Acquired Brain Injury Unit, Scientific Institute IRCCS Eugenio Medea, Lecco, Italy.
Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy.
Eur J Neurol. 2019 Sep;26(9):1183-1190. doi: 10.1111/ene.13963. Epub 2019 May 6.
In patients with moderate and severe paediatric traumatic brain injury (TBI), we investigated the presence and severity of white matter (WM) tract damage, cortical lobar and deep grey matter (GM) atrophies, their interplay and their correlation with outcome rating scales.
Diffusion tensor (DT) and 3D T1-weighted MRI scans were obtained from 22 TBI children (13 boys; mean age at insult = 11.6 years; 72.7% in chronic condition) and 31 age-matched healthy children. Patients were tested with outcome rating scales and the Wechsler Intelligence Scale for Children (WISC). DT MRI indices were obtained from several supra- and infra-tentorial WM tracts. Cortical lobar and deep GM volumes were derived. Comparisons between patients and controls, and between patients in acute (<6 months from the event) vs. chronic (≥6 months) condition were performed.
Patients showed a widespread pattern of decreased WM FA and GM atrophy. Compared to acute, chronic patients showed severer atrophy in the right frontal lobe and reduced FA in the left inferior longitudinal fasciculus and corpus callosum (CC). Decreased axial diffusivity was observed in acute patients versus controls in the inferior fronto-occipital fasciculus and CC. Chronic patients showed increased axial diffusivity in the same structures. Uncinate fasciculus DT MRI abnormalities correlated with atrophy in the frontal and temporal lobes. Hippocampal atrophy correlated with reduced WISC scores, whereas putamen atrophy correlated with lower functional independence measure scores.
The study isolated a distributed fronto-temporal network of structures particularly vulnerable to axonal damage and atrophy that may contribute to cognitive deficits following TBI.
在患有中重度小儿创伤性脑损伤（TBI）的患者中，我们研究了白质（WM）束损伤、皮质脑回和深部灰质（GM）萎缩的存在和严重程度、它们之间的相互作用以及它们与结局评定量表的相关性。
对 22 例 TBI 患儿（男 13 例；平均发病年龄为 11.6 岁；72.7%为慢性期）和 31 名年龄匹配的健康儿童进行了弥散张量（DT）和 3D T1 加权 MRI 扫描。患者接受了结局评定量表和韦氏儿童智力量表（WISC）测试。从多个幕上和幕下 WM 束中获得 DT MRI 指数。得出皮质脑回和深部 GM 体积。对患者与对照组、急性期（事件后<6 个月）与慢性期（≥6 个月）患者进行比较。
患者表现出广泛的 WM FA 降低和 GM 萎缩。与急性期相比，慢性期患者右侧额叶萎缩更严重，左侧下纵束和胼胝体（CC）FA 降低。与对照组相比，急性期患者在下额枕束和 CC 中表现出轴向弥散度降低。慢性期患者在同一结构中表现出轴向弥散度增加。钩束的弥散张量成像异常与额叶和颞叶的萎缩相关。海马萎缩与 WISC 评分降低相关，而壳核萎缩与功能独立性测量评分降低相关。
该研究分离出一个特别容易受到轴突损伤和萎缩影响的额颞叶分布式网络结构，这可能导致 TBI 后的认知缺陷。
