Metabolic Levels in the Corpus Callosum and Their Structural and Behavioral Correlates after Moderate to Severe Pediatric TBI
Metabolic Levels in the Corpus Callosum and Their Structural and Behavioral Correlates after Moderate to Severe Pediatric TBI
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DOI：
10.1089/neu.2009.1058
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发表时间：
2010-03-01
影响因子：
4.2
通讯作者：
Asarnow, Robert F.
中科院分区：
文献类型：
--
作者：
Babikian, Talin;Marion, Sarah DeBoard;Asarnow, Robert F.
继发于外伤性脑损伤（TBI）的弥漫性轴索损伤（DAI）可导致长期功能紊乱。胼胝体（CC）特别容易受到这种类型的损伤。磁共振波谱（MRS）用于表征两个CC感兴趣区域（roi）（前侧和后侧）的代谢状态，以及它们的结构（弥散张量成像；DTI）和神经行为（神经认知功能、双手协调和半球间转移时间[IHTT]）的相关性。研究了两组中度/重度TBI患者（年龄12-18岁）：急性（损伤后5个月，n - 10）和慢性（损伤后14.7个月，n - 8），此外还有10名年龄匹配的健康对照。肌酸（能量代谢）在roi和时间点上各组之间没有差异。在TBI组中，两种roi的胆碱（膜变性/炎症）在急性期后升高，而非慢性期。两种roi的n -乙酰天冬氨酸（NAA）（神经元/轴突完整性）最初都降低，在慢性时间点部分正常化。NAA与DTI分数各向异性（FA）呈正相关（r = 0.88），与大多数神经认知领域呈正相关（r范围0.22-0.65），与IHTT呈负相关（r = -0.89）。肌酸与后侧FA （r = -0.76）、神经认知（r范围-0.22至-0.71）和IHTT （r = 0.76）呈负相关。在特定脑结构的不同时间点进行多模式研究对于描述TBI后的退行性和修复过程是必要的，这允许对随后功能发病率的神经机制的性质和过程进行初步假设。这将有助于指导未来靶向治疗药物的开发。
Diffuse axonal injury (DAI) secondary to traumatic brain injury (TBI) contributes to long-term functional morbidity. The corpus callosum (CC) is particularly vulnerable to this type of injury. Magnetic resonance spectroscopy (MRS) was used to characterize the metabolic status of two CC regions of interest (ROIs) (anterior and posterior), and their structural (diffusion tensor imaging; DTI) and neurobehavioral (neurocognitive functioning, bimanual coordination, and interhemispheric transfer time [IHTT]) correlates. Two groups of moderate/severe TBI patients (ages 12-18 years) were studied: post-acute (5 months post-injury; n - 10), and chronic (14.7 months post-injury; n 8), in addition to 10 age-matched healthy controls. Creatine (energy metabolism) did not differ between groups across both ROIs and time points. In the TBI group, choline (membrane degeneration/in-inflammation) was elevated for both ROIs at the post-acute but not chronic period. N-acetyl aspartate (NAA) (neuronal/axonal integrity) was reduced initially for both ROIs, with partial normalization at the chronic time point. Posterior, not anterior, NAA was positively correlated with DTI fractional anisotropy (FA) (r = 0.88), and most domains of neurocognition (r range 0.22-0.65), and negatively correlated with IHTT (r = -0.89). Inverse corerlations were noted between creatine and posterior FA (r = -0.76), neurocognition (r range -0.22 to -0.71), and IHTT (r = 0.76). Multimodal studies at distinct time points in specific brain structures are necessary to delineate the course of the degenerative and reparative processes following TBI, which allows for preliminary hypotheses about the nature and course of the neural mechanisms of subsequent functional morbidity. This will help guide the future development of targeted therapeutic agents.