[Abstract] 90. Improved Detection of Hemorrhagic Shearing Lesions in Children with Posttraumatic Diffuse Axonal Injury: Correlation with Severity and Outcome

The purpose of this study was to compare the ability of a high-resolution susceptibility-weighted imaging (SWI) sequence to detect hemorrhage in children with diffuse axonal injury (DAI) compared with a conventional gradient-recalled echo (GRE) technique. We also evaluated the utility of thissequence to predict outcome after traumatic brain injury(TBI). We imaged brains of seven patients (aged 144 years; admission Glasgow Coma Scale score of 74) an average of 53 days after injury. Extent of hemorrhage detected by SWI and GRE was correlated with initial GCS as well as discharge outcomes classified using the Glasgow Outcome Score. Hemorrhagic lesions were much more visi-ble on SWI than conventional GRE. SWI detected 1,038 hemorrhagic DAI lesions with an apparent total hemorrhage volume of 57,946mm3, compared with conventional GRE,which detected 162 lesions with an apparent total volume of 28,893mm3. Most (59%) hemorrhagic DAI lesions detected by SWI were small (10mm3) whereas most (43%) lesions detected by GRE were larger (10–20mm3). Patients with lower GCS scores had a greater number and total apparent volume of hemorrhagic lesions. Those who were moderately disabled at discharge (n4) had a greater number and larger total apparent volume of lesions than those with mild disability (n3) at discharge. SWI demonstrates significantly more hemorrhages than conventional gradient echo imaging and therefore potentially can improve diagnosis of diffuse axonal injury as well as prediction of long-term out-come after traumatic brain injury.