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Neuroimaging Biomarkers in Mild Traumatic Brain Injury (mTBI)

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Abstract

Reviewed herein are contemporary neuroimaging methods that detect abnormalities associated with mild traumatic brain injury (mTBI). Despite advances in demonstrating underlying neuropathology in a subset of individuals who sustain mTBI, considerable disagreement persists in neuropsychology about mTBI outcome and metrics for evaluation. This review outlines a thesis for the select use of sensitive neuroimaging methods as potential biomarkers of brain injury recognizing that the majority of individuals who sustain an mTBI recover without neuroimaging signs or neuropsychological sequelae detected with methods currently applied. Magnetic resonance imaging (MRI) provides several measures that could serve as mTBI biomarkers including the detection of hemosiderin and white matter abnormalities, assessment of white matter integrity derived from diffusion tensor imaging (DTI), and quantitative measures that directly assess neuroanatomy. Improved prediction of neuropsychological outcomes in mTBI may be achieved with the use of targeted neuroimaging markers.

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Notes

  1. Definition of concussion and mTBI remains controversial and definitional issues have been discussed by Bigler (2008), but for this review the terms concussion and mTBI are used interchangeably. Based on the International and Interagency Initiative toward Common Data Elements for Research on Traumatic Brain Injury and Psychological Health “TBI is defined as an alteration in brain function, or other evidence of brain pathology, caused by an external force” (p. 1637, Menon et al. 2010).

  2. I sustained a sports-related concussion playing high school football in 1966. I must have displayed significant PTA and confusion on the sideline because I was taken to the emergency room for evaluation and subsequently hospitalized overnight for observation. I am amnestic to those events, but it was recorded on an 8 mm tape. However, I recovered rapidly, as the injury was on a Friday and I practiced Monday and played in the next game on the following Friday. This, of course, was long before return-to-play guidelines but for me, post-concussion symptoms were minimal and short lived.

Abbreviations

ACR:

Anterior corona radiata

ANAM:

Automated neurological assessment metrics

CC:

Corpus callosum

CT:

Computed tomography

CTE:

Chronic traumatic encephalopathy

CVLT:

California verbal learning test

DAI:

Diffuse axonal injury

DKI:

Diffusion kurtosis imaging

DMN:

Default mode network

DOI:

Day-of-injury

DSS:

Disability status scale

DTI:

Diffusion tensor imaging

EF:

Executive function

EN:

Executive network

FE:

Finite element

FLAIR:

Fluid attenuated inversion recovery

fMRI:

Functional magnetic resonance imaging

GCS:

Glasgow coma scale

GM:

Gray matter

GRE:

Gradient recalled echo

GWI:

Gulf war illness

LDFR:

Long delay free recall

LOC:

Loss of consciousness

M:

Mean

MCI:

Mild cognitive impairment

MR:

Magnetic resonance

MRI:

Magnetic resonance imaging

MRS:

Magnetic resonance spectroscopy

MS:

Multiple sclerosis

mTBI:

Mild traumatic brain injury

mcTBI:

Mild complicated traumatic brain injury

OI:

Orthopedically injured

PCS:

Post-concussion(al) syndrome

PTA:

Post-traumatic amnesia

RAS:

Reticular activating system

RAVLT:

Rey auditory verbal learning test

RT:

Reaction time

SD or s.d.:

Standard deviation

SDMT:

Symbol digit modality test

SWI:

Susceptibility weighted imaging

TBI:

Traumatic brain injury

TBSS:

Tract-based spatial statistics

UF:

Uncinate fasciculus

WHO:

World Health Organization

WM:

White matter

WMHs:

White matter hyperintensities

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Acknowledgments

The assistance of Jo Ann Petrie, Ph.D. in the preparation of this manuscript is gratefully acknowledged as is the assistance of Tracy J. Abildskov in preparation of some of the illustrations.

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Bigler, E.D. Neuroimaging Biomarkers in Mild Traumatic Brain Injury (mTBI). Neuropsychol Rev 23, 169–209 (2013). https://doi.org/10.1007/s11065-013-9237-2

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