Sex Differences in White Matter Abnormalities after Mild Traumatic Brain Injury: Localization and Correlation with Outcome
Abstract
PURPOSE: To evaluate sex differences in diffusion-tensor imaging (DTI) white matter abnormalities after mild traumatic brain injury (mTBI) using tract-based spatial statistics (TBSS) and to compare associated clinical outcomes. MATERIALS AND METHODS: The institutional review board approved this study, with waiver of informed consent. DTI in 69 patients with mTBI (47 male and 22 female patients) and 21 control subjects (10 male and 11 female subjects) with normal conventional magnetic resonance (MR) images were retrospectively reviewed. Fractional anisotropy (FA) maps were generated as a measure of white matter integrity. Patients with mTBI underwent serial neurocognitive testing with Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT). Correlation between sex, white matter FA values, ImPACT scores, and time to symptom resolution (TSR) were analyzed with multivariate analysis and TBSS. RESULTS: No significant difference in age was seen between males and females (control subjects, P = .3; patients with mTBI, P = .34). No significant difference was seen in initial ImPACT symptom scores (P = .33) between male and female patients with mTBI. Male patients with mTBI had significantly decreased FA values in the uncinate fasciculus (UF) bilaterally (mean FA, 0.425; 95% confidence interval: 0.375, 0.476) compared with female patients with mTBI and control subjects (P < .05), with a significantly longer TSR (P = .04). Multivariate analysis showed sex and UF FA values independently correlated with TSR longer than 3 months (adjusted odds ratios, 2.27 and 2.38; P = .04 and P < .001, respectively), but initial symptom severity did not (adjusted odds ratio, 1.15; P = .35). CONCLUSION: Relative sparing of the UF is seen in female compared with male patients after mTBI, with sex and UF FA values as stronger predictors of TSR than initial symptom severity.
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Greater preservation of white matter integrity is associated with shorter duration of post-TBI symptoms in women compared with men.
“Another study reported that greater preservation of white matter integrity was associated with shorter duration of post-TBI symptoms in women compared with men. 26”
From Sex Differences in Traumatic Brain Injury: What We Know and What We Should Know (2019) · cites this paper as [26]
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- Authors
- Fakhran, S., Yaeger, K., Collins, M., & Alhilali, L.
- Affiliations
- University of Pittsburgh (US)
- Venue
- Radiology
- Published
- 2014-09
- Volume
- 272
- Issue
- 3
- Pages
- 815-823
- ISSN
- 0033-8419 (ISSN-L)
- 1527-1315
- OpenAlex
- W2122431232
- Cited by
- 83
- References
- 36
- Citations by year
- 2026: 4 · 2025: 4 · 2024: 2 · 2023: 4 · 2022: 12 · 2021: 15 · 2020: 10 · 2019: 9 · 2018: 4 · 2017: 6 · 2016: 5 · 2015: 7 · 2014: 1
- FWCI
- 4.79
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Radiology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Epidemiology › Traumatic Brain Injury Research
- Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Advanced Neuroimaging Techniques and Applications
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Automotive and Human Injury Biomechanics
- Keywords
- mild traumatic brain injury, sex differences, white matter abnormalities, uncinate fasciculus, fractional anisotropy, diffusion tensor imaging, tract-based spatial statistics, symptom resolution time, impact, concussion, white matter integrity
- MeSH terms
- Adolescent, Adult, Brain, Brain Injuries, Child, Female, Humans, Male, Nerve Fibers, Myelinated, Prognosis, Sex Characteristics, Trauma Severity Indices, Young Adult
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