Early MRI Urged for Suspected TBI

Performing MRIs as early as possible after a traumatic brain injury (TBI) may detect microhemorrhages or microbleeding, according to a study published in Radiology.

Researchers from the Walter Reed National Military Medical Center, the Center for Neuroscience and Regenerative Medicine, and The Henry M. Jackson Foundation for the Advancement of Military Medicine in Bethesda, MD, Cornell University in New York, NY, and The NorthTide Group in Sterling, VA, sought to determine if they could detect cerebral microhemorrhages among members of the military who had chronic TBI.

“TBI is a large problem for our military service members and their families,” coauthor Gerard Riedy, MD, PhD, chief of neuroimaging at the National Intrepid Center of Excellence at the Walter Reed National Military Medical Center, said in a release. “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.”

A total of 603 subjects participated in the study. The median time from point of injury to imaging was 856 days. All underwent initial MR imaging, and a subset of patients underwent follow-up imaging. Two independent radiologists identified microhemorrhages, which were compared by number, size, and magnetic susceptibility.[[{"type":"media","view_mode":"media_crop","fid":"42503","attributes":{"alt":"Gerard Riedy, MD, PhD","class":"media-image media-image-right","id":"media_crop_6721606436779","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"4613","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"float: right;","title":"Gerard Riedy, MD, PhD","typeof":"foaf:Image"}}]]

Seven percent of the subjects were found to have at least one occurrence of cerebral microhemorrhage.

Most occurrences were found in the frontal subcortical regions (101 microhemorrhages on the left and 73 microhemorrhages on the right side), for a combined total of 30% (174 of 585). The second most affected region was the parietal subcortical region, with 15% of the total microhemorrhages (87 of 585 microhemorrhages, 41 on the right and 46 on the left), followed by the temporal subcortical region, with 14% of the total microhemorrhages (79 of 585 microhemorrhages, 48 on the right and 31 on the left).

The patients were divided into four groups based on time since the injury occurred:

• Fewer than three months

• Three to six months

• Six to 12 months

• More than one year

Cerebral microhemorrhage was identified in 24% of the subjects who were imaged within three months post-injury, compared to 5.2% of those who were imaged over a year later.

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