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Preliminary findings of cortical thickness abnormalities in blast injured service members and their relationship to clinical findings

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Abstract

Though cortical abnormalities have been demonstrated in moderate and severe traumatic brain injured (TBI) patients, there have been no studies examining cortical changes following blast related mild TBI (mTBI). The purpose of this study was to determine the effects and functional relevance of blast mTBI on cortical thickness in a small cohort of carefully screened blast injured US Service Members (SM). Twelve SM with mTBI acquired through blast injury were compared to 11 demographically matched control SM without TBI. Both mTBI and control participants were active duty and had completed a combat deployment. Subjects underwent MRI examination and the T1 weighted anatomic images were processed using the FreeSurfer suite of tools. Cortical thickness maps were compared between groups and examined for relationships with time since injury (TSI). Utilizing a large database of functional imaging results (BrainMap), significant regions of interest (ROI) were used to determine the behavioral profiles most consistently associated with the specific ROI. In addition, clinical variables were examined as part of post-hoc analysis of functional relevance. Group comparisons controlling for age demonstrated several significant clusters of cortical thinning for the blast injured SM. After multiple comparisons correction (False Discovery Rate (FDR)), two left hemisphere clusters remained significant (left superior temporal (STG) and frontal (SFG) gyri). No clusters were significantly correlated with TSI after FDR correction. Behavioral analysis for the STG and SFG clusters demonstrated three significant behavioral/cognitive sub-domains, each associated with audition and language. Blast injured SMs demonstrated distinct areas of cortical thinning in the STG and SFG. These areas have been previously shown to be associated with audition and language. Post-hoc analyses of clinical records demonstrated significant abnormal audiology reports for the blast injured SM suggesting that the thinning in these ROIs might be related to injury to the external auditory system rather than direct injury to the brain from the blast. It is clear that additional replication is needed in much larger cohorts. Importantly, the combination of imaging tools and methods in this study successfully demonstrated the potential to define unique ROIs and functional correlates that can be used to design future studies.

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Acknowledgments

The views, opinions and/or findings contained in this manuscript are those of the authors and should not be construed as an official Department of Defense or Veterans Affairs position, policy or decision unless so designated by other documentation. Research on this article was done under Contract #W91YTZ-12-C-0132. In the conduct of this research, the investigators adhered to the policies regarding the protection of human subjects as prescribe by Code of Federal Regulations (CFR) Title 45, Volume 1, Part 46; Title 32, Chapter1, Part 219; and Title 21, Chapter 1, Part 50 (Protection of Human Subjects).

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Authors and Affiliations

  1. Defense and Veterans Brain Injury Center, Contractor for the Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc. San Antonio Military Medical Center (SAMMC), San Antonio, TX, USA

    D. F. Tate, M. W. Reid, D. B. Cooper & J. E. Kennedy

  2. LTC, MC, San Antonio Military Medical Center, San Antonio, TX, USA

    G. E. York

  3. Department of Neurology, Mayo Clinic, Rochester, MN, USA

    L. Jones

  4. Research Imaging Institute, University of Texas Health Science Center-San Antonio, San Antonio, TX, USA

    D. A. Robin

  5. LtCol, MC, Air Force Medical Support Agency, Falls Church, VA, USA

    J. Lewis

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  1. D. F. Tate
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Correspondence to D. F. Tate.

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Tate, D.F., York, G.E., Reid, M.W. et al. Preliminary findings of cortical thickness abnormalities in blast injured service members and their relationship to clinical findings. Brain Imaging and Behavior 8, 102–109 (2014). https://doi.org/10.1007/s11682-013-9257-9

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