Relationship between maximum intracranial pressure and traumatic lesions detected by T2*-weighted imaging in diffuse axonal injury.

BACKGROUND We prospectively investigated whether the number of traumatic lesions detected by magnetic resonance imaging correlated with the level of intracranial pressure (ICP) and outcome among patients with diffuse axonal injury (DAI). MATERIALS We prospectively studied 19 patients with closed head injuries who were admitted to the Critical Care and Trauma Services at our medical center and who fulfilled the following criteria: did not recover to a Glasgow Coma Scale score greater than 8 after impact, without fixed dilated pupils, and with initial computed tomography findings compatible with DAI. All subjects (n = 19) underwent ICP monitoring for at least 4 days, and T2*-gradient echo imaging was performed within 4 weeks of the impact. RESULTS A significantly positive correlation was found between the number of lesions detected by magnetic resonance imaging and maximum ICP. The average Glasgow Coma Scale in the good outcome group (Glasgow Outcome Scale IV and V, n = 8) was significantly greater than that in the poor outcome group (Glasgow Outcome Scale I-III, n = 11). The average maximum ICP and the number of lesions in the good outcome group were significantly less than those in the poor outcome group. CONCLUSION The number of lesions detected by T2*-gradient echo imaging correlates with the degree of intracranial hypertension and outcome in DAI.