Magnetic resonance imaging of diffuse axonal injury: Quantitative assessment of white matter lesion volume

Carlos Marquez De La Plata, Andreea Ardelean, Della Koovakkattu, Priya Srinivasan, Anna Miller, Viet Phuong, Caryn Harper, Carol Moore, Anthony Whittemore, Christopher Madden, Ramon Diaz-Arrastia, Michael Devous

Research output: Contribution to journalArticlepeer-review

72 Scopus citations


Diffuse axonal injury (DAI) is a common mechanism of traumatic brain injury (TBI) for which there is no well-accepted anatomic measures of injury severity. The present study aims to quantitatively assess DAI by measuring white matter lesion volume visible in fluid-attenuated inversion recovery (FLAIR) weighted images and to determine whether higher lesion volumes are associated with unfavorable functional outcome 6 months after injury. Twenty-four patients who experienced moderate to severe TBI without extra-axial or major cortical contusions were included in this study. Lesion volume was assessed by quantifying areas of hyperintensities in the white matter utilizing digitized FLAIR images. Two independent raters processed the magnetic resonance (MR) images and determined the total DAI volume. Functional outcome was assessed at 6 months after injury using the Glasgow Outcome Scale-Extended (GOSE). Interclass correlation analyses showed very high interrater reliability for each measure between the two raters (Interclass Correlation Coefficient = 0.95, p ≤ 0.001). Total DAI volume was significantly, although modestly, correlated to GOSE (r = -0.453, p = 0.034). White matter lesion volume resulting from DAI can be quantitatively and reliably assessed from standard FLAIR-weighted MRIs. Patients with greater DAI volume have poorer functional outcomes. These methods may be useful in stratifying injury severity and for the assessment of DAI-directed therapies.

Original languageEnglish (US)
Pages (from-to)591-598
Number of pages8
JournalJournal of neurotrauma
Issue number4
StatePublished - Apr 2007


  • Diffuse axonal injury (DAI)
  • Functional outcome
  • TBI

ASJC Scopus subject areas

  • Clinical Neurology


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