Diffusion Tensor Imaging Abnormalities in Patients With Mild Traumatic Brain Injury and Neurocognitive Impairment

Objective: To determine if diffusion tensor imaging can differentiate patients with chronic cognitive impairment after mild traumatic brain injury (TBI) from normal controls. Methods: Ten patients with persistent cognitive impairment after mild TBI were evaluated at least 2 years after injury. Fractional anisotropy (FA) and apparent diffusion coefficient (ADC) were measured at white matter regions susceptible to axonal injury after TBI. Comparison was made to 10 normal controls. Results: Fractional anisotropy was significantly lower (4.5%; P = 0.01) and ADC higher (7.1%; P = 0.04) in patients at the left side of the genu of the corpus callosum. The mild TBI group also demonstrated a significant increase in FA within the posterior limb of the internal capsule bilaterally (left, 5.1%; P = 0.03; right, 1.9%; P = 0.04). Conclusions: These results demonstrate low FA and high ADC in the genu of the corpus callosum of mild TBI patients with persistent cognitive impairment, suggesting that permanent white matter ultrastructural damage occurs in mild TBI, and that such damage may be associated with persistent cognitive disability. Further longitudinal studies are warranted to elucidate the full importance of the findings.

[1]  H. Levin,et al.  Neurobehavioral outcome following minor head injury: a three-center study. , 1988, Journal of neurosurgery.

[2]  G. Johnson,et al.  Diffuse axonal injury in mild traumatic brain injury: a diffusion tensor imaging study. , 2005, Journal of neurosurgery.

[3]  J. Ponsford,et al.  Factors influencing outcome following mild traumatic brain injury in adults , 2000, Journal of the International Neuropsychological Society.

[4]  J. Adams,et al.  Axonal injury: a universal consequence of fatal closed head injury? , 2004, Acta Neuropathologica.

[5]  M. Esiri,et al.  Axonal damage: a key predictor of outcome in human CNS diseases. , 2003, Brain : a journal of neurology.

[6]  A. Sorensen,et al.  Diffusion-weighted MRI in diffuse axonal injury of the brain , 2002, European Radiology.

[7]  J. Giacino,et al.  Evidence-based cognitive rehabilitation: updated review of the literature from 1998 through 2002. , 2005, Archives of physical medicine and rehabilitation.

[8]  Guy B. Williams,et al.  Diffusion tensor imaging in chronic head injury survivors: correlations with learning and memory indices , 2006, NeuroImage.

[9]  A. Saykin,et al.  Neuroimaging Findings in Mild Traumatic Brain Injury * , 2001, Journal of clinical and experimental neuropsychology.

[10]  A. Sorensen,et al.  Diffusion tensor imaging as potential biomarker of white matter injury in diffuse axonal injury. , 2004, AJNR. American journal of neuroradiology.

[11]  Norman Relkin,et al.  Increased diffusion in the brain of professional boxers: a preclinical sign of traumatic brain injury? , 2003, AJNR. American journal of neuroradiology.

[12]  S A Raskin,et al.  The rehabilitation of attention in individuals with mild traumatic brain injury, using the APT-II programme. , 2000, Brain injury.

[13]  M. Franzen,et al.  Presence of post-concussion syndrome symptoms in patients with chronic pain vs mild traumatic brain injury , 2003, Brain injury.

[14]  Thomas Ptak,et al.  Cerebral fractional anisotropy score in trauma patients: a new indicator of white matter injury after trauma. , 2003, AJR. American journal of roentgenology.

[15]  J A Maldjian,et al.  Traumatic brain injury: diffusion-weighted MR imaging findings. , 1999, AJNR. American journal of neuroradiology.

[16]  J. Barth,et al.  Mild head injury and post concussion syndrome: does anyone really suffer? , 1996, Clinical EEG.

[17]  A. Marmarou,et al.  Contribution of vasogenic and cellular edema to traumatic brain swelling measured by diffusion-weighted imaging. , 1997, Journal of neurosurgery.

[18]  L. Gentry,et al.  Imaging of closed head injury. , 1994, Radiology.

[19]  T A Gennarelli,et al.  Prevalence of MR evidence of diffuse axonal injury in patients with mild head injury and normal head CT findings. , 1994, AJNR. American journal of neuroradiology.

[20]  Mark W. Woolrich,et al.  Advances in functional and structural MR image analysis and implementation as FSL , 2004, NeuroImage.

[21]  Daniela Montaldi,et al.  Are mild head injuries as mild as we think? Neurobehavioral concomitants of chronic post-concussion syndrome , 2006, BMC neurology.

[22]  A. Twijnstra,et al.  Persistence of postconcussional symptoms in uncomplicated, mildly head-injured patients: A prospective cohort study , 1993 .

[23]  J S Kreutzer,et al.  The Prevalence and Symptom Rates of Depression after Traumatic Brain Injury: A Comprehensive Examination , 2002 .

[24]  V. Haughton,et al.  Diffusion tensor MR imaging in diffuse axonal injury. , 2002, AJNR. American journal of neuroradiology.

[25]  Jun Li,et al.  Plasticity of the corticospinal tract in early blindness revealed by quantitative analysis of fractional anisotropy based on diffusion tensor tractography , 2007, NeuroImage.

[26]  C Poupon,et al.  Increased white matter connectivity in euthymic bipolar patients: diffusion tensor tractography between the subgenual cingulate and the amygdalo-hippocampal complex , 2007, Molecular Psychiatry.

[27]  W. LaFrance,et al.  Neuropsychiatric sequelae of traumatic brain injury. , 2009, Seminars in neurology.

[28]  Deanna M. Barch,et al.  Sex influences on material-sensitive functional lateralization in working and episodic memory: Men and women are not all that different , 2006, NeuroImage.

[29]  B. Thompson,et al.  MR imaging of head trauma: review of the distribution and radiopathologic features of traumatic lesions. , 1988, AJR. American journal of roentgenology.