Traumatic microbleeds suggest vascular injury and predict disability in traumatic brain injury

Traumatic microbleeds are small foci of hypointensity seen on T2*-weighted MRI in patients following head trauma that have previously been considered a marker of axonal injury. The linear appearance and location of some traumatic microbleeds suggests a vascular origin. The aims of this study were to...

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Vydané v:Brain (London, England : 1878) Ročník 142; číslo 11; s. 3550
Hlavní autori: Griffin, Allison D, Turtzo, L Christine, Parikh, Gunjan Y, Tolpygo, Alexander, Lodato, Zachary, Moses, Anita D, Nair, Govind, Perl, Daniel P, Edwards, Nancy A, Dardzinski, Bernard J, Armstrong, Regina C, Ray-Chaudhury, Abhik, Mitra, Partha P, Latour, Lawrence L
Médium: Journal Article
Jazyk:English
Vydavateľské údaje: England 01.11.2019
Predmet:
Adolescent
Adult
Autopsy
Axons - pathology
Brain Injuries, Traumatic - diagnostic imaging
Brain Injuries, Traumatic - pathology
Disability Evaluation
Female
Glasgow Outcome Scale
Humans
Intracranial Hemorrhages - diagnostic imaging
Intracranial Hemorrhages - pathology
Iron - blood
Macrophages - pathology
Magnetic Resonance Imaging
Male
Middle Aged
Predictive Value of Tests
Prospective Studies
Tomography, X-Ray Computed
Treatment Outcome
Vascular System Injuries - diagnostic imaging
Vascular System Injuries - pathology
traumatic microbleeds
traumatic vascular injury
MRI biomarkers of traumatic brain injury
radiological-pathological analysis
mild traumatic brain injury
ISSN:1460-2156, 1460-2156
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Shrnutí:Traumatic microbleeds are small foci of hypointensity seen on T2*-weighted MRI in patients following head trauma that have previously been considered a marker of axonal injury. The linear appearance and location of some traumatic microbleeds suggests a vascular origin. The aims of this study were to: (i) identify and characterize traumatic microbleeds in patients with acute traumatic brain injury; (ii) determine whether appearance of traumatic microbleeds predict clinical outcome; and (iii) describe the pathology underlying traumatic microbleeds in an index patient. Patients presenting to the emergency department following acute head trauma who received a head CT were enrolled within 48 h of injury and received a research MRI. Disability was defined using Glasgow Outcome Scale-Extended ≤6 at follow-up. All magnetic resonance images were interpreted prospectively and were used for subsequent analysis of traumatic microbleeds. Lesions on T2* MRI were stratified based on 'linear' streak-like or 'punctate' petechial-appearing traumatic microbleeds. The brain of an enrolled subject imaged acutely was procured following death for evaluation of traumatic microbleeds using MRI targeted pathology methods. Of the 439 patients enrolled over 78 months, 31% (134/439) had evidence of punctate and/or linear traumatic microbleeds on MRI. Severity of injury, mechanism of injury, and CT findings were associated with traumatic microbleeds on MRI. The presence of traumatic microbleeds was an independent predictor of disability (P < 0.05; odds ratio = 2.5). No differences were found between patients with punctate versus linear appearing microbleeds. Post-mortem imaging and histology revealed traumatic microbleed co-localization with iron-laden macrophages, predominately seen in perivascular space. Evidence of axonal injury was not observed in co-localized histopathological sections. Traumatic microbleeds were prevalent in the population studied and predictive of worse outcome. The source of traumatic microbleed signal on MRI appeared to be iron-laden macrophages in the perivascular space tracking a network of injured vessels. While axonal injury in association with traumatic microbleeds cannot be excluded, recognizing traumatic microbleeds as a form of traumatic vascular injury may aid in identifying patients who could benefit from new therapies targeting the injured vasculature and secondary injury to parenchyma.
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ISSN:1460-2156
1460-2156
DOI:10.1093/brain/awz290