Background: Despite normal CT imaging and neurologic functioning, many individuals report postconcussion symptoms following mild traumatic brain injury (MTBI). This dissociation has been enigmatic for clinicians and investigators. Methods: Diffusion tensor imaging tractography of the corpus callosum was performed in 10 adolescents (14 to 19 years of age) with MTBI 1 to 6 days postinjury with Glasgow Coma Scale score of 15 and negative CT, and 10 age- and gender-equivalent uninjured controls. Subjects were administered the Rivermead Post Concussion Symptoms Questionnaire and the Brief Symptom Inventory to assess self-reported cognitive, affective, and somatic symptoms. Results: The MTBI group demonstrated increased fractional anisotropy and decreased apparent diffusion coefficient and radial diffusivity, and more intense postconcussion symptoms and emotional distress compared to the control group. Increased fractional anisotropy and decreased radial diffusivity were correlated with severity of postconcussion symptoms in the MTBI group, but not in the control group. Conclusions: In adolescents with mild traumatic brain injury (MTBI) with Glasgow Coma Scale score of 15 and negative CT, diffusion tensor imaging (DTI) performed within 6 days postinjury showed increased fractional anisotropy and decreased diffusivity suggestive of cytotoxic edema. Advanced MRI-based DTI methods may enhance our understanding of the neuropathology of TBI, including MTBI. Additionally, DTI may prove more sensitive than conventional imaging methods in detecting subtle, but clinically meaningful, changes following MTBI and may be critical in refining MTBI diagnosis, prognosis, and management.

Diffusion tensor imaging of acute mild traumatic brain injury in adolescents.

To evaluate the effects of mild to moderate blast-related traumatic brain injury (TBI) on the microstructure of brain white matter (WM) and neurobehavioral outcomes, we studied 37 veterans and service members (mean age 31.5 years, SD = 7.2; post-injury interval 871.5 days; SD = 343.1), whose report of acute neurological status was consistent with sustaining mild to moderate TBI due to blast while serving in Iraq or Afghanistan. Fifteen veterans without a history of TBI or exposure to blast (mean age 31.4 years, SD = 5.4) served as a comparison group, including seven subjects with extracranial injury (post-injury interval 919.5 days, SD = 455.1), and eight who were uninjured. Magnetic resonance imaging disclosed focal lesions in five TBI participants. Post-concussion symptoms (Neurobehavioral Symptom Inventory), post-traumatic stress disorder (PTSD) symptoms (PTSD Checklist-Civilian), and global distress and depression (Brief Symptom Inventory) were worse in the TBI participants than the compariso...

Diffusion Tensor Imaging of Mild to Moderate Blast-Related Traumatic Brain Injury and Its Sequelae

A spin-echo single-shot echo-planar imaging (SS-EPI) technique with a reduced field of view (FOV) in the phase-encoding direction is presented that simultaneously reduces susceptibility effects and motion artifacts in diffusion-weighted (DW) imaging (DWI) of the spinal cord at a high field strength (3T). To minimize aliasing, an outer volume suppression (OVS) sequence was implemented. Effective fat suppression was achieved with the use of a slice-selection gradient-reversal technique. The OVS was optimized by numerical simulations with respect to T(1) relaxation times and B(1) variations. The optimized sequence was evaluated in vitro and in vivo. In simulations the optimized OVS showed suppression to <0.25% and approximately 3% in an optimal and worst-case scenario, respectively. In vitro measurements showed a mean residual signal of <0.95% +/- 0.42 for all suppressed areas. In vivo acquisition with 0.9 x 1.05 mm(2) in-plane resolution resulted in artifact-free images. The short imaging time of this technique makes it promising for clinical studies.

https://www.onlinelibrary.wiley.com/doi/pdf/10.1002/mrm.21167

Reduced field-of-view MRI using outer volume suppression for spinal cord diffusion imaging

Objective To investigate the relation of white matter integrity using diffusion tensor imaging (DTI) to cognitive and functional outcome of moderate to severe traumatic brain injury (TBI) in children. Design Prospective observational study of children who had sustained moderate to severe TBI and a comparison group of children who had sustained orthopedic injury (OI). Participants Thirty-two children who had sustained moderate to severe TBI and 36 children with OI were studied. Methods Fiber tracking analysis of DTI acquired at 3-month postinjury and assessment of global outcome and cognitive function within 2 weeks of brain imaging. Global outcome was assessed using the Glasgow Outcome Scale and the Flanker task was used to measure cognitive processing speed and resistance to interference. Results Fractional anisotropy and apparent diffusion coefficient values differentiated the groups and both cognitive and functional outcome measures were related to the DTI findings. Dissociations were present wherein the relation of Fractional anisotropy to cognitive performance differed between the TBI and OI groups. A DTI composite measure of white matter integrity was related to global outcome in the children with TBI. Conclusions DTI is sensitive to white matter injury at 3 months following moderate to severe TBI in children, including brain regions that appear normal on conventional magnetic resonance imaging. DTI measures reflecting diffusion of water parallel and perpendicular to white matter tracts as calculated by fiber tracking analysis are related to global outcome, cognitive processing speed, and speed of resolving interference in children with moderate to severe TBI. Longitudinal data are needed to determine whether these relations between DTI and neurobehavioral outcome of TBI in children persist at longer follow-up intervals.

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Diffusion Tensor Imaging in Relation to Cognitive and Functional Outcome of Traumatic Brain Injury in Children

Despite continuous hardware advances, MRI is frequently subject to field perturbations that are of higher than first order in space and thus violate the traditional k-space picture of spatial encoding. Sources of higher order perturbations include eddy currents, concomitant fields, thermal drifts, and imperfections of higher order shim systems. In conventional MRI with Fourier reconstruction, they give rise to geometric distortions, blurring, artifacts, and error in quantitative data. This work describes an alternative approach in which the entire field evolution, including higher order effects, is accounted for by viewing image reconstruction as a generic inverse problem. The relevant field evolutions are measured with a third-order NMR field camera. Algebraic reconstruction is then formulated such as to jointly minimize artifacts and noise in the resulting image. It is solved by an iterative conjugate-gradient algorithm that uses explicit matrix-vector multiplication to accommodate arbitrary net encoding. The feasibility and benefits of this approach are demonstrated by examples of diffusion imaging. In a phantom study, it is shown that higher order reconstruction largely overcomes variable image distortions that diffusion gradients induce in EPI data. In vivo experiments then demonstrate that the resulting geometric consistency permits straightforward tensor analysis without coregistration. Magn Reson Med, 2011. © 2011 Wiley-Liss, Inc.

Higher order reconstruction for MRI in the presence of spatiotemporal field perturbations

A statistical method for the evaluation of image registration for a series of images based on the assessment of consistency properties of the registration results is proposed. Consistency is defined as the residual error of the composition of cyclic registrations. By combining the transformations of different algorithms the consistency error allows a quantitative comparison without the use of ground truth, specifically, it allows a determination as to whether the algorithms are compatible and hence provide comparable registrations. Consistency testing is applied to evaluate retrospective correction of eddy current-induced image distortion in diffusion tensor imaging of the brain. In the literature several image transformations and similarity measures have been proposed, generally showing a significant reduction of distortion in side-by-side comparison of parametric maps before and after registration. Transformations derived from imaging physics and a three-dimensional affine transformation as well as mutual information (MI) and local correlation (LC) similarity are compared to each other by means of consistency testing. The dedicated transformations could not demonstrate a significant difference for more than half of the series considered. LC similarity is well-suited for distortion correction providing more consistent registrations which are comparable to MI.

A. van Muiswinkel

Papers

Quantitative evaluation of image-based distortion correction in diffusion tensor imaging