Quantitative dynamic contrast-enhanced MR imaging shows widespread blood-brain barrier disruption in mild traumatic brain injury patients with post-concussion syndrome

Abstract

ObjectivesTo explore the utility of dynamic contrast-enhanced (DCE) MR imaging for quantitative analysis of blood-brain barrier disruption in mild traumatic brain injury (mTBI) patients with post-concussion syndrome (PCS).MethodsForty-four consecutive patients with PCS after mTBI and 32 controls were included in this retrospective study. K-trans and v(e) from DCE MR imaging were analyzed at contrast-enhancing lesions, T2 hyperintense white matter (WM) lesions, normal-appearing white matter (NAWM), and predilection sites for diffuse axonal injury (Location(DAI)). The Mann-Whitney U-test was performed to compare the parameters between mTBI patients and controls and the parameters were correlated with neuropsychological tests using Mann-Whitney U-test and Spearman rank correlation.ResultsThe median v(e) of the T2 hyperintense WM lesions in mTBI patients (n=21) was higher than that of NAWM in controls (p=.027). Both median K-trans and v(e) at NAWM were also significantly higher in mTBI patients than in controls (p=.023 and p=.029, respectively). In addition, mTBI patients had higher K-trans and v(e) at Location(DAI) than controls (p=.008 and p=.015, respectively). VLT (delayed recall) scores were significantly correlated with v(e) values at T2 hyperintense WM lesions (p=-0.767, p=.044). The median v(e) at Location(DAI) was significantly higher in patients with atypical performance in the digit span test (forward) than in those with average or good performance (p=.043).ConclusionsmTBI patients with PCS had higher K-trans and v(e) values than controls not only at T2 hyperintense WM lesions but also at NAWM and Location(DAI). BBB disruption may be implicated in development of PCS in mTBI patients.Key Points center dot mTBI patients with PCS had higher permeability than controls at T2 hyperintense WM lesions on DCE MR imaging.center dot mTBI patients with PCS had higher permeability than controls also at NAWM and predilection sites for DAI.center dot BBB disruption may be implicated in the development of PCS in mTBI patients. c. European Society of Radiology 2018