ISMRM 23rd Annual Meeting & Exhibition • 30 May - 05 June 2015 • Toronto, Ontario, Canada

Combined Educational & Scientific Session

Traumatic Brain Injury

SKILL LEVEL: Intermediate

ORGANIZERS: Jonathan H. Gillard, M.D., FRCR, MBA & Howard A Rowley, M.D.

Thursday 4 June 2015

This course will explore the utility of MRI in the setting of acute brain injury. Specifically the breadth of MR changes seen in routine clinical practice will be described, as well as the value of mutiparametric MR in better assessing the extent of changes and subsequent prognosis.

Target Audience
This course will describe the spectrum of the MR changes seen in acute brain injury which will benefit both physicists and clinicians involved in their evaluation and care of patients with TBI.

Educational Objectives
As a result of attending this course, participants should be able to:
• Select an MR protocol that can be used to classify the spectrum of MR appearances in acute TBI;
• Illustrate and distinguish the different categories of MR appearances in TBI; and
• Hypothesize mechanisms underlying the MR appearances in TBI.

Moderators: Roland R. Lee, M.D., Joshua S. Shimony, M.D., Ph.D.
10:30   MR Spectroscopy in Acute Brain Injury - What We Can Offer the Clinician Now
Stefan Blüml, Ph.D.
11:00 0829.   
Diffusion kurtosis imaging quantifies the effects of mild traumatic brain injury in football players
Daniel Olson1, Melissa Lancaster2, Ashley LaRoche3, Volkan Arpinar3, Michael McCrea3, and L Tugan Muftuler3
1Biophysics, Medical College of Wisconsin, Milwaukee, Wisconsin, United States, 2Neurology, Medical College of Wisconsin, Wisconsin, United States,3Neurosurgery, Medical College of Wisconsin, Wisconsin, United States

Mild traumatic brain injury (mTBI) is a prevalent injury for athletes in contact sports. In order to study changes in brain tissue microstructure after mTBI, we used Diffusion Kurtosis Imaging (DKI), an extension of DTI. DKI complements DTI by estimating non-Gaussianity of the molecular diffusion in complex tissue microstructures; therefore, it is hypothesized to be more sensitive and specific to subtle microstructural changes due to mild concussion. Radial kurtosis was significantly reduced in athletes with concussions.

11:20 0830.   
Altered Cortical and Subcortical Functional Connectivity in a Single Football Season
Bryson B. Reynolds1, Todd M. Chatlos1, Donna K. Broshek2, Max Wintermark3, Susan F. Saliba4, Howard P. Goodkin5, and T. Jason Druzgal1
1Radiology and Medical Imaging, University of Virginia School of Medicine, Charlottesville, Virginia, United States, 2Psychiatry and Neurobehavioral Sciences, University of Virginia School of Medicine, Charlottesville, Virginia, United States, 3Radiology, Stanford School of Medicine, San Francisco, CA, United States, 4Kinesiology, University of Virginia Curry School, Charlottesville, VA, United States, 5Neurology, University of Virginia Health System, Charlottesville, VA, United States

Biomechanical head impact data shows that football players receive significantly more severe and more numerous subconcussive impacts than lacrosse players. Our data shows that in football players (N=21) there are significant increases in cortical-cortical functional connectivity and significant decreases in subcortical-cortical functional connectivity during the span of a season as measured by rs-fMRI (p<0.001), however there were no observed changes in lacrosse players during a practice season (N=30). Our preliminary data presents a compelling argument that rs-fMRI is capable of detecting and demonstrating physiologic changes in a single football season, likely caused by subconcussive impacts.

11:40 0831.   Longitudinal blood-brain barrier permeability, cerebral flood flow, T2 and diffusion changes following mild traumatic brain injury
Wei Li1,2, Justin Long1, Lora Watts1, Qiang Shen1, Robert Boggs1, Zhao Jiang1, Yunxia Li1, and Timothy Q. Duong1,2
1Research Imaging Institute, University of Texas Health Science Center at San Antonio, San Antonio, TX, United States, 2Ophthalmology, University of Texas Health Science Center at San Antonio, San Antonio, TX, United States

We previously reported CBF and vascular reactivity dysfunction, T2, ADC, and FA abnormality following mild TBI in a rat model. However, it is unclear how the widespread blood-brain barrier permeability changes affect tissue outcome within and lateral to the impact site. This study evaluated the effects of changes in blood-brain barrier permeability described as the Ktrans rate constant on CBF, T2, ADC, and FA diffusion, and by longitudinally monitoring changes of these parameters in the tissue within the impact area and its surrounding. Multimodal MRI measurements were made longitudinally from 1 hour and up to 7 days post TBI.

12:00   MR in Acute Brain Injury - What's on the Horizon
Karen A. Tong, M.D.
12:30   Adjournment & Meet the Teachers