Scholarlink

Background <p>Severe traumatic brain injury (sTBI) is a major cause of mortality and long-term disability, and early prognostic evaluation is essential to support therapeutic decision-making in intensive care. MRI is the reference imaging modality for detecting diffuse axonal injury (DAI), yet the prognostic accuracy and reproducibility of MRI-based radiologic scoring systems remain uncertain.&#xa0;This study aimed to compare the prognostic performance of five published MRI-based DAI scores for predicting 1-year neurological outcome, in a cohort of sTBI patients admitted to intensive care.</p> Methods <p>We analyzed adult patients with sTBI included in the prospective MRI-COMA cohort (NCT00577954). Inclusion criteria were age ≥ 18&#xa0;years, admission to ICU for sTBI, and absence of command following within 7&#xa0;days after sedation withdrawal. Brain MRI was performed between day 7 and day 35 post-injury using standardized T1, FLAIR, T2*/SWI, and diffusion-weighted sequences. Three blinded evaluators (one neurointensivist, two neuroradiologists) independently applied five radiologic scores (Adams, Firsching, Hamdeh, Stockholm, Trondheim). The primary endpoint was the ability of each MRI-based radiologic score to predict 1-year neurological outcome, dichotomized as favorable (GOSE 5–8) or unfavorable (GOSE 1–4). Inter-rater reliability was quantified using Cohen’s and Fleiss’ kappa coefficients.</p> Results <p>Between 2007 and 2023, 443 patients were screened and 185 met eligibility criteria. At one year, 111 patients (59%) had an unfavorable outcome. The prognostic performance of the five MRI scores was moderate, with AUCs ranging from 0.60 [CI95 0.52–0.68] to 0.70 [CI95 0.63–0.77], with no significant differences across scores or raters even between the intensivist and radiologists. Inter-rater reliability was fair to moderate (Fleiss’ κ = 0.28 [CI95 0.22–0.34] to 0.38 [CI95 0.33–0.43]).</p> Conclusion <p>Conventional MRI-based scores have limited prognostic value and reproducibility in cases of sTBI and are therefore not suitable for accurate and objective neuroprognostication.</p>

错误：搜索内容不能为空，请输入英文关键词
错误：关键词超出字数限制，请精简
高级检索

Prognostic Value of MRI Anatomical Radiologic Scores for One-Year Neurological Outcome After Severe Traumatic Brain Injury

  • 期刊论文

  • 出版模式：

    开放获取

  • 发表日期：

    2026年2月26日

查看全文
  • Théo Avignon,
  • Vincent Doat-Sarfati,
  • Thibault Agripnidis,
  • Zacharie Cammilleri,
  • Jean-François Hak,
  • Jérémie Nakache,
  • David Meunier,
  • Julien Sein,
  • Yanis Goutal-Guérin,
  • Jeanne Morel,
  • David Couret,
  • Damien Galanaud,
  • David Lagier,
  • Lionel Velly,
  • Alice Jacquens,
  • Vincent Degos,
  • Louis Puybasset,
  • Pierre Simeone

摘要

Background

Severe traumatic brain injury (sTBI) is a major cause of mortality and long-term disability, and early prognostic evaluation is essential to support therapeutic decision-making in intensive care. MRI is the reference imaging modality for detecting diffuse axonal injury (DAI), yet the prognostic accuracy and reproducibility of MRI-based radiologic scoring systems remain uncertain. This study aimed to compare the prognostic performance of five published MRI-based DAI scores for predicting 1-year neurological outcome, in a cohort of sTBI patients admitted to intensive care.

Methods

We analyzed adult patients with sTBI included in the prospective MRI-COMA cohort (NCT00577954). Inclusion criteria were age ≥ 18 years, admission to ICU for sTBI, and absence of command following within 7 days after sedation withdrawal. Brain MRI was performed between day 7 and day 35 post-injury using standardized T1, FLAIR, T2*/SWI, and diffusion-weighted sequences. Three blinded evaluators (one neurointensivist, two neuroradiologists) independently applied five radiologic scores (Adams, Firsching, Hamdeh, Stockholm, Trondheim). The primary endpoint was the ability of each MRI-based radiologic score to predict 1-year neurological outcome, dichotomized as favorable (GOSE 5–8) or unfavorable (GOSE 1–4). Inter-rater reliability was quantified using Cohen’s and Fleiss’ kappa coefficients.

Results

Between 2007 and 2023, 443 patients were screened and 185 met eligibility criteria. At one year, 111 patients (59%) had an unfavorable outcome. The prognostic performance of the five MRI scores was moderate, with AUCs ranging from 0.60 [CI95 0.52–0.68] to 0.70 [CI95 0.63–0.77], with no significant differences across scores or raters even between the intensivist and radiologists. Inter-rater reliability was fair to moderate (Fleiss’ κ = 0.28 [CI95 0.22–0.34] to 0.38 [CI95 0.33–0.43]).

Conclusion

Conventional MRI-based scores have limited prognostic value and reproducibility in cases of sTBI and are therefore not suitable for accurate and objective neuroprognostication.