demonstrate that susceptibility variations in white and grey matter areas could be attributed to reduction in myelin, accumulation of iron and calcium, and gliosis. QSM showed quantitative changes attributed to secondary damage in areas located rostral to the lesion site that appeared normal in R2 * maps. However, combination of QSM and R2 * was informative in disentangling the underlying tissue changes such as iron accumulation, demyelination, or calcifications. Therefore, combining QSM with R2 * measurement can provide a more detailed assessment of tissue changes and may pave the way for improved diagnosis of TBI, and several other complex neurodegenerative diseases.
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Affiliation(s)
- Karthik Chary
- A. I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland
| | - Mikko J Nissi
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
- Research Unit of Medical Imaging, Physics and Technology, University of Oulu, Oulu, Finland
| | - Olli Nykänen
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
| | - Eppu Manninen
- A. I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland
| | - Ramón I Rey
- Clinical Neurosciences Research Laboratory, Department of Neurology, Health Research Institute of Santiago de Compostela, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Karin Shmueli
- Department of Medical Physics and Biomedical Engineering, University College London, London, UK
| | - Alejandra Sierra
- A. I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland
| | - Olli Gröhn
- A. I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland
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18
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Simultaneous feedback control for joint field and motion correction in brain MRI. Neuroimage 2020; 226:117286. [PMID: 32992003 DOI: 10.1016/j.neuroimage.2020.117286] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 07/21/2020] [Accepted: 08/14/2020] [Indexed: 11/23/2022] Open
Abstract
T2*-weighted gradient-echo sequences count among the most widely used techniques in neuroimaging and offer rich magnitude and phase contrast. The susceptibility effects underlying this contrast scale with B0, making T2*-weighted imaging particularly interesting at high field. High field also benefits baseline sensitivity and thus facilitates high-resolution studies. However, enhanced susceptibility effects and high target resolution come with inherent challenges. Relying on long echo times, T2*-weighted imaging not only benefits from enhanced local susceptibility effects but also suffers from increased field fluctuations due to moving body parts and breathing. High resolution, in turn, renders neuroimaging particularly vulnerable to motion of the head. This work reports the implementation and characterization of a system that aims to jointly address these issues. It is based on the simultaneous operation of two control loops, one for field stabilization and one for motion correction. The key challenge with this approach is that the two loops both operate on the magnetic field in the imaging volume and are thus prone to mutual interference and potential instability. This issue is addressed at the levels of sensing, timing, and control parameters. Performance assessment shows the resulting system to be stable and exhibit adequate loop decoupling, precision, and bandwidth. Simultaneous field and motion control is then demonstrated in examples of T2*-weighted in vivo imaging at 7T.
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19
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Weston P, Morales C, Dunning M, Parry A, Carrera I. Susceptibility weighted imaging at 1.5 Tesla magnetic resonance imaging in dogs: Comparison with T2*-weighted gradient echo sequence and its clinical indications. Vet Radiol Ultrasound 2020; 61:566-576. [PMID: 32663373 DOI: 10.1111/vru.12894] [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: 02/01/2020] [Revised: 04/16/2020] [Accepted: 04/19/2020] [Indexed: 12/30/2022] Open
Abstract
Susceptibility weighted imaging (SWI) is a high resolution, fully velocity-compensated, three-dimensional gradient echo (GE) MRI technique. In humans, SWI has been reported to be more sensitive than T2*-weighted GE sequences in the identification of both intracranial hemorrhage and intra-vascular deoxyhemoglobin. However, published clinical studies comparing SWI to T2*-weighted GE sequences in dogs are currently lacking. The aim of this retrospective, observational study was to compare SWI and T2*-weighted GE sequences in a group of dogs with intracranial disease. Medical records were searched for dogs that underwent a brain MRI examination that included T2*-weighted GE and SWI sequences. The presence and appearance of non-vascular and vascular signal voids observed on T2*-weighted GE and SWI were compared. Thirty-two dogs were included with the following diagnoses: presumed and confirmed intracranial neoplasia (27), cerebrovascular accidents (3), and trauma (2). Hemorrhagic lesions were significantly more conspicuous on SWI than T2*-weighted GE sequences (P < .0001). Venous structures were well defined in all SWI sequences, and poorly defined in all dogs on T2*-weighted GE. Susceptibility weighted imaging enabled identification of vascular abnormalities in 30 of 32 (93.8%) dogs, including: neovascularization in 19 of 32 (59.4%) dogs, displacement of perilesional veins in five of 32 (15.6%) dogs, and apparent dilation of perilesional veins in 10 of 32 (31.3%) dogs. Presence of neovascularization was significantly associated with T1-weighted post-contrast enhancement (P = .0184). Hemorrhagic lesions and venous structures were more conspicuous on SWI compared to T2*-weighted GE sequences. Authors recommend adding SWI to standard brain protocols in dogs for detecting hemorrhage and identifying venous abnormalities for lesion characterization.
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Affiliation(s)
| | | | - Mark Dunning
- Willows Referral Centre, Solihull, UK.,School of Veterinary Medicine and Science, University of Nottingham, Nottingham, UK
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20
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Griffin AD, Turtzo LC, Parikh GY, Tolpygo A, Lodato Z, Moses AD, Nair G, Perl DP, Edwards NA, Dardzinski BJ, Armstrong RC, Ray-Chaudhury A, Mitra PP, Latour LL. Traumatic microbleeds suggest vascular injury and predict disability in traumatic brain injury. Brain 2020; 142:3550-3564. [PMID: 31608359 DOI: 10.1093/brain/awz290] [Citation(s) in RCA: 67] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 07/15/2019] [Accepted: 07/28/2019] [Indexed: 12/14/2022] Open
Abstract
Traumatic microbleeds are small foci of hypointensity seen on T2*-weighted MRI in patients following head trauma that have previously been considered a marker of axonal injury. The linear appearance and location of some traumatic microbleeds suggests a vascular origin. The aims of this study were to: (i) identify and characterize traumatic microbleeds in patients with acute traumatic brain injury; (ii) determine whether appearance of traumatic microbleeds predict clinical outcome; and (iii) describe the pathology underlying traumatic microbleeds in an index patient. Patients presenting to the emergency department following acute head trauma who received a head CT were enrolled within 48 h of injury and received a research MRI. Disability was defined using Glasgow Outcome Scale-Extended ≤6 at follow-up. All magnetic resonance images were interpreted prospectively and were used for subsequent analysis of traumatic microbleeds. Lesions on T2* MRI were stratified based on 'linear' streak-like or 'punctate' petechial-appearing traumatic microbleeds. The brain of an enrolled subject imaged acutely was procured following death for evaluation of traumatic microbleeds using MRI targeted pathology methods. Of the 439 patients enrolled over 78 months, 31% (134/439) had evidence of punctate and/or linear traumatic microbleeds on MRI. Severity of injury, mechanism of injury, and CT findings were associated with traumatic microbleeds on MRI. The presence of traumatic microbleeds was an independent predictor of disability (P < 0.05; odds ratio = 2.5). No differences were found between patients with punctate versus linear appearing microbleeds. Post-mortem imaging and histology revealed traumatic microbleed co-localization with iron-laden macrophages, predominately seen in perivascular space. Evidence of axonal injury was not observed in co-localized histopathological sections. Traumatic microbleeds were prevalent in the population studied and predictive of worse outcome. The source of traumatic microbleed signal on MRI appeared to be iron-laden macrophages in the perivascular space tracking a network of injured vessels. While axonal injury in association with traumatic microbleeds cannot be excluded, recognizing traumatic microbleeds as a form of traumatic vascular injury may aid in identifying patients who could benefit from new therapies targeting the injured vasculature and secondary injury to parenchyma.
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Affiliation(s)
- Allison D Griffin
- Center for Neuroscience and Regenerative Medicine, Bethesda, Maryland, USA.,Acute Cerebrovasular Diagnostics Unit of the National Institute of Neurologic Disorders and Stroke, Bethesda, Maryland, USA
| | - L Christine Turtzo
- Acute Cerebrovasular Diagnostics Unit of the National Institute of Neurologic Disorders and Stroke, Bethesda, Maryland, USA
| | - Gunjan Y Parikh
- R. Adams Cowley Shock Trauma Center, Program in Trauma, University of Maryland School of Medicine, Baltimore, USA.,Division of Neurocritical Care and Emergency Neurology, Department of Neurology, University of Maryland School of Medicine, Baltimore, USA
| | | | - Zachary Lodato
- Center for Neuroscience and Regenerative Medicine, Bethesda, Maryland, USA.,Cold Spring Harbor Laboratory, Cold Spring Harbor, New York, USA
| | - Anita D Moses
- Center for Neuroscience and Regenerative Medicine, Bethesda, Maryland, USA.,Acute Cerebrovasular Diagnostics Unit of the National Institute of Neurologic Disorders and Stroke, Bethesda, Maryland, USA
| | - Govind Nair
- National Institute of Neurological Disorders and Stroke, Bethesda, Maryland, USA
| | - Daniel P Perl
- Center for Neuroscience and Regenerative Medicine, Bethesda, Maryland, USA.,Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Nancy A Edwards
- Surgical Neurology Branch of the National Institute of Neurological Disorders and Stroke, Bethesda, Maryland, USA
| | - Bernard J Dardzinski
- Center for Neuroscience and Regenerative Medicine, Bethesda, Maryland, USA.,Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Regina C Armstrong
- Center for Neuroscience and Regenerative Medicine, Bethesda, Maryland, USA.,Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Abhik Ray-Chaudhury
- Surgical Neurology Branch of the National Institute of Neurological Disorders and Stroke, Bethesda, Maryland, USA
| | - Partha P Mitra
- Cold Spring Harbor Laboratory, Cold Spring Harbor, New York, USA
| | - Lawrence L Latour
- Center for Neuroscience and Regenerative Medicine, Bethesda, Maryland, USA.,Acute Cerebrovasular Diagnostics Unit of the National Institute of Neurologic Disorders and Stroke, Bethesda, Maryland, USA
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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] [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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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] [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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23
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Ferrazzano PA, Rosario BL, Wisniewski SR, Shafi NI, Siefkes HM, Miles DK, Alexander AL, Bell MJ. Use of magnetic resonance imaging in severe pediatric traumatic brain injury: assessment of current practice. J Neurosurg Pediatr 2019; 23:471-479. [PMID: 30738383 PMCID: PMC6687576 DOI: 10.3171/2018.10.peds18374] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Accepted: 10/24/2018] [Indexed: 12/19/2022]
Abstract
OBJECTIVE There is no consensus on the optimal timing and specific brain MRI sequences in the evaluation and management of severe pediatric traumatic brain injury (TBI), and information on current practices is lacking. The authors performed a survey of MRI practices among sites participating in a multicenter study of severe pediatric TBI to provide information for designing future clinical trials using MRI to assess brain injury after severe pediatric TBI. METHODS Information on current imaging practices and resources was collected from 27 institutions participating in the Approaches and Decisions after Pediatric TBI Trial. Multiple-choice questions addressed the percentage of patients with TBI who have MRI studies, timing of MRI, MRI sequences used to investigate TBI, as well as the magnetic field strength of MR scanners used at the participating institutions and use of standardized MRI protocols for imaging after severe pediatric TBI. RESULTS Overall, the reported use of MRI in pediatric patients with severe TBI at participating sites was high, with 40% of sites indicating that they obtain MRI studies in > 95% of this patient population. Differences were observed in the frequency of MRI use between US and international sites, with the US sites obtaining MRI in a higher proportion of their pediatric patients with severe TBI (94% of US vs 44% of international sites reported MRI in at least 70% of patients with severe TBI). The reported timing and composition of MRI studies was highly variable across sites. Sixty percent of sites reported typically obtaining an MRI study within the first 7 days postinjury, with the remainder of responses distributed throughout the first 30-day postinjury period. Responses indicated that MRI sequences sensitive for diffuse axonal injury and ischemia are frequently obtained in patients with TBI, whereas perfusion imaging and spectroscopy techniques are less common. CONCLUSIONS Results from this survey suggest that despite the lack of consensus or guidelines, MRI is commonly obtained during the acute clinical setting after severe pediatric TBI. The variation in MRI practices highlights the need for additional studies to determine the utility, optimal timing, and composition of clinical MRI studies after TBI. The information in this survey describes current clinical MRI practices in children with severe TBI and identifies important challenges and objectives that should be considered when designing future studies.
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Affiliation(s)
| | - Bedda L Rosario
- 4Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | | | - Nadeem I Shafi
- 5Pediatrics, University of Tennessee, Memphis, Tennessee
| | | | - Darryl K Miles
- 7Pediatrics, University of Texas-Southwestern, Dallas, Texas; and
| | - Andrew L Alexander
- 2Medical Physics, and
- 3Psychiatry, University of Wisconsin, Madison, Wisconsin
| | - Michael J Bell
- 8Pediatrics, Children's National Medical Center, Washington, DC
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Holshouser B, Pivonka-Jones J, Nichols JG, Oyoyo U, Tong K, Ghosh N, Ashwal S. Longitudinal Metabolite Changes after Traumatic Brain Injury: A Prospective Pediatric Magnetic Resonance Spectroscopic Imaging Study. J Neurotrauma 2018; 36:1352-1360. [PMID: 30351247 DOI: 10.1089/neu.2018.5919] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
The aims of this study were to evaluate longitudinal metabolite changes in traumatic brain injury (TBI) subjects and determine whether early magnetic resonance spectroscopic imaging (MRSI) changes in discrete brain regions predict 1-year neuropsychological outcomes. Three-dimensional (3D) proton MRSI was performed in pediatric subjects with complicated mild (cMild), moderate, and severe injury, acutely (6-17 days) and 1-year post-injury along with neurological and cognitive testing. Longitudinal analysis found that in the cMild/Moderate group, all MRSI ratios from 12 regions returned to control levels at 1 year. In the severe group, only cortical gray matter regions fully recovered to control levels whereas N-acetylaspartate (NAA) ratios from the hemispheric white matter and subcortical regions remained statistically different from controls. A factor analysis reduced the data to two loading factors that significantly differentiated between TBI groups; one included acute regional NAA variables and another consisted of clinically observed variables (e.g., days in coma). Using scores calculated from the two loading factors in a logistic regression model, we found that the percent accuracy for classification of TBI groups was greatest for the dichotomized attention measure (93%), followed by Full Scale Intelligence Quotient at 91%, and the combined memory Z-score measure (90%). Using the acute basal ganglia NAA/creatine (Cr) ratio alone achieved a higher percent accuracy of 94.7% for the attention measure whereas the acute thalamic NAA/Cr ratio alone achieved a higher percent accuracy of 91.9% for the memory measure. These results support the conclusions that reduced NAA is an early indicator of tissue injury and that measurements from subcortical brain regions are more predictive of long-term cognitive outcome.
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Affiliation(s)
- Barbara Holshouser
- 1 Department of Radiology, Loma Linda University School of Medicine, Loma Linda, California
| | - Jamie Pivonka-Jones
- 2 Department of Pediatrics, Loma Linda University School of Medicine, Loma Linda, California
| | - Joy G Nichols
- 2 Department of Pediatrics, Loma Linda University School of Medicine, Loma Linda, California
| | - Udo Oyoyo
- 1 Department of Radiology, Loma Linda University School of Medicine, Loma Linda, California
| | - Karen Tong
- 1 Department of Radiology, Loma Linda University School of Medicine, Loma Linda, California
| | - Nirmalya Ghosh
- 2 Department of Pediatrics, Loma Linda University School of Medicine, Loma Linda, California
| | - Stephen Ashwal
- 2 Department of Pediatrics, Loma Linda University School of Medicine, Loma Linda, California
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25
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Resch C, Anderson VA, Beauchamp MH, Crossley L, Hearps SJC, van Heugten CM, Hurks PPM, Ryan NP, Catroppa C. Age-dependent differences in the impact of paediatric traumatic brain injury on executive functions: A prospective study using susceptibility-weighted imaging. Neuropsychologia 2018; 124:236-245. [PMID: 30528585 DOI: 10.1016/j.neuropsychologia.2018.12.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 10/12/2018] [Accepted: 12/05/2018] [Indexed: 12/17/2022]
Abstract
Childhood and adolescence represent sensitive developmental periods for brain networks implicated in a range of complex skills, including executive functions (EF; inhibitory control, working memory, and cognitive flexibility). As a consequence, these skills may be particularly vulnerable to injuries sustained during these sensitive developmental periods. The present study investigated 1) whether age at injury differentially affects EF 6 months and 2 years after TBI in children aged 5-15 years, and 2) whether the association between brain lesions and EF depend on age at injury. Children with TBI (n = 105) were categorized into four age-at-injury groups based on previous studies and proposed timing of cerebral maturational spurts: early childhood (5-6 years, n = 14), middle childhood (7-9 years, n = 24), late childhood (10-12 years, n = 52), and adolescence (13-15 years, n = 15). EF were assessed with performance-based tasks and a parent-report of everyday EF. TBI patients' EF scores 6 months and 2 years post-injury were compared to those of typically developing (TD) controls (n = 42). Brain lesions were identified using susceptibility weighted imaging (SWI). Results indicated that inhibitory control performance 2 years post-injury was differentially affected by the impact of TBI depending on age at injury. Follow-up analyses did not reveal significant differences within the age groups, preventing drawing strong conclusions regarding the contribution of age at injury to EF outcome after TBI. Tentatively, large effect sizes suggest that vulnerability is most apparent in early childhood and adolescence. Everyday inhibitory control behaviour was worse for children with TBI than TD children across childhood and adolescence at the 2-year assessment. There was no evidence for impairment in working memory or cognitive flexibility after TBI at the group level. Given small group sizes, findings from analyses into correlations between EF and SWI lesions should be interpreted with caution. Extent, number and volume of brain lesions correlated with adolescent everyday EF behaviour 6 months post-injury. Taken together, the results emphasize the need for long-term follow-up after paediatric TBI during sensitive developmental periods given negative outcomes 2-year post injury. Inhibitory control seems to be particular vulnerable to the impact of TBI. Findings of associations between EF and SWI lesions need to be replicated with larger samples.
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Affiliation(s)
- Christine Resch
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, PO Box 616, 6200 MD, Maastricht, the Netherlands; Australian Centre for Child Neuropsychological Studies, Murdoch Children's Research Institute, Royal Children's Hospital, 50 Flemington Road, Parkville, 3052 Melbourne, Victoria, Australia.
| | - Vicki A Anderson
- Australian Centre for Child Neuropsychological Studies, Murdoch Children's Research Institute, Royal Children's Hospital, 50 Flemington Road, Parkville, 3052 Melbourne, Victoria, Australia; Department of Psychology, Royal Children's Hospital, Melbourne, Australia; Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Australia.
| | - Miriam H Beauchamp
- Department of Psychology, University of Montreal, Pavillon Marie-Victorin, Department de Psychologie, C.P. 6128 Succursale Centre-Ville, Montreal, Quebec, Canada H3C 317; Ste-Justine Research Center, Montreal, Quebec, Canada.
| | - Louise Crossley
- Australian Centre for Child Neuropsychological Studies, Murdoch Children's Research Institute, Royal Children's Hospital, 50 Flemington Road, Parkville, 3052 Melbourne, Victoria, Australia.
| | - Stephen J C Hearps
- Australian Centre for Child Neuropsychological Studies, Murdoch Children's Research Institute, Royal Children's Hospital, 50 Flemington Road, Parkville, 3052 Melbourne, Victoria, Australia.
| | - Caroline M van Heugten
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, PO Box 616, 6200 MD, Maastricht, the Netherlands; School for Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Maastricht University Medical Center, PO Box 616, 6200 MD, Maastricht, the Netherlands.
| | - Petra P M Hurks
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, PO Box 616, 6200 MD, Maastricht, the Netherlands.
| | - Nicholas P Ryan
- Australian Centre for Child Neuropsychological Studies, Murdoch Children's Research Institute, Royal Children's Hospital, 50 Flemington Road, Parkville, 3052 Melbourne, Victoria, Australia; Cognitive Neuroscience Unit, School of Psychology, Deakin University, Geelong, Victoria, Australia.
| | - Cathy Catroppa
- Australian Centre for Child Neuropsychological Studies, Murdoch Children's Research Institute, Royal Children's Hospital, 50 Flemington Road, Parkville, 3052 Melbourne, Victoria, Australia; Department of Psychology, Royal Children's Hospital, Melbourne, Australia; Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Australia.
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26
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Evans E, Asuzu D, Cook NE, Caruso P, Townsend E, Costine-Bartell B, Fortes-Monteiro C, Hotz G, Duhaime AC. Traumatic Brain Injury-Related Symptoms Reported by Parents: Clinical, Imaging, and Host Predictors in Children with Impairments in Consciousness Less than 24 Hours. J Neurotrauma 2018; 35:2287-2297. [PMID: 29681226 DOI: 10.1089/neu.2017.5408] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
This study examined the relationship between acute neuroimaging, host and injury factors, and parent-reported traumatic brain injury (TBI)-related symptoms in children with noncritical head injury at two weeks and three months after injury. Data were collected prospectively on 45 subjects aged three to 16 years old enrolled in the Transforming Research and Clinical Knowledge in Traumatic Brain Injury (TRACK-TBI) study. Subjects had rapid recovery of mental status (Glasgow Coma Score [GCS] = 15 within 24 h), and had no clinical need for neurosurgical intervention. Intra- or extra-axial magnetic resonance imaging (MRI) lesions were categorized using Common Data Elements (CDE) definitions. Host and acute injury factors including neurobehavioral history, race, extracranial injuries, loss of consciousness (LOC), and GCS were analyzed while controlling for pre-injury symptoms, age, sex, and socioeconomic status. Parent-reported cognitive and somatic symptoms were measured by the Health and Behavior Inventory (HBI). Forty-nine percent of children had MRI lesions, most of which were relatively small. LOC predicted increased cognitive and somatic symptoms at two weeks. At three months, pre-injury neurobehavioral history predicted increased cognitive and somatic symptoms. Neuroimaging findings did not predict parent-reported symptom severity, except at three months where extra-axial lesions were associated with less severe cognitive symptoms. While structural MRI lesions do not predict increased parent-reported symptoms in this population, age-specific child performance measures may be more sensitive outcome measures and require further study. Children with pre-injury neurobehavioral problems have more severe symptoms at three months and thus may benefit from longer follow-up and monitoring after traumatic brain injury.
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Affiliation(s)
- Emily Evans
- 1 MGH-Institute of Health Professions , Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts
| | - David Asuzu
- 2 Yale School of Medicine , North Haven, Connecticut
| | - Nathan E Cook
- 3 Department of Physical Medicine and Rehabilitation, Harvard Medical School; Spaulding Rehabilitation Hospital; MassGeneral Hospital for Children™ Sport Concussion Program , Boston, Massachusetts
| | - Paul Caruso
- 4 Department of Radiology, Massachusetts General Hospital , Boston, Massachusetts
| | - Elise Townsend
- 5 Department of Physical Therapy, MGH Institute of Health Professions , Boston, Massachusetts
| | - Beth Costine-Bartell
- 6 Department of Neurosurgery, Massachusetts General Hospital , Harvard Medical School, Boston, Massachusetts
| | - Carla Fortes-Monteiro
- 7 Department of Neurosurgery, Massachusetts General Hospital , Boston, Massachusetts
| | - Gillian Hotz
- 8 KiDZ Neuroscience Center, Department of Neurosurgery, University of Miami Miller School of Medicine , Lois Pope Life Center, Miami, Florida
| | - Ann-Christine Duhaime
- 9 Department of Neurosurgery, Massachusetts General Hospital , Harvard Medical School, Boston, Massachusetts
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Halefoglu AM, Yousem DM. Susceptibility weighted imaging: Clinical applications and future directions. World J Radiol 2018; 10:30-45. [PMID: 29849962 PMCID: PMC5971274 DOI: 10.4329/wjr.v10.i4.30] [Citation(s) in RCA: 71] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2018] [Revised: 04/08/2018] [Accepted: 04/20/2018] [Indexed: 02/06/2023] Open
Abstract
Susceptibility weighted imaging (SWI) is a recently developed magnetic resonance imaging (MRI) technique that is increasingly being used to narrow the differential diagnosis of many neurologic disorders. It exploits the magnetic susceptibility differences of various compounds including deoxygenated blood, blood products, iron and calcium, thus enabling a new source of contrast in MR. In this review, we illustrate its basic clinical applications in neuroimaging. SWI is based on a fully velocity-compensated, high-resolution, three dimensional gradient-echo sequence using magnitude and phase images either separately or in combination with each other, in order to characterize brain tissue. SWI is particularly useful in the setting of trauma and acute neurologic presentations suggestive of stroke, but can also characterize occult low-flow vascular malformations, cerebral microbleeds, intracranial calcifications, neurodegenerative diseases and brain tumors. Furthermore, advanced MRI post-processing technique with quantitative susceptibility mapping, enables detailed anatomical differentiation based on quantification of brain iron from SWI raw data.
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Affiliation(s)
- Ahmet Mesrur Halefoglu
- Department of Radiology, Sisli Hamidiye Etfal Training and Research Hospital, University of Health Sciences, Istanbul 34371, Turkey
| | - David Mark Yousem
- Division of Neuroradiology, Department of Radiology, Johns Hopkins Medical Institution, Baltimore, MI 21287, United States
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28
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Bansal M, Sinha VD, Bansal J. Diagnostic and Prognostic Capability of Newer Magnetic Resonance Imaging Brain Sequences in Diffuse Axonal Injury Patient. Asian J Neurosurg 2018; 13:348-356. [PMID: 29682033 PMCID: PMC5898104 DOI: 10.4103/ajns.ajns_229_16] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Objectives: Diffuse axonal injury is one of the major causes of unconsciousness, profound neurologic deficits and persistent vegetative state after head trauma. In recent years, MR imaging has been gaining popularity as an adjunctive imaging method in patients with DAI. Our study aims to assess the relative diagnostic and prognostic capability of various MRI sequences. Patients and Methods: Retrospective observational study done in 1 year duration on 30 DAI patients. Clinical assessment done with GCS at admission and GOS at 6 month. MRI Brain FLAIR, DWI, T2*GRE AND SWI sequences taken. DAI grade were evaluated for different MRI sequences. Prognosis was correlated to total number of lesion/locations and DAI grade of patients. Statistical analysis was done using SPSS Statistical software (ver.20.0.0) and XL-Stat and ANOVA one way test, post hoc test (Turkey test) and Chi square test. Result: We studied 30 male patients, mean age 32.57±8.72 ranges. The commonest mode of injury is RTA-80%, fall-16% followed by assault-3.33%. Out of 30 patients, 17 patients (56.67%) had GCS <=8, 13 patients (43.33%) had GCS between 9 and 12 and no patient had a GCS score between 13 and 15. The mean GCS score was 8.47±1.50. At a 6 month follow up, out of a total of 30 patients, 2 patients (6.66%) expired (GOS-1), 3 patients (10%) remained in persistent vegetative state (GOS-2), 11 patients (36.67%) and 10 patients (33.33%) were found to be severely (GOS-3) and moderately (GOS-4) disabled respectively and 4 patients (13.33%) showed good recovery (GOS-5). Mean GOS is 3.37+/-1.06. Newer imaging -SWI able to detects lesion better (diagnosis of DAI) as compared to other older sequences like FLAIR,DWI,T2*GRE. But no statistically significant found between total number of lesion/locations to the outcome and also newer imaging do not change the grade of DAI patients. Conclusion: Although advanced imaging in head injury, SWI helps in diagnosing the diffuse axonal injury more efficiently than other imaging sequences, but it is the grade of patients at admission that predicts the outcome best.
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Affiliation(s)
- Mayank Bansal
- Department of Neurosurgery, SMS Medical College, Jaipur, Rajasthan, India
| | - Virendra Deo Sinha
- Department of Neurosurgery, SMS Medical College, Jaipur, Rajasthan, India
| | - Juhi Bansal
- Department of Radiology, SMS Medical College, Jaipur, Rajasthan, India
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Iron deposition in substantia nigra: abnormal iron metabolism, neuroinflammatory mechanism and clinical relevance. Sci Rep 2017; 7:14973. [PMID: 29097764 PMCID: PMC5668412 DOI: 10.1038/s41598-017-14721-1] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Accepted: 10/17/2017] [Indexed: 11/08/2022] Open
Abstract
Parkinson disease (PD) is associated with multiple factors, including iron, which is demonstrated to deposit excessively in PD brains. We detected iron deposition by susceptibility weighted image (SWI) and measured the levels of iron metabolism-related proteins and inflammatory factors in cerebrospinal fluid (CSF) and serum of PD patients and control subjects. Clinical symptoms of PD were evaluated by series of rating scales. Relationships among above factors were analyzed. Results showed that corrected phase (CP) value of substantia nigra (SN) was significantly decreased in PD group compared to control group, hence, SN was the main region with excessive iron deposition. In PD group, ferritin was significantly elevated in CSF and reduced in serum compared to control group, and levels of ferritin in CSF and serum were both significantly and positively correlated with CP value of SN, thus, abnormal iron metabolism in central and peripheral systems was associated with iron deposition. CP value of SN in PD group was significantly and negatively correlated with interleukin-1β level in CSF, so interleukin-1β might be a neuroinflammatory factor produced by excessive iron in SN. Iron deposition in SN was significantly correlated with motor symptoms and part of non-motor symptoms of PD.
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30
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Early detection of cerebral microbleeds following traumatic brain injury using MRI in the hyper-acute phase. Neurosci Lett 2017; 655:143-150. [PMID: 28663054 PMCID: PMC5541760 DOI: 10.1016/j.neulet.2017.06.046] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2017] [Revised: 06/13/2017] [Accepted: 06/24/2017] [Indexed: 12/12/2022]
Abstract
Traumatic cerebral microbleeds (TCMBS) can be identified using susceptibility weighted imaging in the first few hours after injury. TCMBs are a useful indicator of severity in this time frame. The presence of TCMBs is an early indicator of injury severity following trauma. There is a relationship between decreasing size of TCMBs and recovery.
Background Traumatic brain injury (TBI) is a leading cause of death and disability in people under 45. Advanced imaging techniques to identify injury and classify severity in the first few hours and days following trauma could improve patient stratification and aid clinical decision making. Traumatic cerebral microbleeds (TCMBs), detectable on magnetic resonance susceptibility weighted imaging (SWI), can be used as markers of long-term clinical outcome. However, the relationship between TCMBs and injury severity in the first few hours after injury, and their natural evolution, is unknown. Methods We obtained SWI scans in 10 healthy controls, and 13 patients scanned 3–24 h following TBI and again at 7–15 days. TCMBs were identified and total volume quantified for every lesion in each scan. Results TCMBs were present in 6 patients, all with more severe injury classified by GCS. No lesions were identified in patients with an initial GCS of 15. Improvement in GCS in the first 15 days following injury was significantly associated with a reduction in microbleed volume over the same time-period. Conclusion MRI is feasible in severely injured patients in the first 24 h after trauma. Detection of TCMBs using SWI provides an objective early marker of injury severity following trauma. TCMBs revealed in this time frame, offer the potential to help determine the degree of injury, improving stratification, in order to identify patients who require admission to hospital, transfer to a specialist center, or an extended period of intubation on intensive care.
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31
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Short-term efficacy and tolerability of methylphenidate in children with traumatic brain injury and attention problems. Brain Dev 2017; 39:327-336. [PMID: 27903419 DOI: 10.1016/j.braindev.2016.11.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Revised: 11/01/2016] [Accepted: 11/08/2016] [Indexed: 11/20/2022]
Abstract
PURPOSE This study aims to investigate the short-term efficacy and tolerability of immediate-release methylphenidate (IR-MPH) in children with a history of traumatic brain injury (TBI). METHODS Twenty children with TBI (mean age: 12.7±3.1years) who had clinically significant attention deficit and/or hyperactivity-impulsivity symptoms and twenty children with primary Attention Deficit Hyperactivity Disorder (ADHD) (mean age: 12.3±3.05years) were included. Study measures, which included the Turgay DSM-IV based ADHD rating Scale (T-DSM-IV-S), Conners' Parent Rating Scale (CPRS), Conners' Teacher Rating Scale (CTRS-R) and Clinical Global Impression-Improvement Scale (CGI-I), were completed at the baseline for both of the groups. For the TBI group, study measures and an adverse effect scale developed by the authors were completed 8weeks after IR-MPH treatment (10mg dose t.i.d). RESULTS No significant difference was found regarding the baseline scale scores between the study groups. Among children with TBI, most of the scores on T-DSM-IV-S, CPRS and CTRS-R were found to improve significantly after MPH treatment, (p<0.05). 70% (N=14) of the sample were much improved at the endpoint. MPH was generally well-tolerated (95% had either no adverse effect or mild adverse effects). CONCLUSION In this preliminary open-label study, IR-MPH was found as a safe and effective treatment option for ADHD symptoms after TBI. However, future controlled studies are needed to confirm our findings.
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Deistung A, Schweser F, Reichenbach JR. Overview of quantitative susceptibility mapping. NMR IN BIOMEDICINE 2017; 30:e3569. [PMID: 27434134 DOI: 10.1002/nbm.3569] [Citation(s) in RCA: 167] [Impact Index Per Article: 23.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Revised: 05/03/2016] [Accepted: 05/09/2016] [Indexed: 06/06/2023]
Abstract
Magnetic susceptibility describes the magnetizability of a material to an applied magnetic field and represents an important parameter in the field of MRI. With the recently introduced method of quantitative susceptibility mapping (QSM) and its conceptual extension to susceptibility tensor imaging (STI), the non-invasive assessment of this important physical quantity has become possible with MRI. Both methods solve the ill-posed inverse problem to determine the magnetic susceptibility from local magnetic fields. Whilst QSM allows the extraction of the spatial distribution of the bulk magnetic susceptibility from a single measurement, STI enables the quantification of magnetic susceptibility anisotropy, but requires multiple measurements with different orientations of the object relative to the main static magnetic field. In this review, we briefly recapitulate the fundamental theoretical foundation of QSM and STI, as well as computational strategies for the characterization of magnetic susceptibility with MRI phase data. In the second part, we provide an overview of current methodological and clinical applications of QSM with a focus on brain imaging. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Andreas Deistung
- Medical Physics Group, Institute of Diagnostic and Interventional Radiology, Jena University Hospital - Friedrich Schiller University Jena, Jena, Germany
| | - Ferdinand Schweser
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, The State University of New York at Buffalo, NY, USA
- MRI Clinical and Translational Research Center, Jacobs School of Medicine and Biomedical Sciences, The State University of New York at Buffalo, NY, USA
| | - Jürgen R Reichenbach
- Medical Physics Group, Institute of Diagnostic and Interventional Radiology, Jena University Hospital - Friedrich Schiller University Jena, Jena, Germany
- Michael Stifel Center for Data-driven and Simulation Science Jena, Friedrich Schiller University Jena, Jena, Germany
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Toth A, Kornyei B, Kovacs N, Rostas T, Buki A, Doczi T, Bogner P, Schwarcz A. Both hemorrhagic and non-hemorrhagic traumatic MRI lesions are associated with the microstructural damage of the normal appearing white matter. Behav Brain Res 2017; 340:106-116. [PMID: 28249729 DOI: 10.1016/j.bbr.2017.02.039] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Revised: 10/11/2016] [Accepted: 02/22/2017] [Indexed: 10/20/2022]
Abstract
Traumatic microbleeds (TMBs) and non-hemorrhagic lesions (NHLs) on MRI are regarded as surrogate markers of diffuse axonal injury. However, the actual relation between lesional and diffuse pathology remained unclear, since lesions were related to clinical parameters, largely influenced by extracranial factors. The aim of this study is to directly compare TMBs, NHLs and their regional features with the co-existing diffuse injury of the normal appearing white matter (NAWM) as measured by diffusion tensor imaging (DTI). Thirty-eight adults with a closed traumatic brain injury (12 mild, 4 moderate and 22 severe) who underwent susceptibility weighted imaging (SWI), T1-, T2 weighted and FLAIR MRI and routine CT were included in the study. TMB (on SWI) and NHL (on T1-, T2 weighted and FLAIR images) features and Rotterdam scores were evaluated. DTI metrics such as fractional anisotropy (FA) and mean diffusivity (MD) were measured over different NAWM regions. Clinical parameters including age; Glasgow Coma Scale; Rotterdam score; TMB and NHL features were correlated to regional NAWM diffusivity using multiple regression. Overall NHL presence and basal ganglia area TMB load were significantly, negatively correlated with the subcortical NAWM FA values (partial r=-0.37 and -0.36; p=0.006 and 0.025, respectively). The presence of any NHL, or TMBs located in the basal ganglia area indicates diffuse NAWM damage even after adjusting for clinical and CT parameters. To estimate DAI, a conventional lesional MRI pathology evaluation might at least in part substitute the use of quantitative DTI, which is yet not widely feasible in a clinical setting.
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Affiliation(s)
- Arnold Toth
- Department of Neurosurgery, Pécs Medical School, Rét. u. 2, H-7623 Pécs, Hungary; Department of Radiology, Pécs Medical School, Ifjusag str. 13, H-7624 Pécs, Hungary.
| | - Balint Kornyei
- Department of Neurosurgery, Pécs Medical School, Rét. u. 2, H-7623 Pécs, Hungary
| | - Noemi Kovacs
- Department of Neurosurgery, Pécs Medical School, Rét. u. 2, H-7623 Pécs, Hungary
| | - Tamas Rostas
- Department of Radiology, Pécs Medical School, Ifjusag str. 13, H-7624 Pécs, Hungary
| | - Andras Buki
- Department of Neurosurgery, Pécs Medical School, Rét. u. 2, H-7623 Pécs, Hungary; MTA-PTE Clinical Neuroscience MR Research Group, Hungary
| | - Tamas Doczi
- Department of Neurosurgery, Pécs Medical School, Rét. u. 2, H-7623 Pécs, Hungary; Diagnostic Center of Pécs, Rét. u. 2, H-7623 Pécs, Hungary; MTA-PTE Clinical Neuroscience MR Research Group, Hungary
| | - Peter Bogner
- Department of Neurosurgery, Pécs Medical School, Rét. u. 2, H-7623 Pécs, Hungary; Department of Radiology, Pécs Medical School, Ifjusag str. 13, H-7624 Pécs, Hungary
| | - Attila Schwarcz
- Department of Neurosurgery, Pécs Medical School, Rét. u. 2, H-7623 Pécs, Hungary; MTA-PTE Clinical Neuroscience MR Research Group, Hungary
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Yang LY, Huang CC, Chiu WT, Huang LT, Lo WC, Wang JY. Association of traumatic brain injury in childhood and attention-deficit/hyperactivity disorder: a population-based study. Pediatr Res 2016; 80:356-62. [PMID: 27064246 DOI: 10.1038/pr.2016.85] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Accepted: 02/08/2016] [Indexed: 11/10/2022]
Abstract
BACKGROUND We evaluated the risk of attention-deficit hyperactivity disorder (ADHD) following childhood traumatic brain injury (TBI). METHODS Using Taiwan's National Health Insurance Research Database, we included 10,416 newly diagnosed TBI children (aged ≤12 y) between 2001 and 2002 and 41,664 children without TBI, who were frequency matched by sex, age, and year of the index medical service with each TBI child, as controls. Children who had been diagnosed with ADHD prior to their medical service index were excluded. Each individual was followed for 9 y to identify ADHD diagnosis. We also compared the ADHD risk in children who were treated for fractures but not TBI as sensitivity analysis. RESULTS During the 9-y follow-up period, children with TBI had a higher ADHD risk (adjusted hazard ratio (AHR) = 1.32, 95% confidence interval (CI) = 1.19, 1.45) than did those without TBI. Furthermore, children with mild and severe TBI had higher AHRs for ADHD than did those without TBI (AHR = 1.30; 95% CI = 1.10, 1.53; and AHR = 1.37; 95% CI = 1.22, 1.55). However, no significant association was observed between fractures and ADHD. CONCLUSION TBI in childhood is associated with a greater likelihood of developing ADHD.
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Affiliation(s)
- Ling-Yu Yang
- Graduate Institute of Medical Sciences, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Chao-Ching Huang
- Department of Pediatrics, National Cheng Kung University Hospital and College of Medicine, Tainan, Taiwan.,Department of Pediatrics, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Wen-Ta Chiu
- Graduate Institute of Injury Prevention and Control, Taipei Medical University, Taipei, Taiwan
| | - Li-Tung Huang
- Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University, College of Medicine, Kaohsiung, Taiwan
| | - Wei-Cheng Lo
- Graduate Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Jia-Yi Wang
- Graduate Institute of Medical Sciences, College of Medicine, Taipei Medical University, Taipei, Taiwan.,Department of Physiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
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Ryan NP, Beauchamp MH, Beare R, Coleman L, Ditchfield M, Kean M, Silk TJ, Genc S, Catroppa C, Anderson VA. Uncovering cortico-striatal correlates of cognitive fatigue in pediatric acquired brain disorder: Evidence from traumatic brain injury. Cortex 2016; 83:222-30. [PMID: 27603573 DOI: 10.1016/j.cortex.2016.07.020] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Revised: 07/04/2016] [Accepted: 07/22/2016] [Indexed: 11/29/2022]
Abstract
Cognitive fatigue is among the most profound and disabling sequelae of pediatric acquired brain disorders, however the neural correlates of these symptoms in children remains unexplored. One hypothesis suggests that cognitive fatigue may arise from dysfunction of cortico-striatal networks (CSNs) implicated in effort output and outcome valuation. Using pediatric traumatic brain injury (TBI) as a model, this study investigated (i) the sub-acute effect of brain injury on CSN volume; and (ii) potential relationships between cognitive fatigue and sub-acute volumetric abnormalities of the CSN. 3D T1 weighted magnetic resonance imaging sequences were acquired sub-acutely in 137 children (TBI: n = 103; typically developing - TD children: n = 34). 67 of the original 137 participants (49%) completed measures of cognitive fatigue and psychological functioning at 24-months post-injury. Results showed that compared to TD controls and children with milder injuries, children with severe TBI showed volumetric reductions in the overall CSN package, as well as regional gray matter volumetric change in cortical and subcortical regions of the CSN. Significantly greater cognitive fatigue in the TBI patients was associated with volumetric reductions in the CSN and its putative hub regions, even after adjusting for injury severity, socioeconomic status (SES) and depression. In the first study to evaluate prospective neuroanatomical correlates of cognitive fatigue in pediatric acquired brain disorder, these findings suggest that post-injury cognitive fatigue is related to structural abnormalities of cortico-striatal brain networks implicated in effort output and outcome valuation. Morphometric magnetic resonance imaging (MRI) may have potential to unlock early prognostic markers that may assist to identify children at elevated risk for cognitive fatigue post-TBI.
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Affiliation(s)
- Nicholas P Ryan
- Australian Centre for Child Neuropsychological Studies, Murdoch Childrens Research Institute, Melbourne, Australia; Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Australia; Department of Psychology, Royal Children's Hospital, Melbourne, Australia.
| | - Miriam H Beauchamp
- Department of Psychology, University of Montreal, Montreal, Canada; Ste-Justine Research Center, Montreal, Canada
| | - Richard Beare
- Developmental Imaging, Murdoch Childrens Research Institute, Melbourne, Australia
| | - Lee Coleman
- Australian Centre for Child Neuropsychological Studies, Murdoch Childrens Research Institute, Melbourne, Australia
| | - Michael Ditchfield
- Australian Centre for Child Neuropsychological Studies, Murdoch Childrens Research Institute, Melbourne, Australia
| | - Michael Kean
- Developmental Imaging, Murdoch Childrens Research Institute, Melbourne, Australia
| | - Timothy J Silk
- Developmental Imaging, Murdoch Childrens Research Institute, Melbourne, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - Sila Genc
- Developmental Imaging, Murdoch Childrens Research Institute, Melbourne, Australia
| | - Cathy Catroppa
- Australian Centre for Child Neuropsychological Studies, Murdoch Childrens Research Institute, Melbourne, Australia; Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - Vicki A Anderson
- Australian Centre for Child Neuropsychological Studies, Murdoch Childrens Research Institute, Melbourne, Australia; Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Australia; Department of Psychology, Royal Children's Hospital, Melbourne, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Australia
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Brain Magnetic Resonance Imaging for Traumatic Brain Injury: Why, When, and How? Top Magn Reson Imaging 2016; 24:225-39. [PMID: 26502305 DOI: 10.1097/rmr.0000000000000061] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Conventional magnetic resonance imaging (MRI) and angiography (MRA) provide invaluable information in the evaluation of patients with all stages and grades of traumatic brain injury (TBI). The information obtained with MRI provides a more complete assessment of the patient's brain injury and possible long-term sequelae.
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Ellis MJ, McDonald PJ, Cordingley D, Mansouri B, Essig M, Ritchie L. Retirement-from-sport considerations following pediatric sports-related concussion: case illustrations and institutional approach. Neurosurg Focus 2016; 40:E8. [DOI: 10.3171/2016.1.focus15600] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The decision to advise an athlete to retire from sports following sports-related concussion (SRC) remains a persistent challenge for physicians. In the absence of strong empirical evidence to support recommendations, clinical decision making must be individualized and should involve a multidisciplinary team of experts in concussion and traumatic brain injury. Although previous authors have advocated for a more conservative approach to these issues in child and adolescent athletes, there are few reports outlining considerations for this process among this unique population. Here, the authors use multiple case illustrations to discuss 3 subgroups of clinical considerations for sports retirement among pediatric SRC patients including the following: those with structural brain abnormalities identified on neuroimaging, those presenting with focal neurological deficits and abnormalities on physical examination, and those in whom the cumulative or prolonged effects of concussion are suspected or demonstrated. The authors' evolving multidisciplinary institutional approach to return-to-play and retirement decision making in pediatric SRC is also presented.
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Toth A, Kovacs N, Tamas V, Kornyei B, Nagy M, Horvath A, Rostas T, Bogner P, Janszky J, Doczi T, Buki A, Schwarcz A. Microbleeds may expand acutely after traumatic brain injury. Neurosci Lett 2016; 617:207-12. [PMID: 26912192 DOI: 10.1016/j.neulet.2016.02.028] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2015] [Revised: 02/14/2016] [Accepted: 02/15/2016] [Indexed: 10/22/2022]
Abstract
BACKGROUND AND PURPOSE Susceptibility weighted imaging (SWI) is a very sensitive tool for the detection of microbleeds in traumatic brain injury (TBI). The number and extent of such traumatic microbleeds (TMBs) have been shown to correlate with the severity of the injury and the clinical outcome. However, the acute dynamics of TMBs have not been revealed so far. Since TBI is known to constitute dynamic pathological processes, we hypothesized that TMBs are not constant in their appearance, but may progress acutely after injury. MATERIALS AND METHODS We present here five closed moderate/severe (Glasgow coma scale≤13) TBI patients who underwent SWI very early (average=23.4 h), and once again a week (average=185.8 h) after the injury. The TMBs were mapped at both time points by a conventional radiological approach and their numbers and volumes were measured with manual tracing tools by two observers. TMB counts and extents were compared between time points. RESULTS TMBs were detected in four patients, three of them displaying an apparent TMB change. In these patients, TMB confluence and apparent growth were detected in the corpus callosum, coronal radiation or subcortical white matter, while unchanged TMBs were also present. These changes caused a decrease in the TMB count associated with an increase in the overall TMB volume over time. CONCLUSION We have found a compelling evidence that diffuse axonal injury-related microbleed development is not limited strictly to the moment of injury: the TMBs might expand in the acute phase of TBI. The timing of SWI acquisition may be relevant for optimizing the prognostic utility of this imaging biomarker.
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Affiliation(s)
- Arnold Toth
- Department of Neurosurgery, Pécs Medical School, H-7623, Rét. u. 2., Pécs, Hungary.
| | - Noemi Kovacs
- Department of Neurosurgery, Pécs Medical School, H-7623, Rét. u. 2., Pécs, Hungary.
| | - Viktoria Tamas
- Department of Neurosurgery, Pécs Medical School, H-7623, Rét. u. 2., Pécs, Hungary.
| | - Balint Kornyei
- Department of Neurosurgery, Pécs Medical School, H-7623, Rét. u. 2., Pécs, Hungary.
| | - Mate Nagy
- Department of Neurosurgery, Pécs Medical School, H-7623, Rét. u. 2., Pécs, Hungary.
| | - Andrea Horvath
- Department of Neurosurgery, Pécs Medical School, H-7623, Rét. u. 2., Pécs, Hungary; Diagnostic Center of Pécs, H-7623, Rét. u. 2., Pécs, Hungary.
| | - Tamas Rostas
- Department of Radiology, Pécs Medical School, H-7624, Ifjusag str. 13., Pécs, Hungary.
| | - Peter Bogner
- Department of Neurosurgery, Pécs Medical School, H-7623, Rét. u. 2., Pécs, Hungary; Department of Radiology, Pécs Medical School, H-7624, Ifjusag str. 13., Pécs, Hungary.
| | - Jozsef Janszky
- Department of Neurology, Pécs Medical School, H-7623, Rét. u. 2., Pécs, Hungary; MTA-PTE Clinical Neuroscience MR Research Group, Hungary.
| | - Tamas Doczi
- Department of Neurosurgery, Pécs Medical School, H-7623, Rét. u. 2., Pécs, Hungary; Diagnostic Center of Pécs, H-7623, Rét. u. 2., Pécs, Hungary; MTA-PTE Clinical Neuroscience MR Research Group, Hungary.
| | - Andras Buki
- Department of Neurosurgery, Pécs Medical School, H-7623, Rét. u. 2., Pécs, Hungary; MTA-PTE Clinical Neuroscience MR Research Group, Hungary.
| | - Attila Schwarcz
- Department of Neurosurgery, Pécs Medical School, H-7623, Rét. u. 2., Pécs, Hungary; MTA-PTE Clinical Neuroscience MR Research Group, Hungary.
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Kurz FT, Freitag M, Schlemmer HP, Bendszus M, Ziener CH. Grundlagen und Anwendungen der suszeptibilitätsgewichteten Bildgebung. Radiologe 2016; 56:124-36. [DOI: 10.1007/s00117-015-0069-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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40
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Ryan NP, Bijnen L, Catroppa C, Beauchamp MH, Crossley L, Hearps S, Anderson V. Longitudinal outcome and recovery of social problems after pediatric traumatic brain injury (TBI): Contribution of brain insult and family environment. Int J Dev Neurosci 2015; 49:23-30. [DOI: 10.1016/j.ijdevneu.2015.12.004] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2015] [Revised: 11/10/2015] [Accepted: 12/18/2015] [Indexed: 10/22/2022] Open
Affiliation(s)
- Nicholas P. Ryan
- Australian Centre for Child Neuropsychological StudiesMurdoch Childrens Research InstituteMelbourneAustralia
- Melbourne School of Psychological SciencesUniversity of MelbourneMelbourneAustralia
| | - Loeka Bijnen
- Australian Centre for Child Neuropsychological StudiesMurdoch Childrens Research InstituteMelbourneAustralia
| | - Cathy Catroppa
- Australian Centre for Child Neuropsychological StudiesMurdoch Childrens Research InstituteMelbourneAustralia
- Melbourne School of Psychological SciencesUniversity of MelbourneMelbourneAustralia
| | - Miriam H. Beauchamp
- Australian Centre for Child Neuropsychological StudiesMurdoch Childrens Research InstituteMelbourneAustralia
- Department of PsychologyUniversity of MontrealMontrealCanada
- Ste‐Justine Research CenterMontrealQuebecCanada
| | - Louise Crossley
- Australian Centre for Child Neuropsychological StudiesMurdoch Childrens Research InstituteMelbourneAustralia
| | - Stephen Hearps
- Australian Centre for Child Neuropsychological StudiesMurdoch Childrens Research InstituteMelbourneAustralia
| | - Vicki Anderson
- Australian Centre for Child Neuropsychological StudiesMurdoch Childrens Research InstituteMelbourneAustralia
- Melbourne School of Psychological SciencesUniversity of MelbourneMelbourneAustralia
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Verma SK, Kan EM, Lu J, Ng KC, Ling EA, Seramani S, Kn BP, Wong YC, Tan MH, Velan SS. Multi-echo susceptibility-weighted imaging and histology of open-field blast-induced traumatic brain injury in a rat model. NMR IN BIOMEDICINE 2015; 28:1069-1077. [PMID: 26152641 DOI: 10.1002/nbm.3351] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Revised: 05/18/2015] [Accepted: 06/03/2015] [Indexed: 06/04/2023]
Abstract
Blast-induced traumatic brain injury is on the rise, predominantly as a result of the use of improvised explosive devices, resulting in undesirable neuropsychological dysfunctions, as demonstrated in both animals and humans. This study investigated the effect of open-field blast injury on the rat brain using multi-echo, susceptibility-weighted imaging (SWI). Multi-echo SWI provided phase maps with better signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR), making it a sensitive technique for brain injury. Male Sprague-Dawley rats were subjected to a survivable blast of 180 kPa. The visibility of blood vessels of varying sizes improved with multi-echo SWI. Reduced signal intensity from major vessels post-blast indicates increased deoxyhaemoglobin. Relative cerebral blood flow was computed from filtered phase SWI images using inferred changes in oxygen saturation from major blood vessels. Cerebral blood flow decreased significantly at day 3 and day 5 post-blast compared with that pre-blast. This was substantiated by the upregulation of β-amyloid precursor protein (β-APP), a marker of ischaemia, in the neuronal perikaya of the cerebral cortex, as observed by immunofluorescence, and in the cortical tissue by western blot analysis. Our findings indicate the presence of brain ischaemia in post-blast acute phase of injury with possible recovery subsequently. Our results from cerebrovascular imaging, histology and staining provide an insight into the ischaemic state of the brain post-blast and may be useful for prognosis and outcome.
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Affiliation(s)
- Sanjay Kumar Verma
- Laboratory of Molecular Imaging, Singapore Bioimaging Consortium, Singapore
| | - Enci Mary Kan
- Defence Medical and Environmental Research Institute, DSO National Laboratories, Singapore
- Department of Anatomy, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Jia Lu
- Defence Medical and Environmental Research Institute, DSO National Laboratories, Singapore
- Department of Anatomy, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Kian Chye Ng
- Defence Medical and Environmental Research Institute, DSO National Laboratories, Singapore
| | - Eng Ang Ling
- Department of Anatomy, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Sankar Seramani
- Laboratory of Molecular Imaging, Singapore Bioimaging Consortium, Singapore
| | - Bhanu Prakash Kn
- Laboratory of Molecular Imaging, Singapore Bioimaging Consortium, Singapore
| | - Yong Chiat Wong
- Defence Medical and Environmental Research Institute, DSO National Laboratories, Singapore
| | - Mui Hong Tan
- Defence Medical and Environmental Research Institute, DSO National Laboratories, Singapore
| | - S Sendhil Velan
- Laboratory of Molecular Imaging, Singapore Bioimaging Consortium, Singapore
- Clinical Imaging Research Centre, Agency for Science, Technology and Research, Singapore
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Ellis MJ, Leiter J, Hall T, McDonald PJ, Sawyer S, Silver N, Bunge M, Essig M. Neuroimaging findings in pediatric sports-related concussion. J Neurosurg Pediatr 2015; 16:241-7. [PMID: 26031620 DOI: 10.3171/2015.1.peds14510] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT The goal in this review was to summarize the results of clinical neuroimaging studies performed in patients with sports-related concussion (SRC) who were referred to a multidisciplinar ypediatric concussion program. METHODS The authors conducted a retrospective review of medical records and neuroimaging findings for all patients referred to a multidisciplinary pediatric concussion program between September 2013 and July 2014. Inclusion criteria were as follows: 1) age ≤ 19 years; and 2) physician-diagnosed SRC. All patients underwent evaluation and follow-up by the same neurosurgeon. The 2 outcomes examined in this review were the frequency of neuroimaging studies performed in this population (including CT and MRI) and the findings of those studies. Clinical indications for neuroimaging and the impact of neuroimaging findings on clinical decision making were summarized where available. This investigation was approved by the local institutional ethics review board. RESULTS A total of 151 patients (mean age 14 years, 59% female) were included this study. Overall, 36 patients (24%) underwent neuroimaging studies, the results of which were normal in 78% of cases. Sixteen percent of patients underwent CT imaging; results were normal in 79% of cases. Abnormal CT findings included the following: arachnoid cyst (1 patient), skull fracture (2 patients), suspected intracranial hemorrhage (1 patient), and suspected hemorrhage into an arachnoid cyst (1 patient). Eleven percent of patients underwent MRI; results were normal in 75% of cases. Abnormal MRI findings included the following: intraparenchymal hemorrhage and sylvian fissure arachnoid cyst (1 patient); nonhemorrhagic contusion (1 patient); demyelinating disease (1 patient); and posterior fossa arachnoid cyst, cerebellar volume loss, and nonspecific white matter changes (1 patient). CONCLUSIONS Results of clinical neuroimaging studies are normal in the majority of pediatric patients with SRC. However, in selected cases neuroimaging can provide information that impacts decision making about return to play and retirement from the sport.
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Affiliation(s)
- Michael J Ellis
- Departments of 1 Surgery.,Pediatrics and Child Health, and.,Section of Neurosurgery, University of Manitoba.,Pan Am Clinic, and.,Children's Hospital Research Institute of Manitoba, Canada North Concussion Network, Winnipeg, Manitoba, Canada
| | - Jeff Leiter
- Departments of 1 Surgery.,Pan Am Clinic, and
| | | | - Patrick J McDonald
- Departments of 1 Surgery.,Pediatrics and Child Health, and.,Section of Neurosurgery, University of Manitoba.,Pan Am Clinic, and.,Children's Hospital Research Institute of Manitoba, Canada North Concussion Network, Winnipeg, Manitoba, Canada
| | - Scott Sawyer
- Pediatrics and Child Health, and.,Health Sciences Centre Children's Hospital
| | - Norm Silver
- Pediatrics and Child Health, and.,Health Sciences Centre Children's Hospital
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Di Ieva A, Lam T, Alcaide-Leon P, Bharatha A, Montanera W, Cusimano MD. Magnetic resonance susceptibility weighted imaging in neurosurgery: current applications and future perspectives. J Neurosurg 2015. [PMID: 26207600 DOI: 10.3171/2015.1.jns142349] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Susceptibility weighted imaging (SWI) is a relatively new imaging technique. Its high sensitivity to hemorrhagic components and ability to depict microvasculature by means of susceptibility effects within the veins allow for the accurate detection, grading, and monitoring of brain tumors. This imaging modality can also detect changes in blood flow to monitor stroke recovery and reveal specific subtypes of vascular malformations. In addition, small punctate lesions can be demonstrated with SWI, suggesting diffuse axonal injury, and the location of these lesions can help predict neurological outcome in patients. This imaging technique is also beneficial for applications in functional neurosurgery given its ability to clearly depict and differentiate deep midbrain nuclei and close submillimeter veins, both of which are necessary for presurgical planning of deep brain stimulation. By exploiting the magnetic susceptibilities of substances within the body, such as deoxyhemoglobin, calcium, and iron, SWI can clearly visualize the vasculature and hemorrhagic components even without the use of contrast agents. The high sensitivity of SWI relative to other imaging techniques in showing tumor vasculature and microhemorrhages suggests that it is an effective imaging modality that provides additional information not shown using conventional MRI. Despite SWI's clinical advantages, its implementation in MRI protocols is still far from consistent in clinical usage. To develop a deeper appreciation for SWI, the authors here review the clinical applications in 4 major fields of neurosurgery: neurooncology, vascular neurosurgery, neurotraumatology, and functional neurosurgery. Finally, they address the limitations of and future perspectives on SWI in neurosurgery.
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Affiliation(s)
| | - Timothy Lam
- Division of Neurosurgery, Department of Surgery; and
| | - Paula Alcaide-Leon
- Division of Neuroradiology, Department of Radiology, St. Michael's Hospital, University of Toronto, Ontario, Canada
| | - Aditya Bharatha
- Division of Neuroradiology, Department of Radiology, St. Michael's Hospital, University of Toronto, Ontario, Canada
| | - Walter Montanera
- Division of Neuroradiology, Department of Radiology, St. Michael's Hospital, University of Toronto, Ontario, Canada
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Smitherman E, Hernandez A, Stavinoha PL, Huang R, Kernie SG, Diaz-Arrastia R, Miles DK. Predicting Outcome after Pediatric Traumatic Brain Injury by Early Magnetic Resonance Imaging Lesion Location and Volume. J Neurotrauma 2015; 33:35-48. [PMID: 25808802 DOI: 10.1089/neu.2014.3801] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Brain lesions after traumatic brain injury (TBI) are heterogeneous, rendering outcome prognostication difficult. The aim of this study is to investigate whether early magnetic resonance imaging (MRI) of lesion location and lesion volume within discrete brain anatomical zones can accurately predict long-term neurological outcome in children post-TBI. Fluid-attenuated inversion recovery (FLAIR) MRI hyperintense lesions in 63 children obtained 6.2±5.6 days postinjury were correlated with the Glasgow Outcome Scale Extended-Pediatrics (GOS-E Peds) score at 13.5±8.6 months. FLAIR lesion volume was expressed as hyperintensity lesion volume index (HLVI)=(hyperintensity lesion volume / whole brain volume)×100 measured within three brain zones: zone A (cortical structures); zone B (basal ganglia, corpus callosum, internal capsule, and thalamus); and zone C (brainstem). HLVI-total and HLVI-zone C predicted good and poor outcome groups (p<0.05). GOS-E Peds correlated with HLVI-total (r=0.39; p=0.002) and HLVI in all three zones: zone A (r=0.31; p<0.02); zone B (r=0.35; p=0.004); and zone C (r=0.37; p=0.003). In adolescents ages 13-17 years, HLVI-total correlated best with outcome (r=0.5; p=0.007), whereas in younger children under the age of 13, HLVI-zone B correlated best (r=0.52; p=0.001). Compared to patients with lesions in zone A alone or in zones A and B, patients with lesions in all three zones had a significantly higher odds ratio (4.38; 95% confidence interval, 1.19-16.0) for developing an unfavorable outcome.
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Affiliation(s)
- Emily Smitherman
- 1 University of Texas Southwestern Medical Center, University of Texas Southwestern Medical Center , Dallas, Texas
| | - Ana Hernandez
- 2 Department of Neuropsychology, Children's Medical Center , Dallas, Texas
| | - Peter L Stavinoha
- 2 Department of Neuropsychology, Children's Medical Center , Dallas, Texas.,3 Department of Psychiatry, University of Texas Southwestern Medical Center , Dallas, Texas
| | - Rong Huang
- 4 Department of Clinical Research, Children's Medical Center , Dallas, Texas
| | - Steven G Kernie
- 5 Department of Pediatrics, University of Texas Southwestern Medical Center , Dallas, Texas
| | - Ramon Diaz-Arrastia
- 6 Department of Neurology, University of Texas Southwestern Medical Center , Dallas, Texas
| | - Darryl K Miles
- 5 Department of Pediatrics, University of Texas Southwestern Medical Center , Dallas, Texas
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Yuan L, Wei X, Xu C, Jin Y, Wang G, Li Y, Tian H, Chen S. Use of multisequence 3.0-T MRI to detect severe traumatic brain injury and predict the outcome. Br J Radiol 2015; 88:20150129. [PMID: 26067919 DOI: 10.1259/bjr.20150129] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE The aim of this study was to evaluate multisequence 3.0-T MRI in the detection of severe traumatic brain injury (sTBI) and in predicting the outcome. METHODS 32 patients with sTBI were prospectively enrolled, and multisequence 3.0-T MRI was performed 4-8 weeks post injury. Quantitative data were recorded on each sequence. The ability to display the parenchymal lesions was compared with that of 64-slice spiral CT. The clinical and radiological results were correlated with the Glasgow Outcome Scale Extended scores 6 months after injury. RESULTS 3.0-T MRI could display more lesions than CT, especially when the lesion was deeply located. The lesion volumes and diffuse axonal injury (DAI) scores were different between good and poor outcome groups on fluid attenuated inversion recovery (p < 0.05). The apparent diffusion coefficient (ADC) values of the splenium of the corpus callosum and brain stem were also different (p < 0.05). Patients with unfavourable outcome showed a significantly higher volume of haemorrhage on susceptibility-weighted imaging than those with favourable outcomes and had haemorrhages generally located more deeply. Logistic regression analysis revealed that the location of haemorrhage and the ADC values of the splenium of the corpus callosum were independent risk factors for poor outcome, with an overall predictive accuracy of 91.4%. CONCLUSION The joint use of conventional and advanced sequences of 3.0-T MRI can comprehensively detect the pathological changes occurring after sTBI. Haemorrhagic and non-haemorrhagic DAIs in deep structures strongly suggest poor outcome. ADVANCES IN KNOWLEDGE This article improves the understanding of advanced MRI sequences in the detection of patients with sTBI and prediction of prognosis.
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Affiliation(s)
- L Yuan
- 1 Department of Neurosurgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - X Wei
- 2 Department of Diagnostic Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - C Xu
- 1 Department of Neurosurgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Y Jin
- 1 Department of Neurosurgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - G Wang
- 1 Department of Neurosurgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Y Li
- 2 Department of Diagnostic Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - H Tian
- 1 Department of Neurosurgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - S Chen
- 1 Department of Neurosurgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
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Henry LC, Burkhart SO, Elbin RJ, Agarwal V, Kontos AP. Traumatic axonal injury and persistent emotional lability in an adolescent following moderate traumatic brain injury: A case study. J Clin Exp Neuropsychol 2015; 37:439-54. [PMID: 26000663 DOI: 10.1080/13803395.2015.1025708] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
A 15-year-old male was treated secondary to sustaining a moderate traumatic brain injury (moderate TBI). Symptom self-report, and computerized and paper-and-pencil-based neurocognitive, vestibular/ocular motor, and imaging data were used throughout to document impairment and recovery. The patient demonstrated persistent emotional lability concurrent with vestibular impairment. In addition to clinical evaluation and management, the patient also underwent susceptibility-weighted imaging, which revealed axonal shearing across the corpus callosum and areas innervating the prefrontal cortex. Paper-and-pencil neurocognitive measures revealed persisting deficits, despite normal-appearing computerized test results. Implications of this case underline the importance of an integrative evaluation process including clinical interview, neurocognitive and vestibular/ocular physical therapy, and advanced neuroimaging, especially in cases with atypical presentation.
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Affiliation(s)
- Luke C Henry
- a UPMC Sports Medicine Concussion Program/Department of Orthopaedic Surgery , University of Pittsburgh , Pittsburgh , PA , USA
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Park S, Kwak BK, Jung J. Sensitivity of susceptibility-weighted imaging in detecting superparamagnetic iron oxide-labeled mesenchymal stem cells: a comparative study. IRANIAN JOURNAL OF RADIOLOGY 2015; 12:e20782. [PMID: 25901258 PMCID: PMC4389178 DOI: 10.5812/iranjradiol.20782] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Revised: 09/03/2014] [Accepted: 09/20/2014] [Indexed: 12/18/2022]
Abstract
Background: Susceptibility-weighted imaging (SWI) is extremely sensitive in the detection of superparamagnetic iron oxide (SPIO) nanoparticle-labeled cells. However, no study has compared molecular imaging for stem cell detection using SWI and other MRI pulse sequences. Objectives: This study aims to assess the sensitivity of SWI in detecting SPIO nanoparticle-labeled, human bone marrow-derived mesenchymal stem cells (SPIO-hMSCs) compared with that of T2- and T2*-weighted imaging (T2WI and T2*WI, respectively) in a phantom and in vivo study in rats. Materials and Methods: A phantom was prepared with various cell concentrations. In one normal rat, SPIO-hMSCs were implanted directly through burr holes into both caudate putamens, while in three rats without and six rats with photothrombotic infarction, 2.5 × 105/ml SPIO-hMSCs were infused into the ipsilateral internal carotid artery (ICA). T2WI, T2*WI, and SWI findings were compared for dark regions representing SPIO-hMSCs. Results: SWI and T2*WI detected 15 µL of 13 SPIO-hMSCs/µL and 15 µL of 27 SPIO-hMSCs/µL in the phantom, respectively and 3 µL of 333 SPIO-hMSCs/µL and 3 µL of 167 SPIO-hMSCs/µL in the normal rat brain (direct implantation). In the normal rat brain (ICA infusion), one of the three cases showed numerous foci of dark regions dispersed throughout the brain on T2*WI and SWI. Dark regions surrounded the infarcts in all six infracted rat brains. The dark region was most prominent on SWI, followed by T2*WI and T2WI in all six rats (P = 0.002). Implanted SPIO-hMSCs were confirmed using Prussian blue staining. Conclusions: SWI is the most sensitive in the detection of SPIO-hMSCs, with the dark regions representing SPIO-hMSCs being more prominent on SWI than on T2*WI and T2WI.
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Affiliation(s)
- Serah Park
- Department of Radiology, Chung-Ang University College of Medicine, Seoul, Korea
| | - Byung Kook Kwak
- Department of Radiology, Chung-Ang University College of Medicine, Seoul, Korea
- Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
- Corresponding author: Byung Kook Kwak, Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, P. O. Box: 156-755, Seoul, Korea. Tel: +82-262992661, Fax: +82-262631557, E-mail:
| | - Jisung Jung
- Department of Radiology, Chung-Ang University College of Medicine, Seoul, Korea
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Ryan NP, Catroppa C, Beare R, Coleman L, Ditchfield M, Crossley L, Beauchamp MH, Anderson VA. Predictors of longitudinal outcome and recovery of pragmatic language and its relation to externalizing behaviour after pediatric traumatic brain injury. BRAIN AND LANGUAGE 2015; 142:86-95. [PMID: 25677376 DOI: 10.1016/j.bandl.2015.01.007] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2014] [Revised: 01/04/2015] [Accepted: 01/05/2015] [Indexed: 06/04/2023]
Abstract
The purpose of the present investigation was to evaluate the contribution of age-at-insult and brain pathology on longitudinal outcome and recovery of pragmatic language in a sample of children and adolescents with traumatic brain injury (TBI). Children and adolescents with mild to severe TBI (n=112) were categorized according to timing of brain insult: (i) Middle Childhood (5-9 years; n=41); (ii) Late Childhood (10-11 years; n=39); and (iii) Adolescence (12-15 years; n=32) and group-matched for age, gender and socio-economic status (SES) to a typically developing (TD) control group (n=43). Participants underwent magnetic resonance imaging (MRI) including a susceptibility weighted imaging (SWI) sequence 2-8 weeks after injury and were assessed on measures of pragmatic language and behavioural functioning at 6- and 24-months after injury. Children and adolescents with TBI of all severity levels demonstrated impairments in these domains at 6-months injury before returning to age-expected levels at 2-years post-TBI. However, while adolescent TBI was associated with post-acute disruption to skills that preceded recovery to age-expected levels by 2-years post injury, the middle childhood TBI group demonstrated impairments at 6-months post-injury that were maintained at 2-year follow up. Reduced pragmatic communication was associated with frontal, temporal and corpus callosum lesions, as well as more frequent externalizing behaviour at 24-months post injury. Findings show that persisting pragmatic language impairment after pediatric TBI is related to younger age at brain insult, as well as microhemorrhagic pathology in brain regions that contribute to the anatomically distributed social brain network. Relationships between reduced pragmatic communication and more frequent externalizing behavior underscore the need for context-sensitive rehabilitation programs that aim to increase interpersonal effectiveness and reduce risk for maladaptive behavior trajectories into the long-term post injury.
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Affiliation(s)
- Nicholas P Ryan
- Australian Centre for Child Neuropsychological Studies, Murdoch Childrens Research Institute, Melbourne, Australia; Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Australia.
| | - Cathy Catroppa
- Australian Centre for Child Neuropsychological Studies, Murdoch Childrens Research Institute, Melbourne, Australia; Department of Psychology, Royal Children's Hospital, Melbourne, Australia; Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Australia; Department of Pediatrics, University of Melbourne, Melbourne, Australia.
| | - Richard Beare
- Developmental Imaging, Murdoch Childrens Research Institute, Melbourne, Australia.
| | - Lee Coleman
- Department of Radiology, Royal Children's Hospital, Melbourne, Australia.
| | - Michael Ditchfield
- Australian Centre for Child Neuropsychological Studies, Murdoch Childrens Research Institute, Melbourne, Australia.
| | - Louise Crossley
- Australian Centre for Child Neuropsychological Studies, Murdoch Childrens Research Institute, Melbourne, Australia.
| | - Miriam H Beauchamp
- Department of Psychology, University of Montreal, Montreal, Canada; Ste-Justine Research Center, Montreal, Quebec, Canada.
| | - Vicki A Anderson
- Australian Centre for Child Neuropsychological Studies, Murdoch Childrens Research Institute, Melbourne, Australia; Department of Psychology, Royal Children's Hospital, Melbourne, Australia; Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Australia; Department of Pediatrics, University of Melbourne, Melbourne, Australia.
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Ha BC, Jung J, Kwak BK. Susceptibility-weighted imaging for stem cell visualization in a rat photothrombotic cerebral infarction model. Acta Radiol 2015; 56:219-27. [PMID: 24574360 DOI: 10.1177/0284185114525605] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND In cell therapy, magnetic resonance imaging (MRI) has been used to visualize superparamagnetic iron oxide (SPIO)-labeled stem cells homing to a lesion. Improving traceability is to utilize the sequence that maximizes sensitivity to the susceptibility effect of SPIO. PURPOSE To explore the best method by comparing the MRI sequences to visualize mesenchymal stem cells (MSCs) labeled with SPIO. MATERIAL AND METHODS Human bone marrow (hBM)-derived MSCs were labeled by internalization of SPIO nanoparticles. In vitro MRI was performed for the SPIO-labeled hBM-MSCs in tubes with T2-weighted (T2W), T2*-weighted (T2*W), and susceptibility-weighted images (SWI). Contrast-to-noise ratio (CNR) and volumes of dark signal of SPIO-labeled hBM-MSCs were obtained on images of each sequence. Photothrombotic cerebral infarction (PTCI) was induced in eight rats, and 2.5 × 10(5) SPIO-labeled hBM-MSCs were infused through the tail vein on the third day. In vivo MRI of the rat brain was performed using a 3.0 T MRI on the first, third, seventh, and 14th days. CNRspio was obtained on T2W imaging, T2*W imaging, and SWI. The dark signals were compared with the SPIO-positive cells of Prussian blue staining. RESULTS In vitro MRI of 5 × 10(5) SPIO-labeled hBM-MSCs showed the CNR and volume of dark signal to be 63, 517 mm(3) in SWI, 41, 228 mm(3) in T2*W imaging, and 56, 41 mm(3) in T2W imaging, respectively. In vivo MRI showed a dark signal surrounding the high signal intensity of PTCI. Pathologically, the dark signals were matched with SPIO-labeled hBM-MSC in the corresponding rat. The dark signal was most prominent in SWI, then T2*W imaging, and finally in T2W imaging (P <0.05). In SWI, other causes of dark signals were matched with the veins and the choroid plexuses on histopathology. CONCLUSION SWI can visualize SPIO-labeled hBM-MSCs more sensitively, earlier, and with larger size and greater contrast than T2W imaging and T2*W imaging.
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Affiliation(s)
- Bon Chul Ha
- Department of Radiology, Chung-Ang University Hospital, Seoul, Republic of Korea
| | - Jisung Jung
- Department of Radiology, Chung-Ang University Hospital, Seoul, Republic of Korea
| | - Byung Kook Kwak
- Department of Radiology, Chung-Ang University Hospital, Seoul, Republic of Korea
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Max JE, Friedman K, Wilde EA, Bigler ED, Hanten G, Schachar RJ, Saunders AE, Dennis M, Ewing-Cobbs L, Chapman SB, Yang TT, Levin HS. Psychiatric disorders in children and adolescents 24 months after mild traumatic brain injury. J Neuropsychiatry Clin Neurosci 2015; 27:112-20. [PMID: 25923850 PMCID: PMC5007244 DOI: 10.1176/appi.neuropsych.13080190] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
This study aimed to better understand the occurrence of novel psychiatric disorders (NPDs) in children with mild traumatic brain injury (mTBI) in relation to preinjury variables, injury-related variables, and concurrent neurocognitive outcome. Eighty-seven children aged 5-14 years who had experienced mTBI were studied from consecutive hospital admissions with semistructured psychiatric interviews soon after injury (baseline). Fifty-four children were reassessed 24 months postinjury. Standardized instruments were used to evaluate injury severity, lesion characteristics, preinjury variables (lifetime psychiatric disorder, family psychiatric history, family function, socioeconomic status, psychosocial adversity, adaptive function, and academic function), and finally, postinjury neurocognitive and adaptive function. At 24 months postinjury, NPDs had occurred in 17 of 54 (31%) participants. NPD at 24 months was related to frontal white matter lesions and was associated with estimated preinjury reading, preinjury adaptive function, and concurrent deficits in reading, processing speed, and adaptive function. These findings extend earlier reports that the psychiatric morbidity after mTBI in children is more common than previously thought, and moreover, it is linked to preinjury individual variables and injury characteristics and is associated with postinjury adaptive and neurocognitive functioning.
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