Longitudinal whole-brain analysis of multi-subject diffusion data in diffuse axonal injury

Daphine Centola Grassi; Ana Luiza Zaninotto; Fabrício Stewan Feltrin; Fabíola Bezerra de Carvalho Macruz; Maria Concepción García Otaduy; Claudia da Costa Leite; Vinicius Monteiro de Paula Guirado; Wellingson Silva Paiva; Celi Santos Andrade

doi:10.1590/0004-282X-ANP-2020-0595

Arquivos de Neuro-Psiquiatria, Table of Contents

CC BY-NC-ND 4.0 · Arq Neuropsiquiatr 2022; 80(03): 280-288
DOI: 10.1590/0004-282X-ANP-2020-0595

Article

Longitudinal whole-brain analysis of multi-subject diffusion data in diffuse axonal injury

Análise longitudinal do encéfalo por tensor de difusão em lesão axonal difusa

Daphine Centola Grassi

¹Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Departamento de Radiologia, São Paulo SP, Brazil.

²Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Laboratório de Investigação Médica 44, São Paulo SP, Brazil.

,

Ana Luiza Zaninotto

³Massachusetts General Hospital, Institute of Health Professions, Speech and Feeding Disorders Lab, Boston, USA.

⁴Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Departamento de Neurologia, São Paulo SP, Brazil.

,

Fabrício Stewan Feltrin

¹Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Departamento de Radiologia, São Paulo SP, Brazil.

²Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Laboratório de Investigação Médica 44, São Paulo SP, Brazil.

⁵University of Texas Southwestern Medical Center, Dallas, USA.

,

Fabíola Bezerra de Carvalho Macruz

¹Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Departamento de Radiologia, São Paulo SP, Brazil.

²Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Laboratório de Investigação Médica 44, São Paulo SP, Brazil.

,

Maria Concepción García Otaduy

¹Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Departamento de Radiologia, São Paulo SP, Brazil.

²Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Laboratório de Investigação Médica 44, São Paulo SP, Brazil.

,

Claudia da Costa Leite

¹Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Departamento de Radiologia, São Paulo SP, Brazil.

²Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Laboratório de Investigação Médica 44, São Paulo SP, Brazil.

,

Vinicius Monteiro de Paula Guirado

⁴Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Departamento de Neurologia, São Paulo SP, Brazil.

,

Wellingson Silva Paiva

⁴Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Departamento de Neurologia, São Paulo SP, Brazil.

,

Celi Santos Andrade

¹Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Departamento de Radiologia, São Paulo SP, Brazil.

²Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Laboratório de Investigação Médica 44, São Paulo SP, Brazil.

⁶Alliar Group, São Paulo SP, Brazil.

› Author Affiliations

Abstract

ABSTRACT

Background: Diffuse axonal injury occurs with high acceleration and deceleration forces in traumatic brain injury (TBI). This lesion leads to disarrangement of the neuronal network, which can result in some degree of deficiency. The Extended Glasgow Outcome Scale (GOS-E) is the primary outcome instrument for the evaluation of TBI victims. Diffusion tensor imaging (DTI) assesses white matter (WM) microstructure based on the displacement distribution of water molecules. Objective: To investigate WM microstructure within the first year after TBI using DTI, the patient’s clinical outcomes, and associations. Methods: We scanned 20 moderate and severe TBI victims at 2 months and 1 year after the event. Imaging processing was done with the FMRIB software library; we used the tract-based spatial statistics software yielding fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (AD), and radial diffusivity (RD) for statistical analyses. We computed the average difference between the two measures across subjects and performed a one-sample t-test and threshold-free cluster enhancement, using a corrected p-value < 0.05. Clinical outcomes were evaluated with the GOS-E. We tested for associations between outcome measures and significant mean FA clusters. Results: Significant clusters of altered FA were identified anatomically using the JHU WM atlas. We found increasing spotted areas of FA with time in the right brain hemisphere and left cerebellum. Extensive regions of increased MD, RD, and AD were observed. Patients presented an excellent overall recovery. Conclusions: There were no associations between FA and outcome scores, but we cannot exclude the existence of a small to moderate association.

RESUMO

Antecedentes: A lesão axonial difusa ocorre em traumas com alta energia de aceleração e desaceleração, determinando desorganização da microestrutura cerebral, levando a algum déficit. A escala de Glasgow Estendida (GOS-E) é indicada na avaliação clínica das vítimas de trauma cranioencefalico. Imagens por tensor de difusão (DTI) estudam a microestrutura cerebral a partir da difusão das moléculas de água. Objetivo: Investigar a microestrutura cerebral no primeiro ano após trauma, avaliar clinicamente os pacientes e testar para correlações entre estes resultados. Métodos: 20 vítimas de TCE moderado e grave foram avaliados 2 meses e 1 ano depois do trauma. O processamento foi feito usando o software FMRIB (FSL) e a análise estatística foi feita com tract-based spatial statistics software para extrair os parâmetros de DTI. Calculamos a diferença da média entre as duas observações de cada sujeito e fizemos um teste-t para uma amostra e threshold-free cluster enhancement. Realizamos correções para múltiplas comparações e determinamos o valor de p < 0.05 como significativo. Um ano após o trauma, a avaliação clínica foi feita usando a GOS-E. Testamos para associações entre os resultados clínicos e os valores médios de FA dos clusters. Resultados: Os clusters significativos foram identificados usando o atlas JHU WM. Observamos aumento de FA predominantemente no hemisfério cerebral direito e cerebelar à esquerda e também extensas áreas de aumento nos demais parâmetros de DTI. A recuperação dos pacientes foi satisfatória. Conclusões: Não encontramos associações entre os resultados, no entanto alguma associação pequena a moderada não pode ser excluída.

Keywords:

Craniocerebral Trauma - Diffuse Axonal Injury - Diffusion Tensor Imaging - Glasgow Outcome Scale - Regeneration

Palavras-chave:

Traumatismos Craniocerebrais - Lesão Axonal Difusa - Imagem de Tensor de Difusão - Escala de Resultado de Glasgow - Regeneração

Full Text

References

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