This study is unique in that it examines the evolution of white matter injury very early and at 12 months post-injury in pediatric patients following traumatic brain injury (TBI). Diffusion tensor imaging (DTI) was acquired at two time-points: acutely at 6–17 days and 12 months following a complicated mild (cMild)/moderate (mod) or severe TBI. Regional measures of anisotropy and diffusivity were compared between TBI groups and against a group of age-matched healthy controls and used to predict performance on measures of attention, memory, and intellectual functioning at 12-months post-injury. Analysis of the acute DTI data using tract based spatial statistics revealed a small number of regional decreases in fractional anisotropy (FA) in both the cMild/mod and severe TBI groups compared with controls. These changes were observed in the occipital white matter, anterior limb of the internal capsule (ALIC)/basal ganglia, and corpus callosum. The severe TBI group showed regional differences in axial diffusivity (AD) in the brainstem and corpus callosum that were not seen in the cMild/mod TBI group. By 12-months, widespread decreases in FA and increases in apparent diffusion coefficient (ADC) and radial diffusivity (RD) were observed in both TBI groups compared with controls, with the overall number of regions with abnormal DTI metrics increasing over time. The early changes in regional DTI metrics were associated with 12-month performance IQ scores. These findings suggest that there may be regional differences in the brain's reparative processes or that mechanisms associated with the brain's plasticity to recover may also be region based.

中文翻译：

---

小儿创伤性脑损伤后不断发展的白质损伤。

这项研究的独特之处在于它检查了创伤性脑损伤 (TBI) 后儿科患者脑白质损伤的早期和受伤后 12 个月的演变。扩散张量成像 (DTI) 在两个时间点获得：在复杂的轻度 (cMild)/中度 (mod) 或重度 TBI 后 6-17 天和 12 个月急性。比较 TBI 组和年龄匹配的健康对照组的各向异性和扩散率的区域测量值，并用于预测受伤后 12 个月注意力、记忆力和智力功能测量值的表现。使用基于道的空间统计分析急性 DTI 数据显示，与对照组相比，cMild/mod 和重度 TBI 组的各向异性分数 (FA) 均有少量区域性降低。在枕叶白质、内囊前肢 (ALIC)/基底神经节和胼胝体中观察到这些变化。重度 TBI 组在脑干和胼胝体中显示出轴向扩散率 (AD) 的区域差异，这在 cMild/mod TBI 组中没有看到。到 12 个月时，与对照组相比，两个 TBI 组均观察到 FA 普遍下降，表观扩散系数 (ADC) 和径向扩散率 (RD) 增加，且 DTI 指标异常的区域总数随时间增加。区域 DTI 指标的早期变化与 12 个月的表现 IQ 分数相关。这些发现表明，大脑的修复过程可能存在区域差异，或者与大脑可塑性恢复相关的机制也可能是基于区域的。