Department of Cognition and Neuroscience, University of Texas, Dallas, TX, USA.
Neurology. 2011 Aug 30;77(9):818-26. doi: 10.1212/WNL.0b013e31822c61d7. Epub 2011 Aug 3.
To identify structural connectivity change occurring during the first 6 months after traumatic brain injury and to evaluate the utility of diffusion tensor tractography for predicting long-term outcome.
The participants were 28 patients with mild to severe traumatic axonal injury and 20 age- and sex-matched healthy control subjects. Neuroimaging was obtained 0-9 days postinjury for acute scans and 6-14 months postinjury for chronic scans. Long-term outcome was evaluated on the day of the chronic scan. Twenty-eight fiber regions of 9 major white matter structures were reconstructed, and reliable tractography measurements were determined and used.
Although most (23 of 28) patients had severe brain injury, their long-term outcome ranged from good recovery (16 patients) to moderately (5 patients) and severely disabled (7 patients). In concordance with the diverse outcome, the white matter change in patients was heterogeneous, ranging from improved structural connectivity, through no change, to deteriorated connectivity. At the group level, all 9 fiber tracts deteriorated significantly with 7 (corpus callosum, cingulum, angular bundle, cerebral peduncular fibers, uncinate fasciculus, and inferior longitudinal and fronto-occipital fasciculi) showing structural damage acutely and 2 (fornix body and left arcuate fasciculus) chronically. Importantly, the amount of change in tractography measurements correlated with patients' long-term outcome. Acute tractography measurements were able to predict patients' learning and memory performance; chronic measurements also determined performance on processing speed and executive function.
Diffusion tensor tractography is a valuable tool for identifying structural connectivity changes occurring between the acute and chronic stages of traumatic brain injury and for predicting patients' long-term outcome.
确定创伤性脑损伤后最初 6 个月发生的结构连接变化，并评估弥散张量纤维束追踪术预测长期预后的效用。
参与者为 28 例轻度至重度创伤性轴索损伤患者和 20 例年龄和性别匹配的健康对照者。神经影像学检查在损伤后 0-9 天进行急性扫描，在损伤后 6-14 个月进行慢性扫描。在慢性扫描当天评估长期预后。重建了 9 个主要白质结构的 28 个纤维区域，并确定和使用可靠的纤维束追踪测量值。
尽管大多数（28 例中的 23 例）患者存在严重脑损伤，但他们的长期预后从良好恢复（16 例）到中度（5 例）和重度残疾（7 例）不等。与不同的结局一致，患者的白质变化是异质的，从改善的结构连接到没有变化再到连接恶化。在组水平上，所有 9 条纤维束都显著恶化，其中 7 条（胼胝体、扣带束、角束、大脑脚纤维、钩束、下纵束和额枕束）在急性期显示结构损伤，2 条（穹窿体和左弓状束）在慢性期显示结构损伤。重要的是，纤维束追踪测量值的变化量与患者的长期预后相关。急性期纤维束追踪测量值能够预测患者的学习和记忆表现；慢性测量值也决定了处理速度和执行功能的表现。
弥散张量纤维束追踪术是一种有价值的工具，可用于识别创伤性脑损伤急性期和慢性期之间发生的结构连接变化，并预测患者的长期预后。
