MR imaging in the detection of diffuse axonal injury with mild traumatic brain injury

Neurol Res. 2008 Nov;30(9):974-8. doi: 10.1179/016164108X323799. Epub 2008 Aug 7.


Purpose: 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).

Patients and 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.

Conclusion: 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.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Brain / pathology*
  • Brain Injuries / diagnosis
  • Brain Injuries / pathology*
  • Diffuse Axonal Injury / diagnosis
  • Diffuse Axonal Injury / pathology*
  • Diffusion Magnetic Resonance Imaging / methods
  • Echo-Planar Imaging / methods
  • Humans
  • Image Processing, Computer-Assisted
  • Magnetic Resonance Imaging / methods*
  • Middle Aged
  • Reproducibility of Results
  • Sensitivity and Specificity
  • Tomography, X-Ray Computed
  • Young Adult