title: Diffusion tensor imaging for outcome prediction in mild traumatic brain injury: a TRACK-TBI study.
abstract: We evaluated 3T diffusion tensor imaging (DTI) for white matter injury in 76 adult mild traumatic brain injury (mTBI) patients at the semiacute stage (11.2±3.3 days), employing both whole-brain voxel-wise and region-of-interest (ROI) approaches. The subgroup of 32 patients with any traumatic intracranial lesion on either day-of-injury computed tomography (CT) or semiacute magnetic resonance imaging (MRI) demonstrated reduced fractional anisotropy (FA) in numerous white matter tracts, compared to 50 control subjects. In contrast, 44 CT/MRI-negative mTBI patients demonstrated no significant difference in any DTI parameter, compared to controls. To determine the clinical relevance of DTI, we evaluated correlations between 3- and 6-month outcome and imaging, demographic/socioeconomic, and clinical predictors. Statistically significant univariable predictors of 3-month Glasgow Outcome Scale-Extended (GOS-E) included MRI evidence for contusion (odds ratio [OR] 4.9 per unit decrease in GOS-E; p=0.01), ≥1 ROI with severely reduced FA (OR, 3.9; p=0.005), neuropsychiatric history (OR, 3.3; p=0.02), age (OR, 1.07/year; p=0.002), and years of education (OR, 0.79/year; p=0.01). Significant predictors of 6-month GOS-E included ≥1 ROI with severely reduced FA (OR, 2.7; p=0.048), neuropsychiatric history (OR, 3.7; p=0.01), and years of education (OR, 0.82/year; p=0.03). For the subset of 37 patients lacking neuropsychiatric and substance abuse history, MRI surpassed all other predictors for both 3- and 6-month outcome prediction. This is the first study to compare DTI in individual mTBI patients to conventional imaging, clinical, and demographic/socioeconomic characteristics for outcome prediction. DTI demonstrated utility in an inclusive group of patients with heterogeneous backgrounds, as well as in a subset of patients without neuropsychiatric or substance abuse history.
authors.affiliation: 1 Brain and Spinal Injury Center, University of California , San Francisco, California.
authors.forename: Esther L
authors.initials: EL
authors.lastname: Yuh
authors.forename: Shelly R
authors.initials: SR
authors.lastname: Cooper
authors.forename: Pratik
authors.initials: P
authors.lastname: Mukherjee
authors.forename: John K
authors.initials: JK
authors.lastname: Yue
authors.forename: Hester F
authors.initials: HF
authors.lastname: Lingsma
authors.forename: Wayne A
authors.initials: WA
authors.lastname: Gordon
authors.forename: Alex B
authors.initials: AB
authors.lastname: Valadka
authors.forename: David O
authors.initials: DO
authors.lastname: Okonkwo
authors.forename: David M
authors.initials: DM
authors.lastname: Schnyer
authors.forename: Mary J
authors.initials: MJ
authors.lastname: Vassar
authors.forename: Andrew I R
authors.initials: AI
authors.lastname: Maas
authors.forename: Geoffrey T
authors.initials: GT
authors.lastname: Manley
mesh_terms: D000293:Adolescent; D000328:Adult; D001930:Brain Injuries / Q000473:pathology*; D038524:Diffusion Magnetic Resonance Imaging; D005260:Female; D023261:Glasgow Outcome Scale; D006801:Humans; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging; D011379:Prognosis; D020127:Recovery of Function; D055815:Young Adult
keywords: axonal injury; computed tomography; diffusion tensor imaging; magnetic resonance imaging; traumatic brain injury
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