Diffuse and spatially variable white matter disruptions are associated with blast-related mild traumatic brain injury

Davenport, Nicholas D.; Lim, Kelvin O.; Armstrong, Michael; Sponheim, Scott R.

doi:10.1016/j.neuroimage.2011.10.050

Cited by 167 publications

(150 citation statements)

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“…[43][44][45] It is also well documented that mTBI events in children, as well as adults, have led to changes in DTI scalars, FA in particular. 22,25,26,[46][47][48] Our study shows changes in DTI scalars that are significantly associated with RWE metrics in the absence of a clinical diagnosis of concussion or clinically apparent mTBI.…”

Section: Discussionmentioning

confidence: 99%

“…23,24 The sensitivity to subtle DTI changes, especially for subconcussive impacts, can be improved by using methods that are not dependent on spatial co-localization of the injury. 25,26 In order to relate changes in imaging data or cognitive function to head impacts, an effective method of measuring the underlying biomechanical response is required. This information can be provided by the Head Impact Telemetry System (HITSÔ).…”

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confidence: 99%

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Abnormal White Matter Integrity Related to Head Impact Exposure in a Season of High School Varsity Football

Davenport

Whitlow

Urban

et al. 2014

Journal of Neurotrauma

198

155

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The aim of this study was to determine whether the cumulative effects of head impacts from a season of high school football produce magnetic resonance imaging (MRI) measureable changes in the brain in the absence of clinically diagnosed concussion. Players from a local high school football team were instrumented with the Head Impact Telemetry System (HITSÔ) during all practices and games. All players received pre-and postseason MRI, including diffusion tensor imaging (DTI). Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) was also conducted. Total impacts and risk-weighted cumulative exposure (RWE), including linear (RWE Linear ), rotational (RWE Rotational ), and combined components (RWE CP ), were computed from the sensor data. Fractional, linear, planar, and spherical anisotropies (FA, C L , C P , and C S , respectively), as well as mean diffusivity (MD), were used to determine total number of abnormal white matter voxels defined as 2 standard deviations above or below the group mean. Delta (post-preseason) ImPACT scores for each individual were computed and compared to the DTI measures using Spearman's rank correlation coefficient. None of the players analyzed experienced clinical concussion (N = 24). Regression analysis revealed a statistically significant linear relationship between RWE CP and FA. Secondary analyses demonstrated additional statistically significant linear associations between RWE (RWE CP and RWE Linear ) and all DTI measures. There was also a strong correlation between DTI measures and change in Verbal Memory subscore of the ImPACT. We demonstrate that a single season of football can produce brain MRI changes in the absence of clinical concussion. Similar brain MRI changes have been previously associated with mild traumatic brain injury.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Abnormal White Matter Integrity Related to Head Impact Exposure in a Season of High School Varsity Football

Davenport

Whitlow

Urban

et al. 2014

Journal of Neurotrauma

198

155

View full text Add to dashboard Cite

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Section: Clinicalmentioning

confidence: 99%

“…Conventional CT and MRI are primarily sensitive to blood from nearby torn capillaries, rather than axonal damage itself, hence they underestimate the presence of DAI, especially in mTBI. New approaches using diffusion tensor imaging (DTI), positron emission topography (PET), and macromelecular proton fraction (MPF) have showed promising capability in detecting injuries and/or abnormalities that are not visible in CT and MRI (e.g., Petrie et al, 2014;MacDonald et al, 2011;Davenport et al, 2012;Shenton et al, 2012).Magnetoencephalogram (MEG) is a non-invasive functional imaging technique that directly measures the magnetic signal due to neuronal activation in gray matter (GM) with high temporal resolution (<1 ms) and spatial localization accuracy (2-3 mm at cortical level) (Leahy et al, 1998). MEG demonstrates sensitivity to abnormal neuronal signals resulting from axonal injuries.…”

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confidence: 99%

The role of biomarkers and MEG-based imaging markers in the diagnosis of post-traumatic stress disorder and blast-induced mild traumatic brain injury

Huang

Risling

Baker

2016

Psychoneuroendocrinology

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SummaryBackground: Pervasive use of improvised explosive devices (IEDs), rocket-propelled grenades, and land mines in the recent conflicts in Iraq and Afghanistan has brought traumatic brain injury (TBI) and its impact on health outcomes into public awareness. Blast injuries have been deemed signature wounds of these wars. War-related TBI is not new, having become prevalent during WWI and remaining medically relevant in WWII and beyond. Medicine's past attempts to accurately diagnose and disentangle the pathophysiology of war-related TBI parallels current lines of inquiry and highlights limitations in methodology and attribution of symptom etiology, be it organic, psychological, or behavioral. New approaches and biomarkers are needed. Preclinical: Serological biomarkers and biomarkers of injury obtained with imaging techniques represent cornerstones in the translation between experimental data and clinical observations. Experimental models for blast related TBI and PTSD can generate critical data on injury threshold, for example for white matter injury from acceleration. Carefully verified and validated models can be evaluated with gene expression arrays and proteomics to identify new candidates for serological biomarkers. Such models can also be analyzed with diffusion MRI and microscopy in order to identify criteria for detection of diffuse white matter injuries, such as DAI (diffuse axonal injury). The experimental models can also be analyzed with focus on injury outcome in brain stem regions, such as locus coeruleus or nucleus raphe magnus that can be involved in response to anxiety changes. * Corresponding author at: UCSD Radiology Imaging Laboratory, San Diego, CA 92121, USA. Tel.: +1 858 534 1254; fax: +1 8585346046. E-mail address: mxhuang@ucsd.edu (M. Huang). Clinical: Mild (and some moderate) TBI can be difficult to diagnose because the injuries are often not detectable on conventional MRI or CT. There is accumulating evidence that injured brain tissues in TBI patients generate abnormal low-frequency magnetic activity (ALFMA, peaked at 1-4 Hz) that can be measured and localized by magnetoencephalography (MEG). MEG imaging detects TBI abnormalities at the rates of 87% for the mild TBI, group (blast-induced plus non-blast causes) and 100% for the moderate group. Among the mild TBI patients, the rates of abnormalities are 96% and 77% for the blast and non-blast TBI groups, respectively. There is emerging evidence based on fMRI and MEG studies showing hyper-activity in the amygdala and hypo-activity in prefrontal cortex in individuals with PTSD. MEG signal may serve as a sensitive imaging marker for mTBI, distinguishable from abnormalities generated in association with PTSD. More work is needed to fully describe physiological mechanisms of post-concussive symptoms.Published by Elsevier Ltd. BackgroundBlast injuries are deemed the signature wounds of the first wars (Afghanistan and Iraq) of the 21st century (Lancet, 2007;Galarneau et al., 2008). According to a recent U.S. Department Veterans Affairs (DVA) ...

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“…TBI-associated changes in DTI scalar metrics have been well-documented, FA in particular. [9][10][11][12][13][14] In addition to measuring a variety of DTI metrics, data processing and analysis techniques have been developed to utilize these data for visualizing abnormalities in gray matter and white matter tracts. 15,16 With regard to white matter tracts, the diffusion tensor model is not capable of resolving multiple fiber orientations within a voxel, and improved diffusion models and analysis methods are actively being developed.…”

Section: Advanced Diffusion Imaging Techniques Including Diffusion Tmentioning

confidence: 99%

Imaging Evidence and Recommendations for Traumatic Brain Injury: Advanced Neuro- and Neurovascular Imaging Techniques

Wintermark

Sanelli

Anzai

et al. 2014

AJNR Am J Neuroradiol

112

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SUMMARY:Neuroimaging plays a critical role in the evaluation of patients with traumatic brain injury, with NCCT as the first-line of imaging for patients with traumatic brain injury and MR imaging being recommended in specific settings. Advanced neuroimaging techniques, including MR imaging DTI, blood oxygen level-dependent fMRI, MR spectroscopy, perfusion imaging, PET/SPECT, and magnetoencephalography, are of particular interest in identifying further injury in patients with traumatic brain injury when conventional NCCT and MR imaging findings are normal, as well as for prognostication in patients with persistent symptoms. These advanced neuroimaging techniques are currently under investigation in an attempt to optimize them and substantiate their clinical relevance in individual patients. However, the data currently available confine their use to the research arena for group comparisons, and there remains insufficient evidence at the time of this writing to conclude that these advanced techniques can be used for routine clinical use at the individual patient level. TBI imaging is a rapidly evolving field, and a number of the recommendations presented will be updated in the future to reflect the advances in medical knowledge. ABBREVIATIONS:BOLD ϭ blood oxygen level-dependent; FA ϭ fractional anisotropy; MD ϭ mean diffusivity; MEG ϭ magnetoencephalography; TBI ϭ traumatic

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Diffuse and spatially variable white matter disruptions are associated with blast-related mild traumatic brain injury

Cited by 167 publications

References 29 publications

Abnormal White Matter Integrity Related to Head Impact Exposure in a Season of High School Varsity Football

Abnormal White Matter Integrity Related to Head Impact Exposure in a Season of High School Varsity Football

The role of biomarkers and MEG-based imaging markers in the diagnosis of post-traumatic stress disorder and blast-induced mild traumatic brain injury

Imaging Evidence and Recommendations for Traumatic Brain Injury: Advanced Neuro- and Neurovascular Imaging Techniques

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