运动相关性脑震荡患者脑白质骨架的弥散张量成像研究。
A diffusion tensor imaging study on the white matter skeleton in individuals with sports-related concussion.
机构信息
Princeton Neuroscience Institute, Princeton University, Princeton, New Jersey 08544, USA.
出版信息
J Neurotrauma. 2011 Feb;28(2):189-201. doi: 10.1089/neu.2010.1430. Epub 2011 Jan 27.
Recognizing and managing the effects of cerebral concussion is very challenging, given the discrete symptomatology. Most individuals with sports-related concussion will not score below 15 on the Glasgow Coma Scale, but will present with rapid onset of short-lived neurological impairment, demonstrating no structural changes on traditional magnetic resonance imaging (MRI) and computed tomography (CT) scans. The return-to-play decision is one of the most difficult responsibilities facing the physician, and so far this decision has been primarily based on neurological examination, symptom checklists, and neuropsychological (NP) testing. Diffusion tensor imaging (DTI) may be a more objective tool to assess the severity and recovery of function after concussion. We assessed white matter (WM) fiber tract integrity in varsity level college athletes with sports-related concussion without loss of consciousness, who experienced protracted symptoms for at least 1 month after injury. Evaluation of fractional anisotropy (FA) and mean diffusivity (MD) of the WM skeleton using tract-based spatial statistics (TBSS) revealed a large cluster of significantly increased MD for concussed subjects in several WM fiber tracts in the left hemisphere, including parts of the inferior/superior longitudinal and fronto-occipital fasciculi, the retrolenticular part of the internal capsule, and posterior thalamic and acoustic radiations. Qualitative comparison of average FA and MD suggests that with increasing level of injury severity (ranging from sports-related concussion to severe traumatic brain injury), MD might be more sensitive at detecting mild injury, whereas FA captures more severe injuries. In conclusion, the TBSS analysis used to evaluate diffuse axonal injury of the WM skeleton seems sensitive enough to detect structural changes in sports-related concussion.
鉴于脑震荡症状的离散性,识别和管理其影响极具挑战性。大多数与运动相关的脑震荡患者格拉斯哥昏迷量表(Glasgow Coma Scale)评分不会低于 15,但会出现短暂的神经功能障碍,快速发作,传统磁共振成像(MRI)和计算机断层扫描(CT)扫描无结构变化。重返赛场的决定是医生面临的最困难的责任之一,到目前为止,这一决定主要基于神经系统检查、症状检查表和神经心理学(NP)测试。弥散张量成像(DTI)可能是评估脑震荡后严重程度和功能恢复的更客观工具。我们评估了 varsity 级别的大学运动员在运动相关脑震荡中没有失去意识的情况下的白质(WM)纤维束完整性,他们在受伤后至少经历了 1 个月的迁延性症状。使用基于纤维束的空间统计学(TBSS)评估 WM 骨架的各向异性分数(FA)和平均弥散度(MD),发现左半球的几个 WM 纤维束中,包括下/上纵束和额枕束的一部分、内囊后脚、丘脑后和听辐射,出现了大量显著增加 MD 的弥散张量纤维束。平均 FA 和 MD 的定性比较表明,随着损伤严重程度的增加(从运动相关脑震荡到严重创伤性脑损伤),MD 在检测轻度损伤时可能更敏感,而 FA 则能捕获更严重的损伤。总之,用于评估 WM 骨架弥漫性轴索损伤的 TBSS 分析似乎足够敏感,可以检测到与运动相关的脑震荡中的结构变化。