Toth Arnold, Kovacs Noemi, Tamas Viktoria, Kornyei Balint, Nagy Mate, Horvath Andrea, Rostas Tamas, Bogner Peter, Janszky Jozsef, Doczi Tamas, Buki Andras, Schwarcz Attila
Department of Neurosurgery, Pécs Medical School, H-7623, Rét. u. 2., Pécs, Hungary.
Department of Neurosurgery, Pécs Medical School, H-7623, Rét. u. 2., Pécs, Hungary; Diagnostic Center of Pécs, H-7623, Rét. u. 2., Pécs, Hungary.
Neurosci Lett. 2016 Mar 23;617:207-12. doi: 10.1016/j.neulet.2016.02.028. Epub 2016 Feb 18.
Susceptibility weighted imaging (SWI) is a very sensitive tool for the detection of microbleeds in traumatic brain injury (TBI). The number and extent of such traumatic microbleeds (TMBs) have been shown to correlate with the severity of the injury and the clinical outcome. However, the acute dynamics of TMBs have not been revealed so far. Since TBI is known to constitute dynamic pathological processes, we hypothesized that TMBs are not constant in their appearance, but may progress acutely after injury.
We present here five closed moderate/severe (Glasgow coma scale≤13) TBI patients who underwent SWI very early (average=23.4 h), and once again a week (average=185.8 h) after the injury. The TMBs were mapped at both time points by a conventional radiological approach and their numbers and volumes were measured with manual tracing tools by two observers. TMB counts and extents were compared between time points.
TMBs were detected in four patients, three of them displaying an apparent TMB change. In these patients, TMB confluence and apparent growth were detected in the corpus callosum, coronal radiation or subcortical white matter, while unchanged TMBs were also present. These changes caused a decrease in the TMB count associated with an increase in the overall TMB volume over time.
We have found a compelling evidence that diffuse axonal injury-related microbleed development is not limited strictly to the moment of injury: the TMBs might expand in the acute phase of TBI. The timing of SWI acquisition may be relevant for optimizing the prognostic utility of this imaging biomarker.
磁敏感加权成像（SWI）是检测创伤性脑损伤（TBI）中微出血的非常敏感的工具。已表明此类创伤性微出血（TMBs）的数量和范围与损伤的严重程度及临床结果相关。然而，迄今为止TMBs的急性动态变化尚未被揭示。由于已知TBI构成动态病理过程，我们推测TMBs的表现并非恒定不变，而是可能在损伤后急性进展。
我们在此展示5例闭合性中度/重度（格拉斯哥昏迷量表≤13）TBI患者，他们在伤后非常早期（平均=23.4小时）接受了SWI检查，并在伤后一周（平均=185.8小时）再次接受检查。通过传统放射学方法在两个时间点对TMBs进行定位，并由两名观察者使用手动追踪工具测量其数量和体积。比较两个时间点之间的TMB计数和范围。
在4例患者中检测到TMBs，其中3例显示出明显的TMB变化。在这些患者中，在胼胝体、冠状辐射或皮质下白质中检测到TMB融合和明显增大，同时也存在未改变的TMBs。这些变化导致TMB计数减少，而随着时间推移总体TMB体积增加。
我们发现了令人信服的证据，表明弥漫性轴索损伤相关的微出血发展并不严格局限于损伤时刻：TMBs可能在TBI急性期扩大。SWI采集的时机可能与优化这种成像生物标志物的预后效用相关。
