Rūta Pačinskaitė1, Rymantė Gleiznienė2
1Academy of Medicine, Faculty of Medicine, Lithuanian University of Health Sciences, Kaunas, Lithuania.
2Department of Radiology of Lithuanian University of Health Sciences, Kaunas, Lithuania.
DAI is a frequent and detrimental type of traumatic brain injury that may lead to death and disability. DAI is classified into 3 grades based on the anatomic distribution of the injury: grade I involves grey-white matter interfaces, grade II involves fibers of the corpus callosum in addition to grade I locations, grade III involves brainstem in addition to grade I and II locations. Due to the microscopic and delicate nature of axonal damage, DAI may pose difficulties in diagnosis and coexisting brain injuries only complicate the diagnostic process. Thus, this article aims to evaluate the role of radiologic imaging in the diagnosis of DAI and its characteristic findings. Many researchers agree that CT scan is not a sensitive technique for the detection of DAI, however, in the acute setting CT may identify life-threatening injuries that may require surgical intervention. MRI is a rational second-line imaging tool following urgent CT, especially when urgent CT fails to reveal the possible cause of the patient’s symptoms and clinical signs. Yet, conventional MRI sensitivity in detecting DAI is questionable. Advanced MRI sequences could contribute to more accurate diagnosis by depicting microscopic hemorrhagic lesions (SWI), changes in diffusion properties of water (DTI, DWI) or changes in fiber tract connectivity (DTT), alterations in the functional architecture of the brain (fMRI). Location and volume of DAI lesions are important in predicting functional outcomes. In this article, we present a case of a 9-year-old boy who suffered a brain injury due to a traffic accident.
Keywords: diffuse axonal injury, traumatic brain injury, neuroimaging, computed tomography, magnetic resonance imaging, advanced magnetic resonance imaging.