Research Reports - Long-term white matter changes after severe traumatic brain injury

AJNR Am J Neuroradiol. 2014 Jan;35(1):23-9

Dinkel J, Drier A, Khalilzadeh O, Perlbarg V, Czernecki V, Gupta R, Gomas F, Sanchez P, Dormont D, Galanaud D, Stevens RD, Puybasset L; for NICER (Neuro Imaging for Coma Emergence and Recovery) Consortium

BACKGROUND AND PURPOSE: Extensive white matter damage has been documented in
patients with severe traumatic brain injury, yet how this damage evolves in the
long term is not well understood. We used DTI to study white matter changes at 5
years after traumatic brain injury.
MATERIALS AND METHODS: There were 8 healthy control participants and 13 patients
with severe traumatic brain injury who were enrolled in a prospective
observational study, which included clinical assessment and brain MR imaging in
the acute setting (< 6 weeks) and 2 years and 5 years after injury. Only subjects
with mild to moderate disability or no disability at 1 year were included in this
analysis. DTI parameters were measured in 20 different brain regions and were
normalized to values obtained in an age-matched control group.
RESULTS: In the acute setting, fractional anisotropy was significantly lower in
the genu and body of the corpus callosum and in the bilateral corona radiata in
patients compared with control participants, whereas radial diffusivity was
significantly (P < .05) higher in these tracts. At 2 years, fractional anisotropy
in these tracts had further decreased and radial diffusivity had increased. No
significant changes were detected between 2 and 5 years after injury. The
baseline radial diffusivity and fractional anisotropy values in the anterior
aspect of the brain stem, genu and body of the corpus callosum, and the right and
left corona radiata were significantly (P < .05) associated with neurocognitive
sequelae (including amnesia, aphasia, and dyspraxia) at year 5.
CONCLUSIONS: DTI changes in major white matter tracts persist up to 5 years after
severe traumatic brain injury and are most pronounced in the corpus callosum and
corona radiata. Limited structural change is noted in the interval between 2 and
5 years.

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