AUTHOR=Li Biao , Li Wu-gen , Guo Yao , Wang Yang , Xu Lu-yang , Yang Yuan , Xu Shi-guo , Tan Zi-long , Mei Yu-ran , Wang Kai-yang 

TITLE=Integrating fractional amplitude of low-frequency fluctuation and functional connectivity to investigate the mechanism and prognosis of severe traumatic brain injury

JOURNAL=Frontiers in Neurology

VOLUME=Volume 14 - 2023

YEAR=2023

URL=https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2023.1266167

DOI=10.3389/fneur.2023.1266167

ISSN=1664-2295

ABSTRACT=bjective: Functional magnetic resonance imaging (fMRI) has been used for evaluating residual brain function and predicting the prognosis of patients with severe traumatic brain injury (sTBI). This study aimed to integrate the fractional amplitude of low-frequency fluctuation (fALFF) and functional connectivity (FC) to investigate the mechanism and prognosis of patients with sTBI.
Methods: Sixty-five patients with sTBI were included and underwent fMRI scanning within 14 days after brain injury. The patient’s outcome was assessed using the Glasgow Outcome Scale - Extended (GOSE) at six months post-injury. Of the 63 patients who met fMRI data analysis standards, the prognosis of 18 patients was good, and the prognosis of 45 patients was poor. Firstly, we apply fALFF to identify residual brain functional differences in patients who present different prognoses and conjoined it in regions of interest (ROI) - based FC analysis to investigate the residual brain function of sTBI at the acute phase of sTBI. Then, the area under the curve (AUC) was used to evaluate the predictive ability of the brain regions with the difference of fALFF and FC values.
Results: Patients who present good outcomes at six months post-injury have increased fALFF values in Brodmann Area (7, 18, 31, 13, 39 40, 42, 19, 23) and decreased FC values in Brodmann Area (28, 34, 35, 36, 20, 28, 34, 35, 36, 38, 1, 2, 3, 4, 6, 13, 40, 41, 43, 44, 20, 28 35, 36, 38) at acute phase of sTBI. The parameters of these alterations can be used for predicting the long-term outcomes of patients with sTBI, of which the fALFF increase in the temporal lobe, occipital lobe, precuneus, and middle temporal gyrus shown the highest predictive ability.
Conclusion: We provide a compensatory mechanism that several regions of the brain can be spontaneously activated at the acute phase of sTBI in those who present with a good prognosis in the 6-month follow-up, that is, a destructive mode that increases its fALFF in the local regions and weakens its FC to the whole brain. These findings provide a theoretical basis for developing early intervention targets for sTBI patients.