Miriam Hulkower, Abstract Co-Author: Nothing to Disclose

Michael L. Lipton MD, PhD, Presenter: Nothing to Disclose

Molly Zimmerman PhD, Abstract Co-Author: Nothing to Disclose

Young Park MD, Abstract Co-Author: Nothing to Disclose

Namhee Kim PhD, Abstract Co-Author: Nothing to Disclose

Richard Lipton, Abstract Co-Author: Nothing to Disclose

Craig A. Branch PhD, Abstract Co-Author: Nothing to Disclose

Abby Basalely, Abstract Co-Author: Nothing to Disclose

Jonathan Weinberger, Abstract Co-Author: Nothing to Disclose

Tova Gardin, Abstract Co-Author: Nothing to Disclose

Determine the utility of personalized assessment of white matter injury for predicting subacute cognitive outcome after mild traumatic brain injury (mTBI).

After IRB approval and written consent, DTI (3.0 T; 32 directions; b=1000) was performed in 19 patients at <2 weeks and 3 - 6 months after mTBI. Areas of abnormal FA were determined in each patient using a previously validated voxel-wise comparison of each individual to 40 control subjects. Total volume of voxels with either abnormally low or abnormally high FA were calculated separately for each subject. Neuropsychological function and post concussive symptoms were assessed with each MRI and at 1 year. Spearman correlations separately quantified associations between volume of abnormally low or abnormally high FA and cognitive performance.

Areas of abnormally low FA and areas of abnormally high FA were found in 18/19 patients. Volume of abnormally high FA at 3-6 months was associated with memory (ρ=0.505, p= 0.039) and overall cognitive function (ρ=0.638, p=0.002) at the same time point. Volume of abnormally high FA at the time of injury predicted better attention (ρ=0.720, p=0.0003) and motor functioning (ρ=0.736, p=0.010) as well as fewer sleep disturbances (ρ=-0.695, p=0.002) at 3-6 months. Volume of abnormally high FA at 3 months predicted better language function at 6 months (ρ=0.867, p=0.002 ) and at 1 year (ρ=0.929, p=0.003). Associations between volume of abnormally Low FA and worse cognitive outcomes (ρ= 0.071, p= -0.714) were found, but did not reach statistical significance.

Personalized assessment of DTI reveals both areas of abnormally high and areas of abnormally low FA in most patients after mTBI. Low FA, extensively reported as a marker for white matter injury in group analyses of mTBI, did not significantly predict outcomes when assessed at the individual level. High FA, however, was strongly associated with better cognitive and symptomatic outcomes. The findings suggest that personalized assessment of high FA may be a useful predictor of good prognosis, perhaps indicating plasticity as a compensatory response to injury.

mTBI is a major public health problem. Personalized outcome prediction would improve diagnosis and treatment, facilitate resource allocation and serve as a much-needed endpoint in clinical trials.

Hulkower, M, Lipton, M, Zimmerman, M, Park, Y, Kim, N, Lipton, R, Branch, C, Basalely, A, Weinberger, J, Gardin, T, Personalized Assessment of White Matter Injury Based on Diffusion Tensor Imaging (DTI) Predicts Cognitive Performance in Subacute Mild Traumatic Brain Injury (mTBI).  Radiological Society of North America 2011 Scientific Assembly and Annual Meeting, November 26 - December 2, 2011 ,Chicago IL. http://archive.rsna.org/2011/11010362.html