Persistent MRI Findings Unique to Blast and Repetitive Mild TBI: Analysis of the CENC/LIMBIC Cohort Injury Characteristics

David F Tate; Benjamin S C Wade; Carmen S Velez; Erin D Bigler; Nicholas D Davenport; Emily L Dennis; Carrie Esopenko; Sidney R Hinds; Jacob Kean; Eamonn Kennedy; Kimbra Kenney; Andrew R Mayer; Mary R Newsome; Carissa L Philippi; Mary J Pugh; Randall S Scheibel; Brian A Taylor; Maya Troyanskaya; John K Werner; Gerald E York; William Walker; Elisabeth A Wilde

doi:10.1093/milmed/usae031

Persistent MRI Findings Unique to Blast and Repetitive Mild TBI: Analysis of the CENC/LIMBIC Cohort Injury Characteristics

Mil Med. 2024 Feb 24:usae031. doi: 10.1093/milmed/usae031. Online ahead of print.

Authors

David F Tate^{1

2

3}, Benjamin S C Wade^{1

4}, Carmen S Velez^{1

2}, Erin D Bigler^{1

3

5}, Nicholas D Davenport^{6

7}, Emily L Dennis^{1

2}, Carrie Esopenko⁸, Sidney R Hinds⁹, Jacob Kean^{2

10}, Eamonn Kennedy¹⁰, Kimbra Kenney^{9

11}, Andrew R Mayer¹², Mary R Newsome^{13

14}, Carissa L Philippi¹⁵, Mary J Pugh^{2

10}, Randall S Scheibel^{13

14}, Brian A Taylor¹⁶, Maya Troyanskaya^{13

14}, John K Werner⁹, Gerald E York¹⁷, William Walker¹⁸, Elisabeth A Wilde^{1

2

13

14}

Affiliations

¹ Department of Neurology, Traumatic Brain Injury and Concussion Center, University of Utah, Salt Lake City, UT 84132, USA.
² George E. Wahlen VA Salt Lake City Healthcare System, Salt Lake City, UT 84148, USA.
³ Department of Psychology, Brigham Young University, Provo, UT 84604, USA.
⁴ Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA.
⁵ Departments of Neuroscience, Brigham Young University, Provo, UT 84604, USA.
⁶ Minneapolis Veterans Affairs Health Care System, Minneapolis, MN 55417, USA.
⁷ Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, MN 55454, USA.
⁸ Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA.
⁹ Department of Neurology, Uniformed Services University, Bethesda, MD 20814, USA.
¹⁰ Department of Population Health Sciences, University of Utah, Salt Lake City, UT 84108, USA.
¹¹ National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD 20814, USA.
¹² The Mind Research Network, University of New Mexico Health Science Center, Albuquerque, NM 87106, USA.
¹³ Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX 77030, USA.
¹⁴ H. Ben Taub Department of Physical Medicine & Rehabilitation, Baylor College of Medicine, Houston, TX 77030, USA.
¹⁵ Department of Psychological Sciences, University of Missouri-St. Louis, St. Louis, MO 63121, St. Louis.
¹⁶ Department of Imaging Physics, The University of Texas M. D. Anderson Cancer Center, Houston, TX 77030, USA.
¹⁷ Imaging Associates of Alaska, Anchorage, AK 99508, USA.
¹⁸ Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, VA 23298, USA.

PMID: 38401164
DOI: 10.1093/milmed/usae031

Abstract

Introduction: MRI represents one of the clinical tools at the forefront of research efforts aimed at identifying diagnostic and prognostic biomarkers following traumatic brain injury (TBI). Both volumetric and diffusion MRI findings in mild TBI (mTBI) are mixed, making the findings difficult to interpret. As such, additional research is needed to continue to elucidate the relationship between the clinical features of mTBI and quantitative MRI measurements.

Material and methods: Volumetric and diffusion imaging data in a sample of 976 veterans and service members from the Chronic Effects of Neurotrauma Consortium and now the Long-Term Impact of Military-Relevant Brain Injury Consortium observational study of the late effects of mTBI in combat with and without a history of mTBI were examined. A series of regression models with link functions appropriate for the model outcome were used to evaluate the relationships among imaging measures and clinical features of mTBI. Each model included acquisition site, participant sex, and age as covariates. Separate regression models were fit for each region of interest where said region was a predictor.

Results: After controlling for multiple comparisons, no significant main effect was noted for comparisons between veterans and service members with and without a history of mTBI. However, blast-related mTBI were associated with volumetric reductions of several subregions of the corpus callosum compared to non-blast-related mTBI. Several volumetric (i.e., hippocampal subfields, etc.) and diffusion (i.e., corona radiata, superior longitudinal fasciculus, etc.) MRI findings were noted to be associated with an increased number of repetitive mTBIs versus.

Conclusions: In deployment-related mTBI, significant findings in this cohort were only observed when considering mTBI sub-groups (blast mechanism and total number/dose). Simply comparing healthy controls and those with a positive mTBI history is likely an oversimplification that may lead to non-significant findings, even in consortium analyses.

Abstract

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