Volume 26, Issue 1 p. 103-108

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Prognostic Value of Quantitative Diffusion-Weighted MRI in Patients with Traumatic Brain Injury

Afaaf Shakir,

Afaaf Shakir

Stanford University School of Medicine, Stanford, CA

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Didem Aksoy,

Didem Aksoy

Stanford University School of Medicine, Department of Radiology, Stanford Stroke Center, Stanford, CA

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Michael Mlynash,

Michael Mlynash

Stanford University School of Medicine, Department of Neurology, Stanford Stroke Center, Stanford, CA

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Odette A. Harris,

Odette A. Harris

Stanford University School of Medicine, Department of Neurosurgery, Stanford, CA

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Gregory W. Albers,

Gregory W. Albers

Stanford University School of Medicine, Department of Neurology, Director, Stanford Stroke Center, Stanford, CA

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Karen G. Hirsch,

Corresponding Author

Karen G. Hirsch

Stanford University School of Medicine, Department of Neurology, Director, Neurocritical Care, Stanford, CA

Correspondence: Address correspondence to Karen G. Hirsch, Stanford University School of Medicine, Department of Neurology, Director, Neurocritical Care, 780 Welch Road, Suite 350, Stanford, CA 94305, USA. E-mail: [email protected].Search for more papers by this author

Afaaf Shakir,

Afaaf Shakir

Stanford University School of Medicine, Stanford, CA

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Didem Aksoy,

Didem Aksoy

Stanford University School of Medicine, Department of Radiology, Stanford Stroke Center, Stanford, CA

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Michael Mlynash,

Michael Mlynash

Stanford University School of Medicine, Department of Neurology, Stanford Stroke Center, Stanford, CA

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Odette A. Harris,

Odette A. Harris

Stanford University School of Medicine, Department of Neurosurgery, Stanford, CA

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Gregory W. Albers,

Gregory W. Albers

Stanford University School of Medicine, Department of Neurology, Director, Stanford Stroke Center, Stanford, CA

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Karen G. Hirsch,

Corresponding Author

Karen G. Hirsch

Stanford University School of Medicine, Department of Neurology, Director, Neurocritical Care, Stanford, CA

First published: 22 August 2015

https://doi.org/10.1111/jon.12286

Citations: 18

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ABSTRACT

BACKGROUND AND PURPOSE

Data about the predictive value of quantitative diffusion-weighted MRI in traumatic brain injury (TBI) patients is lacking. This study aimed to determine if specific apparent diffusion coefficient (ADC) thresholds could be determined that correlate with outcome in moderate-severe TBI.

METHODS

This retrospective observational study investigated patients with moderate-severe TBI. MRIs obtained post-injury days 1-13 were analyzed. MRIs were obtained on a 1.5T scanner; 20-23 contiguous diffusion-weighted imaging (DWI) sections with a spin-echo echo planar imaging DWI 256×256 reconstructed matrix; field of view 24×24 cm; slice thickness/gap of 5/1.5 or 5/2.5 mm. The ADC value of each brain tissue voxel was determined. The percentage of voxels below different ADC thresholds was calculated and correlated with outcome. A good outcome was defined as discharge to home or a rehabilitation facility.

RESULTS

Seventy-six patients were analyzed. Thirty-five patients (46%) had a good outcome. The timing of MRI scans did not differ between groups, but the mean age did (42±18 years vs. 56±19 years, p<.01, good vs. poor outcome). Patients with poor outcome had significantly higher percentage of brain volume with ADC < 400×10^-6 mm²/second (.85±.67% vs. .60±.29%, poor vs. good outcome, p<.05). Using a ROC curve analysis and Youden's index, an ADC <400×10^-6 mm²/second in ≥.49% of brain was 85% sensitive and 46% specific for poor outcome (p<.05).

CONCLUSIONS

Quantitative MRI offers additional prognostic information in acute TBI. A whole brain tissue ADC threshold of <400×10^-6 mm²/second in ≥.49% of brain may be a novel prognostic biomarker.

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Volume26, Issue1

January/February 2016

Pages 103-108

Prognostic Value of Quantitative Diffusion-Weighted MRI in Patients with Traumatic Brain Injury

ABSTRACT

BACKGROUND AND PURPOSE

METHODS

RESULTS

CONCLUSIONS

References

Citing Literature

References

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Prognostic Value of Quantitative Diffusion-Weighted MRI in Patients with Traumatic Brain Injury

ABSTRACT

BACKGROUND AND PURPOSE

METHODS

RESULTS

CONCLUSIONS

References

Citing Literature

References

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