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Diffusion Tensor Imaging Along the Perivascular Space in Veterans with Remote Mild Traumatic Brain Injuries.

Gursimrat Bhatti1,2, Meghan E Robinson2,3, Taryn White1,2

  • 1Michael E. DeBakey VA Medical Center, Houston, Texas, USA.

Journal of Neurotrauma
|February 17, 2026
PubMed
Summary
This summary is machine-generated.

Mild traumatic brain injury (mTBI) in Veterans is associated with altered glymphatic flow, measured by diffusion tensor imaging along the perivascular space (DTI-ALPS). Higher mTBI severity correlated with increased DTI-ALPS scores, suggesting impaired brain waste clearance.

Keywords:
brain concussionbrain injuriesdiffusion tensor imagingglymphatic flowtraumatic

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Area of Science:

  • Neuroimaging
  • Neurology
  • Biomedical Engineering

Background:

  • Mild traumatic brain injury (mTBI) is prevalent in post-9/11 Veterans, potentially leading to long-term neurological consequences.
  • The glymphatic system, responsible for clearing waste from the brain, may be affected by TBI.
  • Diffusion tensor imaging along the perivascular space (DTI-ALPS) offers a noninvasive method to assess glymphatic function.

Purpose of the Study:

  • To investigate the association between DTI-ALPS measures and remote mTBI exposure in Veterans.
  • To determine if DTI-ALPS can serve as a marker for glymphatic system changes following mTBI.
  • To explore the relationship between mTBI severity and DTI-ALPS index scores.

Main Methods:

  • 140 Veterans from the TRACTS Houston cohort underwent MRI scans.
  • TBI history was assessed using the Boston Assessment of TBI-Lifetime, excluding moderate/severe TBI.
  • DTI-ALPS indices were analyzed in relation to mTBI severity using statistical tests including ANOVA and multivariable regression.

Main Results:

  • Age was negatively correlated with DTI-ALPS indices (p=0.032).
  • DTI-ALPS indices showed a significant difference across mTBI severity groups (p=0.042), increasing with mTBI grade.
  • Multivariable regression indicated mTBI Grade III was associated with higher DTI-ALPS (p=0.017) compared to no TBI.

Conclusions:

  • DTI-ALPS index scores increase with mTBI severity, suggesting impaired glymphatic function.
  • This study identifies a potential persistent glymphatic marker associated with remote mTBI in Veterans.
  • Further research is needed to understand the clinical impact and temporal progression of these DTI-ALPS changes in Veterans.