Levine B, Kovacevic N, Nica E I, Cheung G, Gao F, Schwartz M L, Black S E
Rotman Research Institute, Baycrest Centre for Geriatric Care, Toronto, Canada.
Neurology. 2008 Mar 4;70(10):771-8. doi: 10.1212/01.wnl.0000304108.32283.aa.
To assess the relationship between regional brain volume changes and traumatic brain injury (TBI) severity in patients with and without focal lesions.
Sixty-nine chronic-phase TBI patients spanning the full range of severity were recruited from consecutive hospital admissions. Patients received high-resolution structural MRI a minimum of 1 year after injury. Multivariate statistical analyses assessed covariance patterns between volumes of gray matter, white matter, and sulcal/subdural and ventricular CSF across 38 brain regions and TBI severity as assessed by depth of coma at the time of injury. Patients with diffuse and diffuse plus focal injury were analyzed both separately and together.
There was a stepwise, dose-response relationship between parenchymal volume loss and TBI severity. Patients with moderate and severe TBI were differentiated from those with mild TBI, who were in turn differentiated from noninjured control subjects. A spatially extensive pattern of volume loss covaried with TBI severity, with particularly widespread effects in white matter volume and sulcal/subdural CSF. The most reliable effects were observed in the frontal, temporal, and cingulate regions, although effects were observed to varying degrees in nearly every brain region. Focal lesions were associated with greater volume loss in frontal and temporal regions, but volume loss remained marked even when analyses were restricted to patients with diffuse injury.
Patterns of parenchymal volumetric changes can differentiate among levels of traumatic brain injury (TBI) severity, even in mild TBI. TBI causes a spatially extensive pattern of volume loss that reflects independent but overlapping contributions of focal and diffuse injury.
评估有无局灶性病变的患者脑区体积变化与创伤性脑损伤（TBI）严重程度之间的关系。
从连续入院的患者中招募了69例处于慢性期、涵盖各种严重程度的TBI患者。患者在受伤至少1年后接受了高分辨率结构MRI检查。多变量统计分析评估了38个脑区的灰质、白质、脑沟/硬膜下和脑室脑脊液体积与TBI严重程度之间的协方差模式，TBI严重程度通过受伤时的昏迷深度进行评估。对弥漫性损伤和弥漫性加局灶性损伤的患者分别及合并进行了分析。
实质体积损失与TBI严重程度之间存在逐步的剂量反应关系。中度和重度TBI患者与轻度TBI患者不同，轻度TBI患者又与未受伤的对照受试者不同。体积损失的空间广泛模式与TBI严重程度相关，对白质体积和脑沟/硬膜下脑脊液有特别广泛的影响。在额叶、颞叶和扣带区观察到最可靠的影响，尽管几乎每个脑区都有不同程度的影响。局灶性病变与额叶和颞叶区域更大的体积损失相关，但即使分析仅限于弥漫性损伤患者，体积损失仍然显著。
实质体积变化模式可以区分创伤性脑损伤（TBI）的严重程度水平，即使在轻度TBI中也是如此。TBI导致空间广泛的体积损失模式，反映了局灶性和弥漫性损伤的独立但重叠的影响。
