Advanced neuroimaging applied to veterans and service personnel with traumatic brain injury: state of the art and potential benefits.
Traumatic brain injury (TBI) remains one of the most prevalent forms of morbidity among Veterans and Service Members, particularly for those engaged in the conflicts in Iraq and Afghanistan. Neuroimaging has been considered a potentially useful diagnostic and prognostic tool across the spectrum of TBI generally, but may have particular importance in military populations where the diagnosis of mild TBI is particularly challenging, given the frequent lack of documentation on the nature of the injuries and mixed etiologies, and highly comorbid with other disorders such as post-traumatic stress disorder, depression, and substance misuse. Imaging has also been employed in attempts to understand better the potential late effects of trauma and to evaluate the effects of promising therapeutic interventions. This review surveys the use of structural and functional neuroimaging techniques utilized in military studies published to date, including the utilization of quantitative fluid attenuated inversion recovery (FLAIR), susceptibility weighted imaging (SWI), volumetric analysis, diffusion tensor imaging (DTI), magnetization transfer imaging (MTI), positron emission tomography (PET), magnetoencephalography (MEG), task-based and resting state functional MRI (fMRI), arterial spin labeling (ASL), and magnetic resonance spectroscopy (MRS). The importance of quality assurance testing in current and future research is also highlighted. Current challenges and limitations of each technique are outlined, and future directions are discussed.
Michael E. DeBakey VA Medical Center, Houston, TX, USA. ewilde@bcm.edu.|Department of Neurology, Baylor College of Medicine, Houston, TX, USA. ewilde@bcm.edu.|Department of Radiology, Baylor College of Medicine, Houston, TX, USA. ewilde@bcm.edu.|Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX, USA. ewilde@bcm.edu.
Elisabeth A
EA
Wilde
Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
Sylvain
S
Bouix
Missouri Institute of Mental Health, University of Missouri St. Louis, Berkeley, MO, USA.
David F
DF
Tate
Center for Clinical Spectroscopy, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.|Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
Alexander P
AP
Lin
Michael E. DeBakey VA Medical Center, Houston, TX, USA.|Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX, USA.
Mary R
MR
Newsome
Michael E. DeBakey VA Medical Center, Houston, TX, USA.|Department of Radiology, Baylor College of Medicine, Houston, TX, USA.|Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX, USA.
Brian A
BA
Taylor
Department of Radiology and Medical Imaging, Department of Neurological Surgery, University of Virginia Health System, Charlottesville, VA, USA.
James R
JR
Stone
Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX, USA.
James
J
Montier
Center for Cognitive Health and NFL Neurological Center, Icahn School of Medicine, and Division of Neurology, James J Peters VA Medical Center, New York, NY, USA.
Samuel E
SE
Gandy
Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX, USA.
Brian
B
Biekman
Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.|Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.|Department of Psychiatry, Veterans Affairs Boston Healthcare System, Brockton Division, Brockton, MA, USA.
Martha E
ME
Shenton
Defense Veterans Brain Injury Center, San Antonio Military Medical Center, Fort Sam Houston, TX, USA.
Gerald
G
York
D001921:Brain / Q000473:pathology* / Q000503:physiopathology*; D001930:Brain Injuries / Q000175:diagnosis / Q000473:pathology / Q000503:physiopathology / Q000628:therapy; D006801:Humans; D008889:Military Personnel; D059906:Neuroimaging / Q000379:methods*; D014728:Veterans
Diffusion tensor imaging; Magnetic resonance imaging; Magnetic resonance spectroscopy; Positron emission tomography; Traumatic brain injury; Veteran; fMRI