Diffusion Tensor Imaging of Mild to Moderate Blast-Related Traumatic Brain Injury and Its Sequelae
Diffusion Tensor Imaging of Mild to Moderate Blast-Related Traumatic Brain Injury and Its Sequelae
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DOI：
10.1089/neu.2009.1073
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发表时间：
2010-04-01
影响因子：
4.2
通讯作者：
Li, Xiaoqi
中科院分区：
文献类型：
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作者：
Levin, Harvey S.;Wilde, Elisabeth;Li, Xiaoqi
为评价轻中度爆炸性脑损伤（TBI）对脑白色物质（WM）显微结构和神经行为的影响，我们对37名退伍军人和现役军人进行了研究（平均年龄31.5岁，SD = 7.2;伤后间隔871.5天; SD = 343.1），其急性神经系统状态的报告与在伊拉克或阿富汗服役期间因爆炸而持续轻度至中度TBI一致。15名无创伤性脑损伤史或爆炸暴露史的退伍军人（平均年龄31.4岁，SD = 5.4）作为对照组，包括7名颅外损伤受试者（伤后间隔919.5天，SD = 455.1）和8名未受伤受试者。磁共振成像显示局灶性病变在五个TBI参与者。脑震荡后症状（神经行为症状量表），创伤后应激障碍（PTSD）症状（PTSD检查表-平民），和全球性的痛苦和抑郁症（简要症状量表）在TBI参与者比对照组更糟，但没有组间差异被发现在感知的身体或精神功能（SF-12）。语言记忆（选择性提醒）在TBI组中效率较低，但在非语言记忆（选择性提醒）或决策（爱荷华州赌博任务）方面没有组间差异。TBI组的言语记忆与PTSD的严重程度无关。采用纤维束成像、标准单层感兴趣区测量和基于体素的分析的扩散张量成像（DTI）显示，各向异性分数（FA）和表观扩散系数（ADC）无组间差异。然而，FA的左，右后内囊和左皮质脊髓束与总的话一直回忆呈正相关，而ADC的左，右钩束和左后内囊呈负相关，这一措施的言语记忆。DTI变量与症状测量的相关性不显著且不一致。我们的数据并没有显示在轻度至中度爆炸相关的TBI退伍军人WM损伤，尽管他们的残留症状和言语记忆困难。研究的局限性和对未来研究的影响也进行了讨论。
To evaluate the effects of mild to moderate blast-related traumatic brain injury (TBI) on the microstructure of brain white matter (WM) and neurobehavioral outcomes, we studied 37 veterans and service members (mean age 31.5 years, SD = 7.2; post-injury interval 871.5 days; SD = 343.1), whose report of acute neurological status was consistent with sustaining mild to moderate TBI due to blast while serving in Iraq or Afghanistan. Fifteen veterans without a history of TBI or exposure to blast (mean age 31.4 years, SD = 5.4) served as a comparison group, including seven subjects with extracranial injury (post-injury interval 919.5 days, SD = 455.1), and eight who were uninjured. Magnetic resonance imaging disclosed focal lesions in five TBI participants. Post-concussion symptoms (Neurobehavioral Symptom Inventory), post-traumatic stress disorder (PTSD) symptoms (PTSD Checklist-Civilian), and global distress and depression (Brief Symptom Inventory) were worse in the TBI participants than the comparison group, but no group differences were found in perceived physical or mental functioning (SF-12). Verbal memory (Selective Reminding) was less efficient in the TBI group, but there were no group differences in nonverbal memory (Selective Reminding) or decision making (Iowa Gambling Task). Verbal memory in the TBI group was unrelated to PTSD severity. Diffusion tensor imaging (DTI) using tractography, standard single-slice region-of-interest measurement, and voxel-based analysis disclosed no group differences in fractional anisotropy (FA) and apparent diffusion coefficient (ADC). However, FA of the left and right posterior internal capsule and left corticospinal tract was positively correlated with total words consistently recalled, whereas ADC for the left and right uncinate fasciculi and left posterior internal capsule was negatively correlated with this measure of verbal memory. Correlations of DTI variables with symptom measures were nonsignificant and inconsistent. Our data do not show WM injury in mild to moderate blast-related TBI in veterans despite their residual symptoms and difficulty in verbal memory. Limitations of the study and implications for future research are also discussed.