Life after mild traumatic brain injury: Widespread structural brain changes associated with psychological distress revealed with multimodal magnetic resonance imaging

Abstract

BackgroundTraumatic brain injury (TBI) can alter brain structure and lead to onset of persistent neuropsychological symptoms. This study investigates the relationship between brain damage and psychological distress after mild TBI (mTBI) using multimodal magnetic resonance imaging (MRI).MethodsEighty-nine mTBI patients from the TRACK-TBI (Transforming Research and Clinical Knowledge in Traumatic Brain Injury) pilot study were included. Subscales of the Brief Symptoms Inventory 18 for depression, anxiety, and somatization were used as outcome measures of psychological distress ∼6 months after the traumatic event. Glasgow Coma Scale scores were used to evaluate recovery. MRIs were acquired within 2 weeks post-injury. Perivascular spaces (PVS) were segmented using an enhanced PVS segmentation method, and the volume fraction was calculated for the whole brain and white matter regions. Cortical thickness and gray matter structures volumes were calculated in Freesurfer; diffusion imaging indices and multi-fiber tracts were extracted using the Quantitative Imaging Toolkit. The analysis was performed considering age, sex, intracranial volume, educational attainment, and improvement level upon discharge as covariates.ResultsPerivascular space fractions in the posterior cingulate, fusiform, and postcentral areas were found to be associated with somatization symptoms. Depression, anxiety, and somatization symptoms were associated with the cortical thickness of the frontal- opercularis and occipital pole, putamen and amygdala volumes, and corticospinal tract and superior thalamic radiation. Analyses were also performed on the two hemispheres separately to explore lateralization.ConclusionsThis study shows how PVS, cortical, and microstructural damages can predict the onset of depression, anxiety, and somatization symptoms in mTBI patients.

Association between mild traumatic brain injury, brain structure, and mental health outcomes in the Adolescent Brain Cognitive Development Study

“…There are a few possibilities for the lack of meaningful mediation in our study. First, studies that have found significant structural MR changes after TBI often use very specific time ranges post injury to conduct the MRI scan, often occurring within 1 month of the injury (13,(56)(57)(58). Even within these studies, changing the time interval of MRI after injury resulted in different findings of GM and WM differences over time.…”

“…This is because the screener does not require a hospital or doctor visit to diagnose the injury, but solely relies on reported symptoms. In contrast, most studies conducted post-injury are using patients who report to a hospital or some medical professional shortly after the injury (13, 56-58). With this difference in inclusion criteria, the present study may be collecting a larger portion of mild injuries that have not been included in prior research and consequently have more mild or reduced brain changes.…”