Diffuse axonal injury in mild traumatic brain injury: a diffusion tensor imaging study

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Object. Diffuse axonal injury (DAI) is a major complication of traumatic brain injury (TBI) that leads to functional and psychological deficits. Although DAI is frequently underdiagnosed by conventional imaging modalities, it can be demonstrated using diffusion tensor imaging. The aim of this study was to assess the presence and extent of DAI in patients with mild TBI.

Methods. Forty-six patients with mild TBI and 29 healthy volunteers underwent a magnetic resonance (MR) imaging protocol including: dual—spin echo, fluid-attenuated inversion recovery, T2-weighted gradient echo, and diffusion tensor imaging sequences. In 20 of the patients, MR imaging was performed at a mean of 4.05 days after injury. In the remaining 26, MR imaging was performed at a mean of 5.7 years after injury. In each case, mean diffusivity and fractional anisotropy were measured using both whole-brain histograms and regions of interest analysis. No differences in any of the histogram-derived measures were found between patients and control volunteers. Compared with controls, a significant reduction of fractional anisotropy was observed in patients' corpus callosum, internal capsule, and centrum semiovale, and there were significant increases of mean diffusivity in the corpus callosum and internal capsule. Neither histogram-derived nor regional diffusion tensor imaging metrics differed between the two groups.

Conclusions. Although mean diffusivity and fractional anisotropy abnormalities in these patients with TBI were too subtle to be detected with the whole-brain histogram analysis, they are present in brain areas that are frequent sites of DAI. Because diffusion tensor imaging changes are present at both early and late time points following injury, they may represent an early indicator and a prognostic measure of subsequent brain damage.

Article Information

Address reprint requests to: Matilde Inglese, M.D., Department of Radiology, New York University School of Medicine, 650 First Avenue, New York, New York 10016. email: matilde.inglese@med.nyu.edu.

© AANS, except where prohibited by US copyright law.

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    Images of the brain. a–c: Axial T2-weighted image (a), color-coded mean diffusivity map (b), and color-coded fractional anisotropy map (c) obtained in a patient with mild TBI and no MR imaging—visible abnormalities. Circular ROIs are placed in centrum semiovale bilaterally. d–f: Axial T2-weighted image (d), color-coded mean diffusivity map (e), and color-coded fractional anisotropy map (f) obtained in the same patient. Circular ROIs are placed in the posterior limb of the internal capsule, genu, and splenium of corpus callosum bilaterally.

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