Introduction: Severe traumatic brain injury (TBI) and subarachnoid haemorrhage (SAH) are the most common pathologies on the neuro-ICU and are associated with high mortality and morbidity.
Diffusion tensor imaging (DTI) can provide useful information on the extent of damage in these conditions.
Methods: MRI scanning with DTI analysis was performed in 20 patients (10 SAH and 10 TBI) seven and twelve days after onset of symptoms. Due to various reasons (early death, haemodynamic instability, high oxygen requirements) some patients were not able to be transported to the MRI, leaving 13 MRI scans on day 7 (4 SAH, 9 TBI) and 15 MRI scans (6 SAH, 9 TBI) on day 12.
Whole brain DTI tractography was performed and the fractional anisotropy (FA), average tract length, number of tracts, total tract length, axial diffusivity, radial diffusivity and mean diffusivity were measured in all patients. These results were compared between survivors and non-survivors at 6 months for scans on day 7 and day 12. The analysis was performed for the SAH and TBI group alone and the total group.
Results: DTI analysis on day 12 showed significant differences between survivors and non-survivors at 6 months on FA, average tract length, total tract length and number of tracts (table 1). No differences were observed between patients with SAH and TBI.
Data from MRI scans on day 7 showed no significant differences.
Conclusions: Preliminary results from MRI scanning with diffusion tensor imaging (DTI) show significant differences between survivors and non-survivors on day 12. No differences were observed between the SAH and TBI patients, which is important since both have different pathophysiological mechanisms. Further research and validation of the data in larger patient populations is needed.
Patient Care: Diffusion tensor imaging in the acute setting of severe traumatic brain injury and subarachnoid haemorrhage can provide valuable information on prognosis.
Learning Objectives: By the conclusion of this session, participants should be able to discuss the prognostic value of diffusion tensor imaging in severe traumatic brain injury and subarachnoid haemorrhage.