Common Data Elements for Neuroimaging of Traumatic Brain Injury: Pediatric Considerations

Pediatric Neurosurgery, Massachusetts General Hospital , Boston, Massachusetts 02114, USA.
Journal of neurotrauma (Impact Factor: 3.71). 06/2011; 29(4):629-33. DOI: 10.1089/neu.2011.1927
Source: PubMed


As part of the Traumatic Brain Injury Common Data Elements project, a large-scale effort to define common data elements across a variety of domains, including neuroimaging, special considerations for pediatric patients were introduced. This article is an extension of that initial work, in which pediatric-specific pathoanatomical entities, technical considerations, interpretation paradigms, and safety considerations were reviewed. The goal of this review was to outline differences and specific information relevant to optimal performance and proper interpretation of neuroimaging in pediatric patients with traumatic brain injury. The long-range goal of this project is to facilitate data sharing as well as to provide critical infrastructure for potential clinical trials in this major public health area.

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Available from: Barbara A Holshouser
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    • "Emerging neuroimaging tools with the potential to inform TBI research have been previously identified, both by the original Neuroimaging Workgroup (Duhaime et al., 2010; Haacke et al., 2010) and the Pediatric Neuroimaging Workgroup (Duhaime, 2011). The recommendations for core and supplemental CDEs from the original Neuroimaging Workgroup were generally focused on conventional imaging, largely because of the need to establish radiological definitions for forms of injury identifiable on conventional imaging sequences , and also because these techniques are widely available in many TBI-related studies and across centers. "
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    ABSTRACT: This article identifies emerging neuroimaging measures considered by the inter-agency Pediatric Traumatic Brain Injury (TBI) Neuroimaging Workgroup. This article attempts to address some of the potential uses of more advanced forms of imaging in TBI as well as highlight some of the current considerations and unresolved challenges of using them. We summarize emerging elements likely to gain more widespread use in the coming years, because of 1) their utility in diagnosis, prognosis, and understanding the natural course of degeneration or recovery following TBI, and potential for evaluating treatment strategies; 2) the ability of many centers to acquire these data with scanners and equipment that are readily available in existing clinical and research settings; and 3) advances in software that provide more automated, readily available, and cost-effective analysis methods for large scale data image analysis. These include multi-slice CT, volumetric MRI analysis, susceptibility-weighted imaging (SWI), diffusion tensor imaging (DTI), magnetization transfer imaging (MTI), arterial spin tag labeling (ASL), functional MRI (fMRI), including resting state and connectivity MRI, MR spectroscopy (MRS), and hyperpolarization scanning. However, we also include brief introductions to other specialized forms of advanced imaging that currently do require specialized equipment, for example, single photon emission computed tomography (SPECT), positron emission tomography (PET), encephalography (EEG), and magnetoencephalography (MEG)/magnetic source imaging (MSI). Finally, we identify some of the challenges that users of the emerging imaging CDEs may wish to consider, including quality control, performing multi-site and longitudinal imaging studies, and MR scanning in infants and children.
    Full-text · Article · Jul 2011 · Journal of neurotrauma
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    ABSTRACT: The objective was to systematically review the medical literature and comprehensively summarize clinical research done on biomarkers for pediatric traumatic brain injury (TBI) and to summarize the studies that have assessed serum biomarkers acutely in determining intracranial lesions on CT in children with TBI. The search strategy included a literature search of PubMed®, MEDLINE® and the Cochrane Database from 1966 to August 2011, as well as a review of reference lists of identified studies. Search terms used included pediatrics, children, traumatic brain injury, and biomarkers. Any article with biomarkers of traumatic brain injury as a primary focus and containing a pediatric population was included. The search initially identified 167 articles. Of these, 49 met inclusion and exclusion criteria and were critically reviewed. The median sample size was 58 [IQR 31-101]. The majority of the articles exclusively studied children 36 (74%) and 13 (26%) were studies that included both children and adults in different proportions. There were 99 different biomarkers measured in these 49 studies and the five most frequently examined biomarkers were S100B (27 studies), NSE (15 studies), IL-6 (7 studies), MBP (6 studies), and IL-8 (6 studies). There were 6 studies that assessed the relationship between serum markers and CT lesions. Two studies found that NSE levels ≥ 15 ng/ml within 24 hours of TBI was associated with intracranial lesions. Four studies using serum S100B were conflicting: 2 studies found no association with intracranial lesions and 2 studies found a weak association. The flurry of research in the area over the last decade is encouraging but is limited by small sample sizes, variable practices in sample collection, inconsistent biomarker-related data elements and disparate outcome measures. Future studies of biomarkers for pediatric TBI will require rigorous and more uniform research methodology, common data elements, and consistent performance measures.
    No preview · Article · Oct 2012 · Journal of neurotrauma
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    ABSTRACT: The past decade has seen an increase in the number of articles reporting the use of DTI to detect brain abnormalities in patients with traumatic brain injury. DTI is well-suited to the interrogation of white matter microstructure, the most important location of pathology in TBI. Additionally, studies in animal models have demonstrated the correlation of DTI findings and TBI pathology. One hundred articles met the inclusion criteria for this quantitative literature review. Despite significant variability in sample characteristics, technical aspects of imaging, and analysis approaches, the consensus is that DTI effectively differentiates patients with TBI and controls, regardless of the severity and timeframe following injury. Furthermore, many have established a relationship between DTI measures and TBI outcomes. However, the heterogeneity of specific outcome measures used limits interpretation of the literature. Similarly, few longitudinal studies have been performed, limiting inferences regarding the long-term predictive utility of DTI. Larger longitudinal studies, using standardized imaging, analysis approaches, and outcome measures will help realize the promise of DTI as a prognostic tool in the care of patients with TBI.
    Preview · Article · Jan 2013 · American Journal of Neuroradiology
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