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

Damien Galanaud, Vincent Perlbarg, Rajiv Gupta, Robert D. Stevens, Paola Sanchez, Eléonore Tollard, Nicolas Menjot De Champfleur, Julien Dinkel, Sébastien Faivre, Gustavo Soto-Ares, Benoit Veber, Vincent Cottenceau, Françoise Masson, Thomas Tourdias, Edith André, Gérard Audibert, Emmanuelle Schmitt, Danielle Ibarrola, Frédéric Dailler, Audrey VanhaudenhuyseLuaba Tshibanda, Jean François Payen, Jean François Le Bas, Alexandre Krainik, Nicolas Bruder, Nadine Girard, Steven Laureys, Habib Benali, Louis Puybasset

Research output: Contribution to journalArticlepeer-review

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.

Original languageEnglish (US)
Pages (from-to)1300-1310
Number of pages11
JournalAnesthesiology
Volume117
Issue number6
DOIs
StatePublished - Dec 2012

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

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