The symptoms of Traumatic Brain Injury (TBI) can range from severe physical and mental disability to subtle problems with attention, concentration, or emotional control. Patients with TBI often have persisting, disabling cognitive and emotional problems that impact their work and family lives and limit their ability to seek appropriate care. The pathology underlying more moderate to severe TBI include lesions, contusions and hemorrhages that are readily diagnosed with conventional scanning methods such as magnetic resonance imaging (MRI); however, there may also be other pathology in healthy appearing tissue.  Similarly, the identification of the pathology underlying mild TBI is often more subtle and complicated.

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In the United States alone there are approximately 1.2 million mild TBI cases per year that result in an estimated cost of $56 billion dollars. In the majority (60-70%) of these cases, clinical findings are absent on standard CT scans. Although MRI scans are more sensitive than CT for diagnosing mild TBI injuries such as small petechial lesions, approximately 43-68% of mild TBI cases have normal MRI scans. The fact that traditional imaging modalities may be insensitive to differences between normal and mild/moderate TBI in the majority of cases suggests that the diagnostic utility and predictive validity of more research-based neuroimaging techniques, such as functional magnetic resonance imaging (fMRI), magnetic resonance spectroscopy (MRS), magnetoencephalography (MEG) and diffusion tensor imaging (DTI) needs to be explored.  

Nowhere is the problem of TBI more dramatic than with our returning veterans from Iraq and Afghanistan. Specifically, two-thirds suffer from brain injuries or mental health problems, a rate much higher than that seen in prior conflicts. In fact, mild TBI is the most common injury in returning veterans and may be undiagnosed or misdiagnosed as either post-traumatic stress disorder (PTSD), depression, or as an attention deficit disorder.  The nature of the brain injuries in recently returning veterans is also different – blast injuries predominate over acceleration and deceleration injuries, which are much better understood. Importantly, for unknown reasons, soldiers injured in a blast are more likely to have symptoms of an acute stress reaction or PTSD in addition to a TBI. This combination of factors renders the differential diagnosis of PTSD and TBI extremely challenging for care providers.  

The first step for successful treatment is to better understand the pathophysiology underlying TBI, and to develop biomarkers sensitive to neuronal injury and recovery. This ensures that best care practices will be used when diagnosing and treating patients with TBI. We are currently seeking to identify biomarkers in brain images that 1) improve the ability to differentiate TBI from other diagnoses, 2) correlate with measures of functional outcome, and 3) correlate with cognitive dysfunction, especially in the area of attentional control.

Another primary obstacle is accessibility of care. This is especially true in New Mexico, which is a largely rural state with only a few population centers. Many individuals with TBI return to the medically under-served communities where access to care is more difficult. With our mobile MRI, The MRN unit can uniquely address the needs of this under-served population in New Mexico and adjoining states, establishing a model of diagnostic service for other rural locations in the United States.

MISSION STATEMENT
The MRN will utilize advanced multimodal imaging in combination with comprehensive neurocognitive and psychiatric assessments to further understand the changes in brain function that occur over time as a consequence of TBI. When necessary, we will bring our mobile imaging laboratories to rural populations where access to care is often a burden. Our ultimate goal is to use state-of-the-art neuroimaging technology to help those afflicted with TBI by 1) providing accurate and rapid diagnosis, 2) selecting appropriate therapy for patients, and 3) individualize therapy to optimize functional outcome.

Please see our list of publications for additional information regarding this MRS work and other findings from our TBI team.