I’ve seen cross-sectional slices of brains confirmed to have CTE (Chronic Traumatic Encephalopathy) and these slices all seem to differ greatly from a normal looking brain. Currently, why can’t a CTE diagnosis be confirmed with medical imaging, but only through autopsy?
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A number of diseases can only be diagnosed at autopsy because it is the only way to be *absolutely* sure. For example, creutzfeld-Jakob disease.
In the case of CJD, even though technically it cannot be diagnosed during life, normal testing such as MRI can make a diagnosis of “probable CJD” with be right nearly 99 times out of 100.
Its the same with CTE, the brain shrinking, bleeds and scarring are obvious, but there other some other things which can cause them, for example, multiple strokes, cerebral amyloid angiopathy, etc. So, the only way to be sure is to examine the brain tissue. However, like CJD, when you look at the whole picture in a severe case (too young for cerebral amylod angiopathy, multiple previous concussions, etc.) you can usually give a diagnosis of “probable CTE” when the disease is severe enough. For early/mild disease, the changes might be too slight and easily missed, so diagnosis at this stage is often not reliable.
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