Magnetic Resonance Imaging Evidence of Progression of Subacute Brain Atrophy in Moderate to Severe Traumatic Brain Injury

Ng K, Mikulis DJ, Glazer J, Kabani N, Till C, Greenberg G, Thompson A, Lazinski D, Agid R, Colella B, Green RE. Magnetic resonance imaging evidence of progression of subacute brain atrophy in moderate to severe traumatic brain injury.ObjectiveTo demonstrate subacute progression of brain atrophy (from 4.5–29mo postinjury) in moderate to severe traumatic brain injury (TBI) using structural magnetic resonance imaging (MRI).DesignWithin-subjects, repeated-measures design.SettingInpatient neurorehabilitation program and teaching hospital (MRI department).ParticipantsAdults (N=14) with moderate to severe TBI.InterventionsNot applicable.Main Outcome MeasuresNeuroradiologist readings and volumetric measurements (total brain cerebrospinal fluid and hippocampus) at 4.5 months and 2.5 years postinjury.ResultsTen of 14 patients showed visible atrophy progression. Significant increase in cerebrospinal fluid (CSF) volume (t13=−4.073, P<.001) and decrease in right and left hippocampal volumes (t13=4.221, P<.001 and t13=3.078, P<.005, respectively) were observed from 4.5 months to 2.5 years. Compared with published normative data, patients with TBI showed significantly more pathologic percent annual volume change for the hippocampi (t26=−3.864, P<.001, right; and t26=−2.737, P<.01, left), and a trend for CSF (t26=1.655, P=.059).ConclusionsThis study provides strong MRI evidence for subacute progression of atrophy, as distinct from early, acute neurologic changes observed.