Neuroimaging in adult penetrating brain injury: a guide for radiographers

Abstract

Penetrating brain injuries (PBI) are a medical emergency, often resulting in complex damage and high mortality rates. Neuroimaging is essential to evaluate the location and extent of injuries, and to manage them accordingly. Currently, a myriad of imaging modalities are included in the diagnostic workup for adult PBI, including skull radiography, computed tomography (CT), magnetic resonance imaging (MRI) and angiography, with each modality providing their own particular benefits. This literature review explores the current modalities available for investigating PBI and aims to assist in decision making for the appropriate use of diagnostic imaging when presented with an adult PBI. Based on the current literature, the authors have developed an imaging pathway for adult penetrating brain injury that functions as both a learning tool and reference guide for radiographers and other health professionals. Currently, CT is recommended as the imaging modality of choice for the initial assessment of PBI patients, while MRI is important in the sub-acute setting where it aids prognosis prediction and rehabilitation planning, Additional follow-up imaging, such as angiography, should be dependent upon clinical findings.

Imaging characteristics and treatment of a penetrating brain injury caused by an oropharyngeal foreign body in a dog

“…However, limitations of MRI are acknowledged in the immediate phase (lengthy, contraindicated where ferromagnetic foreign bodies present and incompatible with some monitoring equipment). Hence, MRI is deemed more useful in the subacute phase (48–72 h postinjury) where it is important to assess secondary brain injuries that predict prognosis …”

In situ phase contrast X-ray brain CT

“…In addition, CT can be used in the presence of metallic implants and tattoos with metallic ink, for which MRI is contraindicated due to the dangers imposed by the high magnetic fields required. CT is also better suited for the evaluation of penetrating brain injuries and other trauma and acute neurological emergencies 2 , 3 , where impromptu access to MRI scanners for time-critical assessment is often unavailable, and the presence of magnetic materials cannot be determined prior to the scan.…”

Glass Fragment Injury to the Craniocervical Junction with Interatlantooccipital Penetration to the Subarachnoid Space: Not-To-Be-Missed Important Aspects of Craniocervical Trauma Even in the Middle of the COVID-19 Pandemic: Case Report and Review of Literature

“…This can be better achieved using gadolinium-enhanced MR imaging, which can include a T2-weighted gradient-recalled echo sequence. 17,18 Temple et al 19 tabulated the main modalities used in imaging for penetrating brain injury including the clinical indications and contraindications for each modality.…”