Imaging Traumatic Brain Injury

Written by: James Demetrious, DC, DABCO

The Problem

Sport-related concussion (SRC) is a form of traumatic brain injury (TBI) with approximately 1.6 to 3.8 million annual incidents. SRC may develop long-term sequelae with post-traumatic headache, psychological distress, cognitive impairment, and learning deficits. [1]

The Damage

Brain injury involves multiple tiers of mechanical forces causing immediate local damage and diffuse axonal injury. Diffuse axonal injury, believed to be the primary neuropathology associated with mild TBI, is characterized as widespread microscopic injuries involving physical disruption of axons/cytoskeletons and metabolic alterations in cellular/sub-cellular biochemistry reactions. [1]

Advanced Imaging

In a recent review paper published by Jang et al., the authors present a review paper to describe the role of diffusion tensor imaging (DTI) and diffusion tensor tractography (DTT) in the diagnosis of traumatic axonal injury induced by head trauma due to concussion and mild traumatic brain injury. [2] The authors offer the following images of traumatic axonal injury:

A Tractography Study from the NCAA-DoD CARE Consortium

The newly published NCAA-DoD CARE Consortium paper was published related to the measurement of white matter alterations following SRC utilizing diffusion magnetic resonance imaging. The authors characterized the susceptibility of white-matter fiber tracts longer than 100 mm appeared to be more vulnerable to mild brain injury. [1]

What Can We Do With This Information?

These findings help further inform the pathophysiological mechanisms of concussion, which have important implications for understanding neurobiological recovery and possible development of therapeutic interventions to promote brain recovery after mild TBI. [1]

Recommendations for Prevention, Concussion Protocols, Diagnosis, and Therapeutic Interventions

The ability to visualize axonal injury provides substantial insight into the prevention, diagnosis, and therapeutic approaches for patients sustaining traumatic brain injuries. It is requisite that chiropractic physicians understand these mechanisms and burgeoning research.

At PostGradDC, we offer advanced continuing education to better understand, diagnose, treat and make appropriate referrals of our patients to ancillary providers.


1.) Jang, S.-H.; Cho, M.-J. Role of Diffusion Tensor Imaging in the Diagnosis of Traumatic Axonal Injury in Individual Patients with a Concussion or Mild Traumatic Brain Injury: A Mini-Review. Diagnostics 2022, 12, 1580.

2.) Mustafi et al.Effects of White-Matter Tract Length in Sport-Related Concussion: A Tractography Study from the NCAA-DoD CARE Consortium. Journal of Neurotrauma. Online ahead of print.


The views and opinions expressed in this presentation are solely those of the author. We offer this only to educate and inform.

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