Department of Emergency and Critical Care Medicine, The University of Tokyo Hospital, Bunkyou, Tokyo, Japan.
J Neurol Neurosurg Psychiatry. 2012 Sep;83(9):870-6. doi: 10.1136/jnnp-2012-302742. Epub 2012 Jul 14.
To assess the possibility that diffusion tensor imaging (DTI) can detect white matter damage in mild traumatic brain injury (mTBI) patients via systematic review and meta-analysis.
DTI studies that compared mTBI patients and controls were searched using MEDLINE, Web of Science, and EMBASE, (1980 through April 2012).
A comprehensive literature search identified 28 DTI studies, of which 13 independent DTI studies of mTBI patients were eligible for the meta-analysis. Random effect model demonstrated significant fractional anisotropy (FA) reduction in the corpus callosum (CC) (p=0.023, 95% CIs -0.466 to -0.035, 280 mTBIs and 244 controls) with no publication bias and minimum heterogeneity, and a significant increase in mean diffusivity (MD) (p=0.015, 95% CIs 0.062 to 0.581, 154 mTBIs and 100 controls). Meta-analyses of the subregions of the CC demonstrated in the splenium FA was significantly reduced (p=0.025, 95% CIs -0.689 to -0.046) and MD was significantly increased (p=0.013, 95% CIs 0.113 to 0.950). FA was marginally reduced in the midbody (p=0.099, 95% CIs -0.404 to 0.034), and no significant change in FA (p=0.421, 95% CIs -0.537 to 0.224) and MD (p=0.264, 95% CIs -0.120 to 0.438) in the genu of the CC.
Our meta-analysis revealed the posterior part of the CC was more vulnerable to mTBI compared with the anterior part, and suggested the potential utility of DTI to detect white matter damage in the CC of mTBI patients.
通过系统评价和荟萃分析评估弥散张量成像（DTI）是否可检测轻度创伤性脑损伤（mTBI）患者的脑白质损伤。
通过 MEDLINE、Web of Science 和 EMBASE 搜索比较 mTBI 患者和对照者的 DTI 研究，检索时间从 1980 年至 2012 年 4 月。
全面的文献检索确定了 28 项 DTI 研究，其中 13 项 mTBI 患者的独立 DTI 研究符合荟萃分析的条件。随机效应模型显示胼胝体（CC）的部分各向异性（FA）明显降低（p=0.023，95%CI -0.466 至 -0.035，280 例 mTBI 患者和 244 例对照者），无发表偏倚且异质性最小，平均弥散度（MD）明显增加（p=0.015，95%CI 0.062 至 0.581，154 例 mTBI 患者和 100 例对照者）。对 CC 各亚区的荟萃分析显示，胼胝体压部 FA 明显降低（p=0.025，95%CI -0.689 至 -0.046），MD 明显增加（p=0.013，95%CI 0.113 至 0.950）。胼胝体体部 FA 有降低趋势（p=0.099，95%CI -0.404 至 0.034），CC 膝部 FA 无明显变化（p=0.421，95%CI -0.537 至 0.224），MD 也无明显变化（p=0.264，95%CI -0.120 至 0.438）。
我们的荟萃分析显示 CC 的后部比前部更易受到 mTBI 的影响，提示 DTI 可能有助于检测 mTBI 患者 CC 的白质损伤。
