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Review
. 2025 Mar 25;7(2):fcaf120.
doi: 10.1093/braincomms/fcaf120. eCollection 2025.

Current and prospective roles of magnetic resonance imaging in mild traumatic brain injury

Matilde Sassani  1   2   3 , Tara Ghafari  4 , Pradeepa R W Arachchige  5 , Iman Idrees  6 , Yidian Gao  4 , Alice Waitt  4   6 , Samuel R C Weaver  7 , Ali Mazaheri  4 , Hannah S Lyons  1   2   3 , Olivia Grech  1   2 , Mark Thaller  1   2   3 , Caroline Witton  6 , Andrew P Bagshaw  4 , Martin Wilson  4 , Hyojin Park  4 , Matthew Brookes  5 , Jan Novak  6 , Susan P Mollan  1   8 , Lisa J Hill  9 , Samuel J E Lucas  7 , James L Mitchell  1   2   3 ; UK mTBI Predict Consortium; Alexandra J Sinclair  1   2   3 , Karen Mullinger  4   5 , Davinia Fernández-Espejo  4
Collaborators, Affiliations
Review

Current and prospective roles of magnetic resonance imaging in mild traumatic brain injury

Matilde Sassani et al. Brain Commun. .

Abstract

There is unmet clinical need for biomarkers to predict recovery or the development of long-term sequelae of mild traumatic brain injury, a highly prevalent condition causing a constellation of disabling symptoms. A substantial proportion of patients live with long-lasting sequelae affecting their quality of life and ability to work. At present, symptoms can be assessed through clinical tests; however, there are no imaging or laboratory tests fully reflective of pathophysiology routinely used by clinicians to characterize post-concussive symptoms. Magnetic resonance imaging has potential to link subtle pathophysiological alterations to clinical outcomes. Here, we review the state of the art of MRI research in adults with mild traumatic brain injury and provide recommendations to facilitate transition into clinical practice. Studies utilizing MRI can inform on pathophysiology of mild traumatic brain injury. They suggest presence of early cytotoxic and vasogenic oedema. They also show that mild traumatic brain injury results in cellular injury and microbleeds affecting the integrity of myelin and white matter tracts, all processes that appear to induce delayed vascular reactions and functional changes. Crucially, correlates between MRI parameters and post-concussive symptoms are emerging. Clinical sequences such as T1-weighted MRI, susceptibility-weighted MRI or fluid attenuation inversion recovery could be easily implementable in clinical practice, but are not sufficient, in isolation for prognostication. Diffusion sequences have shown promises and, although in need of analysis standardization, are a research priority. Lastly, arterial spin labelling is emerging as a high-utility research as it could become useful to assess delayed neurovascular response and possible long-term symptoms.

Keywords: biomarkers; concussion; magnetic resonance imaging; magnetic resonance spectroscopy; mild traumatic brain injury.

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Conflict of interest statement

Prof. A.J.S. reports personal fees from Invex therapeutics in her role as Director with stock holdings, during the conduct of the study; other from Allergan, Novartis, Cheisi and Amgen outside the submitted work. S.P.M. reports consultancy fees (Invex Therapeutics; Neurodiem); advisory board fees (Invex therapeutics; Janssen) and speaker fees (Heidelberg Engineering; Chugai-Roche Ltd; Allergan; Santen; Chiesi; and Santhera), all outside the submitted work.

Figures

Graphical Abstract
Graphical Abstract
Created in BioRender. Sassani, M. (2025) https://BioRender.com/f37k702.
Figure 1
Figure 1
Flow diagram illustrating identification, screening and selection of manuscripts included in the systematic search. T1w, T1-weighted.
Figure 2
Figure 2
Key highlights: sequences already widely used in clinical practice. Created in BioRender. Sassani, M. (2025) https://BioRender.com/f5mhnnn.
Figure 3
Figure 3
Key highlights: magnetic resonance spectroscopy and DTI. α-KG, alpha-ketoglutarate; ATP, adenosine triphosphate; Cho, choline; Co-A, coenzyme A; Cr, creatine. Created in BioRender. Sassani, M. (2025) https://BioRender.com/s04q864
Figure 4
Figure 4
Key highlights: experimental magnetic resonance imaging techniques. BOLD, blood-oxygenation-level-dependent effect. Created in BioRender. Sassani, M. (2025) https://BioRender.com/29kenoz
See this image and copyright information in PMC

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