Limited Colocalization of Microbleeds and Microstructural Changes after Severe Traumatic Brain Injury

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  • Sara H Andreasen
  • Kasper W Andersen, University of Copenhagen
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  • Virginia Conde, University of Copenhagen, Norwegian University of Science and Technology
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  • Tim B Dyrby, Technical University of Denmark, University of Copenhagen
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  • Oula Puonti, Technical University of Denmark, University of Copenhagen
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  • Lars Peter Kammersgaard, University of Copenhagen, Rigshospitalet, Københavns Universitetshospital
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  • Camilla G Madsen, University of Copenhagen
  • ,
  • Kristoffer H Madsen, University of Copenhagen, Technical University of Denmark
  • ,
  • Ingrid Poulsen
  • Hartwig R Siebner, University of Copenhagen

Severe traumatic brain injury (TBI) produces shearing forces on long-range axons and brain vessels, causing axonal and vascular injury. To examine whether microbleeds and axonal injury colocalize after TBI, we performed whole-brain susceptibility-weighted imaging (SWI) and diffusion tensor imaging (DTI) in 14 patients during the subacute phase after severe TBI. SWI was used to determine the number and volumes of microbleeds in five brain regions: the frontotemporal lobe; parieto-occipital lobe; midsagittal region (cingular cortex, parasagittal white matter, and corpus callosum); deep nuclei (basal ganglia and thalamus); and brainstem. Averaged fractional anisotropy (FA) and mean diffusivity (MD) were measured to assess microstructural changes in the normal appearing white matter attributed to axonal injury in the same five regions. Regional expressions of microbleeds and microstructure were used in a partial least-squares model to predict the impairment of consciousness in the subacute stage after TBI as measured with the Coma Recovery Scale-Revised (CRS-R). Only in the midsagittal region, the expression of microbleeds was correlated with regional changes in microstructure as revealed by DTI. Microbleeds and microstructural DTI-based metrics of deep, but not superficial, brain regions were able to predict individual CRS-R. Our results suggest that microbleeds are not strictly related to axonal pathology in other than the midsagittal region. While each measure alone was predictive, the combination of both metrics scaled best with individual CRS-R. Structural alterations in deep brain structures are relevant in terms of determining the severity of impaired consciousness in the acute stage after TBI.

Original languageEnglish
JournalJournal of Neurotrauma
Pages (from-to)581-592
Number of pages12
Publication statusPublished - Feb 2020

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