Diffuse Axonal Injury Associated with Chronic Traumatic Brain Injury: Evidence from T2*-weighted Gradient-echo Imaging at 3 T
Rainer Scheida,b,
Cristoph Preulb,
Oliver Gruberb,c,
Christopher Wigginsb,d and
D. Yves von Cramona,b
a Day Clinic of Cognitive Neurology,University of Leipzig, Leipzig, Germany
b the Max-Planck-Institute of Cognitive Neuroscience, Leipzig, Germany
c Department of Psychiatry, University of Ulm, Ulm, Germany
d the MGH-NMR Center, Massachusetts General Hospital, Charlestown, MA
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FIG 1. Frequency and site of traumatic microbleeds according to 10 brain areas. Shown is the total number of traumatic microbleeds in each brain area (front, frontal lobe; temp, temporal lobe; par, parietal lobe; occip, occipital lobe; cereb, cerebellum; bg, basal ganglia; thal, thalamus; cc, corpus callosum; mes, mesencephalon; bs, brain stem).
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FIG 2. Images of a 20-year-old man who was a passenger in a traffic accident in May 1999; he had not been wearing a seat belt. Multiple traumatic microbleeds are shown in the white matter of the right superior frontal gyrus. Left, T2-weighted image; right: T2*-weighted image. Axial view sections obtained from the identical location. Multiple traumatic microbleeds, which are clearly shown on the T2*-weighted gradient-echo images, are not depicted on the T2-weighted MR images. Note that no T2-hyperintense foci are seen. GCS score, 3; GOS score, 5.
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FIG 3. Images of a 22-year-old man who was the driver of a car that collided with a truck in June 1999. Multiple traumatic microbleeds are shown at the gray matter-white matter border. Left, T2-weighted image; right, T2*-weighted image. Images were obtained in the same plane. GCS score, 5; GOS score, 4.
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FIG 4. Images of a 42-year-old man who was a passenger in a traffic accident in September 2000. Traumatic microbleeds are shown in the posterior corpus callosum. Left, T2-weighted image; right, T2*-weighted image. Note the additional traumatic microbleeds in the left side of the splenium and at the gray matter-white matter border of the frontal lobes, which are not visible on the T2-weighted images. No T2-hyperintense callosal lesions are seen. GCS score, 3; GOS score, 4.
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FIG 5. Images of a 39-year-old woman who fell off a horse in July 1996. Traumatic microbleeds are shown in the left rostral brain stem (superior cerebellar peduncle), which is a preferential site for diffuse axonal injury. The nearly symmetrical additional larger dark areas are artifacts from the petrous bone. Left, T2-weighted image; right, T2*-weighted image. GCS score, 14; GOS score, 6.
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FIG 6. Relationships between number and site of traumatic microbleeds and clinical and imaging parameters. Top left, relationship of number of traumatic microbleeds to site of a callosal lesion (P = .0001). Top right, relationship of total number of traumatic microbleeds to the existence of a callosal lesion in general (P = .0000). Bottom left, relationship of total number of traumatic microbleeds to cause of injury (TA, traffic accident; P = .0028). Bottom right, relationship of total number of traumatic microbleeds to existence of inner brain atrophy (P = .0020).
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FIG 7. Images of a 37-year-old man who was a pedestrian in a traffic accident in January 1992; he was hit by an automobile while under the influence of alcohol. Traumatic microbleed is shown in the left midbrain, adjacent to the red nucleus, 99 months after traumatic brain injury. Left, T2-weighted image; right, T2*-weighted image. GCS score, 4; GOS score, 4.
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