The only way to diagnose chronic traumatic encephalopathy (CTE) previously was with an autopsy, but researchers at UCLA have found a way to use MR to diagnose living patients. They developed a software tool that analyzes MR scans and detects shrinkage in several telltale areas of the brain.

CTE is a disorder that tends to affect former football players and others who have a history of repetitive brain trauma. An MR-based technique that can detect patterns of brain changes can help to assess the brain health of this population.

In a single case report published in the American Journal of Geriatric Psychiatry, the researchers assessed a former high school fullback who played for three years and sustained hundreds of blows to the head, including at least one concussion.
In his late 30s, he started to experience mood swings and difficulties with attention and impulse control. He was initially diagnosed with attention deficit hyperactivity disorder and bipolar disorder, and then sought medical help at UCLA earlier this year.

The physicians conducted neuropsychological tests and confirmed that he had impairments in attention, impulse control, and other measures of executive function. But an MR scan showed no sign of Alzheimer’s, stroke, or dementia.

The MR scan did, however, reveal a few small lesions that were consistent with his history of brain trauma. The researchers then used the FDA-cleared MR software analysis tool called Neuroreader to measure the volumes of 45 different regions of his brain.

Since the patient had an MR performed in 2012, they were able to assess the progression of volume loss over time. They found that he had abnormally low volumes for his brainstem, his ventral diencephalon and frontal lobes.

Over the course of four years, the volumes worsened, which suggested that the disease progressed. In total, his brain lost about 14 percent of its total gray-matter volume.

The researchers are working to develop other methods for diagnosing CTE in living patients, such as PET scans that use radioactive tracers that bind to tau aggregates. However, the MRI-based method would be safer and less expensive.

The MR technique may also help speed CTE research so scientists can get a better understanding of its prevalence and assess potential therapies.

Going forward, the researchers plan to conduct larger studies to analyze the MR data for people with histories of head trauma. That would help them better determine if the technique is useful for detecting CTE.

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