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. 2013 May 21;8(5):e64461.
doi: 10.1371/journal.pone.0064461. Print 2013.

Pathophysiological concepts in mild traumatic brain injury: diffusion tensor imaging related to acute perfusion CT imaging

Zwany Metting  1 , Leonardo Cerliani, Lars A Rödiger, Joukje van der Naalt
Affiliations

Pathophysiological concepts in mild traumatic brain injury: diffusion tensor imaging related to acute perfusion CT imaging

Zwany Metting et al. PLoS One. .

Abstract

Background: A subgroup of patients with mild traumatic brain injury (TBI) experiences residual symptoms interfering with their return to work. The pathophysiological substrate of the suboptimal outcome in these patients is a source of debate.

Objective: To provide greater insight into the pathophysiological mechanisms of mild TBI.

Methods: Diffusion tensor imaging (DTI) was performed during follow-up of 18 patients with mild TBI and compared with healthy control subjects. DTI data of the patient group were also compared with perfusion CT imaging in the acute phase of injury.

Results: In patients with mild TBI, a trend was observed for a decreased fractional anisotropy (FA) in widespread bilateral frontal white matter areas with increased mean diffusivity (MD) in the parieto-temporal regions, compared to healthy control subjects. Cerebral blood volume (CBV) correlated significantly with FA in several white matter tracts including the corpus callosum, the internal capsule, the inferior fronto-occipital fascicle, the corticospinal tract, the superior and the inferior longitudinal fascicle.

Conclusion: In mild TBI with normal conventional imaging significant associations between cerebral perfusion in the acute phase of injury and DTI analyses in the chronic phase of injury were discerned. The pathophysiological concept of these findings is being outlined.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Two slabs with regions of interest (ROIs).
In each slab six ROIs were placed in the white matter (WM) and six ROIs were placed in the cortical grey matter (GM). Slab 1 is lower slab, slab 2 is the upper slab.
Figure 2
Figure 2. Fractional anisotropy (FA) and mean diffusivity (MD) in mild traumatic brain injury.
FA and MD in mild traumatic brain injured patients compared to healthy control subjects. There was a trend for a lower FA (red; P<0.08 - TFCE corrected) and a higher MD (blue; P<0.07- TFCE corrected) in the patient group compared to the healthy control group.
Figure 3
Figure 3. Fractional anisotropy (FA) in relation to cerebral blood volume (CBV) in mild traumatic brain injury.
Significant (P<0.05 - TFCE corrected) correlations between FA and CBV in different cerebral areas in mild traumatic brain injured patients. The scatterplot reports the correlation between the CBV values and the mean FA calculated by averaging the FA values over all the voxels on the white matter skeleton where a significant (P<0.05 - TFCE corrected) effect was found in the voxelwise analysis. Abbreviations: PAR-TE = parieto-temporal, OC = occipital, WM = white matter, GM = grey matter, L = only on the left side.
See this image and copyright information in PMC

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