Coma duration prediction in diffuse axonal injury: analyses of apparent diffusion coefficient and clinical prognostic factors.

The purpose of this paper is to evaluate the hypothesis that the Apparent Diffusion Coefficient (ADC) values combined with initial clinical factors indicates the depth of shearing lesions in the brain structure and therefore relates to coma duration of diffuse axonal injury (DAI). Seventy-four adult patients (48 male and 26 female patients) with diffuse axonal injury were examined with convention MR imaging and diffusion weighted MR imaging between 2 hours and 20 days after injury. Apparent diffusion coefficient (ADC) maps were obtained and the mean ADC values of each Region of Interest (ROI) were measured using MRI console software. The lesions involvement of brainstem, deep gray matter, and corpus callosum were determined for each sequence separately as well as for the combination of all sequences. The correlations between magnetic resonance (MR) imaging findings of presence of apparent brain injury combined with initial clinical factors were investigated. Clinical characteristics, such as initial score on the Glasgow Coma Scale (GCS), age, and the number of all lesions, ADC scores of the patient in MR findings were predictive of the duration of coma. Post-traumatic coma duration of DAI could be predicted by cerebral MRI findings in the acute to subacute stage after head injury combined with clinical prognostic factors. Age, ADC scores, GCS, number of lesions are highly significant in predicting coma duration. The technique presented herein might provide a tool for in vivo detection of DAI for the coma duration at the early stages in patients with traumatic brain injury.