Abstract
Purpose: To determine and characterize the radiomics features from structural MRI (MPRAGE) and Diffusion Tensor Imaging (DTI) associated with the presence of mild traumatic brain injuries on student athletes with post-concussive syndrome (PCS).Material and Methods: 122 student athletes (65 M, 57 F), median (IQR) age 18.8 (15–20) years, with a mixed level of play and sports activities, with a known history of concussion and clinical PCS, and 27 (15 M, 12 F), median (IQR) age 20 (19, 21) years, concussion free athlete subjects were MRI imaged in a clinical MR machine. MPRAGE and DTI-FA and DTI-ADC images were used to extract radiomic features from white and gray matter regions within the entire brain (2 ROI) and the eight main lobes of the brain (16 ROI) for a total of 18 analyzed regions. Radiomic features were divided into five different data sets used to train and cross-validate five different filter-based Support Vector Machines. The top selected features of the top model were described. Furthermore, the test predictions of the top four models were ensembled into a single average prediction. The average prediction was evaluated for the association to the number of concussions and time from injury.Results: Ninety-one PCS subjects passed inclusion criteria (91 Cases, 27 controls). The average prediction of the top four models had a sensitivity of 0.80, 95% CI: [0.71, 0.88] and specificity of 0.74 95%CI [0.54, 0.89] for distinguishing subjects from controls. The white matter features were strongly associated with mTBI, while the whole-brain analysis of gray matter showed the worst association. The predictive index was significantly associated with the number of concussions (p < 0.0001) and associated with the time from injury (p < 0.01).Conclusion: MRI Radiomic features are associated with a history of mTBI and they were successfully used to build a predictive machine learning model for mTBI for subjects with PCS associated with a history of one or more concussions.
Highlights
Mild traumatic brain injuries or “Concussion” with Glascow Coma Scale scores of 13 or greater result in transient alterations in brain function with or without loss of consciousness [1]
Unlike other approaches that focused on single tissue properties in their feature selection process [12, 13, 29, 32], or have used only structural MPRAGE features on Mild traumatic brain injuries (mTBI) patients [33], we reported the comprehensive exploration of features from diffusion tensor imaging (DTI)-fractional anisotropy mapping from DTI sequences (FA), DTI-apparent diffusion coefficient from DTI sequences (ADC) as well as MPRAGE and their derived local fractal dimensions map, and wavelet transforms
Future work must include direct comparisons to blood biomarkers and premorbid Behavioral Health conditions and their combination in a multimodal setting. This proof of principle study showed that MRI radiomic features from both diffusion and MPRAGE images were different in post-concussion syndrome (PCS) subjects from trauma-free controls
Summary
Mild traumatic brain injuries (mTBI) or “Concussion” with Glascow Coma Scale scores of 13 or greater result in transient alterations in brain function with or without loss of consciousness [1]. The recovery time of sports-related concussion (SRC) for adolescents takes 3–4 weeks, longer than the commonly reported 7–14 days for adults [7, 8]. Routine clinical MRI studies do not show abnormalities in most SRC and PCS patients, diffusion-weighted (DWI) and diffusion tensor imaging (DTI) have shown variable localized, diffuse, and widespread changes after mild injury [9, 10]. Results from longitudinal studies have shown that the diffusivity changes lasted (“past symptom resolution”) beyond the point when athletes were asymptomatic and were medically cleared to return to play, with abnormal diffusion parameters lasting several months to over a year after the injury [10]
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