OBJECTIVES: The aim of this study was to evaluate multisequence 3.0T magnetic resonance imaging (MRI) in the detection of severe TBI and in predicting the outcome.
METHODS: Thirty-five patients with severe TBI were prospectively enrolled and multisequence 3.0T MRI was performed 4-8 weeks post injury. Quantitative data were recorded on each sequence. The ability to display the parenchymal lesions was compared with that of 64-slice spiral computed tomography (CT). The clinical and radiological results were correlated with the Glasgow Outcome Scale Extended (GOSE) scores 6 months after injury.
RESULTS: 3.0T MRI could display more lesions than CT, especially when the lesion was deeply located. The lesion volumes and diffuse axonal injury (DAI) scores were different between good and poor outcome groups on FLAIR (P < 0.05). The apparent diffusion coefficient (ADC) values of the splenium of the corpus callosum and brain stem were also different (P < 0.05). Patients with unfavorable outcome showed a significantly higher volume of hemorrhage on susceptibility weighted imaging (SWI) than favorable ones and were generally located more deeply. Logistic regression analysis revealed that the location of hemorrhage and the ADC values of the splenium of the corpus callosum were independent risk factors for poor outcome, with an overall predictive accuracy of 91.4%.
CONCLUSION: The joint use of conventional and advanced sequences of 3.0T MRI can comprehensively detect the pathological changes occurring after severe TBI. Hemorrhagic and non-hemorrhagic DAIs in deep structures strongly suggest poor outcome. Advances in knowledge: This article improves the understanding of advanced MRI sequences in detection of sTBI patients and prediction of prognosis.