From impact to recovery: tracking mild traumatic brain injury with MRI-a pilot study and case series

Background Diagnosis and recovery tracking of mild traumatic brain injury (mTBI) is often challenging due to the lack of clear findings on routine imaging techniques. This also complicates defining safe points for returning to activities.Hypothesis/purpose Quantitative susceptibility mapping (QSM) can provide information about cerebral venous oxygen saturation (CSvO2) in the context of brain injury. We tested the prediction that these imaging modalities would enable the detection of changes and recovery patterns in the brains of patients with mTBI.Study design In a case-control study, we recruited a cohort of 24 contact sport athletes for baseline QSM and resting-state functional MRI (rs-fMRI) scanning. Two of those who subsequently experienced head impact with significant post-injury symptoms underwent scans at 3, 7, 14 and 28 days post-injury; one had a boxing match without classical mTBI symptoms were also followed-up on.Results The cohort baseline QSM measurements of the straight sinus were established. The two injured athletes with post-impact symptoms consistent with mTBI had susceptibility results at days 3 and 7 post-impact that fell below the 25th percentile of the baseline values. The per cent amplitude fluctuation quantified from rs-fMRI agreed with the susceptibility trends in the straight sinus.Conclusion QSM holds promise as a diagnostic tool for tracking mTBI progression or recovery in contact sport head injury.