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

Marsh Königs, Petra Jw Pouwels, Lw Ernest van Heurn, Roel Bakx, R. Jeroen Vermeulen, J. Carel Goslings, Bwee Tien Poll-The, Marleen van der Wees, Coriene E. Catsman-Berrevoets, Jaap Oosterlaan

Research output: Contribution to JournalArticleAcademicpeer-review

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.

Original languageEnglish
Pages (from-to)29-43
Number of pages15
JournalBrain Imaging and Behavior
Volume12
Issue number1
Early online date14 Jan 2018
DOIs
Publication statusPublished - 1 Feb 2018

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Neuroimaging
Anisotropy
Magnetic Resonance Imaging
Pediatrics
Wounds and Injuries
Tomography
Functional Neuroimaging
Diffusion Tensor Imaging
Cone-Beam Computed Tomography
Corpus Callosum
Intelligence
Short-Term Memory
Pathology
Traumatic Brain Injury
White Matter
Neuropathology
Common Data Elements

Keywords

  • Behavior problems
  • Diffusion tensor imaging
  • Neurocognitive functioning
  • Pediatrics
  • Tract-based spatial statistics
  • Traumatic brain injury

Cite this

Königs, Marsh ; Pouwels, Petra Jw ; Ernest van Heurn, Lw ; Bakx, Roel ; Jeroen Vermeulen, R. ; Carel Goslings, J. ; Poll-The, Bwee Tien ; van der Wees, Marleen ; Catsman-Berrevoets, Coriene E. ; Oosterlaan, Jaap. / Relevance of neuroimaging for neurocognitive and behavioral outcome after pediatric traumatic brain injury. In: Brain Imaging and Behavior. 2018 ; Vol. 12, No. 1. pp. 29-43.
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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.",
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author = "Marsh K{\"o}nigs and Pouwels, {Petra Jw} and {Ernest van Heurn}, Lw and Roel Bakx and {Jeroen Vermeulen}, R. and {Carel Goslings}, J. and Poll-The, {Bwee Tien} and {van der Wees}, Marleen and Catsman-Berrevoets, {Coriene E.} and Jaap Oosterlaan",
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Königs, M, Pouwels, PJ, Ernest van Heurn, L, Bakx, R, Jeroen Vermeulen, R, Carel Goslings, J, Poll-The, BT, van der Wees, M, Catsman-Berrevoets, CE & Oosterlaan, J 2018, 'Relevance of neuroimaging for neurocognitive and behavioral outcome after pediatric traumatic brain injury' Brain Imaging and Behavior, vol. 12, no. 1, pp. 29-43. https://doi.org/10.1007/s11682-017-9673-3

Relevance of neuroimaging for neurocognitive and behavioral outcome after pediatric traumatic brain injury. / Königs, Marsh; Pouwels, Petra Jw; Ernest van Heurn, Lw; Bakx, Roel; Jeroen Vermeulen, R.; Carel Goslings, J.; Poll-The, Bwee Tien; van der Wees, Marleen; Catsman-Berrevoets, Coriene E.; Oosterlaan, Jaap.

In: Brain Imaging and Behavior, Vol. 12, No. 1, 01.02.2018, p. 29-43.

Research output: Contribution to JournalArticleAcademicpeer-review

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Königs M, Pouwels PJ, Ernest van Heurn L, Bakx R, Jeroen Vermeulen R, Carel Goslings J et al. Relevance of neuroimaging for neurocognitive and behavioral outcome after pediatric traumatic brain injury. Brain Imaging and Behavior. 2018 Feb 1;12(1):29-43. https://doi.org/10.1007/s11682-017-9673-3