Diffusion-weighted imaging for the evaluation of diffuse axonal injury in closed head injury

J Comput Assist Tomogr. Jan-Feb 2003;27(1):5-11. doi: 10.1097/00004728-200301000-00002.


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.

Publication types

  • Comparative Study

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Brain / pathology
  • Diffuse Axonal Injury / diagnosis*
  • Diffusion Magnetic Resonance Imaging*
  • Female
  • Head Injuries, Closed / diagnosis*
  • Humans
  • Magnetic Resonance Imaging
  • Male
  • Middle Aged
  • Retrospective Studies