PDF(Pubmed)
Abstract：
BACKGROUND: Mild traumatic brain injury (mTBI) can result in lasting brain damage that is often too subtle to detect by qualitative visual inspection on conventional MR imaging. Although a number of FDA-cleared MR neuroimaging tools have demonstrated changes associated with mTBI, they are still under-utilized in clinical practice.
METHODS: We investigated a group of 65 individuals with predominantly mTBI (60 mTBI, 48 due to motor-vehicle collision, mean age 47 ± 13 years, 27 men and 38 women) with MR neuroimaging performed in a median of 37 months post-injury. We evaluated abnormalities in brain volumetry including analysis of left-right asymmetry by quantitative volumetric analysis, cerebral perfusion by pseudo-continuous arterial spin labeling (PCASL), white matter microstructure by diffusion tensor imaging (DTI), and neurometabolites via magnetic resonance spectroscopy (MRS).
RESULTS: All participants demonstrated atrophy in at least one lobar structure or increased lateral ventricular volume. The globus pallidi and cerebellar grey matter were most likely to demonstrate atrophy and asymmetry. Perfusion imaging revealed significant reductions of cerebral blood flow in both occipital and right frontoparietal regions. Diffusion abnormalities were relatively less common though a subset analysis of participants with higher resolution DTI demonstrated additional abnormalities. All participants showed abnormal levels on at least one brain metabolite, most commonly in choline and N-acetylaspartate.
CONCLUSIONS: We demonstrate the presence of coup-contrecoup perfusion injury patterns, widespread atrophy, regional brain volume asymmetry, and metabolic aberrations as sensitive markers of chronic mTBI sequelae. Our findings expand the historic focus on quantitative imaging of mTBI with DTI by highlighting the complementary importance of volumetry, arterial spin labeling perfusion and magnetic resonance spectroscopy neurometabolite analyses in the evaluation of chronic mTBI.
METHODS: We investigated a group of 65 individuals with predominantly mTBI (60 mTBI, 48 due to motor-vehicle collision, mean age 47 ± 13 years, 27 men and 38 women) with MR neuroimaging performed in a median of 37 months post-injury. We evaluated abnormalities in brain volumetry including analysis of left-right asymmetry by quantitative volumetric analysis, cerebral perfusion by pseudo-continuous arterial spin labeling (PCASL), white matter microstructure by diffusion tensor imaging (DTI), and neurometabolites via magnetic resonance spectroscopy (MRS).
RESULTS: All participants demonstrated atrophy in at least one lobar structure or increased lateral ventricular volume. The globus pallidi and cerebellar grey matter were most likely to demonstrate atrophy and asymmetry. Perfusion imaging revealed significant reductions of cerebral blood flow in both occipital and right frontoparietal regions. Diffusion abnormalities were relatively less common though a subset analysis of participants with higher resolution DTI demonstrated additional abnormalities. All participants showed abnormal levels on at least one brain metabolite, most commonly in choline and N-acetylaspartate.
CONCLUSIONS: We demonstrate the presence of coup-contrecoup perfusion injury patterns, widespread atrophy, regional brain volume asymmetry, and metabolic aberrations as sensitive markers of chronic mTBI sequelae. Our findings expand the historic focus on quantitative imaging of mTBI with DTI by highlighting the complementary importance of volumetry, arterial spin labeling perfusion and magnetic resonance spectroscopy neurometabolite analyses in the evaluation of chronic mTBI.
摘要：
背景：轻度创伤性脑损伤（mTBI）可导致持续的脑损伤，这种损伤通常过于微妙，无法通过常规MR成像的定性视觉检查来检测。尽管许多FDA批准的MR神经成像工具已经证明了与mTBI相关的变化，它们在临床实践中仍未得到充分利用。
方法：我们调查了一组65名主要患有mTBI（60mTBI，48由于机动车碰撞，平均年龄47±13岁，27名男性和38名女性）的MR神经成像在受伤后的中位数为37个月。我们评估了脑容积异常，包括通过定量容积分析分析左右不对称性，通过伪连续动脉自旋标记（PCASL）进行脑灌注，扩散张量成像（DTI）白质微结构，和神经代谢物通过磁共振波谱（MRS）。
结果：所有参与者都表现出至少一个肺叶结构萎缩或侧脑室容积增加。苍白球和小脑灰质最有可能表现出萎缩和不对称。灌注成像显示枕骨和右额顶区域的脑血流量显着减少。尽管对具有较高分辨率DTI的参与者的子集分析显示出其他异常，但扩散异常相对较少见。所有参与者都显示出至少一种大脑代谢物的异常水平，最常见的是胆碱和N-乙酰天冬氨酸。
结论：我们证明了政变灌注损伤模式的存在，广泛的萎缩，局部脑容量不对称，和代谢异常作为慢性mTBI后遗症的敏感标志物。我们的发现通过强调体积学的互补重要性，扩大了对DTImTBI定量成像的历史重点，动脉自旋标记灌注和磁共振波谱神经代谢物分析在慢性mTBI评估中的应用。
方法：我们调查了一组65名主要患有mTBI（60mTBI，48由于机动车碰撞，平均年龄47±13岁，27名男性和38名女性）的MR神经成像在受伤后的中位数为37个月。我们评估了脑容积异常，包括通过定量容积分析分析左右不对称性，通过伪连续动脉自旋标记（PCASL）进行脑灌注，扩散张量成像（DTI）白质微结构，和神经代谢物通过磁共振波谱（MRS）。
结果：所有参与者都表现出至少一个肺叶结构萎缩或侧脑室容积增加。苍白球和小脑灰质最有可能表现出萎缩和不对称。灌注成像显示枕骨和右额顶区域的脑血流量显着减少。尽管对具有较高分辨率DTI的参与者的子集分析显示出其他异常，但扩散异常相对较少见。所有参与者都显示出至少一种大脑代谢物的异常水平，最常见的是胆碱和N-乙酰天冬氨酸。
结论：我们证明了政变灌注损伤模式的存在，广泛的萎缩，局部脑容量不对称，和代谢异常作为慢性mTBI后遗症的敏感标志物。我们的发现通过强调体积学的互补重要性，扩大了对DTImTBI定量成像的历史重点，动脉自旋标记灌注和磁共振波谱神经代谢物分析在慢性mTBI评估中的应用。
