Department of Psychiatry, University of California San Diego, La Jolla, California; Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, California; VA San Diego Healthcare System, San Diego, California.
Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California; Department of Bioengineering and Therapeutic Sciences, University of California San Francisco, San Francisco, California.
Biol Psychiatry Cogn Neurosci Neuroimaging. 2021 Mar;6(3):352-359. doi: 10.1016/j.bpsc.2020.10.008. Epub 2020 Oct 27.
Brain volumes in regions such as the hippocampus and amygdala have been associated with risk for the development of posttraumatic stress disorder (PTSD). The objective of this study was to determine whether a set of regional brain volumes, measured by magnetic resonance imaging at 2 weeks following mild traumatic brain injury, were predictive of PTSD at 3 and 6 months after injury.
Using data from TRACK-TBI (Transforming Research and Clinical Knowledge in TBI), we included patients (N = 421) with Glasgow Coma Scale scores 13-15 assessed after evaluation in the emergency department and at 2 weeks, 3 months, and 6 months after injury. Probable PTSD diagnosis (PTSD Checklist for DSM-5 score, ≥33) was the outcome. FreeSurfer 6.0 was used to perform volumetric analysis of three-dimensional T1-weighted magnetic resonance images at 3T obtained 2 weeks post injury. Brain regions selected a priori for volumetric analyses were insula, hippocampus, amygdala, superior frontal cortex, rostral and caudal anterior cingulate, and lateral and medial orbitofrontal cortices.
Overall, 77 (18.3%) and 70 (16.6%) patients had probable PTSD at 3 and 6 months. A composite volume derived as the first principal component incorporating 73.8% of the variance in insula, superior frontal cortex, and rostral and caudal cingulate contributed to the prediction of 3-month (but not 6-month) PTSD in multivariable models incorporating other established risk factors.
Results, while needing replication, provide support for a brain reserve hypothesis of PTSD and proof of principle for how prediction of at-risk individuals might be accomplished to enhance prognostic accuracy and enrich clinical prevention trials for individuals at the highest risk of PTSD following mild traumatic brain injury.
海马体和杏仁核等区域的脑容量与创伤后应激障碍（PTSD）的发病风险相关。本研究旨在确定在轻度创伤性脑损伤后 2 周通过磁共振成像测量的一组脑区容积是否能预测损伤后 3 个月和 6 个月的 PTSD。
利用 TRACK-TBI（转化创伤性脑损伤研究与临床知识）的数据，我们纳入了格拉斯哥昏迷量表评分 13-15 分的患者（N=421），在急诊科和损伤后 2 周、3 个月和 6 个月进行评估。使用 PTSD 检查表 DSM-5 得分≥33 作为 PTSD 诊断。使用 FreeSurfer 6.0 对损伤后 2 周获得的 3T 三维 T1 加权磁共振图像进行容积分析。选择额下回、海马体、杏仁核、额上回、前扣带回的头侧和尾侧、外侧和内侧眶额皮质进行容积分析。
总体而言，77 例（18.3%）和 70 例（16.6%）患者在 3 个月和 6 个月时患有 PTSD。一个由额下回、额上回和前扣带回的头侧和尾侧组成的复合容积，纳入了 73.8%的方差，可预测多变量模型中 3 个月（而非 6 个月）的 PTSD，该模型纳入了其他已确定的危险因素。
虽然需要进一步验证，但结果支持 PTSD 的脑储备假说，并为如何预测高危个体提供了原理证明，以提高预后准确性，并为创伤性脑损伤后 PTSD 风险最高的个体丰富临床预防试验。
