扩大的血管周围间隙随时间的变化及与创伤性脑损伤后疗效的关系

IF 1.8 Q3 CLINICAL NEUROLOGY Neurotrauma reports Pub Date : 2024-07-31 eCollection Date: 2024-01-01 DOI:10.1089/neur.2024.0026
Alexa E Walter, Krupa Savalia, Jason Yoon, Justin Morrison, Andrea L C Schneider, Ramon Diaz-Arrastia, Danielle K Sandsmark
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引用次数: 0

摘要

在包括创伤性脑损伤(TBI)在内的各种神经系统疾病的磁共振成像(MRI)扫描中均可看到扩大的血管周围间隙(EPV)。EPV 与认知功能障碍和睡眠障碍有关,但其临床意义尚不清楚。本研究的目的是确定 TBI 后随着时间推移 EPV 的 MRI 负荷,并探讨其与伤后结果的关系。创伤性脑损伤患者在受伤后第 1 天(血液)、2 周(血液、核磁共振成像、结果)和 6 个月(血液、核磁共振成像、结果)接受了数据收集。使用 T1 和 FLAIR 序列对半脑中心、基底节和中脑的代表性切片进行 EPV 负荷评估。对血清进行化验,以测量神经丝光(NfL)和胶质纤维酸性蛋白(GFAP)的浓度。研究对象包括 32 名患有创伤性脑损伤的患者(平均年龄 36.8 岁,78% 为男性,50% 为白人)。从两周(23.5 [95% 置信区间或 CI = 22.0-32.0])到 6 个月(26.0 [95% CI = 22.0-30.0],p = 0.16),EPVs 总计数无明显变化。在自我报告的睡眠测量中,EPVs 计数与失眠严重程度指数(2 周:β = -0.004;95% CI = -0.094,0.086;6 个月:β = 0.002;95% CI = -0.094,0.086)或失眠严重程度指数(2 周:β = -0.004;95% CI = -0.094,0.086)之间没有显著关联。122,0.125)或 Rivermead 脑震荡后症状问卷中的睡眠问题子集(2 周:β = -0.005;95% CI = -0.049,0.039;6 个月:β = -0.019;95% CI = -0.079,0.042)。根据 6 个月未完全恢复(格拉斯哥结果量表扩展版 [GOS-E < 8])与完全恢复(GOS-E = 8)来判定的功能结果与 2 周时 EPV 数量较多有显著相关性(几率比 = 0.94,95% CI = 0.88-0.99)。斯皮尔曼相关性显示 EPVs 数量与 GFAP 或 NfL 之间无明显关系。本研究使用常见的 MRI 序列对 EPVs 进行量化,并研究其作为 TBI 潜在影像生物标记物的效用。鉴于EPV随时间的变化极小,这一时期可能不够长,不足以实现潜在的恢复,也可能表明EPV是结构性结果,不会随时间发生显著变化。
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Change in Enlarged Perivascular Spaces over Time and Associations with Outcomes After Traumatic Brain Injury.

Enlarged perivascular spaces (EPVs) can be seen on magnetic resonance imaging (MRI) scans in various neurological diseases, including traumatic brain injury (TBI). EPVs have been associated with cognitive dysfunction and sleep disturbances; however, their clinical significance remains unclear. The goal of this study was to identify MRI burden of EPVs over time following TBI and to explore their relationship with postinjury outcomes. Individuals with TBI underwent postinjury data collection at Day 1 (blood), 2 weeks (blood, MRI, outcomes), and 6 months (blood, MRI, outcomes). EPV burden was assessed using T1 and FLAIR sequences on representative slices in the centrum semiovale, basal ganglia, and midbrain. Serum blood was assayed to measure concentrations of neurofilament light (NfL) and glial fibrillary acidic protein (GFAP). Thirty-two participants with TBI were included (mean age 36.8 years, 78% male, 50% White). Total EPVs count did not significantly change from 2 weeks (23.5 [95% confidence interval or CI = 22.0-32.0]) to 6 months (26.0 [95% CI = 22.0-30.0], p = 0.16). For self-reported measures of sleep, there were no significant associations between EPVs count and Insomnia Severity Index (2 weeks: β = -0.004; 95% CI = -0.094, 0.086; 6 months: β = 0.002; 95% CI = -0.122, 0.125) or the subset of sleep questions on the Rivermead Post-Concussion Symptoms Questionnaire (2 weeks: β = -0.005; 95% CI = -0.049, 0.039; 6 months: β = -0.019; 95% CI = -0.079, 0.042). Functional outcome, determined by 6 months incomplete recovery (Glasgow Outcome Scale-Extended [GOS-E < 8]) versus complete recovery (GOS-E = 8), was significantly associated with a higher number of EPVs at 2 weeks (odds ratio = 0.94, 95% CI = 0.88-0.99). Spearman correlations showed no significant relationship between EPVs count and GFAP or NfL. This study used commonly acquired MRI sequences to quantify EPVs and investigated their utility as a potential imaging biomarker in TBI. Given the minimal change in EPVs over time, this period may not be long enough for potential recovery or may indicate that EPVs are structural findings that do not significantly change over time.

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