MRI-BASED ASSESSMENT OF WHITE MATTER INTEGRITY IN PEDIATRIC TRAUMATIC BRAIN INJURY

Abstract

Pediatric traumatic brain injury (TBI) poses significant diagnostic and prognostic challenges due to the complex and often subtle nature of white matter damage in the developing brain. This study employed advanced magnetic resonance imaging (MRI) modalities—including diffusion tensor imaging (DTI), diffusion kurtosis imaging (DKI), neurite orientation dispersion and density imaging (NODDI), magnetic resonance spectroscopy (MRS), and volumetric MRI—to assess white matter integrity and its relationship with cognitive outcomes in children with TBI. Quantitative analyses revealed decreased fractional anisotropy (FA) and increased mean diffusivity (MD) across key white matter regions such as the corpus callosum, cingulum, and internal capsule, indicating disrupted axonal integrity. DKI and NODDI metrics further supported these findings, with reduced kurtosis values and neurite density in frontal and temporal white matter. MRS data showed significant reductions in N-acetylaspartate (NAA) and elevations in choline, reflecting neuronal loss and membrane turnover, respectively. Volumetric MRI indicated notable brain atrophy, particularly in the hippocampus and frontal lobe, with volume losses exceeding 10% in several cases. Correlation analysis demonstrated strong associations between imaging biomarkers (e.g., FA, neurite density) and cognitive performance scores (r > 0.5, p < 0.01), highlighting the prognostic value of neuroimaging in pediatric TBI. These findings validate the use of multimodal MRI as a sensitive, non-invasive tool for detecting white matter abnormalities and predicting functional outcomes. The study supports the integration of advanced imaging into clinical protocols for early diagnosis, monitoring, and personalized rehabilitation planning in pediatric TBI. The robust imaging biomarkers identified herein pave the way for precision medicine approaches, offering new avenues for improving outcomes and long-term quality of life in this vulnerable population.