Chapter 11 - Toward Imaging Chronic Traumatic Encephalopathy

Abstract

This chapter is based on a presentation given at Boston University School of Medicine in a symposium entitled “Chronic Traumatic Encephalopathy,” on Nov. 4, 2016. Neuroimaging findings were presented from those at risk for developing chronic traumatic encephalopathy (CTE), including retired National Football League players, university hockey players, and retired professional soccer players. Currently the diagnosis of CTE can be made only post mortem. What is known, however, is that repetitive brain trauma, including both concussive and subconcussive trauma, is a necessary but not sufficient predictor of those who are later diagnosed with CTE at postmortem examination. Of note, although not all those who experience repetitive brain trauma develop CTE, this is nonetheless an important group to study to learn more about possible precursors to CTE in living players, with the goal of developing imaging biomarkers that are associated both with postmortem findings in CTE and with symptoms associated with presumed CTE. In addition, the development of surrogate biomarkers of CTE may then be used to stage the disease while those who are at risk are still living, and when we can intervene as treatments become available in the future. Thus, understanding the antecedents of CTE and working toward developing biomarkers of early changes in the brain, before neurodegeneration, and perhaps even before the appearance of symptoms, would set the stage for intervention with disease-modifying or neuroprotective compounds. Finally, although we are far from our goals, understanding brain changes in those at risk for CTE is an important start.