Differential Tractography and Correlation Tractography Findings on Patients With Mild Traumatic Brain Injury: A Pilot Study

Abstract

Differential tractography and correlation tractography are new tractography modalities to study neuronal changes in brain diseases, but their performances in detecting neuronal injuries are yet to be investigated in patients with mild traumatic brain injury (mTBI). Here we investigated the white matter injury in mTBI patients using differential and correlation tractography. The diffusion MRI was acquired at 33 mTBI patients and 31 health controls. 7 of the mTBI patients had one-year follow-up scans, and differential tractography was used to evaluate injured fiber bundles on these 7 patients. All subjects were evaluated using digital symbol substitution test (DSST) and trail making test A (TMT-A), and the correlation tractography was performed to explore the exact pathways related to the cognitive performance. Our results showed that differential tractography revealed neuronal changes in the corpus callosum in all 7 follow-up mTBI patients with FDR between 0.007 and 0.17. Further, the correlation tractography showed that the splenium of the corpus callosum, combined with the right superior longitudinal fasciculus and right cingulum, were correlated with DSST (FDR = 0.001669) in the acute mTBI patients. The cognitive impairment findings in the acute stage and the longitudinal findings in the corpus callosum in the chronic stage of mTBI patients suggest that differential tractography and correlation tractography are valuable tools in the diagnostic and prognostic evaluation of neuronal injuries in mTBI patients.

Differential and correlational tractography as tract‐based biomarkers in mild traumatic brain injury: A longitudinal MRI study

“…The subject demographics are shown in Table 1. Thirty‐four acute mTBI patients (12 males and 22 females; mean age: 34.97 ± 11.14 years; age range: 18–59 years) and 31 healthy controls (14 males and 17 females; mean age: 38.06 ± 8.18 years; age range: 23–52 years) were included in the study (seven patients and 15 healthy controls were included in our earlier study) 18 . However, one mTBI patient did not perform the cognitive test at the acute stage because of a hand injury, and three patients refused to perform the cognitive test at the chronic stage.…”

“…For the mTBI patients, inclusion criteria were based on the World Health Organization's Collaborating Center for Neurotrauma Task Force 3 . The exclusion criteria were as follows: (1) a history of previous brain injury; (2) penetrating craniocerebral injury and/or presence of a skull fracture; (3) the mTBI being attributable to other injuries (e.g., systemic injuries, facial injuries, or spinal cord injury); (4) a history of neurological disease, a long‐standing psychiatric condition, or other problems (e.g., psychological trauma, language barrier); (5) coexisting medical conditions or drug abuse (e.g., alcohol abuse, administration of sedatives); and (6) structural abnormality on neuroimaging (computed tomography [CT] and MRI) 18 . Healthy controls with neurological impairment and psychiatric disorders were also excluded.…”

“…We have previously conducted differential and correlational tractography to investigate the correlation between the white matter changes and cognitive manifestations in mTBI. Decreased QA in the corpus callosum was identified in seven follow‐up patients 18 . In the current study, we aimed to evaluate the feasibility of differential and correlational tractography as tract‐based biomarkers using a longitudinal study.…”

“…Recently, the generalized q‐sampling imaging (GQI) method, a modal‐free method that calculates the spin distribution function (SDF) from diffusion MR signals, 17 has been applied to study traumatic brain injury 9,18–22 . GQI can differentiate nonrestricted and restricted diffusion through anisotropic and isotropic measures.…”

Diffusion spectrum imaging of patients with middle cerebral artery stenosis

“…The DSI technique can perform QA-aided tractography, which has been proven to outperform DTI using fiber tractography and is less susceptible to crossing fibers ( Yeh et al, 2016 ). DSI has been applied in the research of cerebral conditions, such as chronic stoke, seizure and mild traumatic brain injury ( Yeh et al, 2013 , Li et al, 2022 , da Silva et al, 2020 ).…”