0:01

What is the role of MRI in the setting of head trauma?

0:06

As I mentioned, for children, we are now using

0:09

MRI as the primary means of evaluating

0:12

children who have head trauma in order to

0:16

reduce radiation exposure to those children.

0:21

In the adult situation, the patient is usually

0:24

evaluated acutely with a CT scan, and then if the

0:29

abnormalities are minor and the patient is doing well,

0:32

a follow-up CT scan is usually performed at six to 12

0:36

hours in order to assess the stability of the injury.

0:41

However, in those patients who are doing poorly or

0:43

inpatients, it's not uncommon to get a next-day

0:48

or day-after MRI scan in order to assess the

0:53

diffuse nature or the extensive nature

0:56

of the patient's potential head injury.

0:59

MRI scanning is clearly superior to a CT scan

1:03

for the identification of white matter injuries,

1:06

particularly shearing injuries. It's superior to

1:09

a CT scan, actually, for the presence of hemorrhage,

1:12

and I've shown you some examples of that

1:14

in previous cases.

1:16

It is better than a CT scan for the detection

1:18

of some extra-axial collections, particularly

1:21

those along the clivus and those in areas where

1:25

there's beam hardening artifact on a CT scan.

1:29

For the subfrontal and temporal pole regions,

1:32

again, where there is beam hardening artifact

1:34

from the greater wing of the sphenoid or from

1:37

the skull base along the anterior cranial fossa

1:40

floor, with the cribriform plate and crista galli.

1:45

These are areas where MRI is superior.

1:47

It's not as good for fractures,

1:49

even with the bone windowing.

1:53

The bone algorithm that we use for MRI scans,

1:56

and for those patients who have hyperacute

1:58

hemorrhage—that is, hemorrhage that is still in

2:01

the oxyhemoglobin state—it is not as useful.

2:06

Hemorrhage in the oxyhemoglobin state is

2:09

within the first one hour after the trauma.

2:13

So by the time you get the patient

2:15

through the emergency room to the MRI scan,

2:18

we're usually not in the hyperacute oxyhemoglobin state.

2:23

We're usually in the acute deoxyhemoglobin

2:26

state, and I'll explain that shortly.

Role of MRI in Head Trauma

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