Myelin-related gray matter abnormalities in pediatric mild traumatic brain injury characterized by T1w/T2w imaging

Motivation: Pediatric mild traumatic brain injury (mTBI) can disrupt brain development, particularly myelination, but its effects on gray matter remain unclear. Goal(s): This study aims to investigate the impact of pediatric mTBI on gray matter myelination and brain connectivity using T1w/T2w MRI. Approach: We analyzed 127 mTBI patients and 79 healthy controls, examining demyelination patterns and structural network disruptions by age-at-injury. Significant demyelination was observed in the prefrontal and temporal cortices, with spatial migration from the temporal to frontal regions. Results: Structural covariance network analysis revealed widespread disconnections and hyperconnectivity in the prefrontal cortex, highlighting systemic connectivity disruptions. Impact: Our study reveals the extensive demyelination and network disruptions in pediatric mTBI patients. Identifying vulnerable regions of myelin development may inform targeted therapeutic interventions and improve long-term outcomes in pediatric mTBI, addressing a critical gap in neurodevelopmental injury research.