title: MR imaging findings in mild traumatic brain injury with persistent neurological impairment.
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.
  
  
  
  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.
  
  
  
  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 <45years 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.
  
  
  
  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.
authors.affiliation: Center for Neurological Studies, 23400 Michigan Ave., Suite 210, Dearborn 48124, MI, United States. Electronic address: gabby@neurologicstudies.com.
authors.forename: Gabriela
authors.initials: G
authors.lastname: Trifan
authors.affiliation: 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. Electronic address: ramtilak.gattu@wayne.edu.
authors.forename: Ramtilak
authors.initials: R
authors.lastname: Gattu
authors.affiliation: 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; Department of Biomedical Engineering, Wayne State University, Detroit 48201, MI, United States. Electronic address: nmrimaging@aol.com.
authors.forename: Ewart Mark
authors.initials: EM
authors.lastname: Haacke
authors.affiliation: 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; Department of Biomedical Engineering, Wayne State University, Detroit 48201, MI, United States. Electronic address: zhifeng_kou@wayne.edu.
authors.forename: Zhifeng
authors.initials: Z
authors.lastname: Kou
authors.affiliation: Center for Neurological Studies, 23400 Michigan Ave., Suite 210, Dearborn 48124, MI, United States. Electronic address: drbenson@neurologicstudies.com.
authors.forename: Randall R
authors.initials: RR
authors.lastname: Benson
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001921:Brain / Q000000981:diagnostic imaging / Q000473:pathology; D001924:Brain Concussion / Q000150:complications / Q000000981:diagnostic imaging* / Q000473:pathology*; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009422:Nervous System Diseases / Q000150:complications / Q000000981:diagnostic imaging* / Q000473:pathology*; D012189:Retrospective Studies; D055815:Young Adult
keywords: Agerelated; Deep; Detection; Flair; Fluid-attenuated inversion recovery; Hyperintensities; Litigation; MRI; Microhemorrhage; Mild TBI; Post concussive symptoms; SWI; Sensitivity; Subcortical; Susceptibility-weighted imaging; Traumatic brain injury; White matter