Zaninotto Ana Luiza, Macruz Fabiola, Feltrin Fabricio S, Andrade Celi S, Leite Claudia C, Guirado Vinicius Monteiro de Paula, Paiva Wellingson S, Bouix Sylvain
Psychiatry and Neuroimaging Laboratory, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
Department of Neurosurgery, Hospital das Clínicas da Faculdade de Medicina, Universidade de Sao Paulo (HC-FMUSP), Sao Paulo, Brazil.
Neurotrauma Rep. 2025 Jul 28;6(1):600-612. doi: 10.1089/neur.2024.0149. eCollection 2025.
Most individuals with moderate-to-severe diffuse axonal injury (DAI) have impaired verbal fluency (VF) capacity. Still, the relationship between brain and VF recovery post-DAI has remained mostly unknown. The aim was to assess brain changes in 13 cortical thickness regions of interest (ROIs), fractional anisotropy (FA), and free water (FW) in three language-related tracts; the VF performance at 6 and 12 months after the DAI; and whether brain changes from 3 to 6 months predict VF performance from 6- to 12-month post-DAI. Twenty-one adults with moderate and severe DAI were analyzed. Structural and diffusion data were acquired on a 3T system 3 and 6 months after the injury. The differences in cortical thickness, FA, and FW values over time were analyzed as factors for the phonemic and semantic VF scores between the 6th and 12th months following the DAI. All analyses were corrected for multiple comparisons. Cortical thickness increased over time in 7 of the 13 ROIs in the right hemisphere and 5 of the 13 ROIs in the left hemisphere. There was an increase in FA in the right arcuate fasciculus and the inferior longitudinal fasciculus over time. An increase in phonemic VF scores was detected between 6 and 12 months post-traumatic brain injury, but not in semantic VF scores over time. Cortical thickness changes in the left posterior inferior frontal pars opercularis and left anterior superior temporal sulcus from 3 to 6 months were associated with improved phonemic VF scores over time. There was no association between diffusion magnetic resonance imaging metrics and VF scores. Our findings suggest that brain plasticity plays a significant role in the initial year following traumatic brain injury, as evidenced by increased cortical thickness and white matter integrity. Improved VF is associated with increased thickness in cortical motor regions responsible for speech performance. However, a larger sample size is needed to confirm these findings.
大多数中重度弥漫性轴索损伤（DAI）患者存在言语流畅性（VF）能力受损的情况。然而，DAI后脑与VF恢复之间的关系大多仍不为人知。本研究旨在评估与三种语言相关的脑区中13个感兴趣的皮质厚度区域（ROI）、分数各向异性（FA）和自由水（FW）的脑变化；DAI后6个月和12个月时的VF表现；以及3至6个月时的脑变化是否能预测DAI后6至12个月的VF表现。对21名中重度DAI的成年人进行了分析。在受伤后3个月和6个月时，使用3T系统采集了结构和扩散数据。将皮质厚度、FA和FW值随时间的差异作为DAI后第6个月至第12个月之间音素和语义VF分数的影响因素进行分析。所有分析均针对多重比较进行了校正。右半球13个ROI中的7个以及左半球13个ROI中的5个的皮质厚度随时间增加。随着时间的推移，右侧弓状束和下纵束的FA增加。创伤性脑损伤后6至12个月检测到音素VF分数增加，但语义VF分数随时间未增加。3至6个月时，左侧后下额部盖部和左侧前颞上沟的皮质厚度变化与音素VF分数随时间的改善相关。扩散磁共振成像指标与VF分数之间无关联。我们的研究结果表明，脑可塑性在创伤性脑损伤后的第一年起着重要作用，皮质厚度和白质完整性增加证明了这一点。VF的改善与负责言语表现的皮质运动区域厚度增加有关。然而，需要更大的样本量来证实这些发现。
