A Multimodal Magnetic Resonance Imaging Study of Recovery of Consciousness in Severe Traumatic Brain Injury: Preliminary Results.

ABSTRACT

Accurate and reliable assessment of the conscious state of patients with severe traumatic brain injury (TBI) is vital for their future management. The purpose of the present study is to find an effective and accurate magnetic resonance imaging (MRI) method for predicting recovery of consciousness in patients with severe TBI. Multimodal MR techniques, including structural MRI, MR spectroscopy (MRS), diffusion tensor imaging (DTI), were used to evaluate brain damage in 58 patients with severe TBI. Statistical analysis compared imaging results and recovery over a relatively long period to find the most potent prognostic indicators and predictive method. A total 33 patients gained recovery of consciousness (RC), and 25 did not (NRC). Compared with the RC group, those in the NRC group had a significantly lower N-acetylaspartate to creatine (NAA/Cr) ratio of pons (1.43 ± 0.54 vs. 1.70 ± 0.42), more fiber lines (1046.3 ± 100.8 vs. 975.6 ± 128.1), less peripheral grey matter (pgrey) (579.23 ± 78.85 vs. 638.23 ± 61.16), lower fractional anisotropy (FA) of fibers (0.42 ± 0.04 vs. 0.45 ± 0.03), older age (43.08 ± 14.61 vs. 30.57 ± 12.89), and higher apparent diffusion coefficient (ADC) of fibers (0.99 ± 0.14 vs. 0.89 ± 0.06); all p < 0.05. Age, pgrey, ADC of fibers, NAA/Cr of pons were selected by logistic regression analysis to predict RC, with p values of 0.033 and 0.031, 0.035, 0.030, respectively. Age, pgrey, ADC of fibers, NAA/Cr of pons are effective indicators in the predictive model of RC.