Imaging Evidence and Recommendations for Traumatic Brain Injury: Advanced Neuro- and Neurovascular Imaging Techniques

Abstract

SUMMARY:Neuroimaging plays a critical role in the evaluation of patients with traumatic brain injury, with NCCT as the first-line of imaging for patients with traumatic brain injury and MR imaging being recommended in specific settings. Advanced neuroimaging techniques, including MR imaging DTI, blood oxygen level-dependent fMRI, MR spectroscopy, perfusion imaging, PET/SPECT, and magnetoencephalography, are of particular interest in identifying further injury in patients with traumatic brain injury when conventional NCCT and MR imaging findings are normal, as well as for prognostication in patients with persistent symptoms. These advanced neuroimaging techniques are currently under investigation in an attempt to optimize them and substantiate their clinical relevance in individual patients. However, the data currently available confine their use to the research arena for group comparisons, and there remains insufficient evidence at the time of this writing to conclude that these advanced techniques can be used for routine clinical use at the individual patient level. TBI imaging is a rapidly evolving field, and a number of the recommendations presented will be updated in the future to reflect the advances in medical knowledge. ABBREVIATIONS:BOLD ϭ blood oxygen level-dependent; FA ϭ fractional anisotropy; MD ϭ mean diffusivity; MEG ϭ magnetoencephalography; TBI ϭ traumatic

Radiological–pathological correlation of diffusion tensor and magnetization transfer imaging in a closed head traumatic brain injury model

“…56 The FEA simulation allows for the prediction of the possible locations of DAI by examining the biomechanical predictors of injury based on strain rate in TBI (Fig 3). The current FEA results agree with previous IHC study demonstrating that DAI in the impact-acceleration rat model was maximal in CC at bregma −1.0mm.…”

Imaging Evaluation of Acute Traumatic Brain Injury

“…Other findings that should raise suspicion for arterial injury include epistaxis, LeFort II and III facial fractures, high cervical spine fractures, GCS ≤8, or TAI 36 . Either CTA or MRA can be performed as an initial screening evaluation for arterial injury 11, 17 , though CTA has gained popularity over the past decade with the proliferation of MDCT and the resultant high quality, 3-dimensional reformats (3D), rapid imaging of contrast bolus 37 . Conventional catheter angiography may be necessary for the diagnosis and treatment of certain lesions.…”

Applications of Resting State Functional MR Imaging to Traumatic Brain Injury

“…Findings on fMRI in TBI patients reported in the literature are discussed later. While this technique holds promise for further investigation in TBI patients, existing evidence is insufficient for routine clinical TBI diagnosis and/or prognostication at the individual patient level 19 . However, research is ongoing to determine the appropriate methods of application and interpretation in the clinical setting of TBI.…”