Abnormalities in cardiac-induced brain tissue deformations are now detectable with MRI: A case-report of a patient who underwent craniotomy after trauma

Background: Heartbeat and respiration induce cyclic brain tissue deformations, which receive increasing attention as potential driving force for brain clearance. These deformations can now be assessed using a novel 3D strain tensor imaging (STI) method at 7 T MRI. Methods: An 18-year-old man had suffered a traumatic brain injury and was treated with a craniotomy with a maximal diameter of 12 cm. STI was employed to capture cardiac-induced brain tissue deformations and additional time-resolved 2D flow measurements were acquired to capture cerebrospinal fluid (CSF) flow towards the spinal canal. Results: The craniotomy caused major changes in all aspects of the brain's mechanical dynamics as compared to healthy volunteer references. Tissue strains increased, particularly around the craniotomy, and directionality of deformations showed large abnormalities, also in the contralateral hemisphere. As the brain tissue could pulsate outward from the skull, physiological pulsatile CSF flow at the foramen magnum was abolished. Conclusions: This work illustrates how STI can assess physiological patterns of brain tissue deformation and how craniotomy leads to widespread deformation abnormalities that can be detected at a single patient level. While this case is meant to provide proof of concept, application of STI in other conditions of abnormal brain mechanical dynamics warrants further study.