Sidaros Annette, Skimminge Arnold, Liptrot Matthew G, Sidaros Karam, Engberg Aase W, Herning Margrethe, Paulson Olaf B, Jernigan Terry L, Rostrup Egill
Danish Research Centre for Magnetic Resonance, Copenhagen University Hospital, Hvidovre, Denmark.
Neuroimage. 2009 Jan 1;44(1):1-8. doi: 10.1016/j.neuroimage.2008.08.030. Epub 2008 Sep 4.
Traumatic brain injury (TBI) results in neurodegenerative changes that progress for months, perhaps even years post-injury. However, there is little information on the spatial distribution and the clinical significance of this late atrophy. In 24 patients who had sustained severe TBI we acquired 3D T1-weighted MRIs about 8 weeks and 12 months post-injury. For comparison, 14 healthy controls with similar distribution of age, gender and education were scanned with a similar time interval. For each subject, longitudinal atrophy was estimated using SIENA, and atrophy occurring before the first scan time point using SIENAX. Regional distribution of atrophy was evaluated using tensor-based morphometry (TBM). At the first scan time point, brain parenchymal volume was reduced by mean 8.4% in patients as compared to controls. During the scan interval, patients exhibited continued atrophy with percent brain volume change (%BVC) ranging between -0.6% and -9.4% (mean -4.0%). %BVC correlated significantly with injury severity, functional status at both scans, and with 1-year outcome. Moreover, %BVC improved prediction of long-term functional status over and above what could be predicted using functional status at approximately 8 weeks. In patients as compared to controls, TBM (permutation test, FDR 0.05) revealed a large coherent cluster of significant atrophy in the brain stem and cerebellar peduncles extending bilaterally through the thalamus, internal and external capsules, putamen, inferior and superior longitudinal fasciculus, corpus callosum and corona radiata. This indicates that the long-term atrophy is attributable to consequences of traumatic axonal injury. Despite progressive atrophy, remarkable clinical improvement occurred in most patients.
创伤性脑损伤（TBI）会导致神经退行性变化，这种变化在受伤后的数月甚至数年里持续进展。然而，关于这种晚期萎缩的空间分布及其临床意义的信息却很少。我们对24例遭受严重TBI的患者在受伤后约8周和12个月时进行了三维T1加权磁共振成像（MRI）检查。作为对照，我们对14名年龄、性别和教育程度分布相似的健康受试者在相似的时间间隔内进行了扫描。对于每个受试者，使用SIENA估计纵向萎缩，并使用SIENAX估计在首次扫描时间点之前发生的萎缩。使用基于张量的形态测量法（TBM）评估萎缩的区域分布。在首次扫描时间点，与对照组相比，患者脑实质体积平均减少了8.4%。在扫描间隔期间，患者表现出持续萎缩，脑体积变化百分比（%BVC）在-0.6%至-9.4%之间（平均-4.0%）。%BVC与损伤严重程度、两次扫描时的功能状态以及1年的预后显著相关。此外，与使用约8周时的功能状态所能预测的情况相比，%BVC改善了对长期功能状态的预测。与对照组相比，TBM（置换检验，FDR 0.05）显示在脑干和小脑脚中有一大片连贯的显著萎缩区域，双侧延伸穿过丘脑、内囊和外囊、壳核、上下纵束、胼胝体和放射冠。这表明长期萎缩是创伤性轴索损伤的后果。尽管存在进行性萎缩，但大多数患者仍出现了显著的临床改善。
