Abstract
Mild traumatic brain injury results in a heterogeneous constellation of deficits and symptoms that persist in a subset of patients. This prospective longitudinal study identifies early diffusion tensor imaging biomarkers of mild traumatic brain injury that significantly relate to outcomes at 1 year following injury. DTI was performed on 39 subjects with mild traumatic brain injury within 16 days of injury and 40 controls; 26 subjects with mild traumatic brain injury returned for follow-up at 1 year. We identified subject-specific regions of abnormally high and low fractional anisotropy and calculated mean fractional anisotropy, axial diffusivity, radial diffusivity, and mean diffusivity across all white matter voxels brain-wide and each of several white matter regions. Assessment of cognitive performance and symptom burden was performed at 1 year. Significant associations of brain-wide DTI measures and outcomes included the following: mean radial diffusivity and mean diffusivity with memory; and mean fractional anisotropy, radial diffusivity, and mean diffusivity with health-related quality of life. Significant differences in outcomes were found between subjects with and without abnormally high fractional anisotropy for the following white matter regions and outcome measures: left frontal lobe and left temporal lobe with attention at 1 year, left and right cerebelli with somatic postconcussion symptoms at 1 year, and right thalamus with emotional postconcussion symptoms at 1 year. Individualized assessment of DTI abnormalities significantly relates to long-term outcomes in mild traumatic brain injury. Abnormally high fractional anisotropy is significantly associated with better outcomes and might represent an imaging correlate of postinjury compensatory processes.
Highlights
MethodsDTI was performed on 39 subjects with mild traumatic brain injury within 16 days of injury and 40 controls; 26 subjects with mild traumatic brain injury returned for follow-up at 1 year
BACKGROUND AND PURPOSEMild traumatic brain injury results in a heterogeneous constellation of deficits and symptoms that persist in a subset of patients
Mild traumatic brain injury is associated with a heterogeneous constellation of deficits and symptoms that persist for the long term in 20% of patients who experience concussion.[1]
Summary
DTI was performed on 39 subjects with mild traumatic brain injury within 16 days of injury and 40 controls; 26 subjects with mild traumatic brain injury returned for follow-up at 1 year. Postconcussion Symptoms and Health-Related Quality of Life Outcome Measures At 1 year postinjury, the Rivermead Post Concussion Symptoms Questionnaire[20] was administered to assess PCS, and the Sickness Impact Profile[21] was administered to assess HRQoL. Patients were classified as having postconcussion syndrome on the basis of outcomes at 1 year rather than 3 or 6 months; those with postconcussion syndrome that lasted Ͻ1 year were not classified in this manner. This classification restricts the postconcussion syndrome patient group to those with more persistent and chronic symptoms. Symptoms are categorized into cognitive, somatic, or emotional factors; and each factor is used as an independent outcome measure.[22]
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