White matter hyperintensities might not be a marker of TBI after all
New findings are calling into question the notion that white matter hyperintensities are biomarkers of brain injuries.
Published in the American Journal of Roentgenology, the data suggest that white matter hyperintensities on MRI scans should not be used to determine the severity of mild traumatic brain injuries (mTBI). This information is in contrast to what prior studies have determined, authors of the paper note.
“A challenge in management of patients with mild traumatic brain injury is the lack of objective biomarkers to guide diagnosis, classification, and prognostication. White matter hyperintensities on T2-weighted MRI sequences have been identified as a potential marker for this purpose.”
For their study, the team recruited individuals diagnosed with acute mTBI between November 2015 and January 2018. They had the group undergo multiple 3T MRIs including a high-resolution isotropic 3D T2-weighted FLAIR sequence over a period of three months, in addition to a slew of neurological assessments related to concussion symptoms, cognitive function and lifestyle. Two neuroradiologists reviewed the FLAIR sequences from baseline imaging for the presence of at least one WMH, comparing the findings with that of a group of 148 healthy controls.
The findings were comparable among both groups. At least one WMH was observed in 34% of the mTBI group. Of those, 40% displayed abnormal WMHs, defined as “≥5 punctate foci, at least one focus measuring >3 mm, or at least one focus in an atypical location.” Similar findings were noted in the control group, with 35% having WMHs on imaging, 35% of which were considered abnormal. What's more, neither WMHs nor abnormal WMHs were associated with abnormal neurological assessments.
“WMHs did not show significant differences between mTBI and control groups, nor significant associations with clinical markers in the mTBI group,” author Teena Shetty, MD, MPhil, from the Hospital for Special Surgery in New York City, and colleagues note.
Based on their findings, the team urges against using the presence of WMHs as a marker for mTBI.
The study abstract is available here.
In addition to her background in journalism, Hannah also has patient-facing experience in clinical settings, having spent more than 12 years working as a registered rad tech. She began covering the medical imaging industry for Innovate Healthcare in 2021.