Neural tracts injuries in patients with hypoxic ischemic brain injury: diffusion tensor imaging study

Many studies have reported on vulnerable areas of the brain in hypoxic ischemic brain injury (HI-BI). However, little is known about the involvement of neural tracts following HI-BI. We investigated neural tract injuries in adult patients with HI-BI, using diffusion tensor tractography (DTT). Twelve consecutive patients with HI-BI and 12 control subjects were recruited for this study. We classified the patients into two subgroups according to the preservation of alertness: subgroup A-5 patients who had intact alertness and subgroup B-7 patients who had impaired alertness. DTI-Studio software was used for evaluation of seven neural tracts: corticospinal, cingulum, fornix, superior longitudinal fasciculus, inferior longitudinal fasciculus, inferior fronto-occipital fasciculus, and optic radiation. We measured the DTT parameters (fractional anisotropy, apparent diffusion coefficient and voxel number) of each neural tract. In the individual analysis, all 12 patients showed injuries in all 24 neural tracts in terms of both DTT parameters and integrity, except for the corticospinal tract (75.0% injury). In the group analysis, the patient group showed neural injuries in all 24 neural tracts. In comparison of subgroups A and B, subgroup B showed more severe injuries: subgroup B showed a higher rate of disruption (39.8%) than subgroup A (12.9%) on individual DTTs and subgroup B had more severe injuries in both the cingulum and superior longitudinal fasciculus. In conclusion, we found that extensive injuries in the neural tracts were accompanied by HI-BI. Patients with impaired alertness appeared to show more severe injuries of neural tracts.