Traumatic Brain Injury Case Study
Neuroimaging in traumatic brain injury
1.COMPUTED TOMOGRAPHY (CT) : While severe and moderate traumatic head and brain injuries often mandate head CT, several clinical scales require specific criteria in determining the need for neuroimaging after a mild TBI. These include the New Orleans Criteria (NOC) and the Canadian CT Head Rule (CCHR).(45) Both are relatively straight forward and use seven criteria readily obtained in the setting and evaluation of mild TBI. A head-to-head comparison of the two found that they had equivalent sensitivity in determining the need for neurosurgical intervention, but the Canadian CT Head Rules had a far superior specificity (76.3% versus 12.1%).(47) Because the incidence of TBI is highest in age groups 0 to 4 and 15 to 24, there are often many more years of life expectance at stake.2 Therefore, the threshold …show more content…
Advances in MRI techniques, both structural and functional, continue to occur at a rapid pace. Although MRI scanners are readily available in most United States Hospitals, arranging acute MRI for a patient can be challenging. This is because equipment is expensive, and image acquisition and interpretation are both time-consuming. Thus, it is relatively unavailable for acute imaging. However, as previously discussed, MRI is optimal in the acute setting. Magnetic resonance imaging of TBI in the subacute time frame can greatly assist in optimal patient management. Early comparative studies showed that brain CT failed to detect 10 to 20% of brain abnormalities visualized by MRI after mild TBI.(56) However, 48 to 72 hours after injury, MRI is superior to CT in detection of swelling, bleeding, brain contusions, and axonal injury. Magnetic resonance imaging is also more sensitive and specific for brainstem, basal ganglia, and thalamic imaging than
1.COMPUTED TOMOGRAPHY (CT) : While severe and moderate traumatic head and brain injuries often mandate head CT, several clinical scales require specific criteria in determining the need for neuroimaging after a mild TBI. These include the New Orleans Criteria (NOC) and the Canadian CT Head Rule (CCHR).(45) Both are relatively straight forward and use seven criteria readily obtained in the setting and evaluation of mild TBI. A head-to-head comparison of the two found that they had equivalent sensitivity in determining the need for neurosurgical intervention, but the Canadian CT Head Rules had a far superior specificity (76.3% versus 12.1%).(47) Because the incidence of TBI is highest in age groups 0 to 4 and 15 to 24, there are often many more years of life expectance at stake.2 Therefore, the threshold …show more content…
Advances in MRI techniques, both structural and functional, continue to occur at a rapid pace. Although MRI scanners are readily available in most United States Hospitals, arranging acute MRI for a patient can be challenging. This is because equipment is expensive, and image acquisition and interpretation are both time-consuming. Thus, it is relatively unavailable for acute imaging. However, as previously discussed, MRI is optimal in the acute setting. Magnetic resonance imaging of TBI in the subacute time frame can greatly assist in optimal patient management. Early comparative studies showed that brain CT failed to detect 10 to 20% of brain abnormalities visualized by MRI after mild TBI.(56) However, 48 to 72 hours after injury, MRI is superior to CT in detection of swelling, bleeding, brain contusions, and axonal injury. Magnetic resonance imaging is also more sensitive and specific for brainstem, basal ganglia, and thalamic imaging than