A Comparison of Lesion Detection and Conspicuity on T2-weighted Images (T2 FFE), FLAIR and Diffusion-weighted Images in Patients with Traumatic Brain Injury

ABSTRACT

PURPOSE: To compare the lesion detectability and conspicuity in traumatic brain injury on T-2 FFE , FLAIR and diffusion weighted imaging (DWI) sequences. MATERIALS AND METHODS: Thirty-three patients who underwent MR brain imaging after traumatic brain injury were reviewed. T-2 FFE, FLAIR and diffusion-weighted MR sequences were obtained and were compared in terms of the detectability and conspicuity of intra- and extra- axial lesions which showed abnormal signal intensities. RESULTS: Among 33 patients, a total of 108 lesions were found. T-2 FFE sequences detected 88(81%) of these, FLAIR sequences 91(84%), and diffusion-weighted sequences 57(52%). In the case of petechial hemorrhagic lesions, 16 were detected by T-2 FFE imaging but only one by FLAIR and one by DWI. Sixteen extra-axial lesions (73%) were detected by T-2 FFE, 21 (95%) by FLAIR, and 11(50%) by DWI. Lesion conspicuity on FLAIR images was judged superior to that on T-2 FFE and diffusion-weighted images in 42 lesions (75%). Eleven extra- axial Lesions (92%) were more conspicuous on FLAIR than on T-2 FFE and DWI. CONCLUSION: For detecting traumatic brain lesions and determining their conspicuity, FLAIR imaging was more useful than T-2 FFE and diffusion weighting, while T-2 FFE imaging was more sensitive for the detection of petechial hemorrhage. Although diffusion-weighted imaging was generally inferior to both FLAIR and T-2 FFE in terms of lesion detection and conspicuity, for some lesions it was superior. The results suggest that images obtained at each pulse sequence can be used as complementary imaging sequences, and that in traumatic brain injury, the acquisition of FLAIR, T-2 FFE and diffusion-weighted images is useful.