Advertisement

pp 1-10 | Cite as

Reliability of Magnetic Resonance Tractography in Predicting Early Clinical Improvements in Patients with Diffuse Axonal Injury Grade III

  • Sunil MunakomiEmail author
  • Deepak Poudel
  • Sangam Shrestha
Chapter
Part of the Advances in Experimental Medicine and Biology book series

Abstract

Diffuse axonal injury (DAI) grade III forms a distinct subset of traumatic brain injury wherein it is difficult to predict the outcome and the time taken for early recovery in terms of sustained eye opening and standing with minimal assistance. This study seeks to determine differences in the fractional anisotropy (FI) and diffusion-weighted image (DWI) values obtained from the seeds placed at an appropriate region of interest (ROI) within the magnetic resonance (MR) tractography of the brainstem of brain-injured patients. We found that differences in the DWI values along the corticospinal tract were associated with the days required for early recovery. Moreover, dysautonomia was an independent variable governing a delayed recovery in these patients. The lesions posterior to the corticospinal tract in the brainstem conferred increased odds for the subsequent development of dysautonomia. We conclude that MR tractography, in addition to depicting the anatomical integrity of the concerned tracts, has the potential of becoming a surrogate clinical imaging marker for effectively predicting days for early recovery among patients with DAI grade III.

Keywords

Axonal injury Brain Corticospinal tracts Dysautonomia Magnetic resonance Tractography 

Notes

Conflicts of Interest

The authors declare no conflicts of interest in relation to this article.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The study was approved by the Ethics Committee of the Nobel Medical College and Teaching Hospital in Biratnagar, Nepal (IRC-NMCTH-169/2018).

Informed Consent

Written informed consent was obtained from the guardians, relatives, or next of kin concerning all individual participants included in the study.

References

  1. Abu Hamdeh S, Marklund N, Lannsjö M, Howells T, Raininko R, Wikström J, Enblad P (2017) Extended anatomical grading in diffuse axonal injury using MRI: hemorrhagic lesions in the substantia nigra and mesencephalic tegmentum indicate poor long-term outcome. J Neurotrauma 34(2):341–352Google Scholar
  2. Adams H, Mitchell DE, Graham DI, Doyle D (1977) Diffuse brain damage of immediate impact type. Its relationship to “primary brain stem damage” in head injury. Brain 100:489–502Google Scholar
  3. Adams JH, Doyle D, Ford I, Gennarelli TA, Graham DI, McLellan DR (1989) Diffuse axonal injury in head injury: definition, diagnosis and grading. Histopathology 15:49–59Google Scholar
  4. Alberico AM, Ward JD, Choi SC, Marmarou A, Young HF (1987) Outcome after severe head injury: relationship to mass lesions, diffuse injury, and ICP course in pediatric and adult patients. J Neurosurg 67:648–656Google Scholar
  5. Ashwal S, Babikian T, Gardner-Nichols J, Freier MC, Tong KA, Holshouser BA (2006) Susceptibility-weighted imaging and proton magnetic resonance spectroscopy in assessment of outcome after pediatric traumatic brain injury. Arch Phys Med Rehabil 87(12 Suppl 2):S50–S58Google Scholar
  6. Baguley IJ, Nicholls JL, Felmingham KL, Crooks J, Gurka JA, Wade LD (1999) Dysautonomia after traumatic brain injury: a forgotten syndrome? J Neurol Neurosurg Psychiatry 67(1):39–43Google Scholar
  7. Brezova V, Moen KG, Skandsen T, Vik A, Brewer JB, Salvesen O, Haberg AK (2014) Prospective longitudinal MRI study of brain volumes and diffusion changes during the first year after moderate to severe traumatic brain injury. Neuroimage Clin 5:128–140Google Scholar
  8. Calvi MR, Beretta L, Dell’Acqua A, Anzalone N, Licini G, Gemma M (2011) Early prognosis after severe traumatic brain injury with minor or absent computed tomography scan lesions. J Trauma 70(2):447–451Google Scholar
  9. Chelly H, Chaari A, Daoud E, Dammak H, Medhioub F, Mnif J et al (2011) Diffuse axonal injury in patients with head injuries: an epidemiologic and prognosis study of 124 cases. J Trauma 71(4):838–846Google Scholar
  10. Dinkel J, Drier A, Khalilzadeh O, Perlbarg V, Czernecki V, Gupta R, Gomas F, Sanchez P, Dormont D, Galanaud D, Stevens RD, Puybasset L, for NICER (Neuro Imaging for Coma Emergence and Recovery) Consortium (2014) Long-term white matter changes after severe traumatic brain injury: a 5-year prospective cohort. Am J Neuroradiol 35:23–29Google Scholar
  11. Eum SW, Lim DJ, Kim BR, Cho TH, Park JY, Suh JK et al (1998) Prognostic factors in patients with diffuse axonal injury. J Korean Neurosurg Soc 27:1668–1674Google Scholar
  12. Fabbri A, Servadei F, Marchesini G, Stein SC, Vandelli A (2008) Early predictors of unfavorable outcome in subjects with moderate head injury in the emergency department. J Neurol Neurosurg Psychiatry 79(5):567–573Google Scholar
  13. Firsching R, Woischneck D, Klein S, Ludwig K, Dohring W (2002) Brain stem lesions after head injury. Neurol Res 24(2):145–146Google Scholar
  14. Gennarelli TA (1987) Cerebral concussion and diffuse brain injuries. In: Cooper PR (ed) Head injury, 2nd edn. Williams & Wilkins, Baltimore, pp 108–124Google Scholar
  15. Gennarelli T, Thibault L, Adams J, Graham D, Thompson C, Marcincin R (1982) Diffuse axonal injury and traumatic coma in the primate. Ann Neurol 12:564–574Google Scholar
  16. Hendricks HT, Heeren AH, Vos PE (2010) Dysautonomia after severe traumatic brain injury. Eur J Neurol 17(9):1172–1177Google Scholar
  17. Inglese M, Makani S, Johnson G, Cohen BA, Silver JA, Gonen O, Grossman RI (2005) Diffuse axonal injury in mild traumatic brain injury: a diffusion tensor imaging study. J Neurosurg 103:298–303Google Scholar
  18. Kim CH, Lee HK, Koh YC, Hwang DY (1997) Clinical analysis of diffuse axonal injury (DAI) diagnosed with magnetic resonance image (MRI). J Korean Neurosurg Soc 26:241–248Google Scholar
  19. Kim HJ, Park IS, Kim JH, Kim KJ, Hwang SH, Kim ES et al (2001) Clinical analysis of the prognosis of the patients with cerebral diffuse axonal injuries, based on gradient-echo MR imaging. J Korean Neurosurg Soc 30:168–172Google Scholar
  20. Lee HJ, Sun HW, Lee SJ, Choi NJ, Jung YJ, Hong SK (2018) Clinical outcomes of diffuse axonal injury according to radiological grade. J Trauma Inj 31(2):51–57Google Scholar
  21. Ma J, Zhang K, Wang Z, Chen G (2016) Progress of research on diffuse axonal injury after traumatic brain injury. Neural Plast 2016:9746313Google Scholar
  22. Mac Donald CL, Dikranian K, Song SK, Bayly PV, Holtzman DM, Brody DL (2007) Detection of traumatic axonal injury with diffusion tensor imaging in a mouse model of traumatic brain injury. Exp Neurol 205:116–131Google Scholar
  23. Messori A, Polonara G, Mabiglia C, Salvolini U (2003) Is haemosiderin visible indefinitely on gradient-echo MRI following traumatic intracerebral haemorrhage? Neuroradiology 45:881–886Google Scholar
  24. Moen KG, Skandsen T, Folvik M, Brezova V, Kvistad KA, Rydland J, Manley GT, Vik A (2012) A longitudinal MRI study of traumatic axonal injury in patients with moderate and severe traumatic brain injury. J Neurol Neurosurg Psychiatry 83(12):1193–1200Google Scholar
  25. Oh KS, Ha SI, Suh BS, Lee HS, Lee JS (2001) The correlation of MRI findings to outcome in diffuse axonal injury patients. J Korean Neurosurg Soc 30(Suppl I):S20–S24Google Scholar
  26. Park SW, Park K, Kim YB, Min BK, Hwang SN, Suk JS et al (1991) Prognostic factors in diffuse axonal injuries of brain. J Korean Neurosurg Soc 20:983–990Google Scholar
  27. Park SJ, Hur JW, Kwon KY, Rhee JJ, Lee JW, Lee HK (2009) Time to recover consciousness in patients with diffuse axonal injury: assessment with reference to magnetic resonance grading. J Korean Neurosurg Soc 46(3):205–209Google Scholar
  28. Sidaros A, Engberg AW, Sidaros K, Liptrot MG, Herning M, Petersen P, Paulson OB, Jernigan TL, Rostrup E (2008) Diffusion tensor imaging during recovery from severe traumatic brain injury and relation to clinical outcome: a longitudinal study. Brain 131:559–572Google Scholar
  29. Skandsen T, Kvistad KA, Solheim O, Strand IH, Folvik M, Vik A (2010) Prevalence and impact of diffuse axonal injury in patients with moderate and severe head injury: a cohort study of early magnetic resonance imaging findings and 1-year outcome. J Neurosurg 113(3):556–563Google Scholar
  30. Strich SJ (1956) Diffuse degeneration of the cerebral white matter in severe dementia following head injury. J Neurol Neurosurg Psychiatry 19:163–185Google Scholar
  31. van Eijck MM, Schoonman GG, van der Naalt J, de Vries J, Roks G (2018a) Diffuse axonal injury after traumatic brain injury is a prognostic factor for functional outcome: a systematic review and meta-analysis. Brain Inj 32(4):395–402Google Scholar
  32. van Eijck M, van der Naalt J, de Jongh M, Schoonman G, Oldenbeuving A, Peluso J, de Vries J, Roks G (2018b) Patients with diffuse axonal injury can recover to a favorable long-term functional and quality of life outcome. J Neurotrauma 35(20):2357–2364Google Scholar
  33. Vieira RC, Paiva WS, de Oliveira DV, Teixeira MJ, de Andrade AF, de Sousa RM (2016) Diffuse axonal injury: epidemiology, outcome and associated risk factors. Front Neurol 7:178Google Scholar
  34. Zimmerman RA, Bilaniuk LT, Hackney DB, Goldberg HI, Grossman RI (1986) Head injury: early results of comparing CT and high-field MR. Am J Roentgenol 147:1215–1222Google Scholar

Copyright information

©  Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Sunil Munakomi
    • 1
    Email author
  • Deepak Poudel
    • 2
  • Sangam Shrestha
    • 3
  1. 1.Department of NeurosurgeryNobel Medical College and Teaching HospitalBiratnagarNepal
  2. 2.Department of General AnesthesiaNobel Medical College and Teaching HospitalBiratnagarNepal
  3. 3.Department of PediatricsKoshi Zonal HospitalBiratnagarNepal

Personalised recommendations