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

Abstract

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 (mildRF+, 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 mildRF+ 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 mildRF+ 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.Electronic supplementary materialThe online version of this article (doi:10.1007/s11682-017-9673-3) contains supplementary material, which is available to authorized users.

The structural connectome of children with traumatic brain injury

“…We replicated earlier reported [Königs et al, ] effects of TBI on measures of neurocognitive functioning (FSIQ, digit span, and RALVT encoding) and behavioral functioning (internalizing and externalizing problems) using ANOVA. Subsequently, we investigated the relations between network parameters that showed a main effect of group and measures of neurocognitive and behavioral functioning with a main effect of group.…”

“…In a previous study [Königs et al, ], we found that the current samples of children with mild RF+ TBI and children with moderate/severe TBI had decreased neurocognitive functioning and increased behavior problems. Here, we replicate these findings (see Table III), by showing that mild RF+ TBI and moderate/severe TBI group had lower FSIQ ( P = 0.003, d = −0.93 and P = 0.018, d = −0.84), poorer working memory performance ( P = 0.005, d = −0.92 and P = 0.041, d = −0.67) and poorer encoding in long‐term verbal memory ( P = 0.041, d = −0.63 and P = 0.014, d = −0.86) than the TC group.…”

“…We used aspects of neurocognitive and behavioral functioning with proven sensitivity for TBI as measures of functional outcome. In a previous study, we already showed that the current mild RF+ TBI and moderate/severe TBI groups had lower intelligence, poorer working memory performance, poorer encoding of information in working memory and more internalizing behavior (e.g., symptoms of anxiety and depression) and externalizing behavior problems (e.g., aggression and delinquent behavior) than the TC group [Königs et al, ]. Consequently, we selected these outcome measures to study the relation between network parameters and functional outcome.…”

Diffusion MRI in pediatric brain injury

“…Across the brain, researchers find lower FA in TBI, relative to healthy controls and those with milder injuries [32, 42, 50] (see Figs. 2 and 3).…”

“…TC trauma control group, TBI traumatic brain injury, FA fractional anisotropy. Adapted with permission from Königs et al [50]…”