The prognostic value of magnetic resonance imaging in moderate and severe traumatic brain injury : a Systematic Review and Meta-Analysis

Authors: Haghbayan, Hourmazd
Advisor: Turgeon-Fournier, Alexis
Abstract: Traumatic brain injury is a major cause of mortality and morbidity worldwide and represents a significant socioeconomic burden in developed nations due to residual post-trauma disability among survivors. Despite high rates of long-term unfavourable outcome, few prognostic indicators currently exist to guide early clinical management and counsel family and friends of patients. Over four decades of observational studies have examined the potential role of early magnetic resonance imaging of the brain to distinguish long-term clinical outcome by examining lesion patterns identifiable soon after trauma. This present work thus aims to determine the prognostic value of early magnetic resonance imaging following moderate or severe traumatic brain injury in adults by employing prognostic systematic review and meta-analysis methodology to identify all published studies assessing the relationship between magnetic resonance lesion patterns and long-term clinical outcome. Our search identified 58 individual studies; following meta-analysis, lesions located in the brainstem were associated with all-cause mortality and unfavourable neurological outcome while shear injury patterns compatible with diffuse axonal injury anywhere in the brain were associated with increased risk of unfavourable neurological outcome. Two scoring systems based on lesion depth were associated with progressively worse neurological outcomes as more caudal cerebral structures were affected, confirming the importance of deep lesions. These findings demonstrate the prognostic utility of magnetic resonance imaging early following traumatic brain injury and indicate the need for high quality, well-controlled, prognostic cohort studies given the elevated risk of bias in the current body of literature.
Document Type: Mémoire de maîtrise
Issue Date: 2020
Open Access Date: 3 February 2021
Grantor: Université Laval
Collection:Thèses et mémoires

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