• Stephen Ashwal, Talin Babikian, Joy Gardner-Nichols, Mary-Catherine Freier, Karen A Tong, and Barbara A Holshouser.
• Department of Pediatrics, Division of Child Neurology, Section of Neuroradiology, Loma Linda University School of Medicine, Loma Linda, CA 92350, USA. sashwal@ahs.llumc.edu
• Arch Phys Med Rehabil. 2006 Dec 1; 87 (12 Suppl 2): S50-8.

ObjectiveTo assess the role of magnetic resonance imaging, specifically magnetic resonance spectroscopy (MRS) and susceptibility-weighted imaging (SWI), in the evaluation of children with traumatic brain injury (TBI).Data SourcesLiterature review and data from our recently published clinical studies.Study SelectionChildren with pediatric TBI who underwent SWI. SWI is a 3-dimensional high-resolution magnetic resonance imaging technique that is more sensitive in detecting hemorrhagic lesions seen with diffuse axonal injury (DAI) than conventional imaging. MRS acquires metabolite information that reflects neuronal integrity and function from multiple brain regions and offers early prognostic information regarding outcome.Data ExtractionLiterature review.Data SynthesisLiterature review and review of recently published data from our institution.ConclusionsThe data suggest that more sensitive imaging techniques that provide early evidence of injury and that are better predictors of outcome are needed to identify children at risk for such deficits. Specifically, the number and volume of hemorrhagic DAI lesions as well as changes in spectral metabolites such as reduced N-acetylaspartate or elevations in choline-related compounds correlate with neurologic disability and impairments of global intelligence, memory, and attention.

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