Myelin Content in Mild Traumatic Brain Injury Patients with Post-Concussion Syndrome: Quantitative Assessment with a
Roh-Eul Yoo1, Seung Hong Choi1,2,3, Sung-Won Youn4
1Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.
Objective:
This study aimed to explore the myelin volume change in patients with mild traumatic brain injury (mTBI) with post-concussion syndrome (PCS) using a multidynamic multiecho (MDME) sequence and automatic whole-brain segmentation.
Materials And Methods:
Forty-one consecutive mTBI patients with PCS and 29 controls, who had undergone MRI including the MDME sequence between October 2016 and April 2018, were included. Myelin volume fraction (MVF) maps were derived from the MDME sequence. After three dimensional T1-based brain segmentation, the average MVF was analyzed at the bilateral cerebral white matter (WM), bilateral cerebral gray matter (GM), corpus callosum, and brainstem. The Mann-Whitney U-test was performed to compare MVF and myelin volume between patients with mTBI and controls. Myelin volume was correlated with neuropsychological test scores using the Spearman rank correlation test.
Results:
The average MVF at the bilateral cerebral WM was lower in mTBI patients with PCS (median [interquartile range], 25.2% [22.6%-26.4%]) than that in controls (26.8% [25.6%-27.8%]) (p = 0.004). The region-of-interest myelin volume was lower in mTBI patients with PCS than that in controls at the corpus callosum (1.87 cm3 [1.70-2.05 cm3] vs. 2.21 cm3 [1.86-3.46 cm3]; p = 0.003) and brainstem (9.98 cm3 [9.45-11.00 cm3] vs. 11.05 cm3 [10.10-11.53 cm3]; p = 0.015). The total myelin volume was lower in mTBI patients with PCS than that in controls at the corpus callosum (0.45 cm3 [0.39-0.48 cm3] vs. 0.48 cm3 [0.45-0.54 cm3]; p = 0.004) and brainstem (1.45 cm3 [1.28-1.59 cm3] vs. 1.54 cm3 [1.42-1.67 cm3]; p = 0.042). No significant correlation was observed between myelin volume parameters and neuropsychological test scores, except for the total myelin volume at the bilateral cerebral WM and verbal learning test (delayed recall) (r = 0.425; p = 0.048).
Conclusion:
MVF quantified from the MDME sequence was decreased at the bilateral cerebral WM in mTBI patients with PCS. The total myelin volumes at the corpus callosum and brainstem were decreased in mTBI patients with PCS due to atrophic changes.
Insights
Mild traumatic brain injury (mTBI) with post-concussion syndrome (PCS) shows reduced myelin volume fraction in the white matter. Myelin loss in the corpus callosum and brainstem also occurs in mTBI patients with PCS.
Area of Science:
- Neuroimaging
- Neurology
- Radiology
Background:
- Mild traumatic brain injury (mTBI) can lead to persistent post-concussion syndrome (PCS).
- Myelin volume changes are implicated in neurological disorders, but their role in mTBI with PCS requires further investigation.
Purpose of the Study:
- To explore myelin volume changes in patients with mTBI and PCS.
- To utilize a multidynamic multiecho (MDME) sequence and automatic brain segmentation for myelin quantification.
Main Methods:
- MRI scans using an MDME sequence were performed on 41 mTBI patients with PCS and 29 controls.
- Myelin volume fraction (MVF) maps were generated and analyzed in various brain regions.
- Statistical analysis, including Mann-Whitney U-test and Spearman rank correlation, was employed.
Main Results:
- Patients with mTBI and PCS exhibited significantly lower average MVF in the bilateral cerebral white matter compared to controls.
- Reduced myelin volume was observed in the corpus callosum and brainstem of mTBI patients with PCS.
- A correlation was found between total myelin volume in the white matter and verbal learning test delayed recall.
Conclusions:
- Myelin volume fraction is decreased in the bilateral cerebral white matter of mTBI patients with PCS.
- Atrophic changes contribute to decreased total myelin volumes in the corpus callosum and brainstem in mTBI patients with PCS.
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