Research Reports - Long-term white matter changes after severe traumatic brain injury: A 5-year prospective cohort

AJNR Am J Neuroradiol. 2013 Jul 11

Dinkel J, Drier A, Khalilzadeh O, Perlbarg V, Czernecki V, Gupta R, Gomas F, Sanchez P, Dormont D, Galanaud D, Stevens RD, Puybasset L

BACKGROUND AND PURPOSE:Extensive white matter damage has been documented in
patients with severe traumatic brain injury, yet how this damage evolves in the
long term is not well understood. We used DTI to study white matter changes at 5
years after traumatic brain injury.MATERIALS AND METHODS:There were 8 healthy
control participants and 13 patients with severe traumatic brain injury who were
enrolled in a prospective observational study, which included clinical assessment
and brain MR imaging in the acute setting (< 6 weeks) and 2 years and 5 years
after injury. Only subjects with mild to moderate disability or no disability at
1 year were included in this analysis. DTI parameters were measured in 20
different brain regions and were normalized to values obtained in an age-matched
control group.RESULTS:In the acute setting, fractional anisotropy was
significantly lower in the genu and body of the corpus callosum and in the
bilateral corona radiata in patients compared with control participants, whereas
radial diffusivity was significantly (P < .05) higher in these tracts. At 2
years, fractional anisotropy in these tracts had further decreased and radial
diffusivity had increased. No significant changes were detected between 2 and 5
years after injury. The baseline radial diffusivity and fractional anisotropy
values in the anterior aspect of the brain stem, genu and body of the corpus
callosum, and the right and left corona radiata were significantly (P < .05)
associated with neurocognitive sequelae (including amnesia, aphasia, and
dyspraxia) at year 5.CONCLUSIONS:DTI changes in major white matter tracts persist
up to 5 years after severe traumatic brain injury and are most pronounced in the
corpus callosum and corona radiata. Limited structural change is noted in the
interval between 2 and 5 years.

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