Jill Vanessa Hunter MD, Presenter: Nothing to Disclose

Elisabeth Wilde, Abstract Co-Author: Nothing to Disclose

David Chu PhD, Abstract Co-Author: Nothing to Disclose

Stephen McCauley, Abstract Co-Author: Nothing to Disclose

Gerri Hanten, Abstract Co-Author: Nothing to Disclose

Maya Troyanska, Abstract Co-Author: Nothing to Disclose

Rogaini Yallampalli, Abstract Co-Author: Nothing to Disclose

Xiaoqi Li, Abstract Co-Author: Nothing to Disclose

Jonathan Chia, Abstract Co-Author: Nothing to Disclose

Harvey Levin, Abstract Co-Author: Nothing to Disclose

et al, Abstract Co-Author: Nothing to Disclose

et al, Abstract Co-Author: Nothing to Disclose

This prospective study tests the hypothesis that MRI with diffusion tensor imaging (DTI) adds new and additional information in the acute setting of mild traumatic brain injury (mTBI) in children with normal computed tomography (CT).

Eleven right-handed adolescents (5M,6F; age range 14-17 yrs) presenting to the ER with concussion or mTBI (Glasgow Coma Scale score = 15) were imaged 1-7 days post-injury using 30-direction DTI on a Philips 3T scanner. All subjects had a normal brain CT. A comparison group of 12 uninjured adolescents matched for age (mean = 15.36), gender (6M,6F), handedness, and ethnicity was also imaged. Quantitative DTI analysis was performed in the frontal and temporal white matter, the anterior and posterior limbs of the internal capsule and the corpus callosum using PRIDE V4-Fiber Tracking 4.1 Beta 4 software. Fractional Anisotropy (FA), Apparent Diffusion Coefficient (ADC), and radial diffusivity (mean of the secondary and tertiary eigenvalues) were used as variables. At the time of scanning a series of neuropsychometric tests were also administered.

Statistically significant group differences using t-tests were observed in all ROIs including the right and left frontal, right and left temporal, and right and left anterior and posterior limbs of the internal capsule, with p-values all below 0.0001. In each case, increased FA and decreased ADC and radial diffusivity were found in the group with TBI. Furthermore, there were strong correlations between FA and measures of diffusivity in the total corpus callosum with measures of post-concussive symptomatology and processing speed where higher FA and decreased ADC/diffusivity were associated with increased cognitive dysfunction and cognitive/somatic complaints in the mTBI group.

Quantitative DTI has not been previously applied to adolescent patients in this acute time frame and with such mild injuries. These DTI findings are opposite to the long-term effects of moderate to severe TBI and may reflect neurocytotoxicity.

DTI adds a new diagnostic and prognostic tool in the better understanding of the pathophysiology underlying the sequelae of mild acute TBI in a pediatric population.

Hunter, J, Wilde, E, Chu, D, McCauley, S, Hanten, G, Troyanska, M, Yallampalli, R, Li, X, Chia, J, Levin, H, et al, , et al, , Detection of Acute White Matter Changes Using Diffusion Tensor Imaging in Concussion and Mild Traumatic Brain Injury in Adolescents with Negative CT.  Radiological Society of North America 2007 Scientific Assembly and Annual Meeting, November 25 - November 30, 2007 ,Chicago IL. http://archive.rsna.org/2007/5009684.html