The prognostic importance of traumatic axonal injury on early MRI: the Trondheim TAI-MRI grading and quantitative models
Permanent link
https://hdl.handle.net/10037/35001Date
2024-06-19Type
Journal articleTidsskriftartikkel
Peer reviewed
Author
Moen, Kent Gøran; Flusund, Anne-Mari Holte; Moe, Hans Kristian; Andelic, Nada; Skandsen, Toril; Håberg, Asta; Kvistad, Kjell Arne; Olsen, Øystein E.; Saksvoll, Elin Hildrum; Abel-Grüner, Sebastian; Anke, Audny Gabriele Wagner; Follestad, Turid; Vik, AnneAbstract
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-R2 0.19 vs. 0.16). In moderate-severe TBI, quantitative models including
both FLAIR volume of TAI and contusions performed best (pseudo-R2 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-R2 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.