Diagnostic Problems in Diffuse Axonal Injury

被引:19
|
作者
Jang, Sung Ho [1 ]
机构
[1] Yeungnam Univ, Coll Med, Dept Phys Med & Rehabil, 317-1 Daemyungdong, Taegu 705717, South Korea
基金
新加坡国家研究基金会;
关键词
diffuse axonal injury; traumatic brain injury; diagnosis; concussion; diffusion tensor imaging; TRAUMATIC BRAIN-INJURY; HEAD-INJURY; TENSOR TRACTOGRAPHY; WHITE-MATTER; CLASSIFICATION; LESIONS; HUMANS;
D O I
10.3390/diagnostics10020117
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
In this study, three problems associated with diagnosing diffuse axonal injury (DAI) in patients with traumatic brain injury are reviewed: the shortage of scientific evidence supporting the 6-hour loss of consciousness (LOC) diagnostic criterion to discriminate concussion and DAI, the low sensitivity of conventional brain MRI in the detection of DAI lesions, and the inappropriateness of the term diffuse in DAI. Pathological study by brain biopsy is required to confirm DAI; however, performing a brain biopsy for the diagnosis of DAI in a living patient is impossible. Therefore, the diagnosis of DAI in a living patient is clinically determined based on the duration of LOC, clinical manifestations, and the results of conventional brain MRI. There is a shortage of scientific evidence supporting the use of the 6-hour LOC criterion to distinguish DAI from concussion, and axonal injuries have been detected in many concussion cases with a less than 6-hour LOC. Moreover, due to the low sensitivity of conventional brain MRI, which can only detect DAI lesions in approximately half of DAI patients, diagnostic MRI criteria for DAI are not well established. In contrast, diffusion tensor imaging (DTI) has been shown to have high sensitivity for the detection of DAI lesions. As DTI is a relatively new method, further studies aimed at the establishment of diagnostic criteria for DAI detection using DTI are needed. On the other hand, because DAI distribution is not diffuse but multifocal, and because axonal injury lesions have been detected in concussion patients, steps to standardize the use of terms related to axonal injury in both concussion and DAI are necessary.
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页数:8
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