Lesions in deep gray nuclei after severe traumatic brain injury predict neurologic outcome.

Frédéric Clarençon, Éric Bardinet, Jacques Martinerie, Vincent Pelbarg, Nicolas Menjot de Champfleur, Rajiv Gupta, Eléonore Tollard, Gustavo Soto-Ares, Danielle Ibarrola, Emmanuelle Schmitt, Thomas Tourdias, Vincent Degos, Jérome Yelnik, Didier Dormont, Louis Puybasset, Damien Galanaud,
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)

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.


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