title: Findings from Structural MR Imaging in Military Traumatic Brain Injury.
abstract: OBJECTIVE
  To describe the initial neuroradiology findings in a cohort of military service members with primarily chronic mild traumatic brain injury (TBI) from blast by using an integrated magnetic resonance (MR) imaging protocol.
  
  
  METHODS
  This study was approved by the Walter Reed National Military Medical Center institutional review board and is compliant with HIPAA guidelines. All participants were military service members or dependents recruited between August 2009 and August 2014. There were 834 participants with a history of TBI and 42 participants in a control group without TBI (not explicitly age- and sex-matched). MR examinations were performed at 3 T primarily with three-dimensional volume imaging at smaller than 1 mm(3) voxels for the structural portion of the examination. The structural portion of this examination, including T1-weighted, T2-weighted, before and after contrast agent administrtion T2 fluid attenuation inversion recovery, and susceptibility-weighted images, was evaluated by neuroradiologists by using a modified version of the neuroradiology TBI common data elements (CDEs). Incident odds ratios (ORs) between the TBI participants and a comparison group without TBI were calculated.
  
  
  RESULTS
  The 834 participants were diagnosed with predominantly chronic (mean, 1381 days; median, 888 days after injury) and mild (92% [768 of 834]) TBI. Of these participants, 84.2% (688 of 817) reported one or more blast-related incident and 63.0% (515 of 817) reported loss of consciousness at the time of injury. The presence of white matter T2-weighted hyperintense areas was the most common pathologic finding, observed in 51.8% (432 of 834; OR, 1.75) of TBI participants. Cerebral microhemorrhages were observed in a small percentage of participants (7.2% [60 of 834]; OR, 6.64) and showed increased incidence with TBI severity (P < .001, moderate and severe vs mild). T2-weighted hyperintense areas and microhemorrhages did not collocate by visual inspection. Pituitary abnormalities were identified in a large proportion (29.0% [242 of 834]; OR, 16.8) of TBI participants.
  
  
  CONCLUSIONS
  Blast-related injury and loss of consciousness is common in military TBI. Structural MR imaging demonstrates a high incidence of white matter T2-weighted hyperintense areas and pituitary abnormalities, with a low incidence of microhemorrhage in the chronic phase.
authors.affiliation: From the National Capital Neuroimaging Consortium (NCNC), Bethesda, Md (G.R., J.S.S., W.L., J.O., E.S., P.H.Y., J.G., D.N., J.C., J.H., V.E., J.M., T.R.O.); National Intrepid Center of Excellence (NICoE), 4860 S Palmer Rd, Bethesda, MD 20889 (G.R., J.S.S., W.L., J.O., E.S., P.H.Y., J.G., D.N., J.C., L.M.F., V.E., J.M., T.R.O.); Center for Neuroscience and Regenerative Medicine, Bethesda, Md (G.R., L.M.F.); Uniformed Services University of the Health Sciences, Bethesda, Md (G.R., A.S., L.M.F.); Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Md (P.H.Y.); Walter Reed National Military Medical Center (WRNMMC), Bethesda, Md (P.K., L.M.F.); and VA Maryland Health Care System (VAMHCS), Baltimore, Md (J.B.P.).
authors.forename: Gerard
authors.initials: G
authors.lastname: Riedy
authors.affiliation: From the National Capital Neuroimaging Consortium (NCNC), Bethesda, Md (G.R., J.S.S., W.L., J.O., E.S., P.H.Y., J.G., D.N., J.C., J.H., V.E., J.M., T.R.O.); National Intrepid Center of Excellence (NICoE), 4860 S Palmer Rd, Bethesda, MD 20889 (G.R., J.S.S., W.L., J.O., E.S., P.H.Y., J.G., D.N., J.C., L.M.F., V.E., J.M., T.R.O.); Center for Neuroscience and Regenerative Medicine, Bethesda, Md (G.R., L.M.F.); Uniformed Services University of the Health Sciences, Bethesda, Md (G.R., A.S., L.M.F.); Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Md (P.H.Y.); Walter Reed National Military Medical Center (WRNMMC), Bethesda, Md (P.K., L.M.F.); and VA Maryland Health Care System (VAMHCS), Baltimore, Md (J.B.P.).
authors.forename: Justin S
authors.initials: JS
authors.lastname: Senseney
authors.affiliation: From the National Capital Neuroimaging Consortium (NCNC), Bethesda, Md (G.R., J.S.S., W.L., J.O., E.S., P.H.Y., J.G., D.N., J.C., J.H., V.E., J.M., T.R.O.); National Intrepid Center of Excellence (NICoE), 4860 S Palmer Rd, Bethesda, MD 20889 (G.R., J.S.S., W.L., J.O., E.S., P.H.Y., J.G., D.N., J.C., L.M.F., V.E., J.M., T.R.O.); Center for Neuroscience and Regenerative Medicine, Bethesda, Md (G.R., L.M.F.); Uniformed Services University of the Health Sciences, Bethesda, Md (G.R., A.S., L.M.F.); Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Md (P.H.Y.); Walter Reed National Military Medical Center (WRNMMC), Bethesda, Md (P.K., L.M.F.); and VA Maryland Health Care System (VAMHCS), Baltimore, Md (J.B.P.).
authors.forename: Wei
authors.initials: W
authors.lastname: Liu
authors.affiliation: From the National Capital Neuroimaging Consortium (NCNC), Bethesda, Md (G.R., J.S.S., W.L., J.O., E.S., P.H.Y., J.G., D.N., J.C., J.H., V.E., J.M., T.R.O.); National Intrepid Center of Excellence (NICoE), 4860 S Palmer Rd, Bethesda, MD 20889 (G.R., J.S.S., W.L., J.O., E.S., P.H.Y., J.G., D.N., J.C., L.M.F., V.E., J.M., T.R.O.); Center for Neuroscience and Regenerative Medicine, Bethesda, Md (G.R., L.M.F.); Uniformed Services University of the Health Sciences, Bethesda, Md (G.R., A.S., L.M.F.); Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Md (P.H.Y.); Walter Reed National Military Medical Center (WRNMMC), Bethesda, Md (P.K., L.M.F.); and VA Maryland Health Care System (VAMHCS), Baltimore, Md (J.B.P.).
authors.forename: John
authors.initials: J
authors.lastname: Ollinger
authors.affiliation: From the National Capital Neuroimaging Consortium (NCNC), Bethesda, Md (G.R., J.S.S., W.L., J.O., E.S., P.H.Y., J.G., D.N., J.C., J.H., V.E., J.M., T.R.O.); National Intrepid Center of Excellence (NICoE), 4860 S Palmer Rd, Bethesda, MD 20889 (G.R., J.S.S., W.L., J.O., E.S., P.H.Y., J.G., D.N., J.C., L.M.F., V.E., J.M., T.R.O.); Center for Neuroscience and Regenerative Medicine, Bethesda, Md (G.R., L.M.F.); Uniformed Services University of the Health Sciences, Bethesda, Md (G.R., A.S., L.M.F.); Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Md (P.H.Y.); Walter Reed National Military Medical Center (WRNMMC), Bethesda, Md (P.K., L.M.F.); and VA Maryland Health Care System (VAMHCS), Baltimore, Md (J.B.P.).
authors.forename: Elyssa
authors.initials: E
authors.lastname: Sham
authors.affiliation: From the National Capital Neuroimaging Consortium (NCNC), Bethesda, Md (G.R., J.S.S., W.L., J.O., E.S., P.H.Y., J.G., D.N., J.C., J.H., V.E., J.M., T.R.O.); National Intrepid Center of Excellence (NICoE), 4860 S Palmer Rd, Bethesda, MD 20889 (G.R., J.S.S., W.L., J.O., E.S., P.H.Y., J.G., D.N., J.C., L.M.F., V.E., J.M., T.R.O.); Center for Neuroscience and Regenerative Medicine, Bethesda, Md (G.R., L.M.F.); Uniformed Services University of the Health Sciences, Bethesda, Md (G.R., A.S., L.M.F.); Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Md (P.H.Y.); Walter Reed National Military Medical Center (WRNMMC), Bethesda, Md (P.K., L.M.F.); and VA Maryland Health Care System (VAMHCS), Baltimore, Md (J.B.P.).
authors.forename: Pavel
authors.initials: P
authors.lastname: Krapiva
authors.affiliation: From the National Capital Neuroimaging Consortium (NCNC), Bethesda, Md (G.R., J.S.S., W.L., J.O., E.S., P.H.Y., J.G., D.N., J.C., J.H., V.E., J.M., T.R.O.); National Intrepid Center of Excellence (NICoE), 4860 S Palmer Rd, Bethesda, MD 20889 (G.R., J.S.S., W.L., J.O., E.S., P.H.Y., J.G., D.N., J.C., L.M.F., V.E., J.M., T.R.O.); Center for Neuroscience and Regenerative Medicine, Bethesda, Md (G.R., L.M.F.); Uniformed Services University of the Health Sciences, Bethesda, Md (G.R., A.S., L.M.F.); Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Md (P.H.Y.); Walter Reed National Military Medical Center (WRNMMC), Bethesda, Md (P.K., L.M.F.); and VA Maryland Health Care System (VAMHCS), Baltimore, Md (J.B.P.).
authors.forename: Jigar B
authors.initials: JB
authors.lastname: Patel
authors.affiliation: From the National Capital Neuroimaging Consortium (NCNC), Bethesda, Md (G.R., J.S.S., W.L., J.O., E.S., P.H.Y., J.G., D.N., J.C., J.H., V.E., J.M., T.R.O.); National Intrepid Center of Excellence (NICoE), 4860 S Palmer Rd, Bethesda, MD 20889 (G.R., J.S.S., W.L., J.O., E.S., P.H.Y., J.G., D.N., J.C., L.M.F., V.E., J.M., T.R.O.); Center for Neuroscience and Regenerative Medicine, Bethesda, Md (G.R., L.M.F.); Uniformed Services University of the Health Sciences, Bethesda, Md (G.R., A.S., L.M.F.); Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Md (P.H.Y.); Walter Reed National Military Medical Center (WRNMMC), Bethesda, Md (P.K., L.M.F.); and VA Maryland Health Care System (VAMHCS), Baltimore, Md (J.B.P.).
authors.forename: Alice
authors.initials: A
authors.lastname: Smith
authors.affiliation: From the National Capital Neuroimaging Consortium (NCNC), Bethesda, Md (G.R., J.S.S., W.L., J.O., E.S., P.H.Y., J.G., D.N., J.C., J.H., V.E., J.M., T.R.O.); National Intrepid Center of Excellence (NICoE), 4860 S Palmer Rd, Bethesda, MD 20889 (G.R., J.S.S., W.L., J.O., E.S., P.H.Y., J.G., D.N., J.C., L.M.F., V.E., J.M., T.R.O.); Center for Neuroscience and Regenerative Medicine, Bethesda, Md (G.R., L.M.F.); Uniformed Services University of the Health Sciences, Bethesda, Md (G.R., A.S., L.M.F.); Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Md (P.H.Y.); Walter Reed National Military Medical Center (WRNMMC), Bethesda, Md (P.K., L.M.F.); and VA Maryland Health Care System (VAMHCS), Baltimore, Md (J.B.P.).
authors.forename: Ping-Hong
authors.initials: PH
authors.lastname: Yeh
authors.affiliation: From the National Capital Neuroimaging Consortium (NCNC), Bethesda, Md (G.R., J.S.S., W.L., J.O., E.S., P.H.Y., J.G., D.N., J.C., J.H., V.E., J.M., T.R.O.); National Intrepid Center of Excellence (NICoE), 4860 S Palmer Rd, Bethesda, MD 20889 (G.R., J.S.S., W.L., J.O., E.S., P.H.Y., J.G., D.N., J.C., L.M.F., V.E., J.M., T.R.O.); Center for Neuroscience and Regenerative Medicine, Bethesda, Md (G.R., L.M.F.); Uniformed Services University of the Health Sciences, Bethesda, Md (G.R., A.S., L.M.F.); Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Md (P.H.Y.); Walter Reed National Military Medical Center (WRNMMC), Bethesda, Md (P.K., L.M.F.); and VA Maryland Health Care System (VAMHCS), Baltimore, Md (J.B.P.).
authors.forename: John
authors.initials: J
authors.lastname: Graner
authors.affiliation: From the National Capital Neuroimaging Consortium (NCNC), Bethesda, Md (G.R., J.S.S., W.L., J.O., E.S., P.H.Y., J.G., D.N., J.C., J.H., V.E., J.M., T.R.O.); National Intrepid Center of Excellence (NICoE), 4860 S Palmer Rd, Bethesda, MD 20889 (G.R., J.S.S., W.L., J.O., E.S., P.H.Y., J.G., D.N., J.C., L.M.F., V.E., J.M., T.R.O.); Center for Neuroscience and Regenerative Medicine, Bethesda, Md (G.R., L.M.F.); Uniformed Services University of the Health Sciences, Bethesda, Md (G.R., A.S., L.M.F.); Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Md (P.H.Y.); Walter Reed National Military Medical Center (WRNMMC), Bethesda, Md (P.K., L.M.F.); and VA Maryland Health Care System (VAMHCS), Baltimore, Md (J.B.P.).
authors.forename: Dominic
authors.initials: D
authors.lastname: Nathan
authors.affiliation: From the National Capital Neuroimaging Consortium (NCNC), Bethesda, Md (G.R., J.S.S., W.L., J.O., E.S., P.H.Y., J.G., D.N., J.C., J.H., V.E., J.M., T.R.O.); National Intrepid Center of Excellence (NICoE), 4860 S Palmer Rd, Bethesda, MD 20889 (G.R., J.S.S., W.L., J.O., E.S., P.H.Y., J.G., D.N., J.C., L.M.F., V.E., J.M., T.R.O.); Center for Neuroscience and Regenerative Medicine, Bethesda, Md (G.R., L.M.F.); Uniformed Services University of the Health Sciences, Bethesda, Md (G.R., A.S., L.M.F.); Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Md (P.H.Y.); Walter Reed National Military Medical Center (WRNMMC), Bethesda, Md (P.K., L.M.F.); and VA Maryland Health Care System (VAMHCS), Baltimore, Md (J.B.P.).
authors.forename: Jesus
authors.initials: J
authors.lastname: Caban
authors.affiliation: From the National Capital Neuroimaging Consortium (NCNC), Bethesda, Md (G.R., J.S.S., W.L., J.O., E.S., P.H.Y., J.G., D.N., J.C., J.H., V.E., J.M., T.R.O.); National Intrepid Center of Excellence (NICoE), 4860 S Palmer Rd, Bethesda, MD 20889 (G.R., J.S.S., W.L., J.O., E.S., P.H.Y., J.G., D.N., J.C., L.M.F., V.E., J.M., T.R.O.); Center for Neuroscience and Regenerative Medicine, Bethesda, Md (G.R., L.M.F.); Uniformed Services University of the Health Sciences, Bethesda, Md (G.R., A.S., L.M.F.); Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Md (P.H.Y.); Walter Reed National Military Medical Center (WRNMMC), Bethesda, Md (P.K., L.M.F.); and VA Maryland Health Care System (VAMHCS), Baltimore, Md (J.B.P.).
authors.forename: Louis M
authors.initials: LM
authors.lastname: French
authors.affiliation: From the National Capital Neuroimaging Consortium (NCNC), Bethesda, Md (G.R., J.S.S., W.L., J.O., E.S., P.H.Y., J.G., D.N., J.C., J.H., V.E., J.M., T.R.O.); National Intrepid Center of Excellence (NICoE), 4860 S Palmer Rd, Bethesda, MD 20889 (G.R., J.S.S., W.L., J.O., E.S., P.H.Y., J.G., D.N., J.C., L.M.F., V.E., J.M., T.R.O.); Center for Neuroscience and Regenerative Medicine, Bethesda, Md (G.R., L.M.F.); Uniformed Services University of the Health Sciences, Bethesda, Md (G.R., A.S., L.M.F.); Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Md (P.H.Y.); Walter Reed National Military Medical Center (WRNMMC), Bethesda, Md (P.K., L.M.F.); and VA Maryland Health Care System (VAMHCS), Baltimore, Md (J.B.P.).
authors.forename: Jamie
authors.initials: J
authors.lastname: Harper
authors.affiliation: From the National Capital Neuroimaging Consortium (NCNC), Bethesda, Md (G.R., J.S.S., W.L., J.O., E.S., P.H.Y., J.G., D.N., J.C., J.H., V.E., J.M., T.R.O.); National Intrepid Center of Excellence (NICoE), 4860 S Palmer Rd, Bethesda, MD 20889 (G.R., J.S.S., W.L., J.O., E.S., P.H.Y., J.G., D.N., J.C., L.M.F., V.E., J.M., T.R.O.); Center for Neuroscience and Regenerative Medicine, Bethesda, Md (G.R., L.M.F.); Uniformed Services University of the Health Sciences, Bethesda, Md (G.R., A.S., L.M.F.); Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Md (P.H.Y.); Walter Reed National Military Medical Center (WRNMMC), Bethesda, Md (P.K., L.M.F.); and VA Maryland Health Care System (VAMHCS), Baltimore, Md (J.B.P.).
authors.forename: Victoria
authors.initials: V
authors.lastname: Eskay
authors.affiliation: From the National Capital Neuroimaging Consortium (NCNC), Bethesda, Md (G.R., J.S.S., W.L., J.O., E.S., P.H.Y., J.G., D.N., J.C., J.H., V.E., J.M., T.R.O.); National Intrepid Center of Excellence (NICoE), 4860 S Palmer Rd, Bethesda, MD 20889 (G.R., J.S.S., W.L., J.O., E.S., P.H.Y., J.G., D.N., J.C., L.M.F., V.E., J.M., T.R.O.); Center for Neuroscience and Regenerative Medicine, Bethesda, Md (G.R., L.M.F.); Uniformed Services University of the Health Sciences, Bethesda, Md (G.R., A.S., L.M.F.); Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Md (P.H.Y.); Walter Reed National Military Medical Center (WRNMMC), Bethesda, Md (P.K., L.M.F.); and VA Maryland Health Care System (VAMHCS), Baltimore, Md (J.B.P.).
authors.forename: John
authors.initials: J
authors.lastname: Morissette
authors.affiliation: From the National Capital Neuroimaging Consortium (NCNC), Bethesda, Md (G.R., J.S.S., W.L., J.O., E.S., P.H.Y., J.G., D.N., J.C., J.H., V.E., J.M., T.R.O.); National Intrepid Center of Excellence (NICoE), 4860 S Palmer Rd, Bethesda, MD 20889 (G.R., J.S.S., W.L., J.O., E.S., P.H.Y., J.G., D.N., J.C., L.M.F., V.E., J.M., T.R.O.); Center for Neuroscience and Regenerative Medicine, Bethesda, Md (G.R., L.M.F.); Uniformed Services University of the Health Sciences, Bethesda, Md (G.R., A.S., L.M.F.); Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Md (P.H.Y.); Walter Reed National Military Medical Center (WRNMMC), Bethesda, Md (P.K., L.M.F.); and VA Maryland Health Care System (VAMHCS), Baltimore, Md (J.B.P.).
authors.forename: Terrence R
authors.initials: TR
authors.lastname: Oakes
mesh_terms: D000328:Adult; D001753:Blast Injuries / Q000150:complications*; D001930:Brain Injuries / Q000175:diagnosis* / Q000209:etiology*; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional; D015601:Injury Severity Score; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008889:Military Personnel; D011446:Prospective Studies; D014481:United States