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Published on: August 14, 2019
Diffusion tensor imaging in relation to cognitive and functional outcome of traumatic brain injury in children
Harvey S Levin1, Elisabeth A Wilde, Zili Chu
1Physical Medicine and Rehabilitation Alliance, Baylor College of Medicine, University of Texas-Houston Medical School, Houston, TX 77030, USA.
Insights
Diffusion tensor imaging (DTI) reveals white matter integrity issues in children with moderate to severe traumatic brain injury (TBI). These DTI findings correlate with cognitive and functional outcomes, highlighting DTI
Area of Science:
- Neuroimaging
- Pediatric Neurology
- Traumatic Brain Injury Research
Background:
- Moderate to severe traumatic brain injury (TBI) in children can lead to long-term cognitive and functional deficits.
- Conventional magnetic resonance imaging (MRI) may not detect subtle white matter abnormalities after TBI.
- Diffusion tensor imaging (DTI) offers a sensitive method to assess white matter integrity.
Purpose of the Study:
- To investigate the relationship between white matter integrity, assessed by DTI, and cognitive/functional outcomes in children with moderate to severe TBI.
- To compare DTI findings and their correlations with outcomes between children with TBI and those with orthopedic injuries (OI).
Main Methods:
- A prospective observational study included 32 children with moderate to severe TBI and 36 children with OI.
- DTI was acquired at 3 months post-injury, followed by fiber tracking analysis.
- Global outcome (Glasgow Outcome Scale) and cognitive function (Flanker task) were assessed.
Main Results:
- DTI metrics (fractional anisotropy, apparent diffusion coefficient) differentiated TBI from OI groups.
- Both cognitive and functional outcomes correlated with DTI findings in TBI patients.
- A composite DTI measure of white matter integrity was associated with global outcome in children with TBI.
Conclusions:
- DTI is sensitive to white matter injury in children with moderate to severe TBI, detecting abnormalities not visible on conventional MRI.
- DTI measures are related to global outcome, cognitive processing speed, and interference resolution in pediatric TBI.
- Longitudinal studies are necessary to confirm the persistence of these DTI-outcome relationships over time.
Objective:
To investigate the relation of white matter integrity using diffusion tensor imaging (DTI) to cognitive and functional outcome of moderate to severe traumatic brain injury (TBI) in children.
Design:
Prospective observational study of children who had sustained moderate to severe TBI and a comparison group of children who had sustained orthopedic injury (OI).
Participants:
Thirty-two children who had sustained moderate to severe TBI and 36 children with OI were studied.
Methods:
Fiber tracking analysis of DTI acquired at 3-month postinjury and assessment of global outcome and cognitive function within 2 weeks of brain imaging. Global outcome was assessed using the Glasgow Outcome Scale and the Flanker task was used to measure cognitive processing speed and resistance to interference.
Results:
Fractional anisotropy and apparent diffusion coefficient values differentiated the groups and both cognitive and functional outcome measures were related to the DTI findings. Dissociations were present wherein the relation of Fractional anisotropy to cognitive performance differed between the TBI and OI groups. A DTI composite measure of white matter integrity was related to global outcome in the children with TBI.
Conclusions:
DTI is sensitive to white matter injury at 3 months following moderate to severe TBI in children, including brain regions that appear normal on conventional magnetic resonance imaging. DTI measures reflecting diffusion of water parallel and perpendicular to white matter tracts as calculated by fiber tracking analysis are related to global outcome, cognitive processing speed, and speed of resolving interference in children with moderate to severe TBI. Longitudinal data are needed to determine whether these relations between DTI and neurobehavioral outcome of TBI in children persist at longer follow-up intervals.
Related Concept Videos
01:28Traumatic Brain Injury l: Introduction
01:14Brain Imaging
These technologies include computerized axial tomography (CAT or CT scans), positron-emission tomography (PET scans), magnetic resonance imaging (MRI), functional magnetic resonance imaging (fMRI), and Transcranial Magnetic Stimulation (TMS).