Missouri Institute of Mental Health, University of Missouri-St Louis, Berkeley, Missouri (Drs Bolzenius, Wade, and Tate and Ms Velez); Department of Neurology, Uniformed Services University of the Health Sciences School of Medicine, Bethesda, Maryland (Dr Lewis); Department of Psychology and Neuroscience Center, Brigham Young University, Provo, Utah (Dr Bigler); Defense and Veterans Brain Injury Center, San Antonio, Texas (Drs Cooper, Kennedy, and Reid); Department of Radiology, Brooke Army Medical Center, San Antonio, Texas (Dr Ritter); and Alaska Radiology Associates, TBI Imaging and Research, Anchorage, Alaska (Dr York).
J Head Trauma Rehabil. 2018 Nov/Dec;33(6):393-402. doi: 10.1097/HTR.0000000000000378.
Use diffusion tensor imaging to investigate white matter microstructure attributable to mild TBI (mTBI) and/or posttraumatic stress disorder (PTSD).
Twenty-seven individuals with mTBI only, 16 with PTSD only, 42 with mTBI + PTSD, and 43 service members who sustained orthopedic injury.
Descriptive cross-sectional study.
Clinical diffusion tensor imaging sequence to assess fractional anisotropy, mean, axial, and radial diffusivity within selected regions of interest.
Corrected analyses revealed a pattern of lower white matter integrity in the PTSD group for several scalar metrics. Regions affected included primarily right hemisphere areas of the internal capsule. These differences associated with the PTSD only cohort were observed in relation to all 3 comparison groups, while the mTBI + PTSD group did not exhibit any notable pattern of white matter abnormalities.
Results suggest that lower resolution scan sequences are sensitive to post-acute abnormalities associated with PTSD, particularly in the right hemisphere. In addition, these findings suggest that ongoing PTSD symptoms are associated with differences in white matter diffusion that are more readily detected in a clinical scan sequence than mTBI abnormalities. Future studies are needed to prospectively assess service members prior to onset of injury to verify this pattern of results.
利用弥散张量成像技术研究轻度创伤性脑损伤（mTBI）和/或创伤后应激障碍（PTSD）导致的脑白质微观结构变化。
27 名仅有 mTBI 的个体，16 名仅有 PTSD 的个体，42 名 mTBI+PTSD 的个体，以及 43 名遭受骨科损伤的现役军人。
描述性横断面研究。
采用临床弥散张量成像序列评估感兴趣区的各向异性分数、平均值、轴向和径向弥散度等指标。
校正分析显示，PTSD 组在多个标量指标上存在更低的脑白质完整性。受影响的区域主要包括内囊的右侧半球区域。这些与仅 PTSD 队列相关的差异在与所有 3 个对照组的比较中均可见，而 mTBI+PTSD 组则未表现出明显的脑白质异常模式。
结果表明，低分辨率扫描序列对 PTSD 相关的亚急性异常较为敏感，尤其是在右侧半球。此外，这些发现提示持续的 PTSD 症状与脑白质弥散差异有关，而这些差异在临床扫描序列中比 mTBI 异常更容易被检测到。未来的研究需要前瞻性地在损伤发生前评估现役军人，以验证这种结果模式。
