Findings from Structural MR Imaging in Military Traumatic Brain Injury

Riedy, Gerard; Senseney, Justin S; Liu, Wei; Ollinger, John M.; Sham, Elyssa; Krapiva, Pavel; Patel, Jigar B.; Smith, A S; Yeh, Ping‐Hong; Graner, John L.; Nathan, Dominic E.; Caban, Jesus J.; French, Louis M.; Harper, Jamie; Eskay, Victoria; Morissette, John; Oakes, Terrence R.

doi:10.1148/radiol.2015150438

Cited by 62 publications

(65 citation statements)

References 39 publications

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“…Another consideration in interpreting our findings relates to the effect of white matter hyperintensities, which are common in OEF/OIF veterans with TBI (Riedy et al 2016). There is evidence that these hyperintensities are associated with enhanced white matter abnormalities (Lange et al 2014) as well as with impaired cognition in TBI (Bigler 2006; Clark et al 2016).…”

Section: Discussionmentioning

confidence: 99%

White matter abnormalities are associated with overall cognitive status in blast-related mTBI

Miller

Hayes

Lafleche

et al. 2016

Brain Imaging and Behavior

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Blast-related mild traumatic brain injury (mTBI) is a common injury of the Iraq and Afghanistan Wars. Research has suggested that blast-related mTBI is associated with chronic white matter abnormalities, which in turn are associated with impairment in neurocognitive function. However, findings are inconsistent as to which domains of cognition are affected by TBI-related white matter disruption. Recent evidence that white matter abnormalities associated with blast-related mTBI are spatially variable raises the possibility that the associated cognitive impairment is also heterogeneous. Thus, the goals of this study were to examine (1) whether mTBI-related white matter abnormalities are associated with overall cognitive status and (2) whether white matter abnormalities provide a mechanism by which mTBI influences cognition. Ninety-six Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) veterans were assigned to one of three groups: no-TBI, mTBI without loss of consciousness (LOC) (mTBI−LOC), and mTBI with LOC (mTBI+LOC). Participants were given a battery of neuropsychological tests that were selected for their sensitivity to mTBI. Results showed that number of white matter abnormalities was associated with the odds of having clinically significant cognitive impairment. A mediation analysis revealed that mTBI+LOC was indirectly associated with cognitive impairment through its effect on white matter integrity. These results suggest that cognitive difficulties in blast-related mTBI can be linked to injury-induced neural changes when taking into account the variability of injury as well as the heterogeneity in cognitive deficits across individuals.

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Section: Discussionmentioning

confidence: 99%

White matter abnormalities are associated with overall cognitive status in blast-related mTBI

Miller

Hayes

Lafleche

et al. 2016

Brain Imaging and Behavior

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“…A number of studies in both human and animal models demonstrate TSI as one of the more consistent correlates of cognitive and imaging findings [2, 28, 55, 56]. Namely, with increasing TSI, most TBI (especially mTBI) patients demonstrate improved function [49] and fewer imaging abnormalities.…”

Section: Discussionmentioning

confidence: 99%

Volumetric and shape analyses of subcortical structures in United States service members with mild traumatic brain injury

et al. 2016

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Mild traumatic brain injury (mTBI) is a significant health concern. The majority who sustain mTBI recover, although ~20 % continue to experience symptoms that can interfere with quality of life. Accordingly, there is a critical need to improve diagnosis, prognostic accuracy, and monitoring (recovery trajectory over time) of mTBI. Volumetric magnetic resonance imaging (MRI) has been successfully utilized to examine TBI. One promising improvement over standard volumetric approaches is to analyze high-dimensional shape characteristics of brain structures. In this study, subcortical shape and volume in 76 Service Members with mTBI was compared to 59 Service Members with orthopedic injury (OI) and 17 with post-traumatic stress disorder (PTSD) only. FreeSurfer was used to quantify structures from T1-weighted 3 T MRI data. Radial distance (RD) and Jacobian determinant (JD) were defined vertex-wise on parametric mesh-representations of subcortical structures. Linear regression was used to model associations between morphometry (volume and shape), TBI status, and time since injury (TSI) correcting for age, sex, intracranial volume, and level of education. Volumetric data was not significantly different between the groups. JD was significantly increased in the accumbens and caudate and significantly reduced in the thalamus of mTBI participants. Additional significant associations were noted between RD of the amygdala and TSI. Positive trendlevel associations between TSI and the amygdala and accumbens were observed, while a negative association was observed for third ventricle. Our findings may aid in the initial diagnosis of mTBI, provide biological targets for functional examination, and elucidate regions that may continue remodeling after injury.

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“…The broad category of T2 and FLAIR white matter signal changes was classified as DAI/TAI when there was increased T2 and FLAIR white matter signal in a pattern and distribution that could be consistent with prior traumatic injury. 9,20 Possible DAI/ TAI lesions were typically identified in the subcortical white matter often involving the frontal or parietal lobes; however, we also included periventricular and deep white matter foci in this classification. Other definitions included the following:…”

Section: Mr Imaging Clinical Interpretationmentioning

confidence: 99%

“…A challenge in the interpretation of such structural imaging is determining the importance of imaging findings identified more easily at higher resolution and field strengths. 8 White matter hyperintensities (WMHs), dilated perivascular spaces, pineal gland cysts, and pituitary gland abnormalities have been identified in both mTBI and healthy cohorts, 9,10 and the imaging manifestation of multifocal T2 and FLAIR hyperintensity is visible across conditions including demyelination, inflammation, chronic small vessel ischemia, normal aging, migraine headaches, and moderate/severe TBI. Recent studies in military populations have demonstrated similar rates of WMH in mTBI and non-head trauma groups (Tate et al, 11 41% mTBI versus 49% orthopedically injured versus 29% posttraumatic stress disorder only; and Riedy et al, 9 51.8% mTBI versus 38.1% healthy controls).…”

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confidence: 99%

Structural and Volumetric Brain MRI Findings in Mild Traumatic Brain Injury

Patel

Wilson

Oakes

et al. 2020

AJNR Am J Neuroradiol

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BACKGROUND AND PURPOSE: Routine MR imaging findings are frequently normal following mild traumatic brain injury and have a limited role in diagnosis and management. Advanced MR imaging can assist in detecting pathology and prognostication but is not readily available outside research settings. However, 3D isotropic sequences with 1-mm 3 voxel size are available on community MR imaging scanners. Using such sequences, we compared radiologists' findings and quantified regional brain volumes between a mild traumatic brain injury cohort and non-brain-injured controls to describe structural imaging findings associated with mild traumatic brain injury. MATERIALS AND METHODS:Seventy-one military personnel with persistent symptoms and 75 controls underwent 3T MR imaging. Three neuroradiologists interpreted the scans using common data elements. FreeSurfer was used to quantify regional gray and white matter volumes.RESULTS: WM hyperintensities were seen in 81% of the brain-injured group versus 60% of healthy controls. The odds of $1 WM hyperintensity in the brain-injured group was about 3.5 times the odds for healthy controls (95% CI, 1.58-7.72; P = .002) after adjustment for age. A frontal lobe-only distribution of WM hyperintensities was more commonly seen in the mild traumatic brain injury cohort. Furthermore, 7 gray matter, 1 white matter, and 2 subcortical gray matter regions demonstrated decreased volumes in the brain-injured group after multiple-comparison correction. The mild traumatic brain injury cohort showed regional parenchymal volume loss.CONCLUSIONS: White matter findings are nonspecific and therefore a clinical challenge. Our results suggest that prior trauma should be considered in the differential diagnosis of multifocal white matter abnormalities with a clinical history of mild traumatic brain injury, particularly when a frontal predilection is observed.ABBREVIATIONS: DAI 4 diffuse axonal injury; mTBI 4 mild traumatic brain injury; TAI 4 traumatic axonal injury; TBI 4 traumatic brain injury; WMH 4 white matter hyperintensity

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Findings from Structural MR Imaging in Military Traumatic Brain Injury

Abstract: Blast-related injury and loss of consciousness is common in military TBI. Structural MR imaging demonstrates a high incidence of white matter T2-weighted hyperintense areas and pituitary abnormalities, with a low incidence of microhemorrhage in the chronic phase.

Cited by 62 publications

References 39 publications

White matter abnormalities are associated with overall cognitive status in blast-related mTBI

White matter abnormalities are associated with overall cognitive status in blast-related mTBI

Volumetric and shape analyses of subcortical structures in United States service members with mild traumatic brain injury

Structural and Volumetric Brain MRI Findings in Mild Traumatic Brain Injury

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