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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.


Tim P. Lawrence

Adam Steel

Martyn Ezra

Mhairi Speirs

Pieter M. Pretorius

Gwenaelle Douaud

Tom Cadoux-Hudson

Uzay E. Emir

Natalie L. Voets


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.


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.

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
Keywords Magnetic resonance imaging, Diffuse axonal injury, Secondary injury cascade, Corpus callosum, Posterior cingulate cortex
Public URL
Publisher URL
Additional Information Peer Review Statement: The publishing and review policy for this title is described in its Aims & Scope.; Aim & Scope:; Received: 2018-03-31; Revised: 2018-11-07; Accepted: 2019-01-21; Published: 2019-03-08


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