Figure 3.

Difficulties in assessing lesions - dynamic changes post-injury and multi-modal assessment. Top: Parenchymal changes over time from the DOI (day of injury) scan to 4 years post-injury. The DOI through the scan at 2 months are all from CT and the far right image is a T1-weighted MRI, at 4 years post-injury. The slice level of these images are all at the level of the anterior horn of the lateral ventricle. Note that where the most prominent acute hemorrhages and frontal contusions occur on the DOI scan that this also becomes the center-point for tissue dissolution (encephalomalacia) over time. Shortly after the DOI scan was obtained the child received an intraventricular shunt to aid in intracranial pressure reduction and monitoring. By 2 months post-injury the focal encephalomalacia is very prominent (white arrow) and there is also prominence of the Sylvian fissure (black asterisk) along with ventricular enlargement, indicative of some generalized cerebral volume loss. R, right; L, left. Bottom: Different MRI sequences yield different facets of the brain injury and residual pathology. FLAIR, fluid attenuated inversion recovery; MRI sequence GRE, gradient recalled echo MRI sequence. Reprinted from [Bigler, 2016].