Department of Radiology, Nanjing First Hospital, Nanjing Medical University, No.68, Changle Road, Nanjing, 210006, China.
Department of Radiology, The Affiliated Jiangning Hospital of Nanjing Medical University, Nanjing, China.
Brain Imaging Behav. 2020 Jun;14(3):907-916. doi: 10.1007/s11682-019-00053-3.
Cognitive impairment is a major cause of disability and decline in quality of life in mild traumatic brain injury (mTBI) survivors, but the underlying pathophysiology is still poorly understood. The insula has extensive connections to other cortex and is believed to responsible for integrating external and internal processes and controlling cognitive functions. To explore this hypothesis, we investigated early alterations in the gray matter volume (GMV) and brain functional connectivity (FC) of insula in mTBI patients within 7 days after injury and any possible correlations with cognitive function. A total of 58 mTBI patients at the acute stage and 32 matched healthy controls were recruited and underwentT1-weighted magnetic resonance imaging (MRI)andresting-state functional MRI scans within 7 days of injury. FC was characterized using seed-based region of interest analysis method. The patients' cognitive function was evaluated with Montreal Cognitive Assessment (MoCA) score. The resulting of GMV and FC of insula were correlated with cognitive alterations. We found that the GMV was significantly reduced only in the right insula in mTBI patients and no significant GMV increase was observed in either hemisphere. mTBI patients demonstrated decreased FC in the right parahippocampal gyrus and increased FC in the right supramargianl gyrus. In addition, compared to the healthy controls, the mTBI patients in the acute stage presented a decline in the visuospatial/executive (p = 0.013) and attention (p = 0.038) subcategories. In the mTBI group, the changes in GMV in the right insula were positively correlated with poor attention performance (r = 0.316, p = 0.016). Our data demonstrated alterations of the GMV and resting-stateFC of the right insula in mTBI patients at the acute stage. These early changes in GMV and resting-state FC perhaps serve as a potential biomarker for improving the understanding of cognitive decline for mTBI in the acute setting.
认知障碍是轻度创伤性脑损伤 (mTBI) 幸存者残疾和生活质量下降的主要原因，但潜在的病理生理学仍知之甚少。脑岛与其他皮质有广泛的连接，被认为负责整合外部和内部过程并控制认知功能。为了探索这一假说，我们研究了 mTBI 患者在损伤后 7 天内脑岛灰质体积 (GMV) 和脑功能连接 (FC) 的早期变化，以及与认知功能的任何可能相关性。共招募了 58 名急性 mTBI 患者和 32 名匹配的健康对照者，他们在损伤后 7 天内接受了 T1 加权磁共振成像 (MRI) 和静息态功能磁共振成像扫描。使用基于种子的感兴趣区域分析方法来描述 FC。使用蒙特利尔认知评估 (MoCA) 评分评估患者的认知功能。脑岛的 GMV 和 FC 的结果与认知改变相关。我们发现，mTBI 患者仅右侧脑岛 GMV 明显减少，而两个半球均未观察到明显的 GMV 增加。mTBI 患者右侧海马旁回 FC 降低，右侧额上回 FC 增加。此外，与健康对照组相比，急性阶段的 mTBI 患者在视空间/执行（p=0.013）和注意力（p=0.038）亚类中表现出下降。在 mTBI 组中，右侧脑岛 GMV 的变化与注意力表现不佳呈正相关（r=0.316，p=0.016）。我们的数据表明，急性 mTBI 患者右侧脑岛 GMV 和静息态 FC 发生改变。GMV 和静息态 FC 的这些早期变化可能是改善对急性 mTBI 认知下降理解的潜在生物标志物。
