Potential of heart fatty-acid binding protein, neurofilament light, interleukin-10 and S100 calcium-binding protein B in the acute diagnostics and severity assessment of traumatic brain injury.

BACKGROUND: There is substantial interest in blood biomarkers as fast and objective diagnostic tools for traumatic brain injury (TBI) in the acute setting. METHODS: Adult patients (≥18) with TBI of any severity and indications for CT scanning and orthopaedic injury controls were prospectively recruited during 2011-2013 at Turku University Hospital, Finland. The severity of TBI was classified with GCS: GCS 13-15 was classified as mild (mTBI); GCS 9-12 as moderate (moTBI) and GCS 3-8 as severe (sTBI). Serum samples were collected within 24 hours of admission and biomarker levels analysed with high-performance kits. The ability of biomarkers to distinguish between severity of TBI and CT-positive and CT-negative patients was assessed. RESULTS: Among 189 patients recruited, neurofilament light (NF-L) was obtained from 175 patients with TBI and 40 controls. S100 calcium-binding protein B (S100B), heart fatty-acid binding protein (H-FABP) and interleukin-10 (IL-10) were analysed for 184 patients with TBI and 39 controls. There were statistically significant differences between levels of all biomarkers between the severity classes, but none of the biomarkers distinguished patients with moTBI from patients with sTBI. Patients with mTBI discharged from the ED had lower levels of IL-10 (0.26, IQR=0.21, 0.39 pg/mL), H-FABP (4.15, IQR=2.72, 5.83 ng/mL) and NF-L (8.6, IQR=6.35, 15.98 pg/mL) compared with those admitted to the neurosurgical ward, IL-10 (0.55, IQR=0.31, 1.42 pg/mL), H-FABP (6.022, IQR=4.19, 20.72 ng/mL) and NF-L (13.95, IQR=8.33, 19.93 pg/mL). We observed higher levels of H-FABP and NF-L in older patients with mTBI. None of the biomarkers or their combinations was able to distinguish CT-positive (n=36) or CT-negative (n=58) patients with mTBI from controls. CONCLUSIONS: S100B, H-FABP, NF-L and IL-10 levels in patients with mTBI were significantly lower than in patients with moTBI and sTBI but alone or in combination, were unable to distinguish patients with mTBI from orthopaedic controls. This suggests these biomarkers cannot be used alone to diagnose mTBI in trauma patients in the acute setting.

Potential heating caused by intraparenchymal intracranial pressure transducers in a 3-tesla magnetic resonance imaging system using a body radiofrequency resonator: assessment of the Codman MicroSensor Transducer.

Magnetic resonance imaging and spectroscopy may provide important clinical information in the acute stages of brain injury. For this to occur it must be ensured that intracranial pressure (ICP) monitoring devices are safe to bring into the MR imaging suite. The authors tested a Codman MicroSensor ICP Transducer (Codman & Shurtleff, Inc.) within a 3-T MR imaging system using the transmit body coil and receive-only coils and the transmit-and-receive head coil. Extreme and rapid heating of 64 degrees C was noted with the transducer wire in certain positions when using the transmit body coil and receive-only head coil. This is consistent with the phenomenon of resonance, and the probe was shown to have a distinct resonant response when coupled to HP 4195A Network Analyzer (Hewlett Packard). Coiling some of the transducer wire outside of the receive-only head coil reduced the generated current and so stopped the thermogenesis. This may be due to the introduction of a radiofrequency choke. The ICP transducer performed within clinically acceptable limits in both the static magnetic field and during imaging with high radiofrequency power when the excess wire was in this configuration. No heating was observed when a transmit-and-receive head coil was used. This study has shown when using a high-field magnet, the Codman ICP probe is MR conditional. That is, in the authors' system, it can be safely used with the transmit-and-receive head coil, but when using the transmit body coil the transducer wire must be coiled into concentric loops outside of the receive-only head coil.