Traumatic brain injury: Diffusionweighted MR imaging findings

BACKGROUND AND PURPOSE: Diffuse axonal injury (DAI) accounts for a significant por-tion of primary intra-axial lesions in cases of traumatic brain injury. The goal of this study was to use diffusion-weighted MR imaging to characterize DAI in the setting of acute and subacute traumatic brain injury. METHODS: Nine patients ranging in age from 26 to 78 years were examined with conven-tional MR imaging (including fast spin-echo T2-weighted, fluid-attenuated inversion-recovery, and gradient-echo sequences) as well as echo-planar diffusion-weighted MR imaging 1 to 18 days after traumatic injury. Lesions were characterized as DAI on the basis of their location and their appearance on conventional MR images. Trace apparent diffusion coefficient (ADC) maps were computed off-line with the diffusion-weighted and base-line images. Areas of in-creased signal were identified on the diffusion-weighted images, and regions of interests were used to obtain trace ADC values. RESULTS: In the nine patients studied, isotropic diffusion-weighted images showed areas of increased signal with correspondingly decreased ADC. In one case, decreased ADC was seen 18 days after the initial event