Summary: Cambridge researchers suggest that diffusion tensor imaging (DTI) MRI could better identify concussion patients at risk of life-changing symptoms, significantly improving prognosis accuracy compared to standard CT scans.

Key Takeaways

  1. Diffusion tensor imaging (DTI) MRI could significantly improve the identification of concussion patients at risk for long-term, life-changing symptoms, compared to standard CT scans.
  2. CT scans often fail to detect abnormalities in concussion cases, leading to undiagnosed persistent symptoms in 30%-40% of patients, including severe fatigue, memory loss, and mental health issues.
  3. The integration of DTI MRI and blood biomarkers into clinical practice could greatly enhance prognostic accuracy and improve follow-up care for concussion patients.

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Offering concussion patients a type of MRI scan, called diffusion tensor imaging (DTI), could identify the one in three who may suffer life-changing symptoms, according to Cambridge researchers.

Concussion Symptoms Often Overlooked

Each year, one in 200 Europeans suffer a concussion. In the U.K., over 1 million people visit emergency departments annually for head injuries, the most common brain injury worldwide. UK patients are assessed following National Institute for Health and Care Excellence guidelines, with CT scans used to detect injuries like bruising, bleeding, and swelling based on symptoms.

However, CT scans detect abnormalities in fewer than one in 10 concussion cases, yet 30%-40% of patients discharged after a scan endure significant, potentially life-changing symptoms, such as severe fatigue, memory loss, headaches, and mental health issues.

Virginia Newcombe, PhD, from the University of Cambridge and Addenbrooke’s Hospital, says: “Most head injury patients are sent home with a list of post-concussion symptoms to watch for, advised to seek help from their GP if symptoms worsen. “The issue is that concussion symptoms are often overlooked by both patients and GPs, as they don’t always appear severe enough to warrant follow-up. Without objective evidence, like a scan, patients feel their symptoms are dismissed.”

DTI MRI Improves Concussion Prognosis

In a study published in eClinicalMedicine, Newcombe and colleagues demonstrate that DTI MRI can greatly enhance prognostic models for patients with normal CT scans. DTI measures water movement in tissues, providing detailed images of brain pathways (white matter tracts). Standard MRI scanners can measure this data, producing a DTI ‘score’ based on brain region abnormalities.

Newcombe’s team analyzed data from more than 1,000 patients in the CENTER-TBI study (2014-2017). Among those, 38% had incomplete recoveries, with symptoms persisting three months post-discharge. Assigning DTI scores to 153 patients significantly improved prognosis accuracy—from 69 to 82 correct predictions out of 100.

The researchers also examined blood biomarkers—proteins released by head injuries—for their prognostic potential. While biomarkers alone weren’t sufficient, two proteins—GFAP (within 12 hours) and NFL (12-24 hours)—helped identify patients who might benefit from a DTI scan.

Newcombe emphasizes the need for better assessment tools, given the significant impact of concussion symptoms on lives. The team plans to further explore biomarkers and integrate DTI into clinical practice.

Sophie Richter, PhD, a study co-author, adds: “We aim to combine different patient information—symptoms, blood tests, and brain scans—to improve injury assessment and prognosis.”