Which imaging feature is associated with diffuse axonal injury?

• A. Widespread white matter microhemorrhages at gray–white junction
• B. Isolated temporal lobe contusion
• C. Isolated skull fracture
• D. Absence of intracranial findings

Answer: (A)

Diffuse axonal injury is best identified on MRI by tiny hemorrhagic lesions in the white matter that occur at the gray–white matter interfaces, often involving the corpus callosum and brainstem. These microhemorrhages arise from shear forces that damage axons and small vessels during rapid acceleration–deceleration trauma, making this pattern highly characteristic. That’s why the described feature—widespread white matter microhemorrhages at the gray–white junction—fits DAI so well.

Other scenarios don’t capture this diffuse injury pattern: an isolated temporal lobe contusion is a focal lesion rather than a widespread white matter process; an isolated skull fracture is a bone injury, not an imaging hallmark of axonal injury; and absence of intracranial findings on imaging would miss the microhemorrhages that MRI can reveal in DAI.