title: Susceptibility Weighted Imaging and White Matter Abnormality Findings in Service Members With Persistent Cognitive Symptoms Following Mild Traumatic Brain Injury.
abstract: Mild traumatic brain injury (mTBI) is a major health concern among active duty service members and Veterans returning from combat operations, and it can result in variable clinical and cognitive outcomes. Identifying biomarkers that can improve diagnosis and prognostication has been at the forefront of recent research efforts. The purpose of this study was to compare the sensitivity and specificity of abnormalities identified using more traditional magnetic resonance imaging (MRI) sequences such as fluid attenuation inversion recovery (FLAIR) to more advanced MRI sequences such as susceptibility weighted imaging (SWI) among a cohort of active duty service members experiencing persistent cognitive symptoms after mTBI. One-hundred and fifty-two active duty service members (77 mTBI, 58 orthopedically injured [OI] only, 17 post-traumatic stress disorder [PTSD] only) underwent MRI and neuropsychological evaluation at a large military treatment facility. Results demonstrated that FLAIR white matter hyperintensities (WMHs) were present in all three groups at statistically similar rates (41% mTBI, 49% OI, and 29% PTSD). With the exception of a single OI participant showing a small discrete SWI lesion, SWI abnormalities were overwhelmingly present in mTBI patients (22% mTBI, 1% OI, and 0% PTSD). Functionally, mTBI participants with and without SWI abnormalities did not differ in demographics, symptom reporting, or cognitive performance. However, mTBI participants with and without WMH did differ for on measures of working memory with the mTBI participants with WMH having worse cognitive performance. No other significant differences were noted for those participants with and without imaging abnormalities for either the OI or PTSD only cohorts. These results appear to illustrate the sensitivity and specificity of SWI findings though these results did not have any significant functional impact in this cohort. In contrast, WMHs noted on FLAIR imaging were not sensitive or specific findings, but functionally relevant among mTBI participants. These findings emphasize the complexity of injury and functional outcome in mTBI patients that requires additional examination.
authors.affiliation: Missouri Institute of Mental Health, University of Missouri-St Louis, 4633 World Parkway Circle, Berkeley, MO 63134.
authors.forename: David F
authors.initials: DF
authors.lastname: Tate
authors.affiliation: Department of Radiology, Brooke Army Medical Center, 3551 Roger Brooke Drive, Fort Sam Houston, TX 78234.
authors.forename: Maria
authors.initials: M
authors.lastname: Gusman
authors.affiliation: Austin Radiological Associates, 12554 Riata Vista Circle, Austin, TX 78727.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Kini
authors.affiliation: General Dynamic Technologies, Defense and Veterans Brain Injury Centers, Brooke Army Medical Center, 3551 Roger Brooke Drive, Fort Sam Houston, TX 78234.
authors.forename: Matthew
authors.initials: M
authors.lastname: Reid
authors.affiliation: Missouri Institute of Mental Health, University of Missouri-St Louis, 4633 World Parkway Circle, Berkeley, MO 63134.
authors.forename: Carmen S
authors.initials: CS
authors.lastname: Velez
authors.affiliation: General Dynamic Technologies, Defense and Veterans Brain Injury Centers, Brooke Army Medical Center, 3551 Roger Brooke Drive, Fort Sam Houston, TX 78234.
authors.forename: Ann Marie
authors.initials: AM
authors.lastname: Drennon
authors.affiliation: General Dynamic Technologies, Defense and Veterans Brain Injury Centers, Brooke Army Medical Center, 3551 Roger Brooke Drive, Fort Sam Houston, TX 78234.
authors.forename: Douglas B
authors.initials: DB
authors.lastname: Cooper
authors.affiliation: General Dynamic Technologies, Defense and Veterans Brain Injury Centers, Brooke Army Medical Center, 3551 Roger Brooke Drive, Fort Sam Houston, TX 78234.
authors.forename: Jan E
authors.initials: JE
authors.lastname: Kennedy
authors.affiliation: Brain Injury Rehabilitation Service, Department of Rehabilitation, Brooke Army Medical Center, 3551 Roger Brooke Drive, Fort Sam Houston, TX 78234.
authors.forename: Amy O
authors.initials: AO
authors.lastname: Bowles
authors.affiliation: Department of Psychology and Neuroscience Center, Brigham Young University, 1001 SWKT, Provo, UT 84604.
authors.forename: Erin D
authors.initials: ED
authors.lastname: Bigler
authors.affiliation: Department of Neurology, Uniformed Services University of the Health Sciences School of Medicine, 4301 Jones Bridge Road, Bethesda, MD 20814.
authors.forename: Jeffrey D
authors.initials: JD
authors.lastname: Lewis
authors.affiliation: Austin Radiological Associates, 12554 Riata Vista Circle, Austin, TX 78727.
authors.forename: John
authors.initials: J
authors.lastname: Ritter
authors.affiliation: Alaska Radiology Associates, TBI Imaging and Research, 3650 Piper Street, Suite A, Anchorage, AK 99508.
authors.forename: Gerald E
authors.initials: GE
authors.lastname: York
mesh_terms: D000328:Adult; D001924:Brain Concussion / Q000150:complications*; D001930:Brain Injuries / Q000150:complications / Q000503:physiopathology; D000070642:Brain Injuries, Traumatic / Q000175:diagnosis; D060825:Cognitive Dysfunction / Q000175:diagnosis / Q000209:etiology*; D020833:Diffuse Axonal Injury / Q000175:diagnosis; D005260:Female; D006801:Humans; D056784:Leukoencephalopathies / Q000175:diagnosis* / Q000453:epidemiology; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008889:Military Personnel / Q000706:statistics & numerical data*; D012680:Sensitivity and Specificity; D013313:Stress Disorders, Post-Traumatic / Q000175:diagnosis / Q000503:physiopathology; D014057:Tomography, X-Ray Computed / Q000379:methods; D014728:Veterans / Q000706:statistics & numerical data