Research Reports - Sex differences in white matter abnormalities after mild traumatic brain injury

Radiology. 2014 May 6:132512

Fakhran S(1), Yaeger K, Collins M, Alhilali L

Purpose To evaluate sex differences in diffusion-tensor imaging (DTI) white
matter abnormalities after mild traumatic brain injury (mTBI) using tract-based
spatial statistics (TBSS) and to compare associated clinical outcomes. Materials
and Methods The institutional review board approved this study, with waiver of
informed consent. DTI in 69 patients with mTBI (47 male and 22 female patients)
and 21 control subjects (10 male and 11 female subjects) with normal conventional
magnetic resonance (MR) images were retrospectively reviewed. Fractional
anisotropy (FA) maps were generated as a measure of white matter integrity.
Patients with mTBI underwent serial neurocognitive testing with Immediate
Post-Concussion Assessment and Cognitive Testing (ImPACT). Correlation between
sex, white matter FA values, ImPACT scores, and time to symptom resolution (TSR)
were analyzed with multivariate analysis and TBSS. Results No significant
difference in age was seen between males and females (control subjects, P = .3;
patients with mTBI, P = .34). No significant difference was seen in initial
ImPACT symptom scores (P = .33) between male and female patients with mTBI. Male
patients with mTBI had significantly decreased FA values in the uncinate
fasciculus (UF) bilaterally (mean FA, 0.425; 95% confidence interval: 0.375,
0.476) compared with female patients with mTBI and control subjects (P < .05),
with a significantly longer TSR (P = .04). Multivariate analysis showed sex and
UF FA values independently correlated with TSR longer than 3 months (adjusted
odds ratios, 2.27 and 2.38; P = .04 and P < .001, respectively), but initial
symptom severity did not (adjusted odds ratio, 1.15; P = .35). Conclusion
Relative sparing of the UF is seen in female compared with male patients after
mTBI, with sex and UF FA values as stronger predictors of TSR than initial
symptom severity.

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