Department of Radiology, Washington University School of Medicine, Saint Louis, MO, USA.
Endocrine & Brain Injury Research Alliance, Neurevolution Medicine, PLLC, NUNM Helfgott Research Institute, Portland, Oregon, USA.
BMC Neurol. 2024 Jul 5;24(1):235. doi: 10.1186/s12883-024-03745-6.
Mild traumatic brain injury (mTBI) can result in lasting brain damage that is often too subtle to detect by qualitative visual inspection on conventional MR imaging. Although a number of FDA-cleared MR neuroimaging tools have demonstrated changes associated with mTBI, they are still under-utilized in clinical practice.
We investigated a group of 65 individuals with predominantly mTBI (60 mTBI, 48 due to motor-vehicle collision, mean age 47 ± 13 years, 27 men and 38 women) with MR neuroimaging performed in a median of 37 months post-injury. We evaluated abnormalities in brain volumetry including analysis of left-right asymmetry by quantitative volumetric analysis, cerebral perfusion by pseudo-continuous arterial spin labeling (PCASL), white matter microstructure by diffusion tensor imaging (DTI), and neurometabolites via magnetic resonance spectroscopy (MRS).
All participants demonstrated atrophy in at least one lobar structure or increased lateral ventricular volume. The globus pallidi and cerebellar grey matter were most likely to demonstrate atrophy and asymmetry. Perfusion imaging revealed significant reductions of cerebral blood flow in both occipital and right frontoparietal regions. Diffusion abnormalities were relatively less common though a subset analysis of participants with higher resolution DTI demonstrated additional abnormalities. All participants showed abnormal levels on at least one brain metabolite, most commonly in choline and N-acetylaspartate.
We demonstrate the presence of coup-contrecoup perfusion injury patterns, widespread atrophy, regional brain volume asymmetry, and metabolic aberrations as sensitive markers of chronic mTBI sequelae. Our findings expand the historic focus on quantitative imaging of mTBI with DTI by highlighting the complementary importance of volumetry, arterial spin labeling perfusion and magnetic resonance spectroscopy neurometabolite analyses in the evaluation of chronic mTBI.
轻度创伤性脑损伤（mTBI）可导致持久的脑损伤，这些损伤通常通过常规磁共振成像的定性视觉检查很难检测到。尽管许多已获得美国食品和药物管理局批准的磁共振神经影像学工具已经证明与 mTBI 相关的变化，但它们在临床实践中仍未得到充分利用。
我们研究了一组 65 名主要患有 mTBI 的个体（60 名 mTBI，48 名因机动车碰撞，平均年龄 47±13 岁，27 名男性和 38 名女性），他们在受伤后中位数 37 个月进行了磁共振神经影像学检查。我们评估了脑容积异常，包括通过定量容积分析分析左右不对称、通过伪连续动脉自旋标记（PCASL）评估脑灌注、通过弥散张量成像（DTI）评估白质微观结构以及通过磁共振波谱（MRS）评估神经代谢物。
所有参与者至少有一个脑叶结构出现萎缩或侧脑室体积增大。苍白球和小脑灰质最有可能出现萎缩和不对称。灌注成像显示双侧枕叶和右侧额顶叶区域的脑血流明显减少。弥散异常相对较少见，但对具有更高分辨率 DTI 的参与者进行的子集分析显示存在其他异常。所有参与者至少有一种脑代谢物水平异常，最常见于胆碱和 N-乙酰天门冬氨酸。
我们证明了存在对冲性灌注损伤模式、广泛的萎缩、区域性脑容积不对称和代谢异常，这些都是慢性 mTBI 后遗症的敏感标志物。我们的研究结果通过强调容积、动脉自旋标记灌注和磁共振波谱神经代谢物分析在慢性 mTBI 评估中的互补重要性，扩展了对 mTBI 的弥散成像定量研究的传统重点。
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