The majority of sport-related concussions heal relatively quickly and without complication. Rather than a "structural" injury such as a skull fracture or hematoma, a concussion typically results in a metabolic imbalance in the brain that cannot be detected on standard CT scans or MRIs. The juxtaposition of potassium and calcium ions and the exaggerated demand for glucose create an "energy crisis" in the brain that cannot be adequately captured by the diagnostic imaging techniques available in most hospital emergency rooms.

Researchers around the country are developing imaging techniques that may allow that all-elusive look at the concussed brain. For now, some patients with more significant injuries are participating in studies conducted by the department of Radiology and Biomedical Imaging at the University of California, San Francisco.

Dr. Pratikhttps://jee, Associate Professor of Radiology at UCSF describes how advanced imaging aids research on the effects of concussions and mild traumatic brain injuries.

"Neuroimaging, as it's practiced medically, generally refers to CAT scans, we call them CT scans of the head, and also MRI scans or magnetic resonance imaging scans of the brain. It can also refer to imaging of the spine, and occasionally of the neck as well."

UCSF Radiology: "Examining the Effects of Concussions on the Brain" video (2:59)

"My major research project is in patients who have suffered a mild traumatic brain injury...concussions, for example," said Dr. Mukherjee. "What we find is that we scan the patients early after their injury, within a couple of weeks after their head injury, and then we scan them a month later, and then a year later. Some of the patients have lesions on their MRIs due to the head injury, such as contusions, basically bruises on the brain, which affects mainly the cortex of the brain, the gray matter.

Other patients have little hemorrhages within the white matter of the brain, what we call micro-hemorrhages, and they show up as little black dots on the MRI scans. Those are indications of the patient's injury at the structural level.

We're doing functional MRI (fMRI) and seeing early after the injury...that areas responsible for memory and attention are often altered, such that the areas may be less active early after a concussion, than they would be in a normal person." Functional MRI shows areas of the brain that are activated when the patient is exposed to various tasks or stimuli such as finger tapping, audio, visual, or smell. These stimulated areas show increased blood flow as well as increased use of oxygen. Dr. Mukherjee continued, "But then later after the injury, six months to a year after a concussion, those areas may become more active, in fact may become hyperactive, compared to a normal subject.

So there are dynamic changes that happen after concussion. We're hoping that those may give us more insight into the underlying science of how the brain works, the networks that are involved in these processes and how they can be disrupted by a head injury, even a mild head injury.

And then the other hope is that this information will help in tailoring treatments for these subjects. So perhaps people with concussion who are at risk for persistent problems may benefit from cognitive enhancement therapy, or antidepressants, they may benefit from cognitive therapy like video games designed to improve their memory and and improve their ability to pay attention. These are areas we're actively exploring in our research."

Source: University of California at San Francisco, with permission

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