In this prospective cohort study, we investigated associations between acute diffusion tensor imaging (DTI) and diffusion kurtosis imaging (DKI) metrics and persistent post-concussion symptoms (PPCS) 3 months after mild traumatic brain injury (mTBI). Adult patients with mTBI (n = 176) and community controls (n = 78) underwent 3 Tesla magnetic resonance imaging (MRI) within 72 h post-injury, estimation of cognitive reserve at 2 weeks, and PPCS assessment at 3 months. Eight DTI and DKI metrics were examined with Tract-Based Spatial Statistics. Analyses were performed in the total sample in uncomplicated mTBI only (i.e., without lesions on clinical MRI), and with cognitive reserve both controlled for and not. Patients with PPCS (n = 35) had lower fractional anisotropy (in 2.7% of all voxels) and kurtosis fractional anisotropy (in 6.9% of all voxels), and higher radial diffusivity (in 0.3% of all voxels), than patients without PPCS (n = 141). In uncomplicated mTBI, only fractional anisotropy was significantly lower in patients with PPCS. Compared with controls, patients with PPCS had widespread deviations in all diffusion metrics. When including cognitive reserve as a covariate, no significant differences in diffusion metrics between patients with and without PPCS were present, but patients with PPCS still had significantly higher mean, radial, and axial diffusivity than controls. In conclusion, patients who developed PPCS had poorer white matter microstructural integrity acutely after the injury, compared with patients who recovered and healthy controls. Differences became less pronounced when cognitive reserve was controlled for, suggesting that pre-existing individual differences in axonal integrity accounted for some of the observed differences.

中文翻译：

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轻度创伤性脑损伤后的急性弥散张量和峰度成像及结果

在这项前瞻性队列研究中，我们研究了急性弥散张量成像 (DTI) 和弥散峰度成像 (DKI) 指标与轻度创伤性脑损伤 (mTBI) 后 3 个月持续性脑震荡后症状 (PPCS) 之间的关联。成年 mTBI 患者 ( n  = 176) 和社区对照 ( n  = 78) 在受伤后 72 小时内接受 3 特斯拉磁共振成像 (MRI)，在 2 周时进行认知储备评估，并在 3 个月时进行 PPCS 评估。使用基于区域的空间统计检查了八个 DTI 和 DKI 指标。仅在无并发症的 mTBI（即临床 MRI 上无病变）的总样本中进行分析，并且认知储备受控和不受控。PPCS 患者 ( n = 35）与没有 PPCS 的患者相比，具有较低的分数各向异性（占所有体素的 2.7%）和峰度分数各向异性（占所有体素的 6.9%）和较高的径向扩散率（占所有体素的 0.3%）（n = 141）。在无并发症的 mTBI 中，只有 PPCS 患者的分数各向异性显着较低。与对照组相比，PPCS 患者的所有扩散指标均存在广泛偏差。当将认知储备作为协变量时，有和没有 PPCS 的患者之间的扩散指标不存在显着差异，但 PPCS 患者的平均、径向和轴向扩散率仍然显着高于对照组。总之，与康复的患者和健康对照相比，发生 PPCS 的患者在受伤后急性期的白质微结构完整性较差。当认知储备受到控制时，差异变得不那么明显，这表明轴突完整性方面预先存在的个体差异是观察到的一些差异的原因。