Traumatic brain injury (TBI) is a common cause of death and disability. Predicting prognosis for these patients is often difficult. We studied injuries detected by different radiological modalities and organized by brain regions in a group of adult TBI patients. These findings were correlated with patient Glasgow Outcome Scores (GOS) at 6 to 12 months after injury. The three modalities studied were computed tomography (CT), T2-weighted magnetic resonance imaging (T2), and fluid-attenuated inversion recovery (FLAIR) MRI. Injuries in 16 brain regions (organized into three zones) were analyzed to determine whether geographic distribution of damage was predictive of outcome. The purpose of this study was to identify which modality and region(s) of injury best predict long-term outcome. The patient population consisted of 39 adults (mean age 35.3 yrs; range 18-68 yrs) who were admitted to Loma Linda University Medical Center between February 2001 and May 2003. CT, T2, and FLAIR images were obtained for each patient as well as their GOS score at 6 to 12 months post-TBI. Intraparenchymal lesions were traced, counted, and measured using a semi-automated computer software program (Image Pro Plus) and confirmed by a board-certified neuroradiologist (K.A.T.). The traced lesions were converted to lesion volumes based on slice thickness and pixel size. The brain was artificially divided into 16 anatomical regions, which were additionally grouped into three zones (superficial, deep, and posterior fossa). The GOS results were dichotomized into good outcomes (GOS = 4-5) and poor outcomes (GOS = 1-3). Statistical analysis was performed using parametric tests, including one- and two-way ANOVA tests with Scheffe post hoc comparisons. The extent of injuries detected by T2 and FLAIR images were significantly different between good and poor groups while injuries on CT did not differ. Injuries on FLAIR were most correlated with outcome among the three modalities. No single brain zone injury was a stronger predictor of outcome among the three. However, injuries in the brain stem (BS), frontal white matter (FWM), and thalamus (THAL) were the strongest predictors of outcome among the individual brain regions. The study results conclude that FLAIR is superior to CT and T2-weighted MRI for prognostic determination and injuries in the BS, FWM, and THAL are most predictive of outcome in adults with TBI.
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