Korean Journal of Radiology

The Korean Society of Radiology (대한영상의학회)
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Myelin Content in Mild Traumatic Brain Injury Patients with Post-Concussion Syndrome: Quantitative Assessment with a Multidynamic Multiecho Sequence

  • Roh-Eul Yoo (Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine) ;
  • Seung Hong Choi (Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine) ;
  • Sung-Won Youn (Department of Radiology, Daegu Catholic University Medical Center) ;
  • Moonjung Hwang (GE Healthcare Korea) ;
  • Eunkyung Kim (Department of Radiology, Rehabilitation Medicine, Seoul National University Hospital, Seoul National University College of Medicine) ;
  • Byung-Mo Oh (Department of Radiology, Rehabilitation Medicine, Seoul National University Hospital, Seoul National University College of Medicine) ;
  • Ji Ye Lee (Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine) ;
  • Inpyeong Hwang (Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine) ;
  • Koung Mi Kang (Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine) ;
  • Tae Jin Yun (Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine) ;
  • Ji-hoon Kim (Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine) ;
  • Chul-Ho Sohn (Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine)
  • Received : 2021.03.30
  • Accepted : 2021.08.28
  • Published : 2022.02.01
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Abstract

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.

Keywords

Acknowledgement

This study was supported by the Basic Science Research Program through the National Research Foundation of Korea funded by the Ministry of Science ICT and Future Planning (NRF-2020R1A2C2008949, NRF-2020R1A4A1018714); Creative Pioneering Researchers Program through Seoul National University; Institute for Basic Science (IBSR006-A1); the Basic Science Research Program through the National Research Foundation of Korea funded by the Ministry of Education (2017R1D1A1B04034838); and the Korea Medical Device Development Fund grant funded by the Korea government (the Ministry of Science and ICT, South Korea; the Ministry of Trade, Industry and Energy; the Ministry of Health and Welfare, Republic of Korea; and the Ministry of Food and Drug Safety) (project no. 9991007218, KMDF_PR_20200901_0086). This work was supported by the National Research Foundation of Korea (NRF) grant funded by the Korea government (MSIT) (No. NRF-2021R1A4A1028713).

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