Keong Nicole C, Lock Christine, Soon Shereen, Hernowo Aditya Tri, Czosnyka Zofia, Czosnyka Marek, Pickard John D, Narayanan Vairavan
Department of Neurosurgery, National Neuroscience Institute, Singapore, Singapore.
Duke-NUS Medical School, Singapore, Singapore.
Front Neurol. 2022 Jul 6;13:868026. doi: 10.3389/fneur.2022.868026. eCollection 2022.
The aim of this study was to create a simplistic taxonomy to improve transparency and consistency in, and reduce complexity of, interpreting diffusion tensor imaging (DTI) profiles in white matter disruption. Using a novel strategy of a periodic table of DTI elements, we examined if DTI profiles could demonstrate neural properties of disruption sufficient to characterize white matter changes specific for hydrocephalus vs. non-hydrocephalus, and to distinguish between cohorts of neural injury by their differing potential for reversibility.
DTI datasets from three clinical cohorts representing pathological milestones from reversible to irreversible brain injury were compared to those of healthy controls at baseline, over time and with interventions. The final dataset comprised patients vs. controls in the following groupings: mild traumatic brain injury (mTBI), = 24 vs. 27, normal pressure hydrocephalus (NPH), = 16 vs. 9 and Alzheimer's disease (AD), = 27 vs. 47. We generated DTI profiles from fractional anisotropy (FA) and mean, axial and radial diffusivity measures (MD, L1 and L2 and 3 respectively), and constructed an algorithm to map changes consistently to a periodic table of elements, which fully described their diffusivity and neural properties.
Mapping tissue signatures to a periodic table of DTI elements rapidly characterized cohorts by their differing patterns of injury. At baseline, patients with mTBI displayed the most preserved tracts. In NPH, the magnitude of changes was dependent on "familial" DTI neuroanatomy, i.e., potential for neural distortion from risk of ventriculomegaly. With time, patients with Alzheimer's disease were significantly different to controls across multiple measures. By contrast, patients with mTBI showed both loss of integrity and pathophysiological processes of neural repair. In NPH, some patterns of injury, such as "stretch/compression" and "compression" were more reversible following intervention than others; these neural profile properties suggested "microstructural resilience" to injury.
Using the novel strategy of a periodic table of DTI elements, our study has demonstrated it is possible to distinguish between different cohorts along the spectrum of brain injury by describing neural profile properties of white matter disruption. Further work to contribute datasets of disease toward this proposed taxonomic framework would enhance the translatability of DTI profiles to the clinical-research interface.
本研究的目的是创建一种简化的分类法，以提高对白质破坏中弥散张量成像（DTI）图谱解读的透明度和一致性，并降低其复杂性。我们采用一种新颖的DTI元素周期表策略，研究DTI图谱是否能够展示足以表征脑积水与非脑积水特异性白质变化的破坏神经特性，并根据其不同的可逆潜力区分神经损伤队列。
将代表从可逆性脑损伤到不可逆性脑损伤病理阶段的三个临床队列的DTI数据集，与健康对照在基线、随时间推移以及进行干预时的数据集进行比较。最终数据集包括以下分组中的患者与对照：轻度创伤性脑损伤（mTBI），24例患者对27例对照；正常压力脑积水（NPH），16例患者对9例对照；阿尔茨海默病（AD），27例患者对47例对照。我们从分数各向异性（FA）以及平均、轴向和径向扩散率测量值（分别为MD、L1和L2及L3）生成DTI图谱，并构建一种算法，将变化一致地映射到元素周期表上，该表全面描述了它们的扩散率和神经特性。
将组织特征映射到DTI元素周期表上，能够通过不同的损伤模式迅速对队列进行特征描述。在基线时，mTBI患者的神经束保存最为完好。在NPH中，变化程度取决于“家族性”DTI神经解剖结构，即脑室扩大风险导致神经扭曲的可能性。随着时间推移，阿尔茨海默病患者在多项测量指标上与对照存在显著差异。相比之下，mTBI患者既表现出完整性丧失，也出现了神经修复的病理生理过程。在NPH中，一些损伤模式，如“拉伸/压缩”和“压缩”，在干预后比其他模式更具可逆性；这些神经图谱特性提示了对损伤的“微观结构弹性”。
通过采用DTI元素周期表这一新颖策略，我们的研究表明，通过描述白质破坏的神经图谱特性，可以区分脑损伤谱系中的不同队列。为这个提议的分类框架贡献疾病数据集的进一步工作，将提高DTI图谱在临床研究界面的可转化性。
