Emily Dennis, Karen Caeyenberghs, Talin Babikian, Alexander Olsen, Christopher Giza, Robert Asarnow, Harvey Levin, Peter Kochunov, Neda Jahanshad, Paul Thompson, David Tate, Elisabeth Wilde
Traumatic brain injury (TBI) is a major public health issue around the world. Pediatric TBI patients are at risk of long-term disabilities, as a brain injury sustained during development can affect on-going maturational processes. The white matter (WM) in particular is vulnerable, as myelination continues into the third decade of life and beyond, and poor myelination of tracts can result in decreased integration within brain networks. In addition, variability and heterogeneity are hallmarks of TBI, e.g., injury-related variables and symptoms. These issues combined with small sample sizes limit the power and generalizability of individual studies. In the present study, we employed a meta-analytic approach, combining data across 4 pediatric TBI samples resulting in 104 TBI (75M/29F) and 114 control participants (70M/44F) between 7-18 years, using harmonized processing and analysis as part of the ENIGMA consortium (Enhancing NeuroImaging Genetics through Meta-Analysis). We report lower fractional anisotropy (FA) values in TBI patients across several post-injury windows, particularly in central WM tracts. Within the TBI patient group, we also report marginally significant results of lower FA in younger TBI patients, patients scanned closer to time of injury, and female patients. Although this meta-analytic approach yielded the largest sample size reported yet in pediatric moderate/severe TBI (msTBI) neuroimaging, our trends indicate that larger sample sizes are needed in further studies. As additional cohorts join the ENIGMA Pediatric moderate/severe TBI (msTBI) effort, more robust effects will be revealed.
Mild traumatic brain injury (mTBI) is characterized clinically by a closed head injury involving differential or rotational movement of the brain inside the skull. Over 3 million mTBIs occur annually in the United States alone. Many of the individuals who sustain an mTBI go on to recover fully, but around 20% experience persistent symptoms. These symptoms often last for many weeks to several months. The thalamus, a structure known to serve as a global networking or relay system for the rest of the brain, may play a critical role in neurorehabiliation and its integrity and connectivity after injury may also affect cognitive outcomes. To examine the thalamus, conventional tractography methods to map corticothalamic pathways with diffusion-weighted MRI (DWI) lead to sparse reconstructions that may contain false positive fibers that are anatomically inaccurate. Using a specialized method to zero in on corticothalamic pathways with greater robustness, we noninvasively examined corticothalamic fiber projections using DWI, in 68 service members. We found significantly lower fractional anisotropy (FA), a measure of white matter microstructural integrity, in pathways projecting to the left pre- and postcentral gyri – consistent with sensorimotor deficits often found post-mTBI. Mapping of neural circuitry in mTBI may help to further our understanding of mechanisms underlying recovery post-TBI.
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