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Neuronal Loss in the Medial Cholinergic Pathway From the Nucleus Basalis of Meynert in Patients With Traumatic Axonal Injury: A Preliminary Diffusion Tensor Imaging Study

Hong, Ji Heon PhD; Jang, Sung Ho MD; Kim, Oh Lyong MD, PhD; Kim, Seong Ho MD, PhD; Ahn, Sang Ho MD; Byun, Woo Mok MD; Hong, Cheol Pyo MS; Lee, Dong Hoon MS

Section Editor(s): Caplan, Bruce PhD, ABPP; Bogner, Jennifer PhD, ABPP

The Journal of Head Trauma Rehabilitation: May/June 2012 - Volume 27 - Issue 3 - p 172–176
doi: 10.1097/HTR.0b013e318217192d
Focus on Clinical Research and Practice, Part 2

Objective: The recent development of diffusion tensor imaging (DTI) allows visualization and estimation of the medial cholinergic pathway (MCP), which originates from the nucleus basalis of Meynert and provides cortical cholinergic innervation to the cerebral cortex. We investigated the injury to the MCP in patients with traumatic axonal injury (TAI), using DTI.

Design: Retrospective survey.

Participants: Fourteen patients with chronic TAI and 14 age- and sex-matched normal control subjects.

Main Outcome Measures: Using the Functional Magnetic Resonance Imaging of the Brain (FMRIB) Software Library (FMRIB analysis group, Oxford University, United Kingdom), diffusion tensor images were acquired by using a sensitivity-encoding head coil at 1.5 T DTIs. Fractional anisotropy (FA), mean diffusivity (MD), and tract volume of the MCP were measured.

Results: The FA value and tract volume were significantly decreased in the group with TAI compared with those of the control group (P < .05); in contrast, there was no difference in the MD value between the 2 groups (P > .05).

Conclusions: Changes in DTI parameters of the TAI group appear to be due to neuronal loss of the MCP. We believe that DTI would be useful for the evaluation of the MCP in patients with TAI.

Department of Physical Therapy, Sun Moon University, Asan-si, Chungnam, Republic of Korea (Mr J. H. Hong); Department of Physical Medicine and Rehabilitation (Drs Jang and Ahn), Department of Neurosurgery (Drs O. L. Kim and S. H. Kim), and Department of Diagnostic Radiology (Dr Byun), College of Medicine, Yeungnam University, Namku, Taegu, Republic of Korea; and Department of Radiological Science, College of Health Science, Yonsei University, Seodaemun-gu, Seoul, South Korea (Dr C. P. Hong and Mr Lee).

Corresponding Author: Sung Ho Jang, MD, Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, 317-1, Daemyungdong, Namku, Taegu, 705-717, Republic of Korea (,

This work was supported by National Research Foundation of Korea Grant funded by the Korean Government (KRF-2008-314-E00173).

The authors declare no conflicts of interest.

© 2012 Lippincott Williams & Wilkins, Inc.