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However, reliable biomarkers for identifying individuals at risk for these long\u2010term outcomes remain limited. In this study, we evaluated in\u00a0vivo positron emission tomography (PET) imaging of the 18\u2010kDa translocator protein (TSPO) as a predictive biomarker of epileptogenesis and neurobehavioral dysfunction in a rat model of moderate\u2013severe TBI.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      Adult rats received lateral fluid percussion injury (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200961) or sham surgery (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200914). TSPO PET was performed using [\n                      <jats:sup>18<\/jats:sup>\n                      F]\u2010PBR06 at 1 and 4\u2009weeks postinjury. Long\u2010term behavioral outcomes were assessed at 5\u20136\u2009months post\u2010TBI, followed by continuous 4\u2010week video\u2010electroencephalographic monitoring during 7\n                      <jats:sup>th<\/jats:sup>\n                      month to identify epileptic rats.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      TBI rats demonstrated robust and sustained increases in TSPO binding across multiple brain regions at both time points compared with sham animals (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u2009.001). At 4\u2009weeks postinjury, however, TSPO binding in the cortex, hippocampus, and thalamus was significantly lower in rats that later developed epilepsy (PTE\n                      <jats:sup>+<\/jats:sup>\n                      ) than in those that did not (PTE\n                      <jats:sup>\u2212<\/jats:sup>\n                      ;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u2009.05), with receiver operating characteristic (ROC) analysis showing good predictive performance (area under the curve [AUC]\u2009=\u2009.76,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u2009.01). Behavioral testing identified deficits in spatial learning, memory, and open\u2010field activity in TBI rats (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u2009.05). Data\u2010driven stratification identified behaviorally impaired (TBI\u2010BI\n                      <jats:sup>+<\/jats:sup>\n                      ) and unimpaired (TBI\u2010BI\n                      <jats:sup>\u2212<\/jats:sup>\n                      ) subgroups, with cortical TSPO moderately distinguishing impaired animals (AUC\u2009\u2248\u2009.7). Among impaired rats, those with multidomain behavioral deficits (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200933) showed elevated thalamic TSPO compared to those with a single impairment (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u2009.032), with ROC analysis confirming discrimination (AUC\u2009=\u2009.72,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u2009.018).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Significance<\/jats:title>\n                    <jats:p>Our findings support TSPO PET imaging as a promising early biomarker for predicting PTE and neurobehavioral outcomes following TBI.<\/jats:p>\n                  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