MRI volumetry and diffusion tensor imaging for diagnosis and follow-up of late post-traumatic injuries - 27/03/24
, Pierre-Romain Delmotte a, Claire Gourbeix a, Nicolas Farny a, Bérenger Perret-Liaudet a, Dany Hijazi a, Valentine Batisti a, Grégory Torkomian a, Didier Cassereau b, c, Clara Debarle d, Eimad Shotar e, Celia Gellman f, Bertrand Mathon g, Eleonor Bayen h, Damien Galanaud i, Vincent Perlbarg j, Louis Puybasset a, j, Vincent Degos a
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Highlights |
• | DTI is a key element in the diagnosis and follow-up care for people following a TBI. |
• | DTI markers (particularly FA) are more correlated to post-TBI neurological outcomes than FLAIR. |
• | DTI markers allow a regional analysis of post-TBI white matter injuries. |
• | DTI markers show that in the 10 years post-TBI lesions evolve in a biphasic pattern: their incidence increases for the first 5 years, before stabilizing. |
Abstract |
Background |
Traumatic Brain Injury (TBI) is a major cause of acquired disability and can cause devastating and progressive post-traumatic encephalopathy. TBI is a dynamic condition that continues to evolve over time. A better understanding of the pathophysiology of these late lesions is important for the development of new therapeutic strategies.
Objectives |
The primary objective was to compare the ability of fluid-attenuated reversion recovery (FLAIR) and diffusion tensor imaging (DTI) magnetic resonance imaging (MRI) markers to identify participants with a Glasgow outcome scale extended (GOS-E) score of 7–8, up to 10 years after their original TBI. The secondary objective was to study the brain regionalization of DTI markers. Finally, we analyzed the evolution of late-developing brain lesions using repeated MRI images, also taken up to 10 years after the TBI.
Methods |
In this retrospective study, participants were included from a cohort of people hospitalized following a severe TBI. Following their discharge, they were followed-up and clinically assessed, including a DTI-MRI scan, between 2012 and 2016. We performed a cross-sectional analysis on 97 participants at a median (IQR) of 5 years (3–6) post-TBI, and a further post-TBI longitudinal analysis over 10 years on a subpopulation (n = 17) of the cohort.
Results |
Although the area under the curve (AUC) of FLAIR, fractional anisotropy (FA), and mean diffusivity (MD) were not significantly different, only the AUC of FA was statistically greater than 0.5. In addition, only the FA was correlated with clinical outcomes as assessed by GOS-E score (P<10−4). On the cross-sectional analysis, DTI markers allowed study post-TBI white matter lesions by region. In the longitudinal subpopulation analysis, the observed number of brain lesions increased for the first 5 years post-TBI, before stabilizing over the next 5 years.
Conclusions |
This study has shown for the first time that post-TBI lesions can present in a two-phase evolution. These results must be confirmed in larger studies. French Data Protection Agency (Commission nationale de l'informatique et des libertés; CNIL) study registration no: 1934708v0.
Il testo completo di questo articolo è disponibile in PDF.Keywords : Traumatic brain injury, Diffusion tensor imaging
Abbreviations : AUC, CENTER-TBI, CSF, CT, DTI, DTIFIT, FA, FLAIR, FMRIB, GM, GOS-E, IMPACT-TBI, JHU, MD, MRI, NICU, ROC, SAPS II, STROBE, TBI, TE, TIV, TR, WM, 3DT1
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Vol 67 - N° 2
Articolo 101783- marzo 2024 Ritorno al numero
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