Abstract
Objective The influence of cognitive impairment after mild traumatic brain injury (mTBI) on cerebral vascular perfusion has been widely concerned, yet the resting-state cerebral blood flow (CBF) connectivity alterations based on arterial spin labeling (ASL) in mild traumatic brain injury (mTBI) remain unclear. This study investigated region CBF and CBF connectivity features in acute mTBI patients, as well as the associations between CBF changes and cognitive impairment. Materials and Methods Forty-five acute mTBI patients and 42 health controls underwent pseudocontinuous arterial spin labeling (pCASL) perfusion magnetic resonance imaging (MRI). The alterations in regional CBF and relationship between the CBF changes and cognitive impairment were detected. The ASL-CBF connectivity of the brain regions with regional CBF significant differences was also compared between two groups. Neuropsychological tests covered seven cognitive domains. Associations between the CBF changes and cognitive impairment were further investigated. Results Compared with the healthy controls, the acute mTBI patients exhibited increased CBF in the bilateral inferior temporal gyrus (ITG) and decreased CBF in the right middle frontal gyrus (MFG), the bilateral superior frontal gyrus (SFG), and the right cerebellum posterior lobe (CPL). In the mTBI patients, significant correlations were identified between the CBF changes and cognitive impairment. Importantly, the acute mTBI patients exhibited CBF disconnections between the right CPL and right fusiform gyrus (FG) as well as bilateral ITG, between the left SFG and left middle occipital gyrus (MOG), and between the right SFG and right FG as well as right parahippocampal gyrus. Conclusion Our results suggest that acute mTBI patients exhibit both regional CBF abnormalities and CBF connectivity deficits, which may underlie the cognitive impairment of the acute mTBI patients.
Highlights
Mild traumatic brain injury, commonly referred to as concussion, is recognized as a major public health concern worldwide [1]
We investigated whether the brain region with abnormal cerebral blood flow (CBF) exhibited CBF connectivity changes in acute mild traumatic brain injury (mTBI) patients
The CBF of the left superior frontal gyrus (SFG) and right inferior temporal gyrus (ITG) was correlated with the cognitive scores, respectively
Summary
Mild traumatic brain injury (mTBI), commonly referred to as concussion, is recognized as a major public health concern worldwide [1]. A large number of mTBI patients may have measurable deficits in some cognitive areas, mainly including visuospatial and executive functioning, attention, language, and memory [2, 3], which can interfere with daily life. It is estimated that up to 40-50% of mTBI patients still have cognitive deficit symptoms 3 months after injury and 10-15% at even years after injury [4]. The specific mechanism that leads to brain deficits and cognitive impairment in mTBI patients is still controversial and remains to be elucidated. There are indications that alterations of the CBF are associated with persistent symptoms and impaired cognitive functioning [7]. Several resting-state CBF alterations have been associated with the core clinical cognitive impairments symptoms of mTBI [8, 9]. ASL provides a noninvasive means for estimating CBF, which has been shown to be a robust method of Neural Plasticity assessing microvascular perfusion, and is less influenced by pathologic damage to the blood-brain barrier, including TBI [10]
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