13 Neuroimaging for Traumatic Brain Injury

摘要: Head injury is not a homogeneous phenomenon and has complex clinical course. There are different mechanisms, varying severity, diversity of injuries, secondary effects age or underlying disease. Classifications outcomes inconsistent. Differences in diagnostic procedures practice patterns prevent direct comparison population-based studies. variety imaging methods that measure aspects (Table 13.1), but there no one all-encompassing method. CT the mainstay acute period. The majority evidence relates to use for detecting injuries may require immediate treatment surgery. Speed, availability, ease exam, lesser expense studies remain important factors using this modality setting. Sensitivity detection also increases with repeat scans period (strong evidence). sensitivity specificity MRI brain generally superior CT, although most have been retrospective few comparisons performed recent decade. clearly fractures. outperforms other lesions (limited moderate evidence), particularly diffuse axonal (DAI). allows more detailed analysis including metabolic physiologic measures, further evidence-based research needed. Accurate prognostic information determining management, needs populations. In severe TBI, patient long-term rehabilitation, family counseling. mild patients subtle impairments benefit from counseling education. Prediction rules such as CHALICE prediction rule 13.2) CATCH decision 13.3) potential improve standardize care pediatric head (moderate addition, minimizing children very low risk clinically TBI reduce radiation-induced malignancies. Calvarial plain radiographs poor identifying intracranial pathology strong evidence) hence, recommended unless highly selected suspected nonaccidental trauma. It safe discharge home, after negative study