Diagnostic capabilities of magnetic susceptibility-weighted images in traumatic brain injury in children

Introduction. In MRI, the difference in sensitivity between tissues is used to obtain images weighted by the inhomogeneity of the magnetic field termed susceptibility-weighted imaging (SWI) and a high-resolution 3D radiofrequency gradient echo scan with full speed compensation is applied. The aim was to determine the features of lesions caused by traumatic brain injury in children using the SWI sequence.

Materials and methods. 535 TBI children aged two months up to 18 years old (average age 9.58 ± 1.5) were studied. There were 325 boys (60.7%), 210 girls (39.3%). MRI was performed without and with intravenous contrast on a Phillips Achieva 3 T scanner with T1- and T2WI, 2D and 3D images, FLAIR, magnetic resonance angiography (TOF MRA), SWI, and DW/DTI, MRS and fMRI, SWI were used for visualization of DAI.

Results. Patients included children with severe TBI — 178 (33.3%), moderate TBI — 172 (32.1%) and mild TBI — 185 (34.6%). Of the 535 injured children, 129 (24.1%) had MRI performed within the first 24 hours from the moment of injury, up to 48 hours — at 91 (17.0%), up to 72 hours — in 78 (14.6%) and up to 13 days — in 237 (44.3%). DAI foci at all degrees of TBI were detected in 422 (78.9%) children out of 535 children.

Conclusion. SWI is a sensitive method for diagnosing brain lesions in TBI and significantly contributes to predicting outcomes in the early stages after trauma. The amount of brain lesions diagnosed by SWI correlates with the degree of injury according to the Glasgo Coma Scale. The study of the brain functional connections can inform about possible relationships between the localization of the SWI lesion and cognitive deficits, potentially providing an opportunity to use SWI in the hyperacute phase.

Contribution:
Akhadov T.A., Semenova N.A., Melnikov I.A., Valiullina S.A. — research concept and design;
Bozhko O.V., Zaytseva E.S., Akhlebinina M.I., Demina A.N., Dmitrenko D.M., Kostikova T.D., Mamatkulov A.D. — collection and analysis of data;
Ublinskiy M.V., Khusainova D.N., Manzhurtsev A.V., Menshchikov P.E. — statistical analysis;
Akhadov T.A. — writing text;
Akhadov T.A. — editing;
Akhadov T.A., Melnikov I.A., Valiullina S.A. — approval of the final version of the article.
Akhadov T.A. — responsibility for the integrity of all parts of the article.

Acknowledgement. The study had no sponsorship.

Conflict of interest. The authors declare no conflict of interest.

Received: August 16, 2021
Accepted: October 28, 2021
Published: November 15, 2021

1. Haacke E.M., Xu Y., Cheng Y.C.N., Reichenbach J.R. Susceptibility weighted imaging (SWI). Magn. Reson. Med. 2004; 52(3): 612-8. https://doi.org/10.1002/mrm.20198

2. Beauchamp M.H., Ditchfield M., Babl F.E., Kean M., Catroppa C., Yeates K.O., et al. Detecting traumatic brain lesions in children: CT versus MRI versus susceptibility weighted imaging (SWI). J. Neurotrauma. 2011; 28(6): 915-27. https://doi.org/10.1089/neu.2010.1712

3. Geurts B.H.J., Andriessen T.M.J.C., Goraj B.M., Vos P.E. The reliability of magnetic resonance imaging in traumatic brain injury lesion detection. Brain Inj. 2012; 26(12): 1439-50. https://doi.org/10.3109/02699052.2012.694563

4. Griffin A.D., Turtzo L.C., Parikh G.Y., Tolpygo A., Lodato Z., Moses A.D., et al. Traumatic microbleeds suggest vascular injury and predict disability in traumatic brain injury. Brain. 2019; 142(11): 3550-64. https://doi.org/10.1093/brain/awz290

5. Akhlebinina M.I., Mel’nikov I.A., Akhadov T.A. Algorithm for radiological diagnosis of acute TBI in an emergency hospital. Detskaya khirurgiya. 2020; 24(S1): 17–25. (in Russian)

6. Iverson G.L., Karr J.E., Gardner A.J., Silverberg N.D., Terry D.P. Results of scoping review do not support mild traumatic brain injury being associated with a high incidence of chronic cognitive impairment: Commentary on McInnes et al. 2017. PLoS One. 2019; 14(9): e0218997. https://doi.org/10.1371/journal.pone.0218997

7. Yuh E.L., Mukherjee P., Lingsma H.F., Yue J.K., Ferguson A.R., Gordon W.A., et al. Magnetic resonance imaging improves 3-month outcome prediction in mild traumatic brain injury. Ann. Neurol. 2013; 73(2): 224-35. https://doi.org/10.1002/ana.23783

8. Sugiyama K., Kondo T., Higano S., Endo M., Watanabe H., Shindo K., et al. Diffusion tensor imaging fiber tractography for evaluating diffuse axonal injury. Brain Inj. 2007; 21(4): 413-9. https://doi.org/10.1080/02699050701311042

9. Izzy S., Mazwi N.L., Martinez S., Spencer C.A., Klein J.P., Parikh G., et al. Revisiting grade 3 diffuse axonal injury: not all brainstem microbleeds are prognostically equal. Neurocrit. Care. 2017; 27(2): 199-207. https://doi.org/10.1007/s12028-017-0399-2

10. АAkhadov T.A., Semenova N.A., Valiullina S.A., Manzhurtsev A.V., Bozhko O.V., Mel’nikov I.A., et al. Magnetic resonance imaging in assessing severe traumatic brain injury and predicting brain recovery in children. Rossiyskiy pediatricheskiy zhurnal. 2020; 23(5): 291–8. https://doi.org/10.18821/1560-9561-2020-23-5-291-298 (in Russian)

11. Spitz G., Maller J.J., Ng A., O’Sullivan R., Ferris N.J., Ponsford J.L. Detecting lesions after traumatic brain injury using susceptibility weighted imaging: A comparison with fluid-attenuated inversion recovery and correlation with clinical outcome. J. Neurotrauma. 2013; 30(24): 2038-50. https://doi.org/10.1089/neu.2013.3021

12. Keene C.D., Latimer C.S., Steele L.M., Mac Donald C.L. First confirmed case of chronic traumatic encephalopathy in a professional bull rider. Acta Neuropathologica. 2018; 135(2): 303-5. https://doi.org/10.1007/s00401-017-1801-z

13. Tagge C.A, Fisher A.M., Minaeva O.V., Gaudreau-Balderrama A., Moncaster J.A., Zhang X.L., et al. Concussion, microvascular injury, and early tauopathy in young athletes after impact head injury and an impact concussion mouse model. Brain. 2018; 141(2): 422-58. https://doi.org/10.1093/brain/awx350

14. Hütter B.O., Altmeppen J., Kraff O., Maderwald S., Theysohn J.M., Ringelstein A., et al. Higher sensitivity for traumatic cerebral microbleeds at 7 T ultra-high field MRI: is it clinically significant for the acute state of the patients and later quality of life? Ther. Adv. Neurol. Disord. 2020; 13: 1756286420911295. https://doi.org/10.1177/1756286420911295