Prognostic Value of Diffusion Tensor Imaging Parameters in Severe Traumatic Brain Injury
Prognostic Value of Diffusion Tensor Imaging Parameters in Severe Traumatic Brain Injury
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DOI：
10.1089/neu.2011.2215
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发表时间：
2012-05-01
影响因子：
4.2
通讯作者：
Gullapalli, Rao P.
中科院分区：
文献类型：
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作者：
Betz, Joshua;Zhuo, Jiachen;Gullapalli, Rao P.
扩散张量成像（DTI）最近已成为评估创伤性脑损伤（TBI）的有用工具。在这项研究中，评估了 DTI 测量值与严重 TBI 患者临床状态（无论是在磁共振成像 (MRI) 时还是在出院接受急性 TBI 康复治疗时）之间关系的预后价值。经机构审查委员会批准后，对收治于创伤中心的严重闭合性头部损伤的患者 (n = 59) 进行回顾性评估，以确定 DTI 测量的预后价值。将 DTI 测量值（包括全脑白质、内囊、膝部、压部和胼胝体的表观扩散系数 (ADC)、分数各向异性 (FA)、轴向（平行于）和径向扩散率（垂直于））与 MRI 和出院至急性 TBI 康复时的神经系统状态进行比较。全脑白质ADC、λ（平行）和λ（垂直）平均值及其变异系数（CV）与MRI当天的格拉斯哥昏迷量表（GCS）评分显着相关。所有测量的大脑区域的平均 lambda（平行）与 MRI 当天的 GCS 评分显着相关。结果与 ADC 和 lambda（平行于）的全脑白质平均值以及 FA、ADC、lambda（平行于）和 lambda（垂直于）的 CV 相关；以及所有胼胝体区域的 FA 和 lambda（平行于）的平均值和 CV。根据入院 GCS 评分和年龄进行调整后，纳入区域和全球 DTI 测量结果提高了预后模型的准确性 (p < 0.05)。全脑白质和局部 DTI 测量是 TBI 的敏感标志，与 MRI 和出院康复时的神经状态相关。添加根据年龄、性别和入院 GCS 评分进行调整的 DTI 测量结果显着改善了预后模型。
Diffusion tensor imaging (DTI) has recently emerged as a useful tool for assessing traumatic brain injury (TBI). In this study, the prognostic value of the relationship between DTI measures and the clinical status of severe TBI patients, both at the time of magnetic resonance imaging (MRI), and their discharge to acute TBI rehabilitation, was assessed. Patients (n = 59) admitted to the trauma center with severe closed head injuries were retrospectively evaluated after approval from the institution's institutional review board, to determine the prognostic value of DTI measures. The relationship of DTI measures, including apparent diffusion coefficient (ADC), fractional anisotropy (FA), axial (lambda(parallel to)) and radial diffusivity (lambda(perpendicular to)) from the whole brain white matter, internal capsule, genu, splenium, and body of the corpus callosum, were compared with neurological status at MRI and at discharge to acute TBI rehabilitation. Whole brain white matter averages of ADC, lambda(parallel to), and lambda(perpendicular to), and their coefficient of variation (CV) were significantly correlated with the Glasgow Coma Scale (GCS) score on the day of MRI. The average lambda(parallel to) was significantly correlated with GCS scores on the day of MRI in all measured brain regions. Outcomes were associated with whole brain white matter averages of ADC and lambda(parallel to), and the CVs of FA, ADC, lambda(parallel to), and lambda(perpendicular to); and the averages and CVs of FA and lambda(parallel to) in all corpus callosum regions. The inclusion of regional and global DTI measures improved the accuracy of prognostic models, when adjusted for admission GCS score and age (p < 0.05). Whole brain white matter and regional DTI measures are sensitive markers of TBI, and correlate with neurological status both at MRI and discharge to rehabilitation. The addition of DTI measures adjusted for age, gender, and admission GCS score significantly improved prognostic models.