Features | Partner Sites | Information | LinkXpress
Sign In
ElsMed
Ampronix
Schiller

DTI-MRI Targets Brain Injury Region in Some Concussion Patients

By Medimaging International staff writers
Posted on 30 Apr 2014
Image: Vestibular disturbances correlate with decreased FA in cerebellar regions responsible for sensorimotor processing and central and/or axial balance as well as fusiform gyrus, which is responsible for visually guided locomotion and stereoscopic vision. Images derived from TBSS results and rendered on T1- weighted images from Montreal Neurologic Institute atlas indicate that significant white matter differences in patients with mild TBI and vestibular symptoms involve (a–c) lobule VI and vermian lobules VIIIa, VIIIb, and IX, as shown in axial (a), coronal (b), and sagittal (c) planes, and (d–f) fusiform gyri bilaterally, as shown in axial (d), coronal (e), and sagittal (f) planes. Significant voxels (p < .005, corrected for multiple comparisons) were thickened by using TBSS fill function into local tracts (red) and overlaid on white matter skeleton (blue) (Photo courtesy of Radiology).
Image: Vestibular disturbances correlate with decreased FA in cerebellar regions responsible for sensorimotor processing and central and/or axial balance as well as fusiform gyrus, which is responsible for visually guided locomotion and stereoscopic vision. Images derived from TBSS results and rendered on T1- weighted images from Montreal Neurologic Institute atlas indicate that significant white matter differences in patients with mild TBI and vestibular symptoms involve (a–c) lobule VI and vermian lobules VIIIa, VIIIb, and IX, as shown in axial (a), coronal (b), and sagittal (c) planes, and (d–f) fusiform gyri bilaterally, as shown in axial (d), coronal (e), and sagittal (f) planes. Significant voxels (p < .005, corrected for multiple comparisons) were thickened by using TBSS fill function into local tracts (red) and overlaid on white matter skeleton (blue) (Photo courtesy of Radiology).
Image: Vestibular disturbances correlate with increased mean diffusivity in vermian lobules of spinocerebellum, which processes proprioception input from spinal cord dorsal columns to anticipate future positioning during the course of a movement. Images derived from TBSS results and rendered on T1-weighted images from Montreal Neurologic Institute atlas indicate that significant white matter differences in patients with mild TBI and vestibular symptoms involve vermian lobules II and III, as shown in (a) axial and (b) sagittal planes. Significant voxels (p < 0.05, corrected for multiple comparisons) were thickened by using TBSS fill function into local tracts (red) and overlaid on white matter skeleton (blue) (Photo courtesy of Radiology).
Image: Vestibular disturbances correlate with increased mean diffusivity in vermian lobules of spinocerebellum, which processes proprioception input from spinal cord dorsal columns to anticipate future positioning during the course of a movement. Images derived from TBSS results and rendered on T1-weighted images from Montreal Neurologic Institute atlas indicate that significant white matter differences in patients with mild TBI and vestibular symptoms involve vermian lobules II and III, as shown in (a) axial and (b) sagittal planes. Significant voxels (p < 0.05, corrected for multiple comparisons) were thickened by using TBSS fill function into local tracts (red) and overlaid on white matter skeleton (blue) (Photo courtesy of Radiology).
Convergence insufficiency correlates with increased FA in right anterior thalamic radiation, which is central to processing speed, and right geniculate nucleus optic radiations, the major relay station for the accommodation circuit central to oculomotor convergence. Asymmetric involvement of the right is not unexpected, as the corresponding left visual field is dominant for spatial processing as compared with the right visual field, which is dominant for nonspatial and/or temporal processing. Images derived from TBSS results and rendered on T1-weighted images from Montreal Neurologic Institute atlas show that significant white matter differences in patients with mild TBI and convergence insufficiency involve right anterior thalamic radiation, as shown in (a) coronal and (b) axial planes, and right geniculate nucleus optic radiations; as shown in (c) coronal and (d) axial planes. Significant voxels (P < .05, corrected for multiple comparisons) were thickened by using TBSS fill function into local tracts (red) and overlaid on white matter skeleton (blue) (Photo courtesy of Radiology).
Convergence insufficiency correlates with increased FA in right anterior thalamic radiation, which is central to processing speed, and right geniculate nucleus optic radiations, the major relay station for the accommodation circuit central to oculomotor convergence. Asymmetric involvement of the right is not unexpected, as the corresponding left visual field is dominant for spatial processing as compared with the right visual field, which is dominant for nonspatial and/or temporal processing. Images derived from TBSS results and rendered on T1-weighted images from Montreal Neurologic Institute atlas show that significant white matter differences in patients with mild TBI and convergence insufficiency involve right anterior thalamic radiation, as shown in (a) coronal and (b) axial planes, and right geniculate nucleus optic radiations; as shown in (c) coronal and (d) axial planes. Significant voxels (P < .05, corrected for multiple comparisons) were thickened by using TBSS fill function into local tracts (red) and overlaid on white matter skeleton (blue) (Photo courtesy of Radiology).
Researchers using data provided by a magnetic resonance imaging (MRI) scanning technique have identified regional white matter damage in the brains of individuals who experience chronic dizziness and other symptoms after concussion. The findings suggest that information provided by MRI can speed the onset of effective treatments for concussion patients.

The study’s findings were published online April 15, 2014, in the journal Radiology.

Concussions, also known as mild traumatic brain injury (mTBI), affect between 1.8 and 3.8 million individuals in the United States yearly. One of the most common and debilitating effects of concussion is vestibulopathy, a disorder characterized by imbalance, dizziness, and visual difficulties. Vestibulopathy impairs activities of daily living and puts patients at increased risk for a second injury. Up until now, no specific brain regions have been linked to the prognosis of patients with vestibulopathy.

For the study, the researchers retrospectively reviewed imaging data from 30 mTBI patients with vestibular symptoms and 25 with ocular convergence insufficiency, a condition that occurs when the eyes do not turn inward properly when focusing on a nearby object. Controls consisted of 39 mTBI patients without vestibular abnormalities and 17 with normal ocular convergence. The imaging data were acquired using an MRI technique called diffusion tensor imaging (DTI), which produces a fractional anisotropy (FA) value that can be used to determine damage to the brain's signal-transmitting white matter.

“FA provides a measure of how intact the white matter is,” said Lea Alhilali, MD, from the University of Pittsburgh Medical Center (PA, USA). “The lower the FA value, the more injured the white matter is.”

When Dr. Alhilali and colleagues compared the DTI findings, they discovered that the concussion patients with vestibular symptoms had decreased FA values in brain regions not previously suspected to be involved in post-traumatic vestibulopathy. “Patients with vestibular symptoms had white matter injury in the cerebellar area, which is known to control balance and movement, and also in the fusiform gyri, a brain area that integrates the visual fields of the left and right eye and is important to spatial orientation,” she said.

The findings seem to demonstrate a connection between vestibulopathy and regional brain damage, Dr. Alhilali added. “Vestibulopathy was previously thought to be related to the inner ear structure,” she said. “What’s unique about our study is that it shows that, in these patients, there is also injury to the brain itself.”

The researchers also found that injury to the cerebellar area was associated with a lengthier recovery time. The findings have the potential to change the clinical management of vestibulopathy in concussion patients, Dr. Alhilali reported. DTI findings, for instance, could be used with neurocognitive testing to help determine a patient’s prognosis and begin appropriate treatments. “Vestibular therapy is often very effective,” Dr. Alhilali said. “Using DTI findings, we can treat patients earlier and get them back to a baseline state much sooner.”

The researchers have two objectives in the near term, Dr. Alhilali said. First they want to identify brain injuries associated with other postconcussion symptoms, and then they hope to conduct prospective studies to track patients from shortly after their concussions through recovery. “Concussion is not just one pathology, but many different injuries with different symptoms,” Dr. Alhilali said. “Not every case is the same, and we need to treat each patient individually.”

Related Links:

University of Pittsburgh Medical Center



Channels

Radiography

view channel
Image: The Somatom Scope CT system’s biopsy and intervention modes for CT-guided intervention enhance precision and streamline workflow (Photo courtesy of Siemens Healthcare).

16-Slice CT System’s Technology Extends Operational Lifetime by Minimizing Wear and Tear

A new 16-slice computed tomography (CT) system is designed for clinical routine and is available in two power configurations to better meet clinical, workflow requirements. Siemens Healthcare (Erlangen,... Read more

Ultrasound

view channel
Image: Leading German anesthetists Drs. Wolf Armbruster, Rüdiger Eichholz, and Thomas Notheisen have collaborated to develop the Armbruster Eichholz Notheisen (AEN) training concept for ultrasound-guided regional anesthesia (Photo courtesy of Management and Krankenhaus).

Point-of-Care Ultrasound Training Program Established for Regional Anesthesiologists

Regional anesthesia specialists have developed an innovative ultrasound training program. Leading German anesthetists Drs. Wolf Armbruster, Rüdiger Eichholz, and Thomas Notheisen have collaborated to... Read more

Nuclear medicine

view channel
Image: The ProBeam system treatment room (Photo courtesy of Varian Medical Systems).

Five Proton Therapy Treatment Rooms Plus System Upgrade Deployed at Scripps Proton Therapy Center

An upgrade of a proton system will improve workflow at a US proton therapy center, enabling the use of the fixed-beam treatment rooms as well as more diverse patient-positioning devices.... Read more

General/Advanced Imaging

view channel
Image: New laser technology designed to detect breast cancer based on photoacoustics (Photo courtesy of Universidad Carlos III de Madrid).

Photoacoustics Used to Detect Breast Cancer

Spanish scientists are using new laser technology to detect breast cancer based on photoacoustics. The new approach could become an alternative to mammography or ultrasound. The European science project... Read more

Imaging IT

view channel

Database Tool Centralizes Imaging Workflows into One Platform to Improve Patient Care, Cut Costs

A single database application has been developed to centralize imaging workflows into one easy-to-use platform. It is an intuitive approach that scales as the healthcare provider’s needs grow. With consolidated software and interfaces, users can considerable reduce manual data entry, errors, and down time.... Read more

Industry News

view channel

Global Partnership Provides Treatment Planning Support for Modulated Arc Radiotherapy

Varian Medical Systems (Palo Alto, CA, USA) Eclipse treatment planning software can now be used to plan modulated arc radiotherapy (mARC) treatments at sites using Siemens Healthcare (Erlangen, Germany) medical linear accelerators. Varian Medical Systems and Siemens Healthcare presented their range of solutions that... Read more
 
Copyright © 2000-2014 Globetech Media. All rights reserved.