Ferrazzano Peter, Yeske Benjamin, Mumford Jeanette, Kirk Gregory, Bigler Erin D, Bowen Katherine, O'Brien Nicole, Rosario Bedda, Beers Sue R, Rathouz Paul, Bell Michael J, Alexander Andrew L
Waisman Center, University of Wisconsin, Madison, Wisconsin, USA.
Department of Pediatrics, University of Wisconsin, Madison, Wisconsin, USA.
J Neurotrauma. 2021 Jun 1;38(13):1799-1808. doi: 10.1089/neu.2019.6918. Epub 2021 Feb 24.
Adolescent traumatic brain injury (TBI) is a major public health concern, resulting in >35,000 hospitalizations in the United States each year. Although neuroimaging is a primary diagnostic tool in the clinical assessment of TBI, our understanding of how specific neuroimaging findings relate to outcome remains limited. Our study aims to identify imaging biomarkers of long-term neurocognitive outcome after severe adolescent TBI. Twenty-four adolescents with severe TBI (Glasgow Coma Scale ≤8) enrolled in the ADAPT (Approaches and Decisions after Pediatric TBI) study were recruited for magnetic resonance imaging (MRI) scanning 1-2 years post-injury at 13 participating sites. Subjects underwent outcome assessments ∼1-year post-injury, including the Wechsler Abbreviated Scale of Intelligence (IQ) and the Pediatric Glasgow Outcome Scale-Extended (GOSE-Peds). A typically developing control cohort of 38 age-matched adolescents also underwent scanning and neurocognitive assessment. Brain-image segmentation was performed on T-weighted images using Freesurfer. Brain and ventricular cerebrospinal fluid volumes were used to compute a ventricle-to-brain ratio (VBR) for each subject, and the corpus callosum cross-sectional area was determined in the midline for each subject. The TBI group demonstrated higher VBR and lower corpus callosum area compared to the control cohort. After adjusting for age and sex, VBR was significantly related with GOSE-Peds score in the TBI group ( = 24, = 0.01, cumulative odds ratio = 2.18). After adjusting for age, sex, intracranial volume, and brain volume, corpus callosum cross-sectional area correlated significantly with IQ score in the TBI group (partial cor = 0.68, = 18, = 0.007) and with PSI (partial cor = 0.33, = 0.02). No association was found between VBR and IQ or between corpus callosum and GOSE-Peds. After severe adolescent TBI, quantitative MRI measures of VBR and corpus callosum cross-sectional area are associated with global functional outcome and neurocognitive outcomes, respectively.
青少年创伤性脑损伤（TBI）是一个重大的公共卫生问题，在美国每年导致超过35000人住院治疗。尽管神经影像学是TBI临床评估中的主要诊断工具，但我们对特定神经影像学发现与预后之间的关系的理解仍然有限。我们的研究旨在确定重度青少年TBI后长期神经认知预后的影像学生物标志物。在13个参与研究的地点，招募了24名患有重度TBI（格拉斯哥昏迷量表≤8）并参与ADAPT（儿科TBI后的方法和决策）研究的青少年，在受伤后1至2年进行磁共振成像（MRI）扫描。受试者在受伤后约1年接受预后评估，包括韦氏儿童智力量表简式版（IQ）和儿科格拉斯哥预后量表扩展版（GOSE-Peds）。38名年龄匹配的发育正常的青少年组成的对照队列也接受了扫描和神经认知评估。使用Freesurfer对T加权图像进行脑图像分割。利用脑和脑室脑脊液体积计算每个受试者的脑室与脑比率（VBR），并确定每个受试者中线处胼胝体的横截面积。与对照队列相比，TBI组表现出更高的VBR和更低的胼胝体面积。在调整年龄和性别后，TBI组中VBR与GOSE-Peds评分显著相关（n = 24，p = 0.01，累积优势比 = 2.18）。在调整年龄、性别、颅内体积和脑体积后，TBI组中胼胝体横截面积与IQ评分显著相关（偏相关系数 = 0.68，n = 18，p = 0.007），与PSI也显著相关（偏相关系数 = 0.33，p = 0.02）。未发现VBR与IQ之间或胼胝体与GOSE-Peds之间存在关联。重度青少年TBI后，VBR和胼胝体横截面积的定量MRI测量分别与整体功能预后和神经认知预后相关。
