Neuroradiology (2004) 46: 550558

DOI 10.1007/s00234-004-1227-x DIAGNOSTIC NEURORADIOLOGY

David G. Hughes
Alan Jackson
Abnormalities on magnetic resonance
Damon L. Mason imaging seen acutely following mild
Elizabeth Berry
Sally Hollis traumatic brain injury: correlation
David W. Yates with neuropsychological tests
and delayed recovery

Received: 19 February 2004

Accepted: 13 April 2004
Published online: 8 June 2004

Springer-Verlag 2004
D. G. Hughes (&) A. Jackson
Department of Neuroradiology,
Hope Hospital, Salford M6 8HD, UK
E-mail: david.hughes@srht.nhs.uk
Tel.: +44-161-2064928
Fax: +44-161-2062579
D. L. Mason E. Berry
Department of Behavioural Medicine,
Hope Hospital, Salford M6 8HD, UK
S. Hollis
Medical Statistics Unit,
Lancaster University, Lancaster, UK
D. W. Yates
Department of Emergency Medicine,
Hope Hospital, Salford M6 8HD, UK
Abstract Mild traumatic brain frequently seen, standard MRI tech-
injury (MTBI) is a common reason niques are not helpful in identifying
for hospital attendance and is asso- patients with MTBI who are likely to
ciated with signicant delayed mor- have delayed recovery.
bidity. We studied a series of 80
persons with MTBI. Magnetic reso- Keywords Magnetic resonance
nance imaging (MRI) and neuropsy- imaging Mild traumatic brain
chological testing were used in the injury Neuropsychology
acute phase and a questionnaire for
post-concussion syndrome (PCS) and
return to work status at 6 months. In
26 subjects abnormalities were seen
on MRI, of which 5 were denitely
traumatic. There was weak correla-
tion with abnormal neuropsycholog-
ical tests for attention in the acute
period. There was no signicant cor-
relation with a questionnaire for PCS
and return to work status. Although
non-specic abnormalities are

Introduction pathology which might develop in a manner which is

Mild traumatic brain injury (MTBI) can be dened as a
traumatically induced physiological disruption of brain
function but below a dened severity. MTBI has been
regarded as a trivial condition; however, it is increas-
ingly recognised that many patients develop early neu-
ropsychological impairment which can aect memory,
attention and executive function [1, 2, 3]. More impor-
tantly, up to 50% develop long-term cognitive and
physical dysfunctions which have been termed persistent
post-concussive syndrome (PPCS) [4, 5].
Computed tomography (CT) forms the rst-line
investigation of choice in patients with signicant head
trauma, and CT is advised in MTBI to allow safe early
discharge from hospital care [6]. The role of CT under
these circumstances is to exclude rarely occurring major
initially clinically occult. An additional concern is the
early identication of those who will develop post-con-
cussion syndrome, and who may respond to early non-
operative interventions. Magnetic resonance imaging
(MRI) has a number of potential advantages over CT
and in particular is more sensitive than CT at demon-
strating small extra-axial haematomas and traumatic
brain parenchymal lesions [7]. Fluid attenuated inver-
sion recovery (FLAIR) sequences have been shown to be
particularly sensitive at detecting cortical contusions
and subdural haematomas [8], and gradient echo
T2*-weighted images are highly sensitive to haemor-
rhagic change because of the paramagnetic eects of
haemoglobin breakdown products [9]. The recognition
that MTBI is associated with a high incidence of mor-
bidity has led a number of workers to suggest that MRI

should be performed in some or all patients with MTBI
[10, 11, 12].
The aim of this study was to describe the incidence
and nature of MRI abnormalities occurring in a large
series of patients with MTBI and to determine whether
MRI provides useful predictive information about the
probability of impairment or of its nature or severity.
Methods
Patient recruitment
A total of 271 consecutive patients attending the Salford
Emergency Department with MTBI were asked to par-
ticipate in the study over a 2 year period, and 80 of these
agreed. The study was approved by the local research
ethics committee and all patients gave informed consent
prior to inclusion. Exclusion criteria were age under 18
or above 60 years, history of chronic alcohol or drug
abuse, psychiatric illness or previous traumatic brain
injury or contraindications to MRI. Patient exclusion
criteria were designed to minimise confounding eects of
extraneous variables on the neuropsychological test
scores and to reduce the possibility of pre-existing
structural brain abnormalities. The major reason for
failure to recruit was unwillingness to participate in the
study, including a small number who did not wish to
undergo the MRI. A small number of patients willing to
be included at the time of review in the accident and
emergency department could not be contacted within the
72 h following the injury. The recruited and non-re-
cruited were very similar in age (mean 31 years in both
groups) and sex distribution (74% and 76% male,
respectively).
The mechanisms of injury were road trac accident in
6, fall in 23, assault in 50, no recollection in one. All
patients recruited into the study underwent clinical,
neuroradiological and neuropsychological assessment
within 72 h of sustaining the injury. On GCS assessment
75 subjects received a score of 15, 3 a score of 14, and 2 a
score of 13. Loss of consciousness had occurred in 43
subjects (for less than 30 min because of the denition of
MTBI) and post-traumatic amnesia in 31 with a mean
duration of 30 min. Twenty-ve subjects were admitted
to hospital. A total of 80 control patients were recruited
for the neuropsychological studies. These were recruited
from patients attending the emergency department with
minor ankle injuries. They had no history of head injury.
Only 14 of these underwent MRI due to funding issues
which occurred. As a result we were only able to compare
a small control group to the ndings on MRI with the
MTBI group, which is a serious weakness of the study.
The denition of MTBI used in this study is the fol-
lowing [13]: A patient with mild traumatic brain injury is
a person who has had a traumatically induced physio-
551
logical disruption of brain function, as manifested by at
least one of the following:
Any period of loss of consciousness
Any loss of memory for events immediately before or
after the accident
Any alteration in mental state at the time of the
accident (e.g. feeling dazed, disorientated or confused)
Focal neurological decit(s) that may or may not be
transient
But where the severity of the injury does not exceed the
following:
Loss of consciousness not longer than 30 min
After 30 min an initial Glasgow Coma Scale (GCS) of
1315; and
Posttraumatic amnesia not longer than 24 h
Magnetic resonance imaging
MRI was performed between 24 and 72 h after the injury.
A 1.0-T scanner with standard head coil was used (Impact,
Siemens, Erlangen, Germany). Imaging consisted of
transverse gradient echo T2*-weighted (TR 798 ms, TE
22 ms, ip angle 30, matrix192256, slice thickness
7 mm, with 2-mm gap, time 5 min 8 s), transverse FLAIR
(TR 9000 ms, TE 150 ms, TI 2200 ms, matrix 240256
slice thickness 6 mm, with 3-mm gap, time 4 min 57 s) and
a volume gradient echo T1 sequence (magnetisation pre-
pared rapid acquisition gradient echo) with acquisition in
the sagittal plane (TR 97 ms, TE 4 ms, ip angle 15,
matrix 256256 slice thickness 14 mm, time 7 min 50 s).
The MRI scans were independently assessed by two
consultant neuroradiologists (D.G.H. and A.J.), and
where disagreement occurred, the images were jointly
reviewed and a consensus opinion reached. Each of the
sequences was assessed independently using a proforma
to record the site, size and signal intensity of all paren-
chymal abnormalities. Recognised normal variants which
can give rise to high signal on FLAIR images were not
included in the scoring system. Abnormalities were clas-
sied as denitely traumatic where there were changes on
the scans characteristic of haemorrhage or local mass ef-
fect. Non-specic areas of T2 signal change (deep white
matter hyperintensities, DWMH) on FLAIR images were
identied and patients put in two groups: those with fewer
than ve lesions and those with ve or more lesions.
Neuropsychological assessment
Neuropsychological assessment used a battery of stan-
dard tests designed to identify abnormalities in memory,
attention and executive function. The following 13
neuropsychological measures were employed, and test-
ing was conducted by two experienced psychologists
(D.M. and E.B.):
552
Memory
Backward digit span sequence of the Wechsler
Memory Scale (DSPAN back)
Californian Verbal Learning Test recall over ve
trials (CVLT a15)
CVLF recall 20 min post-initial presentation
(CVLT ldfr)
Rey complex gure test recall of gure after 20 min
(CF delay)
Rey complex gure test recognition from original
design (CF recog)
Attention
Forward digital span sequence of Wechler Memory
Scale (DSPAN for)
Paced auditory serial addition test (PASAT)
Test of Everyday Attention, visual elevator com-
ponent, accuracy (VIS EL acc)
Test of Everyday Attention, visual elevator com-
ponent, time (VIS EL time)
Auditory equivalent of the visual elevator task,
accuracy (AUD EL acc)
Executive function
Wisconsin Card sorting test, no. of categories ob-
tained (WSCT cat)
Wisconsin Card sorting test, perseverative errors
(WCST pers)
Stroop colour-word interference task (STROOP)
Control subjects
To provide control data for neuropsychological studies a
control group of 80 subjects was recruited. These were
identied from patients attending the Emergency
Department with ankle injury with no history of previous
or recent head injury. Controls were individually matched
to patients in the MTBI group on the basis of sex, age and
premorbid IQ as estimated with the National Adult
Reading Test. [14] An ideal match for a particular case
was dened as being of the same sex, within 5 years of age
(within the range 1860) and within 5 IQ points. Where an
ideal match for a case could not be found, one of these
criteria was extended (of dierent sex, n=2; within
10 years of age,n=2; within 10 IQ points, n=2). Controls
underwent the same neuropsychological assessment as
MTBI patients. The possibility of performing MRI on
these controls had been discussed and initially attempted.
Follow-up studies
Those with an initially abnormal MRI scan were invited
for repeat scanning at 3 months. At 6 months they were
contacted by questionnaire, and the Rivermead Post-
Concussion Symptoms Questionnaire (RPCSQ) score
[15, 16] and the return to work status were used as
outcome measures.
Statistical methods
A standardised score for each neuropsychological test
was obtained for each case by dividing the dierence
between the observed value and the predicted values
based on the control scores by the standard error of the
prediction. In a population with the same level of
neuropsychological function as the controls these
standardised scores would have an approximate stan-
dard normal distribution (t distribution on 78 degrees
of freedom). Negative values indicate poorer than ex-
pected performance. Composite measures for attention,
executive function and memory were calculated as the
average standardised score across all tests in that do-
main. In the small number of cases where some indi-
vidual test scores were missing, the composite score was
calculated by averaging across the remaining tests in
that domain.
Neuropsychological scores were compared with con-
trols using simple sample t tests with an expected value
of zero. Comparison of continuous variables (age, IQ
and neuropsychological scores) between subjects with
normal and abnormal scan results were carried out using
the unpaired t test. Similarly, the v2 test was used for
comparisons of categorical variables. For comparisons
between cases with dierent types of MRI abnormality,
adjustment for age and IQ was carried out using analysis
of covariance, to allow for the dierences between the
groups in these factors which are associated with test
performances.
Results
MRI ndings
Initial MRI demonstrated abnormalities in 26 of 80
subjects (95% CI 22%44%). Of these 26, 5 were con-
sidered to have ndings denitely attributable to trau-
matic injury. Two of the ve had small extradural
haemorrhages with no evidence of associated contusional
injury on all three sequences (Fig. 1). These were treated
conservatively without complication. One of the ve had
an area of haemorrhagic contusion which was seen on all
sequences as an area of heterogeneous signal change in
the right frontal lobe (Fig. 2) and two had evidence of
petechial haemorrhage seen as small areas of very low
signal on the gradient echo T2*-weighted sequence
(Fig. 3a) and in one of these cases as high signal on the
FLAIR sequence. Only two of the ve attended for fol-
low-up scan at 3 months. A small area of abnormality
persisted in the haemorrhagic contusion (Fig. 2c), but
one patient with petechial haemorrhage showed no
residual abnormality.
Of the 26 patients 21 had one or more areas of
DWMH on FLAIR images appearing as small areas of

Fig. 1 Axial FLAIR image shows small extradural haematoma
over the left frontal lobe
Fig. 2 a Axial FLAIR image shows haemorrhagic contusion in the
right frontal lobe. b Sagittal GE T1-weighted image showing
haemorrhagic change as high signal (arrow) within the area of
contusion. c Axial FLAIR image 3 months post-trauma shows a
small area of encephalomalacia (arrow)
553
Fig. 3 Axial GE T2-weighted image shows focal low signal area of
petechial haemorrhage
high signal less than 3 mm in diameter. Ten subjects had
less than ve DWMH; seven of these had follow-up
scans. In three of the seven ndings were unchanged,
two were normal, and two showed increased numbers.
Eleven of the 26 patients had multiple (ve or more)
deep white matter hyperintensities on the FLAIR se-
quence. Six of 11 had follow-up scans, all of which were
unchanged. DWMH were identied predominantly in
554

the frontal lobes, and lesions in this area were seen in 17/
21 cases.
All but ve patients had GCS of 15. Of these ve
patients three had normal MRI scans, and two had more
than ve DWMH. All the subjects with denite trau-
matic abnormalities on MRI had GCS 15.
There were signicant dierences in the distribution
of IQ (P=0.005) between the patient groups dened by
MRI abnormality. Sex, social class, and age were not
signicantly related to patient group. The relationship of
MRI abnormalities and demographic data are sum-
marised in Table 1. Of the 14 subjects from the control
group one had a DWMH; the others where normal.
There was no statistically signicant dierence between
these and the MTBI group by v2 analysis.

Neuropsychological ndings

Subjects with normal MRI displayed gross cognitive

dysfunction in each domain (Fig. 4,P<0.0004, P=0.001
and P=0.02 vs. controls for memory, attention and
executive function). Further impairment was seen in those
with abnormal scan results (P=0.10,P<0.0004 and
P=0.02, respectively, vs. MTBI with normal scan). The
numbers in each of the three types of MRI abnormality
are relatively small, but there was little evidence of dif-
ferences in impairment between the three types of
abnormalities (Table 2). Adjustment for age and IQ
moved the scores of subjects with normal and abnormal
scan results slightly closer together (Fig. 4). Following
this adjustment the dierences were no longer statistically
signicant, apart from borderline signicance for atten-
tion (P=0.33, P=0.04 and P=0.18 for memory, atten-
tion and executive function comparing normal
and abnormal scans). At 6 months 50 of 80 subjects re-
sponded to the RPCSQ and return to work status. There
was no statistical signicance between abnormal and
normal scans for RPCSQ score and return to work status.
The numbers of each sub-group of MRI abnormality were
too small for meaningful statistical analysis, but the re-
sults for return to work status are summarised in Table 3.
Fig. 4 Neuropsychological test performance by MRI result at 72 h.
Open points summarise scores of subjects with normal MRI results;
lled points those with abnormal MR results. Scores are standar-
dised so that zero represents no dierence from age and IQ
matched controls, negative values indicate impairment relative to
controls
Discussion
Head injury is a common and serious cause of morbidity
and mortality which has a disproportionate incidence in
children and young adults. Moderate and severe head
injuries are commonly associated with long-term dis-
ability, and these patients are well recognised as an at-
risk group who may require hospitalisation, therapeu-
tic intervention and active rehabilitation. In practice the
overwhelming majority of patients presenting to hospital
with head injury fall into the minimal traumatic brain
injury group [5]. These patients are traditionally inves-
tigated to exclude any serious complications of the in-

Table 1 The relationship of

MRI abnormalities and demo- Normal <5 DWMH >5 DWMH Traumatic
graphic data (DWMH deep (n=54) (n=10) (n=11) (n=5)
white matter hyperintensities)
Age, mean (years) 2910 3213 4013 306
IQ, mean 1068 10010 999 9911
Male sex 42 7 6 4
Social class
I/II 15 3 1
III 24 4 6 1
IV/V 13 2 3 1
Unemployed 2 1 1 3
3-month follow-up scan 7 6 2
Persisting abnormality 5 6 1
at follow-up
 555

Table 2 Neuropsychological test performance by MRI result at structural and functional changes which give rise to the
72 h. Scores are standardised so that zero represents no dierence disability. It is hoped that such knowledge will lead to
from age and IQ matched controls, negative values indicate
impairment relative to controls the development of techniques which can identify pa-
tients at-risk of poor outcome. If such techniques can be
Memory Attention Executive identied, they will provide a basis for eective trials of
function potential therapeutic approaches such as the use of
neuroprotective agents [36].
Unadjusted
Normal )0.40.1 )0.40.1 )0.30.1 Previous studies have commonly focused on patients
Abnormal )0.70.1 )1.10.2 )0.80.2 with more severe injury and often fail to specically
Few UBOs )0.70.2 )0.90.3 )0.70.3 address ndings or outcome in the MTBI group. This is
Multiple UBOs )0.60.2 )1.20.2 )0.70.3 complicated by variations in the denition of MTBI
Traumatic )0.80.3 )1.00.4 )1.40.4
which make eective comparison between studies di-
Adjusted for age and IQ cult or impossible in many cases [37, 38, 39, 40, 41]. In
Normal )0.40.1 )0.50.1 )0.40.1
Abnormal )0.60.2 )0.90.2 )0.70.2
our study we have focused specically on patients with
Few UBOs )0.70.2 )0.70.2 )0.60.3 MTBI and have adopted the denition suggested by Kay
Multiple UBOs )0.50.2 )1.00.2 )0.40.3 [13]. This identies the presence of brain injury based on
Traumatic )0.80.3 )0.90.3 )1.40.4 disruption of mental state, loss of consciousness, mem-
ory impairment or neurological defect but excludes
moderate and severe injury. Of subjects recruited into
jury and then discharged, commonly without follow-up this study only one-third required hospital admission for
[5]. MTBI, which suggests that there was little if any overlap
In recent years it has become increasingly apparent with more severe brain injuries. We do not know of a
that persistent symptoms may be experienced by a sig- directly comparable study. This study has been weak-
nicant number of subjects which may develop into ened by incomplete follow-up data. Patients commonly
long-term disability [17, 18, 19, 20, 21, 22, 23, 24, 25, 26, perceive that the risk from MTBI is restricted to the
27]. Alexander [4] coined the term PPCS to describe this acute phase, and therefore although they present to
clinical progression [28]. The most common complaints hospital they are unwilling or not interested in partici-
in these patients are headaches (6081%), memory pating in long-term follow-up.
decits (2747%), dizziness (2641%) and sleep disor- The use of imaging to identify patients with brain
ders (925%) [29, 30]. Neuropsychological assessment injury who are at high risk of poor outcome has been
commonly shows decits in attention, executive function investigated by a number of previous workers, and
and memory and mood disturbances [19, 29, 30, 31, 32]. imaging abnormalities on CT, MRI and single photon
The frequency and severity of long-term sequelae is emission computed tomography (SPECT) have all been
illustrated in a recent study of 2,962 patients who were associated with poor outcome on all modalities [11, 25,
admitted to hospitals around Glasgow (UK) with head 30, 42, 43, 44, 45, 46, 47]. Although the relative benets
injury [5]. Of these 90% were classied as mild with of each imaging modality remain unclear, it seems that
recorded GCS between 13 and 15. Of these a startling SPECT and MRI have a higher sensitivity to abnor-
47% had disability on follow-up at 1 year. Of these 8% malities than CT [11, 30, 43, 46, 47, 48, 49]. On the basis
were dead or in a vegetative state, 20% had severe dis- of these ndings the use of imaging in research studies of
ability, 28% moderate disability, and only 45% had MTBI has become common, and it has been suggested
made a good recovery. These observations are leading to that MRI should, therefore, play a major role in any
increasing recognition of the sociological and clinical MTBI classication scheme [12] and that even in
importance of MTBI [33]. There is an associated concern clinically mild traumatic brain injury, brain imaging
about the clinical management of MTBI; there is no should be used to identify patients with substantial brain
consensus on how these patients should be investigated damage [10, 11].
and treated [34, 35]. Consequently there is incresing This study is the largest series of patients with MTBI
interest in the biomechanics of the injuries and the to undergo MRI and neuropsychological assessment in

Table 3 Six-month follow-up

data (RPCSQ Rivermead Post- Normal <5 DWHM >5 DWMH Traumatic
Concussion Score Quotient)
Follow-up at 6 months 34/54 6/10 7/11 3/5
RPCSQ, median (quartiles) 17 (2, 34) 20 (5, 25) 30 (8, 40) 44 (36, 49)
Return to work
Yes 22 4 2 1
No 3 1 2 1
Not applicable 9 1 3 1
556
the acute phase. Overall we have demonstrated imaging
abnormalities in 26 of 80 patients (32.5%). Of these ve
were denitely post-traumatic, but the rest were foci of
high signal in white matter, and it is not possible to be
certain whether these represent incidental ndings or are
subtle evidence of axonal injury. Unfortunately, this
study included MRI of only 14 among the control
group, and although statistics show no statistical dif-
ference for high signal foci from the MTBI group, the
numbers of subjects in the control group is likely to be
too small to be useful. Therefore we can only compare
the results with those of studies looking at MRI ndings
in normal populations. The number of these lesions is
more than would be expected in the age group studied
(mean 31 years), suggesting that many were trauma re-
lated. This conclusion is supported by the correlation
between these lesions and neuropsychological decits
and the high incidence of frontal lobe abnormalities (17/
21). Nonetheless, lesions with this appearance are seen in
normal individuals although they are less common un-
der the age of 45 years [50], and an unknown proportion
of the lesions documented in this study may represent
incidental ndings unrelated to the trauma. If the high
signal foci were genuinely due to trauma and hence very
small areas of contusions, they would probably resolve
on follow-up. Follow-up scanning was attempted at
3 months, but attendance was poor and no meaningful
results were produced. Small lesions may have been
missed due to the 3-mm gap between slices on the
FLAIR sequence. This was necessary on the MRI
scanner used to obtain coverage of the whole brain on a
FLAIR sequence in an acceptable time.
MRI has now been used in the investigation of the
head injured patient for a number of years and has
been shown to be more sensitive than CT particularly
for smaller lesions as are typically seen in diuse ax-
onal injury [7, 46, 47, 51, 52]. MRI has also been used
in several smaller series of patients with MTBI. Mittl
et al. [53] studied 20 patients and described 3 with
small high signal areas on spin echo T2-weighted se-
quence and 4 hypo-intense areas on gradient echo T2*
weighting, suggesting petechial haemorrhage. Hofman
et al. [45] found MRI abnormalities in 57% of 21 pa-
tients but identied only a weak correlation between
neuroimaging ndings and neurocognitive outcome.
Uchino et al. [11] demonstrated MRI abnormalities in
all MTBI patients with GCS of 13 or 14 (16/90) but
not in patients with GCS of 15 presentation. A similar
study by Kant et al. [49] compared MRI and CT with
Tc-labelled hexamethyl propyleneamine oxime in 39
patients suering from PPCS after mild head injury
and state that only 9% of the MRI scans were
abnormal. Unfortunately the MRI scanning techniques
were not described.
The sensitivity of MRI can be maximised by
selecting appropriate imaging sequences. We have
chosen sequences to detect oedema, contusion and
haemorrhage within a time scale acceptable to a busy
clinical MRI unit. The gradient echo T2* is very sen-
sitive to haemorrhage particularly deoxyhaemoglobin
which causes susceptibility eects that produce a
marked signal loss [9]. The FLAIR sequence has been
shown to particularly sensitive to diuse axonal injury,
cortical contusion and subdural haematomas [8] and is
particularly sensitive to incidental high signal foci [54].
The third sequence was T1 weighted to maximise the
detection of early sub-acute changes in haemorrhage by
demonstration of hyper-intensity due to methaemo-
globin [55]. This approach, including routine FLAIR
imaging, can be expected to give higher sensitivity than
standard combinations of GE, proton density, T1- and
T2-weighted images which have been recommended in
the literature [12].
There is weak correlation of MRI abnormalities and
abnormal cognitive function in the current study par-
ticularly attention. Hofman et al. [45] found only weak
correlation with reduced neurocognitive performance
despite abnormal MRI scans in 12 of 21 patients.
Voller et al. [25] found MRI abnormalities in 3 of 12
patients with abnormal neuropsychology, but the study
was too small to explore the implications of the MRI
abnormalities. However, MRI abnormalities in the
present study were not related to return to work status
or measures of PPCS at 6 months. These results sug-
gest that MRI cannot be used to identify those patients
who are likely to develop PPCS or to predict long-term
prognosis. The subjects with abnormal MRI were
nearly all GCS 15 so were not identiable as a more
severe subset of MTBI. This nding calls in to ques-
tion the recommendations of previous workers that
imaging should form a component of the investigation
and/or classication of MTBI [10, 11, 12]. Although
MRI can demonstrate abnormalities in patients with
MTBI, the clinical benets of this approach remain
unproven. The use of advanced imaging modalities
such as quantitative atrophy assessment [45, 56],
magnetisation transfer imaging [57] and magnetic res-
onance spectroscopy [58] may oer possible ap-
proaches to improving the prognostic capabilities of
MRI but require substantive prospective studies before
their value can be assessed. The enormous morbidity
resulting from MTBI [5] will ensure that studies to
identify prognosticators and surrogate markers of
outcome will continue.
Conclusion
We have demonstrated using routine MRI techniques
that non-specic abnormalities are common in a group
of patients with MTBI. Although a trend is seen between
poor performance in attention and executive function

testing and an abnormal MRI, there is not sucient
statistical evidence to substantiate this as a meaningful
nding. An abnormal MRI did not predict a poor
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