Contemporary imaging of mild TBI: the journey toward diffusion tensor imaging to assess neuronal damage

Fox, W. Christopher; Park, Min S; Belverud, Shawn; Klugh, Arnett; Rivet, Dennis J.; Tomlin, Jeffrey M.

doi:10.1179/1743132813y.0000000162

Cited by 23 publications

(6 citation statements)

References 70 publications

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“…According to the DSM-IV, a diagnosis of malingering is appropriate when ≥2 of 4 criteria are met [ 36 , 55 ]: (1) presentation of symptoms in a medico-legal context, (2) discordance between the individual’s stated disability and objective data, (3) uncooperative behavior during evaluation, and (4) presentation of antisocial personality disorder. However, our participants met the first two criteria, as they were referred by the WSIB for evaluation and mTBI is a clinical diagnosis that cannot be confirmed with objective data (i.e., none of our participants had positive MRI findings, and there is currently no sensitive and specific imaging technique to diagnose mTBI) [ 55 , 56 ]. In addition, a worker with certain personality traits may find being questioned about their disability or injury to be unnerving, which may satisfy the third criterion independent of any malingering.…”

Section: Discussionmentioning

confidence: 99%

Modeling community integration in workers with delayed recovery from mild traumatic brain injury

et al. 2015

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BackgroundDelayed recovery in persons after mild traumatic brain injury (mTBI) is poorly understood. Community integration (CI) is endorsed by persons with neurological disorders as an important outcome. We aimed to describe CI and its associated factors in insured Ontario workers with delayed recovery following mTBI.MethodsA cross-sectional study of insured workers in the chronic phase following mTBI was performed at a rehabilitation hospital in Ontario, Canada. Sociodemographic, occupational, injury-related, clinical, and claim-related data were collected from self-reports, medical assessments, and insurers’ referral files. Community Integration Questionnaire (CIQ) scores were compared using analysis of variance or Spearman’s correlation tests. Stepwise multivariable linear regression models were used to evaluate the associations with CI.ResultsNinety-four workers with mTBI (45.2 ± 9.9 years old, 61.2 % male) at 197 days post-injury (interquartile range, 139–416 days) were included. The CIQ total and subscale scores were similar to those reported in more severe TBI samples. The CIQ scores were moderately to strongly correlated with various sociodemographic, claim-related, and clinical variables. In the multivariable regression analysis, several covariates accounted for 36.4 % of the CIQ variance in the final fully adjusted model.DiscussionThis study evaluated CI in workers with mTBI, and analyzed its associated variables. Analysis revealed insomnia, head or neck pain, being married or in a relationship, time since injury, and a diagnosis of possible/probable malingering were independently associated with limited CI.ConclusionsWorkers with delayed recovery from mTBI experience difficulty with CI. Insomnia is a particularly relevant covariate, explaining the greater part of its variance. To enhance participation, care should focus on clinical and non-clinical covariates.Electronic supplementary materialThe online version of this article (doi:10.1186/s12883-015-0432-z) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Modeling community integration in workers with delayed recovery from mild traumatic brain injury

et al. 2015

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“…Usually TBI is diagnosed when the symptoms are closely temporally related to the incident that caused the injury, although clinical manifestations can occur at a delayed time. Other evidence of brain pathology from imaging, or diagnostic confirmation of damage to the brain, should ideally be used for confirmation[ 44 ], but these may not be feasible in poorer settings or those that have lower resources.…”

Section: Discussionmentioning

confidence: 99%

Lifetime Prevalence and Factors Associated with Head Injury among Older People in Low and Middle Income Countries: A 10/66 Study

et al. 2015

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IntroductionTraumatic brain injury (TBI) is a growing public health problem around the world, yet there is little information on the prevalence of head injury in low and middle income countries (LMICs). We utilised data collected by the 10/66 research group to investigate the lifetime prevalence of head injury in defined sites in low and middle income countries, its risk factors and its relationship with disability.MethodsWe analysed data from one-phase cross-sectional surveys of all residents aged 65 years and older (n = 16430) distributed across twelve sites in eight low and middle income countries (China, Cuba, Dominican Republic, India, Venezuela, Mexico, Peru, and Puerto Rico). Self-reported cases of head injury with loss of consciousness were identified during the interview. A sensitivity analysis including data provided by informants of people with dementia was also used to estimate the impact of this information on the estimates. Prevalence ratios (PR) from Poisson regressions were used to identify associated risk factors.ResultsThe standardised lifetime prevalence of TBI ranged from 0.3% in China to 14.6% in rural Mexico and Venezuela. Being male (PR: 1.6, 95% CI: 1.29–1.82), younger (PR: 0.95, 95% CI: 0.92–0.99), with lower education (PR 0.91, 95% CI: 0.86–0.96), and having fewer assets (PR 0.92, 95% CI: 0.88–0.96), was associated with a higher prevalence of TBI when pooling estimates across sites.DiscussionOur analysis revealed that the prevalence of TBI in LMICs is similar to that of developed nations. Considering the growing impact of TBI on health resources in these countries, there is an urgent need for further research.

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“…Advances in MRI-based neuroimaging techniques, such as diffusion tensor imaging (DTI), magnetization transfer ratio (MTR), magnetic resonance spectroscopic imaging (MRSI), and perfusion imaging, have brought new potential to mTBI diagnosis ( Shenton et al, 2012 ). DTI investigation of mTBI patients has attracted researchers because this imaging modality is particularly sensitive to microscopic white matter (WM) changes and may be able to detect diffuse axonal injury in mTBI ( Shenton et al, 2012 ; Bigler, 2013 ; Hulkower et al, 2013 ; Fox et al, 2013 ; Ling et al, 2013 ; Kou et al, 2013 ; Hasan et al, 2014 ). DTI is based on diffusion of tissue water molecules and by exploiting the anisotropic nature of diffusion it is possible to gain information about the microstructural organization and integrity of WM fiber tracts that interconnect various brain regions ( Mori and Zhang, 2006 ).…”

Section: Introductionmentioning

confidence: 99%

Multi-modal MRI of mild traumatic brain injury

Narayana

Hasan

et al. 2015

NeuroImage: Clinical

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Multi-modal magnetic resonance imaging (MRI) that included high resolution structural imaging, diffusion tensor imaging (DTI), magnetization transfer ratio (MTR) imaging, and magnetic resonance spectroscopic imaging (MRSI) were performed in mild traumatic brain injury (mTBI) patients with negative computed tomographic scans and in an orthopedic-injured (OI) group without concomitant injury to the brain. The OI group served as a comparison group for mTBI. MRI scans were performed both in the acute phase of injury (~24 h) and at follow-up (~90 days). DTI data was analyzed using tract based spatial statistics (TBSS). Global and regional atrophies were calculated using tensor-based morphometry (TBM). MTR values were calculated using the standard method. MRSI was analyzed using LC Model. At the initial scan, the mean diffusivity (MD) was significantly higher in the mTBI cohort relative to the comparison group in several white matter (WM) regions that included internal capsule, external capsule, superior corona radiata, anterior corona radiata, posterior corona radiata, inferior fronto-occipital fasciculus, inferior longitudinal fasciculus, forceps major and forceps minor of the corpus callosum, superior longitudinal fasciculus, and corticospinal tract in the right hemisphere. TBSS analysis failed to detect significant differences in any DTI measures between the initial and follow-up scans either in the mTBI or OI group. No significant differences were found in MRSI, MTR or morphometry between the mTBI and OI cohorts either at the initial or follow-up scans with or without family wise error (FWE) correction. Our study suggests that a number of WM tracts are affected in mTBI in the acute phase of injury and that these changes disappear by 90 days. This study also suggests that none of the MRI-modalities used in this study, with the exception of DTI, is sensitive in detecting changes in the acute phase of mTBI.

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Contemporary imaging of mild TBI: the journey toward diffusion tensor imaging to assess neuronal damage

Cited by 23 publications

References 70 publications

Modeling community integration in workers with delayed recovery from mild traumatic brain injury

Modeling community integration in workers with delayed recovery from mild traumatic brain injury

Lifetime Prevalence and Factors Associated with Head Injury among Older People in Low and Middle Income Countries: A 10/66 Study

Multi-modal MRI of mild traumatic brain injury

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