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Diffusivity of Normal-Appearing Tissue in Acute Traumatic Brain Injury

Diffusivität von anscheinend normalem Gewebe nach akut traumatischer Hirnverletzung

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Abstract

Background

Apparent diffusion coefficient (ADC) values derived from diffusion-weighted magnetic resonance imaging (MRI) can provide information about traumatic changes not visible in conventional MRI. The ADC values in acute traumatic brain injury (TBI) were measured and correlated with initial severity and outcome scores.

Methods

In this study 22 unselected patients were studied 1 week (mean 7 ± 2 days) after TBI of variable severity. In conventional MRI 7 patients were without visible findings, 15 showed cortical contusions or traumatic axonal injury and 14 healthy subjects served as controls. The ADC values were measured from 46 brain regions away from the visible traumatic changes and compared between the groups. Regional ADC values and the number of abnormal regions were correlated with the Glasgow coma scale (GCS) on arrival in hospital and the Glasgow outcome scale (extended version, GOS-E) at 1 year after injury.

Results

The ADC values of TBI patients with and without visible lesions did not show any differences but both groups differed significantly from the controls in several cortical and deep brain regions. Increased ADC values were common in TBI groups but decreased ADC values were relatively uncommon. The regional ADC values and the number of abnormal regions did not correlate with either GCS or GOS-E scores.

Conclusions

Increased diffusion in normal appearing brain tissue is a common finding 1 week after TBI in patients with and without visible lesions in conventional MRI. More investigations are needed to evaluate how these findings could be used for clinical applications.

Zusammenfassung

Zielsetzung

Die aus der diffusionsgewichteten Magnetresonanztomographie (MRT) abgeleiteten Werte des effektiven Diffusionskoeffizienten ("apparent diffusion coefficient", ADC) können Informationen über traumatisch bedingte Veränderungen geben, die im konventionellen MRT nicht sichtbar werden. Bei Patienten mit akut traumatischen Hirnschäden wurden die ADC-Werte gemessen und mit initialen Schweregraden sowie "outcome scores" in Beziehung gesetzt.

Methoden

Es wurden 22 nichtvorselektierte Patienten eine Woche (Median 7 ± 2 Tage) nach traumatischer Hirnverletzung unterschiedlicher Schweregrade untersucht. Mithilfe des konventionellen MRT zeigten 7 Patienten keine sichtbaren Befunde, 15 Patienten wiesen kortikale Kontusionen oder traumatische axonale Verletzungen auf, und 14 gesunde Patienten wurden als Kontrollen inkludiert. Die ADC-Werte wurden in 46 verschiedenen, von den sichtbaren geschädigten Veränderungen entfernten Hirnbereichen gemessen und zwischen den Gruppen verglichen. Die ADC-Werte örtlich begrenzter Regionen und die Zahl der abnormalen Regionen wurden mit der Glasgow Coma Scale (GCS) bei Ankunft im Krankenhaus sowie ein Jahr nach der Verletzung mit der erweiterten Version der Glasgow Outcome Scale (GOS-E) in Beziehung gesetzt.

Ergebnisse

Die ADC-Werte der Patienten mit traumatischer Hirnverletzung mit und ohne sichtbare Läsionen zeigten keine Unterschiede, aber die Werte beider Gruppen unterschieden sich in verschiedenen kortikalen und tiefen Hirnbereichen signifikant von den Werten der Kontrollgruppe. Höhere ADC-Werte waren in den Gruppen mit traumatischer Hirnverletzung häufiger; verminderte Werte waren relativ selten. Die ADC-Werte örtlich begrenzter Regionen und die Zahl der abnormalen Regionen korrelierten nicht mit den GCS- oder GOS-E-Scores.

Schlussfolgerungen

Diffusionssteigerungen in anscheinend normalem Hirngewebe bilden häufige Befunde eine Woche nach einer traumatischen Hirnverletzung bei Patienten mit und ohne sichtbare Läsionen im konventionellen MRT. Weitere Studien sind nötig, um zu evaluieren, wie diese Ergebnisse klinisch umgesetzt werden können.

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Conflict of Interest Statement

The authors declare that there is no actual or potential conflict of interest in relation to this article.

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Authors and Affiliations

  1. Department of Radiology, Helsinki University Hospital, P.O. Box 340, 00029, HUS, Finland

    N. Brandstack

  2. Department of Radiology, Turku University Hospital, P.O. Box 52, 20521, Turku, Finland

    T. Kurki

  3. Department of Neurology, Turku University Hospital, P.O. Box 52, 20521, Turku, Finland

    H. Hiekkanen & O. Tenovuo

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  1. N. Brandstack
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  2. T. Kurki
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  4. O. Tenovuo
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Correspondence to N. Brandstack.

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Brandstack, N., Kurki, T., Hiekkanen, H. et al. Diffusivity of Normal-Appearing Tissue in Acute Traumatic Brain Injury. Clin Neuroradiol 21, 75–82 (2011). https://doi.org/10.1007/s00062-011-0058-5

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  • DOI: https://doi.org/10.1007/s00062-011-0058-5

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