Prevalence of White Matter Hyperintensities (WMHs) in Cohorts of Young Adults with and Without Mild Traumatic Brain Injury (mTBI)
Teena Shetty1, Guzide Ayse Erdemir2, Joseph T Nguyen1
1Hospital for Special Surgery, 2Neurology, Hospital for Special Surgery
Objective:

To determine the prevalence and severity of WMHs in young healthy adults and those with recent mTBI.

Background:
T2-weighted (T2W) MRI often displays WMHs. Normative data on their prevalence in young, healthy adults and in mTBI is not well characterized and dependent upon classification system, MRI field strength, resolution, and parameters. WMHs are common in various medical conditions and need to be further assessed in the context of mTBI.
Design/Methods:

High-resolution 3-Tesla 3D T2W-FLAIR and SWI images of 303 mTBI and 148 control subjects were retrospectively reviewed by 2 board-certified, blinded neuroradiologists. WMHs were classified as abnormal if ≥5 objective, punctate, white matter foci were present or lesions were >3mm or atypical in location. Rivermead Post-Concussion Symptoms Questionnaire (RPQ3) and Balance Error Scoring System (BESS) were used to assess symptom severity and postural disability.

Results:

34% of mTBI patients and 35% of controls demonstrated at least 1 WMH. Of these subjects, 40% of the mTBI group and 35% of the controls demonstrated ≥5 lesions, one >3 mm lesion, or lesions in atypical locations. There was no significant difference in number of subjects with at least 1 WMH (p=0.757) or abnormal WMHs (p=0.501) between mTBI and control groups. RPQ3 scores were higher across all encounters and BESS total scores were higher in the first two encounters in mTBI patients, suggesting a return to normal of balance/posture overtime.

Conclusions:

This represents the largest cohort of mTBI patients and controls assessing the prevalence of WMHs on high-resolution 3-Tesla 3D T2W-FLAIR MRI. Prevalence of WMHs did not significantly differ between groups and were observed at higher rates than reported in the current literature. Our understanding and clinical interpretation of WMHs in healthy adults and mTBI patients need to be reassessed. RPQ3 and BESS are useful in longitudinal symptom severity tracking for mTBI patients.

10.1212/WNL.0000000000206243