Guo Yong, Wu Lin, Liu Jiacheng, Liu Jinfang, Sun Zhongyi
Department of Neurosurgery, Henan Provincial People's Hospital, Zhengzhou University, Zhengzhou, China.
Department of Ophthalmology, Visual and Anatomical Sciences, Wayne State University School of Medicine, Detroit, MI, USA.
Quant Imaging Med Surg. 2024 Sep 1;14(9):6756-6766. doi: 10.21037/qims-24-348. Epub 2024 Aug 22.
To date, limited research has been conducted on the functionality of the glymphatic system during the recovery phase of severe traumatic brain injury (sTBI). This study aimed to use a diffusion tensor image analysis along the perivascular space (DTI-ALPS) to evaluate glymphatic system function in patients recovering from sTBI who underwent unilateral decompressive craniectomy, and to examine the correlation between the ALPS index and the size of the cranial defect. We hypothesized that assessments would reveal ongoing impairments in glymphatic system function among sTBI patients during the recovery phase.
A total of 23 patients with a history of sTBI who had previously undergone unilateral decompressive craniectomy at Xiangya Hospital of Central South University from January 2020 to December 2020 were enrolled in the study, along with 33 healthy control (HC) subjects. All the subjects underwent magnetic resonance imaging (MRI) with DTI scans, and the ALPS index was subsequently calculated to assess glymphatic system functionality. Additionally, the circumference and sectional area of the cranial defect were measured for each patient. An analysis of variance (ANOVA) was used to compare the ALPS index values between the sTBI patients and HC subjects, while a Pearson correlation analysis was used to examine the correlation between the ALPS index and cranial defect characteristics.
The ALPS index values of both the craniectomy side (t=-9.08, P<0.001) and non-craniectomy side (t=-5.06, P0.001) of the sTBI group were significantly lower than those of the HC group. However, no statistically significant differences were observed between the ALPS index values of the craniectomy and non-craniectomy sides. Additionally, no significant differences were observed in the ALPS index values of both the craniectomy and non-craniectomy sides among the early, intermediate, and late recovery phases. In the sTBI patients, a moderately strong negative correlation was found between the circumference of the cranial defect and the ALPS index of the craniectomy side (r=-0.62, P=0.002), and a moderately negative correlation was found between the sectional area of the cranial defect and the ALPS index of the craniectomy side (r=-0.56, P0.005).
The non-invasive DTI-ALPS technique revealed significantly reduced ALPS index values during the recovery phase of sTBI, indicating persistent impairment in glymphatic system function. A significant negative correlation was found between the ALPS index value of the craniectomy side and the size of the cranial defect. These findings suggest that the ALPS index may serve as a valuable prognostic factor in the recovery phase of sTBI.
迄今为止，关于严重创伤性脑损伤（sTBI）恢复阶段脑淋巴系统功能的研究有限。本研究旨在利用沿血管周围间隙的扩散张量图像分析（DTI-ALPS）评估接受单侧减压颅骨切除术的sTBI恢复患者的脑淋巴系统功能，并研究ALPS指数与颅骨缺损大小之间的相关性。我们假设评估将揭示sTBI患者恢复阶段脑淋巴系统功能持续受损。
选取2020年1月至2020年12月在中南大学湘雅医院接受过单侧减压颅骨切除术的23例sTBI病史患者，以及33例健康对照（HC）受试者纳入研究。所有受试者均接受了磁共振成像（MRI）及DTI扫描，随后计算ALPS指数以评估脑淋巴系统功能。此外，测量了每位患者颅骨缺损的周长和截面积。采用方差分析（ANOVA）比较sTBI患者和HC受试者之间的ALPS指数值，采用Pearson相关分析研究ALPS指数与颅骨缺损特征之间的相关性。
sTBI组颅骨切除侧（t=-9.08，P<0.001）和非颅骨切除侧（t=-5.06，P<0.001）的ALPS指数值均显著低于HC组。然而，颅骨切除侧和非颅骨切除侧的ALPS指数值之间未观察到统计学显著差异。此外，在早期、中期和晚期恢复阶段，颅骨切除侧和非颅骨切除侧的ALPS指数值均未观察到显著差异。在sTBI患者中，颅骨缺损周长与颅骨切除侧ALPS指数之间存在中度强负相关（r=-0.62，P=0.002），颅骨缺损截面积与颅骨切除侧ALPS指数之间存在中度负相关（r=-0.56，P<0.005）。
非侵入性DTI-ALPS技术显示，sTBI恢复阶段ALPS指数值显著降低，表明脑淋巴系统功能持续受损。颅骨切除侧的ALPS指数值与颅骨缺损大小之间存在显著负相关。这些发现表明，ALPS指数可能是sTBI恢复阶段一个有价值的预后因素。
