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Susceptibility-Weighted MRI and Microbleeds in Mild Traumatic Brain Injury: Prediction of Posttraumatic Complaints?
Gerard Hageman1, Jurrit Hof2, Jik Nihom1
1Department of Neurology, Medical Spectrum Twente, Hospital Enschede, Enschede, The Netherlands.
Background:
Only in 7-15% of patients with mild traumatic brain injury (mTBI), traumatic CT-abnormalities are found. Nevertheless, 40% of mTBI patients suffer from posttraumatic complaints not resolving after 6 months. We discuss the ability of susceptibility-weighted imaging (SWI), sensitive for microbleeds, to detect more subtle brain abnormalities.
Summary:
After a search on PubMed, we selected 15 studies on SWI in adult mTBI patients; 11 studies on 3T MRI, and 4 studies on 1.5T MRI. All 1.5T studies showed that, compared to T2, gradient echo, diffusion-weighted imaging, or fluid-attenuated inversion recovery sequences, SWI is more sensitive for microbleeds. Only two 1.5T studies described the association between SWI findings and outcome. In 3 of the 4 studies, no control group was present. The mean number of microbleeds varied from 3.2 to 6.4 per patient. In the 3T studies, the percentage of patients with traumatic microbleeds varied from 5.7 to 28.8%, compared to 0-13.3% in normal controls. Microbleeds were particularly located subcortical or juxtacortical. The number of microbleeds in mTBI varied from 1 to 10 per patient. mTBI patients with microbleeds appeared to have higher symptom severity at 12 months and perform worse on tests of psychomotor speed and speed of information processing after 3 and 12 months, compared to mTBI patients without microbleeds.
Key Messages:
There is some evidence that traumatic microbleeds predict cognitive outcome and persistent posttraumatic complaints in patients with mTBI.
Insights
Susceptibility-weighted imaging (SWI) detects microbleeds in mild traumatic brain injury (mTBI) patients, which are linked to persistent symptoms and cognitive deficits. This advanced MRI technique offers greater sensitivity for subtle brain abnormalities.
Area of Science:
- Neuroimaging
- Radiology
- Neurology
Background:
- Mild traumatic brain injury (mTBI) often presents with normal CT scans, yet many patients experience persistent posttraumatic complaints.
- Standard imaging lacks sensitivity for subtle abnormalities in mTBI.
- Susceptibility-weighted imaging (SWI) is a sensitive MRI technique for detecting microbleeds.
Purpose of the Study:
- To review the utility of SWI in detecting microbleeds in adult mTBI patients.
- To explore the association between SWI findings and patient outcomes.
Main Methods:
- Systematic literature search on PubMed for studies using SWI in adult mTBI.
- Analysis of 15 studies, comparing 3T and 1.5T MRI systems.
- Evaluation of SWI sensitivity for microbleeds compared to other MRI sequences.
Main Results:
- SWI demonstrated higher sensitivity for microbleeds compared to other MRI sequences across multiple studies.
- Traumatic microbleeds were frequently observed in mTBI patients, particularly in subcortical and juxtacortical regions.
- mTBI patients with microbleeds showed increased symptom severity and poorer cognitive performance at 12 months post-injury.
Conclusions:
- SWI is a valuable tool for detecting subtle traumatic microbleeds in mTBI.
- The presence of microbleeds on SWI may predict cognitive outcomes and persistent posttraumatic complaints in mTBI patients.
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