Rate of abnormalities in quantitative MR neuroimaging of persons with chronic traumatic brain injury
Farzaneh Rahmani1, Richard D Batson2, Alexandra Zimmerman3
1Department of Radiology, Washington University School of Medicine, Saint Louis, MO, USA.
Background:
Mild traumatic brain injury (mTBI) can result in lasting brain damage that is often too subtle to detect by qualitative visual inspection on conventional MR imaging. Although a number of FDA-cleared MR neuroimaging tools have demonstrated changes associated with mTBI, they are still under-utilized in clinical practice.
Methods:
We investigated a group of 65 individuals with predominantly mTBI (60 mTBI, 48 due to motor-vehicle collision, mean age 47 ± 13 years, 27 men and 38 women) with MR neuroimaging performed in a median of 37 months post-injury. We evaluated abnormalities in brain volumetry including analysis of left-right asymmetry by quantitative volumetric analysis, cerebral perfusion by pseudo-continuous arterial spin labeling (PCASL), white matter microstructure by diffusion tensor imaging (DTI), and neurometabolites via magnetic resonance spectroscopy (MRS).
Results:
All participants demonstrated atrophy in at least one lobar structure or increased lateral ventricular volume. The globus pallidi and cerebellar grey matter were most likely to demonstrate atrophy and asymmetry. Perfusion imaging revealed significant reductions of cerebral blood flow in both occipital and right frontoparietal regions. Diffusion abnormalities were relatively less common though a subset analysis of participants with higher resolution DTI demonstrated additional abnormalities. All participants showed abnormal levels on at least one brain metabolite, most commonly in choline and N-acetylaspartate.
Conclusion:
We demonstrate the presence of coup-contrecoup perfusion injury patterns, widespread atrophy, regional brain volume asymmetry, and metabolic aberrations as sensitive markers of chronic mTBI sequelae. Our findings expand the historic focus on quantitative imaging of mTBI with DTI by highlighting the complementary importance of volumetry, arterial spin labeling perfusion and magnetic resonance spectroscopy neurometabolite analyses in the evaluation of chronic mTBI.
Insights
Quantitative MRI reveals widespread brain abnormalities in chronic mild traumatic brain injury (mTBI). Advanced imaging techniques like volumetry, perfusion, and spectroscopy show atrophy, reduced blood flow, and metabolic changes, aiding in mTBI evaluation.
Area of Science:
- Neuroimaging
- Radiology
- Neurology
Background:
- Mild traumatic brain injury (mTBI) can cause subtle, lasting brain damage not visible on conventional MRI.
- FDA-cleared MR neuroimaging tools for mTBI are underutilized in clinical practice.
Purpose of the Study:
- To investigate chronic mTBI sequelae using advanced quantitative MR neuroimaging.
- To evaluate brain volumetry, cerebral perfusion, white matter microstructure, and neurometabolites.
Main Methods:
- 65 individuals with chronic mTBI underwent MR neuroimaging (volumetry, PCASL, DTI, MRS).
- Analysis included left-right asymmetry, cerebral blood flow, white matter integrity, and brain metabolite levels.
- Imaging was performed a median of 37 months post-injury.
Main Results:
- All participants showed lobar atrophy or increased ventricular volume.
- Globus pallidi and cerebellar gray matter exhibited the most atrophy and asymmetry.
- Reduced cerebral blood flow was observed in occipital and right frontoparietal regions.
- Abnormal neurometabolite levels (choline, N-acetylaspartate) were common.
Conclusions:
- Quantitative MRI reveals coup-contrecoup perfusion injury, widespread atrophy, asymmetry, and metabolic changes in chronic mTBI.
- Volumetry, PCASL, and MRS offer complementary insights beyond DTI for evaluating chronic mTBI.
- These findings highlight sensitive markers for subtle, lasting brain damage from mTBI.
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