Use of a Brain Navigator to Identify the Precentral Knob of the Precentral Gyrus in Normal Subjects.

BACKGROUND [color=black]The precentral knob of the precentral gyrus is the original site for hand somatotopy in the corticospinal tract, and it is considered an important target for neuromodulation. However, little is known about the anatomical location of the precentral knob for easy clinical use. This study aimed to describe the use of an optical tracking brain navigator to identify the anatomical location of the precentral knob in the precentral gyrus in normal subjects. [/color] MATERIAL AND METHODS [color=black]Twenty healthy right-handed subjects were enrolled for this study. The locations of target and surface points in each subject were determined using a brain navigator. The target and surface points were defined as the precentral knob and the area of the scalp in the vertical direction from the target point, respectively. Then, by placing a marked 1-cm grid on each subject's head, the horizontal and vertical distances from the midline central (Cz) were measured using the point marker.[/color] RESULTS [color=black]The average distance from Cz to the location of the precentral knob in the horizontal direction was 30.75 mm in the right hemisphere, 31.25 mm in the left hemisphere, and 31.00 mm in both hemispheres. The average distance from Cz to the location of the precentral knob in the vertical direction was -12.75 mm in the right hemisphere, -14.50 mm in the left hemisphere, and -13.62 mm in both hemispheres. [/color] CONCLUSIONS [color=black]This study showed that the anatomical location of the precentral knob in normal subjects could be identified using a brain navigator and this method may be used clinically for patients requiring neuromodulation.[/color].

Relationship between short-term memory impairment and the dorsolateral prefrontal cortex injury in patients with mild traumatic brain injury.

BACKGROUND: The prefrontal cortex (PFC) has been reported to be related to memory function. Especially, the dorsolateral PFC (DLPFC) is a substantial neural structure in short-term memory. In this study, using diffusion tensor tractography (DTT), we investigated the relationship between short-term memory impairment and the DLPFC injury in patients with mild traumatic brain injury (TBI). METHODS: We recruited 46 consecutive chronic patients with mild TBI and 42 normal control subjects. Fractional anisotropy (FA) and fiber number (FN) of the prefronto-thalamic tracts were determined for both hemispheres. RESULTS: Significant differences were detected in the FA value of the DLPFC and FN value of the prefronto-thalamic tracts in the patient and control groups (p < 0.05). However, no significant differences were detected in the ventrolateral PFC (VLPFC) and orbitofrontal cortex (OFC) between the patient and control groups (p > 0.05). In addition, the FN value of the DLPFC showed moderate positive correlation with short-term memory (r = 0.510, p < 0.05). However, no significant correlations were detected between the short-term memory and the FA value of the DLPFC, and the FA and FN values of the VLPFC and OFC in the patient group (p > 0.05). CONCLUSIONS: We found that the short-term memory impairment was closely associated with the DLPFC injury in patients with mild TBI. Our results suggest that the estimation of the DLPFC using DTT would be useful for patients with severity of short-term memory impairment following mild TBI.

Severe and extensive traumatic axonal injury following minor and indirect head trauma.

OBJECTIVES: This study reports on a patient with mild traumatic brain injury (TBI) who showed severe and extensive traumatic axonal injury (TAI) of various neural tracts following minor and indirect head trauma, which was demonstrated by diffusion tensor tractography (DTT). CASE DESCRIPTION: A 26-year-old female patient suffered from indirect head trauma resulting from flexion-hyperextension injury after being hit from behind by a slowly moving car. At the time of head trauma, she felt tingling sensation on her four extremities; however, she did not experience loss of consciousness. At 5-day after onset, she began to experience tremor on the right leg and, subsequently, tremor had also developed in the left leg. At 8-days after onset, she could not even stand due to tremor of both legs and began to feel a tingling sensation on both legs. Since ~ 2 weeks after head trauma, myoclonus had developed mainly in the trunk. After 10-weeks after head trauma, when she started rehabilitation, she showed mild quadriparesis (4+/4+) with severe weakness of the proximal joint (shoulder/hip, 4-/4-), severe resting and intentional tremor, ataxic gait and severe myoclonus. CONCLUSIONS: Severe and extensive TAI of various neural tracts was demonstrated in a patient with mild TBI following minor and indirect head trauma, using DTT.

Abundant unusual neural branches from the fornix in patients with mild traumatic brain injury: A diffusion tensor tractography study.

OBJECTIVES: Since the introduction of diffusion tensor tractography (DTT), several studies have been reported on the mechanisms for the recovery of an injured fornix in patients with traumatic brain injury (TBI). We report on patients who showed abundant unusual neural branches from the fornix following mild TBI using DTT. METHODS: Five patients with mild TBI who complained of memory impairment and showed preserved integrity of the fornix with abundant unusual neural branches on DTT, and eight normal subjects were recruited. DTT parameters (fractional anisotropy [FA] and fibre number) of the fornix were measured. RESULTS: All five patients showed memory impairment on only one subscale of the Memory Assessment Scale (MAS), although the global MAS was within the normal range. The FN of the fornix was increased by more than two standard deviations in all five patients compared with that of normal subjects, while the FA value was within two standard deviations of that of normal subjects. On the DTT for the fornix of the patients, three types of unusual neural tracts from the fornix not observed in normal subjects were observed in patients. CONCLUSION: The abundant unusual neural branches from the fornix might be a recovery phenomenon of a mildly injured fornix, although the integrity of the fornix was preserved in these patients.

Traumatic axonal injury despite clinical phenotype of mild traumatic brain injury: a case report.

OBJECTIVES: We report on a patient who suffered traumatic axonal injury (TAI) of various neural tracts despite airbag deployment following mild traumatic brain injury (TBI), which was demonstrated by diffusion tensor tractography (DTT). CASE DESCRIPTION: A 58-year-old female patient suffered from head trauma resulting from an in-car traffic accident. At the time of head trauma, her head and face hit the deployed airbag after flexion-hyperextension-rotation injury. The patient's Glasgow Coma Scale score was 15. Since the day of head trauma, she began to feel headache and upper back pain at the mid-thoracic area. At 7 days after onset, she began to feel pain on the left hand, which spread to the right hand and leg: throbbing and cold pain without allodynia or hyperalgesia (visual analogue scale score: 5). She also felt mild weakness of all four extremities and mild memory impairment. On 4-week DTT, the corticospinal tract showed partial tearing at the subcortical white matter level in both hemispheres . The right fornical crus and right anterior cingulum were discontinued, and narrowing and partial tearing were observed in both spinothalamic tracts. CONCLUSIONS: TAI of four kinds of neural tracts was demonstrated in a patient with mild TBI despite airbag deployment, using DTT.

Recovery of an injured prefronto-caudate tract in a patient with traumatic brain injury: A diffusion tensor tractography study.

OBJECTIVES: We report on a patient with improvement of akinetic mutism (AM), who showed recovery of an injured prefronto-caudate tract following traumatic brain injury (TBI), which was demonstrated by follow-up diffusion tensor tractographies (DTTs). CASE PRESENTATION: A 72-year-old female had suffered from head trauma resulting from falling down the stairs. She was diagnosed as subdural hematoma on the right frontal lobe and subarachnoid haemorrhage. At 5 weeks after head trauma, when starting rehabilitation, she showed no spontaneous movement or speech. She participated in a comprehensive rehabilitative management programme, including movement therapy and dopaminergic drugs, for improvement of AM. During 5 week's intensive rehabilitation, she showed gradual improvement of AM: she became able to perform some daily activities by herself including eating, dressing and walking. RESULTS: On 5-week DTT, the neural connectivity of the caudate nucleus (CN) to the medial prefrontal cortex (PFC; Broadmann area [BA]: 10 and 12) and the orbitofrontal cortex (BA: 11 and 13) was decreased in both hemispheres; in contrast, the neural connectivity of the CN to the medial PFC was increased on the left side on 10-week and 6-month DTT. CONCLUSIONS: Recovery of an injured prefronto-caudate tract concurrent with the improvement of AM was demonstrated in a patient with TBI, using follow-up DTTs.

Changes of the corticospinal tract in the unaffected hemisphere in stroke patients: A diffusion tensor imaging study.

We investigated changes of the corticospinal tract (CST) in the unaffected hemisphere according to severity of the CST injury, using diffusion tensor imaging (DTI). According to the severity of the CST injury in the affected hemisphere, the stroke patients showed different aspects of fiber volume increment of the CST in the unaffected hemisphere; the fiber volume was increased in the early phase in patients with mild injury of CST and later phase in patients with severe injury of CST.

Central pain due to spinothalamic tract injury caused by indirect head trauma following a pratfall.

OBJECTIVES: This study reports on patients who showed central pain due to injury of the spinothalamic tract (STT) caused by fall without direct head trauma. DESIGN: Prospective study. PARTICIPANTS: Two patients with mild traumatic brain injury (TBI) resulting from a fall were enrolled. Patient 1 was a 21-year-old female who had suffered a pratfall with no history of direct head trauma. She had begun to feel pain in both upper trunk and lower back and the left leg since ~ 5 days after onset: constant tingling and throbbing sensation with allodynia. Patient 2 was a 39-year-old male who had suffered a pratfall without direct head trauma. He had begun to feel pain in both arms and legs since ~ 4 days after the fall: constant tingling and pricking sensation without allodynia or hyperalgesia. RESULTS: On diffusion tensor tractograhpy (DTT) of patient 1, partial tearing of the right STT was observed at the subcortical white matter. On DTT of patient 2, partial tearing at the subcortical white matter was observed in the right STT and partial narrowing at the subcortical white matter was observed in the left STT. CONCLUSIONS: This study demonstrated injury of the STT in patients who suffered from central pain following a fall. The results suggest that minor indirect head trauma can cause traumatic axonal injury of the brain.

Injury of the corticoreticular pathway in patients with mild traumatic brain injury: A diffusion tensor tractography study.

BACKGROUND: Little is known about injury of the corticoreticular pathway (CRP) in patients with mild traumatic brain injury (TBI). The current study attempted to investigate injury of the CRP in patients with mild TBI, using diffusion tensor tractography (DTT). METHODS: This study recruited 29 consecutive patients with proximal weakness following mild TBI and 25 control subjects. The CRP was reconstructed and the fractional anisotropy (FA) value, apparent diffusion coefficient (ADC) value and fibre volume of the CRP were measured. The patients were classified according to the configurational classification of the CRP injury: type A-the CRP showed narrowing, type B-the CRP showed partial tearing at subcortical white matter or brainstem and type C-the CRP showed discontinuation at the subcortical white matter or brainstem. RESULT: No significant differences in FA and ADC of the CRP were observed between the patient and control groups (p > 0.05). In contrast, the tract volume of the CRP was significantly lower in the patient group than in the control group (p < 0.05). According to the configurational classification of the CRP injury on DTT, the patients were classified as follows: among 58 hemispheres of 29 patients: type A-9 hemispheres (15.5%) of eight patients, type B-30 hemispheres (51.7%) of 22 patients and type C-13 hemispheres (22.4%) of 11 patients. CONCLUSION: This study demonstrated injury of the CRP in patients who showed proximal weakness following mild TBI, using DTT.

Recovery of Visual Field Defect via Corpus Callosum in a Patient with Cerebral Infarct.

Recovery mechanism of visual field defect in stroke patients has not been clearly elucidated. In this study, we report on a patient with a cerebral infarct who showed recovery of visual field defect via the corpus callosum, using diffusion tensor tractography (DTT) for optic radiation (OR). A 57-year-old male patient underwent conservative management for a cerebral infarct in the subcortical white matter of the right temporal lobe. Left homonymous hemianopsia was detected on the 2-week Humphrey visual field test. However, the patient showed improvement of hemianopsia with time; consequently, a left lower peripheral visual defect with the resolution of the upper and medial portions of the initial left hemianopia was observed on the 11-month Humphrey visual field test. Both 2-week and 11-month DTTs for the right OR showed a discontinuation between the right lateral geniculate nucleus (LGN) and the right OR. On 2-week DTT, the left OR was connected to the transcallosal fibres, and on 11-month DTT, these transcallosal fibres were elongated to the right primary visual cortex via the right posterior OR. The visual field defect in this patient appears to have recovered by the neural pathway originating from the left OR and terminating in the primary visual cortex via the transcallosal fibres and right distal OR. We believe that the results of this study may suggest one of the mechanisms for recovery of visual field defect following injury of OR in stroke patients.

Changes of an injured fornix in a patient with mild traumatic brain injury: diffusion tensor tractography follow-up study.

BACKGROUND: This study investigated the changes of an injured fornix from early stage to chronic stage in a patient with mild traumatic brain injury (TBI), using diffusion tensor tractography (DTT). METHODS: A 25-year-old female suffered from head trauma resulting from a pedestrian car accident. The patient showed a total score of 86 for memory impairment on the Memory Assessment Scale at 2 weeks after onset; however, her memory has been recovered to within normal range, with a score of 105 at 9 months after onset. RESULTS: The middle portion of the right fornical crus showed narrowing and the discontinued left fornical crus was shortened on 9-month DTT compared with 2-week DTT. Two branches from the right fornical column and body were observed on 9-month DTT; in contrast, the two branches from the left fornical column and the left fornical body were elongated and shortened, respectively, on 9-month DTT compared with 2-week DTT. CONCLUSIONS: The narrowed lesion in the middle of the right fornical crus and the shortening of the discontinued left fornical crus appear to indicate degeneration following traumatic axonal injury. In contrast, the neural branches from both fornices appear to be related to the functional recovery mechanisms of the injured fornix.

Ataxia due to injury of the cortico-ponto-cerebellar tract in patients with mild traumatic brain injury.

INTRODUCTION: The cortico-ponto-cerebellar tract (CPCT) is involved in coordination of movement; injury of the CPCT can therefore be accompanied by ataxia. In this study, using diffusion tensor tractography (DTT), we investigated injury of the CPCT in patients with mild traumatic brain injury (TBI). METHODS: We recruited 45 consecutive patients with ataxia following mild TBI and 20 normal control subjects. The score of assessment and rating of ataxia (SARA) was used to evaluate of ataxia. The patients were classified into 2 groups based on the SARA; patient group A had with post-traumatic ataxia and patient group B had without post-traumatic ataxia. The fractional anisotropy (FA) value and fiber number (FN) of the CPCT was measured. RESULTS: Significant differences were observed in the FA and FN values of the CPCT between patient group A and the control group and between patient groups A and B (P < .05). In addition, a significant difference was observed in the FA value only of the CPCT between patient group B and the control group (P < .05). However, no significant difference was observed in the FN value of the CPCT between patient group B and the control group (P > .05). CONCLUSION: By using DTT, injury of the CPCT was demonstrated in patients who showed ataxia following mild TBI. These results suggest that DTT would be useful for evaluation of the CPCT in patients with ataxia after mTBI because mTBI usually does not show any abnormalities on conventional brain MRI.

Difference in the ascending reticular activating system between vegetative and minimally conscious states following traumatic brain injury.

OBJECTIVES: We investigated differences in the ascending reticular activating system (ARAS) between vegetative state (VS) and minimally conscious state (MCS) in patients with traumatic brain injury (TBI) by using diffusion tensor tractography. METHODS: We recruited TBI patients and normal subjects. We reconstructed the lower ARAS and five parts of upper ARAS [prefrontal cortex (PFC), premotor cortex, primary motor cortex, primary somatosensory cortex, and posterior parietal cortex]. RESULTS: Significant differences were observed in the fractional anisotropy (FA) and fiber number (FN) values of the five parts of upper ARAS between the VS and control groups and between the MCS and control groups (P < 0.05), but no differences were detected in the lower ARAS (P > 0.05). The FA and FN values of the PFC in the upper ARAS were significantly different between the VS and MCS groups (P < 0.05). No other significant differences in FA and FN values were detected among the other segments of the upper ARAS or in the lower ARAS (P > 0.05). CONCLUSION: The results indicate that the prefrontal portion of the upper ARAS is the critical area for distinguishing between VS and MCS in patients with TBI.

Relationship between ataxia and inferior cerebellar peduncle injury in patients with cerebral infarct.

INTRODUCTION: The inferior cerebellar peduncle (ICP) is a major neural tract in the cerebellum and is involved in coordination of movement and proprioceptive; therefore, ICP injury can be accompanied by poor coordination of movement, including ataxia. In this study, using diffusion tensor tractography (DTT), we investigated the relationship between ataxia and ICP injury in patients with cerebral infarct. METHODS: We recruited 14 stroke patients with ataxia after the onset of stroke and 12 normal subjects. The Score of Assessment and Rating of Ataxia (SARA) was used to evaluate ataxia. The values of fractional anisotropy (FA), apparent diffusion coefficient, and fiber number (FN) of the ICP were measured for the diffusion tensor imaging parameters. RESULTS: Significant differences were observed in the FA and FN values of the ICP in the affected hemisphere between the patient and control groups (P < .05). In addition, the FN value of the ICP in the affected hemisphere showed a negative correlation with SARA (r = -0.538, P < .05). However, parameters of the ICP in the unaffected hemisphere or the FN value in the unaffected hemisphere showed no correlation with SARA (P > .05). CONCLUSION: We found that the ataxia severity was closely related to the severity of ICP injury in patients with cerebral infarct. Our results suggest that evaluation of the ICP using DTT would be useful for patients with ataxia after cerebral infarct.

Injury of the dentatorubrothalamic tract in patients with post-traumatic tremor following mild traumatic brain injury: a case-control study.

Post-traumatic movement disorder is one of the sequelae of traumatic brain injury. The dentatorubrothalamic tract (DRTT) is reported to be involved in the control of movement. Therefore, injury of the DRTT can be accompanied by abnormal movements, including ataxia, tremor, or dystonia. We investigated DRTT injuries in 27 patients who showed post-traumatic tremor in at least one of four extremities following mild traumatic brain injury. We classified DRTT injuries based on diffusion tensor tractography parameters and configuration: type A: the DRTT showed narrowing, type B: the DRTT showed partial tearing, and type C: the DRTT showed discontinuation. Fractional anisotropy and fiber number of the DRTT were significantly decreased in patients compared with the healthy controls. Based on our DRTT injury classification, among the 54 hemispheres of the 27 patients, type A injury occurred in 22 hemispheres (40.7%) of 17 patients, type B injury was present in 15 hemispheres (27.7%) of 10 patients, and type C injury was observed in 8 hemispheres (14.8%) of 6 patients. Our results suggest that diffusion tensor tractography-based evaluation of the DRTT would be useful when determining cause of post-traumatic tremor in patients with mild traumatic brain injury. The study protocol was approved by the Institutional Review Board of Yeungnam University Hospital (YUMC-2018-09-007) on September 5, 2018.

Diagnostic Approach to Traumatic Axonal Injury of the Optic Radiation in Mild Traumatic Brain Injury.

We describe a diffusion tensor tractography-based diagnostic approach to traumatic axonal injury of the optic radiation in a patient who showed visual field defect after mild traumatic brain injury. A 43-yr-old female patient experienced head trauma during a motor vehicle accident. After the head trauma, she noticed visual disturbance. Peripheral field defects were detected in both eyes on the Humphrey visual field test. After diffusion tensor tractography-based reconstruction of the optic radiation, We determined the fractional anisotropy and fiber number of each whole optic radiation. Four regions of interest were placed on the optic radiations based on diffusion tensor tractography configuration. The right optic radiation showed narrowing, and the left optic radiation revealed partial tearing in the posterior portion. The fiber number of the right optic radiation was more than two standard deviations lower than the control mean. The fractional anisotropy values of the regions of interest 2 (the narrowed area of the right optic radiation) and regions of interest 3 (the partially torn area of the left optic radiation) were more than two standard deviations lower than the control mean. Our results suggest that analysis of the configuration and parameters of the optic radiation based on three-dimensionally reconstructed diffusion tensor tractography results is a useful technique in the detection of traumatic axonal injury of the optic radiation in individual patients with mild traumatic brain injury.

Diagnostic Approach to Traumatic Axonal Injury of the Spinothalamic Tract in Individual Patients with Mild Traumatic Brain Injury.

OBJECTIVES: We investigated an approach for the diagnosis of traumatic axonal injury (TAI) of the spinothalamic tract (STT) that was based on diffusion tensor tractography (DTT) results and a statistical comparison of individual patients who showed central pain following mild traumatic brain injury (mTBI) with the control group. METHODS: Five right-handed female patients in their forties and with central pain following mTBI and 12 age-, sex-, and handedness-matched healthy control subjects were recruited. After DTT reconstruction of the STT, we analyzed the STT in terms of three DTT parameters (fractional anisotropy (FA), mean diffusivity (MD), and fiber number (FN)) and its configuration (narrowing and tearing). To assess narrowing, we determined the area of the STT on an axial slice of the subcortical white matter. RESULTS: the FN values were significantly lower in at least one hemisphere of each patient when compared to those of the control subjects (p < 0.05). Significant decrements from the STT area in the control group were observed in at least one hemisphere of each patient (p < 0.05). Regarding configurational analysis, the STT showed narrowing and/or partial tearing in at least one hemisphere of each of the five patients. CONCLUSIONS: Herein, we demonstrate a DTT-based approach for the diagnosis of TAI of the STT. The approach involves a statistical comparison between DTT parameters of individual patients who show central pain following mTBI and those of an age-, gender-, and handedness-matched control group. We think that the method described in this study can be useful in the diagnosis of TAI of the STT in individual mTBI patients.

Difference in the Ascending Reticular Activating System Injury Between Mild Traumatic Brain Injury and Cerebral Concussion.

INTRODUCTION: We investigated differences in the ascending reticular activating system (ARAS) injuries between patients with mild traumatic brain injury (mTBI) and cerebral concussion by using diffusion tensor tractography (DTT). METHODS: Thirty-one patients with mTBI, 29 patients with concussion, and 30 control subjects were recruited. We used DTT to reconstruct the lower ventral and dorsal ARAS, and the upper ARAS. The fractional anisotropy (FA) value and the fiber number (FN) of the lower ventral and dorsal ARAS, and the upper ARAS were determined. RESULTS: Significant differences were observed in the FA values of the lower ventral and dorsal ARAS on both sides between the mTBI and control groups and between the concussion and control groups (p < 0.05). The FN value was significantly different in the lower ventral ARAS on both sides between the concussion and control groups and between the mTBI and concussion groups (p < 0.05). CONCLUSION: Both the mTBI and concussion patients suffered injuries in the lower ventral and dorsal ARAS, with the concussion patients exhibiting more severe injury in the ventral ARAS than that in the mTBI patients. These results suggest that the terms mTBI and concussion should be used differentially, even though they have used interchangeably for a long time.

The effect of walnut rolling training on hand function and corticospinal tract.

BACKGROUND: We investigated the effect of the walnut rolling training for two weeks on the hand function and corticospinal tract (CST) in normal subjects. METHODS: Seventeen right-handed normal subjects performed walnut rolling training with their non-dominant (left) hand, with the right hand defined as the control side. The walnut rolling training was performed three times daily, for 30 minutes at a time, over two weeks. The Purdue Pegboard Test (PPT), tip pinch and grip strength (GS) were used evaluate the change of hand function, and diffusion tensor tractography (DTT) evaluated change of the CST and transcallosal fibers for the hand motor somatotopy. RESULTS: All of the clinical scores in terms of PPT, tip pinch and GS increased significantly in the post-training (PPT: 16.59±1.09, tip pinch: 5.03±2.18, GS: 40.61±10.99) in the left hand compared with pre-training (PPT: 14.94±1.36, tip pinch: 3.66±1.44, GS: 33.58±11.08) (P<0.05). By contrast, the clinical scores for the right hand did not differ significantly between pre- (PPT: 16.25±1.98, tip pinch: 5.75±2.26, GS: 37.58±14.61) and post-training (PPT: 16.97±1.67, tip pinch: 5.66±2.31, GS: 37.82±14.25). The fiber numbers (FN) of the right CST increased significantly in post-training DTT (2,123.05±529.07) compared with pre-training DTT (1,734.73±581.84) (P<0.05), whereas fractional anisotropy (FA) (pre-training: 0.50±0.02, post-training: 0.51±0.01) did not change significantly. Neither FA nor FN of the left CST and transcallosal fibers changed significantly from pre- (FA: 0.44±0.02, FN: 1,871.15±636.36) to post-training DTTs (FA: 0.45±0.03, FN: 1,823.84±701.14). CONCLUSIONS: We demonstrated improvement of hand function and facilitation of the contralateral CST by walnut rolling training in normal subjects. Our results suggest that walnut rolling training can be used for improvement of hand function and facilitation of the contralateral CST.

Traumatic axonal injury of the cingulum in patients with mild traumatic brain injury: a diffusion tensor tractography study.

The cingulum, connecting the orbitofrontal cortex to the medial temporal lobe, involves in diverse cognition functions including attention, memory, and motivation. To investigate the relationship between the cingulum injury and cognitive impairment in patients with chronic mild traumatic brain injury, we evaluated the integrity between the anterior cingulum and the basal forebrain using diffusion tensor tractography in 73 patients with chronic mild traumatic brain injury (39 males, 34 females, age 43.29 ± 11.42 years) and 40 healthy controls (22 males, 18 females, age 40.11 ± 16.81 years). The patients were divided into three subgroups based on the integrity between the anterior cingulum and the basal forebrain on diffusion tensor tractography: subgroup A (n = 19 patients) - both sides of the anterior cingulum were intact; subgroup B (n = 36 patients) - either side of the anterior cingulum was intact; and subgroup C (18 patients) - both sides of the anterior cingulum were discontinued. There were significant differences in total Memory Assessment Scale score between subgroups A and B and between subgroups A and C. There were no significant differences in diffusion tensor tractography parameters (fractional anisotropy, apparent diffusion coefficient, and fiber volume) between patients and controls. These findings suggest that the integrity between the anterior cingulum and the basal forebrain, but not diffusion tensor tractography parameter, can be used to predict the cognitive function of patients with chronic mild traumatic brain injury. This study was approved by Yeungnam University Hospital Institutional Review Board (approval No. YUMC-2014-01-425-010) on August 16, 2017.