title: Both hemorrhagic and non-hemorrhagic traumatic MRI lesions are associated with the microstructural damage of the normal appearing white matter.
abstract: Traumatic microbleeds (TMBs) and non-hemorrhagic lesions (NHLs) on MRI are regarded as surrogate markers of diffuse axonal injury. However, the actual relation between lesional and diffuse pathology remained unclear, since lesions were related to clinical parameters, largely influenced by extracranial factors. The aim of this study is to directly compare TMBs, NHLs and their regional features with the co-existing diffuse injury of the normal appearing white matter (NAWM) as measured by diffusion tensor imaging (DTI). Thirty-eight adults with a closed traumatic brain injury (12 mild, 4 moderate and 22 severe) who underwent susceptibility weighted imaging (SWI), T1-, T2 weighted and FLAIR MRI and routine CT were included in the study. TMB (on SWI) and NHL (on T1-, T2 weighted and FLAIR images) features and Rotterdam scores were evaluated. DTI metrics such as fractional anisotropy (FA) and mean diffusivity (MD) were measured over different NAWM regions. Clinical parameters including age; Glasgow Coma Scale; Rotterdam score; TMB and NHL features were correlated to regional NAWM diffusivity using multiple regression. Overall NHL presence and basal ganglia area TMB load were significantly, negatively correlated with the subcortical NAWM FA values (partial r=-0.37 and -0.36; p=0.006 and 0.025, respectively). The presence of any NHL, or TMBs located in the basal ganglia area indicates diffuse NAWM damage even after adjusting for clinical and CT parameters. To estimate DAI, a conventional lesional MRI pathology evaluation might at least in part substitute the use of quantitative DTI, which is yet not widely feasible in a clinical setting.
authors.affiliation: Department of Neurosurgery, Pécs Medical School, Rét. u. 2, H-7623 Pécs, Hungary; Department of Radiology, Pécs Medical School, Ifjusag str. 13, H-7624 Pécs, Hungary. Electronic address: prsarn@gmail.com.
authors.forename: Arnold
authors.initials: A
authors.lastname: Toth
authors.affiliation: Department of Neurosurgery, Pécs Medical School, Rét. u. 2, H-7623 Pécs, Hungary.
authors.forename: Balint
authors.initials: B
authors.lastname: Kornyei
authors.affiliation: Department of Neurosurgery, Pécs Medical School, Rét. u. 2, H-7623 Pécs, Hungary.
authors.forename: Noemi
authors.initials: N
authors.lastname: Kovacs
authors.affiliation: Department of Radiology, Pécs Medical School, Ifjusag str. 13, H-7624 Pécs, Hungary.
authors.forename: Tamas
authors.initials: T
authors.lastname: Rostas
authors.affiliation: Department of Neurosurgery, Pécs Medical School, Rét. u. 2, H-7623 Pécs, Hungary; MTA-PTE Clinical Neuroscience MR Research Group, Hungary.
authors.forename: Andras
authors.initials: A
authors.lastname: Buki
authors.affiliation: Department of Neurosurgery, Pécs Medical School, Rét. u. 2, H-7623 Pécs, Hungary; Diagnostic Center of Pécs, Rét. u. 2, H-7623 Pécs, Hungary; MTA-PTE Clinical Neuroscience MR Research Group, Hungary.
authors.forename: Tamas
authors.initials: T
authors.lastname: Doczi
authors.affiliation: Department of Neurosurgery, Pécs Medical School, Rét. u. 2, H-7623 Pécs, Hungary; Department of Radiology, Pécs Medical School, Ifjusag str. 13, H-7624 Pécs, Hungary.
authors.forename: Peter
authors.initials: P
authors.lastname: Bogner
authors.affiliation: Department of Neurosurgery, Pécs Medical School, Rét. u. 2, H-7623 Pécs, Hungary; MTA-PTE Clinical Neuroscience MR Research Group, Hungary.
authors.forename: Attila
authors.initials: A
authors.lastname: Schwarcz
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001921:Brain / Q000000981:diagnostic imaging*; D000070642:Brain Injuries, Traumatic / Q000000981:diagnostic imaging*; D002543:Cerebral Hemorrhage / Q000000981:diagnostic imaging* / Q000209:etiology; D056324:Diffusion Tensor Imaging; D005260:Female; D016489:Head Injuries, Closed / Q000000981:diagnostic imaging; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012720:Severity of Illness Index; D014057:Tomography, X-Ray Computed; D066127:White Matter / Q000000981:diagnostic imaging* / Q000293:injuries*; D055815:Young Adult
keywords: Diffuse axonal injury; Diffusion tensor imaging; MRI; Susceptibility weighted imaging; Traumatic brain injury; Traumatic microbleeds