Diffusion Tensor Imaging as Neurologic Predictor in Patients Affected by Traumatic Brain Injury: Scoping Review

Background: Diffusion tensor imaging (DTI), a variant of Diffusion Weighted Imaging (DWI), enables a neuroanatomical microscopic-like examination of the brain, which can detect brain damage using physical parameters. DTI's application to traumatic brain injury (TBI) has the potential to reveal radiological features that can assist in predicting the clinical outcomes of these patients. What is the ongoing role of DTI in detecting brain alterations and predicting neurological outcomes in patients with moderate to severe traumatic brain injury and/or diffuse axonal injury? Methods: A scoping review of the PubMed, Scopus, EMBASE, and Cochrane databases was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. The aim was to identify all potentially relevant studies concerning the role of DTI in TBI. From an initial pool of 3527 publications, 26 articles were selected based on relevance. These studies included a total of 729 patients with moderate to severe TBI and/or diffuse axonal injury. DTI parameters were analyzed to determine their relationship with neurological outcomes post-TBI, with assessments of several brain functions and regions. Results: The studies included various DTI parameters, identifying significant relationships between DTI variations and neurological outcomes following TBI. Multiple brain functions and regions were evaluated, demonstrating the capability of DTI to detect brain alterations with higher accuracy, sensitivity, and specificity than MRI alone. Conclusions: DTI is a valuable tool for detecting brain alterations in TBI patients, offering enhanced accuracy, sensitivity, and specificity compared to MRI alone. Recent studies confirm its effectiveness in identifying neurological impairments and predicting outcomes in patients following brain trauma, underscoring its utility in clinical settings for managing TBI.