Magnetic resonance imaging is used to assess white matter (WM) abnormalities including total WM volumes and WM hyperintensities (WMHs). Comparisons between several qualitative and quantitative methods to assess WM that are used in research and clinical settings are lacking in pediatric traumatic brain injury (TBI). This study 1) WM methods including Scheltens ratings, manual tracings, NeuroQuant®, and FreeSurfer; (2) compared total WM volumes and WMHs to assess potentially similar reporting of WM integrity; and (3) assessed the relationship between cognitive functions (intelligence, attention, processing speed, and language) and WM in pediatric TBI.Sixty participants (65% male) between ages 8-13 years old, had a complicated-mild (53%), moderate (15%), or severe TBI (32%) with a mean age of 2.6 at the time of injury. NeuroQuant® WMH volumes had poor agreement (ICC = .24), and did not correlate (r = .12, p = .21) with manually traced WMH volumes. Scheltens WMH ratings had good to excellent agreement and correlated with NeuroQuant® (ICC = .62; r = .29, p = .005) and manually traced WMH volumes (ICC = .82; r = .50, p = .000). NeuroQuant® and FreeSurfer total WM volumes had fair agreement and were correlated (ICC = .52; r = .38, p = .004). No significant difference in total WM volumes were found between complicated-mild and moderate-severe TBI groups, and in subgroups with and without WMHs. Processing speed was significantly associated with Scheltens WMH ratings: p = .004, manually traced WMHs: p = .002, and NeuroQuant® WMHs: p = .007. No other association between cognitive functions and WM volumes or hyperintensities were found. Correlations between NeuroQuant® and manual tracings with processing speed differed by sex, where males had significant correlations but females did not. Deciding when to use manual tracing and NeuroQuant® WMH volumes and Scheltens ratings in clinical or research settings will depend on available resources (e.g., time, technology, funding, and expertise) and purpose of assessing WMHs. Total WM volumes did not appear to capture WM pathology as assessed by WMHs, likely due to the sample being underpowered and that total WM volumes possibly included WMHs. Limitations include restricted range of injury severity, heterogeneity of lesions, and small sample size. Additional research is needed in a larger sample of pediatric TBI.



College and Department

Family, Home, and Social Sciences; Psychology

Date Submitted


Document Type





white matter hyperintensities, pediatric, volumes, ratings, traumatic brain injury