Current and prospective roles of magnetic resonance imaging in mild traumatic brain injury
Matilde Sassani, Tara Ghafari, Pradeepa Ruwan Wanni Arachchige, Iman Idrees, Yidian Gao, Alice Waitt, Samuel R. Weaver, Ali Mazaheri, Hannah Lyons, Olivia Grech, Mark Thaller, Caroline Witton, Andrew P. Bagshaw, Martin Wilson, Hyojin Park, Matthew J. Brookes, Jan Novák, Susan P. Mollan, Lisa J. Hill, Samuel J. E. Lucas, James Mitchell, Alexandra J. Sinclair, Aliza Finch, Adam Hampshire, Alice Sitch, Ali Mazaheri, Andrew P. Bagshaw, Asha Strom, Alice Waitt, Andreas Yiangou, Alexander N. Bennett, Angus M. Hunter, Caroline Witton, Davinia Fernández‐Espejo, Dan Ford, Duncan Wilson, Hamid Dehghani, Hyojin Park, Hannah Lyons, Helen Brunger, Henrietta Ellis, Iman Idrees, Ian Varley, Jessica Hubbard, Jun Cao, Jonathan J Deeks, James Mitchell, Jan Novák, Jamie Pringle, John R. Terry, Jack Rogers, Jessikah Fildes, Karen J. Mullinger, Lisa J. Hill, Mark Thaller, Martin Wilson, Matilde Sassani, Matthew J. Brookes, Ned Jenkinson, Ole Møller Jensen, Pete Hellyer, Sebastian C. Coleman, Raymond F. Reynolds, Richard J. Blanch, R. Katie Morris, Ryan Ottridge, Rachel Upthegrove, Pradeepa Ruwan Wanni Arachchige, Sarah Berhane, Samuel J. E. Lucas, S Prosser, Shreshth Dharm-Datta, Tara Ghafari, Waheeda Hawa, Yidian Gao, Alexandra J. Sinclair, Karen J. Mullinger, Davinia Fernández‐Espejo
Abstract
Abstract There is unmet clinical need for biomarkers to predict recovery or the development of long-term sequelae of mild traumatic brain injury, a highly prevalent condition causing a constellation of disabling symptoms. A substantial proportion of patients live with long-lasting sequelae affecting their quality of life and ability to work. At present, symptoms can be assessed through clinical tests; however, there are no imaging or laboratory tests fully reflective of pathophysiology routinely used by clinicians to characterize post-concussive symptoms. Magnetic resonance imaging has potential to link subtle pathophysiological alterations to clinical outcomes. Here, we review the state of the art of MRI research in adults with mild traumatic brain injury and provide recommendations to facilitate transition into clinical practice. Studies utilizing MRI can inform on pathophysiology of mild traumatic brain injury. They suggest presence of early cytotoxic and vasogenic oedema. They also show that mild traumatic brain injury results in cellular injury and microbleeds affecting the integrity of myelin and white matter tracts, all processes that appear to induce delayed vascular reactions and functional changes. Crucially, correlates between MRI parameters and post-concussive symptoms are emerging. Clinical sequences such as T1-weighted MRI, susceptibility-weighted MRI or fluid attenuation inversion recovery could be easily implementable in clinical practice, but are not sufficient, in isolation for prognostication. Diffusion sequences have shown promises and, although in need of analysis standardization, are a research priority. Lastly, arterial spin labelling is emerging as a high-utility research as it could become useful to assess delayed neurovascular response and possible long-term symptoms.