Moderate and severe traumatic brain injury: lesion frequency distribution maps and prognostic importance of brain contusions on early MRI

Tiril Svaasand Eliassen; Lars Eirik Bø; Anne-Mari Holte Flusund; Anne Katharina Köster; Nada Andelic; Toril Skandsen; Anne Vik; Kent Gøran Moen

doi:10.1007/s00330-025-12159-y

Moderate and severe traumatic brain injury: lesion frequency distribution maps and prognostic importance of brain contusions on early MRI

Eur Radiol. 2025 Dec 19. doi: 10.1007/s00330-025-12159-y. Online ahead of print.

Authors

Tiril Svaasand Eliassen¹, Lars Eirik Bø², Anne-Mari Holte Flusund^{3

4}, Anne Katharina Köster⁴, Nada Andelic^{5

6}, Toril Skandsen^{3

7}, Anne Vik^{3

8}, Kent Gøran Moen^{9

8

10

11}

Affiliations

¹ Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway. tirile@stud.ntnu.no.
² Department of Health Research, SINTEF Digital, Trondheim, Norway.
³ Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.
⁴ Department of Radiology, Møre and Romsdal Hospital Trust, Molde Hospital, Molde, Norway.
⁵ Institute of Health and Society, Research Centre for Habilitation and Rehabilitation Models and Services (CHARM), Faculty of Medicine, University of Oslo, Oslo, Norway.
⁶ Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Ullevål, Norway.
⁷ Clinic of Rehabilitation, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.
⁸ Department of Neurosurgery, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.
⁹ Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.
¹⁰ Department of Radiology, Vestre Viken Hospital Trust, Drammen Hospital, Drammen, Norway.
¹¹ Department of Radiology and Nuclear Medicine, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.

PMID: 41417124
DOI: 10.1007/s00330-025-12159-y

Abstract

Objective: Brain contusion frequency, distribution and prognostic value were investigated on early MRI in moderate-severe traumatic brain injury (TBI).

Materials and methods: We prospectively included 301 patients (8-70 years) admitted to Trondheim or Oslo University Hospitals with moderate (n = 123) or severe (n = 178) TBI and brain contusion(s) on MRI within 6 weeks (median 9 days) post-injury. Volumetric segmentation of brain contusions was performed manually on fluid-attenuated inversion recovery (FLAIR) MRI. The segmentations were combined into lesion frequency distribution maps for the whole cohort, moderate and severe TBI separately and three outcome categories. The 12-month outcome was assessed with the Glasgow Outcome Scale-Extended (GOSE). Relationship with the outcome was evaluated visually, with adjusted analyses and with voxel-based lesion-symptom mapping (VLSM).

Results: The frontal (75%) and temporal (82%) lobes had the highest frequency of brain contusions. There was no significant difference in total lesion volume between moderate and severe TBI (median: moderate TBI 15.8 cm³, severe TBI 13.6 cm³, p = 0.30). The total brain contusion volume significantly predicted the 12-month outcome in the adjusted models and decreased with increasing outcome category (GOSE score 1-4, median volume: 37.8 cm³; GOSE score 5-6, median volume: 14.5 cm³; GOSE score 7-8, median volume: 7.1 cm³; p = 0.02). There was no significant association between lesion location and the GOSE score in the VLSM analyses.

Conclusion: In this MRI cohort study, we found similar distributions and volumes of brain contusions in moderate-severe TBI. The brain contusion volume significantly predicted the 12-month outcome, whereas the lesion location was not associated with the outcome.

Key points: Question Accurate prognostic models for TBI are important for clinical decision making, but the value of including MRI measures remains unclear. Findings In moderate and severe TBI, brain contusions had the highest frequency in frontotemporal regions. Contusion volume predicted 12-month functional outcome, whereas there was no association with location. Clinical relevance Our findings indicate that brain contusion volume is more important for functional outcomes than lesion location. The brain contusion volume should be included in future AI models as one predictor of patient outcome after TBI.

Keywords: Brain contusion; Brain mapping; Neuroimaging; Patient outcome assessment.

Abstract

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