Prospective longitudinal MRI study of brain volumes and diffusion changes during the first year after moderate to severe traumatic brain injury
Prospective longitudinal MRI study of brain volumes and diffusion changes during the first year after moderate to severe traumatic brain injury
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DOI：
10.1016/j.nicl.2014.03.012
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发表时间：
2014-01-01
影响因子：
4.2
通讯作者：
Haberg, Asta K.
中科院分区：
文献类型：
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作者：
Brezova, Veronika;Moen, Kent Goran;Haberg, Asta K.
本研究对62例中重度颅脑损伤患者进行前瞻性研究，采用受试者内设计，在伤后早期(1~26天)、3个月和12个月复查MRI，观察皮质灰质(GM)、海马、豆状核、脑叶白质(WM)、脑干和脑室的体积变化，并评估皮质、海马和脑干正常组织中GM表观弥散系数(ADC)的变化。评估入院时格拉斯哥昏迷评分(GCS)、创伤后遗忘(PTA)持续时间和弥漫性轴索损伤(DAI)分级对脑体积和ADC值的影响。最后，我们确定从3个月扫描得到的MRI脑体积是否为格拉斯哥预后量表分类的12个月结果提供了额外的、显著的预测价值-在调整GCS、PTA和年龄后延长。皮质GM丢失迅速，大部分在3个月内完成，但体积减少与GCS评分、PTA或DAI无关。然而，3个月时皮质GM的体积是12个月预后的重要独立预测因子。在12个月时，海马区和豆状核区的体积丢失持续时间较长，并有统计学意义。皮质和皮质下GGM的体积随时间减少的斜率有显著不同。在PTA和GT；2周的个体中，海马体体积的减少最为明显和迅速。在调整了GCS、PTA和年龄后，3个月的海马体和豆状核体积是12个月预后的最好独立预测因素。在脑干中，体积损失在3个月和12个月时都是显著的。脑干体积减少与较低的GCS评分和DAI的存在相关。肺叶白质体积在12个月后首先明显减少。令人惊讶的是，DAI等级对大叶WM量没有影响。脑室扩张主要发生在前3个月，并与脑干和皮质GM的体积变化密切相关，但与脑叶WM的体积无关。重度颅脑损伤、DAI和PTA>；从3个月起持续2周的患者，大脑皮质ADC值较高。ADC值与脑体积之间没有关联，ADC值也不能预测结果。(C)2014年提交人。由Elsevier Inc.发布。这是一篇CC BY-NC-ND许可下的开放获取文章
The objectives of this prospective study in 62 moderate-severe TBI patients were to investigate volume change in cortical gray matter (GM), hippocampus, lenticular nucleus, lobar white matter (WM), brainstem and ventricles using a within subject design and repeated MRI in the early phase (1-26 days) and 3 and 12 months postinjury and to assess changes in GM apparent diffusion coefficient (ADC) in normal appearing tissue in the cortex, hippocampus and brainstem. The impact of Glasgow Coma Scale (GCS) score at admission, duration of post-traumatic amnesia (PTA), and diffusion axonal injury (DAI) grade on brain volumes and ADC values over time was assessed. Lastly, we determined ifMRI-derived brain volumes from the 3-month scans provided additional, significant predictive value to 12-month outcome classified with the Glasgow Outcome Scale-Extended after adjusting for GCS, PTA and age.Cortical GM loss was rapid, largely finished by 3 months, but the volume reduction was unrelated to GCS score, PTA, or presence of DAI. However, cortical GM volume at 3 months was a significant independent predictor of 12-month outcome. Volume loss in the hippocampus and lenticular nucleus was protracted and statistically significant first at 12 months. Slopes of volume reduction over time for the cortical and subcortical GGM were significantly different. Hippocampal volume loss was most pronounced and rapid in individuals with PTA > 2 weeks. The 3-month volumes of the hippocampus and lentiform nucleus were the best independent predictors of 12-month outcome after adjusting for GCS, PTA and age. In the brainstem, volume loss was significant at both 3 and 12 months. Brainstem volume reduction was associated with lower GCS score and the presence of DAI. Lobar WM volume was significantly decreased first after 12 months. Surprisingly DAI grade had no impact on lobar WM volume. Ventricular dilation developed predominantly during the first 3 months, and was strongly associated with volume changes in the brainstem and cortical GM, but not lobar WM volume. Higher ADC values were detected in the cortex in individuals with severe TBI, DAI and PTA > 2 weeks, from 3 months. There were no associations between ADC values and brain volumes, and ADC values did not predict outcome. (C) 2014 The Authors. Published by Elsevier Inc. This is an open access article under the CC BY-NC-ND license