Dennis Emily L, Faskowitz Joshua, Rashid Faisal, Babikian Talin, Mink Richard, Babbitt Christopher, Johnson Jeffrey, Giza Christopher C, Jahanshad Neda, Thompson Paul M, Asarnow Robert F
Imaging Genetics Center, Mark and Mary Stevens Institute for Neuroimaging and Informatics, Keck School of Medicine, University of Southern California, Marina del Rey, CA 90292, USA.
Imaging Genetics Center, Mark and Mary Stevens Institute for Neuroimaging and Informatics, Keck School of Medicine, University of Southern California, Marina del Rey, CA 90292, USA.
Neuroimage Clin. 2017 Mar 31;15:125-135. doi: 10.1016/j.nicl.2017.03.014. eCollection 2017.
Traumatic brain injury (TBI) is a significant public health concern, and can be especially disruptive in children, derailing on-going neuronal maturation in periods critical for cognitive development. There is considerable heterogeneity in post-injury outcomes, only partially explained by injury severity. Understanding the time course of recovery, and what factors may delay or promote recovery, will aid clinicians in decision-making and provide avenues for future mechanism-based therapeutics. We examined regional changes in brain volume in a pediatric/adolescent moderate-severe TBI (msTBI) cohort, assessed at two time points. Children were first assessed 2-5 months post-injury, and again 12 months later. We used tensor-based morphometry (TBM) to localize longitudinal volume expansion and reduction. We studied 21 msTBI patients (5 F, 8-18 years old) and 26 well-matched healthy control children, also assessed twice over the same interval. In a prior paper, we identified a subgroup of msTBI patients, based on interhemispheric transfer time (IHTT), with significant structural disruption of the white matter (WM) at 2-5 months post injury. We investigated how this subgroup (TBI-slow, = 11) differed in longitudinal regional volume changes from msTBI patients (TBI-normal, = 10) with normal WM structure and function. The TBI-slow group had longitudinal decreases in brain volume in several WM clusters, including the corpus callosum and hypothalamus, while the TBI-normal group showed increased volume in WM areas. Our results show prolonged atrophy of the WM over the first 18 months post-injury in the TBI-slow group. The TBI-normal group shows a different pattern that could indicate a return to a healthy trajectory.
创伤性脑损伤（TBI）是一个重大的公共卫生问题，对儿童的影响尤其严重，会在认知发育的关键时期干扰正在进行的神经元成熟。损伤后的结果存在相当大的异质性，损伤严重程度只能部分解释这种异质性。了解恢复的时间进程以及哪些因素可能延迟或促进恢复，将有助于临床医生进行决策，并为未来基于机制的治疗提供途径。我们在一个儿科/青少年中重度创伤性脑损伤（msTBI）队列中，于两个时间点评估了脑容量的区域变化。儿童在受伤后2至5个月首次接受评估，并在12个月后再次评估。我们使用基于张量的形态测量法（TBM）来定位纵向体积的增加和减少。我们研究了21名msTBI患者（5名女性，8至18岁）和26名匹配良好的健康对照儿童，他们也在相同的时间间隔内接受了两次评估。在之前的一篇论文中，我们根据半球间传递时间（IHTT）确定了一个msTBI患者亚组，该亚组在受伤后2至5个月时白质（WM）存在明显的结构破坏。我们研究了这个亚组（TBI-缓慢恢复组，n = 11）与白质结构和功能正常的msTBI患者（TBI-正常恢复组，n = 10）在纵向区域体积变化上的差异。TBI-缓慢恢复组在几个白质簇中脑容量出现纵向减少，包括胼胝体和下丘脑，而TBI-正常恢复组的白质区域体积增加。我们的结果表明，TBI-缓慢恢复组在受伤后的前18个月白质存在长期萎缩。TBI-正常恢复组则呈现出不同的模式，这可能表明其恢复到了健康轨迹。
