Diffusion-weighted imaging improves outcome prediction in pediatric traumatic brain injury
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Published on: August 14, 2019
Nicholas R Galloway1, Karen A Tong, Stephen Ashwal
1Department of Radiation Medicine, Loma Linda University, Loma Linda, California 92354, USA.
Insights
Diffusion-weighted imaging (DWI) and apparent diffusion coefficient (ADC) maps can predict outcomes in pediatric traumatic brain injury (TBI). Lower ADC values in white matter correlate with poorer outcomes, aiding early clinical management.
Area of Science:
- Neuroimaging
- Pediatric Neurology
- Radiology
Background:
- Diffusion-weighted imaging (DWI) and apparent diffusion coefficient (ADC) maps are established tools for lesion detection and outcome prediction in adult traumatic brain injury (TBI).
- Limited research exists on the utility of DWI and ADC in pediatric TBI outcome prediction.
- Conventional imaging may not detect all injury patterns in pediatric TBI.
Purpose of the Study:
- To evaluate the role of DWI and ADC in predicting outcomes following pediatric TBI.
- To identify specific brain regions where ADC values correlate with TBI severity and patient outcomes.
Main Methods:
- Studied 37 pediatric TBI patients and 10 controls, assessing injury severity with Glasgow Coma Scale (GCS) and 6-12-month outcomes with Pediatric Cerebral Performance Category Scale (PCPCS).
- Manually defined 15 regions of interest (ROIs) on ADC maps, excluding T2-weighted image (T2WI) abnormalities, grouped into peripheral gray/white matter, deep gray/white matter, and posterior fossa.
- Analyzed ADC values across five patient groups: controls, all TBI, mild/moderate TBI with good outcomes, severe TBI with good outcomes, and severe TBI with poor outcomes.
Main Results:
- Significantly reduced ADC values were observed in the peripheral white matter of children with severe TBI and poor outcomes compared to those with severe TBI and good outcomes (72.8±14.4 vs. 82.5±3.8 x10⁻³ mm²/sec; p<0.05).
- The average total brain ADC value demonstrated the highest predictive ability, correctly forecasting outcomes in 84% of cases.
- DWI and ADC assessment proved valuable for evaluating injuries, especially in brain areas appearing normal on conventional imaging.
Conclusions:
- ADC values, particularly in peripheral white matter, are significant predictors of outcome in pediatric TBI.
- Average total brain ADC offers a powerful tool for predicting outcomes in pediatric TBI patients.
- Early identification of high-risk pediatric TBI patients using DWI and ADC can facilitate timely and aggressive clinical management.
Abstract:
Diffusion-weighted imaging (DWI) and consequent apparent diffusion coefficient (ADC) maps have been used for lesion detection and as a predictor of outcome in adults with traumatic brain injury (TBI), but few studies have been reported in children. We evaluated the role of DWI and ADC for outcome prediction after pediatric TBI (n=37 TBI; n=10 controls). Fifteen regions of interest (ROIs) were manually drawn on ADC maps that were grouped for analysis into peripheral gray matter, peripheral white matter, deep gray and white matter, and posterior fossa. All ROIs excluded areas that appeared abnormal on T2-weighted images (T2WI). Acute injury severity was measured using the Glasgow Coma Scale (GCS) score, and 6-12-month outcomes were assessed using the Pediatric Cerebral Performance Category Scale (PCPCS) score. Patients were categorized into five groups: (1) controls; (2) all TBI patients; (3) mild/moderate TBI with good outcomes; (4) severe TBI with good outcomes; and (5) severe TBI with poor outcomes. ADC values in the peripheral white matter were significantly reduced in children with severe TBI with poor outcomes (72.8+/-14.4x10(-3) mm2/sec) compared to those with severe TBI and good outcomes (82.5+/-3.8x10(-3) mm2/sec; p<0.05). We also found that the average total brain ADC value alone had the greatest ability to predict outcome and could correctly predict outcome in 84% of cases. Assessment of DWI and ADC values in pediatric TBI is useful in evaluating injury, particularly in brain regions that appear normal on conventional imaging. Early identification of children at high risk for poor outcome may assist in aggressive clinical management of pediatric TBI patients.
