• J Neuroradiology · Jul 2015

    Deafferentation in thalamic and pontine areas in severe traumatic brain injury.

    • M Laouchedi, D Galanaud, C Delmaire, S Fernandez-Vidal, A Messé, S Mesmoudi, F Oulebsir Boumghar, M Pélégrini-Issac, L Puybasset, H Benali, and V Perlbarg.
    • Inserm U1146, CNRS UMR7371, laboratoire d'imagerie biomédicale, Sorbonne universités, UPMC université Paris 06 UMCR2, CHU Pitié-Salpêtrière, 91, boulevard de l'hôpital, 75634 Paris, France; ParIMed Team, LRPE, USTHB, Algiers, Algeria.
    • J Neuroradiology. 2015 Jul 1; 42 (4): 202-11.

    PurposeSevere traumatic brain injury (TBI) is characterized mainly by diffuse axonal injuries (DAI). The cortico-subcortical disconnections induced by such fiber disruption play a central role in consciousness recovery. We hypothesized that these cortico-subcortical deafferentations inferred from diffusion MRI data could differentiate between TBI patients with favorable or unfavorable (death, vegetative state, or minimally conscious state) outcome one year after injury.MethodsCortico-subcortical fiber density maps were derived by using probabilistic tractography from diffusion tensor imaging data acquired in 24 severe TBI patients and 9 healthy controls. These maps were compared between patients and controls as well as between patients with favorable (FO) and unfavorable (UFO) 1-year outcome to identify the thalamo-cortical and ponto-thalamo-cortical pathways involved in the maintenance of consciousness.ResultsThalamo-cortical and ponto-thalamo-cortical fiber density was significantly lower in TBI patients than in healthy controls. Comparing FO and UFO TBI patients showed thalamo-cortical deafferentation associated with unfavorable outcome for projections from ventral posterior and intermediate thalamic nuclei to the associative frontal, sensorimotor and associative temporal cortices. Specific ponto-thalamic deafferentation in projections from the upper dorsal pons (including the reticular formation) was also associated with unfavorable outcome.ConclusionFiber density of cortico-subcortical pathways as measured from diffusion MRI tractography is a relevant candidate biomarker for early prediction of one-year favorable outcome in severe TBI.Copyright © 2014 Elsevier Masson SAS. All rights reserved.

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