The reliability of magnetic resonance imaging in traumatic brain injury lesion detection.
OBJECTIVE
This study compares inter-rater-reliability, lesion detection and clinical relevance of T2-weighted imaging (T2WI), Fluid Attenuated Inversion Recovery (FLAIR), T2*-gradient recalled echo (T2*-GRE) and Susceptibility Weighted Imaging (SWI) in Traumatic Brain Injury (TBI).


METHODS
Three raters retrospectively scored 56 TBI patients' MR images (12-76 years old, median TBI-MRI interval 7 weeks) on number, volume, location and intensity. Punctate lesions (diameter <10 mm) were scored separately from large lesions (diameter ≥ 10 mm). Injury severity was assessed with the Glasgow Coma Scale (GCS), outcome with the Glasgow Outcome Scale-Extended (GOSE).


RESULTS
Inter-rater-reliability for lesion volume and punctate lesion count was good (ICC = 0.69-0.94) except for punctate lesion count on T2WI (ICC = 0.19) and FLAIR (ICC = 0.15). SWI showed the highest number of lesions (mean = 30.0), followed by T2*-GRE (mean = 15.4), FLAIR (mean = 3.1) and T2WI (mean = 2.2). Sequences did not differ in detected lesion volume. Punctate lesion count on T2*-GRE (r = -0.53) and SWI (r = -0.49) correlated with the GCS (p < 0.001).


CONCLUSIONS
T2*-GRE and SWI are more sensitive than T2WI and FLAIR in detecting (haemorrhagic) traumatic punctate lesions. The correlation between number of punctate lesions on T2*-GRE/SWI and the GCS indicates that haemorrhagic lesions are clinically relevant. The considerable inter-rater-disagreement in this study advocates cautiousness in interpretation of punctate lesions using T2WI and FLAIR.
Department of Radiology, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands.
Bram H J
BH
Geurts
Teuntje M J C
TM
Andriessen
Bozena M
BM
Goraj
Pieter E
PE
Vos
D000293:Adolescent; D000328:Adult; D000368:Aged; D001921:Brain / Q000473:pathology*; D001930:Brain Injuries / Q000175:diagnosis* / Q000473:pathology; D002648:Child; D005260:Female; D023261:Glasgow Outcome Scale; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D015599:Trauma Severity Indices