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Mac Donald, Christine
1. Advanced MRI in Blast-Related TBI: Early Predictors of PTSD Christine Mac Donald, PhD Department of Neurology Washington University School of Medicine
2. Research Rationale Traumatic brain injury (TBI) is a major cause of morbidity and mortality in both civilian and military populations Improvised explosive devices (IEDs) have emerged as a popular weaponry tactic in Operation Iraqi Freedom (OIF), now Operation New Dawn (OND) and Operation Enduring Freedom (OEF) Blast-related TBI has been called the “signature injury” of the war yet much is still unknown about this particular mechanism of TBI and its impact on the brain. Axonal damage is a major pathophysiological process following TBI Possibly a primary cause of adverse neurological outcome Current clinical imaging modalities have been optimized for the visualization of hemorrhage and ischemia but are inadequate for direct assessment of axonal injury Diffusion Tensor Imaging may be more sensitive to changes following axonal injury
3. Statistical Perspective The percentage of combat casualties accounted for by explosive mechanisms in Iraq and Afghanistan 78 320,000 79 88 0 Belanger et al., J Int Neuropsych Soc 2009
4. Statistical Perspective 78 320,000 79 88 0 The number of service members of the deployed force who potentially suffer from TBI (19.2%) Long et al., J Neurotrauma2009; Moore et al., NeuroImage2009; RAND Report 2008
5. Statistical Perspective 78 320,000 79 88 0 The percentage of soldiers reporting LoC who were injured via blast explosion Belanger et al., J Int Neuropsych Soc 2009
6. Statistical Perspective 78 320,000 79 88 0 The percentage of injuries seen at a second echelon treatment site that were due to blast Warden, J Head Trauma Rehab 2006
7. Statistical Perspective 78 320,000 15 79 88 0 The current success rate of TBI therapies translating from animal models to human Benzinger et al., J Neurotrauma 2009
8. Advanced MR Imaging Project Department of Defense Grant Congressionally Directed Medical Research Program (CDMRP)
9. Study Objectives Determine whether DTI will noninvasively reveal abnormalities that are not present on CT or conventional MRI acutely following blast-related TBI Use DTI to understand whether there are principal similarities and differences between blast-related TBI and TBI due to other mechanisms (e.g. motor vehicle accidents, falls, and direct blows to the head) Test the hypothesis that specific pattern of injuries detected with these methods will predict specific longer-term psychological deficits
10. Study Participants Enrollment Participant Characteristics All Subjects met DoD Definition for mild, uncomplicated TBI Mac Donald et al, NEJM 2011
20. Study Objectives Determine whether DTI will noninvasively reveal abnormalities that are not present on CT or conventional MRI acutely following blast-related TBI DTI demonstrated abnormal signal consistent with traumatic axonal injury following blast-related TBI not apparent on conventional MR acquired at the time. Use DTI to understand whether there are principal similarities and differences between blast-related TBI and TBI due to other mechanisms (e.g. motor vehicle accidents, falls, and direct blows to the head) Abnormalities were observed in regions commonly reported following civilian TBI however a greater prevalence of patients had abnormalities in regions hypothesized to be vulnerable to blast. Test the hypothesis that specific pattern of injuries detected with these methods will predict specific longer-term psychological deficits Predictive correlations were observed between DTI regions of interest combined with initial clinical data and the severity of Post-Traumatic Stress Disorder determined 6 – 12 months later.
