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. 2015 Feb 6;10(2):e0118061.
doi: 10.1371/journal.pone.0118061. eCollection 2015.

Cerebral hemodynamic changes of mild traumatic brain injury at the acute stage

Hardik Doshi  1 , Natalie Wiseman  2 , Jun Liu  3 , Wentao Wang  4 , Robert D Welch  5 , Brian J O'Neil  5 , Conor Zuk  6 , Xiao Wang  7 , Valerie Mika  8 , Jerzy P Szaflarski  9 , E Mark Haacke  10 , Zhifeng Kou  11
Affiliations

Cerebral hemodynamic changes of mild traumatic brain injury at the acute stage

Hardik Doshi et al. PLoS One. .

Erratum in

Abstract

Mild traumatic brain injury (mTBI) is a significant public health care burden in the United States. However, we lack a detailed understanding of the pathophysiology following mTBI and its relation to symptoms and recovery. With advanced magnetic resonance imaging (MRI), we can investigate brain perfusion and oxygenation in regions known to be implicated in symptoms, including cortical gray matter and subcortical structures. In this study, we assessed 14 mTBI patients and 18 controls with susceptibility weighted imaging and mapping (SWIM) for blood oxygenation quantification. In addition to SWIM, 7 patients and 12 controls had cerebral perfusion measured with arterial spin labeling (ASL). We found increases in regional cerebral blood flow (CBF) in the left striatum, and in frontal and occipital lobes in patients as compared to controls (p = 0.01, 0.03, 0.03 respectively). We also found decreases in venous susceptibility, indicating increases in venous oxygenation, in the left thalamostriate vein and right basal vein of Rosenthal (p = 0.04 in both). mTBI patients had significantly lower delayed recall scores on the standardized assessment of concussion, but neither susceptibility nor CBF measures were found to correlate with symptoms as assessed by neuropsychological testing. The increased CBF combined with increased venous oxygenation suggests an increase in cerebral blood flow that exceeds the oxygen demand of the tissue, in contrast to the regional hypoxia seen in more severe TBI. This may represent a neuroprotective response following mTBI, which warrants further investigation.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Diagram of the ASL analysis workflow.
T2 images were skull-stripped and normalized to the ICBM T1-weighted template. A transformation matrix was applied to skull-stripped rCBF images with SPM8, to bring them into the same template. ROIs were selected automatically in the lobes and in deep brain structures using the Wake Forest University (WFU) PickAtlas.
Fig 2
Fig 2. Major veins selected for susceptibility analysis.
1) Left spetal vein; 2) right septal vein; 3) central septal veins; 4) left thalamostriate vein; 5) right thalamostriate vein; 6) internal cerebral vein; 7) left basal vein of Rosenthal; and 8) right basal vein of Rosenthal.
Fig 3
Fig 3. Mean susceptibility values and standard error in major veins.
* indicates statistically significant difference between controls and acute visit; † indicates statistically significant difference between acute visit and one-month follow up. R: right, L: left, Int: internal.
Fig 4
Fig 4. Mean regional rCBF in the thalamus and striatum and cortical lobes of control and patient groups, with standard error bars.
* p < 0.05.
Fig 5
Fig 5. Group differences in SAC scores between controls and mTBI patients.
* p < 0.05.
See this image and copyright information in PMC

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