Researchers from Cambridge suggest that using a specific brain scan called diffusion tensor imaging MRI for patients with concussion may help identify the one in three individuals who will face long-lasting, significant symptoms.
Researchers from Cambridge propose that utilizing a brain scan known as diffusion tensor imaging MRI for patients with concussion could assist in identifying the one in three individuals likely to suffer from enduring symptoms that can dramatically alter their lives.
Every year, approximately 1 in 200 people in Europe endure a concussion. In the UK alone, over 1 million individuals visit Emergency Departments each year due to recent head injuries, making it the most prevalent type of brain injury globally.
In the UK, when a head injury patient arrives at an Emergency Department, they undergo evaluation based on the NICE head injury guidelines. Depending on their specific symptoms, a CT scan may be conducted to check for any brain injuries like bruising, bleeding, or swelling.
Unfortunately, CT scans reveal abnormalities in less than 10% of concussion patients. Nonetheless, 30-40% of those sent home post-scan continue to experience serious symptoms that could last for years, affecting their quality of life significantly. Common issues include extreme fatigue, memory problems, headaches, and mental health challenges such as anxiety, depression, and post-traumatic stress.
According to Dr. Virginia Newcombe from the University of Cambridge’s Department of Medicine and an Intensive Care Medicine and Emergency Physician at Addenbrooke’s Hospital, “Most head injury patients leave with just a paper outlining post-concussion symptoms and are advised to consult their GP if their condition worsens.”
“The issue is that concussion symptoms are often not recognized by patients or their GPs as severe enough to require further evaluation. Patients often describe it as a ‘hidden disease,’ contrasting with conditions like a broken bone. Without clear evidence of brain injury from a scan, their symptoms frequently feel minimized or overlooked when they seek assistance.”
A study released today in eClinicalMedicine by Dr. Newcombe and her team reveals that an advanced MRI technique named diffusion tensor imaging (DTI) could greatly enhance current predictive models for concussion patients who receive a normal CT scan.
Diving into water molecule movement within tissues, DTI provides intricate images of pathways—referred to as white matter tracts—that connect different brain regions. Standard MRI machines can be modified to collect this data, allowing for the calculation of a DTI “score” based on the number of brain areas showing abnormalities.
Dr. Newcombe and her team analyzed data from over 1,000 participants involved in the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) study conducted from December 2014 to December 2017. They discovered that 38% of these patients did not fully recover, experiencing ongoing symptoms three months after being discharged.
The team evaluated DTI scores in the 153 patients who underwent DTI scanning. This significantly enhanced the accuracy of outcome predictions: the existing clinical model accurately forecasts a poorer outcome in 69 out of 100 cases, while with DTI, this rose to 82 out of 100 cases.
The researchers also examined blood biomarkers—proteins released due to head injury—to determine if they could improve prognostic accuracy. Though biomarkers alone were insufficient, levels of two specific proteins—glial fibrillary acidic protein (GFAP) within the first 12 hours and neurofilament light (NFL) between 12 and 24 hours post-injury—helped in identifying patients who might benefit from a DTI scan.
Dr. Newcombe stated, “Concussion is the leading neurological condition affecting adults; however, health services lack the capacity to routinely follow up with every patient, underscoring the need to identify those at highest risk for enduring symptoms.”
“Current assessment methods post-head injury fall short. Yet DTI—feasible at any facility with an MRI machine—can lead to significantly better evaluations. Given the substantial impact concussion symptoms can have on an individual’s life, this improvement is urgently needed.”
The research team plans to further investigate blood biomarkers to find simpler, more effective predictive methods. They are also looking into ways to make DTI more accessible in clinical settings.
Dr. Sophie Richter, a NIHR Clinical Lecturer in Emergency Medicine and the study’s lead author from Cambridge, added, “We aim to explore how to integrate various pieces of information, such as symptom assessments, blood tests, and brain scans, when a patient presents with a brain injury. This integration could enhance our evaluations of injuries and prognoses.”
This research was supported by funds from the European Union’s Seventh Framework Programme, Wellcome, and the National Institute for Health and Care Excellence.