Research Reports - Combining biochemical and imaging markers to improve diagnosis and characterization of mild traumatic brain injury

PLoS One. 2013 Nov 19;8(11)

Kou Z, Gattu R, Kobeissy F, Welch RD, O'Neil BJ, Woodard JL, Ayaz SI, Kulek A, Kas-Shamoun R, Mika V, Zuk C, Tomasello F, Mondello S.

BACKGROUND: Mild traumatic brain injury (mTBI) is a significant healthcare burden
and its diagnosis remains a challenge in the emergency department. Serum
biomarkers and advanced magnetic resonance imaging (MRI) techniques have already
demonstrated their potential to improve the detection of brain injury even in
patients with negative computed tomography (CT) findings. The objective of this
study was to determine the clinical value of a combinational use of both blood
biomarkers and MRI in mTBI detection and their characterization in the acute
setting (within 24 hours after injury).
METHODS: Nine patients with mTBI were prospectively recruited from the emergency
department. Serum samples were collected at the time of hospital admission and
every 6 hours up to 24 hours post injury. Neuronal (Ubiquitin C-terminal
Hydrolase-L1 [UCH-L1]) and glial (glial fibrillary acidic protein [GFAP])
biomarker levels were analyzed. Advanced MRI data were acquired at 9±6.91 hours
after injury. Patients' neurocognitive status was assessed by using the Standard
Assessment of Concussion (SAC) instrument.
RESULTS: The median serum levels of UCH-L1 and GFAP on admission were increased
4.9 folds and 10.6 folds, respectively, compared to reference values. Three
patients were found to have intracranial hemorrhages on SWI, all of whom had very
high GFAP levels. Total volume of brain white matter (WM) with abnormal
fractional anisotropy (FA) measures of diffusion tensor imaging (DTI) were
negatively correlated with patients' SAC scores, including delayed recall. Both
increased and decreased DTI-FA values were observed in the same subjects. Serum
biomarker level was not correlated with patients' DTI data nor SAC score.
CONCLUSIONS: Blood biomarkers and advanced MRI may correlate or complement each
other in different aspects of mTBI detection and characterization. GFAP might
have potential to serve as a clinical screening tool for intracranial bleeding.
UCH-L1 complements MRI in injury detection. Impairment at WM tracts may account
for the patients' neurocognitive symptoms.

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