Advanced neuroimaging in mild traumatic brain injury

PhD ceremony: Ms. Z. Metting, 16.15 uur, Academiegebouw, Broerstraat 5, Groningen

Dissertation: Advanced neuroimaging in mild traumatic brain injury

Promotor(s): prof. H.P.H. Kremer

Faculty: Medical Sciences

T raumatic brain injury (TBI) is one of the most common neurological diseases and an important cause of disability and death in young adults. The majority (80-90%) sustains mild TBI. Most patients recover within weeks to months although a subgroup experiences disabling symptoms that interfere with their return to work or resumption of social activities.

One of the first and most commonly used imaging techniques in the acute phase of TBI is non-contrast computed tomography (CT). It is the most relevant imaging procedure for the detection of lesions eligible for surgical intervention. However, approximately 20% of the patients with mild TBI without abnormalities on the non-contrast CT, experience problems with work resumption. Perfusion CT is a relatively new imaging method that enables visualisation and quantification of cerebral perfusion. The purpose of this study was to provide additional prognostic factors for patients who sustained mild TBI, especially in those with normal conventional CT imaging, and to elucidate the underlying pathophysiological processes. In addition, the relation between acute phase perfusion CT imaging and diffusion tensor imaging (DTI) with neuropsychological testing in the chronic phase after injury is outlined. The study revealed cerebral perfusion changes in the acute phase after mild TBI in those with a normal conventional CT. These cerebral perfusion abnormalities, in the frontal lobes in particular, are of significant prognostic value. A relation between acute cerebral perfusion with DTI reflecting axonal injury and neuropsychological testing during follow-up could be established, indicating a pathophysiological continuum in this patient category.