| | Use of Diffusion-Tensor Imaging in Traumatic Spinal Cord Injury to Identify Concomitant Traumatic Brain InjuryAbstract Wei CW, Tharmakulasingam J, Crawley A, Kideckel DM, Mikulis DJ, Bradbury C, Green RE. Use of diffusion tensor imaging in traumatic spinal cord injury to identify concomitant traumatic brain injury. ObjectiveTo characterize and differentiate cerebral white matter (WM) changes related selectively to traumatic brain injury (TBI) or spinal cord injury (SCI) in patients with SCIs in order to improve diagnostic accuracy of TBI in people with SCI. DesignDiffusion-tensor imaging (DTI)–derived fractional anisotropy (FA) data in WM tracts were compared between a healthy control and 2 patient groups. Between-subject comparisons of FA were performed using region of interest (ROI) analysis and tract-based spatial statistics. SettingA large, urban inpatient SCI program. ParticipantsThree groups: SCI and concomitant TBI (SCI with TBI, n=7); SCI without TBI (SCI only, n=15); and healthy control subjects (n=12). InterventionsNot applicable. Main Outcome MeasureFA was used as a measure of cerebral WM integrity. ResultsROI analyses showed reduced FA in the genu and splenium of the corpus callosum and forceps minor in patients with SCI with TBI compared with both healthy controls and patients with SCI only. ROI analyses did not show evidence of FA differences in patients with SCI only compared with controls. Tract-based spatial statistics did not demonstrate between-group differences in FA. ConclusionsDTI is a sensitive tool to detect TBI-related WM damage in patients with SCI who have suffered concomitant TBI. No WM abnormalities on DTI could be attributed to SCI alone, although this finding should be further explored in future studies. Therefore, DTI may be a valuable tool to identify TBI in the SCI population. Further research to produce normative FA values is needed to allow identification of TBI in individual patients with SCI. List of Abbreviations: ALIC, anterior limb of the internal capsule, ANOVA, analysis of variance, DAI, diffuse axonal injury, DTI, diffusion-tensor imaging, FA, fractional anisotropy, FMRIB, functional magnetic resonance imaging of the brain, gCC, genu of the corpus callosum, GCS, Glasgow Coma Scale, MRI, magnetic resonance imaging, PLIC, posterior limb of the internal capsule, PTA, posttraumatic amnesia, ROI, region of interest, sCC, splenium of the corpus callosum, SCI, spinal cord injury, TBI, traumatic brain injury, TBSS, tract-based spatial statistics, WM, white matter a Department of Medical Imaging, University of Toronto, Toronto, ON, Canada b Department of Cell and Systems Biology, University of Toronto, Toronto, ON, Canada c Institute of Medical Science, University of Toronto, University Health Network, Toronto, ON, Canada d Department of Medical Imaging, Toronto Western Hospital, University of Toronto, Toronto, ON, Canada e Toronto Rehabilitation Institute, Toronto, ON, Canada f Graduate Department of Rehabilitation Sciences, University of Toronto, Toronto, ON, Canada  Reprint requests to Robin E. Green, PhD, CPsych, Toronto Rehabilitation Institute, The University Centre, 550 University Ave, Toronto, ON, M5G 2A2, Canada
Supported by the Canadian Institutes of Health Research, the Physicians' Services Incorporated, and the Ontario Mental Health Foundation (grant nos. MOP-67072, 05-50, 2005-ABI-392). No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit on the authors or on any organization with which the authors are associated. PII: S0003-9993(08)01387-7 doi:10.1016/j.apmr.2008.07.005 © 2008 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved. | 
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ABSTRACT