Traumatic Brain Injury

Andrew E. Auber1, Clifford Belden1

1 Brooke Army Medical Center, San Antonio, Texas
Publication Name:  Current Protocols in Magnetic Resonance Imaging
Unit Number:  Unit A4.4
DOI:  10.1002/0471142719.mia0404s05
Online Posting Date:  August, 2002
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Magnetic Resonance (MR) imaging of the brain following head injury is used in two distinct clinical contexts, (1) acutely, within days of the injury, to evaluate an unexplained neurologic deficit or to obtain prognostic information, and (2) chronically, to assess the degree of brain injury and explain neurologic or neuropsychologic findings. In this unit, two basic protocols are presented, one for acute imaging and the other for chronic imaging. Advanced MR imaging sequences, such as MR spectroscopy (MRS) and diffusion‐weighted (DW) imaging can provide additional prognostic information in the acute setting and are also described. MR angiography (MRA) and direct vessel wall imaging techniques are mentioned briefly.

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Table of Contents

  • Basic Protocol 1: Acute and Subacute Injury
  • Alternate Protocol 1: Optional Sequences
  • Basic Protocol 2: Chronic Injury
  • Commentary
  • Figures
  • Tables
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  •   FigureFigure a0.40.1 21 year‐old male one year following closed head injury. (AD) and (EH) demonstrate the appearance of shear injury using hemosiderin sensitive gradient echo, FSE T2‐weighted, FLAIR, and 3‐D gradient echo sequences, respectively, at two imaging levels. (AD). The large region of shear injury near the vertex of the left parietal lobe is best seen on the 2‐D gradient echo sequence (A, arrows), with several smaller foci of signal dephasing (arrowheads), likely representing smaller areas of shear injury. The parietal region is essentially normal on T2‐weighted FSE (B) and FLAIR (C) images and barely discernible on a short echo 3‐D gradient echo sequence (D, arrow). (EH). At the level of the third ventricle, shear injury to both basal ganglia (E, arrows), an old parenchymal hematoma in the right frontal lobe (E, open arrow) and the old hemorrhagic contusion in the left frontal lobe (E, arrowhead) are best seen on the 2‐D gradient echo sequences. The old right frontal lobe hematoma is easily seen on T2‐weighted FSE, FLAIR and 3‐D gradient echo sequences as signal dephasing (open arrow F, G, H). The smaller area of contusion in the left frontal lobe is present on all sequences, but appears bright on T2‐weighted FSE (F, arrowhead), and dark on both FLAIR and 3‐D gradient echo sequences (G, H arrowhead). The presence of shear injury in the basal ganglia is only confidently made on the gradient echo sequence, though there is a small focus of increased signal on T2‐weighted FSE images (F, arrow) and decreased signal on FLAIR (G, arrow) and 3‐D gradient echo (H, arrow) sequences. ( NOTE: The described protocol uses coronal gradient echo images. Transverse images are presented to optimally demonstrate the relative lesion conspicuity between basic sequences.)


Literature Cited

Literature Cited
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Key References
   Mittl et al., 1994. See above.
  MRI demonstrates abnormalities in mild head injury patients with normal CT. Axonal injury was found in 30% of patients.
   Kelly et al., 1988. See above.
  This article demonstrates the ability of MR to depict many more lesions in the traumatized patient compared with CT. Over half of contusions and subdurals were seen by MR.
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