Increased glymphatic system activity in patients with mild traumatic brain injury

Zhuozhi Dai; Zhiqi Yang; Zhaolin Li; Mu Li; Hongfu Sun; Zerui Zhuang; Weichao Yang; Zehuan Hu; Xiaofeng Chen; Daiying Lin; Xianheng Wu

doi:10.3389/fneur.2023.1148878

Increased glymphatic system activity in patients with mild traumatic brain injury

Front Neurol. 2023 May 12:14:1148878. doi: 10.3389/fneur.2023.1148878. eCollection 2023.

Authors

Zhuozhi Dai^#^{1

2}, Zhiqi Yang^#³, Zhaolin Li^#⁴, Mu Li^#⁵, Hongfu Sun⁶, Zerui Zhuang⁷, Weichao Yang³, Zehuan Hu¹, Xiaofeng Chen³, Daiying Lin¹, Xianheng Wu¹

Affiliations

¹ Department of Radiology, Shantou Central Hospital, Shantou, Guangdong, China.
² Department of Radiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China.
³ Department of Radiology, Meizhou People's Hospital, Meizhou, Guangdong, China.
⁴ Department of Pulmonary and Critical Care Medicine, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China.
⁵ Department of Neurosurgery, Second Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China.
⁶ School of Information Technology and Electrical Engineering, University of Queensland, Brisbane, QLD, Australia.
⁷ Department of Neurosurgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China.

^# Contributed equally.

Abstract

Purpose: This study aims to investigate the glymphatic system activity changes in patients with mild traumatic brain injury (mTBI), particularly in MRI-negative patients, using analysis along the perivascular space (ALPS) technology.

Methods: A total of 161 mTBI patients (age: 15-92 years old) and 28 healthy controls (age: 15-84 years old) were included in this retrospective study. The mTBI patients were divided into MRI-negative and MRI-positive groups. ALPS index was calculated automatically using whole-brain T1-MPRAGE imaging and diffusion tensor imaging. The Student's t and chi-squared tests were performed to compare the ALPS index, age, gender, course of disease, and Glasgow Coma Scale (GCS) score between groups. Correlations among ALPS index, age, course of disease and GCS score were computed using Spearman's correlation analysis.

Results: Increased activity of the glymphatic system was suggested in mTBI patients based on ALPS index analysis, including the MRI-negative patients. There was a significant negative correlation between the ALPS index and age. In addition, a weak positive correlation between the ALPS index and course of disease was also observed. On the contrary, there was no significant correlation between the ALPS index and sex nor between the ALPS index and GCS score.

Conclusion: Our study demonstrated that the activity level of the glymphatic system was enhanced in mTBI patients, even when their brain MRI scans were negative. These findings may provide novel insights for understanding the pathophysiology of mild TBI.

Keywords: glymphatic system; human; in vivo; magnetic resonance imaging; mild traumatic brain injury.

Grants and funding

This study was supported in part by grants from the National Natural Science Foundation of China (82101985), Natural Science Foundation of Guangdong Province (2021A1515011179), and Medical Scientific Foundation of Guangdong Province (B2021280).