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Updated: May 12, 2026
Diffusion Tensor Magnetic Resonance Imaging in the Analysis of Neurodegenerative Diseases
Published on: July 28, 2013
Whiteout sign on dSIR MRI: A case series highlighting symptom-associated white matter changes not observed on
Joshua P McGeown1,2, Gil Newburn1, Paul Condron1,2
1Mātai Medical Research Institute, Gisborne, New Zealand.
Introduction:
Mild traumatic brain injury (mTBI) is common, and up to half of patients experience persistent symptoms, but conventional neuroimaging typically appears normal. Divided Subtracted Inversion Recovery (dSIR) is a new sequence with high sensitivity to white matter changes that may appear normal on standard imaging.
Case Presentation:
We present a case series of three adolescent males with acute mTBI scanned with both T2-FLAIR and dSIR. In all cases, T2-FLAIR images were normal. In two symptomatic cases, dSIR demonstrated a 'whiteout sign,' with bilateral, symmetrical high signal in cerebral and cerebellar white matter. In one case, the whiteout sign was present at 21 hours post-injury and had largely resolved by 64 hours. The third patient showed no abnormality on dSIR, consistent with their asymptomatic clinical presentation. Across all three cases, dSIR findings corresponded to clinical symptom status at the time of scanning.
Conclusion:
These early observations suggest dSIR may provide a useful imaging marker of secondary brain responses to injury. Further studies are needed to determine the sensitivity, specificity, and clinical value of dSIR in the assessment of mTBI.
Insights
Divided Subtracted Inversion Recovery (dSIR) shows promise for detecting white matter changes after mild traumatic brain injury (mTBI). This new imaging technique identified abnormalities in symptomatic patients where standard scans were normal.
Area of Science:
- Neuroimaging
- Radiology
- Neurology
Background:
- Mild traumatic brain injury (mTBI) is a common injury.
- Persistent symptoms affect up to half of mTBI patients.
- Conventional neuroimaging often appears normal in mTBI cases.
Purpose of the Study:
- To evaluate the utility of Divided Subtracted Inversion Recovery (dSIR) in adolescent mTBI.
- To assess dSIR's sensitivity to white matter changes not visible on standard MRI.
Main Methods:
- Case series of three adolescent males with acute mTBI.
- Comparison of T2-FLAIR and dSIR imaging sequences.
- Correlation of imaging findings with clinical symptom status.
Main Results:
- T2-FLAIR images were normal in all cases.
- dSIR revealed a 'whiteout sign' (bilateral, symmetrical white matter hyperintensity) in two symptomatic patients.
- dSIR findings correlated with clinical presentation and symptom resolution.
Conclusions:
- dSIR may serve as a sensitive imaging biomarker for secondary brain responses post-mTBI.
- Further research is needed to establish dSIR's sensitivity, specificity, and clinical utility in mTBI assessment.
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