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Figure 5–10. Diffusion tensor imaging (DTI) of the corpus callosum.The left images show DTI tractography (upper left) of the corpus callosum superimposed on the T1 image of a traumatic brain injury patient who suffered a severe injury. Note, in comparison with the age-matched individual on the right without a history of brain injury, that the tractography demonstrates a significant reduction in the number of aggregate white matter tracts that can be identified coursing across the corpus callosum and projecting into the left hemisphere. The lower images show the midsagittal plane of the DTI color maps. The arrow in the lower left panel points to the corpus callosum highlighted in red, because DTI is sensitive to the directionality of the fiber tracts; red denotes lateral back-and-forth direction, whereas green reflects anterior-posterior and blue indicates vertical. The arrow in the upper left points to a corpus callosum tract coming out of the forceps minor projection system and is shown here to give the reader orientation for interpreting Figure 5–11.

Figure 5–11. White matter damage in traumatic brain injury (TBI).(A) The top 3-D image shows a cutaway with the left hemisphere diffusion tensor imaging (DTI) tractography findings from a child who sustained a severe TBI. Note the thinning out of tracts, similar to that observed in the case depicted in Figure 5–10. The arrow points to the location of the forceps minor region of white matter projection in the frontal lobe where the mild TBI case presented below shows discontinuity of the tracts in this region. Whereas the disruption of white matter tracts may be substantial in moderate to severe TBI, DTI findings when present in mild TBI are quite subtle and typically much less dramatic. (B) Fluid-attenuated inversion recovery (FLAIR) scan, fractional anisotropy (FA) map, and fiber tracking in a 49-year-old patient with TBI who was imaged 16 months after the initial trauma. The FLAIR image shows no abnormalities (top left). After analysis of the color-coded FA map (top middle), a region with reduced FA was identified in the WM of the left frontal lobe. This region of interest (ROI), illustrated in the top right T2-weighted image, included forceps minor and fronto-temporo-occipital fibers (bottom left), superior oblique view; the ROI is red and located centrally; the fibers are superimposed on an axial T2-weighted scan. At the level of the ROI, the respective fibers are discontinuous (arrow, bottom right; the ROI is left out in this image).Source. Panel (B) images reprinted from Rutgers DR, Toulgoat F, Cazejust J, et al: "White Matter Abnormalities in Mild Traumatic Brain Injury: A Diffusion Tensor Imaging Study." American Journal of Neuroradiology 29:514–519, 2008. Used with permission of the American Society of Neuroradiology.


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