Neuroradiological features of traumatic encephalopathy syndrome using MRI and FDG-PET imaging: a case series in Australia

TL;DR

This case series explores the use of MRI and FDG-PET imaging in diagnosing traumatic encephalopathy syndrome (TES), demonstrating their potential to improve ante-mortem diagnosis and staging.

Contribution

It provides preliminary evidence that current MRI and FDG-PET capabilities, combined with radiologist reports, can aid TES diagnosis and staging.

Findings

Most patients showed posterior parietal atrophy

FDG-PET revealed region-specific hypometabolism patterns

Imaging features may help stratify TES stages

Abstract

Objectives: This study examined whether currently existing clinical structural magnetic resonance imaging (MRI) and fluorodeoxyglucose positron emission tomography (18FDG-PET) capabilities and board-certified radiologists' reports and interpretations can assist with traumatic encephalopathy syndrome (TES) diagnosis. Design: retrospective case series. Setting: this study assessed six patients with TES criteria recruited from the Sydney area, Australia Main outcomes: patients' clinical history and clinical presentation along TES diagnostic criteria, board-certified radiologist reports of structural MRI and 18FDG-PET. Results: one patient was classified as possible CTE, and the others were classified as probable CTE with significant RHI exposure history and a spectrum of cognitive deficits and other neuropsychiatric disturbances consistent with TES diagnostic criteria. Most common radiological features included atrophy of posterior superior parietal region and Evans Index > 0.25. FDG-PET's pattern of common regions of hypometabolism and differing hypometabolism across participants suggested that FDG-PET and structural MRI have the potential for stratifying different TES stages. Conclusions: this study highlights the potential of a combined clinical and radiological approach using solely current capabilities to improve TES diagnosis and suggests a larger study. Such expanded investigation is crucial for advancing the ante-mortem diagnosis and management of CTE.