title: Predicting Outcome after Pediatric Traumatic Brain Injury by Early Magnetic Resonance Imaging Lesion Location and Volume.
abstract: Brain lesions after traumatic brain injury (TBI) are heterogeneous, rendering outcome prognostication difficult. The aim 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 neurological outcome in children post-TBI. Fluid-attenuated inversion recovery (FLAIR) MRI hyperintense lesions in 63 children obtained 6.2±5.6 days postinjury 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)×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 adolescents ages 13-17 years, HLVI-total correlated best with outcome (r=0.5; p=0.007), whereas in younger children under the age of 13, 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% confidence interval, 1.19-16.0) for developing an unfavorable outcome.
authors: 1 University of Texas Southwestern Medical Center, University of Texas Southwestern Medical Center , Dallas, Texas.
authors: Emily
authors: E
authors: Smitherman
authors: 2 Department of Neuropsychology, Children's Medical Center , Dallas, Texas.
authors: Ana
authors: A
authors: Hernandez
authors: 2 Department of Neuropsychology, Children's Medical Center , Dallas, Texas.|3 Department of Psychiatry, University of Texas Southwestern Medical Center , Dallas, Texas.
authors: Peter L
authors: PL
authors: Stavinoha
authors: 4 Department of Clinical Research, Children's Medical Center , Dallas, Texas.
authors: Rong
authors: R
authors: Huang
authors: 5 Department of Pediatrics, University of Texas Southwestern Medical Center , Dallas, Texas.
authors: Steven G
authors: SG
authors: Kernie
authors: 6 Department of Neurology, University of Texas Southwestern Medical Center , Dallas, Texas.
authors: Ramon
authors: R
authors: Diaz-Arrastia
authors: 5 Department of Pediatrics, University of Texas Southwestern Medical Center , Dallas, Texas.
authors: Darryl K
authors: DK
authors: Miles
mesh_terms: D000293:Adolescent; D000367:Age Factors; D001479:Basal Ganglia / Q000473:pathology; D015415:Biomarkers; D001930:Brain Injuries / Q000473:pathology*; D001933:Brain Stem / Q000473:pathology; D002540:Cerebral Cortex / Q000473:pathology; D002648:Child; D002675:Child, Preschool; D003337:Corpus Callosum / Q000473:pathology; D005260:Female; D023261:Glasgow Outcome Scale; D006801:Humans; D007223:Infant; D020772:Internal Capsule / Q000473:pathology; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D017063:Outcome Assessment, Health Care; D011379:Prognosis; D013788:Thalamus / Q000473:pathology
chemical_list: D015415:Biomarkers
keywords: MRI; biomarkers; cognitive function; outcome measures; pediatric brain injury