Diagnosis of Mild Traumatic Brain Injury: A Narrative Review of Advances in Neuroimaging and Patient-Reported Outcome Measures.

Abstract

Mild traumatic brain injury (mTBI) is one of the most common neurological injuries, yet its diagnosis remains challenging because of heterogeneous case definitions, the limited sensitivity of conventional imaging, and the nonspecific nature of post-traumatic symptoms. Computed tomography is widely used in acute trauma care to exclude life-threatening intracranial lesions, but it is often normal in patients with mTBI, including those with persistent symptoms. Conventional magnetic resonance imaging (MRI) may improve lesion detection, although many patients still show no clear abnormalities despite ongoing clinical impairment. Recent advances in neuroimaging, including susceptibility-based imaging, diffusion MRI, magnetic resonance spectroscopy, volumetric analysis, and functional MRI, have improved understanding of subtle structural, microstructural, metabolic, and functional changes after mTBI. In parallel, patient-reported outcome measures (PROMs) have become important tools for assessing symptom burden, functional limitations, emotional distress, and health-related quality of life that may not be captured by imaging alone. In this narrative review, we summarize recent advances in neuroimaging and PROMs in the diagnostic assessment of mTBI and discuss their strengths, limitations, and complementary roles. An integrated approach combining clinical evaluation, imaging findings, and patient-reported outcomes may improve diagnostic characterization and support more individualized management.