![Page 1: Imaging of Traumatic Brain Injury - Rhode Island (RI) · •Traumatic brain injury affects approximately 1.7 million Americans per year, 275,000 hospitalizations and 52,000 deaths](https://reader033.vdocument.in/reader033/viewer/2022042309/5ed56eae11be98291d0423e3/html5/thumbnails/1.jpg)
Imaging of Traumatic Brain Injury
GAURAV JINDAL MD
Assistant Professor in Radiology
Brown University
Rhode Island Medical Imaging
![Page 2: Imaging of Traumatic Brain Injury - Rhode Island (RI) · •Traumatic brain injury affects approximately 1.7 million Americans per year, 275,000 hospitalizations and 52,000 deaths](https://reader033.vdocument.in/reader033/viewer/2022042309/5ed56eae11be98291d0423e3/html5/thumbnails/2.jpg)
DISCLOSURES
• None
![Page 3: Imaging of Traumatic Brain Injury - Rhode Island (RI) · •Traumatic brain injury affects approximately 1.7 million Americans per year, 275,000 hospitalizations and 52,000 deaths](https://reader033.vdocument.in/reader033/viewer/2022042309/5ed56eae11be98291d0423e3/html5/thumbnails/3.jpg)
• Traumatic brain injury affects approximately 1.7 million Americans per year, 275,000 hospitalizations and 52,000 deaths each year.
• TBI contributes to one-third of all injury-related deaths in the United States.
• Annual economic cost of TBI estimated at $76.3 billion
• Neuroimaging plays an important role in both acute and chronic stages of TBI
• In Acute TBI: Imaging studies determine the presence and extent of injury and guide surgical planning
• In Chronic TBI: Sequelae of prior injury, determining prognosis and guiding rehabilitation
![Page 4: Imaging of Traumatic Brain Injury - Rhode Island (RI) · •Traumatic brain injury affects approximately 1.7 million Americans per year, 275,000 hospitalizations and 52,000 deaths](https://reader033.vdocument.in/reader033/viewer/2022042309/5ed56eae11be98291d0423e3/html5/thumbnails/4.jpg)
OBJECTIVES
1. Discuss the basic principles of Neuroimaging (CT and MRI)
2. Overview of normal brain anatomy
3. Imaging findings and prognostic implications in TBI
![Page 5: Imaging of Traumatic Brain Injury - Rhode Island (RI) · •Traumatic brain injury affects approximately 1.7 million Americans per year, 275,000 hospitalizations and 52,000 deaths](https://reader033.vdocument.in/reader033/viewer/2022042309/5ed56eae11be98291d0423e3/html5/thumbnails/5.jpg)
BASICS OF CT IMAGING
![Page 6: Imaging of Traumatic Brain Injury - Rhode Island (RI) · •Traumatic brain injury affects approximately 1.7 million Americans per year, 275,000 hospitalizations and 52,000 deaths](https://reader033.vdocument.in/reader033/viewer/2022042309/5ed56eae11be98291d0423e3/html5/thumbnails/6.jpg)
![Page 7: Imaging of Traumatic Brain Injury - Rhode Island (RI) · •Traumatic brain injury affects approximately 1.7 million Americans per year, 275,000 hospitalizations and 52,000 deaths](https://reader033.vdocument.in/reader033/viewer/2022042309/5ed56eae11be98291d0423e3/html5/thumbnails/7.jpg)
How far have we come?
• In the 1970-80s, it took 120 minutes to perform a CT head
• 1990s, it took about 15-20 minutes
• Today: ?
![Page 8: Imaging of Traumatic Brain Injury - Rhode Island (RI) · •Traumatic brain injury affects approximately 1.7 million Americans per year, 275,000 hospitalizations and 52,000 deaths](https://reader033.vdocument.in/reader033/viewer/2022042309/5ed56eae11be98291d0423e3/html5/thumbnails/8.jpg)
How far have we come?
• In the 1970-80s, it took 120 minutes to perform a CT head
• 1990s, it took about 15-20 minutes
• Today: 5 seconds
![Page 9: Imaging of Traumatic Brain Injury - Rhode Island (RI) · •Traumatic brain injury affects approximately 1.7 million Americans per year, 275,000 hospitalizations and 52,000 deaths](https://reader033.vdocument.in/reader033/viewer/2022042309/5ed56eae11be98291d0423e3/html5/thumbnails/9.jpg)
How is the CT image generated?
• An X-Ray beam passes through the patient
• Based on the densities of different tissues, the X-rays get differentially absorbed.
• Complex mathematical algorithms finally generate the CT image based on the absorption spectrum of the detectors.
• CT MEASURES DENSITY
![Page 10: Imaging of Traumatic Brain Injury - Rhode Island (RI) · •Traumatic brain injury affects approximately 1.7 million Americans per year, 275,000 hospitalizations and 52,000 deaths](https://reader033.vdocument.in/reader033/viewer/2022042309/5ed56eae11be98291d0423e3/html5/thumbnails/10.jpg)
![Page 11: Imaging of Traumatic Brain Injury - Rhode Island (RI) · •Traumatic brain injury affects approximately 1.7 million Americans per year, 275,000 hospitalizations and 52,000 deaths](https://reader033.vdocument.in/reader033/viewer/2022042309/5ed56eae11be98291d0423e3/html5/thumbnails/11.jpg)
BASICS of MRI
![Page 12: Imaging of Traumatic Brain Injury - Rhode Island (RI) · •Traumatic brain injury affects approximately 1.7 million Americans per year, 275,000 hospitalizations and 52,000 deaths](https://reader033.vdocument.in/reader033/viewer/2022042309/5ed56eae11be98291d0423e3/html5/thumbnails/12.jpg)
• The MR machine houses a powerful magnet (x1000s compared to Earth’s magnetic field)
• Complex interplay of exciting hydrogen atoms in the body tissues via radiofrequency pulses and analysing signals based on repeated excitation and deexcitation of protons
• MRI does not involve use of radiation
![Page 13: Imaging of Traumatic Brain Injury - Rhode Island (RI) · •Traumatic brain injury affects approximately 1.7 million Americans per year, 275,000 hospitalizations and 52,000 deaths](https://reader033.vdocument.in/reader033/viewer/2022042309/5ed56eae11be98291d0423e3/html5/thumbnails/13.jpg)
What test to order?
• CT or MRI • CT without contrast • CT without and with
contrast • MRI without/MRI with • CTA • MRA
![Page 14: Imaging of Traumatic Brain Injury - Rhode Island (RI) · •Traumatic brain injury affects approximately 1.7 million Americans per year, 275,000 hospitalizations and 52,000 deaths](https://reader033.vdocument.in/reader033/viewer/2022042309/5ed56eae11be98291d0423e3/html5/thumbnails/14.jpg)
Some general rules:
• For any ACUTE neurological condition: Head CT
• For SUBACUTE/CHRONIC cases: Brain MRI
• CT Brain is almost always performed without IV contrast
• Plain radiographs of the skull: OBSOLETE
![Page 15: Imaging of Traumatic Brain Injury - Rhode Island (RI) · •Traumatic brain injury affects approximately 1.7 million Americans per year, 275,000 hospitalizations and 52,000 deaths](https://reader033.vdocument.in/reader033/viewer/2022042309/5ed56eae11be98291d0423e3/html5/thumbnails/15.jpg)
CT
• Fast
• Readily available
• No screening
• Excellent for detecting hemorrhage and fractures
• Poor soft tissue resolution
• Ionizing radiation
MR
• Exquisite anatomical detail
• No radiation
• Longer scan time
• Screening( Pacemaker, metallic implant, orbital foreign body….)
• Claustrophobia
• Challenging with unstable patients
![Page 16: Imaging of Traumatic Brain Injury - Rhode Island (RI) · •Traumatic brain injury affects approximately 1.7 million Americans per year, 275,000 hospitalizations and 52,000 deaths](https://reader033.vdocument.in/reader033/viewer/2022042309/5ed56eae11be98291d0423e3/html5/thumbnails/16.jpg)
BASIC ANATOMY
• 3 main imaging planes:
i. Axial
ii. Coronal
iii. Sagittal
• CT images are acquired in the axial (transverse) plane
• MRI images can be acquired in any plane
![Page 17: Imaging of Traumatic Brain Injury - Rhode Island (RI) · •Traumatic brain injury affects approximately 1.7 million Americans per year, 275,000 hospitalizations and 52,000 deaths](https://reader033.vdocument.in/reader033/viewer/2022042309/5ed56eae11be98291d0423e3/html5/thumbnails/17.jpg)
AXIAL ‘SLICE’
R L
![Page 18: Imaging of Traumatic Brain Injury - Rhode Island (RI) · •Traumatic brain injury affects approximately 1.7 million Americans per year, 275,000 hospitalizations and 52,000 deaths](https://reader033.vdocument.in/reader033/viewer/2022042309/5ed56eae11be98291d0423e3/html5/thumbnails/18.jpg)
CORONAL
![Page 19: Imaging of Traumatic Brain Injury - Rhode Island (RI) · •Traumatic brain injury affects approximately 1.7 million Americans per year, 275,000 hospitalizations and 52,000 deaths](https://reader033.vdocument.in/reader033/viewer/2022042309/5ed56eae11be98291d0423e3/html5/thumbnails/19.jpg)
SAGITTAL
![Page 20: Imaging of Traumatic Brain Injury - Rhode Island (RI) · •Traumatic brain injury affects approximately 1.7 million Americans per year, 275,000 hospitalizations and 52,000 deaths](https://reader033.vdocument.in/reader033/viewer/2022042309/5ed56eae11be98291d0423e3/html5/thumbnails/20.jpg)
Brain Anatomy
• Cerebral hemispheres: Frontal
Parietal
Temporal
Occipital
• Cerebellum • Brainstem • Ventricles • CSF spaces • Calvarium
![Page 21: Imaging of Traumatic Brain Injury - Rhode Island (RI) · •Traumatic brain injury affects approximately 1.7 million Americans per year, 275,000 hospitalizations and 52,000 deaths](https://reader033.vdocument.in/reader033/viewer/2022042309/5ed56eae11be98291d0423e3/html5/thumbnails/21.jpg)
![Page 22: Imaging of Traumatic Brain Injury - Rhode Island (RI) · •Traumatic brain injury affects approximately 1.7 million Americans per year, 275,000 hospitalizations and 52,000 deaths](https://reader033.vdocument.in/reader033/viewer/2022042309/5ed56eae11be98291d0423e3/html5/thumbnails/22.jpg)
![Page 23: Imaging of Traumatic Brain Injury - Rhode Island (RI) · •Traumatic brain injury affects approximately 1.7 million Americans per year, 275,000 hospitalizations and 52,000 deaths](https://reader033.vdocument.in/reader033/viewer/2022042309/5ed56eae11be98291d0423e3/html5/thumbnails/23.jpg)
![Page 24: Imaging of Traumatic Brain Injury - Rhode Island (RI) · •Traumatic brain injury affects approximately 1.7 million Americans per year, 275,000 hospitalizations and 52,000 deaths](https://reader033.vdocument.in/reader033/viewer/2022042309/5ed56eae11be98291d0423e3/html5/thumbnails/24.jpg)
![Page 25: Imaging of Traumatic Brain Injury - Rhode Island (RI) · •Traumatic brain injury affects approximately 1.7 million Americans per year, 275,000 hospitalizations and 52,000 deaths](https://reader033.vdocument.in/reader033/viewer/2022042309/5ed56eae11be98291d0423e3/html5/thumbnails/25.jpg)
![Page 26: Imaging of Traumatic Brain Injury - Rhode Island (RI) · •Traumatic brain injury affects approximately 1.7 million Americans per year, 275,000 hospitalizations and 52,000 deaths](https://reader033.vdocument.in/reader033/viewer/2022042309/5ed56eae11be98291d0423e3/html5/thumbnails/26.jpg)
![Page 27: Imaging of Traumatic Brain Injury - Rhode Island (RI) · •Traumatic brain injury affects approximately 1.7 million Americans per year, 275,000 hospitalizations and 52,000 deaths](https://reader033.vdocument.in/reader033/viewer/2022042309/5ed56eae11be98291d0423e3/html5/thumbnails/27.jpg)
![Page 28: Imaging of Traumatic Brain Injury - Rhode Island (RI) · •Traumatic brain injury affects approximately 1.7 million Americans per year, 275,000 hospitalizations and 52,000 deaths](https://reader033.vdocument.in/reader033/viewer/2022042309/5ed56eae11be98291d0423e3/html5/thumbnails/28.jpg)
![Page 29: Imaging of Traumatic Brain Injury - Rhode Island (RI) · •Traumatic brain injury affects approximately 1.7 million Americans per year, 275,000 hospitalizations and 52,000 deaths](https://reader033.vdocument.in/reader033/viewer/2022042309/5ed56eae11be98291d0423e3/html5/thumbnails/29.jpg)
CT Windows
BRAIN WINDOW BONE WINDOW
![Page 30: Imaging of Traumatic Brain Injury - Rhode Island (RI) · •Traumatic brain injury affects approximately 1.7 million Americans per year, 275,000 hospitalizations and 52,000 deaths](https://reader033.vdocument.in/reader033/viewer/2022042309/5ed56eae11be98291d0423e3/html5/thumbnails/30.jpg)
AXIAL T1 AXIAL T2 AXIAL DIFFUSION
MRI WINDOWS/SEQUENCES
![Page 31: Imaging of Traumatic Brain Injury - Rhode Island (RI) · •Traumatic brain injury affects approximately 1.7 million Americans per year, 275,000 hospitalizations and 52,000 deaths](https://reader033.vdocument.in/reader033/viewer/2022042309/5ed56eae11be98291d0423e3/html5/thumbnails/31.jpg)
Important principles:
• SYMMETRY is key
• Midline structures should always be in midline
• CSF spaces should be preserved
• Ventricle size