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MRI is the reference imaging modality for detecting diffuse axonal injury (DAI), yet the prognostic accuracy and reproducibility of MRI-based radiologic scoring systems remain uncertain.\u00a0This study aimed to compare the prognostic performance of five published MRI-based DAI scores for predicting 1-year neurological outcome, in a cohort of sTBI patients admitted to intensive care.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We analyzed adult patients with sTBI included in the prospective MRI-COMA cohort (NCT00577954). Inclusion criteria were age\u2009\u2265\u200918\u00a0years, admission to ICU for sTBI, and absence of command following within 7\u00a0days after sedation withdrawal. Brain MRI was performed between day 7 and day 35 post-injury using standardized T1, FLAIR, T2*\/SWI, and diffusion-weighted sequences. Three blinded evaluators (one neurointensivist, two neuroradiologists) independently applied five radiologic scores (Adams, Firsching, Hamdeh, Stockholm, Trondheim). The primary endpoint was the ability of each MRI-based radiologic score to predict 1-year neurological outcome, dichotomized as favorable (GOSE 5\u20138) or unfavorable (GOSE 1\u20134). Inter-rater reliability was quantified using Cohen\u2019s and Fleiss\u2019 kappa coefficients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Between 2007 and 2023, 443 patients were screened and 185 met eligibility criteria. At one year, 111 patients (59%) had an unfavorable outcome. The prognostic performance of the five MRI scores was moderate, with AUCs ranging from 0.60 [CI95 0.52\u20130.68] to 0.70 [CI95 0.63\u20130.77], with no significant differences across scores or raters even between the intensivist and radiologists. Inter-rater reliability was fair to moderate (Fleiss\u2019 \u03ba\u2009=\u20090.28 [CI95 0.22\u20130.34] to 0.38 [CI95 0.33\u20130.43]).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Conventional MRI-based scores have limited prognostic value and reproducibility in cases of sTBI and are therefore not suitable for accurate and objective neuroprognostication.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s12028-026-02474-7","type":"journal-article","created":{"date-parts":[[2026,2,26]],"date-time":"2026-02-26T15:59:35Z","timestamp":1772121575000},"page":"304-313","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Prognostic Value of MRI Anatomical Radiologic Scores for One-Year Neurological Outcome After Severe Traumatic Brain Injury"],"prefix":"10.1007","volume":"45","author":[{"given":"Th\u00e9o","family":"Avignon","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vincent","family":"Doat-Sarfati","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thibault","family":"Agripnidis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zacharie","family":"Cammilleri","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jean-Fran\u00e7ois","family":"Hak","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J\u00e9r\u00e9mie","family":"Nakache","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Meunier","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julien","family":"Sein","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yanis","family":"Goutal-Gu\u00e9rin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeanne","family":"Morel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Couret","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Damien","family":"Galanaud","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Lagier","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lionel","family":"Velly","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alice","family":"Jacquens","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vincent","family":"Degos","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Louis","family":"Puybasset","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0682-9405","authenticated-orcid":false,"given":"Pierre","family":"Simeone","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,2,26]]},"reference":[{"key":"2474_CR1","unstructured":"Saint-Maurice\u202f: Sant\u00e9 publique France. \u00c9pid\u00e9miologie des traumatismes cr\u00e2niens en France et dans les pays occidentaux - Synth\u00e8se bibliographique, avril 2016. 2019"},{"issue":"1","key":"2474_CR2","doi-asserted-by":"publisher","first-page":"100804","DOI":"10.1016\/j.accpm.2021.100804","volume":"40","author":"LM Paget","year":"2021","unstructured":"Paget LM, Boutonnet M, Moyer JD, Delhaye N, D\u2019Aranda E, Beltzer N, et al. 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