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Main KL, Vakhtin AA, Zhuo J, Marion D, Adamson MM, Ashford JW, Gullapalli R, Furst AJ. An iterative ROC procedure identifies white matter tracts diagnostic for traumatic brain injury: an exploratory analysis in U.S. Veterans. Brain Inj 2025:1-19. [PMID: 40257224 DOI: 10.1080/02699052.2025.2492746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2024] [Revised: 03/13/2025] [Accepted: 04/07/2025] [Indexed: 04/22/2025]
Abstract
OBJECTIVE Understanding the pathophysiology of traumatic brain injury (TBI) is crucial for effectively managing care. Diffusion tensor imaging (DTI) is an MRI technology that evaluates TBI pathology in brain white matter. However, DTI analysis generates numerous measures. Choosing between them remains an obstacle to clinical translation. In this study, we leveraged an iterative receiver operating characteristic (ROC) analysis to examine white matter tracts in a group of 380 Veterans, consisting of TBI (n = 243) and non-TBI patients (n = 137). METHOD For each participant, we obtained a whole brain tractography and extracted DTI measures from 50 tracts. The ROC analyzed these variables and produced decision trees of tracts diagnostic for TBI. We expanded our findings by applying jackknife resampling. This procedure removed potential outliers and yielded tracts not observed in the initial ROCs. Finally, we used logistic regression to confirm the tracts predicted TBI status. RESULTS Our results indicate ROC can identify tracts diagnostic for TBI. We also found that groups of tracts are more predictive than any single one. CONCLUSIONS These analyses show that ROC is a useful tool for exploring large, multivariate datasets and may inform the design of clinical algorithms.
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Affiliation(s)
- Keith L Main
- Traumatic Brain Injury Center of Excellence, Defense Health Agency, Silver Spring, Maryland, USA
| | - Andrei A Vakhtin
- The Mind Research Network/Lovelace Biomedical and Environmental Research Institute, Traumatic Brain Injury Division, Albuquerque, New Mexico, USA
| | - Jiachen Zhuo
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Donald Marion
- Traumatic Brain Injury Center of Excellence, Defense Health Agency, Silver Spring, Maryland, USA
| | - Maheen M Adamson
- Women's Operational Military Exposure Network, Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA
- Rehabilitation Services, Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, California, USA
| | - J Wesson Ashford
- War Related Illness and Injury Center, Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California, USA
| | - Rao Gullapalli
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Ansgar J Furst
- War Related Illness and Injury Center, Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California, USA
- Polytrauma System of Care, Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, California, USA
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Kornaropoulos EN, Winzeck S, Rumetshofer T, Wikstrom A, Knutsson L, Correia MM, Sundgren PC, Nilsson M. Sensitivity of Diffusion MRI to White Matter Pathology: Influence of Diffusion Protocol, Magnetic Field Strength, and Processing Pipeline in Systemic Lupus Erythematosus. Front Neurol 2022; 13:837385. [PMID: 35557624 PMCID: PMC9087851 DOI: 10.3389/fneur.2022.837385] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 03/16/2022] [Indexed: 11/13/2022] Open
Abstract
There are many ways to acquire and process diffusion MRI (dMRI) data for group studies, but it is unknown which maximizes the sensitivity to white matter (WM) pathology. Inspired by this question, we analyzed data acquired for diffusion tensor imaging (DTI) and diffusion kurtosis imaging (DKI) at 3T (3T-DTI and 3T-DKI) and DTI at 7T in patients with systemic lupus erythematosus (SLE) and healthy controls (HC). Parameter estimates in 72 WM tracts were obtained using TractSeg. The impact on the sensitivity to WM pathology was evaluated for the diffusion protocol, the magnetic field strength, and the processing pipeline. Sensitivity was quantified in terms of Cohen's d for group comparison. Results showed that the choice of diffusion protocol had the largest impact on the effect size. The effect size in fractional anisotropy (FA) across all WM tracts was 0.26 higher when derived by DTI than by DKI and 0.20 higher in 3T compared with 7T. The difference due to the diffusion protocol was larger than the difference due to magnetic field strength for the majority of diffusion parameters. In contrast, the difference between including or excluding different processing steps was near negligible, except for the correction of distortions from eddy currents and motion which had a clearly positive impact. For example, effect sizes increased on average by 0.07 by including motion and eddy correction for FA derived from 3T-DTI. Effect sizes were slightly reduced by the incorporation of denoising and Gibbs-ringing removal (on average by 0.011 and 0.005, respectively). Smoothing prior to diffusion model fitting generally reduced effect sizes. In summary, 3T-DTI in combination with eddy current and motion correction yielded the highest sensitivity to WM pathology in patients with SLE. However, our results also indicated that the 3T-DKI and 7T-DTI protocols used here may be adjusted to increase effect sizes.
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Affiliation(s)
- Evgenios N. Kornaropoulos
- Clinical Sciences, Diagnostic Radiology, Lund University, Lund, Sweden
- Division of Anaesthesia, University of Cambridge, Cambridge, United Kingdom
| | - Stefan Winzeck
- Division of Anaesthesia, University of Cambridge, Cambridge, United Kingdom
- BioMedIA Group, Department of Computing, Imperial College London, London, United Kingdom
| | | | - Anna Wikstrom
- Clinical Sciences, Diagnostic Radiology, Lund University, Lund, Sweden
| | - Linda Knutsson
- Department of Medical Radiation Physics, Lund University, Lund, Sweden
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University, School of Medicine, Baltimore, MD, United States
- F.M. Kirby Research Center, Kennedy Krieger Institute, Baltimore, MD, United States
| | - Marta M. Correia
- MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, United Kingdom
| | - Pia C. Sundgren
- Clinical Sciences, Diagnostic Radiology, Lund University, Lund, Sweden
- Lund University BioImaging Center, Lund University, Lund, Sweden
- Department of Medical Imaging and Physiology, Skåne University Hospital, Lund, Sweden
| | - Markus Nilsson
- Clinical Sciences, Diagnostic Radiology, Lund University, Lund, Sweden
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