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

Objectives: To 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).

Methods: Forty-four consecutive patients with PCS after mTBI and 32 controls were included in this retrospective study. K and v 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). 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.

Results: The median v of the T2 hyperintense WM lesions in mTBI patients (n=21) was higher than that of NAWM in controls (p=.027). Both median K and v 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 and v at Location than controls (p=.008 and p=.015, respectively). VLT (delayed recall) scores were significantly correlated with v values at T2 hyperintense WM lesions (p=-0.767, p=.044). The median v at Location was significantly higher in patients with atypical performance in the digit span test (forward) than in those with average or good performance (p=.043).

Conclusions: mTBI patients with PCS had higher K and v values than controls not only at T2 hyperintense WM lesions but also at NAWM and Location. BBB disruption may be implicated in development of PCS in mTBI patients.

Key Points: • mTBI patients with PCS had higher permeability than controls at T2 hyperintense WM lesions on DCE MR imaging. • mTBI patients with PCS had higher permeability than controls also at NAWM and predilection sites for DAI. • BBB disruption may be implicated in the development of PCS in mTBI patients.