Assessment of white matter injury and outcome in severe brain trauma: a prospective multicenter cohort.
Anesthesiology. 2012-12-01; 117(6): 1300-1310
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1. Anesthesiology. 2012 Dec;117(6):1300-10. doi: 10.1097/ALN.0b013e3182755558.
Assessment of white matter injury and outcome in severe brain trauma: a
prospective multicenter cohort.
Galanaud D(1), Perlbarg V, Gupta R, Stevens RD, Sanchez P, Tollard E, de
Champfleur NM, Dinkel J, Faivre S, Soto-Ares G, Veber B, Cottenceau V, Masson F,
Tourdias T, André E, Audibert G, Schmitt E, Ibarrola D, Dailler F, Vanhaudenhuyse
A, Tshibanda L, Payen JF, Le Bas JF, Krainik A, Bruder N, Girard N, Laureys S,
Benali H, Puybasset L; Neuro Imaging for Coma Emergence and Recovery Consortium.
Collaborators: Dormont D, Abdennour L, Leclercq D, Poete P, Riegel B, Tavernier
B, Jissendi P, Delmaire C, Pruvo JP, Gouin P, Guitard PG, Gérardin E, Perot G,
Sztark F, Dousset V, Boularan A, Perrigault PF, Le Bars E, Bonafé A, Charpentier
C, Baumann A, Di Roio C, Sappey-Marinier D.
(1)Department of Neuroradiology, Pitié Salpêtrière Hospital, & Université Pierre
et Marie Curie (Paris VI), Boulevard de l’Hôpital, Paris, France.
BACKGROUND: 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).
METHODS: 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.
RESULTS: 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
CONCLUSIONS: White matter assessment with quantitative DTI increases the accuracy
of long-term outcome prediction compared with the available clinical/radiographic
PMID: 23135261 [Indexed for MEDLINE]