Diffusion Tensor Tractography of Traumatic Diffuse Axonal Injury

Department of Cognition and Neuroscience, The University of Texas at Dallas, Richardson, USA.
Archives of neurology (Impact Factor: 7.42). 06/2008; 65(5):619-26. DOI: 10.1001/archneur.65.5.619
Source: PubMed


Diffuse axonal injury is a common consequence of traumatic brain injury that frequently involves the parasagittal white matter, corpus callosum, and brainstem.
To examine the potential of diffusion tensor tractography in detecting diffuse axonal injury at the acute stage of injury and predicting long-term functional outcome.
Tract-derived fiber variables were analyzed to distinguish patients from control subjects and to determine their relationship to outcome.
Inpatient traumatic brain injury unit.
From 2005 to 2006, magnetic resonance images were acquired in 12 patients approximately 7 days after injury and in 12 age- and sex-matched controls.
Six fiber variables of the corpus callosum, fornix, and peduncular projections were obtained. Glasgow Outcome Scale-Extended scores were assessed approximately 9 months after injury in 11 of the 12 patients.
At least 1 fiber variable of each region showed diffuse axonal injury-associated alterations. At least 1 fiber variable of the anterior body and splenium of the corpus callosum correlated significantly with the Glasgow Outcome Scale-Extended scores. The predicted outcome scores correlated significantly with actual scores in a mixed-effects model.
Diffusion tensor tractography-based quantitative analysis at the acute stage of injury has the potential to serve as a valuable biomarker of diffuse axonal injury and predict long-term outcome.

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    • "In the case of all patients, reduced FA values were reported in regions without macroscopic lesions, principally the internal capsule and corpus callosum. These findings are supported by other more recent studies (Rutgers et al., 2008; Wang et al., 2008) which compared controls to TBI patients (Figure 2). They reported a significant reduction of FA in both the callosal genu and splenium regions, and a reduction in the number of splenium-reconstructed fibers for severe TBI (Rutgers et al., 2008). "
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    • "across the spectrum of TBI severity (Hulkower et al., 2013). However, in the acute phase of injury, both increased and decreased FA values have been reported (Bazarian et al., 2007; Huisman et al., 2004; Wang et al., 2008; Wilde et al., 2008). It is speculated that elevated FA reflects more water molecules trapped in the intracellular compartment due to cytotoxic edema (Edlow & Wu, 2012). "
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    • "In addition, discrimination of the whole fornix from adjacent neural structure using conventional brain CT or MRI is impossible. By contrast, diffusion tensor tractography (DTT), which is derived from diffusion tensor imaging (DTI), has enabled three-dimensional visualization of the fornix, and many studies have reported on fornix injury using DTT (Nakayama et al., 2006; Sugiyama et al., 2007; Wang et al., 2008; Jang et al., 2009; Chang et al., 2010; Hong and Jang, 2010; Yeo et al., 2011). "

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