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Background <p>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).</p> Objective <p>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 T<sub>1</sub>.</p> Materials and methods <p>Neurologically healthy controls (n = 37) and patients with persistent symptoms following TBI (n = 29) were examined with T<sub>2</sub>-FLAIR and dSIR sequences. T<sub>2</sub>-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.</p> Results <p>Overt pathology was seen on the T<sub>2</sub>-FLAIR images in six msTBI patients and one mTBI patient. No widespread changes were seen on the T<sub>2</sub>-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 <b>κ =</b> 0.85.</p> Conclusion <p>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.</p>

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

  • 期刊论文

  • 发表日期：

    2025年12月16日

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  • Daniel Cornfeld,
  • Gil Newburn,
  • Paul Condron,
  • Taylor Emsden,
  • Mark Bydder,
  • Miriam Scadeng,
  • Tracy Melzer,
  • Leigh Potter,
  • Samantha Holdsworth,
  • Eryn Kwon,
  • Joshua McGeown,
  • Graeme Bydder

摘要

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.