Traumatic brain injury: diffusion-weighted MR imaging findings.
OBJECTIVE
Diffuse axonal injury (DAI) accounts for a significant portion of primary intra-axial lesions in cases of traumatic brain injury. The goal of this study was to use diffusion-weighted MR imaging to characterize DAI in the setting of acute and subacute traumatic brain injury.


METHODS
Nine patients ranging in age from 26 to 78 years were examined with conventional MR imaging (including fast spin-echo T2-weighted, fluid-attenuated inversion-recovery, and gradient-echo sequences) as well as echo-planar diffusion-weighted MR imaging 1 to 18 days after traumatic injury. Lesions were characterized as DAI on the basis of their location and their appearance on conventional MR images. Trace apparent diffusion coefficient (ADC) maps were computed off-line with the diffusion-weighted and base-line images. Areas of increased signal were identified on the diffusion-weighted images, and regions of interests were used to obtain trace ADC values.


RESULTS
In the nine patients studied, isotropic diffusion-weighted images showed areas of increased signal with correspondingly decreased ADC. In one case, decreased ADC was seen 18 days after the initial event.


CONCLUSIONS
Decreased ADC can be demonstrated in patients with DAI in the acute setting and may persist into the subacute period, beyond that described for cytotoxic edema in ischemia.
Liu
A Y
AY
Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia 19104, USA.
Maldjian
J A
JA
Bagley
L J
LJ
Sinson
G P
GP
Grossman
R I
RI
D000328:Adult; D000368:Aged; D001924:Brain Concussion / Q000175:diagnosis*; D002421:Caudate Nucleus / Q000293:injuries / Q000473:pathology; D002540:Cerebral Cortex / Q000293:injuries / Q000473:pathology; D003337:Corpus Callosum / Q000293:injuries / Q000473:pathology; D020833:Diffuse Axonal Injury / Q000175:diagnosis*; D004058:Diffusion; D017352:Echo-Planar Imaging; D005260:Female; D006801:Humans; D007089:Image Enhancement; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged