Catalog Home Page

Prognostic significance of magnetic resonance imaging in patients with severe nonpenetrating traumatic brain injury requiring decompressive craniectomy

Ho, K.M., Honeybul, S. and Ambati, R. (2018) Prognostic significance of magnetic resonance imaging in patients with severe nonpenetrating traumatic brain injury requiring decompressive craniectomy. World Neurosurgery . In Press.

[img]
PDF - Authors' Version
Embargoed until February 2019.

Link to Published Version: https://doi.org/10.1016/j.wneu.2018.01.203
*Subscription may be required

Abstract

Background
Diffuse axonal injury (DAI) detected on magnetic resonance imaging (MRI) may be useful to predict outcome after traumatic brain injury (TBI).

Methods
This study compared the ability of the International Mission for Prognosis and Analysis of Clinical Trials (IMPACT) prognostic model with DAI on MRI, to predict 18-months neurological outcome in 56 patients who had required a decompressive craniectomy after TBI.

Results
Of the 56 patients included in the study (19 scans occurred within 14 days; median time for all patients 24 days, interquartile range 14-42), 18 (32%) had evidence of DAI on the MRI scans. The presence of DAI on the MRI diffusion-weighted (DW), T2*-weighted-gradient-echo and susceptibility-weighted (SWI) sequences was associated with an increased risk of unfavorable outcome at 18-months compared to those without DAI (44% vs. 17%, difference=27%, 95% confidence interval 2.4-46.7%; p=0.032), particularly when brainstem was involved. However, neither the grading (I to IV) nor the number of brain regions with DAI was as good as the IMPACT model in discriminating between patients with unfavorable and favorable outcome (area under the receiver-operating-characteristic curve: 0.625 and 0.621 vs 0.918, respectively; p<0.001 for both comparisons). After adjusting for the IMPACT prognostic risks, DAI in different brain regions and the grading of DAI were also not independently associated with unfavorable outcome.

Conclusions
The prognostic significance of DAI on MRI may, in part, be captured by the IMPACT prognostic model. More research is needed before MRI should be routinely used to prognosticate outcomes of patients with TBI requiring decompressive craniectomy.

Publication Type: Journal Article
Murdoch Affiliation: School of Veterinary and Life Sciences
Publisher: Elsevier
Copyright: © 2018 Published by Elsevier Inc
URI: http://researchrepository.murdoch.edu.au/id/eprint/40182
Item Control Page Item Control Page