title: Fast detection of diffuse axonal damage in severe traumatic brain injury: comparison of gradient-recalled echo and turbo proton echo-planar spectroscopic imaging MRI sequences.
abstract: OBJECTIVE
  Diffuse axonal injury (DAI) is a common type of primary neuronal injury in patients with severe traumatic brain injury (TBI), and is frequently accompanied by tissue tear hemorrhage. T2-weighted gradient-recalled echo (GRE) sequences are more sensitive than T2-weighted spin-echo images for detection of hemorrhage. The purpose of this study is to compare turbo Proton Echo Planar Spectroscopic Imaging (t-PEPSI), an extremely fast sequence, with GRE sequence in the detection of DAI.
  
  
  METHODS
  Twenty-one patients (mean age 26.8 years) with severe TBI occurred at least 3 months earlier, underwent a brain MR Imaging study on a 1.5-T scanner. A qualitative evaluation of the t-PEPSI sequences was performed by identifying the optimal echo time and in-plane resolution. The number and size of DAI lesions, as well as the signal intensity contrast ratio (SI CR), were computed for each set of GRE and t-PEPSI images, and divided according to their anatomic location as lobar and/or deep brain.
  
  
  RESULTS
  There was no significant difference between GRE and t-PEPSI sequences in the detection of the total number of DAI lesions (291 vs. 230, respectively). GRE sequence delineated a higher number of DAI in the temporal lobe compared to the t-PEPSI sequence (74 vs. 37, P < .004), while no differences were found for the other regions. The SI CR was significantly lower with the t-PEPSI than the GRE sequence (P < .00001).
  
  
  CONCLUSIONS
  Owing to its very short scan time and high sensitivity to the hemorrhage foci, the t-PEPSI sequence may be used as an alternative to the GRE to assess brain DAI in severe TBI patients, especially if uncooperative and medically unstable.
authors.affiliation: IRCCS, Fondazione S. Lucia, Rome, Italy.
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Giugni
authors.forename: Umberto
authors.initials: U
authors.lastname: Sabatini
authors.forename: Gisela E
authors.initials: GE
authors.lastname: Hagberg
authors.forename: Rita
authors.initials: R
authors.lastname: Formisano
authors.forename: Alessandro
authors.initials: A
authors.lastname: Castriota-Scanderbeg
mesh_terms: D000293:Adolescent; D000328:Adult; D001930:Brain Injuries / Q000150:complications*; D020833:Diffuse Axonal Injury / Q000175:diagnosis* / Q000209:etiology*; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D011446:Prospective Studies; D013997:Time Factors