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Diffusion Imaging Findings in US Service Members With Mild Traumatic Brain Injury and Posttraumatic Stress Disorder

Bolzenius, Jacob D., PhD; Velez, Carmen S., BS; Lewis, Jeffrey D., MD, PhD; Bigler, Erin D., PhD; Wade, Benjamin S. C., PhD; Cooper, Douglas B., PhD; Kennedy, Jan E., PhD; Reid, Matthew W., PhD; Ritter, John L., MD; York, Gerald E., MD; Tate, David F., PhD

Section Editor(s): Caplan, Bruce PhD, ABPP; Bogner, Jennifer PhD, ABPP; Brenner, Lisa PhD, ABPP; Malec, James PhD, ABPP

The Journal of Head Trauma Rehabilitation: November/December 2018 - Volume 33 - Issue 6 - p 393–402
doi: 10.1097/HTR.0000000000000378
Focus on Clinical Research and Practice

Objective: Use diffusion tensor imaging to investigate white matter microstructure attributable to mild TBI (mTBI) and/or posttraumatic stress disorder (PTSD).

Participants: Twenty-seven individuals with mTBI only, 16 with PTSD only, 42 with mTBI + PTSD, and 43 service members who sustained orthopedic injury.

Design: Descriptive cross-sectional study.

Main Measures: Clinical diffusion tensor imaging sequence to assess fractional anisotropy, mean, axial, and radial diffusivity within selected regions of interest.

Results: Corrected analyses revealed a pattern of lower white matter integrity in the PTSD group for several scalar metrics. Regions affected included primarily right hemisphere areas of the internal capsule. These differences associated with the PTSD only cohort were observed in relation to all 3 comparison groups, while the mTBI + PTSD group did not exhibit any notable pattern of white matter abnormalities.

Conclusion: Results suggest that lower resolution scan sequences are sensitive to post–acute abnormalities associated with PTSD, particularly in the right hemisphere. In addition, these findings suggest that ongoing PTSD symptoms are associated with differences in white matter diffusion that are more readily detected in a clinical scan sequence than mTBI abnormalities. Future studies are needed to prospectively assess service members prior to onset of injury to verify this pattern of results.

Missouri Institute of Mental Health, University of Missouri-St Louis, Berkeley, Missouri (Drs Bolzenius, Wade, and Tate and Ms Velez); Department of Neurology, Uniformed Services University of the Health Sciences School of Medicine, Bethesda, Maryland (Dr Lewis); Department of Psychology and Neuroscience Center, Brigham Young University, Provo, Utah (Dr Bigler); Defense and Veterans Brain Injury Center, San Antonio, Texas (Drs Cooper, Kennedy, and Reid); Department of Radiology, Brooke Army Medical Center, San Antonio, Texas (Dr Ritter); and Alaska Radiology Associates, TBI Imaging and Research, Anchorage, Alaska (Dr York).

Corresponding Author: David F. Tate, PhD, Missouri Institute of Mental Health, University of Missouri-St Louis, 4633 World Parkway Circle, Berkeley, MO 63134 (

The authors gratefully acknowledge the generous time and effort the Service Members made in supporting this study. They also gratefully acknowledge the clinical effort and expertise of the Brooke Army Medical Center Brain Injury and Rehabilitation Service staff in the identification, recruitment, consenting, and treatment of Service Members who are a part of this study.

This work is supported in part by the Defense and Veterans Brain Injury Centers at the US Army Medical Research and Materiel Command (USAMRMC; W81XWH-13-2-0025) and the Chronic Effects of Neurotrauma Consortium (CENC; PT108802-SC104835).

The view(s) expressed herein are those of the author and do not reflect the official policy or position of the Defense and Veterans Brain Injury Center, Brooke Army Medical Center, the US Army Medical Department, the US Army Office of the Surgeon General, the Department of the Army, the Department of the Air Force, Department of Defense, or the US Government.

The authors declare no conflicts of interest.

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