by
Gus Iversen, Editor in Chief | August 12, 2024
Advanced MR scans using diffusion tensor imaging (DTI), could be key in identifying the one in three concussion patients who develop persistent and life-altering symptoms, according to research from the University of Cambridge.
While CT scans are commonly used to detect brain injuries like bruising and bleeding, they identify abnormalities in less than 10% of concussion cases. Despite this, 30-40% of patients discharged after a normal CT scan continue to experience significant symptoms, including severe fatigue, memory problems, and mental health issues, which can persist for years.
Dr. Virginia Newcombe, from the University of Cambridge's Department of Medicine, emphasized the challenge: “The nature of concussion means patients and their GPs often don’t recognize that their symptoms are serious enough to need follow-up. Without objective evidence of a brain injury, such as a scan, these patients often feel that their symptoms are dismissed or ignored when they seek help.”
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Whole brain diffusion tensor tractography in an age-matched control subject and two patients with serial images at approximately two days, six weeks, and one year following severe traumatic brain injury. (Courtesy: Univ. of Cambridge)
The study, published in eClinicalMedicine, demonstrates that DTI can substantially improve prognostic models for patients with concussion. By measuring how water molecules move in tissue, DTI provides detailed images of the brain's white matter tracts, which are often disrupted in concussion. The researchers assigned DTI scores to 153 patients, significantly improving the accuracy of predicting poor outcomes from 69% to 82%.
The team also explored the role of blood biomarkers in improving prognosis, identifying two proteins, GFAP and NFL, which were indicative of patients who might benefit from a DTI scan. Although these biomarkers alone weren't sufficient for a prognosis, they showed potential when combined with DTI.
Dr. Newcombe pointed out the urgent need for better assessment tools, noting that DTI could be integrated into existing MR scanners, making it accessible in many healthcare settings. Future research will focus on further refining these methods and integrating them into clinical practice to better predict and manage concussion outcomes.
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