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Table 1 Conventional magnetic resonance in traumatic brain injury

From: Clinical review: Prognostic value of magnetic resonance imaging in acute brain injury and coma

  Authors (ref.)
  Kampfl, 1998 [19] Firsching, 1998 [18] Pierallini, 2000 [30] Yanagawa, 2000 [28] Paterakis, 2000 [27] Firsching, 2001 [29] Firsching, 2002 [95] Wedekind, 2002 [31] Carpentier, 2006 [17]
Study design Case-control Prospective Prospective Prospective Prospective Prospective Prospective Retrospective Prospective
Sequences T1, T2 T1, T2 T1, T2, FLAIR T2, T2* T1, T2 T1, T2 T1, T2 T1, T2, T2* MRS, T2, T2*
Inclusion criteria VS between 6 and 8 weeks Admission in coma (duration >24 hours) GCS score <8, coma >1 week, post-traumatic amnesia >4 weeks Alive after 1 week Discrepancy between CT scan and neurological status Admission in coma (duration >24 hours) GCS score <8 GCS score <8 Severe TBI
Number of patients 80 61 37 34 33 102 100 40a 40
Delay to MRI 6 to 8 weeks <7 days 60 to 90 days <3 weeks <48 hours <8 days <7 days 1 to 39 days 17.5 ± 6.4
Outcome Variable of Interest GOS score (2 versus 3–5) at 2, 3, 6, 9 and 12 months Mortality Clinical assessment at 3, 6 and 12 months GOS score at 3 months GOS score (2–3 versus 4–5) at 6 months Mortality and outcome at 3 months to 3 yearsb Mortality at 6 months GOS score, DRS >6 months (mean delay: 11.3 months) GOS score (1–2 versus 4–5) and DRS at 18 months
Main results Independent factor of poor outcome on multivariate analysis. Corpus callosum: OR 213.8 (95% CI 14.2 to 3213.3). Brainstem lesions OR 6.9 (95% CI 1.1 to 42.9) Brainstem lesions: mortality rate of 44%. Bilateral brainstem lesions: mortality rate of 100% Volume of FLAIR corpus callosum lesions correlated with first clinical evaluation. Volume of FLAIR frontal lobe lesion correlated with clinical outcome at 1 year Number of T2 lesions correlated with GOS score. Number of T2* lesions correlated with GOS score DAI stages correlated with outcome. No patient with good outcome had haemorrhagic DAI Bilateral pons lesions: mortality rate of 100%. Outcome correlated with presence/absence and unilateral/bilateral brainstem lesions Bilateral upper pontine lesion predicts mortality More lesions of corpus callosum, basal ganglia and (para-)hippo-campal lesions in patients with brainstem lesions Total burden of FLAIR and T2* lesions correlated with DRS and GOS score
  1. aTwenty patients with brainstem lesions were matched to 20 patients without brainstem lesions. bAt last examination. CI, confidence interval; DAI, diffuse axonal injury; DRS, disability rating scale; FLAIR, fluid-attenuated inversion recovery; GCS, Glasgow Coma Scale; GOS, Glasgow Outcome Scale; MRI, magnetic resonance imaging; MRS, magnetic resonance spectroscopy; NA, not applicable; OR, odds ratio; T2*, T2* weighted sequence; TBI, traumatic brain injury; VS, vegetative state.