Predictive Utility of Diffusion MRI After Mild Traumatic Brain Injury in Civilian Populations: A Systematic Review
Sanne van Rhijn1, Maria Teixeira-Dias1, Nick Medford1
1Department of Neuropsychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London (all authors); Perinatal Mental Health Service, West London National Health Service Trust, London (van Rhijn).
Objective:
A considerable number of people experience persisting symptoms and functional limitations after mild traumatic brain injury (mTBI). It is unclear whether subtle white matter changes contribute to this phenomenon. In this systematic review, the authors evaluated whether microstructural white matter indices on advanced MRI are related to clinical dysfunction among patients without abnormalities on standard brain computed tomography (CT) or MRI (uncomplicated mTBI).
Methods:
A search of multiple databases was performed. Studies with individuals who experienced blast-related, sports-related, or multiple mTBIs were excluded. Diffusion tensor imaging (DTI) and susceptibility-weighted imaging (SWI) metrics and cognitive, neuropsychiatric, or functional outcome measures were extracted from each study.
Results:
Thirteen studies were selected (participants with mTBI, N=553; healthy control group, N=438). Seven DTI studies evaluated cognitive function, with five reporting significant correlations between reduced white matter integrity and deficits in attention, processing speed, and executive function at 6-12 months after injury (three studies included only individuals with uncomplicated mTBI). Four studies found significant correlations between DTI metrics and persistent postconcussive symptoms after 3-12 months (one study included only individuals with uncomplicated mTBI). Two SWI studies reported conflicting findings regarding the relationship between the presence of microbleeds and postconcussive symptoms.
Conclusions:
The results revealed that indices of microstructural white matter integrity may relate to clinical presentation 3-12 months after injury in uncomplicated mTBI. However, analysis methods and brain regions studied varied across studies. Further research is needed to identify relationships between white matter indices in specific brain regions and symptom persistence beyond 12 months.
Insights
Subtle white matter changes may explain persistent symptoms after mild traumatic brain injury (mTBI). Advanced MRI shows links between white matter integrity and cognitive deficits or postconcussive symptoms months after uncomplicated mTBI.
Area of Science:
- Neuroscience
- Radiology
- Neurology
Background:
- Persistent symptoms and functional limitations are common after mild traumatic brain injury (mTBI).
- The role of subtle white matter changes in these long-term effects remains unclear.
- This review focuses on uncomplicated mTBI, excluding blast, sports-related, or multiple injuries.
Approach:
- Systematic review of advanced MRI techniques, including Diffusion Tensor Imaging (DTI) and Susceptibility-Weighted Imaging (SWI).
- Extracted microstructural white matter indices and clinical outcomes (cognitive, neuropsychiatric, functional) from 13 studies.
- Included studies with uncomplicated mTBI patients and healthy controls, excluding specific injury types.
Key Points:
- Five of seven DTI studies found correlations between reduced white matter integrity and cognitive deficits (attention, processing speed, executive function) 6-12 months post-injury.
- Four studies linked DTI metrics to persistent postconcussive symptoms 3-12 months after injury.
- Two SWI studies showed conflicting results regarding microbleeds and symptom persistence.
Conclusions:
- Microstructural white matter integrity may correlate with clinical presentation 3-12 months after uncomplicated mTBI.
- Variability in analysis methods and brain regions studied necessitates further research.
- Future studies should investigate regional white matter indices and symptom persistence beyond 12 months.
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