Neurocognitive and neuroimaging correlates of pediatric traumatic brain injury: A diffusion tensor imaging (DTI) study

Abstract

This study examined the sensitivity of diffusion tensor imaging (DTI) to microstructural white matter (WM) damage in mild and moderate pediatric traumatic brain injury (TBI). Fourteen children with TBI and 14 controls ages 10-18 had DTI scans and neurocognitive evaluations at 6-12 months post-injury. Groups did not differ in intelligence, but children with TBI showed slower processing speed, working memory and executive deficits, and greater behavioral dysregulation. The TBI group had lower fractional anisotropy (FA) in three WM regions: inferior frontal, superior frontal, and supracallosal. There were no group differences in corpus callosum. FA in the frontal and supracallosal regions was correlated with executive functioning. Supracallosal FA was also correlated with motor speed. Behavior ratings showed correlations with supracallosal FA. Parent-reported executive deficits were inversely correlated with FA. Results suggest that DTI measures are sensitive to long-term WM changes and associated with cognitive functioning following pediatric TBI.

Mind the gaps—advancing research into short-term and long-term neuropsychological outcomes of youth sports-related concussions

“…[162][163][164][165][166] These discrepancies may be due, in part, to the considerable spatial heterogeneity in the brain areas examined, 167 as well as differences in the postinjury interval. FA may still have prognostic value, with evidence suggesting that the direction and magnitude of change correlates with clinical outcomes; 166,168 however, this idea awaits validation in both paediatric and adult populations. FA might lack the necessary sensitivity to fully appreciate changes in white matter tract integrity following brain injury, and measures of diffusivity may be more appropriate.…”

Emerging Imaging Tools for Use with Traumatic Brain Injury Research

“…Significant differences in the FA, ADC, or MD, or other DTIderived diffusivity metrics have been demonstrated in studies of TBI in both adults (Bigler et al, 2010b;Kraus et al, 2007;Lipton et al, 2008;Perlbarg et al, 2009;Warner et al, 2010a) and children (Ewing-Cobbs et al, 2008;Levin et al, 2008;McCauley et al, 2011;Wilde et al, 2006bWilde et al, , 2010Wozniak et al, 2007;Wu et al, 2010a;Yuan et al, 2007), with decreases in FA and increases in measures of diffusivity often found in chronic post-injury intervals. More importantly, changes in DTIderived measures have shown correlation with injury severity (Arfanakis et al, 2002;Benson et al, 2007;Wilde et al, 2010;Yuan et al, 2007), functional outcome (Huisman et al, 2004;Levin et al, 2008;Salmond et al, 2006;Wozniak et al, 2007), neurologic functioning (Caeyenberghs et al, 2010a,b), and cognitive ability (Bigler et al, 2010b;Ewing-Cobbs et al, 2008;Kraus et al, 2007;Kumar et al, 2009;Levin et al, 2008;McCauley et al, 2011;Niogi et al, 2008;Salmond et al, 2006;Warner et al, 2010a;Wilde et al, 2010). Longitudinal studies have also indicated that DTI might serve as a tool for revealing changes in the neural tissue during recovery from TBI (Bendlin et al, 2008;Sidaros et al, 2008;Wu et al, 2010a).…”

Consensus Statement on Concussion in Sport – the 3rd International Conference on Concussion in Sport held in Zurich, November 2008

“…An additional consideration in assessing the child or adolescent athlete with a concussion is that in the clinical evaluation by the healthcare professional there may be the need to include both patient and parent input as well as teacher and school input when appropriate. (101)(102)(103)(104)(105)(106)(107) The decision to use NP testing is broadly the same as the adult assessment paradigm. However, timing of testing may differ in order to assist planning in school and home management (and may be performed while the patient is still symptomatic).…”