title: Cognitive impairment in mild traumatic brain injury: a longitudinal diffusional kurtosis and perfusion imaging study.
abstract: OBJECTIVE
  Cognitive impairment is frequent among patients with mild traumatic brain injury despite the absence of detectable damage on conventional MR imaging. In this study, the quantitative MR imaging techniques DTI, DKI, and ASL were used to measure changes in the structure and function in the thalamus and WM of patients with MTBI during a short follow-up period, to determine whether these techniques can be used to investigate relationships with cognitive performance and to predict outcome.
  
  
  METHODS
  Twenty patients with MTBI and 16 controls underwent MR imaging at 3T and a neuropsychological battery designed to yield measures for attention, concentration, executive functioning, memory, learning, and information processing. MK, FA, MD, and CBF were measured in the thalamus by using region-of-interest analysis and in WM by using tract-based spatial statistics. Analyses were performed comparing regional imaging measures of subject groups and the results of testing of their associations with neuropsychological performance.
  
  
  RESULTS
  Patients with MTBI exhibited significant differences from controls for DTI, DKI, and ASL measures in the thalamus and various WM regions both within 1 month after injury and >9 months after injury. At baseline, DTI and DKI measures in the thalamus and various WM regions were significantly associated with performance in different neuropsychological domains, and cognitive impairment was significantly associated with MK in the thalamus and FA in optic radiations.
  
  
  CONCLUSIONS
  Combined application of DTI, DKI, and ASL to study MTBI might be useful for investigating dynamic changes in the thalamus and WM as well as cognitive impairment during a short follow-up period, though the small number of patients examined did not predict outcome.
authors.affiliation: Department of Radiology, Center for Biomedical Imaging, New York University School of Medicine, 660 First Ave, 4th Floor, Room 420, New York, New York 10016, USA. Elan.Grossman@nyumc.org
authors.forename: E J
authors.initials: EJ
authors.lastname: Grossman
authors.forename: J H
authors.initials: JH
authors.lastname: Jensen
authors.forename: J S
authors.initials: JS
authors.lastname: Babb
authors.forename: Q
authors.initials: Q
authors.lastname: Chen
authors.forename: A
authors.initials: A
authors.lastname: Tabesh
authors.forename: E
authors.initials: E
authors.lastname: Fieremans
authors.forename: D
authors.initials: D
authors.lastname: Xia
authors.forename: M
authors.initials: M
authors.lastname: Inglese
authors.forename: R I
authors.initials: RI
authors.lastname: Grossman
mesh_terms: D000293:Adolescent; D000328:Adult; D001930:Brain Injuries / Q000150:complications / Q000175:diagnosis*; D003072:Cognition Disorders / Q000175:diagnosis* / Q000209:etiology; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods*; D005260:Female; D006801:Humans; D007089:Image Enhancement / Q000379:methods; D007090:Image Interpretation, Computer-Assisted / Q000379:methods; D008137:Longitudinal Studies; D018810:Magnetic Resonance Angiography / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009413:Nerve Fibers, Myelinated / Q000473:pathology*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013788:Thalamus / Q000473:pathology*; D055815:Young Adult