Metabolic imaging of mild traumatic brain injury

Lin, Alexander P.; Liao, Huijun; Merugumala, Sai; Prabhu, Sanjay P.; Meehan, William P.; Ross, Brian D.

doi:10.1007/s11682-012-9181-4

Cited by 121 publications

(138 citation statements)

References 48 publications

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“…NAA has been extensively studied in mTBI, either in absolute amounts or in ratios to Cr and Cho. Decreases in any of these three values, usually interpreted as neuronal injury, have been recorded throughout the gray matter and WM, in specific regions, as well as globally (149)(150)(151)(152)(153)(154)(155)(156)(157)(158)(159)(160). Some of these findings have shown correlations with postconcussive symptoms (156,159), as in a recent study that found lower global WM NAA only in symptomatic patients (Fig 7) (161).…”

Section: Metabolic Alterations: Proton Mr Spectroscopy and A Brief Nomentioning

confidence: 62%

“…This is consistent with the view that in mTBI, as opposed to more severe injuries, there is less cell-membrane breakdown, which would release 1 H MR spectroscopically detectable Cho. In the chronic TBI stages, however, any Cho elevations are likely to reflect glial proliferation (160). Time from injury, therefore, should be taken into account when discussing changes in Cho, while in the interpretation of the NAA/Cho ratio, possible Cho increases (149,167), as well as decreases (166), should be considered.…”

Section: State Of the Art: Mr Imaging Applications In Mild Traumatic mentioning

confidence: 99%

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MR Imaging Applications in Mild Traumatic Brain Injury: An Imaging Update

Wu¹,

Kirov²,

Gonen³

et al. 2016

Radiology

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Mild traumatic brain injury (mTBI), also commonly referred to as concussion, affects millions of Americans annually. Although computed tomography is the first-line imaging technique for all traumatic brain injury, it is incapable of providing long-term prognostic information in mTBI. In the past decade, the amount of research related to magnetic resonance (MR) imaging of mTBI has grown exponentially, partly due to development of novel analytical methods, which are applied to a variety of MR techniques. Here, evidence of subtle brain changes in mTBI as revealed by these techniques, which are not demonstrable by conventional imaging, will be reviewed. These changes can be considered in three main categories of brain structure, function, and metabolism. Macrostructural and microstructural changes have been revealed with threedimensional MR imaging, susceptibility-weighted imaging, diffusion-weighted imaging, and higher order diffusion imaging. Functional abnormalities have been described with both task-mediated and resting-state blood oxygen leveldependent functional MR imaging. Metabolic changes suggesting neuronal injury have been demonstrated with MR spectroscopy. These findings improve understanding of the true impact of mTBI and its pathogenesis. Further investigation may eventually lead to improved diagnosis, prognosis, and management of this common and costly condition.q RSNA, 2016

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Section: Metabolic Alterations: Proton Mr Spectroscopy and A Brief Nomentioning

confidence: 62%

Section: State Of the Art: Mr Imaging Applications In Mild Traumatic mentioning

confidence: 99%

MR Imaging Applications in Mild Traumatic Brain Injury: An Imaging Update

Wu¹,

Kirov²,

Gonen³

et al. 2016

Radiology

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“…Although both MRS and MRI exploit the spin-relaxation properties of protons, MRI uses this information to create a 2D image of the brain, whereas MRS determines the relative concentrations of various brain metabolites. 74 In a study of 11 former professional soccer players, MRS revealed a significant increase in choline (a marker for cellular proliferation and tissue damage) and myoinositol (a glial activation marker) compared with age-matched controls. 68 No neurocognitive deficits were reported in this study group.…”

Section: Magnetic Resonance Spectroscopymentioning

confidence: 99%

Sports-related brain injuries: connecting pathology to diagnosis

Pan¹,

Connolly²,

Dangelmajer³

et al. 2016

FOC

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Neurosurg Focus 40 (4):E14, 2016M any sports-related brain injuries involve mild traumatic brain injuries (mTBIs), which result from physical blows to the head sustained over a period of time. Sports associated with an increased risk of head injury include American football, ice hockey, soccer, rugby, the martial arts, boxing, and bicycling. 21,90 These injuries are often unrecognized, undiagnosed, or underreported, which reflects the fact that this is a growing medical concern, often labeled a "silent epidemic." 8,66 Chronic exposure to mild brain injuries can result in long-term neurological consequences and represents a spectrum of disorders. The most remarkable outcome of mTBI is termed chronic traumatic encephalopathy (CTE), a clinical syndrome that is associated with neurodegeneration and behavioral, cognitive, and/or motor deficits. Although this disease has distinct pathological features, CTE is considered a diagnosis of exclusion because only postmortem biopsies can confirm the diagnosis. Therefore, new diagnostic methods need to be developed to: 1) inform patients of a definitive diagnosis, 2) better understand the epidemiology and risk factors of the disease, and 3) implement intervention programs to prevent any potential long-term complications. This review examines how understanding the pathology and molecular changes associated with repeated head trauma can lead to the discovery of novel imaging techniques and biomarkers. Mild Traumatic Brain Injury and CTEChronic traumatic encephalopathy has evolved from the so-called punch-drunk syndrome, which was used to describe a distinct neuropsychiatric condition that seemed to affect boxers, eventually becoming known as dementia pugilistica during the 1920s and 1930s. Symptoms such ABBrEvIATIoNs AD = Alzheimer's disease; APOE = apolipoprotein E; ASL = arterial spin labeling; BBB = blood-brain barrier; BOLD = blood oxygen level-dependent; CA = cornu ammonis; CTE = chronic traumatic encephalopathy; DTI = diffusion tensor imaging; FA = fractional anisotropy; fMRI = functional MRI; GFAP = glial fibrillary acidic protein; GRE = gradient recall echo; miRNA = microRNA; MRS = MR spectroscopy; mTBI = mild traumatic brain injury; NFL = National Football League; NFT = neurofibrillary tangle; NINDS = National Institute of Neurological Disorders and Stroke; NSE = neuron-specific enolase; p-tau = phosphorylated tau; SWI = susceptibility-weighted imaging; TDP-43 = TAR DNA-binding protein 43;18 F-FDDNP = 2-(1-{6- [(2-[fluorine-18] Brain injuries are becoming increasingly common in athletes and represent an important diagnostic challenge. Early detection and management of brain injuries in sports are of utmost importance in preventing chronic neurological and psychiatric decline. These types of injuries incurred during sports are referred to as mild traumatic brain injuries, which represent a heterogeneous spectrum of disease. The most dramatic manifestation of chronic mild traumatic brain injuries is termed chronic traumatic encephalopathy, which is associated with profo...

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“…24,25 In two longitudinal studies in which patients were scanned 3 or 4 times to perform the time course of postinjury recovery of brain metabolism, we showed that concussion, an mTBI caused by any type of acceleration-deceleration of the brain, frequently encountered in contact sports, caused a reversible decrease in NAA content of the frontal lobe white matter. 26,27 In these studies, an inclusion criterion was the constancy in the Cho/Cr ratio that allowed the semiquantitative determination of NAA relative to both Cr and Cho.…”

mentioning

confidence: 90%

Decrease in N-Acetylaspartate Following Concussion May Be Coupled to Decrease in Creatine

Vagnozzi¹,

Signoretti²,

Floris³

et al. 2013

Journal of Head Trauma Rehabilitation

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Objectives:To assess the time course changes in N-acetylaspartate (NAA) and creatine (Cr) levels in the brain of athletes who suffered a sport-related concussion. Participants: Eleven nonconsecutive athletes with concussive head injury and 11 sex-and age-matched control volunteers Main outcome measures: At 3, 15, 30, and 45 days postinjury, athletes were examined by proton magnetic resonance spectroscopy for the determination of NAA, Cr, and choline (Cho) levels. Proton magnetic resonance spectroscopic data recorded for the control group were used for comparison. Results: Compared with controls (2.18 ± 0.19), athletes showed an increase in the NAA/Cr ratio at 3 (2.71 ± 0.16; P < .01) and 15 (2.54 ± 0.21; P < .01) days postconcussion, followed by a decrease and subsequent normalization at 30 (1.95 ± 0.16, P < .05) and 45 (2.17 ± 0.20; P < .05) days postconcussion. The NAA/Cho ratio decreased at 3, 15, and 30 days postinjury (P < .01 compared with controls), with no differences observed in controls at 45 days postconcussion. Compared with controls, significant increase in the Cho/Cr ratio after 3 (+33%, P < .01) and 15 (+31.5%, P < .01) days postinjury was observed whereas no differences were recorded at 30 and 45 days postinjury. Conclusions: This cohort of athletes indicates that concussion may cause concomitant decrease in cerebral NAA and Cr levels. This provokes longer time for normalization of metabolism, as well as longer time for resolution of concussion-associated clinical symptoms. Geology and Environmental Sciences, Viale A. Doria 6, 95125 Catania, Italy (lazzarig@unict.it). DOI: 10.1097/HTR.0b013e3182795045C ONCUSSION is defined as a biomechanically induced brain injury characterized by the absence of gross anatomic damages. Supported by the absence of structural lesions on traditional neuroimaging, a general and broadly accepted view is that mild traumatic brain injury (mTBI) is indeed a very frequent entity but is not a very serious injury, leading only to transient disturbances, and that no intervention other than observation is typically required. However, mTBI triggers molecular changes in neuronal cells involving a complex cascade of neurometabolic alterations 1-3 that reversibly modify the concentrations of several low-molecular-weight compounds actively involved in functions crucial for cell homeostasis and survival. 3,4 Such a cascade of molecular events is considered as the determinant of the so-called state of metabolic brain vulnerability, 5,6 which transiently exposes cerebral tissue to the cumulative effect of a second mTBI occurring during this particular period. 7,8 High-energy phosphates, 9,10 coenzyme A metabolites, 11 ATP catabolites, 11 and neurotransmitters, 12,13 are some of the substances whose concentrations are temporarily affected as a result of a traumatic insult. Of

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Metabolic imaging of mild traumatic brain injury

Cited by 121 publications

References 48 publications

MR Imaging Applications in Mild Traumatic Brain Injury: An Imaging Update

MR Imaging Applications in Mild Traumatic Brain Injury: An Imaging Update

Sports-related brain injuries: connecting pathology to diagnosis

Decrease in N-Acetylaspartate Following Concussion May Be Coupled to Decrease in Creatine

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