The role of magnetic resonance imaging in the diagnosis of diffuse axonal injury

PURPOSE: To evaluate the diagnostic efficacy of a combination of MRI sequences - SWI (susceptibility-weighted imaging), which is highly sensitive to the haemorrhagic component, and diffusion tensor imaging DTI with assessment of fractional anisotropy (FA) and mean diffusivity (MD) - in the verification of diffuse axonal injury (DAI) following traumatic brain injury (TBI). To establish a correlation between the degree of injury determined by this MRI protocol, the morphological classification of DAI according to J.H. Adams 1989, and the phenomenon of clinico-tomographic dissociation. Based on the obtained data, to develop a standardized MRI protocol for the diagnosis of DAI. The combined use of SWI and DTI MRI sequences, taking into account optimal time windows, confirms the ability of MRI to reflect the morphological substrate of injury and increases the percentage of DAI verification, thereby resolving the phenomenon of clinico-tomographic dissociation. Based on the identified correlations, a standardised MRI protocol for the diagnosis of DAI was formulated, adapted to the terminology and requirements.