Reliability of Magnetic Resonance Tractography in Predicting Early Clinical Improvements in Patients with Diffuse Axonal Injury Grade III. In: Pokorski M, editor. Trends in Biomedical Research. Cham: Springer International Publishing; 2020. pp. 19-28. [DOI: 10.1007/5584_2019_445]

Diffusion Tensor Imaging as Neurologic Predictor in Patients Affected by Traumatic Brain Injury: Scoping Review

Background: Diffusion tensor imaging (DTI), a variant of Diffusion Weighted Imaging (DWI), enables a neuroanatomical microscopic-like examination of the brain, which can detect brain damage using physical parameters. DTI's application to traumatic brain injury (TBI) has the potential to reveal radiological features that can assist in predicting the clinical outcomes of these patients. What is the ongoing role of DTI in detecting brain alterations and predicting neurological outcomes in patients with moderate to severe traumatic brain injury and/or diffuse axonal injury? Methods: A scoping review of the PubMed, Scopus, EMBASE, and Cochrane databases was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. The aim was to identify all potentially relevant studies concerning the role of DTI in TBI. From an initial pool of 3527 publications, 26 articles were selected based on relevance. These studies included a total of 729 patients with moderate to severe TBI and/or diffuse axonal injury. DTI parameters were analyzed to determine their relationship with neurological outcomes post-TBI, with assessments of several brain functions and regions. Results: The studies included various DTI parameters, identifying significant relationships between DTI variations and neurological outcomes following TBI. Multiple brain functions and regions were evaluated, demonstrating the capability of DTI to detect brain alterations with higher accuracy, sensitivity, and specificity than MRI alone. Conclusions: DTI is a valuable tool for detecting brain alterations in TBI patients, offering enhanced accuracy, sensitivity, and specificity compared to MRI alone. Recent studies confirm its effectiveness in identifying neurological impairments and predicting outcomes in patients following brain trauma, underscoring its utility in clinical settings for managing TBI.

Diffuse Axonal Injury Pattern Predicts Timing of In-Hospital Neurologic Recovery: A Retrospective Case Series

BACKGROUND

Diffuse axonal injury (DAI) is a devastating traumatic neurologic injury with variable prognosis. Although outcomes such as mortality have been described, the time course of neurologic progression is poorly understood. We investigated the association between DAI neuroanatomic injury pattern and neurologic recovery timing.

METHODS

A retrospective review of our institution's trauma registry identified patients diagnosed with DAI from 2017-2021. The neuroradiologist's review of a head computed tomography scan was used to score DAI severity. In-hospital neurologic examinations were reviewed, and the Glasgow Coma Scale (GCS) was calculated for all patients throughout the hospital stay. Categorical variables were analyzed using the Fisher exact test, and continuous variables were analyzed using the Kruskal-Wallis test.

RESULTS

Nineteen DAI patients (grade 1 = 8; grade 2 = 1; grade 3 = 10) were included (mean age 31 years, 79% male). Mean Rotterdam computed tomography score, Injury Severity Scale, and admission GCS were comparable across DAI grades. Mean time in days to follow commands was shorter for those with grade 1 DAI (9.3) compared with grade 2 (17 days) or grade 3 (19 days) DAI (P = 0.02). Throughout hospitalization, patients with grade 1 DAI had higher motor (P = 0.006), eye (P = 0.001), and total GCS (P = 0.011) scores compared with those with grade 2 or 3 DAI. At the time of discharge, total GCS and the frequency of command following was similar across DAI grades.

CONCLUSIONS

Patients with grade 1 DAI demonstrated the fastest short-term neurologic recovery, although final discharge neurologic examination was comparable across DAI grades. DAI classification can provide useful short-term prognostic information regarding in-hospital neurologic improvement.

Combination of Neutrophil-to-Lymphocyte Ratio and Admission Glasgow Coma Scale Score Is Independent Predictor of Clinical Outcome in Diffuse Axonal Injury

BACKGROUND

The neutrophil-to-lymphocyte ratio (NLR) is an independent predictor of clinical outcome of different diseases, such as acute ischemic stroke, intracerebral hemorrhage, malignant tumor, and traumatic brain injury. However, the prognostic value of NLR plus admission Glasgow Coma Scale score (NLR-GCS) is still unclear in patients with diffuse axonal injury (DAI). Therefore this study assessed the relationship between the NLR-GCS and 6-month outcome of DAI patients.

METHODS

The clinical characteristics of DAI patients admitted to our department between January 2014 and January 2020 were retrospectively analyzed. The candidate risk factors were screened by using univariate analysis, and the independence of resultant risk factors was evaluated by the binary logistic regression analysis and least absolute shrinkage and selection operator regression analysis. The predictive value of NLR-GCS in an unfavorable outcome was assessed by the receiver operating characteristics curve analysis.

RESULTS

A total of 93 DAI patients were included. Binary logistic regression analysis and least absolute shrinkage and selection operator regression analysis showed the level of NLR on admission was an independent risk factor of unfavorable outcomes in DAI patients. The ROC curve analysis showed that the predictive capacity of the combination of NLR and admission GCS score and combination of NLR and coma duration outperformed NLR, admission GCS score, and coma duration alone.

CONCLUSIONS

The higher NLR level on admission is independently associated with unfavorable outcomes of DAI patients at 6 months. Furthermore, the combination of NLR and admission GCS score provides the superior predictive capacity to either NLR or GCS alone.