title: White matter compromise in veterans exposed to primary blast forces.
abstract: OBJECTIVE
  Use diffusion tensor imaging to investigate white matter alterations associated with blast exposure with or without acute symptoms of traumatic brain injury (TBI).
  
  
  METHODS
  Forty-five veterans of the recent military conflicts included 23 exposed to primary blast without TBI symptoms, 6 having primary blast with mild TBI, and 16 unexposed to blast.
  
  
  METHODS
  Cross-sectional case-control study.
  
  
  METHODS
  Neuropsychological testing and diffusion tensor imaging metrics that quantified the number of voxel clusters with altered fractional anisotropy (FA) radial diffusivity, and axial diffusivity, regardless of their spatial location.
  
  
  RESULTS
  Significantly lower FA and higher radial diffusivity were observed in veterans exposed to primary blast with and without mild TBI relative to blast-unexposed veterans. Voxel clusters of lower FA were spatially dispersed and heterogeneous across affected individuals.
  
  
  CONCLUSIONS
  These results suggest that lack of clear TBI symptoms following primary blast exposure may not accurately reflect the extent of brain injury. If confirmed, our findings would argue for supplementing the established approach of making diagnoses based purely on clinical history and observable acute symptoms with novel neuroimaging-based diagnostic criteria that "look below the surface" for pathology.
authors.affiliation: Mid-Atlantic Mental Illness Research Education and Clinical Center, Durham, North Carolina (Drs Taber, Hurley, Rowland, Lamar, and Morey and Ms Haswell); Research and Education Service Line, W. G. (Bill) Hefner VA Medical Center, Salisbury, North Carolina (Drs Taber, Hurley, Rowland, Hurt, and Lamar); Division of Biomedical Sciences, Edward Via College of Osteopathic Medicine, Blacksburg, Virginia (Dr Taber); Departments of Physical Medicine and Rehabilitation (Dr Taber) and Psychiatry and Behavioral Sciences (Dr Hurley), Baylor College of Medicine, Houston, Texas; Departments of Psychiatry and Behavioral Medicine (Drs Hurley and Rowland), Radiology (Dr Hurley), Neurobiology and Anatomy (Dr Rowland), Wake Forest School of Medicine, Winston-Salem, North Carolina; Durham VA Medical Center, Durham, North Carolina (Ms Haswell and Dr Morey); Duke-UNC Brain Imaging and Analysis Center (Ms Haswell and Dr Morey) and Department of Psychiatry and Behavioral Sciences (Dr Morey), Duke University, Durham, North Carolina.
authors.forename: Katherine H
authors.initials: KH
authors.lastname: Taber
authors.forename: Robin A
authors.initials: RA
authors.lastname: Hurley
authors.forename: Courtney C
authors.initials: CC
authors.lastname: Haswell
authors.forename: Jared A
authors.initials: JA
authors.lastname: Rowland
authors.forename: Susan D
authors.initials: SD
authors.lastname: Hurt
authors.forename: Cory D
authors.initials: CD
authors.lastname: Lamar
authors.forename: Rajendra A
authors.initials: RA
authors.lastname: Morey
mesh_terms: D000328:Adult; D001753:Blast Injuries / Q000150:complications*; D001930:Brain Injuries / Q000175:diagnosis* / Q000209:etiology* / Q000473:pathology; D016022:Case-Control Studies; D056324:Diffusion Tensor Imaging; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008297:Male; D008875:Middle Aged; D014728:Veterans; D066127:White Matter / Q000473:pathology*