title: Diffusion-weighted imaging differentiates ischemic tissue from traumatized tissue.
abstract: OBJECTIVE
  Diffusion-weighted magnetic resonance imaging (MRI) has been shown to be particularly effective in detecting early (0 to 4 hours) pathophysiological changes in localized brain regions after cerebral ischemia. The present study sought to establish whether diffusion-weighted MRI would be similarly effective in predicting outcome after traumatic brain injury.
  
  
  METHODS
  Diffusion-weighted MRI images and T2-weighted MRI images were obtained over 4 hours after either moderate fluid percussion-induced traumatic brain injury or unilateral carotid ligation in rats.
  
  
  RESULTS
  Diffusion-weighted MRI images of traumatic brain injury demonstrated focal regions of image hypointensity as early as 1 hour after trauma. The relative diffusion coefficient in these hypointense regions was significantly increased (P < .005) by 4 hours after trauma compared with the noninjured hemisphere, but only in the transverse plane in the x direction. In contrast, induction of diffuse, nonfocal ischemia by unilateral carotid ligation resulted in scattered regions of hyperintensity with a significant (P < .001) decrease in relative diffusion coefficient as early as 1 hour after ligation compared with the noninjured hemisphere. This decrease exhibited no directionality.
  
  
  CONCLUSIONS
  We conclude that traumatic brain injury results in an increased water diffusion distance with the directionality indicative of bulk flow of extracellular fluid toward the lateral ventricles (vasogenic edema). In contrast, the decreased water diffusion distance with no apparent directionality observed in ischemia is most likely indicative of cytotoxic edema. Diffusion-weighted MRI therefore has the potential to differentiate cases of traumatic brain injury with no focal ischemia from those instances of traumatic brain injury in which focal ischemia is a complication.
authors.affiliation: Department of Molecular Sciences, James Cook University, Townsville, Queensland, Australia.
authors.forename: C C
authors.initials: CC
authors.lastname: Hanstock
authors.forename: A I
authors.initials: AI
authors.lastname: Faden
authors.forename: M R
authors.initials: MR
authors.lastname: Bendall
authors.forename: R
authors.initials: R
authors.lastname: Vink
mesh_terms: D000818:Animals; D001834:Body Water; D001929:Brain Edema / Q000503:physiopathology; D001930:Brain Injuries / Q000473:pathology / Q000503:physiopathology*; D002545:Brain Ischemia / Q000473:pathology / Q000503:physiopathology*; D004058:Diffusion; D008279:Magnetic Resonance Imaging; D008297:Male; D051381:Rats; D017207:Rats, Sprague-Dawley