MR imaging in the detection of diffuse axonal injury with mild traumatic brain injury

Topal, Naile Bolca; Hakyemez, Bahattin; Erdoğan, Cüneyt; Bulut, Mehtap; Köksal, Özlem; Akköse, Şule; Doǧan, Şeref; Parlak, Müfıt; Özgüç, Halil; Korfalı, Ender

doi:10.1179/016164108x323799

Cited by 80 publications

(47 citation statements)

References 19 publications

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“…The standard clinical MRI sequences that are routinely performed in mTBI are the following five procedures: (1) the anatomical sequence or T1, which can also be done as a thin-slice threedimensional volume that permits quantitative measurements of brain structures (quantification methods for T1 and other sequences reviewed by Brewer 2009;Brewer et al 2009;Filippi and Agosta 2009;Holdsworth and Bammer 2008;Pagani et al 2008); (2) the T2 sequence that highlights cerebrospinal fluid (CSF), where increased CSF may be an indication of atrophy (MacKenzie et al 2002;Trivedi et al 2007); (3) the FLAIR sequence that is particularly sensitive to WM signal abnormalities (Akhtar et al 2003;Ding et al 2008;Sigmund et al 2007;Topal et al 2008); (4) the GRE or SWI sequences that are sensitive to hemorrhagic lesions (Chastain et al 2009;Hammoud and Wasserman 2002;Tong et al 2003;Topal et al 2008); and (5) the DTI where various metrics can assess WM integrity . Figure 3, from Levine et al (2008), shows the application of quantitative neuroimaging to assess the overall structural integrity of the brain following injury and shows the effect of TBI injury severity on atrophic changes (brain volume loss) that occur, including those associated with mTBI.…”

Section: Mri In the Subacute And Chronic Phase Of Mtbimentioning

confidence: 99%

“…However, with MRI, there are many more methods of image analysis that can be applied, especially those that are specific to detecting white matter (WM) integrity like the fluid-attenuated inversion recovery (FLAIR) sequence, diffusion tensor imaging (DTI), and MRI measures that directly assess the biochemical composition of the brain via magnetic resonance spectroscopy (MRS; Gasparovic et al 2009;Topal et al 2008;Yeo et al 2006). There has also been a recent MRI improvement in detecting hemosiderin using what is referred to as susceptibility weighted imaging (SWI; Tong et al 2008).…”

Section: Acute Neuroimaging In Mtbimentioning

confidence: 99%

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Neuroimaging in Mild Traumatic Brain Injury

Bigler

2010

Psychol. Inj. and Law

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Neuroimaging in mild traumatic brain injury (mTBI) is reviewed. While computed tomography remains the acute standard for neuroimaging of mTBI, it is only sensitive to gross abnormalities and is typically performed as a measure to rule out more serious and life-threatening injury. Magnetic resonance imaging (MRI), especially at field strength of 3.0 T, is the follow-up neuroimaging standard for assessing potential underlying structural injury to the brain. Several MRI sequences are particularly sensitive to subtle hemorrhagic lesions and signal abnormalities in white matter, sensitive enough to detect pathology when present in mTBI. Clinical correlation of neuropsychological outcome with neuroimaging findings is discussed along with the future potential for functional neuroimaging in evaluating the mTBI patient.Keywords Mild traumatic brain injury (mTBI) . Neuroimaging . Neuropsychological outcome . White matter . Magnetic resonance imaging (MRI) . Computed tomography (CT) . Functional neuroimaging A history of positive neuroimaging findings provides important information that assists the clinician in understanding the sequelae and potential effects of a traumatic brain injury (TBI) on neuropsychological test performance. Much has been written about neuroimaging methods and findings in TBI, which are summarized elsewhere (Dubroff and Newberg 2008; Le and Gean 2009). The focus of this article is just on neuroimaging findings in mild traumatic brain injury (mTBI) and how such findings provide additional context about the likely neuropathology of mTBI and its relationship to neurocognitive and neurobehavioral sequelae. This review will be brief and primarily focused on the clinical information that exists in standard radiological reports of mTBI patients and its relevance to neurobehavioral and neurocognitive sequelae. Obviously, psychological and neuropsychological assessments of the mTBI patient typically occur weeks or months post-injury. This circumstance requires that any clinician who sees the patient on follow-up must rely on the medical information, including clinical neuroimaging that has already been performed. This also means that the clinician needs to understand the decision making that takes place in the emergency department (ED) for how a mTBI is triaged and when radiological procedures are performed that typically follow established guidelines (Davis 2007;Jagoda et al. 2008). As such, this review begins with an examination of the literature on acute neuroimaging and what is typically performed in the mTBI patient. Acute Neuroimaging in mTBIA review of the medical literature on acute neuroimaging of TBI shows that, when medically indicated, computed tomography (CT) is typically the first scan performed in any patient who sustains a TBI, including those who meet

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Section: Mri In the Subacute And Chronic Phase Of Mtbimentioning

confidence: 99%

Section: Acute Neuroimaging In Mtbimentioning

confidence: 99%

Neuroimaging in Mild Traumatic Brain Injury

Bigler

2010

Psychol. Inj. and Law

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“…DTI allows detection of white matter tracts in the brain and can be used to visualize DAI. A recent study determined that fluid-attenuated inversion recovery, gradient echo, and diffusion-weighted imaging were superior to conventional spin-echo MRI in detecting DAI, but unlike DTI, these do not image the damaged axon tracts directly [13]. Given time, the brain may eventually recover, at least partially, from a single injury.…”

Section: Figurementioning

confidence: 99%

Traumatic brain injury research opportunities: Results of Department of Veterans Affairs Consensus Conference

Kupersmith¹,

Lew²,

Ommaya³

et al. 2009

JRRD

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Traumatic brain injury (TBI) is one of the foremost medical problems resulting from the wars in Afghanistan and Iraq. In 2006, 13,969 active-duty servicemen and servicewomen with incident TBI were treated in the military medical system; of those, 7.6 percent were hospitalized [1]. While the consequences of moderate to severe TBI capture public and media attention, the majority of brain injuries are mild. Mild TBI (mTBI) represents 85 to 90 percent of civilians with TBI and a large majority with war-related TBI [2][3][4][5]. Our current ability to accurately diagnose war-related mTBI is greatly challenged because much of our knowledge of this injury is based on experience accrued from civilian patients, even though the conditions under which war-related injuries occur differ vastly from those of civilian injuries. TBIs of civilian patients typically result from falls or motor-vehicle or sports-related incidents, whereas war-related TBIs are more often sustained under emotionally traumatic circumstances. Furthermore, since a major portion of current war-related injuries result from blast exposure, inherently different mechanical processes are involved.Although the definition of mTBI varies, it typically refers to injuries that are associated with loss or alteration of consciousness for <30 minutes, posttraumatic amnesia for <24 hours, and an acute Glasgow Coma Score of 13-15 [6]. The most frequent complaints include headaches, fatigue, irritability, and attention and memory problems. Based on civilian experience, the belief is that the majority of otherwise healthy young individuals fully recover from a single uncomplicated mTBI within anywhere from several days to, at most, several months. However, a minority of patients with mTBI experience persistent problems. Diagnosing TBI may be difficult when patients arrive months after the initial injury and present with symptoms that are concordant with traumatic exposure.Postconcussive syndrome (PCS) is diagnosed when patients with mTBI present with ongoing symptomatic complaints. Those who experience multiple TBIs are more likely to have long-lasting symptoms [7]. PCS can occur with any level of head injury severity. According to recent reports, U.S. soldiers returning from Iraq have a high rate of coexistence of mTBI-related complaints and posttraumatic stress disorder (PTSD) [8]. PTSD is an anxiety disorder that may develop after exposure to a traumatic event in which grave harm occurred or was threatened [9]. PCS and PTSD have many symptoms in common, but a hallmark of PTSD is reexperiencing the traumatic event. As expected, PTSD is more prevalent than TBI in combat veterans.An important issue that complicates differentiating traumatic stress and TBI is the retrospective diagnosis of war-related mTBI. The diagnosis is

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“…Perhaps not only the loci but also the severity and mechanism of injury in mTBI influence the likelihood that PTSD develops following a psychologically traumatic event. The areas of the brain with altered function identified by functional imaging in PTSD, including ventromedial frontal lobes and anterior medial temporal lobes [52][53], are included within the areas that are damaged in mTBI [36][37][54][55]. The episodes of mTBI with LOC may have slightly injured the inferior frontal lobes, as suggested by the associated finding of impaired olfaction, without severe enough injury to reduce the likelihood of PTSD developing.…”

Section: Variablementioning

confidence: 99%

For veterans with mild traumatic brain injury, improved posttraumatic stress disorder severity and sleep correlated with symptomatic improvement

Ruff

Riechers²,

Wang³

et al. 2012

JRRD

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Abstract-This was an observational study of a cohort of 63 Operation Iraqi Freedom/Operation Enduring Freedom veterans with mild traumatic brain injury (mTBI) associated with an explosion. They had headaches, residual neurological deficits (NDs) on neurological examination, and posttraumatic stress disorder (PTSD) and were seen on average 2.5 years after their last mTBI. We treated them with sleep hygiene counseling and oral prazosin. We monitored headache severity, daytime sleepiness using the Epworth Sleepiness Scale, cognitive performance using the Montreal Cognitive Assessment test, and the presence of NDs. We quantitatively measured olfaction and assessed PTSD severity using the PTSD Checklist-Military Version. Nine weeks after starting sleep counseling and bedtime prazosin, the veterans' headache severity decreased, cognitive function as assayed with a brief screening tool improved, and daytime sleepiness diminished. Six months after completing treatment, the veterans demonstrated additional improvement in headache severity and daytime sleepiness and their improvements in cognitive function persisted. There were no changes in the prevalence of NDs or olfaction scores. Clinical improvements correlated with reduced PTSD severity and daytime sleepiness. The data suggested that reduced clinical manifestations following mTBI correlated with PTSD severity and improvement in sleep, but not the presence of NDs or olfaction impairment.

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MR imaging in the detection of diffuse axonal injury with mild traumatic brain injury

Abstract: MR imaging can be helpful in revealing DAI lesions in patients with normal CT scan findings after MTBI. FLAIR, GRE and DW sequences are superior to conventional spin-echo images in detecting DAI lesions.

Cited by 80 publications

References 19 publications

Neuroimaging in Mild Traumatic Brain Injury

Neuroimaging in Mild Traumatic Brain Injury

Traumatic brain injury research opportunities: Results of Department of Veterans Affairs Consensus Conference

For veterans with mild traumatic brain injury, improved posttraumatic stress disorder severity and sleep correlated with symptomatic improvement

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