Neuroimaging correlates of symptom burden and functional recovery following mild traumatic brain injury: A systematic review

  1. Joshua P. McGeown
  2. Mangor Pedersen
  3. Remika Mito
  4. Alice Theadom
  5. Jerome J. Maller
  6. Paul Condron
  7. Samantha J. Holdsworth
Read the full article

Listed in

This article is not in any list yet, why not save it to one of your lists.
Log in to save this article

Abstract

Background

Mild traumatic brain injury (mTBI) represents 95% of all traumatic brain injuries. Despite being classified as “mild,” mTBI can lead to significant, long-term symptoms that impact quality of life. Diagnostic and management strategies rely heavily on subjective symptom reporting due to a lack of validated biomarkers. Identifying neuroimaging biomarkers to study the pathophysiological features contributing to symptom burden and poor recovery is critical for improving mTBI management.

Objective

To evaluate the relationships between acute Magnetic Resonance Imaging (MRI) findings and mTBI symptom burden and functional recovery, and to understand how these relationships evolve over time.

Methods

The review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Systematic searches were conducted in MEDLINE, SCOPUS, and Cochrane Library databases to identify studies on mTBI with acute MRI data, symptom burden or functional recovery assessments, and at least one follow-up clinical timepoint, covering publications from inception to February 5, 2024.

Results

Fifty-two of 6,759 articles were included. The review identified heterogeneous evidence across MRI modalities. Structural MRI findings showed limited correlation with clinical outcomes, while changes in white matter and functional connectivity were more strongly associated with symptom burden and recovery. Disruptions in multi-functional hubs such as the thalamus, superior longitudinal fasciculus, and cingulate cortex were linked to increased symptom burden and poorer recovery outcomes.

Conclusions

Acutely acquired MRI and clinical data provide crucial insights into the complexities of mTBI symptomology and recovery. This underscores the need to incorporate symptom burden and recovery measures in mTBI neuroimaging studies.

Key findings

  • Divergent neuroimaging findings in mTBI patients with incomplete vs. full recovery

  • Thalamus, SLF, and cingulate disruptions linked to mTBI symptom burden and recovery

  • Opportunity to guide neuroimaging analysis by clinically driven phenotypes

  • Opportunity to embrace multimodal analytical frameworks to advance understanding

  • Significant methodological heterogeneity across studies

Article activity feed

  1. Version published to 10.1101/2025.04.28.25326598v1 on medRxiv