Wilde Elisabeth A, Hyseni Ilirjana, Lindsey Hannah M, Faber Jessica, McHenry James M, Bigler Erin D, Biekman Brian D, Hollowell Laura L, McCauley Stephen R, Hunter Jill V, Ewing-Cobbs Linda, Aitken Mary E, MacLeod Marianne, Chu Zili D, Noble-Haeusslein Linda J, Levin Harvey S
Department of Neurology, Traumatic Brain Injury and Concussion Center, University of Utah, Salt Lake City, UT, United States.
H. Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX, United States.
Front Neurol. 2021 Dec 23;12:734055. doi: 10.3389/fneur.2021.734055. eCollection 2021.
Plasticity is often implicated as a reparative mechanism when addressing structural and functional brain development in young children following traumatic brain injury (TBI); however, conventional imaging methods may not capture the complexities of post-trauma development. The present study examined the cingulum bundles and perforant pathways using diffusion tensor imaging (DTI) in 21 children and adolescents (ages 10-18 years) 5-15 years after sustaining early childhood TBI in comparison with 19 demographically-matched typically-developing children. Verbal memory and executive functioning were also evaluated and analyzed in relation to DTI metrics. Beyond the expected direction of quantitative DTI metrics in the TBI group, we also found qualitative differences in the streamline density of both pathways generated from DTI tractography in over half of those with early TBI. These children exhibited hypertrophic cingulum bundles relative to the comparison group, and the number of tract streamlines negatively correlated with age at injury, particularly in the late-developing anterior regions of the cingulum; however, streamline density did not relate to executive functioning. Although streamline density of the perforant pathway was not related to age at injury, streamline density of the left perforant pathway was significantly and positively related to verbal memory scores in those with TBI, and a moderate effect size was found in the right hemisphere. DTI tractography may provide insight into developmental plasticity in children post-injury. While traditional DTI metrics demonstrate expected relations to cognitive performance in group-based analyses, altered growth is reflected in the white matter structures themselves in some children several years post-injury. Whether this plasticity is adaptive or maladaptive, and whether the alterations are structure-specific, warrants further investigation.
在探讨幼儿创伤性脑损伤（TBI）后大脑结构和功能发育时，可塑性常被视为一种修复机制；然而，传统成像方法可能无法捕捉创伤后发育的复杂性。本研究使用扩散张量成像（DTI）对21名儿童和青少年（10 - 18岁）进行了研究，这些儿童在幼儿期遭受TBI后5 - 15年，将其与19名人口统计学匹配的正常发育儿童进行比较，观察了扣带束和穿通通路。还对言语记忆和执行功能进行了评估，并分析了其与DTI指标的关系。除了TBI组中DTI定量指标的预期变化方向外，我们还发现，超过半数早期TBI患者的DTI纤维束成像所生成的两条通路的纤维束密度存在质的差异。相对于对照组，这些儿童的扣带束表现为肥大，纤维束数量与受伤年龄呈负相关，尤其是在扣带束发育较晚的前部区域；然而，纤维束密度与执行功能无关。虽然穿通通路的纤维束密度与受伤年龄无关，但TBI患者中左侧穿通通路的纤维束密度与言语记忆得分显著正相关，在右侧半球发现了中等效应量。DTI纤维束成像可能有助于深入了解儿童受伤后的发育可塑性。虽然传统的DTI指标在基于组的分析中显示出与认知表现的预期关系，但在受伤几年后的一些儿童中，白质结构本身反映出了生长的改变。这种可塑性是适应性的还是适应不良的，以及这些改变是否具有结构特异性，都有待进一步研究。
