MRI is more sensitive than CT for subtle findings adjacent to the calvarium or skull base (eg, small cortical contusions and subdural hematomas) [29]. It is also more sensitive for small white matter lesions in traumatic axonal injury or DAI. Only 10% of DAI is positive on CT because >80% of lesions are not associated with macroscopic hemorrhage and therefore have a higher chance of detection on MRI using a combination of T2- weighted, T2*-weighted, and diffusion-weighted images [18]. 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]. Head Trauma 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. Arteriography Cervicocerebral There is no relevant literature to support the use of catheter angiography in the short-term follow-up imaging evaluation of acute head trauma. CT Head Head CT is useful for the evaluation of any trauma patient with neurologic deterioration, especially in the acute setting and regardless of whether the initial imaging was positive or negative [2].
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]. It is also more sensitive for small white matter lesions in traumatic axonal injury or DAI. Only 10% of DAI is positive on CT because >80% of lesions are not associated with macroscopic hemorrhage and therefore have a higher chance of detection on MRI using a combination of T2- weighted, T2*-weighted, and diffusion-weighted images [18]. 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]. Head Trauma 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. Arteriography Cervicocerebral There is no relevant literature to support the use of catheter angiography in the short-term follow-up imaging evaluation of acute head trauma. CT Head Head CT is useful for the evaluation of any trauma patient with neurologic deterioration, especially in the acute setting and regardless of whether the initial imaging was positive or negative [2].