创伤性脑损伤后儿童白质纤维束的差异：RAPBI研究
Diverging white matter trajectories in children after traumatic brain injury: The RAPBI study.
作者信息
Dennis Emily L, Rashid Faisal, Ellis Monica U, Babikian Talin, Vlasova Roza M, Villalon-Reina Julio E, Jin Yan, Olsen Alexander, Mink Richard, Babbitt Christopher, Johnson Jeffrey, Giza Christopher C, Thompson Paul M, Asarnow Robert F
机构信息
From the Imaging Genetics Center (E.L.D., F.R., J.E.V.-R., Y.J., P.M.T.), Mary and Mark Stevens Institute for Neuroimaging and Informatics, Keck School of Medicine, University of Southern California, Marina del Rey; Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior (M.U.E., T.B., A.O., R.F.A.), Department of Psychology (R.F.A.), and Brain Research Institute (R.F.A.), UCLA, Los Angeles; Fuller Theological Seminary School of Psychology (M.U.E.), Pasadena; CIBORG Laboratory (R.M.V.), Department of Radiology, Children's Hospital Los Angeles, CA; Department of Psychology (A.O.), Norwegian University of Science and Technology; Department of Physical Medicine and Rehabilitation (A.O.), St. Olavs Hospital, Trondheim University Hospital, Norway; Harbor-UCLA Medical Center and Los Angeles BioMedical Research Institute (R.M.), Department of Pediatrics, Torrance; Miller Children's Hospital (C.B.), Long Beach; Department of Pediatrics (J.J.), LAC+USC Medical Center; Department of Neurosurgery and Division of Pediatric Neurology, UCLA Brain Injury Research Center (C.C.G.), Mattel Children's Hospital; and Departments of Neurology, Pediatrics, Psychiatry, Radiology, Engineering, and Ophthalmology (P.M.T.), USC, Los Angeles, CA.
出版信息
Neurology. 2017 Apr 11;88(15):1392-1399. doi: 10.1212/WNL.0000000000003808. Epub 2017 Mar 15.
OBJECTIVE
To examine longitudinal trajectories of white matter organization in pediatric moderate/severe traumatic brain injury (msTBI) over a 12-month period.
METHODS
We studied 21 children (16 M/5 F) with msTBI, assessed 2-5 months postinjury and again 13-19 months postinjury, as well as 20 well-matched healthy control children. We assessed corpus callosum function through interhemispheric transfer time (IHTT), measured using event-related potentials, and related this to diffusion-weighted MRI measures of white matter (WM) microstructure. At the first time point, half of the patients with TBI had significantly slower IHTT (TBI-slow-IHTT, n = 11) and half were in the normal range (TBI-normal-IHTT, n = 10).
RESULTS
The TBI-normal-IHTT group did not differ significantly from healthy controls, either in WM organization in the chronic phase or in the longitudinal trajectory of WM organization between the 2 evaluations. In contrast, the WM organization of the TBI-slow-IHTT group was significantly lower than in healthy controls across a large portion of the WM. Longitudinal analyses showed that the TBI-slow-IHTT group experienced a progressive decline between the 2 evaluations in WM organization throughout the brain.
CONCLUSIONS
We present preliminary evidence suggesting a potential biomarker that identifies a subset of patients with impaired callosal organization in the first months postinjury who subsequently experience widespread continuing and progressive degeneration in the first year postinjury.
目的
研究小儿中重度创伤性脑损伤（msTBI）患者在12个月期间白质组织的纵向变化轨迹。
方法
我们研究了21名患有msTBI的儿童（16名男性/5名女性），在受伤后2 - 5个月以及再次在受伤后13 - 19个月进行评估，同时研究了20名匹配良好的健康对照儿童。我们通过使用事件相关电位测量的半球间传递时间（IHTT）来评估胼胝体功能，并将其与白质（WM）微观结构的扩散加权MRI测量结果相关联。在第一个时间点，一半的TBI患者IHTT明显较慢（TBI - 慢 - IHTT，n = 11），另一半在正常范围内（TBI - 正常 - IHTT，n = 10）。
结果
TBI - 正常 - IHTT组在慢性期的WM组织或两次评估之间的WM组织纵向变化轨迹方面与健康对照组均无显著差异。相比之下，TBI - 慢 - IHTT组的WM组织在大部分WM区域明显低于健康对照组。纵向分析表明，TBI - 慢 - IHTT组在两次评估之间全脑的WM组织出现了渐进性下降。
结论
我们提供了初步证据，表明存在一种潜在的生物标志物，可识别受伤后最初几个月胼胝体组织受损的患者亚组，这些患者在受伤后第一年随后会经历广泛的持续和渐进性退化。
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