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Frontal and temporal morphometric findings on MRI in children after moderate to severe traumatic brain injury
Elisabeth A Wilde1, Jill V Hunter, Mary R Newsome
1Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, Texas, USA.
Abstract:
In vivo MRI volumetric analysis enables investigators to evaluate the extent of tissue loss following traumatic brain injury (TBI). However, volumetric studies of pediatric TBI are sparse, and there have been no volumetric studies to date in children examining specific subregions of the prefrontal and temporal lobes. In this study, MRI volumetry was used to evaluate brain volume differences in the whole brain, and prefrontal, temporal, and posterior regions of children following moderate to severe TBI as compared to uninjured children of similar age and demographic characteristics. The TBI group had significantly reduced whole brain, and prefrontal and temporal regional tissue volumes as well as increased cerebrospinal fluid (CSF). Confidence interval testing further revealed group differences on gray matter (GM) and white matter (WM) in the superior medial and ventromedial prefrontal regions, WM in the lateral frontal region, and GM, WM, and CSF in the temporal region. Whole brain volume and total brain GM were reduced, and total ventricular volume, total CSF volume, and ventricle-to-brain ratio (VBR) were increased in the TBI group. Additional analyses comparing volumetric data from typically developing children and subgroups of TBI patients with and without regional focal lesions suggested that GM loss in the frontal areas was primarily attributable to focal injury, while WM loss in the frontal and temporal lobes was related to both diffuse and focal injury. Finally, volumetric measures of preserved frontotemporal tissue were related to functional recovery as measured by the Glasgow Outcome Scale (adapted for children) with greater tissue preservation predicting better recovery.
Insights
Pediatric traumatic brain injury (TBI) causes significant whole brain and regional tissue loss, particularly in the prefrontal and temporal lobes. Greater preserved brain tissue in children with TBI predicts better functional recovery.
Area of Science:
- Neuroscience
- Radiology
- Pediatric Medicine
Background:
- Volumetric MRI studies of pediatric traumatic brain injury (TBI) are limited, especially concerning specific prefrontal and temporal lobe subregions.
- Understanding regional brain volume changes in pediatric TBI is crucial for assessing injury extent and predicting outcomes.
Purpose of the Study:
- To investigate whole brain and specific regional (prefrontal, temporal) volume differences in children with moderate to severe TBI compared to controls.
- To examine gray matter (GM) and white matter (WM) changes in specific subregions and their relationship to injury type (focal vs. diffuse).
- To correlate preserved frontotemporal tissue volume with functional recovery in pediatric TBI survivors.
Main Methods:
- In vivo MRI volumetric analysis was employed to compare brain volumes in children with and without TBI.
- Detailed regional volumetry focused on whole brain, prefrontal, and temporal lobes, including GM, WM, and cerebrospinal fluid (CSF) assessments.
- Glasgow Outcome Scale (adapted for children) was used to measure functional recovery.
Main Results:
- Children with TBI exhibited significantly reduced whole brain, prefrontal, and temporal tissue volumes, alongside increased CSF and ventricular volumes.
- Specific GM and WM differences were identified in prefrontal and temporal regions, with injury type influencing tissue loss.
- Preserved frontotemporal tissue volume positively correlated with better functional recovery outcomes.
Conclusions:
- Pediatric TBI leads to significant volumetric reductions in critical brain regions, impacting both gray and white matter.
- Both focal and diffuse injury mechanisms contribute to tissue loss in the frontal and temporal lobes.
- Volumetric MRI assessment of frontotemporal tissue preservation is a valuable predictor of functional recovery in pediatric TBI.
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