Ultra-high contrast MRI: a new technique for recognizing secondary changes to the brain in patients with persistent symptoms following traumatic brain injury

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Abstract
Background Management of patients with persistent or worsening symptoms following traumatic brain injury (TBI) presents difficulties. MRI is usually negative in mild TBI (mTBI) and usually only shows residual quiescent disease in moderate to severe TBI (msTBI). Objective We hypothesize that patients with persistent symptoms from prior TBI will show findings on a divided Subtracted Inversion Recovery (dSIR) sequence that are sensitive to small changes from normal in white matter T1. Materials and methods Neurologically healthy controls (n = 37) and patients with persistent symptoms following TBI (n = 29) were examined with T2-FLAIR and dSIR sequences. T2-FLAIR images were evaluated for minor changes and overt pathology. dSIR images were evaluated for “whiteout signs” defined as widespread, bilateral, and symmetrical high signal in white matter. Odds ratios were calculated for the association between the presence of a whiteout sign and being in the symptomatic group. Results Overt pathology was seen on the T2-FLAIR images in six msTBI patients and one mTBI patient. No widespread changes were seen on the T2-FLAIR images in the control or TBI groups. Whiteout signs were seen on the dSIR images in 25 of 29 TBI patients and in three of 37 controls. The whiteout sign was strongly associated with symptomatic TBI status, with odds ratios ≥ 14. The kappa statistic for inter-reader correlation (whiteout sign vs. no whiteout sign) was κ = 0.85. Conclusion The whiteout sign was strongly associated with being in the symptomatic group and is a potential biomarker for recognition of secondary changes to the brain in patients with persistent symptoms following TBI.
Funding Information
  • Fred Lewis Enterprise Foundation
  • Hugh Green Foundation
  • JN & HB Williams Foundation
  • Mangatawa Beale Williams Memorial Trust
  • Neurological Foundation of New Zealand
  • Trust Tairāwhiti
  • Friends of Mātai Blue Sky Fund
  • GE Healthcare
  • Mātai Ngā Māngai Maori
  • Kānoa—Regional Economic Development & Investment Unit of New Zealand

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