Traumatic brain injury (TBI) represents a major public health challenge worldwide. Traumatic axonal injury (TAI) is a key determinant of outcome yet remains difficult to assess directly in vivo in routine clinical practice and is therefore typically inferred indirectly using advanced neuroimaging techniques. Cerebral microbleeds (CMBs), detected primarily with susceptibility-based MRI sequences, have emerged as putative imaging markers associated with axonal injury and injury severity in TBI. A broad and heterogeneous body of literature has explored their relevance using gradient-echo (GRE), susceptibility-weighted imaging (SWI), quantitative susceptibility mapping (QSM), and diffusion tensor imaging (DTI), as well as neuropsychological correlates. In this mini review, we provide a focused narrative synthesis of studies examining the detection, characterization, and interpretative framework of CMBs in TBI, with particular emphasis on susceptibility-based MRI and diffusion imaging approaches. We highlight areas of convergence and inconsistency in the literature and discuss methodological and conceptual considerations relevant to the use of CMBs as context-dependent imaging markers in TBI.

Introduction:Traumatic Brain Injury (TBI) often leads to lasting cognitive and functional deficits, with Traumatic Axonal Injury (TAI) being a significant prognostic factor. This study investigated white matter microstructural changes in moderate-to-severe TBI, focusing on the presence and number of cerebral microbleeds (MBs) using diffusion tensor imaging (DTI). Materials and methods:51 participants were recruited and categorized into three groups: 17 controls, 17 TBI patients with MBs (MBP), and 17 TBI patients without MBs (MBN). Age matching was applied to minimize confounding effects. MRI scans were acquired using a 3 T Siemens MAGNETOM Prisma scanner, and DTI data were preprocessed using FSL software. Whole white matter and corpus callosum masks were reconstructed using FreeSurfer, while tractography-based methods were implemented with FSL. Fractional anisotropy (FA) and mean diffusivity (MD) were extracted and compared across groups. Group-level voxel-wise statistical analysis was conducted using Tract-Based Spatial Statistics (TBSS), and generalized linear models (GLiMs) were applied to assess the effects of age, sex and MB number on DTI parameters. Results:Significant decrease in FA (p = 0,008 - 0,042) and increases in MD (p = 0,004 - 0,016) were observed in the WM masks when comparing the MBP group with the controls. In the TBSS analysis FA (p = 0,008) and MD (p = 0,005) showed significant differences between the MBP-CON comparison, while FA (p = 0,012) and MD (p = 0,043) were significantly different between the MBP and MBN groups. Moreover, a significant FA decrease was observed in the corpus callosum when comparing the MBP and MBN groups (p = 0,007). Additionally, an increasing number of microbleeds was significantly associated with altered DTI metrics in across all white matter masks. Conclusion:Our findings highlight MBs as potential markers of more extensive white matter injury in moderate-to-severe TBI. The increase in MBs suggests even greater white matter damage, indicating a progression of microstructural alterations. On a global scale, tractography enhances the sensitivity in detecting structural alterations compared to traditional segmentation techniques. Examination of central white matter areas holds significant importance in uncovering the relevance of MBs.

Bevezetés: A glomus caroticum (carotistest) az arteria carotis bifurcatióban elhelyezkedő, kemoreceptorokat tartalmazó sejtcsoport, amely biztosítja a szervezet gyors alkalmazkodását a vérplazma fluktuáló oxigén-, szén-dioxid- és pH-szintjéhez. A glomus caroticum paraganglioma neuroendokrin, paraszimpatikus eredetű, hipervaszkularizált, lassan növekvő nyaki terime, amely kapcsolódhat a szomszédos nyaki képletekkel. Egyetlen ismert kuratív terápiája a sebészi reszekció. Célkitűzés: Az intézetünkben 2015 és 2024 között glomus caroticum paraganglioma miatt végzett műtétek eredményeinek összegzése, elemzése. Módszer: Retrospektív analízisünk során elemeztük a betegek demográfiai adatait, a műtét időtartamát és a hospitalizációs időt. Regisztráltuk az esetleges szövődményeket, a szövettani diagnózist és az utánkövetési időt. Eredmények: Vizsgálatunkba 7 férfi és 10 nőbeteget vontunk be, összesen 19 műtétet végeztünk. Átlagéletkoruk 56,41 év (medián: 58 év) volt. A műtéti idő átlagosan 104 perc, a hospitalizációs idő átlagosan 5,84 nap (medián: 6 nap) volt. Műtét előtti embolisatio esetén (9 esetben) az átlagos műtéti idő 117 perc, embolisatio nélkül átlagosan 94 perc volt. A szövettani diagnózis 16 műtétnél paragangliomát/glomus caroticum tumort, 1 esetben Antoni A típusú schwannomát, 1 esetben áttétes ductalis emlőcarcinomát, 1 esetben struma nodosát igazolt kolloidos meszesedéssel. 2 esetben végeztünk carotisrevascularisatiót, 1 esetben Dacron, 1 esetben poli(tetrafluor-etilén) műér-interpositum beültetésével. Neurológiai szövődmény 9 esetben lépett fel rekedtség, beszéd vagy nyelési nehezítettség formájában. Látótérkiesés, ptosis a poli(tetrafluor-etilén) műér-interpositum beültetésén átesett betegnél jelentkezett. Megbeszélés: A preoperatív embolisatio csökkentheti a műtéti idő hosszát, a perioperatív vérzés kockázatát. A műtéti idő tekintetében vizsgálatunkban ennek ellenkezője igazolódott, de a kis esetszám, illetve a szignifikancia kérdése miatt további vizsgálatok szükségesek. Következtetés: A betegek ellátásában elengedhetetlen multidiszciplináris szemléletmód elősegítésére magas progresszivitási szintű centrumokban szorgalmazzuk endokrin/paraganglioma team létrehozását. Orv Hetil. 2025; 166(51): 2012–2017.

OBJECTIVES:This study aimed to determine whether focal MRI lesions such as microbleeds (MBs) and focal white matter hyperintensities (FWMHs) serve as reliable and specific markers for tract-level white matter injury in traumatic brain injury (TBI). MATERIALS & METHODS:Twenty-two patients with moderate-to-severe TBI and 22 age-matched healthy controls underwent MRI on a 3 T Siemens Prisma scanner. Imaging included susceptibility-weighted imaging (SWI), fluid-attenuated inversion recovery (FLAIR), and diffusion tensor imaging (DTI). Focal lesions were manually identified on SWI and FLAIR and mapped onto tractography reconstructions. Diffusion metrics-fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (AD), and radial diffusivity (RD) were compared between lesion-affected tracts, contralateral normal-appearing white matter (NAWM), and corresponding control tracts. Statistical analyses were performed using repeated measures ANOVA with Greenhouse-Geisser correction and Bonferroni-adjusted post hoc tests for FA. Friedman tests were conducted for MD, AD, and RD, followed by Bonferroni-corrected Wilcoxon post hoc comparisons. RESULTS:In this study, we identified 27 MBs and 66 FWMHs intersecting white matter tracts. We observed notable differences in diffusion metrics when comparing lesion-affected tracts to healthy controls. In MB-affected tracts, fractional anisotropy (FA) differed significantly (p = 0.002), while mean diffusivity (MD) also showed a significant alteration (p = 0.002), along with radial diffusivity (RD) (p < 0.001). Similarly, in FWMH-affected tracts, significant differences were observed in FA (p < 0.001), MD (p < 0.001), axial diffusivity (AD) (p < 0.001), and RD (p < 0.001). However, we did not find any significant differences between lesion-affected tracts and the contralateral normal-appearing white matter (NAWM). CONCLUSION:MBs and FWMHs do not co-localize with axonal injury at the tract level but indicate a global white matter damage.

Introduction: The role of p16 and p53 immunohistochemistry in the diagnosis of rare and aggressive uterine carcinosarcoma (UCS) has been well established. However, enhancer of zeste homolog 2 (EZH2), a histone methyltransferase and a member of the polycomb group family is a relatively new biomarker, with limited published data on its significance in this tumor type. The goal of this study was to examine EZH2 expression in UCS and its components, in correlation with morphological features, and p16 and p53 staining patterns. Methods: Twenty-eight UCSs were included in the study. EZH2, p16 and p53 immunoreactivity were assessed independently by two pathologists in both tumor components (epithelial and mesenchymal). EZH2 and p16 immunostains were scored semiquantitatively: based on the percentage and intensity of tumor cell staining a binary staining index ("high- or low-expressing") was calculated. The p53 staining pattern was evaluated as wild-type or aberrant (diffuse nuclear, null, or cytoplasmic expression). Statistical tests were used to evaluate the correlation between staining patterns for all three markers and the different tumor components and histotypes. Results: High EZH2 and p16 expression and aberrant p53 patterns were present in 89.3% 78.6% and 85.7% of the epithelial component and in 78.6%, 62.5% and 82.1% of the mesenchymal component, respectively. Differences among these expression rates were not found to be significant (p > 0.05). Regarding the epithelial component, aberrant p53 pattern was found to be significantly (p = 0.0474) more frequent in the serous (100%) than in endometrioid (66.6%) histotypes. Within the mesenchymal component, p53 null expression pattern occurred significantly (p = 0.0257) more frequently in heterologous sarcoma components (71.4%) compared to the homologous histotype (18.8%). Conclusion: In conclusion, EZH2, p16 and p53 seem to play a universal role in the pathogenesis of UCS; however, a distinctive pattern of p53 expression appears to exist between the serous and endometrioid carcinoma components and also between the homologous and heterologous sarcoma components.

Background and Aim: Since the initial release of the World Wide Web, the capabilities of web browsers have grown from presenting formatted documents to running complex programs, such as 3D game engines. The medical imaging community started to adopt technologies that came with the fifth major version of the HyperText Markup Language (HTML5). It led to the creation of various web-based radiological applications such as cornerstone.js or BrainBrowser. BrainBrowser supports both 3D and 2D rendering of neuroimaging data. However, it cannot run important image processing algorithms, such as brain extraction and linear registration, which are essential in most neuroimaging workflows. The most commonly used library that supports these algorithms is the FMRIB Software Library (FSL). We aim to build a web-based cross-platform neuroimaging platform that combines data visualization with image processing.Methods: We built our system as an extension of BrainBrowser. We developed WebMRI in Java Script and designed the user interface using HTML, CSS, and Bootstrap. We used Emscripten to port the brain extraction and linear registration tools of FSL to the web. Results: We built WebMRI, a fully web-based extensible neuroimaging platform that combines the visualization capabilities of BrainBrowser with the brain extraction and linear registration tools of FSL by porting them from C++ to WebAssembly. We extended BrainBrowser with a plugin system that makes it easy to bring other processing algorithms into the platform. We released the WebMRI source code on Github: https://github.com/wpmed92/WebMRI.Conclusions: We developed and released WebMRI, a web-based cross-platform open-source neuroimaging platform.

AbstractBackground and AimSince the initial release of the World Wide Web, the capabilities of web browsers have grown from presenting formatted documents to running complex programs, such as 3D game engines. The medical imaging community started to adopt technologies that came with the fifth major version of the HyperText Markup Language (HTML5). It led to the creation of various web-based radiological applications such as cornerstone.js or BrainBrowser. BrainBrowser supports both 3D and 2D rendering of neuroimaging data. However, it cannot run important image processing algorithms, such as brain extraction and linear registration, which are essential in most neuroimaging workflows. The most commonly used library that supports these algorithms is the FMRIB Software Library (FSL). We aim to build a web-based cross-platform neuroimaging platform that combines data visualization with image processing.MethodsWe built our system as an extension of BrainBrowser. We developed WebMRI in JavaScript and designed the user interface using HTML, CSS, and Bootstrap. We used Emscripten to port the brain extraction and linear registration tools of FSL to the web.ResultsWe built WebMRI, a fully web-based extensible neuroimaging platform that combines the visualization capabilities of BrainBrowser with the brain extraction and linear registration tools of FSL by porting them from C++ to WebAssembly. We extended BrainBrowser with a plugin system that makes it easy to bring other processing algorithms into the platform. We released the WebMRI source code on Github: https://github.com/wpmed92/WebMRI.ConclusionsWe developed and released WebMRI, a web-based cross-platform open-source neuroimaging platform.

Background and Objectives: Chronic suppurative otitis media (CSOM) with or without cholesteatoma is a frequent chronic inflammatory condition in children, which may lead to severe hearing loss that affects speech development. Treatment of recurrent CSOM associated with unserviceable hearing requires a specialized approach with regard to disease eradication and hearing rehabilitation. In this study, we investigated the advantages of subtotal petrosectomy (SP) combined with cochlear implantation (CI) in children with CSOM associated with unserviceable hearing and describe our experience with regard to the efficacy of this method, together with a literature review.Subjects and Methods: SP with sequential or simultaneous CI was performed in three children (four ears), and postoperative audiometric data were recorded.Results: The study included two male and one female patient. Mean age at the time of SP was 10.75 years (7–13 years). Sequential implantation was performed in three ears. Facial nerve palsy occurred after SP in one patient. The latest word recognition scores of Cases 1, 2, and 3 were 80% (at 60 dB), 75% (at 60 dB), and 70% (at 50 dB) and 90% (at 50 dB), respectively.Conclusions: SP with CI may be safe and reliable in children with CSOM associated with unserviceable hearing.

Currently the most widespread way of reporting in radiology is dictation mainly due to performance benefits. The output of this method is plain text, which varies in style (structure, nomenclature, abbreviations, etc.) and content between doctors even when reporting the exact same case. Templated radiology provides a structure for reporting and aims to help in generating more unified reports. We propose a web-based system for creating and using radiological structured reporting templates.We developed our software based on web technologies. We wrote the system with modular design in mind. We have separate libraries for the different functionalities: a rendering library which renders the templates based on a schema, an editor library which handles template creation, and an evaluator library, which parses, and executes our custom domain specific language, FormScript, which enables dynamic behavior in our templates. We also developed a Single Page Application to create, browse, use and share templating reports. The backend of the application is powered by Firebase from Google.We deployed our system at a publicly accessible domain at https://app.radiosheets.com.

A traumatic brain injury (TBI) induces the formation of cerebral microbleeds (CMBs), which are associated with cognitive impairments, psychiatric disorders, and gait dysfunctions in patients. Elderly people frequently suffer TBIs, especially mild brain trauma (mTBI). Interestingly, aging is also an independent risk factor for the development of CMBs. However, how TBI and aging may interact to promote the development of CMBs is not well established. In order to test the hypothesis that an mTBI exacerbates the development of CMBs in the elderly, we compared the number and cerebral distribution of CMBs and assessed them by analysing susceptibility weighted (SW) MRI in young (25 ± 10 years old, n = 18) and elder (72 ± 7 years old, n = 17) patients after an mTBI and in age-matched healthy subjects (young: 25 ± 6 years old, n = 20; aged: 68 ± 5 years old, n = 23). We found significantly more CMBs in elder patients after an mTBI compared with young patients; however, we did not observe a significant difference in the number of cerebral microhemorrhages between aged and aged patients with mTBI. The majority of CMBs were found supratentorially (lobar and basal ganglion). The lobar distribution of supratentorial CMBs showed that aging enhances the formation of parietal and occipital CMBs after mTBIs. This suggests that aging and mTBIs do not synergize in the induction of the development of CMBs, and that the different distribution of mTBI-induced CMBs in aged patients may lead to specific age-related clinical characteristics of mTBIs.

Purpose: A former rodent study showed that cerebral traumatic microbleeds (TMBs) may temporarily become invisible shortly after injury when detected by susceptibility weighted imaging (SWI). The present study aims to validate this phenomenon in human SWI. Methods: In this retrospective study, 46 traumatic brain injury (TBI) patients in various forms of severity were included and willingly complied with our strict selection criteria. Clinical parameters potentially affecting TMB count, Rotterdam and Marshall CT score, Mayo Clinic Classification, contusion number, and total volume were registered. The precise time between trauma and MRI [5 h 19 min to 141 h 54 min, including SWI and fluid-attenuated inversion recovery (FLAIR)] was individually recorded; TMB and FLAIR lesion counts were assessed. Four groups were created based on elapsed time between the trauma and MRI: 0–24, 24–48, 48–72, and >72 h. Kruskal–Wallis, ANOVA, Chi-square, and Fisher’s exact tests were used to reveal differences among the groups within clinical and imaging parameters; statistical power was calculated retrospectively for each comparison. Results: The Kruskal–Wallis ANOVA with Conover post hoc analysis showed significant (p = 0.01; 1−β > 0.9) median TMB number differences in the subacute period: 0–24 h = 4.00 (n = 11); 24–48 h = 1 (n = 14); 48–72 h = 1 (n = 11); and 72 h ≤ 7.5 (n = 10). Neither clinical parameters nor FLAIR lesions depicted significant differences among the groups. Conclusion: Our results demonstrate that TMBs on SWI MRI may temporarily become less detectable at 24–72 h following TBI.

This systematic review aims to test the hypothesis that microbleeds detected by MRI are common and show a characteristic pattern in cerebral fat embolism (CFE). Eighty-four papers involving 140 CFE patients were eligible for this review based on a systematic literature search up to 31 January 2020. An additional case was added from hospital records. Patient data were individually scrutinised to extract epidemiological, clinical and imaging variables. Characteristic CFE microbleed pattern resembling a “walnut kernel” was defined as punctuate hypointensities of monotonous size, diffusely located in the subcortical white matter, the internal capsule and the corpus callosum, with mostly spared corona radiata and non-subcortical centrum semiovale, detected by susceptibility- or T2* weighted imaging. The presence rate of this pattern and other, previously described MRI markers of CFE such as the starfield pattern and further diffusion abnormalities were recorded and statistically compared. The presence rate of microbleeds of any pattern, the “walnut kernel microbleed pattern”, diffusion abnormality of any pattern, the starfield pattern, and cytotoxic edema in the corpus callosum was found to be 98.11%, 89.74%, 97.64%, 68.5%, and 77.27% respectively. The presence rate between the walnut kernel and the starfield pattern was significantly ( p < 0.05) different. Microbleeds are common and mostly occur in a characteristic pattern resembling a “walnut kernel” in the CFE MRI literature. Microbleeds of this pattern in SWI or T2* MRI, along with the starfield pattern in diffusion imaging appear to be the most important imaging markers of CFE and may aid the diagnosis in clinically equivocal cases.

This study aims to test computer-aided diagnosis (CAD) for thyroid nodules in clinical ultrasonography (US) practice with a focus towards identifying thyroid entities associated with CAD system misdiagnoses. Two-hundred patients referred to thyroid US were prospectively enrolled. An experienced radiologist evaluated the thyroid nodules and saved axial images for further offline blinded analysis using a commercially available CAD system. To represent clinical practice, not only true nodules, but mimicking lesions were also included. Fine needle aspiration biopsy (FNAB) was performed according to present guidelines. US features and thyroid entities significantly associated with CAD system misdiagnosis were identified along with the diagnostic accuracy of the radiologist and the CAD system. Diagnostic specificity regarding the radiologist was significantly (p < 0.05) higher than when compared with the CAD system (88.1% vs. 40.5%) while no significant difference was found in the sensitivity (88.6% vs. 80%). Focal inhomogeneities and true nodules in thyroiditis, nodules with coarse calcification and inspissated colloid cystic nodules were significantly (p < 0.05) associated with CAD system misdiagnosis as false-positives. The commercially available CAD system is promising when used to exclude thyroid malignancies, however, it currently may not be able to reduce unnecessary FNABs, mainly due to the false-positive diagnoses of nodule mimicking lesions.

The aim of this study was to visualize the tumor propagation and surrounding mucosal field in radiography-based 3D model for advanced stage HNSCC and combine it with HPV genotyping and miRNA expression characterization of the visualized area. 25 patients with T1-3 clinical stage HNSCC were enrolled in mapping biopsy sampling. Biopsy samples were evaluated for HPV positivity and miR-21-5p, miR-143, miR-155, miR-221-5p expression in Digital Droplet PCR system. Significant miRNA expression differences of HPV positive tumor tissue biopsies were found for miR-21-5p, miR-143 and miR-221-5p compared to the HPV negative tumor biopsy series. Peritumoral mucosa showed patchy pattern alterations of miR-21-5p and miR-155 in HPV positive cases, while gradual change of miR-21-5p and miR-221-5p was seen in HPV negative tumors. In our study we found differences of the miRNA expression patterns among the HPV positive and negative tumorous tissues as well as the surrounding mucosal fields. The CT based 3D models of the cancer field and surrounding mucosal surface can be utilized to improve proper preoperative planning. Complex evaluation of HNSCC tissue organization field can elucidate the clinical and molecular differentiation of HPV positive and negative cases, and enhance effective organ saving therapeutic strategies.

The authors present a case report of a patient who was treated conservatively for a non-specific headache for more than a decade, while an arachnoidal cyst in the middle cranial fossa, over the temporal bone tegmen was diagnosed, but ruled out as the cause of the headache. The patient was referred to our ENT department with left, purulent ear discharge. Besides a chronic purulent otitis media, a cholesterol granuloma occupying the antrum, eroding the tegmen of the pyramid bone and penetrating into the middle cranial fossa was diagnosed. Case presentation of a patient with cholesterol granuloma, surgical options, differential diagnostic problems, and a literature review are presented. Tympanoplasty with cortical mastoidectomy was carried out to treat the chronic purulent otitis media, and the cholesterol granuloma was removed during transmastoid craniotomy. The iatrogenic temporal meningo-encephalic tissue herniation was repaired and the bone defect of the tegmen was reconstructed with septal cartilage. The patient's headache diminished immediately after the surgery. The chronic ear discharge stopped, the cholesterol granuloma was excised completely and the cerebral herniation was repaired successfully. Neither CSF leak, nor further herniation or meningitis were noticed. Two years after the operation the patient is asymptomatic. A large cholesterol granuloma, eroding into the middle cranial fossa can cause serious complications, and needs a high level of attention besides individualized surgical treatment based on the surgeon's abilities and skills. Orv Hetil. 2019; 160(52): 2067-2072.

The aim of this study was to evaluate the nuclear expression of histone methyltransferase enhancer of zeste homolog 2 (EZH2) in endocervical neoplastic lesions such as invasive endocervical adenocarcinoma (ECA) and cervical in situ adenocarcinoma (AIS) in comparison with normal endocervix and non-neoplastic counterparts. A total of 54 consecutive neoplastic cases (37 ECA, 17 AIS) and 32 non-neoplastic endocervical lesions (15 reactive atypia, 9 microglandular hyperplasia, 3 tuboendometrioid metaplasia, 3 tunnel cluster, 2 endometriosis) were included in the study with adjacent normal endocervix if present. EZH2 immunoreactivity was evaluated semiquantitatively by three independent experts in lesions and adjacent normal glandular epithelium as well. EZH2 expression was defined robust if at least two of the three experts rated partial or diffuse positivity. Robust EZH2 expression was statistically compared among the neoplastic, non-neoplastic, and normal glandular epithelium samples. Diagnostic test capability of robust EZH2 expression was calculated. Fifty-three out of the 54 neoplastic cases (98%) showed robust EZH2 expression. Robust EZH2 expression was significantly less often (4 out of 32 cases, 12.5%) found in the non-neoplastic endocervical lesions (p < 0.0001) and never (0 out of 66 samples) in the adjacent normal glandular epithelium. Robust EZH2 overexpression had a sensitivity and specificity of over 95% in detecting neoplastic lesions versus non-neoplastic lesions or normal glandular epithelium. EZH2 may play a role in the pathogenesis of endocervical neoplasia, and the detection of robust expression of EZH2 might be a useful differential diagnostic tool in problematic endocervical lesions in histology and cytology as well.

Previously, we reported human traumatic brain injury cases demonstrating acute to subacute microbleed appearance changes in susceptibility-weighted imaging (SWI-magnetic resonance imaging [MRI]). This study aims to confirm and characterize such temporal microbleed appearance alterations in an experimental model. To elicit microbleed formation, brains of male Sprague Dawley rats were pierced in a depth of 4 mm, in a parasagittal position bilaterally using 159 mu m and 474 mu m needles, without the injection of autologous blood or any agent. Rats underwent 4.7 T MRI immediately, then at multiple time points until 125 h. Volumes of hypointensities consistent with microbleeds in SWI were measured using an intensity threshold-based approach. Microbleed volumes across time points were compared using repeated measures analysis of variance. Microbleeds were assessed by Prussian blue histology at different time points. Hypointensity volumes referring to microbleeds were significantly decreased (corrected p < 0.05) at 24 h compared with the immediate or the 125 h time points. By visual inspection, microbleeds were similarly detectable at the immediate and 125 h imaging but were decreased in extent or completely absent at 24 h or 48 h. Histology confirmed the presence of microbleeds at all time points and in all animals. This study confirmed a general temporary reduction in visibility of microbleeds in the acute phase in SWI. Such short-term appearance dynamics of microbleeds should be considered when using SWI as a diagnostic tool for microbleeds in traumatic brain injury and various diseases.

Traumatic microbleeds (TMBs) and non-hemorrhagic lesions (NHLs) on MRI are regarded as surrogate markers of diffuse axonal injury. However, the actual relation between lesional and diffuse pathology remained unclear, since lesions were related to clinical parameters, largely influenced by extracranial factors. The aim of this study is to directly compare TMBs, NHLs and their regional features with the co-existing diffuse injury of the normal appearing white matter (NAWM) as measured by diffusion tensor imaging (DTI). Thirty-eight adults with a closed traumatic brain injury (12 mild, 4 moderate and 22 severe) who underwent susceptibility weighted imaging (SWI), Tl-, T2 weighted and FLAIR MRI and routine CT were included in the study. TMB (on SWI) and NHL (on T1-, T2 weighted and FLAIR images) features and Rotterdam scores were evaluated. DTI metrics such as fractional anisotropy (FA) and mean diffusivity (MD) were measured over different NAWM regions. Clinical parameters including age; Glasgow Coma Scale; Rotterdam score; TMB and NHL features were correlated to regional NAWM diffusivity using multiple regression. Overall NHL presence and basal ganglia area TMB load were significantly, negatively correlated with the subcortical NAWM FA values (partial r = -0.37 and -0.36; p = 0.006 and 0.025, respectively). The presence of any NHL, or TMBs located in the basal ganglia area indicates diffuse NAWM damage even after adjusting for clinical and CT parameters. To estimate DAI, a conventional lesional MRI pathology evaluation might at least in part substitute the use of quantitative DTI, which is yet not widely feasible in a clinical setting. (C) 2017 Elsevier B.V. All rights reserved.