Prognostic value of computed tomography and magnetic resonance imaging findings in acute traumatic brain injury in prediction of poor neurological outcome and mortality: a systematic review and meta-analysis.

IF 2.5 3区 医学 Q2 CLINICAL NEUROLOGY
Arvin Naeimi, Sepehr Aghajanian, Kyana Jafarabady, Reza Aletaha, Seyed Farzad Maroufi, MirHojjat Khorasanizadeh, Martina Stippler
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引用次数: 0

Abstract

Traumatic brain injury (TBI) is a major cause of morbidity and mortality, impacting healthcare systems and economies. Early identification of poor outcomes is crucial for effective treatment. This systematic review assesses the prognostic value of computed tomography (CT) and magnetic resonance imaging (MRI) findings in predicting poor neurological outcomes and mortality in the acute phase of TBI. A comprehensive search of Scopus, MEDLINE, and Web of science databases was performed to identify studies examining CT and MR-based imaging findings and their association with poor outcomes as assessed by Glasgow outcome score as well as mortality within the early acute phase of TBI following injury/admission. Qualitative evaluation of included studies revealed several imaging sequences that modify the outcome of the patients, including extra-axial and intra-axial hemorrhage, swirl sign, contrast extravasation, midline shift, closed and open cranial cisterns, signs of edema, presence of cranial fractures, intracranial hemorrhage, cerebral microbleeds, diffuse axonal injury, apparent diffusion coefficient and fractional anisotropy in diffusion tensor imaging, as well as, concentrations of brain metabolites(N-acetyl aspartate, Creatinine, Choline, Myo-inositol, glutamate, and glutamine) in magnetic resonance spectroscopy. Among these markers, subarachnoid hemorrhage (SAH) and subdural hematoma (SDH) emerged as the most predictive of poor outcomes based on meta-analysis findings. SAH was significantly associated with an increased risk of mortality (OR: 3.35, 95% CI: 2.41-4.65, I²=51.3%) and poor outcomes (OR: 2.69, 95% CI: 2.44-2.96, I²=0%). Similarly, SDH correlated with higher mortality risk (OR: 2.44, 95% CI: 2.14-2.78, I²=0%) and worse outcomes (OR: 2.00, 95% CI: 1.12-3.59, I²=60.9%). In contrast, epidural hematoma (EDH) was linked to better outcomes (OR: 0.60, 95% CI: 0.52-0.68, I²=0%) but not significantly associated with mortality (OR: 0.38, 95% CI: 0.09-1.65, I²=73.7%). The results of this systematic review and meta-analysis provide an overview of clinically feasible imaging markers of prognostic value and may inform clinical decision-making in the future.

急性创伤性脑损伤中计算机断层扫描和磁共振成像结果在预测神经系统不良预后和死亡率方面的预后价值:系统回顾和荟萃分析。
创伤性脑损伤(TBI)是发病和死亡的主要原因,对医疗保健系统和经济造成影响。早期识别不良后果对有效治疗至关重要。本系统综述评估了计算机断层扫描(CT)和磁共振成像(MRI)结果在预测创伤性脑损伤急性期不良神经功能预后和死亡率方面的预后价值。我们对 Scopus、MEDLINE 和 Web of science 数据库进行了全面检索,以确定有关 CT 和 MR 成像结果及其与格拉斯哥结果评分评估的不良预后以及受伤/入院后 TBI 早期急性期死亡率之间关系的研究。对所纳入研究的定性评估显示,有几种成像序列会影响患者的预后,包括轴外和轴内出血、漩涡征、造影剂外渗、中线移位、颅骨闭合和开放性颅腔、水肿征象、颅骨骨折、颅内出血、脑微出血、弥漫性轴索损伤、弥散张量成像中的表观弥散系数和分数各向异性,以及磁共振波谱中脑代谢物(N-乙酰天冬氨酸、肌酸酐、胆碱、肌醇、谷氨酸和谷氨酰胺)的浓度。根据荟萃分析结果,在这些标记物中,蛛网膜下腔出血(SAH)和硬膜下血肿(SDH)最能预测不良预后。SAH 与死亡率风险增加(OR:3.35,95% CI:2.41-4.65,I²=51.3%)和不良预后(OR:2.69,95% CI:2.44-2.96,I²=0%)明显相关。同样,SDH 与较高的死亡风险(OR:2.44,95% CI:2.14-2.78,I²=0%)和较差的预后(OR:2.00,95% CI:1.12-3.59,I²=60.9%)相关。相比之下,硬膜外血肿(EDH)与更好的预后有关(OR:0.60,95% CI:0.52-0.68,I²=0%),但与死亡率无显著关联(OR:0.38,95% CI:0.09-1.65,I²=73.7%)。本系统综述和荟萃分析的结果概述了临床上可行的具有预后价值的成像标志物,可为今后的临床决策提供参考。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Neurosurgical Review
Neurosurgical Review 医学-临床神经学
CiteScore
5.60
自引率
7.10%
发文量
191
审稿时长
6-12 weeks
期刊介绍: The goal of Neurosurgical Review is to provide a forum for comprehensive reviews on current issues in neurosurgery. Each issue contains up to three reviews, reflecting all important aspects of one topic (a disease or a surgical approach). Comments by a panel of experts within the same issue complete the topic. By providing comprehensive coverage of one topic per issue, Neurosurgical Review combines the topicality of professional journals with the indepth treatment of a monograph. Original papers of high quality are also welcome.
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