title: Assessment of white matter injury and outcome in severe brain trauma: a prospective multicenter cohort.
abstract: 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.
authors.affiliation: Department of Neuroradiology, Pitié Salpêtrière Hospital, & Université Pierre et Marie Curie (Paris VI), Boulevard de l'Hôpital, Paris, France. galanaud@gmail.com
authors.forename: Damien
authors.initials: D
authors.lastname: Galanaud
authors.forename: Vincent
authors.initials: V
authors.lastname: Perlbarg
authors.forename: Rajiv
authors.initials: R
authors.lastname: Gupta
authors.forename: Robert D
authors.initials: RD
authors.lastname: Stevens
authors.forename: Paola
authors.initials: P
authors.lastname: Sanchez
authors.forename: Eléonore
authors.initials: E
authors.lastname: Tollard
authors.forename: Nicolas Menjot
authors.initials: NM
authors.lastname: de Champfleur
authors.forename: Julien
authors.initials: J
authors.lastname: Dinkel
authors.forename: Sébastien
authors.initials: S
authors.lastname: Faivre
authors.forename: Gustavo
authors.initials: G
authors.lastname: Soto-Ares
authors.forename: Benoit
authors.initials: B
authors.lastname: Veber
authors.forename: Vincent
authors.initials: V
authors.lastname: Cottenceau
authors.forename: Françoise
authors.initials: F
authors.lastname: Masson
authors.forename: Thomas
authors.initials: T
authors.lastname: Tourdias
authors.forename: Edith
authors.initials: E
authors.lastname: André
authors.forename: Gérard
authors.initials: G
authors.lastname: Audibert
authors.forename: Emmanuelle
authors.initials: E
authors.lastname: Schmitt
authors.forename: Danielle
authors.initials: D
authors.lastname: Ibarrola
authors.forename: Frédéric
authors.initials: F
authors.lastname: Dailler
authors.forename: Audrey
authors.initials: A
authors.lastname: Vanhaudenhuyse
authors.forename: Luaba
authors.initials: L
authors.lastname: Tshibanda
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Payen
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Le Bas
authors.forename: Alexandre
authors.initials: A
authors.lastname: Krainik
authors.forename: Nicolas
authors.initials: N
authors.lastname: Bruder
authors.forename: Nadine
authors.initials: N
authors.lastname: Girard
authors.forename: Steven
authors.initials: S
authors.lastname: Laureys
authors.forename: Habib
authors.initials: H
authors.lastname: Benali
authors.forename: Louis
authors.initials: L
authors.lastname: Puybasset
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001930:Brain Injuries / Q000378:metabolism / Q000473:pathology* / Q000628:therapy; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D009413:Nerve Fibers, Myelinated / Q000378:metabolism / Q000473:pathology*; D011446:Prospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome; D055815:Young Adult