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Figure 5–11. White matter damage in traumatic brain injury (TBI).

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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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