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Alanezi ST, Almutairi WM, Cronin M, Gobbo O, O'Mara SM, Sheppard D, O'Connor WT, Gilchrist MD, Kleefeld C, Colgan N. Whole-brain traumatic controlled cortical impact to the left frontal lobe: Magnetic resonance image-based texture analysis. J Neuropathol Exp Neurol 2024; 83:94-106. [PMID: 38164986 DOI: 10.1093/jnen/nlad110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2024] Open
Abstract
This research assesses the capability of texture analysis (TA) derived from high-resolution (HR) T2-weighted magnetic resonance imaging to identify primary sequelae following 1-5 hours of controlled cortical impact mild or severe traumatic brain injury (TBI) to the left frontal cortex (focal impact) and secondary (diffuse) sequelae in the right frontal cortex, bilateral corpus callosum, and hippocampus in rats. The TA technique comprised first-order (histogram-based) and second-order statistics (including gray-level co-occurrence matrix, gray-level run length matrix, and neighborhood gray-level difference matrix). Edema in the left frontal impact region developed within 1 hour and continued throughout the 5-hour assessments. The TA features from HR images confirmed the focal injury. There was no significant difference among radiomics features between the left and right corpus callosum or hippocampus from 1 to 5 hours following a mild or severe impact. The adjacent corpus callosum region and the distal hippocampus region (s), showed no diffuse injury 1-5 hours after mild or severe TBI. These results suggest that combining HR images with TA may enhance detection of early primary and secondary sequelae following TBI.
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Affiliation(s)
- Saleh T Alanezi
- Physics Department, Faculty of Science, Northern Border University, ArAr, Saudi Arabia
- School of Natural Sciences, College of Science and Engineering, University of Galway, Galway, Ireland
| | - Waleed M Almutairi
- Medical Imaging Department, King Abdullah bin Abdulaziz University Hospital, Riyadh, Saudi Arabia
- Department of Physics, College of Science, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Michelle Cronin
- Conway Institute, University College Dublin, Belfield, Dublin, Ireland
| | - Oliviero Gobbo
- School of Pharmacy and Pharmaceutical Sciences & Institute of Neuroscience, Trinity College, Dublin, Ireland
| | - Shane M O'Mara
- Institute of Neuroscience, Trinity College, Dublin, Ireland
| | - Declan Sheppard
- Department of Radiology, University Hospital Galway, Galway, Ireland
| | - William T O'Connor
- University of Limerick School of Medicine, Castletroy, Limerick, Ireland
| | - Michael D Gilchrist
- School of Mechanical & Materials Engineering, University College Dublin, Belfield, Dublin, Ireland
| | - Christoph Kleefeld
- School of Natural Sciences, College of Science and Engineering, University of Galway, Galway, Ireland
| | - Niall Colgan
- School of Natural Sciences, College of Science and Engineering, University of Galway, Galway, Ireland
- Department of Engineering, Technological University of the Shannon, Athlone, Ireland
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2
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Cottam NC, Bamfo T, Harrington MA, Charvet CJ, Hekmatyar K, Tulin N, Sun J. Cerebellar structural, astrocytic, and neuronal abnormalities in the SMNΔ7 mouse model of spinal muscular atrophy. Brain Pathol 2023; 33:e13162. [PMID: 37218083 PMCID: PMC10467044 DOI: 10.1111/bpa.13162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 04/18/2023] [Indexed: 05/24/2023] Open
Abstract
Spinalmuscular atrophy (SMA) is a neuromuscular disease that affects as many as 1 in 6000 individuals at birth, making it the leading genetic cause of infant mortality. A growing number of studies indicate that SMA is a multi-system disease. The cerebellum has received little attention even though it plays an important role in motor function and widespread pathology has been reported in the cerebella of SMA patients. In this study, we assessed SMA pathology in the cerebellum using structural and diffusion magnetic resonance imaging, immunohistochemistry, and electrophysiology with the SMNΔ7 mouse model. We found a significant disproportionate loss in cerebellar volume, decrease in afferent cerebellar tracts, selective lobule-specific degeneration of Purkinje cells, abnormal lobule foliation and astrocyte integrity, and a decrease in spontaneous firing of cerebellar output neurons in the SMA mice compared to controls. Our data suggest that defects in cerebellar structure and function due to decreased survival motor neuron (SMN) levels impair the functional cerebellar output affecting motor control, and that cerebellar pathology should be addressed to achieve comprehensive treatment and therapy for SMA patients.
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Affiliation(s)
- Nicholas C. Cottam
- Department of Biological SciencesDelaware State UniversityDoverDelawareUSA
| | - Tiffany Bamfo
- Department of Biological SciencesDelaware State UniversityDoverDelawareUSA
| | | | - Christine J. Charvet
- Delaware Center for Neuroscience ResearchDelaware State UniversityDoverDelawareUSA
- Department of Anatomy, Physiology and PharmacologyAuburn UniversityAuburnAlabamaUSA
- Department of PsychologyDelaware State UniversityDoverDEUnited States
| | - Khan Hekmatyar
- Center for Biomedical and Brain ImagingUniversity of DelawareNewarkDelawareUSA
- Bioimaging Research Center for Biomedical and Brain ImagingUniversity of GeorgiaAthensGeorgiaUSA
| | - Nikita Tulin
- Department of NeuroscienceTemple UniversityPhiladelphiaPennsylvaniaUSA
| | - Jianli Sun
- Department of Biological SciencesDelaware State UniversityDoverDelawareUSA
- Delaware Center for Neuroscience ResearchDelaware State UniversityDoverDelawareUSA
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3
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Grant M, Liu J, Wintermark M, Bagci U, Douglas D. Current State of Diffusion-Weighted Imaging and Diffusion Tensor Imaging for Traumatic Brain Injury Prognostication. Neuroimaging Clin N Am 2023; 33:279-297. [PMID: 36965946 DOI: 10.1016/j.nic.2023.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/27/2023]
Abstract
Advanced imaging techniques are needed to assist in providing a prognosis for patients with traumatic brain injury (TBI), particularly mild TBI (mTBI). Diffusion tensor imaging (DTI) is one promising advanced imaging technique, but has shown variable results in patients with TBI and is not without limitations, especially when considering individual patients. Efforts to resolve these limitations are being explored and include developing advanced diffusion techniques, creating a normative database, improving study design, and testing machine learning algorithms. This article will review the fundamentals of DTI, providing an overview of the current state of its utility in evaluating and providing prognosis in patients with TBI.
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Affiliation(s)
- Matthew Grant
- Department of Radiology, Stanford University, 453 Quarry Road, Palo Alto, CA 94304, USA; Department of Radiology, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Rd, Bethesda, MD 20814, USA; Department of Radiology, Landstuhl Regional Medical Center, Dr Hitzelberger Straße, 66849 Landstuhl, Germany.
| | - JiaJing Liu
- Department of Radiology, Stanford University, 453 Quarry Road, Palo Alto, CA 94304, USA
| | - Max Wintermark
- Department of Radiology, Stanford University, 453 Quarry Road, Palo Alto, CA 94304, USA; Neuroradiology Department, The University of Texas Anderson Cancer Center, 1400 Pressler Street, Unit 1482, Houston, TX 77030, USA
| | - Ulas Bagci
- Radiology and Biomedical Engineering Department, Northwestern University, 737 North Michigan Drive, Suite 1600, Chicago, IL 60611, USA; Department of Computer Science, University of Central Florida, 4328 Scorpius Street, Orlando, Florida, 32816
| | - David Douglas
- Department of Radiology, Stanford University, 453 Quarry Road, Palo Alto, CA 94304, USA; Department of Radiology, 96th Medical Group, Eglin Air Force Base, 307 Boatner Road, Eglin Air Force Base, Florida 32542, USA
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Li M, Wu F, Cao Y, Jiang X, Kong L, Tang Y. Abnormal white matter integrity in Papez circuit in first-episode medication-naive adults with anxious depression: A combined voxel-based analysis and region of interest study. J Affect Disord 2023; 324:489-495. [PMID: 36610591 DOI: 10.1016/j.jad.2022.12.149] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 12/25/2022] [Accepted: 12/31/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND Anxious depression is one of the subtypes of major depressive disorder (MDD), usually defined as "patients with MDD and high levels of anxiety symptoms". Compared to non-anxious MDD (naMDD), patients with anxious MDD (aMDD) have more severe depressive symptoms and suicidal ideation, worse treatment outcomes and remission rates, and poorer prognosis. Current research suggests that the Papez circuit is an important brain structure closely related to emotion, memory, and cognition. This study applied DTI to explore the altered white matter integrity in Papez circuit of patients with aMDD. METHODS DTI data were acquired from 30 medication-naive outpatients with naMDD and 55 with aMDD and 88 demographically similar healthy control (HC) subjects. Voxel-based analysis (VBM) and region of interest (ROI) analysis were conducted to explore the significant difference of fractional anisotropy (FA) values among 3 groups. Pearson's correlations were performed to analyze the correlation between FA values and the score of HAMA-14 and HAMD-17. RESULTS We found that aMDD patients had significantly higher FA values in left fornix (belong to Papez circuit) and left posterior thalamic radiation and right anterior corona radiata (belong to limbic-thalamo-cortical circuitry) compared with HC. And there was variability in the white matter integrity in right posterior thalamic radiation (belong to limbic-thalamo-cortical circuitry) and left fornix (belong to Papez circuit) between aMDD and naMDD patients. LIMITATIONS The cross-sectional study and the population vary between aMDD group and naMDD group are limitations. CONCLUSIONS Abnormal white matter integrity in Papez circuit and Limbic-Thalamo-Cortical circuitry may play an important role in the neuropathology of aMDD and might help to identify aMDD.
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Affiliation(s)
- Mengxue Li
- Department of Psychiatry, The First Hospital of China Medical University, Shenyang 110001, Liaoning, China
| | - Feng Wu
- Department of Psychiatry, The First Hospital of China Medical University, Shenyang 110001, Liaoning, China
| | - Yang Cao
- Shenyang Mental Health Center, Shenyang 110168, Liaoning, China
| | - Xiaowei Jiang
- Department of Psychiatry, The First Hospital of China Medical University, Shenyang 110001, Liaoning, China
| | - Lingtao Kong
- Department of Psychiatry, The First Hospital of China Medical University, Shenyang 110001, Liaoning, China.
| | - Yanqing Tang
- Department of Psychiatry, The First Hospital of China Medical University, Shenyang 110001, Liaoning, China
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Maurer JM, Harenski KA, Paul S, Vergara VM, Stephenson DD, Gullapalli AR, Anderson NE, Clarke GJ, Nyalakanti PK, Harenski CL, Decety J, Mayer AR, Arciniegas DB, Calhoun VD, Parrish TB, Kiehl KA. Machine learning classification of chronic traumatic brain injury using diffusion tensor imaging and NODDI: A replication and extension study. Neuroimage: Reports 2023; 3:100157. [PMID: 37169013 PMCID: PMC10168530 DOI: 10.1016/j.ynirp.2023.100157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Individuals with acute and chronic traumatic brain injury (TBI) are associated with unique white matter (WM) structural abnormalities, including fractional anisotropy (FA) differences. Our research group previously used FA as a feature in a linear support vector machine (SVM) pattern classifier, observing high classification between individuals with and without acute TBI (i.e., an area under the curve [AUC] value of 75.50%). However, it is not known whether FA could similarly classify between individuals with and without history of chronic TBI. Here, we attempted to replicate our previous work with a new sample, investigating whether FA could similarly classify between incarcerated men with (n = 80) and without (n = 80) self-reported history of chronic TBI. Additionally, given limitations associated with FA, including underestimation of FA values in WM tracts containing crossing fibers, we extended upon our previous study by incorporating neurite orientation dispersion and density imaging (NODDI) metrics, including orientation dispersion (ODI) and isotropic volume (Viso). A linear SVM based classification approach, similar to our previous study, was incorporated here to classify between individuals with and without self-reported chronic TBI using FA and NODDI metrics as separate features. Overall classification rates were similar when incorporating FA and NODDI ODI metrics as features (AUC: 82.50%). Additionally, NODDI-based metrics provided the highest sensitivity (ODI: 85.00%) and specificity (Viso: 82.50%) rates. The current study serves as a replication and extension of our previous study, observing that multiple diffusion MRI metrics can reliably classify between individuals with and without self-reported history of chronic TBI.
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6
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Lindsey HM, Hodges CB, Greer KM, Wilde EA, Merkley TL. Diffusion-Weighted Imaging in Mild Traumatic Brain Injury: A Systematic Review of the Literature. Neuropsychol Rev 2023; 33:42-121. [PMID: 33721207 DOI: 10.1007/s11065-021-09485-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Accepted: 02/09/2021] [Indexed: 12/14/2022]
Abstract
There is evidence that diffusion-weighted imaging (DWI) is able to detect tissue alterations following mild traumatic brain injury (mTBI) that may not be observed on conventional neuroimaging; however, findings are often inconsistent between studies. This systematic review assesses patterns of differences in DWI metrics between those with and without a history of mTBI. A PubMed literature search was performed using relevant indexing terms for articles published prior to May 14, 2020. Findings were limited to human studies using DWI in mTBI. Articles were excluded if they were not full-length, did not contain original data, if they were case studies, pertained to military populations, had inadequate injury severity classification, or did not report post-injury interval. Findings were reported independently for four subgroups: acute/subacute pediatric mTBI, acute/subacute adult mTBI, chronic adult mTBI, and sport-related concussion, and all DWI acquisition and analysis methods used were included. Patterns of findings between studies were reported, along with strengths and weaknesses of the current state of the literature. Although heterogeneity of sample characteristics and study methods limited the consistency of findings, alterations in DWI metrics were most commonly reported in the corpus callosum, corona radiata, internal capsule, and long association pathways. Many acute/subacute pediatric studies reported higher FA and lower ADC or MD in various regions. In contrast, acute/subacute adult studies most commonly indicate lower FA within the context of higher MD and RD. In the chronic phase of recovery, FA may remain low, possibly indicating overall demyelination or Wallerian degeneration over time. Longitudinal studies, though limited, generally indicate at least a partial normalization of DWI metrics over time, which is often associated with functional improvement. We conclude that DWI is able to detect structural mTBI-related abnormalities that may persist over time, although future DWI research will benefit from larger samples, improved data analysis methods, standardized reporting, and increasing transparency.
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Sheldrake E, Lam B, Al-Hakeem H, Wheeler AL, Goldstein BI, Dunkley BT, Ameis S, Reed N, Scratch SE. A Scoping Review of Magnetic Resonance Modalities Used in Detection of Persistent Postconcussion Symptoms in Pediatric Populations. J Child Neurol 2022; 38:85-102. [PMID: 36380680 DOI: 10.1177/08830738221120741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Up to 30% of youth with concussion experience PPCSs (PPCS) lasting 4 weeks or longer, and can significantly impact quality of life. Magnetic resonance imaging (MRI) has the potential to increase understanding of causal mechanisms underlying PPCS. However, there are no clear modalities to assist in detecting PPCS. This scoping review aims to synthesize findings on utilization of MRI among children and youth with PPCS, and summarize progress and limitations. Thirty-six studies were included from 4907 identified papers. Many studies used multiple modalities, including (1) structural (n = 27) such as T1-weighted imaging, diffusion weighted imaging, and susceptibility weighted imaging; and (2) functional (n = 23) such as functional MRI and perfusion-weighted imaging. Findings were heterogeneous among modalities and regions of interest, which warrants future reviews that report on the patterns and potential advancements in the field. Consideration of modalities that target PPCS prediction and sensitive modalities that can supplement a biopsychosocial approach to PPCS would benefit future research.
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Affiliation(s)
- Elena Sheldrake
- Bloorview Research Institute, Toronto, Ontario, Canada.,Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
| | - Brendan Lam
- Bloorview Research Institute, Toronto, Ontario, Canada
| | | | - Anne L Wheeler
- Neuroscience and Mental Health Program, 7979Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Physiology, University of Toronto, Toronto, Ontario, Canada
| | - Benjamin I Goldstein
- 7978Centre for Addiction and Mental Health, Toronto, Toronto, Ontario, Canada.,Department of Pharmacology and Toxicology, University of Toronto, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Benjamin T Dunkley
- Neuroscience and Mental Health Program, 7979Hospital for Sick Children, Toronto, Ontario, Canada.,Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Stephanie Ameis
- 7978Centre for Addiction and Mental Health, Toronto, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.,Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Nick Reed
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
| | - Shannon E Scratch
- Bloorview Research Institute, Toronto, Ontario, Canada.,Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada.,Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
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8
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Li KR, Wu AG, Tang Y, He XP, Yu CL, Wu JM, Hu GQ, Yu L. The Key Role of Magnetic Resonance Imaging in the Detection of Neurodegenerative Diseases-Associated Biomarkers: A Review. Mol Neurobiol 2022; 59:5935-5954. [PMID: 35829831 DOI: 10.1007/s12035-022-02944-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 06/28/2022] [Indexed: 11/30/2022]
Abstract
Neurodegenerative diseases (NDs), including chronic disease such as Alzheimer's disease, Parkinson's disease, Huntington's disease, and multiple sclerosis, and acute diseases like traumatic brain injury and ischemic stroke are characterized by progressive degeneration, brain tissue damage and loss of neurons, accompanied by behavioral and cognitive dysfunctions. So far, there are no complete cures for NDs; thus, early and timely diagnoses are essential and beneficial to patients' treatment. Magnetic resonance imaging (MRI) has become one of the advanced medical imaging techniques widely used in the clinical examination of NDs due to its non-invasive diagnostic value. In this review, research published in English in current decade from PubMed electronic database on the use of MRI to detect specific biomarkers of NDs was collected, summarized, and discussed, which provides valuable suggestions for the early diagnosis, prevention, and treatment of NDs in the clinic.
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Affiliation(s)
- Ke-Ru Li
- Department of Human Anatomy, School of Preclinical Medicine, Southwest Medical University, Luzhou, 646000, Sichuan, China
- Sichuan Key Medical Laboratory of New Drug Discovery and Druggability Evaluation, Luzhou Key Laboratory of Activity Screening and Druggability Evaluation for Chinese Materia Medica, Southwest Medical University, Luzhou, 646000, China
- Department of Radiology, Chongqing University Fuling Hospital, Chongqing, 408000, China
| | - An-Guo Wu
- Sichuan Key Medical Laboratory of New Drug Discovery and Druggability Evaluation, Luzhou Key Laboratory of Activity Screening and Druggability Evaluation for Chinese Materia Medica, Southwest Medical University, Luzhou, 646000, China
- School of Pharmacy, Southwest Medical University, Luzhou, 646000, China
| | - Yong Tang
- Sichuan Key Medical Laboratory of New Drug Discovery and Druggability Evaluation, Luzhou Key Laboratory of Activity Screening and Druggability Evaluation for Chinese Materia Medica, Southwest Medical University, Luzhou, 646000, China
| | - Xiao-Peng He
- Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, the Affiliated Hospital of Southwest Medical University, Luzhou, 646000, Sichuan, China
| | - Chong-Lin Yu
- Department of Human Anatomy, School of Preclinical Medicine, Southwest Medical University, Luzhou, 646000, Sichuan, China
| | - Jian-Ming Wu
- Sichuan Key Medical Laboratory of New Drug Discovery and Druggability Evaluation, Luzhou Key Laboratory of Activity Screening and Druggability Evaluation for Chinese Materia Medica, Southwest Medical University, Luzhou, 646000, China
- School of Pharmacy, Southwest Medical University, Luzhou, 646000, China
| | - Guang-Qiang Hu
- Department of Human Anatomy, School of Preclinical Medicine, Southwest Medical University, Luzhou, 646000, Sichuan, China.
| | - Lu Yu
- Sichuan Key Medical Laboratory of New Drug Discovery and Druggability Evaluation, Luzhou Key Laboratory of Activity Screening and Druggability Evaluation for Chinese Materia Medica, Southwest Medical University, Luzhou, 646000, China.
- School of Pharmacy, Southwest Medical University, Luzhou, 646000, China.
- Department of Chemistry, School of Preclinical Medicine, Southwest Medical University, Luzhou, 646000, Sichuan, China.
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Harrington DL, Hsu PY, Theilmann RJ, Angeles-Quinto A, Robb-Swan A, Nichols S, Song T, Le L, Rimmele C, Matthews S, Yurgil KA, Drake A, Ji Z, Guo J, Cheng CK, Lee RR, Baker DG, Huang M. Detection of Chronic Blast-Related Mild Traumatic Brain Injury with Diffusion Tensor Imaging and Support Vector Machines. Diagnostics (Basel) 2022; 12. [PMID: 35454035 DOI: 10.3390/diagnostics12040987] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 04/07/2022] [Accepted: 04/08/2022] [Indexed: 01/13/2023] Open
Abstract
Blast-related mild traumatic brain injury (bmTBI) often leads to long-term sequalae, but diagnostic approaches are lacking due to insufficient knowledge about the predominant pathophysiology. This study aimed to build a diagnostic model for future verification by applying machine-learning based support vector machine (SVM) modeling to diffusion tensor imaging (DTI) datasets to elucidate white-matter features that distinguish bmTBI from healthy controls (HC). Twenty subacute/chronic bmTBI and 19 HC combat-deployed personnel underwent DTI. Clinically relevant features for modeling were selected using tract-based analyses that identified group differences throughout white-matter tracts in five DTI metrics to elucidate the pathogenesis of injury. These features were then analyzed using SVM modeling with cross validation. Tract-based analyses revealed abnormally decreased radial diffusivity (RD), increased fractional anisotropy (FA) and axial/radial diffusivity ratio (AD/RD) in the bmTBI group, mostly in anterior tracts (29 features). SVM models showed that FA of the anterior/superior corona radiata and AD/RD of the corpus callosum and anterior limbs of the internal capsule (5 features) best distinguished bmTBI from HCs with 89% accuracy. This is the first application of SVM to identify prominent features of bmTBI solely based on DTI metrics in well-defined tracts, which if successfully validated could promote targeted treatment interventions.
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10
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Grassi DC, Zaninotto AL, Feltrin FS, Macruz FBDC, Otaduy MCG, Leite CDC, Guirado VMDP, Paiva WS, Andrade CS. Longitudinal whole-brain analysis of multi-subject diffusion data in diffuse axonal injury. Arq Neuro-Psiquiatr 2022; 80:280-288. [DOI: 10.1590/0004-282x-anp-2020-0595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Accepted: 05/30/2021] [Indexed: 11/22/2022]
Abstract
ABSTRACT Background: Diffuse axonal injury occurs with high acceleration and deceleration forces in traumatic brain injury (TBI). This lesion leads to disarrangement of the neuronal network, which can result in some degree of deficiency. The Extended Glasgow Outcome Scale (GOS-E) is the primary outcome instrument for the evaluation of TBI victims. Diffusion tensor imaging (DTI) assesses white matter (WM) microstructure based on the displacement distribution of water molecules. Objective: To investigate WM microstructure within the first year after TBI using DTI, the patient’s clinical outcomes, and associations. Methods: We scanned 20 moderate and severe TBI victims at 2 months and 1 year after the event. Imaging processing was done with the FMRIB software library; we used the tract-based spatial statistics software yielding fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (AD), and radial diffusivity (RD) for statistical analyses. We computed the average difference between the two measures across subjects and performed a one-sample t-test and threshold-free cluster enhancement, using a corrected p-value < 0.05. Clinical outcomes were evaluated with the GOS-E. We tested for associations between outcome measures and significant mean FA clusters. Results: Significant clusters of altered FA were identified anatomically using the JHU WM atlas. We found increasing spotted areas of FA with time in the right brain hemisphere and left cerebellum. Extensive regions of increased MD, RD, and AD were observed. Patients presented an excellent overall recovery. Conclusions: There were no associations between FA and outcome scores, but we cannot exclude the existence of a small to moderate association.
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Affiliation(s)
| | | | - Fabrício Stewan Feltrin
- Universidade de São Paulo, Brazil; Universidade de São Paulo, Brazil; University of Texas Southwestern Medical Center, USA
| | | | | | | | | | | | - Celi Santos Andrade
- Universidade de São Paulo, Brazil; Universidade de São Paulo, Brazil; Alliar Group, Brazil
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11
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Crasta JE, Tucker RN, Robinson J, Chen HW, Crocetti D, Suskauer SJ. Altered white matter diffusivity and subtle motor function in a pilot cohort of adolescents with sports-related concussion. Brain Inj 2022; 36:393-400. [PMID: 35157539 PMCID: PMC9133076 DOI: 10.1080/02699052.2022.2034181] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Background and objective: Adolescents with sports-related concussion (SRC) demonstrate acute and persistent deficits in subtle motor function. However, there is limited research examining related neurological underpinnings. This pilot study examined changes in motor-associated white matter pathways using diffusion tensor imaging (DTI) and their relationship with subtle motor function. Methods: Twelve adolescents with SRC (12–17 years) within two-weeks post-injury and 13 never-injured neurotypical peers completed DTI scanning. A subset of 6 adolescents with SRC returned for a follow-up visit post-medical clearance from concussion. Subtle motor function was evaluated using the Physical and Neurological Examination of Subtle Signs (PANESS). Results: Adolescents with SRC showed higher mean diffusivity (MD) of the superior corona radiata and greater subtle motor deficits compared to controls. Across all participants, greater subtle motor deficits were associated with higher (more atypical) MD of the superior corona radiata. Preliminary longitudinal analysis indicated reduction in fractional anisotropy of the corpus callosum but no change in the MD of the superior corona radiata from the initial visit to the follow-up visit post-medical clearance. Conclusions: These findings support preliminary evidence for a brain–behavior relationship between superior corona radiata microstructure and subtle motor deficits in adolescents with SRC that merits further investigation.
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Affiliation(s)
- Jewel E Crasta
- Occupational Therapy Division, The Ohio State University, Columbus, Ohio, USA
| | | | | | | | | | - Stacy J Suskauer
- Kennedy Krieger Institute, Baltimore, Maryland, USA.,Department of Physical Medicine and Rehabilitation and Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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12
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Good T, Schirner M, Shen K, Ritter P, Mukherjee P, Levine B, McIntosh AR. Personalized Connectome-Based Modeling in Patients with Semi-Acute Phase TBI: Relationship to Acute Neuroimaging and 6 Month Follow-Up. eNeuro 2022; 9:ENEURO. [PMID: 35105657 DOI: 10.1523/ENEURO.0075-21.2022] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 01/10/2022] [Accepted: 01/14/2022] [Indexed: 12/26/2022] Open
Abstract
Following traumatic brain injury (TBI), cognitive impairments manifest through interactions between microscopic and macroscopic changes. On the microscale, a neurometabolic cascade alters neurotransmission, while on the macroscale diffuse axonal injury impacts the integrity of long-range connections. Large-scale brain network modeling allows us to make predictions across these spatial scales by integrating neuroimaging data with biophysically based models to investigate how microscale changes invisible to conventional neuroimaging influence large-scale brain dynamics. To this end, we analyzed structural and functional neuroimaging data from a well characterized sample of 44 adult TBI patients recruited from a regional trauma center, scanned at 1–2 weeks postinjury, and with follow-up behavioral outcome assessed 6 months later. Thirty-six age-matched healthy adults served as comparison participants. Using The Virtual Brain, we fit simulations of whole-brain resting-state functional MRI to the empirical static and dynamic functional connectivity of each participant. Multivariate partial least squares (PLS) analysis showed that patients with acute traumatic intracranial lesions had lower cortical regional inhibitory connection strengths than comparison participants, while patients without acute lesions did not differ from the comparison group. Further multivariate PLS analyses found correlations between lower semiacute regional inhibitory connection strengths and more symptoms and lower cognitive performance at a 6 month follow-up. Critically, patients without acute lesions drove this relationship, suggesting clinical relevance of regional inhibitory connection strengths even when traumatic intracranial lesions were not present. Our results suggest that large-scale connectome-based models may be sensitive to pathophysiological changes in semi-acute phase TBI patients and predictive of their chronic outcomes.
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Kim E, Yoo RE, Seong MY, Oh BM. A systematic review and data synthesis of longitudinal changes in white matter integrity after mild traumatic brain injury assessed by diffusion tensor imaging in adults. Eur J Radiol 2021; 147:110117. [PMID: 34973540 DOI: 10.1016/j.ejrad.2021.110117] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 10/28/2021] [Accepted: 12/20/2021] [Indexed: 01/16/2023]
Abstract
PURPOSE This study aimed to review diffusion tensor imaging studies of mild traumatic brain injury (mTBI) in adults with longitudinal acquisition of data and investigate the variability of findings in association with related factors, such as the time post-injury. METHODS Eligible studies from PubMed and EMBASE were searched to identify relevant studies for review. Of the 540 studies, 23 observational studies without intervention and with the following characteristics were included: original research in which adults with mTBI were examined, diffusion tensor imaging was acquired at least twice, white matter integrity was investigated by estimating diffusion metrics, and mode of injury was not restricted to sport- or blast-related mTBI. RESULTS Baseline scans were acquired within 3 weeks post-injury, followed by longitudinal scans within 3 months and at 12 months post-injury. During the acute/subacute period, mixed results (increase, decrease, or no significant change) of fractional anisotropy (FA) were observed compared to those in controls. Some studies reported increased FA during the acute/subacute period compared to controls, followed by normalization of FA. Decreased FA was also reported during the acute/subacute period, which lasted long into the chronic phase. In the acute phase, the mean diffusivity (MD) was greater than that in the controls. Compared to the early phase of injury, MD was reduced in the follow-up phase in most studies in the mTBI group. Insignificant differences in FA and MD have been reported in several studies. Such variability limits the clinical usefulness of diffusion tensor metrics. CONCLUSIONS There was a high variability in reported changes in white matter integrity. Decreased FA not only in acute/subacute but also in long-term period after injury may indicate long-term neurodegenerative processes after mTBI. Nevertheless, longitudinal changes in MD towards normalization suggest possible recovery. Long-term cohort studies with research initiatives should be considered to elucidate brain changes after mTBI.
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Affiliation(s)
- Eunkyung Kim
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul, Republic of Korea; Biomedical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea
| | - Roh-Eul Yoo
- Department of Radiology, Seoul National University Hospital and Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Min Yong Seong
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Byung-Mo Oh
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul, Republic of Korea; Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea; National Traffic Injury Rehabilitation Hospital, Yangpyeong, Republic of Korea.
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14
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Shukla A, Ware AL, Guo S, Goodyear B, Beauchamp MH, Zemek R, Craig W, Doan Q, Beaulieu C, Yeates KO, Lebel C; Pediatric Emergency Research Canada A-CAP study team. Examining brain white matter after pediatric mild traumatic brain injury using neurite orientation dispersion and density imaging: An A-CAP study. Neuroimage Clin 2021; 32:102887. [PMID: 34911193 DOI: 10.1016/j.nicl.2021.102887] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 10/26/2021] [Accepted: 11/16/2021] [Indexed: 12/04/2022]
Abstract
We examined white matter microstructure after pediatric mTBI using NODDI and DTI. Children with mTBI did not significantly differ from those with OI on any metrics. Minor alterations, if any, may be present in children at the post-acute stage after mTBI. Large longitudinal studies are needed to understand long-term brain changes post injury.
Background Pediatric mild traumatic brain injury (mTBI) affects millions of children annually. Diffusion tensor imaging (DTI) is sensitive to axonal injuries and white matter microstructure and has been used to characterize the brain changes associated with mild traumatic brain injury (mTBI). Neurite orientation dispersion and density imaging (NODDI) is a diffusion model that can provide additional insight beyond traditional DTI metrics, but has not been examined in pediatric mTBI. The goal of this study was to employ DTI and NODDI to gain added insight into white matter alterations in children with mTBI compared to children with mild orthopedic injury (OI). Methods Children (mTBI n = 320, OI n = 176) aged 8–16.99 years (12.39 ± 2.32 years) were recruited from emergency departments at five hospitals across Canada and underwent 3 T MRI on average 11 days post-injury. DTI and NODDI metrics were calculated for seven major white matter tracts and compared between groups using univariate analysis of covariance controlling for age, sex, and scanner type. False discovery rate (FDR) was used to correct for multiple comparisons. Results Univariate analysis revealed no significant group main effects or interactions in DTI or NODDI metrics. Fractional anisotropy and neurite density index in all tracts exhibited a significant positive association with age and mean diffusivity in all tracts exhibited a significant negative association with age in the whole sample. Conclusions Overall, there were no significant differences between mTBI and OI groups in brain white matter microstructure from either DTI or NODDI in the seven tracts. This indicates that mTBI is associated with relatively minor white matter differences, if any, at the post-acute stage. Brain differences may evolve at later stages of injury, so longitudinal studies with long-term follow-up are needed.
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15
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Vasiukova OR, Akhlebinina MI, Manzhurtsev AV, Menshchikov PE, Ublinskiy MV, Yakovlev AN, Akhadov TA, Semenova NA. The diffusion-tensor imaging reveals alterations in water diffusion parameters in acute pediatric concussion. Acta Neurol Belg 2021; 121:1463-8. [PMID: 32246319 DOI: 10.1007/s13760-020-01347-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 03/24/2020] [Indexed: 10/24/2022]
Abstract
Wide-spread visualization methods which are computed tomography (CT) and magnetic resonance imaging (MRI) are not sensitive to mild traumatic brain injury (mTBI). However, mTBI may cause changes of cerebral microstructure that could be found using diffusion-tensor imaging. The aim of this study is to reveal the impact of acute mTBI (no more than 3 days after trauma) on diffusion parameters in corpus callosum, corticospinal tract, and thalamus in children (aged 14-18). Fractional anisotropy (FA) and apparent diffusion coefficient (ADC) were analyzed. Significant increase in FA and decrease in ADC were observed in thalamus. The trend to an increase in FA is observed in corpus callosum.
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16
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Shapiro JS, Takagi M, Silk T, Anderson N, Clarke C, Davis GA, Hearps SJ, Ignjatovic V, Rausa V, Seal ML, Babl FE, Anderson V. No Evidence of a Difference in Susceptibility-Weighted Imaging Lesion Burden or Functional Network Connectivity between Children with Typical and Delayed Recovery Two Weeks Post-Concussion. J Neurotrauma 2021; 38:2384-2390. [PMID: 33823646 PMCID: PMC8881952 DOI: 10.1089/neu.2021.0069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Susceptibility weighted imaging (SWI) and resting state functional magnetic resonance imaging have been highlighted as two novel neuroimaging modalities that have been underutilized when attempting to predict whether a child with concussion will recover normally or have a delayed recovery course. This study aimed to investigate whether there was a difference between children who recover normally from a concussion and children with delayed recovery in terms of SWI lesion burden and resting state network makeup. Forty-one children who presented to the emergency department of a tertiary level pediatric hospital with concussion participated in this study as a part of a larger prospective, longitudinal observational cohort study into concussion assessment and recovery. Children underwent neuroimaging 2 weeks post-injury and were classified as either normally recovering (n = 27), or delayed recovering (n = 14) based on their post-concussion symptoms at 2 weeks post-injury. No participants showed lesions detected using SWI; therefore, no group differences could be assessed. No between-group resting state network differences were uncovered using dual regression analysis. These findings, alongside previously published work, suggest that potential causes of delayed recovery from concussion may not be found using current neuroimaging paradigms.
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Affiliation(s)
- Jesse S. Shapiro
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Melbourne School of Psychological Sciences, University of Melbourne, Victoria, Australia
- Monash School of Psychological Sciences, Monash University, Melbourne, Victoria, Australia
| | - Michael Takagi
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Melbourne School of Psychological Sciences, University of Melbourne, Victoria, Australia
- Monash School of Psychological Sciences, Monash University, Melbourne, Victoria, Australia
| | - Tim Silk
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- School of Psychology, Deakin University, Melbourne, Victoria, Australia
- Department of Pediatrics, University of Melbourne, Victoria, Australia
| | - Nicholas Anderson
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Cathriona Clarke
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Gavin A. Davis
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | | | - Vera Ignjatovic
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Department of Pediatrics, University of Melbourne, Victoria, Australia
| | - Vanessa Rausa
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Marc L. Seal
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Department of Pediatrics, University of Melbourne, Victoria, Australia
| | - Franz E. Babl
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Department of Pediatrics, University of Melbourne, Victoria, Australia
- Emergency Department, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Vicki Anderson
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Melbourne School of Psychological Sciences, University of Melbourne, Victoria, Australia
- Department of Pediatrics, University of Melbourne, Victoria, Australia
- Psychology Service, Royal Children's Hospital, Melbourne, Victoria, Australia
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17
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Lima Santos JP, Kontos AP, Mailliard S, Eagle SR, Holland CL, Suss SJ, Abdul-Waalee H, Stiffler RS, Bitzer HB, Blaney NA, Colorito AT, Santucci CG, Brown A, Kim T, Iyengar S, Skeba A, Diler RS, Ladouceur CD, Phillips ML, Brent D, Collins MW, Versace A. White Matter Abnormalities Associated With Prolonged Recovery in Adolescents Following Concussion. Front Neurol 2021; 12:681467. [PMID: 34248824 PMCID: PMC8264142 DOI: 10.3389/fneur.2021.681467] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 05/27/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Concussion symptoms in adolescents typically resolve within 4 weeks. However, 20 - 30% of adolescents experience a prolonged recovery. Abnormalities in tracts implicated in visuospatial attention and emotional regulation (i.e., inferior longitudinal fasciculus, ILF; inferior fronto-occipital fasciculus, IFOF; uncinate fasciculus; UF) have been consistently reported in concussion; yet, to date, there are no objective markers of prolonged recovery in adolescents. Here, we evaluated the utility of diffusion MRI in outcome prediction. Forty-two adolescents (12.1 - 17.9 years; female: 44.0%) underwent a diffusion Magnetic Resonance Imaging (dMRI) protocol within the first 10 days of concussion. Based on days of injury until medical clearance, adolescents were then categorized into SHORT (<28 days; N = 21) or LONG (>28 days; N = 21) recovery time. Fractional anisotropy (FA) in the ILF, IFOF, UF, and/or concussion symptoms were used as predictors of recovery time (SHORT, LONG). Forty-two age- and sex-matched healthy controls served as reference. Higher FA in the ILF (left: adjusted odds ratio; AOR = 0.36, 95% CI = 0.15 - 0.91, P = 0.030; right: AOR = 0.28, 95% CI = 0.10 - 0.83, P = 0.021), IFOF (left: AOR = 0.21, 95% CI = 0.07 - 0.66, P = 0.008; right: AOR = 0.30, 95% CI = 0.11 - 0.83, P = 0.020), and UF (left: AOR = 0.26, 95% CI = 0.09 - 0.74, P = 0.011; right: AOR = 0.28, 95% CI = 0.10 - 0.73, P = 0.010) was associated with SHORT recovery. In additional analyses, while adolescents with SHORT recovery did not differ from HC, those with LONG recovery showed lower FA in the ILF and IFOF (P < 0.014). Notably, inclusion of dMRI findings increased the sensitivity and specificity (AUC = 0.93) of a prediction model including clinical variables only (AUC = 0.75). Our findings indicate that higher FA in long associative tracts (especially ILF) might inform a more objective and accurate prognosis for recovery time in adolescents following concussion.
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Affiliation(s)
- João Paulo Lima Santos
- Department of Psychiatry, Western Psychiatric Hospital, University of Pittsburgh, Pittsburgh, PA, United States
| | - Anthony P Kontos
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center (UPMC) Sports Concussion Program-University of Pittsburgh, Pittsburgh, PA, United States
| | - Sarrah Mailliard
- Department of Psychiatry, Western Psychiatric Hospital, University of Pittsburgh, Pittsburgh, PA, United States
| | - Shawn R Eagle
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center (UPMC) Sports Concussion Program-University of Pittsburgh, Pittsburgh, PA, United States
| | - Cynthia L Holland
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center (UPMC) Sports Concussion Program-University of Pittsburgh, Pittsburgh, PA, United States
| | - Stephen J Suss
- Department of Psychiatry, Western Psychiatric Hospital, University of Pittsburgh, Pittsburgh, PA, United States
| | - Halimah Abdul-Waalee
- Department of Psychiatry, Western Psychiatric Hospital, University of Pittsburgh, Pittsburgh, PA, United States
| | - Richelle S Stiffler
- Department of Psychiatry, Western Psychiatric Hospital, University of Pittsburgh, Pittsburgh, PA, United States
| | - Hannah B Bitzer
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center (UPMC) Sports Concussion Program-University of Pittsburgh, Pittsburgh, PA, United States
| | - Nicholas A Blaney
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center (UPMC) Sports Concussion Program-University of Pittsburgh, Pittsburgh, PA, United States
| | - Adam T Colorito
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center (UPMC) Sports Concussion Program-University of Pittsburgh, Pittsburgh, PA, United States
| | - Christopher G Santucci
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center (UPMC) Sports Concussion Program-University of Pittsburgh, Pittsburgh, PA, United States
| | - Allison Brown
- Department of Psychiatry, Western Psychiatric Hospital, University of Pittsburgh, Pittsburgh, PA, United States
| | - Tae Kim
- Department of Radiology, Magnetic Resonance Research Center, University of Pittsburgh, Pittsburgh, PA, United States
| | - Satish Iyengar
- Department of Psychiatry, Western Psychiatric Hospital, University of Pittsburgh, Pittsburgh, PA, United States
| | - Alexander Skeba
- Department of Psychiatry, Western Psychiatric Hospital, University of Pittsburgh, Pittsburgh, PA, United States
| | - Rasim S Diler
- Department of Psychiatry, Western Psychiatric Hospital, University of Pittsburgh, Pittsburgh, PA, United States
| | - Cecile D Ladouceur
- Department of Psychiatry, Western Psychiatric Hospital, University of Pittsburgh, Pittsburgh, PA, United States
| | - Mary L Phillips
- Department of Psychiatry, Western Psychiatric Hospital, University of Pittsburgh, Pittsburgh, PA, United States
| | - David Brent
- Department of Psychiatry, Western Psychiatric Hospital, University of Pittsburgh, Pittsburgh, PA, United States
| | - Michael W Collins
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center (UPMC) Sports Concussion Program-University of Pittsburgh, Pittsburgh, PA, United States
| | - Amelia Versace
- Department of Psychiatry, Western Psychiatric Hospital, University of Pittsburgh, Pittsburgh, PA, United States.,Department of Radiology, Magnetic Resonance Research Center, University of Pittsburgh, Pittsburgh, PA, United States
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Kaufman MW, Su CA, Trivedi NN, Lee MK, Nelson GB, Cupp SA, Voos JE. The Current Status of Concussion Assessment Scales: A Critical Analysis Review. JBJS Rev 2021; 9:01874474-202106000-00001. [PMID: 34101673 DOI: 10.2106/jbjs.rvw.20.00108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
» Concussion is a complex pathophysiologic process that affects the brain; it is induced by biomechanical forces, with alteration in mental status with or without loss of consciousness. » Concussion assessment tools may be broadly categorized into (1) screening tests such as the SAC (Standardized Assessment of Concussion), the BESS (Balance Error Scoring System), and the King-Devick (KD) test; (2) confirmatory tests including the SCAT (Sport Concussion Assessment Tool), the ImPACT (Immediate Post-Concussion Assessment and Cognitive Testing), and the VOMS (Vestibular Oculomotor Screening); and (3) objective examinations such as brain network activation (BNA) analysis, imaging studies, and physiologic markers. » The KD, child SCAT3 (cSCAT3), child ImPACT (cImPACT), and VOMS tests may be used to evaluate for concussion in the pediatric athlete. » Future work with BNA, functional magnetic resonance imaging, diffusion tensor imaging, and serum biomarkers may provide more objective assessment of concussion, neurologic injury, and subsequent recovery.
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Affiliation(s)
| | - Charles A Su
- Departments of Orthopaedic Surgery (C.A.S., N.N.T., G.B.N., S.A.C., and J.E.V.) and Family Medicine (S.A.C.), University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Nikunj N Trivedi
- Departments of Orthopaedic Surgery (C.A.S., N.N.T., G.B.N., S.A.C., and J.E.V.) and Family Medicine (S.A.C.), University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Michelle K Lee
- Center for Neurological Restoration, Cleveland Clinic, Cleveland, Ohio
| | - Grant B Nelson
- Departments of Orthopaedic Surgery (C.A.S., N.N.T., G.B.N., S.A.C., and J.E.V.) and Family Medicine (S.A.C.), University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Sean A Cupp
- Departments of Orthopaedic Surgery (C.A.S., N.N.T., G.B.N., S.A.C., and J.E.V.) and Family Medicine (S.A.C.), University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - James E Voos
- Departments of Orthopaedic Surgery (C.A.S., N.N.T., G.B.N., S.A.C., and J.E.V.) and Family Medicine (S.A.C.), University Hospitals Cleveland Medical Center, Cleveland, Ohio
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20
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Collij LE, Ingala S, Top H, Wottschel V, Stickney KE, Tomassen J, Konijnenberg E, ten Kate M, Sudre C, Lopes Alves I, Yaqub MM, Wink AM, Van ‘t Ent D, Scheltens P, van Berckel BN, Visser PJ, Barkhof F, Braber AD. White matter microstructure disruption in early stage amyloid pathology. Alzheimers Dement (Amst) 2021; 13:e12124. [PMID: 33816751 PMCID: PMC8015832 DOI: 10.1002/dad2.12124] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 09/17/2020] [Indexed: 01/18/2023]
Abstract
INTRODUCTION Amyloid beta (Aβ) accumulation is the first pathological hallmark of Alzheimer's disease (AD), and it is associated with altered white matter (WM) microstructure. We aimed to investigate this relationship at a regional level in a cognitively unimpaired cohort. METHODS We included 179 individuals from the European Medical Information Framework for AD (EMIF-AD) preclinAD study, who underwent diffusion magnetic resonance (MR) to determine tract-level fractional anisotropy (FA); mean, radial, and axial diffusivity (MD/RD/AxD); and dynamic [18F]flutemetamol) positron emission tomography (PET) imaging to assess amyloid burden. RESULTS Regression analyses showed a non-linear relationship between regional amyloid burden and WM microstructure. Low amyloid burden was associated with increased FA and decreased MD/RD/AxD, followed by decreased FA and increased MD/RD/AxD upon higher amyloid burden. The strongest association was observed between amyloid burden in the precuneus and body of the corpus callosum (CC) FA and diffusivity (MD/RD) measures. In addition, amyloid burden in the anterior cingulate cortex strongly related to AxD and RD measures in the genu CC. DISCUSSION Early amyloid deposition is associated with changes in WM microstructure. The non-linear relationship might reflect multiple stages of axonal damage.
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Affiliation(s)
- Lyduine E. Collij
- Dept. of Radiology and Nuclear MedicineAmsterdam UMC, Location VUmcAmsterdamThe Netherlands
| | - Silvia Ingala
- Dept. of Radiology and Nuclear MedicineAmsterdam UMC, Location VUmcAmsterdamThe Netherlands
| | - Herwin Top
- Dept. of Radiology and Nuclear MedicineAmsterdam UMC, Location VUmcAmsterdamThe Netherlands
| | - Viktor Wottschel
- Dept. of Radiology and Nuclear MedicineAmsterdam UMC, Location VUmcAmsterdamThe Netherlands
| | | | - Jori Tomassen
- Alzheimer CenterAmsterdam UMC, Location VUmcAmsterdamThe Netherlands
| | | | - Mara ten Kate
- Dept. of Radiology and Nuclear MedicineAmsterdam UMC, Location VUmcAmsterdamThe Netherlands
| | - Carole Sudre
- Alzheimer CenterAmsterdam UMC, Location VUmcAmsterdamThe Netherlands
- Institute of Neurology and Healthcare EngineeringUniversity College LondonLondonUK
| | - Isadora Lopes Alves
- Dept. of Radiology and Nuclear MedicineAmsterdam UMC, Location VUmcAmsterdamThe Netherlands
| | - Maqsood M. Yaqub
- Dept. of Radiology and Nuclear MedicineAmsterdam UMC, Location VUmcAmsterdamThe Netherlands
| | - Alle Meije Wink
- Dept. of Radiology and Nuclear MedicineAmsterdam UMC, Location VUmcAmsterdamThe Netherlands
| | - Dennis Van ‘t Ent
- Dept. of Biological PsychologyVU University AmsterdamAmsterdamThe Netherlands
| | - Philip Scheltens
- Alzheimer CenterAmsterdam UMC, Location VUmcAmsterdamThe Netherlands
| | - Bart N.M. van Berckel
- Dept. of Radiology and Nuclear MedicineAmsterdam UMC, Location VUmcAmsterdamThe Netherlands
| | - Pieter Jelle Visser
- Alzheimer CenterAmsterdam UMC, Location VUmcAmsterdamThe Netherlands
- Department of Psychiatry and NeuropsychologySchool for Mental Health and Neuroscience (MHeNS), Alzheimer Centrum LimburgMaastricht UniversityMaastrichtThe Netherlands
- Department of NeurobiologyCare Sciences Division of NeurogeriatricsKarolinska InstitutetStockholmSweden
| | - Frederik Barkhof
- Dept. of Radiology and Nuclear MedicineAmsterdam UMC, Location VUmcAmsterdamThe Netherlands
- Institute of Neurology and Healthcare EngineeringUniversity College LondonLondonUK
| | - Anouk Den Braber
- Dept. of Biological PsychologyVU University AmsterdamAmsterdamThe Netherlands
- Alzheimer CenterAmsterdam UMC, Location VUmcAmsterdamThe Netherlands
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21
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Christensen J, Eyolfson E, Salberg S, Mychasiuk R. Traumatic brain injury in adolescence: A review of the neurobiological and behavioural underpinnings and outcomes. Developmental Review 2021; 59:100943. [DOI: 10.1016/j.dr.2020.100943] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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22
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Qi X, Arfanakis K. Regionconnect: Rapidly extracting standardized brain connectivity information in voxel-wise neuroimaging studies. Neuroimage 2020; 225:117462. [PMID: 33075560 PMCID: PMC7811895 DOI: 10.1016/j.neuroimage.2020.117462] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 08/03/2020] [Accepted: 10/09/2020] [Indexed: 02/06/2023] Open
Abstract
Reporting white matter findings in voxel-wise neuroimaging studies typically lacks specificity in terms of brain connectivity. Therefore, the purpose of this work was to develop an approach for rapidly extracting standardized brain connectivity information for white matter regions with significant findings in voxel-wise neuroimaging studies. The new approach was named regionconnect and is based on precalculated average healthy adult brain connectivity information stored in standard space in a fashion that allows fast retrieval and integration. Towards this goal, the present work first generated and evaluated the white matter connectome of the IIT Human Brain Atlas v.5.0. It was demonstrated that the edges of the atlas connectome are representative of those of individual participants of the Human Connectome Project in terms of the spatial organization of streamlines and spatial patterns of track-density. Next, the new white matter connectome was used to develop multi-layer, connectivity-based labels for each white matter voxel of the atlas, consistent with the fact that each voxel may contain axons from multiple connections. The regionconnect algorithm was then developed to rapidly integrate information contained in the multi-layer labels across voxels of a white matter region and to generate a list of the most probable connections traversing that region. Usage of regionconnect does not require high angular resolution diffusion MRI or any MRI data. The regionconnect algorithm as well as the white matter tractogram and connectome, multi-layer, connectivity-based labels, and associated resources developed for the IIT Human Brain Atlas v.5.0 in this work are available at www.nitrc.org/projects/iit. An interactive, online version of regionconnect is also available at www.iit.edu/~mri.
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Affiliation(s)
- Xiaoxiao Qi
- Department of Biomedical Engineering, Illinois Institute of Technology, Chicago, IL, United States
| | - Konstantinos Arfanakis
- Department of Biomedical Engineering, Illinois Institute of Technology, Chicago, IL, United States; Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, United States; Department of Diagnostic Radiology and Nuclear Medicine, Rush University Medical Center, Chicago, IL, United States.
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Rausa VC, Shapiro J, Seal ML, Davis GA, Anderson V, Babl FE, Veal R, Parkin G, Ryan NP, Takagi M. Neuroimaging in paediatric mild traumatic brain injury: a systematic review. Neurosci Biobehav Rev 2020; 118:643-653. [PMID: 32905817 DOI: 10.1016/j.neubiorev.2020.08.017] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 08/02/2020] [Accepted: 08/29/2020] [Indexed: 01/05/2023]
Abstract
Neuroimaging is being increasingly applied to the study of paediatric mild traumatic brain injury (mTBI) to uncover the neurobiological correlates of delayed recovery post-injury. The aims of this systematic review were to: (i) evaluate the neuroimaging research investigating neuropathology post-mTBI in children and adolescents from 0-18 years, (ii) assess the relationship between advanced neuroimaging abnormalities and PCS in children, (iii) assess the quality of the evidence by evaluating study methodology and reporting against best practice guidelines, and (iv) provide directions for future research. A literature search of MEDLINE, PsycINFO, EMBASE, and PubMed was conducted. Abstracts and titles were screened, followed by full review of remaining articles where specific eligibility criteria were applied. This systematic review identified 58 imaging studies which met criteria. Based on several factors including methodological heterogeneity and relatively small sample sizes, the literature currently provides insufficient evidence to draw meaningful conclusions about the relationship between MRI findings and clinical outcomes. Future research is needed which incorporates prospective, longitudinal designs, minimises potential confounds and utilises multimodal imaging techniques.
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Affiliation(s)
- Vanessa C Rausa
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia.
| | - Jesse Shapiro
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia; Melbourne School of Psychological Sciences, University of Melbourne, Victoria, Australia.
| | - Marc L Seal
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia; Department of Paediatrics, University of Melbourne, Victoria, Australia.
| | - Gavin A Davis
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia.
| | - Vicki Anderson
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia; Melbourne School of Psychological Sciences, University of Melbourne, Victoria, Australia; Psychology Service, The Royal Children's Hospital, Melbourne, Australia.
| | - Franz E Babl
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia; Emergency Department, Royal Children's Hospital, Melbourne, Victoria, Australia; Department of Paediatrics, University of Melbourne, Victoria, Australia.
| | - Ryan Veal
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia.
| | - Georgia Parkin
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia.
| | - Nicholas P Ryan
- Department of Paediatrics, University of Melbourne, Victoria, Australia; Cognitive Neuroscience Unit, Deakin University, Geelong, Australia.
| | - Michael Takagi
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia; Melbourne School of Psychological Sciences, University of Melbourne, Victoria, Australia.
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Shapiro JS, Silk T, Takagi M, Anderson N, Clarke C, Davis GA, Dunne K, Hearps SJ, Ignjatovic V, Rausa V, Seal M, Babl FE, Anderson V. Examining Microstructural White Matter Differences between Children with Typical and Those with Delayed Recovery Two Weeks Post-Concussion. J Neurotrauma 2020; 37:1300-1305. [DOI: 10.1089/neu.2019.6768] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Affiliation(s)
- Jesse S. Shapiro
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Melbourne School of Psychological Sciences, University of Melbourne, Victoria, Australia
| | - Tim Silk
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Melbourne School of Psychological Sciences, University of Melbourne, Victoria, Australia
- School of Psychology, Deakin University, Melbourne, Victoria, Australia
| | - Michael Takagi
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Melbourne School of Psychological Sciences, University of Melbourne, Victoria, Australia
| | - Nicholas Anderson
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Cathriona Clarke
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Gavin A. Davis
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Kevin Dunne
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Victoria, Australia
- Department of Rehabilitation Medicine, Royal Children's Hospital, Melbourne, Victoria, Australia
| | | | - Vera Ignjatovic
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Victoria, Australia
| | - Vanessa Rausa
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Marc Seal
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Victoria, Australia
| | - Franz E. Babl
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Victoria, Australia
- Emergency Department, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Vicki Anderson
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Melbourne School of Psychological Sciences, University of Melbourne, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Victoria, Australia
- Psychology Service, Royal Children's Hospital, Melbourne, Victoria, Australia
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25
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Ware AL, Shukla A, Goodrich-Hunsaker NJ, Lebel C, Wilde EA, Abildskov TJ, Bigler ED, Cohen DM, Mihalov LK, Bacevice A, Bangert BA, Taylor HG, Yeates KO. Post-acute white matter microstructure predicts post-acute and chronic post-concussive symptom severity following mild traumatic brain injury in children. Neuroimage Clin 2019; 25:102106. [PMID: 31896466 PMCID: PMC6940617 DOI: 10.1016/j.nicl.2019.102106] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 11/15/2019] [Accepted: 11/19/2019] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Mild traumatic brain injury (TBI) is a global public health concern that affects millions of children annually. Mild TBI tends to result in subtle and diffuse alterations in brain tissue, which challenges accurate clinical detection and prognostication. Diffusion tensor imaging (DTI) holds promise as a diagnostic and prognostic tool, but little research has examined DTI in post-acute mild TBI. The current study compared post-acute white matter microstructure in children with mild TBI versus those with mild orthopedic injury (OI), and examined whether post-acute DTI metrics can predict post-acute and chronic post-concussive symptoms (PCS). MATERIALS AND METHODS Children aged 8-16.99 years with mild TBI (n = 132) or OI (n = 69) were recruited at emergency department visits to two children's hospitals, during which parents rated children's pre-injury symptoms retrospectively. Children completed a post-acute (<2 weeks post-injury) assessment, which included a 3T MRI, and 3- and 6-month post-injury assessments. Parents and children rated PCS at each assessment. Mean diffusivity (MD) and fractional anisotropy (FA) were derived from diffusion-weighted MRI using Automatic Fiber Quantification software. Multiple multivariable linear and negative binomial regression models were used to test study aims, with False Discovery Rate (FDR) correction for multiple comparisons. RESULTS No significant group differences were found in any of the 20 white matter tracts after FDR correction. DTI metrics varied by age and sex, and site was a significant covariate. No interactions involving group, age, and sex were significant. DTI metrics in several tracts robustly predicted PCS ratings at 3- and 6-months post-injury, but only corpus callosum genu MD was significantly associated with post-acute PCS after FDR correction. Significant group by DTI metric interactions on chronic PCS ratings indicated that left cingulum hippocampus and thalamic radiation MD was positively associated with 3-month PCS in the OI group, but not in the mild TBI group. CONCLUSIONS Post-acute white matter microstructure did not differ for children with mild TBI versus OI after correcting for multiple comparisons, but was predictive of post-acute and chronic PCS in both injury groups. These findings support the potential prognostic utility of this advanced DTI technique.
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Affiliation(s)
- Ashley L Ware
- Department of Psychology, University of Calgary, Canada; Hotchkiss Brain Institute, University of Calgary, Canada; Alberta Children's Hospital Research Institute, University of Calgary, Canada.
| | - Ayushi Shukla
- Hotchkiss Brain Institute, University of Calgary, Canada; Department of Radiology, University of Calgary, Canada
| | - Naomi J Goodrich-Hunsaker
- Department of Neurology, University of Utah, USA; Department of Psychology, Brigham Young University, USA
| | - Catherine Lebel
- Hotchkiss Brain Institute, University of Calgary, Canada; Department of Radiology, University of Calgary, Canada; Alberta Children's Hospital Research Institute, University of Calgary, Canada
| | | | | | - Erin D Bigler
- Department of Neurology, University of Utah, USA; Department of Psychology, Brigham Young University, USA
| | - Daniel M Cohen
- Abigail Wexner Research Institute at Nationwide Children's Hospital, USA; Department of Pediatrics, The Ohio State University, USA
| | - Leslie K Mihalov
- Abigail Wexner Research Institute at Nationwide Children's Hospital, USA; Department of Pediatrics, The Ohio State University, USA
| | - Ann Bacevice
- Department of Pediatrics, Case Western Reserve University, USA
| | | | - H Gerry Taylor
- Abigail Wexner Research Institute at Nationwide Children's Hospital, USA
| | - Keith O Yeates
- Department of Psychology, University of Calgary, Canada; Hotchkiss Brain Institute, University of Calgary, Canada; Alberta Children's Hospital Research Institute, University of Calgary, Canada
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26
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Jang I, Chun IY, Brosch JR, Bari S, Zou Y, Cummiskey BR, Lee TA, Lycke RJ, Poole VN, Shenk TE, Svaldi DO, Tamer GG, Dydak U, Leverenz LJ, Nauman EA, Talavage TM. Every hit matters: White matter diffusivity changes in high school football athletes are correlated with repetitive head acceleration event exposure. Neuroimage Clin 2019; 24:101930. [PMID: 31630026 PMCID: PMC6807364 DOI: 10.1016/j.nicl.2019.101930] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Revised: 06/29/2019] [Accepted: 07/09/2019] [Indexed: 11/29/2022]
Abstract
Recent evidence of short-term alterations in brain physiology associated with repeated exposure to moderate intensity subconcussive head acceleration events (HAEs), prompts the question whether these alterations represent an underlying neural injury. A retrospective analysis combining counts of experienced HAEs and longitudinal diffusion-weighted imaging explored whether greater exposure to incident mechanical forces was associated with traditional diffusion-based measures of neural injury—reduced fractional anisotropy (FA) and increased mean diffusivity (MD). Brains of high school athletes (N = 61) participating in American football exhibited greater spatial extents (or volumes) experiencing substantial changes (increases and decreases) in both FA and MD than brains of peers who do not participate in collision-based sports (N = 15). Further, the spatial extents of the football athlete brain exhibiting traditional diffusion-based markers of neural injury were found to be significantly correlated with the cumulative exposure to HAEs having peak translational acceleration exceeding 20 g. This finding demonstrates that subconcussive HAEs induce low-level neurotrauma, with prolonged exposure producing greater accumulation of neural damage. The duration and extent of recovery associated with periods in which athletes do not experience subconcussive HAEs now represents a priority for future study, such that appropriate participation and training schedules may be developed to minimize the risk of long-term neurological dysfunction. Brain volumes evidencing injury are larger in football athletes than controls. Spatial extent of decreased FA correlates with head acceleration event exposure. Spatial extent of increased MD correlates with head acceleration event exposure.
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Affiliation(s)
- Ikbeom Jang
- School of Electrical and Computer Engineering, Purdue University, West Lafayette, IN, United States of America.
| | - Il Yong Chun
- School of Electrical and Computer Engineering, Purdue University, West Lafayette, IN, United States of America
| | - Jared R Brosch
- Department of Neurology, Indiana University School of Medicine, Indianapolis, IN, United States of America
| | - Sumra Bari
- School of Electrical and Computer Engineering, Purdue University, West Lafayette, IN, United States of America
| | - Yukai Zou
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN, United States of America; College of Veterinary Medicine, Purdue University, West Lafayette, IN, United States of America
| | - Brian R Cummiskey
- School of Mechanical Engineering, Purdue University, West Lafayette, IN, United States of America
| | - Taylor A Lee
- School of Mechanical Engineering, Purdue University, West Lafayette, IN, United States of America
| | - Roy J Lycke
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN, United States of America
| | - Victoria N Poole
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN, United States of America
| | - Trey E Shenk
- School of Electrical and Computer Engineering, Purdue University, West Lafayette, IN, United States of America
| | - Diana O Svaldi
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN, United States of America
| | - Gregory G Tamer
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN, United States of America
| | - Ulrike Dydak
- School of Health Sciences, Purdue University, West Lafayette, IN, United States of America
| | - Larry J Leverenz
- Department of Health and Kinesiology, Purdue University, West Lafayette, IN, United States of America
| | - Eric A Nauman
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN, United States of America; School of Mechanical Engineering, Purdue University, West Lafayette, IN, United States of America; Department of Basic Medical Sciences, Purdue University, West Lafayette, IN, United States of America
| | - Thomas M Talavage
- School of Electrical and Computer Engineering, Purdue University, West Lafayette, IN, United States of America; Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN, United States of America
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27
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Yin B, Li DD, Huang H, Gu CH, Bai GH, Hu LX, Zhuang JF, Zhang M. Longitudinal Changes in Diffusion Tensor Imaging Following Mild Traumatic Brain Injury and Correlation With Outcome. Front Neural Circuits 2019; 13:28. [PMID: 31133818 PMCID: PMC6514143 DOI: 10.3389/fncir.2019.00028] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 04/01/2019] [Indexed: 11/13/2022] Open
Abstract
The chronic consequences of traumatic brain injury (TBI) may contribute to the increased risk for early cognitive decline and dementia, primarily due to diffusion axonal injury. Previous studies in mild TBI (mTBI) have been controversial in describing the white matter tract integrity changes occurring at acute and subacute post-injury. In this prospective longitudinal study, we aim to investigate the longitudinal changes of white matter (WM) using diffusion tensor imaging (DTI) and their correlations with neuropsychological tests. Thirty-three patients with subacute mTBI and 31 matched healthy controls were studied with an extensive imaging and clinical battery. Neuroimaging was obtained within 7 days post-injury for acute scans and repeated at 1 and 3 months post-injury. Using a region-of-interest-based approach, tract-based spatial statistics was used to conduct voxel-wise analysis on diffusion changes in mTBI and was compared to those of healthy matched controls, scanned during the same time period and rescanned with an interval similar to that of patients. We found decreased fractional anisotropy (FA) values in the left anterior limb of internal capsule (ALIC) and right inferior fronto-occipital fasciculus (IFOF) during the 7 days post-injury, which showed longitudinal evidence of recovery following 1 month post-injury. Increased FA values in these two tracts at 1 month post-injury were positively associated with better performance on cognitive information processing speed at initial assessment. By contrast, there were also some tracts (right anterior corona radiata, forceps major, and body of corpus callosum) exhibiting the continuing loss of integrity sustaining even beyond 3 months, which can predict the persisting post-concussion syndromes. Continuing loss of structural integrity in some tracts may contribute to the persistent post-concussion syndromes in mTBI patients, suggesting certain tracts providing an objective biomarker for tracking the pathological recovery process following mTBI.
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Affiliation(s)
- Bo Yin
- Department of Medical Imaging, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.,Department of Neurosurgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Dan-Dong Li
- Department of Neurosurgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Huan Huang
- Department of Radiology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Cheng-Hui Gu
- Department of Neurosurgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Guang-Hui Bai
- Department of Radiology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Liu-Xun Hu
- Department of Neurosurgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Jin-Fei Zhuang
- Department of Rehabilitation Medicine, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Ming Zhang
- Department of Medical Imaging, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
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McKeithan L, Hibshman N, Yengo-Kahn AM, Solomon GS, Zuckerman SL. Sport-Related Concussion: Evaluation, Treatment, and Future Directions. Med Sci (Basel) 2019; 7:medsci7030044. [PMID: 30884753 PMCID: PMC6473667 DOI: 10.3390/medsci7030044] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 03/11/2019] [Accepted: 03/11/2019] [Indexed: 01/16/2023] Open
Abstract
Sport-related concussion (SRC) is a highly prevalent injury predominantly affecting millions of youth through high school athletes every year. In recent years, SRC has received a significant amount of attention due to potential for long-term neurologic sequelae. However, the acute symptoms and possibility of prolonged recovery account for the vast majority of morbidity from SRC. Modifying factors have been identified and may allow for improved prediction of a protracted course. Potential novel modifying factors may include genetic determinants of recovery, as well as radiographic biomarkers, which represent burgeoning subfields in SRC research. Helmet design and understanding the biomechanical stressors on the brain that lead to concussion also represent active areas of research. This narrative review provides a general synopsis of SRC, including relevant definitions, current treatment paradigms, and modifying factors for recovery, in addition to novel areas of research and future directions for SRC research.
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Affiliation(s)
- Lydia McKeithan
- Vanderbilt Sports Concussion Center, Vanderbilt University School of Medicine, Nashville, TN 37232, USA.
| | - Natalie Hibshman
- Vanderbilt Sports Concussion Center, Vanderbilt University School of Medicine, Nashville, TN 37232, USA.
| | - Aaron M Yengo-Kahn
- Vanderbilt Sports Concussion Center, Vanderbilt University School of Medicine, Nashville, TN 37232, USA.
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN 37232, USA.
| | - Gary S Solomon
- Vanderbilt Sports Concussion Center, Vanderbilt University School of Medicine, Nashville, TN 37232, USA.
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN 37232, USA.
| | - Scott L Zuckerman
- Vanderbilt Sports Concussion Center, Vanderbilt University School of Medicine, Nashville, TN 37232, USA.
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN 37232, USA.
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29
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Zhang J, Tian L, Zhang L, Cheng R, Wei R, He F, Li J, Luo B, Ye X. Relationship between white matter integrity and post-traumatic cognitive deficits: a systematic review and meta-analysis. J Neurol Neurosurg Psychiatry 2019; 90:98-107. [PMID: 30072375 DOI: 10.1136/jnnp-2017-317691] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Revised: 06/25/2018] [Accepted: 06/27/2018] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To investigate relationships between cognitive domains and white matter changes in different regions in patients with cognitive deficits after traumatic brain injury (TBI). METHODS Databases including PubMed, Embase, Web of Science and CENTRAL were searched for studies published before 5 August 2017. Correlation coefficients between cognition and white matter integrity, measured by diffusion metrics, including fractional anisotropy (FA), were pooled from 49 studies including 1405 patients. The influence of demographic factors was assessed by meta-regression analysis. RESULTS Significant pooled FA-executive correlations (p<0.001) were found across various regions, including the corpus callosum (CC) (r=0.42, 95% CI 0.30 to 0.54), superior longitudinal fasciculus (r=0.50, 95% CI 0.41 to 0.59) and internal capsule (IC) (r=0.49, 95% CI 0.37 to 0.61). The fornix (r=0.62, 95% CI 0.45 to 0.78) and cingulum (r=0.57, 95% CI 0.34 to 0.81) particularly correlated with memory (p<0.001). The CC and IC also showed significant relationships with attention and processing speed (p<0.001). Demographic factors had no influence overall, except that studies with a greater proportion of males had stronger correlations between memory and white matter (p<0.05). CONCLUSIONS FA is the most sensitive metric for detecting post-TBI cognitive decline across various domains. Representative white matter regions, such as the CC and IC, perform better than whole-brain white matter for reflecting a wide range of cognitive domains, including memory, attention and executive functions. Moreover, the fornix and cingulum particularly reflect memory function. They yield insights into particular imaging indicators that have neuropsychological value.
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Affiliation(s)
- Jie Zhang
- Department of Rehabilitation Medicine, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, China
| | - Liang Tian
- Department of Rehabilitation Medicine, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, China
| | - Li Zhang
- Department of Rehabilitation Medicine, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, China
| | - Ruidong Cheng
- Department of Rehabilitation Medicine, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, China
| | - Ruili Wei
- Department of Neurology and Brain Medical Centre, The First Affiliated Hospital, Zhejiang University, Hangzhou, China
| | - Fangping He
- Department of Neurology and Brain Medical Centre, The First Affiliated Hospital, Zhejiang University, Hangzhou, China
| | - Juebao Li
- Department of Rehabilitation Medicine, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, China
| | - Benyan Luo
- Department of Neurology and Brain Medical Centre, The First Affiliated Hospital, Zhejiang University, Hangzhou, China
| | - Xiangming Ye
- Department of Rehabilitation Medicine, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, China
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30
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Douglas DB, Ro T, Toffoli T, Krawchuk B, Muldermans J, Gullo J, Dulberger A, Anderson AE, Douglas PK, Wintermark M. Neuroimaging of Traumatic Brain Injury. Med Sci (Basel) 2018; 7:E2. [PMID: 30577545 PMCID: PMC6358760 DOI: 10.3390/medsci7010002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 12/12/2018] [Accepted: 12/14/2018] [Indexed: 12/15/2022] Open
Abstract
The purpose of this article is to review conventional and advanced neuroimaging techniques performed in the setting of traumatic brain injury (TBI). The primary goal for the treatment of patients with suspected TBI is to prevent secondary injury. In the setting of a moderate to severe TBI, the most appropriate initial neuroimaging examination is a noncontrast head computed tomography (CT), which can reveal life-threatening injuries and direct emergent neurosurgical intervention. We will focus much of the article on advanced neuroimaging techniques including perfusion imaging and diffusion tensor imaging and discuss their potentials and challenges. We believe that advanced neuroimaging techniques may improve the accuracy of diagnosis of TBI and improve management of TBI.
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Affiliation(s)
- David B Douglas
- Department of Neuroradiology, Stanford University, Palo Alto, CA 94301, USA.
- Department of Radiology, David Grant Medical Center, Travis AFB, CA 94535, USA.
| | - Tae Ro
- Department of Radiology, David Grant Medical Center, Travis AFB, CA 94535, USA.
| | - Thomas Toffoli
- Department of Radiology, David Grant Medical Center, Travis AFB, CA 94535, USA.
| | - Bennet Krawchuk
- Department of Radiology, David Grant Medical Center, Travis AFB, CA 94535, USA.
| | - Jonathan Muldermans
- Department of Radiology, David Grant Medical Center, Travis AFB, CA 94535, USA.
| | - James Gullo
- Department of Radiology, David Grant Medical Center, Travis AFB, CA 94535, USA.
| | - Adam Dulberger
- Department of Radiology, David Grant Medical Center, Travis AFB, CA 94535, USA.
| | - Ariana E Anderson
- Department of Psychiatry and Biobehavioral Sciences, UCLA, Los Angeles, CA 90095, USA.
| | - Pamela K Douglas
- Department of Psychiatry and Biobehavioral Sciences, UCLA, Los Angeles, CA 90095, USA.
- Institute for Simulation and Training, University of Central Florida, Orlando, FL 32816, USA.
| | - Max Wintermark
- Department of Neuroradiology, Stanford University, Palo Alto, CA 94301, USA.
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31
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Manning KY, Llera A, Dekaban GA, Bartha R, Barreira C, Brown A, Fischer L, Jevremovic T, Blackney K, Doherty TJ, Fraser DD, Holmes J, Beckmann CF, Menon RS. Linked MRI signatures of the brain's acute and persistent response to concussion in female varsity rugby players. Neuroimage Clin 2019; 21:101627. [PMID: 30528959 DOI: 10.1016/j.nicl.2018.101627] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Revised: 11/22/2018] [Accepted: 12/01/2018] [Indexed: 12/14/2022]
Abstract
Acute brain changes are expected after concussion, yet there is growing evidence of persistent abnormalities well beyond clinical recovery and clearance to return to play. Multiparametric MRI is a powerful approach to non-invasively study structure-function relationships in the brain, however it remains challenging to interpret the complex and heterogeneous cascade of brain changes that manifest after concussion. Emerging conjunctive, data-driven analysis approaches like linked independent component analysis can integrate structural and functional imaging data to produce linked components that describe the shared inter-subject variance across images. These linked components not only offer the potential of a more comprehensive understanding of the underlying neurobiology of concussion, but can also provide reliable information at the level of an individual athlete. In this study, we analyzed resting-state functional MRI (rs-fMRI) and diffusion tensor imaging (DTI) within a cohort of female varsity rugby players (n = 52) through the in- and off-season, including concussed athletes (n = 21) who were studied longitudinally at three days, three months and six months after a diagnosed concussion. Linked components representing co-varying white matter microstructure and functional network connectivity characterized (a) the brain's acute response to concussion and (b) persistent alterations beyond clinical recovery. Furthermore, we demonstrate that these long-term brain changes related to specific aspects of a concussion history and allowed us to monitor individual athletes before and longitudinally after a diagnosed concussion. Diffusion alterations were present acutely post-concussion and during the in-season. Linked variation of brain structure-function persisted 6-months after injury. Multiparametric signatures related to concussion history, even in healthy athletes.
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Lee JB, Affeldt BM, Gamboa Y, Hamer M, Dunn JF, Pardo AC, Obenaus A. Repeated Pediatric Concussions Evoke Long-Term Oligodendrocyte and White Matter Microstructural Dysregulation Distant from the Injury. Dev Neurosci 2018; 40:358-375. [PMID: 30466074 DOI: 10.1159/000494134] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Accepted: 09/30/2018] [Indexed: 11/19/2022] Open
Abstract
Concussion or mild traumatic brain injury (mTBI) is often accompanied by long-term behavioral and neuropsychological deficits. Emerging data suggest that these deficits can be exacerbated following repeated injuries. However, despite the overwhelming prevalence of mTBI in children due to falls and sports-related activities, the effects of mTBI on white matter (WM) structure and its development in children have not been extensively examined. Moreover, the effect of repeated mTBI (rmTBI) on developing WM has not yet been studied, despite the possibility of exacerbated outcomes with repeat injuries. To address this knowledge gap, we investigated the long-term effects of single (s)mTBI and rmTBI on the WM in the pediatric brain, focusing on the anterior commissure (AC), a WM structure distant to the injury site, using diffusion tensor imaging (DTI) and immunohistochemistry (IHC). We hypothesized that smTBI and rmTBI to the developing mouse brain would lead to abnormalities in microstructural integrity and impaired oligodendrocyte (OL) development. We used a postnatal day 14 Ascl1-CreER: ccGFP mouse closed head injury (CHI) model with a bilateral repeated injury. We demonstrate that smTBI and rmTBI differentially lead to myelin-related diffusion changes in the WM and to abnormal OL development in the AC, which are accompanied by behavioral deficits 2 months after the initial injury. Our results suggest that mTBIs elicit long-term behavioral alterations and OL-associated WM dysregulation in the developing brain. These findings warrant additional research into the development of WM and OL as key components of pediatric TBI pathology and potential therapeutic targets.
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Affiliation(s)
- Jeong Bin Lee
- Department of Basic Sciences, Loma Linda University School of Medicine, Loma Linda, California, USA
| | - Bethann M Affeldt
- Department of Basic Sciences, Loma Linda University School of Medicine, Loma Linda, California, USA
| | - Yaritxa Gamboa
- Department of Basic Sciences, Loma Linda University School of Medicine, Loma Linda, California, USA
| | - Mary Hamer
- Department of Basic Sciences, Loma Linda University School of Medicine, Loma Linda, California, USA
| | - Jeff F Dunn
- Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Andrea C Pardo
- Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Andre Obenaus
- Department of Basic Sciences, Loma Linda University School of Medicine, Loma Linda, California, USA, .,Department of Pediatrics, University of California Irvine School of Medicine, Irvine, California, USA,
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Studerus-Germann AM, Gautschi OP, Bontempi P, Thiran JP, Daducci A, Romascano D, von Ow D, Hildebrandt G, von Hessling A, Engel DC. Central nervous system microbleeds in the acute phase are associated with structural integrity by DTI one year after mild traumatic brain injury: A longitudinal study. Neurol Neurochir Pol 2018; 52:710-719. [PMID: 30245171 DOI: 10.1016/j.pjnns.2018.08.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 08/31/2018] [Accepted: 08/31/2018] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Several imaging modalities are under investigation to unravel the pathophysiological mystery of delayed performance deficits in patients after mild traumatic brain injury (mTBI). Although both imaging and neuropsychological studies have been conducted, only few data on longitudinal correlations of diffusion tensor imaging (DTI), susceptibility weighted imaging (SWI) and extensive neuropsychological testing exist. METHODS MRI with T1- and T2-weighted, SWI and DTI sequences at baseline and 12 months of 30 mTBI patients were compared with 20 healthy controls. Multiparametric assessment included neuropsychological testing of cognitive performance and post-concussion syndrome (PCS) at baseline, 3 and 12 months post-injury. Data analysis encompassed assessment of cerebral microbleeds (Mb) in SWI, tract-based spatial statistics (TBSS) and voxel-based morphometry (VBM) of DTI (VBM-DTI). Imaging markers were correlated with neuropsychological testing to evaluate sensitivity to cognitive performance and post-concussive symptoms. RESULTS Patients with Mb in SWI in the acute phase showed worse performance in several cognitive tests at baseline and in the follow-ups during the chronic phase and higher symptom severity in the post concussion symptom scale (PCSS) at twelve months post-injury. In the acute phase there was no statistical difference in structural integrity as measured with DTI between mTBI patients and healthy controls. At twelve months post-injury, loss of structural integrity in mTBI patients was found in nearly all DTI indices compared to healthy controls. CONCLUSIONS Presence of Mb detected by SWI was associated with worse cognitive outcome and persistent PCS in mTBI patients, while DTI did not prove to predict neuropsychological outcome in the acute phase.
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Affiliation(s)
- Aline M Studerus-Germann
- Division of Neuropsychology, Department of Neurology, Cantonal Hospital, St. Gallen, Switzerland; Department of Psychopathology and Clinical Intervention, University of Zurich, Switzerland
| | - Oliver P Gautschi
- Department of Neurosurgery, Cantonal Hospital St. Gallen, St. Gallen, Switzerland; Department of Neurosurgery, Geneva University Medical Center, Faculty of Medicine, University of Geneva, Switzerland
| | | | - Jean-Philippe Thiran
- Signal Processing Laboratory (LTS5), Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | - Alessandro Daducci
- Signal Processing Laboratory (LTS5), Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | - David Romascano
- Signal Processing Laboratory (LTS5), Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | - Dieter von Ow
- Emergency Department, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Gerhard Hildebrandt
- Department of Neurosurgery, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Alexander von Hessling
- Department of Radiology and Nuclear Medicine, Cantonal Hospital St. Gallen, St. Gallen, Switzerland; Department of Radiology and Nuclear Medicine, Cantonal Hospital Lucerne, Lucerne, Switzerland
| | - Doortje C Engel
- Department of Neurosurgery, Cantonal Hospital St. Gallen, St. Gallen, Switzerland; Department of Neurosurgery, University Hospital Tübingen, Tübingen, Germany.
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Mustafi SM, Harezlak J, Koch KM, Nencka AS, Meier TB, West JD, Giza CC, DiFiori JP, Guskiewicz KM, Mihalik JP, LaConte SM, Duma SM, Broglio SP, Saykin AJ, McCrea M, McAllister TW, Wu YC. Acute White-Matter Abnormalities in Sports-Related Concussion: A Diffusion Tensor Imaging Study from the NCAA-DoD CARE Consortium. J Neurotrauma 2018; 35:2653-2664. [PMID: 29065805 DOI: 10.1089/neu.2017.5158] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Sports-related concussion (SRC) is an important public health issue. Although standardized assessment tools are useful in the clinical management of acute concussion, the underlying pathophysiology of SRC and the time course of physiological recovery after injury remain unclear. In this study, we used diffusion tensor imaging (DTI) to detect white matter alterations in football players within 48 h after SRC. As part of the NCAA-DoD CARE Consortium study of SRC, 30 American football players diagnosed with acute concussion and 28 matched controls received clinical assessments and underwent advanced magnetic resonance imaging scans. To avoid selection bias and partial volume effects, whole-brain skeletonized white matter was examined by tract-based spatial statistics to investigate between-group differences in DTI metrics and their associations with clinical outcome measures. Mean diffusivity was significantly higher in brain white matter of concussed athletes, particularly in frontal and subfrontal long white matter tracts. In the concussed group, axial diffusivity was significantly correlated with the Brief Symptom Inventory and there was a similar trend with the symptom severity score of the Sport Concussion Assessment Tool. In addition, concussed athletes with higher fractional anisotropy performed better on the cognitive component of the Standardized Assessment of Concussion. Overall, the results of this study are consistent with the hypothesis that SRC is associated with changes in white matter tracts shortly after injury, and these differences are correlated clinically with acute symptoms and functional impairments.
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Affiliation(s)
- Sourajit Mitra Mustafi
- 1 Department of Radiology and Imaging Sciences, Indiana University School of Medicine , Indianapolis, Indiana
| | - Jaroslaw Harezlak
- 2 Department of Epidemiology and Biostatistics, School of Public Health, Indiana University , Bloomington, Indiana
| | - Kevin M Koch
- 3 Department of Radiology, Medical College of Wisconsin , Milwaukee, Wisconsin
| | - Andrew S Nencka
- 3 Department of Radiology, Medical College of Wisconsin , Milwaukee, Wisconsin
| | - Timothy B Meier
- 4 Department of Neurosurgery, Medical College of Wisconsin , Milwaukee, Wisconsin
| | - John D West
- 1 Department of Radiology and Imaging Sciences, Indiana University School of Medicine , Indianapolis, Indiana
| | - Christopher C Giza
- 5 Department of Neurosurgery, David Geffen School of Medicine at University of California Los Angeles, Division of Pediatric Neurology, Mattel Children's Hospital-UCLA Los Angeles , California
| | - John P DiFiori
- 6 Division of Sports Medicine, Departments of Family Medicine and Orthopedics, University of California Los Angeles , Los Angeles, California
| | - Kevin M Guskiewicz
- 7 Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill , Chapel Hill, North Carolina
| | - Jason P Mihalik
- 7 Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill , Chapel Hill, North Carolina
| | - Stephen M LaConte
- 8 School of Biomedical Engineering and Sciences, Wake-Forest and Virginia Tech University , Virginia Tech Carilion Research Institute, Roanoke, Virginia
| | - Stefan M Duma
- 9 School of Biomedical Engineering and Sciences, Wake-Forest and Virginia Tech University , Blacksburg, Virginia
| | - Steven P Broglio
- 10 NeuroTrauma Research Laboratory, School of Kinesiology, University of Michigan , Ann Arbor, Michigan
| | - Andrew J Saykin
- 1 Department of Radiology and Imaging Sciences, Indiana University School of Medicine , Indianapolis, Indiana
| | - Michael McCrea
- 4 Department of Neurosurgery, Medical College of Wisconsin , Milwaukee, Wisconsin
| | - Thomas W McAllister
- 11 Department of Psychology, Indiana University School of Medicine , Indianapolis, Indiana
| | - Yu-Chien Wu
- 1 Department of Radiology and Imaging Sciences, Indiana University School of Medicine , Indianapolis, Indiana
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Mayer AR, Kaushal M, Dodd AB, Hanlon FM, Shaff NA, Mannix R, Master CL, Leddy JJ, Stephenson D, Wertz CJ, Suelzer EM, Arbogast KB, Meier TB. Advanced biomarkers of pediatric mild traumatic brain injury: Progress and perils. Neurosci Biobehav Rev 2018; 94:149-165. [PMID: 30098989 DOI: 10.1016/j.neubiorev.2018.08.002] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Revised: 07/27/2018] [Accepted: 08/03/2018] [Indexed: 12/20/2022]
Abstract
There is growing public concern about neurodegenerative changes (e.g., Chronic Traumatic Encephalopathy) that may occur chronically following clinically apparent and clinically silent (i.e., sub-concussive blows) pediatric mild traumatic brain injury (pmTBI). However, there are currently no biomarkers that clinicians can use to objectively diagnose patients or predict those who may struggle to recover. Non-invasive neuroimaging, electrophysiological and neuromodulation biomarkers have promise for providing evidence of the so-called "invisible wounds" of pmTBI. Our systematic review, however, belies that notion, identifying a relative paucity of high-quality, clinically impactful, diagnostic or prognostic biomarker studies in the sub-acute injury phase (36 studies on unique samples in 28 years), with the majority focusing on adolescent pmTBI. Ultimately, well-powered longitudinal studies with appropriate control groups, as well as standardized and clearly-defined inclusion criteria (time post-injury, injury severity and past history) are needed to truly understand the complex pathophysiology that is hypothesized (i.e., still needs to be determined) to exist during the acute and sub-acute stages of pmTBI and may underlie post-concussive symptoms.
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Affiliation(s)
- Andrew R Mayer
- The Mind Research Network/Lovelace Biomedical and Environmental Research Institute, Pete & Nancy Domenici Hall, 1011 Yale Blvd. NE, Albuquerque, NM, 87106, United States; Neurology Department, University of New Mexico School of Medicine, Albuquerque, NM, 87131, United States; Psychiatry Department, University of New Mexico School of Medicine, Albuquerque, NM, 87131, United States; Psychology Department, University of New Mexico, Albuquerque, NM, 87131, United States.
| | - Mayank Kaushal
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, 53226, United States
| | - Andrew B Dodd
- The Mind Research Network/Lovelace Biomedical and Environmental Research Institute, Pete & Nancy Domenici Hall, 1011 Yale Blvd. NE, Albuquerque, NM, 87106, United States
| | - Faith M Hanlon
- The Mind Research Network/Lovelace Biomedical and Environmental Research Institute, Pete & Nancy Domenici Hall, 1011 Yale Blvd. NE, Albuquerque, NM, 87106, United States
| | - Nicholas A Shaff
- The Mind Research Network/Lovelace Biomedical and Environmental Research Institute, Pete & Nancy Domenici Hall, 1011 Yale Blvd. NE, Albuquerque, NM, 87106, United States
| | - Rebekah Mannix
- Division of Emergency Medicine, Boston Children's Hospital, Boston, MA, 02115, United States
| | - Christina L Master
- Center for Injury Research and Prevention, The Children's Hospital of Philadelphia, PA, 19104, United States; Division of Orthopedic Surgery, The Children's Hospital of Philadelphia, Philadelphia, PA, 19104, United States
| | - John J Leddy
- UBMD Department of Orthopaedics and Sports Medicine, University at Buffalo, Buffalo, NY, 14214, United States
| | - David Stephenson
- The Mind Research Network/Lovelace Biomedical and Environmental Research Institute, Pete & Nancy Domenici Hall, 1011 Yale Blvd. NE, Albuquerque, NM, 87106, United States
| | - Christopher J Wertz
- The Mind Research Network/Lovelace Biomedical and Environmental Research Institute, Pete & Nancy Domenici Hall, 1011 Yale Blvd. NE, Albuquerque, NM, 87106, United States
| | - Elizabeth M Suelzer
- Medical College of Wisconsin Libraries, Medical College of Wisconsin, Milwaukee, WI, 53226, United States
| | - Kristy B Arbogast
- Center for Injury Research and Prevention, The Children's Hospital of Philadelphia, PA, 19104, United States
| | - Timothy B Meier
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, 53226, United States; Department of Cell Biology, Neurobiology and Anatomy, Medical College of Wisconsin, Milwaukee, WI, 53226, United States
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Abstract
Conventional neuroimaging examinations are typically normal in concussed young athletes. A current focus of research is the characterization of subtle abnormalities after concussion using advanced neuroimaging techniques. These techniques have the potential to identify biomarkers of concussion. In the future, such biomarkers will likely provide important clinical information regarding the appropriate time interval before return to play, as well as the risk for prolonged postconcussive symptoms and long-term cognitive impairment. This article discusses results from advanced imaging techniques and emphasizes imaging modalities that will likely become available in the near future for the clinical evaluation of concussed young athletes.
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Affiliation(s)
- Jeffrey P Guenette
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA; Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, 1249 Boylston Street, Boston, MA 02215, USA
| | - Martha E Shenton
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA; Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, 1249 Boylston Street, Boston, MA 02215, USA; VA Boston Healthcare System, Brockton Division, 940 Belmont Street, Brockton, MA 02301, USA; Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA
| | - Inga K Koerte
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, 1249 Boylston Street, Boston, MA 02215, USA; Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA; Department of Child and Adolescent Psychiatry, Psychosomatic, and Psychotherapy, Ludwig-Maximilian-Universität, Nußbaumstr 5a, Munich 80336, Germany.
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Abstract
Diffusion weighted magnetic resonance imaging (DWI) and related techniques such as diffusion tensor imaging (DTI) are uniquely sensitive to the microstructure of the brain and spinal cord. In the acute aftermath of nervous system injury, for example, DWI reveals changes caused by injury that remains invisible on other MRI contrasts such as T2-weighted imaging. This ability has led to a demonstrated clinical utility in cerebral ischemia. However, despite strong promise in preclinical models and research settings, DWI has not been as readily adopted for other acute injuries such as traumatic spinal cord, brain, or peripheral nerve injury. Furthermore, the precise biophysical mechanisms that underlie DWI and DTI changes are not fully understood. In this report, we review the DWI and DTI changes that occur in acute neurological injury of cerebral ischemia, spinal cord injury, traumatic brain injury, and peripheral nerve injury. Their associations with the underlying biology are examined with an emphasis on the role of acute axon and dendrite beading. Lastly, emerging DWI techniques to overcome the limitations of DTI are discussed as these may offer the needed improvements to translate to clinical settings.
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Affiliation(s)
- Matthew D Budde
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, United States.
| | - Nathan P Skinner
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, United States; Medical Scientist Training Program, Medical College of Wisconsin, Milwaukee, WI, United States
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Schmidt J, Rubino C, Boyd LA, Virji-Babul N. The Role of Physical Activity in Recovery From Concussion in Youth: A Neuroscience Perspective. J Neurol Phys Ther 2018; 42:155-62. [PMID: 29864097 DOI: 10.1097/NPT.0000000000000226] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND PURPOSE Concussion is a major public health concern and one of the least understood neurological injuries. Children and youth are disproportionally affected by concussion, and once injured, take longer to recover. Current guidelines recommend a period of physical and cognitive rest with a gradual progressive return to activity. Although there is limited high-quality evidence (eg, randomized controlled trials) on the benefit of physical activity and exercise after concussion, most studies report a positive impact of exercise in facilitating recovery after concussion. In this article we characterize the complex and dynamic changes in the brain following concussion by reviewing recent results from neuroimaging studies and to inform physical activity participation guidelines for the management of a younger population (eg, 14-25 years of age) after concussion. SUMMARY OF KEY POINTS Novel imaging methods and tools are providing a picture of the changes in the structure and function of the brain following concussion. These emerging results will, in the future, assist in creating objective, evidence-based pathways for clinical decision-making. Until such time, physical therapists should be aware that current neuroimaging evidence supports participation in physical activity after an initial and brief period of rest, and consider how best to incorporate exercise into rehabilitation to enhance recovery following concussion. RECOMMENDATIONS FOR CLINICAL PRACTICE It is important that physical therapists understand the neurobiological impact of concussion injury and recovery, and be informed of the scientific rationale for the recommendations and guidelines for engagement in physical activity.Video Abstract available for more insights from the authors (see Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A205).
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40
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Schmidt J, Hayward KS, Brown KE, Zwicker JG, Ponsford J, van Donkelaar P, Babul S, Boyd LA. Imaging in Pediatric Concussion: A Systematic Review. Pediatrics 2018; 141:peds.2017-3406. [PMID: 29678928 DOI: 10.1542/peds.2017-3406] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/12/2018] [Indexed: 11/24/2022] Open
Abstract
CONTEXT Pediatric mild traumatic brain injury (mTBI) is a common and poorly understood injury. Neuroimaging indexes brain injury and outcome after pediatric mTBI, but remains largely unexplored. OBJECTIVE To investigate the differences in neuroimaging findings in children/youth with mTBI. Measures of behavior, symptoms, time since injury, and age at injury were also considered. DATA SOURCES A systematic review was conducted up to July 6, 2016. STUDY SELECTION Studies were independently screened by 2 authors and included if they met predetermined eligibility criteria: (1) children/youth (5-18 years of age), (2) diagnosis of mTBI, and (3) use of neuroimaging. DATA EXTRACTION Two authors independently appraised study quality and extracted demographic and outcome data. RESULTS Twenty-two studies met the eligibility criteria, involving 448 participants with mTBI (mean age = 12.7 years ± 2.8). Time postinjury ranged from 1 day to 5 years. Seven different neuroimaging methods were investigated in included studies. The most frequently used method, diffusion tensor imaging (41%), had heterogeneous findings with respect to the specific regions and tracts that showed group differences. However, group differences were observed in many regions containing the corticospinal tract, portions of the corpus callosum, or frontal white-matter regions; fractional anisotropy was increased in 88% of the studies. LIMITATIONS This review included a heterogeneous sample with regard to participant ages, time since injury, symptoms, and imaging methods which prevented statistical pooling/modelling. CONCLUSIONS These data highlight essential priorities for future research (eg, common data elements) that are foundational to progress the understanding of pediatric concussion.
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Affiliation(s)
- Julia Schmidt
- Department of Physical Therapy, The University of British Columbia, Vancouver, Canada; .,School of Allied Health, College of Science, Health and Engineering, La Trobe University, Melbourne, Australia
| | - Kathryn S Hayward
- Department of Physical Therapy, The University of British Columbia, Vancouver, Canada.,Florey Institute of Neuroscience and Mental Health, National Health and Medical Research Council and University of Melbourne, Parkville, Australia.,Centre for Research Excellence in Stroke Rehabilitation and Brain Recovery, Melbourne, Australia
| | - Katlyn E Brown
- Department of Physical Therapy, The University of British Columbia, Vancouver, Canada
| | - Jill G Zwicker
- Department of Physical Therapy, The University of British Columbia, Vancouver, Canada.,BC Children's Hospital Research Institute, Vancouver, Canada; and
| | | | - Paul van Donkelaar
- Department of Physical Therapy, The University of British Columbia, Vancouver, Canada
| | - Shelina Babul
- Department of Physical Therapy, The University of British Columbia, Vancouver, Canada.,BC Children's Hospital Research Institute, Vancouver, Canada; and
| | - Lara A Boyd
- Department of Physical Therapy, The University of British Columbia, Vancouver, Canada
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Dennis EL, Wilde EA, Newsome MR, Scheibel RS, Troyanskaya M, Velez C, Wade BSC, Drennon AM, York GE, Bigler ED, Abildskov TJ, Taylor BA, Jaramillo CA, Eapen B, Belanger H, Gupta V, Morey R, Haswell C, Levin HS, Hinds SR, Walker WC, Thompson PM, Tate DF. ENIGMA MILITARY BRAIN INJURY: A COORDINATED META-ANALYSIS OF DIFFUSION MRI FROM MULTIPLE COHORTS. Proc IEEE Int Symp Biomed Imaging 2018; 2018:1386-1389. [PMID: 30034577 PMCID: PMC6049824 DOI: 10.1109/isbi.2018.8363830] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Traumatic brain injury (TBI) is a significant cause of morbidity in military Veterans and Service Members. While most individuals recover fully from mild injuries within weeks, some continue to experience symptoms including headaches, disrupted sleep, and other cognitive, behavioral or physical symptoms. Diffusion magnetic resonance imaging (dMRI) shows promise in identifying areas of structural disruption and predicting outcomes. Although some studies suggest widespread structural disruption after brain injury, dMRI studies of military brain injury have yielded mixed results so far, perhaps due to the subtlety of mild injury, individual differences in injury location, severity and mechanism, and comorbidity with other disorders such as post-traumatic stress disorder (PTSD), depression, and substance abuse. We present preliminary dMRI results from the ENIGMA (Enhancing Neuroimaging Genetics through Meta-Analysis) military brain injury working group. We found higher fractional anisotropy (FA) in participants with a history of TBI. Understanding the injury and recovery process, along with factors that influence these, will lead to improved diagnosis and treatment.
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Affiliation(s)
- Emily L Dennis
- Imaging Genetics Center, Keck School of Medicine of USC, Marina del Rey, CA, USA
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, UCLA, Los Angeles, CA, USA
| | - Elisabeth A Wilde
- Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
- Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX, USA
- Department of Neurology, University of Utah, Salt Lake City, UT, USA
- Department of Radiology, Baylor College of Medicine, Houston, TX, USA
| | - Mary R Newsome
- Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
- Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX, USA
| | - Randall S Scheibel
- Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
- Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX, USA
| | - Maya Troyanskaya
- Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
- Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX, USA
| | - Carmen Velez
- University of Missouri-St. Louis, St. Louis, MO, USA
| | - Benjamin S C Wade
- University of Missouri-St. Louis, St. Louis, MO, USA
- Ahmanson-Lovelace Brain Mapping Center, Department of Neurology, UCLA, Los Angeles, CA, USA
| | | | | | - Erin D Bigler
- Department of Psychology and Neuroscience, Brigham Young University, Provo, UT, USA
| | - Tracy J Abildskov
- Department of Psychology and Neuroscience, Brigham Young University, Provo, UT, USA
| | - Brian A Taylor
- Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
- Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX, USA
- Department of Radiology, Baylor College of Medicine, Houston, TX, USA
| | - Carlos A Jaramillo
- Polytrauma Rehabilitation Center, South Texas Veterans Health Care System, San Antonio, TX
| | - Blessen Eapen
- Polytrauma Rehabilitation Center, South Texas Veterans Health Care System, San Antonio, TX
| | - Heather Belanger
- James A. Haley Veterans Hospital, Tampa, FL, USA
- University of South Florida, Tampa, FL, USA
| | - Vikash Gupta
- Imaging Genetics Center, Keck School of Medicine of USC, Marina del Rey, CA, USA
| | | | | | - Harvey S Levin
- Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
- Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX, USA
| | - Sidney R Hinds
- Department of Defense/United States Army Medical Research and Materiel Command
| | - William C Walker
- Defense and Veterans Brain Injury Center, San Antonio, TX, USA
- Department of Physical Medicine & Rehabilitation, Virginia Commonwealth University, Richmond VA
- Hunter Holmes McGuire VAMC, Richmond VA
| | - Paul M Thompson
- Imaging Genetics Center, Keck School of Medicine of USC, Marina del Rey, CA, USA
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, UCLA, Los Angeles, CA, USA
- Departments of Neurology, Pediatrics, Psychiatry, Radiology, Engineering, and Ophthalmology, USC, Los Angeles, CA
| | - David F Tate
- University of Missouri-St. Louis, St. Louis, MO, USA
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Grassi DC, Conceição DMD, Leite CDC, Andrade CS. Current contribution of diffusion tensor imaging in the evaluation of diffuse axonal injury. Arq Neuro-Psiquiatr 2018; 76:189-199. [DOI: 10.1590/0004-282x20180007] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Accepted: 12/12/2017] [Indexed: 11/22/2022]
Abstract
ABSTRACT Traumatic brain injury (TBI) is the number one cause of death and morbidity among young adults. Moreover, survivors are frequently left with functional disabilities during the most productive years of their lives. One main aspect of TBI pathology is diffuse axonal injury, which is increasingly recognized due to its presence in 40% to 50% of all cases that require hospital admission. Diffuse axonal injury is defined as widespread axonal damage and is characterized by complete axotomy and secondary reactions due to overall axonopathy. These changes can be seen in neuroimaging studies as hemorrhagic focal areas and diffuse edema. However, the diffuse axonal injury findings are frequently under-recognized in conventional neuroimaging studies. In such scenarios, diffuse tensor imaging (DTI) plays an important role because it provides further information on white matter integrity that is not obtained with standard magnetic resonance imaging sequences. Extensive reviews concerning the physics of DTI and its use in the context of TBI patients have been published, but these issues are still hazy for many allied-health professionals. Herein, we aim to review the current contribution of diverse state-of-the-art DTI analytical methods to the understanding of diffuse axonal injury pathophysiology and prognosis, to serve as a quick reference for those interested in planning new studies and who are involved in the care of TBI victims. For this purpose, a comprehensive search in Pubmed was performed using the following keywords: “traumatic brain injury”, “diffuse axonal injury”, and “diffusion tensor imaging”.
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O'Phelan KH, Otoshi CK, Ernst T, Chang L. Common Patterns of Regional Brain Injury Detectable by Diffusion Tensor Imaging in Otherwise Normal-Appearing White Matter in Patients with Early Moderate to Severe Traumatic Brain Injury. J Neurotrauma 2018; 35:739-749. [PMID: 29228858 PMCID: PMC5831746 DOI: 10.1089/neu.2016.4944] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Traumatic brain injury (TBI) alters the lives of millions of people every year. Although mortality rates have improved, attributed to better pre-hospital care and reduction of secondary injury in the critical care setting, improvements in functional outcomes post-TBI have been difficult to achieve. Diffusion-tensor imaging (DTI) allows detailed measurement of microstructural damage in regional brain tissue post-TBI, thus improving our understanding of the extent and severity of TBI. Twenty subjects were recruited from a neurological intensive care unit and compared to 18 healthy control subjects. Magnetic resonance imaging (MRI) scanning was performed on a 3.0-Tesla Siemens TIM Trio Scanner (Siemens Medical Solutions, Erlangen, Germany) including T1- and T2-weighted sequences and DTI. Images were processed using DTIStudio software. SAS (SAS Institute Inc., Cary, NC) was used for statistical analysis of group differences in 14 brain regions (25 regions of interests [ROIs]). Seventeen TBI subjects completed scanning. TBI and control subjects did not differ in age or sex. All TBI subjects had visible lesions on structural MRI. TBI subjects had seven brain regions (nine ROIs) that showed significant group differences on DTI metrics (fractional anisotropy, radial diffusion, or mean diffusion) compared to noninjured subjects, including the corpus callosum (genu and splenium), superior longitudinal fasciculus, internal capsule, right retrolenticular internal capsule, posterior corona radiata, and thalamus. However, 16 ROIs showed relatively normal DTI measures. Quantitative DTI demonstrates multiple areas of microstructual injury in specific normal-appearing white matter brain regions. DTI may be useful for assessing the extent of brain injury in patients with early moderate to severe TBI.
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Affiliation(s)
- Kristine H. O'Phelan
- Department of Neurology, Miller School of Medicine, University of Miami, Miami, Florida
| | - Chad K. Otoshi
- Department of Medicine, Neuroscience and MRI Research Program, John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu, Hawaii
| | - Thomas Ernst
- Department of Medicine, Neuroscience and MRI Research Program, John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu, Hawaii
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | - Linda Chang
- Department of Medicine, Neuroscience and MRI Research Program, John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu, Hawaii
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, Maryland
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Wright DK, O'Brien TJ, Mychasiuk R, Shultz SR. Telomere length and advanced diffusion MRI as biomarkers for repetitive mild traumatic brain injury in adolescent rats. Neuroimage Clin 2018; 18:315-324. [PMID: 29876252 PMCID: PMC5987845 DOI: 10.1016/j.nicl.2018.01.033] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Revised: 01/24/2018] [Accepted: 01/26/2018] [Indexed: 12/13/2022]
Abstract
Mild traumatic brain injuries (mTBI) are of worldwide concern in adolescents of both sexes, and repeated mTBI (RmTBI) may have serious long-term neurological consequences. As such, the study of RmTBI and discovery of objective biomarkers that can help guide medical decisions is an important undertaking. Diffusion-weighted MRI (DWI), which provides markers of axonal injury, and telomere length (TL) are two clinically relevant biomarkers that have been implicated in a number of neurological conditions, and may also be affected by RmTBI. Therefore, this study utilized the lateral impact injury model of RmTBI to investigate changes in diffusion MRI and TL, and how these changes relate to each other. Adolescent male and female rats received either three mTBIs or three sham injuries. The first injury was given on postnatal day 30 (P30), with the repeated injuries separated by four days each. Seven days after the final injury, a sample of ear tissue was collected for TL analysis. Rats were then euthanized and whole brains were collected and fixated for MRI analyses that included diffusion and high-resolution structural sequences. Compared to the sham-injured group, RmTBI rats had significantly shorter TL at seven days post-injury. Analysis of advanced DWI measures found that RmTBI rats had abnormalities in the corpus callosum and cortex at seven days post-injury. Notably, many of the DWI changes were correlated with TL. These findings demonstrate that TL and DWI measurements are changed by RmTBI and may represent clinically applicable biomarkers for this.
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Affiliation(s)
- David K Wright
- Department of Anatomy and Neuroscience, The University of Melbourne, Parkville, VIC 3010, Australia; The Florey Institute of Neuroscience and Mental Health, Parkville, VIC 3052, Australia; Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC 3004, Australia
| | - Terence J O'Brien
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC 3004, Australia; Department of Medicine, The Royal Melbourne Hospital, The University of Melbourne, VIC 3010, Australia
| | - Richelle Mychasiuk
- Alberta Children's Hospital Research Institute, University of Calgary, Department of Psychology, Calgary, AB, Canada
| | - Sandy R Shultz
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC 3004, Australia; Department of Medicine, The Royal Melbourne Hospital, The University of Melbourne, VIC 3010, Australia.
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Lancaster MA, Olson DV, McCrea MA, Nelson LD, LaRoche AA, Muftuler LT. Acute white matter changes following sport-related concussion: A serial diffusion tensor and diffusion kurtosis tensor imaging study. Hum Brain Mapp 2018; 37:3821-3834. [PMID: 27237455 DOI: 10.1002/hbm.23278] [Citation(s) in RCA: 78] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Revised: 05/05/2016] [Accepted: 05/23/2016] [Indexed: 01/23/2023] Open
Abstract
Recent neuroimaging studies have suggested that following sport-related concussion (SRC) physiological brain alterations may persist after an athlete has shown full symptom recovery. Diffusion MRI is a versatile technique to study white matter injury following SRC, yet serial follow-up studies in the very acute stages following SRC utilizing a comprehensive set of diffusion metrics are lacking. The aim of the current study was to characterize white matter changes within 24 hours of concussion in a group of high school and collegiate athletes, using Diffusion Tensor and Diffusion Kurtosis Tensor metrics. Participants were reassessed a week later. At 24 hours post-injury, the concussed group reported significantly more concussion symptoms than a well-matched control group and demonstrated poorer performance on a cognitive screening measure, yet these differences were nonsignificant at the 8-day follow-up. Similarly, within 24-hours after injury, the concussed group exhibited a widespread decrease in mean diffusivity, increased axial kurtosis and, to a lesser extent, decreased axial and radial diffusivities compared with control subjects. At 8 days post injury, the differences in these diffusion metrics were even more widespread in the injured athletes, despite improvement of symptoms and cognitive performance. These MRI findings suggest that the athletes might not have reached full physiological recovery a week after the injury. These findings have significant implications for the management of SRC because allowing an athlete to return to play before the brain has fully recovered from injury may have negative consequences. Hum Brain Mapp 37:3821-3834, 2016. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Melissa A Lancaster
- Department of Neurology, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, Wisconsin, 53226.,Department of Neurosurgery, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, Wisconsin, 53226
| | - Daniel V Olson
- Department of Biophysics, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, Wisconsin, 53226
| | - Michael A McCrea
- Department of Neurology, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, Wisconsin, 53226.,Department of Neurosurgery, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, Wisconsin, 53226
| | - Lindsay D Nelson
- Department of Neurology, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, Wisconsin, 53226.,Department of Neurosurgery, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, Wisconsin, 53226
| | - Ashley A LaRoche
- Department of Neurosurgery, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, Wisconsin, 53226
| | - L Tugan Muftuler
- Department of Neurosurgery, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, Wisconsin, 53226.
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Brooks MA, Bazarian JJ, Prichep LS, Dastidar SG, Talavage TM, Barr W. The Use of an Electrophysiological Brain Function Index in the Evaluation of Concussed Athletes. J Head Trauma Rehabil 2018; 33:1-6. [DOI: 10.1097/htr.0000000000000328] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Fidan E, Foley LM, New LA, Alexander H, Kochanek PM, Hitchens TK, Bayır H. Metabolic and Structural Imaging at 7 Tesla After Repetitive Mild Traumatic Brain Injury in Immature Rats. ASN Neuro 2018; 10:1759091418770543. [PMID: 29741097 PMCID: PMC5944144 DOI: 10.1177/1759091418770543] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Revised: 03/03/2018] [Accepted: 03/20/2018] [Indexed: 11/15/2022] Open
Abstract
Mild traumatic brain injury (mTBI) in children is a common and serious public health problem. Traditional neuroimaging findings in children who sustain mTBI are often normal, putting them at risk for repeated mTBI (rmTBI). There is a need for more sensitive imaging techniques capable of detecting subtle neurophysiological alterations after injury. We examined neurochemical and white matter changes using diffusion tensor imaging of the whole brain and proton magnetic resonance spectroscopy of the hippocampi at 7 Tesla in 18-day-old male rats at 7 days after mTBI and rmTBI. Traumatic axonal injury was assessed by beta-amyloid precursor protein accumulation using immunohistochemistry. A significant decrease in fractional anisotropy and increase in axial and radial diffusivity were observed in several brain regions, especially in white matter regions, after a single mTBI versus sham and more prominently after rmTBI. In addition, we observed accumulation of beta-amyloid precursor protein in the external capsule after mTBI and rmTBI. mTBI and rmTBI reduced the N-acetylaspartate/creatine ratio (NAA/Cr) and increased the myoinositol/creatine ratio (Ins/Cr) versus sham. rmTBI exacerbated the reduction in NAA/Cr versus mTBI. The choline/creatine (Cho/Cr) and (lipid/Macro Molecule 1)/creatine (Lip/Cr) ratios were also decreased after rmTBI versus sham. Diffusion tensor imaging findings along with the decrease in Cho and Lip after rmTBI may reflect damage to axonal membrane. NAA and Ins are altered at 7 days after mTBI and rmTBI likely reflecting neuro-axonal damage and glial response, respectively. These findings may be relevant to understanding the extent of disability following mTBI and rmTBI in the immature brain and may identify possible therapeutic targets.
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Affiliation(s)
- Emin Fidan
- Safar Center for Resuscitation Research, Department of Critical Care Medicine, University of Pittsburgh, PA, USA
| | - Lesley M. Foley
- Pittsburgh NMR Center for Biomedical Research, Carnegie Mellon University, PA, USA
- Animal Imaging Center, University of Pittsburgh, PA, USA
| | - Lee Ann New
- Safar Center for Resuscitation Research, Department of Critical Care Medicine, University of Pittsburgh, PA, USA
| | - Henry Alexander
- Safar Center for Resuscitation Research, Department of Critical Care Medicine, University of Pittsburgh, PA, USA
| | - Patrick M. Kochanek
- Safar Center for Resuscitation Research, Department of Critical Care Medicine, University of Pittsburgh, PA, USA
| | - T. Kevin Hitchens
- Pittsburgh NMR Center for Biomedical Research, Carnegie Mellon University, PA, USA
- Animal Imaging Center, University of Pittsburgh, PA, USA
| | - Hülya Bayır
- Safar Center for Resuscitation Research, Department of Critical Care Medicine, University of Pittsburgh, PA, USA
- Children's Neuroscience Institute
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España LY, Lee RM, Ling JM, Jeromin A, Mayer AR, Meier TB. Serial Assessment of Gray Matter Abnormalities after Sport-Related Concussion. J Neurotrauma 2017; 34:3143-3152. [DOI: 10.1089/neu.2017.5002] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Affiliation(s)
- Lezlie Y. España
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Ryan M. Lee
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Josef M. Ling
- The Mind Research Network/Lovelace Biomedical and Environmental Research Institute, Albuquerque, New Mexico
| | | | - Andrew R. Mayer
- The Mind Research Network/Lovelace Biomedical and Environmental Research Institute, Albuquerque, New Mexico
- Neurology Department, University of New Mexico School of Medicine, Albuquerque, New Mexico
- Department of Psychology, University of New Mexico, Albuquerque, New Mexico
| | - Timothy B. Meier
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin
- Department of Cell Biology, Neurobiology and Anatomy, Medical College of Wisconsin, Milwaukee, Wisconsin
- Laureate Institute for Brain Research, Tulsa, Oklahoma
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50
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Manning KY, Schranz A, Bartha R, Dekaban GA, Barreira C, Brown A, Fischer L, Asem K, Doherty TJ, Fraser DD, Holmes J, Menon RS. Multiparametric MRI changes persist beyond recovery in concussed adolescent hockey players. Neurology 2017; 89:2157-2166. [PMID: 29070666 PMCID: PMC5696642 DOI: 10.1212/wnl.0000000000004669] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Accepted: 09/06/2017] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVE To determine whether multiparametric MRI data can provide insight into the acute and long-lasting neuronal sequelae after a concussion in adolescent athletes. METHODS Players were recruited from Bantam hockey leagues in which body checking is first introduced (male, age 11-14 years). Clinical measures, diffusion metrics, resting-state network and region-to-region functional connectivity patterns, and magnetic resonance spectroscopy absolute metabolite concentrations were analyzed from an independent, age-matched control group of hockey players (n = 26) and longitudinally in concussed athletes within 24 to 72 hours (n = 17) and 3 months (n = 14) after a diagnosed concussion. RESULTS There were diffusion abnormalities within multiple white matter tracts, functional hyperconnectivity, and decreases in choline 3 months after concussion. Tract-specific spatial statistics revealed a large region along the superior longitudinal fasciculus with the largest decreases in diffusivity measures, which significantly correlated with clinical deficits. This region also spatially intersected with probabilistic tracts connecting cortical regions where we found acute functional connectivity changes. Hyperconnectivity patterns at 3 months after concussion were present only in players with relatively less severe clinical outcomes, higher choline concentrations, and diffusivity indicative of relatively less axonal disruption. CONCLUSIONS Changes persisted well after players' clinical scores had returned to normal and they had been cleared to return to play. Ongoing white matter maturation may make adolescent athletes particularly vulnerable to brain injury, and they may require extended recovery periods. The consequences of early brain injury for ongoing brain development and risk of more serious conditions such as second impact syndrome or neural degenerative processes need to be elucidated.
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Affiliation(s)
- Kathryn Y Manning
- From the Department of Medical Biophysics (K.Y.M., A.S., R.B., R.S.M.), Department of Microbiology and Immunology (G.A.D., C.B.), Department of Anatomy and Cell Biology (A.B), Department of Physical Medicine and Rehabilitation (T.J.D.), and School of Occupational Therapy (J.H.), University of Western Ontario; Centre for Functional and Metabolic Mapping (K.Y.M., R.B., R.S.M.) and Molecular Medicine (G.A.D., C.B., A.B.), Robarts Research Institute; Primary Care Sport Medicine (L.F., K.A.), Family Medicine, Fowler Kennedy Sport Medicine; and Paediatrics Critical Care Medicine (D.D.F.), London Health Sciences Centre, London, Ontario, Canada
| | - Amy Schranz
- From the Department of Medical Biophysics (K.Y.M., A.S., R.B., R.S.M.), Department of Microbiology and Immunology (G.A.D., C.B.), Department of Anatomy and Cell Biology (A.B), Department of Physical Medicine and Rehabilitation (T.J.D.), and School of Occupational Therapy (J.H.), University of Western Ontario; Centre for Functional and Metabolic Mapping (K.Y.M., R.B., R.S.M.) and Molecular Medicine (G.A.D., C.B., A.B.), Robarts Research Institute; Primary Care Sport Medicine (L.F., K.A.), Family Medicine, Fowler Kennedy Sport Medicine; and Paediatrics Critical Care Medicine (D.D.F.), London Health Sciences Centre, London, Ontario, Canada
| | - Robert Bartha
- From the Department of Medical Biophysics (K.Y.M., A.S., R.B., R.S.M.), Department of Microbiology and Immunology (G.A.D., C.B.), Department of Anatomy and Cell Biology (A.B), Department of Physical Medicine and Rehabilitation (T.J.D.), and School of Occupational Therapy (J.H.), University of Western Ontario; Centre for Functional and Metabolic Mapping (K.Y.M., R.B., R.S.M.) and Molecular Medicine (G.A.D., C.B., A.B.), Robarts Research Institute; Primary Care Sport Medicine (L.F., K.A.), Family Medicine, Fowler Kennedy Sport Medicine; and Paediatrics Critical Care Medicine (D.D.F.), London Health Sciences Centre, London, Ontario, Canada
| | - Gregory A Dekaban
- From the Department of Medical Biophysics (K.Y.M., A.S., R.B., R.S.M.), Department of Microbiology and Immunology (G.A.D., C.B.), Department of Anatomy and Cell Biology (A.B), Department of Physical Medicine and Rehabilitation (T.J.D.), and School of Occupational Therapy (J.H.), University of Western Ontario; Centre for Functional and Metabolic Mapping (K.Y.M., R.B., R.S.M.) and Molecular Medicine (G.A.D., C.B., A.B.), Robarts Research Institute; Primary Care Sport Medicine (L.F., K.A.), Family Medicine, Fowler Kennedy Sport Medicine; and Paediatrics Critical Care Medicine (D.D.F.), London Health Sciences Centre, London, Ontario, Canada
| | - Christy Barreira
- From the Department of Medical Biophysics (K.Y.M., A.S., R.B., R.S.M.), Department of Microbiology and Immunology (G.A.D., C.B.), Department of Anatomy and Cell Biology (A.B), Department of Physical Medicine and Rehabilitation (T.J.D.), and School of Occupational Therapy (J.H.), University of Western Ontario; Centre for Functional and Metabolic Mapping (K.Y.M., R.B., R.S.M.) and Molecular Medicine (G.A.D., C.B., A.B.), Robarts Research Institute; Primary Care Sport Medicine (L.F., K.A.), Family Medicine, Fowler Kennedy Sport Medicine; and Paediatrics Critical Care Medicine (D.D.F.), London Health Sciences Centre, London, Ontario, Canada
| | - Arthur Brown
- From the Department of Medical Biophysics (K.Y.M., A.S., R.B., R.S.M.), Department of Microbiology and Immunology (G.A.D., C.B.), Department of Anatomy and Cell Biology (A.B), Department of Physical Medicine and Rehabilitation (T.J.D.), and School of Occupational Therapy (J.H.), University of Western Ontario; Centre for Functional and Metabolic Mapping (K.Y.M., R.B., R.S.M.) and Molecular Medicine (G.A.D., C.B., A.B.), Robarts Research Institute; Primary Care Sport Medicine (L.F., K.A.), Family Medicine, Fowler Kennedy Sport Medicine; and Paediatrics Critical Care Medicine (D.D.F.), London Health Sciences Centre, London, Ontario, Canada
| | - Lisa Fischer
- From the Department of Medical Biophysics (K.Y.M., A.S., R.B., R.S.M.), Department of Microbiology and Immunology (G.A.D., C.B.), Department of Anatomy and Cell Biology (A.B), Department of Physical Medicine and Rehabilitation (T.J.D.), and School of Occupational Therapy (J.H.), University of Western Ontario; Centre for Functional and Metabolic Mapping (K.Y.M., R.B., R.S.M.) and Molecular Medicine (G.A.D., C.B., A.B.), Robarts Research Institute; Primary Care Sport Medicine (L.F., K.A.), Family Medicine, Fowler Kennedy Sport Medicine; and Paediatrics Critical Care Medicine (D.D.F.), London Health Sciences Centre, London, Ontario, Canada
| | - Kevin Asem
- From the Department of Medical Biophysics (K.Y.M., A.S., R.B., R.S.M.), Department of Microbiology and Immunology (G.A.D., C.B.), Department of Anatomy and Cell Biology (A.B), Department of Physical Medicine and Rehabilitation (T.J.D.), and School of Occupational Therapy (J.H.), University of Western Ontario; Centre for Functional and Metabolic Mapping (K.Y.M., R.B., R.S.M.) and Molecular Medicine (G.A.D., C.B., A.B.), Robarts Research Institute; Primary Care Sport Medicine (L.F., K.A.), Family Medicine, Fowler Kennedy Sport Medicine; and Paediatrics Critical Care Medicine (D.D.F.), London Health Sciences Centre, London, Ontario, Canada
| | - Timothy J Doherty
- From the Department of Medical Biophysics (K.Y.M., A.S., R.B., R.S.M.), Department of Microbiology and Immunology (G.A.D., C.B.), Department of Anatomy and Cell Biology (A.B), Department of Physical Medicine and Rehabilitation (T.J.D.), and School of Occupational Therapy (J.H.), University of Western Ontario; Centre for Functional and Metabolic Mapping (K.Y.M., R.B., R.S.M.) and Molecular Medicine (G.A.D., C.B., A.B.), Robarts Research Institute; Primary Care Sport Medicine (L.F., K.A.), Family Medicine, Fowler Kennedy Sport Medicine; and Paediatrics Critical Care Medicine (D.D.F.), London Health Sciences Centre, London, Ontario, Canada
| | - Douglas D Fraser
- From the Department of Medical Biophysics (K.Y.M., A.S., R.B., R.S.M.), Department of Microbiology and Immunology (G.A.D., C.B.), Department of Anatomy and Cell Biology (A.B), Department of Physical Medicine and Rehabilitation (T.J.D.), and School of Occupational Therapy (J.H.), University of Western Ontario; Centre for Functional and Metabolic Mapping (K.Y.M., R.B., R.S.M.) and Molecular Medicine (G.A.D., C.B., A.B.), Robarts Research Institute; Primary Care Sport Medicine (L.F., K.A.), Family Medicine, Fowler Kennedy Sport Medicine; and Paediatrics Critical Care Medicine (D.D.F.), London Health Sciences Centre, London, Ontario, Canada
| | - Jeff Holmes
- From the Department of Medical Biophysics (K.Y.M., A.S., R.B., R.S.M.), Department of Microbiology and Immunology (G.A.D., C.B.), Department of Anatomy and Cell Biology (A.B), Department of Physical Medicine and Rehabilitation (T.J.D.), and School of Occupational Therapy (J.H.), University of Western Ontario; Centre for Functional and Metabolic Mapping (K.Y.M., R.B., R.S.M.) and Molecular Medicine (G.A.D., C.B., A.B.), Robarts Research Institute; Primary Care Sport Medicine (L.F., K.A.), Family Medicine, Fowler Kennedy Sport Medicine; and Paediatrics Critical Care Medicine (D.D.F.), London Health Sciences Centre, London, Ontario, Canada
| | - Ravi S Menon
- From the Department of Medical Biophysics (K.Y.M., A.S., R.B., R.S.M.), Department of Microbiology and Immunology (G.A.D., C.B.), Department of Anatomy and Cell Biology (A.B), Department of Physical Medicine and Rehabilitation (T.J.D.), and School of Occupational Therapy (J.H.), University of Western Ontario; Centre for Functional and Metabolic Mapping (K.Y.M., R.B., R.S.M.) and Molecular Medicine (G.A.D., C.B., A.B.), Robarts Research Institute; Primary Care Sport Medicine (L.F., K.A.), Family Medicine, Fowler Kennedy Sport Medicine; and Paediatrics Critical Care Medicine (D.D.F.), London Health Sciences Centre, London, Ontario, Canada.
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