What traditional neuropsychological assessment got wrong about mild traumatic brain injury. III: the added value of advanced neuroimaging

Advanced neuroimaging methods have the ability to demonstrate neurobiological factors and detect potential underlying neuropathology associated with mild traumatic brain injury (mTBI), even in the absence of standard, conventional clinical computed tomography (CT) and/or magnetic resonance (MR) imaging (MRI) results. This is Part III of a four-part series of critiques about the limitations of traditional neuropsychological methods in the clinical as well as research-based assessment of the mTBI patient. Part III reviews advanced quantitative image analysis methods used to examine brain structure, neural network integrity and functional connectivity following mTBI. Furthermore, this review demonstrates the relationship between symptom burden following mTBI and detecting underlying neuropathology, where traditional neuropsychological tests may reflect no impairment. Significant neuroimaging associations implicating neurobiological, pathophysiological and neuropathological underpinnings associated with mTBI may be demonstrated where traditional neuropsychological measures may be unrevealing. Characterizations from traditional neuropsychological measures as independent tests indicating no lasting sequelae from mTBI, especially after three-months post-injury from mTBI need to be viewed within the context of what advanced neuroimaging can demonstrate. Future directions involving the integration of advanced neuroimaging developments applicable to the mTBI patient are reviewed, especially when integrated with neuropsychological methods.