Subacute MR Imaging: Diffuse Axonal Injury, Brain Stem Lesions and Prognostic Factors

  • Toril Skandsen
  • Anne Vik


CT is insufficient in the diagnosis of diffuse axonal injury (DAI) and brain stem injury (BSI). Such injuries are very common and clinically important in severe traumatic brain injury, especially in the context of high-energy trauma. Magnetic resonance imaging (MRI) is the superior image modality to gain an overview of the traumatic lesions in the brain parenchyma. The neuroanatomic and prognostic information provided by MRI is important during the subacute phase of clinical management and rehabilitation. Thus, MRI should be considered in all patients with severe TBI.


Magnetic Resonance Imaging Apparent Diffusion Coefficient Diffusion Tensor Imaging Severe Traumatic Brain Injury Susceptibility Weighted Imaging 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. Adams JH, Doyle D, Ford I et al (1989) Diffuse axonal injury in head injury: definition, diagnosis and grading. Histopathology 15:49–59PubMedCrossRefGoogle Scholar
  2. Andriessen TM, Jacobs B, Vos PE (2010) Clinical characteristics and pathophysiological mechanisms of focal and diffuse traumatic brain injury. J Cell Mol Med 14:2381–2392PubMedCrossRefGoogle Scholar
  3. Blumbergs P, Reilly P, Vink R (2008) Trauma. In: love S, Louis DN, Elison DW (eds) Greenfield’s neuropathology. Edward Arnold Ltd., Oxford NY, pp 733–832Google Scholar
  4. Chastain CA, Oyoyo U, Zipperman M et al (2009) Predicting outcomes of traumatic brain injury by imaging modality and injury distribution. J Neuro­trauma 26:1183–1196PubMedCrossRefGoogle Scholar
  5. Firsching R, Woischneck D, Klein S et al (2001) Classification of severe head injury based on magnetic resonance imaging. Acta Neurochir 143:263–271CrossRefGoogle Scholar
  6. Gentry LR, Godersky JC, Thompson B (1988) MR imaging of head trauma: review of the distribution and radiopathologic features of traumatic lesions. AJNR Am J Neuroradiol 9:101–110Google Scholar
  7. Gentry LR, Godersky JC, Thompson BH (1989) Traumatic brain stem injury: MR imaging. Radiology 171:177–187PubMedGoogle Scholar
  8. Haacke EM, Duhaime AC, Gean AD et al (2010) Common data elements in radiologic imaging of traumatic brain injury. J Magn Reson Imaging 32:516–543PubMedCrossRefGoogle Scholar
  9. Hersey BI, Faro SH, Shah PN et al (2009) Introduction to brain injury imaging. In: Jallo J, Loftus C (eds) Neurotrauma and critical care of the brain. Thieme Medical Publishers Inc., New York, pp 97–141Google Scholar
  10. Huisman TA, Sorensen AG, Hergan K et al (2003) Diffusion-weighted imaging for the evaluation of diffuse axonal injury in closed head injury. J Comput Assist Tomogr 27:5–11PubMedCrossRefGoogle Scholar
  11. Kampfl A, Franz G, Aichner F et al (1998a) The persistent vegetative state after closed head injury: clinical and magnetic resonance imaging findings in 42 patients. J Neurosurg 88:809–816PubMedCrossRefGoogle Scholar
  12. Kampfl A, Schmutzhard E, Franz G et al (1998b) Prediction of recovery from post-traumatic vegetative state with cerebral magnetic-resonance imaging. Lancet 351:1763–1767PubMedCrossRefGoogle Scholar
  13. Le Bihan D, Mangin JF, Poupon C et al (2001) Diffusion tensor imaging: concepts and applications. J Magn Reson Imaging 13:534–546PubMedCrossRefGoogle Scholar
  14. Marquez de la Plata C, Ardelean A, Koovakkattu D et al (2007) Magnetic resonance imaging of diffuse axonal injury: quantitative assessment of white matter lesion volume. J Neurotrauma 24:591–598PubMedCrossRefGoogle Scholar
  15. Marquez de la Plata CD, Yang FG, Wang JY et al (2011) Diffusion tensor imaging biomarkers for traumatic axonal injury: analysis of three analytic methods. J Int Neuropsychol Soc 17:24–35PubMedCrossRefGoogle Scholar
  16. Parizel PM, Van Goethem JW, Ozsarlak O et al (2005) New developments in the neuroradiological diagnosis of craniocerebral trauma. Eur Radiol 15:569–581PubMedCrossRefGoogle Scholar
  17. Pierallini A, Pantano P, Fantozzi LM et al (2000) Correlation between MRI findings and long-term outcome in patients with severe brain trauma. Neuroradiology 42:860–867PubMedCrossRefGoogle Scholar
  18. Povlishock JT, Katz DI (2005) Update of neuropathology and neurological recovery after traumatic brain injury. J Head Trauma Rehabil 20:76–94PubMedCrossRefGoogle Scholar
  19. Rutgers DR, Toulgoat F, Cazejust J et al (2007) White matter abnormalities in mild traumatic brain injury: a diffusion tensor imaging study. AJNR Am J Neuroradiol 29(3):514–519PubMedCrossRefGoogle Scholar
  20. Schaefer PW (2001) Applications of DWI in clinical neurology. J Neurol Sci 186(Suppl 1):S25–S35PubMedCrossRefGoogle Scholar
  21. Scheid R, Ott DV, Roth H et al (2007) Comparative magnetic resonance imaging at 1.5 and 3 Tesla for the evaluation of traumatic microbleeds. J Neurotrauma 24:1811–1816PubMedCrossRefGoogle Scholar
  22. Shibata Y, Matsumura A, Meguro K et al (2000) Differentiation of mechanism and prognosis of traumatic brain stem lesions detected by magnetic resonance imaging in the acute stage. Clin Neurol Neurosurg 102:124–128PubMedCrossRefGoogle Scholar
  23. Sidaros A, Engberg AW, Sidaros K et al (2008) Diffusion tensor imaging during recovery from severe traumatic brain injury and relation to clinical outcome: a longitudinal study. Brain 131:559–572PubMedCrossRefGoogle Scholar
  24. Skandsen T, Kvistad KA, Solheim O et al (2010) Prevalence and impact of diffuse axonal injury in patients with moderate and severe head injury: a cohort study of early magnetic resonance imaging findings and 1-year outcome. J Neurosurg 113:556–563PubMedCrossRefGoogle Scholar
  25. Skandsen T, Kvistad KA, Solheim O et al (2011) Prognostic value of magnetic resonance imaging in moderate and severe head injury: a prospective study of early MRI findings and one-year outcome. J Neurotrauma 28:1–9CrossRefGoogle Scholar
  26. Tong KA, Ashwal S, Holshouser BA et al (2004) Diffuse axonal injury in children: clinical correlation with hemorrhagic lesions. Ann Neurol 56:36–50PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2012

Authors and Affiliations

  1. 1.Department of Neuroscience, Faculty of MedicineNorwegian University of Science and Technology (NTNU)TrondheimNorway
  2. 2.Department of Physical Medicine and RehabilitationSt. Olavs Hospital, Trondheim University HospitalTrondheimNorway
  3. 3.Department of NeurosurgerySt. Olavs Hospital, Trondheim University HospitalTrondheimNorway
  4. 4.Department of NeuroscienceNorwegian University of Science and TechnologyTrondheimNorway

Personalised recommendations