Diffusion Tensor Imaging for Outcome Prediction in Mild Traumatic Brain Injury: A TRACK-TBI Study

• Published in: Journal of neurotrauma Vol. 31; no. 17; pp. 1457 - 1477
• Main Authors: Yuh, Esther L., Cooper, Shelly R., Mukherjee, Pratik, Yue, John K., Lingsma, Hester F., Gordon, Wayne A., Valadka, Alex B., Okonkwo, David O., Schnyer, David M., Vassar, Mary J., Maas, Andrew I.R., Manley, Geoffrey T., Casey, Scott S., Cheong, Maxwell, Dams-O'Connor, Kristen, Hricik, Allison J., Inoue, Tomoo, Menon, David K., Morabito, Diane J., Pacheco, Jennifer L., Puccio, Ava M., Sinha, Tuhin K.
• Format: Journal Article
• Language: English
• Published: United States Mary Ann Liebert, Inc 01.09.2014
• Subjects: Adolescent; Adult; Brain damage; Brain Injuries - pathology; Diffusion Magnetic Resonance Imaging; Female; Glasgow Outcome Scale; Humans; Male; Medical imaging; Middle Aged; Multimodal Imaging; Original; Prognosis; Recovery of Function; Trauma; Young Adult; computed tomography; traumatic brain injury; diffusion tensor imaging; axonal injury; magnetic resonance imaging
• ISSN: 0897-7151; 1557-9042; 1557-9042
• DOI: 10.1089/neu.2013.3171

We evaluated 3T diffusion tensor imaging (DTI) for white matter injury in 76 adult mild traumatic brain injury (mTBI) patients at the semiacute stage (11.2±3.3 days), employing both whole-brain voxel-wise and region-of-interest (ROI) approaches. The subgroup of 32 patients with any traumatic intracranial lesion on either day-of-injury computed tomography (CT) or semiacute magnetic resonance imaging (MRI) demonstrated reduced fractional anisotropy (FA) in numerous white matter tracts, compared to 50 control subjects. In contrast, 44 CT/MRI-negative mTBI patients demonstrated no significant difference in any DTI parameter, compared to controls. To determine the clinical relevance of DTI, we evaluated correlations between 3- and 6-month outcome and imaging, demographic/socioeconomic, and clinical predictors. Statistically significant univariable predictors of 3-month Glasgow Outcome Scale-Extended (GOS-E) included MRI evidence for contusion (odds ratio [OR] 4.9 per unit decrease in GOS-E; p=0.01), ≥1 ROI with severely reduced FA (OR, 3.9; p=0.005), neuropsychiatric history (OR, 3.3; p=0.02), age (OR, 1.07/year; p=0.002), and years of education (OR, 0.79/year; p=0.01). Significant predictors of 6-month GOS-E included ≥1 ROI with severely reduced FA (OR, 2.7; p=0.048), neuropsychiatric history (OR, 3.7; p=0.01), and years of education (OR, 0.82/year; p=0.03). For the subset of 37 patients lacking neuropsychiatric and substance abuse history, MRI surpassed all other predictors for both 3- and 6-month outcome prediction. This is the first study to compare DTI in individual mTBI patients to conventional imaging, clinical, and demographic/socioeconomic characteristics for outcome prediction. DTI demonstrated utility in an inclusive group of patients with heterogeneous backgrounds, as well as in a subset of patients without neuropsychiatric or substance abuse history.