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Objective Documentation of Traumatic Brain Injury Subsequent to Mild Head Trauma: Multimodal Brain Imaging With MEG, SPECT, and MRI

Lewine, Jeffrey David PhD; Davis, John T. PhD; Bigler, Erin D. PhD; Thoma, Robert PhD; Hill, Dina PhD; Funke, Michael MD, PhD; Sloan, John Henry MD; Hall, Sandra PhD; Orrison, William W. MD

Section Editor(s): Caplan, Bruce PhD, ABPP, Issue Editor

Journal of Head Trauma Rehabilitation: May-June 2007 - Volume 22 - Issue 3 - p 141–155
doi: 10.1097/01.HTR.0000271115.29954.27
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Objective To determine to what extent magnetic resonance imaging (MRI), single photon emission computed tomography (SPECT), and magnetoencephalography (MEG) can provide objective evidence of brain injury in adult patients with persistent (>1 year) postconcussive symptoms following mild blunt head trauma.

Design A retrospective and blind review of imaging data with respect to the presence of specific somatic, psychiatric, and cognitive complaints.

Setting/Participants Thirty complete data sets (with MRI, SPECT, MEG, and neuropsychological testing results) were collected between 1994 and 2000 from the MEG programs at the Albuquerque VAMC and the University of Utah.

Main Outcome Measures MRI data were evaluated for focal and diffuse structural abnormalities, SPECT data for regions of hypoperfusion, and resting MEG data for abnormal dipolar slow wave activity (DSWA) and epileptiform transients.

Results Structural MRI was abnormal for 4 patients. SPECT showed regions of hypoperfusion in 12 patients, while MEG showed abnormal activity in 19 patients. None of the imaging methods produced findings statistically associated with postconcussive psychiatric symptoms. A significant association was found between basal ganglia hypoperfusion and postconcussive headaches. For patients with cognitive complaints, abnormalities were more likely to be detected by MEG (86%) than either SPECT (40%) or MRI (18%) (P < .01). MEG also revealed significant (P < .01) associations between temporal lobe DSWA and memory problems, parietal DSWA and attention problems, and frontal DSWA and problems in executive function.

Conclusions Functional brain imaging data collected in a resting state can provide objective evidence of brain injury in mild blunt head trauma patients with persistent postconcussive somatic and/or cognitive symptoms. MEG proved to be particularly informative for patients with cognitive symptoms.

Department of Radiology, the University of Utah School of Medicine, Salt Lake City (Drs Lewine, Davis, Bigler, Thoma, Hill, Funke, and Orrison); Hoglund Brain Imaging Center (Drs Lewine and Hall), Department of Neurology and the Department of Psychiatry and Behavioral Sciences (Dr Lewine), and Department of Preventative Medicine and Public Health (Dr Hall), University of Kansas Medical Center, Kansas City; Department of Psychology, Brigham Young University, Provo, Utah (Dr Bigler); and Department of Psychiatry, University of New Mexico (Dr Thoma and Hill) and St. Joseph's Rehabilitation Center, St. Joseph's Hospital (Dr Sloan), Albuquerque, NM.

Corresponding author: Jeffrey David Lewine, PhD, Illinois MEG Center, The Alexian Neurosciences Institute, Alexian Brothers Medical Center, 800 Biesterfield Rd, Suite 610, Elk Grove Village, IL 60007 (e-mail: Jeffrey.Lewine@abbhh.net).

This work was supported by research grants from NSF (CCR-0105504), The University of Kansas Research Institute, Picker International, and Neuromag Ltd to J.D.L. The authors are grateful to K. Paulson, M. Johnson, K. Hatch, D. Detmers, J. Meyer, and R. Christensen for technical support and to Michael Hartshorne for the evaluation of SPECT data. The authors also thank the reviewers and JHTR editors for their valuable and insightful comments.

© 2007 Lippincott Williams & Wilkins, Inc.