Multi-Modal Magnetic Resonance Imaging in the Acute and Sub-Acute Phase of Mild Traumatic Brain Injury: Can We See the Difference?

Tóth, Arnold; Kovács, Noémi; Perlaki, Gábor; Orsi, G.; Aradi, Mihály; Komáromy, Hedvig; Ezer, Erzsébet; Bukovics, Péter; Farkas, Orsolya; Janszky, József; Dóczi, Tamás; Büki, András; Schwarcz, Attila

doi:10.1089/neu.2012.2486

Cited by 99 publications

(78 citation statements)

References 63 publications

(60 reference statements)

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“…Magnetic resonance imaging allows for the detection of gross cerebral atrophy, 77,137,152 small contusions, white matter shearing, foci of axonal injury, and small subacute hemorrhages. 105 MRI is also useful for evaluating the brain-CSF border, distinguishing the interface between gray and white matter, and detecting cerebral edema, which are all important factors to consider when evaluating mTBI.…”

Section: Magnetic Resonance Imagingmentioning

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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Section: Magnetic Resonance Imagingmentioning

confidence: 99%

Sports-related brain injuries: connecting pathology to diagnosis

Pan¹,

Connolly²,

Dangelmajer³

et al. 2016

FOC

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“…Their analysis revealed a significant decrease in cortical volumes and increase in ventricular volumes at 1 month after injury in the mTBI group. 4 Ling and coworkers 5 studied 50 patients with mTBI and 50 healthy controls at two time points (14 days and 4 months) after injury. 5 They reported increased fractional anisotropy in the bilateral superior frontal cortex during the semi-acute phase with no significant differences between groups in neuropsychological testing and gray matter atrophy at either time point.…”

Section: Introductionmentioning

confidence: 99%

Differences in Regional Brain Volumes Two Months and One Year after Mild Traumatic Brain Injury

Zagorchev

Meyer

Stehlé

et al. 2016

Journal of Neurotrauma

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Conventional structural imaging is often normal after mild traumatic brain injury (mTBI). There is a need for structural neuroimaging biomarkers that facilitate detection of milder injuries, allow recovery trajectory monitoring, and identify those at risk for poor functional outcome and disability. We present a novel approach to quantifying volumes of candidate brain regions at risk for injury. Compared to controls, patients with mTBI had significantly smaller volumes in several regions including the caudate, putamen, and thalamus when assessed 2 months after injury. These differences persisted but were reduced in magnitude 1 year after injury, suggesting the possibility of normalization over time in the affected regions. More pronounced differences, however, were found in the amygdala and hippocampus, suggesting the possibility of regionally specific responses to injury.

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“…101 The ability to distinguish hemorrhagic from nonhemorrhagic DAI is beneficial since treatment, outcome, and prognosis will differ between these 2 conditions. In the last few years, several articles have been published on the application of SWI in patients with TBI.…”

Section: Swi In Neurotraumatologymentioning

confidence: 99%

“…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%

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

Ieva¹,

Lam²,

Alcaide‐Leon

et al. 2015

JNS

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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...

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Multi-Modal Magnetic Resonance Imaging in the Acute and Sub-Acute Phase of Mild Traumatic Brain Injury: Can We See the Difference?

Cited by 99 publications

References 63 publications

Sports-related brain injuries: connecting pathology to diagnosis

Sports-related brain injuries: connecting pathology to diagnosis

Differences in Regional Brain Volumes Two Months and One Year after Mild Traumatic Brain Injury

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

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