Lesions in deep gray nuclei after severe traumatic brain injury predict neurologic outcome.
PLoS ONE. 2017-11-02; 12(11): e0186641
DOI: 10.1371/journal.pone.0186641
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PURPOSE: This study evaluates the correlation between injuries to deep gray
matter nuclei, as quantitated by lesions in these nuclei on MR T2 Fast Spin Echo
(T2 FSE) images, with 6-month neurological outcome after severe traumatic brain
injury (TBI).
MATERIALS AND METHODS: Ninety-five patients (80 males, mean age = 36.7y) with
severe TBI were prospectively enrolled. All patients underwent a MR scan within
the 45 days after the trauma that included a T2 FSE acquisition. A 3D deformable
atlas of the deep gray matter was registered to this sequence; deep gray matter
lesions (DGML) were evaluated using a semi-quantitative classification scheme.
The 6-month outcome was dichotomized into unfavorable (death, vegetative or
minimally conscious state) or favorable (minimal or no neurologic deficit)
outcome.
RESULTS: Sixty-six percent of the patients (63/95) had both satisfactory
registration of the 3D atlas on T2 FSE and available clinical follow-up. Patients
without DGML had an 89% chance (P = 0.0016) of favorable outcome while those with
bilateral DGML had an 80% risk of unfavorable outcome (P = 0.00008). Multivariate
analysis based on DGML accurately classified patients with unfavorable
neurological outcome in 90.5% of the cases.
CONCLUSION: Lesions in deep gray matter nuclei may predict long-term outcome
after severe TBI with high sensitivity and specificity.