Assessment of White Matter Injury and Outcome in Severe Brain Trauma A Prospective Multicenter Cohort
Assessment of White Matter Injury and Outcome in Severe Brain Trauma A Prospective Multicenter Cohort
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DOI：
10.1097/aln.0b013e3182755558
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发表时间：
2012-12-01
期刊：
影响因子：
8.8
通讯作者：
Puybasset, Louis
中科院分区：
文献类型：
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作者：
Galanaud, Damien;Perlbarg, Vincent;Puybasset, Louis
背景：现有的预测重型颅脑损伤后康复的方法缺乏准确性。这项研究的目的是确定定量扩散张量成像(DTI)对预后的价值。方法：在一项多中心研究中，作者前瞻性地纳入了105名在颅脑损伤后至少7天仍昏迷的患者。患者接受了脑磁共振成像，包括20个预先选择的白质束的DTI。患者在1年后用改良的格拉斯哥预后评分进行评估。在这个训练数据库上构建用于结果预测的综合DTI评分，然后在独立数据库(n=38)上进行验证。结果：在训练数据库中使用DTI评分预测不良结局，受试者操作特征曲线下面积为0.84(95%CI：0.75~0.91)。DTI评分预测不良结局的敏感性为%，特异性为95%。在非验证数据库中，受试者工作特征曲线下面积为0.80(95%可信区间：0.54~0.94)。在训练数据库上，与国际预后和临床试验分析任务评分相比，重新分类方法在分类准确性方面有显著提高(P<；0.05)。在验证数据库中观察到类似的结果。结论：与现有的临床/放射学预后评分相比，脑白质定量DTI评估提高了长期预后预测的准确性。
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 validation database.Conclusions: White matter assessment with quantitative DTI increases the accuracy of long-term outcome prediction compared with the available clinical/radiographic prognostic score.