Abstract
Objectives: We investigated an approach for the diagnosis of traumatic axonal injury (TAI) of the spinothalamic tract (STT) that was based on diffusion tensor tractography (DTT) results and a statistical comparison of individual patients who showed central pain following mild traumatic brain injury (mTBI) with the control group. Methods: Five right-handed female patients in their forties and with central pain following mTBI and 12 age-, sex-, and handedness-matched healthy control subjects were recruited. After DTT reconstruction of the STT, we analyzed the STT in terms of three DTT parameters (fractional anisotropy (FA), mean diffusivity (MD), and fiber number (FN)) and its configuration (narrowing and tearing). To assess narrowing, we determined the area of the STT on an axial slice of the subcortical white matter. Results: the FN values were significantly lower in at least one hemisphere of each patient when compared to those of the control subjects (p < 0.05). Significant decrements from the STT area in the control group were observed in at least one hemisphere of each patient (p < 0.05). Regarding configurational analysis, the STT showed narrowing and/or partial tearing in at least one hemisphere of each of the five patients. Conclusions: Herein, we demonstrate a DTT-based approach for the diagnosis of TAI of the STT. The approach involves a statistical comparison between DTT parameters of individual patients who show central pain following mTBI and those of an age-, gender-, and handedness-matched control group. We think that the method described in this study can be useful in the diagnosis of TAI of the STT in individual mTBI patients.
Highlights
A traumatic brain injury (TBI) might be classified as mild, moderate, or severe
We investigated a diagnostic approach for the diagnosis of traumatic axonal injury (TAI) of the spinothalamic tract (STT), an injury that produces central pain
Significant differences were not observed for the fractional anisotropy (FA) and mean diffusivity (MD) values of both hemispheres in each of the five patients when compared with the mean values for the control subjects (p > 0.05)
Summary
A traumatic brain injury (TBI) might be classified as mild, moderate, or severe. Mild TBI (mTBI), which accounts for 70–90% of all TBI, usually shows negative results on conventional brain magnetic resonance imaging (MRI) [1,2]. Diagnostics 2019, 9, 199 diffusion tensor imaging (DTI) in the 1990s [6,7,8] Most of these studies have focused on demonstrating TAI in an mTBI group comprised of a number of patients. The DTI method using ROIs can yield false results due to the high variability among individuals in the anatomical location of a neural tract, and it has lower reliability than the diffusion tensor tractotography (DTT) method [7,8,9,10]. Methods for detecting the TAI of neural tracts in mTBI have not been fully established, a few methods, such as DTT parameter measurement, configurational analysis, and DTI parameter measurement using ROIs, have been suggested [7,8,11,12,13,14]. The diagnostic method is based on a statistical comparison of selected DTT parameters of an individual patient who has central pain following mTBI with those of an age-, gender-, and handedness-matched control group [11,13,15]
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