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MRIs Illuminate Brain Injuries That CT Scans Do Not Reveal

While most individuals who experience a mild traumatic brain injury recover fully, about 15% will suffer long-term neurological issues, including headache. Currently, computed tomography CT scans are used to assess such injuries, but a recent study reveals that magnetic resonance imaging (MRIs) may be the more effective tool for predicting long-term outcomes.

In a study that appeared last month in Annals of Neurology,researchers from the University of California San Francisco (UCSF) and the San Francisco General Hospital and Trauma Center (SFGF) followed 135 people treated for mild traumatic brain injury at three level-one trauma centers. Each of the patients underwent CT scans at their initial evaluation; one week later an MRI was ordered. The CT scans demonstrated that 99 of the patients had no detectable signs of injury. However, in 27 of the 99 patients, the MRIs revealed focal lesions—areas of microscopic bleeding on the brain.

It is a significant finding that MRIs demonstrated trauma when CTs did not, according to senior author Geoff Manley, MD, PhD, the chief of neurosurgery at SFGH and vice chair of the Department of Neurological Surgery at UCSF.

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

Currently, Dr. Manley noted, there is no standard of care for mild traumatic head injuries. When people seek care for such an injury at a hospital, they are typically treated and released.

The treatment is all over the place, if you’re getting treatment at all,” he said.

Furthermore, there is no way to predict who will struggle with prolonged effects. However, a portion of this study provided a clue into that area.

Three months after the brain injuries, researchers evaluated patients on the Glasgow Coma Scale—a neurological assessment tool. Those patients with injuries evident on the CT and MRI scans had scores that were twice as serious as their counterparts who had no evidence of injury.

The findings of this study are an important step in improving the lives of patients with brain injuries, the authors noted, by detecting the injuries, monitoring treatment, identifying those who would most benefit from treatment and facilitating more effective clinical trials.

Glasgow Coma Scale

Eyes

  1. Does not open eyes
  2. Opens eyes in response to painful stimuli
  3. Opens eyes in response to voice
  4. Opens eyes spontaneously
  5. N/A
  6. N/A

Verbal

  1. Makes no sounds
  2. Incomprehensible sounds
  3. Utters inappropriate words
  4. Confused, disoriented
  5. Oriented, converses normally
  6. N/A

Motor

  1. Makes no movements
  2. Extension to painful stimuli (decerebrate response)
  3. Abnormal flexion to painful stimuli (decorticate response)
  4. Flexion/Withdrawal to painful stimuli
  5. Localizes painful stimuli
  6. Obeys commands
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