Regional Cerebral Metabolism in Blast-Induced Mild Traumatic Brain Injury

描述(由申请人提供)： 冲击波诱发的创伤性脑损伤是最近在阿富汗和伊拉克冲突中服役的军事人员中的主要损伤。即使在轻微的脑损伤后，脑震荡后综合征也经常发生持续的长期认知障碍，这直接影响到服役人员的健康和安全。对结构性和/或功能性脑损伤的准确诊断、评估和预后是极其重要和迫切需要的。遗憾的是，目前对轻度脑外伤的诊断和评估主要是基于自我报告的病史、主观测量和临床结果。常规的结构影像检查，如CT或MRI，在评估轻度颅脑损伤中的作用非常有限。近年来，多项研究表明正电子发射断层扫描(PET)是检测轻型颅脑损伤患者局部脑代谢(RCM)改变的可靠工具，并有可能客观评价轻型颅脑损伤的功能损害。由于其生化敏感性和可定量测量，已发现即使在没有明显结构变化的情况下，也能够检测到RCM的细微变化。尽管PET在评估轻度颅脑损伤方面有很大的潜力，但由于异常发现模式的多样性，先前研究得出的结论有限，部分原因是其他并发症，如创伤后应激障碍(PTSD)，在临床、神经行为和影像表现上引入了令人困惑的结果。在这个项目中，我们将评估因冲击波诱导的轻度脑损伤而持续脑震荡综合征患者的局部脑代谢变化。创伤后应激障碍患者将被包括在内，以了解令人困惑的发现。本次研究共招募210名受试者，每组70人(创伤后应激障碍；创伤后应激障碍；健康对照)。我们将测量RCM，并为所有个人进行标准的神经心理评估。将应用适当的统计分析来比较不同组之间的RCM和认知功能/神经行为结果。我们将确定RCM和神经行为结果之间是否有任何相关性。本研究的结果将有助于我们了解颅脑损伤的病理生理变化，尤其是代谢变化。RCM异常的严重程度和程度将作为临床评估和可能的预后的客观指标。

DESCRIPTION (provided by applicant): Blast-induced traumatic brain injury (TBI) is the leading injury among military personnel who were serving in recent conflicts in Afghanistan and Iraq. Post-concussive syndrome with persistent long term cognitive impairment frequently occurs even after mild TBI, which directly impacts the health and safety of service members. Accurate diagnosis, assessment, and prognosis of structural and/or functional brain injury are extremely important and urgently needed. Unfortunately, current diagnosis and assessment for mild TBI are mainly based on self reported history, subjective measures and clinical findings. Conventional structural imaging studies such as CT or MRI have a very limited role in evaluation of mild TBI. Recently, several studies have demonstrated that Positron Emission Tomography (PET) is a reliable tool for detection of regional cerebral metabolic (RCM) changes in mild-TBI and have potential to objectively assess the functional impairment of mild TBI. PET, due to its biochemical sensitivity and quantitative measurability, has been found being able to detect subtle changes in RCM even without apparent structural changes. Despite the promising potential of PET in mild TBI evaluation, conclusion from prior studies has been limited due to variability in pattern of abnormal findings, partly due to other comorbidities such as Post Traumatic Stress Disorder (PTSD) which introduce confounding findings in clinical, neurobehavioral, and imaging presentation. In this project we will evaluate the regional cerebral metabolism changes in patients who had sustained post-concussion syndrome due to blast-induced mild TBI. PTSD patients will be included to understand the confounding findings. A total number of 210 individuals will be recruited in this study with 70 in each group (TBI; PTSD; healthy control). We will measure RCM and conduct standard neuropsychological assessments for all individuals. Appropriate statistical analyses will be applied to compare RCM and cognitive function/neurobehavioral findings among different groups. We will determine whether there is any correlation between RCM and neurobehavioral findings. The result of this study will help us understand the pathophysiological changes, especially the metabolic changes of TBI. The severity and extent of abnormal RCM findings will serve as an objective measurement for clinical evaluation, and possibly prognosis of mild TBI.