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AJNR - American Journal of Neuroradiology

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American Journal of Neuroradiology 26:1140-1148, May 2005
© 2005 American Society of Neuroradiology

BRAIN

Fast Detection of Diffuse Axonal Damage in Severe Traumatic Brain Injury: Comparison of Gradient-Recalled Echo and Turbo Proton Echo-Planar Spectroscopic Imaging MRI Sequences

Elisabetta Giugni^a, Umberto Sabatini^a, Gisela E. Hagberg^a, Rita Formisano^a and Alessandro Castriota-Scanderbeg^a

^a From the IRCCS, Fondazione S. Lucia, Rome, Italy

Address reprint requests to Elisabetta Giugni, MD, IRCCS, Fondazione S. Lucia Via Ardeatina 306 Rome 00179 Italy

BACKGROUND AND PURPOSE: Diffuse axonal injury (DAI) is a common type of primary neuronal injury in patients with severe traumatic brain injury (TBI), and is frequently accompanied by tissue tear hemorrhage. T2-weighted gradient-recalled echo (GRE) sequences are more sensitive than T2-weighted spin-echo images for detection of hemorrhage. The purpose of this study is to compare turbo Proton Echo Planar Spectroscopic Imaging (t-PEPSI), an extremely fast sequence, with GRE sequence in the detection of DAI.

METHODS: Twenty-one patients (mean age 26.8 years) with severe TBI occurred at least 3 months earlier, underwent a brain MR Imaging study on a 1.5-T scanner. A qualitative evaluation of the t-PEPSI sequences was performed by identifying the optimal echo time and in-plane resolution. The number and size of DAI lesions, as well as the signal intensity contrast ratio (SI CR), were computed for each set of GRE and t-PEPSI images, and divided according to their anatomic location as lobar and/or deep brain.

RESULTS: There was no significant difference between GRE and t-PEPSI sequences in the detection of the total number of DAI lesions (291 vs. 230, respectively). GRE sequence delineated a higher number of DAI in the temporal lobe compared to the t-PEPSI sequence (74 vs. 37, P < .004), while no differences were found for the other regions. The SI CR was significantly lower with the t-PEPSI than the GRE sequence (P < .00001).

CONCLUSION: Owing to its very short scan time and high sensitivity to the hemorrhage foci, the t-PEPSI sequence may be used as an alternative to the GRE to assess brain DAI in severe TBI patients, especially if uncooperative and medically unstable.