Diffusion-Weighted Imaging for the Evaluation of Diffuse Axonal Injury in Closed Head Injury.
Huisman, Thierry A. G. M.; Sorensen, A. Gregory; Hergan, Klaus; Gonzalez, R. Gilberto; Schaefer, Pamela W.
[Miscellaneous Article] Journal of Computer Assisted Tomography. 27(1):5-11, January/February 2003.

(Format: HTML, PDF)

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.

(C) 2003 Lippincott Williams & Wilkins, Inc.