title: Neuroimaging correlates of novel psychiatric disorders after pediatric traumatic brain injury.
abstract: OBJECTIVE
  To study magnetic resonance imaging (MRI) correlates of novel (new-onset) psychiatric disorders (NPD) after traumatic brain injury (TBI) and orthopedic injury (OI).
  
  
  METHODS
  Participants were 7 to 17 years of age at the time of hospitalization for either TBI or OI. The study used a prospective, longitudinal, controlled design with standardized psychiatric assessments conducted at baseline (reflecting pre-injury function) and 3 months post-injury. MRI assessments including diffusion tensor imaging (DTI)-derived fractional anisotropy (FA), volumetric measures of gray and white matter regions, volumetric measures of lesions, and cortical thickness were conducted. Injury severity was assessed by standard clinical scales. The outcome measure was the presence of an NPD identified during the first 3 months after injury.
  
  
  RESULTS
  There were 88 participants (TBI, 44; OI, 44). NPD occurred more frequently in the TBI (21/44; 48%) versus the OI (6/44; 14%) group (Fisher's exact test, p = .001). NPD in TBI participants was not related to injury severity. Multivariate analysis of covariance of the relationship between FA in hypothesized regions of interest (bilateral frontal and temporal lobes, bilateral centrum semiovale, bilateral uncinate fasciculi) and NPD and group (TBI versus OI) was significant, and both variables (NPD, p < .05; group, p < .001) were jointly significantly related to FA. NPD was not significantly related to volumetric measures of white or gray matter structures, volumetric measures of lesions, or cortical thickness measures.
  
  
  CONCLUSIONS
  Lowered white matter integrity may be more important in the pathophysiology of NPD than indices of gray matter or white matter atrophic changes, macroscopic lesions, and injury severity.
authors.affiliation: University of California-San Diego, San Diego, CA 92123, USA. jmax@ucsd.edu
authors.forename: Jeffrey E
authors.initials: JE
authors.lastname: Max
authors.forename: Elisabeth A
authors.initials: EA
authors.lastname: Wilde
authors.forename: Erin D
authors.initials: ED
authors.lastname: Bigler
authors.forename: Wesley K
authors.initials: WK
authors.lastname: Thompson
authors.forename: Marianne
authors.initials: M
authors.lastname: MacLeod
authors.forename: Ana C
authors.initials: AC
authors.lastname: Vasquez
authors.forename: Tricia L
authors.initials: TL
authors.lastname: Merkley
authors.forename: Jill V
authors.initials: JV
authors.lastname: Hunter
authors.forename: Zili D
authors.initials: ZD
authors.lastname: Chu
authors.forename: Ragini
authors.initials: R
authors.lastname: Yallampalli
authors.forename: Gillian
authors.initials: G
authors.lastname: Hotz
authors.forename: Sandra B
authors.initials: SB
authors.lastname: Chapman
authors.forename: Tony T
authors.initials: TT
authors.lastname: Yang
authors.forename: Harvey S
authors.initials: HS
authors.lastname: Levin
mesh_terms: D000293:Adolescent; D001921:Brain / Q000473:pathology*; D001930:Brain Injuries / Q000150:complications / Q000473:pathology*; D002648:Child; D056324:Diffusion Tensor Imaging / Q000295:instrumentation / Q000379:methods; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000295:instrumentation / Q000379:methods*; D008297:Male; D001523:Mental Disorders / Q000209:etiology / Q000473:pathology*; D059906:Neuroimaging / Q000295:instrumentation / Q000379:methods*; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales; D012720:Severity of Illness Index