TY - JOUR T1 - Magnetic resonance in traumatic brain injury: A comparative study of the different conventional magnetic resonance imaging sequences and their diagnostic value in diffuse axonal injury JO - Neurocirugía (English edition) T2 - AU - Cicuendez,Marta AU - Castaño-León,Ana AU - Ramos,Ana AU - Hilario,Amaya AU - Gómez,Pedro A. AU - Lagares,Alfonso SN - 25298496 M3 - 10.1016/j.neucie.2017.06.007 DO - 10.1016/j.neucie.2017.06.007 UR - https://revistaneurocirugia.com/en-magnetic-resonance-in-traumatic-brain-articulo-S2529849617300448 AB - ObjectiveTo compare the identification capability of traumatic axonal injury (TAI) by different sequences on conventional magnetic resonance (MR) studies in traumatic brain injury (TBI) patients. Material and methodsWe retrospectively analysed 264 TBI patients to whom a MR had been performed in the first 60 days after trauma. All clinical variables related to prognosis were registered, as well as the data from the initial computed tomography. The MR imaging protocol consisted of a 3-plane localiser sequence T1-weighted and T2-weighted fast spin-echo, FLAIR and gradient-echo images (GRET2*). TAI lesions were classified according to Gentry and Firsching classifications. We calculated weighted kappa coefficients and the area under the ROC curve for each MR sequence. A multivariable analysis was performed to correlate MR findings in each sequence with the final outcome of the patients. ResultsTAI lesions were adequately visualised on T2, FLAIR and GRET2* sequences in more than 80% of the studies. Subcortical TAI lesions were well on FLAIR and GRET2* sequences visualised haemorrhagic TAI lesions. We saw that these MR sequences had a high inter-rater agreement for TAI diagnosis (0.8). T2 sequence presented the highest value on ROC curve in Gentry (0.68, 95%CI: 0.61–0.76, p<0.001, Nagerlkerke-R2 0.26) and Firsching classifications (0.64, 95%CI 0.57–0.72, p<0.001, Nagerlkerke-R2 0.19), followed by FLAIR and GRET2* sequences. Both classifications determined by each of these sequences were associated with poor outcome after performing a multivariable analyses adjusted for prognostic factors (p<0.02). ConclusionsWe recommend to perform conventional MR study in subacute phase including T2, FLAIR and GRET2* sequences for visualise TAI lesions. These MR findings added prognostic information in TBI patients. ER -