Diffusion tensor tractography of traumatic diffuse axonal injury

Arch Neurol. 2008 May;65(5):619-26. doi: 10.1001/archneur.65.5.619.


Background: Diffuse axonal injury is a common consequence of traumatic brain injury that frequently involves the parasagittal white matter, corpus callosum, and brainstem.

Objective: To examine the potential of diffusion tensor tractography in detecting diffuse axonal injury at the acute stage of injury and predicting long-term functional outcome.

Design: Tract-derived fiber variables were analyzed to distinguish patients from control subjects and to determine their relationship to outcome.

Setting: Inpatient traumatic brain injury unit.

Patients: From 2005 to 2006, magnetic resonance images were acquired in 12 patients approximately 7 days after injury and in 12 age- and sex-matched controls.

Main outcome measures: Six fiber variables of the corpus callosum, fornix, and peduncular projections were obtained. Glasgow Outcome Scale-Extended scores were assessed approximately 9 months after injury in 11 of the 12 patients.

Results: At least 1 fiber variable of each region showed diffuse axonal injury-associated alterations. At least 1 fiber variable of the anterior body and splenium of the corpus callosum correlated significantly with the Glasgow Outcome Scale-Extended scores. The predicted outcome scores correlated significantly with actual scores in a mixed-effects model.

Conclusion: Diffusion tensor tractography-based quantitative analysis at the acute stage of injury has the potential to serve as a valuable biomarker of diffuse axonal injury and predict long-term outcome.

Publication types

  • Controlled Clinical Trial
  • Research Support, N.I.H., Extramural
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Adolescent
  • Adult
  • Axons / pathology*
  • Brain / pathology*
  • Brain / physiopathology
  • Corpus Callosum / pathology
  • Corpus Callosum / physiopathology
  • Diffuse Axonal Injury / diagnosis*
  • Diffuse Axonal Injury / physiopathology
  • Diffusion Magnetic Resonance Imaging / methods*
  • Female
  • Fornix, Brain / pathology
  • Fornix, Brain / physiopathology
  • Glasgow Outcome Scale
  • Humans
  • Image Processing, Computer-Assisted
  • Male
  • Models, Neurological
  • Nerve Fibers, Myelinated / pathology
  • Neural Pathways / injuries
  • Neural Pathways / pathology
  • Neural Pathways / physiopathology
  • Predictive Value of Tests
  • Tegmentum Mesencephali / pathology
  • Tegmentum Mesencephali / physiopathology
  • Treatment Outcome