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Research ArticleBrain
Open Access

Long-Term White Matter Changes after Severe Traumatic Brain Injury: A 5-Year Prospective Cohort

J. Dinkel, A. Drier, O. Khalilzadeh, V. Perlbarg, V. Czernecki, R. Gupta, F. Gomas, P. Sanchez, D. Dormont, D. Galanaud, R.D. Stevens, L. Puybasset and for NICER (Neuro Imaging for Coma Emergence and Recovery) Consortium
American Journal of Neuroradiology January 2014, 35 (1) 23-29; DOI: https://doi.org/10.3174/ajnr.A3616
J. Dinkel
aFrom the Department of Radiology (J.D., O.K., R.G.), Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
bDepartment of Radiology (J.D.), University Hospital Heidelberg, Heidelberg, Germany
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A. Drier
cDepartments of Neuroradiology (A.D., D.D., D.G.)
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O. Khalilzadeh
aFrom the Department of Radiology (J.D., O.K., R.G.), Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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V. Perlbarg
fINSERM, UMRS 678 (V.P.)
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V. Czernecki
dNeurology (V.C.)
gINSERM, CRICM UMR S975 (V.C.), Université Pierre et Marie Curie-Paris 6, Paris, France
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R. Gupta
aFrom the Department of Radiology (J.D., O.K., R.G.), Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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F. Gomas
hDepartment of Anesthesiology and Intensive Care (F.G.), Louis Mourier Hospital, Colombes, France
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P. Sanchez
eAnesthesiology and Intensive Care (P.S., L.P.), Pitié Salpêtrière Hospital, Assistance Publique–Hôpitaux de Paris, France
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D. Dormont
cDepartments of Neuroradiology (A.D., D.D., D.G.)
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D. Galanaud
cDepartments of Neuroradiology (A.D., D.D., D.G.)
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R.D. Stevens
iDivision of Neuroscience Critical Care (R.D.S.), Department of Anesthesiology Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.
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L. Puybasset
eAnesthesiology and Intensive Care (P.S., L.P.), Pitié Salpêtrière Hospital, Assistance Publique–Hôpitaux de Paris, France
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  • Fig 1.
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    Fig 1.

    MR images of a patient with severe TBI at baseline (A and D), year 2 (B and E), and year 5 (C and F). On the conventional FLAIR images (A–C), the hyperintensity of the right frontal lobe (arrow) decreases with time with some minimal atrophic changes. The corresponding FA maps (D–F) are presented. In the acute setting, the normalized FA was slightly reduced in the genu (0.80) and body (0.92) of the corpus callosum and in the bilateral corona radiata (right: 0.96; left: 0.98) compared with control participants (normalized value = 1). At 2 years, most of the normalized FA values in these tracts had further decreased: genu (0.81) and body (0.79) of corpus callosum; corona radiata (right: 0.89; left: 0.96). At 5 years, the values slightly increased: genu (0.82) and body (0.85) of corpus callosum; corona radiata (right: 0.92; left: 0.97).

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    Fig 2.

    Normalized FA (A), and Lt (B) values of patients and control participants at baseline and follow-up steps. The x-axis represents the ROIs (in posterior fossa: 1- MCP: middle cerebellar peduncle; 2- antBS: anterior brain stem; 3- postBS: posterior brain stem; 4- CP-R: right cerebral peduncle; 5- CP-L: left cerebral peduncle; in deep brain: 6- g-CC: genu of the corpus callosum; 7- b-CC: body of the corpus callosum; 8-second-CC: splenium of the corpus callosum; 9- ALIC-R: right side anterior arm of the internal capsule; 10- ALIC-L: left side anterior arm of the internal capsule; 11- PLIC-R: right side posterior arm of the internal capsule; 12- PLIC-L: left side posterior arm of the internal capsule; in superficial brain regions: 13- SS-R: right stratum sagittale; 14- SS-L: left stratum sagittale; 15- SLF-R: right superior longitudinal fasciculus; 16- SLF-L: left superior longitudinal fasciculus; 17- EC-R: right external capsule; 18- EC-L: left external capsule; 19- CR-R: right corona radiata; 20- CR-L: left corona radiata). There were no significant differences in DTI parameters between baseline and year 2 in the control group and between year 2 and year 5 in the TBI group. ‡: P < .05; for comparison of baseline values between control participants and patients (corrected P). *: P < .05; for repeated-measures ANOVA in the patient group between baseline and follow-up steps. Data are presented as mean and standard error of mean (handles). The connection lines are for clarity.

  • Fig 3.
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    Fig 3.

    The changes (year 2 vs baseline) in normalized FA (A) and Lt (B) in the presented ROIs were significantly higher in the patients vs healthy control participants. P < .05 for comparison between patients and control participants in all of the presented ROIs.

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    Fig 4.

    The normalized FA (A) and Lt (B) values at baseline were significantly different in patients with cognitive sequelae at year 5 (including amnesia, aphasia, and dyspraxia) vs healthy control participants. P < .05 for ANOVA among the groups and for comparison between healthy control participants and patients with sequelae in all of the presented ROIs.

Tables

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  • Patient characteristics

    Range
    Age (y)32.4 (9.0)(18–49)
    Men/women, n13/0−
    GCS at admission, n (SD)6 (4)(3–8)
    ICU stay duration (d)47.5 (23.1)(10–97)
    Assisted ventilation duration (d)33.1 (16.9)(9–72)
    Type of accident, n (%)
        MVA10 (77)−
        Assault, fall, other3 (23)−
    Hematoma, n (%)a
        Epidural3 (23)−
        Subdural1 (8)−
        Subarachnoid hemorrhage8 (61)−
    Midline shift3 (23)−
    Compressed third ventricle4 (31)−
    Contusion, n (%)b10 (77)−
    Neurosurgical intervention, n (%)2 (15)−
    Neurologic sequelae, n (%)
        Amnesia2 (15)−
        Aphasia1 (8)−
        Dyspraxia2 (15)−
    • Note:—Variables are presented as mean (standard deviation) or number (percentage).

    • GCS indicates Glasgow Coma Scale; ICU, intensive care unit; SD, standard deviation; MVA, motor-vehicle collision.

    • ↵a Hematoma was defined as an area spontaneously hyperdense on the first CT scan.

    • ↵b Contusion was defined as a focal area appearing hypodense or of mixed density on the CT scan.

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American Journal of Neuroradiology: 35 (1)
American Journal of Neuroradiology
Vol. 35, Issue 1
1 Jan 2014
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J. Dinkel, A. Drier, O. Khalilzadeh, V. Perlbarg, V. Czernecki, R. Gupta, F. Gomas, P. Sanchez, D. Dormont, D. Galanaud, R.D. Stevens, L. Puybasset, for NICER (Neuro Imaging for Coma Emergence and Recovery) Consortium
Long-Term White Matter Changes after Severe Traumatic Brain Injury: A 5-Year Prospective Cohort
American Journal of Neuroradiology Jan 2014, 35 (1) 23-29; DOI: 10.3174/ajnr.A3616

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Long-Term White Matter Changes after Severe Traumatic Brain Injury: A 5-Year Prospective Cohort
J. Dinkel, A. Drier, O. Khalilzadeh, V. Perlbarg, V. Czernecki, R. Gupta, F. Gomas, P. Sanchez, D. Dormont, D. Galanaud, R.D. Stevens, L. Puybasset, for NICER (Neuro Imaging for Coma Emergence and Recovery) Consortium
American Journal of Neuroradiology Jan 2014, 35 (1) 23-29; DOI: 10.3174/ajnr.A3616
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