5-Year imaging sequelae of concussive blast injury and relation to early clinical outcome.
5-Year imaging sequelae of concussive blast injury and relation to early clinical outcome.
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DOI：
10.1016/j.nicl.2017.02.005
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发表时间：
2017
期刊：
影响因子：
--
通讯作者：
Temkin N
中科院分区：
文献类型：
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作者：
Mac Donald CL;Barber J;Andre J;Evans N;Panks C;Sun S;Zalewski K;Elizabeth Sanders R;Temkin N
目前的影像诊断技术往往是不敏感的潜在病理变化后，轻度创伤性脑损伤（TBI）或脑震荡，以至于明确定义这些简单的轻度脑损伤包括放射学检查结果的缺乏。在美国军队中，由于军人因担心被调离部队而淡化症状的自然倾向，尤其是在战斗中，这使得临床医生很难明确诊断和确定治疗方案，这使得情况变得更加复杂。关于这些战时脑损伤的长期影响仍然存在问题。本研究的目的是评估现役美国军队爆炸脑震荡的长期成像后遗症，并利用先前在这些患者中收集的纵向数据来确定指示慢性神经退行性变的持续DTI信号变化的预测因子。在这5年的随访中，共对50例爆炸性TBI和44例战斗部署对照进行了评价，采用了先进的神经成像技术，包括弥散张量成像和定量容积法。虽然DTI图像上的白色物质区域的横截面分析在统计校正后未显示出组间的显著差异，但在单个受试者水平上对脑损伤的异质性具有灵活性的方法确定了74%的震荡冲击波TBI队列具有指示慢性脑损伤的各向异性分数降低。利用急性/亚急性和1年随访中收集的临床和人口统计学数据进行逻辑回归，以确定这些长期成像变化的预测因素，确定脑损伤诊断、老年、言语记忆和言语流畅性最能预测损伤后5年DTI异常的存在，AUC为0.78，表明预测强度良好。这些结果为这种脑损伤病理学的演变而不是解决提供了支持性证据，增加了越来越多的文献，这些文献描述了即使在轻度TBI和脑震荡后慢性神经变性的成像特征。设计图：前瞻性、观察性、纵向研究患者：震荡冲击波（n = 50），战斗部署对照（n = 44），损伤后5年分析扩散张量成像，1年结果高度预测。影像学异常似乎从亚急性发展到1年，再到5年扫描。研究结果表明，慢性神经变性在大多数冲击波脑震荡患者。
Current imaging diagnostic techniques are often insensitive to the underlying pathological changes following mild traumatic brain injury (TBI) or concussion so much so that the explicit definition of these uncomplicated mild brain injuries includes the absence of radiological findings. In the US military, this is complicated by the natural tendency of service members to down play symptoms for fear of removal from their unit particularly in combat making it challenging for clinicians to definitively diagnose and determine course of treatment. Questions remain regarding the long-term impact of these war-time brain injuries. The objective of the current study was to evaluate the long-term imaging sequelae of blast concussion in active-duty US military and leverage previous longitudinal data collected in these same patients to identify predictors of sustained DTI signal change indicative of chronic neurodegeneration. In total, 50 blast TBI and 44 combat-deployed controls were evaluated at this 5-year follow up by advanced neuroimaging techniques including diffusion tensor imaging and quantitative volumetry. While cross-sectional analysis of regions of white matter on DTI images did not reveal significant differences across groups after statistical correction, an approach flexible to the heterogeneity of brain injury at the single-subject level identified 74% of the concussive blast TBI cohort to have reductions in fractional anisotropy indicative of chronic brain injury. Logistic regression leveraging clinical and demographic data collected in the acute/sub-acute and 1-year follow up to determine predictors of these long-term imaging changes determined that brain injury diagnosis, older age, verbal memory and verbal fluency best predicted the presence of DTI abnormalities 5 years post injury with an AUC of 0.78 indicating good prediction strength. These results provide supporting evidence for the evolution not resolution of this brain injury pathology, adding to the growing body of literature describing imaging signatures of chronic neurodegeneration even after mild TBI and concussion. Design: prospective, observational, longitudinal research study Patients: concussive blast (n = 50), combat-deployed control (n = 44) Diffusion tensor imaging analyzed 5 yr post-injury, highly predicted by 1 yr outcomes. Imaging abnormalities appear to evolve from sub-acute, to 1-year, to 5-year scan. Findings indicate chronic neurodegeneration in majority of blast concussion patients.