The state of Alabama is a major force in sports, and sports injuries such as concussion are not uncommon. A new study published in the American Journal of Roentgenology shows that the bright spots on brain MRI scans, known as white matter hyperintensities, may not be a reliable way to diagnose mild traumatic brain injury, or mTBI. Prior to this study, white matter hyperintensities were believed to be a biomarker of mTBI and helped physicians guide diagnosis, classification and prognostication of mTBI.

White matter hyperintensities are areas that appear brighter than the normal brain on an MRI scan.

“White matter hyperintensities can occur with a number of brain conditions, including silent stroke, multiple sclerosis and normal aging, so these findings are not specific to head injury,” said Manoj Tanwar, M.D., chief of MRI and assistant professor in the University of Alabama at Birmingham Department of Radiology.

This prospective study took place at seven medical centers in the United States between 2015 and 2018. A cohort of 303 patients with mild head injuries and 148 healthy volunteers were tested up to four times each. At each visit, doctors checked symptoms such as headaches, balance and memory changes through questionnaires and balance tests. Patients had brain scans using a high-powered 3T MRI.

Researchers found that about one in three people had at least one white matter hyperintensity, whether they had a concussion or not. The spots did not match how bad the symptoms were or how well someone recovered. The results suggest that these bright spots on MRI are common but do not help doctors tell whether someone has a concussion or predict recovery.

“MRI remains a useful tool for brain injury since it can show other changes such as small bleeds or nerve fiber damage,” Tanwar said. “But it is essential to undergo a full clinical assessment and testing to understand the complete picture.”

This study was funded by GE-NFL Head Health Initiative.