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Traumatic Axonal Injury on Early Magnetic Resonance Imaging and Associations with Long-Term Outcome in Children with
Anne-Mari Holte Flusund1,2, Mari Olsen1,3, Oddrun Sandrød4,5
1Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.
Insights
Traumatic axonal injury (TAI) is common in pediatric moderate-to-severe traumatic brain injury (TBI). More severe TAI grades on early MRI correlate with increased disability risk at 1 and 5 years post-injury.
Area of Science:
- Neuroscience
- Radiology
- Pediatric Neurology
Background:
- Traumatic brain injury (TBI) in children and adolescents can lead to long-term disability.
- Traumatic axonal injury (TAI) is a key neuropathological feature of TBI.
- Early assessment of TAI may inform prognosis and rehabilitation.
Purpose of the Study:
- To investigate the prevalence, location, and burden of TAI using early MRI in pediatric TBI.
- To examine the association between TAI characteristics and long-term outcomes (1 and 5 years post-injury).
Main Methods:
- Prospective cohort study of 56 pediatric patients (0-18 years) with moderate or severe TBI.
- Early MRI (within 6 weeks) using FLAIR, DWI, and T2*/SWI sequences to assess TAI.
- Long-term outcomes assessed using the Glasgow Outcome Scale Extended (GOSE) at 1 and 5 years.
- Logistic regression analyses to determine associations between TAI and outcomes.
Main Results:
- TAI was detected in 72% of moderate TBI and 89% of severe TBI cases.
- Larger TAI volumes on FLAIR were observed in the severe TBI group.
- More severe TAI grades (standard and Trondheim TAI-MRI) were significantly associated with increased disability risk at 1 and 5 years.
- Bilateral TAI in specific brain regions was linked to severe TBI and disability.
Conclusions:
- TAI is highly prevalent in pediatric moderate-to-severe TBI.
- Early MRI assessment of TAI provides valuable prognostic information.
- TAI grading on early MRI can help predict long-term disability and guide rehabilitation strategies.
Abstract:
In a cohort of children and adolescents with moderate and severe traumatic brain injury (TBI), we explored the location and burden of traumatic axonal injury (TAI) on early magnetic resonance imaging (MRI) and its associations with long-term outcomes at 1 and 5 years post-injury. Fifty-six patients (0-18 years) with moderate (n = 29) or severe (n = 27) TBI, where MRI was performed within 6 weeks, were prospectively included. TAI lesion locations (including grading), numbers, and volumes were registered on fluid-attenuated inversion recovery (FLAIR) and diffusion-weighted imaging, and locations and numbers were registered on T2* gradient echo or susceptibility-weighted imaging. Long-term outcomes at 1 and 5 years post-injury were dichotomized into good outcome (Glasgow Outcome Scale Extended [GOSE] score 7-8) and disability (GOSE score ≤6). Logistic regression analyses, unadjusted and adjusted for the presence of TAI on the different MRI sequences, were performed. The median age was 14.3 years, 66% were boys, and the median number of days to MRI was 8. TAI was found in 89% of the patients with severe TBI and 72% of the patients with moderate TBI. The volumes of TAI on FLAIR were larger in the severe group than in the moderate group (p = 0.007). We found an increased risk of disability at 1-year post-injury with both more severe standard TAI grades (p = 0.005) and Trondheim TAI-MRI grades (p = 0.001). Similar results were found at 5 years post-injury. TAI bilaterally in the basal ganglia, thalami, mesencephalon, and/or pons was only observed in patients with severe TBI and disability. TAI had a high prevalence in our moderate-to-severe pediatric TBI cohort, and more severe grades of TAI were associated with an increased risk of disability at both 1 and 5 years post-injury. Assessing TAI on early MRI in pediatric TBI patients provides valuable prognostic insights and supports the optimization of rehabilitation strategies.
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