Student Research Committee, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran.
Neuroscience Research Center, Iran University of Medical Sciences, Tehran, Iran.
Neurosurg Rev. 2024 Nov 6;47(1):837. doi: 10.1007/s10143-024-03071-y.
Traumatic brain injury (TBI) is a major cause of morbidity and mortality, impacting healthcare systems and economies. Early identification of poor outcomes is crucial for effective treatment. This systematic review assesses the prognostic value of computed tomography (CT) and magnetic resonance imaging (MRI) findings in predicting poor neurological outcomes and mortality in the acute phase of TBI. A comprehensive search of Scopus, MEDLINE, and Web of science databases was performed to identify studies examining CT and MR-based imaging findings and their association with poor outcomes as assessed by Glasgow outcome score as well as mortality within the early acute phase of TBI following injury/admission. Qualitative evaluation of included studies revealed several imaging sequences that modify the outcome of the patients, including extra-axial and intra-axial hemorrhage, swirl sign, contrast extravasation, midline shift, closed and open cranial cisterns, signs of edema, presence of cranial fractures, intracranial hemorrhage, cerebral microbleeds, diffuse axonal injury, apparent diffusion coefficient and fractional anisotropy in diffusion tensor imaging, as well as, concentrations of brain metabolites(N-acetyl aspartate, Creatinine, Choline, Myo-inositol, glutamate, and glutamine) in magnetic resonance spectroscopy. Among these markers, subarachnoid hemorrhage (SAH) and subdural hematoma (SDH) emerged as the most predictive of poor outcomes based on meta-analysis findings. SAH was significantly associated with an increased risk of mortality (OR: 3.35, 95% CI: 2.41-4.65, I²=51.3%) and poor outcomes (OR: 2.69, 95% CI: 2.44-2.96, I²=0%). Similarly, SDH correlated with higher mortality risk (OR: 2.44, 95% CI: 2.14-2.78, I²=0%) and worse outcomes (OR: 2.00, 95% CI: 1.12-3.59, I²=60.9%). In contrast, epidural hematoma (EDH) was linked to better outcomes (OR: 0.60, 95% CI: 0.52-0.68, I²=0%) but not significantly associated with mortality (OR: 0.38, 95% CI: 0.09-1.65, I²=73.7%). The results of this systematic review and meta-analysis provide an overview of clinically feasible imaging markers of prognostic value and may inform clinical decision-making in the future.
创伤性脑损伤 (TBI) 是发病率和死亡率的主要原因，影响着医疗保健系统和经济。早期识别不良结局对于有效治疗至关重要。本系统评价评估了计算机断层扫描 (CT) 和磁共振成像 (MRI) 发现对预测 TBI 急性期不良神经结局和死亡率的预后价值。对 Scopus、MEDLINE 和 Web of Science 数据库进行了全面检索，以确定研究 CT 和基于 MRI 的影像学发现及其与不良结局（格拉斯哥结局评分评估）和损伤/入院后 TBI 早期急性阶段死亡率之间关系的研究。对纳入研究的定性评估显示了几种改变患者结局的影像学序列，包括外囊和内囊出血、漩涡征、对比外渗、中线移位、闭合和开放颅腔、水肿征象、颅骨骨折、颅内出血、脑微出血、弥漫性轴索损伤、表观扩散系数和扩散张量成像中的分数各向异性以及磁共振波谱中脑代谢物（N-乙酰天冬氨酸、肌酸、胆碱、肌醇、谷氨酸和谷氨酰胺）浓度。在这些标志物中，根据荟萃分析结果，蛛网膜下腔出血 (SAH) 和硬膜下血肿 (SDH) 是预测不良结局的最具预测性的标志物。SAH 与死亡率增加显著相关（OR：3.35，95%CI：2.41-4.65，I²=51.3%）和不良结局（OR：2.69，95%CI：2.44-2.96，I²=0%）。同样，SDH 与更高的死亡率风险相关（OR：2.44，95%CI：2.14-2.78，I²=0%）和更差的结局（OR：2.00，95%CI：1.12-3.59，I²=60.9%）。相比之下，硬膜外血肿 (EDH) 与更好的结局相关（OR：0.60，95%CI：0.52-0.68，I²=0%），但与死亡率无显著相关性（OR：0.38，95%CI：0.09-1.65，I²=73.7%）。本系统评价和荟萃分析的结果提供了具有预后价值的临床可行影像学标志物的概述，并可能为未来的临床决策提供信息。
