Magnetic Resonance Imaging Evidence of Progression of Subacute Brain Atrophy in Moderate to Severe Traumatic Brain Injury

Abstract

Ng K, Mikulis DJ, Glazer J, Kabani N, Till C, Greenberg G, Thompson A, Lazinski D, Agid R, Colella B, Green RE. Magnetic resonance imaging evidence of progression of subacute brain atrophy in moderate to severe traumatic brain injury.

Objective

To demonstrate subacute progression of brain atrophy (from 4.5–29mo postinjury) in moderate to severe traumatic brain injury (TBI) using structural magnetic resonance imaging (MRI).

Design

Within-subjects, repeated-measures design.

Setting

Inpatient neurorehabilitation program and teaching hospital (MRI department).

Participants

Adults (N=14) with moderate to severe TBI.

Interventions

Not applicable.

Main Outcome Measures

Neuroradiologist readings and volumetric measurements (total brain cerebrospinal fluid and hippocampus) at 4.5 months and 2.5 years postinjury.

Results

Ten of 14 patients showed visible atrophy progression. Significant increase in cerebrospinal fluid (CSF) volume (t13=−4.073, P<.001) and decrease in right and left hippocampal volumes (t13=4.221, P<.001 and t13=3.078, P<.005, respectively) were observed from 4.5 months to 2.5 years. Compared with published normative data, patients with TBI showed significantly more pathologic percent annual volume change for the hippocampi (t26=−3.864, P<.001, right; and t26=−2.737, P<.01, left), and a trend for CSF (t26=1.655, P=.059).

Conclusions

This study provides strong MRI evidence for subacute progression of atrophy, as distinct from early, acute neurologic changes observed.

Key Words: Atrophy, Brain injuries, Magnetic resonance imaging, Follow-up studies, Rehabilitation

a Department of Medical Imaging, Division of Neuroradiology, University Health Network, University of Toronto, Toronto, ON, Canada

b Graduate Department of Rehabilitation Sciences, University of Toronto, Toronto, ON, Canada

c Toronto Rehabilitation Institute, Toronto, ON, Canada

d Sunnybrook Health Sciences Centre, Toronto, ON, Canada

Reprint requests to Robin Green, PhD, CPsych, 550 University Ave, Room 11004, Toronto, ON, Canada, M5G 2A2

Supported by the Canadian Institutes of Health Research and the Physicians' Services Inc (grant nos. MOP-67072, 05-50) and the Toronto Rehabilitation Institute, which receives funding under the Provincial Rehabilitation Research Program from the Ministry of Health and Long-Term Care in Ontario.

No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit on the authors or on any organization with which the authors are associated.

PII: S0003-9993(08)01406-8

doi:10.1016/j.apmr.2008.07.006

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