Detection of Pathologic Changes Following Traumatic Brain Injury Using Magnetic Resonance Imaging

Background: Approximately two percent of Finns have sequels after traumatic brain injury (TBI), and many TBI patients are young or middle-aged. The high rate of unemployment after TBI has major economic consequences for society, and traumatic brain injury often has remarkable personal consequences, as well. Structural imaging is often needed to support the clinical TBI diagnosis. Accurate early diagnosis is essential for successful rehabilition and, thus, may also influence the patient’s outcome. Traumatic axonal injury and cortical contusions constitute the majority of traumatic brain lesions. Several studies have shown magnetic resonance imaging (MRI) to be superior to computed tomography (CT) in the detection of these lesions. However, traumatic brain injury often leads to persistent symptoms even in cases with few or no findings in conventional MRI. Aims and methods: The aim of this prospective study was to clarify the role of conventional MRI in the imaging of traumatic brain injury, and to investigate how to improve the radiologic diagnostics of TBI by using more modern diffusion-weighted imaging (DWI) and diffusion tensor imaging (DTI) techniques. We estimated, in a longitudinal study, the visibility of the contusions and other intraparenchymal lesions in conventional MRI at one week and one year after TBI. We used DWI-based measurements to look for changes in the diffusivity of the normal-appearing brain in a case-control study. DTI-based tractography was used in a case-control study to evaluate changes in the volume, diffusivity, and anisotropy of the long association tracts in symptomatic TBI patients with no visible signs of intracranial or intraparenchymal abnormalities on routine MRI. We further studied the reproducibility of different tools to identify and measure white-matter tracts by using a DTI sequence suitable for clinical protocols. Results: Both the number and extent of visible traumatic lesions on conventional MRI diminished significantly with time. Slightly increased diffusion in the normal-appearing brain was a common finding at one week after TBI, but it was not significantly associated with the injury severity. Fractional anisotropy values, that represent the integrity of the white-matter tracts, were significantly diminished in several tracts in TBI patients compared to the control subjects. Compared to the cross-sectional ROI method, the tract-based analyses had better reproducibility to identify and measure white-matter tracts of interest by means of DTI tractography. Conclusions: As conventional MRI is still applied in clinical practice, it should be carried out soon after the injury, at least in symptomatic patients with negative CT scan. DWI-related brain diffusivity measurements may be used to improve the documenting of TBI. DTI tractography can be used to improve radiologic diagnostics in a symptomatic TBI sub-population with no findings on conventional MRI. Reproducibility of different tools to quantify fibre tracts vary considerably, which should be taken into consideration in the clinical DTI applications.

Effects of Obesity and Weight Loss Following Bariatric Surgery on Brain Function, Structural Integrity and Metabolism

Obesity is one of the key challenges to health care system worldwide and its prevalence is estimated to rise to pandemic proportions. Numerous adverse health effects follow with increasing body weight, including increased risk of hypertension, diabetes, hypercholesterolemia, musculoskeletal pain and cancer. Current evidence suggests that obesity is associated with altered cerebral reward circuit functioning and decreased inhibitory control over appetitive food cues. Furthermore, obesity causes adverse shifts in metabolism and loss of structural integrity within the brain. Prior cross-sectional studies do not allow delineating which of these cerebral changes are recoverable after weight loss. We compared morbidly obese subjects with healthy controls to unravel brain changes associated with obesity. Bariatric surgery was used as an intervention to study which cerebral changes are recoverable after weight loss. In Study I we employed functional magnetic resonance imaging (fMRI) to detect the brain basis of volitional appetite control and its alterations in obesity. In Studies II-III we used diffusion tensor imaging (DTI) and voxel-based morphometry (VBM) to quantify the effects of obesity and the effects of weight loss on structural integrity of the brain. In study IV we used positron emission tomography (PET) with [18F]-FDG in fasting state and during euglycemic hyperinsulinemia to quantify effects of obesity and weight loss on brain glucose uptake. The fMRI experiment revealed that a fronto-parietal network is involved in volitional appetite control. Obese subjects had lower medial frontal and dorsal striatal brain activity during cognitive appetite control and increased functional connectivity within the appetite control circuit. Obese subjects had initially lower grey matter and white matter densities than healthy controls in VBM analysis and loss of integrity in white matter tracts as measured by DTI. They also had initially elevated glucose metabolism under insulin stimulation but not in fasting state. After the weight loss following bariatric surgery, obese individuals’ brain volumes recovered and the insulin-induced increase in glucose metabolism was attenuated. In conclusion, obesity is associated with altered brain function, coupled with loss of structural integrity and elevated glucose metabolism, which are likely signs of adverse health effects to the brain. These changes are reversed by weight loss after bariatric surgery, implicating that weight loss has a causal role on these adverse cerebral changes. Altogether these findings suggest that weight loss also promotes brain health.Key words: brain, obesity, bariatric surgery, appetite control, structural magnetic resonance

The tree we heard fall : analyzing the societal processes following focusing events

Fokuserande händelser är plötsliga, ovanliga och för med sig negativa konsekvenser för ett stort antal människor. Det handlar om det vi i vardagligt tal kallar kriser och katastrofer. En intensiv medierapportering i kombination med oroade medborgare gör att kriser och katastrofer är viktiga samhällspåfrestningar som beslutsfattare måste hantera. Syftet med avhandlingen är att öka förståelsen för hur fokuserande händelser påverkar samhälleliga processer. Avhandlingens två övergripande forskningsfrågor tar fasta på jämförelsen av olika typer av fokuserande händelser. För det första, skillnader i hur naturkatastrofer och katastrofer som tillkommit genom mänskligt handlade påverkar samhället, och för det andra, hur händelser med olika stark fokuseringskraft påverkar samhället. Medborgarreaktioner studeras i en experimentell laboratoriestudie, den mediala rapporteringen analyseras genom kvantitativ innehållsanalys av texter och bilder, och på den parlamentariska arenan analyseras riksdagsdebatten genom kvantitativ innehållsanalys. De temaområden som identifieras i den teoretiska referensramen ligger till grund för analysen och tar fasta på de känslor som händelsen ger upphov till, hur händelsen kontextualiseras (framing), skuldbeläggning samt möjliga lösningar som förs fram. Resultatet från studierna visar att skillnader mellan olika typer av händelser syns tydligast hos medborgare, uttryckt genom starkare emotionella reaktioner för händelser med stark fokusering, och på den mediala arenan, genom mer utrymme för dessa händelser. Då kriser och katastrofer med olika stark fokuseringskraft når riksdagen får de däremot ett relativt likadant mottagande. I jämförelsen mellan naturkatastrofer och människoskapade händelser visar resultaten att naturkatastrofer ofta diskuteras som specifika händelser, medan människoskapade händelser placeras i en bredare samhällelig kontext och diskuteras under längre tid. Avhandlingen bidrar till diskussionen om hur våra känslor och vår kognition samspelar i krissituationer. De omedvetna signaler som vår kropp ger oss gällande hur vi ska reagera på en farlig situation kan påverka om vi är rädda, oroliga eller till och med positivt inställda. I ljuset av de tre studierna är det tydligt att de emotionella reaktionerna minskar ju högre upp i den politiska processen vi kommer. Trots att medborgare och medier reagerar starkt är de emotionella reaktionerna på den politiska arenan relativt milda och skuldbeläggningen näst intill icke-existerande.