Systematic review on the characterization of chronic traumatic encephalopathy by MRI and MRS

Abstract

Background: Chronic traumatic encephalopathy (CTE) is a neurodegenerative disease that is found in people who have suffered from chronic traumatic brain injury (TBI). Up to now, diagnosis of CTE could only be made based on postmortem histopathological examinations. The application of MR techniques might offer a promising possibility for in vivo diagnoses.

Purpose/hypothesis: To provide a critical systematic review of the characterization of chronic TBI and CTE by considering the range of MR techniques.

Study type: This was a systematic review for which the electronic databases PubMed and Embase were searched using the terms ("chronic traumatic encephalopathy" OR "punch drunk syndrome" OR "chronic traumatic brain injury" OR "dementia pugilistica" OR "chronic head trauma") AND ("magnetic resonance imaging" OR mri OR imaging OR mrs OR "magnetic resonance spectroscopy" OR spectroscopy).

Population/subjects/phantom/specimen/animal model: Of the 432 studies identified by the database search, 25 were included in this review.

Field strength/sequence: Diffusion, structural, and functional MRI sequences and MR spectroscopy were evaluated at 1.5T or 3T and at 11.74T for the ex vivo studies.

Assessment: Data were extracted by two reviewers independently. Specific inclusion and exclusion criteria like the study design, publication type, and applied MR techniques were used to select studies for review.

Statistical tests: Results of the original research articles were stated in this review as significant if P ≤ 0.05.

Results: Of the included articles, two were ex vivo studies focusing on the coregistration of histology and MRI. All other studies were based on in vivo data.

Data conclusion: The included studies varied considerably regarding study setup, MR techniques, and results. Nevertheless, this work aims to establish links between the studies and discusses the results and limitations associated with the characterization of chronic TBI and CTE based on MR.

Level of evidence: 3 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2019;49:212-228.

Keywords: chronic traumatic encephalopathy; magnetic resonance; neuroimaging; tau-pathology; traumatic brain injury.