Modeling Progressive Brain Volume Losses in Chronic Moderate Severe Traumatic Brain Injury: Extensive, but Attenuating.
7 affiliations
- 1KITE Research Institute, University Health Network, Toronto, Ontario, Canada.
- 2Department of Psychiatry, Temerty Faculty of Medicine, Toronto, Ontario, Canada.
- 3RCSI University of Medicine and Health Sciences, Dublin, Ireland.
- 4Department of Medical Imaging, Temerty Faculty of Medicine, Toronto, Canada.
- 5Toronto Western Hospital, University Health Network, Toronto, Canada.
- 6York University, Department of Psychology, Toronto, Canada.
- 7York University, Department of Mathematics and Stastistics, Toronto, Canada.
Abstract
Objective
Progressive brain atrophy has now been widely observed in the chronic stages of moderate-severe traumatic brain injury (msTBI), but there is only coarse information regarding its prevalence and magnitude, and whether rate of atrophy accelerates or attenuates across time. We examined these questions in a Canadian inception cohort from the Toronto Rehab TBI Recovery Study.Methods
N = 123 patients with post-traumatic amnesia ranging from > 1 h to 10 weeks (70%, > 7 days) were administered up to three MRIs at approximately 5 months, 1 year, and 3 years post-injury. N = 32 healthy controls were scanned up to two times on average 14 months apart. Ventricle-to-brain ratio (VBR) was calculated and manual segmentation of the hippocampi (HPC), corpus callosum (CC), and substructures was employed. For each region, annualized rates of progressive atrophy were modeled from approximately 5 months to 1 year and 1 to 3 years post-TBI; proportions of patients with annualized volume losses of 2.5%-5%, 5%-10%, and > 10% were estimated.Results
Mixed-effects longitudinal models estimated robust progressive atrophy in both time windows in all regions compared to controls, but with significant attenuation across windows. In the earlier window, > 10% annualized loss was estimated in 76.2% of patients for VBR, 53.2% for CC, and 25.0% for HPC bilaterally. In the later window, at least 5%-10% annualized loss was estimated in 63.3% of patients for VBR, 49.4% for CC, and 17.7% for right HPC; for left HPC, 6.3% of patients showed at least 2.5%-5% annualized decline.Interpretation
Clinically concerning prevalence and degree of progressive volume losses were observed in the chronic stages of msTBI, with tapering of losses across time, and regional variations. Research is needed to understand and mitigate clinical impact of these declines.
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BibTeX
@article{green2026modeling,
title = {{Modeling Progressive Brain Volume Losses in Chronic Moderate Severe Traumatic Brain Injury: Extensive, but Attenuating.}},
author = {Robin E A Green and Brenda Colella and Alana Changoor and David J Mikulis and Adrienne Li and Kadeen Johns and Georges A Monette},
journal = {Annals of clinical and translational neurology},
year = {2026},
month = oct,
doi = {10.1002/acn3.70514},
url = {https://europepmc.org/article/MED/42897842},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Modeling Progressive Brain Volume Losses in Chronic Moderate Severe Traumatic Brain Injury: Extensive, but Attenuating.
AU - Robin E A Green
AU - Brenda Colella
AU - Alana Changoor
AU - David J Mikulis
AU - Adrienne Li
AU - Kadeen Johns
AU - Georges A Monette
PY - 2026
DA - 2026/10/19
JO - Annals of clinical and translational neurology
DO - 10.1002/acn3.70514
UR - https://europepmc.org/article/MED/42897842
AB - Objective Progressive brain atrophy has now been widely observed in the chronic stages of moderate-severe traumatic brain injury (msTBI), but there is only coarse information regarding its prevalence and magnitude, and whether rate of atrophy accelerates or attenuates across time. We examined these questions in a Canadian inception cohort from the Toronto Rehab TBI Recovery Study.Methods N = 123 patients with post-traumatic amnesia ranging from > 1 h to 10 weeks (70%, > 7 days) were administered up to three MRIs at approximately 5 months, 1 year, and 3 years post-injury. N = 32 healthy controls were scanned up to two times on average 14 months apart. Ventricle-to-brain ratio (VBR) was calculated and manual segmentation of the hippocampi (HPC), corpus callosum (CC), and substructures was employed. For each region, annualized rates of progressive atrophy were modeled from approximately 5 months to 1 year and 1 to 3 years post-TBI; proportions of patients with annualized volume losses of 2.5%-5%, 5%-10%, and > 10% were estimated.Results Mixed-effects longitudinal models estimated robust progressive atrophy in both time windows in all regions compared to controls, but with significant attenuation across windows. In the earlier window, > 10% annualized loss was estimated in 76.2% of patients for VBR, 53.2% for CC, and 25.0% for HPC bilaterally. In the later window, at least 5%-10% annualized loss was estimated in 63.3% of patients for VBR, 49.4% for CC, and 17.7% for right HPC; for left HPC, 6.3% of patients showed at least 2.5%-5% annualized decline.Interpretation Clinically concerning prevalence and degree of progressive volume losses were observed in the chronic stages of msTBI, with tapering of losses across time, and regional variations. Research is needed to understand and mitigate clinical impact of these declines.
SN - 2328-9503
ER -