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Vol. 32. Issue 4.
Pages 161-169 (July - August 2021)
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Vol. 32. Issue 4.
Pages 161-169 (July - August 2021)
Clinical Research
DOI: 10.1016/j.neucie.2020.05.001
Use of diffusion tensor imaging to assess the vasogenic edema in traumatic pericontusional tissue
Uso de la resonancia de tensor de difusión para estudiar el edema vasogénico pericontusional
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Mónica Laraa, Apolonia Mollb, Antonio Masb, María José Picadob, Carmen Gassentb, Jaume Pomarc, Juan Antonio Llompart-Poud, Marta Brella, Javier Ibáñeza, Jon Pérez-Bárcenad,
Corresponding author
juan.perez@ssib.es

Corresponding author.
a Neurosurgical Department, Son Espases University Hospital, Palma de Mallorca, Spain
b Radiology Department, Son Espases University Hospital, Palma de Mallorca, Spain
c Neuropsychology and Cognition Research Group, Research Institute on Health IDISBA & IUNICS-UIB, Palma de Mallorca, Spain
d Intensive Care Department, Son Espases University Hospital, Palma de Mallorca, Spain
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Table 1. Clinical data of TBI patients.
Table 2. Patients and controls demographic characteristics.
Table 3. Volume of the vasogenic edema and DTI values in the three groups.
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Abstract
Background and objective

Cerebral edema is a frequent and serious complication of traumatic brain injury (TBI). Diffusion tensor imaging (DTI) is considered a useful technique to assess white matter integrity after TBI. The objective of this prospective, observational study was to assess the characteristics of the vasogenic edema in the traumatic pericontusional tissue and compare it to the vasogenic edema found in brain tumors. We also included a control group.

Methods

Using DTI, the Apparent diffusion coefficient (ADC) and Fractional anisotropy (FA) were measured in the area of vasogenic edema in both TBI and tumor patients. The measurements in the control group were done in the gray and white matter. We included 15 TBI patients, 18 tumor patients and 15 controls.

Results

ADC and FA showed no differences between TBI and tumor patients (p=0.27 for AF; p=0.79 for ADC). Compared to healthy controls, TBI and tumor patients presented higher ADC values and lower FA values. The differences between TBI and controls were statistically significant (p<0.05).

Conclusions

In this prospective observational study using DTI-MRI in a selected group of mild and moderate TBI patients with vasogenic pericontusional edema we have shown that there were no significant differences of the ADC and FA values compared to brain tumor patients. Furthermore, healthy controls showed significant lower ADC values and higher FA values compared to TBI and tumor patients. Future studies, using DTI-MRI, should address whether any therapy has a favorable impact on the vasogenic edema of TBI patients with brain contusions.

Keywords:
Traumatic brain injury
Brain contusion
Pericontusional edema
Vasogenic edema
Diffusion tensor imaging
Resumen
Antecedentes y objetivo

El edema cerebral es una complicación grave y frecuente en pacientes con traumatismo craneoencefálico (TCE). La resonancia de tensor de difusión (DTI-RM) es considerada como una técnica de imagen muy útil para valorar la integridad de la sustancia blanca tras un TCE. El objetivo de este estudio prospectivo y observacional es valorar las características del edema vasogénico pericontusional de pacientes traumáticos y comparar dichas zonas con el edema vasogénico de pacientes con tumores cerebrales. También se ha incluido un grupo control.

Pacientes y métodos

Se ha empleado la DTI-RM para cuantificar el coeficiente de difusión aparente (ADC) y la anisotropía fraccional (AF) en las zonas de edema vasogénico en pacientes con contusiones cerebrales traumáticas y tumores cerebrales. Las mediciones del grupo control se hicieron tanto en la sustancia gris como en la sustancia blanca. Se incluyeron 15 pacientes con TCE, 18 pacientes con tumores cerebrales y 15 controles.

Resultados

Los valores del ADC y de la AF fueron similares en los pacientes con TCE y tumores cerebrales (p=0.27 para los valores de AF; p=0,79 para los valores de ADC). Respecto a los controles, tanto los pacientes con TCE como con tumores cerebrales presentaron valores más elevados del ADC y valores más bajos de la AF. Las diferencias en estas variables entre los pacientes con TCE y los controles fueron estadísticamente significativas (p<0,05).

Conclusiones

En este estudio observacional y prospectivo, utilizando DTI-RM en un grupo seleccionado de pacientes con TCE leve y moderado con edema vasogénico pericontusional, no hubo diferencias significativas en los valores del ADC y de la AF en comparación con los pacientes con tumores cerebrales. Sin embargo, los controles sanos tuvieron valores del ADC más bajos y valores de la AF más altos en comparación con los pacientes con TCE y tumores cerebrales. Futuros estudios podrían abordar, utilizando DTI-RM, si algún tratamiento tiene un impacto favorable en el edema vasogénico de pacientes con TCE y contusiones cerebrales.

Palabras clave:
Traumatismo craneoencefálico
Contusiones cerebrales
Edema pericontusional
Edema vasogénico
Resonancia de tensor de difusión

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