Department of Radiology, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, 53226, USA.
Department of Neurosurgery, Medical College of Wisconsin, 8701 Watertown Plank Rd., Milwaukee, WI, 53226, USA.
Neuropsychol Rev. 2023 Mar;33(1):160-191. doi: 10.1007/s11065-020-09451-7. Epub 2020 Aug 18.
Mild traumatic brain injury (mTBI) is a major public health concern. Cerebrovascular alterations play a significant role in the evolution of injury sequelae and in the process of post-traumatic brain repair. Arterial spin labeling (ASL) is an advanced perfusion magnetic resonance imaging technique that permits noninvasive quantification of cerebral blood flow (CBF). This is the first systematic review of ASL research findings in patients with mTBI. Our approach followed the American Academy of Neurology (AAN) and PRISMA guidelines. We searched Ovid/MEDLINE, Web of Science, Scopus, and the Cochrane Index for relevant articles published as of February 20, 2020. Full-text results were combined into Rayyan software for further evaluation. Data extraction, including risk of bias ratings, was performed using American Academy of Neurology's four-tiered classification scheme. Twenty-three articles met inclusion criteria comprising data on up to 566 mTBI patients and 654 control subjects. Of the 23 studies, 18 reported some type of regional CBF abnormality in mTBI patients at rest or during a cognitive task, with more findings of decreased than increased CBF. The evidence supports the conclusion that mTBI likely causes ASL-derived CBF anomalies. However, synthesis of findings was challenging due to substantial methodological variations across studies and few studies with low risk of bias. Thus, larger-scale prospective cohort studies are needed to more definitively chart the course of CBF changes in humans after mTBI and to understand how individual difference factors contribute to post-injury CBF changes.
轻度创伤性脑损伤 (mTBI) 是一个主要的公共卫生关注点。脑血管改变在损伤后遗症的演变和创伤后大脑修复过程中起着重要作用。动脉自旋标记 (ASL) 是一种先进的灌注磁共振成像技术，可无创地定量测量脑血流 (CBF)。这是对 mTBI 患者 ASL 研究结果的首次系统评价。我们的方法遵循美国神经病学学会 (AAN) 和 PRISMA 指南。我们在 2020 年 2 月 20 日之前在 Ovid/MEDLINE、Web of Science、Scopus 和 Cochrane Index 上搜索了相关文章。全文结果在 Rayyan 软件中进行了组合，以进行进一步评估。使用美国神经病学学会的四级分类方案进行数据提取，包括偏倚风险评分。23 篇文章符合纳入标准，包括多达 566 名 mTBI 患者和 654 名对照受试者的数据。在 23 项研究中，有 18 项研究报告了 mTBI 患者在休息或进行认知任务时存在某种类型的局部 CBF 异常，发现 CBF 减少的情况多于增加的情况。证据支持这样的结论，即 mTBI 可能导致 ASL 衍生的 CBF 异常。然而，由于研究之间存在很大的方法学差异，并且很少有低偏倚风险的研究，因此很难综合研究结果。因此，需要进行更大规模的前瞻性队列研究，以更明确地描绘 mTBI 后人类 CBF 变化的过程，并了解个体差异因素如何导致损伤后 CBF 变化。
