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Intraventricular hemorrhage (IVH ntraventricular hemorrhage (IVHntraventricular hemorrhage (IVH ntraventricular hemorrhage (IVH ntraventricular hemorrhage (IVH ntraventricular hemorrhage (IVHntraventricular hemorrhage (IVH ntraventricular hemorrhage (IVH ntraventricular hemorrhage (IVH ntraventricular hemorrhage (IVHntraventricular hemorrhage (IVH ntraventricular hemorrhage (IVH ntraventricular hemorrhage (IVHntraventricular hemorrhage (IVHntraventricular hemorrhage (IVH) on initial ) on initial Computed tomography (CT)Computed tomography (CT) Computed tomography (CT)Computed tomography (CT) Computed tomography (CT) Computed tomography (CT) Computed tomography (CT) Computed tomography (CT)Computed tomography (CT)Computed tomography (CT) was reported reported reported reported to predict to predict lesions of d iffuse axonal injury (DAI) iffuse axonal injury (DAI) iffuse axonal injury (DAI) iffuse axonal injury (DAI) iffuse axonal injury (DAI)iffuse axonal injury (DAI) iffuse axonal injury (DAI) iffuse axonal injury (DAI) iffuse axonal injury (DAI)iffuse axonal injury (DAI) iffuse axonal injury (DAI)iffuse axonal injury (DAI)iffuse axonal injury (DAI)iffuse axonal injury (DAI) in the corpus callosum on in the corpus callosum on in the corpus callosum on in the corpus callosum on in the corpus callosum on in the corpus callosum on in the corpus callosum on in the corpus callosum on subsequent subsequent magnetic resonance Imaging (MRI)agnetic resonance Imaging (MRI)agnetic resonance Imaging (MRI)agnetic resonance Imaging (MRI)agnetic resonance Imaging (MRI) agnetic resonance Imaging (MRI)agnetic resonance Imaging (MRI) agnetic resonance Imaging (MRI)agnetic resonance Imaging (MRI) agnetic resonance Imaging (MRI)agnetic resonance Imaging (MRI) agnetic resonance Imaging (MRI)agnetic resonance Imaging (MRI)agnetic resonance Imaging (MRI)agnetic resonance Imaging (MRI)agnetic resonance Imaging (MRI)agnetic resonance Imaging (MRI) agnetic resonance Imaging (MRI) agnetic resonance Imaging (MRI) agnetic resonance Imaging (MRI)agnetic resonance Imaging (MRI). We aimed to examine the relationship between We aimed to examine the relationship between We aimed to examine the relationship between We aimed to examine the relationship between We aimed to examine the relationship between We aimed to examine the relationship between We aimed to examine the relationship between We aimed to examine the relationship between We aimed to examine the relationship between We aimed to examine the relationship between We aimed to examine the relationship between We aimed to examine the relationship between We aimed to examine the relationship between We aimed to examine the relationship between We aimed to examine the relationship between initial initial initial initial CT findingsT findings T findings T findings T findings andand DAI lesions detected detected detected on MRI, andand the relationship between the relationship between the relationship between the relationship between the relationship between the relationship between the relationship between the relationship between the relationship between the relationship between severity of severity of severity of severity of severity of IVHIVHIVH (I VH score scorescore ) and and severity of severity of severity of severity of severity of severity of DAI DAI DAI (DAI staging)(DAI staging) (DAI staging)(DAI staging) (DAI staging)(DAI staging) (DAI staging)(DAI staging).

TRANSCRIPT

  • 1

    Full title page

    Intraventricular Hemorrhage on Initial Computed Tomography as Marker

    of Diffuse Axonal Injury after Traumatic Brain Injury

    Regular manuscript

    Daddy Mata-Mbemba1, MD, PhD; Shunji Mugikura

    1, MD, PhD; Atsuhiro

    Nakagawa2, MD, PhD; Takaki Murata

    1, MD, PhD; Yumiko Kato

    1, MD,

    PhD; Yasuko Tatewaki1, MD, PhD; Li Li

    1 MD, PhD; Kei Takase

    1, MD,

    PhD; Kiyoshi Ishii, MD, PhD Shigeki Kushimoto3, MD, PhD; Teiji

    Tominaga2, MD, PhD, and Shoki Takahashi

    1, MD, PhD.

    Department of 1Diagnostic Radiology,

    2 Neurosurgery, and

    3Division of

    Emergency Medicine, Tohoku University Graduate School of Medicine,

    Sendai, Japan and

    4Department of Radiology, Sendai city hospital, Sendai, Japan

    *Address correspondence to:

    Shunji Mugikura, M.D., Ph.D.

    Department of Diagnostic Radiology, Tohoku University, Graduate School

    of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Japan 980-8574

    Tel: International access code +81-22-717-7312

    Fax: International access code +81-22-717-7316

    Email: mugi@rad.med.tohoku.ac.jp

    Page 1 of 34

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  • 2

    Abbreviated title page

    Intraventricular Hemorrhage on Initial Computed Tomography as Marker

    of Diffuse Axonal Injury after Traumatic Brain Injury

    Page 2 of 34

    Jour

    nal o

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    rotra

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    Intra

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    emor

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    ompu

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    iffus

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    xona

    l Inju

    ry aft

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    auma

    tic B

    rain I

    njury

    (doi: 1

    0.108

    9/neu

    .2014

    .3453

    )Th

    is ar

    ticle

    has

    bee

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  • 3

    ABSTRACT:

    Intraventricular hemorrhage (IVH) on initial Computed tomography (CT) was reported

    to predict lesions of diffuse axonal injury (DAI) in the corpus callosum on subsequent

    magnetic resonance Imaging (MRI). We aimed to examine the relationship between

    initial CT findings and DAI lesions detected on MRI, and the relationship between the

    severity of IVH (IVH score) and severity of DAI (DAI staging). A consecutive 140

    patients with traumatic brain injury (TBI) who underwent MRI within 30 days after

    onset were revisited. We reviewed their initial CT for the following six findings: status

    of basal cistern, status of midline shift, epidural hematoma, IVH, subarachnoid

    hemorrhage, and volume of hemorrhagic mass and IVH score was assigned in each

    patient. Based on MRI findings, patients were divided into DAI and non-DAI groups,

    and were assigned a DAI staging. Then, to confirm the IVH on initial CT predicts DAI

    lesions on MRI, we used multivariate analysis of the six CT findings including IVH and

    examined the relationship between IVH score and DAI staging. The IVH detected on

    CT was the only predictor of DAI (P=0.0139). The IVH score and DAI staging showed

    significant positive correlation (P

  • 4

    conclusion, IVH on initial CT is the only maker of DAI on subsequent MRI, specifically

    severe DAI (stage 2 or 3)

    Key words

    computed tomography

    intraventricular hemorrhage

    diffuse axonal injury

    traumatic brain injury

    corpus callosum

    Page 4 of 34

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    auma

    tic B

    rain I

    njury

    (doi: 1

    0.108

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    .2014

    .3453

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  • 5

    INTRODUCTION:

    Diffuse axonal injury (DAI) is thought to be one of the most important factors in

    determining the prognosis of patients with traumatic brain injury (TBI).1 For instance, a

    severe DAI may transform young, productive individuals into dependent patients,

    sometimes requiring institutionalized care, which results in increased socio-economic

    burden .2-3

    In the routine practice, CT remains the first choice imaging modality for initial

    and early follow-up evaluations in patients with TBI,4 while, MRI is often additionally

    performed later mainly to screen for lesions suggesting DAI (DAI lesions), because CT

    fails to accurately reveal them. In that sense, knowing the initial CT findings predicting

    DAI lesions on subsequent MRI will assist emergency physicians to properly select

    patients who should undergo MRI study.

    The three-grading of DAI based on the locations of DAI lesions on MRI (DAI

    stage) as proposed by Gentry et al.5

    was reported to significantly predict the functional

    outcome of patients with the stage 3 being the worst.6-7

    Recently, Matsukawa et al.8

    reported that the presence or severity of intraventricular hemorrhage (IVH) on initial CT

    was associated with DAI lesions in the corpus callosum on subsequent MRI (DAI stage

    Page 5 of 34

    Jour

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    Intra

    vent

    ricul

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    Initi

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    xona

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    ry aft

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    (doi: 1

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    .3453

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  • 6

    2), however they did not examine the relationship between IVH and DAI lesions located

    in the cerebral hemisphere (DAI stage 1) or those in the brain stem (DAI stage 3)..

    Therefore, to clarify the clinical significance of IVH on initial CT for predicting

    the DAI lesions on subsequent MRI, we sought to examine: 1) the relationship between

    various initial CT findings, including IVH, and the presence of DAI on subsequent MR

    imaging, and 2) the relationship between the severity of IVH on initial CT and stage of

    DAI on MRI, which has never been investigated to the best of our knowledge.

    PATIENTS AND METHODS:

    Study population

    We retrospectively reviewed the records of all consecutive TBI patients who

    were registered in the electronic radiological database of our institution, a major tertiary

    referral hospital in northeastern japan, between the January 2007 and June 2011. One

    hundred-forty patients (age range: 6-89 years) who underwent initial MRI within 30

    days after onset were included in this study.6-7, 9

    Male sex was predominant (102

    patients [72.9%]) and Traffic accident was the main mean of injury (94 patients

    [67.1%]). At the time of their admission to the emergency room, clinical symptoms

    were mild (Glasgow coma scale [GCS] GCS 1315) in 89(63.9%) patients, moderate

    Page 6 of 34

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    (doi: 1

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