Detecting axonal injury in individual patients after traumatic brain injury
| العنوان: | Detecting axonal injury in individual patients after traumatic brain injury |
|---|---|
| المؤلفون: | Adriana Azor, Stefano Sandrone, Neil S. Graham, Amy Jolly, Karl Zimmerman, Daniel Friedland, David J. Sharp, Maria Bălăeţ |
| المساهمون: | Guarantors of Brain, Imperial College Healthcare NHS Trust- BRC Funding, The Royal British Legion, National Institute for Health Research, UK DRI Ltd |
| المصدر: | Brain |
| بيانات النشر: | Oxford University Press (OUP), 2020. |
| سنة النشر: | 2020 |
| مصطلحات موضوعية: | 0301 basic medicine, Adult, Male, medicine.medical_specialty, Traumatic brain injury, diffuse axonal injury, White matter, 03 medical and health sciences, 0302 clinical medicine, Fractional anisotropy, Brain Injuries, Traumatic, medicine, Medical imaging, Image Processing, Computer-Assisted, Humans, 11 Medical and Health Sciences, diagnostic pipeline, Neurology & Neurosurgery, business.industry, AcademicSubjects/SCI01870, traumatic brain injury, Diffuse axonal injury, Reproducibility of Results, Original Articles, Middle Aged, medicine.disease, diffusion tensor imaging, White Matter, Axons, 17 Psychology and Cognitive Sciences, Editor's Choice, 030104 developmental biology, medicine.anatomical_structure, Diffusion Magnetic Resonance Imaging, nervous system, Susceptibility weighted imaging, Anisotropy, Female, AcademicSubjects/MED00310, Neurology (clinical), Radiology, Abnormality, business, 030217 neurology & neurosurgery, Diffusion MRI |
| الوصف: | Jolly et al. develop a diffusion MRI pipeline for the diagnosis of axonal injury in individual patients with traumatic brain injury. They demonstrate the sensitivity of this pipeline for detecting axonal injury, show its relationship to clinical measures, and provide practical guidelines for its use in subacute and chronic TBI. Poor outcomes after traumatic brain injury (TBI) are common yet remain difficult to predict. Diffuse axonal injury is important for outcomes, but its assessment remains limited in the clinical setting. Currently, axonal injury is diagnosed based on clinical presentation, visible damage to the white matter or via surrogate markers of axonal injury such as microbleeds. These do not accurately quantify axonal injury leading to misdiagnosis in a proportion of patients. Diffusion tensor imaging provides a quantitative measure of axonal injury in vivo, with fractional anisotropy often used as a proxy for white matter damage. Diffusion imaging has been widely used in TBI but is not routinely applied clinically. This is in part because robust analysis methods to diagnose axonal injury at the individual level have not yet been developed. Here, we present a pipeline for diffusion imaging analysis designed to accurately assess the presence of axonal injury in large white matter tracts in individuals. Average fractional anisotropy is calculated from tracts selected on the basis of high test-retest reliability, good anatomical coverage and their association to cognitive and clinical impairments after TBI. We test our pipeline for common methodological issues such as the impact of varying control sample sizes, focal lesions and age-related changes to demonstrate high specificity, sensitivity and test-retest reliability. We assess 92 patients with moderate-severe TBI in the chronic phase (≥6 months post-injury), 25 patients in the subacute phase (10 days to 6 weeks post-injury) with 6-month follow-up and a large control cohort (n = 103). Evidence of axonal injury is identified in 52% of chronic and 28% of subacute patients. Those classified with axonal injury had significantly poorer cognitive and functional outcomes than those without, a difference not seen for focal lesions or microbleeds. Almost a third of patients with unremarkable standard MRIs had evidence of axonal injury, whilst 40% of patients with visible microbleeds had no diffusion evidence of axonal injury. More diffusion abnormality was seen with greater time since injury, across individuals at various chronic injury times and within individuals between subacute and 6-month scans. We provide evidence that this pipeline can be used to diagnose axonal injury in individual patients at subacute and chronic time points, and that diffusion MRI provides a sensitive and complementary measure when compared to susceptibility weighted imaging, which measures diffuse vascular injury. Guidelines for the implementation of this pipeline in a clinical setting are discussed. |
| اللغة: | English |
| URL الوصول: | https://explore.openaire.eu/search/publication?articleId=doi_dedup___::85e64dcde3d1ced0840d17229cfbffc8 http://hdl.handle.net/10044/1/85588 |
| Rights: | OPEN |
| رقم الانضمام: | edsair.doi.dedup.....85e64dcde3d1ced0840d17229cfbffc8 |
| قاعدة البيانات: | OpenAIRE |
| الوصف غير متاح. |