Researchers from the University of Cambridge have found that offering patients with concussion a brain scan known as diffusion tensor imaging MRI could help identify those at risk of experiencing persistent symptoms that can be life changing. Concussion is a common form of brain injury, with more than 1 million people in the UK attending Emergency Departments annually with head injuries. Currently, patients are assessed according to the NICE head injury guidelines and may be referred for a CT scan to look for brain injuries such as bruising, bleeding, and swelling. However, CT scans only identify abnormalities in a small percentage of patients with concussion.
Many patients discharged from the Emergency Department following a normal CT scan experience significant symptoms that can last for years, including severe fatigue, poor memory, headaches, and mental health issues. Dr. Virginia Newcombe, an Intensive Care Medicine and Emergency Physician, explains that patients often feel that their symptoms are dismissed or ignored without objective evidence of a brain injury. Diffusion tensor imaging (DTI) is an advanced form of MRI that measures how water molecules move in brain tissue, providing detailed images of the pathways that connect different parts of the brain. By using DTI, researchers were able to improve the accuracy of prognostic models for patients with concussion.
The study, published in eClinicalMedicine, analyzed data from over 1,000 patients and found that DTI scores could significantly enhance the current clinical model’s ability to predict a patient’s outcome following a concussion. By utilizing DTI scores, researchers could accurately predict a poorer outcome in 82 out of 100 cases, compared to 69 out of 100 with the current clinical model. Additionally, blood biomarkers were also investigated to see if they could improve the accuracy of prognosis. Two specific proteins, GFAP and NFL, were found to be useful in identifying patients who may benefit from a DTI scan.
Dr. Newcombe emphasizes the importance of identifying patients at greatest risk of persistent symptoms following a concussion, as current methods for assessing outcomes are not sufficient. Implementing DTI scans, which can be easily done in any center with an MRI scanner, can provide much more accurate assessments of a patient’s prognosis. The research team plans to further explore blood biomarkers to find simpler and more practical predictors, as well as ways to integrate different types of information obtained when a patient presents with a brain injury to improve assessment and prognosis.
The research was funded by the European Union’s Seventh Framework Programme, Wellcome, and the National Institute for Health and Care Excellence. Dr. Sophie Richter, a NIHR Clinical Lecturer in Emergency Medicine and first author on the study, highlights the goal of integrating various types of information obtained during a patient’s hospital presentation to enhance the assessment of brain injury and prognosis. By utilizing DTI scans and blood biomarkers, researchers hope to provide more accurate and personalized care for patients with concussion, ultimately improving outcomes and quality of life for those affected by this common neurological condition.