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Purpose: We have developed a helmet for trans-calvarial delivery of low-level, NIR light to the brain to assess the feasibility and effectiveness of low-level light therapy after moderate TBI. Methods: In this ongoing randomized controlled trial, we are enrolling adult subjects with in 72 hours of moderate TBI (GCS = 9-12 or GCS = 13-15 + abnormalCT). Subjects are randomized to treatment group (20 minutes of light therapy on 3 consecutive days immediately after enrollment) or control group (Sham treatment with the helmetwithout the light). All subjects undergo clinical assessments at baseline and after 2 weeks, 3 months, 6 months, and one year. Subjects also undergo MRI at baseline and after 2 weeks and 3 months. We obtain structural (T1, FLAIR, SWI, and Angiography), high-resolution DTI, resting-state functional MRI, cerebrovascular reactivity (CVR) imaging using hypercapniaBOLDMRI, and perfusion imaging using arterial spin labeling (ASL). Results: Of the 10 enrolled patients so far, 4 are still in the study while the rest were lost to follow-up. Light therapy did not lead to any adverse effects in any patient. The most common abnormalities were edema (3 subjects) and microhemorrhages (3 subjects). Angiography was normal in all subjects. There was abnormal CVR around left lentiform nucleus in one subject, with concordant abnormal perfusion in the same area. The Disability Rating Scale improved in one subject, while it did not change in any other subject. There was no change in the structural MRI findings from baseline to week 2 in any of the subjects. Conclusion: Our preliminary results, while the study population is still blinded, suggest that low-level light therapy is safe in patients with moderate traumatic brain injury. Assessment of the efficacy of low-level light therapy is pending further data collection and unblinded analysis of the data. [ABSTRACT FROM AUTHOR]

Purpose: A novel atlas-based software called Anatom-e (Anatom-e Systems, Houston TX) has a deformable anatomic template of brain structures. This atlas of white matter tracts can be aligned with the MRI data of a patient to illustrate white matter pathways and injury pattern. In this study, we describe this approach in a cohort of acute head trauma patients. Materials and Methods: In an IRB approved prospective pilot study, 4 subjects (mean age 50 - 17 yrs) with acute head trauma gave written informed consent for acquisition of MRI. The MRI (T1, Flair, DWI, and SWI) were performed on 3-T scanners (Siemens Healthcare, Germany). De-identified images were imported to Anatom-e. The MR images were manually aligned over the template of the Anatom-e in axial, coronal, sagittal planes. For all subjects, deformable anatomic template was well aligned with MRI sequence. The tractography and functional circuit options were selected from software for visualization of white matter tracts. Results: Spatial relationship of the white matter tracts systems including projection tracts (e.g. corticospinal tract), association tracts (e.g. arcuate fasciculus), and commissural tracts (e.g. corpus callosum) were easily visualized in 3D volumetric plane with Anatom-e. Various projection tracts were demonstrated collecting projections from many areas of cortex to brainstem and were also easily visualized. The trajectories of the acute fasciculus, superior and inferior longitudinal fasciculus were well demonstrated with Anatom-e software. The forceps minor, rostrum, body, & forceps major of corpus callosum were also easily appreciated. The software depicts the 3D relationship of white matter tracts and other brain structures or lesions. Conclusions: White matter tracts were easily illustrated with deformable anatomic template of Anatom-e software by using routine MRI sequences. Anatom-e can also predict the sets of signs and symptoms that can be expected from a morphologic map of the injury pattern. As such, the software can be used in the clinical settings and teaching purposes. [ABSTRACT FROM AUTHOR]