Implications of DTI in mild traumatic brain injury for detecting neurological recovery and predicting long-term behavioural outcome in paediatric and young population-a systematic review.

Abstract

This systematic review was done with the aim to answer these three questions: 1) Is there any change in diffusion metrics in MRI-DTI sequences after mildtraumatic brain injury in paediatric and young population?, 2) Is there any correlation of these changes in diffusion metrics with severity of post concussionsymptoms?, 3) Is the change in diffusion metrics predictive of neurocognitive function or neurological recovery? Eligibility criteria- Mild TBI patients upto 22 years of age, MRI- DTI sequence done post injury, Outcome measurement with follow up at least for onemonth and articles published in English language only.Data sources- PubMed, EMBASE, CINAHL, Scopus and Cochrane RESULTS: Some studies show increased FA and some studies show decrease FA and few showed no change in white matter microstructure in mTBI patients and thisdepends on the duration of injury. Prediction of PCSs severity on the basis of changes in white matter microstructure showed inconsistent results.Radiological recovery in contrast to clinical recovery, is often delayed ranging from 6 months to 2-3 years. But change in diffusion metrics after mTBI isnot definite predictive of neurocognitive outcomes. Large, properly designed, multicentric studies with appropriate extracranial or orthopedic control and long follow up are needed to establish the use of DTIin mTBI for predicting behavioral outcome.