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Cited by 599Traumatic Brain Injury ResearchAdvanced Neuroimaging Techniques and ApplicationsAutomotive and Human Injury Biomechanics

Detection of Blast-Related Traumatic Brain Injury in U.S. Military Personnel

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Mac Donald, Christine L., Johnson, Ann M., Cooper, Dana, Nelson, Elliot C., Werner, Nicole J., Shimony, Joshua S., Snyder, Abraham Z., Raichle, Marcus E. +4 more·2011·New England Journal of Medicine
DOI 10.1056/nejmoa1008069PMC PMC3146351
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Abstract

BACKGROUND: Blast-related traumatic brain injuries have been common in the Iraq and Afghanistan wars, but fundamental questions about the nature of these injuries remain unanswered. METHODS: We tested the hypothesis that blast-related traumatic brain injury causes traumatic axonal injury, using diffusion tensor imaging (DTI), an advanced form of magnetic resonance imaging that is sensitive to axonal injury. The subjects were 63 U.S. military personnel who had a clinical diagnosis of mild, uncomplicated traumatic brain injury. They were evacuated from the field to the Landstuhl Regional Medical Center in Landstuhl, Germany, where they underwent DTI scanning within 90 days after the injury. All the subjects had primary blast exposure plus another, blast-related mechanism of injury (e.g., being struck by a blunt object or injured in a fall or motor vehicle crash). Controls consisted of 21 military personnel who had blast exposure and other injuries but no clinical diagnosis of traumatic brain injury. RESULTS: Abnormalities revealed on DTI were consistent with traumatic axonal injury in many of the subjects with traumatic brain injury. None had detectable intracranial injury on computed tomography. As compared with DTI scans in controls, the scans in the subjects with traumatic brain injury showed marked abnormalities in the middle cerebellar peduncles (P<0.001), in cingulum bundles (P=0.002), and in the right orbitofrontal white matter (P=0.007). In 18 of the 63 subjects with traumatic brain injury, a significantly greater number of abnormalities were found on DTI than would be expected by chance (P<0.001). Follow-up DTI scans in 47 subjects with traumatic brain injury 6 to 12 months after enrollment showed persistent abnormalities that were consistent with evolving injuries. CONCLUSIONS: DTI findings in U.S. military personnel support the hypothesis that blast-related mild traumatic brain injury can involve axonal injury. However, the contribution of primary blast exposure as compared with that of other types of injury could not be determined directly, since none of the subjects with traumatic brain injury had isolated primary blast injury. Furthermore, many of these subjects did not have abnormalities on DTI. Thus, traumatic brain injury remains a clinical diagnosis. (Funded by the Congressionally Directed Medical Research Program and the National Institutes of Health; ClinicalTrials.gov number, NCT00785304.).

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  • In military personnel, blast exposure without PTSD can affect cingulum FA.

    “In the case of military personnel, there is the contributing complication that blast exposure (without PTSD) can affect cingulum FA (e.g., Ivanov et al., 2017; MacDonald et al., 2011)”

    From The cingulum bundle: Anatomy, function, and dysfunction (2018) · cites this paper as MacDonald et al., 2011

    The Results (Findings on DTI and Conventional MRI; page unavailable) report cingulum abnormalities and reduced relative anisotropy in military personnel with blast-related traumatic brain injury. The Methods (Subjects; page unavailable) exclude a history of psychiatric disorder but do not establish that participants were free of PTSD. The paper measures relative anisotropy rather than cingulum fractional anisotropy (FA), and the Discussion says it cannot isolate the effect of blast exposure from other injury mechanisms. (LLM, conf=0.88)

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Authors
Mac Donald, C. L., Johnson, A. M., Cooper, D., Nelson, E. C., Werner, N. J., Shimony, J. S., Snyder, A. Z., Raichle, M. E., Witherow, J. R., Fang, R., Flaherty, S. F., & Brody, D. L.
Affiliations
  • Washington University in St. Louis (US)
  • Landstuhl Regional Medical Center (DE)
ORCID
Venue
New England Journal of Medicine
Publisher
Massachusetts Medical Society
Published
2011-06-02
Volume
364
Issue
22
Pages
2091-2100
ISSN
  • 0028-4793 (ISSN-L)
  • 1533-4406
DOI
10.1056/nejmoa1008069
PMC
PMC3146351
OpenAlex
W2124911240
Cited by
599
References
1
Citations by year
2026: 23 · 2025: 9 · 2024: 18 · 2023: 14 · 2022: 22 · 2021: 20 · 2020: 45 · 2019: 25 · 2018: 42 · 2017: 53 · 2016: 46 · 2015: 64 · 2014: 50 · 2013: 70 · 2012: 71
FWCI
52.30
Type
journal article
Language
en
Open access
Locations
  • New England Journal of Medicine (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
  • Digital Commons@Becker (Washington University School of Medicine) (submittedVersion)
Funders
  • U.S. Department of Defense (W81XWH)
  • Australian Government
  • National Institutes of Health (5k08ns049237-05, W81XWH)
  • National Institute of Neurological Disorders and Stroke (F32NS062529, 5K08NS49237, P30NS048056, K08-NS049237, P50NS006833, P50 NS06833)
  • Eunice Kennedy Shriver National Institute of Child Health and Human Development (K23HD053212)
Topics
  • Health Sciences › Medicine › Epidemiology › Traumatic Brain Injury Research
  • Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Advanced Neuroimaging Techniques and Applications
  • Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Automotive and Human Injury Biomechanics
Keywords
blast-related traumatic brain injury, mild traumatic brain injury, traumatic axonal injury, diffusion tensor imaging, military personnel, Iraq and Afghanistan wars, white matter abnormalities, middle cerebellar peduncle, cingulum
MeSH terms
Adult, Blast Injuries, Brain, Brain Injuries, Humans, Male, Middle Aged, Military Personnel, United States, Case-Control Studies, Diffuse Axonal Injury, Iraq War, 2003-2011, Young Adult, Afghan Campaign 2001-, Diffusion Tensor Imaging

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