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AJNR - American Journal of Neuroradiology

Published ahead of print on February 13, 2008
doi: 10.3174/ajnr.A0970

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American Journal of Neuroradiology 29:967-973, May 2008
© 2008 American Society of Neuroradiology

FUNCTIONAL

Extent of Microstructural White Matter Injury in Postconcussive Syndrome Correlates with Impaired Cognitive Reaction Time: A 3T Diffusion Tensor Imaging Study of Mild Traumatic Brain Injury

S.N. Niogi^a, P. Mukherjee^b, J. Ghajar^c,d, C. Johnson^e, R.A. Kolster^a,c, R. Sarkar^c, H. Lee^f, M. Meeker^f, R.D. Zimmerman^e, G.T. Manley^e and B.D. McCandliss^a

^a Department of Psychiatry, Sackler Institute, Weill Medical College of Cornell University, New York, NY
^b Department of Radiology, University of California, San Francisco, San Francisco, Calif
^c Brain Trauma Foundation, New York, NY
^d Department of Neurological Surgery, Weill Medical College of Cornell University, New York, NY
^e Department of Radiology, Weill Medical College of Cornell University, New York, NY
^f Department of Neurological Surgery, University of California, San Francisco, Calif

Please address correspondence to Bruce D. McCandliss, MD, Sackler Institute, Department of Psychiatry, Weill Medical College of Cornell University, 525 E. 68th St, New York, NY 10065; e-mail: bdm2001{at}med.cornell.edu

BACKGROUND AND PURPOSE: Diffusion tensor imaging (DTI) may be a useful index of microstructural changes implicated in diffuse axonal injury (DAI) linked to persistent postconcussive symptoms, especially in mild traumatic brain injury (TBI), for which conventional MR imaging techniques may lack sensitivity. We hypothesized that for mild TBI, DTI measures of DAI would correlate with impairments in reaction time, whereas the number of focal lesions on conventional 3T MR imaging would not.

MATERIALS AND METHODS: Thirty-four adult patients with mild TBI with persistent symptoms were assessed for DAI by quantifying traumatic microhemorrhages detected on a conventional set of T2*-weighted gradient-echo images and by DTI measures of fractional anisotropy (FA) within a set of a priori regions of interest. FA values 2.5 SDs below the region average, based on a group of 26 healthy control adults, were coded as exhibiting DAI.

RESULTS: DTI measures revealed several predominant regions of damage including the anterior corona radiata (41% of the patients), uncinate fasciculus (29%), genu of the corpus callosum (21%), inferior longitudinal fasciculus (21%), and cingulum bundle (18%). The number of damaged white matter structures as quantified by DTI was significantly correlated with mean reaction time on a simple cognitive task (r = 0.49, P = .012). In contradistinction, the number of traumatic microhemorrhages was uncorrelated with reaction time (r = –0.08, P = .71).

CONCLUSION: Microstructural white matter lesions detected by DTI correlate with persistent cognitive deficits in mild TBI, even in populations in which conventional measures do not. DTI measures may thus contribute additional diagnostic information related to DAI.

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