Archives of Physical Medicine and Rehabilitation
Volume 89, Issue 12, Supplement , Pages S45-S50, December 2008

Use of Diffusion Tensor Imaging to Examine Subacute White Matter Injury Progression in Moderate to Severe Traumatic Brain Injury

  • Gahl Greenberg, MD

      Affiliations

    • Department of Medical Imaging, Division of Neuroradiology, University Health Network, Toronto, ON, Canada
    • ,
  • David J. Mikulis, MD

      Affiliations

    • Research Institute, Division of Brain Imaging and Behaviour Systems, University Health Network, Toronto Western Division, Toronto, ON, Canada
    • Department of Medical Imaging, Division of Neuroradiology, University Health Network, Toronto, ON, Canada
    • ,
  • Kevin Ng, MBBS, FRANZCR

      Affiliations

    • Department of Medical Imaging, Division of Neuroradiology, University Health Network, Toronto, ON, Canada
    • ,
  • Danielle DeSouza, BSc

      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 Green, PhD, CPsych, Toronto Rehabilitation Institute, 550 University Ave, Toronto, ON, M5G 2A2, Canada

Abstract 

Greenberg G, Mikulis DJ, Ng K, DeSouza D, Green RE. Use of diffusion tensor imaging to examine subacute white matter injury progression in moderate to severe traumatic brain injury.

Objective

To demonstrate subacute progression of white matter (WM) injury (4.5mo–2.5y postinjury) in patients with traumatic brain injury using diffusion-tensor imaging.

Design

Prospective, repeated-measures, within-subjects design.

Setting

Inpatient neurorehabilitation program and teaching hospital MRI department.

Participants

Brain-injured adults (N=13) with a mean Glasgow Coma Scale score of 7.67±4.16.

Interventions

Not applicable.

Main Outcome Measures

Fractional anisotropy (FA) values were measured at 4.5 and 29 months postinjury in right and left frontal and temporal deep WM tracts and the anterior and posterior corpus callosum.

Results

FA significantly decreased in frontal and temporal tracts: right frontal (.38±.06 to .30±.06; P<.005), left frontal (.37±.06 to .32±.06; P<.05), right temporal (.28±.05 to .22±.018; P<.005), and left temporal (.28±.05 to .24±.02; P<.05). No significant changes were in the corpus callosum.

Conclusions

Preliminary results demonstrate progression of WM damage as evidenced by interval changes in diffusion anisotropy. Future research should examine the relationship between decreased FA and long-term clinical outcome.

Key Words: Brain injuries, Follow-up studies, Magnetic resonance imaging, Rehabilitation

List of Abbreviations: CT, computed tomography, DAI, diffuse axonal injury, DTI, diffusion-tensor imaging, FA, fractional anisotropy, FLAIR, fluid-attenuated inversion recovery, MRI, magnetic resonance imaging, NS, not significant, PTA, posttraumatic amnesia, ROI, region of interest, SPGR, spoiled gradient recalled, TBI, traumatic brain injury, 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)01407-X

doi:10.1016/j.apmr.2008.08.211

Archives of Physical Medicine and Rehabilitation
Volume 89, Issue 12, Supplement , Pages S45-S50, December 2008

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