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Published on: August 14, 2019
Persistent MRI Findings Unique to Blast and Repetitive Mild TBI: Analysis of the CENC/LIMBIC Cohort Injury
David F Tate1,2,3, Benjamin S C Wade1,4, Carmen S Velez1,2
1Department of Neurology, Traumatic Brain Injury and Concussion Center, University of Utah, Salt Lake City, UT 84132, USA.
Introduction:
MRI represents one of the clinical tools at the forefront of research efforts aimed at identifying diagnostic and prognostic biomarkers following traumatic brain injury (TBI). Both volumetric and diffusion MRI findings in mild TBI (mTBI) are mixed, making the findings difficult to interpret. As such, additional research is needed to continue to elucidate the relationship between the clinical features of mTBI and quantitative MRI measurements.
Material And Methods:
Volumetric and diffusion imaging data in a sample of 976 veterans and service members from the Chronic Effects of Neurotrauma Consortium and now the Long-Term Impact of Military-Relevant Brain Injury Consortium observational study of the late effects of mTBI in combat with and without a history of mTBI were examined. A series of regression models with link functions appropriate for the model outcome were used to evaluate the relationships among imaging measures and clinical features of mTBI. Each model included acquisition site, participant sex, and age as covariates. Separate regression models were fit for each region of interest where said region was a predictor.
Results:
After controlling for multiple comparisons, no significant main effect was noted for comparisons between veterans and service members with and without a history of mTBI. However, blast-related mTBI were associated with volumetric reductions of several subregions of the corpus callosum compared to non-blast-related mTBI. Several volumetric (i.e., hippocampal subfields, etc.) and diffusion (i.e., corona radiata, superior longitudinal fasciculus, etc.) MRI findings were noted to be associated with an increased number of repetitive mTBIs versus.
Conclusions:
In deployment-related mTBI, significant findings in this cohort were only observed when considering mTBI sub-groups (blast mechanism and total number/dose). Simply comparing healthy controls and those with a positive mTBI history is likely an oversimplification that may lead to non-significant findings, even in consortium analyses.
Insights
Comparing traumatic brain injury (TBI) history alone is insufficient. Blast-related mild TBI (mTBI) and repetitive injuries show specific MRI changes, highlighting the need for subgroup analysis in veterans.
Area of Science:
- Neuroimaging
- Traumatic Brain Injury Research
- Military Health
Background:
- Magnetic Resonance Imaging (MRI) is crucial for identifying biomarkers in traumatic brain injury (TBI).
- Interpreting volumetric and diffusion MRI findings in mild TBI (mTBI) remains challenging.
- Further research is needed to link mTBI clinical features with quantitative MRI measurements.
Purpose of the Study:
- To investigate the relationship between clinical features of mild TBI (mTBI) and quantitative MRI measurements in a large cohort of veterans.
- To explore differences in MRI findings between individuals with and without a history of mTBI.
- To identify specific MRI biomarkers associated with different types and severities of mTBI.
Main Methods:
- Analysis of volumetric and diffusion MRI data from 976 veterans and service members.
- Utilized regression models to assess relationships between imaging measures and mTBI clinical features.
- Controlled for covariates including acquisition site, sex, and age; analyzed regions of interest separately.
Main Results:
- No significant overall differences were found between mTBI and control groups after multiple comparisons.
- Blast-related mTBI showed volumetric reductions in corpus callosum subregions compared to non-blast mTBI.
- Increased repetitive mTBIs correlated with volumetric changes in hippocampal subfields and diffusion changes in specific white matter tracts.
Conclusions:
- Subgroup analysis of mTBI (blast mechanism, cumulative dose) is essential for detecting significant findings in deployment-related injuries.
- Comparing broad mTBI history versus healthy controls may oversimplify results and lead to non-significant findings.
- The study underscores the importance of nuanced approaches in mTBI research.
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