Aix Marseille University, AP-HM, Department of Anesthesiology and Critical Care Medicine, University Hospital Timone, Marseille, France; Aix Marseille University, CNRS, Inst Neurosci Timone, UMR7289 Marseille, France.
Aix Marseille University, CNRS, Inst Neurosci Timone, UMR7289 Marseille, France; Aix Marseille University, CNRS, Laboratoire des Sciences de l'Information et des Systèmes, UMR7296 Marseille, France.
Ann Phys Rehabil Med. 2022 Nov;65(6):101599. doi: 10.1016/j.rehab.2021.101599. Epub 2022 Feb 15.
Traumatic brain injury (TBI) lesions are known to evolve over time, but the duration and consequences of cerebral remodelling are unclear. Degenerative mechanisms occurring in the chronic phase after TBI could constitute "tertiary" lesions related to the neurological outcome.
The objective of this prospective study of severe TBI was to longitudinally evaluate the volume of white and grey matter structures and white matter integrity with 2 time-point multimodal MRI.
Longitudinal MRI follow-up was obtained for 11 healthy controls (HCs) and 22 individuals with TBI (mean [SD] 60 [15] months after injury) along with neuropsychological assessments. TBI individuals were classified in the "favourable" recovery group (Glasgow Outcome Scale Extended [GOSE] 6-8) and "unfavourable" recovery group (GOSE 3-5) at 5 years. Variation in brain volumes (3D T1-weighted image) and white matter integrity (diffusion tensor imaging [DTI]) were quantitatively assessed over time and used to predict neurological outcome.
TBI individuals showed a marked decrease in volumes of whole white matter (median -11.4% [interquartile range -5.8; -14.6]; p < 0.001) and deep grey nuclear structures (-17.1% [-10.6; -20.5]; p < 0.001). HCs did not show any significant change over the same time period. Median volumetric loss in several brain regions was higher with GOSE 3-5 than 6-8. These lesions were associated with lower fractional anisotropy and higher mean diffusivity at baseline. Volumetric variations were positively correlated with normalized fractional anisotropy and negatively with normalized mean diffusivity at baseline and follow-up. A computed predictive model with baseline DTI showed good accuracy to predict neurological outcome (area under the receiver operating characteristic curve 0.82 [95% confidence interval 0.81-0.83]) CONCLUSIONS: We characterised the striking atrophy of deep brain structures after severe TBI. DTI imaging in the subacute phase can predict the occurrence and localization of these tertiary lesions as well as long-term neurological outcome.
ClinicalTrials.gov: NCT00577954. Registered on October 2006.
已知创伤性脑损伤（TBI）病变随时间而演变，但脑重塑的持续时间和后果尚不清楚。TBI 后慢性期发生的退行性机制可能构成与神经功能结局相关的“三级”病变。
本项对严重 TBI 的前瞻性研究旨在通过 2 次多点多时相 MRI 对脑白质和灰质结构的体积和脑白质完整性进行纵向评估。
对 11 名健康对照者（HC）和 22 名 TBI 患者（损伤后 60[15]个月）进行了纵向 MRI 随访，并进行了神经心理学评估。TBI 患者在 5 年时被分为“预后良好”组（格拉斯哥预后评分扩展[GOSE] 6-8）和“预后不良”组（GOSE 3-5）。定量评估脑容积（3D T1 加权图像）和脑白质完整性（弥散张量成像[DTI]）随时间的变化，并用于预测神经功能结局。
TBI 患者的全脑白质体积明显减少（中位数-11.4%[四分位距-5.8；-14.6]；p<0.001）和深部灰质核结构体积减少（-17.1%[-10.6；-20.5]；p<0.001）。同一时期 HC 无明显变化。GOSE 3-5组多个脑区的容积丢失中位数高于 GOSE 6-8 组。这些病变与基线时较低的各向异性分数和较高的平均弥散系数相关。体积变化与基线和随访时的归一化各向异性分数呈正相关，与归一化平均弥散系数呈负相关。基于基线 DTI 的计算预测模型对神经功能结局具有良好的预测准确性（受试者工作特征曲线下面积 0.82[95%置信区间 0.81-0.83]）。
我们描述了严重 TBI 后深部脑结构的明显萎缩。亚急性期的 DTI 成像可以预测这些三级病变的发生和定位以及长期的神经功能结局。
ClinicalTrials.gov：NCT00577954。于 2006 年 10 月注册。
