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MRI Picks Up Brain Injuries That CT Misses

December 19, 2012
Written by: , Filed in: Diagnostic Imaging, Emergency Radiology, Neuroradiology
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In more than one quarter of emergency-department patients treated for mild traumatic brain injury during a clinical trial, MRI picked up signs of brain damage when CT scans didn’t.

The trial involved 135 patients at three urban trauma centers: San Francisco General Hospital & Trauma Center, University of Pittsburgh Medical Center, and University Medical Center Brackenridge in Austin, Texas. All received CT scans when they were admitted, and 99 of those scans showed no detectable injury.

MRI performed about a week and a half later found focal lesions indicating microscopic bleeding in the brain in 27 of those 99 “all clear” patients. Patients with those lesions had a greater risk of neurological abnormalities three months after their injury.

Geoff Manley, MD, PhD, senior author of the study, said:

This work raises questions of how we’re currently managing patients via CT scan. Having a normal CT scan doesn’t, in fact, say you’re normal.

Dr. Manley is chief of neurosurgery at San Francisco General and vice chair of the neurological surgery department at the University of California, San Francisco. He was quoted in a UCSF news release. An article about the research was published online earlier this month in Annals of Neurology.

About 15 percent of patients with mild traumatic brain injury suffer long-term neurological problems, but no standard test has been developed to predict which ones. MRI might be a good step in that direction.

It also might help in developing treatment regimens for those with mild traumatic brain injury by flagging patients who might benefit most from that treatment.

The well-publicized consequences of injuries to combat veterans and athletes have increasingly focused attention on traumatic brain injury. MRI may be poised to play a much more significant role in the condition’s diagnosis and treatment. The potential patient base is huge: at least 1.7 million Americans seek medical attention each year for acute head injuries, and the Centers for Disease Control and Prevention estimate that far more suffer such injuries but don’t get professional treatment.

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MRI also detects unusual brain activity among adolescents who have a genetic risk of bipolar disorder but no symptoms. For details, see our Facebook page.

Related seminar: Neuroradiology Review

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