Mild traumatic brain injury and very early clinical magnetic resonance imaging findings: a prospective cohort study

Abstract: C Einarsen, RH Karlsen, J Xu, KA Kvistad, A Håberg, A Vik, S Bjøralt, T Skandsen Mild Traumatic Brain Injury and Very Early Clinical Magnetic Resonance Imaging Findings: A Prospective Cohort Study. Background: Previous studies have shown that CT has limited sensitivity in detecting brain tissue damage in patients with mild traumatic brain injury (TBI), demonstrating that up to 30 % of patients with normal CT have intracranial lesions depicted by early MRI. Susceptibility weighted imaging (SWI) at 3 Tesla together with diffusion is considered to be the most sensitive imaging technique for detection of early traumatic brain injury. Objective: To study the frequency of intracranial findings on very early clinical MRI (within 72 hours) in a prospective cohort of patients with mild TBI, and to assess the frequency of findings in MRI in patients with normal CT. Methods: Patients with mild TBI according to WHO criteria, seen at a level I trauma center and a municipal emergency clinic in Trondheim, Norway, were prospectively included during an 18-month period. 65% of the patients were treated without hospital admittance. Exclusion criteria were: other major trauma, earlier complicated mild, moderate or severe TBI, developmental disorders, neurological disease, and severe psychiatric disease or drug/alcohol abuse affecting adherence to the research protocol. CT was performed as a part of the initial assessment. MRI was performed at a Siemens Skyra 3 Tesla system, and included 3D T1, 3D T2, 3D FLAIR, diffusion and SWI. Results: 163 patients (mean (SD) age 32 (13)) were examined with MRI at mean (SD) 52 (20) hours (88%