European Radiology

, Volume 29, Issue 3, pp 1308–1317 | Cite as

Quantitative dynamic contrast-enhanced MR imaging shows widespread blood-brain barrier disruption in mild traumatic brain injury patients with post-concussion syndrome

  • Roh-Eul Yoo
  • Seung Hong ChoiEmail author
  • Byung-Mo Oh
  • Sang Do Shin
  • Eun Jung Lee
  • Dong Jae Shin
  • Sang Won Jo
  • Koung Mi Kang
  • Tae Jin Yun
  • Ji-hoon Kim
  • Chul-Ho Sohn



To explore the utility of dynamic contrast-enhanced (DCE) MR imaging for quantitative analysis of blood-brain barrier disruption in mild traumatic brain injury (mTBI) patients with post-concussion syndrome (PCS).


Forty-four consecutive patients with PCS after mTBI and 32 controls were included in this retrospective study. Ktrans and ve from DCE MR imaging were analyzed at contrast-enhancing lesions, T2 hyperintense white matter (WM) lesions, normal-appearing white matter (NAWM), and predilection sites for diffuse axonal injury (LocationDAI). The Mann-Whitney U-test was performed to compare the parameters between mTBI patients and controls and the parameters were correlated with neuropsychological tests using Mann-Whitney U-test and Spearman rank correlation.


The median ve of the T2 hyperintense WM lesions in mTBI patients (n=21) was higher than that of NAWM in controls (p=.027). Both median Ktrans and ve at NAWM were also significantly higher in mTBI patients than in controls (p=.023 and p=.029, respectively). In addition, mTBI patients had higher Ktrans and ve at LocationDAI than controls (p=.008 and p=.015, respectively). VLT (delayed recall) scores were significantly correlated with ve values at T2 hyperintense WM lesions (p=−0.767, p=.044). The median ve at LocationDAI was significantly higher in patients with atypical performance in the digit span test (forward) than in those with average or good performance (p=.043).


mTBI patients with PCS had higher Ktrans and ve values than controls not only at T2 hyperintense WM lesions but also at NAWM and LocationDAI. BBB disruption may be implicated in development of PCS in mTBI patients.

Key Points

• mTBI patients with PCS had higher permeability than controls at T2 hyperintense WM lesions on DCE MR imaging.

• mTBI patients with PCS had higher permeability than controls also at NAWM and predilection sites for DAI.

• BBB disruption may be implicated in the development of PCS in mTBI patients.


Blood-brain barrier Magnetic resonance imaging Perfusion Permeability Post-concussion syndrome (PCS) 





Blood-brain barrier


Central nervous system


Computerized neurocognitive function tests


Continuous performance test


Diffuse axonal injury


Dynamic contrast-enhanced


Diffusion tensor imaging


Diffusion-weighted imaging


Fluid-attenuated inversion recovery


Fast spoiled gradient echo


Interquartile range


Mild TBI


Normal-appearing white matter


Post-concussion syndrome


Receiver operating characteristics


Rivermead post-concussion symptoms questionnaire


Susceptibility-weighted imaging


Verbal learning test


White matter



This study was supported by a grant from Bayer Healthcare, the Korea Health Technology R&D Project through the Korea Health Industry Development Institute (KHIDI), funded by the Ministry of Health & Welfare of South Korea (HI16C1111), and by the Ministry of Science, ICT & Future Planning (2016M3C7A1914002), by Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Science, ICT & Future Planning (2017R1A2B2006526) and by the Ministry of Education (2017R1D1A1B04034838), by Creative-Pioneering Researchers Program through Seoul National University (SNU), and by Project Code (IBS-R006-D1).

Compliance with ethical standards


The scientific guarantor of this publication is Seung Hong Choi.

Conflict of interest

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was waived by the Institutional Review Board.

Ethical approval

Institutional Review Board approval was obtained.


• retrospective

• case-control study / cross sectional study / observational

• performed at one institution

Supplementary material

330_2018_5656_MOESM1_ESM.docx (36 kb)
ESM 1 (DOCX 36 kb)


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Copyright information

© European Society of Radiology 2018

Authors and Affiliations

  • Roh-Eul Yoo
    • 1
  • Seung Hong Choi
    • 1
    • 2
    • 3
    Email author
  • Byung-Mo Oh
    • 4
  • Sang Do Shin
    • 5
  • Eun Jung Lee
    • 6
  • Dong Jae Shin
    • 7
  • Sang Won Jo
    • 8
  • Koung Mi Kang
    • 1
  • Tae Jin Yun
    • 1
  • Ji-hoon Kim
    • 1
  • Chul-Ho Sohn
    • 1
  1. 1.Department of Radiology, Seoul National University HospitalSeoul National University College of MedicineSeoulKorea
  2. 2.Center for Nanoparticle Research, Institute for Basic Science (IBS)Seoul National UniversitySeoulKorea
  3. 3.School of Chemical and Biological EngineeringSeoul National UniversitySeoulKorea
  4. 4.Department of Rehabilitation Medicine, Seoul National University HospitalSeoul National University College of MedicineSeoulKorea
  5. 5.Department of Emergency MedicineSeoul National University College of MedicineSeoulKorea
  6. 6.Department of RadiologyChung-Ang University HospitalSeoulKorea
  7. 7.Department of RadiologySeran General HospitalSeoulKorea
  8. 8.Department of RadiologyKangbuk Samsung HospitalSeoulKorea

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