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The diffused nature of mild traumatic brain injury (mTBI) impacts brainwhite-matter pathways with potentially long-term consequences, even afterinitial symptoms have resolved. To understand post-mTBI recovery inadolescents, longitudinal studies are needed to determine the interplay betweenhighly individualised recovery trajectories and ongoing development. To capturethe distributed nature of mTBI and recovery, we employ connectomes to probe thebrain's structural organisation. We present a diffusion MRI study on adolescentmTBI subjects scanned one day, two weeks and one year after injury withcontrols. Longitudinal global network changes over time suggests an altered andmore 'diffuse' network topology post-injury (specifically lower transitivityand global efficiency). Stratifying the connectome by its back-bone, known asthe 'rich-club', these network changes were driven by the 'peripheral' localsubnetwork by way of increased network density, fractional anisotropy anddecreased diffusivities. This increased structural integrity of the localsubnetwork may be to compensate for an injured network, or it may be robust tomTBI and is exhibiting a normal developmental trend. The rich-club alsorevealed lower diffusivities over time with controls, potentially indicative oflonger-term structural ramifications. Our results show evolving, diffusealterations in adolescent mTBI connectomes beginning acutely and continuing toone year.

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Longitudinal structural connectomic and rich-club analysis in adolescent  mTBI reveals persistent, distributed brain alterations acutely through to one  year post-injury