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-Francois Payen de la Garanderie, 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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