A Voxel-based analysis of FDG-PET in traumatic brain injury: regional metabolism and relationship between the thalamus and cortical areas

[EN] The objective was to study the correlations and the differences in glucose metabolism between the thalamus and cortical structures in a sample of severe traumatic brain injury (TBI) patients with different neurological outcomes. We studied 49 patients who had suffered a severe TBI and 10 healthy control subjects using 18Ffluorodeoxyglucose positron emission tomography (18F-FDG-PET). The patients were divided into three groups: a vegetative or minimally-conscious state (MCS&VS) group (n = 17), which included patients who were in a vegetative or a minimally conscious state; an In-post-traumatic amnesia (In-PTA) group (n = 12), which included patients in PTA; and an Out-PTA group (n = 20), which included patients who had recovered from PTA. SPM5 software was used to determine the metabolic differences between the groups. FDG-PET images were normalized and four regions of interest were generated around the thalamus, precuneus, and the frontal and temporal lobes. The groups were parameterized using Student's t-test. Principal component analysis was used to obtain an intensity-estimated-value per subject to correlate the function between the structures. Differences in glucose metabolism in all structures were related to the neurological outcome, and the most severe patients showed the most severe hypometabolism. We also found a significant correlation between the cortico-thalamocortical metabolism in all groups. Voxel-based analysis suggests a functional correlation between these four areas, and decreased metabolism was associated with less favorable outcomes. Higher levels of activation of the cortico-cortical connections appear to be related to better neurological condition. Differences in the thalamocortical correlations between patients and controls may be related to traumatic dysfunction due to focal or diffuse lesions.A preliminary version of the manuscript presented here has obtained the 2nd award of IV Convocatoria de los Premios de Investigacio´n en Medicina del Colegio de Me´dicos de Valladolid (IV edition of the Medical Research Award of the Offi- cial College of Physicians of Valladolid).Garcia Panach, J.; Lull Noguera, N.; Lull Noguera, JJ.; Ferri Domínguez, J.; Martínez, C.; Sopena, P.; Robles Viejo, M.... (2011). A Voxel-based analysis of FDG-PET in traumatic brain injury: regional metabolism and relationship between the thalamus and cortical areas. Journal of Neurotrauma. 28(9):1707-1717. doi:10.1089/neu.2011.1851S1707171728

Voxel-based statistical analysis of thalamic glucose metabolism in traumatic brain injury: relationship with consciousness and cognition

Objective: To study the relationship between thalamic glucose metabolism and neurological outcome after severe traumatic brain injury (TBI). Methods: Forty-nine patients with severe and closed TBI and 10 healthy control subjects with 18F-FDG PET were studied. Patients were divided into three groups: MCS&VS group (n ¼ 17), patients in a vegetative or a minimally conscious state; In-PTA group (n ¼ 12), patients in a state of post-traumatic amnesia (PTA); and Out-PTA group (n ¼ 20), patients who had emerged from PTA. SPM5 software implemented in MATLAB 7 was used to determine the quantitative differences between patients and controls. FDG-PET images were spatially normalized and an automated thalamic ROI mask was generated. Group differences were analysed with two sample voxel-wise t-tests. Results: Thalamic hypometabolism was the most prominent in patients with low consciousness (MCS&VS group) and the thalamic hypometabolism in the In-PTA group was more prominent than that in the Out-PTA group. Healthy control subjects showed the greatest thalamic metabolism. These differences in metabolism were more pronounced in the internal regions of the thalamus. Conclusions: The results confirm the vulnerability of the thalamus to suffer the effect of the dynamic forces generated during a TBI. Patients with thalamic hypometabolism could represent a sub-set of subjects that are highly vulnerable to neurological disability after TBI.Lull Noguera, N.; Noé, E.; Lull Noguera, JJ.; Garcia Panach, J.; Chirivella, J.; Ferri, J.; López-Aznar, D.... (2010). Voxel-based statistical analysis of thalamic glucose metabolism in traumatic brain injury: relationship with consciousness and cognition. Brain Injury. 24(9):1098-1107. doi:10.3109/02699052.2010.494592S10981107249Gallagher, C. 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ANÁLISIS BASADO EN VÓXEL DE FDG-PET EN TRAUMATISMOS CRANEOENCEFÁLICOS: METABOLISMO Y CORRELACIÓN EN SISTEMA FRONTOTALÁMICO

Cada vez que entra un paciente en la unidad de daño cerebral del hospital Valencia al Mar, tras haber sufrido un Traumatismo Craneoencefálico (TCE) se le realiza una batería de pruebas que determinan el estado neurológico en el que se encuentra. Posteriormente se le realiza un PET (Tomografía por Emisión de Positrones) para obtener más información sobre su estado y funcionalidad. Una de las principales preocupaciones de familiares, profesionales de la salud y del propio paciente es, en qué medida van a recuperar la conciencia. La experiencia de los profesionales médicos les permite en la mayoría de los casos, por medio de la imagen cerebral FDG-PET (Fluorodesoxiglucosa-PET), establecer una relación entre la estructura talámica y el estado del paciente, pero se hace necesaria la búsqueda de métodos más objetivos y precisos. Como consecuencia, se propuso una colaboración entre el hospital Valencia al Mar y el instituto ITACA de la Universidad Politécnica de Valencia, en forma de Tesis Doctoral de Nuria Lull Noguera y posteriormente en forma de Tesis de Máster del autor de este documento, con el estudio de técnicas de Análisis Basado en Vóxel (ABV) de esa imagen FDG-PET. Este ABV permite aportar información cuantitativa sobre esta relación entre Regiones de Interés (ROI's) y el estado neurológico del paciente. Esta Tesis de Máster centra su atención en el estudio, por medio de ABV, de regiones cerebrales que tengan relación con el estado neurológico de los pacientes que sufren un TCE. El objetivo de nuestro estudio es obtener resultados que permitan reforzar esta relación entre el tálamo y el estado del paciente y ampliarlo a otras estructuras cerebrales, como es la corteza frontal, para obtener una visión más amplia de las relaciones entre estructuras y su importancia en la capacidad funcional de los pacientes, y en un futuro, puedan sumar a la evaluación y pronóstico por parte de los profesionales médicos. Los aspectos técnicos cubiertos en esta Tesis de Master incluyen el preproceso y posterior análisis estadístico de la neuroimagen de PET, y el manejo y conocimiento de las técnicas que hacen posible estos análisis. Los resultados obtenidos son esperanzadores y nos animan a continuar investigando en esta línea.García Panach, J. (2009). ANÁLISIS BASADO EN VÓXEL DE FDG-PET EN TRAUMATISMOS CRANEOENCEFÁLICOS: METABOLISMO Y CORRELACIÓN EN SISTEMA FRONTOTALÁMICO. http://hdl.handle.net/10251/11901Archivo delegad