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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).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      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\u2009cm\n                      <jats:sup>3<\/jats:sup>\n                      , severe TBI 13.6\u2009cm\n                      <jats:sup>3<\/jats:sup>\n                      ,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.30). The total brain contusion volume significantly predicted the 12-month outcome in the adjusted models and decreased with increasing outcome category (GOSE score 1\u20134, median volume: 37.8\u2009cm\n                      <jats:sup>3<\/jats:sup>\n                      ; GOSE score 5\u20136, median volume: 14.5\u2009cm\n                      <jats:sup>3<\/jats:sup>\n                      ; GOSE score 7\u20138, median volume: 7.1\u2009cm\n                      <jats:sup>3<\/jats:sup>\n                      ;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.02). There was no significant association between lesion location and the GOSE score in the VLSM analyses.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Key Points<\/jats:title>\n                    <jats:p>\n                      <jats:bold>\n                        <jats:italic>Question<\/jats:italic>\n                      <\/jats:bold>\n                      <jats:italic>Accurate prognostic models for TBI are important for clinical decision making, but the value of including MRI measures remains unclear.<\/jats:italic>\n                    <\/jats:p>\n                    <jats:p>\n                      <jats:bold>\n                        <jats:italic>Findings<\/jats:italic>\n                      <\/jats:bold>\n                      <jats:italic>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.<\/jats:italic>\n                    <\/jats:p>\n                    <jats:p>\n                      <jats:bold>\n                        <jats:italic>Clinical relevance<\/jats:italic>\n                      <\/jats:bold>\n                      <jats:italic>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.<\/jats:italic>\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Graphical Abstract<\/jats:title>\n                  <\/jats:sec>","DOI":"10.1007\/s00330-025-12159-y","type":"journal-article","created":{"date-parts":[[2025,12,19]],"date-time":"2025-12-19T14:33:00Z","timestamp":1766154780000},"page":"3518-3530","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Moderate and severe traumatic brain injury: lesion frequency distribution maps and prognostic importance of brain contusions on early MRI"],"prefix":"10.1007","volume":"36","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-0116-1186","authenticated-orcid":false,"given":"Tiril Svaasand","family":"Eliassen","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lars Eirik","family":"B\u00f8","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anne-Mari Holte","family":"Flusund","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anne Katharina","family":"K\u00f6ster","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nada","family":"Andelic","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Toril","family":"Skandsen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anne","family":"Vik","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kent G\u00f8ran","family":"Moen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,12,19]]},"reference":[{"key":"12159_CR1","doi-asserted-by":"publisher","first-page":"663","DOI":"10.2214\/ajr.150.3.663","volume":"150","author":"LR Gentry","year":"1988","unstructured":"Gentry LR, Godersky JC, Thompson B (1988) MR imaging of head trauma: review of the distribution and radiopathologic features of traumatic lesions. 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J Cogn Neurosci 19:1081\u20131088","journal-title":"J Cogn Neurosci"}],"container-title":["European Radiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00330-025-12159-y.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00330-025-12159-y","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00330-025-12159-y.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,16]],"date-time":"2026-04-16T11:22:06Z","timestamp":1776338526000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00330-025-12159-y"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12,19]]},"references-count":44,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2026,5]]}},"alternative-id":["12159"],"URL":"https:\/\/doi.org\/10.1007\/s00330-025-12159-y","relation":{},"ISSN":["1432-1084"],"issn-type":[{"value":"1432-1084","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,12,19]]},"assertion":[{"value":"13 February 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"19 October 2025","order":2,"name":"revised","label":"Revised","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"1 November 2025","order":3,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"19 December 2025","order":4,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Compliance with ethical standards"}},{"value":"The scientific guarantor of this publication is Kent G\u00f8ran Moen, kent.g.moen@ntnu.no.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Guarantor"}},{"value":"The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"Turid Follestad and Lars Eirik B\u00f8 kindly provided statistical advice for this manuscript.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Statistics and biometry"}},{"value":"Written informed consent was obtained from all surviving subjects (patients), or for incapacitated or younger than 16 years, from their next of kin.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Informed consent"}},{"value":"The study was approved by the Regional Committee for Medical Research Ethics (2009\/2328, 2017\/1214).","order":6,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}},{"value":"The patients in this study come from two cohorts of traumatic brain injury (TBI) patients: The Trondheim Moderate and Severe TBI cohort (673 patients) and the Oslo Severe TBI cohort (153 patients). Parts of these cohorts have previously been included in three studies: (1) Patients from these two cohorts, together with a cohort of patients with mild TBI, were partly included in a study of Moe et al [\n                      \n                      ]. This study focused on traumatic axonal injury (TAI) and not brain contusions. (2) Patients from these two cohorts were partly included in a study of Flusund et al [\n                      \n                      ]. The study of Flusund et al used the same method of lesion mapping and voxel-based lesion-symptom mapping (VLSM) as the current study, but they made lesion maps of TAI instead of brain contusions. Lesion mapping has not been performed to study brain contusions in these patient cohorts before, and this is also addressed in the article. (3) Patients from these two cohorts, together with a cohort of patients with mild TBI, were also partly included in a study of Moen et al [\n                      \n                      ]. The study of Moen et al also studied the prognostic value of brain contusions on MRI. However, they studied the presence and volume of brain contusions in these cohorts, while in the current study, we studied volume and location of brain contusions and with other methods.","order":7,"name":"Ethics","group":{"name":"EthicsHeading","label":"Study subjects or cohorts overlap"}},{"order":8,"name":"Ethics","group":{"name":"EthicsHeading","label":"Methodology"}}]}}