Application Of 3.0T MRI Multiple Sequences In Evaluation Of Severe Traumatic Brain Injury

Objective: To investigate the value of 3.0T MRI multi-sequences in the clinical diagnosis and evaluation of severe traumatic brain injury, through the observation and quantitative analysis of lesions on MRI each sequence in severe TBI patients.Methods: A total of 35 patients with Glasgow coma scale(GCS) ≤ 8 who were hospitalized and had a clearly first head trauma history from January 2014 to April 2016 in the First Hospital of Ji Lin University were selected. All patients underwent 3.0T MRI multiple sequences examination, including T1 WI, T2 WI, fluid attenuated inversion recovery(FLAIR) sequences, diffusion weighted imaging(DWI) and enhanced T2 star weighted angiography(ESWAN) sequence. The signal characteristics of lesions on each MR sequence images in severe TBI patients were observed and the detected difference of each sequences for the different nature of lesions was compared, the number, volume of hemorrhagic lesions on ESWAN sequence and non-hemorrhagic lesions on FLAIR sequence were quantified and correlation analysis was performed with Glasgow coma scale.21 patients were diagnosed as diffuse axonal injury(DAI) in 35 patients with severe traumatic brain injury and their ESWAN imaging findings were summarized, including the lesion location, shape and quantity. Correlation between DAI grading and GCS score were evaluated. According to the length of coma time, the patients were divided into two groups, the difference of the number and volume of bleeding lesions in different parts of ESWAN sequence were compared.Results:(1) Lesions in patients with severe TBI on each imaging technology: the nature of the lesions were divided into hemorrhagic lesions and non-hemorrhagic lesions, ESWAN sequence showed more hemorrhagic lesions than other sequences clearly(P<0.01), FLAIR sequence detected more non-hemorrhagic lesions than other sequences(P<0.05), the number, volume of different nature lesions detected by FLAIR and ESWAN sequence were negatively correlated with GCS score(P<0.05);(2) The lesions of 21 DAI cases were scattered in axonal dense area(near the midline of brain, such as the subcortical white matter, corpus callosum, brain stem, et al), Lesions showed punctate, speckled, patchy, and cable like or bead like. DAI grade and GCS score showed negative correlation(r =-0.509, P<0.05). There were statistical differences(P<0.05) in bleeding foci number and volume of frontal white matter, parietotemporaloccipital white matter, corpus callosum, thalamus and brainstem between two groups DAI patients.Conclusions:(1) The joint inspection of 3.0T MRI multi-sequences can objectively find comprehensive pathophysiological changes after s TBI; wherein, ESWAN and FLAIR sequence can improve the detection of lesions with different properties and assess the clinical severity of patients;(2) ESWAN sequence is helpful for the detection and classification of hemorrhagic shear lesions and can provide reliable imaging information for clinical diagnosis and assessment of disturbance of consciousness in DAI patients;(3) The joint use of multiple sequences after TBI can be helpful to the early diagnosis, severity evaluation and judgment of prognosis in patients with TBI.