White Matter Hyperintensities on High-Resolution 3-T MRI: Frequency in Mild Traumatic Brain Injury and Associations
Manoj Tanwar1, Eric Miller2, Apostolos J Tsiouris3
1Department of Radiology, University of Alabama at Birmingham, Birmingham, AL.
Abstract:
BACKGROUND. A challenge in the management of patients with mild traumatic brain injury (mTBI) is the lack of objective biomarkers to guide diagnosis, classification, and prognostication. White matter hyperintensities (WMHs) on T2-weighted MRI sequences have been identified as a potential marker for this purpose. OBJECTIVE. The purpose of this study was to compare WMHs on high-resolution 3-T MRI between individuals with and without mTBI and assess associations of WMHs with clinical markers of mTBI. METHODS. This prospective study recruited individuals with acute mTBI and a matched control group of individuals without mTBI from seven U.S. centers from November 2015 to January 2018. Participants underwent up to four clinical encounters (baseline through ≈ 3 months after enrollment). At each encounter, clinical markers of head injury were tested, including the Rivermead Post-Concussion Symptoms Questionnaire-3 (RPQ-3), assessing early postconcussive symptoms (physical symptoms), Rivermead Post-Concussion Symptoms Questionnaire-13 (RPQ-13), assessing late postconcussive symptoms (psychosocial functioning and lifestyle), and Balance Error Scoring System (BESS) test, assessing postural stability. Participants also underwent at each encounter 3-T MRI including a high-resolution isotropic 3D T2-weighted FLAIR sequence. Two neuroradiologists independently reviewed the FLAIR sequences from the baseline encounters for the presence of at least one WMH and for the presence of abnormal WMHs (defined as five or more punctate foci, at least one focus measuring > 3 mm, or at least one focus in an atypical location); discrepancies were resolved by a consensus process involving possible review by a group of four neuroradiologists. RESULTS. The mTBI group included 303 participants (mean age, 21.6 ± 8.2 years [SD]; 162 male participants, 141 female participants); the control group included 148 participants (mean age, 21.8 ± 8.3 years; 71 male participants, 77 female participants). At least one WMH was present in 102 (34%) participants in the mTBI group, 40% (n = 41) of whom had abnormal WMHs, and 52 (35%) participants in the control group (p = .76), 35% (n = 18) of whom had abnormal WMHs (p = .50). Neither WMHs nor abnormal WMHs were associated with RPQ-3, RPQ-13, or BESS total score at any time point (p > .05). CONCLUSION. WMHs did not show significant differences between mTBI and control groups, nor did they show significant associations with clinical markers in the mTBI group. CLINICAL IMPACT. The findings do not support the utility of WMHs as a marker of mTBI. TRIAL REGISTRATION. ClinicalTrials.gov NCT02556177.
