Research Reports - The reliability of magnetic resonance imaging in traumatic brain injury lesion detection

Brain Inj. 2012 Jun 25

Geurts BH, Andriessen TM, Goraj BM, Vos PE

Objective: This study compares inter-rater-reliability, lesion detection and
clinical relevance of T2-weighted imaging (T2WI), Fluid Attenuated Inversion
Recovery (FLAIR), T2*-gradient recalled echo (T2*-GRE) and Susceptibility
Weighted Imaging (SWI) in Traumatic Brain Injury (TBI). Methods: Three raters
retrospectively scored 56 TBI patients' MR images (12-76 years old, median
TBI-MRI interval 7 weeks) on number, volume, location and intensity. Punctate
lesions (diameter <10 mm) were scored separately from large lesions (diameter
≥10 mm). Injury severity was assessed with the Glasgow Coma Scale (GCS), outcome
with the Glasgow Outcome Scale-Extended (GOSE). Results: Inter-rater-reliability
for lesion volume and punctate lesion count was good (ICC = 0.69-0.94) except for
punctate lesion count on T2WI (ICC = 0.19) and FLAIR (ICC = 0.15). SWI showed the
highest number of lesions (mean = 30.0), followed by T2*-GRE (mean = 15.4), FLAIR
(mean = 3.1) and T2WI (mean = 2.2). Sequences did not differ in detected lesion
volume. Punctate lesion count on T2*-GRE (r = -0.53) and SWI (r = -0.49)
correlated with the GCS (p < 0.001). Conclusions: T2*-GRE and SWI are more
sensitive than T2WI and FLAIR in detecting (haemorrhagic) traumatic punctate
lesions. The correlation between number of punctate lesions on T2*-GRE/SWI and
the GCS indicates that haemorrhagic lesions are clinically relevant. The
considerable inter-rater-disagreement in this study advocates cautiousness in
interpretation of punctate lesions using T2WI and FLAIR.

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