Contrast-Enhanced FLAIR (Fluid-Attenuated Inversion Recovery) for Evaluating Mild Traumatic Brain Injury

Kim, Soo Chin; Park, Sun Won; Ryoo, Inseon; Jung, Sung Eun; Yun, Tae Jin; Choi, Seung Hong; Kim, Ji Hoon; Sohn, Chul Ho

doi:10.1371/journal.pone.0102229

Cited by 27 publications

(22 citation statements)

References 31 publications

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“…In our cohort of TBI participants, we identified areas of postcontrast administration T2-weighted abnormalities in only 13.6% of TBI participants (we also noted a single case [2.4%] in the participants without TBI). This is lower than what was recently reported (44) in patients with acute TBI who had a higher incidence (36%). It is uncertain if this represents the residua of TBI or possibly some focus of chronic inflammation that persists from the original insult.…”

Section: Discussioncontrasting

confidence: 72%

Findings from Structural MR Imaging in Military Traumatic Brain Injury

Riedy¹,

Senseney

Liu

et al. 2016

Radiology

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Section: Discussioncontrasting

confidence: 72%

Findings from Structural MR Imaging in Military Traumatic Brain Injury

Riedy¹,

Senseney

Liu

et al. 2016

Radiology

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“…17 To our knowledge, only one investigation has recently described meningeal enhancement on contrast-enhanced FLAIR images in mild TBI patients. 23 In that study, 32 (59%) out of 54 patients with persistent symptoms following closed head injury had either diffuse or focal meningeal enhancement on contrast-enhanced FLAIR images. However, the study was a retrospective analysis of patients with persistent symptoms, imaged up to 14 days after injury, and most (75%) with evidence of concomitant SDH.…”

Section: ‰ Early Mri Detection Of Mild Tbimentioning

confidence: 89%

Trauma-Specific Brain Abnormalities in Suspected Mild Traumatic Brain Injury Patients Identified in the First 48 Hours after Injury: A Blinded Magnetic Resonance Imaging Comparative Study Including Suspected Acute Minor Stroke Patients

Ricciardi

Bokkers

Butman

et al. 2017

Journal of Neurotrauma

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We assessed the utility of a brief MRI protocol, appropriate for the acute setting, to detect acute traumatic brain injury (TBI) in patients with suspected mild TBI (mTBI) and distinguish traumatic from nontraumatic brain injury by comparing trauma with nontrauma patients. Twenty-two patients with suspected mTBI were included in this exploratory study over a period of 9 months. Median time from injury to MR scanning was 5.4 h (interquartile range 3.6-15.3). To determine the specificity of certain findings for TBI, 61 patients presenting with suspected minor acute stroke were included as a comparative group using the same MRI methods. A selected series of MRI sequences (diffusion-weighted imaging, fluid attenuated inversion recovery [FLAIR], and T2* weighted) were independently evaluated by two neuroradiologists blinded to clinical diagnosis, for presence of specific findings. In a separate session, all cases in which at least one MRI sequence above was positive were classified as TBI, stroke, or indeterminate. Intracranial MRI abnormalities were observed in 47 (57%) of the 83 studied patients. Based on findings on MRI, 12 (55%) of 22 suspected mTBI patients were classified as having traumatic injury. Nine (47%) of the 19 suspected mTBI patients with a negative CT had findings on MRI. Abnormalities on MRI consistent with trauma were observed most frequently on postcontrast FLAIR (83%) and T2*-weighted (58%) sequences. We demonstrated the ability of a fast MRI protocol to identify trauma-related abnormalities not seen on CT, and differentiate acute trauma from nonspecific chronic disease in a blinded cohort of mTBI patients.

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“…Our findings likely have relevance to a broader population, given that previous research shows prevalence of TMI in the population screened with MRI was approximately 1 in 2 2 and is observed in concert with other intracranial injury. 24 The existence of TMI after minor injury that does not result in acute medical evaluation, such as after sports concussion, has yet to be demonstrated. However, as is true of other forms of traumatic intracranial injury, it is reasonable to expect that injury to the meninges, and the related biological response examined here, may apply to all severities of TBI.…”

mentioning

confidence: 99%

Differential Gene Expression Associated with Meningeal Injury in Acute Mild Traumatic Brain Injury

Livingston

Gill

Cota

et al. 2017

Journal of Neurotrauma

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Injury to the meninges is not uncommon after traumatic brain injury (TBI), yet minimal research has been directed toward understanding the relevant biology. After a concussive event, the meninges are observed to abnormally enhance on post-contrast magnetic resonance imaging (MRI) in some patients, but not all. The aim of this work is to identify genes differentially expressed in patients with meningeal injury. Patients presenting to the emergency room with suspected TBI received a standard research MRI and blood draw within 48 h of injury. Two groups of patients were included: those with and without abnormal enhancement of the meninges on post-contrast MRI, both without other imaging findings. Groups were compared on microarray gene expression in peripheral blood samples using Affymetrix (Santa Clara, CA) and Partek Genomics Suite (Partek, Inc., St. Louis, MO) software (false discovery rate, <0.05). Forty patients were enrolled with a time from injury to MRI/blood draw of 16.8 h (interquartile range, 7.5-24.1). We observed 76 genes to be differentially expressed in patients with meningeal injury compared to those without, such as receptor for Fc fragment of IgA, multiple C2 domains, transmembrane 2, and G-protein-coupled receptor 27, which have been previously associated with initiating inflammatory mediators, phagocytosis, and other regulatory mechanisms. Post-contrast MRI is able to detect meningeal injury and has a unique biological signature observed through gene expression. These findings suggest that an acute inflammatory response occurs in response to injury to the meninges following a concussion.

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Contrast-Enhanced FLAIR (Fluid-Attenuated Inversion Recovery) for Evaluating Mild Traumatic Brain Injury

Cited by 27 publications

References 31 publications

Findings from Structural MR Imaging in Military Traumatic Brain Injury

Findings from Structural MR Imaging in Military Traumatic Brain Injury

Trauma-Specific Brain Abnormalities in Suspected Mild Traumatic Brain Injury Patients Identified in the First 48 Hours after Injury: A Blinded Magnetic Resonance Imaging Comparative Study Including Suspected Acute Minor Stroke Patients

Differential Gene Expression Associated with Meningeal Injury in Acute Mild Traumatic Brain Injury

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