ENIGMA Pediatric msTBI diffusion MRI supplemental data

Objective: Our study addressed aims: (1) test the hypothesis that
moderate-severe TBI in pediatric patients is associated with widespread
white matter (WM) disruption; (2) test the hypothesis that age and sex
impact WM organization after injury; and (3) examine associations between
WM organization and neurobehavioral outcomes. Methods: Data from ten
previously enrolled, existing cohorts recruited from local hospitals and
clinics were shared with the ENIGMA (Enhancing NeuroImaging Genetics
through Meta-Analysis) Pediatric msTBI working group. We conducted a
coordinated analysis of diffusion MRI (dMRI) data using the ENIGMA dMRI
processing pipeline. Results: Five hundred and seven children and
adolescents (244 with complicated mild to severe TBI [msTBI] and 263
controls) were included. Patients were clustered into three post-injury
intervals: acute/subacute - <2 months, post-acute - 2-6 months,
chronic - 6+ months. Outcomes were dMRI metrics and post-injury behavioral
problems as indexed by the Child Behavior Checklist (CBCL). Our analyses
revealed altered WM diffusion metrics across multiple tracts and all
post-injury intervals (effect sizes ranging between d=-0.5 to -1.3).
Injury severity is a significant contributor to the extent of WM
alterations but explained less variance in dMRI measures with increasing
time post-injury. We observed a sex-by-group interaction: females with TBI
had significantly lower fractional anisotropy in the uncinate fasciculus
than controls (?=0.043), which coincided with more parent-reported
behavioral problems (?=-0.0027). Conclusions: WM disruption after msTBI is
widespread, persistent, and influenced by demographic and clinical
variables. Future work will test techniques for harmonizing neurocognitive
data, enabling more advanced analyses to identify symptom clusters and
clinically-meaningful patient subtypes.

研究目标：本研究旨在达成三项核心研究目的：（1）验证儿童中重度创伤性脑损伤（Traumatic Brain Injury, TBI）与广泛白质（white matter, WM）破坏相关的假说；（2）验证年龄与性别可影响损伤后白质组织结构的假说；（3）探究白质组织结构与神经行为结局之间的关联。
研究方法：本研究纳入10项已完成受试者招募、来源于当地医院与诊所的现有队列研究数据，并共享至ENIGMA（通过元分析加强神经影像学遗传学研究，Enhancing NeuroImaging Genetics through Meta-Analysis）儿童中重度TBI工作组。本研究采用ENIGMA弥散磁共振成像（diffusion MRI, dMRI）处理管线，对弥散磁共振成像数据开展协同分析。
研究结果：本研究共纳入507名儿童及青少年，其中244例为合并复杂型轻至重度创伤性脑损伤（moderate-severe TBI, msTBI）患者，263例为健康对照。根据损伤后时间窗将患者分为三组：急性/亚急性组（损伤后<2个月）、亚急性后期组（损伤后2~6个月）以及慢性期组（损伤后≥6个月）。本研究的结局指标包括弥散磁共振成像指标及以儿童行为量表（Child Behavior Checklist, CBCL）评分表征的损伤后行为问题。分析结果显示，在所有损伤后时间窗内，多条脑白质纤维束的弥散磁共振成像指标均出现异常改变（效应量范围为d=-0.5至-1.3）。损伤严重程度是白质改变程度的重要影响因素，但随着损伤后时间的延长，其对弥散磁共振成像指标变异的解释度逐渐降低。本研究观察到组别×性别交互作用：与健康对照相比，创伤性脑损伤女性患者的钩束各向异性分数（fractional anisotropy, FA）显著更低（β=0.043），且该表现与家长报告的更多行为问题相吻合（β=-0.0027）。
研究结论：中重度创伤性脑损伤后的白质破坏范围广泛且持续存在，并受人口统计学与临床变量的影响。未来研究将验证神经认知数据的标准化协调技术，以开展更高级的分析，从而识别症状群及具有临床意义的患者亚型。

搜集汇总

背景与挑战

背景概述

该数据集是ENIGMA儿科中重度创伤性脑损伤（msTBI）扩散磁共振成像（dMRI）的补充数据，包含507名儿童和青少年的dMRI指标，用于研究白质（WM）损伤、年龄和性别的影响，以及WM与神经行为结果的关系。数据来自十个现有队列，通过协调分析发现WM损伤广泛且持久，损伤严重性和性别是重要影响因素。数据集以文档文件形式提供，适用于神经影像学和儿科脑损伤研究。