Consistent levels of brain abnormality discovered in mTBI patients

Researchers at the Albert Einstein College of Medicine have made impressive headway in developing a new technique by which physicians can assess concussion patients.

The current study, published today in the online edition of Brain Imaging and Behavior, involved 34 patients — 19 women and 15 men, ages 19 to 64 — who had suffered mild traumatic brain injury (mTBI) as well as 30 healthy control patients. Utilizing an MRI technique known as diffusion tensor imaging (DTI), researchers were able to inspect microstructural abnormalities across the entire brain of each individual patient.

The DTI technology — which is able to detect even the slightest amount of damage to the brain by measuring the direction of water diffusion in white matter — was analyzed by a new software component known as Enhanced Z-score Microstructural Assessment Pathology (EZ-MAP). The results revealed that patients diagnosed with mTBI had unique spatial patterns of low fractional anisotropy (FA). This low volume of FA in mTBI patients evolved steadily over the duration of the study period, the researchers reported.

Afflicted patients were also found to have unique patterns of unusually high FA discernable from the low FA regions. Michael L. Lipton, MD, lead author of the study and associate director of the Gruss Magnetic Resonance Center at the college and medical director of MRI services at Montefiore Medical Center, said researchers found the heightened FA pattern to be consistent even in patients who had suffered injury more than one year prior.

"We suspect that high FA represents a response to the injury. In other words, the brain may be trying to compensate for the injury by developing and enhancing other neural connections. This is a new and unexpected finding," he said.

Concussions are currently diagnosed by taking into consideration the severity of the patient’s accident and the type of symptoms present (dizziness, behavioral alterations, ect.). With the success of the DTI interface combined with EZ-MAP analytics, more secure diagnoses may be possible when treating mTBI patients and predicting the longevity and consistency of their symptoms, the researchers reported. 

The Robust Detection of Traumatic Axonal Injury in Individual Mild Traumatic Brain Injury Patients: Intersubject Variation, Change Over Time and Bidirectional Changes in Anisotropy study stresses the importance of regarding each mTBI case as distinctive. The Centers for Disease Control and Prevention predicts that nearly one million Americans will sustain a head injury this year and a 2003 federal study estimated that concussions cost the U.S. approximately $80 billion annually. Thus, now is as good a time as any to start regarding mTBI cases as more exclusive, Lipton stated.

The authors of the study reported no conflicts of interest.

Illustration attributed to Patrick J. Lynch, medical illustrator, and C. Carl Jaffe, MD, cardiologist, via Creative Commons license.

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