Objective: Severity of pediatric traumatic brain injury (TBI) relates to loss of cortical brain volume but how volume loss relates to neurocognitive outcome is not fully understood. Since changes in cortical volume are associated with development, pediatric TBI likely disrupts cortical development. The current study examined the relation of cortical volume to intellectual functioning in children with complicated mild to severe TBI to those who were age and sex matched but only sustained orthopedic injury (OI). Method: MRI studies (1.5 Tesla) from the Social Outcomes of Brain Injury in Kids (SOBIK) investigation compared 72 children with TBI to 52 with OI in terms of FreeSurfer (version 5.3 using the QDEC function) determined cortical volume measures in relation to Wechsler Abbreviated Scale of Intelligence (WASI) scores. The SOBIK neuroimaging sample is comprised of children assessed more than 6 months post-injury during the chronic phase who were on average 10 years of age at the time of MRI and neuropsychological studies. Results: Controlling for age, sex and multiple comparisons with significance set at p ≤ .05, as expected the TBI children exhibited significant and widely dispersed volume loss associated with injury severity. Larger volume of the right insular cortex and anterior and inferior temporal lobe were positively correlated with IQ in the TBI group. In contrast for the OI sample, more broadly distributed positive correlations with IQ were observed involving both hemispheres. Conclusion: Preserved cortical volume in the right insular cortex, temporal polar and inferotemporal region were associated with higher IQ in pediatric TBI.

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