Diffusion tensor imaging detects clinically important axonal damage after mild traumatic brain injury: A pilot study
Diffusion tensor imaging detects clinically important axonal damage after mild traumatic brain injury: A pilot study
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DOI：
10.1089/neu.2007.0241
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发表时间：
2007-09-01
影响因子：
4.2
通讯作者：
Peterson, Derick
中科院分区：
文献类型：
--
作者：
Bazarian, Jeffrey J.;Zhong, Jianhui;Peterson, Derick
目前研究的目的是利用弥散张量成像(DTI)检测轻度创伤性脑损伤(TBI)后临床上重要的脑白质轴突损伤。为此，我们对6名单纯性轻度脑外伤患者和6名配对的骨科对照患者进行了前瞻性、先导性研究。所有受试者在受伤后72小时内接受DTI扫描、脑震荡后症状(PCS)评估和神经行为测试。用分位数方法比较了轻度脑损伤组和对照组全脑白质体素和5个预选感兴趣区的分数各向异性(FA)和示踪值。此外，使用基于体素的形态计量学对全脑图像进行了分析。所有受试者在1个月时接受生活质量和重复PCS评估。全脑图像显示轻度颅脑损伤受试者的1(St)百分位数踪迹值显著降低(平均值为0.465比0.488，p=0.049)。这些示踪值与72h(r=-0.57，p=0.05)和1个月(r=-0.61，p=0.04)的PCS评分呈正相关。ROI分析显示，轻度颅脑损伤受试者左侧前内囊的平均痕迹(0.536比0.574，p=0.007)显著低于对照组(P=0.007)，而胼胝体后部的最大感兴趣区特定中位数FA值(平均0.801比0.756，p=0.035)更高。这些FA值与72小时PCS评分(r=0.63，p=0.03)和两项神经行为测试(视觉运动速度[r=-0.63，p=0.03]和冲动控制[r=0.59，p=0.04]相关。总体而言，DTI检测到轻度脑外伤受试者与对照组相比，微量FA值显著降低，FA值显著升高。这些异常与不良的临床结局有关。我们认为这些发现代表了轴突肿胀，这是轴突损伤过程中的早期步骤。
The goal of the current investigation was to detect clinically important axonal damage in cerebral white matter after mild traumatic brain injury (TBI) using diffusion tensor imaging (DTI). To this end, we evaluated a prospective, pilot study of six subjects with isolated mild TBI and six matched orthopedic controls. All subjects underwent DTI scanning, post-concussive symptom (PCS) assessment, and neurobehavioral testing within 72 h of injury. Fractional anisotropy (FA) and trace values in white matter voxels of whole brain and five preslected regions of interest (ROI) were compared in mild TBI and control subjects using a quantile approach. In addition, whole brain images were analyzed using voxel-based morphometry. All subjects underwent quality of life and repeat PCS assessment at 1 month. Whole brain images revealed significantly lower 1(st) percentile trace values (mean 0.465 vs. 0.488, p = 0.049) among mild TBI subjects. These trace values correlated with PCS scores at both 72 h (r = -0.57, p = 0.05) and 1 month (r = -0.61, p = 0.04). Analysis of ROIs showed mild TBI subjects to have significantly lower mean trace in the left anterior internal capsule (0.536 vs. 0.574, p = 0.007) and higher maximum ROI-specific median FA values (mean 0.801 vs. 0.756, p = 0.035) in the posterior corpus callosum. These FA values correlated with 72-h PCS score (r = 0.63, p = 0.03), and two neurobehavioral tests (visual motor speed [r = -0.63, p = 0.03] and impulse control [r = 0.59, p = 0.04]). Collectively, DTI detected significantly lower trace and elevated FA values in mild TBI subjects compared to controls. These abnormalities correlated to poor clinical outcome. We believe these findings represent axonal swelling, an early step in the process of axonal injury.