TY - JOUR
T1 - Diffusion tensor imaging for outcome prediction in mild traumatic brain injury
T2 - a TRACK-TBI study
AU - Yuh, Esther L.
AU - Cooper, Shelly R.
AU - Mukherjee, Pratik
AU - Yue, John K.
AU - Lingsma, Hester F.
AU - Gordon, Wayne A.
AU - Valadka, Alex B.
AU - Okonkwo, David O.
AU - Schnyer, David M.
AU - Vassar, Mary J.
AU - Maas, Andrew I.R.
AU - Manley, Geoffrey T.
AU - Casey, Scott S.
AU - Cheong, Maxwell
AU - Dams-O'Connor, Kristen
AU - Hricik, Allison J.
AU - Inoue, Tomoo
AU - Menon, David K.
AU - Morabito, Diane J.
AU - Pacheco, Jennifer L.
AU - Puccio, Ava M.
AU - Sinha, Tuhin K.
PY - 2014/9/1
Y1 - 2014/9/1
N2 - 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.
AB - 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.
KW - axonal injury
KW - computed tomography
KW - diffusion tensor imaging
KW - magnetic resonance imaging
KW - traumatic brain injury
UR - http://www.scopus.com/inward/record.url?scp=84910674536&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84910674536&partnerID=8YFLogxK
U2 - 10.1089/neu.2013.3171
DO - 10.1089/neu.2013.3171
M3 - Article
C2 - 24742275
AN - SCOPUS:84910674536
SN - 0897-7151
VL - 31
SP - 1457
EP - 1477
JO - Journal of neurotrauma
JF - Journal of neurotrauma
IS - 17
ER -