Post-traumatic epilepsy (PTE) is a life-long complication of traumatic brain injury (TBI) and is a major public health problem that has an estimated incidence that ranges from 2%-50%, depending on the severity of the TBI. Currently, the pathomechanism that in-duces epileptogenesis in TBI patients is unclear, and one of the most challenging goals in the epilepsy community is to predict which TBI patients will develop epilepsy. In this work, we used diffusion-weighted imaging (DWI) of 14 TBI patients recruited in the Epilepsy Bioinformatics Study for Antiepileptogenic Therapy (EpiBioS4Rx)to measure and analyze fractional anisotropy (FA), obtained from tract-based spatial statistic (TBSS) analysis. Then we used these measurements to train two support vector machine (SVM) models to predict which TBI patients have developed epilepsy. Our approach, tested on these 14 patients with a leave-two-out cross-validation, allowed us to obtain an accuracy of 0.857 $\pm$ 0.18 (with a 95% level of confidence), demonstrating it to be potentially promising for the early characterization of PTE.
Vanderbilt University（范德堡大学）；Vanderbilt University Institute of Imaging Science（范德堡大学影像科学研究所）
Veterans with mild traumatic brain injury (mTBI) have reported auditory and visual dysfunction that persists beyond the acute incident. The etiology behind these symptoms is difficult to characterize with current clinical imaging. These functional deficits may be caused by shear injury or micro-bleeds, which can be detected with special imaging modalities. We explore these hypotheses in a pilot study of multi-parametric MRI. We extract over 1,000 imaging and clinical metrics and project them to a low-dimensional space, where we can discriminate between healthy controls and patients with mTBI. …
Perelman School of Medicine（佩雷尔曼医学院）；University of Pennsylvania（宾夕法尼亚大学）
Baseline injury categorization is important to traumatic brain injury (TBI) research and treatment. Current categorization is dominated by symptom-based scores that insufficiently capture injury heterogeneity. In this work, we apply unsupervised clustering to identify novel TBI phenotypes. Our approach uses a generalized low-rank model (GLRM) model for feature selection in a procedure analogous to wrapper methods. The resulting clusters reveal four novel TBI phenotypes with distinct feature profiles and that correlate to 90-day functional and cognitive status.
Cerebrovascular dynamics and pathomechanisms that evolve in the minutes and hours following traumatic vascular injury in the brain remain largely unknown. We investigated the pathophysiology evolution within the first three hours after closed-head traumatic brain injury (TBI) and subarachnoid hemorrhage (SAH), two common traumatic vascular injuries, in mice. We took a multi-modal imaging approach using photoacoustic, color Doppler, and magnetic resonance imaging (MRI) in mice. Brain oxygenation (%sO2) and velocity-weighted volume of blood flow (VVF) values significantly decreased from baseline…
Traumatic brain injury (TBI) is a complex injury that is hard to predict and diagnose, with many studies focused on associating head kinematics to brain injury risk. Recently, there has been a push towards using computationally expensive finite element (FE) models of the brain to create tissue deformation metrics of brain injury. Here, we developed a 3 degree-of-freedom lumped-parameter brain model, built based on the measured natural frequencies of a FE brain model simulated with live human impact data, to be used to rapidly estimate peak brain strains experienced during head rotational accel…
Traumatic brain injury can be caused by various types of head impacts. However, due to different kinematic characteristics, many brain injury risk estimation models are not generalizable across the variety of impacts that humans may sustain. The current definitions of head impact subtypes are based on impact sources (e.g., football, traffic accident), which may not reflect the intrinsic kinematic similarities of impacts across the impact sources. To investigate the potential new definitions of impact subtypes based on kinematics, 3,161 head impacts from various sources including simulation, co…
Lawrence Livermore National Laboratory（劳伦斯利弗莫尔国家实验室）；Medical College of Wisconsin（威斯康星医学院）；University of California, San Diego（加州大学圣地亚哥分校）；Baylor College of Medicine（贝勒医学院）；Massachusetts General Hospital（麻省总医院）；Harvard Medical School（哈佛医学院）；University of California, San Francisco（加州大学旧金山分校）
Prognoses of Traumatic Brain Injury (TBI) outcomes are neither easily nor accurately determined from clinical indicators. This is due in part to the heterogeneity of damage inflicted to the brain, ultimately resulting in diverse and complex outcomes. Using a data-driven approach on many distinct data elements may be necessary to describe this large set of outcomes and thereby robustly depict the nuanced differences among TBI patients' recovery. In this work, we develop a method for modeling large heterogeneous data types relevant to TBI. Our approach is geared toward the probabilistic represen…
The prediction and prevention of traumatic brain injury, spinal injury and general musculo-skeletal injury is a very important aspect of preventive medical science. Recently, in a series of papers, I have proposed a new coupled loading-rate hypothesis as a unique cause of all above injuries. This new hypothesis states that the main cause of all mechanical injuries is a Euclidean Jolt, which is an impulsive loading that strikes any part of the human body (head, spine or any bone/joint) - in several coupled degrees-of-freedom simultaneously. It never goes in a single direction only. Also, it is …
The discovery that repetitive mild traumatic brain injury (mTBI) can result in chronic traumatic encephalopathy (CTE) in high risk contact sports has led to increased scrutiny of head protective gear. In this work, we asked if it was physically possible to prevent mTBI in American football with helmets alone. Here, we show that modern helmets of several types are unlikely to prevent mTBI from high speed collisions as might be seen in the NFL, but that introducing liquid as an energy absorbing medium can dramatically reduce the forces of impact across a spectrum of impact severities. We hypothe…
Mining the contribution of intensive care clinical course to outcome after traumatic brain injury
University of Cambridge（剑桥大学）；Johns Hopkins University（约翰斯·霍普金斯大学）；Humanitas University（Humanitas大学）；Karolinska Institutet（卡罗林斯卡学院）；University of Stirling（斯特灵大学）；Leiden University Medical Center（莱顿大学医学中心）；Cambridge Centre for Artificial Intelligence in Medicine（剑桥医学人工智能中心）
TractSpLearn: Specialized Shared-Manifold Learning for Individualized Detection of Subtle White Matter Alterations in Mild Traumatic Brain Injury
University of Liège（列日大学）；Lund University, Skane University Hospital（隆德大学，斯卡纳大学医院）；Guizhou University（贵州大学）；Maastricht University（马斯特里赫特大学）；Lund University（隆德大学）；Aix-Marseille Univ, CNRS, CRMBM（艾克斯-马赛大学，法国国家科学研究中心，CRMBM）
Developing an accurate and reliable injury predictor is central to the biomechanical studies of traumatic brain injury. State-of-the-art efforts continue to rely on empirical, scalar metrics based on kinematics or model-estimated tissue responses explicitly pre-defined in a specific brain region of interest. They could suffer from loss of information. A single training dataset has also been used to evaluate performance but without cross-validation. In this study, we developed a deep learning approach for concussion classification using implicit features of the entire voxel-wise white matter fi…
The diffused nature of mild traumatic brain injury (mTBI) impacts brain white-matter pathways with potentially long-term consequences, even after initial symptoms have resolved. To understand post-mTBI recovery in adolescents, longitudinal studies are needed to determine the interplay between highly individualised recovery trajectories and ongoing development. To capture the distributed nature of mTBI and recovery, we employ connectomes to probe the brain's structural organisation. We present a diffusion MRI study on adolescent mTBI subjects scanned one day, two weeks and one year after injury…
Strain and strain rate are effective traumatic brain injury predictors. Kinematics-based models estimating these metrics suffer from significant different distributions of both kinematics and the injury metrics across head impact types. To address this, previous studies focus on the kinematics but not the injury metrics. We have previously shown the kinematic features vary largely across head impact types, resulting in different patterns of brain deformation. This study analyzes the spatial distribution of brain deformation and applies principal component analysis (PCA) to extract the represen…
New York University（纽约大学）；New York University Shanghai（上海纽约大学）
Mild Traumatic Brain Injury (mTBI) is a significant public health problem. The most troubling symptoms after mTBI are cognitive complaints. Studies show measurable differences between patients with mTBI and healthy controls with respect to tissue microstructure using diffusion MRI. However, it remains unclear which diffusion measures are the most informative with regard to cognitive functions in both the healthy state as well as after injury. In this study, we use diffusion MRI to formulate a predictive model for performance on working memory based on the most relevant MRI features. The key ch…
In this paper, machine learning models are used to predict outcomes for patients with persistent post-concussion syndrome (PCS). Patients had sustained a concussion at an average of two to three months before the study. By utilizing assessed data, the machine learning models aimed to predict whether or not a patient would continue to have PCS after four to five months. The random forest classifier achieved the highest performance with an 85% accuracy and an area under the receiver operating characteristic curve (AUC) of 0.94. Factors found to be predictive of PCS outcome were Post-Traumatic St…
