Roh-Eul Yoo1, Seung Hong Choi2,3,4, Byung-Mo Oh5, Sang Do Shin6, Eun Jung Lee7, Dong Jae Shin8, Sang Won Jo9, Koung Mi Kang1, Tae Jin Yun1, Ji-Hoon Kim1, Chul-Ho Sohn1. 1. Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, 28, Yongon-dong, Chongno-gu, Seoul, 110-744, Korea. 2. Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, 28, Yongon-dong, Chongno-gu, Seoul, 110-744, Korea. verocay@snuh.org. 3. Center for Nanoparticle Research, Institute for Basic Science (IBS), Seoul National University, Seoul, 151-742, Korea. verocay@snuh.org. 4. School of Chemical and Biological Engineering, Seoul National University, Seoul, 151-742, Korea. verocay@snuh.org. 5. Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul National University College of Medicine, 28, Yongon-dong, Chongno-gu, Seoul, 110-744, Korea. 6. Department of Emergency Medicine, Seoul National University College of Medicine, 28, Yongon-dong, Chongno-gu, Seoul, 110-744, Korea. 7. Department of Radiology, Chung-Ang University Hospital, Seoul, Korea. 8. Department of Radiology, Seran General Hospital, Seoul, Korea. 9. Department of Radiology, Kangbuk Samsung Hospital, Seoul, Korea.
Abstract
OBJECTIVES: To explore the utility of dynamic contrast-enhanced (DCE) MR imaging for quantitative analysis of blood-brain barrier disruption in mild traumatic brain injury (mTBI) patients with post-concussion syndrome (PCS). METHODS: Forty-four consecutive patients with PCS after mTBI and 32 controls were included in this retrospective study. Ktrans and ve from DCE MR imaging were analyzed at contrast-enhancing lesions, T2 hyperintense white matter (WM) lesions, normal-appearing white matter (NAWM), and predilection sites for diffuse axonal injury (LocationDAI). The Mann-Whitney U-test was performed to compare the parameters between mTBI patients and controls and the parameters were correlated with neuropsychological tests using Mann-Whitney U-test and Spearman rank correlation. RESULTS: The median ve of the T2 hyperintense WM lesions in mTBI patients (n=21) was higher than that of NAWM in controls (p=.027). Both median Ktrans and ve at NAWM were also significantly higher in mTBI patients than in controls (p=.023 and p=.029, respectively). In addition, mTBI patients had higher Ktrans and ve at LocationDAI than controls (p=.008 and p=.015, respectively). VLT (delayed recall) scores were significantly correlated with ve values at T2 hyperintense WM lesions (p=-0.767, p=.044). The median ve at LocationDAI was significantly higher in patients with atypical performance in the digit span test (forward) than in those with average or good performance (p=.043). CONCLUSIONS: mTBI patients with PCS had higher Ktrans and ve values than controls not only at T2 hyperintense WM lesions but also at NAWM and LocationDAI. BBB disruption may be implicated in development of PCS in mTBI patients. KEY POINTS: • mTBI patients with PCS had higher permeability than controls at T2 hyperintense WM lesions on DCE MR imaging. • mTBI patients with PCS had higher permeability than controls also at NAWM and predilection sites for DAI. • BBB disruption may be implicated in the development of PCS in mTBI patients.
OBJECTIVES: To explore the utility of dynamic contrast-enhanced (DCE) MR imaging for quantitative analysis of blood-brain barrier disruption in mild traumatic brain injury (mTBI) patients with post-concussion syndrome (PCS). METHODS: Forty-four consecutive patients with PCS after mTBI and 32 controls were included in this retrospective study. Ktrans and ve from DCE MR imaging were analyzed at contrast-enhancing lesions, T2 hyperintense white matter (WM) lesions, normal-appearing white matter (NAWM), and predilection sites for diffuse axonal injury (LocationDAI). The Mann-Whitney U-test was performed to compare the parameters between mTBI patients and controls and the parameters were correlated with neuropsychological tests using Mann-Whitney U-test and Spearman rank correlation. RESULTS: The median ve of the T2 hyperintense WM lesions in mTBI patients (n=21) was higher than that of NAWM in controls (p=.027). Both median Ktrans and ve at NAWM were also significantly higher in mTBI patients than in controls (p=.023 and p=.029, respectively). In addition, mTBI patients had higher Ktrans and ve at LocationDAI than controls (p=.008 and p=.015, respectively). VLT (delayed recall) scores were significantly correlated with ve values at T2 hyperintense WM lesions (p=-0.767, p=.044). The median ve at LocationDAI was significantly higher in patients with atypical performance in the digit span test (forward) than in those with average or good performance (p=.043). CONCLUSIONS: mTBI patients with PCS had higher Ktrans and ve values than controls not only at T2 hyperintense WM lesions but also at NAWM and LocationDAI. BBB disruption may be implicated in development of PCS in mTBI patients. KEY POINTS: • mTBI patients with PCS had higher permeability than controls at T2 hyperintense WM lesions on DCE MR imaging. • mTBI patients with PCS had higher permeability than controls also at NAWM and predilection sites for DAI. • BBB disruption may be implicated in the development of PCS in mTBI patients.
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