Department of Radiology, University Hospital Leuven, Belgium.
icometrix, Research and Development, Belgium.
Neuroradiol J. 2022 Aug;35(4):468-476. doi: 10.1177/19714009211049714. Epub 2021 Oct 13.
Imaging plays a crucial role in the diagnosis, prognosis and follow-up of traumatic brain injury. Whereas computed tomography plays a pivotal role in the acute setting, magnetic resonance imaging is best suited to detect the true extent of traumatic brain injury, and more specifically diffuse axonal injury. Post-traumatic brain atrophy is a well-known complication of traumatic brain injury.
This study investigated the correlation between diffuse axonal injury detected with fluid-attenuated inversion recovery and susceptibility-weighted imaging magnetic resonance imaging, post-traumatic brain atrophy and functional outcome (Glasgow outcome scale - extended).
Twenty patients with a closed head injury and diffuse axonal injury detected with fluid-attenuated inversion recovery and susceptibility-weighted imaging were included. The total volumes of the diffuse axonal injury fluid-attenuated inversion recovery lesions were determined for each subject's initial (<14 days) and follow-up magnetic resonance scan (average: day 303 ± 83 standard deviation). The different brain volumes were automatically quantified using a validated and both US Food and Drug Administration-cleared and CE-marked machine learning algorithm (icobrain). The number of susceptibility-weighted imaging lesions and functional outcome scores (Glasgow outcome scale - extended) were retrieved from the Collaborative European NeuroTrauma Effectiveness Research Traumatic Brain Injury dataset.
The volumetric fluid-attenuated inversion recovery diffuse axonal injury lesion load showed a significant inverse correlation with functional outcome (Glasgow outcome scale - extended) ( = -0.57; = 0.0094) and white matter volume change ( = -0.50; = 0.027). In addition, white matter volume change correlated significantly with the Glasgow outcome scale - extended score ( = 0.0072; = 0.58). Moreover, there was a strong inverse correlation between longitudinal fluid-attenuated inversion recovery lesion volume change and whole brain volume change ( = -0.63; = 0.0028). No significant correlation existed between the number of diffuse axonal injury susceptibility-weighted imaging lesions, brain atrophy and functional outcome.
Volumetric analysis of diffuse axonal injury on fluid-attenuated inversion recovery imaging and automated brain atrophy calculation are potentially useful tools in the clinical management and follow-up of traumatic brain injury patients with diffuse axonal injury.
影像学在创伤性脑损伤的诊断、预后和随访中起着至关重要的作用。虽然计算机断层扫描在急性情况下起着关键作用，但磁共振成像最适合检测创伤性脑损伤的真实程度，特别是弥漫性轴索损伤。创伤后脑萎缩是创伤性脑损伤的一种常见并发症。
本研究旨在探讨液体衰减反转恢复和磁化传递加权成像磁共振成像检测到的弥漫性轴索损伤与创伤后脑萎缩和功能预后（格拉斯哥预后评分-扩展）之间的相关性。
纳入 20 例闭合性头部损伤伴液体衰减反转恢复和磁化传递加权成像检测到的弥漫性轴索损伤患者。为每位患者的初始（<14 天）和随访磁共振扫描（平均：303±83 天标准差）确定弥漫性轴索损伤液体衰减反转恢复病变的总容积。使用经过验证且同时获得美国食品和药物管理局批准和 CE 标志的机器学习算法（icobrain）自动定量不同的脑容积。从协作性欧洲神经创伤功效研究创伤性脑损伤数据集检索磁化传递加权成像病变数量和功能预后评分（格拉斯哥预后评分-扩展）。
体积液体衰减反转恢复弥漫性轴索损伤病变负荷与功能预后（格拉斯哥预后评分-扩展）（ = -0.57； = 0.0094）和白质体积变化呈显著负相关（ = -0.50； = 0.027）。此外，白质体积变化与格拉斯哥预后评分-扩展评分显著相关（ = 0.0072； = 0.58）。此外，纵向液体衰减反转恢复病变体积变化与全脑体积变化之间存在强烈的负相关（ = -0.63； = 0.0028）。弥漫性轴索损伤磁化传递加权成像病变数量、脑萎缩与功能预后之间无显著相关性。
液体衰减反转恢复成像上弥漫性轴索损伤的容积分析和自动脑萎缩计算可能是弥漫性轴索损伤创伤性脑损伤患者临床管理和随访的有用工具。
