Current and future diagnostic tools for traumatic brain injury. CT, conventional MRI, and diffusion tensor imaging

David L. Brody, Christine L. Mac Donald, Joshua S. Shimony

Research output: Chapter in Book/Report/Conference proceedingChapter

8 Scopus citations

Abstract

Brain imaging plays a key role in the assessment of traumatic brain injury. In this review, we present our perspectives on the use of computed tomography (CT), conventional magnetic resonance imaging (MRI), and newer advanced modalities such as diffusion tensor imaging. Specifically, we address assessment for immediately life-threatening intracranial lesions (noncontrast head CT), assessment of progression of intracranial lesions (noncontrast head CT), documenting intracranial abnormalities for medicolegal reasons (conventional MRI with blood-sensitive sequences), presurgical planning for post-traumatic epilepsy (high spatial resolution conventional MRI), early prognostic decision making (conventional MRI with diffusion-weighted imaging), prognostic assessment for rehabilitative planning (conventional MRI and possibly diffusion tensor imaging in the future), stratification of subjects and pharmacodynamic tracking of targeted therapies in clinical trials (specific MRI sequences or positron emission tomography (PET) ligands, e.g., diffusion tensor imaging for traumatic axonal injury). We would like to emphasize that all of these methods, especially the newer research approaches, require careful radiologic-pathologic validation for optimal interpretation. We have taken this approach in a mouse model of pericontusional traumatic axonal injury. We found that the extent of reduction in the diffusion tensor imaging parameter relative anisotropy directly correlated with the number of amyloid precursor protein (APP)-stained axonal varicosities (r2=0.81, p<0.0001, n=20 injured mice). Interestingly, however, the least severe contusional injuries did not result in APP-stained axonal varicosities, but did cause reduction in relative anisotropy. Clearly, both the imaging assessments and the pathologic assessments will require iterative refinement.

Original languageEnglish
Title of host publicationHandbook of Clinical Neurology
PublisherElsevier B.V.
Pages267-275
Number of pages9
DOIs
StatePublished - Jan 1 2015

Publication series

NameHandbook of Clinical Neurology
Volume127
ISSN (Print)0072-9752
ISSN (Electronic)2212-4152

Keywords

  • Amyloid precursor protein
  • Computed tomography
  • Diffusion tensor imaging
  • Magnetic resonance imaging
  • Medicolegal documentation
  • Post-traumatic epilepsy
  • Prognosis
  • Radiological-pathological correlation
  • Traumatic brain injury

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    Brody, D. L., Mac Donald, C. L., & Shimony, J. S. (2015). Current and future diagnostic tools for traumatic brain injury. CT, conventional MRI, and diffusion tensor imaging. In Handbook of Clinical Neurology (pp. 267-275). (Handbook of Clinical Neurology; Vol. 127). Elsevier B.V.. https://doi.org/10.1016/B978-0-444-52892-6.00017-9