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mild_traumatic_brain_injury_diagnosis

Mild traumatic brain injury diagnosis

Mild traumatic brain injury(mTBI) remains a challenge to accurately assess with conventional neuroimaging.

The main challenge in the diagnosis lies in the fact that severe intracranial lesions are often associated with mild head injury, especially in the presence of specific risk factors.

Mild traumatic brain injury biomarkers

One of the main challenges of TBI at present is the lack of specific diagnostic biomarkers, especially for mild TBI (mTBI), which remains currently difficult to value in clinical practice. In this context MiRNAs may be important mediators of the profound molecular and cellular changes that occur after TBI in both the short and the long term. Recently, plasma miRNAs profiling in human TBI, have revealed dynamic temporal regulation of miRNA expression within the cortex. The aim of this study was to select a specific miRNAs panel for mTBI, by focusing the research on the prognostic meaning of miRNAs in the hours following the trauma, in order to be able to use these miRNAs as potential biomarkers useful for monitoring the follow up of mild TBI. Serum levels of 17 miRNAs were measured by RT-quantitative polymerase chain reaction (qPCR) in 20 patients with mTBI at three different time-points (0 h, 24 h, 48 h) and in 10 controls. For 15 miRNAs they found a significant difference in the comparison among the three-time points: for each of these miRNAs the values were greater at baseline and progressively reduced at 24 h and 48 h. These data allow us to consider the miRNAs included in a panel as sensitive and specific biomarkers for mTBI, useful in monitoring the post-trauma period 1).

S100B in mild traumatic brain injury

see S100B in mild traumatic brain injury.

Computed tomography

see Computed tomography for mild traumatic brain injury.

MRI

MRI will demonstrate abnormalities in up to 25% of cases where CT is normal.

DTI has been proved to be a valuable tool to identify diffuse axonal injury (DAI) after mTBI. Additionally, some studies showed associations between DAI and unfavourable cognitive outcome. SWI has shown to be a highly sensitive imaging method to identify microbleeds. The presence and quantity of microbleeds in this imaging technique can further provide aetiological evidence for persistent post-traumatic symptoms (pPTS).

Magnetic resonance spectroscopy (MRS) provides information about local neurons metabolism and preliminary data show that creatine-phosphocreatine levels measured after mTBI are predictive of cognitive outcome and emotional distress. The results of one study have shown functional magnetic resonance imaging (fMRI) as a useful tool to differentiate mTBI patients with pPTS from controls and mTBI patients without pPTS in a resting-state condition. From the evaluated diagnostic approaches to predict pPTS after mTBI, DTI, SWI, MRS, and fMRI seem to have adequate sensitivity and specificity as predictive diagnostic tools for pPTS. Large longitudinal clinical trials are warranted to validate the prognostic applicability and practicability in daily clinical practice 2) 3).

Diffusion tensor imaging

Recent research holds out the promise that diffusion tensor imaging (DTI) can be used to predict recovery in mTBI patients. Unlike computed tomography or conventional magnetic resonance imaging, DTI is sensitive to microstructural axonal injury, the neuropathology that is thought to be most responsible for the persistent cognitive and behavioral impairments that often occur after mTBI. Through the use of newer DTI analysis techniques such as automated region of interest analysis, tract-based voxel-wise analysis, and quantitative tractography, researchers have shown that frontal and temporal association white matter pathways are most frequently damaged in mTBI and that the microstructural integrity of these tracts correlates with behavioral and cognitive measures. Future longitudinal DTI studies are needed to elucidate how symptoms and the microstructural pathology evolve over time. Moving forward, large-scale investigations will ascertain whether DTI can serve as a predictive imaging biomarker for long-term neurocognitive deficits after mTBI that would be of value for triaging patients to clinical trials of experimental cognitive enhancement therapies and rehabilitation methods, as well as for monitoring their response to these interventions 4).

DTI and MRS have been at the forefront of research as a result of their noninvasiveness and ease of acquisition, and hence it is thought that the use of these neuroimaging modalities has the potential to aid clinical decision making and management, including guiding return-to-play protocols 5).

References

1)
Polito F, Famà F, Oteri R, Raffa G, Vita G, Conti A, Daniele S, Macaione V, Passalacqua M, Cardali S, Di Giorgio RM, Gioffrè M, Angileri FF, Germanò A, Aguennouz M. Circulating miRNAs expression as potential biomarkers of mild traumatic brain injury. Mol Biol Rep. 2020 Mar 26. doi: 10.1007/s11033-020-05386-7. [Epub ahead of print] PubMed PMID: 32219772.
2)
Studerus-Germann AM, Thiran JP, Daducci A, Gautschi OP. Diagnostic approaches to predict persistent post-traumatic symptoms after mild traumatic brain injury - a literature review. Int J Neurosci. 2016 Apr;126(4):289-98. doi: 10.3109/00207454.2015.1033620. Epub 2015 Jul 28. PubMed PMID: 26000929.
3)
Toth A. Magnetic Resonance Imaging Application in the Area of Mild and Acute Traumatic Brain Injury: Implications for Diagnostic Markers? In: Kobeissy FH, editor. Brain Neurotrauma: Molecular, Neuropsychological, and Rehabilitation Aspects. Boca Raton (FL): CRC Press/Taylor & Francis; 2015. Chapter 24. PubMed PMID: 26269902.
4)
Niogi SN, Mukherjee P. Diffusion tensor imaging of mild traumatic brain injury. J Head Trauma Rehabil. 2010 Jul-Aug;25(4):241-55. doi: 10.1097/HTR.0b013e3181e52c2a. Review. PubMed PMID: 20611043.
5)
Dimou S, Lagopoulos J. Toward Objective Markers of Concussion in Sport: A Review of White Matter and Neurometabolic Changes in the Brain after Sports-Related Concussion. J Neurotrauma. 2014 Jan 23. [Epub ahead of print] PubMed PMID: 24266534.
mild_traumatic_brain_injury_diagnosis.txt · Last modified: 2020/03/29 18:42 by administrador