title: Postconcussional disorder and PTSD symptoms of military-related traumatic brain injury associated with compromised neurocircuitry.
abstract: Traumatic brain injury (TBI) is a common combat injury, often through explosive blast, and produces heterogeneous brain changes due to various mechanisms of injury. It is unclear whether the vulnerability of white matter differs between blast and impact injury, and the consequences of microstructural changes on neuropsychological function are poorly understood in military TBI patients. Diffusion tensor imaging (DTI) techniques were used to assess the neurocircuitry in 37 U.S. service members (29 mild, 7 moderate, 1 severe; 17 blast and 20 nonblast), who sustained a TBI while deployed, compared to 14 nondeployed, military controls. High-dimensional deformable registration of MRI diffusion tensor data was followed by fiber tracking and tract-specific analysis along with region-of-interest analysis. DTI results were examined in relation to post-concussion and post-traumatic stress disorder (PTSD) symptoms. The most prominent white matter microstructural injury for both blast and nonblast patients was in the frontal fibers within the fronto-striatal (corona radiata, internal capsule) and fronto-limbic circuits (fornix, cingulum), the fronto-parieto-occipital association fibers, in brainstem fibers, and in callosal fibers. Subcortical superior-inferiorly oriented tracts were more vulnerable to blast injury than nonblast injury, while direct impact force had more detrimental effects on anterior-posteriorly oriented tracts, which tended to cause heterogeneous left and right hemispheric asymmetries of white matter connectivity. The tractography using diffusion anisotropy deficits revealed the cortico-striatal-thalamic-cerebellar-cortical (CSTCC) networks, where increased post-concussion and PTSD symptoms were associated with low fractional anisotropy in the major nodes of compromised CSTCC neurocircuitry, and the consequences on cognitive function were explored as well.
authors.affiliation: Traumatic Brain Injury Image Analysis Lab, Department of Radiology, Henry Jackson Foundation for the Advancement of Military Medicine, Rockville, Maryland.
authors.forename: Ping-Hong
authors.initials: PH
authors.lastname: Yeh
authors.forename: Binquan
authors.initials: B
authors.lastname: Wang
authors.forename: Terrence R
authors.initials: TR
authors.lastname: Oakes
authors.forename: Louis M
authors.initials: LM
authors.lastname: French
authors.forename: Hai
authors.initials: H
authors.lastname: Pan
authors.forename: John
authors.initials: J
authors.lastname: Graner
authors.forename: Wei
authors.initials: W
authors.lastname: Liu
authors.forename: Gerard
authors.initials: G
authors.lastname: Riedy
mesh_terms: D000328:Adult; D016880:Anisotropy; D001921:Brain / Q000503:physiopathology*; D001930:Brain Injuries / Q000150:complications* / Q000503:physiopathology; D038524:Diffusion Magnetic Resonance Imaging; D056324:Diffusion Tensor Imaging; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008297:Male; D008889:Military Personnel; D009434:Neural Pathways / Q000503:physiopathology; D009483:Neuropsychological Tests; D038223:Post-Concussion Syndrome / Q000209:etiology / Q000503:physiopathology*; D011569:Psychiatric Status Rating Scales; D013313:Stress Disorders, Post-Traumatic / Q000209:etiology / Q000503:physiopathology*; D013997:Time Factors
keywords: blast injury; concussion; diffusion tensor imaging; neurocircuitry; post-traumatic stress disorder; traumatic brain injury
references.citation: Eur Radiol. 2005 Mar;15(3):569-81
references.pmid: 15696294
references.citation: US Army Med Dep J. 2008 Jul-Sep;:7-17
references.pmid: 20088060
references.citation: Neuroimage. 2008 Apr 1;40(2):570-582
references.pmid: 18255316
references.citation: Psychiatry Res. 2010 Dec 30;184(3):177-85
references.pmid: 21051206
references.citation: Neurology. 2008 Mar 18;70(12):948-55
references.pmid: 18347317
references.citation: Neuroimage. 2008 Aug 15;42(2):503-14
references.pmid: 18556217
references.citation: Hum Brain Mapp. 2011 Jun;32(6):999-1011
references.pmid: 20669166
references.citation: Neurosci Res. 2005 May;52(1):37-45
references.pmid: 15811551
references.citation: J Rehabil Res Dev. 2009;46(6):667-72
references.pmid: 20104396
references.citation: Arch Clin Neuropsychol. 2007 Feb;22 Suppl 1:S15-37
references.pmid: 17276030
references.citation: J Neurotrauma. 2011 Jul;28(7):1229-36
references.pmid: 21529318
references.citation: J Neurotrauma. 2009 Jun;26(6):861-76
references.pmid: 19397424
references.citation: AJR Am J Roentgenol. 1988 May;150(5):1133-42
references.pmid: 3258718
references.citation: J Rehabil Res Dev. 2010;47(9):841-50
references.pmid: 21174249
references.citation: Neuroimage. 2009 Jan 1;44(1):83-98
references.pmid: 18501637
references.citation: Neuroimage. 2009 Jun;46(2):486-99
references.pmid: 19385016
references.citation: AJNR Am J Neuroradiol. 2008 May;29(5):843-52
references.pmid: 18339719
references.citation: Neuron. 2003 Dec 4;40(5):885-95
references.pmid: 14659088
references.citation: Radiology. 1989 Apr;171(1):177-87
references.pmid: 2928523
references.citation: Appl Neuropsychol. 2008;15(2):113-6
references.pmid: 18568603
references.citation: NMR Biomed. 2011 Nov;24(9):1119-28
references.pmid: 21432927
references.citation: Soc Cogn Affect Neurosci. 2006 Dec;1(3):203-13
references.pmid: 18985107
references.citation: AJR Am J Roentgenol. 1988 Mar;150(3):663-72
references.pmid: 3257624
references.citation: Alcohol Clin Exp Res. 2003 Feb;27(2):301-9
references.pmid: 12605080
references.citation: Proc Natl Acad Sci U S A. 2005 Aug 23;102(34):12212-7
references.pmid: 16103359
references.citation: Stroke. 1989 Oct;20(10):1396-402
references.pmid: 2799871
references.citation: Neuroimage. 2003 Nov;20(3):1714-22
references.pmid: 14642481
references.citation: Neuroimage. 2009 Aug;47 Suppl 2:T152-3
references.pmid: 19457364
references.citation: J Head Trauma Rehabil. 2012 May-Jun;27(3):188-98
references.pmid: 21642855
references.citation: J Neuropsychiatry Clin Neurosci. 2006 Spring;18(2):141-5
references.pmid: 16720789
references.citation: J Head Trauma Rehabil. 2010 Jul-Aug;25(4):241-55
references.pmid: 20611043
references.citation: J Consult Clin Psychol. 1990 Dec;58(6):775-89
references.pmid: 2292627
references.citation: Proc Natl Acad Sci U S A. 1996 Sep 3;93(18):9985-90
references.pmid: 8790444
references.citation: Histopathology. 1989 Jul;15(1):49-59
references.pmid: 2767623
references.citation: Aviat Space Environ Med. 2011 Jan;82(1):34-9
references.pmid: 21235103
references.citation: J Neurosurg. 2005 Aug;103(2):298-303
references.pmid: 16175860
references.citation: Biol Psychiatry. 2003 Aug 1;54(3):338-52
references.pmid: 12893109
references.citation: AJNR Am J Neuroradiol. 2002 May;23(5):794-802
references.pmid: 12006280
references.citation: Brain. 2006 Mar;129(Pt 3):564-83
references.pmid: 16399806
references.citation: Front Neurol. 2010 Dec 10;1:151
references.pmid: 21206523
references.citation: F1000 Med Rep. 2010 Aug 19;2:64
references.pmid: 21173852
references.citation: Biomech Model Mechanobiol. 2013 Jan;12(1):137-50
references.pmid: 22434184
references.citation: Neurosurgery. 2005 Nov;57(5):891-916; discussion 891-916
references.pmid: 16284560
references.citation: Hum Brain Mapp. 2002 Nov;17(3):143-55
references.pmid: 12391568
references.citation: J Trauma. 2001 Apr;50(4):695-706
references.pmid: 11303167
references.citation: J Neurotrauma. 2009 Jun;26(6):815-25
references.pmid: 19397423
references.citation: J Neurotrauma. 2010 Apr;27(4):683-94
references.pmid: 20088647
references.citation: Neuroimage. 2006 Jul 15;31(4):1487-505
references.pmid: 16624579
references.citation: Eur Radiol. 1998;8(6):960-5
references.pmid: 9683701
references.citation: J Physiol. 2006 Dec 15;577(Pt 3):907-24
references.pmid: 16959856
references.citation: Front Neurosci. 2009 Dec 15;3(3):350-62
references.pmid: 20198152
references.citation: Neuroimage. 2008 Aug 15;42(2):1032-44
references.pmid: 18602840
references.citation: Behav Res Ther. 1996 Aug;34(8):669-73
references.pmid: 8870294
references.citation: NMR Biomed. 2002 Nov-Dec;15(7-8):468-80
references.pmid: 12489096
references.citation: J Magn Reson B. 1994 Mar;103(3):247-54
references.pmid: 8019776
references.citation: J Head Trauma Rehabil. 2006 Sep-Oct;21(5):375-8
references.pmid: 16983222
references.citation: Curr Opin Neurol. 2011 Dec;24(6):584-9
references.pmid: 21968550
references.citation: J Neurosurg. 2011 Jul;115(1):130-9
references.pmid: 21417709
references.citation: N Engl J Med. 2011 Jun 2;364(22):2091-100
references.pmid: 21631321
references.citation: Neuroimage. 2009 Jul 15;46(4):967-80
references.pmid: 19341801
references.citation: Science. 2008 Jan 25;319(5862):406-8
references.pmid: 18218877
references.citation: J Neurosci Methods. 2007 Jan 30;159(2):277-81
references.pmid: 16949675
references.citation: Neuroimage. 2011 Jan;54 Suppl 1:S62-8
references.pmid: 20483375
references.citation: Neuroimage. 2004 Mar;21(3):1174-81
references.pmid: 15006684
references.citation: J Neurol Neurosurg Psychiatry. 2005 Feb;76(2):266-8
references.pmid: 15654048
references.citation: Neurobiol Dis. 2004 Oct;17(1):29-43
references.pmid: 15350963
references.citation: Science. 2011 Jul 15;333(6040):353-7
references.pmid: 21764750
references.citation: Brain. 2007 Oct;130(Pt 10):2508-19
references.pmid: 17872928
references.citation: Neuroimage. 2004;23 Suppl 1:S208-19
references.pmid: 15501092
references.citation: BMC Neurol. 2011 Feb 23;11:24
references.pmid: 21345223
references.citation: AJNR Am J Neuroradiol. 2004 Mar;25(3):370-6
references.pmid: 15037457
references.citation: Prog Neurobiol. 2002 Jul;67(4):281-344
references.pmid: 12207973
references.citation: Neuroimage. 2002 Oct;17(2):825-41
references.pmid: 12377157
references.citation: J Int Neuropsychol Soc. 2010 Jan;16(1):194-9
references.pmid: 19758488
references.citation: Radiology. 2009 Sep;252(3):816-24
references.pmid: 19567646
references.citation: Cereb Cortex. 2006 Apr;16(4):553-60
references.pmid: 16033925
references.citation: Brain Imaging Behav. 2012 Jun;6(2):329-42
references.pmid: 22684769
references.citation: Magn Reson Imaging. 2010 Jan;28(1):22-40
references.pmid: 19608369
references.citation: Magn Reson Med. 2000 Oct;44(4):625-32
references.pmid: 11025519
references.citation: J Abnorm Child Psychol. 2003 Oct;31(5):543-54
references.pmid: 14561061
references.citation: AJNR Am J Neuroradiol. 2008 Mar;29(3):514-9
references.pmid: 18039754
references.citation: J Cogn Neurosci. 2005 Apr;17(4):687-93
references.pmid: 15829087
references.citation: N Engl J Med. 2004 Jul 1;351(1):13-22
references.pmid: 15229303
references.citation: J Head Trauma Rehabil. 2006 Sep-Oct;21(5):398-402
references.pmid: 16983225
references.citation: Magn Reson Imaging. 2012 May;30(4):496-505
references.pmid: 22285880
references.citation: Brain. 2011 Aug;134(Pt 8):2248-60
references.pmid: 21764818
references.citation: Psychiatry Res. 2009 Jul 15;173(1):22-30
references.pmid: 19442492
references.citation: Neuroimage. 2011 Jan 1;54(1):49-59
references.pmid: 20682348
references.citation: Neuroimaging Clin N Am. 2002 May;12(2):175-87, vii
references.pmid: 12391630
references.citation: Neurology. 2010 Feb 23;74(8):643-50
references.pmid: 20089939
references.citation: Neuroimage. 2008 Jun;41(2):448-61
references.pmid: 18407524
references.citation: NMR Biomed. 2002 Nov-Dec;15(7-8):456-67
references.pmid: 12489095
references.citation: Hum Brain Mapp. 1996;4(1):58-73
references.pmid: 20408186
references.citation: Brain. 2005 Jan;128(Pt 1):189-200
references.pmid: 15548553
references.citation: Hum Brain Mapp. 2002 Jan;15(1):1-25
references.pmid: 11747097
references.citation: AJNR Am J Neuroradiol. 2008 May;29(5):967-73
references.pmid: 18272556
references.citation: Cereb Cortex. 2012 Jan;22(1):158-65
references.pmid: 21616982
references.citation: N Engl J Med. 2005 May 19;352(20):2043-7
references.pmid: 15901856
references.citation: Radiology. 2000 Dec;217(3):897-903
references.pmid: 11110960
references.citation: Radiology. 1996 Dec;201(3):637-48
references.pmid: 8939209
references.citation: Brain Inj. 2008 Feb;22(2):115-22
references.pmid: 18240040
references.citation: Med Image Comput Comput Assist Interv. 2005;8(Pt 1):172-9
references.pmid: 16685843
references.citation: Neuroimage. 2001 Jun;13(6 Pt 1):1174-85
references.pmid: 11352623
references.citation: Ann Neurol. 1999 Feb;45(2):265-9
references.pmid: 9989633
references.citation: J Clin Exp Neuropsychol. 2010 Oct;32(8):871-80
references.pmid: 20383801
references.citation: Biol Psychiatry. 2007 Jul 15;62(2):104-6
references.pmid: 17601484
references.citation: Brain Imaging Behav. 2012 Jun;6(2):137-92
references.pmid: 22438191
references.citation: Magn Reson Med. 1996 Dec;36(6):893-906
references.pmid: 8946355
references.citation: Neuroimage. 2011 Jan 15;54(2):974-84
references.pmid: 20851772
references.citation: AJNR Am J Neuroradiol. 2003 Jun-Jul;24(6):1049-56
references.pmid: 12812926
references.citation: Annu Rev Neurosci. 1986;9:357-81
references.pmid: 3085570
references.citation: J Neurotrauma. 2007 Sep;24(9):1447-59
references.pmid: 17892407
references.citation: J Neurotrauma. 2009 Apr;26(4):481-95
references.pmid: 19196176
references.citation: J Neurotrauma. 2010 May;27(5):853-62
references.pmid: 20199173
references.citation: J Neuropsychiatry Clin Neurosci. 1995 Winter;7(1):103-12
references.pmid: 7711480
references.citation: NeuroRehabilitation. 2010;26(3):223-31
references.pmid: 20448312
references.citation: Hum Brain Mapp. 2003 Apr;18(4):306-21
references.pmid: 12632468
references.citation: J Neurotrauma. 2007 Mar;24(3):446-59
references.pmid: 17402851
references.citation: Neuropathol Appl Neurobiol. 2007 Apr;33(2):226-37
references.pmid: 17359363
references.citation: Ann N Y Acad Sci. 2010 Oct;1208:38-45
references.pmid: 20955324
references.citation: J Neurotrauma. 2002 Mar;19(3):379-85
references.pmid: 11939505
references.citation: Neuroimage. 2007 May 15;36(1):19-27
references.pmid: 17398118
references.citation: NMR Biomed. 2002 Nov-Dec;15(7-8):435-55
references.pmid: 12489094
references.citation: Brain Inj. 2006 Sep;20(10):1053-9
references.pmid: 17060138