Revisiting Grade 3 Diffuse Axonal Injury: Not All Brainstem Microbleeds are Prognostically Equal
Revisiting Grade 3 Diffuse Axonal Injury: Not All Brainstem Microbleeds are Prognostically Equal
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DOI：
10.1007/s12028-017-0399-2
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发表时间：
2017-10-01
影响因子：
3.5
通讯作者：
Edlow, Brian L.
中科院分区：
文献类型：
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作者：
Izzy, Saef;Mazwi, Nicole L.;Edlow, Brian L.
脑干创伤性轴索损伤（TAI）（也称为“3级弥漫性轴索损伤”）患者可能恢复功能独立性，但缺乏急性预后生物标志物。我们假设，通过创伤性微出血（TMB）负荷测量的背侧脑干TAI程度与1年功能结局的相关性比腹侧脑干、胼胝体或全脑TMB负荷更强。此外，我们假设脑干内的上升觉醒网络（AAN）的TMB与1年outcome.Using一个前瞻性的结果数据库的患者治疗中度至重度创伤性脑损伤在住院康复医院，我们回顾性地确定了39例接受急性梯度回波（GRE）磁共振成像（MRI）。在急性GRE扫描上对TMB进行计数，并在背侧脑干、腹侧脑干和胼胝体中计数。还将TMB映射到AAN核的图谱上。主要结局是损伤后1年的残疾评定量表（DRS）评分。通过计算斯皮尔曼等级相关系数评估局部TMB、AAN TMB体积和1年DRS评分之间的相关性，TMB的平均值+/- SD为：背侧脑干= 0.7 +/- 1.4，腹侧脑干= 0.2 +/- 0.6，胼胝体= 1.8 +/- 2.8，全局= 14.4 +/- 12.5。AAN核内的平均+/- SD TMB体积为6.1 +/- 18.7 mm（3）。背侧脑干TMB增加和AAN TMB体积较大与1年结局较差相关（分别为R = 0.37，p = 0.02和R = 0.36，p = 0.02）。全球，胼胝体，和腹侧脑干TMBs与outcome.These研究结果表明，背侧脑干TAI，特别是涉及AAN核，可能有更大的预后效用比在大脑或脑干病变的总数。
Recovery of functional independence is possible in patients with brainstem traumatic axonal injury (TAI), also referred to as "grade 3 diffuse axonal injury," but acute prognostic biomarkers are lacking. We hypothesized that the extent of dorsal brainstem TAI measured by burden of traumatic microbleeds (TMBs) correlates with 1-year functional outcome more strongly than does ventral brainstem, corpus callosal, or global brain TMB burden. Further, we hypothesized that TMBs within brainstem nuclei of the ascending arousal network (AAN) correlate with 1-year outcome.Using a prospective outcome database of patients treated for moderate-to-severe traumatic brain injury at an inpatient rehabilitation hospital, we retrospectively identified 39 patients who underwent acute gradient-recalled echo (GRE) magnetic resonance imaging (MRI). TMBs were counted on the acute GRE scans globally and in the dorsal brainstem, ventral brainstem, and corpus callosum. TMBs were also mapped onto an atlas of AAN nuclei. The primary outcome was the disability rating scale (DRS) score at 1 year post-injury. Associations between regional TMBs, AAN TMB volume, and 1-year DRS score were assessed by calculating Spearman rank correlation coefficients.Mean +/- SD number of TMBs was: dorsal brainstem = 0.7 +/- 1.4, ventral brainstem = 0.2 +/- 0.6, corpus callosum = 1.8 +/- 2.8, and global = 14.4 +/- 12.5. The mean +/- SD TMB volume within AAN nuclei was 6.1 +/- 18.7 mm(3). Increased dorsal brainstem TMBs and larger AAN TMB volume correlated with worse 1-year outcomes (R = 0.37, p = 0.02, and R = 0.36, p = 0.02, respectively). Global, callosal, and ventral brainstem TMBs did not correlate with outcomes.These findings suggest that dorsal brainstem TAI, especially involving AAN nuclei, may have greater prognostic utility than the total number of lesions in the brain or brainstem.