Emerging Imaging Tools for Use with Traumatic Brain Injury Research

Abstract

This article identifies emerging neuroimaging measures considered by the inter-agency Pediatric Traumatic Brain Injury (TBI) Neuroimaging Workgroup. This article attempts to address some of the potential uses of more advanced forms of imaging in TBI as well as highlight some of the current considerations and unresolved challenges of using them. We summarize emerging elements likely to gain more widespread use in the coming years, because of 1) their utility in diagnosis, prognosis, and understanding the natural course of degeneration or recovery following TBI, and potential for evaluating treatment strategies; 2) the ability of many centers to acquire these data with scanners and equipment that are readily available in existing clinical and research settings; and 3) advances in software that provide more automated, readily available, and cost-effective analysis methods for large scale data image analysis. These include multi-slice CT, volumetric MRI analysis, susceptibility-weighted imaging (SWI), diffusion tensor imaging (DTI), magnetization transfer imaging (MTI), arterial spin tag labeling (ASL), functional MRI (fMRI), including resting state and connectivity MRI, MR spectroscopy (MRS), and hyperpolarization scanning. However, we also include brief introductions to other specialized forms of advanced imaging that currently do require specialized equipment, for example, single photon emission computed tomography (SPECT), positron emission tomography (PET), encephalography (EEG), and magnetoencephalography (MEG)/magnetic source imaging (MSI). Finally, we identify some of the challenges that users of the emerging imaging CDEs may wish to consider, including quality control, performing multi-site and longitudinal imaging studies, and MR scanning in infants and children.

Mind the gaps—advancing research into short-term and long-term neuropsychological outcomes of youth sports-related concussions

“…Filling the gaps-fluid-based biomarkers ■ Clarify the diagnostic and prognostic utility of existing fluid-based biomarkers, and expand sampling beyond CSF and blood ■ Explore the utility of lipid, metabolite, oxidative and inflammatory biomarkers, with up-front consideration of FDA-approval requirements 160,161 Fractional anisotropy (FA), as measured by DTI, allows inference of the structural integrity of white matter tracts, which are commonly disrupted after TBI. The clinical implications of FA change remain controversial, as both increased and decreased FA has been observed in concussion studies.…”

Advanced neuroimaging in the clinic: critical appraisal of the evidence base

“…Regarding critical appraisal worksheet grades for DTI-mTBI detection reviews, 1 review achieved Grade A, 29 8 reviews achieved Grade B 8,24,25,36,39,41,42,44 and 14 reviews achieved Grade C. 6,[26][27][28][30][31][32][33][34][35]37,38,40,43 Of the reviews of DTI-mTBI outcome prediction, three reviews achieved Grade B 25,39,41 and the remaining reviews were Grade C. 6,[26][27][28][30][31][32]37,40 Of the reviews of DSC-glioma detection, 1 review achieved Grade A, 7 1 review achieved Grade B 62 and 24 reviews achieved Grade C. 9,12,[45][46][47][48][49][50][51][52][53][54]…”

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

“…Several studies have described the long acquisition times required to obtain an SW image, 15,31,33,50,57,65,66,80,92,99,100,115 which makes movement artifacts likely to occur because of patient discomfort, which subsequently distorts SWI findings.…”

“…SWI is prone to air-tissue artifacts with phase data 22,50,92,108,111 and susceptibility artifacts, such as bone structures, 105 which can distort image findings. Furthermore, the sliceby-slice method, which neuroradiologists and computer programs use in counting the number of lesions found in SW images, may lead to an exaggeration of the number of lesions or a misinterpretation of blood vessels as lesions, spanning over many slices.…”