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MRI Study Finds ‘Brain Scars’ in Troops With Blast-Related mTBI

by U.S. Medicine

February 4, 2016

Researchers ‘Surprised’ by Extent of Damage

By Brenda L. Mooney

BETHESDA, MD — “Brain scars” were detected in more than half of the active-duty servicemembers who underwent magnetic resonance imaging (MRI) in a recent study, even though they had been diagnosed with blast-related mild traumatic brain injury (mTBI), not a more-serious condition.

During the conflicts in Iraq and Afghanistan between 2000 and 2015, mTBI, essentially a concussion, was diagnosed in more than 300,000 troops, according to the Armed Forces Health Surveillance Center.

While mTBI usually is diagnosed based on behavioral observations as well as patient recall of events, such as post-traumatic amnesia and loss of consciousness, the military has been seeking a better way to assess and diagnosis the condition.

IED-photo-slider

In 2011, U.S. Army Pfc. Richard Mills, security forces rifleman attached to Provincial Reconstruction Team Zabul, secures his eyes and ears as Afghan National Army soldiers conduct a controlled detonation of a Taliban-planted Senior Airman Grovert Fuentes-Contreras

That’s why Gerard Riedy, MD, PhD, from the National Intrepid Center of Excellence (NICoE) at the Walter Reed National Military Medical Center in Bethesda, MD, led a study to look at advanced brain imaging with MRI as a tool for assessing mTBI.

“Working at Walter Reed, I saw people with mTBI get routine brain scans, and I thought we could do better,” Riedy said. Results were published recently in the journal Radiology.1

The study team used MRI to look at 834 military servicemembers with mTBI related to blast injuries and compared them with 42 participants without any type of TBI. More than 84% of them reported one or more blast-related incidents, and 63% reported loss of consciousness at the time of injury.

Scans found white matter T2 hyperintensities, i.e., “brain scars,” in 52% of the mTBI patients. Cerebral microhemorrhages were observed in a small percentage, 7.2%, and showed increased incidence with TBI severity

“Blast-related injury and loss of consciousness is common in military TBI,” study authors wrote. “Structural MR imaging demonstrates a high incidence of white matter T2-weighted hyperintense areas and pituitary abnormalities, with a low incidence of microhemorrhage in the chronic phase.”

“We were really surprised to see so much damage to the brain in the mTBI patients,” Riedy recounted. “It’s expected that people with mTBI should have normal MRI results, yet more than 50% had these abnormalities.”

The research also uncovered pituitary abnormalities in almost one-third of the patients, 29%. Previous research has shown a decline in pituitary function in troops with mild brain injury, possibly related to blast-related trauma, according to the study.

“A scar on a brain scan is an objective finding,” Riedy pointed out. “We start with the objective and build a foundation for the correct diagnosis of mTBI and then bring in the subjective measures later.”

The study said it included radiologic observations from the largest advanced neuroimaging cohort of military TBI participants ever described, emphasizing, “Neuroimaging has the advantage of objective identification of lesions that potentially serve as biomarkers for TBI.”

Injured servicemembers already have benefitted from the discovery, he said, adding, “An objective measure of traumatic brain injury can lead to proper therapies.”

For the first time, he explained, patients can see what had been called the invisible wounds of war.


6 Comments

  • Barbara Cross says:

    What is the clinical relevance of this finding? Sm/Veterans are already being treated for residuals based on the reported history and objective findings of clinicians, what will this add other than to reinforce the notion that they are brain damaged or broken. If they have a scar then what? How is this going to change treatment of residuals since the scientific publications state the trajectory is resolution of symptoms in days to months?

  • Richard Wayne says:

    Interesting. I wish to review the full article but no full reference was made available, what is the full Citation of this referenced article? Thank you.

  • Dan McArthur says:

    A nonspecific T2 hyperintensity is a common incidental finding, not a “brain scar”.

  • Barbara Cross says:

    What is the clinical relevance of this finding? Sm/Veterans are already being treated for residuals based on the reported history and objective findings of clinicians, what will this add other than to reinforce the notion that they are brain damaged or broken. If they have a scar then what? How is this going to change treatment of residuals since the scientific publications state the trajectory is resolution of symptoms in days to months?

  • Richard Wayne says:

    Interesting. I wish to review the full article but no full reference was made available, what is the full Citation of this referenced article? Thank you.

  • Dan McArthur says:

    A nonspecific T2 hyperintensity is a common incidental finding, not a “brain scar”.


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