Assessment of thalamic perfusion in patients with mild traumatic brain injury by true FISP arterial spin labelling MR imaging at 3T

Objective: To assess cerebral blood flow (CBF) changes in patients with mild traumatic brain injury (MTBI) using an arterial spin labelling (ASL) perfusion MRI and to investigate the severity of neuropsychological functional impairment with respect to haemodynamic changes. Materials and methods: Twenty-one patients with MTBI and 20 healthy controls were studied at 3T MR. The median time since the onset of brain injury in patients was 24.6 months. Both patients and controls underwent a traditional consensus battery of neurocognitive tests. ASL was performed using true fast imaging with steady state precession and a flow-sensitive alternating inversion recovery preparation. Regional CBF were measured in both deep and cortical gray matter as well as white matter at the level of basal ganglia. Results: The mean regional CBF was significantly lower in patients with MTBI (45.9 ± 9.8 ml/100 g min−1) as compared to normal controls (57.1 ± 8.1 ml/100 g min−1; p = 0.002) in both sides of thalamus. The decrease of thalamic CBF was significantly correlated with several neurocognitive measures including processing and response speed, memory/learning, verbal fluency and executive function in patients. Conclusions: Haemodynamic impairment can occur and persist in patients with MTBI, the extent of which is more severe in thalamic regions and correlate with neurocognitive dysfunction during the extended course of disease.

[1]  J. Adams,et al.  Selective loss of neurons from the thalamic reticular nucleus following severe human head injury. , 1993, Journal of neurotrauma.

[2]  Xavier Golay,et al.  Routine clinical brain MRI sequences for use at 3.0 Tesla , 2005, Journal of magnetic resonance imaging : JMRI.

[3]  E. J. Green,et al.  Secondary hypoxia following moderate fluid percussion brain injury in rats exacerbates sensorimotor and cognitive deficits. , 1999, Journal of neurotrauma.

[4]  M. Fukui,et al.  Decreased thalamic metabolism without thalamic magnetic resonance imaging abnormalities following shearing injury to the substantia nigra , 2002, Journal of Clinical Neuroscience.

[5]  Donald S. Williams,et al.  Perfusion imaging , 1992, Magnetic resonance in medicine.

[6]  S Warach,et al.  A general kinetic model for quantitative perfusion imaging with arterial spin labeling , 1998, Magnetic resonance in medicine.

[7]  T. L. Davis,et al.  Mr perfusion studies with t1‐weighted echo planar imaging , 1995, Magnetic resonance in medicine.

[8]  D Kushner,et al.  Mild traumatic brain injury: toward understanding manifestations and treatment. , 1998, Archives of internal medicine.

[9]  R. Busto,et al.  Widespread Hemodynamic Depression and Focal Platelet Accumulation after Fluid Percussion Brain Injury: A Double-Label Autoradiographic Study in Rats , 1996, Journal of cerebral blood flow and metabolism : official journal of the International Society of Cerebral Blood Flow and Metabolism.

[10]  W. Lishman Physiogenesis and Psychogenesis in the ‘Post-Concussional Syndrome’ , 1988, British Journal of Psychiatry.

[11]  Jonathan P Coles,et al.  Regional ischemia after head injury , 2004, Current opinion in critical care.

[12]  Stephen R. Wisniewski,et al.  Assessment of Cerebral Blood Flow and CO2 Reactivity after Controlled Cortical Impact by Perfusion Magnetic Resonance Imaging using Arterial Spin-Labeling in Rats , 1997, Journal of cerebral blood flow and metabolism : official journal of the International Society of Cerebral Blood Flow and Metabolism.

[13]  T. Kaushik,et al.  Development and Validation of a Web-Based Screening Tool for Monitoring Cognitive Status , 2002, The Journal of head trauma rehabilitation.

[14]  P. Fatouros,et al.  Ultra-early evaluation of regional cerebral blood flow in severely head-injured patients using xenon-enhanced computerized tomography. , 1992, Journal of neurosurgery.

[15]  Jack M Fletcher,et al.  Magnetic Resonance Imaging in Relation to Functional Outcome of Pediatric Closed Head Injury: A Test of the Ommaya-Gennarelli Model. , 1997, Neurosurgery.

[16]  Seong-Gi Kim Quantification of relative cerebral blood flow change by flow‐sensitive alternating inversion recovery (FAIR) technique: Application to functional mapping , 1995, Magnetic resonance in medicine.

[17]  M. Lezak Neuropsychological assessment, 3rd ed. , 1995 .

[18]  P. Kochanek,et al.  One-year study of spatial memory performance, brain morphology, and cholinergic markers after moderate controlled cortical impact in rats. , 1999, Journal of neurotrauma.

[19]  Peter Jezzard,et al.  Quantitative perfusion measurements using pulsed arterial spin labeling: Effects of large region‐of‐interest analysis , 2005, Journal of magnetic resonance imaging : JMRI.

[20]  J. Miller,et al.  Head injury and brain ischaemia--implications for therapy. , 1985, British journal of anaesthesia.

[21]  R. Guillery Anatomical evidence concerning the role of the thalamus in corticocortical communication: a brief review. , 1995, Journal of anatomy.

[22]  S. Inao,et al.  Cerebral blood flow regulation under activation of the primary somatosensory cortex during electrical stimulation of the forearm. , 1999, Neurological Research.

[23]  L. Martin,et al.  Thalamic neuron apoptosis emerges rapidly after cortical damage in immature mice , 2002, Neuroscience.

[24]  U. Klose,et al.  FAIR true‐FISP perfusion imaging of the kidneys , 2004, Magnetic resonance in medicine.

[25]  Donald S. Williams,et al.  Cerebral blood flow at one year after controlled cortical impact in rats: assessment by magnetic resonance imaging. , 2002, Journal of neurotrauma.

[26]  R. Guillery,et al.  Functional organization of thalamocortical relays. , 1996, Journal of neurophysiology.

[27]  I. Grant,et al.  Postconcussional disorder: time to acknowledge a common source of neurobehavioral morbidity. , 1994, The Journal of neuropsychiatry and clinical neurosciences.

[28]  Peter Jezzard,et al.  Rapid T1 mapping using multislice echo planar imaging , 2001, Magnetic resonance in medicine.

[29]  Jason Fletcher,et al.  The construct of problem solving in higher level neuropsychological assessment and rehabilitation. , 2004, Archives of clinical neuropsychology : the official journal of the National Academy of Neuropsychologists.

[30]  W. Sturm,et al.  Neuropsychological assessment , 2007, Journal of Neurology.

[31]  Xavier Golay,et al.  Determining the longitudinal relaxation time (T1) of blood at 3.0 Tesla , 2004, Magnetic resonance in medicine.

[32]  M. Witter,et al.  Neuropsychology of infarctions in the thalamus: a review , 2000, Neuropsychologia.

[33]  J. Masdeu,et al.  Discordance between FDG uptake and technetium-99m-HMPAO brain perfusion in acute traumatic brain injury. , 1998, Journal of nuclear medicine : official publication, Society of Nuclear Medicine.

[34]  K A Dunn,et al.  Traumatic brain injury in the United States: A public health perspective. , 1999, The Journal of head trauma rehabilitation.

[35]  B. Crosson,et al.  Role of the thalamus in language: is it related to schizophrenic thought disorder? , 1987, Schizophrenia bulletin.

[36]  P. Kochanek,et al.  Severe controlled cortical impact in rats: assessment of cerebral edema, blood flow, and contusion volume. , 1995, Journal of neurotrauma.

[37]  J. Povlishock,et al.  Focal ischemia due to traumatic contusions documented by stable xenon-CT and ultrastructural studies. , 1995, Journal of neurosurgery.

[38]  S. Naddaf,et al.  SPECT brain perfusion abnormalities in mild or moderate traumatic brain injury. , 1998, Clinical nuclear medicine.

[39]  A. Nobre,et al.  Qualitative mapping of cerebral blood flow and functional localization with echo-planar MR imaging and signal targeting with alternating radio frequency. , 1994, Radiology.

[40]  J. Malec Mild traumatic brain injury. , 1997, Archives of physical medicine and rehabilitation.

[41]  J. Adams,et al.  Ischaemic brain damage in fatal head injuries. , 1971, Lancet.

[42]  Y. Shim,et al.  A serial study of regional cerebral blood flow deficits in patients with left anterior thalamic infarction: Anatomical and neuropsychological correlates , 2008, Journal of the Neurological Sciences.

[43]  T. Mcintosh,et al.  Effects of Traumatic Brain Injury on Regional Cerebral Blood Flow in Rats as Measured with Radiolabeled Microspheres , 1989, Journal of cerebral blood flow and metabolism : official journal of the International Society of Cerebral Blood Flow and Metabolism.

[44]  M. Bergsneider,et al.  The neurochemical and metabolic cascade following brain injury: moving from animal models to man. , 1995, Journal of neurotrauma.

[45]  D. O'Leary,et al.  Specification of neocortical areas and thalamocortical connections. , 1994, Annual review of neuroscience.

[46]  Jian Xu,et al.  Measurement of deep gray matter perfusion using a segmented true–fast imaging with steady‐state precession (True‐FISP) arterial spin‐labeling (ASL) method at 3T , 2009, Journal of magnetic resonance imaging : JMRI.

[47]  O. Steward,et al.  Axonal degeneration induced by experimental noninvasive minor head injury. , 1985, Journal of neurosurgery.

[48]  C. Robertson,et al.  Regional Cerebral Blood Flow After Controlled Cortical Impact Injury in Rats , 1995, Anesthesia and analgesia.

[49]  B. Lerer,et al.  Cerebral blood flow in chronic symptomatic mild traumatic brain injury , 2003, Psychiatry Research: Neuroimaging.

[50]  J D Pickard,et al.  Cognitive sequelae of head injury: involvement of basal forebrain and associated structures. , 2004, Brain : a journal of neurology.

[51]  J. H. Duyn,et al.  Multislice Imaging of Quantitative Cerebral Perfusion with Pulsed Arterial Spin-Labeling , 1998, NeuroImage.