Diffuse Axonal Injury In Road Traffic Accidents: Factor, The Value Of DWI In Diagnosis And Coma Duration Prognostication Study

Purpose To identify factors related diffuse axonal injury in road traffic accident and evaluate the value of diffusion-weighted imaging (DWI) in diagnosis of acute and subacute diffuse axonal injury Establish normal Apparent Diffusion Coefficient (ADC) values range of human brain so as to establish a model to prognosticate the duration of coma. It is useful for guiding therapeutic strategies to prevent the complication and further damage of axonal injury for clinical.Methods The patients were victims of road traffic accidents and were randomly chosen from August 2002 to March 2004 who presenting to some medical radiology center with recent trauma .The data were retrospectively evaluated based on diagnostic criteria for clinical and imaging. The study group consisted of 100 diffuse axonal injury patients (group A) and 100 non diffuse axonal injury patients (group B). All scans were obtained at 1.5T(GE) MRI scanner. Apparent Diffusion Coefficient Maps were obtained and the mean ADC values of each ROI (Region of Interest) was measured using MRI console software. Convention MR imaging consisted of spin-echo Tl-weighted imaging and T2-weighted imaging. Diffusion-weighted imaging was performed using spin-echo echo-plannar sequence. All the data analysis used by SPSS 10.0 software. The analysis methods were used logistic regression (backward stepwise) for the factors related to DAI and logistic regression model for the coma duration prognostication model established, percentile of multiple indicatrixes was used for the normal ADC values range of human brain. The relationships with group A and group B were analyzed by chi-square test and compare means for each group used independent-samples t test.Results Logistic regression analysis showed the factors related to DAI include sex, contact force of head, multiple injury involving body or face, complication, brainstem, Glagow coma sorces(GCS), pupils change or not, extradural hemorrhage,intracranial hemorrhage , road environment and crash type. Among them, sex, contact force of head, multiple injury involving body or face, brainstem, crash type are the risk factors, complication, Glagow coma sorces, pupils change or not, extradural hemorrhage, intracranial hemorrhage , road environment are the protective factors. Isotropic diffusion-weighted images showed lesions with increased signal intensity and corresponding decreased ADC in patients with DAI in the acute setting and may persist into the subacute period. Compared with the images, conventional MR is more sensitive than computed tomography, DWI is more sensitive than conventional MR in the detection of the acute and subacute diffuse axonal head injuries. Differences were considered significant at f<0.01. Percentile of multiple indicatrixes of 90% normal ADC values range of human brain and a model to prognosticate the duration of coma have been successfully established.Conclusions As the risk factors of DAI, man must build up individual safe ideology to prevent the injury. Always service the roads is also very important. Special contact force of head, multiple injury involving body or face, brainstem, the crash type indicate DAI might have been happened. DWI is of great value in diagnosis of acute and subacute diffuse axonal injuries The coma duration prognostication model could prognosticate the duration of coma for clinical. It is useful for guiding therapeutic strategies to prevent the complication and further damage of axonal injury.