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Lee J, Baniewicz E, Peterkin NL, Greenman D, Griffin AD, Jikaria N, Turtzo LC, Luby M, Latour LL. Edema progression in proximity to traumatic microbleeds: evolution of cytotoxic and vasogenic edema on serial MRI. Neuroimage Rep 2024; 4:100199. [PMID: 38558768 PMCID: PMC10976922 DOI: 10.1016/j.ynirp.2024.100199] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
Introduction Although cerebral edema is common following traumatic brain injury (TBI), its formation and progression are poorly understood. This is especially true for the mild TBI population, who rarely undergo magnetic resonance imaging (MRI) studies, which can pick up subtle structural details not visualized on computed tomography, in the first few days after injury. This study aimed to visually classify and quantitatively measure edema progression in relation to traumatic microbleeds (TMBs) in a cohort of primarily mild TBI patients up to 30 days after injury. Researchers hypothesized that hypointense lesions on Apparent Diffusion Coefficient (ADC) detected acutely after injury would evolve into hyperintense Fluid Attenuated Inversion Recover (FLAIR) lesions. Methods This study analyzed the progression of cerebral edema after acute injury using multimodal MRI to classify TMBs as potential edema-related biomarkers. ADC and FLAIR MRI were utilized for edema classification at three different timepoints: ≤48 hours, ~1 week, and 30 days after injury. Hypointense lesions on ADC (ADC+) suggested the presence of cytotoxic edema while hyperintense lesions on FLAIR (FLAIR+) suggested vasogenic edema. Signal intensity Ratio (SIR) calculations were made using ADC and FLAIR to quantitatively confirm edema progression. Results Our results indicated the presence of ADC+ lesions ≤48 hours and ~1 week were associated with FLAIR+ lesions at ~1 week and 30 days, respectively, suggesting some progression of cytotoxic edema to vasogenic edema over time. Ten out of 15 FLAIR+ lesions at 30 days (67%) were ADC+ ≤48 hours. However, ADC+ lesions ≤48 hours were not associated with FLAIR+ lesions at 30 days; 10 out of 25 (40%) ADC+ lesions ≤48 hours were FLAIR+ at 30 days, which could indicate that some lesions resolved or were not visualized due to associated atrophy or tissue necrosis. Quantitative analysis confirmed the visual progression of some TMB lesions from ADC+ to FLAIR+. FLAIR SIRs at ~1 week were significantly higher when lesions were ADC+ ≤48 hours (1.22 [1.08-1.32] vs 1.03 [0.97-1.11], p=0.002). Conclusion Awareness of how cerebral edema can evolve in proximity to TMBs acutely after injury may facilitate identification and monitoring of patients with traumatic cerebrovascular injury and assist in development of novel therapeutic strategies.
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Affiliation(s)
- Jacquie Lee
- Acute Cerebrovascular Diagnostics Unit, National Institute of Neurological Disorders and Stroke, Bethesda (MD), United States
- American University, Washington (DC), United States
| | - Emily Baniewicz
- Acute Cerebrovascular Diagnostics Unit, National Institute of Neurological Disorders and Stroke, Bethesda (MD), United States
| | - Nicole L. Peterkin
- Acute Cerebrovascular Diagnostics Unit, National Institute of Neurological Disorders and Stroke, Bethesda (MD), United States
| | - Danielle Greenman
- Acute Cerebrovascular Diagnostics Unit, National Institute of Neurological Disorders and Stroke, Bethesda (MD), United States
- University of California Riverside, Department of Psychology, Riverside, (CA), United States
| | - Allison D. Griffin
- Acute Cerebrovascular Diagnostics Unit, National Institute of Neurological Disorders and Stroke, Bethesda (MD), United States
- Vanderbilt University Institute of Imaging Science, Department of Radiology & Radiological Sciences, Nashville, (TN), United States
| | - Neekita Jikaria
- Acute Cerebrovascular Diagnostics Unit, National Institute of Neurological Disorders and Stroke, Bethesda (MD), United States
- Penn State College of Medicine, Department of Surgery, Hershey, (PA), United States
| | - L. Christine Turtzo
- Acute Cerebrovascular Diagnostics Unit, National Institute of Neurological Disorders and Stroke, Bethesda (MD), United States
| | - Marie Luby
- Acute Cerebrovascular Diagnostics Unit, National Institute of Neurological Disorders and Stroke, Bethesda (MD), United States
| | - Lawrence L. Latour
- Acute Cerebrovascular Diagnostics Unit, National Institute of Neurological Disorders and Stroke, Bethesda (MD), United States
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Torres MB, Schaefer EW, Jikaria N, Ortenzi G, Cooper AB. Does the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) accurately predict mortality for patients with elevated MELD scores? Am J Surg 2022; 224:475-482. [DOI: 10.1016/j.amjsurg.2022.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 12/27/2021] [Accepted: 01/19/2022] [Indexed: 11/29/2022]
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Turtzo LC, Luby M, Jikaria N, Griffin AD, Greenman D, Bokkers RPH, Parikh G, Peterkin N, Whiting M, Latour LL. Cytotoxic Edema Associated with Hemorrhage Predicts Poor Outcome after Traumatic Brain Injury. J Neurotrauma 2021; 38:3107-3118. [PMID: 34541886 DOI: 10.1089/neu.2021.0037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Magnetic resonance imaging (MRI) is used rarely in the acute evaluation of traumatic brain injury (TBI) but may identify findings of clinical importance not detected by computed tomography (CT). We aimed to characterize the association of cytotoxic edema and hemorrhage, including traumatic microbleeds, on MRI obtained within hours of acute head trauma and investigated the relationship to clinical outcomes. Patients prospectively enrolled in the Traumatic Head Injury Neuroimaging Classification study (NCT01132937) with evidence of diffusion-related findings or hemorrhage on neuroimaging were included. Blinded interpretation of MRI for diffusion-weighted lesions and hemorrhage was conducted, with subsequent quantification of apparent diffusion coefficient (ADC) values. Of 161 who met criteria, 82 patients had conspicuous hyperintense lesions on diffusion-weighted imaging (DWI) with corresponding regions of hypointense ADC in proximity to hemorrhage. Median time from injury to MRI was 21 (10-30) h. Median ADC values per patient grouped by time from injury to MRI were lowest within 24 h after injury. The ADC values associated with hemorrhagic lesions are lowest early after injury, with an increase in diffusion during the subacute period, suggesting transformation from cytotoxic to vasogenic edema during the subacute post-injury period. Of 118 patients with outcome data, 60 had Glasgow Outcome Scale Extended scores ≤6 at 30/90 days post-injury. Cytotoxic edema on MRI (odds ratio [OR] 2.91 [1.32-6.37], p = 0.008) and TBI severity (OR 2.51 [1.32-4.74], p = 0.005) were independent predictors of outcome. These findings suggest that in patients with TBI who had findings of hemorrhage on CT, patients with DWI/ADC lesions on MRI are more likely to do worse.
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Affiliation(s)
- L Christine Turtzo
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland, USA
| | - Marie Luby
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland, USA
| | - Neekita Jikaria
- Center for Neuroscience and Regenerative Medicine, Bethesda, Maryland, USA
| | | | - Danielle Greenman
- Center for Neuroscience and Regenerative Medicine, Bethesda, Maryland, USA
| | - Reinoud P H Bokkers
- Department of Radiology, Medical Imaging Center, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Gunjan Parikh
- R Adams Shock Trauma Center and University of Maryland School of Medicine, Baltimore, Maryland, USA.,Division of Neurocritical Care and Emergency Neurology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Nicole Peterkin
- Center for Neuroscience and Regenerative Medicine, Bethesda, Maryland, USA
| | - Mark Whiting
- Center for Neuroscience and Regenerative Medicine, Bethesda, Maryland, USA
| | - Lawrence L Latour
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland, USA.,Center for Neuroscience and Regenerative Medicine, Bethesda, Maryland, USA
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Turtzo LC, Jikaria N, Cota MR, Williford JP, Uche V, Davis T, MacLaren J, Moses AD, Parikh G, Castro MA, Pham DL, Butman JA, Latour LL. Meningeal blood-brain barrier disruption in acute traumatic brain injury. Brain Commun 2020; 2:fcaa143. [PMID: 33829156 DOI: 10.1093/braincomms/fcaa143] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [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: 02/13/2020] [Revised: 07/21/2020] [Accepted: 08/03/2020] [Indexed: 01/27/2023] Open
Abstract
The meninges serve as a functional barrier surrounding the brain, critical to the immune response, and can be compromised following head trauma. Meningeal enhancement can be detected on contrast-enhanced MRI in patients presenting with acute traumatic brain injury, even when head CT is negative. Following head trauma, gadolinium-based contrast appears to extravasate from the vasculature, enhancing the dura within minutes, and later permeates the subarachnoid space. The aims of this study were to characterize the initial kinetics of the uptake of contrast agent after injury and the delayed redistribution of contrast enhancement in the subarachnoid space in hyperacute patients. Neuroimaging was obtained prospectively in two large ongoing observational studies of patients aged 18 years or older presenting to the emergency department with suspected acute head injury. Dynamic contrast-enhanced MRI studies in a cohort of consecutively enrolling patients with mild traumatic brain injury (n = 36) determined that the kinetic half-life of dural-related meningeal enhancement was 1.3 ± 0.6 min (95% enhancement within 6 min). The extravasation of contrast into the subarachnoid space was investigated in a cohort of CT negative mild traumatic brain injury patients initially imaged within 6 h of injury (hyperacute) who subsequently underwent a delayed MRI, with no additional contrast administration, several hours after the initial MRI. Of the 32 patients with delayed post-contrast imaging, 18 (56%) had conspicuous expansion of the contrast enhancement into the subarachnoid space, predominantly along the falx and superior sagittal sinus. Patients negative for traumatic meningeal enhancement on initial hyperacute MRI continued to have no evidence of meningeal enhancement on the delayed MRI. These studies demonstrate that (i) the initial enhancement of the traumatically injured meninges occurs within minutes of contrast injection, suggesting highly permeable meningeal vasculature, and that (ii) contrast in the meninges redistributes within the subarachnoid space over the period of hours, suggesting a compromise in the blood-brain and/or blood-cerebrospinal barriers. Data from the parent study indicate that up to one in two patients with mild traumatic brain injury have traumatic brain injury on acute (<48 h) MRI, with a higher prevalence seen in patients with moderate or severe traumatic brain injury. The current study's findings of traumatic meningeal enhancement and the subsequent delayed extravasation of contrast into the subarachnoid spaces indicate that a substantial percentage of patients with even mild traumatic brain injury may have a transient disruption in barriers separating the vasculature from the brain.
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Affiliation(s)
- Lisa Christine Turtzo
- Acute Cerebrovascular Diagnostics Unit, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD 20892, USA
| | - Neekita Jikaria
- Center for Neuroscience and Regenerative Medicine, Bethesda, MD 20814, USA
| | - Martin R Cota
- Center for Neuroscience and Regenerative Medicine, Bethesda, MD 20814, USA
| | | | - Victoria Uche
- Center for Neuroscience and Regenerative Medicine, Bethesda, MD 20814, USA
| | - Tara Davis
- Johns Hopkins Suburban Hospital, Bethesda, MD 20814, USA
| | - Judy MacLaren
- Johns Hopkins Suburban Hospital, Bethesda, MD 20814, USA
| | - Anita D Moses
- Center for Neuroscience and Regenerative Medicine, Bethesda, MD 20814, USA
| | - Gunjan Parikh
- R Adams Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD 21201, USA
| | - Marcelo A Castro
- Center for Neuroscience and Regenerative Medicine, Bethesda, MD 20814, USA
| | - Dzung L Pham
- Center for Neuroscience and Regenerative Medicine, Bethesda, MD 20814, USA
| | - John A Butman
- Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, MD 20892, USA
| | - Lawrence L Latour
- Acute Cerebrovascular Diagnostics Unit, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD 20892, USA
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Kovacs ZI, Tu TW, Sundby M, Qureshi F, Lewis BK, Jikaria N, Burks SR, Frank JA. MRI and histological evaluation of pulsed focused ultrasound and microbubbles treatment effects in the brain. Theranostics 2018; 8:4837-4855. [PMID: 30279741 PMCID: PMC6160777 DOI: 10.7150/thno.24512] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [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: 12/22/2017] [Accepted: 07/26/2018] [Indexed: 12/12/2022] Open
Abstract
Magnetic resonance imaging (MRI)-guided pulsed focused ultrasound (pFUS) combined with microbubbles (MB) contrast agent infusion has been shown to transiently disrupt the blood-brain barrier (BBBD), increasing the delivery of neurotherapeutics to treat central nervous system (CNS) diseases. pFUS interaction with the intravascular MB results in acoustic cavitation forces passing through the neurovascular unit (NVU), inducing BBBD detected on contrast-enhanced MRI. Multiple pFUS+MB exposures in Alzheimer's disease (AD) models are being investigated as a method to clear amyloid plaques by activated microglia or infiltrating immune cells. Since it has been reported that pFUS+MB can induce a sterile inflammatory response (SIR) [1-5] in the rat, the goal of this study was to investigate the potential long-term effects of SIR in the brain following single and six weekly sonications by serial high-resolution MRI and pathology. Methods: Female Sprague Dawley rats weighing 217±16.6 g prior to sonication received bromo-deoxyuridine (BrdU) to tag proliferating cells in the brain. pFUS was performed at 548 kHz, ultrasound burst 10 ms and initial peak negative pressure of 0.3 MPa (in water) for 120 s coupled with a slow infusion of ~460 µL/kg (5-8×107 MB) that started 30 s before and 30 s during sonication. Nine 2 mm focal regions in the left cortex and four regions over the right hippocampus were treated with pFUS+MB. Serial high-resolution brain MRIs at 3 T and 9.4 T were obtained following a single or during the course of six weekly pFUS+MB resulting in BBBD in the left cortex and the right hippocampus. Animals were monitored over 7 to 13 weeks and imaging results were compared to histology. Results: Fewer than half of the rats receiving a single pFUS+MB exposure displayed hypointense voxels on T2*-weighted (w) MRI at week 7 or 13 in the cortex or hippocampus without differences compared to the contralateral side on histograms of T2* maps. Single sonicated rats had evidence of limited microglia activation on pathology compared to the contralateral hemisphere. Six weekly pFUS+MB treatments resulted in pathological changes on T2*w images with multiple hypointense regions, cortical atrophy, along with 50% of rats having persistent BBBD and astrogliosis by MRI. Pathologic analysis of the multiple sonicated animals demonstrated the presence of metallophagocytic Prussian blue-positive cells in the parenchyma with significantly (p<0.05) increased areas of activated astrocytes and microglia, and high numbers of systemic infiltrating CD68+ macrophages along with BrdU+ cells compared to contralateral brain. In addition, multiple treatments caused an increase in the number of hyperphosphorylated Tau (pTau)-positive neurons containing neurofibrillary tangles (NFT) in the sonicated cortex but not in the hippocampus when compared to contralateral brain, which was confirmed by Western blot (WB) (p<0.04). Conclusions: The repeated SIR following multiple pFUS+MB treatments could contribute to changes on MR imaging including persistent BBBD, cortical atrophy, and hypointense voxels on T2w and T2*w images consistent with pathological injury. Moreover, areas of astrogliosis, activated microglia, along with higher numbers of CD68+ infiltrating macrophages and BrdU+ cells were detected in multiple sonicated areas of the cortex and hippocampus. Elevations in pTau and NFT were detected in neurons of the multiple sonicated cortex. Minimal changes on MRI and histology were observed in single pFUS+MB-treated rats at 7 and 13 weeks post sonication. In comparison, animals that received 6 weekly sonications demonstrated evidence on MRI and histology of vascular damage, inflammation and neurodegeneration associated with the NVU commonly observed in trauma. Further investigation is recommended of the long-term effects of multiple pFUS+MB in clinical trials.
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Tu TW, Ibrahim WG, Jikaria N, Munasinghe JP, Witko JA, Hammoud DA, Frank JA. On the detection of cerebral metabolic depression in experimental traumatic brain injury using Chemical Exchange Saturation Transfer (CEST)-weighted MRI. Sci Rep 2018; 8:669. [PMID: 29330386 PMCID: PMC5766554 DOI: 10.1038/s41598-017-19094-z] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Accepted: 12/21/2017] [Indexed: 12/13/2022] Open
Abstract
Metabolic abnormalities are commonly observed in traumatic brain injury (TBI) patients exhibiting long-term neurological deficits. This study investigated the feasibility and reproducibility of using chemical exchange saturation transfer (CEST) MRI to detect cerebral metabolic depression in experimental TBI. Phantom and in vivo CEST experiments were conducted at 9.4 Tesla to optimize the selective saturation for enhancing the endogenous contrast-weighting of the proton exchanges over the range of glucose proton chemical shifts (glucoCEST) in the resting rat brain. The optimized glucoCEST-weighted imaging was performed on a closed-head model of diffuse TBI in rats with 2-deoxy-D-[14C]-glucose (2DG) autoradiography validation. The results demonstrated that saturation duration of 1‒2 seconds at pulse powers 1.5‒2µT resulted in an improved contrast-to-noise ratio between the gray and white matter comparable to 2DG autoradiographs. The intrasubject (n = 4) and intersubject (n = 3) coefficient of variations for repeated glucoCEST acquisitions (n = 4) ranged between 8‒16%. Optimization for the TBI study revealed that glucoCEST-weighted images with 1.5μT power and 1 s saturation duration revealed the greatest changes in contrast before and after TBI, and positively correlated with 2DG autoradiograph (r = 0.78, p < 0.01, n = 6) observations. These results demonstrate that glucoCEST-weighted imaging may be useful in detecting metabolic abnormalities following TBI.
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Affiliation(s)
- Tsang-Wei Tu
- Frank Laboratory, Radiology & Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, MD, United States. .,Center for Neuroscience and Regenerative Medicine, Henry Jackson Foundation, Bethesda, MD, United States. .,Molecular Imaging Laboratory, Department of Radiology, Howard University, Washington, DC, United States.
| | - Wael G Ibrahim
- Center for Infectious Disease Imaging, Radiology & Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, MD, United States
| | - Neekita Jikaria
- Frank Laboratory, Radiology & Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, MD, United States.,Center for Neuroscience and Regenerative Medicine, Henry Jackson Foundation, Bethesda, MD, United States.,Acute Stroke Research Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, United States
| | - Jeeva P Munasinghe
- Mouse Imaging Facility, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, United States
| | - Jaclyn A Witko
- Frank Laboratory, Radiology & Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, MD, United States.,Center for Neuroscience and Regenerative Medicine, Henry Jackson Foundation, Bethesda, MD, United States
| | - Dima A Hammoud
- Center for Infectious Disease Imaging, Radiology & Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, MD, United States
| | - Joseph A Frank
- Frank Laboratory, Radiology & Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, MD, United States.,National Institute of Biomedical Imaging and Bioengineering, National Institutes of Health, Bethesda, MD, United States
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Fowlkes B, Ghanouni P, Sanghvi N, Coussios C, Lyon PC, Gray M, Mannaris C, Victor MDS, Stride E, Cleveland R, Carlisle R, Wu F, Middleton M, Gleeson F, Aubry JF, Pauly KB, Moonen C, Vortman J, Ghanouni P, Sharabi S, Daniels D, Last D, Guez D, Levy Y, Volovick A, Grinfeld J, Rachmilevich I, Amar T, Zibly Z, Mardor Y, Harnof S, Plaksin M, Weissler Y, Shoham S, Kimmel E, Naor O, Farah N, Shoham S, Paeng DG, Xu Z, Snell J, Quigg AH, Eames M, Jin C, Everstine AC, Sheehan JP, Lopes BS, Kassell N, Looi T, Khokhlova V, Mougenot C, Hynynen K, Drake J, Slayton M, Amodei RC, Compton K, McNelly A, Latt D, Slayton M, Amodei RC, Compton K, Kearney J, Melodelima D, Dupre A, Chen Y, Perol D, Vincenot J, Chapelon JY, Rivoire M, Guo W, Ren G, Shen G, Neidrauer M, Zubkov L, Weingarten MS, Margolis DJ, Lewin PA, McDannold N, Sutton J, Vykhodtseva N, Livingstone M, Kobus T, Zhang YZ, Vykhodtseva N, McDannold N, Schwartz M, Huang Y, Lipsman N, Jain J, Chapman M, Sankar T, Lozano A, Hynynen K, Schwartz M, Yeung R, Huang Y, Lipsman N, Jain J, Chapman M, Lozano A, Hynynen K, Damianou C, Papadopoulos N, Volovick A, Grinfeld J, Levy Y, Brokman O, Zadicario E, Brenner O, Castel D, Wu SY, Grondin J, Zheng W, Heidmann M, Karakatsani ME, Sánchez CJS, Ferrera V, Konofagou EE, Damianou C, Yiannakou M, Cho H, Lee H, Han M, Choi JR, Lee T, Ahn S, Chang Y, Park J, Ellens N, Partanen A, Farahani K, Airan R, Carpentier A, Canney M, Vignot A, Lafon C, Chapelon JY, Delattre JY, Idbaih A, Odéen H, Bolster B, Jeong EK, Parker DL, Gaur P, Feng X, Fielden S, Meyer C, Werner B, Grissom W, Marx M, Ghanouni P, Pauly KB, Weber H, Taviani V, Pauly KB, Ghanouni P, Hargreaves B, Tanaka J, Kikuchi K, Ishijima A, Azuma T, Minamihata K, Yamaguchi S, Nagamune T, Sakuma I, Takagi S, Santin MD, Marsac L, Maimbourg G, Monfort M, Larrat B, François C, Lehéricy S, Tanter M, Aubry JF, Karakatsani ME, Samiotaki G, Wang S, Acosta C, Feinberg ER, Konofagou EE, Kovacs ZI, Tu TW, Papadakis GZ, Reid WC, Hammoud DA, Frank JA, Kovacs ZI, Kim S, Jikaria N, Bresler M, Qureshi F, Frank JA, Xia J, Tsui PS, Liu HL, Plata JC, Fielden S, Sveinsson B, Hargreaves B, Meyer C, Pauly KB, Plata JC, Salgaonkar VA, Adams M, Diederich C, Ozhinsky E, Bucknor MD, Rieke V, Partanen A, Mikhail A, Severance L, Negussie AH, Wood B, de Greef M, Schubert G, Moonen C, Ries M, Poorman ME, Dockery M, Chaplin V, Dudzinski SO, Spears R, Caskey C, Giorgio T, Grissom W, Costa MM, Papaevangelou E, Shah A, Rivens I, Box C, Bamber J, ter Haar G, Burks SR, Nagle M, Nguyen B, Bresler M, Frank JA, Burks SR, Nagle M, Nguyen B, Bresler M, Kim S, Milo B, Frank JA, Le NM, Song S, Zhou K, Nabi G, Huang Z, Ben-Ezra S, Rosen S, Mihcin S, Strehlow J, Karakitsios I, Le N, Schwenke M, Demedts D, Prentice P, Haase S, Preusser T, Melzer A, Mestas JL, Chettab K, Gomez GS, Dumontet C, Werle B, Lafon C, Marquet F, Bour P, Vaillant F, Amraoui S, Dubois R, Ritter P, Haïssaguerre M, Hocini M, Bernus O, Quesson B, Livneh A, Kimmel E, Adam D, Robin J, Arnal B, Fink M, Tanter M, Pernot M, Khokhlova TD, Schade GR, Wang YN, Kreider W, Simon J, Starr F, Karzova M, Maxwell A, Bailey MR, Khokhlova V, Lundt JE, Allen SP, Sukovich JR, Hall T, Xu Z, Schade GR, Wang YN, Khokhlova TD, May P, Lin DW, Bailey MR, Khokhlova V, Constans C, Deffieux T, Tanter M, Aubry JF, Park EJ, Ahn YD, Kang SY, Park DH, Lee JY, Vidal-Jove J, Perich E, Ruiz A, Jaen A, Eres N, del Castillo MA, Myers R, Kwan J, Coviello C, Rowe C, Crake C, Finn S, Jackson E, Carlisle R, Coussios C, Pouliopoulos A, Li C, Tinguely M, Tang MX, Garbin V, Choi JJ, Lyon PC, Mannaris C, Gray M, Folkes L, Stratford M, Carlisle R, Wu F, Middleton M, Gleeson F, Coussios C, Nwokeoha S, Carlisle R, Cleveland R, Wang YN, Khokhlova TD, Li T, Farr N, D’Andrea S, Starr F, Gravelle K, Chen H, Partanen A, Lee D, Hwang JH, Tardoski S, Ngo J, Gineyts E, Roux JP, Clézardin P, Melodelima D, Conti A, Magnin R, Gerstenmayer M, Lux F, Tillement O, Mériaux S, Penna SD, Romani GL, Dumont E, Larrat B, Sun T, Power C, Zhang YZ, Sutton J, Miller E, McDannold N, Sapozhnikov O, Tsysar S, Yuldashev PV, Khokhlova V, Svet V, Kreider W, Li D, Pellegrino A, Petrinic N, Siviour C, Jerusalem A, Cleveland R, Yuldashev PV, Karzova M, Cunitz BW, Dunmire B, Kreider W, Sapozhnikov O, Bailey MR, Khokhlova V, Inserra C, Guedra M, Mauger C, Gilles B, Solovchuk M, Sheu TWH, Thiriet M, Zhou Y, Neufeld E, Baumgartner C, Payne D, Kyriakou A, Kuster N, Xiao X, McLeod H, Melzer A, Dillon C, Rieke V, Ghanouni P, Parker DL, Payne A, Khokhova VA, Yuldashev PV, Sinilshchikov I, Andriyakhina Y, Khokhlova TD, Kreider W, Maxwell A, Sapozhnikov O, Partanen A, Rybyanets A, Shvetsova N, Berkovich A, Shvetsov I, Sapozhnikov O, Khokhlova V, Shaw CJ, Rivens I, Civale J, Giussani D, ter Haar G, Lees C, Bour P, Marquet F, Ozenne V, Toupin S, Quesson B, Dumont E, Ozhinsky E, Salgaonkar V, Diederich C, Rieke V, Kaye E, Monette S, Maybody M, Srimathveeravalli G, Solomon S, Gulati A, Preusser T, Haase S, Bezzi M, Jenne JW, Lango T, Levy Y, Müller M, Sat G, Tanner C, Zangos S, Günther M, Melzer A, Lafon C, Dinh AH, Niaf E, Bratan F, Guillen N, Souchon R, Lartizien C, Crouzet S, Rouviere O, Chapelon JY, Han Y, Wang S, Konofagou EE, Payen T, Palermo C, Sastra S, Chen H, Han Y, Olive K, Konofagou EE, van Breugel JM, de Greef M, Mougenot C, van den Bosch MA, Moonen C, Ries M, Gerstenmayer M, Magnin R, Fellah B, Le Bihan D, Larrat B, Gerstenmayer M, Magnin R, Mériaux S, Le Bihan D, Larrat B, Allen SP, Hernandez-Garcia L, Cain CA, Hall T, Lyka E, Elbes D, Coviello C, Cleveland R, Coussios C, Zhou K, Le NM, Li C, Huang Z, Tamano S, Jimbo H, Azuma T, Yoshizawa S, Fujiwara K, Itani K, Umemura SI, Damianou C, Yiannakou M, Ellens N, Partanen A, Stoianovici D, Farahani K, Zaini Z, Takagi R, Yoshizawa S, Umemura SI, Zong S, Shen G, Watkins R, Pascal-Tenorio A, Adams M, Plata JC, Salgaonkar V, Jones P, Butts-Pauly K, Diederich C, Bouley D, Rybyanets A, Ren G, Guo W, Shen G, Chen Y, Lin CY, Hsieh HY, Wei KC, Liu HL, Garnier C, Renault G, Farr N, Partanen A, Negussie AH, Mikhail A, Seifabadi R, Wilson E, Eranki A, Kim P, Wood B, Lübke D, Jenne JW, Huber P, Günther M, Lübke D, Georgii J, Schwenke M, Dresky CV, Haller J, Günther M, Preusser T, Jenne JW, Eranki A, Farr N, Partanen A, Yarmolenko P, Negussie AH, Sharma K, Celik H, Wood B, Kim P, Li G, Qiu W, Zheng H, Tsai MY, Chu PC, Liu HL, Webb T, Vyas U, Pauly KB, Walker M, Zhong J, Looi T, Waspe AC, Drake J, Hodaie M, Yang FY, Huang SL, Zur Y, Volovick A, Assif B, Aurup C, Kamimura H, Wang S, Chen H, Acosta C, Carneiro AA, Konofagou EE, Volovick A, Grinfeld J, Castel D, Rothlübbers S, Schwaab J, Tanner C, Mihcin S, Houston G, Günther M, Jenne JW, Ozhinsky E, Bucknor MD, Rieke V, Azhari H, Weiss N, Sosna J, Goldberg SN, Barrere V, Melodelima D, Jang KW, Burks SR, Kovacs ZI, Tu TW, Lewis B, Kim S, Nagle M, Jikaria N, Frank JA, Zhou Y, Wang X, Ahn YD, Park EJ, Park DH, Kang SY, Lee JY, Suomi V, Konofagou EE, Edwards D, Cleveland R, Larrabee Z, Eames M, Hananel A, Aubry JF, Rafaely B, Volovick A, Grinfeld J, Kimmel E, Debbiny RE, Dekel CZ, Assa M, Kimmel E, Menikou G, Damianou C, Mouratidis P, Rivens I, ter Haar G, Pineda-Pardo JA, de Pedro MDÁ, Martinez R, Hernandez F, Casas S, Oliver C, Pastor P, Vela L, Obeso J, Greillier P, Zorgani A, Souchon R, Melodelima D, Catheline S, Lafon C, Solovov V, Vozdvizhenskiy MO, Orlov AE, Wu CH, Sun MK, Shih TT, Chen WS, Prieur F, Pillon A, Mestas JL, Cartron V, Cebe P, Chansard N, Lafond M, Lafon C, Inserra C, Seya PM, Chen WS, Bera JC, Boissenot T, Larrat B, Fattal E, Bordat A, Chacun H, Guetin C, Tsapis N, Maruyama K, Unga J, Suzuki R, Fant C, Lafond M, Rogez B, Ngo J, Lafon C, Mestas JL, Afadzi M, Myhre OF, Vea S, Bjørkøy A, Yemane PT, van Wamel A, Berg S, Hansen R, Angelsen B, Davies C. International Society for Therapeutic Ultrasound Conference 2016. J Ther Ultrasound 2017. [PMCID: PMC5374646 DOI: 10.1186/s40349-016-0079-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
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Kovacs ZI, Kim S, Jikaria N, Qureshi F, Milo B, Lewis BK, Bresler M, Burks SR, Frank JA. Disrupting the blood-brain barrier by focused ultrasound induces sterile inflammation. Proc Natl Acad Sci U S A 2017; 114:E75-E84. [PMID: 27994152 PMCID: PMC5224365 DOI: 10.1073/pnas.1614777114] [Citation(s) in RCA: 264] [Impact Index Per Article: 37.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
MRI-guided pulsed focused ultrasound (pFUS) combined with systemic infusion of ultrasound contrast agent microbubbles (MB) causes localized blood-brain barrier (BBB) disruption that is currently being advocated for increasing drug or gene delivery in neurological diseases. The mechanical acoustic cavitation effects of opening the BBB by low-intensity pFUS+MB, as evidenced by contrast-enhanced MRI, resulted in an immediate damage-associated molecular pattern (DAMP) response including elevations in heat-shock protein 70, IL-1, IL-18, and TNFα indicative of a sterile inflammatory response (SIR) in the parenchyma. Concurrent with DAMP presentation, significant elevations in proinflammatory, antiinflammatory, and trophic factors along with neurotrophic and neurogenesis factors were detected; these elevations lasted 24 h. Transcriptomic analysis of sonicated brain supported the proteomic findings and indicated that the SIR was facilitated through the induction of the NFκB pathway. Histological evaluation demonstrated increased albumin in the parenchyma that cleared by 24 h along with TUNEL+ neurons, activated astrocytes, microglia, and increased cell adhesion molecules in the vasculature. Infusion of fluorescent beads 3 d before pFUS+MB revealed the infiltration of CD68+ macrophages at 6 d postsonication, as is consistent with an innate immune response. pFUS+MB is being considered as part of a noninvasive adjuvant treatment for malignancy or neurodegenerative diseases. These results demonstrate that pFUS+MB induces an SIR compatible with ischemia or mild traumatic brain injury. Further investigation will be required before this approach can be widely implemented in clinical trials.
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Affiliation(s)
- Zsofia I Kovacs
- Frank Laboratory, Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, MD 20892;
| | - Saejeong Kim
- Frank Laboratory, Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, MD 20892
| | - Neekita Jikaria
- Frank Laboratory, Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, MD 20892
| | - Farhan Qureshi
- Frank Laboratory, Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, MD 20892
| | - Blerta Milo
- Frank Laboratory, Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, MD 20892
| | - Bobbi K Lewis
- Frank Laboratory, Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, MD 20892
| | - Michele Bresler
- Frank Laboratory, Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, MD 20892
| | - Scott R Burks
- Frank Laboratory, Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, MD 20892
| | - Joseph A Frank
- Frank Laboratory, Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, MD 20892;
- National Institute of Biomedical Imaging and Bioengineering, National Institutes of Health, Bethesda, MD 20892
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Zaaroor M, Sinai A, Goldsher D, Eran A, Nassar M, Schlesinger I, Parker J, Ravikumar V, Ghanouni P, Stein S, Halpern C, Krishna V, Hargrove A, Agrawal P, Changizi B, Bourekas E, Knopp M, Rezai A, Mead B, Kim N, Mastorakos P, Suk JS, Miller W, Klibanov A, Hanes J, Price R, Wang S, Olumolade O, Kugelman T, Jackson-Lewis V, Karakatsani ME, Han Y, Przedborski S, Konofagou E, Hynynen K, Aubert I, Leinenga G, Nisbet R, Hatch R, Van der Jeugd A, Evans H, Götz J, Götz J, Nisbet R, Van der Jeugd A, Evans H, Leinenga G, Fishman P, Yarowsky P, Frenkel V, Wei-Bin S, Nguyen B, Sanchez CS, Acosta C, Chen C, Wu SY, Karakatsani ME, Konofagou E, Aryal M, Papademetriou IT, Zhang YZ, Power C, McDannold N, Porter T, Kovacs Z, Kim S, Jikaria N, Qureshi F, Bresler M, Frank J, Odéen H, Chiou G, Snell J, Todd N, Madore B, Parker D, Pauly KB, Marx M, Ghanouni P, Jonathan S, Grissom W, Arvanitis C, McDannold N, Clement G, Parker D, de Bever J, Odéen H, Payne A, Christensen D, Maimbourg G, Santin MD, Houdouin A, Lehericy S, Tanter M, Aubry JF, Pauly KB, Federau C, Werner B, Halpern C, Ghanouni P, Preusser T, McLeod H, Abraham C, Pichardo S, Curiel L, Ramaekers P, de Greef M, Berriet R, Moonen C, Ries M, Paeng DG, Dillon C, Janát-Amsbury M, Payne A, Corea J, Ye PP, Arias AC, Pauly KB, Lustig M, Svedin B, Payne A, Xu Z, Parker D, Snell J, Quigg A, Eames M, Jin C, Everstine A, Sheehan J, Lopes MB, Kassell N, Snell J, Quigg A, Drake J, Price K, Lustgarten L, Sin V, Mougenot C, Donner E, Tam E, Hodaie M, Waspe A, Looi T, Pichardo S, Lee W, Chung YA, Jung Y, Song IU, Yoo SS, Lee W, Kim HC, Jung Y, Chung YA, Song IU, Lee JH, Yoo SS, Caskey C, Zinke W, Cosman J, Shuman J, Schall J, Aurup C, Wang S, Chen H, Acosta C, Konofagou E, Kamimura H, Carneiro A, Todd N, Sun T, Zhang YZ, Power C, Nazai N, Patz S, Livingstone M, McDannold N, Mainprize T, Huang Y, Alkins R, Chapman M, Perry J, Lipsman N, Bethune A, Sahgal A, Trudeau M, Hynynen K, Liu HL, Hsu PH, Wei KC, Sun T, Power C, Zhang YZ, Sutton J, Alexander P, Aryal M, Miller E, McDannold N, Kobus T, Zhang YZ, McDannold N, Carpentier A, Canney M, Vignot A, Beccaria K, Leclercq D, Lafon C, Chapelon JY, Hoang-Xuan K, Delattre JY, Idbaih A, Xu Z, Moore D, Xu A, Schmitt P, Snell J, Foley J, Eames M, Sheehan J, Kassell N, Sukovich J, Cain C, Xu Z, Pandey A, Snell J, Chaudhary N, Camelo-Piragua S, Allen S, Paeng DG, Cannata J, Teofilovic D, Bertolina J, Kassell N, Hall T, Xu Z, Wu SY, Karakatsani ME, Grondin J, Sanchez CS, Ferrera V, Konofagou E, ter Haar G, Mouratidis P, Repasky E, Timbie K, Badr L, Campbell B, McMichael J, Buckner A, Prince J, Stevens A, Bullock T, Price R, Skalina K, Guha C, Orsi F, Bonomo G, Vigna PD, Mauri G, Varano G, Schade G, Wang YN, Pillarisetty V, Hwang JH, Khokhlova V, Bailey M, Khokhlova T, Khokhlova V, Sinilshchikov I, Yuldashev P, Andriyakhina Y, Kreider W, Maxwell A, Khokhlova T, Sapozhnikov O, Partanen A, Lundt J, Allen S, Sukovich J, Hall T, Cain C, Xu Z, Preusser T, Haase S, Bezzi M, Jenne J, Langø T, Midiri M, Mueller M, Sat G, Tanner C, Zangos S, Guenther M, Melzer A, Menciassi A, Tognarelli S, Cafarelli A, Diodato A, Ciuti G, Rothluebbers S, Schwaab J, Strehlow J, Mihcin S, Tanner C, Tretbar S, Preusser T, Guenther M, Jenne J, Payen T, Palermo C, Sastra S, Chen H, Han Y, Olive K, Konofagou E, Adams M, Salgaonkar V, Scott S, Sommer G, Diederich C, Vidal-Jove J, Perich E, Ruiz A, Velat M, Melodelima D, Dupre A, Vincenot J, Yao C, Perol D, Rivoire M, Tucci S, Mahakian L, Fite B, Ingham E, Tam S, Hwang CI, Tuveson D, Ferrara K, Scionti S, Chen L, Cvetkovic D, Chen X, Gupta R, Wang B, Ma C, Bader K, Haworth K, Maxwell A, Holland C, Sanghvi N, Carlson R, Chen W, Chaussy C, Thueroff S, Cesana C, Bellorofonte C, Wang Q, Wang H, Wang S, Zhang J, Bazzocchi A, Napoli A, Staruch R, Bing C, Shaikh S, Nofiele J, Szczepanski D, Staruch MW, Williams N, Laetsch T, Chopra R, Ghanouni P, Rosenberg J, Bitton R, Napoli A, LeBlang S, Meyer J, Hurwitz M, Pauly KB, Partanen A, Yarmolenko P, Partanen A, Celik H, Eranki A, Beskin V, Santos D, Patel J, Oetgen M, Kim A, Kim P, Sharma K, Chisholm A, Drake J, Aleman D, Waspe A, Looi T, Pichardo S, Napoli A, Bazzocchi A, Scipione R, Temple M, Waspe A, Amaral JG, Huang Y, Endre R, Lamberti-Pasculli M, de Ruiter J, Campbell F, Stimec J, Gupta S, Singh M, Mougenot C, Hopyan S, Hynynen K, Czarnota G, Drake J, Brenin D, Rochman C, Kovatcheva R, Vlahov J, Zaletel K, Stoinov J, Han Y, Wang S, Konofagou E, Bucknor M, Rieke V, Shim J, Staruch R, Koral K, Chopra R, Laetsch T, Lang B, Wong C, Lam H, Kovatcheva R, Vlahov J, Zaletel K, Stoinov J, Shinkov A, Hu J, Sharma K, Zhang X, Macoskey J, Ives K, Owens G, Gurm H, Shi J, Pizzuto M, Cain C, Xu Z, Payne A, Dillon C, Christofferson I, Hilas E, Shea J, Greillier P, Ankou B, Bessière F, Zorgani A, Pioche M, Kwiecinski W, Magat J, Melot-Dusseau S, Lacoste R, Quesson B, Pernot M, Catheline S, Chevalier P, Lafon C, Marquet F, Bour P, Vaillant F, Amraoui S, Dubois R, Ritter P, Haïssaguerre M, Hocini M, Bernus O, Quesson B, Tebebi P, Burks S, Kim S, Milo B, Frank J, Gertner M, Zhang J, Wong A, Fite B, Liu Y, Kheirolomoom A, Seo J, Watson K, Mahakian L, Tam S, Zhang H, Foiret J, Borowsky A, Ferrara K, Xu D, Melzer A, Thanou M, Centelles M, Wright M, Amrahli M, So PW, Gedroyc W, Centelles M, Wright M, Gedroyc W, Thanou M, Kneepkens E, Heijman E, Keupp J, Weiss S, Nicolay K, Grüll H, Fite B, Wong A, Liu Y, Kheirolomoom A, Mahakian L, Tam S, Foiret J, Ferrara K, Burks S, Nagle M, Kim S, Milo B, Frank J, Sapozhnikov O, Nikolaeva AV, Terzi ME, Tsysar SA, Maxwell A, Cunitz B, Bailey M, Mourad P, Downs M, Yang G, Wang Q, Konofagou E, Burks S, Nagle M, Nguyen B, Bresler M, Kim S, Milo B, Frank J, Burks S, Nagle M, Kim S, Milo B, Frank J, Chen J, Farry J, Dixon A, Du Z, Dhanaliwala A, Hossack J, Klibanov A, Ranjan A, Maples D, Chopra R, Bing C, Staruch R, Wardlow R, Staruch MW, Malayer J, Ramachandran A, Nofiele J, Namba H, Kawasaki M, Izumi M, Kiyasu K, Takemasa R, Ikeuchi M, Ushida T, Crake C, Papademetriou IT, Zhang YZ, Porter T, McDannold N, Kothapalli SVVN, Leighton W, Wang Z, Partanen A, Gach HM, Straube W, Altman M, Chen H, Kim YS, Lim HK, Rhim H, Kim YS, Lim HK, Rhim H, van Breugel J, Braat M, Moonen C, van den Bosch M, Ries M, Marrocchio C, Dababou S, Bitton R, Pauly KB, Ghanouni P, Lee JY, Lee JY, Chung HH, Kang SY, Kang KJ, Son KH, Zhang D, Adams M, Salgaonkar V, Plata J, Jones P, Pascal-Tenorio A, Bouley D, Sommer G, Pauly KB, Diederich C, Bond A, Dallapiazza R, Huss D, Warren A, Sperling S, Gwinn R, Shah B, Elias WJ, Curley C, Zhang Y, Negron K, Miller W, Klibanov A, Abounader R, Suk JS, Hanes J, Price R, Karakatsani ME, Samiotaki G, Wang S, Kugelman T, Acosta C, Konofagou E, Kovacs Z, Tu TW, Papadakis G, Hammoud D, Frank J, Silvestrini M, Wolfram F, Güllmar D, Reichenbach J, Hofmann D, Böttcher J, Schubert H, Lesser TG, Almquist S, Parker D, Christensen D, Camarena F, Jiménez-Gambín S, Jiménez N, Konofagou E, Chang JW, Chaplin V, Griesenauer R, Miga M, Caskey C, Ellens N, Airan R, Quinones-Hinojosa A, Farahani K, Partanen A, Feng X, Fielden S, Zhao L, Miller W, Wintermark M, Pauly KB, Meyer C, Guo S, Lu X, Zhuo J, Xu S, Gullapalli R, Gandhi D, Jin C, Brokman O, Eames M, Snell J, Paeng DG, Baek H, Kim H, Leung S, Webb T, Pauly KB, McDannold N, Zhang YZ, Vykhodtseva N, Nguyen TS, Sukovich J, Hall T, Xu Z, Cain C, Park CK, Park SM, Jung NY, Kim MS, Chang WS, Jung HH, Chang JW, Pichardo S, Hynynen K, Plaksin M, Weissler Y, Shoham S, Kimmel E, Quigg A, Snell J, Paeng DG, Eames M, Sapozhnikov O, Rosnitskiy PB, Khokhlova V, Shoham S, Krupa S, Hazan E, Naor O, Levy Y, Maimon N, Brosh I, Kimmel E, Kahn I, Sukovich J, Xu Z, Hall T, Allen S, Cain C, Cahill J, Sun T, Zhang YZ, Power C, Livingstone M, McDannold N, Todd N, Colas EC, Wydra A, Waspe A, Looi T, Maev R, Pichardo S, Drake J, Aly A, Sun T, Zhang YZ, Sesenoglu-Laird O, Padegimas L, Cooper M, McDannold N, Waszczak B, Tehrani S, Miller W, Slingluff C, Larner J, Andarawewa K, Bucknor M, Ozhinsky E, Shah R, Krug R, Rieke V, Deckers R, Linn S, Suelmann B, Braat M, Witkamp A, Vaessen P, van Diest P, Bartels LW, Bos C, van den Bosch M, Borys N, Storm G, Van der Wall E, Moonen C, Farr N, Alnazeer M, Yarmolenko P, Katti P, Partanen A, Eranki A, Kim P, Wood B, Farrer A, Almquist S, Dillon C, Parker D, Christensen D, Payne A, Ferrer C, Bartels LW, de Senneville BD, van Stralen M, Moonen C, Bos C, Liu Y, Liu J, Fite B, Foiret J, Leach JK, Ferrara K, Gupta R, Cvetkovic D, Ma C, Chen L, Haase S, Zidowitz S, Melzer A, Preusser T, Lee HL, Hsu FC, Kuo CC, Jeng SC, Chen TH, Yang NY, Chiou JF, Jeng SC, Kao YT, Pan CH, Wu JF, Chen TH, Hsu FC, Lee HL, Chiou JF, Hsu FC, Tsai YC, Lee HL, Chiou JF, Johnson S, Parker D, Payne A, Li D, He Y, Mihcin S, Karakitsios I, Strehlow J, Schwenke M, Haase S, Demedts D, Levy Y, Preusser T, Melzer A, Mihcin S, Rothluebbers S, Karakitsios I, Xiao X, Strehlow J, Demedts D, Cavin I, Sat G, Preusser T, Melzer A, Minalga E, Payne A, Merrill R, Parker D, Hadley R, Ramaekers P, Ries M, Moonen C, de Greef M, Shahriari K, Parvizi MH, Asadnia K, Chamanara M, Kamrava SK, Chabok HR, Schwenke M, Strehlow J, Demedts D, Tanner C, Rothluebbers S, Preusser T, Strehlow J, Stein R, Demedts D, Schwenke M, Rothluebbers S, Preusser T, Demedts D, Haase S, Muller S, Strehlow J, Langø T, Preusser T, Tan J, Zachiu C, Ramaekers P, Moonen C, Ries M, Wolfram F, Güllmar D, Schubert H, Lesser TG, Erasmus HP, Colas EC, Waspe A, Mougenot C, Looi T, Van Arsdell G, Benson L, Drake J, Jang KW, Tu TW, Jikaria N, Nagle M, Angstadt M, Lewis B, Qureshi F, Burks S, Frank J, McLean H, Payne A, Hoogenboom M, Eikelenboom D, den Brok M, Wesseling P, Heerschap A, Fütterer J, Adema G, Wang K, Zhang Y, Zhong P, Xiao X, Joy J, McLeod H, Melzer A, Bing C, Staruch R, Nofiele J, Szczepanski D, Staruch MW, Laetsch T, Chopra R, Bing C, Staruch R, Yarmolenko P, Celik H, Nofiele J, Szczepanski D, Kim P, Kim H, Lewis M, Chopra R, Shah R, Ozhinsky E, Rieke V, Bucknor M, Diederich C, Salgaonkar V, Jones P, Adams M, Ozilgen A, Zahos P, Coughlin D, Tang X, Lotz J, Jedruszczuk K, Gulati A, Solomon S, Kaye E, Fielden S, Mugler J, Miller W, Pauly KB, Meyer C, Barbato G, Scoarughi GL, Corso C, Gorgone A, Migliore IG, Larrabee Z, Hananel A, Eames M, Aubry JF, Eranki A, Farr N, Partanen A, Sharma K, Yarmolenko P, Wood B, Kim P, Farr N, Kothapalli SVVN, Eranki A, Negussie A, Wilson E, Seifabadi R, Kim P, Chen H, Wood B, Partanen A, Moon H, Kang J, Sim C, Chang JH, Kim H, Lee HJ, Sasaki N, Takiguchi M, Sebeke L, Luo X, de Jager B, Heemels M, Heijman E, Grüll H, Strehlow J, Schwenke M, Demedts D. 5th International Symposium on Focused Ultrasound. J Ther Ultrasound 2016. [PMCID: PMC5123388 DOI: 10.1186/s40349-016-0076-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Tu TW, Williams RA, Lescher JD, Jikaria N, Turtzo LC, Frank JA. Radiological-pathological correlation of diffusion tensor and magnetization transfer imaging in a closed head traumatic brain injury model. Ann Neurol 2016; 79:907-20. [PMID: 27230970 DOI: 10.1002/ana.24641] [Citation(s) in RCA: 72] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Revised: 03/13/2016] [Accepted: 03/14/2016] [Indexed: 12/27/2022]
Abstract
OBJECTIVE Metrics of diffusion tensor imaging (DTI) and magnetization transfer imaging (MTI) can detect diffuse axonal injury in traumatic brain injury (TBI). The relationship between the changes in these imaging measures and the underlying pathologies is still relatively unknown. This study investigated the radiological-pathological correlation between these imaging techniques and immunohistochemistry using a closed head rat model of TBI. METHODS TBI was performed on female rats followed longitudinally by magnetic resonance imaging (MRI) out to 30 days postinjury, with a subset of animals selected for histopathological analyses. A MRI-based finite element analysis was generated to characterize the pattern of the mechanical insult and estimate the extent of brain injury to direct the pathological correlation with imaging findings. RESULTS DTI axial diffusivity and fractional anisotropy (FA) were sensitive to axonal integrity, whereas radial diffusivity showed significant correlation to the myelin compactness. FA was correlated with astrogliosis in the gray matter, whereas mean diffusivity was correlated with increased cellularity. Secondary inflammatory responses also partly affected the changes of these DTI metrics. The magnetization transfer ratio (MTR) at 3.5ppm demonstrated a strong correlation with both axon and myelin integrity. Decrease in MTR at 20ppm correlated with the extent of astrogliosis in both gray and white matter. INTERPRETATION Although conventional T2-weighted MRI did not detect abnormalities following TBI, DTI and MTI afforded complementary insight into the underlying pathologies reflecting varying injury states over time, and thus may substitute for histology to reveal diffusive axonal injury pathologies in vivo. This correlation of MRI and histology furthers understanding of the microscopic pathology underlying DTI and MTI changes in TBI. Ann Neurol 2016;79:907-920.
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Affiliation(s)
- Tsang-Wei Tu
- Frank Laboratory, Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, MD
| | - Rashida A Williams
- Frank Laboratory, Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, MD
| | - Jacob D Lescher
- Frank Laboratory, Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, MD
| | - Neekita Jikaria
- Frank Laboratory, Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, MD
| | - L Christine Turtzo
- Frank Laboratory, Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, MD.,Center for Neuroscience and Regenerative Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD
| | - Joseph A Frank
- Frank Laboratory, Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, MD.,National Institute of Biomedical Imaging and Bioengineering, National Institutes of Health, Bethesda, MD
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Tu TW, Lescher JD, Williams RA, Jikaria N, Turtzo LC, Frank JA. Abnormal Injury Response in Spontaneous Mild Ventriculomegaly Wistar Rat Brains: A Pathological Correlation Study of Diffusion Tensor and Magnetization Transfer Imaging in Mild Traumatic Brain Injury. J Neurotrauma 2016; 34:248-256. [PMID: 26905805 DOI: 10.1089/neu.2015.4355] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [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: 11/12/2022] Open
Abstract
Spontaneous mild ventriculomegaly (MVM) was previously reported in ∼43% of Wistar rats in association with vascular anomalies without phenotypic manifestation. This mild traumatic brain injury (TBI) weight drop model study investigates whether MVM rats (n = 15) have different injury responses that could inadvertently complicate the interpretation of imaging studies compared with normal rats (n = 15). Quantitative MRI, including diffusion tensor imaging (DTI) and magnetization transfer imaging (MTI), and immunohistochemistry (IHC) analysis were used to examine the injury pattern up to 8 days post-injury in MVM and normal rats. Prior to injury, the MVM brain showed significant higher mean diffusivity, axial diffusivity, and radial diffusivity, and lower fractional anisotropy (FA) and magnetization transfer ratio (MTR) in the corpus callosum than normal brain (p < 0.05). Following TBI, normal brains exhibited significant decreases of FA in the corpus callosum, whereas MVM brains demonstrated insignificant changes in FA, suggesting less axonal injury. At day 8 after mild TBI, MTR of the normal brains significantly decreased whereas the MTR of the MVM brains significantly increased. IHC staining substantiated the MRI findings, demonstrating limited axonal injury with significant increase of microgliosis and astrogliosis in MVM brain compared with normal animals. The radiological-pathological correlation data showed that both DTI and MTI were sensitive in detecting mild diffuse brain injury, although DTI metrics were more specific in correlating with histologically identified pathologies. Compared with the higher correlation levels reflecting axonal injury pathology in the normal rat mild TBI, the DTI and MTR metrics were more affected by the increased inflammation in the MVM rat mild TBI. Because MVM Wistar rats appear normal, there was a need to screen rats prior to TBI research to rule out the presence of ventriculomegaly, which may complicate the interpretation of imaging and IHC observations.
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Affiliation(s)
- Tsang-Wei Tu
- 1 Frank Laboratory, Radiology and Imaging Sciences, Clinical Center, National Institutes of Health , Bethesda, Maryland
| | - Jacob D Lescher
- 1 Frank Laboratory, Radiology and Imaging Sciences, Clinical Center, National Institutes of Health , Bethesda, Maryland
| | - Rashida A Williams
- 1 Frank Laboratory, Radiology and Imaging Sciences, Clinical Center, National Institutes of Health , Bethesda, Maryland
| | - Neekita Jikaria
- 1 Frank Laboratory, Radiology and Imaging Sciences, Clinical Center, National Institutes of Health , Bethesda, Maryland
| | - L Christine Turtzo
- 2 Acute Studies Core, National Institute of Neurological Disorders and Stroke, National Institutes of Health , Bethesda, Maryland
| | - Joseph A Frank
- 1 Frank Laboratory, Radiology and Imaging Sciences, Clinical Center, National Institutes of Health , Bethesda, Maryland.,3 National Institute of Biomedical Imaging and Bioengineering, National Institutes of Health , Bethesda, Maryland
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