title: 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.
authors.affiliation: Clinical Neuropsychology Section, FGB VU University Amsterdam, Van der Boechorststraat 1, 1081BT, Amsterdam, The Netherlands. m.konigs@vu.nl.|Emma Children's Hospital, Academic Medical Center, Amsterdam, The Netherlands. m.konigs@vu.nl.
authors.forename: Marsh
authors.identifier: 0000-0003-0200-0445
authors.initials: M
authors.lastname: Königs
authors.affiliation: Department of Physics and Medical Technology, VU University Medical Center, Amsterdam, The Netherlands.|Neuroscience Campus Amsterdam, Amsterdam, The Netherlands.
authors.forename: Petra Jw
authors.initials: PJ
authors.lastname: Pouwels
authors.affiliation: Pediatric Surgical Center of Amsterdam, Emma Children's Hospital Academic Medical Center and VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: L W
authors.initials: LW
authors.lastname: Ernest van Heurn
authors.affiliation: Pediatric Surgical Center of Amsterdam, Emma Children's Hospital Academic Medical Center and VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Roel
authors.initials: R
authors.lastname: Bakx
authors.affiliation: Department of Pediatric Neurology, VU University Medical Center, Amsterdam, The Netherlands.|Department of Pediatric Neurology, Maastricht University, Medical Center, Maastricht, The Netherlands.
authors.forename: R
authors.initials: R
authors.lastname: Jeroen Vermeulen
authors.forename: J Carel
authors.initials: JC
authors.lastname: Goslings
authors.affiliation: Trauma Unit, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: J
authors.initials: J
authors.lastname: Carel Goslings
authors.affiliation: Department of Pediatric Neurology, Emma Children's Hospital Academic Medical Centre, Amsterdam, The Netherlands.
authors.forename: Bwee Tien
authors.initials: BT
authors.lastname: Poll-The
authors.affiliation: Libra Rehabilitation Medicine and Audiology, 'Blixembosch', Eindhoven, The Netherlands.
authors.forename: Marleen
authors.initials: M
authors.lastname: van der Wees
authors.affiliation: Department of Pediatric Neurology, Erasmus University Hospital/ Sophia Children's Hospital, Rotterdam, The Netherlands.
authors.forename: Coriene E
authors.initials: CE
authors.lastname: Catsman-Berrevoets
authors.affiliation: Clinical Neuropsychology Section, FGB VU University Amsterdam, Van der Boechorststraat 1, 1081BT, Amsterdam, The Netherlands.|Emma Children's Hospital, Academic Medical Center, Amsterdam, The Netherlands.|Department of Pediatrics, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Jaap
authors.initials: J
authors.lastname: Oosterlaan
mesh_terms: D000293:Adolescent; D000294:Adolescent Behavior; D001921:Brain / Q000000981:diagnostic imaging*; D000070642:Brain Injuries, Traumatic / Q000150:complications / Q000000981:diagnostic imaging* / Q000523:psychology* / Q000628:therapy; D002648:Child; D002652:Child Behavior; D002653:Child Behavior Disorders / Q000000981:diagnostic imaging / Q000209:etiology; D003071:Cognition; D003430:Cross-Sectional Studies; D056324:Diffusion Tensor Imaging; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007859:Learning Disabilities / Q000000981:diagnostic imaging / Q000209:etiology; D008279:Magnetic Resonance Imaging; D008297:Male; D001523:Mental Disorders / Q000000981:diagnostic imaging / Q000209:etiology; D059906:Neuroimaging; D011379:Prognosis; D014057:Tomography, X-Ray Computed; D066127:White Matter / Q000000981:diagnostic imaging / Q000293:injuries
keywords: Behavior problems; Diffusion tensor imaging; Neurocognitive functioning; Pediatrics; Tract-based spatial statistics; Traumatic brain injury