Department of Radiology, Perioperative and Pain Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.
Department of Radiology (IDI), Girona Biomedical Research Institute (IDIBGI), Hospital Universitari de Girona Dr. Josep Trueta, Girona, Spain.
J Neurotrauma. 2020 Aug 15;37(16):1761-1776. doi: 10.1089/neu.2019.6623. Epub 2020 Apr 24.
There is growing interest in developing magnetic resonance imaging (MRI) biomarkers of brain connectivity from resting-state functional (rs-fMRI) and diffusion tensor imaging (DTI) to aid in the diagnosis and management of patients with mild traumatic brain injury (mTBI). To determine whether early MRI biomarkers of brain connectivity are useful in predicting outcome after mTBI, we conducted a systematic review using the following inclusion criteria: 1) patients aged >16 years with mTBI, 2) MRI performed during the first month post-injury, 3) outcome measure available, 4) control group, and 5) original article published in a peer-reviewed journal. Of the 1351 citations identified, 14 studies met inclusion criteria (5 rs-fMRI and 10 DTI; 680 patients with mTBI vs. 436 controls) including those where MRI was performed from <12 h to 1 month post-injury. The most common clinical outcome measure used in these studies was symptom burden using the Rivermead Post-Concussion Questionnaire. The most frequently studied brain connectivity MRI biomarkers were global functional connectivity, default-mode network, and fractional anisotropy (FA). Despite the scant evidence and considerable methodological heterogeneity observed among studies, we conclude that brain connectivity MRI biomarkers obtained within 1 month of injury may be potentially useful in predicting outcome in mTBI. Further longitudinal studies are needed to evaluate the effect of mTBI on MRI-based brain connectivity biomarkers and examine how incorporation of these tests can inform the clinical care of individual mTBI patients.
人们对开发磁共振成像（MRI）脑连接生物标志物越来越感兴趣，这些生物标志物源自静息态功能（rs-fMRI）和弥散张量成像（DTI），以帮助诊断和管理轻度创伤性脑损伤（mTBI）患者。为了确定脑连接的早期 MRI 生物标志物是否有助于预测 mTBI 后的结果，我们使用以下纳入标准进行了系统评价：1）年龄>16 岁的 mTBI 患者，2）伤后第一个月内进行 MRI，3）有结果测量，4）对照组，5）发表在同行评议期刊上的原始文章。在确定的 1351 条引文中，有 14 项研究符合纳入标准（5 项 rs-fMRI 和 10 项 DTI；680 例 mTBI 患者与 436 例对照组），其中包括伤后<12 小时至 1 个月内进行 MRI 的研究。这些研究中最常用的临床结果测量是使用 Rivermead 脑震荡后问卷测量的症状负担。最常研究的脑连接 MRI 生物标志物是全局功能连接、默认模式网络和各向异性分数（FA）。尽管观察到的证据很少，而且研究之间存在相当大的方法学异质性，但我们得出结论，伤后 1 个月内获得的脑连接 MRI 生物标志物可能有助于预测 mTBI 的结果。需要进一步的纵向研究来评估 mTBI 对基于 MRI 的脑连接生物标志物的影响，并研究如何将这些测试纳入个体 mTBI 患者的临床护理。
