Longitudinal white matter microstructural changes in pediatric mild traumatic brain injury: An A-CAP study

Area of Science:

• Neuroscience
• Pediatric Neurology
• Radiology

Background:

• Pediatric mild traumatic brain injury (mTBI) is common, but its long-term effects on white matter microstructure are not fully understood.
• Persistent symptoms after mTBI in children can impact neurodevelopment and quality of life.

Purpose of the Study:

• To investigate white matter microstructural trajectories in children after mTBI.
• To examine the relationship between white matter changes and persistent symptoms in pediatric mTBI.

Main Methods:

• A prospective, longitudinal cohort study involving children aged 8-16.99 years with mTBI or orthopedic injury (OI).
• Diffusion-weighted imaging (DWI) was used to assess white matter microstructure (mean diffusivity and fractional anisotropy) at post-acute and chronic time points.
• Children were classified as mTBI with or without persistent symptoms based on pre-injury and 1-month post-injury symptom ratings.

Main Results:

• Children with mTBI without persistent symptoms showed higher fractional anisotropy in the superior longitudinal fasciculus compared to OI.
• Younger children with mTBI and persistent symptoms exhibited higher mean diffusivity in the anterior thalamic radiations.
• Lower mean diffusivity in the arcuate fasciculus and superior longitudinal fasciculus was observed in mTBI without persistent symptoms compared to OI at 6 months post-injury.

Conclusions:

• White matter microstructural changes, potentially indicating neuroinflammation and axonal swelling, persist for at least 6 months post-injury in children with mTBI.
• These changes are more pronounced in younger children experiencing persistent symptoms after mTBI.
• More organized white matter microstructure is associated with better clinical outcomes in children recovering from mTBI.