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Abstract
Objective: To evaluate whether diffusion tensor imaging (DTI) will noninvasively reveal white matter changes not present on conventional MRI in acute blast-related mild traumatic brain injury (mTBI) and to determine correlations with clinical measures and recovery.
Methods: Prospective observational study of 95 US military service members with mTBI enrolled within 7 days from injury in Afghanistan and 101 healthy controls. Assessments included Rivermead Post-Concussion Symptoms Questionnaire (RPCSQ), Post-Traumatic Stress Disorder Checklist Military (PCLM), Beck Depression Inventory (BDI), Balance Error Scoring System (BESS), Automated Neuropsychological Assessment Metrics (ANAM), conventional MRI, and DTI.
Results: Significantly greater impairment was observed in participants with mTBI vs controls: RPCSQ (19.7 ± 12.9 vs 3.6 ± 7.1, p < 0.001), PCLM (32 ± 13.2 vs 20.9 ± 7.1, p < 0.001), BDI (7.4 ± 6.8 vs 2.5 ± 4.9, p < 0.001), and BESS (18.2 ± 8.4 vs 15.1 ± 8.3, p = 0.01). The largest effect size in ANAM performance decline was in simple reaction time (mTBI 74.5 ± 148.4 vs control −11 ± 46.6 milliseconds, p < 0.001). Fractional anisotropy was significantly reduced in mTBI compared with controls in the right superior longitudinal fasciculus (0.393 ± 0.022 vs 0.405 ± 0.023, p < 0.001). No abnormalities were detected with conventional MRI. Time to return to duty correlated with RPCSQ (r = 0.53, p < 0.001), ANAM simple reaction time decline (r = 0.49, p < 0.0001), PCLM (r = 0.47, p < 0.0001), and BDI (r = 0.36 p = 0.0005).
Conclusions: Somatic, behavioral, and cognitive symptoms and performance deficits are substantially elevated in acute blast-related mTBI. Postconcussive symptoms and performance on measures of posttraumatic stress disorder, depression, and neurocognitive performance at initial presentation correlate with return-to-duty time. Although changes in fractional anisotropy are uncommon and subtle, DTI is more sensitive than conventional MRI in imaging white matter integrity in blast-related mTBI acutely.
GLOSSARY
- ANAM=
- Automated Neuropsychological Assessment Metrics;
- BDI=
- Beck Depression Inventory;
- BESS=
- Balance Error Scoring System;
- DTI=
- diffusion tensor imaging;
- FA=
- fractional anisotropy;
- FDR=
- false discovery rate;
- KAF=
- Kandahar Airfield;
- LNK=
- Bastion/Camp Leatherneck;
- mTBI=
- mild traumatic brain injury;
- PCLM=
- Post-Traumatic Stress Disorder Checklist Military;
- PTA=
- posttraumatic amnesia;
- PTSD=
- posttraumatic stress disorder;
- ROI=
- region of interest;
- RPCSQ=
- Rivermead Post-Concussion Symptoms Questionnaire;
- SLF=
- superior longitudinal fasciculus;
- SRT=
- simple reaction time;
- TOMM=
- Test of Memory Malingering
Footnotes
↵* These authors contributed equally to this work.
The opinions or assertions contained herein are the private views of the authors and are not to be construed as official or as reflecting the views of the Department of the Army or the Department of Defense.
Go to Neurology.org for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
Supplemental data at Neurology.org
- Received November 15, 2014.
- Accepted in final form March 5, 2015.
- © 2015 American Academy of Neurology
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