Longitudinal changes in the corpus callosum following pediatric traumatic brain injury.
Longitudinal changes in the corpus callosum following pediatric traumatic brain injury.
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小儿创伤性脑损伤后胼胝体的纵向变化。
DOI：
10.1159/000317058
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发表时间：
2010
影响因子：
2.9
通讯作者：
Levin,HarveyS
中科院分区：
文献类型：
--
作者：
Wu,TrevorC;Wilde,ElisabethA;Bigler,ErinD;Li,Xiaoqi;Merkley,TriciaL;Yallampalli,Ragini;McCauley,StephenR;Schnelle,KathleenP;Vasquez,AnaC;Chu,Zili;Hanten,Gerri;Hunter,JillV;Levin,HarveyS
背景胼胝体萎缩（CC）是中度至重度创伤性脑损伤（TBI）的一个有记录的后果，使用定量磁共振成像（MRI）将其表示为体积损失。其他先进的成像方式，例如扩散张量成像 (DTI) 也检测到 CC 中 TBI 后的白质微观结构改变。儿科 TBI 后随着时间的推移，宏观结构变化（例如体积和微观结构变化）的方式和程度，以及它们与处理速度测量的关系是本纵向研究的重点。因此，确定了 TBI 参与者和对照组在受伤后约 3 个月和 18 个月时的 DTI 和 CC 体积变化，以及它们与处理速度的关系。方法对 48 名 7-17 岁的患有复杂轻度或中度至重度 TBI（n = 23）或骨科损伤（OI；n = 25）的儿童和青少年进行了研究。参与者接受了脑部 MRI 检查，并在两个时间点进行了 Eriksen 侧翼任务。结果在受伤后 3 个月，总 CC 及其分区（膝部/前部、身体/中央和压部/后部）的 DTI 指标存在显着的组间差异，与 OI 组相比，TBI 组表现出显着较低的各向异性分数 (FA) 和较高的表观扩散系数 (ADC)。这些组间差异在所有 CC 亚区域损伤后 18 个月时也存在，TBI 组的 FA 较低，ADC 较高。就 DTI 的纵向变化而言，尽管平均 FA 存在组间差异，但随着时间的推移，两组通常都表现出 FA 适度增加，尽管这种增加仅在压部/后亚区域显着。有趣的是，TBI 组通常还表现出 ADC 从 3 个月增加到 18 个月，尽管 OI 组表现出 ADC 随着时间的推移而下降。从体积上看，3个月时，中前部和身体/中央分区以及总CC的组间差异微乎其微。然而，到 18 个月时，与 OI 组相比，TBI 组除压部/后区外的所有分区的体积均显着减小。与 OI 组不同，OI 组的 CC 子区域体积随时间显着增加，而 TBI 组则表现出显着且一致的体积减少。在两次访问中，处理速度测量的表现并没有区分各组，只有 OI 组随着时间的推移表现出显着改善的表现。在这两种情况下，处理速度仅在 TBI 组中与压部/后部的 FA 和总 CC 相关，并且在 18 个月时相关性更强。然而，在微观结构水平上，DTI 显示了即使在受损的 CC 中也持续成熟和发育的指标，以及潜在退行性变化的证据。与可能反映整体神经元损失和轴突损伤程度的体积测量不同，DTI 可能反映 TBI 后白质损伤后成熟和适应的某些方面。多模态成像研究对于进一步了解儿童 TBI 的长期后果可能很重要。
BackgroundAtrophy of the corpus callosum (CC) is a documented consequence of moderate-to-severe traumatic brain injury (TBI), which has been expressed as volume loss using quantitative magnetic resonance imaging (MRI). Other advanced imaging modalities such as diffusion tensor imaging (DTI) have also detected white matter microstructural alteration following TBI in the CC. The manner and degree to which macrostructural changes such as volume and microstructural changes develop over time following pediatric TBI, and their relation to a measure of processing speed is the focus of this longitudinal investigation. As such, DTI and volumetric changes in the CC in participants with TBI and a comparison group at approximately 3 and 18 months after injury as well as their relation to processing speed were determined.MethodsForty-eight children and adolescents aged 7–17 years who sustained either complicated mild or moderate-to-severe TBI (n= 23) or orthopedic injury (OI; n= 25) were studied. The participants underwent brain MRI and were administered the Eriksen flanker task at both time points.ResultsAt 3 months after injury, there were significant group differences in DTI metrics in the total CC and its subregions (genu/anterior, body/central and splenium/posterior), with the TBI group demonstrating significantly lower fractional anisotropy (FA) and a higher apparent diffusion coefficient (ADC) in comparison to the OI group. These group differences were also present at 18 months after injury in all CC subregions, with lower FA and a higher ADC in the TBI group. In terms of longitudinal changes in DTI, despite the group difference in mean FA, both groups generally demonstrated a modest increase in FA over time though this increase was only significant in the splenium/posterior subregion. Interestingly, the TBI group also generally demonstrated ADC increases from 3 to 18 months though the OI group demonstrated ADC decreases over time. Volumetrically, the group differences at 3 months were marginal for the midanterior and body/central subregions and total CC. However, by 18 months, the TBI group demonstrated a significantly decreased volume in all subregions except the splenium/posterior area relative to the OI group. Unlike the OI group, which showed a significant volume increase in subregions of the CC over time, the TBI group demonstrated a significant and consistent volume decrease. Performance on a measure of processing speed did not differentiate the groups at either visit, and only the OI group showed significantly improved performance over time. Processing speed was related to FA in the splenium/posterior and total CC only in the TBI group on both occasions, with a stronger relation at 18 months.ConclusionIn response to TBI, macrostructural volume loss in the CC occurred over time; yet, at the microstructural level, DTI demonstrated both indicators of continued maturation and development even in the damaged CC, as well as evidence of potential degenerative change. Unlike volumetrics, which likely reflects the degree of overall neuronal loss and axonal damage, DTI may reflect some aspects of postinjury maturation and adaptation in white matter following TBI. Multimodality imaging studies may be important to further understand the long-term consequences of pediatric TBI.
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影响因子：
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作者：
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DOI：
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发表时间：
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作者：
T. Wu;E. Wilde;E. Bigler;R. Yallampalli;S. McCauley;M. Troyanskaya;Z. Chu;Xiaoqi Li;Gerri R. Hanten;J. Hunter;H. Levin
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