BACKGROUND:Existing methods to predict recovery after severe traumatic brain injury lack accuracy. The aim of this study is to determine the prognostic value of quantitative diffusion tensor imaging (DTI). METHODS:In a multicenter study, the authors prospectively enrolled 105 patients who remained comatose at least 7 days after traumatic brain injury. Patients underwent brain magnetic resonance imaging, including DTI in 20 preselected white matter tracts. Patients were evaluated at 1 yr with a modified Glasgow Outcome Scale. A composite DTI score was constructed for outcome prognostication on this training database and then validated on an independent database (n=38). DTI score was compared with the International Mission for Prognosis and Analysis of Clinical Trials Score. RESULTS:Using the DTI score for prediction of unfavorable outcome on the training database, the area under the receiver operating characteristic curve was 0.84 (95% CI: 0.75-0.91). The DTI score had a sensitivity of 64% and a specificity of 95% for the prediction of unfavorable outcome. On the validation-independent database, the area under the receiver operating characteristic curve was 0.80 (95% CI: 0.54-0.94). On the training database, reclassification methods showed significant improvement of classification accuracy (P < 0.05) compared with the International Mission for Prognosis and Analysis of Clinical Trials score. Similar results were observed on the validation database. CONCLUSIONS:White matter assessment with quantitative DTI increases the accuracy of long-term outcome prediction compared with the available clinical/radiographic prognostic score.

译文

背景:现有的预测严重颅脑外伤后恢复的方法缺乏准确性。这项研究的目的是确定定量扩散张量成像(DTI)的预后价值。
方法:在一项多中心研究中,作者前瞻性地招募了105名在颅脑外伤后至少7天仍保持昏迷状态的患者。患者接受了脑磁共振成像,包括在20个预选的白质区中的DTI。使用改良的格拉斯哥成果量表对患者进行1年评估。在该训练数据库上构建了综合的DTI评分以进行预后,然后在独立的数据库上进行了验证(n = 38)。将DTI得分与国际预后和临床试验分析得分进行比较。
结果:使用DTI评分预测训练数据库上的不良结果,接收器工作特征曲线下方的面积为0.84(95%CI:0.75-0.91)。 DTI评分对不良结局的预测具有64%的敏感性和95%的特异性。在独立于验证的数据库上,接收器工作特性曲线下的面积为0.80(95%CI:0.54-0.94)。在培训数据库上,与国际临床试验预后和评估得分相比,重新分类方法显示出分类准确度的显着提高(P <0.05)。在验证数据库上观察到了相似的结果。
结论:与可用的临床/影像学预后评分相比,定量DTI的白质评估可提高长期结果预测的准确性。

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