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AJNR - American Journal of Neuroradiology

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American Journal of Neuroradiology 25:370-376, March 2004
© 2004 American Society of Neuroradiology

BRAIN

Diffusion Tensor Imaging as Potential Biomarker of White Matter Injury in Diffuse Axonal Injury

Thierry A.G.M. Huisman^a,d, Lee H. Schwamm^b, Pamela W. Schaefer^c, Walter J. Koroshetz^b, Neetha Shetty-Alva^a, Yelda Ozsunar, Ona Wu^a and A. Gregory Sorensen^a

^a MGH-NMR Center, Division of Neuroradiology, Massachusetts General Hospital and Harvard Medical School, Boston
^b Department of Neurology, Division of Neuroradiology, Massachusetts General Hospital and Harvard Medical School, Boston
^c Department of Radiology, Division of Neuroradiology, Massachusetts General Hospital and Harvard Medical School, Boston
^d Department of Radiology, University Children’s Hospital Zurich, Zurich, Switzerland

Address reprint requests to Thierry A.G.M. Huisman, MD, University Children’s Hospital Zurich, Department of Radiology, Steinwiesstrasse 75, CH-8032 Zurich, Switzerland

BACKGROUND AND PURPOSE: Multiple biomarkers are used to quantify the severity of traumatic brain injury (TBI) and to predict outcome. Few are satisfactory. CT and conventional MR imaging underestimate injury and correlate poorly with outcome. New MR imaging techniques, including diffusion tensor imaging (DTI), can provide information about brain ultrastructure by quantifying isotropic and anisotropic water diffusion. Our objective was to determine if changes in anisotropic diffusion in TBI correlate with acute Glasgow coma scale (GCS) and/or Rankin scores at discharge.

METHODS:Twenty patients (15 male, five Female; mean age, 31 years) were evaluated. Apparent diffusion coefficients (ADCs) and fractional anisotropy (FA) values were measured at multiple locations and correlated with clinical scores. Results were compared with those of 15 healthy control subjects.

RESULTS: ADC values were significantly reduced within the splenium (18%, P = .001). FA values were significantly reduced in the internal capsule (14%; P < .001) and splenium (16%; P = .002). FA values were significantly correlated with GCS (r = 0.65–0.74; P < .001) and Rankin (r = 0.68–0.71; P < .001) scores for the internal capsule and splenium. The correlation between FA and clinical markers was better than for the corresponding ADC values. No correlation was found between ADC of the internal capsule and GCS/Rankin scores.

CONCLUSION: DTI reveals changes in the white matter that are correlated with both acute GCS and Rankin scores at discharge. DTI may be a valuable biomarker for the severity of tissue injury and a predictor for outcome.