Abstract
Diffusion tensor imaging (DTI) can noninvasively quantify white matter (WM) integrity. Although its application in adult traumatic brain injury (TBI) is common, few studies in children have been reported. The purposes of this study were to examine the alteration of fractional anisotropy (FA) in children with TBI experienced during early childhood and to quantify the association between FA and injury severity. FA was assessed in 9 children with TBI (age = 7.89 +/- 1.00 years; Glasgow Coma Scale [GCS] = 10.11 +/- 4.68) and a control group of 12 children with orthopedic injuries without central nervous system involvement (age = 7.51 +/- 0.95 years). All of the subjects were at minimum 12 months after injury. We examined group differences in a series of predetermined WM regions of interest with t test analysis. We subsequently conducted a voxel-wise comparison with Spearman partial correlation analysis. Correlations between FA and injury severity were also calculated on a voxel-wise basis. FA values were significantly reduced in the TBI group in genu of corpus callosum (CC), posterior limb of internal capsule (PLIC), superior longitudinal fasciculus (SLF), superior fronto-occipital fasciculus (SFO), and centrum semiovale (CS). GCS scores were positively correlated with FA in several WM areas including CC, PLIC, SLF, CS, SFO, and inferior fronto-occipital fasciculus (IFO). This DTI study provides evidence that WM integrity remains abnormal in children with moderate-to-severe TBI experienced during early childhood and that injury severity correlated strongly with FA.
Highlights
AND PURPOSE: Diffusion tensor imaging (DTI) can noninvasively quantify white matter (WM) integrity
fractional anisotropy (FA) values were significantly reduced in the traumatic brain injury (TBI) group in genu of corpus callosum (CC), posterior limb of internal capsule (PLIC), superior longitudinal fasciculus (SLF), superior fronto-occipital fasciculus (SFO), and centrum semiovale (CS)
GCS scores were positively correlated with FA in several WM areas including CC, PLIC, SLF, CS, SFO, and inferior fronto-occipital fasciculus (IFO)
Summary
FA was assessed in 9 children with TBI (age ϭ 7.89 Ϯ 1.00 years; Glasgow Coma Scale [GCS] ϭ 10.11 Ϯ 4.68) and a control group of 12 children with orthopedic injuries without central nervous system involvement (age ϭ 7.51 Ϯ 0.95 years). Correlations between FA and injury severity were calculated on a voxel-wise basis. This project was part of a larger research project (National Institutes of Health RO1 HD044279) that studied the familial and social environment of young children with TBI and their influence on cognitive and behavioral recovery. Inclusion of a comparison group with OI injuries allowed us to examine the consequences of TBI relative to the functioning of a group of children likely to be similar in family characteristics, preinjury behavior, and the stresses associated with acute hospitalization. Recruitment Criteria In the parent project, consecutive admissions of children with mild, moderate, and severe TBI or with OI not involving the central nervous system were recruited at ages 36 – 84 months (at the time of injury). Eligible children with OI were matched on time since injury, age, sex, ethnicity, and handedness with the TBI group
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