Your SlideShare is downloading. ×
0
Mac Donald, Christine
Mac Donald, Christine
Mac Donald, Christine
Mac Donald, Christine
Mac Donald, Christine
Mac Donald, Christine
Mac Donald, Christine
Mac Donald, Christine
Mac Donald, Christine
Mac Donald, Christine
Mac Donald, Christine
Mac Donald, Christine
Mac Donald, Christine
Mac Donald, Christine
Mac Donald, Christine
Mac Donald, Christine
Mac Donald, Christine
Mac Donald, Christine
Mac Donald, Christine
Mac Donald, Christine
Mac Donald, Christine
Mac Donald, Christine
Upcoming SlideShare
Loading in...5
×

Thanks for flagging this SlideShare!

Oops! An error has occurred.

×
Saving this for later? Get the SlideShare app to save on your phone or tablet. Read anywhere, anytime – even offline.
Text the download link to your phone
Standard text messaging rates apply

Mac Donald, Christine

793

Published on

Published in: Health & Medicine
0 Comments
0 Likes
Statistics
Notes
  • Be the first to comment

  • Be the first to like this

No Downloads
Views
Total Views
793
On Slideshare
0
From Embeds
0
Number of Embeds
0
Actions
Shares
0
Downloads
0
Comments
0
Likes
0
Embeds 0
No embeds

Report content
Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
No notes for slide
  • CONFIDENTIAL
  • CONFIDENTIAL
  • CONFIDENTIAL
  • Transcript

    • 1. Advanced MRI in Blast-Related TBI:  Early Predictors of PTSD<br />Christine Mac Donald, PhD<br />Department of Neurology<br />Washington University School of Medicine<br />
    • 2. Research Rationale<br />Traumatic brain injury (TBI) is a major cause of morbidity and mortality in both civilian and military populations<br />Improvised explosive devices (IEDs) have emerged as a popular weaponry tactic in Operation Iraqi Freedom (OIF), now Operation New Dawn (OND) and Operation Enduring Freedom (OEF) <br />Blast-related TBI has been called the “signature injury” of the war yet much is still unknown about this particular mechanism of TBI and its impact on the brain.<br />Axonal damage is a major pathophysiological process following TBI<br />Possibly a primary cause of adverse neurological outcome<br />Current clinical imaging modalities have been optimized for the visualization of hemorrhage and ischemia but are inadequate for direct assessment of axonal injury<br />Diffusion Tensor Imaging may be more sensitive to changes following axonal injury<br />
    • 3. Statistical Perspective<br />The percentage of combat casualties accounted for by explosive mechanisms in Iraq and Afghanistan<br />78<br />320,000<br />79<br />88<br />0<br />Belanger et al., J Int Neuropsych Soc 2009<br />
    • 4. Statistical Perspective<br />78<br />320,000<br />79<br />88<br />0<br />The number of service members of the deployed force who potentially suffer from TBI (19.2%)<br />Long et al., J Neurotrauma2009; Moore et al., NeuroImage2009; RAND Report 2008<br />
    • 5. Statistical Perspective<br />78<br />320,000<br />79<br />88<br />0<br />The percentage of soldiers reporting LoC who were injured via blast explosion<br />Belanger et al., J Int Neuropsych Soc 2009<br />
    • 6. Statistical Perspective<br />78<br />320,000<br />79<br />88<br />0<br />The percentage of injuries seen at a second echelon treatment site that were due to blast<br />Warden, J Head Trauma Rehab 2006<br />
    • 7. Statistical Perspective<br />78<br />320,000<br />15<br />79<br />88<br />0<br />The current success rate of TBI therapies translating from animal models to human<br />Benzinger et al., J Neurotrauma 2009<br />
    • 8. Advanced MR Imaging Project<br />Department of Defense Grant<br />Congressionally Directed Medical Research Program (CDMRP)<br />
    • 9. Study Objectives<br />Determine whether DTI will noninvasively reveal abnormalities that are not present on CT or conventional MRI acutely following blast-related TBI<br />Use DTI to understand whether there are principal similarities and differences between blast-related TBI and TBI due to other mechanisms (e.g. motor vehicle accidents, falls, and direct blows to the head)<br />Test the hypothesis that specific pattern of injuries detected with these methods will predict specific longer-term psychological deficits<br />
    • 10. Study Participants<br />Enrollment<br />Participant Characteristics<br />All Subjects met DoD Definition for mild, uncomplicated TBI<br />Mac Donald et al, NEJM 2011<br />
    • 11. Brain Regions of Interest<br />Mac Donald et al, NEJM 2011<br />
    • 12. Comparison of DTI to Conventional MRI<br />Mac Donald et al, NEJM 2011<br />
    • 13. Regions Commonly Reported in Civilian TBI<br />Dashed lines indicated 2 SD below mean control<br />Mac Donald et al, NEJM 2011<br />
    • 14. Simulations predict high shear stresses in specific regions, independent of blast orientation<br />Taylor et al, J Biomedical Engineering 2009<br />
    • 15. Regions Predicted to be Vulnerable to Blast<br />Dashed lines indicated 2 SD below mean control<br />Mac Donald et al, NEJM 2011<br />
    • 16. Is this Clinically Relevant?<br />
    • 17. Clinical Predictors: PTSD<br />DTI addition was significant (βDTI= -0.28, p=0.016)<br />
    • 18. PTSD Severity by Criteria<br />
    • 19. Clinical Predictors: Hyperarousal<br />
    • 20. Study Objectives<br />Determine whether DTI will noninvasively reveal abnormalities that are not present on CT or conventional MRI acutely following blast-related TBI<br />DTI demonstrated abnormal signal consistent with traumatic axonal injury following blast-related TBI not apparent on conventional MR acquired at the time.<br />Use DTI to understand whether there are principal similarities and differences between blast-related TBI and TBI due to other mechanisms (e.g. motor vehicle accidents, falls, and direct blows to the head)<br />Abnormalities were observed in regions commonly reported following civilian TBI however a greater prevalence of patients had abnormalities in regions hypothesized to be vulnerable to blast.<br />Test the hypothesis that specific pattern of injuries detected with these methods will predict specific longer-term psychological deficits<br />Predictive correlations were observed between DTI regions of interest combined with initial clinical data and the severity of Post-Traumatic Stress Disorder determined 6 – 12 months later.<br />
    • 21. Implications and Future Directions<br /><ul><li>The implementation of these imaging methods is logistically feasible in this population.
    • 22. This approach is useful at the individual subject level.
    • 23. The results are broadly consistent with animal models and simulations of blast.
    • 24. Further studies are ongoing to attempt to expand upon these findings in a larger cohort and better understand how they relate to functional outcome</li></li></ul><li>Acknowledgements<br />Landstuhl Regional Medical Center<br />Washington University<br />Trauma Surgery & Critical Care<br />Dept of Radiology<br />LRMC PI: LTC Raymond Fang, MD (2009 – Present)<br />LRMC PI: COL Stephen Flaherty, MD (2007-2009)<br />Marcus Raichle, MD<br />Josh Shimony, MD PhD<br />Avi Snyder, MD PhD<br />MAJ Shawna Scully, MD Caroline Tuman<br />Dept of Psychiatry<br />Elliot Nelson, MD<br />Dept of Radiology – MRI Clinic<br />Dept of Neuropsychology<br />COL Stephen Sauter, MD <br />LTC John Witherow, MD <br />Tim Roberts<br />TSgt Kris Robertson<br />SSgt Kelly McKay<br />Tim McKay<br />Carl Russell <br />Don Albrant<br />SGT Antoinette Sherman<br />HM2 Ludwig Williams<br />MSGT Kenny Caywood<br />Nicole Werner, PhD<br />Clinical Coordination<br />Annie Johnson<br />Psychometricians<br />Leslie French, PhD<br />Justin Hampton<br />Erik Schumaker<br />Elaine Tamez<br />TBI Screen Team<br />Kathie Martin Karen Williams<br />SGT Shawn Nelson Pam Nyman<br />Linda Wierzechowski Janna Welsh <br />

    ×