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Diffusion-Weighted Imaging for the Evaluation of Diffuse Axonal Injury in Closed Head Injury

2003; Lippincott Williams & Wilkins; Volume: 27; Issue: 1 Linguagem: Inglês

10.1097/00004728-200301000-00002

1532-3145

Thierry A. G. M. Huisman, A. Gregory Sorensen, Klaus Hergan, R. Gilberto González, Pamela W. Schaefer,

Traumatic Brain Injury and Neurovascular Disturbances

Purpose The purpose of this work was to compare diffusion-weighted imaging (DWI) with conventional MRI in the detection of shearing injuries in acute closed head injuries. Method Twenty-five patients (19 male, 6 female) were examined within 48 h of trauma. Conventional MRI included T2-weighted fast spin echo, fluid-attenuated inversion recovery (FLAIR), and T2*-weighted gradient echo sequences. Full tensor DWI with calculation of apparent diffusion coefficient (ADC) maps was also performed. Lesions were identified and compared on all sequences. Results Four hundred twenty-seven lesions were counted by the combined use of all sequences. DWI identified 70 lesions not seen on conventional MRI. DWI identified 310 shearing injuries, followed by T2/FLAIR (n = 248) and T2* (n = 202). The majority of DWI-positive lesions showed decreased diffusion (65%). Conclusion DWI is valuable in closed head injury because it identifies additional shearing injuries not visible on T2/FLAIR or T2* sequences. Furthermore, DWI/ADC maps differentiate between lesions with decreased or increased diffusion. DWI is less sensitive than T2* imaging for detecting hemorrhagic lesions.