Diverging volumetric trajectories following pediatric traumatic brain injury.
Diverging volumetric trajectories following pediatric traumatic brain injury.
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DOI：
10.1016/j.nicl.2017.03.014
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发表时间：
2017
期刊：
影响因子：
--
通讯作者：
Asarnow RF
中科院分区：
文献类型：
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作者：
Dennis EL;Faskowitz J;Rashid F;Babikian T;Mink R;Babbitt C;Johnson J;Giza CC;Jahanshad N;Thompson PM;Asarnow RF
创伤性脑损伤(TBI)是一个重要的公共卫生问题，对儿童尤其具有破坏性，在认知发育的关键时期破坏正在进行的神经元成熟。损伤后的结果有相当大的异质性，只能部分地用损伤严重程度来解释。了解康复的时间进程，以及哪些因素可能延迟或促进康复，将有助于临床医生做出决策，并为未来基于机制的治疗提供途径。我们研究了在两个时间点评估的儿童/青少年中重度脑损伤(MsTBI)队列中脑体积的区域性变化。儿童首先在受伤后2-5个月进行评估，12个月后再次进行评估。我们使用基于张量的形态计量学(TBM)来定位纵向体积膨胀和缩小。我们研究了21名msTBI患者(5名女性，8-18岁)和26名匹配良好的健康对照组儿童，也在同一时间间隔内进行了两次评估。在之前的一篇论文中，我们根据大脑半球间转移时间(IHTT)确定了一组msTBI患者，在损伤后2-5个月白质(WM)有显著的结构破坏。我们研究了这一亚组(TBI-Slow，N=11.0)与具有正常WM结构和功能的msTBI患者(TBI-Normal，N=10.0)在纵向区域体积变化方面的差异。慢脑损伤组大鼠的几个WM簇的脑体积纵向缩小，包括胼胝体和下丘脑，而脑损伤正常组大鼠的WM区体积增加。我们的结果显示，在损伤后的头18个月中，慢速脑损伤组的WM持续萎缩。脑损伤-正常组显示出一种不同的模式，可能表明回到健康的轨道。研究了颅脑损伤与对照组局部体积纵向变化的差异。研究发现，颅脑损伤组白质、灰质和皮质下区域体积的变化与认知能力的变化有关。以大脑半球间转移时间(IHTT)为依据比较脑损伤组内各亚组，结果显示慢脑损伤组与对照组相比，脑挫裂伤的驱动力增强，退变时间延长。
Traumatic brain injury (TBI) is a significant public health concern, and can be especially disruptive in children, derailing on-going neuronal maturation in periods critical for cognitive development. There is considerable heterogeneity in post-injury outcomes, only partially explained by injury severity. Understanding the time course of recovery, and what factors may delay or promote recovery, will aid clinicians in decision-making and provide avenues for future mechanism-based therapeutics. We examined regional changes in brain volume in a pediatric/adolescent moderate-severe TBI (msTBI) cohort, assessed at two time points. Children were first assessed 2–5 months post-injury, and again 12 months later. We used tensor-based morphometry (TBM) to localize longitudinal volume expansion and reduction. We studied 21 msTBI patients (5 F, 8–18 years old) and 26 well-matched healthy control children, also assessed twice over the same interval. In a prior paper, we identified a subgroup of msTBI patients, based on interhemispheric transfer time (IHTT), with significant structural disruption of the white matter (WM) at 2–5 months post injury. We investigated how this subgroup (TBI-slow, N = 11) differed in longitudinal regional volume changes from msTBI patients (TBI-normal, N = 10) with normal WM structure and function. The TBI-slow group had longitudinal decreases in brain volume in several WM clusters, including the corpus callosum and hypothalamus, while the TBI-normal group showed increased volume in WM areas. Our results show prolonged atrophy of the WM over the first 18 months post-injury in the TBI-slow group. The TBI-normal group shows a different pattern that could indicate a return to a healthy trajectory. Studied differences in regional volume change longitudinally between TBI and control. Found decreases in TBI group in white matter, gray matter and subcortical regions Changes in regional volume were associated with changes in cognitive performance. Compared subgroups within TBI group based on interhemispheric transfer time (IHTT) TBI-slow group seems to drive TBI vs. control results, show prolonged degeneration.