Data_Sheet_1_Longitudinal Neuroimaging in Pediatric Traumatic Brain Injury: Current State and Consideration of Factors That Influence Recovery.PDF

Traumatic brain injury (TBI) is a leading cause of death and disability for children and adolescents in the U.S. and other developed and developing countries. Injury to the immature brain varies greatly from that of the mature, adult brain due to numerous developmental, pre-injury, and injury-related factors that work together to influence the trajectory of recovery during the course of typical brain development. Substantial damage to brain structure often underlies subsequent functional limitations that persist for years following pediatric TBI. Advances in neuroimaging have established an important role in the acute management of pediatric TBI, and magnetic resonance imaging (MRI) techniques have a particular relevance for the sequential assessment of long-term consequences from injuries sustained to the developing brain. The present paper will discuss the various factors that influence recovery and review the findings from the present neuroimaging literature to assess altered development and long-term outcome following pediatric TBI. Four MR-based neuroimaging modalities have been used to examine recovery from pediatric TBI longitudinally: (1) T1-weighted structural MRI is sensitive to morphological changes in gray matter volume and cortical thickness, (2) diffusion-weighted MRI is sensitive to changes in the microstructural integrity of white matter, (3) MR spectroscopy provides a sensitive assessment of metabolic and neurochemical alterations in the brain, and (4) functional MRI provides insight into the functional changes that occur as a result of structural damage and typical developmental processes. As reviewed in this paper, 13 cohorts have contributed to only 20 studies published to date using neuroimaging to examine longitudinal changes after TBI in pediatric patients. The results of these studies demonstrate considerable heterogeneity in post-injury outcome; however, the existing literature consistently shows that alterations in brain structure, function, and metabolism can persist for an extended period of time post-injury. With larger sample sizes and multi-site cooperation, future studies will be able to further examine potential moderators of outcome, such as the developmental, pre-injury, and injury-related factors discussed in the present review.

脑外伤（TBI）是美国及其他发达和发展中国家儿童和青少年死亡及残疾的主要原因。由于发育、受伤前及受伤相关因素众多，这些因素相互作用共同影响典型大脑发育过程中的恢复轨迹，因此不成熟的大脑受伤情况与成熟成人大脑受伤情况存在显著差异。大脑结构的严重损伤常常是导致儿童脑外伤后多年持续存在的功能限制的根源。神经影像学的进步在儿童脑外伤的急性管理中发挥了重要作用，而磁共振成像（MRI）技术在评估发育中大脑受伤的长期后果方面具有特别的意义。本文将讨论影响恢复的各种因素，并回顾神经影像学文献中的发现，以评估儿童脑外伤后的发育改变及长期预后。本研究使用基于MRI的四种神经影像学方法对儿童脑外伤的恢复进行纵向研究：（1）T1加权结构MRI对灰质体积和皮质厚度的形态学变化敏感；（2）扩散加权MRI对白质微结构完整性的变化敏感；（3）MR波谱学能够对大脑的代谢和神经化学改变进行敏感评估；（4）功能性MRI能够揭示由于结构损伤及典型发育过程引起的功能变化。正如本文所述，13个队列仅贡献了20项研究，这些研究使用神经影像学对儿童脑外伤后的纵向变化进行了考察。这些研究的结果表明，受伤后的预后存在显著异质性；然而，现有文献一致表明，受伤后大脑结构、功能和代谢的改变可以持续较长时间。随着样本量的增加和多点合作，未来的研究将能够进一步探讨潜在的结果调节因素，如本综述中讨论的发育、受伤前和受伤相关因素。