Summary On Neuroimaging In Pediatric Traumatic Brain Injury

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Research Summary Paper
PP7050: Physiological Psychology
Argosy University, Orange County
23 October 2013

Article Summary: “Neuroimaging in Pediatric Traumatic Brain Injury: Current and Future Predictors of Functional Outcome”(Suskauer & Huisman, 2009) A review by Suskaur and Huisman (2009) discusses new brain imaging techniques (i.e., diffusion weighted (DWI) and diffusion tensor imaging (DTI), susceptibility weighted imaging (SWI), and H-magnetic resonance spectroscopy (H-MRS)) and presents current research on their abilities to identify functional outcomes following TBI in the pediatric population due to their sensitivity in detecting microstructural brain injuries such as diffuse axonal injury (DAI). This review also discusses traditional anatomical imaging techniques such as computed tomography (CT) and magnetic resonance imaging (MRI) as well as their insensitivity in detecting microstructural brain injuries. The authors suggest that the ability to more accurately identify the degree of brain injury early on may assist in determining patients’ sequelae of injury, individualizing treatment, implementing early intervention to limit further brain injury, and increasing efficiency of rehab for patients.
Current research studies related to this review are referenced. For example, according to Lee and Newberg (2005), brain imaging following TBI is often essential to identifying patients’ sequelae of injury and prompting necessary interventions (i.e., surgery). This supports the clinical relevance of this review. Furthermore, according to Bauer and Fritz (2004), many age-related differences between the brain of a child and that of an adult exist that impact injury and rehabilitation. Therefore, the authors of this review solely focus on the pediatric population for the sake of continuity of findings. The method employed in this review was a review of current literature. Specifically, details of brain imaging methods are explicated. For example, according to the authors, CT is quick, easy, and accessible and provides information on the acute setting of TBI. However it has limited ability to identify the extent of DAI, only presents more obvious injuries, and is limited by its use of ionizing radiation. MRI is more accurate in detecting DAI. MRI studies have revealed associations between anatomical locations of lesions and post-TBI global functioning. For example, studies have demonstrated that deeper, more centrally located brain lesions are associated with worse outcomes (Grados et al., 2001). Anatomical MRI studies have also demonstrated relationships between post-traumatic ADHD, personality change, anxiety disorders and obsessive-compulsive disorders. However, there is no significant consensus in this literature. DWI is a new, noninvasive functional MRI technique that shows differentiation between the diffusion of protons in the brain and, therefore, differentiation between cytotoxic and vasogenic edemas, which are associated with DAI. Studies reveal that vasogenic may be reversible, while cytotoxic usually is not. Overall, DWI provides a greater degree of abnormality and better predicts outcomes compared to other techniques. DTI takes it a step further and measures the direction and proportion of diffusion. DTI results have been found to demonstrate relationships with injury severity and functional outcome. Additionally, DTI shows promise for future research investigating underlying mechanisms of recovery and pediatric brain development. SWI measures extracellular and extravascular blood products in the brain. It is very sensitive in detecting quantity and volume of lesions, which are associated with global (i.e., coma) and neurocognitive outcomes (i.e., IQ). H-MRS assesses for injury by analyzing the presence of neurometabolites. Disturbance in these has been found to be predictive of specific outcomes (i.e., good/bad, cognitive, and behavioral). In sum, future research
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