Lesions in deep gray nuclei after severe traumatic brain injury predict neurologic outcome

Frédéric Clarençon (1) , Éric Bardinet (2) , Jacques Martinerie (2) , Vincent Pelbarg (2) , Nicolas Menjot de Champfleur (3, 4) , Rajiv Gupta (5) , Eléonore Tollard (6) , Gustavo Soto-Ares (7) , Danielle Ibarrola (8) , Emmanuelle Schmitt (9) , Thomas Tourdias (10) , Vincent Degos (11, 1) , Jérome Yelnik (2) , Didier Dormont (1) , Louis Puybasset (12) , Damien Galanaud (1)

1 CHU Pitié-Salpêtrière [AP-HP]
2 ICM - Institut du Cerveau et de la Moëlle Epinière = Brain and Spine Institute
3 CHRU Montpellier - Centre Hospitalier Régional Universitaire [Montpellier]
4 L2C - Laboratoire Charles Coulomb
5 Department of Civil Engineering [Hamirpur]
6 Service de Radiologie [CHU Rouen]
7 Services de neuroradiologie [Lille]
8 CERMEP - imagerie du vivant - Centre d'Etude et de Recherche Multimodal Et Pluridisciplinaire en imagerie du vivant
9 Département de neuroradiologie diagnostique et thérapeutique [CHRU Nancy]
10 Service de neurologie [Bordeaux]
11 PROTECT - Neuroprotection du Cerveau en Développement / Promoting Research Oriented Towards Early Cns Therapies
12 Johns Hopkins University School of Medicine [Baltimore]

PURPOSE: This study evaluates the correlation between injuries to deep gray matter nuclei, as quantitated by lesions in these nuclei on MR T2 Fast Spin Echo (T2 FSE) images, with 6-month neurological outcome after severe traumatic brain injury (TBI). MATERIALS AND METHODS: Ninety-five patients (80 males, mean age = 36.7y) with severe TBI were prospectively enrolled. All patients underwent a MR scan within the 45 days after the trauma that included a T2 FSE acquisition. A 3D deformable atlas of the deep gray matter was registered to this sequence; deep gray matter lesions (DGML) were evaluated using a semi-quantitative classification scheme. The 6-month outcome was dichotomized into unfavorable (death, vegetative or minimally conscious state) or favorable (minimal or no neurologic deficit) outcome. RESULTS: Sixty-six percent of the patients (63/95) had both satisfactory registration of the 3D atlas on T2 FSE and available clinical follow-up. Patients without DGML had an 89% chance (P = 0.0016) of favorable outcome while those with bilateral DGML had an 80% risk of unfavorable outcome (P = 0.00008). Multivariate analysis based on DGML accurately classified patients with unfavorable neurological outcome in 90.5% of the cases. CONCLUSION: Lesions in deep gray matter nuclei may predict long-term outcome after severe TBI with high sensitivity and specificity.

Mots clés: Humans; Outcome Assessment (Health Care); Female; Male; Adult; Brain Injuries; Traumatic; Gray Matter

Domaines: Sciences du Vivant [q-bio]

Frédéric Clarençon, Éric Bardinet, Jacques Martinerie, Vincent Pelbarg, Nicolas Menjot de Champfleur, et al.. Lesions in deep gray nuclei after severe traumatic brain injury predict neurologic outcome. PLoS ONE, 2017, 12 (11), pp.e0186641. ⟨10.1371/journal.pone.0186641⟩. ⟨hal-01743095⟩