Neuroimaging in traumatic brain imaging

Abstract

Traumatic brain injury (TBI) is a common and potentially devastating clinical problem. Because prompt proper management of TBI sequelae can significantly alter the clinical course especially within 48 h of the injury, neuroimaging techniques have become an important part of the diagnostic work up of such patients. In the acute setting, these imaging studies can determine the presence and extent of injury and guide surgical planning and minimally invasive interventions. Neuroimaging also can be important in the chronic therapy of TBI, identifying chronic sequelae, determining prognosis, and guiding rehabilitation.

FIG. 1.

MRI of 66-year-old male after a motor vehicle accident showing a large right frontal intraparenchymal hemorrhage on the FLAIR (left image) and T2 (right image) sequences. The FLARE images shows diffuse, heterogeneous increased signal intensity consistent with evolving blood products with surrounding edema in the frontal lobe.

FIG. 2.

CT of an 87-year-old female status post fall showing a large subdural hematoma along the left cerebral convexity with significant midline shift and effacement of the left lateral ventricle.

FIG. 3.

CT of an 80-year-old female status post fall showing a large left subdural hematoma in addition to substantial subarachnoid hemorrhage (arrows).

FIG. 4.

CT scan of 35-year-old male with recent motor vehicle accident demonstrating longitudinal fracture of the right petrous bone (thin arrow) that extends into the skull base (thick arrow).

FIG. 5.

FDG-PET scan of 33-year-old male status post motor vehicle accident demonstrates hypometabolism affecting the temporo-parietal and occipital (thin arrows) regions as well as the caudate and putamen (thick arrows), which are findings suggesting diffuse axonal injury.

FIG. 6.

FDG-PET scan of a 38-year-old male with head injury 15 years ago with encephalomalacia in the left temporal lobe demonstrates marked hypometabolism in the left temporal lobe (thin arrow) and right cerebellar hypometabolism (thick arrow) consistent with crossed cerebellar diaschisis.

FIG. 7.

FDG-PET scan of a 43-year-old female with head injury 2 years ago now with cognitive and memory dysfunction as well as language problems demonstrates hypometabolism in the entire left hemisphere (arrow) related to the head trauma.

FIG. 8.

FDG-PET scan of a 49-year-old female with MVA 6 years ago and persistent headache and memory problems with bilateral decreased temporal lobe metabolism (arrows).

FIG. 9.

FDG-PET scan of a 69-year-old boxer with visual and memory problems evaluated for dementia pugilistica. The findings demonstrate moderate global cortical hypometabolism and preservation of subcortical and occipital structures most consistent with depression, not DAI.