Neuroimaging Methods for Diagnosis of Mild Traumatic Brain Injury

描述(由申请人提供)： 摘要/项目摘要轻度创伤性脑损伤(MTBI)是最近在伊拉克和阿富汗服役的退伍军人的主要发病率来源。使用弥散张量成像(DTI)来评估与mTBI相关的脑白质损害已经引起了人们的浓厚兴趣。该建议的目标是通过与一大批非脑外伤退伍军人进行比较，在单个受试者中提供脑白质损伤的定量评估和可视化。我们的方法包括执行全脑分析以创建FA(分数各向异性)图，该图通过与100名参照组的平均FA进行比较，提示单个受试者的脑白质损伤。我们提出了用于显著性检验的初步和验证性分析方法：(I)使用一种称为置换检验的非参数统计方法，然后对多个比较测试进行一种新颖的无阈值校正；(Ii)使用基于总体的推理统计来计算全脑Z-统计图，然后对多个比较进行更典型的基于聚类的校正。我们的初步数据表明，可以在单个受试者中有效地评估脑白质损伤。因此，我们的建议超越了将DTI应用于mTBI研究的传统方法，以进行小组比较。如果成功并在更大规模的研究中得到证实，我们提出的方法将为临床诊断单个mTBI患者提供客观的损伤证据。 公共卫生相关性： 项目简介轻度创伤性脑损伤(TBI)已经对OEF/OIF退伍军人的健康和福祉产生了不利影响。然而，轻度创伤性脑损伤的诊断和治疗一直具有挑战性，因为它与创伤后应激障碍和抑郁症有显著的重叠。人们对使用被称为弥散张量成像(DTI)的先进MRI方法来评估轻度脑外伤对脑组织的损害有着浓厚的兴趣。传统上，DTI仅用于对轻度脑外伤患者得出一般结论的研究，而不是专注于对个别患者的评估。拟议的研究计划将调查DTI的使用，以可视化个别退伍军人的脑损伤，以帮助诊断轻微的脑外伤。如果我们的方法是成功的，DTI可以用于临床评估轻度脑外伤。

DESCRIPTION (provided by applicant): Abstract / Project Summary Mild traumatic brain injury (mTBI) is a source of major morbidity in recent veterans who served in Iraq and Afghanistan. There has been keen interest in using diffusion tensor imaging (DTI) to assess white matter damage associated with mTBI. The goal of this proposal is to provide quantitative assessment and visualization of white matter damage in a single subject that is based on comparison to a large reference group of non-TBI veterans. Our approach involves performing a whole-brain analysis to create an FA (fractional anisotropy) map that is suggestive of white matter injury in a single subject by comparison to mean FA from a reference group of 100 subjects. We propose primary and confirmatory analytic methods for significance testing: (i) using a method of non-parametric statistics known as permutation testing followed by a novel "threshold-free" correction for multiple comparison testing, and (ii) using population based inferential statistics to compute whole brain Z-statistic map followed by more typical cluster-based correction for multiple comparisons. Our preliminary data suggests that white matter damage can be effectively assessed in single subjects. Thus, our proposal moves beyond the conventional application of DTI to mTBI research for making group comparisons. If successful and then confirmed in a larger scale study, the approach we propose would provide objective evidence of injury for diagnosing individual patients with mTBI in the clinical setting. PUBLIC HEALTH RELEVANCE: Project Narrative Mild traumatic brain injury (TBI) has had detrimental impact on the health and well-being of OEF/OIF veterans. However, the diagnosis and treatment of mild TBI has been challenging because of significant overlap with PTSD and depression. There has been keen interest in using advanced MRI methods called diffusion tensor imaging (DTI) to assess damage to brain tissue in mild TBI. Traditionally, DTI has only been used in research to draw general conclusions about patients with mild TBI but has not focused on assessment of individual patients. The proposed research program will investigate the use of DTI to visualize brain injury in individual veterans to aid in the diagnosis of mild TBI. If our approach is successful, DTI could be used for evaluation of mild TBI in the clinic.