Multimodal Patho-Connectomics of Brain Injury

The paper introduces the concept of patho-connectomics, an injury-specific connectome creation and analysis paradigm, that treats injuries as a diffuse disease pervading the whole brain network. The foundation of the “patho-connectomic” ideology of analysis is that no part of the brain can function in isolation, and abnormality in the brain network is a combination of structural and functional anomalies. Brain injuries introduce anomalies in this brain network that could affect the quality of brain tissue, break a pathway, and lead to disrupted connectivity in neural circuits. This in turn affects functionality. Thus, patho-connectomes go beyond the traditional connectome and include information of tissue quality and structural and functional connectivity, forming a comprehensive map of the brain network. Information from diffusion and functional MRI are combined to create these patho-connectomes. The creation and analysis of patho-connectomes are discussed in the case of brain tumors, that suffers from the challenges of mass effect and infiltration of the peritumoral region, which in turn affect the surgical and radiation plan, and in traumatic brain injury, where the exact injury may be difficult to determine, but the effect is diffuse manifesting in heterogenous symptoms. A network-based approach to analysis of both these forms of injury will help determine the effect of pathology on the whole brain, while incorporating recovery and plasticity. Thus, patho-connectomics with a broad network perspective on brain injuries, has the potential to cause a major paradigm shift in their research of brain injuries, facilitating subject specific analysis and paving the way for precision medicine.