Assessment of white matter injury and outcome in severe brain trauma: a prospective multicenter cohort.

Abstract : 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.
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Anesthesiology, Lippincott, Williams & Wilkins, 2012, 117 (6), pp.1300-10. 〈10.1097/ALN.0b013e3182755558〉
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Soumis le : mercredi 24 avril 2013 - 19:43:20
Dernière modification le : lundi 10 décembre 2018 - 01:23:19

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Damien Galanaud, Vincent Perlbarg, Rajiv Gupta, Robert D Stevens, Paola Sanchez, et al.. Assessment of white matter injury and outcome in severe brain trauma: a prospective multicenter cohort.. Anesthesiology, Lippincott, Williams & Wilkins, 2012, 117 (6), pp.1300-10. 〈10.1097/ALN.0b013e3182755558〉. 〈hal-00817567〉

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