Research Reports - Predicting outcome after pediatric traumatic brain injury by early magnetic resonance imaging lesion location and volume

J Neurotrauma. 2015 Jun 19

Smitherman E(1), Hernandez A(2), Stavinoha PL(2,)(3), Huang R(4), Kernie SG(5),
Diaz-Arrastia R(6), Miles DK(5)

Brain lesions after traumatic brain injury (TBI) are heterogeneous, rendering
outcome prognostication difficult. The aim of this study is to investigate
whether early magnetic resonance imaging (MRI) of lesion location and lesion
volume within discrete brain anatomical zones can accurately predict long-term
neurological outcome in children post-TBI. Fluid-attenuated inversion recovery
(FLAIR) MRI hyperintense lesions in 63 children obtained 6.2±5.6 days postinjury
were correlated with the Glasgow Outcome Scale Extended-Pediatrics (GOS-E Peds)
score at 13.5±8.6 months. FLAIR lesion volume was expressed as hyperintensity
lesion volume index (HLVI)=(hyperintensity lesion volume / whole brain
volume)×100 measured within three brain zones: zone A (cortical structures); zone
B (basal ganglia, corpus callosum, internal capsule, and thalamus); and zone C
(brainstem). HLVI-total and HLVI-zone C predicted good and poor outcome groups
(p<0.05). GOS-E Peds correlated with HLVI-total (r=0.39; p=0.002) and HLVI in all
three zones: zone A (r=0.31; p<0.02); zone B (r=0.35; p=0.004); and zone C
(r=0.37; p=0.003). In adolescents ages 13-17 years, HLVI-total correlated best
with outcome (r=0.5; p=0.007), whereas in younger children under the age of 13,
HLVI-zone B correlated best (r=0.52; p=0.001). Compared to patients with lesions
in zone A alone or in zones A and B, patients with lesions in all three zones had
a significantly higher odds ratio (4.38; 95% confidence interval, 1.19-16.0) for
developing an unfavorable outcome.

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