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Toril Skandsen

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YNICL Journal 2026 Journal Article

Changes in brain morphology over the first year in adult mixed-mechanism mild traumatic brain injury: the role of injury severity factors

  • Jonas Stenberg
  • Gerard Janez Brett Clarke
  • Hallvard Røe Evensmoen
  • Anne Vik
  • Toril Skandsen
  • Asta Kristine Håberg

OBJECTIVE: Assess changes in brain morphology after mild traumatic brain injury (mTBI). METHODS: In the community-based Trondheim mTBI study, 194 patients with mixed-mechanism mTBI (age 32.5y, 63.4% men) were scanned with 3T brain MRI within 72 h, at 3- and 12 months post-injury. Eighty-three age-, sex-, and education-matched community controls were scanned at the same intervals. MRIs were analyzed using the longitudinal FreeSurfer-pipeline. Linear mixed models were conducted to assess changes in cortical thickness and area and subcortical volumes over time, with gray matter/white matter (GM/WM) intensity ratio - reflecting changes in underlaying tissue contrast - as a covariate. Sub-group analyses were performed in patients with: complicated mTBI (intracranial traumatic lesions on MRI) vs. uncomplicated mTBI; loss of consciousness (LOC) vs. no LOC; Glasgow Coma Scale score 13-14 vs 15; post-traumatic amnesia duration 1-24 h vs < 1 h. RESULTS: Patients with mTBI had larger ventricular volumes compared to controls at all timepoints and significant ventricular dilation over 12 months. The ventricular dilation was most pronounced in complicated mTBI. Additionally, patients with complicated mTBI showed a decrease in cortical area, cerebral white matter, thalamic and hippocampal volumes over time. Cortical thickness remained stable over the 12 months when GM/WM intensity ratio was adjusted for. CONCLUSION: Increased ventricular volume during the first year following the injury characterized mTBI. Greater ventricular dilation and decreases in cortical area and subcortical volumes were present in complicated mTBI. Changes in GM/WM intensity ratio affected cortical measures and should, together with injury severity factors, be accounted for in future studies.

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YNICL Journal 2014 Journal Article

Prospective longitudinal MRI study of brain volumes and diffusion changes during the first year after moderate to severe traumatic brain injury

  • Veronika Brezova
  • Kent Gøran Moen
  • Toril Skandsen
  • Anne Vik
  • James B. Brewer
  • Øyvind Salvesen
  • Asta K. Håberg

The objectives of this prospective study in 62 moderate-severe TBI patients were to investigate volume change in cortical gray matter (GM), hippocampus, lenticular nucleus, lobar white matter (WM), brainstem and ventricles using a within subject design and repeated MRI in the early phase (1-26 days) and 3 and 12 months postinjury and to assess changes in GM apparent diffusion coefficient (ADC) in normal appearing tissue in the cortex, hippocampus and brainstem. The impact of Glasgow Coma Scale (GCS) score at admission, duration of post-traumatic amnesia (PTA), and diffusion axonal injury (DAI) grade on brain volumes and ADC values over time was assessed. Lastly, we determined if MRI-derived brain volumes from the 3-month scans provided additional, significant predictive value to 12-month outcome classified with the Glasgow Outcome Scale-Extended after adjusting for GCS, PTA and age. Cortical GM loss was rapid, largely finished by 3 months, but the volume reduction was unrelated to GCS score, PTA, or presence of DAI. However, cortical GM volume at 3 months was a significant independent predictor of 12-month outcome. Volume loss in the hippocampus and lenticular nucleus was protracted and statistically significant first at 12 months. Slopes of volume reduction over time for the cortical and subcortical GGM were significantly different. Hippocampal volume loss was most pronounced and rapid in individuals with PTA > 2 weeks. The 3-month volumes of the hippocampus and lentiform nucleus were the best independent predictors of 12-month outcome after adjusting for GCS, PTA and age. In the brainstem, volume loss was significant at both 3 and 12 months. Brainstem volume reduction was associated with lower GCS score and the presence of DAI. Lobar WM volume was significantly decreased first after 12 months. Surprisingly DAI grade had no impact on lobar WM volume. Ventricular dilation developed predominantly during the first 3 months, and was strongly associated with volume changes in the brainstem and cortical GM, but not lobar WM volume. Higher ADC values were detected in the cortex in individuals with severe TBI, DAI and PTA > 2 weeks, from 3 months. There were no associations between ADC values and brain volumes, and ADC values did not predict outcome.

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