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Ultra-high contrast MRI: a new technique for recognizing secondary changes to the brain in patients with persistent
Daniel Cornfeld1,2, Gil Newburn3, Paul Condron3,4
1Matai Medical Research Institute, Gisborne, New Zealand. d.cornfeld@matai.org.nz.
Background:
Management of patients with persistent or worsening symptoms following traumatic brain injury (TBI) presents difficulties. MRI is usually negative in mild TBI (mTBI) and usually only shows residual quiescent disease in moderate to severe TBI (msTBI).
Objective:
We hypothesize that patients with persistent symptoms from prior TBI will show findings on a divided Subtracted Inversion Recovery (dSIR) sequence that are sensitive to small changes from normal in white matter T1.
Materials And Methods:
Neurologically healthy controls (n = 37) and patients with persistent symptoms following TBI (n = 29) were examined with T2-FLAIR and dSIR sequences. T2-FLAIR images were evaluated for minor changes and overt pathology. dSIR images were evaluated for "whiteout signs" defined as widespread, bilateral, and symmetrical high signal in white matter. Odds ratios were calculated for the association between the presence of a whiteout sign and being in the symptomatic group.
Results:
Overt pathology was seen on the T2-FLAIR images in six msTBI patients and one mTBI patient. No widespread changes were seen on the T2-FLAIR images in the control or TBI groups. Whiteout signs were seen on the dSIR images in 25 of 29 TBI patients and in three of 37 controls. The whiteout sign was strongly associated with symptomatic TBI status, with odds ratios ≥ 14. The kappa statistic for inter-reader correlation (whiteout sign vs. no whiteout sign) was κ = 0.85.
Conclusion:
The whiteout sign was strongly associated with being in the symptomatic group and is a potential biomarker for recognition of secondary changes to the brain in patients with persistent symptoms following TBI.
Insights
A new MRI technique, divided Subtracted Inversion Recovery (dSIR), identified "whiteout signs" in most patients with persistent traumatic brain injury (TBI) symptoms, suggesting it may be a valuable biomarker.
Area of Science:
- Neuroimaging
- Radiology
- Neurology
Background:
- Persistent symptoms after traumatic brain injury (TBI) pose management challenges.
- Standard MRI often shows no abnormalities in mild TBI (mTBI) or only residual changes in moderate to severe TBI (msTBI).
Purpose of the Study:
- To test the hypothesis that divided Subtracted Inversion Recovery (dSIR) MRI sequences can detect white matter changes in patients with persistent TBI symptoms.
- To evaluate dSIR's sensitivity to subtle T1 changes in white matter.
Main Methods:
- Compared T2-FLAIR and dSIR MRI sequences in healthy controls (n=37) and TBI patients (n=29) with persistent symptoms.
- Assessed T2-FLAIR for overt pathology and dSIR for "whiteout signs" (widespread white matter changes).
- Calculated odds ratios to determine the association between whiteout signs and symptomatic TBI status.
Main Results:
- T2-FLAIR showed overt pathology in only a few msTBI/mTBI patients.
- No widespread changes were observed on T2-FLAIR in any group.
- Whiteout signs were present in 25/29 TBI patients but only 3/37 controls.
- The whiteout sign showed a strong association (OR ≥ 14) with symptomatic TBI.
Conclusions:
- The "whiteout sign" on dSIR MRI is strongly associated with persistent symptoms following TBI.
- This sign is a potential imaging biomarker for identifying secondary brain changes in TBI patients.
- dSIR may improve the detection of subtle white matter abnormalities not visible on conventional MRI.
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