Abstract
There is evidence that diffusion-weighted imaging (DWI) is able to detect tissue alterations following mild traumatic brain injury (mTBI) that may not be observed on conventional neuroimaging; however, findings are often inconsistent between studies. This systematic review assesses patterns of differences in DWI metrics between those with and without a history of mTBI. A PubMed literature search was performed using relevant indexing terms for articles published prior to May 14, 2020. Findings were limited to human studies using DWI in mTBI. Articles were excluded if they were not full-length, did not contain original data, if they were case studies, pertained to military populations, had inadequate injury severity classification, or did not report post-injury interval. Findings were reported independently for four subgroups: acute/subacute pediatric mTBI, acute/subacute adult mTBI, chronic adult mTBI, and sport-related concussion, and all DWI acquisition and analysis methods used were included. Patterns of findings between studies were reported, along with strengths and weaknesses of the current state of the literature. Although heterogeneity of sample characteristics and study methods limited the consistency of findings, alterations in DWI metrics were most commonly reported in the corpus callosum, corona radiata, internal capsule, and long association pathways. Many acute/subacute pediatric studies reported higher FA and lower ADC or MD in various regions. In contrast, acute/subacute adult studies most commonly indicate lower FA within the context of higher MD and RD. In the chronic phase of recovery, FA may remain low, possibly indicating overall demyelination or Wallerian degeneration over time. Longitudinal studies, though limited, generally indicate at least a partial normalization of DWI metrics over time, which is often associated with functional improvement. We conclude that DWI is able to detect structural mTBI-related abnormalities that may persist over time, although future DWI research will benefit from larger samples, improved data analysis methods, standardized reporting, and increasing transparency.
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Notes
DVBIC time post-injury guidelines used for imaging of non-deployed service members with mTBI are available at: https://dvbic.dcoe.mil/material/neuroimaging-following-mild-tbi-non-deployed-setting-reference-card
The frequencies reported in parentheses (N) indicate the number of studies that used a given technique/outcome measure unless otherwise indicated.
ENIGMA's standardized processing pipelines for DTI analyses are available at http://enigma.ini.usc.edu/protocols/dti-protocols/
Access the Traumatic Brain Injury Common Data Elements, developed by the National Institute of Neurological Disorders and Stroke in 2012, at https://www.commondataelements.ninds.nih.gov/Traumatic%20Brain%20Injury
Access the Sport-Related Concussion Common Data Elements, developed by the National Institute of of Neurological Disorders and Stroke in 2017, at https://www.commondataelements.ninds.nih.gov/Sport%20Related%20Concussion#pane-163
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We would like to thank Elizabeth Hovenden (research assistant) and Billie White (clinical librarian) for their help with the preparation of this manuscript as well as the researchers and participants for their involvement in the reviewed studies.
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Two of the papers included in the present review were authored by Tricia L. Merkley, and nine of the papers included in the present review were authored by Elisabeth A. Wilde.
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Lindsey, H.M., Hodges, C.B., Greer, K.M. et al. Diffusion-Weighted Imaging in Mild Traumatic Brain Injury: A Systematic Review of the Literature. Neuropsychol Rev 33, 42–121 (2023). https://doi.org/10.1007/s11065-021-09485-5
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DOI: https://doi.org/10.1007/s11065-021-09485-5