Dynamics of cerebral edema and the apparent diffusion coefficient of water changes in patients with severe traumatic brain injury. A prospective MRI study |
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Authors: | Anne Pasco Aram Ter Minassian Catherine Chapon Laurent Lemaire Florence Franconi Dana Darabi Christine Caron Jean-Pierre Benoit Jean-Jacques Le Jeune |
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Institution: | (1) Department of Radiology, Larrey Hospital, Angers University, 49033 Cedex, France;(2) Department of Anaesthesiology, Larrey Hospital, Angers University, 49033 Cedex, France;(3) Inserm, U 646, Angers, 49100, France;(4) Angers University, 49100 Angers, France;(5) SCAS, Angers University, 49045 Angers, France |
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Abstract: | The distinction between intracellular (ICE) and extracellular edema (ECE) has a crucial prognostic and therapeutic importance
in patients with severe traumatic brain injury (STBI). Indeed, ICE usually leads to cellular death, and maintenance of a cerebral
perfusion pressure (CPP) above 70 mmHg is still under debate since this practice may increase ECE. The purpose of this study
was to describe the ECE and ICE kinetics associated with STBI using quantitative diffusion MRI. Twelve patients were prospectively
studied. The initial ADC in ICE measured on day 1.3±0.7 is significantly reduced compared to normal-appearing parenchyma (0.51±0.12
* 10−3 mm2/s vs. 0.76±0.03 * 10−3 mm2/s, n=12, P<0.0001) and reaches normality on MRI 3 performed on day 14.2±3.3. In patients presenting an extension of ICE on MRI 2 performed
on day 6.7±1.4 (ADCMRI2=0.40±0.11 * 10−3 mm2/s), ADC values in the extension area at the first MRI were slightly, but not significantly reduced compared to normal parenchyma
(0.69±0.05 * 10-3 mm2/s, P=0.29). Normalization occurred equally by day 14. ADC in ECE (1.34±0.22 * 10−3 mm2/s) was elevated and stable with time under CPP therapy. Therefore, ECE is not worsened by CCP therapy, and ICE appears more
relevant than ECE in STBI. |
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Keywords: | Raumatic brain injury Edema Magnetic resonance imaging Diffusion Apparent diffusion coefficient |
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