Imaging of Neurotrauma in Acute and Chronic Settings

Abstract

: Traumatic injuries of the brain and spinal cord are a significant source of mortality and long-term disability. A recent systematic study in a rat model of spinal cord injury (SCI) indicates severe, destructive, and very protracted inflammation as the key mechanism initiated by the massive injury involving the white matter. Although the severe inflammation is localized and counteracted by astrogliosis, it has a damaging effect on the blood vessels in the surrounding spinal cord, leading to persistent vasogenic edema. To evaluate these injuries, imaging of the brain and spinal cord plays a crucial role in the acute trauma work-up, allowing clinicians to quickly identify abnormalities that require immediate medical or surgical intervention or to exclude them from the work-up. Recently, anti-inflammatory agents have been shown to inhibit and accelerate the elimination of post-SCI inflammation in preclinical studies, and an exciting potential has arisen for the use of anti-inflammatory drugs in clinical studies to achieve neuroprotection (i.e., inhibition of destruction caused by inflammation) and to inhibit vasogenic edema in SCI, traumatic brain injury, and stroke. In both subacute and chronic settings, imaging can be a guide to therapy and provide important prognostic information. In this review, we discuss the imaging work-up and evolving imaging findings of neurotrauma in the acute and chronic setting, including conventional and advanced imaging techniques. As neuroimaging is the primary mode of diagnostic analysis in neurotrauma, it is a critical component in future clinical trials evaluating neuroprotective therapies.

Research progress and prospects of benefit-risk assessment methods for umbilical cord mesenchymal stem cell transplantation in the clinical treatment of spinal cord injury

“…In one study, of 367 patients with SCI diagnosed by MRI, only one had a negative CT scan after trauma, yielding a false-negative rate of 0.3% [ 83 ]. However, CT imaging of the spinal cord is not ideal, so any patient with suspected SCI should be evaluated with MRI because MRI can provide information about not only the location and severity of the injury in the spine but also the cause of the injury, which may include haematoma, bone fragments, or disc herniation [ 84 ]. Therefore, for SCIs, the gold standard in the diagnostic stage is CT, which means that when SCI occurs, a CT examination should be performed first to check for bone damage.…”

Polymeric Dendrimers as Nanocarrier Vectors for Neurotheranostics

“…The CNS diseases such as neurodegenerative, neurotrauma, ischemic injury, and cancer are among the leading cause of disability and death today. [ 186–188 ] However, currently there are no safe and effective therapeutic strategies for these diseases, as only very few small molecular weight drugs (2%) can pass the BBB and maintain their therapeutic activity in the CNS. The structure of BBB is composed of tight junctions between endothelial cells of capillary vasculature.…”