Impaired Glymphatic Function in Diffuse Axonal Injury: Evaluation Using the Diffusion Tensor Imaging Analysis Along...

Area of Science:

• Neuroscience
• Radiology
• Biomedical Engineering

Background:

• Traumatic brain injury (TBI) can lead to diffuse axonal injury (DAI), a key pathological feature.
• Glymphatic system impairment is a suspected consequence of TBI, impacting brain waste clearance.

Purpose of the Study:

• To evaluate glymphatic system function in patients with DAI using diffusion tensor imaging analysis along the perivascular space (DTI-ALPS).
• To assess the relationship between DAI severity and glymphatic system activity.

Main Methods:

• 162 TBI patients (84 with DAI, 78 without) underwent MRI with DTI.
• The ALPS index was calculated to measure glymphatic system activity.
• Statistical analyses included ANCOVA and correlation analysis with DAI grade and GCS score.

Main Results:

• Patients with DAI exhibited a significantly lower ALPS index compared to those without DAI (P < 0.001).
• The ALPS index significantly differed across DAI grades (P < 0.001).
• A negative correlation was found between ALPS index and DAI grade (r=-0.47), and a weak positive correlation with GCS score (r=0.174).

Conclusions:

• DAI is associated with impaired glymphatic system function, indicated by a lower ALPS index.
• Higher DAI grades correspond to more severe glymphatic impairment.
• Findings enhance understanding of DAI pathophysiology and aid in predicting patient prognosis and recovery.