MR imaging findings in mild traumatic brain injury with persistent neurological impairment

• Published in: Magnetic resonance imaging Vol. 37; pp. 243 - 251
• Main Authors: Trifan, Gabriela, Gattu, Ramtilak, Haacke, Ewart Mark, Kou, Zhifeng, Benson, Randall R.
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Inc 01.04.2017
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Agerelated; Brain - diagnostic imaging; Brain - pathology; Brain Concussion - complications; Brain Concussion - diagnostic imaging; Brain Concussion - pathology; Case-Control Studies; Deep; Detection; Female; Flair; Fluid-attenuated inversion recovery; Humans; Hyperintensities; Litigation; Magnetic Resonance Imaging - methods; Male; Microhemorrhage; Middle Aged; Mild TBI; MRI; Nervous System Diseases - complications; Nervous System Diseases - diagnostic imaging; Nervous System Diseases - pathology; Post concussive symptoms; Radiology; Retrospective Studies; Sensitivity; Subcortical; Susceptibility-weighted imaging; SWI; Traumatic brain injury; White matter; Young Adult; Susceptibility-weighted imaging; Traumatic brain injury; Fluid-attenuated inversion recovery; SWI; MRI; Litigation; Flair; Agerelated; Mild TBI; Microhemorrhage; Hyperintensities; Deep; White matter; Sensitivity; Post concussive symptoms; Detection; Subcortical
• ISSN: 0730-725X; 1873-5894
• DOI: 10.1016/j.mri.2016.12.009

Traumatic brain injury (TBI) is a widespread cause of neurologic disability, with >70% of cases being mild in severity. Magnetic resonance imaging provides objective biomarkers in the diagnosis of brain injury by detecting brain lesions resulting from trauma. This paper reports on the detection rates of presumed trauma-related pathology using fluid-attenuated inversion recovery (FLAIR) and susceptibility-weighted imaging (SWI) in TBI patients with chronic, persistent symptoms. Methods: 180 subjects with persistent neurobehavioral symptoms following head trauma referred by personal injury attorneys and 94 asymptomatic, age-matched volunteers were included in the study. 83% of TBI subjects were classified as mild. Results: TBI subjects had a significantly greater number of lesions detected by FLAIR than controls (42% vs. 22%) and more lesions detected by SWI than controls (28% vs. 3%). To reduce the confounding effects of aging, we examined mild TBI subjects <45years of age, which reduced the rate of lesions detected by FLAIR (26% vs. 2%) and SWI (15% vs. 0%). This younger group, which contained few age-related lesions, also demonstrated that subcortical lesions on FLAIR are more specific for TBI than deeper lesions. Conclusions: While the presence of litigation in mild TBI cases with incomplete recovery has been associated with greater expression of symptomatology and, by extension, poorer outcomes, this study shows that mild TBI patients in litigation with chronic, persistent symptoms may have associated brain injury underlying their symptoms detectable by MRI biomarkers.