Emerging Utility of Applied Magnetic Resonance Imaging in the Management of Traumatic Brain Injury

Abstract

Traumatic brain injury (TBI) is a widespread and expensive problem globally. The standard diagnostic workup for new TBI includes obtaining a noncontrast computed tomography image of the head, which provides quick information on operative pathologies. However, given the limited sensitivity of computed tomography for identifying subtle but meaningful changes in the brain, magnetic resonance imaging (MRI) has shown better utility for ongoing management and prognostication after TBI. In recent years, advanced applications of MRI have been further studied and are being implemented as clinical tools to help guide care. These include functional MRI, diffusion tensor imaging, MR perfusion, and MR spectroscopy. In this review, we discuss the scientific basis of each of the above techniques, the literature supporting their use in TBI, and how they may be clinically implemented to improve the care of TBI patients.

Keywords: MR perfusion; MR spectroscopy; diffusion tensor imaging; functional MRI; magnetic resonance imaging; traumatic brain injury.

Figure 1

Noncontrast computed tomography (CT) of the head (top row) and diffusion-weighted imaging (DWI) of the brain (bottom row) of the same patient after traumatic brain injury (TBI). Imaging markers of diffuse axonal injury (DAI) include microhemorrhages on susceptibility-weighted imaging (SWI) as well as focal areas of cytotoxic edema on DWI (arrows) that are not visible on CT.