Sener Süleyman, Van Hecke Wim, Feyen Bart F E, Van der Steen Gregory, Pullens Pim, Van de Hauwe Luc, Menovsky Tomas, Parizel Paul M, Jorens Philippe G, Maas Andrew I R
*Department of Neurosurgery, Antwerp University Hospital, Edegem, Belgium; ‡Department of Radiology, Antwerp University Hospital, Edegem, Belgium; §Department of Intensive Care, Antwerp University Hospital, Edegem, Belgium; ¶University of Antwerp, Edegem, Belgium.
Neurosurgery. 2016 Dec;79(6):786-793. doi: 10.1227/NEU.0000000000001325.
A great need exists in traumatic brain injury (TBI) and aneurysmal subarachnoid hemorrhage (aSAH) for objective biomarkers to better characterize the disease process and to serve as early endpoints in clinical studies. Diffusion tensor imaging (DTI) has shown promise in TBI, but much less is known about aSAH.
To explore the use of whole-brain DTI tractography in TBI and aSAH as a biomarker and early endpoint.
Of a cohort of 43 patients with severe TBI (n = 20) or aSAH (n = 23) enrolled in a prospective, observational, multimodality monitoring study, DTI data were acquired at approximately day 12 (median, 12 days; interquartile range, 12-14 days) after injury in 22 patients (TBI, n = 12; aSAH, n = 10). Whole-brain DTI tractography was performed, and the following parameters quantified: average fractional anisotropy, mean diffusivity, tract length, and the total number of reconstructed fiber tracts. These were compared between TBI and aSAH patients and correlated with mortality and functional outcome assessed at 6 months by the Glasgow Outcome Scale Extended.
Significant differences were found for fractional anisotropy values (P = .01), total number of tracts (P = .03), and average tract length (P = .002) between survivors and nonsurvivors. A sensitivity analysis showed consistency of results between the TBI and aSAH patients for the various DTI measures.
DTI parameters, assessed at approximately day 12 after injury, correlated with mortality at 6 months in patients with severe TBI or aSAH. Similar patterns were found for both TBI and aSAH patients. This supports a potential role of DTI as early endpoint for clinical studies and a predictor of late mortality.
aSAH, aneurysmal subarachnoid hemorrhageDTI, diffusion tensor imagingFA, fractional anisotropyGOSE, Glasgow Outcome Scale ExtendedTBI, traumatic brain injuryTE, echo timeTR, repetition time.
在创伤性脑损伤（TBI）和动脉瘤性蛛网膜下腔出血（aSAH）领域，迫切需要客观的生物标志物来更好地描述疾病进程，并作为临床研究的早期终点。扩散张量成像（DTI）已在TBI研究中展现出前景，但关于aSAH的了解却少得多。
探讨全脑DTI纤维束成像在TBI和aSAH中作为生物标志物及早期终点的应用。
在一项前瞻性、观察性、多模态监测研究中纳入了43例重度TBI患者（n = 20）或aSAH患者（n = 23），其中22例患者（TBI，n = 12；aSAH，n = 10）在受伤后约第12天（中位数为12天；四分位间距为12 - 14天）获取了DTI数据。进行全脑DTI纤维束成像，并对以下参数进行量化：平均各向异性分数、平均扩散率、纤维束长度以及重建纤维束的总数。将这些参数在TBI和aSAH患者之间进行比较，并与伤后6个月时通过扩展格拉斯哥预后量表评估的死亡率和功能结局相关联。
幸存者与非幸存者之间在各向异性分数值（P = .01）、纤维束总数（P = .03）和平均纤维束长度（P = .002）方面存在显著差异。敏感性分析显示，TBI和aSAH患者在各种DTI测量结果上具有一致性。
在受伤后约第12天评估的DTI参数与重度TBI或aSAH患者6个月时的死亡率相关。TBI和aSAH患者均发现了相似模式。这支持了DTI作为临床研究早期终点和晚期死亡率预测指标的潜在作用。
aSAH，动脉瘤性蛛网膜下腔出血；DTI，扩散张量成像；FA，各向异性分数；GOSE，扩展格拉斯哥预后量表；TBI，创伤性脑损伤；TE，回波时间；TR，重复时间
