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MAGNETIC RESONANCE IMAGING IN ASSESSING SEVERE TRAUMATIC BRAIN INJURY AND PREDICTING BRAIN RECOVERY IN CHILDREN


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Abstract

Introduction. In Russia, about 250 thousand patients are hospitalized with a traumatic brain injury, 6% of them show severe head injury. About 50% of patients have adverse outcomes. Aim of this work. To investigate the prognostic value of magnetic resonance imaging (MRI) in the diagnosis of severe head injury (SHI) in children during the acute period. Materials and methods. 356 SHI children were examined. Computed tomography (CT) was performed in 284 children. MRI was performed with a Philips Achiev 3T scanner to obtain multiplanar T1 and T2WI, 2D and 3D isotropic images, FLAIR, SWI, DWI, MRS, and fMRI. Results. MRI studies were performed in 221 children (62.1%) in the first 24 hours after injury, within 48 hours - in 42 (11.79%), up to 72 hours - in 60 (16.85%), and up to 7 days - in 33 (9.26%) after injury. The following damages were identified: basal sections of the frontal (74%), temporal (79%), less often - parietal (25%) and occipital (5%) lobes, cerebellum (10%). The SWI sequence revealed a correlation between the number and volume of hemorrhages and outcomes. The average value of the diffusion coefficient predicted outcome in 81% of cases. 1H MRS revealed a decrease in the ratio of NAA/Cr, an increase in the ratio of Glx/Glu, and the appearance of the signal of lactate. Functional magnetic resonance imaging (fMRI) was performed in 36 children in a coma only with audio stimulation. A hemodynamic response was obtained in 25 patients. In the first 2 days after injury, the hemispheric and regional blood flow velocity increased by 56%. Conclusion. The complexity of diagnosing significant details of brain damage that can predict neurological and cognitive outcomes is a major problem in severe SHI. MRI is the main imaging method that provides an accurate prognosis of head injury outcomes.


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