Longitudinal whole-brain analysis of multi-subject diffusion data in diffuse axonal injury

ABSTRACT

Background: Diffuse axonal injury occurs with high acceleration and deceleration forces in traumatic brain injury (TBI). This lesion leads to disarrangement of the neuronal network, which can result in some degree of deficiency. The Extended Glasgow Outcome Scale (GOS-E) is the primary outcome instrument for the evaluation of TBI victims. Diffusion tensor imaging (DTI) assesses white matter (WM) microstructure based on the displacement distribution of water molecules. Objective: To investigate WM microstructure within the first year after TBI using DTI, the patient’s clinical outcomes, and associations. Methods: We scanned 20 moderate and severe TBI victims at 2 months and 1 year after the event. Imaging processing was done with the FMRIB software library; we used the tract-based spatial statistics software yielding fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (AD), and radial diffusivity (RD) for statistical analyses. We computed the average difference between the two measures across subjects and performed a one-sample t-test and threshold-free cluster enhancement, using a corrected p-value < 0.05. Clinical outcomes were evaluated with the GOS-E. We tested for associations between outcome measures and significant mean FA clusters. Results: Significant clusters of altered FA were identified anatomically using the JHU WM atlas. We found increasing spotted areas of FA with time in the right brain hemisphere and left cerebellum. Extensive regions of increased MD, RD, and AD were observed. Patients presented an excellent overall recovery. Conclusions: There were no associations between FA and outcome scores, but we cannot exclude the existence of a small to moderate association.

RESUMO

Antecedentes: A lesão axonial difusa ocorre em traumas com alta energia de aceleração e desaceleração, determinando desorganização da microestrutura cerebral, levando a algum déficit. A escala de Glasgow Estendida (GOS-E) é indicada na avaliação clínica das vítimas de trauma cranioencefalico. Imagens por tensor de difusão (DTI) estudam a microestrutura cerebral a partir da difusão das moléculas de água. Objetivo: Investigar a microestrutura cerebral no primeiro ano após trauma, avaliar clinicamente os pacientes e testar para correlações entre estes resultados. Métodos: 20 vítimas de TCE moderado e grave foram avaliados 2 meses e 1 ano depois do trauma. O processamento foi feito usando o software FMRIB (FSL) e a análise estatística foi feita com tract-based spatial statistics software para extrair os parâmetros de DTI. Calculamos a diferença da média entre as duas observações de cada sujeito e fizemos um teste-t para uma amostra e threshold-free cluster enhancement. Realizamos correções para múltiplas comparações e determinamos o valor de p < 0.05 como significativo. Um ano após o trauma, a avaliação clínica foi feita usando a GOS-E. Testamos para associações entre os resultados clínicos e os valores médios de FA dos clusters. Resultados: Os clusters significativos foram identificados usando o atlas JHU WM. Observamos aumento de FA predominantemente no hemisfério cerebral direito e cerebelar à esquerda e também extensas áreas de aumento nos demais parâmetros de DTI. A recuperação dos pacientes foi satisfatória. Conclusões: Não encontramos associações entre os resultados, no entanto alguma associação pequena a moderada não pode ser excluída.

Keywords:

Craniocerebral Trauma - Diffuse Axonal Injury - Diffusion Tensor Imaging - Glasgow Outcome Scale - Regeneration

Palavras-chave:

Traumatismos Craniocerebrais - Lesão Axonal Difusa - Imagem de Tensor de Difusão - Escala de Resultado de Glasgow - Regeneração

Authors’ contributions:

MCGO, CCL, VMPG, WSP: contributions for the design of the work; ALZ, FSF, FBCM, VMPG: contributions in the collection of data; DCG, CSA: contributions in the analysis of data; All authors: contributions in the writing, critical revision and final approval.

Support

Grants 2015/18136-1, 2016/05547-6 and 2017/17065-9 from São Paulo Research Foundation - FAPESP.

Publication History

Received: 07 February 2021

Accepted: 30 May 2021

Article published online:
30 January 2023

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