Back to Search
Start Over
Extended Anatomical Grading in Diffuse Axonal Injury Using MRI: Hemorrhagic Lesions in the Substantia Nigra and Mesencephalic Tegmentum Indicate Poor Long-Term Outcome.
- Source :
-
Journal of neurotrauma [J Neurotrauma] 2017 Jan 15; Vol. 34 (2), pp. 341-352. Date of Electronic Publication: 2016 Jul 25. - Publication Year :
- 2017
-
Abstract
- Clinical outcome after traumatic diffuse axonal injury (DAI) is difficult to predict. In this study, three magnetic resonance imaging (MRI) sequences were used to quantify the anatomical distribution of lesions, to grade DAI according to the Adams grading system, and to evaluate the value of lesion localization in combination with clinical prognostic factors to improve outcome prediction. Thirty patients (mean 31.2 years ±14.3 standard deviation) with severe DAI (Glasgow Motor Score [GMS] <6) examined with MRI within 1 week post-injury were included. Diffusion-weighted (DW), T2*-weighted gradient echo and susceptibility-weighted (SWI) sequences were used. Extended Glasgow outcome score was assessed after 6 months. Number of DW lesions in the thalamus, basal ganglia, and internal capsule and number of SWI lesions in the mesencephalon correlated significantly with outcome in univariate analysis. Age, GMS at admission, GMS at discharge, and low proportion of good monitoring time with cerebral perfusion pressure <60 mm Hg correlated significantly with outcome in univariate analysis. Multivariate analysis revealed an independent relation with poor outcome for age (p = 0.005) and lesions in the mesencephalic region corresponding to substantia nigra and tegmentum on SWI (p = 0.008). We conclude that higher age and lesions in substantia nigra and mesencephalic tegmentum indicate poor long-term outcome in DAI. We propose an extended MRI classification system based on four stages (stage I-hemispheric lesions, stage II-corpus callosum lesions, stage III-brainstem lesions, and stage IV-substantia nigra or mesencephalic tegmentum lesions); all are subdivided by age (≥/<30 years).<br />Competing Interests: Author Disclosure Statement No competing financial interests exist.
- Subjects :
- Adolescent
Adult
Cerebral Hemorrhage classification
Cerebral Hemorrhage epidemiology
Diffuse Axonal Injury classification
Diffuse Axonal Injury epidemiology
Female
Glasgow Coma Scale trends
Humans
Magnetic Resonance Imaging classification
Male
Middle Aged
Time Factors
Tomography, X-Ray Computed classification
Tomography, X-Ray Computed trends
Treatment Outcome
Young Adult
Cerebral Hemorrhage diagnostic imaging
Diffuse Axonal Injury diagnostic imaging
Magnetic Resonance Imaging trends
Substantia Nigra diagnostic imaging
Tegmentum Mesencephali diagnostic imaging
Subjects
Details
- Language :
- English
- ISSN :
- 1557-9042
- Volume :
- 34
- Issue :
- 2
- Database :
- MEDLINE
- Journal :
- Journal of neurotrauma
- Publication Type :
- Academic Journal
- Accession number :
- 27356857
- Full Text :
- https://doi.org/10.1089/neu.2016.4426