From Lovelace Biomedical Research (J.B.P., T.R.O., P.S.), Albuquerque, New Mexico.
VA Maryland Health Care System (J.B.P.), Baltimore, Maryland.
AJNR Am J Neuroradiol. 2020 Jan;41(1):92-99. doi: 10.3174/ajnr.A6346. Epub 2020 Jan 2.
Routine MR imaging findings are frequently normal following mild traumatic brain injury and have a limited role in diagnosis and management. Advanced MR imaging can assist in detecting pathology and prognostication but is not readily available outside research settings. However, 3D isotropic sequences with ∼1-mm voxel size are available on community MR imaging scanners. Using such sequences, we compared radiologists' findings and quantified regional brain volumes between a mild traumatic brain injury cohort and non-brain-injured controls to describe structural imaging findings associated with mild traumatic brain injury.
Seventy-one military personnel with persistent symptoms and 75 controls underwent 3T MR imaging. Three neuroradiologists interpreted the scans using common data elements. FreeSurfer was used to quantify regional gray and white matter volumes.
WM hyperintensities were seen in 81% of the brain-injured group versus 60% of healthy controls. The odds of ≥1 WM hyperintensity in the brain-injured group was about 3.5 times the odds for healthy controls (95% CI, 1.58-7.72; = .002) after adjustment for age. A frontal lobe-only distribution of WM hyperintensities was more commonly seen in the mild traumatic brain injury cohort. Furthermore, 7 gray matter, 1 white matter, and 2 subcortical gray matter regions demonstrated decreased volumes in the brain-injured group after multiple-comparison correction. The mild traumatic brain injury cohort showed regional parenchymal volume loss.
White matter findings are nonspecific and therefore a clinical challenge. Our results suggest that prior trauma should be considered in the differential diagnosis of multifocal white matter abnormalities with a clinical history of mild traumatic brain injury, particularly when a frontal predilection is observed.
轻度创伤性脑损伤（TBI）后，常规磁共振成像（MR）检查结果通常正常，其在诊断和治疗中的作用有限。高级 MR 成像有助于检测病变和预测预后，但在研究环境之外并不容易获得。然而，社区 MR 成像扫描仪上可获得具有约 1mm 体素大小的 3D 各向同性序列。我们使用这些序列，比较了轻度 TBI 队列和非脑损伤对照者的放射科医生发现和量化的区域性脑容量，以描述与轻度 TBI 相关的结构成像发现。
71 名持续性症状的军事人员和 75 名对照者接受了 3T MR 成像。3 名神经放射科医生使用通用数据元素解读扫描结果。FreeSurfer 用于量化区域性灰质和白质体积。
脑损伤组中 81%的患者存在 WM 高信号，而健康对照组中为 60%。在调整年龄后，脑损伤组中至少存在 1 个 WM 高信号的可能性约为健康对照组的 3.5 倍（95%CI，1.58-7.72；=0.002）。轻度 TBI 队列中更常见的是 WM 高信号的额区分布。此外，在多重比较校正后，脑损伤组的 7 个灰质、1 个白质和 2 个皮质下灰质区域体积减少。脑损伤组表现出区域性实质容量损失。
WM 发现是非特异性的，因此具有临床挑战性。我们的结果表明，对于有轻度 TBI 临床病史的多灶性 WM 异常，应考虑到先前的创伤，特别是当观察到额区倾向时，应在鉴别诊断中考虑到先前的创伤。
