Objective:

A considerable number of people experience persisting symptoms and functional limitations after mild traumatic brain injury (mTBI). It is unclear whether subtle white matter changes contribute to this phenomenon. In this systematic review, the authors evaluated whether microstructural white matter indices on advanced MRI are related to clinical dysfunction among patients without abnormalities on standard brain computed tomography (CT) or MRI (uncomplicated mTBI).

Methods:

A search of multiple databases was performed. Studies with individuals who experienced blast-related, sports-related, or multiple mTBIs were excluded. Diffusion tensor imaging (DTI) and susceptibility-weighted imaging (SWI) metrics and cognitive, neuropsychiatric, or functional outcome measures were extracted from each study.

Results:

Thirteen studies were selected (participants with mTBI, N=553; healthy control group, N=438). Seven DTI studies evaluated cognitive function, with five reporting significant correlations between reduced white matter integrity and deficits in attention, processing speed, and executive function at 6–12 months after injury (three studies included only individuals with uncomplicated mTBI). Four studies found significant correlations between DTI metrics and persistent postconcussive symptoms after 3–12 months (one study included only individuals with uncomplicated mTBI). Two SWI studies reported conflicting findings regarding the relationship between the presence of microbleeds and postconcussive symptoms.

Conclusions:

The results revealed that indices of microstructural white matter integrity may relate to clinical presentation 3–12 months after injury in uncomplicated mTBI. However, analysis methods and brain regions studied varied across studies. Further research is needed to identify relationships between white matter indices in specific brain regions and symptom persistence beyond 12 months.

中文翻译：

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扩散 MRI 在平民轻度创伤性脑损伤后的预测效用：系统评价

客观的：

相当多的人在轻度创伤性脑损伤 (mTBI) 后经历持续的症状和功能限制。目前尚不清楚细微的白质变化是否会导致这种现象。在这篇系统综述中，作者评估了标准脑计算机断层扫描 (CT) 或 MRI（无并发症的 mTBI）无异常的患者中，高级 MRI 的微结构白质指数是否与临床功能障碍相关。

方法：

对多个数据库进行了检索。针对经历过爆炸相关、运动相关或多次 mTBI 的个体的研究被排除在外。从每项研究中提取了弥散张量成像（DTI）和磁敏加权成像（SWI）指标以及认知、神经精神或功能结果测量。

结果：

选择了 13 项研究（患有 mTBI 的参与者，N=553；健康对照组，N=438）。 7 项 DTI 研究评估了认知功能，其中 5 项研究报告了损伤后 6-12 个月时白质完整性降低与注意力、处理速度和执行功能缺陷之间存在显着相关性（三项研究仅纳入无并发症 mTBI 的个体）。四项研究发现 DTI 指标与 3-12 个月后持续性脑震荡后症状之间存在显着相关性（一项研究仅包括患有无并发症 mTBI 的个体）。 SWI 的两项研究报告了关于微出血的存在与脑震荡后症状之间关系的相互矛盾的发现。

结论：

结果显示，在无并发症的 mTBI 中，微结构白质完整性指数可能与损伤后 3-12 个月的临床表现有关。然而，不同研究的分析方法和研究的大脑区域有所不同。需要进一步研究来确定特定大脑区域的白质指数与症状持续超过 12 个月之间的关系。