MR imaging findings in mild traumatic brain injury with persistent neurological impairment |
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| Affiliation: | 1. Center for Neurological Studies, 23400 Michigan Ave., Suite 210, Dearborn 48124, MI, United States;2. Department of Radiology, 3990 John R Street, HUH-Harper Suite 4J. MR Research Center, Wayne State University School of Medicine, Detroit 48201, MI, United States;3. Department of Biomedical Engineering, Wayne State University, Detroit 48201, MI, United States;1. Institute for Biomedical Engineering, University and ETH Zurich, Zurich, Switzerland;2. Division of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland;1. Institute of Imaging Science, Vanderbilt University, Nashville, TN 37232, USA;2. Department of Radiology and Radiological Sciences, Vanderbilt University, Nashville, TN 37232, USA;3. Department of Physics and Astronomy, Vanderbilt University, Nashville, TN 37232, USA;4. AstraZeneca, Alderley Park, MACCLESFIELD, Cheshire SK10 4TG, United Kingdom;5. Department of Biomedical Engineering, Vanderbilt University, Nashville, TN 37232, USA;6. Department of Molecular Physiology and Biophysics, Vanderbilt University, Nashville, TN 37232, USA;7. Vanderbilt-Ingram Cancer Center, Vanderbilt University, Nashville, TN 37232, USA;1. Molecular Imaging Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA;2. Magnetic Resonance Spectroscopy Core Facility, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA;1. Department of Radiology, University of Wisconsin-Madison, Madison, WI, USA;2. Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Germany;3. Clinic of Radiology and Nuclear Medicine, Basel University Hospital, Basel, Switzerland;4. Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, WI, USA;5. Department of Medical Physics, University of Wisconsin-Madison, Madison, WI, USA;6. Pathology Clinic, University of Wisconsin-Madison, Madison, WI, USA;7. Department of Medicine, University of Wisconsin-Madison, Madison, WI, USA;8. Department of Emergency Medicine, University of Wisconsin-Madison, Madison, WI, USA;9. Department of Surgery, University of Wisconsin-Madison, Madison, WI, USA;1. Center for Magnetic Resonance Research, Department of Radiology, University of Minnesota Medical School, Minneapolis, MN, USA;2. Diagnostic Radiology Residency Program, Department of Radiology, University of Minnesota Medical School, Minneapolis, MN, USA;3. Department of Neurology, University of Minnesota Medical School, Minneapolis, MN, USA;1. Department of Radiology, Boston University School of Medicine, Boston, MA 02118, USA;2. Department of Radiology, Masschusetts General Hospital, Boston, MA 02118, USA;3. Department of Pathology and Laboratory Medicine, Boston University School of Medicine, Boston, MA 02118, USA |
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| Abstract: | 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 < 45 years 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. |
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