Clinical Utility of Diffusion Tensor Imaging for Evaluating Patients with Diffuse Axonal Injury and Cognitive Disorders in the Chronic Stage

Abstract

Although diffuse axonal injury (DAI) usually ellicits cognitive disorders, abnormal brain findings are generally undetected by conventional imaging techniques. The aim of this study was to evaluate the feasibility of using diffusion tensor imaging (DTI) to detect lesions in DAI patients and to investigate the correlation between DAI lesions and cognitive disorders. We examined 16 healthy controls and 11 patients with DAI. Using voxel-based analysis, we found that there were significantly more brain regions with decreased fractional anisotropy (FA) in the brain but DAI patients compared to healthy controls (p < 0.001), whereas few lesions were detected via conventional magnetic resonance imaging. There was a significant relationship between the results of the Wechsler Adult Intelligence Scale-Revised, Trail Making Test, and some indices of the Wechsler Memory Scale-Revised and the decreased FA observed in various areas of the brain (p < 0.001). The total cognitive scores on the functional independence and functional assessment measures, which represent behavioral problems, were correlated with the cluster (number of DAI lesions, p = 0.007) and voxel numbers (total size of all DAI lesions, p = 0.001). In the fiber tractography-based analysis, DAI patients with memory disorders showed an interruption of fibers within the fornix compared to healthy controls. These results indicate that DTI is a useful technique not only for detecting DAI lesions but also for examining cognitive disorders in DAI patients.

Injury of the cingulum in patients with putaminal hemorrhage: a diffusion tensor tractography study

“…Since introduction of DTI, many studies have investigated injury of the cingulum in various brain pathologies, including subarachnoid hemorrhage, traumatic brain injury, and hypoxic ischemic brain injury (Sugiyama et al, 2009; Wilde et al, 2010, 2011; Wu et al, 2010; McCauley et al, 2011; Wang et al, 2011; Hong et al, 2012; Lee et al, 2012; Baek et al, 2013; Sanjuan et al, 2013; Zheng et al, 2013). Most of these studies investigated injury of the cingulum using DTI parameters [Sugiyama et al, 2009; Wilde et al, 2010, 2011; Wu et al, 2010; McCauley et al, 2011; Wang et al, 2011; Hong et al, 2012; Lee et al, 2012; Sanjuan et al, 2013; Zheng et al, 2013 (Epub ahead of print)].…”

“…Most of these studies investigated injury of the cingulum using DTI parameters [Sugiyama et al, 2009; Wilde et al, 2010, 2011; Wu et al, 2010; McCauley et al, 2011; Wang et al, 2011; Hong et al, 2012; Lee et al, 2012; Sanjuan et al, 2013; Zheng et al, 2013 (Epub ahead of print)]. Only a few studies have reported that discontinuation of the anterior cingulum was related to cognitive dysfunction following brain injury (Baek et al, 2013).…”

“…However, recently developed diffusion tensor tractography (DTT), derived from diffusion tensor imaging (DTI), enables three dimensional reconstruction and evaluation of the architecture and integrity of the cingulum (Concha et al, 2005). Consequently, many studies have reported on injury of the cingulum in various brain pathologies using DTI (Sugiyama et al, 2009; Wilde et al, 2010, 2011; Wu et al, 2010; McCauley et al, 2011; Wang et al, 2011; Lee et al, 2012; Baek et al, 2013). However, no study on injury of the cingulum in patients with PH has been reported.…”

Relation between cognition and neural connection from injured cingulum to brainstem cholinergic nuclei in chronic patients with traumatic brain injury

“…Consequently, injury of the cingulum after TBI is known to accompany cognitive dysfunction [12][13][14][15][16][17][18]. In the past, demonstration of the state of the cingulum has been difficult due to limitations of conventional brain CT and MRI in assessing the state of the cingulum, which cannot discriminate from adjacent structures in these brain images [4].…”

“…Recently, diffuse tensor tractography (DTT), derived from diffusion tensor imaging (DTI), has enabled three-dimensional visualization and evaluation of the cingulum [3,19]. Using DTI, many studies have reported on the association between cingulum injury and cognitive dysfunction in patients with TBI [12][13][14][15][16][17][18]. However, little is known about mechanisms for recovery of an injured cingulum following TBI [7,8].…”