Brain Volume Changes in Patients with Acute Brain Dysfunction Due to Sepsis
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Sepsis-induced brain dysfunction (SIBD) is often encountered in sepsis patients and is related to increased morbidity. No specific tests are available for SIBD, and neuroimaging findings are often normal. In this study, our aim was to analyze the diagnostic value of volumetric analysis of the brain structures and to find out its significance as a prognostic measure.
In this prospective observational study, brain magnetic resonance imaging (MRI) sections of 25 consecutively enrolled SIBD patients (17 with encephalopathy and 8 with coma) and 22 healthy controls underwent volumetric evaluation by an automated segmentation method.
Ten SIBD patients had normal MRI, and 15 patients showed brain lesions or atrophy. The most prominent volume reduction was found in cerebral and cerebellar white matter, cerebral cortex, hippocampus, and amygdala, whereas deep gray matter regions and cerebellar cortex were relatively less affected. SIBD patients with normal MRI showed significantly reduced volumes in hippocampus and cerebral white matter. Caudate nuclei, putamen, and thalamus showed lower volume values in non-survivor SIBD patients, and left putamen and right thalamus showed a more pronounced volume reduction in coma patients.
Volumetric analysis of the brain appears to be a sensitive measure of volumetric changes in SIBD. Volume reduction in specific deep gray matter regions might be an indicator of unfavorable outcome.
KeywordsSepsis Brain dysfunction Neuroimaging Volume change Volumetric analysis
The authors thank the personnel of the Multidisciplinary Critical Care Unit at the University of Istanbul for support and are indebted to Bio. Fatma Vildan Adali for assistance.
GO, ET, BB, SS, and FE contributed to conception and design of the study. GO, PEÖ, and FE contributed to acquisition, analysis, and interpretation of data from sepsis patients. BB contributed to acquisition, analysis, and interpretation of volumetric analysis of brain regions. SS and MB contributed to acquisition, analysis, and interpretation of brain magnetic resonance imaging. ET and BB performed the statistical analysis. GO, ET, BB, and FE were involved in drafting the manuscript or revising it critically for important intellectual content. All authors read and approved the final manuscript.
Source of Support
This study was funded by Scientific Research Projects Coordination Unit of Istanbul University (Grant Nos. 35165 and 2793/53037).
Conflict of interest
All authors declare that they have no conflict of interests.
Ethical Approval/Informed Consent
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. The study was approved by the Institutional Review Board (approval number: 2013/98), and informed consent was obtained from all individual participants or their relatives included in the study.
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