Early detection of cerebral microbleeds following traumatic brain injury using MRI in the hyper-acute phase

Lawrence, Tim; Pretorius, Pieter; Ezra, Martyn; Cadoux-Hudson, Tom; Voets, Natalie L.

doi:10.1016/j.neulet.2017.06.046

Cited by 39 publications

(34 citation statements)

References 23 publications

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“…Similar changes in CMB volume have previously been reported during the acute and chronic phases following a traumatic brain injury. [24][25][26] Liu et al found a dramatic decrease in quantitative measures of CMBs from serial imaging acquired beyond 2 years postinjury, 24 while Lawrence et al and Watanabe et al reported the appearance of CMBs within the first few hours following injury; CMBs showed reductions in volume over a 2-15-day period that were associated with patient recovery. 25,26 Thus, identifying treatment strategies to accelerate the mechanism through which CMBs decrease in size may be a viable alternative for minimizing CMBassociated deficits.…”

Section: Discussionmentioning

confidence: 99%

Risk factors of radiotherapy‐induced cerebral microbleeds and serial analysis of their size compared with white matter changes: A 7T MRI study in 113 adult patients with brain tumors

Morrison

Hess

Clarke

et al. 2019

Magnetic Resonance Imaging

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Background Although radiation therapy (RT) contributes to survival benefit in many brain tumor patients, it has also been associated with long‐term brain injury. Cerebral microbleeds (CMBs) represent an important manifestation of radiation‐related injury. Purpose To characterize the change in size and number of CMBs over time and to evaluate their relationship to white matter structural integrity as measured using diffusion MRI indices. Study Type Longitudinal, retrospective, human cohort. Population In all, 113 brain tumor patients including patients treated with focal RT (n = 91, 80.5%) and a subset of nonirradiated controls (n = 22, 19.5%). Field Strength/Sequence Single and multiecho susceptibility‐weighted imaging (SWI) and multiband, shell, and direction diffusion tensor imaging (DTI) at 7 T. Assessment Patients were scanned either once or serially. CMBs were detected and quantified on SWI images using a semiautomated approach. Local and global fractional anisotropy (FA) were measured from DTI data for a subset of 35 patients. Statistical Tests Potential risk factors for CMB development were determined by multivariate linear regression and using linear mixed‐effect models. Longitudinal FA was quantitatively and qualitatively evaluated for trends. Results All patients scanned at 1 or more years post‐RT had CMBs. A history of multiple surgical resections was a risk factor for development of CMBs. The total number and volume of CMBs increased by 18% and 11% per year, respectively, although individual CMBs decreased in volume over time. Simultaneous to these microvascular changes, FA decreased by a median of 6.5% per year. While the majority of nonirradiated controls had no CMBs, four control patients presented with fewer than five CMBs. Data Conclusion Identifying patients who are at the greatest risk for CMB development, with its likely associated long‐term cognitive impairment, is an important step towards developing and piloting preventative and/or rehabilitative measures for patients undergoing RT. Level of Evidence: 3 Technical Efficacy: Stage 4 J. Magn. Reson. Imaging 2019;50:868–877.

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Section: Discussionmentioning

confidence: 99%

Risk factors of radiotherapy‐induced cerebral microbleeds and serial analysis of their size compared with white matter changes: A 7T MRI study in 113 adult patients with brain tumors

Morrison

Hess

Clarke

et al. 2019

Magnetic Resonance Imaging

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“…This can be debated as "tissue at risk" may well be identified. Nevertheless, MRI is seen as very useful in predicting short-term and long-term functional outcome (16,17). Neurointensivists, nowadays, are confronted with the dilemma when to perform MRI in critically ill patients.…”

Section: Discussionmentioning

confidence: 99%

Safety of Early MRI Examinations in Severe TBI: A Test Battery for Proper Patient Selection

et al. 2020

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Introduction: Early magnetic resonance imaging (MRI) provides important information for management and prognosis in patients with severe traumatic brain injury (sTBI). Yet, optimal timing of MRI remains unknown. The aim of our study was to evaluate the safety of early MRI and to identify a method for appropriate patient selection to minimize adverse events related to the intrahospital transport (IHT) and the MRI examination. Methods: Twenty-six patients with sTBI [mean Glasgow Coma Scale (GCS) 6, range 3-8] admitted to our neurosurgical ICU from 03/2015 to 12/2017 and receiving at least one MRI within the first 14 days after initial traumatic event were prospectively included in the study. The following requirements were fulfilled for at least 4 h prior to anticipated MRI: MAP > 70 mmHg, aPCO 2 30-40 mmHg, stable ICP < 25 mmHg. All relevant cardiopulmonary and cerebral parameters and medication were recorded. The following MRI sequences were performed: DWI, FLAIR, 3D T2-space, 3D T1 MPRAGE, 3D SWI, 3D TOF, pASL, and 1 H/ 31 P-MRS. Results: Four females and 22 males (aged 23-78 years, mean 46.4 years) with a median GCS on admission of 5 (range 3-8) were analyzed. In total, 40 IHTs were performed within the first 14 days (mean 6 days, range 1-14 days). Mean pre-MRI ICP was 14.1 mmHg (range 3-32 mmHg). The mean post-MRI ICP was 14.3 mmHg (range 3-29 mmHg), decreasing to a mean ICP of 13.2 mmHg after 1 h (range 3-29 mmHg). There were no significant differences in ICP measurements before and after MRI (p = 0.30). MAP remained stable with no significant changes during the entire IHT and MRI. No other adverse events were observed as well. Conclusion: Early MRI in acute severe TBI is feasible and safe. Yet, careful patient selection with prior adequate testing of cardiopulmonary and cerebral parameters is crucial to minimize transport-or examination-related morbidity.

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“…The scanning protocol included T1-weighted MPRAGE, T2-weighted Turbo spin echo and T2* susceptibility weighted structural imaging (SWI) sequences, 2D proton magnetic resonance spectroscopic (MRS) chemical shift imaging (CSI) and diffusion-weighted imaging. SWI findings for a subset of this study population have been reported previously (45). Single-slab multi-voxel MRSI data were acquired using a point-resolved spectroscopy (PRESS) sequence using the following parameters: TR = 1700 ms, TE = 135 ms. Six saturation bands were applied (40 mm superior and inferior, 50 mm anterior, posterior, right and left lateral).…”

Section: Mri Data Acquisitionmentioning

confidence: 99%

MRS and DTI evidence of progressive posterior cingulate cortex and corpus callosum injury in the hyper-acute phase after Traumatic Brain Injury

et al. 2019

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The posterior cingulate cortex (PCC) and corpus callosum (CC) are susceptible to trauma, but injury often evades detection. PCC Metabolic disruption may predict CC white matter tract injury and the secondary cascade responsible for progression. While the time frame for the secondary cascade remains unclear in humans, the first 24 h (hyper-acute phase) are crucial for life-saving interventions. Objectives : To test whether Magnetic Resonance Imaging (MRI) markers are detectable in the hyper-acute phase and progress after traumatic brain injury (TBI) and whether alterations in these parameters reflect injury severity. Methods : Spectroscopic and diffusion-weighted MRI data were collected in 18 patients with TBI (within 24 h and repeated 7–15 days following injury) and 18 healthy controls (scanned once). Results : Within 24 h of TBI N-acetylaspartate was reduced (F = 11.43, p = 0.002) and choline increased (F = 10.67, p = 0.003), the latter driven by moderate-severe injury (F = 5.54, p = 0.03). Alterations in fractional anisotropy (FA) and axial diffusivity (AD) progressed between the two time-points in the splenium of the CC (p = 0.029 and p = 0.013). Gradual reductions in FA correlated with progressive increases in choline (p = 0.029). Conclusions : Metabolic disruption and structural injury can be detected within hours of trauma. Metabolic and diffusion parameters allow identification of severity and provide evidence of injury progression.

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Early detection of cerebral microbleeds following traumatic brain injury using MRI in the hyper-acute phase

Cited by 39 publications

References 23 publications

Risk factors of radiotherapy‐induced cerebral microbleeds and serial analysis of their size compared with white matter changes: A 7T MRI study in 113 adult patients with brain tumors

Risk factors of radiotherapy‐induced cerebral microbleeds and serial analysis of their size compared with white matter changes: A 7T MRI study in 113 adult patients with brain tumors

Safety of Early MRI Examinations in Severe TBI: A Test Battery for Proper Patient Selection

MRS and DTI evidence of progressive posterior cingulate cortex and corpus callosum injury in the hyper-acute phase after Traumatic Brain Injury

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