MR imaging in the detection of diffuse axonal injury with mild traumatic brain injury.
OBJECTIVE
To evaluate the occurrence and distribution of mild traumatic brain injury (MTBI) caused by diffuse axonal injury (DAI) using magnetic resonance (MR) imaging and to attempt to correlate MR findings with post-concussion symptoms (PCS).


METHODS
Forty MTBI patients (mean age: 32.5 years) with normal cranial computed tomography (CT) findings were examined with standard MR protocol including T(1)-weighted, T(2)-weighted, fluid attenuated inversion recovery (FLAIR), gradient echo (GRE) and diffusion-weighted (DW) sequences. MR imaging was performed within 24 hours of injury. The lesions were classified as DAI based on their location and morphologic appearance.


RESULTS
In MR imaging of five (12.5%) of the patients, the lesions compatible with DAI were observed. Four patients (10%) had the foci of low signal intensity compatible with hemorrhagic shear injury on the GRE sequence, and five (12.5%) patients had high signal intensity on FLAIR and DW sequence.


CONCLUSIONS
MR imaging can be helpful in revealing DAI lesions in patients with normal CT scan findings after MTBI. FLAIR, GRE and DW sequences are superior to conventional spin-echo images in detecting DAI lesions.
Topal
Naile Bolca
NB
Department of Radiology, Uludag University Medical School, 16059 Gorukle, Bursa, Turkey. nailebolca@yahoo.com
Hakyemez
Bahattin
B
Erdogan
Cuneyt
C
Bulut
Mehtap
M
Koksal
Ozlem
O
Akkose
Sule
S
Dogan
Seref
S
Parlak
Mufit
M
Ozguc
Halil
H
Korfali
Ender
E
D000293:Adolescent; D000328:Adult; D000368:Aged; D001921:Brain / Q000473:pathology*; D001930:Brain Injuries / Q000175:diagnosis / Q000473:pathology*; D020833:Diffuse Axonal Injury / Q000175:diagnosis / Q000473:pathology*; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods; D017352:Echo-Planar Imaging / Q000379:methods; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008875:Middle Aged; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed; D055815:Young Adult