Traumatic Brain Injury Imaging Research Roadmap

Abstract

SUMMARY:The past decade has seen impressive advances in the types of neuroimaging information that can be acquired in patients with traumatic brain injury. However, despite this increase in information, understanding of the contribution of this information to prognostic accuracy and treatment pathways for patients is limited. Available techniques often allow us to infer the presence of microscopic changes indicative of alterations in physiology and function in brain tissue. However, because histologic confirmation is typically lacking, conclusions reached by using these techniques remain solely inferential in almost all cases. Hence, a need exists for validation of these techniques by using data from large population samples that are obtained in a uniform manner, analyzed according to well-accepted procedures, and correlated with closely monitored clinical outcomes. At present, many of these approaches remain confined to population-based research rather than diagnosis at an individual level, particularly with regard to traumatic brain injury that is mild or moderate in degree. A need and a priority exist for patient-centered tools that will allow advanced neuroimaging tools to be brought into clinical settings. One barrier to developing these tools is a lack of an age-, sex-, and comorbidities-stratified, sequence-specific, reference imaging data base that could provide a clear understanding of normal variations across populations. Such a data base would provide researchers and clinicians with the information necessary to develop computational tools for the patient-based interpretation of advanced neuroimaging studies in the clinical setting.The recent "Joint ASNR-ACR HII-ASFNR TBI Workshop: Bringing Advanced Neuroimaging for Traumatic Brain Injury into the Clinic" on May 23, 2014, in Montreal, Quebec, Canada, brought together neuroradiologists, neurologists, psychiatrists, neuropsychologists, neuroimaging scientists, members of the National Institute of Neurologic Disorders and Stroke, industry representatives, and other traumatic brain injury stakeholders to attempt to reach consensus on issues related to and develop consensus recommendations in terms of creating both a well-characterized normative data base of comprehensive imaging and ancillary data to serve as a reference for tools that will allow interpretation of advanced neuroimaging tests at an individual level of a patient with traumatic brain injury. The workshop involved discussions concerning the following: 1) designation of the policies and infrastructure needed for a normative data base, 2) principles for characterizing normal control subjects, and 3) standardizing research neuroimaging protocols for traumatic brain injury. The present article summarizes these recommendations and examines practical steps to achieve them.

Diffusion Tensor Imaging of the Normal Cervical and Thoracic Pediatric Spinal Cord

“…The validation requires examining a population of subjects that have core variables such as age, sex, race, ethnicity, handedness, and education levels for any normative data base. 9 Twenty-two typically developing subjects (mean age, 11.44 Ϯ 3.07 years) were recruited. There were 8 males (mean age, 10.51 Ϯ 3.31 years) and 14 females (mean age, 11.97 Ϯ 2.92 years).…”

Orthopedic Injured versus Uninjured Comparison Groups for Neuroimaging Research in Mild Traumatic Brain Injury

“…However, some advanced quantitative im-aging techniques such as DTI lack the normative data necessary for both useful group comparison and more precision-based analysis of individuals. Further, despite general consensus around the importance of group comparability of demographic variables, including age, sex, education, and socioeconomic status (SES), in brain injury research, [6][7][8] and evidence that these variables may be associated with risk for sustaining brain injury 7,9 and traumatic injury in general, 10,11 debate continues surrounding which comparison group is most appropriate for imaging studies in mTBI.…”

Twenty-Five Diagnoses on Midline Images of the Brain: From Fetus to Child to Adult

“…Rotational acceleration-deceleration forces may be a particular risk factor for DAI (5)(6)(7)(8). Susceptibility-weighted imaging is an important addition to routine imaging protocols in patients with trauma, especially with a suspected DAI.…”