MRI Techniques Offer New Look at Head Injuries

In recent years, traumatic brain injuries have become a source of concern at virtually every level of sport. Sports organizations are instituting new rules to protect players, teaching techniques that could lower risks, and experimenting with different kinds of safety equipment, but the concerns surrounding concussions persist, particularly as they relate to younger athletes whose developing brains are thought to be more vulnerable.

While it’s unlikely that we’ll ever be able to fully put aside these safety concerns, medical researchers are doing their part to explore and better understand them.    

Dr. Barry Southers, program director and professor with the University of Cincinnati Advanced Medical Imaging Technology program, is also an assistant coach for his second-grade son’s youth football team. The latter role is one he takes seriously.

“I have to do concussion training on at least a yearly basis, so as a coach, it’s prompted me to learn more,” he says. “I don’t want to just be a bystander and hope that nothing happens. I want to do everything I can to make sure my son and all his friends and teammates are safe.”

Southers, an MRI (magnetic resonance imaging) expert with more than 20 years of experience with medical imaging, says that new MRI techniques may help pave the way to better, more accurate diagnoses of brain injuries, and provide a path toward more aggressive treatment earlier in the process.

Doctors use MRI to create detailed images of the body that can help in diagnoses of a variety of conditions. However, according to Southers, a routine scan might not be particularly illuminating for TBI patients.

“A lot of times routine scans don’t demonstrate some of the areas that are damaged,” he says. “But if you start doing some other types of MR techniques, it could potentially help to show some pathology and solidify a diagnosis and help the patient get better.”

The brain can be a difficult organ to analyze for abnormalities. Head injuries are more difficult to pinpoint than, for example, knee injuries. Some problems caused by blows to the head may not show up on a typical scan, and many are what Southers calls “invisible.”

“Say you’re looking for an ACL tear in your knee, you can get the MRI and see, ‘yes, the patient has an ACL tear’ or ‘no, they don’t,’ ” says Southers. “When you look at the brain, though, because of its complexity and how it functions, not seeing anything on a routine scan doesn’t mean that the patient’s not exhibiting problems.”

Today, most concussion diagnoses are based on a patient’s symptoms. These can include physical problems such as severe headaches or nausea and vomiting, or cognitive problems such as confusion or lapses in memory.

Scanning technology can help provide additional context for a diagnosis — if there’s a skull fracture or bleeding in the brain, for example.

“A lot of times patients might fall and hit their head, and they might feel okay or they might have a headache,” Southers says. “But if you do a scan it might show a hemorrhage, bleeding on the brain, which is obviously much more serious. Historically, that’s where imaging plays a role.”

Additionally, functional MRI (fMRI) technology can reveal changes in brain activity. A study published in the Journal of Neurotrauma found that concussed youths performed worse than a non-concussed control group on a test of working memory performance and related brain activity.

However, emerging imaging techniques can reveal changes in the brain, even in patients who are asymptomatic and have never been diagnosed with a concussion.

A study by the Radiological Society of North America used diffusion tensor imaging, an advanced MRI technique, to study the brains of youth football players. In the study, images were taken before and after the season and then compared. Even though none of the players in the study suffered a concussion, the post-season images revealed deterioration in areas of white matter, which essentially act as communication lines between different areas of the brain.

These studies reveal that there are ways in which changes in the brain can be detected, even in the absence of concussion symptoms, providing a more accurate picture of a patient’s health than previously available imaging techniques would allow.

 “If a patient goes in and has a routine scan, if they don’t see anything, they go back and probably have some kind of conservative treatment,” says Southers. “But if you did some additional sequences, it could turn out that there were micro-hemorrhages present.

“Personally, I would want to know,” he continues. “If I were in that position, knowing what I know, I would say ‘You have to run this on me,’ because otherwise it could not be diagnosed or not be detected.”

Despite these revelations, there remains much to be uncovered in relation to how the brain reacts to the playing of football and other contact sports.

“We’re still just scratching the surface,” Southers says. “We know so little that we’re just now learning that full-contact sports can cause issues, even without it being a diagnosed problem.”

As for his son, Southers and his wife felt comfortable that the head coach, who is also a physician, would understand the importance of keeping the kids safe.

“I know you can’t prove or say with 100 percent certainty that they won’t get a concussion, but I did appreciate the fact that they were educated on concussions and they took it as seriously as they do,” he says. “Even with reluctance, that’s why we decided to let our son play.”

Despite his concerns, Southers and his fellow coaches instruct the team in proper tackling techniques, which he hopes will reduce the likelihood of them suffering an injury.

“It’s still a rough sport — that’s probably why we love watching it,” he says “But as coaches and parents, we’re doing our part to make sure they’re instructed the right way.”