Technique Helps Predict Likelihood of Migraines in Concussion Patients

February 01, 2016

Shannon entropy (SE) analysis more accurately reveals mild traumatic brain injury (mTBI) than mean fractional anisotropy (FA), more accurately reveals those patients with mTBI who will develop post-traumatic migraines (PTM), and inversely correlates with time to recovery (TTR), according to new research published online in the journal, Radiology.

Joseph Delic, M.D., of the University of Pittsburgh Medical Center, and colleagues obtained FA maps and performed neurocognitive testing in 74 patients with mTBI. Mean FA and SE were correlated with clinical variables and were used to determine the areas under the receiver operating characteristic curve (AUCs) and likelihood ratios for mTBI and development of PTM.

SE analysis of whole-brain FA histograms demonstrated outstanding diagnostic performance for distinguishing patients who have suffered a true concussive injury from control subjects and was further able to help distinguish those patients with mTBI with PTM. Lower SE also correlated with increased recovery time in patients with mTBI.

Based on information theory, SE measures the complexity of a data set. The larger the amount of information or complexity contained in a data set, the more data points that are required to characterize the data set, and the higher the SE.

“Our study results suggest that SE analysis of FA histograms may better reflect the white matter pathologic conditions underlying mTBI and postconcussive symptoms and may have a role as a diagnostic tool and prognostic biomarker in individual patients with concussion,” the authors write.

Sample histograms for, A, a control subject and, B, a patient with mild traumatic brain injury.
Figure 1. Sample histograms for, A, a control subject and, B, a patient with mild traumatic brain injury. Despite the overall similar appearance of the curves, subjective differences in the complexity of the histogram shape are seen between the patient and the control subject.
Histogram of the time to presentation for patients with mild traumatic brain injury (mTBI) shows that the majority of the patients (83 percent) presented within 2 months of injury.
Figure 2. Histogram of the time to presentation for patients with mild traumatic brain injury (mTBI) shows that the majority of the patients (83 percent) presented within 2 months of injury. The remaining nine patients with mTBI presented more than 12 weeks after the initial injury.
Graphs displaying the diagnostic performance of mean fractional anisotropy (FA) and Shannon entropy (SE).
Figure 3. Graphs displaying the diagnostic performance of mean fractional anisotropy (FA) and Shannon entropy (SE). Receiver operating characteristic curves measure the diagnostic performance of a given test based on the area underneath the curve, with large areas indicating high performance and smaller areas indicating poor performance. These graphs demonstrate that (A) mean FA performs acceptably differentiating patients with mild traumatic brain injury from control subjects, with a substantial amount of area under the curve. However, SE was an even better test to distinguish patients with mild traumatic brain injury, with a significantly greater area under the curve, indication better diagnostic performance. The difference becomes more pronounced in attempting to predict the presence of posttraumatic migraine, where, in C, mean FA performed poorly, with very little area under the curve, but SE continues to demonstrate excellent performance, with a relatively large area under the curve (D).

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