Neuroimaging in pediatric traumatic brain injury: current and future predictors of functional outcome

Although neuroimaging has long played a role in the acute management of pediatric traumatic brain injury (TBI), until recently, its use as a tool for understanding and predicting long-term brain-behavior relationships after TBI has been limited by the relatively poor sensitivity of routine clinical imaging for detecting diffuse axonal injury (DAI). Newer magnetic resonance-based imaging techniques demonstrate improved sensitivity to DAI. Early research suggests that these techniques hold promise for identifying imaging predictors and correlates of chronic function, both globally and within specific neuropsychological domains. In this review, we describe the principles of new, advanced imaging techniques including diffusion weighted and diffusion tensor imaging, susceptibility weighted imaging, and (1)H-magnetic resonance spectroscopy. In addition, we summarize current research demonstrating their early success in establishing relationships between imaging measures and functional outcomes after TBI. With the ongoing research, these imaging techniques may allow earlier identification of possible chronic sequelae of tissue injury for each child with TBI, thereby facilitating efficacy and efficiency in delivering successful rehabilitation services.