Diffuse vascular injury: convergent-type hemorrhage in the supratentorial white matter on susceptibility-weighted image in cases of severe traumatic brain damage

Iwamura, Asami; Taoka, Toshiaki; Fukusumi, Akio; Sakamoto, Masahiko; Miyasaka, Toshiteru; Ochi, Tomoko; Akashi, Toshiaki; Okuchi, Kazuo; Kichikawa, Kimihiko

doi:10.1007/s00234-011-0892-9

Cited by 34 publications

(26 citation statements)

References 14 publications

(18 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Notably, a prior study by Iwamura et al characterized supratentorial deep white matter hemorrhages and proposed a four-grade classification system based on their degree and distribution: 1) small hemorrhage, 2) single bead-like hemorrhage, 3) convergent-type hemorrhage, 4) and “massive hemorrhage” [29]. A limitation of this approach, however, is that the radiologic classification of brainstem lesions is based on the histopathological model proposed by JH Adams, in which all brainstem lesions are classified as “grade 3.” Moreover, brainstem microbleeds were not specifically analyzed.…”

Section: Methodsmentioning

confidence: 99%

Revisiting Grade 3 Diffuse Axonal Injury: Not All Brainstem Microbleeds are Prognostically Equal

et al. 2017

View full text Add to dashboard Cite

Background Recovery of functional independence is possible in patients with brainstem traumatic axonal injury (TAI), also referred to as “grade 3 diffuse axonal injury,” but acute prognostic biomarkers are lacking. We hypothesized that the extent of dorsal brainstem TAI measured by burden of traumatic microbleeds (TMBs) correlates with 1-year functional outcome more strongly than does ventral brainstem, corpus callosal, or global brain TMB burden. Further, we hypothesized that TMBs within brainstem nuclei of the ascending arousal network (AAN) correlate with 1-year outcome. Methods Using a prospective outcome database of patients treated for moderate-to-severe traumatic brain injury (TBI) at an inpatient rehabilitation hospital, we retrospectively identified 39 patients who underwent acute gradient-recalled echo (GRE) MRI. TMBs were counted on the acute GRE scans globally and in the dorsal brainstem, ventral brainstem, and corpus callosum. TMBs were also mapped onto an atlas of AAN nuclei. The primary outcome was the Disability Rating Scale (DRS) score at 1 year post-injury. Associations between regional TMBs, AAN TMB volume, and 1-year DRS score were assessed by calculating Spearman rank correlation coefficients. Results Mean+/−SD number of TMBs were: dorsal brainstem=0.7+/−1.4, ventral brainstem=0.2+/−0.6, corpus callosum=1.8+/−2.8, and global=14.4+/−12.5. The mean+/−SD TMB volume within AAN nuclei was 6.1+/−18.7 mm3. Increased dorsal brainstem TMBs and larger AAN TMB volume correlated with worse 1-year outcomes (R=0.37, p=0.02, and R=0.36, p=0.02, respectively). Global, callosal, and ventral brainstem TMBs did not correlate with outcomes. Conclusions These findings suggest that dorsal brainstem TAI, especially involving AAN nuclei, may have greater prognostic utility than the total number of lesions in the brain or brainstem.

show abstract

Section: Methodsmentioning

confidence: 99%

Revisiting Grade 3 Diffuse Axonal Injury: Not All Brainstem Microbleeds are Prognostically Equal

et al. 2017

View full text Add to dashboard Cite

show abstract

“…The corpus callosum, deep grey nuclei, brain stem and cerebellum are often involved. 85 The major differential diagnosis is DAI. The number and anatomic distribution of the haemorrhages allow differentiation from DAI ( Figure 10).…”

Section: Diffuse Vascular Injurymentioning

confidence: 99%

MDCT imaging of traumatic brain injury

Lolli¹,

Pezzullo²,

Delpierre³

et al. 2016

BJR

View full text Add to dashboard Cite

The aim of emergency imaging is to detect treatable lesions before secondary neurological damage occurs. CT plays a primary role in the acute setting of head trauma, allowing accurate detection of lesions requiring immediate neurosurgical treatment. CT is also accurate in detecting secondary injuries and is therefore essential in follow-up. This review discusses the main characteristics of primary and secondary brain injuries.

show abstract

“…In the last few years, several articles have been published on the application of SWI in patients with TBI. 5,9,10,15,17,18,33,45,46,51,58,82,94,95,[99][100][101] …”

Section: Swi In Neurotraumatologymentioning

confidence: 99%

“…Various studies have demonstrated the effectiveness of SWI in outcome prediction using SWI for hemorrhage grading, 51 the dichotomization of patients with and those without CMBs, 29,33 or the detection of a greater number and volume of lesions. 5,9,94,95,99 Despite having various SWI methods for outcome prediction, the current state of research has yet to reveal which method would exhibit the highest accuracy and specificity in predicting outcome and recovery.…”

Section: 82 Outcome Predictionmentioning

confidence: 99%

“…17 Although these studies offer promising evidence for outcome prediction using SWI, an overarching limitation is the lack of consensus in defining "outcome." Most studies assessed neurological status using either the Glasgow Outcome Scale 15,51,82,99 or Pediatric Cerebral Performance Category Scale (PCPCS). 18,94 There is preliminary evidence that SWI is useful in predicting outcome through cognitive factors as well, including IQ, attention, and verbal reasoning.…”

Section: 82 Outcome Predictionmentioning

confidence: 99%

See 1 more Smart Citation

Magnetic resonance susceptibility weighted imaging in neurosurgery: current applications and future perspectives

Ieva¹,

Lam²,

Alcaide‐Leon

et al. 2015

JNS

View full text Add to dashboard Cite

T he initial development of MR venography by Reichenbach et al. 90 laid the foundation for Haacke et al. 42 to apply the principles of MR venography in conventional MRI for broader usage in clinical and research settings. By utilizing magnitude and phase information, both of which are normally acquired from conventional MRI data, susceptibility weighted imaging (SWI) has an enhanced ability to detect microhemorrhages 4,12,26 and microvasculature. 26,27,41,92 It is a highly sensitive imaging modality able to depict magnetic substances, such as deoxygenated hemoglobin, with high contrast 42 and to help investigate neurological diseases, 82 grade tumors, 25,63 and assist in determining treatment or prognosis. 18,26,37,70,71,115 Over the past years, the SWI technique has found applications in the different fields of neurosurgery, namely neurooncology, vascular neurosurgery, neurotraumatolabbreviatioNs AVM = arteriovenous malformation; CCM = cerebral cavernous malformation; CMB = cerebral microbleed; CVS = cortical vessel sign; DAI = diffuse axonal injury; DBS = deep brain stimulation; DWI = diffusion-weighted imaging; GBM = glioblastoma multiforme; GCS = Glasgow Coma Scale; GPe = external globus pallidus; GPi = internal GP; GRE = gradient-recalled echo; ITSS = intratumoral susceptibility signal; mIP = minimum intensity projection; MRA = MR angiography; MS = multiple sclerosis; PD = proton density; PQ = percentagewise quantification; PWI = perfusion-weighted imaging; SN = substantia nigra; STN = subthalamic nucleus; SWI = susceptibility weighted imaging; TBI = traumatic brain injury; VM = vascular malformation. Susceptibility weighted imaging (SWI) is a relatively new imaging technique. Its high sensitivity to hemorrhagic components and ability to depict microvasculature by means of susceptibility effects within the veins allow for the accurate detection, grading, and monitoring of brain tumors. This imaging modality can also detect changes in blood flow to monitor stroke recovery and reveal specific subtypes of vascular malformations. In addition, small punctate lesions can be demonstrated with SWI, suggesting diffuse axonal injury, and the location of these lesions can help predict neurological outcome in patients. This imaging technique is also beneficial for applications in functional neurosurgery given its ability to clearly depict and differentiate deep midbrain nuclei and close submillimeter veins, both of which are necessary for presurgical planning of deep brain stimulation. By exploiting the magnetic susceptibilities of substances within the body, such as deoxyhemoglobin, calcium, and iron, SWI can clearly visualize the vasculature and hemorrhagic components even without the use of contrast agents. The high sensitivity of SWI relative to other imaging techniques in showing tumor vasculature and microhemorrhages suggests that it is an effective imaging modality that provides additional information not shown using conventional MRI. Despite SWI's clinical advantages, its implementation in MRI protocols is st...

show abstract

Diffuse vascular injury: convergent-type hemorrhage in the supratentorial white matter on susceptibility-weighted image in cases of severe traumatic brain damage

Cited by 34 publications

References 14 publications

Revisiting Grade 3 Diffuse Axonal Injury: Not All Brainstem Microbleeds are Prognostically Equal

Revisiting Grade 3 Diffuse Axonal Injury: Not All Brainstem Microbleeds are Prognostically Equal

MDCT imaging of traumatic brain injury

Magnetic resonance susceptibility weighted imaging in neurosurgery: current applications and future perspectives

Contact Info

Product

Resources

About