Axonal Injury, Cerebral Contusions on MRI Are Associated With Poorer Functional Outcome in CT-Negative TBI
By Nancy Melville
VIRTUAL -- August 27, 2021 -- The presence of diffuse axonal injury and contusion on MRI among patients with acute traumatic brain injury (TBI) who otherwise test negative on initial head CT can be an important indicator of poorer functional outcomes after 6 months, according to a study presented at the Virtual 2021 American Association of Neurological Surgeons (AANS).
“In this cohort of patients with acute TBI with negative head CTs, the presence of diffuse axonal injury and/or contusions on MRI was associated with poorer 6-month functional outcome, [such as] being unable to return to baseline work capacity, or worse,” said John K. Yue, MD, University of California at San Francisco, San Francisco, California. “MRI may be a more sensitive assessment tool for predicting persistent functional disability.”
For the prospective Transforming Research and Clinical Knowledge in Traumatic Brain Injury Pilot (TRACK-TBI Pilot) study, the authors assessed prospective data on 110 patients (mean age, 36.8 years) who had presented to an emergency department within 24 hours of TBI and received negative head CT. The patients had also received study-specific MRI evaluation within 16 days of injury and completed the 6-month Glasgow Outcome Scale-Extended (GOSE) score.
Among the patients, 28% had positive findings on MRI, including 18% with traumatic axonal injury, 4% with diffuse axonal injury only, 3% with subdural hematoma only, 2% had traumatic axonal injury plus contusion, 2% had diffuse axonal injury plus contusion plus subdural hematoma, and 1% had contusion only. Of the patients, 40% were admitted to hospital, with no difference according to whether they had negative or positive MRI findings.
At the 6-month follow-up, 32% of the patients had moderate disability or worse, with a GOSE score
However, a subgroup analysis showed that as many as 80% of those with diffuse axonal injury had a GOSE score
Those with combined diffuse axonal injury and contusion were more likely to have GOSE of ≤6 compared with those without the combination (67% vs 28%).
“There exists a subset of TBI patients who may benefit from triage to subacute MRI,” said Dr. Yue. “If positive, especially for contusions and diffuse axonal injury, this subset of patients may qualify for triage to specialist follow-up and/or concussion clinics for additional therapy.”
[Presentation title: Diffuse Axonal Injury and Cerebral Contusions on MRI Are Associated With Poorer Functional Outcome in CT-Negative TBI]