Abstract

Case Report

The role of Diffusion-Weighted Imaging in better delineating the extent of Diffuse Axonal Injury in a pediatric patient: A case report and brief review of the literature

Aikaterini Solomou*, Pantelis Kraniotis and Vasileios Patriarcheas

Published: 09 April, 2020 | Volume 4 - Issue 1 | Pages: 022-025

Introduction: Diffuse axonal injury (DAI) is a major cause of disability in the pediatric patient. Herein we describe the MRI/DWI findings in a case with DAI. We also discuss the current role of CT and MRI with DWI in the evaluation of DAI.

Aim of the study: To stress the role of diffusion-weighted imaging in diffuse axonal injury.

Methods: A pediatric patient, who was hospitalized in the ICU, was submitted to MRI with DWI for the evaluation of brain lesions. The patient was scanned with T1-weighted images, T2-weighted images, FLAIR, T2*-weighted images and diffusion weighted images.

Result: Brain lesions caused by DAI were more conspicuous on diffusion-weighted images compared to FLAIR images. T2*-weighted images were a helpful adjunct in showing micro-hemorrhages.

Conclusion: T2*-weighted images and FLAIR images alone underestimate the true extent brain lesions in DAI compared to DWI.

Read Full Article HTML DOI: 10.29328/journal.acr.1001034 Cite this Article Read Full Article PDF

Keywords:

Diffuse axonal injury; Diffusion-weighted imaging; Pediatric head trauma

References

  1. Levin HS, Diaz-Arrastia RR, Diagnosis, prognosis, and clinical management of mild traumatic brain injury. Lancet Neurol. 2015; 14: 506-517. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/25801547
  2. Hyder AA, Wunderlich CA, Puvanachandra P, Gururaj G, Kobusingye OC. The impact of traumatic brain injuries: a global perspective. NeuroRehabilitation. 2007; 22: 341-353. Pubmed: https://www.ncbi.nlm.nih.gov/pubmed/18162698
  3. Taylor CA, Bell JM, Breiding MJ, Xu L. Traumatic Brain Injury-Related Emergency Department Visits, Hospitalizations, and Deaths - United States, 2007 and 2013. MMWR Surveill Summ. 2017; 66: 1-16. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/28301451
  4. Adams JH, Jennett B, Murray LS, Teasdale GM, Gennarelli TA, et al. Neuropathological findings in disabled survivors of a head injury. J Neurotrauma. 2011; 28: 701-709. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/21401319
  5. Lolli V, Pezzullo M, Delpierre I, Sadeghi N. MDCT imaging of traumatic brain injury. Br J Radiol. 2016; 89: 20150849. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/26607650
  6. McKee AC, Daneshvar DH. The neuropathology of traumatic brain injury. Handb Clin Neurol. 2015; 127: 45-66. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/25702209
  7. Jeong HW, Choi SW, Youm JY, Lim JW, Kwon HJ., et al. Mortality and Epidemiology in 256 Cases of Pediatric Traumatic Brain Injury: Korean Neuro-Trauma Data Bank System (KNTDBS) 2010-2014. J Korean Neurosurg Soc. 2017; 60: 710-716. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/29142631
  8. Le TH, Gean AD. Gean, Neuroimaging of traumatic brain injury. Mt Sinai J Med. 2009; 76: 145-162. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/19306377
  9. Lee B1, Newberg A. Neuroimaging in traumatic brain imaging. NeuroRx. 2005; 2: 372-383. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/15897957
  10. Marshall LF, Marshall SB, Klauber MR, Van Berkum Clark M, Eisenberg H, et al. The diagnosis of head injury requires a classification based on computed axial tomography. J Neurotrauma. 1992; 9 Suppl 1: S287-292. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/1588618
  11. Maas AI, Hukkelhoven CW, Marshall LF, Steyerberg EW. Prediction of outcome in traumatic brain injury with computed tomographic characteristics: a comparison between the computed tomographic classification and combinations of computed tomographic predictors. Neurosurgery. 2005; 57: 1173-1182. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/16331165
  12. Charry JD, Falla JD, Ochoa JD, Pinzón MA, Tejada JH, et al. External Validation of the Rotterdam Computed Tomography Score in the Prediction of Mortality in Severe Traumatic Brain Injury. J Neurosci Rural Pract. 2017; 8 (Suppl 1): S23-S26. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/28936067
  13. Amyot F, Arciniegas DB, Brazaitis MP, Curley KC6, Diaz-Arrastia R, et al. A Review of the Effectiveness of Neuroimaging Modalities for the Detection of Traumatic Brain Injury. J Neurotrauma. 2015; 32: 1693-721. PubMed: https://pubmed.ncbi.nlm.nih.gov/26176603/
  14. Haghbayan H, Boutin A, Laflamme M, Lauzier F, Shemilt M, et al., The Prognostic Value of MRI in Moderate and Severe Traumatic Brain Injury: A Systematic Review and Meta-Analysis. Crit Care Med. 2017; 45: e1280-e1288. PubMed: https://pubmed.ncbi.nlm.nih.gov/29028764/
  15. Ferrazzano PA, Rosario BL, Wisniewski SR, Shafi NI, Siefkes HM, et al., Use of magnetic resonance imaging in severe pediatric traumatic brain injury: assessment of current practice. J Neurosurg Pediatr. 2019; 23: 471-479. PubMed: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6687576/
  16. Mittl RL, Grossman RI, Hiehle JF, Hurst RW, Kauder DR, et al. Imaging of closed head injury. Radiology. 1994; 191: 1-17. PubMed: https://pubmed.ncbi.nlm.nih.gov/8134551/
  17. Parizel PM, Van Goethem OJW, van den Hauwe L, Dillen C, Verlooy J, et al. Imaging findings in diffuse axonal injury after closed head trauma. Eur Radiol. 1998; 8: 960-965. PubMed: https://pubmed.ncbi.nlm.nih.gov/9683701/
  18. Anderson CV, Wood DM, Bigler ED, Blatter DD. Lesion volume, injury severity, and thalamic integrity following head injury. J Neurotrauma. 1996; 13: 59-65. PubMed: https://pubmed.ncbi.nlm.nih.gov/8714861/
  19. Gale SD, Johnson SC, Bigler ED, Blatter DD. Trauma-induced degenerative changes in brain injury: a morphometric analysis of three patients with preinjury and postinjury MR scans. J Neurotrauma. 1995; 12: 151-158. PubMed: https://pubmed.ncbi.nlm.nih.gov/7629861/
  20. Yanagawa Y, Tsushima Y, Tokumaru A, Un-no Y, Sakamoto T, et al. A quantitative analysis of head injury using T2*-weighted gradient-echo imaging. J Trauma. 2000; 49: 272-7. PubMed: https://pubmed.ncbi.nlm.nih.gov/10963538/
  21. Ashikaga R, Araki Y, Ishida O. MRI of head injury using FLAIR. Neuroradiology. 1997; 39: 239-242. PubMed: https://pubmed.ncbi.nlm.nih.gov/9144669/
  22. Hesselink JR, Dowd CF, Healy ME, Hajek P, Baker LL, et al. MR imaging of brain contusions: a comparative study with CT. AJR Am J Roentgenol. 1988L 150: 1133-1142. PubMed: https://pubmed.ncbi.nlm.nih.gov/3258718/
  23. Mittl RL, Grossman RI, Hiehle JF, Hurst RW, Kauder DR, et al. Prevalence of MR evidence of diffuse axonal injury in patients with mild head injury and normal head CT findings. AJNR Am J Neuroradiol. 1994; 15: 1583-1589. PubMed: https://pubmed.ncbi.nlm.nih.gov/7985582/
  24. Huisman TAGM, Sorensen AG, Hergan K, Gonzalez RG, Schaefer PW. Diffusion-weighted imaging for the evaluation of diffuse axonal injury in closed head injury. J Comput Assist Tomogr. 2003; 27:: 5-11. PubMed: https://pubmed.ncbi.nlm.nih.gov/12544235/
  25. Ito J, Marmarou A, Barzó P, Fatouros P, Corwin F. Characterization of edema by diffusion-weighted imaging in experimental traumatic brain injury. J Neurosurg. 1996; 84: 97-103. PubMed: https://pubmed.ncbi.nlm.nih.gov/8613843/
  26. Povlishock JT, Christman CW. The pathobiology of traumatically induced axonal injury in animals and humans: a review of current thoughts. J Neurotrauma. 1995; 12: 555-564. PubMed: https://pubmed.ncbi.nlm.nih.gov/8683606/
  27. Schaefer PW, Grant PE, Gonzalez RG. Diffusion-weighted MR imaging of the brain. Radiology. 2000; 217: 331-345. PubMed: https://pubmed.ncbi.nlm.nih.gov/11058626/
  28. Jones DK, Dardis R, Ervine M, Horsfield MA, Jeffree M, et al. Cluster analysis of diffusion tensor magnetic resonance images in human head injury. Neurosurgery. 2000; 47: 306-313; discussion 313-4. PubMed: https://pubmed.ncbi.nlm.nih.gov/10942003/
  29. Ezaki Y, Tsutsumi K, Morikawa M, Nagata I. Role of diffusion-weighted magnetic resonance imaging in diffuse axonal injury. Acta Radiol. 2006; 47: 733-740. PubMed: https://pubmed.ncbi.nlm.nih.gov/16950714/
  30. Schaefer PW, Huisman TA, Sorensen AG, Gonzalez RG, Schwamm LH. Diffusion-weighted MR imaging in closed head injury: high correlation with initial glasgow coma scale score and score on modified Rankin scale at discharge. Radiology. 2004; 233: 58-66. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/15304663

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