Study shows brain scarring in more than half of concussed military members

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 - MTBI MRI brain scars
Axial T2 FLAIR image shows multiple white matter T2-weighted hyperintense areas (arrows) in a 28-year-old man with blast-related mild TBI. This patient had a total of 76 lesions on all sections.
Source: RSNA

The largest imaging-based study yet of active-duty U.S. service members suffering blast-related concussions has found that many more than expected develop white matter T2 hyperintensities, also known as “brain scars.”

Led by Gerard Riedy, MD, PhD, a Walter Reed research team used MRI to study 834 military service members with mild traumatic brain injury (MTBI) related to blast injuries.

Of these, more than half—432, or just under 52 percent—showed brain scarring, while a large subset (242 of 834, or 29 percent) had blast-associated abnormalities of the pituitary gland.

Meanwhile Riedy et al. observed cerebral microhemorrhages in a small but not insignificant number of participants (60 of 834, or 7.2 percent).

The high count of visually observable injuries may have owed to the number and severity of the blasts, as more than 84 percent survived one or more explosions and 63 percent reported being knocked out cold by a blast.

The study appeared online ahead of print Dec. 15 in  Radiology.

In a news release announcing the study’s publication,  Radiology publisher RSNA notes that, up to now, MTBI assessment has consisted largely of observing patient behavior and gauging levels of amnesia and other signs of cognitive struggle.

“A scar on a brain scan is an objective finding,” Riedy said in prepared remarks. “We start with the objective and build a foundation for the correct diagnosis of MTBI and then bring in the subjective measures later.”

Riedy adds that, until now, it was expected that people with MTBI would have normal MRI results.

“We were really surprised to see so much damage to the brain,” he says of the 52-percent finding.

The research has already helped military personnel and their families, according to the RSNA, as the advanced imaging allows those affected to “see for the first time what has previously been called the invisible wounds of war.”

RSNA points out that the research will further help guide MTBI therapies as distinct from those for post-traumatic stress, as symptoms for the two conditions often overlap but treatments for one are unlikely to work on the other.

According to the Armed Forces Health Surveillance Center, more than 300,000 service members have been diagnosed with MTBI between 2000 and 2015.