Publish in this journal
Journal Information
Share
Share
Download PDF
More article options
ePub
Visits
...
Special article
DOI: 10.1016/j.neucie.2020.02.003
Available online 26 February 2020
Sixto Obrador SENEC prize 2019: Utility of diffusion tensor imaging as a prognostic tool in moderate to severe traumatic brain injury. Part I. Analysis of DTI metrics performed during the early subacute stage
Premio Sixto Obrador SENEC 2019: el uso de la secuencia tensor de difusión como herramienta pronóstica en los pacientes con traumatismo craneoencefálico grave y moderado. Parte I. Análisis de las características del tensor de difusión realizado durante la fase subaguda precoz
Visits
...
Ana M. Castaño-Leona,
Corresponding author
, Marta Cicuendezb, Blanca Navarro-Maina, Pablo M. Munarriza, Igor Paredesa, Santiago Cepedac, Amaya Hilariod, Ana Ramosd, Pedro A. Gómeza, Alfonso Lagaresa
a Servicio de Neurocirugía, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Madrid, Spain
b Servicio de Neurocirugía, Hospital Universitario Vall d`Hebron, Universidad de Barcelona, Barcelona, Spain
c Servicio de Neurocirugía, Hospital Universitario Río Hortega, Universidad de Valladolid, Valladolid, Spain
d Servicio de Neurorradiología, Hospital Universitario 12 de Octubre, Universidad, Complutense de Madrid, Madrid, Spain
Received 26 November 2019. Accepted 27 November 2019
Article information
Abstract
Full Text
Bibliography
Download PDF
Statistics
Figures (4)
Show moreShow less
Tables (5)
Table 1. Patient demographic, clinical and radiological characteristics.
Table 2. Analysis of intra- and inter-observer reliability.
Table 3. Summary of the median and interquartile range of FA values in the different white matter tracts studied and results of comparisons between healthy controls and patients with moderate and severe TBI using the Mann-Whitney U test.
Table 4. Spearman's rho correlation indexes between FA values and patient outcomes.
Table 5. Discrimination analysis of unfavourable outcome by calculating the area under the curve (AUC) and its confidence interval, in brackets, for each white matter tract.
Show moreShow less
Abstract
Background and objectives

Traumatic axonal injury (TAI) contributes significantly to mortality and morbidity after traumatic brain injury (TBI). Its identification is still a diagnostic challenge because of the limitations of conventional imaging techniques to characterized it. Diffusion tensor imaging (DTI) can indirectly identify areas of damaged white matter (WM) integrity by detecting water molecule diffusion alterations. Our main objective is to characterize the TAI using DTI at the early subacute stage in our series of moderate to severe TBI patients and to evaluate if there is a relationship between the information provided by the DTI and patient’s outcome.

Materials and methods

We have obtained DTI data from 217 patients with moderate to severe TBI acquired at a median of 19 days after TBI, and patient DTI metrics were compared with data obtained from 58 age-matched healthy controls. Region of interest (ROI) method was applied to obtain mean fractional anisotropy (FA) value in 28 WM fiber bundles susceptible to TAI.

Results

Our main results were that when we compared patients with controls, patients, regardless of TBI severity, showed significantly reduced mean FA in almost all ROI measured. We found statistically significant correlation between FA metrics and some clinical characteristics. Additionally, the FA values of the three portions of Corpus callosum, Cingulum and cerebral peduncles measured at the early subacute stage were highly associated with outcome assessed at hospital discharge and at 6 and 12 months after TBI.

Conclusions

We conclude that DTI is a useful tool to characterize TAI and the detection of FA reduction in the subacute stage after TBI is associated with long-term unfavorable outcome.

Keywords:
Axial diffusivity
Diffusion tensor imaging
Fractional anisotropy
Longitudinal analysis
Ordinal regression analysis
Outcome measures
Radial diffusivity
Traumatic brain injury
Resumen
Antecedentes y objetivos

La lesión axonal traumática (LAT) contribuye significativamente a la mortalidad y morbilidad tras traumatismo craneoencefálico (TCE). Sin embargo, la caracterización de la LAT supone un reto diagnóstico para las técnicas de neuroimagen habitual. La secuencia de RM Tensor de difusión (DTI, diffusion tensor Imaging) es capaz de detectar el grado de difusión de las moléculas de agua tisular y así inferir la afectación traumática de la sustancia blanca. El objetivo principal de este trabajo ha sido caracterizar la LAT a través de la secuencia DTI realizada en la fase subaguda precoz en nuestra serie de pacientes con TCE moderado y grave y evaluar si existe asociación con la evolución de los pacientes.

Materiales y métodos

Se ha realizado RM-DTI a 217 pacientes con TCE moderado y grave en la fase subaguda precoz tras el TCE (mediana=19 días). El método de análisis elegido es por región de interés (ROI, Region of interest) para calcular el valor medio de FA (Fractional anisotropy) en 28 haces de sustancia blanca (SB). Los valores obtenidos en los pacientes se han comparado con aquellos medidos en 58 sujetos sanos.

Resultados

Los resultados principales han sido que los pacientes, independientemente de la gravedad, demostraron valores de FA significativamente inferiores al grupo control en prácticamente todos los haces estudiados. Se detectó asociación entre el valor de FA y algunas variables clínicas de interés. Adicionalmente, los valores de FA de las tres porciones del Cuerpo calloso, Cíngulo y pedúnculos cerebrales se correlacionaron con la evolución del paciente evaluada a los 6 y 12 meses tras el TCE.

Conclusiones

El DTI es una herramienta útil para caracterizar la LAT y la detección de la reducción de FA en la fase subaguda precoz se relaciona con evolución desfavorable de los pacientes a medio y largo plazo.

Palabras clave:
Difusión axial
Tensor de diffusion
Anisotropía fraccionada
Análisis longitudinal
Regresión ordinal
Medidas de evolución
Difusión radial
Traumatismo craneoencefálico

Article

These are the options to access the full texts of the publication Neurocirugía (English edition)
Member
Member of the Sociedad Española de Neurocirugía

If it is the first time you have accessed you can obtain your credentials by contacting Elsevier Spain in suscripciones@elsevier.com or by calling our Customer Service at902 88 87 40 if you are calling from Spain or at +34 932 418 800 (from 9 to 18h., GMT + 1) if you are calling outside of Spain.

If you already have your login data, please click here .

If you have forgotten your password you can you can recover it by clicking here and selecting the option ¿I have forgotten my password¿.

Subscriber
Subscriber

If you already have your login data, please click here .

If you have forgotten your password you can you can recover it by clicking here and selecting the option “I have forgotten my password”
Subscribe
Subscribe to

Neurocirugía (English edition)

Comprar
Comprar acceso al artículo

Comprando el artículo el PDF del mismo podrá ser descargado

Precio 22,50 €

Comprar ahora
Contact
Phone for subscriptions and reporting of errors
From Monday to Friday from 9 a.m. to 6 p.m. (GMT + 1) except for the months of July and August which will be from 9 a.m. to 3 p.m.
Calls from Spain
932 415 960
Calls from outside Spain
+34 932 415 960
Email
Idiomas
Neurocirugía (English edition)

Subscribe to our newsletter

Article options
Tools
es en

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?

es en
Política de cookies Cookies policy
Utilizamos cookies propias y de terceros para mejorar nuestros servicios y mostrarle publicidad relacionada con sus preferencias mediante el análisis de sus hábitos de navegación. Si continua navegando, consideramos que acepta su uso. Puede cambiar la configuración u obtener más información aquí. To improve our services and products, we use "cookies" (own or third parties authorized) to show advertising related to client preferences through the analyses of navigation customer behavior. Continuing navigation will be considered as acceptance of this use. You can change the settings or obtain more information by clicking here.