Research Reports - Relevance of neuroimaging for neurocognitive and behavioral outcome after pediatric traumatic brain injury

Brain Imaging Behav. 2017 Jan 14. doi: 10.1007/s11682-017-9673-3. [Epub ahead of

Königs M(1,)(2), Pouwels PJ(3,)(4), Ernest van Heurn LW(5), Bakx R(5), Jeroen
Vermeulen R(6,)(7), Carel Goslings J(8), Poll-The BT(9), van der Wees M(10),
Catsman-Berrevoets CE(11), Oosterlaan J(12,)(13,)(14).

This study aims to (1) investigate the neuropathology of mild to severe pediatric
TBI and (2) elucidate the predictive value of conventional and innovative
neuroimaging for functional outcome. Children aged 8-14 years with trauma control
(TC) injury (n = 27) were compared to children with mild TBI and risk factors for
complicated TBI (mild(RF+), n = 20) or moderate/severe TBI (n = 17) at 2.8 years
post-injury. Neuroimaging measures included: acute computed tomography (CT),
volumetric analysis on post-acute conventional T1-weighted magnetic resonance
imaging (MRI) and post-acute diffusion tensor imaging (DTI, analyzed using
tract-based spatial statistics and voxel-wise regression). Functional outcome was
measured using Common Data Elements for neurocognitive and behavioral
functioning. The results show that intracranial pathology on acute CT-scans was
more prevalent after moderate/severe TBI (65%) than after mild(RF+) TBI (35%;
p = .035), while both groups had decreased white matter volume on conventional
MRI (ps ≤ .029, ds ≥ -0.74). The moderate/severe TBI group further showed
decreased fractional anisotropy (FA) in a widespread cluster affecting all white
matter tracts, in which regional associations with neurocognitive functioning
were observed (FSIQ, Digit Span and RAVLT Encoding) that consistently involved
the corpus callosum. FA had superior predictive value for functional outcome
(i.e. intelligence, attention and working memory, encoding in verbal memory and
internalizing problems) relative to acute CT-scanning (i.e. internalizing
problems) and conventional MRI (no predictive value). We conclude that children
with mild(RF+) TBI and moderate/severe TBI are at risk of persistent white matter
abnormality. Furthermore, DTI has superior predictive value for neurocognitive
out-come relative to conventional neuroimaging. 

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