{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T21:58:41Z","timestamp":1791669521350,"version":"4.3.4"},"reference-count":50,"publisher":"SAGE Publications","issue":"2","license":[{"start":{"date-parts":[[2017,1,1]],"date-time":"2017-01-01T00:00:00Z","timestamp":1483228800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2017,1,1]],"date-time":"2017-01-01T00:00:00Z","timestamp":1483228800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Journal of Neurotrauma"],"published-print":{"date-parts":[[2017,1]]},"abstract":"<jats:p>\n                    Clinical outcome after traumatic diffuse axonal injury (DAI) is difficult to predict. In this study, three magnetic resonance imaging (MRI) sequences were used to quantify the anatomical distribution of lesions, to grade DAI according to the Adams grading system, and to evaluate the value of lesion localization in combination with clinical prognostic factors to improve outcome prediction. Thirty patients (mean 31.2 years \u00b114.3 standard deviation) with severe DAI (Glasgow Motor Score [GMS] &lt;6) examined with MRI within 1 week post-injury were included. Diffusion-weighted (DW), T2*-weighted gradient echo and susceptibility-weighted (SWI) sequences were used. Extended Glasgow outcome score was assessed after 6 months. Number of DW lesions in the thalamus, basal ganglia, and internal capsule and number of SWI lesions in the mesencephalon correlated significantly with outcome in univariate analysis. Age, GMS at admission, GMS at discharge, and low proportion of good monitoring time with cerebral perfusion pressure &lt;60\u2009mm Hg correlated significantly with outcome in univariate analysis. Multivariate analysis revealed an independent relation with poor outcome for age (\n                    <jats:italic toggle=\"yes\">p<\/jats:italic>\n                    \u2009=\u20090.005) and lesions in the mesencephalic region corresponding to substantia nigra and tegmentum on SWI (\n                    <jats:italic toggle=\"yes\">p<\/jats:italic>\n                    \u2009=\u20090.008). We conclude that higher age and lesions in substantia nigra and mesencephalic tegmentum indicate poor long-term outcome in DAI. We propose an extended MRI classification system based on four stages (stage I\u2014hemispheric lesions, stage II\u2014corpus callosum lesions, stage III\u2014brainstem lesions, and stage IV\u2014substantia nigra or mesencephalic tegmentum lesions); all are subdivided by age (\u2265\/&lt;30 years).\n                  <\/jats:p>","DOI":"10.1089\/neu.2016.4426","type":"journal-article","created":{"date-parts":[[2016,6,29]],"date-time":"2016-06-29T22:29:25Z","timestamp":1467239365000},"page":"341-352","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":91,"title":["Extended Anatomical Grading in Diffuse Axonal Injury Using MRI: Hemorrhagic Lesions in the Substantia Nigra and Mesencephalic Tegmentum Indicate Poor Long-Term Outcome"],"prefix":"10.1177","volume":"34","author":[{"given":"Sami","family":"Abu Hamdeh","sequence":"first","affiliation":[{"name":"Uppsala University","place":["Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Niklas","family":"Marklund","sequence":"additional","affiliation":[{"name":"Uppsala University","place":["Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marianne","family":"Lannsj\u00f6","sequence":"additional","affiliation":[{"name":"Uppsala University","place":["Sweden"]},{"name":"Uppsala University\/County Council of G\u00e4vleborg","place":["Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tim","family":"Howells","sequence":"additional","affiliation":[{"name":"Uppsala University","place":["Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raili","family":"Raininko","sequence":"additional","affiliation":[{"name":"Uppsala University","place":["Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Johan","family":"Wikstr\u00f6m","sequence":"additional","affiliation":[{"name":"Uppsala University","place":["Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Per","family":"Enblad","sequence":"additional","affiliation":[{"name":"Uppsala University","place":["Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2017,1,15]]},"reference":[{"key":"e_1_3_2_2_2","first-page":"1","article-title":"Surveillance for traumatic brain injury-related deaths\u2014United States, 1997\u20132007","volume":"60","author":"Coronado V.G.","year":"2011","unstructured":"Coronado V.G., , Xu L., , Basavaraju S.V., , McGuire L.C., , Wald M.M., , Faul M.D., , Guzman B.R., , and Hemphill J.D. 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