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Volumetric MRI Findings in Mild Traumatic Brain Injury (mTBI) and Neuropsychological Outcome. Neuropsychol Rev 2023; 33:5-41. [PMID: 33656702 DOI: 10.1007/s11065-020-09474-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Accepted: 12/20/2020] [Indexed: 10/22/2022]
Abstract
Region of interest (ROI) volumetric assessment has become a standard technique in quantitative neuroimaging. ROI volume is thought to represent a coarse proxy for making inferences about the structural integrity of a brain region when compared to normative values representative of a healthy sample, adjusted for age and various demographic factors. This review focuses on structural volumetric analyses that have been performed in the study of neuropathological effects from mild traumatic brain injury (mTBI) in relation to neuropsychological outcome. From a ROI perspective, the probable candidate structures that are most likely affected in mTBI represent the target regions covered in this review. These include the corpus callosum, cingulate, thalamus, pituitary-hypothalamic area, basal ganglia, amygdala, and hippocampus and associated structures including the fornix and mammillary bodies, as well as whole brain and cerebral cortex along with the cerebellum. Ventricular volumetrics are also reviewed as an indirect assessment of parenchymal change in response to injury. This review demonstrates the potential role and limitations of examining structural changes in the ROIs mentioned above in relation to neuropsychological outcome. There is also discussion and review of the role that post-traumatic stress disorder (PTSD) may play in structural outcome in mTBI. As emphasized in the conclusions, structural volumetric findings in mTBI are likely just a single facet of what should be a multimodality approach to image analysis in mTBI, with an emphasis on how the injury damages or disrupts neural network integrity. The review provides an historical context to quantitative neuroimaging in neuropsychology along with commentary about future directions for volumetric neuroimaging research in mTBI.
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Chen W, Yao C, Li S, Huang H, Zhu Z, Chen R, Su W, Huang X, Xu L, Sun K, Song J, Jiang R, Wang G. Cognitive impairment in diffuse axonal injury patients with favorable outcome. Front Neurosci 2023; 17:1077858. [PMID: 36761409 PMCID: PMC9905128 DOI: 10.3389/fnins.2023.1077858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Accepted: 01/09/2023] [Indexed: 01/26/2023] Open
Abstract
Background and purpose Traumatic brain injury (TBI), especially the severe TBI are often followed by persistent cognitive sequalae, including decision-making difficulties, reduced neural processing speed and memory deficits. Diffuse axonal injury (DAI) is classified as one of the severe types of TBI. Part of DAI patients are marginalized from social life due to cognitive impairment, even if they are rated as favorable outcome. The purpose of this study was to elucidate the specific type and severity of cognitive impairment in DAI patients with favorable outcome. Methods The neurocognition of 46 DAI patients with favorable outcome was evaluated by the Chinese version of the Montreal Cognitive Assessment Basic (MoCA-BC), and the differences in the domains of cognitive impairment caused by different grades of DAI were analyzed after data conversion of scores of nine cognitive domains of MoCA-BC by Pearson correlation analysis. Results Among the 46 DAI patients with favorable outcome, eight had normal cognitive function (MoCA-BC ≥ 26), and 38 had cognitive impairment (MoCA-BC < 26). The MoCA-BC scores were positively correlated with pupillary light reflex (r = 0.361, p = 0.014), admission Glasgow Coma Scale (GCS) (r = 0.402, p = 0.006), and years of education (r = 0.581, p < 0.001). Return of consciousness (r = -0.753, p < 0.001), Marshall CT (r = -0.328, p = 0.026), age (r = -0.654, p < 0.001), and DAI grade (r = -0.403, p = 0.006) were found to be negatively correlated with the MoCA-BC scores. In patients with DAI grade 1, the actually deducted scores (Ads) of memory (r = 0.838, p < 0.001), abstraction (r = 0.843, p < 0.001), and calculation (r = 0.782, p < 0.001) were most related to the Ads of MoCA-BC. The Ads of nine cognitive domains and MoCA-BC were all proved to be correlated, among patients with DAI grade 2. However, In the DAI grade 3 patients, the highest correlation with the Ads of MoCA-BC were the Ads of memory (r = 0.904, p < 0.001), calculation (r = 0.799, p = 0.006), orientation (r = 0.801, p = 0.005), and executive function (r = 0.869, p = 0.001). Conclusion DAI patients with favorable outcome may still be plagued by cognitive impairment, and different grades of DAI cause different domains of cognitive impairment.
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Affiliation(s)
- Weiliang Chen
- Department of Neurosurgery, Haining People’s Hospital, Jiaxing, Zhejiang, China
| | - Chunyu Yao
- Department of Neurosurgery, Haining People’s Hospital, Jiaxing, Zhejiang, China
| | - Shengwen Li
- The Second Department of Orthopaedics, Haining People’s Hospital, Haining, Zhejiang, China
| | - Hongguang Huang
- Department of Neurosurgery, The First Affiliated Hospital of Zhejiang University Medical College, Hangzhou, Zhejiang, China
| | - Zujian Zhu
- Department of Neurosurgery, Haining People’s Hospital, Jiaxing, Zhejiang, China
| | - Rui Chen
- Department of Neurosurgery, Haining People’s Hospital, Jiaxing, Zhejiang, China
| | - Wen Su
- Department of Neurosurgery, Haining People’s Hospital, Jiaxing, Zhejiang, China
| | - Xiao Huang
- Department of Neurosurgery, Haining People’s Hospital, Jiaxing, Zhejiang, China
| | - Lisheng Xu
- Department of Neurosurgery, Haining People’s Hospital, Jiaxing, Zhejiang, China
| | - Kaijie Sun
- Department of Neurosurgery, Haining People’s Hospital, Jiaxing, Zhejiang, China
| | - Jiannan Song
- Department of Neurosurgery, Haining People’s Hospital, Jiaxing, Zhejiang, China
| | - Rongcai Jiang
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China,Rongcai Jiang,
| | - Guanjun Wang
- Department of Neurosurgery, Haining People’s Hospital, Jiaxing, Zhejiang, China,*Correspondence: Guanjun Wang,
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Chen W, Wang G, Yao C, Zhu Z, Chen R, Su W, Jiang R. The ratio of serum neuron-specific enolase level to admission glasgow coma scale score is associated with diffuse axonal injury in patients with moderate to severe traumatic brain injury. Front Neurol 2022; 13:887818. [PMID: 36119705 PMCID: PMC9475250 DOI: 10.3389/fneur.2022.887818] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 07/27/2022] [Indexed: 11/20/2022] Open
Abstract
Background Moderate to severe traumatic brain injury (TBI) is frequently accompanied by diffuse axonal injury (DAI). Considering the low sensitivity of computed tomography (CT) examination for microbleeds and axonal damage, identification of DAI is difficult using conventional diagnostic methods in the acute phase. Neuron-specific enolase (NSE) has been demonstrated to be increased in serum following various types of TBI and is already clinically/commercially available. We conjecture that serum NSE level to admission GCS score ratio (NGR) may be a useful indicator for the early diagnosis of DAI. Methods This study included 115 patients with moderate-to-severe TBI who underwent NSE measurements within 6 h after injury and brain magnetic resonance imaging (MRI) within 30 days. The positive and negative DAI groups were divided according to MRI findings. Results Among the 115 patients, 49 (42.6%) were classified into the DAI group and 66 (57.4%) patients into the non-DAI group by clinical MRI. The NGR of patients without DAI was found to be significantly lower than those of patients with DAI (p < 0.0001). NGR presented the largest Pearson r value (r = 0.755, 95% CI 0.664–0.824, p < 0.0001) and high diagnostic accuracy for DAI [area under the curve (AUC) = 0.9493; sensitivity, 90.91%; and specificity, 85.71%]. Patients with TBI presenting with higher NGR were more likely to suffer an unfavorable neurological outcome [6-month extended Glasgow Outcome Scale (GOSE) 1–4]. Conclusions The NGR on admission could serve as an independent predictor of DAI with moderate-to-severe TBI.
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Affiliation(s)
- Weiliang Chen
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China
- Key Laboratory of Post-Neuroinjury Neuro-repair and Regeneration in the Central Nervous System, Tianjin Key Laboratory of Injury and Regenerative Medicine of Nervous System, Tianjin Neurological Institute, Ministry of Education, Tianjin Medical University, Tianjin, China
- Department of Neurosurgery, Haining People's Hospital, Jiaxing, China
| | - Guanjun Wang
- Department of Neurosurgery, Haining People's Hospital, Jiaxing, China
| | - Chunyu Yao
- Department of Neurosurgery, Haining People's Hospital, Jiaxing, China
| | - Zujian Zhu
- Department of Neurosurgery, Haining People's Hospital, Jiaxing, China
| | - Rui Chen
- Department of Neurosurgery, Haining People's Hospital, Jiaxing, China
| | - Wen Su
- Department of Neurosurgery, Haining People's Hospital, Jiaxing, China
| | - Rongcai Jiang
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China
- Key Laboratory of Post-Neuroinjury Neuro-repair and Regeneration in the Central Nervous System, Tianjin Key Laboratory of Injury and Regenerative Medicine of Nervous System, Tianjin Neurological Institute, Ministry of Education, Tianjin Medical University, Tianjin, China
- *Correspondence: Rongcai Jiang
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Herrera-Martinez MP, García-Ballestas E, Lozada-Martínez ID, Moscote-Salazar LR, Al-Dhahir M. Letter to the Editor. Traumatic axonal injury: causes and effects. J Neurosurg 2021; 135:981-982. [PMID: 33962379 DOI: 10.3171/2021.1.jns204452] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Mónica Patricia Herrera-Martinez
- 1Center of Biomedical Research (CIB), Faculty of Medicine, University of Cartagena, Colombia
- 3Latinamerican Council of Neurocritical Care (CLaNi), Cartagena, Colombia
| | - Ezequiel García-Ballestas
- 1Center of Biomedical Research (CIB), Faculty of Medicine, University of Cartagena, Colombia
- 3Latinamerican Council of Neurocritical Care (CLaNi), Cartagena, Colombia
| | - Ivan David Lozada-Martínez
- 2Medical-Surgical Research Center, University of Cartagena, Colombia
- 3Latinamerican Council of Neurocritical Care (CLaNi), Cartagena, Colombia
- 4Colombian Clinical Research Group in Neurocritical Care, University of Cartagena, Colombia; and
| | - Luis Rafael Moscote-Salazar
- 1Center of Biomedical Research (CIB), Faculty of Medicine, University of Cartagena, Colombia
- 2Medical-Surgical Research Center, University of Cartagena, Colombia
- 3Latinamerican Council of Neurocritical Care (CLaNi), Cartagena, Colombia
- 4Colombian Clinical Research Group in Neurocritical Care, University of Cartagena, Colombia; and
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Moe HK, Vik A, Flusund AMH, Stenberg J, Skandsen T, Moen KG. Letter to the editor: Grading of traumatic axonal injury on clinical MRI and functional outcome. Acta Neurochir (Wien) 2021; 163:1443-1444. [PMID: 33630141 DOI: 10.1007/s00701-021-04759-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Accepted: 02/04/2021] [Indexed: 01/03/2023]
Affiliation(s)
- Hans Kristian Moe
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.
| | - Anne Vik
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Department of Neurosurgery, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Anne-Mari Holte Flusund
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Department of Radiology, Molde Hospital, Molde, Norway
| | - Jonas Stenberg
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Toril Skandsen
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Department of Physical Medicine and Rehabilitation, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Kent Gøran Moen
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Department of Radiology, Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
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Moe HK, Follestad T, Andelic N, Håberg AK, Flusund AMH, Kvistad KA, Saksvoll EH, Olsen Ø, Abel-Grüner S, Sandrød O, Skandsen T, Vik A, Moen KG. Traumatic axonal injury on clinical MRI: association with the Glasgow Coma Scale score at scene of injury or at admission and prolonged posttraumatic amnesia. J Neurosurg 2020; 135:562-573. [PMID: 33096528 DOI: 10.3171/2020.6.jns20112] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 06/08/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The aim in this study was to investigate if MRI findings of traumatic axonal injury (TAI) after traumatic brain injury (TBI) are related to the admission Glasgow Coma Scale (GCS) score and prolonged duration of posttraumatic amnesia (PTA). METHODS A total of 490 patients with mild to severe TBI underwent brain MRI within 6 weeks of injury (mild TBI: median 2 days; moderate to severe TBI: median 8 days). The location of TAI lesions and measures of total TAI lesion burden (number and volume of lesions on FLAIR and diffusion-weighted imaging and number of lesions on T2*-weighted gradient echo or susceptibility-weighted imaging) were quantified in a blinded manner for clinical information. The volume of contusions on FLAIR was likewise recorded. Associations between GCS score and the location and burden of TAI lesions were examined with multiple linear regression, adjusted for age, Marshall CT score (which includes compression of basal cisterns, midline shift, and mass lesions), and alcohol intoxication. The predictive value of TAI lesion location and burden for duration of PTA > 28 days was analyzed with multiple logistic regression, adjusted for age and Marshall CT score. Complete-case analyses of patients with TAI were used for the regression analyses of GCS scores (n = 268) and PTA (n = 252). RESULTS TAI lesions were observed in 58% of patients: in 7% of mild, 69% of moderate, and 93% of severe TBI cases. The TAI lesion location associated with the lowest GCS scores were bilateral lesions in the brainstem (mean difference in GCS score -2.5), followed by lesions bilaterally in the thalamus, unilaterally in the brainstem, and lesions in the splenium. The volume of TAI on FLAIR was the measure of total lesion burden most strongly associated with the GCS score. Bilateral TAI lesions in the thalamus had the largest predictive value for PTA > 28 days (OR 16.2, 95% CI 3.9-87.4). Of the measures of total TAI lesion burden, the FLAIR volume of TAI predicted PTA > 28 days the best. CONCLUSIONS Bilateral TAI lesions in the brainstem and thalamus, as well as the total volume of TAI lesions on FLAIR, had the strongest association with the GCS score and prolonged PTA. The current study proposes a first step toward a modified classification of TAI, with grades ranked according to their relation to these two measures of clinical TBI severity.
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Affiliation(s)
| | - Turid Follestad
- 2Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim
| | - Nada Andelic
- 3Institute of Health and Society, Research Centre for Habilitation and Rehabilitation Models and Services (CHARM), Faculty of Medicine, University of Oslo
- 4Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Ullevål
| | - Asta Kristine Håberg
- Departments of1Neuromedicine and Movement Science and
- Departments of5Radiology and Nuclear Medicine
| | - Anne-Mari Holte Flusund
- Departments of1Neuromedicine and Movement Science and
- 6Department of Radiology, Molde Hospital, Molde; and
| | | | - Elin Hildrum Saksvoll
- 7Department of Radiology, Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
| | - Øystein Olsen
- 7Department of Radiology, Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
| | | | | | - Toril Skandsen
- Departments of1Neuromedicine and Movement Science and
- 9Physical Medicine and Rehabilitation, and
| | - Anne Vik
- Departments of1Neuromedicine and Movement Science and
- 10Neurosurgery, St. Olav's Hospital, Trondheim University Hospital, Trondheim
| | - Kent Gøran Moen
- Departments of1Neuromedicine and Movement Science and
- 7Department of Radiology, Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
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