MRI is more sensitive than CT for subtle findings adjacent to the calvarium or skull base (eg, small cortical contusions and subdural hematomas) [29]. MRI is also more sensitive for small white matter Head Trauma lesions in traumatic axonal injury or DAI. MRI with diffusion-weighted imaging can detect acute ischemic stroke (specifically infarct core) with higher sensitivity than head CT. There is some controversy about the necessity of MRI in the acute phase. A single-center 2-year retrospective study of all patients with TBI who underwent both CT and MRI in the acute phase found MRI to be more sensitive for small intracranial lesions, especially shearing injuries (DAI), which could be of prognostic value in patients with unexplained poor GCS scores. However, none of these additional findings affected management plans in the acute phase [36]. A single-center 3-year prospective study of all patients with TBI who underwent both CT and MRI in the acute phase also found MRI to be more sensitive for subtle contusions, shearing injuries, and extra-axial hematomas (33% of cases). Once again, the additional information did not affect management in the acute phase [37]. MRI Head with DTI There is no relevant literature to support the use of DTI in the short-term follow-up imaging evaluation of acute head trauma. Radiography Skull There is no relevant literature to support the use of radiographs in the short-term follow-up imaging evaluation of acute head trauma. Variant 7: Subacute or chronic head trauma with unexplained cognitive or neurologic deficit(s). Initial imaging. As noted in the introduction/background section, head trauma is a significant public health concern and is also a leading cause of morbidity and mortality in children and young adults, especially in the setting of moderate, severe, or penetrating head trauma.
Head Trauma PCAs. MRI is more sensitive than CT for subtle findings adjacent to the calvarium or skull base (eg, small cortical contusions and subdural hematomas) [29]. MRI is also more sensitive for small white matter Head Trauma lesions in traumatic axonal injury or DAI. MRI with diffusion-weighted imaging can detect acute ischemic stroke (specifically infarct core) with higher sensitivity than head CT. There is some controversy about the necessity of MRI in the acute phase. A single-center 2-year retrospective study of all patients with TBI who underwent both CT and MRI in the acute phase found MRI to be more sensitive for small intracranial lesions, especially shearing injuries (DAI), which could be of prognostic value in patients with unexplained poor GCS scores. However, none of these additional findings affected management plans in the acute phase [36]. A single-center 3-year prospective study of all patients with TBI who underwent both CT and MRI in the acute phase also found MRI to be more sensitive for subtle contusions, shearing injuries, and extra-axial hematomas (33% of cases). Once again, the additional information did not affect management in the acute phase [37]. MRI Head with DTI There is no relevant literature to support the use of DTI in the short-term follow-up imaging evaluation of acute head trauma. Radiography Skull There is no relevant literature to support the use of radiographs in the short-term follow-up imaging evaluation of acute head trauma. Variant 7: Subacute or chronic head trauma with unexplained cognitive or neurologic deficit(s). Initial imaging. As noted in the introduction/background section, head trauma is a significant public health concern and is also a leading cause of morbidity and mortality in children and young adults, especially in the setting of moderate, severe, or penetrating head trauma.