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Diffusion tensor imaging in moderate-to-severe pediatric traumatic brain injury: changes within an 18 month post-injury interval

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Abstract

Traumatic brain injury (TBI) is a leading cause of death and disability in children, yet little is known regarding the pattern of TBI-related microstructural change and its impact on subsequent development. Diffusion tensor imaging (DTI) was used to examine between-group differences at two time points (planned intervals of 3 months and 18 months post-injury) and within-group longitudinal change in a group of children and adolescents aged 7–17 years with moderate-to-severe TBI (n = 20) and a comparison group of children with orthopedic injury (OI) (n = 21). In the 3- and 18-month cross-sectional analyses, tract-based spatial statistics (TBSS) generally revealed decreased fractional anisotropy (FA) and increased apparent diffusion coefficient (ADC) in the TBI group in regions of frontal, temporal, parietal, and occipital white matter as well as several deep subcortical structures, though areas of FA decrease were more prominent at the 3-month assessment, and areas of ADC increase were more prominent at the 18 month assessment, particularly in the frontal regions. In terms of the within-group changes over time, the OI group demonstrated primarily diffuse increases in FA over time, consistent with previous findings of DTI-measured white matter developmental change. The TBI group demonstrated primarily regions of FA decrease and ADC increase over time, consistent with presumed continued degenerative change, though regions of ADC decrease were also appreciated. These results suggest that TBI-related microstructural changes are dynamic in children and continue until at least 18 months post-injury. Understanding the course of these changes in DTI metrics may be important in TBI for facilitating advances in management and intervention.

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Acknowledgements

This work was supported by the National Institute Neurological Disorders and Stroke grant R01-NS21889 (“Neurobehavioral outcome of head injury in children,” Levin, PI). We also acknowledge the generous contribution of Mission Connect of the TIRR Foundation. We gratefully acknowledge the contribution of Ana C. Vasquez, Deleene Menefee, PhD., Summer Lane, Lori Cook, Sandra B. Chapman, PhD., and Gillian Hotz, PhD. in data collection, and Joshua Cooper and Alyssa P. Ibarra in manuscript preparation. We thank the participants and their families for their participation in this research. None of the authors have any financial or other relationship(s) that could be construed as a conflict of interest with respect to the content of this manuscript. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

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Authors and Affiliations

  1. Physical Medicine and Rehabilitation Alliance, Baylor College of Medicine and the University of Texas-Houston Medical School, Houston, TX, USA

    Elisabeth A. Wilde, Kareem W. Ayoub, Trevor C. Wu, Stephen R. McCauley & Harvey S. Levin

  2. Department of Radiology, Baylor College of Medicine, Houston, TX, USA

    Elisabeth A. Wilde, Zili D. Chu & Jill V. Hunter

  3. Department of Neurology, Baylor College of Medicine, Houston, TX, USA

    Elisabeth A. Wilde, Stephen R. McCauley & Harvey S. Levin

  4. Department of Bioengineering, Rice University, Houston, TX, USA

    Kareem W. Ayoub

  5. Department of Psychology, Brigham Young University, Provo, UT, USA

    Erin D. Bigler & Trevor C. Wu

  6. Department of Neuroscience, Brigham Young University, Provo, UT, USA

    Erin D. Bigler

  7. Department of Psychiatry and the Utah Brain Institute, University of Utah, Salt Lake City, UT, USA

    Erin D. Bigler

  8. Department of Pediatric Radiology, Texas Children’s Hospital, Houston, TX, USA

    Zili D. Chu & Jill V. Hunter

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  1. Elisabeth A. Wilde
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  2. Kareem W. Ayoub
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  3. Erin D. Bigler
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  6. Trevor C. Wu
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  7. Stephen R. McCauley
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  8. Harvey S. Levin
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Correspondence to Elisabeth A. Wilde.

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Elisabeth A. Wilde and Kareem W. Ayoub contributed equally to this work.

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Wilde, E.A., Ayoub, K.W., Bigler, E.D. et al. Diffusion tensor imaging in moderate-to-severe pediatric traumatic brain injury: changes within an 18 month post-injury interval. Brain Imaging and Behavior 6, 404–416 (2012). https://doi.org/10.1007/s11682-012-9150-y

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