Australian Centre for Child Neuropsychological Studies,Murdoch Children's Research Institute,Melbourne,Australia.
Developmental Imaging,Murdoch Childrens Research Institute,Melbourne,Australia.
Psychol Med. 2018 Mar;48(4):679-691. doi: 10.1017/S0033291717002057. Epub 2017 Aug 7.
Deficits in social cognition may be among the most profound and disabling sequelae of paediatric traumatic brain injury (TBI); however, the neuroanatomical correlates of longitudinal outcomes in this domain remain unexplored. This study aimed to characterize social cognitive outcomes longitudinally after paediatric TBI, and to evaluate the use of sub-acute diffusion tensor imaging (DTI) to predict these outcomes.
The sample included 52 children with mild complex-severe TBI who were assessed on cognitive theory of mind (ToM), pragmatic language and affective ToM at 6- and 24-months post-injury. For comparison, 43 typically developing controls (TDCs) of similar age and sex were recruited. DTI data were acquired sub-acutely (mean = 5.5 weeks post-injury) in a subset of 65 children (TBI = 35; TDC = 30) to evaluate longitudinal prospective relationships between white matter microstructure assessed using Tract-Based Spatial Statistics and social cognitive outcomes.
Whole brain voxel-wise analysis revealed significantly higher mean diffusivity (MD), axial diffusivity (AD) and radial diffusivity (RD) in the sub-acute TBI group compared with TDC, with differences observed predominantly in the splenium of the corpus callosum (sCC), sagittal stratum (SS), dorsal cingulum (DC), uncinate fasciculus (UF) and middle and superior cerebellar peduncles (MCP & SCP, respectively). Relative to TDCs, children with TBI showed poorer cognitive ToM, affective ToM and pragmatic language at 6-months post-insult, and those deficits were related to abnormal diffusivity of the sCC, SS, DC, UF, MCP and SCP. Moreover, children with TBI showed poorer affective ToM and pragmatic language at 24-months post-injury, and those outcomes were predicted by sub-acute alterations in diffusivity of the DC and MCP.
Abnormal microstructure within frontal-temporal, limbic and cerebro-cerebellar white matter may be a risk factor for long-term social difficulties observed in children with TBI. DTI may have potential to unlock early prognostic markers of long-term social outcomes.
社交认知缺陷可能是儿科创伤性脑损伤（TBI）最严重和致残的后遗症之一；然而，该领域的纵向结果的神经解剖学相关性仍未得到探索。本研究旨在描述儿科 TBI 后社交认知的纵向结果，并评估亚急性期弥散张量成像（DTI）在预测这些结果中的作用。
该样本包括 52 名轻度复杂-重度 TBI 患儿，他们在损伤后 6 个月和 24 个月时进行认知心理理论（ToM）、语用语言和情感 ToM 评估。为了进行比较，招募了 43 名年龄和性别相似的典型发育对照（TDC）。在 65 名儿童（TBI=35；TDC=30）的亚急性期采集 DTI 数据（平均=损伤后 5.5 周），以评估使用基于体素的空间统计学评估的白质微观结构与社交认知结果之间的纵向前瞻性关系。
全脑体素分析显示，亚急性期 TBI 组的平均弥散度（MD）、轴向弥散度（AD）和径向弥散度（RD）显著高于 TDC，差异主要发生在胼胝体体部（sCC）、矢状层（SS）、背侧扣带束（DC）、钩束（UF）和中脑和上小脑脚（MCP 和 SCP）。与 TDC 相比，损伤后 6 个月时，TBI 患儿的认知 ToM、情感 ToM 和语用语言能力较差，这些缺陷与 sCC、SS、DC、UF、MCP 和 SCP 的弥散异常有关。此外，TBI 患儿在损伤后 24 个月时表现出较差的情感 ToM 和语用语言能力，这些结果可以通过 DC 和 MCP 的亚急性改变来预测。
额叶-颞叶、边缘和脑-小脑白质内的异常微观结构可能是 TBI 患儿长期社交困难的危险因素。DTI 可能具有揭示长期社交结果的潜在早期预后标志物的潜力。
