Neuroimaging of deployment-associated traumatic brain injury (TBI) with a focus on mild TBI (mTBI) since 2009.
David H Salat, Meghan E Robinson, Danielle R Miller and 2 others
PMID 28981347WHAT IT FOUND
Brain scans in military mild TBI suggest possible white matter, activity, and metabolism changes, but findings vary with injury type, timing, PTSD, and imaging method.
No scan is ready to diagnose mild TBI.
Key findings
01No single brain imaging method is clearly best for identifying or assessing military mild TBI.
02Many imaging group differences may be better explained by PTSD than by mild TBI alone.
03After blast mild TBI, white matter changes may be spread unevenly across individuals, so standard group comparisons can miss them.
STILL TO COME
How it was doneWhat they found
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What it does not show
This is a narrative review, not a systematic review, and the authors state they did not fully evaluate all included studies. The reviewed imaging studies used different populations, injury types, times since injury, and imaging methods, so results are hard to compare. Many studies relied on retrospective self-reported TBI history, which can be unreliable and influenced by memory, motivation, or missing records. Symptoms attributed to mild TBI can also come from PTSD or depression, and some studies did not adequately separate these. Blast and blunt trauma often occur together, so the paper cannot show what primary blast alone does to the brain. No imaging method is established as clinically diagnostic for mild TBI.
Declared interests
The authors report no conflicts of interest. The work was supported by the National Institute of Mental Health, the National Institute of Neurological Disorders and Stroke, and the Department of Defense.
The easy way to misread this
Do not conclude that a brain scan can diagnose mild TBI in a Veteran. The review says no imaging method is clearly dominant, the reliability and sensitivity of these methods are not established, and findings vary with injury timing, blast versus blunt trauma, and comorbid PTSD or depression.