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How Early MRI Could Improve Traumatic Brain Injury Care

Between one-fifth and one-fourth of military personnel serving in Iraq and Afghanistan sustained a traumatic brain injury (TBI) during their service, according to the Institute of Medicine. Neuroimaging physicians at Walter Reed National Military Medical Center in Bethesda, Maryland, believe earlier MRI imaging of those patients might someday lead to better outcomes among afflicted servicemen and women.

“TBI is a large problem for our military service members and their families,” says Gerard Riedy, MD, PhD, chief of neuroimaging at the National Intrepid Center of Excellence at the Walter Reed National Military Medical Center. “We found that many of those who have served and suffered this type of injury were not imaged until many, many months after injury occurred, thus resulting in lower rates of cerebral microhemorrhage detection, which delays treatment.”

To examine the idea, Riedy and colleagues used susceptibility-weighted MR imaging, which is highly sensitive for imaging hemorrhage, to evaluate 603 military service members with TBI. The scan can image cerebral microhemorrhages that occur as a direct result of TBI and can lead to severe secondary injuries such as brain swelling or stroke. The capability to monitor the evolution of microhemorrhages might provide important information regarding disease progression or recovery. The study results were published online in the journal Radiology.

The patients were divided into four groups based on time since the injury occurred, ranging from less than three months to more than a year (median was 856 days). The results found that those who were imaged more than a year after the injury had a much lower occurrence of cerebral microhemorrhages than those who were scanned 12 months or fewer after TBI.

Cerebral microhemorrhage was identified in 24% of military personnel who were imaged within three months postinjury, compared to 5.2% of the patients who were imaged more than a year later. Overall, 7% of the 603 military service members who participated in the study were found to have at least one occurrence of cerebral microhemorrhage.

The researchers attribute this to changes in iron deposits in the brain as time goes on, making it more difficult to detect microbleeding, according to a press release describing the study. The nearly 19 percentage-point difference between personnel who were imaged closer to when they were injured suggests that earlier imaging in the field might lead to the opportunity to treat patients sooner.

“Early characterization of cerebral microhemorrhages may help explain clinical symptoms of acute TBI and identify the severity of brain damage,” Riedy says. “We believe that having access to MRI in the field would facilitate early detection of TBI, thus providing timely treatment.”

The study also supports previous claims that using susceptibility-weighted imaging to evaluate brain injury patients may be more effective than conventional MRI. In this study’s capacity, using susceptibility-weighted imaging resulted in detecting significantly more microhemorrhages due to a higher spatial resolution and signal, with 77% of cerebral microhemorrhages appearing more evident through susceptibility-weighted imaging when compared to conventional MRI.