MRA Head and Neck There is no relevant literature to support the use of MRA in the initial imaging evaluation of acute head trauma. MRI Functional (fMRI) Head There is no relevant literature to support the use of fMRI in the initial imaging evaluation of acute head trauma. MRI Head There is no relevant literature to support the use of MRI in the initial imaging evaluation of acute head trauma (please see Variant 4 for discussion of MRI after negative head CT). MRI Head with DTI There is no relevant literature to support the use of DTI in the initial imaging evaluation of acute head trauma. Radiography Skull There is no relevant literature to support the use of radiographs in the initial imaging evaluation of acute head trauma (replaced by CT, which is more sensitive for neurosurgical lesions). 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. There is some controversy about the necessity, with other guidelines recommending against routine repeat CT in the presence of a normal initial CT and in the absence of neurologic deterioration [2]. A single-center 2-year retrospective study of 2,444 ED patients with head trauma of varying severity and a negative head CT (80.8% of all scans) found a very low rate (1 case or 0.04%) of intracranial complications within 72 hours. Of the discharged patients (74.1%), <1% returned to the ED and received a repeat CT (all negative). Of the admitted patients (25.9%), <10% received a repeat CT, with only one positive for a small parietal lobe contusion, which was not visible on the initial CT and did not require neurosurgical intervention [34]. There is also some controversy about the necessity of routine observation and repeat CT in head trauma patients with coagulopathy and a normal initial CT.
Head Trauma PCAs. MRA Head and Neck There is no relevant literature to support the use of MRA in the initial imaging evaluation of acute head trauma. MRI Functional (fMRI) Head There is no relevant literature to support the use of fMRI in the initial imaging evaluation of acute head trauma. MRI Head There is no relevant literature to support the use of MRI in the initial imaging evaluation of acute head trauma (please see Variant 4 for discussion of MRI after negative head CT). MRI Head with DTI There is no relevant literature to support the use of DTI in the initial imaging evaluation of acute head trauma. Radiography Skull There is no relevant literature to support the use of radiographs in the initial imaging evaluation of acute head trauma (replaced by CT, which is more sensitive for neurosurgical lesions). 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. There is some controversy about the necessity, with other guidelines recommending against routine repeat CT in the presence of a normal initial CT and in the absence of neurologic deterioration [2]. A single-center 2-year retrospective study of 2,444 ED patients with head trauma of varying severity and a negative head CT (80.8% of all scans) found a very low rate (1 case or 0.04%) of intracranial complications within 72 hours. Of the discharged patients (74.1%), <1% returned to the ED and received a repeat CT (all negative). Of the admitted patients (25.9%), <10% received a repeat CT, with only one positive for a small parietal lobe contusion, which was not visible on the initial CT and did not require neurosurgical intervention [34]. There is also some controversy about the necessity of routine observation and repeat CT in head trauma patients with coagulopathy and a normal initial CT.