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      Reduced cortical thickness with increased lifetime burden of PTSD in OEF/OIF Veterans and the impact of comorbid TBI ☆

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          Abstract

          Posttraumatic stress disorder (PTSD) and mild traumatic brain injury (mTBI) in military personnel is increasing dramatically following the OEF/OIF conflicts and is associated with alterations to brain structure. The present study examined the relationship between PTSD and cortical thickness, and its possible modification by mTBI, in a 104-subject OEF/OIF veteran cohort ranging in age from 20 to 62 years. For each participant, two T1-weighted scans were averaged to create high-resolution images for calculation of regional cortical thickness. PTSD symptoms were assessed using the Clinician Administered PTSD Scale (CAPS) and scores were derived based on the previous month's symptoms (“current”) and a Cumulative Lifetime Burden of PTSD (CLB-P) reflecting the integral of CAPS scores across the lifetime. Mild TBI was diagnosed using the Boston Assessment of TBI-Lifetime (BAT-L). Results demonstrated a clear negative relationship between current PTSD severity and thickness in both postcentral gyri and middle temporal gyri. This relationship was stronger and more extensive when considering lifetime burden (CLB-P), demonstrating the importance of looking at trauma in the context of an individual's lifetime, rather than only at their current symptoms. Finally, interactions with current PTSD only and comorbid current PTSD and mTBI were found in several regions, implying an additive effect of lifetime PTSD and mTBI on cortical thickness.

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          Combat duty in Iraq and Afghanistan, mental health problems, and barriers to care.

          Charles W Hoge, Carl A. Castro, Stephen C. Messer … (2004)
          The current combat operations in Iraq and Afghanistan have involved U.S. military personnel in major ground combat and hazardous security duty. Studies are needed to systematically assess the mental health of members of the armed services who have participated in these operations and to inform policy with regard to the optimal delivery of mental health care to returning veterans. We studied members of four U.S. combat infantry units (three Army units and one Marine Corps unit) using an anonymous survey that was administered to the subjects either before their deployment to Iraq (n=2530) or three to four months after their return from combat duty in Iraq or Afghanistan (n=3671). The outcomes included major depression, generalized anxiety, and post-traumatic stress disorder (PTSD), which were evaluated on the basis of standardized, self-administered screening instruments. Exposure to combat was significantly greater among those who were deployed to Iraq than among those deployed to Afghanistan. The percentage of study subjects whose responses met the screening criteria for major depression, generalized anxiety, or PTSD was significantly higher after duty in Iraq (15.6 to 17.1 percent) than after duty in Afghanistan (11.2 percent) or before deployment to Iraq (9.3 percent); the largest difference was in the rate of PTSD. Of those whose responses were positive for a mental disorder, only 23 to 40 percent sought mental health care. Those whose responses were positive for a mental disorder were twice as likely as those whose responses were negative to report concern about possible stigmatization and other barriers to seeking mental health care. This study provides an initial look at the mental health of members of the Army and the Marine Corps who were involved in combat operations in Iraq and Afghanistan. Our findings indicate that among the study groups there was a significant risk of mental health problems and that the subjects reported important barriers to receiving mental health services, particularly the perception of stigma among those most in need of such care. Copyright 2004 Massachusetts Medical Society
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            A hybrid approach to the skull stripping problem in MRI.

            F Ségonne, A M Dale, E. Busa … (2004)
            We present a novel skull-stripping algorithm based on a hybrid approach that combines watershed algorithms and deformable surface models. Our method takes advantage of the robustness of the former as well as the surface information available to the latter. The algorithm first localizes a single white matter voxel in a T1-weighted MRI image, and uses it to create a global minimum in the white matter before applying a watershed algorithm with a preflooding height. The watershed algorithm builds an initial estimate of the brain volume based on the three-dimensional connectivity of the white matter. This first step is robust, and performs well in the presence of intensity nonuniformities and noise, but may erode parts of the cortex that abut bright nonbrain structures such as the eye sockets, or may remove parts of the cerebellum. To correct these inaccuracies, a surface deformation process fits a smooth surface to the masked volume, allowing the incorporation of geometric constraints into the skull-stripping procedure. A statistical atlas, generated from a set of accurately segmented brains, is used to validate and potentially correct the segmentation, and the MRI intensity values are locally re-estimated at the boundary of the brain. Finally, a high-resolution surface deformation is performed that accurately matches the outer boundary of the brain, resulting in a robust and automated procedure. Studies by our group and others outperform other publicly available skull-stripping tools. Copyright 2004 Elsevier Inc.
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              Automated manifold surgery: constructing geometrically accurate and topologically correct models of the human cerebral cortex.

              B Fischl, A. Liu, A.M. Dale (2001)
              Highly accurate surface models of the cerebral cortex are becoming increasingly important as tools in the investigation of the functional organization of the human brain. The construction of such models is difficult using current neuroimaging technology due to the high degree of cortical folding. Even single voxel misclassifications can result in erroneous connections being created between adjacent banks of a sulcus, resulting in a topologically inaccurate model. These topological defects cause the cortical model to no longer be homeomorphic to a sheet, preventing the accurate inflation, flattening, or spherical morphing of the reconstructed cortex. Surface deformation techniques can guarantee the topological correctness of a model, but are time-consuming and may result in geometrically inaccurate models. In order to address this need we have developed a technique for taking a model of the cortex, detecting and fixing the topological defects while leaving that majority of the model intact, resulting in a surface that is both geometrically accurate and topologically correct.
              Article 0 comments Cited 519 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                William P. Milberg
                Journal
                Journal ID (nlm-ta): Neuroimage (Amst)
                Journal ID (iso-abbrev): Neuroimage (Amst)
                Title: NeuroImage : Clinical
                Publisher: Elsevier
                ISSN (Electronic): 2213-1582
                Publication date PMC-release: 22 April 2013
                Publication date (Electronic): 22 April 2013
                Publication date Collection: 2013
                Volume: 2
                Pages: 601-611
                Affiliations
                [a ]Translational Research Center for TBI and Stress Disorders (TRACTS), VA Boston Healthcare System, USA
                [b ]A. A. Martinos Center for Biomedical Imaging, Boston, MA, USA
                [c ]Department of Psychiatry, Harvard Medical School, Boston, MA, USA
                [d ]Division of Aging, Brigham and Women's Hospital, Boston, MA, USA
                Author notes
                [* ]Corresponding author at: TRACTS/GRECC (182), VA Boston Healthcare System, 150 S. Huntington Ave., Boston, MA 02130, USA. Tel.: + 1 857 364 2946. William_milberg@ 123456hms.harvard.edu
                Article
                Publisher ID: S2213-1582(13)00048-X
                DOI: 10.1016/j.nicl.2013.04.009
                PMC ID: 3777819
                PubMed ID: 24179811
                SO-VID: e14f45ba-bf82-4cc5-a36d-a15985a0366d
                Copyright © © 2013 The Authors
                License:

                This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike License, which permits non-commercial use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                Date received : 7 January 2013
                Date revision received : 7 April 2013
                Date accepted : 8 April 2013
                Categories
                Subject: Article

                Keywords: posttraumatic stress disorder,mild traumatic brain injury,cortical thickness,whole-brain analysis,neuroimaging,comorbidity
                Data availability:
                Keywords: posttraumatic stress disorder, mild traumatic brain injury, cortical thickness, whole-brain analysis, neuroimaging, comorbidity

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