Use Of Suseptibility Weighted Image And Diffusion Weighted Images In Traumatic Brain Injury

Objective:To evaluate the use of Diffusion Weighted Imaging and Suseptibility Weighted imaging in traumatic brain injury (TBI) causing hemorrhage and axonal injury and to correlate these with imaging features and Glasgow Coma Scale.Materials and Methods:Total of 25 patients with TBI (18 males,7 females) aged between 6 and 67 years with mean age of 36.88 years and 30 healthy volunteers (age and sex matched) were evaluated with CT and MRI imaging modalities. All the cases were examined by an experienced Neurologist. All the TBI patients were divided according to GCS into two groups mild (n=13) as the first group and severe and moderate (n=12) as the second group. According to the time duration from the time of trauma to the time of scan the patients were divided into acute (within 1 week) and sub acute (1 week to 1 month). Post traumatic patients with 6 to 12 months of history were divided according to GCS score into two groups good prognosis (n=19) and poor prognosis(n=6).The CT scans were done by Philips Brilliance 6 row and GE 16 row MSCT scanners. MRI scans were done using GE Signa HD 1.5 T MRI scanner (USA). Scanning sequences included axial T1WI, T2WI, DTI and SWI.GE ADW4.3 Functool data processing work station was used. Minimum intensity projection images (SWIminp) were obtained for SWI images. The number of hemorrhagic areas were noted and the area of the hemorrhage was measured using SPIN (Signal Processing In NMR) software. GE Adw 4.3 Functool software was used to access the relevant brain regions for Fractional Anisotrophy values (FA) and Average Diffusion Coefficient (ADC). DTI images were divided into 20 regions based on the anatomical regions. CT and SWI images were analyzed for size and number of hemorrhagic lesions in correlation GCS and GOS (Glasgow Outcome Scale) for control group, mild, moderate and severe brain injury patients. Number of hemorrhages, area of hemorrhage, FA values, ADC values were compared and analyzed in accordance with GCS and GOS.Results1.â‘ SWIminp images were able to find smaller area of hemorrhage than CT (P=0.021) and were able to find more number of hemorrhagic area than CT (P<0.001). In patients with less severe degree of hemorrhage SWI showed smaller areas of hemorrhage (P=0.001) and more number of hemorrhagic area (P<0.001)â‘¡SWI and CT both showed area of hemorrhage in patients with good and poor prognosis (P=0.003 and P= 0.002). For the number of hemorr-hagic areas in poor and good prognosis patients CT showed significant difference (P=0.003) but SWI did not show any significant difference (P=0.110). SWI and CT images for number of hemorrhages and area of hemorrhages were correlated with GOS score (P<0.001)2.â‘ In DTI study, the FA values decreased in different areas of the brain but the decrease was more in control group than in mild trauma patients'group and it was in turn more than the re-injury group. The ADC values changed varyingly.â‘¡In TBI patients in 65% of brain area (13/20), the FA values of brain regions was significantly associated with GOS score (P<0.05). In 90% of the brain areas (18/20) ADC values were not associated with GOS score.3.In bilateral frontal and temporal lobes, the hemorrhage size and number were negatively correlated with SWI findings and FA values and were positively correlated with SWI findings and ADC values.ConclusionTraumatic brain injury (TBI) after cerebral hemorrhage associated with brain edema and nerve fiber and axonal damage leading to clinical symptoms and the severity of pathological changes affecting the prognosis important, this study 53 patients with traumatic brain injury patients,25 patients with a complete CT, SWI, DTI image data and clinical data are comprehensive control study, the preliminary draw the following conclusions:1.SWI compared with CT examination and conventional MR sequences in the sensitivity of the detection of TBI patients with hemorrhage, and the measurement of the size and number of hemorrhage,SWI has significant advantages. While SWI compared with CT examination and conventional MR sequences in the sensitivity of the detection of TBI patients with hemorrhage, and the measurement of the size and number of hemorrhage, SWI has significant advantages. While SWI has good correlation With the evaluation of the degree of damage in TBI patients,and the GCS score of clinical.2.DTI is sensitive detection of TBI patients with pathological changes of white matter and microscopic changes, which FA values reflect the degree of brain damage TBI and the prognosis of patients with significant correlation; ADC values reflect the different stages of TBI pathology part of the evolution of the region; both with The clinical prognosis of TBI GOS score of relevance.3.SWI detected the size and numberof cerebral hemorrhage with the TBI patients in some brain areas and DTI measuremented of FA values were negatively correlated; ADC values were Positively correlated.4.Combined both reflect cerebral hemorrhage, but also reflect the brain edema and cerebral axonal injury in functional MRI, in the SWI and DTI techniques to help patients with traumatic brain injury and accurate diagnosis and objective evaluation of disease prognosis, is a promising imaging strategy for traumatic brain injury.