Brain Injury

E. Giugni, G. LuccicHenti, G. E. HAgberg, A. CHerubini, F. FAsAno, U. SAbAtini

Magnetic resonance (MR) is the imaging technique of choice for the study of traumatic brain injury (TBI) in clinically stable patients, both in the acute and in the chronic phase, and is beginning to erode the role of computed tomography (CT) also in clinically unstable trauma patients [1-3].

In the latter the role of MR is still to be established. Despite its high sensitivity to focal traumatic lesions, the correlations among MR parameters, clinical picture and prognosis are not wholly satisfactory. Partly, this stems from the fact that the scales used for the clinical evaluation of the acute patient, such as the Glasgow Coma Scale (GCS) [4], are not suitable to predict prognosis in trauma patients, who exhibit a wide range of complex neuropathological conditions [5]. The sparce distribution of MR machines in hospital structures, the difficulty of monitoring vital signs in the tunnel, suboptimal accuracy in depicting fractures, acquisition times and cost are further disadvantages.

Current guidelines consider CT as the imaging technique of choice in unstable patients, where the primary goal is rapid detection of haematomas and other lesions requiring surgery [6]. However, the availability of high-field MR, which enables short times of acquisition with conventional sequences as well as use of ultrafast sequences very sensitive to magnetic susceptibility, like echo-planar (EPI) [7, 8] and turbo-proton echo-planar spectroscopy (t-PEPSI) [9,10], is expected to make this technique the method of choice also to image clinically unstable patients. Indeed, high-field MR (e.g. 3.0 T) is both more sensitive to focal lesions containing blood components and exhibits an enhanced ability to detect structural and metabolic changes in apparently intact white and grey matter by use of advanced techniques such as diffusion tensor (DTI) and spectroscopy (MRS). These techniques are expected to improve the currently poor correlations with the clinical picture and to become indispensable tools in predicting outcome.

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