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Five-Year Serial Brain MRI Analysis of Military Members Exposed to Chronic Sub-Concussive Overpressures
Rafael Glikstein1, Gerd Melkus1, Eduardo Portela de Oliveira1
1The Ottawa Hospital - Civic Campus, Ottawa, Ontario, Canada.
Background:
The Canadian Special Operations Forces Command conducts explosives operations and training which exposes members to explosive charges at close proximity. This 5-year longitudinal trial was conducted in follow-up to our initial trial which examined military breachers with MRI and EEG pre and post blast exposure.
Purpose:
To examine brain MRI findings in military personnel exposed to multiple repeated blast exposures.
Study Type:
Five-year longitudinal prospective trial.
Population:
Ninety-two males aged 23-42 with an average of 9.4 years of blast exposure.
Field Strength/Sequence:
3 T brain MRI/T1-weighted 3D with reconstruction in three planes, T2-weighted, T2-weighted fluid attenuated inversion recovery (FLAIR) 3D with reconstruction in three planes, T2-weighted gradient spin echo (GRE), saturation weighted images, DWI and ADC maps, diffusion tensor imaging.
Assessment:
All MRI scans were interpreted by the two neuroradiologists and one neuroradiology Fellow in a blinded fashion using a customized neuroradiology reporting form.
Statistical Tests:
Matching parametric statistics represented the number of participants whose brain parameters improved or deteriorated over time. Odds ratio (OR) and 95% confidence intervals (CI) were computed using log regression modeling to determine volume loss, white matter lesions, hemosiderosis, gliosis, cystic changes and enlarged Virchow Robin (VR) spaces. A Kappa (κ) statistic with a 95% CI was calculated to determine rater variability between readers.
Results:
A significant deterioration was observed in volume loss (OR = 1.083, 95% CI 0.678-1.731, permutation test), white matter changes (OR: 0.754, 95% CI 0.442-1.284, permutation test), and enlargement of VR spaces (OR: 0.775, 95% CI 0.513-1.171). Interrater reliability was low: κ = 0.283, 0.156, and 0.557 for volume loss, white matter changes, and enlargement of VR spaces, respectively.
Data Conclusion:
There were significant changes in brain volume, white matter lesions, and enlargement of VR spaces.
Evidence Level:
2 TECHNICAL EFFICACY: Stage 2.
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