title: MRI for coma emergence and recovery.
abstract: OBJECTIVE
  Data from MRI can be used to generate detailed maps of central nervous system anatomy and functional activation. Here, we review new research that integrates advanced MRI acquisition and analysis to predict and track recovery following severe traumatic brain injury (TBI) or anoxic ischemic encephalopathy (AIE) following cardiac arrest.
  
  
  RESULTS
  Diffusion tensor MRI studies of comatose TBI patients demonstrate specific distributions of white matter damage that are robustly associated with long-term functional outcomes. In unconscious patients with AIE, whole brain diffusion restriction has prognostic significance, as do regional changes in diffusion restriction or anisotropy. Results using functional MRI suggest that coma following TBI and cardiac arrest is associated with disconnections within cerebral architectures associated with arousal and conscious perception. The relation between these disconnections and postinjury recovery is being explored in ongoing cohorts.
  
  
  CONCLUSIONS
  MRI of the brain is feasible in critically ill patients following TBI or cardiac arrest, revealing patterns of structural damage and functional disconnection that can help predict outcome in the long term. Prospective studies are needed to validate these findings and to identify relationships between MRI-defined alterations and specific postinjury cognitive and behavioural phenotypes.
authors: aDepartment of Anesthesiology and Critical Care Medicine bDepartment of Neurology cDepartment of Neurosurgery dDepartment of Radiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA eDepartment of Anesthesiology and Intensive Care, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Université Paris 6-Pierre-et-Marie-Curie, Paris, France.
authors: Robert D
authors: RD
authors: Stevens
authors: Yousef
authors: Y
authors: Hannawi
authors: Louis
authors: L
authors: Puybasset
mesh_terms: D001921:Brain / Q000473:pathology* / Q000503:physiopathology; D001930:Brain Injuries / Q000473:pathology* / Q000503:physiopathology; D003128:Coma / Q000473:pathology*; D038524:Diffusion Magnetic Resonance Imaging; D005260:Female; D023261:Glasgow Outcome Scale; D006323:Heart Arrest / Q000150:complications / Q000473:pathology / Q000503:physiopathology; D006801:Humans; D020925:Hypoxia-Ischemia, Brain / Q000473:pathology* / Q000503:physiopathology; D007090:Image Interpretation, Computer-Assisted; D008279:Magnetic Resonance Imaging; D008297:Male; D009473:Neuronal Plasticity; D011379:Prognosis; D020127:Recovery of Function