Research Reports - Neuroimaging correlates of novel psychiatric disorders after pediatric traumatic brain injury

J Am Acad Child Adolesc Psychiatry. 2012 Nov;51(11):1208-17

Max JE, Wilde EA, Bigler ED, Thompson WK, Macleod M, Vasquez AC, Merkley TL, Hunter JV, Chu ZD, Yallampalli R, Hotz G, Chapman SB, Yang TT, Levin HS

OBJECTIVE: To study magnetic resonance imaging (MRI) correlates of novel
(new-onset) psychiatric disorders (NPD) after traumatic brain injury (TBI) and
orthopedic injury (OI).
METHOD: Participants were 7 to 17 years of age at the time of hospitalization for
either TBI or OI. The study used a prospective, longitudinal, controlled design
with standardized psychiatric assessments conducted at baseline (reflecting
pre-injury function) and 3 months post-injury. MRI assessments including
diffusion tensor imaging (DTI)-derived fractional anisotropy (FA), volumetric
measures of gray and white matter regions, volumetric measures of lesions, and
cortical thickness were conducted. Injury severity was assessed by standard
clinical scales. The outcome measure was the presence of an NPD identified during
the first 3 months after injury.
RESULTS: There were 88 participants (TBI, 44; OI, 44). NPD occurred more
frequently in the TBI (21/44; 48%) versus the OI (6/44; 14%) group (Fisher's
exact test, p = .001). NPD in TBI participants was not related to injury
severity. Multivariate analysis of covariance of the relationship between FA in
hypothesized regions of interest (bilateral frontal and temporal lobes, bilateral
centrum semiovale, bilateral uncinate fasciculi) and NPD and group (TBI versus
OI) was significant, and both variables (NPD, p < .05; group, p < .001) were
jointly significantly related to FA. NPD was not significantly related to
volumetric measures of white or gray matter structures, volumetric measures of
lesions, or cortical thickness measures.
CONCLUSIONS: Lowered white matter integrity may be more important in the
pathophysiology of NPD than indices of gray matter or white matter atrophic
changes, macroscopic lesions, and injury severity.

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