Traumatic brain injury and the frontal lobes: What can we gain with diffusion tensor imaging?
Cortex. 2012-02-01; 48(2): 156-165
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1. Cortex. 2012 Feb;48(2):156-65. doi: 10.1016/j.cortex.2011.06.020. Epub 2011 Jul
Traumatic brain injury and the frontal lobes: what can we gain with diffusion
Zappalà G(1), Thiebaut de Schotten M, Eslinger PJ.
(1)Behavioral Neurology Unit, Garibaldi Hospital, Catania, Italy.
Traumatic brain injury (TBI) is a leading cause of death in the young population
and long-term disability in relation to pervasive cognitive-behavioural
disturbances that follow frontal lobe damage. To date, emphasis has been placed
primarily on the clinical correlates of frontal cortex damage, whilst
identification of the contribution of subjacent white matter lesion is less
clear. Our poor understanding of white matter pathology in TBI is primarily due
to the low sensitivity of conventional neuroimaging to identify pathological
changes in less severe traumatic injury and the lack of methods to localise white
matter pathology onto individual frontal lobe connections. In this paper we focus
on the potential contribution of diffusion tensor imaging (DTI) to TBI. Our
review of the current literature supports the conclusion that DTI is particularly
sensitive to changes in the microstructure of frontal white matter, thus
providing a valuable biomarker of the severity of traumatic injury and prognostic
indicator of recovery of function. Furthermore we propose an atlas approach to
TBI to map white matter lesions onto individual tracts. In the cases presented
here we showed a direct correspondence between the clinical manifestations of the
patients and the damage to specific white matter tracts. We are confident that in
the near future the application of DTI to TBI will improve our understanding of
the complex and heterogeneous clinical symptomatology which follows a TBI,
especially mild and moderate head injury, which still represents 70-80% of all
Copyright © 2011 Elsevier Srl. All rights reserved.
PMID: 21813118 [Indexed for MEDLINE]