Voxel-based Morphometry Study In Patients With Traumatic Brain Injury

Objective: To analyze the brain morphological changes of mild, moderate and severe traumatic brain injury patients respectively and its correlation between the changes and clinical symptoms by using voxel-based morphology(VBM), so as to investigate the possible pathophysiological mechanisms and clinical significance of different degrees of damage in patients with traumatic brain injury.Methods:(1) Totally 20 patients with m TBI(m TBI group) and 20 healthy controls(HCs group) underwent conventional MRI scan and T1 3D-MPRAGE scan,using Dartel-VBM of SPM8 to extract the images of density and volume of gray matter and white matter then two-sample t test was used to compare the morphological changes of gray matter and white matter between m TBI group and HCs group.( 2) Totally 28 patients with moderate to severe and 28 healthy controls underwent conventional MRI scan and T1 3D-MPRAGE scan, using Dartel-VBM of SPM8 to extract the images of density and volume of gray matter and white matter then two-sample t test was used to compare the morphological changes of gray matter and white matter between the two groups.(3)Pearson correlation analysis is used respectively to explore the correlation between morphological differences in brain areas in patients with TBI and clinical parameters, including the glasgow coma scale(GCS), disability rating scale(DRS),motor function assessment scale(MAS), agitated behavior scale(ABS), clinical dementia scale(CDR), mini-mental mental state examination(MMSE), han hamilton anxiety scale(HAMA), daily living scale(ADL).Results:(1)Patients with m TBI exist reduction of the density and volume of gray matter and white matter(voxel p <0.01, cluser p <0.05, Gaussian Random Fields correction), the density of gray matter reducing areas: bilateral cerebellum posterior lobe and left cerebellum anterior lobe; the density of white matter reducing area: right medial prefrontal; the volume of gray matter reducing areas: bilateral calcarine andleft parahippocampal gyrus; the volume of white matter reducing areas: left medial prefrontal and right precentral gyrus.(2)Patients with moderate to severe TBI have abnormal changes in density of gray matter(p < 0.05, False Discovery Rate correction, K≥30 voxels), the density of gray matter increasing areas: left cerebellum posterior lobe, left rectal gyrus, right posterior cingulate, bilateral precuneus and paracentral lobule; the density of gray matter reducing areas: right cerebellum posterior lobe, bilateral parahippocampal gyrus, left insula, right middle frontal gyrus, right superior temporal gyrus, bilateral caudate and thalamus, left middle temporal gyrus, left inferior frontal gyrus, left anterior cingulate, and right calcarine; the density of white matter and the volume of gray matter exist only reduction(voxel p <0.01, cluster p <0.05, Gaussian Random Fields correction), the density of white matter reducing areas: bilateral medial prefrontal; the volume of gray matter reducing areas: right parahippocampal gyrus,right precentral gyrus, and bilateral thalamus.( 3) m TBI group: the reduction of gray matter density of right cerebellum posterior lobe is correlated with GCS scores(r =-0.461, p = 0.012), the reduction of white matter density of right medial prefrontal is correlated with MAS scores(r =0.427, p = 0.021), the reduction of gray matter volume of bilateral calcarine is correlated with GCS scores(r =-0.469, p = 0.010), the reduction of white matter volume of left medial prefrontal is correlated with MMSE score(r =-0.402, p =0.031); Patients with moderate to severe TBI group: the reduction of gray matter density of right cerebellum posterior lobe is correlated with CDR scores(r =-0.464, p= 0.011), and significantly correlated with DRS scores(r =-0.678, p = 0.001), ADL scores(r =-0.480, p = 0.008), MAS scores(r = 0.586, p = 0.001), and MMSE scores(r = 0.575, p = 0.001), the reduction of gray matter density of right parahippocampal gyrus is correlated with MMSE scores(r = 0.459, p = 0.012), ADL scores(r =-0.385,p = 0.039) and significantly correlated with CDR scores(r =-0.475, p = 0.009), the reduction of gray matter density of left parahippocampal gyrus is correlated with ABS scores(r =-0.434, p = 0.019), the reduction of gray matter density of right insular is correlated with ABS scores(r = 0.396, p = 0.033), the reduction of gray matter density of right middle frontal gyrus is correlated with ADL scores(r =-0.413, p =0.026), and significantly correlated with MMSE scores(r = 0.493, p = 0.007), and CDR scores(r =-0.513, p = 0.004), the reduction of gray matter density of bilateral caudate and thalamus is correlated with ABS scores(r =-0.372, p = 0.049), and CDR scores(r =-0.428, p = 0.021), the reduction of gray matter density of left anterior cingulate is correlated with CDR scores(r =-0.373, p = 0.047), the reduction of white matter density of right medial prefrontal is correlated with CDR scores(r =-0.385, p= 0.039), and MMSE scores(r = 0.387, p = 0.038), the reduction of gray matter volume of bilateral thalamus is correlated with MMSE scores(r = 0.409, p = 0.028),and ADL scores(r =-0.413, p = 0.026), and significantly correlated with DRS scores(r =-0.527, p = 0.003), and MAS scores(r = 0.518, p = 0.004), the reduction of gray matter volume of right precentral gyrus is correlated with ADL scores(r =-0.370, p =0.048).Conclusion: Compared to the healthy controls, there are significant brain morphological changes in patients with TBI, and the changes are closely correlated to their parameters of clinical neurocognitive function assessment; Large-scale data mining and longitudinal study will help us to track the development and outcome of TBI, so as to provid theory foundation for speculating the prognosis.