Marquez de la Plata Carlos, Ardelean Andreea, Koovakkattu Della, Srinivasan Priya, Miller Anna, Phuong Viet, Harper Caryn, Moore Carol, Whittemore Anthony, Madden Christopher, Diaz-Arrastia Ramon, Devous Michael
Department of Neurology, University of Texas Southwestern Medical Center, Dallas, Texas 75390-9036, USA.
J Neurotrauma. 2007 Apr;24(4):591-8. doi: 10.1089/neu.2006.0214.
Diffuse axonal injury (DAI) is a common mechanism of traumatic brain injury (TBI) for which there is no well-accepted anatomic measures of injury severity. The present study aims to quantitatively assess DAI by measuring white matter lesion volume visible in fluid-attenuated inversion recovery (FLAIR) weighted images and to determine whether higher lesion volumes are associated with unfavorable functional outcome 6 months after injury. Twenty-four patients who experienced moderate to severe TBI without extra-axial or major cortical contusions were included in this study. Lesion volume was assessed by quantifying areas of hyperintensities in the white matter utilizing digitized FLAIR images. Two independent raters processed the magnetic resonance (MR) images and determined the total DAI volume. Functional outcome was assessed at 6 months after injury using the Glasgow Outcome Scale-Extended (GOSE). Interclass correlation analyses showed very high interrater reliability for each measure between the two raters (Interclass Correlation Coefficient = 0.95, p <or= 0.001). Total DAI volume was significantly, although modestly, correlated to GOSE (r = -0.453, p = 0.034). White matter lesion volume resulting from DAI can be quantitatively and reliably assessed from standard FLAIR-weighted MRIs. Patients with greater DAI volume have poorer functional outcomes. These methods may be useful in stratifying injury severity and for the assessment of DAI-directed therapies.
弥漫性轴索损伤（DAI）是创伤性脑损伤（TBI）的常见机制，目前尚无被广泛接受的损伤严重程度的解剖学测量方法。本研究旨在通过测量液体衰减反转恢复（FLAIR）加权图像中可见的白质病变体积来定量评估DAI，并确定更高的病变体积是否与伤后6个月时不良的功能结局相关。本研究纳入了24例经历中度至重度TBI且无轴外或主要皮质挫伤的患者。通过利用数字化FLAIR图像量化白质中的高信号区域来评估病变体积。两名独立的评估者处理磁共振（MR）图像并确定总的DAI体积。使用格拉斯哥扩展预后量表（GOSE）在伤后6个月评估功能结局。组内相关分析显示两名评估者之间每项测量的评估者间信度非常高（组内相关系数 = 0.95，p≤0.001）。总的DAI体积与GOSE显著相关，尽管相关性较弱（r = -0.453，p = 0.034）。由DAI导致的白质病变体积可从标准的FLAIR加权MRI中进行定量且可靠的评估。DAI体积更大的患者功能结局更差。这些方法可能有助于对损伤严重程度进行分层以及评估针对DAI的治疗。
