The prognostic importance of traumatic axonal injury on early MRI: the Trondheim TAI-MRI grading and quantitative models
Objectives We analysed magnetic resonance imaging (MRI) findings after traumatic brain injury (TBI) aiming to improve the grading of traumatic axonal injury (TAI) to better reflect the outcome. Methods Four-hundred sixty-three patients (8–70 years) with mild ( n = 158), moderate ( n = 129), or sev...
Gespeichert in:
| Veröffentlicht in: | European radiology 2024-12, Vol.34 (12), p.8015-8029 |
|---|---|
| Hauptverfasser: | , , , , , , , , , , , , |
| Format: | Artikel |
| Sprache: | eng |
| Schlagworte: | |
| Online-Zugang: | Volltext |
| Tags: |
Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
|
| container_end_page | 8029 |
|---|---|
| container_issue | 12 |
| container_start_page | 8015 |
| container_title | European radiology |
| container_volume | 34 |
| creator | Moen, Kent Gøran Flusund, Anne-Mari Holte Moe, Hans Kristian Andelic, Nada Skandsen, Toril Håberg, Asta Kvistad, Kjell Arne Olsen, Øystein Saksvoll, Elin Hildrum Abel-Grüner, Sebastian Anke, Audny Follestad, Turid Vik, Anne |
| description | Objectives
We analysed magnetic resonance imaging (MRI) findings after traumatic brain injury (TBI) aiming to improve the grading of traumatic axonal injury (TAI) to better reflect the outcome.
Methods
Four-hundred sixty-three patients (8–70 years) with mild (
n
= 158), moderate (
n
= 129), or severe (
n
= 176) TBI and early MRI were prospectively included. TAI presence, numbers, and volumes at predefined locations were registered on fluid-attenuated inversion recovery (FLAIR) and diffusion-weighted imaging, and presence and numbers on T2*GRE/SWI. Presence and volumes of contusions were registered on FLAIR. We assessed the outcome with the Glasgow Outcome Scale Extended. Multivariable logistic and elastic-net regression analyses were performed.
Results
The presence of TAI differed between mild (6%), moderate (70%), and severe TBI (95%). In severe TBI, bilateral TAI in mesencephalon or thalami and bilateral TAI in pons predicted worse outcomes and were defined as the worst grades (4 and 5, respectively) in
the Trondheim TAI-MRI grading
.
The Trondheim TAI-MRI grading
performed better than the
standard
TAI grading in severe TBI (pseudo-
R
2
0.19 vs. 0.16). In moderate-severe TBI, quantitative models including both FLAIR volume of TAI and contusions performed best (pseudo-
R
2
0.19–0.21). In patients with mild TBI or Glasgow Coma Scale (GCS) score 13, models with the volume of contusions performed best (pseudo-
R
2
0.25–0.26).
Conclusions
We propose
the Trondheim TAI-MRI grading
(grades 1–5) with bilateral TAI in mesencephalon or thalami, and bilateral TAI in pons as the worst grades. The predictive value was highest for the quantitative models including FLAIR volume of TAI and contusions (GCS score |
| doi_str_mv | 10.1007/s00330-024-10841-1 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_11557676</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>3127420282</sourcerecordid><originalsourceid>FETCH-LOGICAL-c429t-6edcbbfbfd97795e1759ee2eabf707396269659ba44d85b63ad763173cfc1533</originalsourceid><addsrcrecordid>eNp9kU1v1DAQhi0EomXhD3AAS1y4BMYfiRMuqKpoWakICeVuOckk61Vib-2k6v57vN22FA6cbM-8fubjJeQtg08MQH2OAEJABlxmDErJMvaMnDIp-N3z-ZP7CXkV4xYAKibVS3IiyrIquOCn5LbeIN0FPzgfZ9tSO-18mI1rkfqezsEskznEza13ZqTWbZewp95RNGHc0x-_1l_onBB18K7boJ1ofbbOUpgOwXTWDdS4jl4vxs12TqQbpJPvcIyvyYvejBHf3J8rUl98q8-_Z1c_L9fnZ1dZK3k1ZwV2bdP0Td9VSlU5MpVXiBxN0ytQIk1RVEVeNUbKrsybQphOFYIp0fYty4VYka9H7G5ppsRCl2Ya9S7YyYS99sbqvzPObvTgbzRjea6KxFqR90dCG2xakdPOB6OTAUJpkQOwpPh4XyP46wXjrCcbWxxH49AvUQtQUILk_AD78I9065eQNptUjCvJgZc8qfhDSR9jwP6xXwaHykofrdfJen1nvT508e7ppI9fHrxOAnEUxJRyA4Y_tf-D_Q3OQLlu</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>3127420282</pqid></control><display><type>article</type><title>The prognostic importance of traumatic axonal injury on early MRI: the Trondheim TAI-MRI grading and quantitative models</title><source>MEDLINE</source><source>NORA - Norwegian Open Research Archives</source><source>SpringerLink Journals - AutoHoldings</source><creator>Moen, Kent Gøran ; Flusund, Anne-Mari Holte ; Moe, Hans Kristian ; Andelic, Nada ; Skandsen, Toril ; Håberg, Asta ; Kvistad, Kjell Arne ; Olsen, Øystein ; Saksvoll, Elin Hildrum ; Abel-Grüner, Sebastian ; Anke, Audny ; Follestad, Turid ; Vik, Anne</creator><creatorcontrib>Moen, Kent Gøran ; Flusund, Anne-Mari Holte ; Moe, Hans Kristian ; Andelic, Nada ; Skandsen, Toril ; Håberg, Asta ; Kvistad, Kjell Arne ; Olsen, Øystein ; Saksvoll, Elin Hildrum ; Abel-Grüner, Sebastian ; Anke, Audny ; Follestad, Turid ; Vik, Anne</creatorcontrib><description>Objectives
We analysed magnetic resonance imaging (MRI) findings after traumatic brain injury (TBI) aiming to improve the grading of traumatic axonal injury (TAI) to better reflect the outcome.
Methods
Four-hundred sixty-three patients (8–70 years) with mild (
n
= 158), moderate (
n
= 129), or severe (
n
= 176) TBI and early MRI were prospectively included. TAI presence, numbers, and volumes at predefined locations were registered on fluid-attenuated inversion recovery (FLAIR) and diffusion-weighted imaging, and presence and numbers on T2*GRE/SWI. Presence and volumes of contusions were registered on FLAIR. We assessed the outcome with the Glasgow Outcome Scale Extended. Multivariable logistic and elastic-net regression analyses were performed.
Results
The presence of TAI differed between mild (6%), moderate (70%), and severe TBI (95%). In severe TBI, bilateral TAI in mesencephalon or thalami and bilateral TAI in pons predicted worse outcomes and were defined as the worst grades (4 and 5, respectively) in
the Trondheim TAI-MRI grading
.
The Trondheim TAI-MRI grading
performed better than the
standard
TAI grading in severe TBI (pseudo-
R
2
0.19 vs. 0.16). In moderate-severe TBI, quantitative models including both FLAIR volume of TAI and contusions performed best (pseudo-
R
2
0.19–0.21). In patients with mild TBI or Glasgow Coma Scale (GCS) score 13, models with the volume of contusions performed best (pseudo-
R
2
0.25–0.26).
Conclusions
We propose
the Trondheim TAI-MRI grading
(grades 1–5) with bilateral TAI in mesencephalon or thalami, and bilateral TAI in pons as the worst grades. The predictive value was highest for the quantitative models including FLAIR volume of TAI and contusions (GCS score <13) or FLAIR volume of contusions (GCS score ≥ 13), which emphasise artificial intelligence as a potentially important future tool.
Clinical relevance statement
The Trondheim TAI-MRI grading
reflects patient outcomes better in severe TBI than today’s standard TAI grading and can be implemented after external validation. The prognostic importance of volumetric models is promising for future use of artificial intelligence technologies.
Key Points
Traumatic axonal injury (TAI) is an important injury type in all TBI severities. Studies demonstrating which MRI findings that can serve as future biomarkers are highly warranted.
This study proposes the most optimal MRI models for predicting patient outcome at 6 months after TBI; one updated pragmatic model and a volumetric model.
The Trondheim TAI-MRI grading, in severe TBI, reflects patient outcome better than today’s standard grading of TAI and the prognostic importance of volumetric models in all severities of TBI is promising for future use of AI.</description><identifier>ISSN: 1432-1084</identifier><identifier>ISSN: 0938-7994</identifier><identifier>EISSN: 1432-1084</identifier><identifier>DOI: 10.1007/s00330-024-10841-1</identifier><identifier>PMID: 38896232</identifier><language>eng</language><publisher>Berlin/Heidelberg: Springer Berlin Heidelberg</publisher><subject>Adolescent ; Adult ; Aged ; Artificial intelligence ; Biomarkers ; Brain Injuries, Traumatic - diagnostic imaging ; Child ; Contusions ; Diagnostic Radiology ; Diffuse Axonal Injury - diagnostic imaging ; Elastic analysis ; Female ; Head injuries ; Humans ; Imaging ; Injury analysis ; Internal Medicine ; Interventional Radiology ; Magnetic resonance imaging ; Magnetic Resonance Imaging - methods ; Male ; Medical imaging ; Medicine ; Medicine & Public Health ; Mesencephalon ; Middle Aged ; Neuro ; Neuroimaging ; Neuroradiology ; Pons ; Prognosis ; Prospective Studies ; Radiology ; Regression analysis ; Traumatic brain injury ; Ultrasound ; Young Adult</subject><ispartof>European radiology, 2024-12, Vol.34 (12), p.8015-8029</ispartof><rights>The Author(s) 2024</rights><rights>2024. The Author(s).</rights><rights>The Author(s) 2024. This work is published under http://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>info:eu-repo/semantics/openAccess</rights><rights>The Author(s) 2024 2024</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c429t-6edcbbfbfd97795e1759ee2eabf707396269659ba44d85b63ad763173cfc1533</citedby><cites>FETCH-LOGICAL-c429t-6edcbbfbfd97795e1759ee2eabf707396269659ba44d85b63ad763173cfc1533</cites><orcidid>0000-0003-0937-1986</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00330-024-10841-1$$EPDF$$P50$$Gspringer$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00330-024-10841-1$$EHTML$$P50$$Gspringer$$Hfree_for_read</linktohtml><link.rule.ids>230,314,780,784,885,26567,27924,27925,41488,42557,51319</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/38896232$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Moen, Kent Gøran</creatorcontrib><creatorcontrib>Flusund, Anne-Mari Holte</creatorcontrib><creatorcontrib>Moe, Hans Kristian</creatorcontrib><creatorcontrib>Andelic, Nada</creatorcontrib><creatorcontrib>Skandsen, Toril</creatorcontrib><creatorcontrib>Håberg, Asta</creatorcontrib><creatorcontrib>Kvistad, Kjell Arne</creatorcontrib><creatorcontrib>Olsen, Øystein</creatorcontrib><creatorcontrib>Saksvoll, Elin Hildrum</creatorcontrib><creatorcontrib>Abel-Grüner, Sebastian</creatorcontrib><creatorcontrib>Anke, Audny</creatorcontrib><creatorcontrib>Follestad, Turid</creatorcontrib><creatorcontrib>Vik, Anne</creatorcontrib><title>The prognostic importance of traumatic axonal injury on early MRI: the Trondheim TAI-MRI grading and quantitative models</title><title>European radiology</title><addtitle>Eur Radiol</addtitle><addtitle>Eur Radiol</addtitle><description>Objectives
We analysed magnetic resonance imaging (MRI) findings after traumatic brain injury (TBI) aiming to improve the grading of traumatic axonal injury (TAI) to better reflect the outcome.
Methods
Four-hundred sixty-three patients (8–70 years) with mild (
n
= 158), moderate (
n
= 129), or severe (
n
= 176) TBI and early MRI were prospectively included. TAI presence, numbers, and volumes at predefined locations were registered on fluid-attenuated inversion recovery (FLAIR) and diffusion-weighted imaging, and presence and numbers on T2*GRE/SWI. Presence and volumes of contusions were registered on FLAIR. We assessed the outcome with the Glasgow Outcome Scale Extended. Multivariable logistic and elastic-net regression analyses were performed.
Results
The presence of TAI differed between mild (6%), moderate (70%), and severe TBI (95%). In severe TBI, bilateral TAI in mesencephalon or thalami and bilateral TAI in pons predicted worse outcomes and were defined as the worst grades (4 and 5, respectively) in
the Trondheim TAI-MRI grading
.
The Trondheim TAI-MRI grading
performed better than the
standard
TAI grading in severe TBI (pseudo-
R
2
0.19 vs. 0.16). In moderate-severe TBI, quantitative models including both FLAIR volume of TAI and contusions performed best (pseudo-
R
2
0.19–0.21). In patients with mild TBI or Glasgow Coma Scale (GCS) score 13, models with the volume of contusions performed best (pseudo-
R
2
0.25–0.26).
Conclusions
We propose
the Trondheim TAI-MRI grading
(grades 1–5) with bilateral TAI in mesencephalon or thalami, and bilateral TAI in pons as the worst grades. The predictive value was highest for the quantitative models including FLAIR volume of TAI and contusions (GCS score <13) or FLAIR volume of contusions (GCS score ≥ 13), which emphasise artificial intelligence as a potentially important future tool.
Clinical relevance statement
The Trondheim TAI-MRI grading
reflects patient outcomes better in severe TBI than today’s standard TAI grading and can be implemented after external validation. The prognostic importance of volumetric models is promising for future use of artificial intelligence technologies.
Key Points
Traumatic axonal injury (TAI) is an important injury type in all TBI severities. Studies demonstrating which MRI findings that can serve as future biomarkers are highly warranted.
This study proposes the most optimal MRI models for predicting patient outcome at 6 months after TBI; one updated pragmatic model and a volumetric model.
The Trondheim TAI-MRI grading, in severe TBI, reflects patient outcome better than today’s standard grading of TAI and the prognostic importance of volumetric models in all severities of TBI is promising for future use of AI.</description><subject>Adolescent</subject><subject>Adult</subject><subject>Aged</subject><subject>Artificial intelligence</subject><subject>Biomarkers</subject><subject>Brain Injuries, Traumatic - diagnostic imaging</subject><subject>Child</subject><subject>Contusions</subject><subject>Diagnostic Radiology</subject><subject>Diffuse Axonal Injury - diagnostic imaging</subject><subject>Elastic analysis</subject><subject>Female</subject><subject>Head injuries</subject><subject>Humans</subject><subject>Imaging</subject><subject>Injury analysis</subject><subject>Internal Medicine</subject><subject>Interventional Radiology</subject><subject>Magnetic resonance imaging</subject><subject>Magnetic Resonance Imaging - methods</subject><subject>Male</subject><subject>Medical imaging</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Mesencephalon</subject><subject>Middle Aged</subject><subject>Neuro</subject><subject>Neuroimaging</subject><subject>Neuroradiology</subject><subject>Pons</subject><subject>Prognosis</subject><subject>Prospective Studies</subject><subject>Radiology</subject><subject>Regression analysis</subject><subject>Traumatic brain injury</subject><subject>Ultrasound</subject><subject>Young Adult</subject><issn>1432-1084</issn><issn>0938-7994</issn><issn>1432-1084</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><sourceid>C6C</sourceid><sourceid>EIF</sourceid><sourceid>3HK</sourceid><recordid>eNp9kU1v1DAQhi0EomXhD3AAS1y4BMYfiRMuqKpoWakICeVuOckk61Vib-2k6v57vN22FA6cbM-8fubjJeQtg08MQH2OAEJABlxmDErJMvaMnDIp-N3z-ZP7CXkV4xYAKibVS3IiyrIquOCn5LbeIN0FPzgfZ9tSO-18mI1rkfqezsEskznEza13ZqTWbZewp95RNGHc0x-_1l_onBB18K7boJ1ofbbOUpgOwXTWDdS4jl4vxs12TqQbpJPvcIyvyYvejBHf3J8rUl98q8-_Z1c_L9fnZ1dZK3k1ZwV2bdP0Td9VSlU5MpVXiBxN0ytQIk1RVEVeNUbKrsybQphOFYIp0fYty4VYka9H7G5ppsRCl2Ya9S7YyYS99sbqvzPObvTgbzRjea6KxFqR90dCG2xakdPOB6OTAUJpkQOwpPh4XyP46wXjrCcbWxxH49AvUQtQUILk_AD78I9065eQNptUjCvJgZc8qfhDSR9jwP6xXwaHykofrdfJen1nvT508e7ppI9fHrxOAnEUxJRyA4Y_tf-D_Q3OQLlu</recordid><startdate>202412</startdate><enddate>202412</enddate><creator>Moen, Kent Gøran</creator><creator>Flusund, Anne-Mari Holte</creator><creator>Moe, Hans Kristian</creator><creator>Andelic, Nada</creator><creator>Skandsen, Toril</creator><creator>Håberg, Asta</creator><creator>Kvistad, Kjell Arne</creator><creator>Olsen, Øystein</creator><creator>Saksvoll, Elin Hildrum</creator><creator>Abel-Grüner, Sebastian</creator><creator>Anke, Audny</creator><creator>Follestad, Turid</creator><creator>Vik, Anne</creator><general>Springer Berlin Heidelberg</general><general>Springer Nature B.V</general><general>Springer Nature</general><scope>C6C</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QO</scope><scope>8FD</scope><scope>FR3</scope><scope>K9.</scope><scope>NAPCQ</scope><scope>P64</scope><scope>7X8</scope><scope>3HK</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0003-0937-1986</orcidid></search><sort><creationdate>202412</creationdate><title>The prognostic importance of traumatic axonal injury on early MRI: the Trondheim TAI-MRI grading and quantitative models</title><author>Moen, Kent Gøran ; Flusund, Anne-Mari Holte ; Moe, Hans Kristian ; Andelic, Nada ; Skandsen, Toril ; Håberg, Asta ; Kvistad, Kjell Arne ; Olsen, Øystein ; Saksvoll, Elin Hildrum ; Abel-Grüner, Sebastian ; Anke, Audny ; Follestad, Turid ; Vik, Anne</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c429t-6edcbbfbfd97795e1759ee2eabf707396269659ba44d85b63ad763173cfc1533</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><topic>Adolescent</topic><topic>Adult</topic><topic>Aged</topic><topic>Artificial intelligence</topic><topic>Biomarkers</topic><topic>Brain Injuries, Traumatic - diagnostic imaging</topic><topic>Child</topic><topic>Contusions</topic><topic>Diagnostic Radiology</topic><topic>Diffuse Axonal Injury - diagnostic imaging</topic><topic>Elastic analysis</topic><topic>Female</topic><topic>Head injuries</topic><topic>Humans</topic><topic>Imaging</topic><topic>Injury analysis</topic><topic>Internal Medicine</topic><topic>Interventional Radiology</topic><topic>Magnetic resonance imaging</topic><topic>Magnetic Resonance Imaging - methods</topic><topic>Male</topic><topic>Medical imaging</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Mesencephalon</topic><topic>Middle Aged</topic><topic>Neuro</topic><topic>Neuroimaging</topic><topic>Neuroradiology</topic><topic>Pons</topic><topic>Prognosis</topic><topic>Prospective Studies</topic><topic>Radiology</topic><topic>Regression analysis</topic><topic>Traumatic brain injury</topic><topic>Ultrasound</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Moen, Kent Gøran</creatorcontrib><creatorcontrib>Flusund, Anne-Mari Holte</creatorcontrib><creatorcontrib>Moe, Hans Kristian</creatorcontrib><creatorcontrib>Andelic, Nada</creatorcontrib><creatorcontrib>Skandsen, Toril</creatorcontrib><creatorcontrib>Håberg, Asta</creatorcontrib><creatorcontrib>Kvistad, Kjell Arne</creatorcontrib><creatorcontrib>Olsen, Øystein</creatorcontrib><creatorcontrib>Saksvoll, Elin Hildrum</creatorcontrib><creatorcontrib>Abel-Grüner, Sebastian</creatorcontrib><creatorcontrib>Anke, Audny</creatorcontrib><creatorcontrib>Follestad, Turid</creatorcontrib><creatorcontrib>Vik, Anne</creatorcontrib><collection>Springer Nature OA Free Journals</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Biotechnology Research Abstracts</collection><collection>Technology Research Database</collection><collection>Engineering Research Database</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Premium</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>MEDLINE - Academic</collection><collection>NORA - Norwegian Open Research Archives</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>European radiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Moen, Kent Gøran</au><au>Flusund, Anne-Mari Holte</au><au>Moe, Hans Kristian</au><au>Andelic, Nada</au><au>Skandsen, Toril</au><au>Håberg, Asta</au><au>Kvistad, Kjell Arne</au><au>Olsen, Øystein</au><au>Saksvoll, Elin Hildrum</au><au>Abel-Grüner, Sebastian</au><au>Anke, Audny</au><au>Follestad, Turid</au><au>Vik, Anne</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>The prognostic importance of traumatic axonal injury on early MRI: the Trondheim TAI-MRI grading and quantitative models</atitle><jtitle>European radiology</jtitle><stitle>Eur Radiol</stitle><addtitle>Eur Radiol</addtitle><date>2024-12</date><risdate>2024</risdate><volume>34</volume><issue>12</issue><spage>8015</spage><epage>8029</epage><pages>8015-8029</pages><issn>1432-1084</issn><issn>0938-7994</issn><eissn>1432-1084</eissn><abstract>Objectives
We analysed magnetic resonance imaging (MRI) findings after traumatic brain injury (TBI) aiming to improve the grading of traumatic axonal injury (TAI) to better reflect the outcome.
Methods
Four-hundred sixty-three patients (8–70 years) with mild (
n
= 158), moderate (
n
= 129), or severe (
n
= 176) TBI and early MRI were prospectively included. TAI presence, numbers, and volumes at predefined locations were registered on fluid-attenuated inversion recovery (FLAIR) and diffusion-weighted imaging, and presence and numbers on T2*GRE/SWI. Presence and volumes of contusions were registered on FLAIR. We assessed the outcome with the Glasgow Outcome Scale Extended. Multivariable logistic and elastic-net regression analyses were performed.
Results
The presence of TAI differed between mild (6%), moderate (70%), and severe TBI (95%). In severe TBI, bilateral TAI in mesencephalon or thalami and bilateral TAI in pons predicted worse outcomes and were defined as the worst grades (4 and 5, respectively) in
the Trondheim TAI-MRI grading
.
The Trondheim TAI-MRI grading
performed better than the
standard
TAI grading in severe TBI (pseudo-
R
2
0.19 vs. 0.16). In moderate-severe TBI, quantitative models including both FLAIR volume of TAI and contusions performed best (pseudo-
R
2
0.19–0.21). In patients with mild TBI or Glasgow Coma Scale (GCS) score 13, models with the volume of contusions performed best (pseudo-
R
2
0.25–0.26).
Conclusions
We propose
the Trondheim TAI-MRI grading
(grades 1–5) with bilateral TAI in mesencephalon or thalami, and bilateral TAI in pons as the worst grades. The predictive value was highest for the quantitative models including FLAIR volume of TAI and contusions (GCS score <13) or FLAIR volume of contusions (GCS score ≥ 13), which emphasise artificial intelligence as a potentially important future tool.
Clinical relevance statement
The Trondheim TAI-MRI grading
reflects patient outcomes better in severe TBI than today’s standard TAI grading and can be implemented after external validation. The prognostic importance of volumetric models is promising for future use of artificial intelligence technologies.
Key Points
Traumatic axonal injury (TAI) is an important injury type in all TBI severities. Studies demonstrating which MRI findings that can serve as future biomarkers are highly warranted.
This study proposes the most optimal MRI models for predicting patient outcome at 6 months after TBI; one updated pragmatic model and a volumetric model.
The Trondheim TAI-MRI grading, in severe TBI, reflects patient outcome better than today’s standard grading of TAI and the prognostic importance of volumetric models in all severities of TBI is promising for future use of AI.</abstract><cop>Berlin/Heidelberg</cop><pub>Springer Berlin Heidelberg</pub><pmid>38896232</pmid><doi>10.1007/s00330-024-10841-1</doi><tpages>15</tpages><orcidid>https://orcid.org/0000-0003-0937-1986</orcidid><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1432-1084 |
| ispartof | European radiology, 2024-12, Vol.34 (12), p.8015-8029 |
| issn | 1432-1084 0938-7994 1432-1084 |
| language | eng |
| recordid | cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_11557676 |
| source | MEDLINE; NORA - Norwegian Open Research Archives; SpringerLink Journals - AutoHoldings |
| subjects | Adolescent Adult Aged Artificial intelligence Biomarkers Brain Injuries, Traumatic - diagnostic imaging Child Contusions Diagnostic Radiology Diffuse Axonal Injury - diagnostic imaging Elastic analysis Female Head injuries Humans Imaging Injury analysis Internal Medicine Interventional Radiology Magnetic resonance imaging Magnetic Resonance Imaging - methods Male Medical imaging Medicine Medicine & Public Health Mesencephalon Middle Aged Neuro Neuroimaging Neuroradiology Pons Prognosis Prospective Studies Radiology Regression analysis Traumatic brain injury Ultrasound Young Adult |
| title | The prognostic importance of traumatic axonal injury on early MRI: the Trondheim TAI-MRI grading and quantitative models |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-07T07%3A44%3A03IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_pubme&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=The%20prognostic%20importance%20of%20traumatic%20axonal%20injury%20on%20early%20MRI:%20the%20Trondheim%20TAI-MRI%20grading%20and%20quantitative%20models&rft.jtitle=European%20radiology&rft.au=Moen,%20Kent%20G%C3%B8ran&rft.date=2024-12&rft.volume=34&rft.issue=12&rft.spage=8015&rft.epage=8029&rft.pages=8015-8029&rft.issn=1432-1084&rft.eissn=1432-1084&rft_id=info:doi/10.1007/s00330-024-10841-1&rft_dat=%3Cproquest_pubme%3E3127420282%3C/proquest_pubme%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=3127420282&rft_id=info:pmid/38896232&rfr_iscdi=true |