Role of repeat CT scans in the management of traumatic brain injury

Doddamani, Ramesh; Gupta, Sunil; Singla, Navneet; Mohindra, Sandeep; Singh, Paramjeet

doi:10.1016/j.ijnt.2012.04.007

Cited by 11 publications

(14 citation statements)

References 24 publications

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“…In some studies, it has been advocated that if the first CT scan is done too early after the injury, it can fail to detect the early head injury. They recommended an interval of routine repeat scans to be 12–24 hours; others recommend 8 hours for the repetition [ 10 , 11 ].…”

Section: Discussionmentioning

confidence: 99%

Analysis of Repeated CT Scan Need in Blunt Head Trauma

Eroğlu

Onur

Ozkaya

et al. 2013

Emergency Medicine International

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Background. Computed tomography (CT) is a vital tool in the workup of patients with closed head trauma. The aim of this study was to investigate the necessity of serial CT scans in patients with blunt head trauma. Methods. This is a retrospective study analyzing trauma patients between January and June 2012. Data were analysed by using frequencies, Kolmogorov-Smirnov (K-S), and Chi-square tests. Results. Of the total 351 control Head CTs, it was seen there were no different in 346 (98.6%). In CTs of another 3 patients (0.9%), there were increasing or new, in the other 2 (0.6%) there was a decrease in the pathology present. Of 24 (6.8%) patients who had a hemorrhage in the first CT, there was an increase in the hemorrhage in one of them, a decrease of the pathology in 2 of them. Of 27 (7.7%) patients who had fracture in first CT, 2 had a new intracranial hemorrhage. The relation of the results between the first and second CTs were statistically significant (P < 0.001, χ 2 test). Conclusion. Repeated CT scans after 6 hours in EDs observation rooms are not necessary if first CT is normal in most situations. Special attention may be needed in patients with an underlying chronic disease.

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Section: Discussionmentioning

confidence: 99%

Analysis of Repeated CT Scan Need in Blunt Head Trauma

Eroğlu

Onur

Ozkaya

et al. 2013

Emergency Medicine International

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“…Doddamani et al 27. found new lesions were present in 5.5% of the second and third CT scans, and observed a change in management in 23% of patients, of which almost half the changes were due to radiological differences alone.…”

Section: Role Of Computed Tomographymentioning

confidence: 98%

“…25 Some radiology departments perform repeat CT examinations on patients to monitor changes in injuries, in particular vascular or infectious complications, 26 however, repeat imaging is not routine and should be undertaken at the request of neurologists or other appropriate clinicians. Doddamani et al 27 found new lesions were present in 5.5% of the second and third CT scans, and observed a change in management in 23% of patients, of which almost half the changes were due to radiological differences alone. However, a recent metaanalysis concluded that repeat CT in traumatic brain injury patients changes the management in only a minority of patients, hence the use remains controversial.…”

Section: Role Of Computed Tomographymentioning

confidence: 98%

Neuroimaging in adult penetrating brain injury: a guide for radiographers

Temple

Donald

Skora

et al. 2015

J of Medical Radiation Sci

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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.

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“…Limitations of noncontrast CT include a poor sensitivity for small hemorrhages, diffuse axonal injury (DAI), arterial dissection, and vascular damage 6 , 7 . In particular, in TBI patients with secondary progression of initially undetected small cerebral hemorrhages might cause a decline in the functional status of the patient, which motivates the need of early detection of these traumatic lesions 8 …”

Section: Introductionmentioning

confidence: 99%

Detection of small traumatic hemorrhages using a computer-generated average human brain CT

Afzali-Hashemi

Hazewinkel

Tjepkema-Cloostermans

et al. 2018

J. Med. Imag.

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Abstract. Computed tomography is a standard diagnostic imaging technique for patients with traumatic brain injury (TBI). A limitation is the poor-to-moderate sensitivity for small traumatic hemorrhages. A pilot study using an automatic method to detect hemorrhages <10 mm in diameter in patients with TBI is presented. We have created an average image from 30 normal noncontrast CT scans that were automatically aligned using deformable image registration as implemented in Elastix software. Subsequently, the average image was aligned to the scans of TBI patients, and the hemorrhages were detected by a voxelwise subtraction of the average image from the CT scans of nine TBI patients. An experienced neuroradiologist and a radiologist in training assessed the presence of hemorrhages in the final images and determined the false positives and false negatives. The 9 CT scans contained 67 small haemorrhages, of which 97% was correctly detected by our system. The neuroradiologist detected three false positives, and the radiologist in training found two false positives. For one patient, our method showed a hemorrhagic contusion that was originally missed. Comparing individual CT scans with a computed average may assist the physicians in detecting small traumatic hemorrhages in patients with TBI.

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Role of repeat CT scans in the management of traumatic brain injury

Cited by 11 publications

References 24 publications

Analysis of Repeated CT Scan Need in Blunt Head Trauma

Analysis of Repeated CT Scan Need in Blunt Head Trauma

Neuroimaging in adult penetrating brain injury: a guide for radiographers

Detection of small traumatic hemorrhages using a computer-generated average human brain CT

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