A prospective diffusion tensor imaging study in mild traumatic brain injury
A prospective diffusion tensor imaging study in mild traumatic brain injury
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DOI：
10.1212/wnl.0b013e3181d0ccdd
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发表时间：
2010-02-23
期刊：
影响因子：
9.9
通讯作者：
Yeo, R. A.
中科院分区：
文献类型：
--
作者：
Mayer, A. R.;Ling, J.;Yeo, R. A.
目的：只有少数研究对轻度创伤性脑损伤(MTBI)半急性期脑白质异常的性质、功能意义和病程进行了研究。本研究使用弥散张量成像(DTI)来研究脑白质的完整性，并比较传统解剖扫描、神经心理测试和DTI客观区分mTBI患者和对照组的准确性。方法：对22例半急性期脑损伤患者(平均为伤后12天)、21名匹配的健康对照组和更大样本的健康对照组(n=32)进行了广泛的影像和临床研究。结果：尽管效应大小与文献值一致，但MTBI患者在临床影像扫描或神经心理表现上与对照组没有差异。相反，mTBI患者表现出明显更大的分数各向异性，这是由于胼胝体和几个左半球束的放射状弥散系数降低所致。DTI测量在区分患者和对照组方面比传统的临床测量更准确。结论：目前脑白质异常的发现提示轻度创伤性脑损伤(MTBI)半急性期脑组织可能存在细胞毒性水肿。最初对轴突的机械损伤会破坏离子稳态和细胞内外水的比例，主要影响垂直于轴突的扩散。弥散张量成像测量可用于mTBI的客观分型，并可作为潜在的恢复生物标志物。神经病学(R)2010；74：643-650
Objectives: Only a handful of studies have investigated the nature, functional significance, and course of white matter abnormalities associated with mild traumatic brain injury (mTBI) during the semi-acute stage of injury. The present study used diffusion tensor imaging (DTI) to investigate white matter integrity and compared the accuracy of traditional anatomic scans, neuropsychological testing, and DTI for objectively classifying mTBI patients from controls.Methods: Twenty-two patients with semi-acute mTBI (mean = 12 days postinjury), 21 matched healthy controls, and a larger sample (n = 32) of healthy controls were studied with an extensive imaging and clinical battery. A subset of participants was examined longitudinally 3-5 months after their initial visit.Results: mTBI patients did not differ from controls on clinical imaging scans or neuropsychological performance, although effect sizes were consistent with literature values. In contrast, mTBI patients demonstrated significantly greater fractional anisotropy as a result of reduced radial diffusivity in the corpus callosum and several left hemisphere tracts. DTI measures were more accurate than traditional clinical measures in classifying patients from controls. Longitudinal data provided preliminary evidence of partial normalization of DTI values in several white matter tracts.Conclusions: Current findings of white matter abnormalities suggest that cytotoxic edema may be present during the semi-acute phase of mild traumatic brain injury (mTBI). Initial mechanical damage to axons disrupts ionic homeostasis and the ratio of intracellular and extracellular water, primarily affecting diffusion perpendicular to axons. Diffusion tensor imaging measurement may have utility for objectively classifying mTBI, and may serve as a potential biomarker of recovery. Neurology(R) 2010; 74: 643-650