1. Which patients with head injury should undergo imaging in the acute setting? 2. What is the sensitivity and specificity of imaging for all brain.

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Presentation transcript:

1. Which patients with head injury should undergo imaging in the acute setting? 2. What is the sensitivity and specificity of imaging for all brain injury?

Image Modality in Traumatic Brain Injury 1. Skull plain film 2. Brain CT 3. Brain MRI

Skull Plain Film 1. Inadequate to survey soft tissue lesion. 2. Proven outranged by CT in detecting bony lesion of skull fracture. 3. Now considered totally supplanted by brain CT if CT is available. Eur Radiol (2005) 15: 569–581

Brain CT 1. Intracranial hematoma. 2. Bony fracture. 3. Foreign body. 4. Mass effect. 5. Ischemic change.

Indication For Brain CT - Initial 1. GCS less than 12. 2. Patients with GCS greater than 13 but with dangerous sign. GCS 15: 5% showed CT abnormality. GCS 13: Up to 30% showed CT abnormality. J Rehabil Med 2004; Suppl. 43: 61–75

Other Risk Groups 1. Intoxicated 2. Coagulopathy 3. Patients difficult to approach

Indication For Brain CT - Delayed 1. New neurological sign developed clinically. 2. High risk groups of progression in brain injury. Coagulopathy Severe injury Heterogeneous appearance of an intracranial hemorrhage J Trauma. 2006;61:226 –233.

Comparing Different Image modalities 1. Hard to set standard reference for sensitivity and specificity. 2. Comparison of CT and MR was often discussed following rapid development of MR techniques.

Superiority of Brain MRI over Brain CT in Traumatic Brain Injury 1. Detect rate of SAH on MRI is equal to or greater than CT. 2. No beam hardening. Advantage in detecting small extra-axial hematoma. 3. High sensitivity over secondary Infarction. Eur Radiol (2005) 15: 569–581 Top Magn Reson Imaging (1998) 9:208-227

Superiority of Brain MRI over Brain CT in Traumatic Brain Injury 4. New modality: FLAIR and gradient echo improve MRI detection rate over hemorrhage. DWI, FLAIR and gradient echo improve MRI detection rate over diffuse axonal injury.

Diffuse Axonal Injury (DAI) 1. DAI constituted approximately 48%of all primary lesions of traumatic brain injury . 1, DWI-hyperintense and ADC-hyperintense, most likely representing lesions with vasogenic edema 2, DWI-hyperintense and ADChypointense, indicating cytotoxic edema 3, central hemorrhagic lesion surrounded by an area of increased diffusion. 2. Severe conscious change with poor outcome. 3. Difficult to identify from CT. Eur. Radiol. 8, 960±965 (1998)

Indication of Brain MRI 1. Severe clinical neurological sign unexplained by brain CT. Intoxication, alcohol. Diffuse axonal injury. Secondary infarction.