Overall, a normal CT tends to be associated with better outcomes than an abnormal CT, and in one study of 72 patients without systemic injury, focal hemorrhages >4.1 mL predicted a 2-fold greater risk of a poor outcome than patients with smaller lesions [31]. In the setting of penetrating head trauma, most commonly gunshot wounds (including self-inflicted), only 10% survive to reach the hospital, where morbidity and mortality remain extremely high. CT findings associated with an especially poor prognosis include brain stem and bilateral hemispheric injuries [30]. Traditional CT scoring systems for ICH and mass effect (eg, Marshall, Rotterdam) have been shown to predict mortality in moderate to severe head trauma. The NeuroImaging Radiological Interpretation System is a more recently developed CT scoring system, which uses standardized terminology from the National Institutes of Health common data elements for TBI imaging and which offers improved prediction of clinical disposition and management in TBI patients (ie, who will need prolonged admissions or neurosurgical procedures), beyond prediction of mortality alone [32,33]. CTA Head and Neck There is no relevant literature to support the use of CTA in the initial imaging evaluation of acute head trauma without suspected vascular injury (see Variants 8 and 9 when suspected). Please refer to discussion under Variants 8 and 9 on clinical risk factors that are associated with intracranial vascular injury and would support the use of CTA/CT venography (CTV). FDG-PET/CT Brain There is no relevant literature to support the use of FDG-PET/CT in the initial imaging evaluation of acute head trauma. HMPAO SPECT or SPECT/CT Brain There is no relevant literature to support the use of SPECT in the initial imaging evaluation of acute head trauma. MR Spectroscopy Head There is no relevant literature to support the use of MRS in the initial imaging evaluation of acute head trauma.
Head Trauma PCAs. Overall, a normal CT tends to be associated with better outcomes than an abnormal CT, and in one study of 72 patients without systemic injury, focal hemorrhages >4.1 mL predicted a 2-fold greater risk of a poor outcome than patients with smaller lesions [31]. In the setting of penetrating head trauma, most commonly gunshot wounds (including self-inflicted), only 10% survive to reach the hospital, where morbidity and mortality remain extremely high. CT findings associated with an especially poor prognosis include brain stem and bilateral hemispheric injuries [30]. Traditional CT scoring systems for ICH and mass effect (eg, Marshall, Rotterdam) have been shown to predict mortality in moderate to severe head trauma. The NeuroImaging Radiological Interpretation System is a more recently developed CT scoring system, which uses standardized terminology from the National Institutes of Health common data elements for TBI imaging and which offers improved prediction of clinical disposition and management in TBI patients (ie, who will need prolonged admissions or neurosurgical procedures), beyond prediction of mortality alone [32,33]. CTA Head and Neck There is no relevant literature to support the use of CTA in the initial imaging evaluation of acute head trauma without suspected vascular injury (see Variants 8 and 9 when suspected). Please refer to discussion under Variants 8 and 9 on clinical risk factors that are associated with intracranial vascular injury and would support the use of CTA/CT venography (CTV). FDG-PET/CT Brain There is no relevant literature to support the use of FDG-PET/CT in the initial imaging evaluation of acute head trauma. HMPAO SPECT or SPECT/CT Brain There is no relevant literature to support the use of SPECT in the initial imaging evaluation of acute head trauma. MR Spectroscopy Head There is no relevant literature to support the use of MRS in the initial imaging evaluation of acute head trauma.