Assessment of White Matter Injury and Outcome in Severe Brain Trauma: A Prospective Multicenter Cohort

Existing methods to predict recovery after severe traumatic brain injury lack accuracy. The aim of this study is to determine the prognostic value of quantitative diffusion tensor imaging (DTI). In a multicenter study, the authors prospectively enrolled 105 patients who remained comatose at least 7...

Full description

Saved in:

Bibliographic Details
Published in:	Anesthesiology (Philadelphia) 2012-12, Vol.117 (6), p.1300-1310
Main Authors:	GALANAUD, Damien, PERLBARG, Vincent, VEBER, Benoit, COTTENCEAU, Vincent, MASSON, Françoise, TOURDIAS, Thomas, ANDRE, Edith, AUDIBERT, Gerard, SCHMITT, Emmanuelle, IBARROLA, Danielle, DAILLER, Frédéric, VANHAUDENHUYSE, Audrey, GUPTA, Rajiv, TSHIBANDA, Luaba, PAYEN, Jean-François, LE BAS, Jean-François, KRAINIK, Alexandre, BRUDER, Nicolas, GIRARD, Nadine, LAUREYS, Steven, BENALI, Habib, PUYBASSET, Louis, STEVENS, Robert D, SANCHEZ, Paola, TOLLARD, Eléonore, MENJOT DE CHAMPFLEUR, Nicolas, DINKEL, Julien, FAIVRE, Sébastien, SOTO-ARES, Gustavo
Format:	Article
Language:	eng
Subjects:	Adolescent Adult Aged Anesthesia Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy Biological and medical sciences Brain Injuries - metabolism Brain Injuries - pathology Brain Injuries - therapy Cohort Studies Computer Science Female Follow-Up Studies Human health sciences Humans Magnetic Resonance Imaging - methods Male Medical Imaging Medical sciences Middle Aged Nerve Fibers, Myelinated - metabolism Nerve Fibers, Myelinated - pathology Neurologie Neurology Prospective Studies Sciences de la santé humaine Severity of Illness Index Treatment Outcome Young Adult
Online Access:	Get full text
Tags:	Add Tag No Tags, Be the first to tag this record!

Description
Summary:	Existing methods to predict recovery after severe traumatic brain injury lack accuracy. The aim of this study is to determine the prognostic value of quantitative diffusion tensor imaging (DTI). In a multicenter study, the authors prospectively enrolled 105 patients who remained comatose at least 7 days after traumatic brain injury. Patients underwent brain magnetic resonance imaging, including DTI in 20 preselected white matter tracts. Patients were evaluated at 1 yr with a modified Glasgow Outcome Scale. A composite DTI score was constructed for outcome prognostication on this training database and then validated on an independent database (n=38). DTI score was compared with the International Mission for Prognosis and Analysis of Clinical Trials Score. Using the DTI score for prediction of unfavorable outcome on the training database, the area under the receiver operating characteristic curve was 0.84 (95% CI: 0.75-0.91). The DTI score had a sensitivity of 64% and a specificity of 95% for the prediction of unfavorable outcome. On the validation-independent database, the area under the receiver operating characteristic curve was 0.80 (95% CI: 0.54-0.94). On the training database, reclassification methods showed significant improvement of classification accuracy (P < 0.05) compared with the International Mission for Prognosis and Analysis of Clinical Trials score. Similar results were observed on the validation database. White matter assessment with quantitative DTI increases the accuracy of long-term outcome prediction compared with the available clinical/radiographic prognostic score.
ISSN:	0003-3022 1528-1175 1528-1175