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AJNR - American Journal of Neuroradiology

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American Journal of Neuroradiology 23:1509-1515, October 2002
© 2002 American Society of Neuroradiology

BRAIN

Brain Atrophy in Mild or Moderate Traumatic Brain Injury: A Longitudinal Quantitative Analysis

John D. MacKenzie^a, Faez Siddiqi^a, James S. Babb^c, Linda J. Bagley^a, Lois J. Mannon^a, Grant P. Sinson^b and Robert I. Grossman^a

^a Department of Radiology, University of Pennsylvania Medical, Center, Philadelphia, PA
^b Department of Neurosurgery, University of Pennsylvania Medical, Center, Philadelphia, PA
^c Fox Chase Cancer Center, Philadelphia, PA

Address reprint requests to Robert I. Grossman, MD, New York University School of Medicine, Department of Radiology, 550 First Street, HW-209, New York, NY 10016

BACKGROUND AND PURPOSE: Although mild or moderate traumatic brain injury (TBI) is known to cause persistent neurologic sequelae, the underlying structural changes remain elusive. Our purpose was to assess decreases in the volume of brain parenchyma (VBP) in patients with TBI and to determine if clinical parameters are predictors of the extent of atrophy.

METHODS: We retrospectively assessed the total VBP in 14 patients with mild or moderate TBI at more than 3 months after injury and in seven patients at two time points more than 3 months apart. VBP was calculated from whole-brain MR images and then normalized by calculating the percent VBP (%VBP) to correct for intraindividual variations in cranial size. Clinical parameters at the time of trauma were evaluated for potential predictors of atrophy. Findings were compared with those of control subjects of similar ages.

RESULTS: In the single time-point analysis, brain volumes, CSF volumes, and %VBP were not significantly different between patients and control subjects. In the longitudinal analysis, the rate of decline in %VBP (0.02 versus 0.0064 U/day, P = .05) and the change in %VBP between the first and second time points (-4.16 ± 1.68 versus -1.49 ± 1.7, P = .022 [mean ±SD]) were significantly greater in patients. Change in %VBP was significantly greater in patients with loss of consciousness (LOC) than in those without LOC (P = .023).

CONCLUSION: Whole-brain atrophy occurs after mild or moderate TBI and is evident at an average of 11 months after trauma. Injury that produces LOC leads to more atrophy. These findings may help elucidate an etiology for the persistent or new neurologic deficits that occur months after injury.

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