Abstract
With significant advances in the field of neuroradiology in the last decade, the role of neuroimaging in the evaluation of traumatic brain injury (TBI) continues to evolve. In acute TBI, the neurosurgeon uses imaging primarily for the structural evaluation of intracranial injuries, to assess for possible surgical intervention. Computed tomography (CT) remains the modality of choice in this setting. Magnetic resonance (MR) imaging is clearly superior for demonstrating nonsurgical lesions such as diffuse axonal injury, small extra-axial collections, and brainstem pathology. Technical factors, in particular time and patient monitoring, limit the utility of MR in the acute setting. It is therefore generally reserved for patients whose neurological status is worse than predicted from the CT findings or for targeted evaluation of the posterior fossa. More recently, MR spectroscopy, MR diffusion, and functional imaging techniques such as positron emission tomography (PET), single photon emission computed tomography (SPECT) and functional MR imaging have yielded potential insights into the pathophysiology of TBI. These modalities are likely to have a prognostic role in the management of trauma patients.
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