Journal of neurotrauma最新文献

{"title":"Acute Neuroimaging Findings Are Associated with Poor Outcome after Mild Traumatic Brain Injury: A Systematic Review and Meta-Analysis.","authors":"Breanna K Nelson, Sidney A Saint, Lea N Farah, Tala B Bagh, Noah D Silverberg, Jacob L Stubbs, William J Panenka","doi":"10.1177/08977151261434925","DOIUrl":"10.1177/08977151261434925","url":null,"abstract":"<p><p>Previous studies have failed to determine whether acute neuroimaging findings after mild traumatic brain injury (mTBI) are associated with poor outcomes. We performed a systematic review and meta-analysis to determine whether such indicators are associated with health outcomes, recovery-related outcomes, or concurrent indicators of injury severity. We searched MEDLINE, PsycINFO, and Web of Science in April 2024. We extracted data from prospective studies or retrospective analyses of prospective data, where computed tomography scans were acquired within 1 week of mTBI or magnetic resonance imaging scans were acquired within 3 months of injury, according to PRISMA guidelines. The primary outcome measure was the Glasgow Outcome Scale. Secondary outcomes and indicators of injury severity included self-reported loss of consciousness, post-traumatic amnesia, and post-concussion symptom scores. The protocol for this study was pre-registered (PROSPERO #CRD42020190659). We included 64 studies in the review and 25 studies in the meta-analyses. The presence of acute neuroimaging findings after mTBI was associated with higher odds of poor outcome (OR = 2.04 [1.29-3.24], <i>p</i> = 0.0024, <i>k</i> = 7, <i>n</i> = 2,947) and loss of consciousness (OR = 1.42 [1.02-1.97], <i>p</i> = 0.039, <i>k</i> = 15, <i>n</i> = 3,912) compared to those without acute neuroimaging findings, but not post-traumatic amnesia (OR = 1.27 [0.65-2.49], <i>p</i> = 0.49, <i>k</i> = 10, <i>n</i> = 5,155) or post-concussion symptoms (Hedge's <i>g</i> = 0.00 [-0.17-0.17], <i>p</i> = 0.97, <i>k</i> = 9, <i>n</i> = 3,616). Results from qualitative analysis of outcome data that could not be synthesized quantitatively are congruent. Acute neuroimaging findings after mTBI are associated with poor functional outcome and may be clinically relevant for identifying patients at a higher risk for poor outcomes.</p>","PeriodicalId":16512,"journal":{"name":"Journal of neurotrauma","volume":" ","pages":"1707-1727"},"PeriodicalIF":3.8,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147512810","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Noninvasive Methods for Measurement of Intracranial Pressure in Patients with Acute Neurotrauma: A Systematic Review and Meta-Analysis.","authors":"Allice Nyborg Rosenkrans Lind, Maria Hjort Kristensen, Victor Hvingelby, Mads Rasmussen, Klaus Ulrik Koch, Asger Granfeldt, Ronni Mikkelsen, Line Kirkegaard Rasmussen, Claus Ziegler Simonsen, Martin Fauerholdt Gude, Anders Rosendal Korshøj","doi":"10.1177/08977151261436289","DOIUrl":"10.1177/08977151261436289","url":null,"abstract":"<p><p>Invasive intracranial pressure (ICP) monitoring provides essential guidance for the treatment of patients with suspected head injuries; however, it remains incompatible with prehospital use. While several noninvasive ICP-measuring methods exist, previous studies have not adequately addressed their potential in a prehospital setting. In this systematic review and meta-analysis of diagnostic test accuracy, we explore the accuracy of existing noninvasive methods for ICP monitoring and assess their potential usefulness in prehospital screening for elevated ICP. This systematic review and meta-analysis were conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses guideline. Embase, Scopus, PubMed, CENTRAL, and Cochrane databases were sought for relevant articles on June 23, 2025. All studies evaluating minimally invasive and transportable methods for ICP assessment were included. Animal studies, <i>in vitro</i> studies, reviews, and meta-analyses were excluded. Study selection was performed by two independent reviewers, and conflicts were resolved by a third reviewer. Potential for prehospital use of each method was evaluated using four predetermined criteria. Summary receiver operator characteristic curves and summarized sensitivity and specificity were reported if multiple studies investigating the same method were eligible for meta-analysis. The applicability and risk of bias of the included studies were assessed using the Quality Assessment of Diagnostic Accuracy Studies 2 tool for diagnostic test accuracy studies. Fifty-five articles were included. Ultrasound of optic nerve sheath diameter (ONSD) was the method with the highest potential for prehospital use. We found a summarized sensitivity of 92.6% (95% confidence interval [CI]: 87.0; 95.9%) and a summarized specificity of 85.1% (95% CI: 74.1; 92.0%) for detecting increased ICP through ONSD measurement. Other methods for diagnosing elevated ICP diagnosis showed poor diagnostic accuracy or low potential for prehospital use. We found ultrasound estimation of the ONSD to show the highest potential for prehospital use. Prospective studies are needed to verify their diagnostic capability in the prehospital setting.</p>","PeriodicalId":16512,"journal":{"name":"Journal of neurotrauma","volume":" ","pages":"1735-1748"},"PeriodicalIF":3.8,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147574440","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sex Differences in the Treatment Effect of Targeted Heart Rate Aerobic Exercise in Adolescents with Acute Sport-Related Concussion.","authors":"Elizabeth V Castro, Haley M Chizuk, John J Leddy, Nell Aronoff, Eve M Valera, Mohammad N Haider","doi":"10.1177/08977151261433831","DOIUrl":"10.1177/08977151261433831","url":null,"abstract":"<p><p>Prescribed aerobic exercise is the recommended treatment for athletes with sport-related concussion (SRC) who present with exercise intolerance. A recent randomized controlled trial (RCT) found that higher volumes of aerobic exercise, compared with lower volumes, may not be as efficacious in adolescent females with SRC compared with adolescent males. We reanalyzed data from our previously published randomized controlled trials (RCT) and hypothesized that prescribed aerobic exercise, and not stretching, within 10 days of injury would result in faster recovery after SRC in males compared with females. The first RCT (<i>n</i> = 103) recruited from 2015 to 2018 and the second RCT (<i>n</i> = 115) recruited from 2018 to 2020. Sexes were compared in each RCT, then samples were stratified by sex, and intervention groups were compared using a Log-rank test. There were no significant differences in recovery times between males and females in either RCT, regardless of intervention. When stratified by sex and comparing intervention groups, males in RCT1 who were prescribed aerobic exercise (<i>n</i> = 28) recovered 6 days faster than males prescribed stretching (<i>n</i> = 27, <i>p</i> = 0.004) but there was no significant difference for females (aerobic exercise [<i>n</i> = 24] vs. stretching [<i>n</i> = 24, 3-day difference, <i>p</i> = 0.564]). In RCT2, males prescribed aerobic exercise (<i>n</i> = 39) recovered 8 days faster than the stretching group (<i>n</i> = 34, <i>p</i> = 0.020), whereas there was no significant difference for females (aerobic exercise [<i>n</i> = 22] vs. stretching [<i>n</i> = 20, 3-day difference, <i>p</i> = 0.587]). This reanalysis of prior RCT data revealed that male adolescents after SRC recovered significantly faster by 7-8 days when prescribed aerobic exercise within 10 days of injury, whereas female adolescents had a nonsignificant improvement of 3 days. Future adequately powered studies should account for variability between sexes.</p>","PeriodicalId":16512,"journal":{"name":"Journal of neurotrauma","volume":" ","pages":"1806-1813"},"PeriodicalIF":3.8,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147474036","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Infant Abusive Head Trauma Induces Seizures and Cellular Stress in a Pre-Clinical Mouse Model.","authors":"Sydney Harris, Matt Hudson, Marissa Sgro, Sabrina Salberg, Crystal N Li, Elaina Vlassopoulos, Glenn R Yamakawa, Bridgette D Semple, Holly R Chinnery, Richelle Mychasiuk","doi":"10.1177/08977151261440774","DOIUrl":"10.1177/08977151261440774","url":null,"abstract":"<p><p>Abusive head trauma (AHT) occurs when a child is grasped and shaken with such force that the brain moves within the skull. AHTs are not isolated events; repetition occurs in 30-50% of cases, with affected children experiencing ∼10 episodes. While many AHTs appear asymptomatic, there is often underlying cellular and neurological damage. Notably, seizures following AHT may be solely electrographic without overt behavioral signs and detectable only via electroencephalography (EEG). Thus, we examined electrographic seizures and indicators of cell stress in a mouse model of repeat AHT. On postnatal day (P)8, mice underwent hippocampal electrode surgery. On P10-12, 5 min of baseline EEG was recorded, followed by an AHT and 15 min of postinjury EEG recording. AHTs were modeled by securing a mouse to a shaking device at 400 rpm (5g) for 60 s. Sham mice underwent the same surgery and EEG recording procedures but were placed on the shaking device while it remained stationary. A separate cohort of mice forewent surgery but were exposed to the same AHT procedure and were euthanized on P21 or P45 for gene expression and telomere length (TL) analysis. Electrographic seizures occurred following 35.7% of AHTs, while no sham mice exhibited electrographic seizures. Repetitive AHTs affected gene expression in the hippocampus and olfactory bulbs, in genes related to cell stress (<i>TERT, Sod1, P53, Drd2, Dnmt3a, iNOS</i>), and TL at P21. These findings suggest that despite the absence of observable behavioral deficits, repeat AHTs result in measurable cellular damage and electrographic seizure activity.</p>","PeriodicalId":16512,"journal":{"name":"Journal of neurotrauma","volume":" ","pages":"1843-1855"},"PeriodicalIF":3.8,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147627995","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Low or Low-Normal Insulin-Like Growth Factor 1 After Traumatic Brain Injury: Interpretation and Implications.","authors":"Varun Mishra, Melissa Martinez, Justin Weppner","doi":"10.1177/08977151261434917","DOIUrl":"10.1177/08977151261434917","url":null,"abstract":"<p><p>Growth hormone deficiency (GHD) is a prevalent consequence of traumatic brain injury (TBI) that can contribute to prolonged adverse symptoms and impaired quality of life. The overlap between symptoms of GHD and chronic TBI complicates the clinical picture, highlighting the need for precise diagnostic tools. Insulin-like growth factor 1 (IGF-1), a key mediator of growth hormone (GH) activity, is frequently utilized as a surrogate marker of GH status. However, IGF-1 levels may be normal in patients with confirmed GHD. Furthermore, low or low-normal IGF-1 is not specific to GHD, and provocative testing is required to confirm GHD in most patients with suspected deficiency. To provide a pragmatic clinical framework for interpreting IGF-1 <i>z</i>-score <0 in symptomatic patients after TBI, we reviewed the literature in the PubMed and PubMed Central databases addressing IGF-1 and GHD, differential diagnoses associated with low and low-normal IGF-1, and international guidelines on GH testing. Among TBI patients, GHD remains a leading cause of reduced IGF-1, but alternative diagnoses include malnutrition, chronic liver or kidney disease, poorly controlled diabetes mellitus, hypothyroidism, sepsis, and genetic conditions such as Laron syndrome. A systematic and evidence-based approach to IGF-1 interpretation is essential for distinguishing primary neuroendocrine dysfunction from secondary causes. The use of <i>z</i>-scores improves diagnostic precision by standardizing IGF-1 levels for age and sex. Our framework aids clinicians in integrating thorough neuroendocrine evaluation with broader medical assessments, clinical considerations, and comorbidities, thereby improving diagnostic accuracy and patient management. Future research should emphasize refined screening protocols for neuroendocrine dysfunction in TBI.</p>","PeriodicalId":16512,"journal":{"name":"Journal of neurotrauma","volume":" ","pages":"1728-1734"},"PeriodicalIF":3.8,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147499271","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Neuropathological and Behavioral Effects of Mild Traumatic Brain Injury at High Altitude.","authors":"Caroline A Browne, Alexandru Korotcov, Nathan P Cramer, Mihika Gangolli, Xiufen Xu, Shalini Jaiswal, Asamoah Bosomtwi, Kathleen Hatch, Cara Olsen, Katherine Groen, Cheryl D Stimpson, Bernard J Dardzinski, Daniel P Perl, Dara L Dickstein, Zygmunt Galdzicki","doi":"10.1177/08977151261438726","DOIUrl":"10.1177/08977151261438726","url":null,"abstract":"<p><strong>Objective: </strong>In lowlanders, ascent to and prolonged stay at high altitude (HA) can trigger maladaptive changes in neurovascularization, immune function, and hippocampal-dependent cognitive impairment. Mild traumatic brain injury (mTBI) induces similar neuropathological and behavioral alterations. The primary objective of this study was to characterize the impact of mTBI at HA on behavioral and neuropathological outcomes in controlled murine models.</p><p><strong>Methods: </strong>Baseline magnetic resonance imaging (MRI), diffusion tensor imaging (DTI), and [¹⁸F]fluorodeoxyglucose positron emission tomography (PET) were conducted in male C57BL/6J mice prior to exposure to either sea level (SL) or chronic HA (12 weeks, 5000 m simulated in a hypobaric chamber). Mice were then assigned to mTBI (three repetitive closed head injuries) or Sham groups. The impact of HA-mTBI on novel object recognition and contextual fear memory recall, analogs of human subcategories of memory altered at HA, was evaluated 9-12 days postinjury, followed by imaging.</p><p><strong>Results: </strong>Relative to their post-HA imaging assessment, HA-mTBI cerebral blood flow within the cortex, hippocampus, and thalamus was reduced, as was global brain volume. Moreover, statistical parametric mapping analysis detected clear HA-mTBI interactions in glucose uptake with reductions at the injury site and contralateral increases in the cortex and amygdala. Significant clusters were identified by MRI and DTI in the cortex, caudate, and corpus callosum for T2 values, trace, and radial diffusivity in HA-mTBI animals relative to their post-HA assessments. The principal component analysis and Pearson's correlations reveal distinct imaging signatures associated with HA exposure and TBI hippocampal integrity and thalamocortical connectivity, which may contribute to deficits in spatial memory and alterations in exploratory behavior.</p><p><strong>Summary: </strong>The combined burden of chronic HA exposure and mTBI induces a complex neuropathological interaction, evidenced by region-dependent white matter vulnerability, gray matter alterations, and impaired cerebral glucose metabolism. Although HA exposure and mTBI independently produced behavioral deficits, a synergistic behavioral effect was not detected, revealing a critical dissociation between structural/metabolic injury and functional outcomes.</p>","PeriodicalId":16512,"journal":{"name":"Journal of neurotrauma","volume":" ","pages":"1824-1842"},"PeriodicalIF":3.8,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147874020","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Injury Severity and Free-Water Volume Fraction Predict Regional White Matter Atrophy During the First Year Following Moderate-Severe Traumatic Brain Injury.","authors":"Daniel J Brennan, Jeffrey B Ware, Ramon Diaz-Arrastia, Junghoon J Kim","doi":"10.1177/08977151261438982","DOIUrl":"10.1177/08977151261438982","url":null,"abstract":"<p><p>Traumatic axonal injury is a common endophenotype of traumatic brain injury (TBI) in which injury to axons is a dominant component. In previous investigations, we identified a significant reduction of white matter (WM) volume from 3 to 12 months post-injury, an increased rate of atrophy during this period associated with a longer duration of post-traumatic amnesia (PTA), widespread reductions in white-matter fractional anisotropy (FA), and elevated free-water (FW) content in a cohort of moderate-to-severe TBI patients. To provide a more comprehensive characterization of the spatiotemporal trajectory of TBI-induced WM degeneration, we have estimated the spatial distribution of WM atrophy related to the duration of PTA in the first year following moderate-to-severe TBI (msTBI) (<i>N</i> = 33) and examined the degree to which baseline diffusion measures of WM integrity, FW and FW-corrected fractional anisotropy (F-FA), were each associated with subsequent WM atrophy. WM atrophy was observed diffusely across the brain, with the greatest effects in the splenium of the corpus callosum, corona radiata, and brainstem. Increased atrophy in the central WM was correlated with greater duration of PTA. Finally, elevated FW volume fraction at 3 months post-injury predicted greater subsequent WM atrophy, while F-FA did not show a significant relationship. These findings suggest that early FW elevation may serve as a biomarker of progressive WM neurodegeneration following TBI, and neuroinflammatory processes may underlie this relationship. Future research should directly investigate the underlying mechanisms of FW-related neuropathology and its role in progressive neurodegeneration following msTBI.</p>","PeriodicalId":16512,"journal":{"name":"Journal of neurotrauma","volume":" ","pages":"1789-1794"},"PeriodicalIF":3.8,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147627915","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Treatment of Persisting Symptoms after Concussion with Repetitive Transcranial Magnetic Stimulation: A Double-Blinded, Randomized, Controlled Trial.","authors":"Christina Campbell, Alison J Wilson, Sané Du Plessis, Melanie H Vergeer, Kaiden Jobin, Jean-Michel Galarneau, Liu Shi Gan, Chantel T Debert","doi":"10.1177/08977151261440773","DOIUrl":"10.1177/08977151261440773","url":null,"abstract":"&lt;p&gt;&lt;p&gt;Following a mild traumatic brain injury (mTBI), up to 30% of individuals will experience persisting symptoms beyond 3 months. Repetitive transcranial magnetic stimulation (rTMS) is a noninvasive neuromodulation technique that has shown promise as an intervention for persisting symptoms after concussion (PSaC); however, to determine efficacy, larger clinical trials are required. The objective of this study was to investigate the efficacy of high-frequency rTMS targeting the left dorsolateral prefrontal cortex as an intervention for PSaC. This randomized, double-blinded, sham-controlled study recruited adults (aged 18-75 years) experiencing PSaC for at least 3 months and up to 5 years post-mTBI. Participants were randomized 1:1 to receive 20 sessions of rTMS (10 Hz, 10 trains of 60 pulses with 45 s inter-train intervals, 100-120% resting motor threshold) using either an active or sham coil. The primary outcome was the Rivermead Postconcussion Symptoms Questionnaire (RPQ). The primary end-point was the difference in total RPQ score change from baseline at post-rTMS and 1- and 3-month follow-ups in active compared with sham rTMS. Secondary exploratory outcomes included anxiety, depression, quality of life, headache, post-traumatic stress disorder (PTSD), and cognition. To determine the effects of rTMS, a difference-in-differences approach was adopted using linear mixed models, which controlled for age, sex, and baseline stress (life stress questionnaire [LSQ]). One hundred and forty individuals were screened, and 91 participants were enrolled (mean age 41.3 ± 11.3; 61% female). For our primary end-point, there was no significant difference in differences in total RPQ score between the active and sham groups at post-rTMS (β = 1.07, 95% CI [-3.01, 5.1], &lt;i&gt;p&lt;/i&gt; = 0.607), 1 month (β = 3.81, 95% CI [-0.72, 8.3], &lt;i&gt;p&lt;/i&gt; = 0.099), or 3 months (β = -3.18, 95% CI [-7.1, 0.70], &lt;i&gt;p&lt;/i&gt; = 0.108). However, both active and sham groups demonstrated a significant improvement in total RPQ scores from baseline at post-rTMS, 1 month, and 3 months. The secondary outcomes (depression, anxiety, quality of life, headache impact, cognition, post-traumatic stress) demonstrated a significant effect of time, but no significant effect of group. Age and sex did not influence the model; however, higher baseline LSQ (&gt;300) was associated with higher scores in both active and sham groups at all timepoints for every outcome measure other than headache impact. Lower LSQ significantly influenced response to active rTMS treatment with regard to PTSD symptoms at post-rTMS timepoint only but not in the sham group. In conclusion, there was no significant difference between active and sham rTMS when evaluating symptom severity scores. However, both treatment groups significantly improved following intervention, which was maintained up to 3 months. Lower baseline LSQ significantly influenced PTSD symptom response in the active group at post-rTMS only. Alternative neuromodulation","PeriodicalId":16512,"journal":{"name":"Journal of neurotrauma","volume":" ","pages":"1749-1762"},"PeriodicalIF":3.8,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147674424","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"CT-Based Automated Segmentation and Recurrence Prediction in Chronic Subdural Hematoma: A Dual-Label Multicenter Study.","authors":"Hong Wu, Xiaowei Lv, Jianxin Yang, Dujing Lei, Sailong Wan, Cuiwei Bai, Shunfu Zhuang, Baogang Wang, Dingtai Wei, Xinquan Long, Hui Xue, Xunan Zhang, Xuhui Fan, Linjie Huang, Zixuan Tian, Ming Li, Han Wang, Xiaorui Yin","doi":"10.1177/08977151261434893","DOIUrl":"10.1177/08977151261434893","url":null,"abstract":"<p><p>Chronic subdural hematoma (CSDH) frequently recurs after burr-hole surgery, yet most prior imaging studies have focused primarily on hematoma and have not addressed the biomechanical effects of brain compression, which may play an important role in recurrence. In addition, reliance on manual annotation and subjective feature selection limits reproducibility and hinders large-scale clinical translation. This multicenter study included 897 patients with CSDH from six medical centers and developed a fully automated dual-label framework, termed CSDH-Net, to simultaneously segment CSDH and compressed brain tissue using nnU-Net, characterize their interaction through radiomic, volumetric, topological, and intensity-based features, and provide objective recurrence prediction. Recurrence risk was modeled using LightGBM with cross-validation and externally validated in two independent centers, and model interpretability was assessed through shapley additive explanations (SHAP) analyses. The segmentation model achieved a Dice score of 0.953 in internal validation and scores of 0.875 (for CSDH) and 0.980 (for compressed brain tissue) in external testing. The recurrence prediction model yielded area under the receiver operating characteristic curves of 0.830 in training and 0.741 in external validation. At a clinically justified threshold prioritizing sensitivity, the model achieved 85% recall in the external test cohort with acceptable specificity. SHAP and feature importance analyses consistently identified gray-level dependence nonuniformity, hematoma surface area/axis length, mean curvature of compressed brain tissue, and a cross-label spatial descriptor reflecting hematoma thickness as biologically meaningful predictors across datasets. These findings demonstrate that CSDH-Net enables accurate dual-label segmentation and interpretable, imaging-based recurrence prediction across different centers, offering objective and reproducible risk stratification that may support preoperative counseling, personalized follow-up planning, and integration into routine neurosurgical workflows. This study was prospectively registered in the Chinese Clinical Trial Registry (ChiCTR2500110736).</p>","PeriodicalId":16512,"journal":{"name":"Journal of neurotrauma","volume":" ","pages":"1763-1777"},"PeriodicalIF":3.8,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147504097","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Imaging Traumatic Brain Injuries in Mice with Potassium Channel PET Tracer [¹⁸F]3F4AP.","authors":"Karla M Ramos-Torres, Amal Tiss, Kryslaine L Radomski, Alexandra Kapolis, Kazue Takahashi, Seresa McDowell, Emiri T Mandeville, Ji Hyun Park, Lauren Zhang, Yang Sun, Yu-Peng Zhou, Eng H Lo, Regina C Armstrong, Pedro Brugarolas","doi":"10.1177/08977151261438980","DOIUrl":"10.1177/08977151261438980","url":null,"abstract":"<p><p>Traumatic brain injury (TBI) can lead to secondary injuries, including axon and myelin damage, which contributes to long-term neurological deficits. The positron emission tomography (PET) tracer [¹⁸F]3F4AP, a fluorinated derivative of the U.S. Food and Drug Administration (FDA)-approved drug 4-aminopyridine, selectively binds to voltage-gated potassium (K_V) channels, offering a novel approach to assess TBI-related node of Ranvier disruption and demyelination. This study evaluated [¹⁸F]3F4AP PET in penetrating and non-penetrating TBI models. Either controlled cortical impact (CCI, penetrating) or concussive (non-penetrating) TBI models were used to induce TBI in mice. Dynamic PET imaging with [¹⁸F]3F4AP was performed at time points of 0, 3, 7, 14, and/or 28-31 days post-injury (dpi), with quantitative analyses comparing tracer uptake in injured versus control regions. Luxol fast blue staining was conducted to evaluate histological myelin loss. In the CCI model, [¹⁸F]3F4AP PET imaging demonstrated a 31% increase in tracer uptake at the injury site at 7 dpi, correlating with histological evidence of demyelination. Tracer uptake gradually declined over time, reflecting potential remyelination. The concussive TBI model showed a smaller and more diffuse increase in uptake at 7 dpi compared to CCI. [¹⁸F]3F4AP PET imaging effectively detects demyelination following TBI with a very high sensitivity to penetrating injuries. These findings highlight the potential of [¹⁸F]3F4AP as a valuable imaging biomarker for the assessment of TBI progression and/or therapeutic response. Further studies are warranted to explore its clinical applicability and comparison with other imaging modalities.</p>","PeriodicalId":16512,"journal":{"name":"Journal of neurotrauma","volume":" ","pages":"1795-1805"},"PeriodicalIF":3.8,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147627923","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}