Archives of Physical Medicine and Rehabilitation
Volume 89, Issue 12, Supplement , Pages S85-S91, December 2008

Use of Diffusion-Tensor Imaging in Traumatic Spinal Cord Injury to Identify Concomitant Traumatic Brain Injury

  • Corie W. Wei, MD

      Affiliations

    • Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
    • ,
  • Januthy Tharmakulasingam, BSc

      Affiliations

    • Department of Cell and Systems Biology, University of Toronto, Toronto, ON, Canada
    • ,
  • Adrian Crawley, PhD

      Affiliations

    • Department of Medical Imaging, Toronto Western Hospital, University of Toronto, Toronto, ON, Canada
    • ,
  • David M. Kideckel, MSc

      Affiliations

    • Institute of Medical Science, University of Toronto, University Health Network, Toronto, ON, Canada
    • ,
  • David J. Mikulis, MD

      Affiliations

    • Department of Medical Imaging, Toronto Western Hospital, University of Toronto, Toronto, ON, Canada
    • ,
  • Cheryl L. Bradbury, PsyD, CPsych

      Affiliations

    • Toronto Rehabilitation Institute, Toronto, ON, Canada
    • Graduate Department of Rehabilitation Sciences, University of Toronto, Toronto, ON, Canada
    • ,
  • Robin E. Green, PhD, CPsych

      Affiliations

    • Toronto Rehabilitation Institute, Toronto, ON, Canada
    • Graduate Department of Rehabilitation Sciences, University of Toronto, Toronto, ON, Canada
    • Corresponding Author InformationReprint requests to Robin E. Green, PhD, CPsych, Toronto Rehabilitation Institute, The University Centre, 550 University Ave, Toronto, ON, M5G 2A2, Canada

Abstract 

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.

Objective

To 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.

Design

Diffusion-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.

Setting

A large, urban inpatient SCI program.

Participants

Three groups: SCI and concomitant TBI (SCI with TBI, n=7); SCI without TBI (SCI only, n=15); and healthy control subjects (n=12).

Interventions

Not applicable.

Main Outcome Measure

FA was used as a measure of cerebral WM integrity.

Results

ROI 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.

Conclusions

DTI 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.

Key Words: Brain injuries, Diffusion magnetic resonance imaging, Rehabilitation, Spinal cord injuries

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

 

 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

Archives of Physical Medicine and Rehabilitation
Volume 89, Issue 12, Supplement , Pages S85-S91, December 2008

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