Citation

Miles DK, Smitherman E, Hernandez A, Stavinoha PL, Huang R, Kernie S, Diaz-Arrastia R. J. Neurotrauma 2015; 33(1): 35-48.

Affiliation

University Of Texas Southwestern Medical Center, Pediatrics , 5323 Harry Hines Blvd , Dallas, Texas, United States , 75390-9063 , 214-456-7969 ; darryl.miles@utsouthwestern.edu.

Copyright

(Copyright © 2015, Mary Ann Liebert Publishers)

DOI

10.1089/neu.2014.3801

PMID

25808802

Abstract

Brain lesions after traumatic brain injury (TBI) are heterogeneous, rendering outcome prognostication difficult. The purpose 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 neurologic outcome in children after TBI. Fluid-attenuated inversion recovery (FLAIR) MRI hyperintense lesions in 63 children obtained 6.2 +5.6 days from injury 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) x 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 adolescent ages 13-17 years, HLVI-total correlated best with outcome (r = 0.5; p = 0.007) whereas in younger children under the age of thirteen years, 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% CI 1.19 to 16.0) for developing an unfavorable outcome.

Language: en