The Toronto traumatic brain injury study - Injury severity and quantified MRI
The Toronto traumatic brain injury study - Injury severity and quantified MRI
复制标题
DOI：
10.1212/01.wnl.0000304108.32283.aa
复制
发表时间：
2008-03-04
期刊：
影响因子：
9.9
通讯作者：
Black, S. E.
中科院分区：
文献类型：
--
作者：
Levine, B.;Kovacevic, N.;Black, S. E.
目的：为了评估区域脑容量的变化和创伤性脑损伤（TBI）的严重程度与患者和无focal lesions.Methods的关系：69慢性期TBI患者跨越整个范围的严重程度被招募从连续入院。患者在受伤后至少1年接受高分辨率结构MRI。多变量统计分析评估了38个脑区的灰质、白色物质、脑沟/硬膜下和脑室CSF体积与损伤时昏迷深度评估的TBI严重程度之间的协方差模式。弥漫性和弥漫性加局灶性损伤患者分别和together.Results：有一个逐步的，剂量反应关系的实质体积损失和TBI的严重程度。将中度和重度TBI患者与轻度TBI患者区分开来，后者又与未受伤的对照受试者区分开来。体积损失的空间广泛模式与TBI严重程度相关，对白色物质体积和脑沟/硬膜下CSF的影响尤其广泛。在额叶、颞叶和扣带回区域观察到了最可靠的效应，尽管几乎在每个大脑区域都观察到了不同程度的效应。局灶性病变与额颞区更大的体积损失，但体积损失仍然显着，即使分析仅限于患者弥漫性injure.Conclusions：模式的实质体积变化可以区分创伤性脑损伤（TBI）的严重程度，即使在轻度TBI。TBI引起空间上广泛的体积损失模式，反映了局灶性和弥漫性损伤的独立但重叠的贡献。
Objective: To assess the relationship between regional brain volume changes and traumatic brain injury (TBI) severity in patients with and without focal lesions.Methods: Sixty-nine chronic-phase TBI patients spanning the full range of severity were recruited from consecutive hospital admissions. Patients received high-resolution structural MRI a minimum of 1 year after injury. Multivariate statistical analyses assessed covariance patterns between volumes of gray matter, white matter, and sulcal/subdural and ventricular CSF across 38 brain regions and TBI severity as assessed by depth of coma at the time of injury. Patients with diffuse and diffuse plus focal injury were analyzed both separately and together.Results: There was a stepwise, dose-response relationship between parenchymal volume loss and TBI severity. Patients with moderate and severe TBI were differentiated from those with mild TBI, who were in turn differentiated from noninjured control subjects. A spatially extensive pattern of volume loss covaried with TBI severity, with particularly widespread effects in white matter volume and sulcal/subdural CSF. The most reliable effects were observed in the frontal, temporal, and cingulate regions, although effects were observed to varying degrees in nearly every brain region. Focal lesions were associated with greater volume loss in frontal and temporal regions, but volume loss remained marked even when analyses were restricted to patients with diffuse injury.Conclusions: Patterns of parenchymal volumetric changes can differentiate among levels of traumatic brain injury (TBI) severity, even in mild TBI. TBI causes a spatially extensive pattern of volume loss that reflects independent but overlapping contributions of focal and diffuse injury.