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

Lawrence, Tim P.; Steel, Adam; Ezra, Martyn; Speirs, Mhairi; Pretorius, Pieter M.; Douaud, Gwenaelle; Sotiropoulos, Stamatios; Cadoux-Hudson, Tom; Emir, Uzay E.; Voets, Natalie L.

Abstract

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.

Citation

Lawrence, T. P., Steel, A., Ezra, M., Speirs, M., Pretorius, P. M., Douaud, G., …Voets, N. L. (2019). MRS and DTI evidence of progressive posterior cingulate cortex and corpus callosum injury in the hyper-acute phase after Traumatic Brain Injury. Brain Injury, 33(7), 854-868. https://doi.org/10.1080/02699052.2019.1584332

• Journal Article Type: Article
• Acceptance Date: Jan 21, 2019
• Online Publication Date: Mar 8, 2019
• Publication Date: Mar 8, 2019
• Deposit Date: Mar 17, 2019
• Publicly Available Date: Mar 18, 2019
• Journal: Brain Injury
• Print ISSN: 0269-9052
• Electronic ISSN: 1362-301X
• Publisher: Taylor and Francis
• Peer Reviewed: Peer Reviewed
• Volume: 33
• Issue: 7
• Pages: 854-868
• DOI: https://doi.org/10.1080/02699052.2019.1584332
• Keywords: Magnetic resonance imaging, Diffuse axonal injury, Secondary injury cascade, Corpus callosum, Posterior cingulate cortex
• Public URL: https://nottingham-repository.worktribe.com/output/1659817
• Publisher URL: https://www.tandfonline.com/doi/full/10.1080/02699052.2019.1584332
• Additional Information: Peer Review Statement: The publishing and review policy for this title is described in its Aims & Scope.; Aim & Scope: http://www.tandfonline.com/action/journalInformation?show=aimsScope&journalCode=ibij20; Received: 2018-03-31; Revised: 2018-11-07; Accepted: 2019-01-21; Published: 2019-03-08
• Contract Date: Mar 18, 2019