Novel coaxial cable sensors that feature high sensitivity and high spatial resolution are developed for health monitoring of concrete structures using a time-domain reflectometry (TDR). The new sensor was designed based on the topology change of its outer conductor, which was fabricated with tightly wrapped commercial tin-plated steel spiral covered with solder. The cracks that developed within concrete structures will lead to out-of-contact of local steel spirals. This topology change results in a large impedance discontinuity that can be measured with a TDR. A simplified equivalent transmission line model and numerical full-wave simulations using finite-difference time-domain techniques were used to optimize the sensor design. The sensors under test demonstrated high sensitivity and the capability of multiple-crack detection. A plasma-sprayed coating technique was employed to improve sensor uniformity. Engineering implementation issues, e.g., signal loss, signal postprocessing, and sensor design optimization, were also addressed.