Article Text

  1. M. Zipperman,
  2. A. Aguilera,
  3. E. Joo,
  4. L. Shutter,
  5. S. Ashwal,
  6. K. Tong
  1. Loma Linda, CA.


High resolution susceptibility weighted imaging (SWI) is a more sensitive imaging modality to detect diffuse hemorrhagic axonal injury than conventional T2-weighted gradient-recalled echo sequences. There is some evidence that traumatic injuries to deeper brain structures may be related to the long term neurologic outcome. In this study, hemorrhagic lesions were analyzed for volume and anatomical distribution to determine the relationship between regional injury and level of disability measured by the Glasgow Outcome Score (GOS) at 6 months or greater. 76 adult patients presenting with traumatic brain injury were imaged with SWI sequences along with a standard magnetic resonance imaging protocol. SWI scans were imported into computer software (Image Pro Plus, Media Cybernetics Inc.) to measure the area of each hypointense lesion. The volume was extrapolated by multiplying effective slice thickness by area. Each lesion was assigned an anatomical region out of 16 possible locations such as frontal or parietal lobes, as well as categories for deeper brain structures such as basal ganglia or corpus callosum. The GOS was determined on 47 of these patients at 6 months or greater. Hemorrhagic volumes were compared to GOS in each brain region individually and to grouped regions that differentiated more superficial locations from deeper brain structures. Significance was reported at p ≤ 0.05. Mean hemorrhage volume was significantly higher in patients with poor outcomes (GOS of 1 to 3) when compared to those with good outcomes (GOS 4-5) in the grouped category including the thalamus, basal ganglia, and corpus callosum. There were non-significant trends of higher volumes with poor outcomes in the grouped category that included frontal, parietal, temporal, and occipital regions as well as the category that combined brain stem and cerebellum. Results showed 9 of the 16 locations demonstrating higher volumes of hemorrhagic lesions in patients with poor outcome. The increased sensitivity of SWI allows for detection of lesions that may not be observed in other modalities. Deep brain structures such as the thalamus, basal ganglia, and corpus callosum may be important in predicting long term outcome as represented by the significantly higher lesion volumes in patients with a GOS of 1-3 indicating death, vegetative state, or severe disability. This supports what has previously been reported and may be of use in tailoring a rehabilitative treatment plan.

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