title: FDG-PET imaging in mild traumatic brain injury: a critical review.
abstract: Traumatic brain injury (TBI) affects an estimated 1.7 million people in the United States and is a contributing factor to one third of all injury related deaths annually. According to the CDC, approximately 75% of all reported TBIs are concussions or considered mild in form, although the number of unreported mild TBIs (mTBI) and patients not seeking medical attention is unknown. Currently, classification of mTBI or concussion is a clinical assessment since diagnostic imaging is typically inconclusive due to subtle, obscure, or absent changes in anatomical or physiological parameters measured using standard magnetic resonance (MR) or computed tomography (CT) imaging protocols. Molecular imaging techniques that examine functional processes within the brain, such as measurement of glucose uptake and metabolism using [(18)F]fluorodeoxyglucose and positron emission tomography (FDG-PET), have the ability to detect changes after mTBI. Recent technological improvements in the resolution of PET systems, the integration of PET with magnetic resonance imaging (MRI), and the availability of normal healthy human databases and commercial image analysis software contribute to the growing use of molecular imaging in basic science research and advances in clinical imaging. This review will discuss the technological considerations and limitations of FDG-PET, including differentiation between glucose uptake and glucose metabolism and the significance of these measurements. In addition, the current state of FDG-PET imaging in assessing mTBI in clinical and preclinical research will be considered. Finally, this review will provide insight into potential critical data elements and recommended standardization to improve the application of FDG-PET to mTBI research and clinical practice.
authors.affiliation: Department of Anatomy, Physiology and Genetics, Uniformed Services University Bethesda, MD, USA ; Neuroscience Program, Department of Neuroscience, Uniformed Services University Bethesda, MD, USA ; Center for Neuroscience and Regenerative Medicine Bethesda, MD, USA.
authors.forename: Kimberly R
authors.initials: KR
authors.lastname: Byrnes
authors.affiliation: Center for Neuroscience and Regenerative Medicine Bethesda, MD, USA ; Department of Radiology and Radiological Sciences, Uniformed Services University Bethesda, MD, USA.
authors.forename: Colin M
authors.initials: CM
authors.lastname: Wilson
authors.affiliation: Neuroscience Program, Department of Neuroscience, Uniformed Services University Bethesda, MD, USA.
authors.forename: Fiona
authors.initials: F
authors.lastname: Brabazon
authors.affiliation: Neuroscience Program, Department of Neuroscience, Uniformed Services University Bethesda, MD, USA.
authors.forename: Ramona
authors.initials: R
authors.lastname: von Leden
authors.affiliation: Nuclear Medicine Service, Walter Reed National Military Medical Center Bethesda, MD, USA ; Department of Neurology, Uniformed Services University Bethesda, MD, USA.
authors.forename: Jennifer S
authors.initials: JS
authors.lastname: Jurgens
authors.affiliation: National Intrepid Center of Excellence Bethesda, MD, USA.
authors.forename: Terrence R
authors.initials: TR
authors.lastname: Oakes
authors.affiliation: Center for Neuroscience and Regenerative Medicine Bethesda, MD, USA ; Department of Radiology and Radiological Sciences, Uniformed Services University Bethesda, MD, USA.
authors.forename: Reed G
authors.initials: RG
authors.lastname: Selwyn
keywords: FDG; clinical research; experimental research; fluorodeoxyglucose; mTBI; positron emission tomography; traumatic brain injury