title: Diffusion tensor imaging and white matter lesions at the subacute stage in mild traumatic brain injury with persistent neurobehavioral impairment.
abstract: Mild traumatic brain injury (mTBI) can induce long-term behavioral and cognitive disorders. Although the exact origin of these mTBI-related disorders is not known, they may be the consequence of diffuse axonal injury (DAI). Here, we investigated whether MRI at the subacute stage can detect lesions that are associated with poor functional outcome in mTBI by using anatomical images (T(1) ) and diffusion tensor imaging (DTI). Twenty-three patients with mTBI were investigated and compared with 23 healthy volunteers. All patients underwent an MRI investigation and clinical tests between 7 and 28 days (D15) and between 3 and 4 months (M3) after injury. Patients were divided in two groups of poor outcome (PO) and good outcome (GO), based on their complaints at M3. Groupwise differences in gray matter partial volume between PO patients, GO patients and controls were analyzed using Voxel-Based Morphometry (VBM) from T(1) data at D15. Differences in microstructural architecture were investigated using Tract-Based Spatial Statistics (TBSS) and the diffusion images obtained from DTI data at D15. Permutation-based non-parametric testing was used to assess cluster significance at p < 0.05, corrected for multiple comparisons. Twelve GO patients and 11 PO patients were identified on the basis of their complaints. In PO patients, gray matter partial volume was significantly lower in several cortical and subcortical regions compared with controls, but did not differ from that of GO patients. No difference in diffusion variables was found between GO and controls. PO patients showed significantly higher mean diffusivity values than both controls and GO patients in the corpus callosum, the right anterior thalamic radiations and the superior longitudinal fasciculus, the inferior longitudinal fasciculus and the fronto-occipital fasciculus bilaterally. In conclusion, PO patients differed from GO patients by the presence of diffusion changes in long association white matter fiber tracts but not by gray matter partial volume. These results suggest that DTI at the subacute stage may be a predictive marker of poor outcome in mTBI.
authors.affiliation: Inserm, UPMC Univ Paris 06, UMR_S 678, Laboratoire d'Imagerie Fonctionnelle, Paris F-75013, France. Arnaud.Messe@imed.jussieu.fr
authors.forename: Arnaud
authors.initials: A
authors.lastname: Messé
authors.forename: Sophie
authors.initials: S
authors.lastname: Caplain
authors.forename: Gaëlle
authors.initials: G
authors.lastname: Paradot
authors.forename: Delphine
authors.initials: D
authors.lastname: Garrigue
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Mineo
authors.forename: Gustavo
authors.initials: G
authors.lastname: Soto Ares
authors.forename: Denis
authors.initials: D
authors.lastname: Ducreux
authors.forename: Frédéric
authors.initials: F
authors.lastname: Vignaud
authors.forename: Gaëlle
authors.initials: G
authors.lastname: Rozec
authors.forename: Hubert
authors.initials: H
authors.lastname: Desal
authors.forename: Mélanie
authors.initials: M
authors.lastname: Pélégrini-Issac
authors.forename: Michèle
authors.initials: M
authors.lastname: Montreuil
authors.forename: Habib
authors.initials: H
authors.lastname: Benali
authors.forename: Stéphane
authors.initials: S
authors.lastname: Lehéricy
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001921:Brain / Q000473:pathology*; D001930:Brain Injuries / Q000150:complications / Q000175:diagnosis*; D003072:Cognition Disorders / Q000175:diagnosis* / Q000209:etiology; D056324:Diffusion Tensor Imaging; D005260:Female; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis* / Q000209:etiology; D008875:Middle Aged; D011237:Predictive Value of Tests; D055815:Young Adult