We then present an overview of DTI, and image acquisition techniques and processing methods for techniques beyond DTI. First, we briefly introduce the fundamental principles that subtend DTI. This article will review the potential benefits and challenges of using DTI in TBI. 6, 7 DTI metrics are thought to reflect the integrity of microstructural properties of white matter and have been applied extensively as neuroimaging biomarkers to study a range of clinical conditions. In contrast, diffusion tensor imaging (DTI) is an advanced MRI technique that came into existence in the mid-1980s and is capable of providing rich information on the brain’s neuroanatomic connectome. 5 Many advanced neuroimaging techniques are actively being researched in an attempt to better diagnose concussions. However, in the setting of a concussion, conventional magnetic resonance imaging (MRI) is typically normal. For example, in the setting of severe TBI, the detection of an epidural hematoma may require emergent neuro-surgical management. Neuroimaging plays a critical role in the acute setting to guide appropriate management by detecting injuries that require intervention or further monitoring. 4 The clinical symptoms from TBI range from mild cognitive impairment to severe disability. 4 According to the Veterans Health Administration, the cost of treating a patient with TBI for the first year averages $11,700, whereas the cost of treating a non-TBI patient is $2400. 1 In the military population, TBI is common in soldiers who have been exposed to an explosion. 1 The most common causes of TBI are motor vehicle accidents, falls, sports-related injury, and assault, 1– 3 with falls being the most common overall while motor vehicle accidents are the most common cause of TBI-related deaths. 1– 3 Adults older than 75 years of age have higher rates of hospitalization and death. The incidence in emergency room visits related to TBI has been increasing over the past decade. Traumatic brain injury(TBI) is a common problem that affects 1.7 million people and results in 275,000 hospitalizations and 52,000 deaths in the United States annually.
We conclude by discussing future directions in DTI research in TBI including the role of machine learning in the pattern classification of TBI. Despite the continued advancements in DTI and related diffusion techniques over the past 20 years, DTI techniques are sensitive for TBI at the group level only and there is insufficient evidence that DTI plays a role at the individual level. We discuss clinical applications of DTI and review the DTI literature as it pertains to TBI. The purpose of this article is to systematically review the role of DTI and advanced diffusion techniques in the setting of TBI, including diffusion kurtosis imaging (DKI), neurite orientation dispersion and density imaging, diffusion spectrum imaging, and q-ball imaging. Diffusion tensor imaging (DTI) is an advanced magnetic resonance imaging technique that is capable of providing rich information on the brain’s neuroanatomic connectome. Neuroimaging plays a critical role in the setting in traumatic brain injury (TBI).
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