The Prognostic Value of MRI in Moderate and Severe Traumatic Brain Injury: A Systematic Review and Meta-Analysis
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Published on: August 14, 2019
Hourmazd Haghbayan1,2, Amélie Boutin1, Mathieu Laflamme1,3
1CHU de Québec - Université Laval Research Centre, Population Health and Optimal Health Practices Research Unit (Trauma-Emergency-Critical Care Medicine), Université Laval, Québec, QC, Canada.
Objectives:
Traumatic brain injury is a major cause of death and disability, yet many predictors of outcome are not precise enough to guide initial clinical decision-making. Although increasingly used in the early phase following traumatic brain injury, the prognostic utility of MRI remains uncertain. We thus undertook a systematic review and meta-analysis of studies evaluating the predictive value of acute MRI lesion patterns for discriminating clinical outcome in traumatic brain injury.
Data Sources:
MEDLINE, EMBASE, BIOSIS, and CENTRAL from inception to November 2015.
Study Selection:
Studies of adults who had MRI in the acute phase following moderate or severe traumatic brain injury. Our primary outcomes were all-cause mortality and the Glasgow Outcome Scale.
Data Extraction:
Two authors independently performed study selection and data extraction. We calculated pooled effect estimates with a random effects model, evaluated the risk of bias using a modified version of Quality in Prognostic Studies and determined the strength of evidence with the Grading of Recommendations, Assessment, Development, and Evaluation.
Data Synthesis:
We included 58 eligible studies, of which 27 (n = 1,652) contributed data to meta-analysis. Brainstem lesions were associated with all-cause mortality (risk ratio, 1.78; 95% CI, 1.01-3.15; I = 43%) and unfavorable Glasgow Outcome Scale (risk ratio, 2.49; 95% CI, 1.72-3.58; I = 81%) at greater than or equal to 6 months. Diffuse axonal injury patterns were associated with an increased risk of unfavorable Glasgow Outcome Scale (risk ratio, 2.46; 95% CI, 1.06-5.69; I = 74%). MRI scores based on lesion depth demonstrated increasing risk of unfavorable neurologic outcome as more caudal structures were affected. Most studies were at high risk of methodological bias.
Conclusions:
MRI following traumatic brain injury yields important prognostic information, with several lesion patterns significantly associated with long-term survival and neurologic outcome. Given the high risk of bias in the current body of literature, large well-controlled studies are necessary to better quantify the prognostic role of early MRI in moderate and severe traumatic brain injury.
Insights
Acute MRI findings in traumatic brain injury (TBI) can predict long-term outcomes. Brainstem lesions and diffuse axonal injury patterns on MRI are associated with increased mortality and poor neurologic function after TBI.
Area of Science:
- Neuroscience
- Radiology
- Clinical Medicine
Background:
- Traumatic brain injury (TBI) is a leading cause of death and disability.
- Current outcome predictors for TBI lack precision for clinical decision-making.
- The prognostic value of early Magnetic Resonance Imaging (MRI) in TBI is uncertain.
Purpose of the Study:
- To systematically review and meta-analyze studies on the predictive value of acute MRI lesion patterns for clinical outcomes in TBI.
- To evaluate the prognostic utility of MRI in the early phase following TBI.
Main Methods:
- Systematic review and meta-analysis of studies published up to November 2015.
- Inclusion of adult patients with moderate or severe TBI who underwent acute MRI.
- Primary outcomes: all-cause mortality and Glasgow Outcome Scale (GOS).
Main Results:
- Brainstem lesions correlated with higher mortality and unfavorable GOS at 6 months.
- Diffuse axonal injury patterns on MRI were linked to an increased risk of unfavorable GOS.
- MRI-based lesion depth scores indicated a higher risk of poor neurologic outcome with more caudal lesion involvement.
- Most included studies exhibited a high risk of methodological bias.
Conclusions:
- Acute MRI in TBI provides significant prognostic information regarding long-term survival and neurologic outcomes.
- Specific lesion patterns, such as brainstem involvement and diffuse axonal injury, are key predictors.
- High risk of bias in current literature necessitates large, well-controlled studies to refine the prognostic role of early MRI in moderate to severe TBI.
