Increased gray matter diffusion anisotropy in patients with persistent post-concussive symptoms following mild traumatic brain injury.
Increased gray matter diffusion anisotropy in patients with persistent post-concussive symptoms following mild traumatic brain injury.
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DOI：
10.1371/journal.pone.0066205
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发表时间：
2013
期刊：
影响因子：
3.7
通讯作者：
Shenton ME
中科院分区：
文献类型：
--
作者：
Bouix S;Pasternak O;Rathi Y;Pelavin PE;Zafonte R;Shenton ME
诊断为轻度创伤性脑损伤（mTBI）的个体中有很大比例会出现持续性脑震荡后症状（PPCS）。关于这些症状的病理学知之甚少，并且通常没有基于常规临床成像的放射学证据。我们的目的是利用方法来评估微观组织结构的变化，并确定是否与PPCS的链接。开发了一种新的分析方法，用于在高分辨率弥散张量成像（DTI）中识别脑损伤位置不均匀时的异常。从47名正常对照者中建立了一个包含145个感兴趣脑区（ROI）的标准图谱。将每个受试者的扩散测量值与图谱进行比较，生成受试者特定的损伤概况。异常ROI由高于给定阈值的绝对z分数值定义。该方法应用于11例PPCS患者mTBI和11个匹配的对照。每个个体的Z评分信息用两个位置无关的指标进行总结：“负荷”（异常区域的数量）和“严重程度”（最大绝对Z评分）。然后使用Wilcoxon秩和检验计算组差异。结果显示，与对照组相比，患者的各向异性分数（FA）的负荷（p= 0.018）和严重程度（p =0.006）在统计学上显著更高。 受试者特异性损伤表现为灰质FA异常高（11例患者中发生30例），白色物质FA异常低（11例受试者中发生3例）。受试者特异性特征提供了关于PPCS相关病理学的重要信息。灰质（GM）各向异性增加是一种新的体内发现，这与脑创伤动物模型一致，该模型将GM中FA增加与神经胶质增生等病理学相关。此外，个体化分析显示了增强PPCS患者临床护理的前景，因为它可以在诊断使用常规成像无法显示的脑损伤中发挥作用。
A significant percentage of individuals diagnosed with mild traumatic brain injury (mTBI) experience persistent post-concussive symptoms (PPCS). Little is known about the pathology of these symptoms and there is often no radiological evidence based on conventional clinical imaging. We aimed to utilize methods to evaluate microstructural tissue changes and to determine whether or not a link with PPCS was present. A novel analysis method was developed to identify abnormalities in high-resolution diffusion tensor imaging (DTI) when the location of brain injury is heterogeneous across subjects. A normative atlas with 145 brain regions of interest (ROI) was built from 47 normal controls. Comparing each subject’s diffusion measures to the atlas generated subject-specific profiles of injury. Abnormal ROIs were defined by absolute z-score values above a given threshold. The method was applied to 11 PPCS patients following mTBI and 11 matched controls. Z-score information for each individual was summarized with two location-independent measures: “load” (number of abnormal regions) and “severity” (largest absolute z-score). Group differences were then computed using Wilcoxon rank sum tests. Results showed statistically significantly higher load (p = 0.018) and severity (p = 0.006) for fractional anisotropy (FA) in patients compared with controls. Subject-specific profiles of injury evinced abnormally high FA regions in gray matter (30 occurrences over 11 patients), and abnormally low FA in white matter (3 occurrences over 11 subjects). Subject-specific profiles provide important information regarding the pathology associated with PPCS. Increased gray matter (GM) anisotropy is a novel in-vivo finding, which is consistent with an animal model of brain trauma that associates increased FA in GM with pathologies such as gliosis. In addition, the individualized analysis shows promise for enhancing the clinical care of PPCS patients as it could play a role in the diagnosis of brain injury not revealed using conventional imaging.
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