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BACKGROUND: At present, the most common examination modality for diffuse axonal injury (DAI) is CT or MRI. However, both methods exhibit low sensitivity in the diagnosis of DAI lesions.OBJECTIVE: To investigate the value of fluid attenuated inversion recovery (FLAIR) in the clinical diagnosis of DAI, and to compare with T2-weighted images.DESIGN, TIME AND SETTING: This prospective study was based on imaging analysis, and wasperformed in the First Affiliated Hospital of Chongqing Medical University (Chongqing, China) between October 2002 and April 2004.PARTICIPANTS: Sixty-three patients with craniocerebral injury were admitted to the Department of Neurosurgery at the First Affiliated Hospital of Chongqing Medical University, including 50 males and 13females. The patients were included in the experiment and were divided into DAI (n=24) and non-DAl (n=39)groups, according to the emergent CT findings and clinical manifestations.METHODS: Both groups underwent MR examinations, including axial and sagittal T1 weighted images (TR=450 ms, TE = 8-9 ms), T2-weighted images (TR = 3600 ms, TE = 100 ms), and FLAIR (TR = 10 000 ms,TI = 2500 ms, TE = 40 ms), 8-mm thick and 2-mm wide, using a GE Sigma MRI device.MAIN OUTCOME MEASURES: The DAI diagnostic rate and lesion-detecting rate of T2-weighted images and FLAIR were determined.RESULTS: All 63 patients were included in the final analysis. The DAI diagnosis rates of FLAIR and T2-weighted images were 88% (21/24) and 62% (15/24), respectively, of which the difference was statistically significant (P < 0.05). T2-weighted images and FLAIR detected lesions located in the gray matter-white matter junction in parasagittal areas, the corpus callosum, deep periventricular white matter,basal ganglia, intal capsule, hippocampus, cerebellum, and brain stem, with a detailed amount of 123 and 256, respectively. FLAIR was significantly greater than T2-weighted images (P < 0.01 ).CONCLUSION: FLAIR is superior to T2-weighted images for improving the DAI diagnostic rate and lesion-detecting rate, as well as revealing the extent and severity of DAI.