Abstract
Region of interest (ROI) volumetric assessment has become a standard technique in quantitative neuroimaging. ROI volume is thought to represent a coarse proxy for making inferences about the structural integrity of a brain region when compared to normative values representative of a healthy sample, adjusted for age and various demographic factors. This review focuses on structural volumetric analyses that have been performed in the study of neuropathological effects from mild traumatic brain injury (mTBI) in relation to neuropsychological outcome. From a ROI perspective, the probable candidate structures that are most likely affected in mTBI represent the target regions covered in this review. These include the corpus callosum, cingulate, thalamus, pituitary-hypothalamic area, basal ganglia, amygdala, and hippocampus and associated structures including the fornix and mammillary bodies, as well as whole brain and cerebral cortex along with the cerebellum. Ventricular volumetrics are also reviewed as an indirect assessment of parenchymal change in response to injury. This review demonstrates the potential role and limitations of examining structural changes in the ROIs mentioned above in relation to neuropsychological outcome. There is also discussion and review of the role that post-traumatic stress disorder (PTSD) may play in structural outcome in mTBI. As emphasized in the conclusions, structural volumetric findings in mTBI are likely just a single facet of what should be a multimodality approach to image analysis in mTBI, with an emphasis on how the injury damages or disrupts neural network integrity. The review provides an historical context to quantitative neuroimaging in neuropsychology along with commentary about future directions for volumetric neuroimaging research in mTBI.
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Notes
For the purposes of this review, concussion and mTBI will be used interchangeably. The justification for this is as follows: As described by McCrory et al. (2017) the concussion term is more often used in sports-related injuries. Concussion, minor head injury, mild head injury or closed head injury all have their own legacy within the medical, neuroimaging and neuropsychological literature and nosology (Yamamoto et al., 2018). Most often, “concussion” when used in this review will be either related to sports injury or will have been used in the title of the article (Arciniegas & Silver, 2001; McCrory et al., 2017a, b; McCrory & Berkovic, 2001). When residual symptoms persist beyond three months, they are considered to be moving toward being chronic , observed in up to a third of those who experience a mild TBI (Hiploylee et al., 2017; van der Horn et al., 2016).
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Acknowledgements
The author is now retired and emeritus professor of Psychology and Neuroscience at Brigham Young University, Adjunct Professor of Neurology and Psychiatry at the University of Utah and Volunteer Clinical Professor, University of California at Davis. The contents of the article reflect his personal writings on the topic, with no specific grant funding to acknowledge. Dr. Bigler does participate in forensic consultation work. Also, as part of his University of Utah adjunct professorship, he is a member of the TBI and Concussion Center that receives funding support from the U.S. Army Medical Research and Material Command and from the U.S. Department of Veterans Affairs Chronic Effects of Neurotrauma Consortium under Award No. W81XWH-13-2-0095 and the CENC Neuroimaging Core under 1I01RX001062 along with the Long-Term Impact of Military-Relevant Brain Injury Consortium. The U.S. Army Medical Research Acquisition Activity, 820 Chandler Street, Fort Detrick MD 21702-5014 is the awarding and administering acquisition office. Any opinions, findings, conclusions or recommendations expressed in this publication are those of the author and do not necessarily reflect the views of the U.S. Government, or the U.S. Department of Veterans Affairs, and no official endorsement should be inferred. The assistance of Tracy J. Abildskov, Kayla Alder and Holly Paxton-Winiarski with various aspects associated with this manuscript is gratefully acknowledged.
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Bigler, E.D. Volumetric MRI Findings in Mild Traumatic Brain Injury (mTBI) and Neuropsychological Outcome. Neuropsychol Rev 33, 5–41 (2023). https://doi.org/10.1007/s11065-020-09474-0
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DOI: https://doi.org/10.1007/s11065-020-09474-0