Diffusion tensor imaging for outcome prediction in mild traumatic brain injury: a TRACK-TBI study

Esther L. Yuh, Shelly R. Cooper, Pratik Mukherjee, John K. Yue, Hester F. Lingsma, Wayne A. Gordon, Alex B. Valadka, David O. Okonkwo, David M. Schnyer, Mary J. Vassar, Andrew I.R. Maas, Geoffrey T. Manley, Scott S. Casey, Maxwell Cheong, Kristen Dams-O'Connor, Allison J. Hricik, Tomoo Inoue, David K. Menon, Diane J. Morabito, Jennifer L. PachecoAva M. Puccio, Tuhin K. Sinha

Research output: Contribution to journalArticlepeer-review

158 Scopus citations


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.

Original languageEnglish (US)
Pages (from-to)1457-1477
Number of pages21
JournalJournal of neurotrauma
Issue number17
StatePublished - Sep 1 2014
Externally publishedYes


  • axonal injury
  • computed tomography
  • diffusion tensor imaging
  • magnetic resonance imaging
  • traumatic brain injury

ASJC Scopus subject areas

  • Clinical Neurology


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