Dense Longitudinal Precision Neuroimaging of Recovery from Traumatic Brain Injury

Traumatic brain injury (TBI) disrupts white matter tracts essential for cognition and emotion. Diffusion tensor imaging (DTI) can noninvasively measure white matter integrity. However, DTI has been inconsistent in predicting patient recovery from TBI, possibly due to the complex, dynamic, and individual-specific process of post-TBI white matter remodeling. Here, we employed dense longitudinal neuroimaging to track white matter recovery weekly over six months after a TBI within a single patient and a control in a similar age group (21 vs. 24 y.o.). In the patient, but not in the control, DTI metrics precisely tracked parabolic trajectories across time, with early structural alterations continuing for more than 15 weeks before reversing direction. The extent of alteration in each tract was correlated with the time until reversal. These continuous DTI changes also mediated recovery of cognitive and emotional function, suggesting they are not passive markers of damage but dynamic processes underlying functional improvement. Complementary diffusion basis spectrum imaging (DBSI) revealed an initial phase of cellular loss followed by inflammatory remodeling, vascular adaptations, and persistent metabolic activity. Our findings indicate that recovery does not follow predefined phases but rather individualized transition points, which could define optimal windows for rehabilitation. Identifying these inflection points may enable personalized interventions aligned with biologically relevant structural shifts, rather than broad recovery periods.