Sorbonne University, GRC 29, AP-HP, DMU DREAM, Department of Anaesthesiology and Critical Care Medicine, AP-HP, Pitié-Salpêtrière Hospital, 47-83, boulevard de l'Hôpital, 75013, Paris, France.
Sorbonne University, GRC 29, AP-HP, DMU DREAM, Department of Anaesthesiology and Critical Care Medicine, AP-HP, Pitié-Salpêtrière Hospital, 47-83, boulevard de l'Hôpital, 75013, Paris, France.
Ann Phys Rehabil Med. 2024 Mar;67(2):101783. doi: 10.1016/j.rehab.2023.101783. Epub 2023 Dec 25.
Traumatic Brain Injury (TBI) is a major cause of acquired disability and can cause devastating and progressive post-traumatic encephalopathy. TBI is a dynamic condition that continues to evolve over time. A better understanding of the pathophysiology of these late lesions is important for the development of new therapeutic strategies.
The primary objective was to compare the ability of fluid-attenuated reversion recovery (FLAIR) and diffusion tensor imaging (DTI) magnetic resonance imaging (MRI) markers to identify participants with a Glasgow outcome scale extended (GOS-E) score of 7-8, up to 10 years after their original TBI. The secondary objective was to study the brain regionalization of DTI markers. Finally, we analyzed the evolution of late-developing brain lesions using repeated MRI images, also taken up to 10 years after the TBI.
In this retrospective study, participants were included from a cohort of people hospitalized following a severe TBI. Following their discharge, they were followed-up and clinically assessed, including a DTI-MRI scan, between 2012 and 2016. We performed a cross-sectional analysis on 97 participants at a median (IQR) of 5 years (3-6) post-TBI, and a further post-TBI longitudinal analysis over 10 years on a subpopulation (n = 17) of the cohort.
Although the area under the curve (AUC) of FLAIR, fractional anisotropy (FA), and mean diffusivity (MD) were not significantly different, only the AUC of FA was statistically greater than 0.5. In addition, only the FA was correlated with clinical outcomes as assessed by GOS-E score (P<10). On the cross-sectional analysis, DTI markers allowed study post-TBI white matter lesions by region. In the longitudinal subpopulation analysis, the observed number of brain lesions increased for the first 5 years post-TBI, before stabilizing over the next 5 years.
This study has shown for the first time that post-TBI lesions can present in a two-phase evolution. These results must be confirmed in larger studies. French Data Protection Agency (Commission nationale de l'informatique et des libertés; CNIL) study registration no: 1934708v0.
创伤性脑损伤（TBI）是获得性残疾的主要原因，并可导致毁灭性和进行性的创伤后脑病。TBI 是一种持续随时间演变的动态状态。更好地了解这些迟发性病变的病理生理学对于开发新的治疗策略很重要。
主要目的是比较液体衰减反转恢复（FLAIR）和弥散张量成像（DTI）磁共振成像（MRI）标志物的能力，以识别在原始 TBI 后长达 10 年时，格拉斯哥结局量表扩展（GOS-E）评分为 7-8 的参与者。次要目的是研究 DTI 标志物的脑区域化。最后，我们使用重复的 MRI 图像分析迟发性脑损伤的演变，这些图像也是在 TBI 后长达 10 年内拍摄的。
在这项回顾性研究中，参与者来自因严重 TBI 住院的患者队列。在出院后，他们接受了随访和临床评估，包括在 2012 年至 2016 年间进行 DTI-MRI 扫描。我们对 97 名参与者进行了中位数（IQR）为 5 年（3-6）的横截面分析，并对队列中的亚组（n=17）进行了长达 10 年的 TBI 后纵向分析。
尽管 FLAIR、各向异性分数（FA）和平均弥散度（MD）的曲线下面积（AUC）没有显著差异，但只有 FA 的 AUC 统计学上大于 0.5。此外，只有 FA 与 GOS-E 评分评估的临床结果相关（P<10）。在横截面分析中，DTI 标志物允许按区域研究 TBI 后白质病变。在纵向亚组分析中，在 TBI 后最初的 5 年内观察到的脑损伤数量增加，然后在接下来的 5 年内稳定下来。
这项研究首次表明 TBI 后病变可能呈两阶段演变。这些结果必须在更大的研究中得到证实。法国数据保护局（Commission nationale de l'informatique et des libertés；CNIL）研究注册号：1934708v0。
